bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of itch in Parkinson disease
Authors: Sondrup Maria A. , Bjergen Cecilie , Gaarskjær Anne N. , Joseph Andrea , Lassen Rikke S. , Mamedov Shiran , Poulsen Maria B. , Radovanovic Tessa , Schacksen Cathrine S. , Thaarup Maja , Andersen Maria S. , Oppel Lorenz M. , Gazerani Parisa
Published: May 2021

Introduction:

Sensory abnormalities (eg, pain) are common in Parkinson disease (PD) with a negative impact on quality of life. As itch is less studied in PD, and pain and itch partially share sensory pathways, we designed this study to identify the occurrence and pattern of spontaneous itch, and responsiveness to a surrogate itch model in PD.

Methods:

The study protocol was approved (N-20180079) and PD patients and their best matched controls were recruited. A questionnaire was used to collect general information on itch. Sensory alterations were determined by subjective ratings and mechanical sensitivity threshold before and after a standard histamine-dependent itch model on forearms. Itch and pain intensities were rated on visual and numerical rating scales, respectively. Dispersion of itch was drawn on arm charts. Presence and area of alloknesis and hyperknesis were determined. Group comparisons were performed in SPSS with a significant level of 0.05. Descriptive statistic was used for questionnaire’s analysis.

Results:

Patients (n=20; 68.10±7.91 y, F/M ratio: 8/12) and controls (n=20; 67.35±7.65 y, F/M ratio: 8/12) were examined. PD patients rated less physical and emotional descriptors, except for the stinging (P=0.028). No difference was found between the groups in histamine-provoked itch intensity (P=0.799) or the itchy area. A significantly larger area of hyperknesis was found in PD (P=0.011), but not for the area of alloknesis (P=0.221). Sex-related responses yielded only a tendency toward higher responses in female patients.

Discussion:

PD does not seem to influence perception of itch, neither spontaneous nor evoked itch, except for hyperknesis area, which was found significantly larger in PD patients following the application of histamine. This finding proposes a potential alteration in central processing of itch that needs further investigation and whether and how it is affected by, for example, PD pathogenesis.
Mental Health Status of Canadian Funeral Service Workers at the Beginning of the COVID-19 Pandemic
Authors: Durand-Moreau Quentin , Galarneau Jean-Michel
Published: May 2021

Objective:

To describe the mental health situation and job stress levels of Funeral Service Workers (FSW) during the first months of the pandemic.

Methods:

We conducted a cross-sectional study in Canada between May and July 2020. Funeral service professional organizations were asked to spread a questionnaire to their members including job description, assessment of anxiety (GAD-7), depression (PHQ-8), and job stress (effort-reward imbalance questionnaire).

Results:

Fifty-eight FSW completed a questionnaire, 32% reported anxiety symptoms (GAD-7 > 10), 29% reported depressive symptoms (PHQ-8 > 10), 31% reported job stress. Women were more likely to report overcommitment (66.7% vs. 31.8%, P = 0.015).

Conclusions:

Levels of anxiety and depression identified in Canadian FSW were higher than those identified in other occupational groups during the first few months of the pandemic.
Exposure to Chemical and Biological Agents at Work and Cardiovascular Disease in Brazil
Authors: Silva de Carvalho Thalyta Gleyane , Tavares Nayranne Hivina Carvalho , Bastos Maria Luiza Almeida , Rodrigues de Oliveira Bárbara Bruna , Araújo Larissa Fortunato , Ferreira Marcelo José Monteiro
Published: May 2021

Objective:

Investigating the relationship between exposure to chemical and biological agents at work and the occurrence of cardiovascular diseases in a Brazilian national health survey.

Methods:

A cross-sectional study using the database of 36.442 participants from the Brazilian National Health Survey. Logistic Regression analysis was performed for multivariable models.

Results:

After adjustments for key confounders, we observed that those individuals exposed to chemical agents and biological materials at work had 62% (95% CI: 1.20; 2.20) and 66% (95% CI: 1.03; 2.65), respectively, higher odds of having cardiovascular disease compared to employed individuals who did not report exposure to biological materials/chemical agents at work.

Conclusion:

This study draws attention to the role of chemical and biological risks in the occurrence of cardiovascular diseases. In this sense, it is necessary developing systematic and intersectoral actions for Workers’ Health Surveillance to promote health and prevent chronic non-communicable diseases.
Impact of Advising on Total Worker Health Implementation
Authors: Tenney Liliana , Dexter Lynn , Shapiro David C. , Dally Miranda , Brown Carol E. , Schwatka Natalie V. , Huebschmann Amy G. , McMillen Jim , Newman Lee S.
Published: May 2021

Objective:

Little is understood about the mechanisms for improving the adoption and implementation of Total Worker Health® (TWH) in workplace settings. The primary objective of this study was to identify whether the delivery of TWH advising is associated with subsequent changes in TWH in small-to-medium sized businesses.

Methods:

We conducted a longitudinal study of a TWH intervention in 200 organizations completing Health Links Healthy Workplace Assessments™ between October 2016 and December 2019. Organizations were offered consultation via telephonic and live web-based advising sessions.

Results:

Organizations exhibited non-significant albeit positive change in assessment scores from baseline to assessment 2. Businesses receiving advising showed significant score improvements from assessment 2 to 3, versus those without advising.

Conclusions:

TWH consultation may enhance adoption of organizational behaviors that promote worker health, safety, and well-being over time.
Job Stress and Cardiometabolic Lifestyle Modification Behaviors Among Workers in High-risk and Low-risk Workplaces
Authors: Jung Jiyeon , Choo Jina , Park Sooyeon , Moon Jihyun , Noh Songwhi
Published: May 2021

Objective:

There is scarce evidence revealing an association between job stress and cardiometabolic lifestyle modification behaviors among workers.

