bluuebunny/crossref_metadata_2025 huggingface dataset:
Governors in Control: Executive Orders, State-Local Preemption, and the COVID-19 Pandemic
Authors: Weissert Carol S , Uttermark Matthew J , Mackie Kenneth R , Artiles Alexandra
Published: June 2021

The nation’s governors took strong and decisive action in responding to the 2020 COVID-19 pandemic, often directly affecting their local governments. These actions allow us to examine this question: Will governors’ actions in an unprecedented emergency situation centralize the authority of the state or rely on local governments to deal with localized problems? Additionally, what factors affect those decisions? We examine all governors’ executive orders affecting local governments in the first five months of the 2020 pandemic. We find that preemption did occur, especially in the early months of the pandemic. States that gave their localities more autonomy were associated with preemption throughout the pandemic; the governor’s party affiliation and her ideological match with local officials were associated with greater preemption in some phases of the pandemic but not others.
Maternal Schizophrenia, Skin-to-Skin Contact, and Infant Feeding Initiation
Authors: Taylor Clare L , Brown Hilary K , Saunders Natasha R , Barker Lucy C , Chen Simon , Cohen Eyal , Dennis Cindy-Lee , Ray Joel G , Vigod Simone N
Published: June 2021

Background

The World Health Organization recommends mothers and infants be in direct skin-to-skin contact immediately after birth and initiate breastfeeding as soon as possible. Little is known in women with schizophrenia.

Methods

We conducted a population-based cohort study using administrative health data from Ontario, Canada (2012–2014), comparing women with (n = 471) and without schizophrenia (n = 218 435), and their infants, on the primary outcomes of any skin-to-skin contact and opportunity to initiate breastfeeding within the first 2 h after birth. For dyads with available data, secondary outcomes of intention to breastfeed, breastfeeding support, any breastmilk, and exclusive breastmilk at discharge were assessed. Modified Poisson regression was used to generate relative risks (aRR) and 95% confidence intervals (CI), adjusted for maternal age, parity, neighbourhood income, region of residence, smoking in pregnancy, and maternal medical and non-psychotic psychiatric comorbidity for all outcomes.

Results

Maternal schizophrenia was associated with lower likelihood of skin-to-skin contact (65.2% vs 78.1%; aRR 0.88, 95% CI: 0.82–0.94), and breastfeeding initiation post-delivery (38.9% vs 52.6% aRR 0.80, CI: 0.71–0.90) compared to dyads unexposed to maternal schizophrenia. Secondary outcomes followed a similar pattern. The magnitude of the effect was slightly less when restricting the cohort to full-term, vaginal deliveries, not admitted to NICU, and infant not discharged to social services.

Conclusions

Reduced maternal-infant skin-to-skin contact and breastfeeding initiation immediately after birth may significantly impact maternal–child bonding and the establishment breastfeeding in this population. Mothers with schizophrenia may require individualized support to promote these WHO recommended hospital practices in the early post-natal period.
Two-Layer Compared With One-Layer Vaginal Cuff Closure at the Time of Total Laparoscopic Hysterectomy to Reduce Complications
Authors: Peters Ann , Ali Riyas , Miles Shana , Foley Christine E. , Buffie Alexandra , Ruppert Kristine , Mansuria Suketu M.
Published: June 2021

OBJECTIVE:

To explore whether two-layer laparoscopic vaginal cuff closure at the time of laparoscopic hysterectomy is associated with a lower rate of postoperative complications compared with a standard one-layer cuff closure.

METHODS:

A retrospective cohort study of total laparoscopic hysterectomies performed by fellowship-trained minimally invasive gynecologic surgeons between 2011 and 2017 was performed. Surgeons sutured the vaginal cuff laparoscopically, either in a two- or one-layer closure. The primary outcome was a composite of total postoperative complications, including all medical and surgical complications within 30 days and vaginal cuff complications within 180 days. Factors known to influence laparoscopic vaginal cuff complications including age, postmenopausal status, body mass index, tobacco use, and immunosuppressant medications were examined and controlled for, while surgeon skill, colpotomy technique, and suture material remained standardized. We conducted statistical analyses including χ2, Fisher exact test, logistic regression, and post hoc power calculations.

RESULTS:

Of the 2,973 women who underwent total laparoscopic hysterectomies, 40.8% (n=1,213) of vaginal cuffs were closed with a two-layer closure and 59.2% (n=1,760) with a one-layer technique. Two-layer vaginal cuff closure was associated with decreased numbers of total postoperative complications (3.5% vs 5.7%; P<.01). The primary difference stemmed from lower vaginal cuff complications within 180 days (0.9% vs 2.6%; P<.01); no differences in 30-day medical and surgical postoperative complications were observed between the two groups (2.6% vs 3.1%; P=.77). No patients in the two-layer vaginal cuff closure cohort experienced a vaginal cuff dehiscence or mucosal separation compared with 1.0% in the one-layer group (P<.01). Compared with a one-layer closure, a two-layer closure was protective from postoperative complications (adjusted odds ratio 0.38, 95% CI 0.19–0.74).

CONCLUSION:

Although postoperative complications with laparoscopic hysterectomies are rare, two-layer laparoscopic vaginal cuff closure is associated with lower total postoperative complications compared with a one-layer closure. The difference was primary driven by cuff complications.
Term Pregnancy After Complete Response of Placental Site Trophoblastic Tumor to Immunotherapy
Authors: Polnaszek Brock , Mullen Mary , Bligard Katherine , Raghuraman Nandini , Massad L. Stewart
Published: June 2021

BACKGROUND:

Standard treatment for placental site trophoblastic tumor is hysterectomy. This may be unacceptable to women desiring fertility. Cells aberrant in placental site trophoblastic tumor display an ability to invade normal tissue while evading the immune system.

