bluuebunny/crossref_metadata_2025 huggingface dataset:
Tracking the upstream history of aquatic microbes in a boreal lake yields new insights on microbial community assembly
Authors: Crevecoeur Sophie , Prairie Yves T , del Giorgio Paul A
Published: August 2022

Bacterial community structure can change rapidly across short spatial and temporal scales as environmental conditions vary, but the mechanisms underlying those changes are still poorly understood. Here, we assessed how a lake microbial community assembles by following its reorganization from the main tributary, which, when flowing into the lake, first traverses an extensive macrophyte-dominated vegetated habitat, before reaching the open water. Environmental conditions in the vegetated habitat changed drastically compared to both river and lake waters and represented a strong environmental gradient for the incoming bacteria. We used amplicon sequencing of the 16S rRNA gene and transcript to reconstruct the shifts in relative abundance of individual taxa and link this to their pattern in activity (here assessed with RNA:DNA ratios). Our results indicate that major shifts in relative abundance were restricted mostly to rare taxa (<0.1% of relative abundance), which seemed more responsive to environmental changes. Dominant taxa (>1% of relative abundance), on the other hand, traversed the gradient mostly unchanged with relatively low and stable RNA:DNA ratios. We also identified a high level of local recruitment and a seedbank of taxa capable of activating/inactivating, but these were almost exclusively associated with the rare biosphere. Our results suggest a scenario where the lake community results from a reshuffling of the rank abundance structure within the incoming rare biosphere, driven by selection and growth, and that numerical dominance is not a synonym of activity, growth rate, or environmental selection, but rather reflect mass effects structuring these freshwater bacterial communities.
The origins and molecular evolution of SARS-CoV-2 lineage B.1.1.7 in the UK
Authors: Hill Verity , Du Plessis Louis , Peacock Thomas P , Aggarwal Dinesh , Colquhoun Rachel , Carabelli Alesandro M , Ellaby Nicholas , Gallagher Eileen , Groves Natalie , Jackson Ben , McCrone J T , O’Toole Áine , Price Anna , Sanderson Theo , Scher Emily , Southgate Joel , Volz Erik , Barclay Wendy S , Barrett Jeffrey C , Chand Meera , Connor Thomas , Goodfellow Ian , Gupta Ravindra K , Harrison Ewan M , Loman Nicholas , Myers Richard , Robertson David L , Pybus Oliver G , Rambaut Andrew
Published: August 2022

The first SARS-CoV-2 variant of concern (VOC) to be designated was lineage B.1.1.7, later labelled by the World Health Organization as Alpha. Originating in early autumn but discovered in December 2020, it spread rapidly and caused large waves of infections worldwide. The Alpha variant is notable for being defined by a long ancestral phylogenetic branch with an increased evolutionary rate, along which only two sequences have been sampled. Alpha genomes comprise a well-supported monophyletic clade within which the evolutionary rate is typical of SARS-CoV-2. The Alpha epidemic continued to grow despite the continued restrictions on social mixing across the UK and the imposition of new restrictions, in particular, the English national lockdown in November 2020. While these interventions succeeded in reducing the absolute number of cases, the impact of these non-pharmaceutical interventions was predominantly to drive the decline of the SARS-CoV-2 lineages that preceded Alpha. We investigate the only two sampled sequences that fall on the branch ancestral to Alpha. We find that one is likely to be a true intermediate sequence, providing information about the order of mutational events that led to Alpha. We explore alternate hypotheses that can explain how Alpha acquired a large number of mutations yet remained largely unobserved in a region of high genomic surveillance: an under-sampled geographical location, a non-human animal population, or a chronically infected individual. We conclude that the latter provides the best explanation of the observed behaviour and dynamics of the variant, although the individual need not be immunocompromised, as persistently infected immunocompetent hosts also display a higher within-host rate of evolution. Finally, we compare the ancestral branches and mutation profiles of other VOCs and find that Delta appears to be an outlier both in terms of the genomic locations of its defining mutations and a lack of the rapid evolutionary rate on its ancestral branch. As new variants, such as Omicron, continue to evolve (potentially through similar mechanisms), it remains important to investigate the origins of other variants to identify ways to potentially disrupt their evolution and emergence.
Masquelet Technique for the Tibia: A Systematic Review and Meta-Analysis of Contemporary Outcomes
Authors: Griffin Jarod T. , Landy David C. , Sneed Chandler R. , Liu Boshen , Kavolus Matthew , Pectol Richard W. , Gitajn Ida Leah , Oh Jong-Keon , Aneja Arun
Published: August 2022

Objective:

To systematically review outcomes of the Masquelet “induced membrane” technique (MT) in treatment of tibial segmental bone loss and to assess the impact of defect size on union rate when using this procedure.

Data Sources:

PubMed, EBSCO, Cochrane, and SCOPUS were searched for English language studies from January 1, 2010, through December 31, 2019.

Study Selection:

Studies describing the MT procedure performed in tibiae of 5 or more adult patients were included. Pseudo-arthrosis, nonhuman, pediatric, technique, nontibial bone defect, and non-English studies were excluded, along with studies with less than 5 patients. Selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria.

Data Extraction:

A total of 30 studies with 643 tibiae were included in this meta-analysis. Two reviewers systematically screened titles or abstracts, followed by full texts, to ensure quality, accuracy, and consensus among authors for inclusion or exclusion criteria of the studies. In case of disagreement, articles were read in full to assess their eligibility by the senior author. Study quality was assessed using previously reported criteria.