Methods:

A cross-sectional, correlation study was conducted among workers in high-risk and low-risk workplaces by work characteristics.

Results:

Workers in high-risk workplaces had significantly higher job stress levels than low-risk workplaces. Higher job stress was significantly associated with lower cardiometabolic lifestyle modification behaviors (β = −0.14, P = .001). This significant association was evident only for high-risk workplaces in total job stress (β = −0.16, P = .001), including job demand (β = −0.16, P = .005) and job insecurity (β = −0.11, P = .026).

Conclusions:

Strategies for alleviating job stress should be prioritized to high-risk workplaces, and these efforts may concomitantly contribute to cardiometabolic risk reduction.
Clinical Case Complexity in Occupational Health
Authors: Lalloo Drushca , Gallagher John , Macdonald Ewan , McDonnell Conor
Published: May 2021

Objectives:

Clinical case complexity is an inherent factor in occupational health (OH), yet it is poorly defined and understood. Our aim was to identify the multiple sources of complexity in OH and propose a conceptual complexity framework model for clinical OH practice.

Methods:

Through a scoping review, expert panel consensus, and content analysis of OH clinical case reports, we identified relevant complexity-contributing factors (CCFs) specifically tailored to the OH setting, which we defined and validated.

Results:

The proposed model consists of three primary domains (PDs); health factors, workplace factors and biopsychosocial factors. Twenty-seven CCFs are described and defined within these PDs.

Conclusions:

This work lays the foundation for improved understanding, identification, and assessment of complexity in OH. This is imperative for ensuring high quality clinical practice standards, identifying training needs and appropriate triaging/resource allocation.
Serum markers for predicting advanced fibrosis in patients with chronic hepatitis B and nonalcoholic fatty liver disease
Authors: Wang Qi , Xie Wen , Liu Ligai , Wang Peng , Pan Calvin Q.
Published: May 2021

To compare the diagnostic utility of serum markers in nonalcoholic fatty liver disease (NAFLD) patients with chronic hepatitis B (CHB).

This study enrolled 118 consecutive biopsy-proven NAFLD patients with or without CHB. Fibrosis scores of each marker were compared against histological fibrosis staging. Receiver operating characteristic curve (ROC) analysis helped assess the accuracy of each marker.

In patients with both diseases, 12.96% (7/54) had advanced fibrosis on biopsy and aspartate aminotransferase (AST) to platelet ratio index was the best performing marker for predicting advanced fibrosis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC (95% confidence interval) for AST to platelet ratio index (APRI) were 0%, 93.62%, 0%, 86.27%, and 0.676 (0.524–0.828), respectively. The markers ranked as follows from highest to lowest with respect to their accuracy: APRI; BARD; fibrosis-4; and AST to ALT ratio. In patients without CHB, fibrosis-4 was the best performing marker for predicting advanced fibrosis. The sensitivity, specificity, PPV, NPV, and area under the ROC (95% confidence interval) for fibrosis-4 were 77.78%, 85.45%, 46.67%, 95.92%, and 0.862 (0.745–0.978), respectively.

Serum markers are less reliable in predicting advanced fibrosis in NAFLD patients with CHB; APRI is the most accurate predictor of the absence of advanced fibrosis.
Seasonal variation in incidence and outcomes of out of hospital cardiac arrest
Authors: El Sibai Rayan H. , Bachir Rana H. , El Sayed Mazen J.
Published: May 2021

Out of hospital cardiac arrest (OHCA) remains a leading cause of mortality among adults in the United States. Environmental impact on incidence and outcomes of OHCA has not been fully investigated in recent years. Previous studies showed a possible increase in incidence and mortality in winter season and during seasons with temperature extremes. This study examines seasonal variation in incidence and outcomes of OHCA in the United States.

Retrospective study of adult OHCA using the Nationwide Emergency Department Sample was carried out. Monthly incidence rate per 100,000 ED presentations was calculated. Survival rates for each month of admission were examined by hospital region. Multivariate analyses were conducted to determine the effect of the season and month of admission on survival.

A total of 122,870 adult OHCA cases presented to emergency departments (EDs) in 2014 and were included. Average incidence of OHCA cases was 147 per 100,000 ED presentations. Overall survival rate in the study population was 5.6% (95% confidence intervals [CI] = 5.4%–5.9%). Patients had an average age of 65.5 (95% CI: 65.3–65.7) years and were mainly men (61.8%). Rates of OHCA presentations were highest during December and January (9.9% and 10.0%) while survival rates were lowest during December (4.6%) and highest in June (6.9%). Regional variation in OHCA outcomes was also noted with highest average survival rate in West (7.8%) and lowest in South (4.3%). After adjusting for confounders including region of hospital, Summer season (Ref: all other seasons), and more specifically month of June (Ref: all other months) were found to be positively associated with survival (OR 1.27, 95% CI [1.07–1.52], P-value = .008) and (OR 1.43, 95% CI [1.08–1.89], P-value = .012 respectively).

Incidence and outcomes of out of hospital cardiac arrest presentations to the emergency departments in the United States have seasonal variation. Both incidence and mortality of OHCA increase during colder months, and survival is significantly higher in summer season or in June. Exploring how to use this variation to improve outcomes through refresher training of medical providers or through other mitigation plans is needed.
Clinical study of herbal mixture “Diding Oral Medicine” as an alternative to preventative antibiotics in perioperative hemorrhoids
Authors: Gao Hengqing , Cheng Xiaohong , Liu Runping , Wang Xiaoqiang , Wang Wei , Gong Furao , Pan Renping , Hu Jing
Published: May 2021

To study the clinical effects of Diding Oral Medicine as an alternative to preventative antibiotics in perioperative hemorrhoids.

