bluuebunny/crossref_metadata_2025 huggingface dataset:
HIV Testing in Adults Presenting With Central Nervous System Infections
Authors: Ma Bert , Vigil Karen J , Hasbun Rodrigo
Published: June 2020

Background

Universal HIV testing in adults presenting to a health care setting was recommended by the Centers for Disease Control and Prevention (CDC) in 2006, but compliance in central nervous system (CNS) infections is unknown.

Methods

A multicenter study of adults presenting with CNS infections to 18 hospitals in Houston and New Orleans between 2000 and 2015 was done to characterize HIV testing and explore factors associated with a positive HIV test.

Results

A total of 1478 patients with a diagnosis of meningitis or encephalitis were identified; 180 were excluded because of known HIV diagnosis (n = 100) or were <17 years old (n = 80). Out of 1292 patients, 642 (49.7%) had HIV testing, and testing did not differ significantly before or after the CDC recommendations in 2006 (53% vs 48%; P = .068). An HIV test was more commonly done in patients who were non-Caucasian, had fever >38°C, or had seizures on presentation, and of those tested, non-Caucasian patients and those with photophobia were more likely to have a positive HIV test (P < .05). HIV testing also varied by type of CNS infection: community-acquired bacterial meningitis (98/130, 75.4%), encephalitis (174/255, 68.2%), aseptic meningitis (285/619, 46.0%), and health care–associated meningitis (85/288, 29.5%; P < .001).

Conclusions

Even though HIV testing should be done in all adults presenting with a CNS infection, testing remains ~50% and did not improve after the recommendation for universal testing by the CDC in 2006.
The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017
Authors: Klein Eili Y , Schueller Emily , Tseng Katie K , Morgan Daniel J , Laxminarayan Ramanan , Nandi Arindam
Published: June 2020

Background

Influenza, which peaks seasonally, is an important driver for antibiotic prescribing. Although influenza vaccination has been shown to reduce severe illness, evidence of the population-level effects of vaccination coverage on rates of antibiotic prescribing in the United States is lacking.

Methods

We conducted a retrospective analysis of influenza vaccination coverage and antibiotic prescribing rates from 2010 to 2017 across states in the United States, controlling for differences in health infrastructure and yearly vaccine effectiveness. Using data from IQVIA’s Xponent database and the US Centers for Disease Control and Prevention’s FluVaxView, we employed fixed-effects regression analysis to analyze the relationship between influenza vaccine coverage rates and the number of antibiotic prescriptions per 1000 residents from January to March of each year.

Results

We observed that, controlling for socioeconomic differences, access to health care, childcare centers, climate, vaccine effectiveness, and state-level differences, a 10–percentage point increase in the influenza vaccination rate was associated with a 6.5% decrease in antibiotic use, equivalent to 14.2 (95% CI, 6.0–22.4; P = .001) fewer antibiotic prescriptions per 1000 individuals. Increased vaccination coverage reduced prescribing rates the most in the pediatric population (0–18 years), by 15.2 (95% CI, 9.0–21.3; P < .001) or 6.0%, and the elderly (aged 65+), by 12.8 (95% CI, 6.5–19.2; P < .001) or 5.2%.

Conclusions

Increased influenza vaccination uptake at the population level is associated with state-level reductions in antibiotic use. Expanding influenza vaccination could be an important intervention to reduce unnecessary antibiotic prescribing.
Analysis of Ganciclovir-Resistant Cytomegalovirus Infection Caused by the UL97 Gene Mutation in Codons 460 and 520 in Pediatric Patients: A Case Series
Authors: Boonsathorn Sophida , Pasomsub Ekawat , Techasaensiri Chonnamet , Apiwattanakul Nopporn
Published: June 2020

Background

Drug-resistant cytomegalovirus (CMV) infection has been increasingly recognized. However, there are limited data in pediatric patients. In this study, the prevalence and factors associated with CMV infection with UL97 mutations in pediatric patients treated with ganciclovir but not responding to treatment were evaluated.

Methods

This retrospective study was conducted from January 2013 to December 2017. All patients who were suspected of having ganciclovir-resistant CMV infection and had never had ganciclovir prophylaxis were included. Genotypic assay for UL97 mutations in codons 460 and 520 conferring ganciclovir resistance was performed. Factors associated with the presence of UL97 mutations were analyzed.

Results

Of 34 patients included, 10 patients (29.4%) had a genotypically confirmed UL97 mutation. The median age (interquartile range [IQR]) was 3 (0.85–8.68) years. Ganciclovir resistance was tested at a median time (IQR) of 22.5 (14.3–31) days after initiation of ganciclovir. All resistant isolates harbored a UL97 mutation in codon 460. Compared with patients infected with CMV without UL97 mutation, those infected with UL97 mutation strains were younger (median age [IQR], 3.02 [0.85–8.68] vs 10.45 [2.7–16.4] years) and had a higher maximum viral load (median [IQR], 5.06 [4.74–6.05] vs 4.42 [4.03–4.87] copies/mL). Six of 10 (60%) patients were successfully treated with high-dose ganciclovir (7.5 mg/kg twice daily).