Data Synthesis:

Meta-analysis was performed with random-effects models and meta-regression. A meta-analytic estimate of union rate independent of defect size when using the MT in the tibia was 84% (95% CI, 79%–88%). There was no statistically significant association between defect size and union rate (P = 0.11).

Conclusions:

The MT is an effective method for the treatment of segmental bone loss in the tibia and can be successful even for large defects. Future work is needed to better understand the patient-specific factors most strongly associated with MT success and complications.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Risk of Postoperative Sciatic Nerve Palsy After Posterior Acetabular Fracture Fixation: Does Patient Position Matter?
Authors: Chen Jason Y. , Sharma Ishani , Sabbagh Ramsey S. , Narendran Nakul , Everhart Josh S. , Slaven James E. , Archdeacon Michael T. , Sagi Henry Claude , Mullis Brian H. , Natoli Roman M.
Published: August 2022

Objectives:

To determine whether the prone or lateral position is associated with postoperative sciatic nerve palsy in posterior acetabular fracture fixation.

Design:

Retrospective cohort study.

Setting:

Three Level I trauma centers.

Patients:

Patients with acetabular fractures treated with a posterior approach (n = 1045).

Intervention:

Posterior acetabular fixation in the prone or lateral positions.

Outcome Measurements:

The primary outcome was the prevalence of postoperative sciatic nerve palsy by position. Secondary outcomes were risk factors for nerve palsy, using multiple regression analysis and propensity scoring.

Results:

The rate of postoperative sciatic nerve palsy was 9.5% (43/455) in the prone position and 1.5% (9/590) in the lateral position (P < 0.001). Intraoperative blood loss and surgical duration were significantly higher for patients who developed a postoperative sciatic nerve palsy. Subgroup analysis showed that position did not influence palsy prevalence in posterior wall fractures. For other fracture patterns, propensity score analysis demonstrated a significantly increased odds ratio of palsy in the prone position [aOR 7.14 (2.22–23.00); P = 0.001].

Conclusions:

With the exception of posterior wall fracture patterns, the results of this study suggest that factors associated with increased risk for postoperative sciatic nerve palsy after a posterior approach are fractures treated in the prone position, increased blood loss, and prolonged operative duration. These risks should be considered alongside the other goals (eg, reduction quality) of acetabular fracture surgery when choosing surgical positioning.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Pulmonary tuberculosis infection and CMV reactivation following daratumumab treatment in a patient with relapsed plasmablastic lymphoma
Authors: Cao Wenyue , Wan Yuling , Yang Xingcheng , Huang Wei , Wei Jia
Published: August 2022

Plasmablastic lymphoma (PBL) is an aggressive lymphoma with limited treatment strategies. Tuberculosis (TB) infection poses a high risk for patients with hematologic malignancies, especially those treated with immune agents but were never reported post-daratumumab treatment. Herein, we reported a TB infection in a 57-year-old male diagnosed with HIV-negative PBL receiving daratumumab-based treatment, who showed atypical lung infection and yielded Mycobacterium tuberculosis and cytomegalovirus (CMV) in the bronchoalveolar lavage fluid. Anti-TB therapy was administered, and the following daratumumab treatment was complete with good tolerance. In this case, we demonstrated that TB infection might occur after daratumumab therapy, and adequate attention should be paid to atypical symptoms.
Artificial Intelligence for the Prediction of In-Hospital Clinical Deterioration: A Systematic Review
Authors: Veldhuis Lars I. , Woittiez Nicky J. C. , Nanayakkara Prabath W. B. , Ludikhuize Jeroen
Published: August 2022

OBJECTIVES:

To analyze the available literature on the performance of artificial intelligence-generated clinical models for the prediction of serious life-threatening events in non-ICU adult patients and evaluate their potential clinical usage.

DATA SOURCES:

The PubMed database was searched for relevant articles in English literature from January 1, 2000, to January 23, 2022. Search terms, including artificial intelligence, machine learning, deep learning, and deterioration, were both controlled terms and free-text terms.

STUDY SELECTION:

We performed a systematic search reporting studies that showed performance of artificial intelligence-based models with outcome mortality and clinical deterioration.

DATA EXTRACTION:

Two review authors independently performed study selection and data extraction. Studies with the same outcome were grouped, namely mortality and various forms of deterioration (including ICU admission, adverse events, and cardiac arrests). Meta-analysis was planned in case sufficient data would be extracted from each study and no considerable heterogeneity between studies was present.

DATA SYNTHESIS:

In total, 45 articles were included for analysis, in which multiple methods of artificial intelligence were used. Twenty-four articles described models for the prediction of mortality and 21 for clinical deterioration. Due to heterogeneity of study characteristics (patient cohort, outcomes, and prediction models), meta-analysis could not be performed. The main reported measure of performance was the area under the receiver operating characteristic (AUROC) (n = 38), of which 33 (87%) had an AUROC greater than 0.8. The highest reported performance in a model predicting mortality had an AUROC of 0.935 and an area under the precision-recall curve of 0.96.