From August 2017 to February 2018, a total of 214 patients who were treated with external exfoliation and internal ligation of mixed hemorrhoids in our hospital were divided into the control group and experimental group by way of stratified random (107 cases in each group). Patients in the control group were given antibiotics preventatively before operation, while patients in the experimental group took Diding Oral Medicine before operation, and the white blood cell count, neutrophil count, wound recovery, pain score, anal bulge score, and pathogen culture of wound secretions were compared between the 2 groups.

There was no significant difference in white blood cell count and neutrophil count between both groups before and after operation (P > .05). The wound seepage score, wound edema score, and wound area score in the experimental group were lower than those in the control group, and the wound healing in the experimental group was shorter than that in the control group (all P < .05). The pain score and anal bulge score of the experimental group were decreased significantly compared to the control group (P < .05). In addition, the detection rate of pathogenic bacteria in the experimental group was downregulated significantly compared to the control group (P < .05).

The Diding Oral Medicine has prominent bacteriostatic and antibacterial effects on patients with hemorrhoids during perioperative period, and promotes wound healing, reduces pain stress, and anal bulge.
Clinical implication of homocysteine in premature acute coronary syndrome female patients
Authors: Zhao Yunfeng , Zhang Jun
Published: May 2021

Homocysteine (Hcy) is a risk factor for the presence of atherosclerotic vascular disease and hypercoagulability states, which is associated with increased risk of cardiovascular events in cardiovascular disease patients. Whereas the role of Hcy in premature acute coronary syndrome (ACS) female patients is still obscure. Hence, we aimed to explore the relationship of Hcy with clinical features, and more importantly, to probe its predictive value for major adverse cardiovascular events (MACE) risk in premature ACS female patients.

By retrospectively reviewing the medical charts of 1441 premature ACS female patients, we collected patients’ Hcy level (at diagnosis) and other clinical data. According to the follow-up records, the accumulating MACE occurrence was calculated.

Hcy presented with a skewed distribution with median value 11.3 μmol/L (range: 4.4–64.0 μmol/L, inter quartile: 9.2–14.1 μmol/L). Hcy was associated with older age, heavy body mass index, dysregulated liver/renal/cardiac indexes, hypertension history, and old myocardial infarction history. The 1-year, 3-year, 5-year MACE incidence was 2.9%, 10.7%, and 12.6%, respectively. Interestingly, Hcy was increased in 1-year MACE patients compared with 1-year non-MACE patients, in 3-year MACE patients compared with 3-year non-MACE patients, in 5-year MACE patients compared with 5-year non-MACE patients, and it had a good value for predicting 1-year/3-year/5-year MACE risk. Furthermore, Hcy was also correlated with increased accumulating MACE occurrence.

Hcy associates with increased age and body mass index, dysregulated liver, renal, and cardiac indexes; more interestingly, it predicts increased MACE risk in premature ACS female patients.
Laparoscopic distal pancreatectomy in a patient with aberrant splenic artery originating from the superior mesenteric artery
Authors: Ishida Hiroyuki , Ishikawa Yoshiya , Akahoshi Keiichi , Ueda Hiroki , Morimoto Koichiro , Yamashita Hironari , Ogawa Kosuke , Ono Hiroaki , Kudo Atsushi , Tanaka Shinji , Tanabe Minoru
Published: May 2021

Rationale:

Splenic artery originating from the superior mesenteric artery is extremely rare. Because of this, its significance in laparoscopic distal pancreatectomy has never been reported. Here, we present the first case of laparoscopic distal pancreatectomy in a patient with a splenic artery arising from the superior mesenteric artery.

Patient concerns:

A 46-year-old Japanese woman with type 2 diabetes mellitus presented with worsening glycemic control. Abdominal ultrasonography revealed a pancreatic tail mass.

Diagnoses:

The patient was diagnosed with pancreatic neuroendocrine tumor by endoscopic ultrasound-guided fine needle aspiration. Preoperative computed tomography showed that the splenic artery with branches of dorsal pancreatic artery originated from the superior mesenteric artery.

Interventions:

The patient underwent laparoscopic distal pancreatectomy. Prior to pancreatectomy, the splenic artery and its dorsal pancreatic branches were clamped using the superior and inferior approaches, respectively, to avoid bleeding and congestion.

Outcomes:

The postoperative course was uneventful.

Lessons:

Preoperative evaluation of anatomical variants and development of strategies are important to avoid intraoperative complications in pancreatic surgery. Our results revealed that laparoscopic distal pancreatectomy can be performed safely by strategic approach even in a patient with a rare aberrant splenic artery.
Clinical characterization of benign enterovirus infection in neonates
Authors: Chen Wenwen , Dai Shuzhen , Xu Liping
Published: May 2021

Enteroviruses is a group of positive single-stranded RNA viruses ubiquitous in the environment, which is a causative agent of epidemic diseases in children and infants. But data on neonates are still limited. The present study aimed to describe the clinical characteristics of enterovirus infection in neonates and arise the awareness of this disease to general public.

Between March 2018 and September 2019, data from all of the neonates diagnosed with enterovirus infection were collected and analyzed from neonatal intensive care unit of Zhangzhou Hospital in Fujian, China.