CASE:

We present a case of a 23-year-old woman with stage I placental site trophoblastic tumor who declined hysterectomy. Tumor assay for program cell death-ligand 1 staining was performed and suggestive of an immune-responsive tumor. The patient initiated intravenous pembrolizumab 200 mg every 2 weeks, and by cycle 3 her β-hCG level fell to undetectable. She subsequently conceived and went on to have an uncomplicated term vaginal birth after cesarean. At 6 weeks postpartum, she remained without evidence of disease.

CONCLUSION:

Immunotherapy can eliminate early program cell death-ligand 1–positive placental site trophoblastic tumor with subsequent normal pregnancy.
Nifedipine for Acute Tocolysis of Preterm Labor
Authors: Hawkins J. Seth , Wells C. Edward , Casey Brian M. , McIntire Donald D. , Leveno Kenneth J.
Published: June 2021

OBJECTIVE:

To evaluate the effectiveness of acute nifedipine tocolysis in preventing preterm birth in women in preterm labor.

METHOD:

This was a randomized, double-blind, placebo-controlled trial of nifedipine in women with a singleton pregnancy between 28 0/7 and 33 6/7 weeks of gestation who were admitted with uterine activity, intact membranes, and cervical dilatation from 2 to 4 cm. Women were randomized to receive nifedipine 20 mg or placebo orally, followed by a repeat dose after 90 minutes if contractions persisted. The study drug was continued every 4 hours to complete a 48-hour regimen. The primary outcome was birth before 37 weeks of gestation. A total of 150 women were necessary to detect a one-third reduction in this outcome. After treating 88 patients, a preplanned interim analysis of blinded outcomes by the Data Safety Monitoring Committee recommended discontinuation of the trial due to futility.

RESULTS:

A total of 90 women were enrolled between May 2014 and November 2017. After two women withdrew, 88 were analyzed: 46 in the nifedipine group and 42 in the placebo group. There was no significant difference in the primary outcome of delivery before 37 weeks of gestation in the nifedipine group compared with the placebo group (52% vs 48%, relative risk [RR] 1.1, 95% CI 0.7–1.7), nor in the secondary outcome of delivery at least 48 hours from randomization (78% vs 71%, respectively, RR 1.1, 95% CI 0.9–1.4). There were also no significant differences between groups in neonatal outcomes.

CONCLUSION:

Acute tocolysis of preterm labor with nifedipine did not affect preterm birth rates, delivery within 48 hours, or neonatal outcomes.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT02132533.
Association of Proximity to a Long-Term Acute Care Hospital With Hospital Tracheostomy Practices
Authors: Mehta Anuj B. , Matlock Daniel , Douglas Ivor S.
Published: June 2021

OBJECTIVES:

Availability of long-term acute care hospitals has been associated with hospital discharge practices. It is unclear if long-term acute care hospital availability can influence patient care decisions. We sought to determine the association of long-term acute care hospital availability at different hospitals with the likelihood of tracheostomy.

DESIGN:

Retrospective cohort study.

SETTING:

California Patient Discharge Database, 2016–2018.

PATIENTS:

Adult patients receiving mechanical ventilation for respiratory failure.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Using the California Patient Discharge Database 2016–2018, we identified all mechanically ventilated patients and those who received tracheostomy. We determine the association between tracheostomy and the distance between each hospital and the nearest long-term acute care hospital and the number of long-term acute care hospital beds within 20 miles of each hospital. Among 281,502 hospitalizations where a patient received mechanical ventilation, 22,899 (8.1%) received a tracheostomy. Patients admitted to a hospital closer to a long-term acute care hospital compared with those furthest from a long-term acute care hospital had 38.9% (95% CI, 33.3–44.6%) higher odds of tracheostomy (closest hospitals 8.7% vs furthest hospitals 6.3%, adjusted odds ratio = 1.65; 95% CI, 1.40–1.95). Patients had a 32.4% (95% CI, 27.6–37.3%) higher risk of tracheostomy when admitted to a hospital with more long-term acute care hospital beds in the immediate vicinity (most long-term acute care hospital beds within 20 miles 8.9% vs fewest long-term acute care hospital beds 6.7%, adjusted odds ratio = 1.54; 95% CI, 1.31–1.80). Distance to the nearest long-term acute care hospital was inversely correlated with hospital risk-adjusted tracheostomy rates (ρ = –0.25; p < 0.0001). The number of long-term acute care hospital beds within 20 miles was positively correlated with hospital risk-adjusted tracheostomy rates (ρ = 0.22; p < 0.0001).

CONCLUSIONS:

Proximity and availability of long-term acute care hospital beds were associated with patient odds of tracheostomy and hospital tracheostomy practices. These findings suggest a hospital effect on tracheostomy decision-making over and above patient case-mix. Future studies focusing on shared decision-making for tracheostomy are needed to ensure goal-concordant care for prolonged mechanical ventilation.
Pattern of Brain Injury in Patients With Thrombotic Thrombocytopenic Purpura in the Precaplacizumab Era
Authors: Mirouse Adrien , Legriel Stéphane , Dumas Guillaume , Labro Guylaine , Veyradier Agnès , Zafrani Lara , Valade Sandrine , Hourmant Yannick , Boutboul David , Darmon Michael , Coppo Paul , Mariotte Eric , Azoulay Elie
Published: June 2021

OBJECTIVES:

To describe short- and long-term neurologic prognosis of patients with thrombotic thrombocytopenic purpura and to identify clusters associated with evolution.