CONCLUSIONS:

Currently, a growing number of studies develop and analyzes artificial intelligence-based prediction models to predict critical illness and deterioration. We show that artificial intelligence-based prediction models have an overall good performance in predicting deterioration of patients. However, external validation of existing models and its performance in a clinical setting is highly recommended.
Clinical characteristics and treatment outcomes of patients with small cell carcinoma of the urinary bladder
Authors: Muranaka Takashi , Hashimoto Kohei , Shindo Tetsuya , Shibamori Kosuke , Kyoda Yuki , Kobayashi Ko , Tanaka Toshiaki , Masumori Naoya
Published: August 2022

Background

Small cell carcinoma of the urinary bladder (SCUB) is rare. The optimal treatment for SCUB remains unclear. To address the problem of appropriate treatment for each case, we assessed single-modality and surgery-based multimodality treatments in patients with SCUB.

Materials and methods

We retrospectively reviewed the medical records of 12 patients with SCUB between 1990 and 2013. All patients underwent transurethral resection of the bladder tumor and were diagnosed with SCUB. Their clinicopathological characteristics were assessed, and the outcomes were compared according to the treatment modality.

Results

The median (range) age at diagnosis was 66 years (range, 53–85 years). T1–4N0M0 was observed in 8 patients (66%), N1–3M0 in 2 (17%), and NanyM1 in 2 (17%). After transurethral resection of the bladder tumor, 6 patients (50%) underwent cystectomy alone, and 4 (33%) underwent cystectomy and presurgical or adjuvant chemotherapy with etoposide and cisplatin. During the median follow-up period of 20.7 months, 6 patients (50%) died of cancer, and 2 patients (17%) died of other causes. The median overall survival period was 1.9 years. The 5-year overall survival rate in patients who underwent cystectomy and chemotherapy was 75%, whereas that in those who underwent cystectomy alone and transurethral resection alone were 22% and 0%, respectively (p = 0.012). Recurrence-free survival was significantly correlated with cause-specific survival (r = 0.95; 95% confidence interval, 0.81–0.99; p < 0.001).

Conclusions

Radical cystectomy with chemotherapy using the etoposide and cisplatin regimen improved the prognosis of patients with SCUB and TxNxM0. The time from initial progression to death due to cancer was very short, indicating that the initial treatment strategy is crucial.
The indispensable role of urinalysis for patients undergoing treatment for nonmuscle invasive bladder cancer
Authors: Di Gianfrancesco Luca , Ragonese Mauro , Palermo Giuseppe , Sacco Emilio , Nazario Foschi , Bassi PierFrancesco , Racioppi Marco
Published: August 2022

Despite several efforts in the search for noninvasive biomarkers to provide prognostic information for noninvasive muscle bladder cancer, none have shown significant potential. In this context, standard urinalysis is still necessary to provide many data. This method is an inexpensive, simple, and easy-to-repeat tool to follow-up patients over time. Urinalysis does not fall within study protocols and allows evaluation of the immune activation/response (even if indirectly). As such, this method can certainly provide useful information for prognosis.
Management of Iron Deficiency in Heart Failure: A Review of Evidence
Authors: Gale Stormi E. , Nguyen Bobbie , Dunn Steven P. , Kellison Erik , Gorman Emily F. , Beavers Craig
Published: August 2022

Iron deficiency is common in patients with heart failure and has been associated with worse outcomes, including increases in mortality, disease progression, and hospitalizations. As such, several studies have evaluated the role of iron supplementation in mitigating these risks. Evidence for the role of intravenous iron in improving exercise capacity, quality of life, and hospitalizations is promising, although the benefits of oral iron remain less clear. This review will evaluate the literature surrounding iron supplementation in heart failure and provide practical recommendations for its management.
Efficacy and Safety of Finerenone for Prevention of Cardiovascular Events in Type 2 Diabetes Mellitus With Chronic Kidney Disease: A Meta-analysis of Randomized Controlled Trials
Authors: Yang Shuai , Shen Wen , Zhang Hong-zhou , Wang Chen-xi , Yu Wan-qian , Wu Qing-hua
Published: August 2022

Only a few meta-analyses evaluated the effect of finerenone on cardiovascular events in type 2 diabetes mellitus with chronic kidney disease. The main aim of this meta-analysis was to gain more reliable assessments of the efficacy and safety of finerenone for prevention of cardiovascular events in diabetic kidney disease. We searched for finerenone in the treatment of diabetic kidney disease from database (PubMed, Embase, and ClinicalTrials.gov) until December 30, 2021. Relative risks (RRs) with 95% confidence intervals (CIs) calculated by the Mantel–Haenszel random-effects model were used as summary statistics for the categorical data. We included 4 studies that met the inclusion criteria with 13,943 participants. The finerenone group demonstrated a great benefit in reducing the incidence of major adverse cardiac events (RR: 0.88; 95% CI 0.80–0.96; P = 0.003), all-cause mortality (RR: 0.89; 95% CI 0.80–0.99; P = 0.04), myocardial infarction (RR: 0.79; 95% CI 0.67–0.92; P = 0.003), and new-onset hypertension (RR: 0.71; 95% CI 0.62–0.81; P < 0.00001). No difference was found in adverse events between the finerenone and placebo groups (RR: 1.00; 95% CI [0.98–1.01], P = 0.59), whereas a higher risk of hyperkalemia was observed in the finerenone group than in the placebo group (RR = 2.04, 95% CI 1.80–2.32; P < 0.00001). Besides, cerebrovascular events and new-onset atrial fibrillation did not increase in patients taking finerenone. Overall, finerenone treatment showed a great benefit of reducing the risk of major adverse cardiac events, all-cause mortality, myocardial infarction, and new-onset hypertension events in patients with type 2 diabetes mellitus and chronic kidney disease.
Markers of subclinical vascular damage in young adults with type 1 diabetes mellitus: the role of central blood pressure
Authors: Marcon Denise , Tagetti Angela , Piona Claudia , Giontella Alice , Bortolotti Stefano , Bonafini Sara , Carletti Lorenza , Morandi Anita , Trombetta Maddalena , Maffeis Claudio , Fava Cristiano
Published: August 2022