A total of 23 neonates were enrolled. All of them presented with fever (100%), and some with rashes (39.1%). The incidence of aseptic meningitis was high (91.3%), but only a small proportion (28.6%) presented with cerebrospinal fluid (CSF) leukocytosis. The positive value for nucleic acid detection in CSF was significantly higher than throat swab (91.3% vs 43.5%, P = .007). Five of the infected neonates presented with aseptic meningitis (23.8%) underwent brain magnetic resonance imaging examination and no craniocerebral injuries were found. Subsequent follow-ups were performed in 15 of them (71.4%) and no neurological sequelae was found.

Aseptic meningitis is a common type of enterovirus infection in neonates with a benign course. Nucleic acid detection of CSF has an important diagnostic value. Febrile neonates would be suggested to screen for enterovirus infection in addition to complete septic workup. An unnecessary initiation or earlier cessation of antibiotics could be considered in enterovirus infection, but that indications still need further studies to guarantee the safety.
Association between Toll-like receptor gene polymorphisms and risk of Helicobacter pylori infection
Authors: Ma Xiaocong , Lu Liying , Tang Yan , Luo Weisheng , Li Jianxiang , Tang Meiwen
Published: May 2021

Background:

There were many case-control studies performed the association between TLRs gene polymorphisms and the correlation of Helicobactor pylori infection, these results were inconformity. Therefore, a comprehensive meta-analysis was performed to evaluate the TLRs gene polymorphism and susceptibility to
H. pylori
infection.

Methods:

Eligible studies were searched from PubMed, EMBASE, Web of science, Cochrane library, CNKI, CBM, Wan Fang Database and VIP Database, all the databases were searched from inception to December 2020. OR with the corresponding 95% CI were presented as associations between certain TLR gene polymorphism and the risk of
H. pylori
infection, all the included data will be analyzed with the software of Review Manager 5.2 and STATA 14.2.

Results:

This study will provide a high-quality evidence to find the TLR gene polymorphisms with
H. pylori
infection susceptibility.

Conclusion:

This study will explore which TLR genotype increase the risk of
H. pylori
infection.
Laparoscopic lumbar artery ligation of type II endoleaks following endovascular aneurysm repair
Authors: Chung Byeoung Hoon , Yu Hee Chul , Yang Jae Do , Lee Mi Rin , Lee Min Ro , Hwang Hong Pil
Published: May 2021

Introduction:

Although the clinical significance of type II endoleaks remain controversial, management strategies continue to expand. The laparoscopic approach is a minimally invasive method for persistent type II endoleak repair after endovascular aneurysm repair.

Patient concerns:

A 70 - year - old male patient with a history of endovascular aneurysm repair with left internal iliac artery embolization presented with persistent type II endoleak from the lumbar arteries 2 years ago. The aneurysm sac size had increased more than 10 mm during follow up period.

Diagnosis:

Persistent type II endoleak after endovascular aneurysm repair.

Interventions:

Transarterial embolization was attempted and failed. A minimally invasive laparoscopic lumbar artery ligation was then utilized.

Outcomes:

The patient was discharged without any complications after surgery. Follow-up computed tomography angiography has shown the complete disappearance of the type II endoleaks.

Conclusions:

Laparoscopic lumbar artery ligation may be a safe and effective alternative treatment for type II endoleaks, especially in high resource settings.
Identification of potential serum exosomal microRNAs involved in acinar-ductal metaplasia that is a precursor of pancreatic cancer associated with chronic pancreatitis
Authors: Sheng Li-Ping , Han Chao-Qun , Nie Chi , Xu Tao , Zhang Kun , Li Xuan-Ji , Xie Xin-Ru , Lin Rong , Ding Zhen
Published: May 2021

Backgrounds:

Due to difficulty in early diagnosis of chronic pancreatitis (CP), it is urgent to find novel biomarkers to detect CP. Exosomal microRNAs (Exo-miRNAs) located in the serum may be potential diagnostic and therapeutic targets for CP.

Objective:

To identify differentially expressed Exo-miRNAs (DE-Exo-miRNAs) in the serum of CP patients, we performed a bioinformatics analysis.

Methods:

The dataset GSE128508 was downloaded from the Gene Expression Omnibus (GEO) database. The analysis was carried out using BRB-ArrayTools and significance analysis of microarrays (SAM). The target genes of DE-S-Exo-miRNAs were predicted by miRWalk databases. Further gene ontology (GO) term and Kyoto Encyclopedia of Genomes (KEGG) pathway analyses were performed with plug-in ClueGO in Cytoscape software 3.7.0. Subsequently, the interaction regulatory network between encoded proteins of target genes was performed with the Search Tool for the Retrieval of Interacting Genes (STRING) database and analyzed using plug-in Molecular Complex Detection (MCODE) and cytoHubba in Cytoscape software 3.7.0.

Results:

We identified 227 DE-Exo-miRNAs in the serum. Further analysis using the miRWalk database identified 5164 target genes of these miRNAs. The protein–protein interaction (PPI) regulatory network of 1912 potential target genes for hub 10 up-regulated miRNAs with high degrees and one down-regulated miRNAs were constructed using the STRING database and Cytoscape software. The functional analysis using Cytoscape software tool highlighted that target genes involved in pancreatic cancer. Acinar-ductal metaplasia (ADM) in the inflammatory environment of CP is a precursor of pancreatic cancer. Subsequently, we constructed a network of target genes associated with ADM and their miRNAs.

Conclusions:

Exo-miRNAs in the serum as well as their target genes may be promising targets for the early diagnosis and treatment of CP. In addition, we identified potential Exo-miRNAs involved in ADM that is a precursor of pancreatic cancer associated with CP.
A case report of aggressive course of CD30+ primary cutaneous anaplastic large cell lymphoma
Authors: Lyu Wen-Tian , Song Qi-Bin , Qiong Wang , Liu Jing , Yong Ren , Yi Feng-Tao , Han Dong-liang
Published: May 2021

Introduction:

CD30+ primary cutaneous anaplastic large cell lymphoma (PC-ALCL) is a rare T-cell neoplasm, and has been reported to present with an indolent behavior. The PC-ALCL with aggressive behavior has not been reported in the literature.