Conclusions

UL97 mutation ganciclovir-resistant CMV infection was not uncommon in the pediatric population. Screening for this mutation should be considered in patients experiencing virological worsening while ganciclovir is given, even if patients have not previously received ganciclovir prophylaxis.
Observation of asexual reproduction with symbiont transmission in planktonic foraminifera
Authors: Takagi Haruka , Kurasawa Atsushi , Kimoto Katsunori
Published: June 2020

Gamete release has been frequently observed in laboratory cultures of various species of planktonic foraminifera. Those observations have been taken as evidence that these organisms produce new generations exclusively by sexual reproduction. We report here the first observation of asexual reproduction in Globigerinita uvula, a small, microperforate foraminifera. The asexual phase was associated with the release of ca. 110 offspring, all of which hosted symbiotic algae that must have been passed on directly from the parent. This event was also the first observation of vertical transmission of symbionts in planktonic foraminifera. Although the trigger of the observed asexual reproduction and its frequency in nature remain unknown, our observation indicates that among the planktonic foraminifera, at least G. uvula has not abandoned the asexual phase of its life cycle.
Medial Plating of Pauwels Type III Femoral Neck Fractures Decreases Shear and Angular Displacement Compared with a Derotational Screw
Authors: Nwankwo Chima D. , Schimoler Patrick , Greco Victor , Kharlamov Alexander , Westrick Edward R. , Miller Mark Carl
Published: June 2020

Objectives:

The purpose of this mechanical study was to compare 2 methods of augmented stabilization of Pauwels type III femoral neck fractures.

Methods:

Ten matched pairs of young cadaveric femurs were cut 22 cm distal to the lesser trochanter. All specimens received a 70-degree osteotomy, which was stabilized with a 135-degree sliding hip screw. One of each pair received augmented fixation with a 6.5 mm fully threaded cannulated screw. The other specimen in the matched pair had additional fixation with a 3.5 mm 5-hole tubular plate placed at the inferior-medial femoral neck. Each specimen was tested under cyclic axial loading conditions (5000 cycles between 200 and 1400 N at 2 cycles/sec) and subsequently loaded to failure. The angular displacement (varus), interfragmentary (shear) displacement, and failure loads were calculated.

Results:

In the augmented plate group, 7 specimens failed by angular displacement and 3 failed by shear displacement. In the augmented screw group, 8 specimens failed by angular displacement and 2 by shear displacement. The plate group was found to have significantly less angular displacement, regardless of completed cycles, than the augmented screw group (0.75 ± 0.35 degrees vs. 2.15 ± 1.99 degrees averaged across completed cycles, P < 0.01). Similarly, the plate group was found to have significantly less shear displacement, regardless of completed cycles, than the augmented screw group (0.77 ± 0.70 mm vs. 1.22 ± 0.92 mm averaged across completed cycles, P = 0.01). The average failure load of the plate group (4930 ± 1578 N) was also larger but not significantly different from the screw group (3824 ± 2140 N), P = 0.12.

Conclusions:

Augmenting sliding hip screw stabilization of a Pauwels type III fracture with a medial plate applied to the femoral neck significantly decreases angular displacement and shear displacement compared with augmentation with a derotational screw.
Risk of Injury to the Neurovascular Structures in the Pararectus Approach Used in Acetabular Fractures: A Cadaver Study
Authors: Kati Yusuf A. , Kose Ozkan , Acar Baver , Turan Adil , Ozturk Serra , Sindel Muzaffer
Published: June 2020

Objectives:

Complex acetabular fractures involving the quadrilateral plate may necessitate infrapectineal buttress plating, which can be performed through the pararectus approach. The aim of this cadaveric study was to identify the anatomical guide points to protect neurovascular structures at the risk of injury during the pararectus approach.

Methods:

Six fresh frozen cadavers (12 hemipelves) were dissected in this study. Location of the inferior epigastric artery (IEA), obturator nerve and corona mortis (CM) was measured using common anatomic landmarks, namely, anterior superior iliac spine, symphysis pubis (SP), and sacroiliac (SI) joint.

Results:

In the superficial dissection of the abdominal wall, the mean distance between the IEA and anterior superior iliac spine was 106.7 ± 5.2 (range, 99.2–116.4) mm, and the mean distance between IEA and SP was 77.9 ± 3.5 (range, 70.6–82.2) mm. In deep dissection, the mean distance between the SI joint and the SP was 133.1 ± 5.7 (range, 126.0–142.0) mm. The mean distance between the SI joint and ON was 37.3 ± 2.8 (range, 31.0–41.0) mm. The CM was unable to be detected in 2 cadavers, 1 on the right and 1 on the left hemipelves. The mean distance between the CM and SP was 47.7 ± 3.9 (range, 43.0–55.0) mm.

Conclusions:

A pararectus approach is a useful approach which allows infrapectineal plating in the treatment of complex acetabular fractures; however, the preservation of critical neurovascular structures is essential during dissection. This study is helpful to identify the structures at risk according to commonly used anatomic landmarks. These data might be a necessary guideline for hip and trauma surgeons.
The Total Artificial Heart
Authors: Arabía Francisco A.
Published: June 2020