Introduction:

Type 1 diabetes mellitus (T1D) is a chronic disease leading to cardiovascular complications that can be diagnosed early as subclinical vascular damage. To prevent such damage, it is important to increase knowledge of the effects of the different cardiovascular risk factors in patients with T1D. The aim of our study was to assess possible associations between markers of subclinical arterial damage and traditional cardiovascular risk factors, with a special focus on peripheral blood pressure and central blood pressure (cBP), in a sample of young adults with T1D.

Patients and methods:

The study included 172 T1D patients (mean age 24.7 ± 8.7 years, duration of T1D 13.5 ± 9.6 years). Pulse wave velocity (PWV), pulse wave analysis and cBP were assessed by tonometry (SphygmoCor Xcel). Carotid intima–media thickness (cIMT) and carotid distensibility coefficient (cDC) were assessed by high-resolution echo-Doppler analysis and further examined with dedicated hardware.

Results:

Seventeen patients (10.1%) were classified as hypertensive by office peripheral blood pressure, and 48 patients (27.9%) were classified as hypertensive by cBP. One hundred sixteen patients (68.8%) had cDC under the range of normality, one patient had a PWV (0.6%) above 10 m/s, and no patients had a cIMT above 0.9 mm. In multivariable analysis, central SBP, but not metabolic parameters, remained associated with all the markers of subclinical arterial damage [cIMT (β = 0.288 ± 0.001; P < 0.001), PWV (β = 0.374 ± 0.007; P < 0.001), cDC (β = −0.149 ± 0.055; P = 0.029)].

Conclusion:

The independent association between cBP and markers of subclinical vascular damage underlines the importance of haemodynamic factors in the development of early signs of macrovascular disease in T1D patients. Further studies are warranted to better define the role of cBP to stratify cardiovascular risk, to individualize the need for follow-up and to tailor preventive strategies in T1D patients.
Predictive model of hypertension resolution after adrenalectomy in primary aldosteronism: the SPAIN-ALDO score
Authors: Araujo-Castro Marta , Paja Fano Miguel , González Boillos Marga , Pla Peris Begoña , Pascual-Corrales Eider , García Cano Ana María , Parra Ramírez Paola , Martín Rojas-Marcos Patricia , Ruiz-Sanchez Jorge Gabriel , Vicente Delgado Almudena , Gómez Hoyos Emilia , Ferreira Rui , García Sanz Iñigo , Recasens Sala Mònica , Barahona San Millan Rebeca , Picón César María José , Díaz Guardiola Patricia , García González Juan Jesús , Perdomo Carolina M. , Manjón Miguélez Laura , García Centeno Rogelio , Percovich Juan Carlos , Rebollo Román Ángel , Gracia Gimeno Paola , Robles Lázaro Cristina , Morales-Ruiz Manuel , Hanzu Felicia A.
Published: August 2022

Purpose:

To develop a predictive model of hypertension resolution after adrenalectomy in patients with primary aldosteronism (PA), based on their presurgical characteristics.

Methods:

A retrospective multicenter study of PA patients in follow-up in 20 Spanish tertiary hospitals between 2018 and 2021 was performed (SPAIN-ALDO Register). Clinical response postadrenalectomy was classified according to the primary aldosteronism surgical outcome (PASO) consensus criteria. The predictive model was developed using a multivariate logistic regression model with the estimation of all possible equations.

Results:

A total of 146 patients (54.8% females; mean age of 51.5 ± 10.9 years) with PA who underwent unilateral adrenalectomy were included. After a mean follow-up of 29.1 ± 30.43 months after surgery, hypertension cure was obtained in 37.7% (n = 55) of the patients. The predictive model with the highest diagnostic accuracy to predict hypertension cure combined the variables female sex, use of two or fewer antihypertensive medications, hypertension grade 1, without type 2 diabetes and nonobesity. The area under the receiver operating characteristic curve of this model was 0.841 [0.769–0.914]. Based on this model, the group of patients with a higher probability of cure (80.4%) were those without type 2 diabetes, BMI <30 kg/m2, female sex, hypertension grade 1 and who use two or fewer antihypertensives. Our predictive model offered a slightly higher diagnostic accuracy than Wachtel's (area under the curve [AUC]: 0.809), Utsumi's (AUC: 0.804) and Zarnegar's (AUC: 0.796) models and was similar than the Burello's (AUC: 0.833) model.

Conclusion:

Female sex, use of two or fewer antihypertensive medications, hypertension grade 1, no type 2 diabetes and nonobesity may predict hypertension cure after adrenalectomy in patients with PA. Our score provides a potential tool to guide preoperative patient counseling.
Bilateral Cystoid Macular Edema Following Bimatoprost Implants
Authors: Patel Shivam H. , Badar Ayesha , Bakhsh Saaquib , Jusufbegovic Denis
Published: August 2022

Purpose:

To report the development of bilateral cystoid macular edema (CME) following bimatoprost implant (Durysta) injections in both eyes to treat primary open angle glaucoma (POAG).