Patient concerns:

We treated a patient with PC-ALCL that exhibited indolent behavior in the past 2 years and aggressive behavior within the last 3 months before presentation.

Diagnosis:

Aggressive CD30+ primary cutaneous anaplastic large cell lymphoma.

Interventions:

The radiotherapy regimen was individualized in terms of the target volume delineation and dose prescription, and the dose–response relationship was evaluated.

Outcomes:

The mean distance of microscopic infiltration was 14.1 mm in depth and 14.3 mm circumferentially. The lesion completely regressed after the delivery of 40 Gy in 20 fractions over 4 weeks. The tumor did not recur over the next year.

Conclusion:

An aggressive disease course is rare for indolent CD30+ PC-ALCL, which has similar histopathological characteristics as indolent PC-ALCL. The radiotherapy strategy should be individualized with curative intent.
Perfusion image guided mechanical thrombectomy combined with tirofiban successfully revascularize systemic lupus erythematosus related acute large vessel occlusion
Authors: Wang Han , Hu Haitao , Xu Jing , Qian Cong
Published: May 2021

Rationale:

Systemic lupus erythematosus (SLE) is an important cause of stroke, more than a half the cases present as acute ischemic stroke. Thrombolysis is an effective choice in most cases, but for large vessel occlusion, mechanical thrombectomy is more effective. Here we reported a case of SLE-related stroke with left middle cerebral artery (MCA) occlusion, who was successfully treated by MT and tirofiban.

Patient concern:

A 38-year-old female suffered from right hemiplegia and aphasia for 8 hours. She was diagnosed with SLE 20 years ago, and neuropsychiatric SLE was considered 8 months before this onset. One month ago, glucocorticoids were discontinued by herself because of deterioration of bilateral femoral head osteonecrosis.

Diagnosis:

Left MCA occlusion was confirmed by computed tomography perfusion.

Intervention:

Immediate mechanical thrombectomy was performed and tirofiban was given to prevent re-occlusion of left MCA. Twenty fourhours later oral antiplatelet was given after intracranial hemorrhage was ruled out.

Outcomes:

Her neurological symptom improved several days later, and she was transferred to further rehabilitation. At 4 months follow-up she can live independently with mild hypophrasia. There was no further events of ischemic stroke in 1-year follow-up.

Lessons:

Mechanical thrombectomy is a highly effective and indispensable treatment for SLE related large vessel occlusion. In addition, tirofiban may reduce vessel reocclusion in special cases such as SLE and artery stenosis.
Efficacy and safety of high and low dose recombinant human erythropoietin on neurodevelopment of premature infants
Authors: Qin Na , Qin Huibin
Published: May 2021

Background:

To evaluate the effect of recombinant human erythropoietin (rhEPO) in nervous system of premature infants including different dosage.

Methods:

The multiple databases like Pubmed, Embase, Cochrane databases and China National Knowledge Database were used to search for the relevant studies, and full-text articles involved in the evaluation on effect of rhEPO for neurodevelopment among premature infants. Review Manager 5.2 was adopted to estimate the effects of the results among selected articles. Forest plots, sensitivity analysis and bias analysis for the articles included were also conducted.

Results:

Finally, 10 eligible studies were eventually satisfied the included criteria. The results showed that rhEPO was much higher than placebo group in composite cognitive score (MD = 5.89, 95% confidential interval {CI} [1.95, 9.82], P = .003; I

2
= 89%), there was no significant difference between rhEPO and placebo groups (RR = 0.93, 95% CI [0.60, 1.43], P = .74; I

2
= 51%) and no difference in neurodevelopmental impairment between rhEPO and placebo was insignificant (RR = 0.55 95% CI [0.30, 1.02], P = .06). Composite cognitive score in high dose rhEPO was much higher than placebo group (MD = 10.39, 95% CI [8.84, 11.93], P < .0001, I

2
= 0%) and low dose rhEPO also had higher composite cognitive score than placebo group (MD = 2.58, 95% CI [0.80, 4.37], P = .004, I

2
= 11%). Limited publication bias was observed in this study.

Conclusion:

Recombinant human erythropoietin might be a promotor for neurodevelopment among premature infants with limited adverse events.
Off-label tocilizumab and adjuvant iron chelator effectiveness in a group of severe COVID-19 pneumonia patients
Authors: Birlutiu Victoria , Birlutiu Rares Mircea , Chicea Liana
Published: May 2021

Tocilizumab (TCZ), a monoclonal recombinant antibody against IL-6 receptor, is currently used in managing the cytokine release syndrome (CRS) that occurred in coronavirus disease 2019 (COVID-19) selected cases. The primary objective of our study was to establish the effectiveness of TCZ in patients with severe or critical severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia.

We retrospectively analyzed 25 consecutive patients, admitted in the Academic Emergency Hospital Sibiu, Romania from April 1, 2020 until May 25, 2020, all with confirmed SARS-CoV-2 infection and severe pneumonia. All patients were treated off-label with TCZ, beside their standard care. Adjuvant iron chelator was associated in 11 patients.

