bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparative study on alcohol-diesel blended fuels in a common rail diesel engine: Combined effects of carbon numbers, oxygen content, and molecular structure
Authors: Li Zilong , Mi Shijie , Zhang Yaoyuan , Zhu Jizhen , Qian Yong , Zhu Lei , Lu Xingcai
Published: June 2021

Abundant alcohols, including ethanol, propanol, butanol, and pentanol, are expected to be used in compression ignition engines to ease the shortages of fossil fuel. The various alcohols have quite a different combustion and emission characteristics in the engine due to the changes in molecular structures. In this paper, a series of experiments were conducted on a modified common-rail diesel engine fueled with diesel/alcohols blended fuels in a wide operating range. The effects of alcohol chain length, oxygen content, and molecular structure on engine combustion and emission characteristics are studied systematically. The experimental results show that the blending of alcohols increases the peak values of in-cylinder pressure and maximum pressure rising rate. Besides, the combustion duration and ignition delay are mainly affected by oxygen content and isomer structure. The addition of short-chain alcohols will significantly reduce the total mass of particulate matter (PM) emissions, while the CO and HC emissions increase appropriately. The CO, HC, aldehydes, and ethylene emissions are mainly affected by carbon chain length and isomer structure. For PM emissions, the carbon chain length, molecular structure, and oxygen content of alcohol fuels have different influences on PM number, PM mass, and particle size distributions. The shorter carbon chain of alcohol leads to smaller particle size, and higher oxygen content leads to lower total particle mass.
A real world analysis of first line treatment of advanced EGFR mutated non-small cell lung cancer: A multi-center, retrospective study
Authors: Lee Chung-Shien , Ahmed Iman , Miao Emily , Chung Shirley , Patel Khilna , Kohn Nina , Seetharamu Nagashree
Published: June 2021

Introduction

The recently published FLAURA trial demonstrated that osimertinib has remarkable efficacy in front-line setting for non-small cell lung cancer (NSCLC). While this has transformed current practice, there are no effective treatments following progression on osimertinib. The aim of our study was to compare progression-free survival (PFS) and overall survival (OS) between patients initiated on osimertinib to those started on other EGFR TKIs.

Methods

This was a multicenter, retrospective study conducted at two large academic centers. Adult patients with EGFR-mutated non-small cell lung cancer (NSCLC) who received EGFR therapy between 2014 and 2019 were included. Patients were dichotomized based on front-line TKI (osimertinib vs. other). PFS, OS, and time-to-discontinuation were evaluated.

Results

One-hundred seventy-two patients were included in the final analysis. Fifty-two (30.2%) patients received osimertinib and 120 (69.8%) patients received another EGFR TKI. The PFS rates at 6, 12, and 18 months were 86.3%, 79.5%, 69.8% in the osimertinib group and 86.6%, 64.2%, 39.3% in the other EGFR TKI group, respectively (p < 0.0036).Estimated OS at 6, 12, and 18 months was similar for both groups: 94.2%, 94.2%, 80.2% and 95.7%, 93.9%, 84.1%, respectively [Adjusted HR = 0.95 (95% CI, 0.37–2.44; p < 0.9128].

Conclusion

Osimertinib demonstrated greater 12 and 18 month PFS compared to other EGFR TKIs. This finding is consistent with results of the FLAURA trial. However, unlike FLAURA, there were no differences in estimated OS between the two groups in our study. Further research to evaluate optimal sequencing strategies in the real world of first, second and third generation TKIs is needed.
Second Report of PDE10A-BRAF Fusion in Pediatric Spindle Cell Sarcoma With Infantile Fibrosarcoma-Like Morphology Suggesting PDE10A-BRAF Fusion Is a Recurrent Event
Authors: Hughes Caitlin E , Correa Hernán , Benedetti Daniel J , Smith Brianna , Sumegi Janos , Bridge Julia
Published: June 2021

Infantile/congenital fibrosarcoma (IFS) is the most common soft tissue tumor in children less than one year of age. The most common anatomic site of IFS is in the extremities or trunk, and rarely in the abdomen or retroperitoneum. Approximately 70-90% of cases are characterized by a distinct t(12;15)(p13;q25) translocation resulting in an ETV6-NTRK3 gene fusion. As such, TRK inhibitors are considered frontline therapy in TRK-fusion positive IFS. The ETV6-NTRK3 fusion is also detected in congenital mesoblastic nephroma (CMN) and less frequently in myeloid leukemias, secretory breast carcinoma, and mammary-type secretory carcinoma of the skin and salivary glands. Infrequently, cases of tumors with IFS-like morphology without the characteristic ETV6-NTRK3 gene fusion have been identified. Herein, an ETV6-NTRK3 fusion negative spindle cell sarcoma with IFS-like morphology subjected to genomic profiling revealed a PDE10A-BRAF fusion, a fusion event that has been detected previously in an isolated case of undifferentiated infantile sarcoma.
Malignant Mesothelioma With EWSR1-ATF1 Fusion in Two Adolescent Male Patients
Authors: Ren Hezhen , Rassekh S Rod , Lacson Atilano , Lee Cheng-Han , Dickson Brendan C , Chung Catherine T , Lee Anna F
Published: June 2021