DESIGN:

Prospective French cohort.

SETTING:

ICU in a reference center.

PATIENTS:

All consecutive patients with newly diagnosed thrombocytopenic purpura.

INTERVENTION:

Comprehensive clinical, biological, and radiological evaluation at admission. Neurocognitive recovery was assessed using Glasgow Outcome Scale (range 1–5, with 1 representing death and 5 representing no or minimal neurologic deficit).

MEASUREMENTS AND MAIN RESULTS:

Among the 130 newly diagnosed patients with thrombocytopenic purpura, 108 (83%; age 43 [30–52]; 73% women) presented with neurologic signs, including headaches (51%), limb weakness, paresthesia, and/or aphasia (49%), pyramidal syndrome (30%), decreased consciousness (20%), seizure (19%), cognitive impairment (34%), cerebellar syndrome (18%), and visual symptoms (20%). A hierarchical cluster analysis identified three distinct groups of patients. Cluster 1 included younger patients (37 [27–48], 41 [32–52], and 48 [35–54], in clusters 1, 2 and 3, respectively; p = 0.045), with a predominance of headaches (75%, 27%, and 36%; p < 0.0001). Cluster 2 patients had ataxic gait and cerebellar syndrome (77%, 0%, and 0%; p < 0.0001) and dizziness (50%, 0%, and 0%; p < 0.0001). Cluster 3 included patients with delirium (36%, 0%, and 9%; p < 0.0001), obtundation (58%, 0%, and 24%; p < 0.0001), and seizure (36%, 0%, and 14%; p < 0.0001). Acute kidney injury was 32%, 68%, and 77%, in clusters 1, 2, and 3, respectively (p < 0.0001). The three clusters did not differ for other biological or brain imaging. After a median follow-up of 34 months (12–71 mo), 100 patients (93%) were alive with full neurocognitive recovery (i.e., Glasgow Outcome Scale score 5) in 89 patients (89%). Patients from cluster 1 more frequently exhibited full recovery (Glasgow Outcome Scale score of 5) compared with clusters 2 and 3, (44 [98%], 13 [65%], and 21 [60%] at 3 mo; p < 0.0001), (44 [100%], 15 [68%], and 23 [69%] at 6 mo; p < 0.0001), and (40 [100%], 15 [79%], and 20 [57%] at 1 yr; p < 0.0001).

CONCLUSIONS:

Initial clinical neurologic evaluation in thrombocytopenic purpura patients distinguishes three groups of patients with different clinical and functional outcomes.
Simultaneous Use of Hypertonic Saline and IV Furosemide for Fluid Overload: A Systematic Review and Meta-Analysis
Authors: Liu Chang , Peng Zhiyong , Gao Xiaolan , Gajic Ognjen , Dong Yue , Prokop Larry J. , Murad M. Hassan , Kashani Kianoush B. , Domecq Juan Pablo
Published: June 2021

OBJECTIVES:

To evaluate the efficacy of the simultaneous hypertonic saline solution and IV furosemide (HSS+Fx) for patients with fluid overload compared with IV furosemide alone (Fx).

DATA SOURCES:

Electronic databases (MEDLINE, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, PsycINFO, Scopus, and WOS) were searched from inception to March 2020.

STUDY SELECTION:

Randomized controlled trials on the use of HSS+Fx in adult patients with fluid overload versus Fx were included.

DATA EXTRACTION:

Data were collected on all-cause mortality, hospital length of stay, heart failure–related readmission, along with inpatient weight loss, change of daily diuresis, serum creatinine, and 24-hour urine sodium excretion from prior to post intervention. Pooled analysis with random effects models yielded relative risk or mean difference with 95% CIs.

DATA SYNTHESIS:

Eleven randomized controlled trials comprising 2,987 acute decompensated heart failure patients were included. Meta-analysis demonstrated that HSS+Fx was associated with lower all-cause mortality (relative risk, 0.55; 95% CI, 0.46–0.67; p < 0.05; I2
= 12%) and heart failure–related readmissions (relative risk, 0.50; 95% CI, 0.33–0.76; p < 0.05; I2
= 61%), shorter hospital length of stay (mean difference, –3.28 d; 95% CI, –4.14 to –2.43; p < 0.05; I2
= 93%), increased daily diuresis (mean difference, 583.87 mL; 95% CI, 504.92–662.81; p < 0.05; I2
= 76%), weight loss (mean difference, –1.76 kg; 95% CI, –2.52 to –1.00; p < 0.05; I2
= 57%), serum sodium change (mean difference, 6.89 mEq/L; 95% CI, 4.98–8.79; p < 0.05; I2
= 95%), and higher 24-hour urine sodium excretion (mean difference, 61.10 mEq; 95% CI, 51.47–70.73; p < 0.05; I2
= 95%), along with decreased serum creatinine (mean difference, –0.46 mg/dL; 95% CI, –0.51 to –0.41; p < 0.05; I2
= 89%) when compared with Fx. The Grading of Recommendation, Assessment, Development, and Evaluation certainty of evidence ranged from low to moderate.