Six female and 19 male patients admitted in our hospital all with confirmed SARS-CoV-2 infection and severe pneumonia as defined by Chinese Centers for Disease Control and Prevention were enrolled in this study. Seventeen of the 25 enrolled patients (68%) were seriously ill requiring noninvasive ventilation or oxygen mask, and 8 cases (32%) were critically ill requiring invasive mechanical ventilation. All patients received TCZ, and also received hydroxychloroquine, and lopinavir/ritonavir 200/50 mg for 10 days. Adjuvant iron chelator (deferasirox – marketed as Exjade) was associated in 11 patients who had ferritin serum levels above 1000 ng/mL. No side effects were encountered during infusions or after TCZ. We observed a rapid increase in arterial oxygen saturation for 20 of the 25 cases (80%) with a favorable evolution toward healing. Survivors were younger than 60 years old (80%), had less comorbidities (10% no comorbidities, 70% with 1 or 2 comorbidities), lower serum ferritin levels (30% under 1000 ng/mL), and 50% had no serum glucose elevation. Our patients with CRS had no response to corticosteroid therapy. Five out of the 25 patients had an unfavorable evolution to death. The off-label use of TCZ in patients with severe or critically ill form of SARS-CoV-2 infection had good results in our study.

Off-label use of TCZ in severe and critical cases of COVID-19 pneumonia is effective in managing the “cytokine storm.” Better outcomes were noted in younger patients. Associated adjuvant iron chelators may contribute to a good outcome and needs to be confirmed in larger studies.
Determination of Force Required to Produce Stab Wounds in Cadaveric Chest Tissues
Authors: Gitto Lorenzo , Serinelli Serenella , Werner Frederick W. , Ordway Nathaniel R. , Stoppacher Robert
Published: May 2021

When investigating deaths due to stab wounds, a common question asked to the forensic pathologist concerns the force required to inflict a given wound.

In this study, tests were performed on 6 human cadavers. A material testing machine was used to produce the stab wounds and to record the force required to penetrate skin, muscle, cartilage, and rib bone of the chest. Three different blades were used: a steak knife, a butcher knife, and a lock-blade knife. On each cadaver, chest injuries were produced at the following locations: (a) skin, intercostal soft tissues; (b) skin, muscle, and cartilage; and (c) skin, muscle, and bone. After the experiment, a chest dissection was performed to confirm the correct locations of the produced stab wounds.

The force required to insert a knife into cartilage or bone was significantly greater than the force to insert it into a region only covered by skin. There was wide variation in the force required to insert a knife into different bodies, but no force for any knife at any location for all bodies was greater than 261 N.

This study allowed us to obtain quantitative measures of the force required to penetrate human chest tissues, removing subjective factors.
Frequency of Extracorporeal Membrane Oxygenation Support and Outcomes After Implementation of a Structured PICU Network in Neonates and Children: A Prospective Population-Based Study in the West of France
Authors: Bourgoin Pierre , Aubert Lucie , Joram Nicolas , Launay Elise , Beuchee Alain , Roue Jean Michel , Baruteau Alban , Fernandez Modesto , Pavy Carine , Baron Olivier , Flamant Cyril , Liet Jean Michel , Ozanne Bruno , Chenouard Alexis
Published: May 2021

OBJECTIVES:

To describe the frequency and outcomes on the use of extracorporeal membrane oxygenation (ECMO) among critically ill neonates and children within a structured pediatric critical care network in the West of France. To assess the optimality of decision-making process for patients primarily admitted in non-ECMO centers.

DESIGN:

Observational prospective population-based study from January 2015 to December 2019.

PATIENTS:

Neonates over 34 weeks of gestational age, weighing more than 2,000 g and children under 15 years and 3 months old admitted in one of the 10 units belonging to a Regional Pediatric Critical Care Network.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Eight-thousand one hundred eighty-nine children and 3,947 newborns were admitted within one of the 10 units of the network over the study period. Sixty-five children (8.1% [95% CI, 6.2–10‰]) and 35 newborns (9.4% [95% CI, 6.4–12%]) required ECMO support. Of these patients, 31 were first admitted to a non-ECMO center, where 20 were cannulated in situ (outside the regional ECMO center) and 11 after transfer to the ECMO regional center. Cardiogenic shock, highest serum lactate level, and cardiac arrest prior to first phone call with the regional ECMO center were associated with higher rate of in situ cannulation. During the study period, most of the patients were cannulated for underlying cardiac issue (42/100), postoperative cardiac surgery instability (38/100), and pediatric (10/100) and neonatal (10/100) respiratory distress syndrome. Patients primarily admitted in non-ECMO centers or not had similar 28-day post-ICU survival rates compared with those admitted in the referral ECMO center (58% vs 51%; p = 0.332). Pre-ECMO cardiac arrest, ECMO, and lower pH at ECMO onset were associated with lower 28-day post-ICU survival.

CONCLUSIONS:

Our local results suggest that a structured referral network for neonatal and pediatric ECMO in the region of Western France facilitated escalation of care with noninferior (or similar) early mortality outcome. Our data support establishing referral networks in other equivalent regions.
A randomized clinical trial of single dose liposomal bupivacaine versus indwelling analgesic catheter in patients undergoing surgical stabilization of rib fractures
Authors: Leasia Kiara N. , Ciarallo Christopher , Prins Jonne T.H. , Preslaski Candice , Perkins-Pride Elizabeth , Hardin Kimberly , Cralley Alexis , Burlew Clay Cothren , Coleman Jamie J. , Cohen Mitchell J. , Lawless Ryan , Platnick K. Barry , Moore Ernest E. , Pieracci Fredric M.
Published: May 2021

INTRODUCTION

Locoregional analgesia (LRA) remains underused in patients with chest wall injuries. Surgical stabilization of rib fractures (SSRF) offers an opportunity to deliver surgeon-directed LRA under direct visualization at the site of surgical intervention. We hypothesized that a single-dose liposomal bupivacaine (LB) intercostal nerve block provides comparable analgesia to an indwelling, peripheral nerve plane analgesic catheter with continuous bupivacaine infusion (IC), each placed during SSRF.