Methods:

Case Report

Results:

A 93-year-old woman with a history of POAG received bimatoprost implant (Durysta) injections in both eyes four weeks apart. The patient subsequently developed progressively decreased visual acuity in both eyes due to bilateral CME, which improved with topical corticosteroid therapy.

Conclusions:

Bimatoprost implant (Durysta) can cause CME in susceptible individuals. Patients who received the implant should be assessed for the presence of CME following any decline in visual acuity, particularly in high-risk patients.
Effects of Selective Serotonin Reuptake Inhibitor Use on 3,4-Methylenedioxymethamphetamine–Assisted Therapy for Posttraumatic Stress Disorder
Authors: Price Collin M. , Feduccia Allison A. , DeBonis Katrina
Published: August 2022

Background

Among the renewed applications of psychedelic medicines in psychiatry, 3,4-methylenedioxymethamphetamine (MDMA)–assisted therapy for posttraumatic stress disorder (PTSD) has demonstrated the most promise in early small-scale studies. Recent exploratory analyses from prior clinical trials of MDMA-assisted therapy for PTSD have suggested that recent use of selective serotonin reuptake inhibitors (SSRIs)—the only medication class with United States Food and Drug Administration (FDA) approval to treat PTSD—can significantly dampen the efficacy of this novel therapy. Although psychedelic medicines are not yet FDA approved, MDMA is very likely to be the first to achieve FDA approval—perhaps within the next 2 years. Given this timeline, the field would benefit from more knowledge about potential interactions between this novel therapy and our current treatments.

Methods

This brief report reviews selected literature in the basic and clinical neurosciences relevant to the interaction of SSRIs and MDMA.

Findings

The possibility that SSRI use could dampen future responses to MDMA-assisted therapy for PTSD raises many important questions about the biological mechanisms as well as ethical implications around the most appropriate way to counsel patients. In this brief report, we compare the evidence for SSRIs and MDMA-assisted therapy in the treatment of PTSD and discuss what is known about the neurobiological interactions between these 2 medicines.

Conclusions

There is strong neurobiological plausibility for the hypothesis that chronic SSRI use dampens response to MDMA-assisted therapy, although current knowledge in the field is limited and primarily relates to acute pharmacodynamic interactions. Our commentary highlights the urgent need for future work dedicated to addressing this important clinical topic.
Assessing the Variability of Antibiotic Management in Patients With Open Hand Fractures Presenting to the Pediatric Emergency Department
Authors: Görgens Sophia , Patel Deepa , Keenan Kaitlin , Fishbein Joanna , Bullaro Francesca
Published: August 2022

Objectives

Open hand fractures may be difficult to recognize and treat. There is variability in management and administration of antibiotics for these types of injuries. Unlike open long bone fractures, there is no standardized protocol for antibiotic administration for open hand fractures in children. The objective of this study is to assess the variability of antibiotic management of open hand fractures in children.

Methods

We performed a retrospective chart review at a tertiary hospital in New York of patients with hand injuries between ages 0 and 18 years presenting to the emergency department during January 2019 and December 2020. Patient encounters were reviewed for open fractures of the hand. Descriptive statistics were included for demographic and physical characteristics.

Results

There were 80 encounters with open hand fractures, of which the most common being tuft fractures (77.5%). The mean age was 7.6 years (SD, 4.7 years) with male predominance (58.8%). Crush injuries were the most common mechanism of injury (78.8%). Bedside repair was performed on 62 encounters (77.5%), of which 45 (72.5%) required nail bed repair, 56 (90.3%) required suturing, and 24 (38.7%) required reduction. Antibiotics were given to 62 (77.5%) encounters, most commonly oral cefalexin (45.2%), oral amoxicillin-clavulanic acid (27.4%), and intravenous cefazolin (14.5%). Median time to antibiotics from emergency department registration to administration was 150 minutes (interquartile range, 92–216 minutes). Antibiotic prescriptions were sent for 71 encounters (88.8%). Seventy seven (96.3%) of the encounters were discharged home.

Conclusions

Pediatric open hand fractures have a variability of type and timing to antibiotics. Future initiatives should attempt to create standardized guidelines for management of open hand fractures.
Implementation of Standardized Care for the Medical Stabilization of Patients With Anorexia Nervosa
Authors: Shafii Taraneh , Morrison Alex , Qu Pingping , Rutman Lori , Kaplan Ron
Published: August 2022

Introduction:

Approaches to refeeding patients with anorexia nervosa for medical stabilization vary across institutions, and there is no established standard of care. This study assessed the impact of a refeeding pathway on hospital length of stay and transfer to the psychiatry unit.

Methods:

This quality improvement intervention sought to standardize care for adolescents with anorexia nervosa at a tertiary care, free-standing children’s hospital from Spring 2017 to Fall 2018. The pathway specified admission criteria, nutritional advancement, activity restriction, laboratory monitoring, readiness to transfer to the psychiatry unit, and discharge criteria. Statistical process control analysis was utilized to identify system-level changes over time. We used linear regression to assess pre- and postpathway differences in length of stay and transfer to the psychiatry unit.