The total artificial heart (TAH) is a device that replaces the failing ventricles. There have been numerous TAHs designed over the last few decades, but the one with the largest patient experience is the SynCardia temporary TAH. The 50-mL and 70-mL sizes have been approved in the United States, Europe, and Canada as a bridge to transplantation. It is indicated in patients with severe biventricular failure or structural heart issues that preclude the use of a left ventricular assist device. The majority of the patients implanted are Interagency Registry for Mechanically Assisted Circulatory Support profile 1 or 2. The 1-year survival in experienced centers that have implanted over 10 TAHs is 73%. The risk factors for death include older age, need for preimplantation dialysis, and malnutrition. The most common causes of death are multiple organ failure, usually the result of physiologic deterioration before implantation, and neurologic dysfunction. The device allows the patient to be discharged home and managed as an outpatient. Proper patient selection, the timing of intervention, patient care, and device management are essential for a suitable outcome. In addition, the CARMAT TAH is another device that will soon be studied in a clinical trial in the United States. The BiVACOR TAH is a revolutionary design utilizing electromagnetic levitation that is expected to enter a clinical trial in the next few years.
Abdominal Involvement in Children With Bacteriologically Confirmed Tuberculosis
Authors: Sartoris Giulia , Seddon James A. , Rabie Helena , Nel Etienne D. , Losurdo Giuseppe , Schaaf H. Simon
Published: June 2020

Background:

Abdominal tuberculosis (TB) in children is poorly described and often poses a diagnostic challenge. We evaluated abdominal involvement in children presenting with bacteriologically confirmed TB.

Methods:

We undertook a retrospective study at Tygerberg Hospital, Cape Town, from January 1, 2014, through December 31, 2018, of all children (<13 years) diagnosed with bacteriologically confirmed TB, in whom abdominal involvement was found. Demographic and clinical data were collected through folder review, laboratory records and imaging reports.

Results:

Of 966 children with bacteriologically confirmed TB, 111 (11.5%) had abdominal involvement; 16 (14.4%) were excluded from further analysis because of lack of clinical data. The median age of the remaining 95 children was 43 months (interquartile range 20–94); 26 (27%) were HIV positive. The main gastrointestinal symptoms/signs were weight loss (84.2%), abdominal distention (54.7%), hepatomegaly (60.0%) and abdominal pain (26.3%). The main pathologic types were intra-abdominal lymph nodes (68.4%), solid organ involvement (54.7%), peritoneal type (23.2%) and intestinal type (10.5%). Splenic abscesses and solid organ involvement on ultrasonography were more common in HIV-positive children (P < 0.001 and P = 0.008, respectively). Liver abscesses were associated with age less than 5 years (P = 0.03), while abdominal lymphadenopathy on ultrasonography was more common in children older than 5 years (P = 0.038). Abdominal specimens were collected in an attempt to identify Mycobacterium tuberculosis in 15 of 95 (15.8%) patients and were positive in 13 of 15 (86.7%).

Conclusions:

Over 10% of children with confirmed TB had abdominal involvement. Abdominal TB should be considered in any pediatric TB case with abdominal symptoms, and ultrasonography should be the radiologic study of choice.
Conceptual aspects, impact, and state of the art of dependent prescription in Brazil: narrative review
Authors: Andrade Heuler S. , Guimarães Eliete A.A. , Obreli Neto Paulo R. , Pereira Mariana L. , Zanetti Maria O.B. , Reis Tiago M. , Baldoni André O.
Published: June 2020

Background:

Nonmedical prescription is recognized in several countries as an excellent strategy in facing emerging demands that put a strain on the health system. It is a practice carried out by professionals who are not doctors and who, after obtaining specific qualifications and legal authorization, can prescribe medication and curatives. In Brazil, although there is already a legal subsidy for prescription in some professions, it is still an underdeveloped activity with few studies.

Objective:

This study aimed to describe the conceptual aspects and state of the art of this type of prescription in Brazil.

Methods:

It is a narrative review of the literature that included national and international regulations related to the subject, as well as available articles, published in electronic journals in different databases. Key terms used were nonmedical prescription, nursing prescription, and pharmaceutical prescription.

Results:

It was evidenced that nonmedical prescription has ample potential for improving the quality of care and the health conditions of patients. One can highlight as positive results the improvement of work satisfaction and self-confidence of those who have developed this practice; improvement of teamwork reported by other professionals due to the reduction of work overload; greater patient satisfaction in relation to access; and care provided by prescribers.

Conclusions:

It is understood that there are many challenges for the consolidation of this activity in Brazil and that its success depends on a joint effort of health and educational institutions, health professionals, and patients.
Implementation of an infection control program with emphasis on cohorting to patients with carbapenemase-producing Enterobacteriaceae. The experience of 2 years in a tertiary teaching hospital in northern Portugal
Authors: Vigário Ana , Gonçalves João A. , Costa Ana R. , Pinheiro Guiomar , Reis Ernestina , Oliveira Júlio R.
Published: June 2020

Background:

The emergence of carbapenemase-producing Enterobacterales (CPE) represents a major public health threat. Our purpose was to evaluate a surveillance and cohorting program implemented in patients infected or carriers of CPE.

Methods:

A prospective registry of CPE carriers or infected patients was analyzed from October 2015 until December 2017. All inpatients presenting with CPE were included in a hospital cohort with dedicated healthcare staff and contact precaution measures.

Results:

A total of 480 patients were identified, of which 15.8% (n = 76) were infected. Men comprised 56.7% of the cohort (n = 272) and 69.2% (n = 332) were elderly. About 46.3% (n = 222) had a previous hospital admission and 81.7% (n = 392) had at least 1 antibiotic course in the previous 90 days. There was a decline in infected patients in 2017. Periodic and admission screenings accounted for 63% and 74% of cases in 2016 and 2017, with increased detection rate comparing with contact/investigation screenings. In 2017, significantly fewer patients were identified outside the admission/point of prevalence screening (P = .009). In 2017 the proportion of invasive carbapenem-resistant Klebsiella pneumoniae amongst CPE in our center was below the national average (2016: 13.3% vs 5.2%; 2017: 6.6% vs 8.6%). A reduction of the consumption of carbapenems was also observed in 2017.