METHODS

Noninferiority, single-center, randomized clinical trial (2017–2020) was performed. Patients were randomized to receive either IC or LB during SSRF. The IC was tunneled into the surgical field (subscapular space), and LB involved thoracoscopic intercostal blocks of ribs 3 to 8. The primary outcome was the Sequential Clinical Assessment of Respiratory Function score, measured daily for 5 days postoperatively. Secondary outcomes included daily narcotic equivalents and failure of primary LRA, defined as requiring a second LRA modality.

RESULTS

Thirty-four patients were enrolled: 16 IC and 18 LB. Age, Injury Severity Score, RibScore, Blunt Pulmonary Contusion Score, and use of nonnarcotic analgesics was similar between groups. Duration of IC was 4.5 days. There were three failures in the IC group versus one in the LB group (p = 0.23). There was no significant difference in Sequential Clinical Assessment of Respiratory Function score between the IC and LB groups. On postoperative days 2 to 4, narcotic requirements were less than half in the LB, as compared with the IC group; however, this difference was not statistically significant. Average wholesale price was US $605 for IC and US $434 for LB.

CONCLUSION

In this noninferiority trial, LB provided at least comparable and potentially superior LRA as compared with IC among patients undergoing SSRF.

LEVEL OF EVIDENCE

Therapeutic, level II.
Analysis of putative quadruplex-forming sequences in fungal genomes: novel antifungal targets?
Authors: Warner Emily F. , Bohálová Natália , Brázda Václav , Waller Zoë A. E. , Bidula Stefan
Published: May 2021

Fungal infections cause >1 million deaths annually and the emergence of antifungal resistance has prompted the exploration for novel antifungal targets. Quadruplexes are four-stranded nucleic acid secondary structures, which can regulate processes such as transcription, translation, replication and recombination. They are also found in genes linked to virulence in microbes, and ligands that bind to quadruplexes can eliminate drug-resistant pathogens. Using a computational approach, we quantified putative quadruplex-forming sequences (PQS) in 1359 genomes across the fungal kingdom and explored their presence in genes related to virulence, drug resistance and biological processes associated with pathogenicity in Aspergillus fumigatus. Here we present the largest analysis of PQS in fungi and identify significant heterogeneity of these sequences throughout phyla, genera and species. PQS were genetically conserved in Aspergillus spp. and frequently pathogenic species appeared to contain fewer PQS than their lesser/non-pathogenic counterparts. GO-term analysis identified that PQS-containing genes were involved in processes linked with virulence such as zinc ion binding, the biosynthesis of secondary metabolites and regulation of transcription in A. fumigatus. Although the genome frequency of PQS was lower in A. fumigatus, PQS could be found enriched in genes involved in virulence, and genes upregulated during germination and hypoxia. Moreover, PQS were found in genes involved in drug resistance. Quadruplexes could have important roles within fungal biology and virulence, but their roles require further elucidation.
dPQL: a lossless distributed algorithm for generalized linear mixed model with application to privacy-preserving hospital profiling
Authors: Luo Chongliang , Islam Md. Nazmul , Sheils Natalie E. , Buresh John , Chen Yong
Published: May 2021

Hospital profiling provides a quantitative comparison of health care providers for their quality of care regarding certain clinical outcomes. To implement hospital profiling, the generalized linear mixed model (GLMM) is usually used to fit clinical or administrative claims data, adjusting for the effects of covariates. For better generalizability, data across multiple hospitals, databases or networks are desired. However, due to the privacy regulation and the computation complexity of GLMM, a convenient distributed algorithm for hospital profiling is needed. In this paper, we develop a novel distributed Penalized Quasi Likelihood algorithm (dPQL) to fit GLMM, when only aggregated data, rather than the individual patient data are available across hospitals. The dPQL algorithm is based on a newly-developed distributed linear mixed model (DLMM) algorithm. This proposed dPQL algorithm is lossless, i.e. it obtains identical results as if the individual patient data are pooled from all hospitals. We demonstrate the usage of the dPQL algorithms by ranking 929 hospitals for COVID-19 mortality or referral to hospice in Asch, et al. 2020.
Genomic risk prediction for breast cancer in older women
Authors: Lacaze Paul , Bakshi Andrew , Riaz Moeen , Orchard Suzanne G , Tiller Jane , Neumann Johannes T , Carr Prudence R , Joshi Amit D , Cao Yin , Warner Erica T , Manning Alisa , Nguyen-Dumont Tú , Southey Melissa C. , Milne Roger L , Ford Leslie , Sebra Robert , Schadt Eric , Gately Lucy , Gibbs Peter , Thompson Bryony A , Macrae Finlay A , James Paul , Winship Ingrid , McLean Catriona , Zalcberg John R , Woods Robyn L , Chan Andrew T , Murray Anne M , McNeil John J
Published: May 2021

Background

Genomic risk prediction models for breast cancer (BC) have been predominantly developed with data from women aged less than 70 years. Prospective studies of women aged 70 years or older have been limited.

Methods

We assessed the effect of a 313-variant polygenic risk score (PRS) for BC in 6,339 women of European ancestry aged ≥70 years. We evaluated incident BC diagnoses over a median follow-up of 4.7 years. A multivariable Cox regression model including conventional risk factors was applied to prospective data, and re-evaluated after adding the PRS. We also assessed the association of rare pathogenic variants (PVs) with BC in susceptibility genes (BRCA1/BRCA2/PALB2/CHEK2/ATM).