Results:

There were 161 patient encounters for anorexia nervosa admitted for medical stabilization. 84% of the sample were female with median age of 15.2 (IQR 14.0–17.0) years. There was no difference in hospital length of stay between the pre- and postpathway groups. There was a statistically significant increase in the proportion of patients transferred to the psychiatry unit over the study period.

Conclusion:

Clinical pathway use to deliver standardized care to achieve medical stability for patients with anorexia nervosa did not shorten hospital length of stay. Multiple potentially confounding medical and psychosocial factors may have contributed to this lack of improvement.
Increased Lung Immune Metabolic Activity in COVID-19 Survivors
Authors: Rodrigues Rosana Souza , Motta Ribeiro Gabriel , Barreto Miriam Menna , Zin Walter Araujo , de Toledo-Mendes Júlia , Martins Philippe Alcantara G. , de Almeida Sergio Altino , Basílio Rodrigo , Martins-Gonçalves Remy , Hottz Eugênio Damaceno , Bozza Patricia T. , Bozza Fernando A. , Carvalho Alysson Roncally Silva , Rosado-de-Castro Paulo Henrique
Published: August 2022

Purpose

We quantified lung glycolytic metabolic activity, clinical symptoms and inflammation, coagulation, and endothelial activation biomarkers in 2019 coronavirus disease (COVID-19) pneumonia survivors.

Methods

Adults previously hospitalized with moderate to severe COVID-19 pneumonia were prospectively included. Subjects filled out a questionnaire on clinical consequences, underwent chest CT and 18F-FDG PET/CT, and provided blood samples on the same day. Forty-five volunteers served as control subjects. Analysis of CT images and quantitative voxel-based analysis of PET/CT images were performed for both groups. 18F-FDG uptake in the whole-lung volume and in high- and low-attenuation areas was calculated and normalized to liver values. Quantification of plasma markers of inflammation (interleukin 6), d-dimer, and endothelial cell activation (angiopoietins 1 and 2, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1) was also performed.

Results

We enrolled 53 COVID-19 survivors (62.3% were male; median age, 50 years). All survivors reported at least 1 persistent symptom, and 41.5% reported more than 6 symptoms. The mean lung density was greater in survivors than in control subjects, and more metabolic activity was observed in normal and dense lung areas, even months after symptom onset. Plasma proinflammatory, coagulation, and endothelial activation biomarker concentrations were also significantly higher in survivors.

Conclusion

We observed more metabolic activity in areas of high and normal lung attenuation several months after moderate to severe COVID-19 pneumonia. In addition, plasma markers of thromboinflammation and endothelial activation persisted. These findings may have implications for our understanding of the in vivo pathogenesis and long-lasting effects of COVID-19 pneumonia.
Reflux-Qual-Short-Form Questionnaire: Translation and Validation of the Greek Version
Authors: Georganta Antonia , Koreli Alexandra , Mantoudi Alexandra , Mpouzika Meropi , Androulakis Emmanouil , Dokoutsidou Eleni , Tsiou Chrysoula , Adamakidou Theodoula
Published: August 2022

The aim of this study was the translation and validation of the Reflux-Qual Short-Form (RQS), a quality of life questionnaire in a Greek sample of 148 individuals with gastroesophageal reflux disease (GERD). This tool through eight items explores the effects of GERD in five dimensions of quality of life: daily activity, well-being, psychological impact, sleep, and eating. Exploratory factor analysis yielded a one-factor scale for the Greek-translated version. Internal consistency reliability of the questionnaire was deemed very satisfactory based on Cronbach's alpha coefficient, which was equal to 0.816. Split-half reliability was evaluated as an additional measure of internal consistency. The test–retest reliability analysis revealed a good stability after a 1-month interval. Construct validity was measured by the correlation level between each item and the adjusted global score, resulting in an acceptable level of convergence between the items. Concurrent validity was confirmed using the 36-Item Short Form Health Survey (SF-36) as a reference scale. This study indicates that RQS Questionnaire is a short, simple, reliable, and valid tool that can be used to assess quality of life in Greek individuals with GERD.
Improving Clinical Documentation Compliance Pre-Gastrointestinal Endoscopy Procedures Through the Use of an Endoscopy Checklist
Authors: Kelly Veronica , Baar-Daley K. Michelle
Published: August 2022

Production pressure in endoscopy units, to avoid procedural delays, can lead to documentation gaps that pose a patient safety risk. Fast-paced, high-volume endoscopy units within a 673-bed academic medical center, incomplete and illegible documentation were identified during a 2018 Joint Commission survey. Pre-procedure safety checklists help ensure accurate clinical handovers. Checklists promote team communication that includes the patient to have complete and relevant information to perform a safe procedure and speak up to identify discrepancies. An endoscopy-specific safety checklist was used by the procedural team immediately pre-procedure. This quality improvement project used Plan Do Study Act cycles to incorporate changes suggested by users. Chart audits were conducted pre- and post-pilot. The results showed significant improvements in physician documentation completeness and legibility, suggesting the checklist prompted clarification of documentation and communication between the nurse and the physician. Nursing assessment saw a 27.1% improvement, suggesting clarification of clinical handover between the admitting and procedural nurses. Improved communication was perceived by staff. This project showed how a standardized tool to promote team communication and clarification of discrepancies pre-procedure can contribute to prevention of errors.
Methicillin-Resistant Staphylococcus aureus Carriage on The Hands of Healthcare Workers: An Assessment for Hand Hygiene Practices in Jos, Nigeria.
Authors: Alobu Emeka Walter , Adeoye Philip , Selowo Temitope Toluse , Aina Daniel Olagoke , Abdulazis Longwap Saleh , Ojukwu Uzoamaka Chinonso , Danladi Joel Bala , Johnny Chukwuwike Sunday
Published: August 2022

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) is capable of causing a wide range of infections. Contaminated hands of healthcare workers (HCWs) act as a potential source of MRSA transmission in hospitals.