CONCLUSIONS:

Benefits of the HSS+Fx over Fx were observed across all examined outcomes in acute decompensated heart failure patients with fluid overload. There is at least moderate certainty that HSS+Fx is associated with a reduction in mortality in patients with acute decompensated heart failure. Factors associated with a successful HSS+Fx utilization are still unknown. Current evidence cannot be extrapolated to other than fluid overload states in acute decompensated heart failure.
Sun Protection Outreach Teaching by Students (SPOTS)—Evaluating the Efficacy of Skin Cancer Prevention Education for Adolescents
Authors: Chaudhry Sofia B. , Armbrecht Eric S. , Gibbons Mitchell , Council M. Laurin , Knutson Alex , Lickerman Stephanie
Published: June 2021

BACKGROUND

The Sun Protection Outreach Teaching by Students (SPOTS) program addresses an unmet need by training medical students to teach adolescents about skin cancer prevention and early detection.

OBJECTIVE

To measure (1) changes in adolescents' knowledge, attitudes, and behaviors regarding sun protection and (2) the impact on medical students' confidence in skin cancer preventive counseling.

METHODS

Pre-SPOTS and 1-month post-SPOTS program surveys were completed by adolescent participants and medical student instructors.

RESULTS

Amongst adolescent students, analysis of 1,142 pre-program surveys and 618 post-program surveys revealed statistically significant improvements in knowledge, attitudes, and behaviors. Among the favorable results, 26%, 41%, and 20% improvements over baseline were observed in SPF knowledge, preference for natural untanned skin, and intent to wear sunscreen, respectively (p < .001). One-third of adolescents reported having tried to increase sunscreen use. Amongst medical students, analysis of 78 pre-teaching and 74 post-teaching surveys revealed an increase in feeling “very confident” in counseling patients, from 23% pre-teaching to 82% post-teaching (p < .001).

CONCLUSION

SPOTS demonstrated a dual benefit to adolescents and medical students. The program is available for dermatologists to implement in their communities.
Correlation Between QTc Dispersion and Soluble Growth-stimulating Gene 2 Protein on the Early Prognosis of Acute Carbon Monoxide Poisoning Heart Disease
Authors: Liu Yongjian , Gao Xun , Xiao Qingmian , Wang Weizhan , Zhu Baoyue
Published: June 2021

This study aimed to explore the correlation between QTc dispersion (QTcd) and soluble growth-stimulating gene 2 protein (sST2) after heart rate correction in patients with acute carbon monoxide poisoning heart disease. Among the 150 patients, 35 cases had severe toxic heart disease. The concentrations of sST2, cardiac troponin I, and creatine kinase-MB in the severe group began to increase from admission, 24 hours, and 2 days, respectively, and their detected values were all higher than those in the nonsevere group and the normal control group. There were statistically significant differences in sST2 and QTcd between the poisoning, nonsevere, and normal control groups before the treatment. There was a statistically significant difference between the indexes of the poisoning groups at different degrees 2 and 3 days after poisoning. Receiver operating characteristic curve analysis confirmed the sensitivity and specificity of sST2 and QTcd. The correlation analysis showed that sST2 and QTcd levels were positively correlated with the incidence of severe heart disease at admission. Generally, the combined observation of sST2 and QTcd improved the prediction sensitivity and were early predictor indexes of toxic heart disease.
Clinical and Bacteriologic Characteristics of Six Cases of Bifidobacterium breve Bacteremia Due to Probiotic Administration in the Neonatal Intensive Care Unit
Authors: Sakurai Yoshie , Watanabe Tatsuya , Miura Yuichiro , Uchida Toshihiko , Suda Natsumi , Yoshida Marie , Nawa Tatsuro
Published: June 2021

Background:

Bifidobacterium breve is widely used as a probiotic in preterm infants and children with congenital surgical conditions, however, some cases of probiotics-induced bacteremia have been reported recently.

Objectives:

To examine the clinical and bacteriologic features of Bifidobacterium breve bacteremia caused by a probiotic (BBG-01) in term and preterm infants.

Methods:

We included 298 patients who were admitted to the neonatal intensive care unit of Miyagi Children’s Hospital and were given BBG-01 as a probiotic within the period June 2014 to February 2019. We experienced six cases of B. breve bacteremia and assessed their features retrospectively.

Results:

The incidence rate of B. breve bacteremia in our hospital was 2% (6/298), higher than reported previously. The median age at onset, corrected age, and weight of the patients was 8 days (range: 5–27 days), 35 weeks (range: 26–39 weeks), and 1,940 g (range: 369–2734 g), respectively. The bacteremia triggers were gastrointestinal perforations in two cases, food protein-induced enterocolitis syndrome in two cases, adhesive ileus in one case, ileal volvulus in one case, and aspiration pneumonia following esophageal atresia repair in one case. B. breve was detected on blood cultures after a median of 5 days 13 hours (range: 4 days 18 hours–9 days 13 hours). No patient demonstrated serious symptoms, such as septic shock. All patients received antibiotics and recovered without any sequelae.

Conclusions:

Ileus and intestinal mucosal damage, such as enteritis, can cause B. breve bacteremia. The incidence of B. breve bacteremia may be higher than reported previously and detection via culture may require a longer time than typically needed for more common bacteria. It is associated with a good prognosis.
High Incidence of Congenital Syphilis in New Zealand
Authors: Gilmour Leeyan Sharon , Best Emma Joanne , Duncanson Mavis Joy , Wheeler Benjamin John , Sherwood Jill , Thirkell Callum Evans , Walls Tony
Published: June 2021

Background:

Syphilis, a disease once in decline, has made a resurgence worldwide. New Zealand has had increasing syphilis rates since enhanced syphilis surveillance was initiated in 2013. This study reports epidemiologic, descriptive and treatment data on management of infants prenatally exposed or vertically infected with syphilis across New Zealand as reported by pediatricians.