Conclusion:

The implementation of the program has increased the number of patients identified by the preventive method and stabilized the emergence of new CPE cases. Furthermore, the program cohort compared well with the national picture, with a lower number of infected patients and a lower proportion of carbapenem-resistant K pneumoniae in invasive specimens. These indicators reflect the added value of the CPE surveillance and cohorting program.
Job Demands and the Effects on Quality of Life of Employed Family Caregivers of Older Adults With Dementia: A Cross-Sectional Study
Authors: WANG Yu-Nu , HSU Wen-Chuin , SHYU Yea-Ing Lotus
Published: June 2020

Background

Employed family caregivers are affected by job demands, which can affect quality of care provided to recipients. However, it is important to understand how job demands and the ability to reconcile employment and caregiving influence family caregivers’ quality of life.

Purpose

The aim of this study was to examine the extent to which job demands influenced quality of life for employed family caregivers of older adults with dementia in Taiwan.

Methods

This cross-sectional study analyzed secondary data from self-completed questionnaires collected from December 2010 to December 2011. Participants were 214 employed family caregivers of older adults with dementia in Taiwan. How job demands and caregiving influence quality of life was determined with hierarchical multiple regression analysis. Job demands included working hours, workplace inflexibility, work inefficiency, and difficulty in reconciling work and family caregiving.

Results

After controlling for demographics, caregiving resources, and caregiving role demands, employed family caregivers of older adults with dementia with fewer working hours and greater work efficiency reported significantly better quality of life (β = −.130, p = .049; β = −.263, p < .001) than those with more working hours and less work efficiency.

Conclusions/Implications for Practice

Employed family caregivers of older adults with dementia who had more working hours and less work efficiency had a greater likelihood of poorer quality of life than other employed family caregivers. Clinicians could use these findings to identify groups at high risk for poor quality of life. We suggest developing policies and interventions to help employed family caregivers of older adults with dementia to reduce working hours and improve work efficiency in order to improve quality of life, which could also improve quality of care for recipients.
Left Pulmonary Artery Ligation and Chronic Pulmonary Artery Banding Model for Inducing Right Ventricular—Pulmonary Hypertension in Sheep
Authors: Ukita Rei , Tipograf Yuliya , Tumen Andrew , Donocoff Rachel , Stokes John W. , Foley Neal M. , Talackine Jennifer , Cardwell Nancy L. , Rosenzweig Erika B. , Cook Keith E. , Bacchetta Matthew
Published: June 2020

Pulmonary hypertension (PH) is a progressive disease that leads to cardiopulmonary dysfunction and right heart failure from pressure and volume overloading of the right ventricle (RV). Mechanical cardiopulmonary support has theoretical promise as a bridge to organ transplant or destination therapy for these patients. Solving the challenges of mechanical cardiopulmonary support for PH and RV failure requires its testing in a physiologically relevant animal model. Previous PH models in large animals have used pulmonary bead embolization, which elicits unpredictable inflammatory responses and has a high mortality rate. We describe a step-by-step guide for inducing pulmonary hypertension and right ventricular hypertrophy (PH-RVH) in sheep by left pulmonary artery (LPA) ligation combined with progressive main pulmonary artery (MPA) banding. This approach provides a controlled method to regulate RV afterload as tolerated by the animal to achieve PH-RVH, while reducing acute mortality. This animal model can facilitate evaluation of mechanical support devices for PH and RV failure.
Thromboembolic Events in Patients With Left Ventricular Assist Devices Are Related to Microparticle-Induced Coagulation
Authors: Kramser Nicolas , Oehler Daniel , Saeed Diyar , Aubin Hug , Akhyari Payam , Kelm Malte , Westenfeld Ralf , Horn Patrick
Published: June 2020

Thromboembolic events (TEs) are a feared complication in patients supported by a continuous-flow left ventricular assist device (LVAD).

The aim of the study was to analyze the role of circulating microparticles (MPs) in activating the coagulation system in LVAD patients, which might contribute to the occurrence of TEs. First, we analyzed the effect of LVAD support on endothelial function, on the levels of endothelial MPs (EMPs) and platelet MPs (PMPs), and on the procoagulative activity of circulating MPs (measured as MP-induced thrombin formation) before LVAD implantation, post-implantation, and at a 3 month follow-up (n = 15). Second, these parameters were analyzed in 43 patients with ongoing LVAD support who were followed up for the occurrence of TEs in the following 12 months.

In patients undergoing LVAD implantation, the levels of PMPs and MP-induced thrombin formation increased post-LVAD implantation. The flow-mediated vasodilation (FMD) decreased, while the levels of EMPs increased post-LVAD implantation.