Aim

This study aims at detecting the carriage of MRSA on the hands of HCWs during patient care and the evaluation of the effective practice of hand hygiene protocol.

Methodology

This study was a cross-sectional point (prevalence) study done in wards and intensive care units (ICUs) of a tertiary care hospital. Cultures from hand swabs were obtained from HCWs during clinical rounds without prior information about the procedure. A second culture was also taken after the use of an alcohol-based hand rub or handwash (after 1 minute of use).

Result

Of a total of 145 HCWs screened, 24 (17%) were positive for MRSA. Doctors were 9 while nurses were 10. Six (4%) HCWs remained positive for MRSA after washing their hands or using an alcohol-based hand rub.

Conclusion

Commitment to preventing healthcare-associated infections requires that regular monitoring of hand hygiene practices be in place. A rapid diagnostic protocol such as MRSA chromogenic agar has a shorter turnaround time compared to standard laboratory workflow in identifying MRSA. Evaluation of the transmission rate of MRSA from HCWs to patients will be encouraged in further studies.
Oceanobacillus alkalisoli sp. nov., an alkaliphilic bacterium isolated from saline-alkaline soil
Authors: Jin Pin-Jiao , Sun Lei , Rao Manik Prabhu Narsing , Jiao Jian-Yu , Sun Xiu-Jun , Li Wen-Jun , Wang Shuang
Published: August 2022

Two alkaliphilic strains, designated APA_J-2 (6-2)T and APA_J-5 (13-2), were isolated from saline-alkali soil sampled in Jilin Province, PR China. Phylogenetic analysis based on 16S rRNA gene sequences revealed that the two strains APA_J-2 (6-2)T and APA_J-5(13–2) were closely related to members of the genus

Oceanobacillus

, and had the highest sequence similarity to

Oceanobacillus indicireducens

JCM 17251T (96.8 and 96.9 %, respectively). The 16S rRNA gene sequence similarity between the two novel isolates was 99.6 %, indicating that they were similar species. Cells were Gram-stain-positive, aerobic, motile and rod-shaped. The strains grew at 15–45 °C (optimum, 37 °C), pH 8.0–11.0. (optimum, pH 9) and with 0–10 % (w/v) NaCl (optimum, 5 %). The strains contained menaquinone-7 as the respiratory quinone and anteiso-C15 : 0 as the predominant cellular fatty acid. The major polar lipids were diphosphatidylglycerol, phosphatidylglycerol and phosphatidylinositol. The genomic DNA G+C content was 40.0 mol%. The average nucleotide identity (ANI), amino acid identity (AAI) and digital DNA–DNA hybridization (dDDH) values of strain APA_J-2 (6-2)T with

O. indicireducens

JCM 17251T were 85.5, 87.9 and 30.7 %, respectively. The ANI, AAI and dDDH values of strain APA_J-5 (13-2) with

O. indicireducens

JCM 17251T were 85.7, 87.7 and 30.8 %, respectively. Based on the phylogenetic, phenotypic, biochemical, chemotaxonomic and genome data, strains APA_J-2 (6-2)T and APA_J-5 (13-2) represent a novel species of the genus

Oceanobacillus

, for which the name Oceanobacillus alkalisoli sp. nov. is proposed. The type strain is APA_J-2 (6-2)T (=KCTC 43253T=GDMCC 1.2242T).
Mathematical modeling of the waning of anti-RBD IgG SARS-CoV-2 antibody titers after a two-dose BNT162b2 mRNA vaccination
Authors: Torres Javier , Ontañón Jesús , de Cabo Carlos , Lozano Julia , Ángeles Requena María , Blas Joaquín , Rodríguez-García José Luis , Mas Antonio , Cimas Francisco J. , Solera Javier
Published: August 2022

Objective

Serum antibody levels have been linked to immune protection in SARS-CoV-2 infection. After exposure to the virus and/or vaccination there is an increase in serum antibody titers followed by progressive non-linear waning of antibody levels. Our aim was to find out if this waning of antibody titers would adjust to a mathematical model.

Methods

We studied serum anti-RBD (receptor binding domain) IgG antibody titers over a ten-month period in a cohort of 54 health-care workers who were either never infected with SARS-CoV-2 (naive, nHCWs group, n = 27) or previously infected (experienced, eHCWs group, n = 27) with the virus after the second dose of the BNT162b2 mRNA vaccine. We have selected a risk threshold of 1000 UA/ml anti-RBD Ab titer for symptomatic infection based on the upper titer threshold for those volunteers who suffered infection prior to the omicron outbreak. Two mathematical models, exponential and potential, were used to quantify antibody waning kinetics and the relative quality of the goodness of fit to the data between both models was compared using the Akaike Information Criterion.