Methods:

Over a 26-month period from April 2018 to May 2020 (inclusive), pediatricians throughout New Zealand notified potential, probable and confirmed cases of congenital syphilis to the New Zealand Pediatric Surveillance Unit. National reporting numbers were concurrently ascertained to demonstrate reporting accuracy.

Results:

Thirty-two cases were notified, comprised of 25 infants born to women with positive antenatal syphilis serology (5 whom developed congenital syphilis), and 7 infants diagnosed with congenital syphilis after birth where syphilis was not diagnosed in pregnancy. There were 12 cases of congenital syphilis; an incidence rate of 9.4 cases per 100,000 live births. Nine of the 12 infants had clinical features of congenital syphilis. One-third of maternal infections were early syphilis, and the women who gave birth to infected infants were less likely to have received antenatal care, adequate treatment and follow-up monitoring of treatment for syphilis during pregnancy.

Conclusions:

This study quantifies an important burden of disease from congenital syphilis in our population. Case finding and treatment of syphilis in pregnancy are critical to prevent this. Our findings support the urgent need for measures such as repeat maternal syphilis screening in early third trimester; whether by affected region or instituted for all, in the context of rising cases.
NUT Carcinoma in the Pelvic Cavity With Unusual Pathologic Features
Authors: Jung Minsun , Kim Se Ik , Kim Jae-Weon , Jeon Yoon Kyung , Lee Cheol
Published: June 2021

NUT carcinoma is an aggressive epithelial malignancy defined by NUTM1 translocation, usually arising in the head/neck or thorax regions and showing squamous differentiation. Herein, we describe an extraordinary case of NUT carcinoma in the pelvic cavity. The patient was a 54-yr-old woman who was found to have a large pelvic mass with multiple metastases, suggestive of advanced ovarian cancer. Peritoneal seeding nodules were resected and subjected to pathologic examination. Upon microscopic investigation, infiltration of tumor cells showing monotonous-round morphology without squamous features was observed. Immunohistochemical analysis revealed faint/dot-like expression of cytokeratin, focal expression of vimentin, and diffuse expression of the estrogen receptor, but there was no detection of p40, p63, and Myc. NUT was diffusely and strongly expressed in nuclei, in which it exhibited a speckled pattern. Subsequent dual-color break-apart fluorescence in situ hybridization of NUTM1 confirmed a genetic translocation. Next, target-enriched next-generation sequencing covering ~200 major cancer-associated genes found no other significant alterations. After 2 cycles of chemotherapy, bilateral pleural effusion developed that were diagnosed as metastatic NUT carcinoma. The data suggest that NUT carcinoma should be enlisted in the differential diagnosis of poorly differentiated malignancies arising in the pelvic organs.
Virtual Unenhanced Images
Authors: Lennartz Simon , Pisuchpen Nisanard , Parakh Anushri , Cao Jinjin , Baliyan Vinit , Sahani Dushyant , Hahn Peter F. , Kambadakone Avinash
Published: June 2021

Objectives

The aim of this study was to compare qualitative and quantitative metrics of virtual unenhanced (VUE) images among dual-source dual-energy computed tomography (dsDECT), rapid kV-switching DECT (rsDECT), and dual-layer detector DECT (dlDECT) using patient and phantom data.

Materials and Methods

Forty-four patients with clinical contrast-enhanced abdominal examinations on each of the 3 DECT scanner types and a phantom scanned with the same protocols were included in this retrospective study. Qualitative and quantitative assessment was performed on VUE images. Quantitative evaluation included measurement of attenuation and image noise for various tissues and the phantom. Virtual unenhanced image attenuation and noise were compared between scanner types, and intrapatient interscanner reproducibility of virtual unenhanced image attenuation was calculated as the percentage of measurement pairs with an interscanner difference ≤ 10 HU. Image quality, noise, sharpness, and iodine elimination were assessed qualitatively by 2 radiologists.

Results

Significant interscanner differences in VUE attenuation and noise were found in all tissues. dlDECT and rsDECT showed significantly higher VUE attenuation than dsDECT in the aorta, portal vein, and kidneys (P < 0.05). Conversely, VUE attenuation in dsDECT was significantly higher than in dlDECT/rsDECT for subcutaneous and retroperitoneal fat (both P < 0.05). A total of 91.9% (385/419) of measurements were reproducible between rsDECT and dlDECT, 70.9% (297/419) between dsDECT and rsDECT, and 66.8% (280/419) between dsDECT and dlDECT. Virtual unenhanced image attenuation in the contrast media–filled phantom cavity was 12.7 ± 4.7 HU in dlDECT, −5.3 ± 4.2 HU in rsDECT, and −4.0 ± 10.7 HU in dsDECT with significant differences between dlDECT and rsDECT/dsDECT, respectively (P < 0.05), between which attenuation was comparable in the unenhanced extraluminal phantom component (P = 0.11–0.62). Qualitatively, dsDECT yielded best iodine elimination, whereas sharpness, image noise, and overall image quality were rated higher in dlDECT and rsDECT.