TEs occurred in eight patients with ongoing LVAD support despite adequate coagulation. The levels of PMPs and MP-induced thrombin formation were higher in LVAD patients with TEs than in LVAD patients without TEs and were independent predictors for the risk of TEs under LVAD support. As conclusion, implantation of LVAD enhanced MP-induced coagulation, which was independently associated with the occurrence of TEs. These parameters may serve in risk stratification for early transplantation and individualized modification of standard LVAD therapy.
How Are We Monitoring Brain Injuries in Patients With Left Ventricular Assist Device? A Systematic Review of Literature
Authors: Fan Tracey H. , Hassett Catherine E. , Migdady Ibrahim , Price Carrie , Choi Chun Woo , Katzan Irene , Cho Sung-Min
Published: June 2020

Despite the common occurrence of brain injury in patients with left ventricular assist device (LVAD), optimal neuromonitoring methods are unknown. A systematic review of PubMed and six electronic databases from inception was conducted until June 5, 2019. Studies reporting methods of neuromonitoring while on LVAD were extracted. Of 5,190 records screened, 37 studies met the inclusion criteria. The neuromonitoring methods include Transcranial Doppler ultrasound for emboli monitoring (TCD-e) (n = 13) and cerebral autoregulation (n = 3), computed tomography and magnetic resonance imaging (n = 9), serum biomarkers (n = 7), carotid ultrasound (n = 3), and near-infrared spectroscopy (n = 2). Of 421 patients with TCD-e, thromboembolic events (TEs) were reported in 79 patients (20%) and microembolic signals (MES) were detected in 105 patients (27%). Ischemic stroke was more prevalent in patients with MES compared to patients without MES (43% vs.13%, p < 0.001). Carotid ultrasound for assessing carotid stenosis was unreliable after LVAD implantation. Elevated lactate dehydrogenase (LDH) levels were associated with TEs. Significant heterogeneity exists in timing, frequency, and types of neuromonitoring tools. TCD-e and serial LDH levels appeared to have potential for assessing the risk of ischemic stroke. Future prospective research incorporating protocolized TCD-e and LDH may assist in monitoring adverse events in patients with LVAD.
Novel Orally Administered Recombinant Anti-TNF Alpha Fusion Protein for the Treatment of Ulcerative Colitis
Authors: Almon Einat , Shaaltiel Yoseph , Sbeit Wisam , Fich Alex , Schwartz Doron , Waterman Mattitiahu , Szlaifer Mali , Reuveni Hadar , Amit-Cohen Bat-chen , Alon Sari , Chertkoff Raul , Paz Alona , Ilan Yaron
Published: June 2020

Background and Objective:

OPRX-106 is an orally administered BY2 plant cell-expressing recombinant TNF fusion protein (TNFR). Oral administration of OPRX-106 was shown to be safe and effective in inducing favorable anti-inflammatory immune modulation in humans. The current study was aimed at determining the safety and efficacy of OPRX-106 in patients with ulcerative colitis (UC).

Methods:

Twenty-five patients with active mild-to-moderate UC were enrolled in an open-label trial. Patients were randomized to receive 2 or 8 mg of OPRX-106 administered orally once daily, for 8 weeks. Patients were monitored for safety and efficacy including clinical response or clinical remission, based on the Mayo score. The histopathological improvement in Geboes score, calprotectin level and hs-CRP, and exploratory immune parameters by means of fluorescence-activated cell sorting and cytokine levels were monitored.

Results:

Oral administration of OPRX-106 was found to be safe and well tolerated without absorption into the circulation. Out of 24 patients, 18 completed the trial. The analysis of the patients completing treatment demonstrated clinical efficacy as measured by clinical response or remission in 67% and 28%, respectively. Reduction in calprotectin levels and improved Geboes score were noted in the majority of the treated patients. The beneficial clinical effect was associated with an increase in a CD4+CD25+FoxP3 subset of suppressor lymphocytes and a reduction in interleukin 6 and interferon gamma serum levels.

Conclusions:

Oral administration of the nonabsorbable OPRX-106 is safe and effective in mild-to-moderate UC, and not associated with immune suppression, while inducing favorable anti-inflammatory immune modulation.
Patient and Family Member Experiences in Critical Care Research and Quality Improvement Projects
Authors: Bench Suzanne , O’Shea Alison , Boaz Annette
Published: June 2020

Background

Public and patient involvement in healthcare research is increasing, but the effect of involvement on individuals, service delivery, and health outcomes—particularly in specialist population groups like critical care—remains unclear, as does the best way to involve people who have experienced critical illness.

Objectives

The aim of the study was to explore former patients’ and family members’ views and experiences of involvement in critical care research and/or quality improvement.

Methods

Using a qualitative methodology, semistructured telephone interviews were conducted with seven former intensive care unit patients and three close family members across England. Data were analyzed using a standard process of inductive thematic analysis.

Results

Four key themes were identified: making it happen, overcoming hurdles, it helps, and respect and value. Findings center on the need for flexibility, inclusivity, and transparency. They further highlight the particular challenges faced by critical illness survivors and their family members in relation to research involvement, the importance of individualized support and training, and the vital role that project leads have in making people feel valued and equal partners in the process.

Discussion

This is the first study to explore patients’ experiences of involvement in critical care research. Despite the small, homogenous sample, the study provides valuable and important data to guide future practice. It highlights the need to enable and support people to make informed choices at a time when they are ready to do so. It further highlights the importance of gatekeepers to avoid vulnerable people contributing before they are ready—a practice that could negatively affect their health status.
Repeatability and Validity of Peripheral Refraction with Two Different Autorefractors
Authors: Morrison Ann M. , Mutti Donald O.
Published: June 2020

SIGNIFICANCE

The Welch Allyn SureSight (Welch Allyn, Skaneateles Falls, NY) and Plusoptix PowerRefractor (Plusoptix, Nuremberg, Germany) are often used with infants, but little is known about the repeatability and validity of their peripheral refractive error measurements. Selecting the best instrument will support future refractive error and emmetropization studies.