Results

We found that the waning of anti-RBD IgG antibody levels adjusted significantly to both exponential and potential models in all participants from both the naïve and experienced groups. Moreover, the waning slopes were significantly more pronounced for the naive when compared to the experienced health-care workers. In the nHCWs group, titers would descend below this 1000-units threshold at a median of 210.6 days (IQ range: 74,2). However, for the eHCWs group, the risk threshold would be reached at 440.0 days (IQ range: 135,2) post-vaccination.

Conclusions

The goodness of the fit of the anti-RBD IgG antibody waning would allow us to predict when the antibody titers would fall below an established threshold in both naive and previously infected subjects.
Interspecific territoriality has facilitated recent increases in the breeding habitat overlap of North American passerines
Authors: Nesbit D.A. , Cowen M.C. , Grether G.F. , Drury J.P.
Published: August 2022

As species’ ranges shift in response to human-induced global changes, species interactions are expected to play a large role in shaping the resultant range dynamics and, subsequently, the composition of modified species assemblages. Most research on the impact of species interactions on range dynamics focuses on the effects of trophic interactions and exploitative competition for resources, but an emerging body of work shows that interspecific competition for territories and mates also affects species range shifts. As such, it is paramount to build a strong understanding of how these forms of behavioural interference between species impact landscape-scale patterns. Here, we examine recent (1997-2019) range dynamics of North American passerines to test the hypothesis that behavioural interference impacts the ease with which species move across landscapes. Over this 22-year period, we found that fine-scale spatial overlap between species (syntopy) increased more for species pairs that engage in interspecific territoriality than for those that do not. We found no evidence, however, for an effect of reproductive interference (hybridisation) on syntopy, and no effect of either type of interference on range-wide overlap (sympatry). Examining the net effects of species interactions on continent-scale range shifts may require species occurrence data spanning longer time periods than are currently available for North American passerines, but our results show that interspecific territoriality has had an overall stabilising influence on species coexistence over the past two decades.
Reduced oocyte quality and exacerbation of the maternal age effect are enduring consequences of low-level atrazine exposure in mouse
Authors: Yun Yan , Lee Sunkyung , So Christina , Manhas Rushali , Kim Carol , Wibowo Tabitha , Hori Michael , Hunter Neil
Published: August 2022

BACKGROUND

Egg development has unique features that render it vulnerable to environmental perturbation. The herbicide atrazine is an endocrine disruptor shown to have detrimental effects on reproduction across a number of vertebrate species.

OBJECTIVES

To determine whether exposure to low levels of atrazine impairs meiosis in female mammals using a mouse model; in particular, whether and how the fidelity of oocyte chromosome segregation is affected, and whether the aging-related aneuploidy is exacerbated.

METHODS

Female C57BL/6J mice were exposed to two levels of atrazine in drinking water, with the lower level corresponding to detected environmental contamination. To model exposure during development, atrazine was ingested by pregnant females at 0.5 days post coitum and continued until pups were weaned at 21 days post-partum. For adult exposure, 2-month-old females ingested atrazine for 3 months. For each exposure group, various indicators of oocyte quality were determined, including developmental capacity and chromosomal abnormalities during the two meiotic divisions.

RESULTS

Developmental exposure caused only minor effects on the fetal events of meiotic prophase-I and establishment of initial follicle pools. However, ovulation was enhanced while oocyte quality was significantly reduced. At the chromosome level, misalignment and numerical and structural abnormalities were increased at both meiotic divisions. Furthermore, fertilization efficiency was impaired in vitro, and apoptosis was elevated in blastocysts derived from the eggs of atrazine-exposed females. Similar levels of chromosomal defects were seen in oocytes following both developmental and adult exposure regimens suggesting that quiescent primordial follicles may be the consequential targets of atrazine. Importantly, defects were observed long after exposure was terminated. Moreover, dramatic increases in chromosomally abnormal oocytes were seen in older mice indicating that atrazine exposure during development exacerbates the effects of maternal aging on oocyte quality. Indeed, analogous to the effects of maternal age, atrazine exposure resulted in weakened cohesion between sister chromatids.

CONCLUSION

Low-level atrazine exposure causes persistent changes to the female mammalian germline with potential consequences for reproductive lifespan and congenital disease.
Looking for a sign forecasting failure in actions: reaching errors triggered by a slowdown of movement and specific brain activity in preceding trials
Authors: Kobayashi Toshiki , Takemi Mitsuaki , Nozaki Daichi
Published: August 2022

Even experts can sometimes fail while performing fully learned movements. Do such failures suddenly arise, or are there any forecasting signs? It has been reported that the kinematics of the early phase of movements can predict the failure, and brain activity patterns specific to failures are observed just before the movement onset. The presence of abnormal brain activity patterns long before (> 30 s) a failure in a cognitive task leads us to question if signs of a failure in action could exist in trials preceding the failure. Here, we examined this question using a reaching movement adaptation paradigm conventionally used to test motor learning dynamics. Firstly, the presence of a behavioral sign that preceded failures was observed: the peak velocity of the reaching movement significantly decreased in the preceding two trials. Secondly, specific theta and alpha band activity of EEG were observed in the failure trials and the trials preceding the failure. These results suggest that a failure in actions does not occur suddenly, and some signs preceding failures can be observed in the prior trials. Our approach may pave the way to investigate how we prevent failures and improve motor performance.