Conclusions

There are significant interscanner differences in the attenuation measurements and qualitative assessment of VUE images, which should be acknowledged when using these images in patients that are being scanned on different DECT scanner types during imaging follow-up.
Employing a Xiphoid-umbilicus Approach in an Endoscopic Totally Extraperitoneal Procedure for the Preperitoneal Repair of Midline Ventral Hernias
Authors: Tang Rui , Wu Weidong , Jiang Huiyong , Zhang Yizhong , Liu Nan , Wei Nina
Published: June 2021

Objectives:

Endoscopic totally extraperitoneal sublay (TES) repair seems to be a promising procedure for treating ventral hernias because repairing at the preperitoneal layer reduces damage to the natural musculoaponeurotic structures of the abdominal wall. This article reports the preliminary surgical results after such a procedure with a xiphoid-umbilicus approach for a midline ventral hernia of the middle-upper abdomen.

Materials and Methods:

Fifteen cases with a small midline ventral hernia scheduled for preperitoneal repair with a TES procedure with a xiphoid-umbilicus approach were included. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed.

Results:

The patients’ average age was 55.80±15.33 years, body mass index was 26.49±2.98, defect size was 4.59±2.28 cm2, and the most frequent region was M3. Five of 15 procedures were conducted in a bottom-up direction, and 10 of 15 with single-port surgery. Only 1 repair failed due to severe peritoneal damage. The operation duration was 120.4±47.7 minutes. All patients recovered quickly and uneventfully, and no case needed readmission. No severe intraoperative and postoperative complications occurred. Only 1 case developed seroma, and there was no surgical site infection, pain, trocar site hernia, and recurrence observed during short-term follow-up (3 to 12 mo).

Conclusions:

Endoscopic preperitoneal repair helps reduce damage to the abdominal wall during a TES procedure. Compared with a suprapubic approach, employing a xiphoid-umbilicus approach facilitates preperitoneal repair for small ventral hernias of the middle-upper abdomen. This will be a future option for minimally invasive surgical repair of such ventral hernias (Supplemental Digital Content 1, Video, http://links.lww.com/SLE/A287).
Phylogenomic analysis supports the reclassification of Burkholderia novacaledonica as Caballeronia novacaledonica comb. nov.
Authors: Lozano Mauricio Javier , Mogro Ezequiel Gerdardo , Draghi Walter Omar
Published: June 2021

Burkholderia novacaledonica

is a Betaproteobacterial species isolated from ultramafic soils in New Caledonia. The characterization and classification of this species into the

Burkholderia

genus was done simultaneously with the proposal of the new genus

Caballeronia

, initially composed of closely related

Burkholderia glathei

-like species. Thereafter, some reports based on the use of phylogenetic marker genes suggested that

B. novacaledonica

forms part of

Caballeronia

genus. Lacking a formal validation, and with the availability of its genome sequence, a genome-based phylogeny of

B. novacaledonica

was obtained to unravel its taxonomic position in Burkholderia sensu lato. A partial gyrB gene phylogeny, extended multilocus sequence typing on homologous protein sequences, and genomic distance-based phylogeny, all support the placement of this species in the

Caballeronia

genus. Therefore, the reclassification of

B. novacaledonica

to Caballeronia novacaledonica comb. nov. is proposed.
OVARIAN GRANULOSA CELLS FROM WOMEN WITH PCOS EXPRESS LOW LEVELS OF SARS-COV-2 RECEPTORS AND CO-FACTORS
Authors: Naigaonkar Aalaap , Patil Krutika , Joseph Shaini , Hinduja Indira , Mukherjee Srabani
Published: June 2021

Purpose

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is global pandemic with more than 3 million deaths so far. Female reproductive tract organs express coronavirus-associated receptors and factors (SCARFs); suggesting they may be susceptible to SARS-CoV-2 infection however the susceptibility of ovary/follicle/oocyte to the same is still elusive. Co-morbidities like obesity, type-2 diabetes mellitus, cardiovascular disease etc. increase the risk of SARS-CoV-2 infection. These features are common in women with polycystic ovary syndrome (PCOS), warranting further scope to study SCARFs expression in ovary of these women.

Materials and methods

SCARFs expression in ovary and ovarian tissues of women with PCOS and healthy women was explored by analyzing publically available microarray datasets. Transcript expression of SCARFs were investigated in mural and cumulus granulosa cells (MGCs and CGCs) from control and PCOS women undergoing in vitro fertilization (IVF).

Results

Microarray data revealed that ovary expresses all genes necessary for SARS-CoV-2 infection. PCOS women mostly showed down-regulated/unchanged levels of SCARFs. MGCs and CGCs from PCOS women showed lower expression of receptors ACE2, BSG and DPP4 and protease CTSB than in controls. MGCs showed lower expression of protease CTSL in PCOS than in controls. Expression of TMPRSS2 was not detected in both cell types.

Conclusions

Human ovarian follicle may be susceptible to SARS-CoV-2 infection. Lower expression of SCARFs in PCOS indicate that the risk of SARS-CoV-2 infection to the ovary may be lesser in these women than controls. This knowledge may help in safe practices at IVF settings in the current pandemic.
The effect of Health Literacy on COVID-19 Vaccine Hesitancy: The Moderating Role of Stress
Authors: Zhang Huiqiao , Li Yue , Peng Sihui , Jiang Yue , Jin Huihui , Zhang Fan
Published: June 2021

Background

The COVID-19 vaccine is an essential means to establish group immunity and prevent the spread of the pandemic. However, the public’s hesitation has created major difficulties to the promotion of the vaccine. By investigating the relationship between health literacy and COVID-19 vaccine hesitancy, as well as the potential moderating role of stress, the present study would provide critical insights for tailoring vaccine-promotion strategies.

Objective

The two-fold research purpose is: i) address the effect of health literacy on people’s attitude toward COVID-19 vaccine, ii) clarify the role of stress in this effect.