PURPOSE

The purpose of this study was to determine the validity and repeatability of peripheral refractive error measurements and peripheral refraction profiles measured with the Welch Allyn SureSight and Plusoptix PowerRefractor compared with the criterion standard Grand Seiko WR-5100K (Grand Seiko Co., Hiroshima, Japan).

METHODS

Cycloplegic (tropicamide 1%) autorefraction was measured in the right eyes of 21 adult subjects (31.4 ± 10.4 years) with the three instruments in randomized order on two separate visits, at least 24 hours apart, centrally, and at 30 and 20° temporal and nasal gaze.

RESULTS

The SureSight measurements were within 0.24 D and not significantly different from the Grand Seiko WR-5100K in any gaze (P < .65), whereas the PowerRefractor measurements were more myopic by as much as −0.97 D and significantly different in four of the five gaze directions (P < .04). The 95% limits of agreement between occasions by gaze ranged from ±0.38 to ±0.61 D for the SureSight, similar to or slightly better than the WR-5100K (±0.31 to ±1.51 D) and the PowerRefractor (±0.72 to ±1.71 D). There were no significant differences between visits for any instrument in any gaze (P < .94). The repeatability of the SureSight was also better than that for the Grand Seiko when peripheral refraction was represented by quadratic fits to the data.

CONCLUSIONS

These findings suggest that the Welch Allyn SureSight is the most suitable portable autorefractor to use to monitor peripheral autorefraction based on better repeatability between occasions and better validity compared with the criterion standard Grand Seiko WR-5100K.
Effect of Topical Pilocarpine on Choroidal Thickness in Healthy Subjects
Authors: Maltsev Dmitrii S. , Kulikov Alexei N. , Vasiliev Alexander S.
Published: June 2020

SIGNIFICANCE

This is a proof-of-concept study showing the possibility of pharmacological control for choroidal thickness using pilocarpine as an agent that causes 2 to 5% choroidal thinning in healthy eyes after the instillation.

PURPOSE

The purpose of this article was to study the effect of instillation of 1% pilocarpine on choroidal thickness in healthy subjects.

METHODS

Sixteen healthy individuals (seven males and nine females; mean ± standard deviation age, 25.8 ± 3.3 years) were included. All participants received optical coherence tomography to evaluate subfoveal choroidal thickness (SCT) and choroidal area on cross-sectional scan within 4-mm central area. Axial length was measured using optical biometry. Optical coherence tomography was performed before and after pilocarpine was instilled six times for a 75-minute period in one eye; the fellow eye was used as the control. Subfoveal choroidal thickness and choroidal area were measured by two masked graders in random fashion and averaged for analysis.

RESULTS

After instillation of 1% pilocarpine, percentage SCT change in study and control eye was −3.3 ± 3.8% and 0.4 ± 3.2%, respectively (P = .03). Percentage change choroidal area in study and control eye was −2.3 ± 2.5% and 0.8 ± 3.3%, respectively (P < .001). There was a correlation between percentage SCT change and axial length (r = −0.56, P < .001), as well as between percentage SCT change and baseline SCT (r = 0.72, P < .001).

CONCLUSIONS

Instillation of 1% pilocarpine causes a decrease of choroidal thickness, which is more substantial in eyes with short axial length and thick choroid.
Case Report: Posterior Uveitis after Divalent Human Papillomavirus Vaccination in an Asian Female
Authors: Ye Hongfei , Feng Huazhang , Zhao Peiquan , Fei Ping
Published: June 2020

SIGNIFICANCE

Vaccine-associated uveitis has appeared in recent years because of various vaccines, whereas cases for human papillomavirus (HPV) vaccination were rarely reported. With more and more females becoming aware of its importance and choosing HPV vaccination, much more attention should be paid on the adverse effects of it.

PURPOSE

The purpose of this study was to report a rare case of posterior uveitis after divalent HPV vaccination in an Asian female.

CASE REPORT

A 29-year-old woman presented with acute vision loss accompanied by symptoms of headache, tinnitus, and myalgia after the third injection of HPV vaccination. The best-corrected visual acuity dropped to 20/500 for both eyes, and optical coherence tomography revealed bilateral multifocal submacular fluid. A short course of oral prednisone as well as Ozurdex intravitreal injection resulted in the reversal of all signs and symptoms.

CONCLUSIONS

Although this case resembled Harada disease, we diagnosed it as vaccine-induced uveitis rather than coincidental autoimmune disease based on the rapid response to a short course of systemic corticosteroids. Because vaccine-induced uveitis is rare and difficult to distinguish from coincidental autoimmune disease, our case reminds eye care providers to be aware of the possible association between vaccination and a Harada-like reaction and to ask appropriately directed questions when obtaining history from young patients with uveitis. Based on this case, we also suggest Ozurdex intravitreal injection as a potential therapeutic choice, especially for patients with contraindication or personal concern to systemic corticosteroid.
The Mind Cannot Go Blind: Effects of Central Vision Loss on Judging One's Crossing Time
Authors: Graber Madeline , Hassan Shirin E.
Published: June 2020

SIGNIFICANCE

This study explored whether people with AMD can accurately judge the time they need to cross the street. The results suggest that AMD-related vision loss does not affect a person's ability to estimate his/her own street-crossing time, whereas familiarity with the street does.

PURPOSE

The purpose of this study was to assess whether people with AMD could judge accurately their street-crossing time.