Results

The PRS, as a continuous variable, was an independent predictor of incident BC (hazard ratio [HR] per standard deviation (SD)=1.4, 95% confidence interval [CI] 1.3-1.6, N=110 cases) and hormone receptor (ER/PR)-positive disease (HR=1.5 [CI 1.2-1.9], N=79 cases). Women in the top quintile of the PRS distribution had higher risk of BC than women in the lowest quintile (HR=2.2 [CI 1.2-3.9]). The concordance index of the model without the PRS was 0.62 (95% CI 0.56-0.68) which improved after addition of the PRS to 0.65 (95% CI 0.59-0.71). Among 41 (0.6%) carriers of PVs in BC susceptibility genes, we observed no incident BC diagnoses.

Conclusion

The 313-variant PRS predicts BC risk in women aged 70 years and older.
Splice-specificlynknockout mice reveal a dominant function of LynB in preventing autoimmunity
Authors: Brian Ben F. , Sauer Monica L. , Ruis Brian , Auger Jennifer L. , Senevirathne S. Erandika , Swanson Whitney L. , Nunez Myra G. , Moriarity Branden S. , Lowell Clifford A. , Binstadt Bryce A. , Freedman Tanya S.
Published: May 2021

The unique roles of the Src-family kinases LynA and LynB in immune activating and inhibitory signaling have eluded definition. Here we report that LynB, the shorter splice product oflyn, carries the dominant immunosuppressive function. We used CRISPR/Cas9 gene editing to constrainlynsplicing and expression to a single product: LynAKOor LynBKOmice. While activities of both isoforms regulate homeostatic Lyn expression, only LynB protects against autoimmune disease. LynBKOmonocytes and dendritic cells are TLR4-hyper-responsive, and TLR4 expression increases with age in LynBKOmyeloid and B cells. These changes are accompanied by the development of an inflammatory disease that resembles human systemic lupus erythematosus (SLE). The interplay between LynB and TLR4 likely underlies the autoimmunity risk associated withLYNhypomorph andTLR4hypermorph alleles.
Longitudinal SARS-CoV-2 infection study in a German medical school
Authors: Schön Michael , Lindenau Clemens , Böckers Anja , Altrock Claire-Marie , Messerer David A. C. , Krys Lydia , Nosanova Anastasia , Lang Nicole , Renz Andrea , Kroschel Joris , Beil Alexandra , Pensel Elke , Grab Claudia , Mayer Benjamin , Fassnacht Ulrich , Delling Jan Philipp , Engelmann Magdalena , Horneffer Astrid , Zernickel Maria , Debatin Klaus-Michael , Münch Jan , Kirchhoff Frank , Wirth Thomas , Boeckers Tobias M.
Published: May 2021

In light of the COVID-19 pandemic, universities around the world were challenged by the difficult decision whether classes could be held face-to-face in the winter semester 20/21. The gross anatomy course is considered an essential practical element of medical school. In order to protect the participants and teaching staff and to gain more knowledge about SARS-CoV-2 infections among students during a semester with face-to-face teaching a longitudinal test study was conducted. Medical students from the first three years of medical school were also invited. Out of a total of almost 1,000 swabs, only two active asymptomatic infections were detected at the start of the semester, none during the semester. At semester start, approximately 6% of the students had antibodies. At the end of the semester, only nine seroconversions after infection in 671 individuals occurred. This was surprisingly low because a massive second wave of infections hit Germany during the same period. The conclusion therefore is that face-to-face teaching under these measures was not infection-promoting even with high incidence rates in the overall population with the SARS-CoV-2 variants present at that time period. Moreover, the results are indicative of a preventive effect of hygiene concepts together with repetitive testings before and during a semester.
SARS-CoV-2 infections and hospitalizations among immigrants in Norway – significance of occupation, household crowding, education, household income and medical risk. A nationwide register study
Authors: Labberton Angela S , Godøy Anna , Elgersma Ingeborg Hess , Heine Strand Bjørn , Telle Kjetil , Arnesen Trude , Nygård Karin Maria , Indseth Thor
Published: May 2021

Background

As in other countries, the coronavirus disease 2019 (COVID-19) pandemic has affected Norway’s immigrant population disproportionately with significantly higher infection rates and hospitalizations. The reasons for this are uncertain.

Methods

Through the national emergency preparedness register, BeredtC19, we have studied laboratory-confirmed infections with SARS-CoV-2 and related hospitalizations in the entire Norwegian population, by birth-country background for the period 15 June 2020 – 31 March 2021, excluding the first-wave due to limited test capacity and restrictive test criteria. Straightforward linkage of individual-level data allowed adjustment for demographics, socioeconomic factors (occupation, household crowding, education, and household income), and underlying medical risk for severe COVID-19 in regression models.

Results

The sample comprised 5.49 million persons, of which 0.91 million born outside of Norway, 82 532 confirmed cases, and 3088 hospitalizations. Confirmed infections in this period (per 100 000): foreign-born 3140, Norwegian-born with foreign-born parents 4799, Norwegian-born with Norwegian-born parent(s) 1011. Hospitalizations (per 100 000): foreign-born 147, Norwegian-born with foreign-born parents 47, Norwegian-born with Norwegian-born parent(s) 37. The addition of socioeconomic and medical factors to the base-model (age, sex, municipality of residence) attenuated excess infection rates by 12.0% and hospitalizations by 3.8% among foreign-born, and 10.9% and 46.2% respectively among Norwegian-born with foreign parents, compared to Norwegian-born with Norwegian-born parent(s).

Conclusion

There were large differences in infection rates and hospitalizations by country background, and these do not appear to be fully explained by socioeconomic and medical factors. Our results may have implications for health policy, including the targeting of mitigation strategies.