Methods

With structured questionnaires, an online survey was conducted to evaluate general public’s COVID-19 vaccine hesitancy, health literacy, and perceived stress. In total, 560 responses were collected, and moderated regression analysis was conducted to test the effect of health literacy on vaccine hesitancy among people with different levels of stress.

Results

A total of 560 participants aged over 18 years were included in this study. About 39.8% of the respondents reported vaccine hesitancy, and this rate is higher among those aged 20-30 years old (83%) and female (71.3%). The results showed people with higher level of health literacy are less likely to have vaccine hesitancy (β =-2.00, 95%CI= [-3.00∼ -0.99]). However, this effect was only among those with lower to moderate level of stress (β =-3.43, p<0.001), among the people with high stress, no significant effect of health literacy was found (β =-0.53, p>0.05).

Conclusions

By focusing on the effect of health literacy on COVID-19 vaccine hesitancy, the findings showed education program increasing individual’s health literacy may also effectively reduce the public’s vaccine hesitancy and promote accepting attitude. However, for people with high level of stress, other health programs need to be developed to enhance their positive attitude toward the COVID-19 vaccine. In conclusion, promotion strategies should be tailored for different populations, with considering individual factors such as health literacy and stress.
The role of prisons in disseminating tuberculosis in Brazil: a genomic epidemiology study
Authors: Walter Katharine S. , dos Santos Paulo César Pereira , Gonçalves Thais Oliveira , da Silva Brunna Oliveira , Santos Andrea da Silva , Leite Alessandra de Cássia , da Silva Alessandra Moura , Moreira Flora Martinez Figueira , de Oliveira Roberto Dias , Lemos Everton Ferreira , Cunha Eunice , Liu Yiran E. , Ko Albert , Colijn Caroline , Cohen Ted , Mathema Barun , Croda Julio , Andrews Jason R.
Published: June 2021

Background

Globally, prisons are high-incidence settings for tuberculosis. Yet the role of prisons as reservoirs of M. tuberculosis, propagating epidemics through spillover from prisons to surrounding communities, has been difficult to measure directly.

Methods and Findings

To quantify the role of prisons in driving wider community M. tuberculosis transmission, we conducted prospective genomic surveillance in Central West Brazil from 2014 to 2019. We whole genome sequenced 1,152 M. tuberculosis isolates collected during active and passive surveillance inside and outside prisons and linked genomes to detailed incarceration histories. We applied multiple phylogenetic and genomic clustering approaches and inferred timed transmission trees. We found that M. tuberculosis sequences from incarcerated and non-incarcerated people were closely related in a maximum likelihood phylogeny. The majority (70.8%; 46/65) of genomic clusters including people with no incarceration history also included individuals with a recent history of incarceration. Among cases in individuals with no incarceration history, 50.6% (162/320) were in clusters that included individuals with recent incarceration history, suggesting that transmission chains often span prisons and communities. We identified a minimum of 18 highly probable spillover events, M. tuberculosis transmission from people with a recent incarceration history to people with no prior history of incarceration, occurring in the state’s four largest cities and across sampling years. We additionally found that frequent transfers of people between the state’s prisons creates a highly connected prison network that likely disseminates M. tuberculosis across the state.

Conclusions

We developed a framework for measuring spillover from high-incidence environments to surrounding communities by integrating genomic and spatial information to reconstruct tuberculosis transmission chains. Our findings indicate that, in this setting, prisons serve not only as disease reservoirs, but also disseminate M. tuberculosis across highly connected prison networks, both amplifying and propagating M. tuberculosis risk in surrounding communities.
Trends in COVID-19 vaccination intent, determinants and reasons for vaccine hesitancy: results from repeated cross-sectional surveys in the adult general population of Greece during November 2020-June 2021
Authors: Sypsa V , Roussos S , Engeli V , Paraskevis D , Tsiodras S , Hatzakis A
Published: June 2021

Background

Vaccine hesitancy is a major barrier to achieve large-scale COVID-19 vaccination. We report trends in vaccination intention and associated determinants from surveys in the adult general population in Greece.

Methods

Four cross-sectional phone surveys were conducted in November 2020, February, April and May 2021 on nationally representative samples of adults in Greece. Multinomial logistic regression was used on the combined data of the surveys to evaluate independent predictors of vaccination unwillingness/uncertainty.

Results

Vaccination intention increased from 67.6% in November 2020 to 84.8%. in May 2021. Individuals aged 65 years or older were more willing to get vaccinated (May 2021: 92.9% vs. 79.5% in 18-39 years, p<0.001) but between age-groups differences decreased over time. Vaccination intention increased substantially in both sexes, though earlier among men than women and was higher in individuals with postgraduate studies (May 2021: 91.3% vs. 84.0% up to junior high). From multivariable analysis, unwillingness and/or uncertainty to get vaccinated was associated with younger age, female gender (in particular in the April 2021 survey), lower educational level and living with a child ≤12 years old. Among those with vaccine hesitancy, concerns about vaccine effectiveness declined over time (21.6% in November 2020 vs. 9.6% in May 2021, p=0.014) and were reported more often by men; safety concerns remained stable over time (66.3% in November 2020 vs. 62.1% in May 2021, p=0.658) and were reported more often by women.

Conclusions

Vaccination intention increased substantially over time. Tailored communication is needed to address vaccine hesitancy and concerns regarding vaccine safety.