METHODS

Fifty-one AMD subjects and 47 age-matched normally sighted subjects (controls) estimated their time to cross a single-lane, one-way street four times (pre-estimate). Then, subjects actually crossed the street four times and subsequently estimated their crossing time four additional times (post-estimate). A linear mixed model with repeated measures for subject was used to determine if the ratio between subjects' estimated and actual crossing times changed as a function of subject group (AMD vs. control) and whether estimates changed before and after actually crossing the street. Univariate correlations and multiple regression analyses were also performed to determine which of the measured experimental variables were the best predictors of a subject's ability to estimate his/her crossing time.

RESULTS

No significant difference in crossing ratios were found between the AMD (average, 1.05) and control (average, 1.16) subjects (P = .11). This was true for both the pre-crossing (AMD, 1.09; controls, 1.23; P = .11) and post-crossing ratios (AMD, 1.01; controls, 1.09; P = .17). Both subject groups' crossing ratios, however, decreased significantly going from pre to post (P < .0001). Increased age, longer actual crossing time, and experience gained from previously crossing the street resulted in less overestimation of one's crossing time.

CONCLUSIONS

Our data suggest that familiarity with the street as opposed to central vision loss from AMD affects a person's ability to estimate his/her crossing time.
Long-term and Temporal Outcomes of Transcatheter Versus Surgical Aortic-valve Replacement in Severe Aortic Stenosis
Authors: Zhang Xin-Lin , Zhang Xiao-Wen , Lan Rong-Fang , Chen Zheng , Wang Lian , Xu Wei , Xu Biao
Published: June 2020

Objective:

To determine the 5-year and temporal performance of TAVR versus SAVR.

Background:

TAVR has become a valuable treatment for severe aortic stenosis but the long-term safety and efficacy remain unclear.

Methods:

Databases were searched until October 6, 2019 for randomized trials with ≥5 years’ follow-up. Primary outcome was all-cause mortality. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with random-effects models.

Results:

We included 4 trials with 3,758 patients. TAVR was associated with a significantly higher 5-year all-cause mortality than SAVR (OR, 1.19; 95% CI, 1.03–1.37; P = 0.02). Landmark analysis showed no significant difference within 2 years (OR, 0.92; 95% CI, 0.79–1.08; P = 0.33) but a statistically higher mortality in TAVR between 2 and 5 years (OR, 1.32; 95% CI, 1.14–1.52; P = 0.0002), with significant difference between these 2 temporal phases (P for interaction = 0.001). Similar interaction was found for cardiovascular mortality and several other outcomes. Rates of all-cause mortality or disabling stroke, permanent pacemaker implantation, aortic-valve rehospitalization, and reintervention were higher, but rates of major bleeding and new-onset fibrillation were lower in TAVR at 5 years. The incidences of myocardial infarction, stroke, and transient ischemic attack were not statistically different between TAVR and SAVR.

Conclusions:

TAVR was associated with a significantly higher all-cause mortality at 5 years compared with SAVR. Of note, all-cause mortality presented a characteristic temporal pattern showing increased risk between 2 and 5 years but not within 2 years. Longer-term follow-up data are warranted.
The Effect of Beta-lactam Allergy Status on the Rate of Surgical Site Infections: A Retrospective Cohort Study
Authors: Wilhelm Nathaniel B. , Bonsall Thomas J. , Miller Clayton L.
Published: June 2020

Objective:

To determine if patients with reported BL allergies have increased odds of developing SSI compared to reported NBL allergic patients.

Summary of Background Data:

SSI represent a significant risk of morbidity and mortality for patients. Cefazolin-based perioperative antibiotic prophylaxis is the guideline-recommended drug-of-choice for most procedures. Due to over-reporting of BL allergies, many patients may not receive guideline-directed cephalosporin-based prophylaxis, which may result in an increased SSI rate.

Methods:

A single-center retrospective cohort design study was performed. Data was collected on all targeted surgical procedures: cesarean section, vaginal, and abdominal hysterectomy, colon, laminectomy, and spinal fusion surgeries.

Results:

During the study period, 2676 procedures were analyzed with 454 (17%) and 2222 (83%) in reported BL and NBL allergic cohorts, respectively. Significantly more SSI developed in the BL cohort versus NBL cohort (3.1% vs 1.5%, odds ratio 2.015; 95% confidence interval, 1.090–3.724; P = 0.023). Through a multivariate logistic regression, receipt of a NBL antibiotic regimen was the only variable to have a significant effect on SSI rate (adjusted odds ratio, 3.815; 95% confidence interval, 1.142–12.749; P = 0.030).

Conclusion:

Reported BL allergic patients have an increased odds of developing SSI in comparison to NBL allergic patients. The increased risk is likely related to administration of NBL antibiotic regimens in comparison to BL-based regimens. Thorough antibiotic allergy history collection can be a valuable SSI prevention tool to safely increase the proportion of patients receiving BL regimen.
Intravenous administration of human amniotic mesenchymal stem cells improves outcomes in rats with acute traumatic spinal cord injury.
Authors: Zhou Hong-Long , Fang Hua , Luo Hai-Tao , Ye Min-Hua , Yu Guo-Yong , Zhang Yan , Mao Guo-Hua , Gao Zi-Yun , Cheng Zu-Jue , Zhu Xin-Gen
Published: June 2020