Funding

The phone surveys were conducted with the kind support of the Greek Shipowners’ Social Welfare Company SYN-ENOSIS

Conflicts of interest statement

The authors have no conflict of interest related to this article
The Influence of Irreversibly Electroporated Cells on Post Pulse Drug Delivery to Reversibly Electroporated Cells
Authors: Becker Sid M.
Published: June 2021

Electroporation can result in cell death in some proportion of a population of cells and, because the nature of the membrane disruption can vary significantly in irreversibly electroporated cells, there is uncertainty in the magnitude of and the transient behaviour of the associated permeability increases. This study numerically investigates the drug uptake by a population of cells that includes both reversibly and irreversibly electroporated cells. A theoretical continuum model is developed and simulations are conducted in conditions of low porosity (cells in tissues) and of high porosity (cells in suspension). This model estimates the permeability increases of electroporated cells using empirically based predictions of the dependence of long−lived electropore density on the local electric field magnitude. A parametric investigation investigates how the transmembrane transport characteristics of irreversibly electroporated cells (permeability and resealing rate) affect the drug uptake of the surviving cells. The results show that the magnitude and duration of the permeability increases of irreversibly electroporated cells is much more influential in low porosity tissues than in high porosity dilute suspensions. In applications of electroporation of cells in tissues, the uncertainty of irreversibly electroporated cells should be considered in regions of tissue experiencing field strengths for which the fraction of the total cells that are irreversibly electroporated exceeds about 0.1.
Uncovering the Genetic Profiles Underlying the Intrinsic Organization of the Human Cerebellum
Authors: Wang Yaping , Chai Lin , Chu Congying , Li Deying , Gao Chaohong , Wu Xia , Yang Zhengyi , Zhang Yu , Xu Junhai , Nyengaard Jens Randel , Eickhoff Simon B. , Liu Bing , Madsen Kristoffer Hougaard , Jiang Tianzi , Fan Lingzhong
Published: June 2021

The functional diversity of the human cerebellum is largely believed to be derived more from its extensive connections rather than being limited to its mostly invariant architecture. However, whether and how the determination of cerebellar connections in its intrinsic organization interact with microscale gene expression is still unknown. Here we decode the genetic profiles of the cerebellar functional organization by investigating the genetic substrates simultaneously linking cerebellar functional heterogeneity and its drivers, i.e., the connections. We not only identified 443 network-specific genes but also discovered that their co-expression pattern correlated strongly with intra-cerebellar functional connectivity (FC). Ninety of these genes were also linked to the FC of cortico-cerebellar cognitive-limbic networks. To further discover the biological functions of these genes, we performed a “virtual gene knock-out” by observing the change in the coupling between gene co-expression and FC and divided the genes into two subsets, i.e., a positive gene contribution indicator (GCI+) involved in cerebellar neurodevelopment and a negative gene set (GCI−) related to neurotransmission. A more interesting finding is that GCI− is significantly linked with the cerebellar connectivity-behavior association and many recognized brain diseases that are closely linked with the cerebellar functional abnormalities. Our results could collectively help to rethink the genetic substrates underlying the cerebellar functional organization and offer possible micro-macro interacted mechanistic interpretations of the cerebellum-involved high order functions and dysfunctions in neuropsychiatric disorders.
Intracranial Human Recordings Reveal Intensity Coding for the Pain of Others in the Insula
Authors: Soyman Efe , Bruls Rune , Ioumpa Kalliopi , Müller-Pinzler Laura , Gallo Selene , van Straaten Elisabeth C.W. , Self Matthew W. , Peters Judith C. , Possel Jessy K. , Onuki Yoshiyuki , Baayen Johannes C. , Idema Sander , Keysers Christian , Gazzola Valeria
Published: June 2021

Based on neuroimaging data, the insula is considered important for people to empathize with the pain of others, whether that pain is perceived through facial expressions or the sight of limbs in painful situations. Here we present the first report of intracranial electroencephalographic (iEEG) recordings from the insulae collected while 7 presurgical epilepsy patients rated the intensity of a woman’s painful experiences viewed in movies. In two separate conditions, pain was deduced from seeing facial expressions or a hand being slapped by a belt. We found that broadband activity in the 20-190 Hz range correlated with the trial-by-trial perceived intensity in the insula for both types of stimuli. Using microwires at the tip of a selection of the electrodes, we additionally isolated 8 insular neurons with spiking that correlated with perceived intensity. Within the insula, we found a patchwork of locations with differing selectivities within our stimulus set, some representing intensity only for facial expressions, others only for the hand being hit, and others for both. That we found some locations with intensity coding only for faces, and others only for hand across simultaneously recorded locations suggests that insular activity while witnessing the pain of others cannot be entirely reduced to a univariate salience representation. Psychophysics and the temporal properties of our signals indicate that the timing of responses encoding intensity for the sight of the hand being hit are best explained by kinematic information; the timing of those encoding intensity for facial expressions are best explained by shape information in the face. In particular, the furrowing of the eyebrows and the narrowing of the eyes of the protagonist in the movies suffice to predict both the rating of and the timing of the neuronal response to the facial expressions. Comparing the broadband activity in the iEEG signal with spiking activity and an fMRI experiment with similar stimuli revealed a consistent spatial organization for the representation of intensity from our hand stimuli, with stronger intensity representation more anteriorly and around neurons with intensity coding. In contrast, for the facial expressions, we found that the activity at the three levels of measurement do not coincide, suggesting a more disorganized representation. Together, our intracranial recordings indicate that the insula encodes, in a partially intermixed layout, both static and dynamic cues from different body parts that reflect the intensity of pain experienced by others.