We previously reported that intraspinal transplantation of human amniotic mesenchymal stem cells (hAMSCs) promotes functional recovery in a rat model of acute traumatic spinal cord injury (SCI). However, whether intravenous transplantation of hAMSCs also has therapeutic benefit remains uncertain. In this study, we assessed whether intravenous transplantation of hAMSCs improves outcomes in rats with acute traumatic SCI. In addition, the potential mechanisms underlying the possible benefits of this therapy were investigated. Adult female Sprague–Dawley rats were subjected to SCI using a weight drop device, and then hAMSCs or PBS were administered after 2 h via the tail vein. Our results indicated that transplanted hAMSCs could migrate to injured spinal cord lesion. Compared with the control group, hAMSCs transplantation significantly decreased the numbers of ED1+ macrophages/microglia and caspase-3+ cells, and reduced levels of inflammatory cytokines, such as tumor necrosis factor alpha, interleukin-6 and IL-1β. In addition, hAMSCs transplantation significantly attenuated Evans blue extravasation, promoted angiogenesis and axonal regeneration. hAMSCs transplantation also significantly improved functional recovery. These results suggest that intravenous administration of hAMSCs provides neuroprotective effects in rats after acute SCI, and could be an alternative therapeutic approach for the treatment of acute SCI.
Diagnostic Model of in-Hospital Mortality in Patients with Acute ST-Segment Elevation Myocardial Infarction Used Artificial Intelligence Methods
Authors: Li Yong
Published: June 2020

Background

Preventing in-hospital mortality in Patients with ST-segment elevation myocardial infarction (STEMI) is a crucial step.

Objectives

The objective of our research was to to develop and externally validate the diagnostic model of in-hospital mortality in acute STEMI patients used artificial intelligence methods.

Methods

We divide non-randomly the American population with acute STEMI into a training set, a test set,and a validation set. We converted the unbalanced data into balanc ed data. We used artificial intelligence methods to develop and externally validate the dia gnostic model of in-hospital mortality in acute STEMI patients. We used confusion matrix combined with the area under the receiver operating characteristic curve (AUC) to evaluat e the pros and cons of the above models.

Results

The strongest predictors of in-hospital mortality were age, gender, cardiogenic shock, atrial fibrillation(AF), ventricular fibrillation(VF),third degree atrioventricular block,in-hospital bleeding, underwent percutaneous coronary intervention(PCI) during hospitalization, underwent coronary artery bypass grafting (CABG) during hospitalization, hypertension history, diabetes history, and myocardial infarction history.The F2 score of logistic regression in the training set, the test set, and the validation data set were 0.81, 0.6, and 0.59 respectively.The AUC of logistic regression in the training set, the test set, and the validation data set were 0.77, 0.78, and 0.8 respectively. The diagnostic model built by logistic regression was the best.

Conclusion

We had used artificial intelligence methods developed and externally validated the diagnostic model of in-hospital mortality in acute STEMI patients.

We registered this study with WHO International Clinical Trials Registry Platform (ICTRP) (registration number: ChiCTR1900027129; registered date: 1 November 2019).
Dopamine Release Neuroenergetics in Mouse Striatal Slices
Authors: Msackyi Msema , Chen Yuanxin , Tsering Wangchen , Wang Ninghan , Zhao Jingyu , Zhang Hui
Published: June 2020

Parkinson’s disease (PD) is the second most common neurodegenerative disease. Dopamine (DA) neurons in the substantia nigra par compacta with axonal projections to the dorsal striatum (dSTR) degenerate in PD while in contrast, DA neurons in the ventral tegmental area with axonal projections to the ventral striatum including the nucleus accumbens (NAcc) shell, are largely spared. To understand the pathogenesis of PD, it is important to study the neuroenergetics of DA neurons. This study aims to uncover the relative contribution of glycolysis and oxidative phosphorylation (OxPhos) to evoked DA release in the striatum. We measured evoked DA release in mouse striatal brain slices by fast-scan cyclic voltammetry every 2 minutes. Blocking OxPhos caused a greater reduction in evoked DA release in the dSTR compared to the NAcc shell, and blocking glycolysis caused a greater reduction in evoked DA release in the NAcc shell than in the dSTR. Furthermore, when glycolysis was bypassed in favor of direct OxPhos, evoked DA release in the NAcc shell was decreased by ∼50% over 40 minutes whereas evoked DA release in the dSTR was largely unaffected. These results demonstrated that the dSTR relies primarily on OxPhos for energy production to maintain evoked DA release whereas the NAcc shell relies more on glycolysis. Using two-photon imaging, we consistently found that the oxidation level of the DA terminals was higher in the dSTR than in the NAcc shell. Together, these findings partially explain the specific vulnerability of DA terminals in the dSTR to degeneration in PD.

Significant statement

The neuroenergetics of dopaminergic neuron is important to understand Parkinson’s disease (PD), a neurodegenerative disorder associated with mitochondrial dysfunctions. However, the relative contributions of glycolysis and oxidative phosphorylation (OxPhos) to presynaptic energy demands in DA terminals are unclear. We addressed this question by measuring DA release in the dorsal striatum and nucleus accumbens (NAcc) shell of mouse brain using FSCV under reagents blocking different energy systems. We found that the NAcc shell relies on both glycolysis and OxPhos to maintain DA release while the dSTR relies heavily on OxPhos. We demonstrate the different neuroenergetics of DA terminals in these two brain areas, providing new fundamentally important insight into the specific vulnerability of DA terminals in the dSTR to degeneration in PD.