Malignant mesothelioma is a neoplasm of serosal surfaces, most commonly affecting the pleura. The peritoneum, pericardium, and tunica vaginalis are less frequently involved. Malignant mesothelioma with EWSR1-ATF1 fusion in young adults was recently reported in the literature. Here, we present two pediatric cases of EWSR1-ATF1 translocation-associated malignant mesothelioma in the peritoneum and pericardium respectively. Both cases lacked a known exposure history. Microscopy in both cases showed predominantly epithelioid morphology with ample eosinophilic cytoplasm, and immunohistochemistry was positive for pan-keratin, calretinin, and WT1. Both cases showed EWSR1-ATF1 gene rearrangement by RNA sequencing, which was instrumental in confirming the diagnosis of malignant mesothelioma and to exclude more common pediatric sarcomas, especially in the context of limited sampling.
Development of a shear forming envelope for carbon fibre non-crimp fabrics
Authors: Lux Benedikt , Fial Julian , Schmidt Olivia , Carosella Stefan , Middendorf Peter , Fox Bronwyn
Published: June 2021

Our research aims to develop a shear forming envelope for the preforming of textiles, a critical step in the manufacture of fibre-reinforced composite materials. This paper demonstrates the progress towards this aim by conducting picture frame tests to empirically determine the locking angle of non-crimp fabrics with different fibre orientations. While conventional shear tests typically utilise woven textile samples with orthogonal fibre directions of 0°/90°, the investigation of non-crimp fabrics, especially with non-standard fibre orientations, is less common. As a result, there is little knowledge about the shear deformation behaviour of these fabric types, despite their relevance to the aerospace industry. In this study, the shear locking angles of various carbon fibre non-crimp fabrics are investigated, gradually reducing the relative fibre angles of the textile materials from ±45° to ±22.5°. Previously, it was observed that unidirectional 0° reinforcement layers induce draping defects when forming multiaxial non-crimp fabric stacks into curved aerospace stiffeners. Their substitution by reinforcements with smaller cross-ply angles such as ±30° resulted in better formability and reduced defects. It is however unclear, how the shear locking angle decreases with more acute cross-ply angles. Here, we report for the first time a correlation between the fibre orientation of the non-crimp fabric and its shear locking angle. The resulting shear forming envelope provides composite design and manufacturing guidance for an enhanced utilisation of the advantageous but anisotropic properties of carbon fibre textiles.
Effect of CO2 laser treatment on the leather surface morphology and wettability
Authors: Gulbinienė Ada , Fataraitė-Urbonienė Eglė , Jucienė Milda , Dobilaitė Vaida , Valeika Virgilijus
Published: June 2021

The aim of this research was to determine the influence of pulsed CO2 laser treatment on crust leather surface morphology and wettability. The obtained results revealed that pulsed CO2 laser engraving can be used as an effective tool for crust leather surface treatment. Pulsed CO2 laser treatment only negligible affects the macrostructure of leather, while the morphology and wetting of the leather surface after treatment were changed. It was found that an increase of laser pulses number increases the initial water contact angle value and intensifies the water droplet relaxation process. After laser treatment, the water droplet contact angle relaxation rate increases twofold compare to those for untreated leather. SEM micrographs showed increased defectiveness with rough surface patterns, thermally affected areas, and change of microstructure. The EDX analysis revealed that the engraved leather surface contains a significantly higher amount of carbon but smaller quantities of oxygen compared to those of untreated samples. It was found that only after laser treatment chromium and sulfur in the EDX spectra appear while for untreated samples these elements on the surface were not observed. The results indicate that for investigated samples laser engraving does not affect the concentration of hexavalent chromium and are in accordance with EU requirements.
Complication and revision rates after reverse total shoulder revision from hemiarthroplasty: a systematic review
Authors: Reddy Arjun K , Checketts Jake X , Stephens B Joshua , Anderson J Michael , Cooper Craig M , Hunt Tyler , Fishbeck Keith , Boose Marshall , Detweiler Byron , Chalkin Brian , Norris Brent L
Published: June 2021

Background

Thus, the purpose of the present study was to (1) characterize common postoperative complications and (2) quantify the rates of revision in patients undergoing hemiarthroplasty to reverse total shoulder arthroplasty revisional surgery. We hypothesize that hardware loosenings will be the most common complication to occur in the sample, with the humeral component being the most common loosening.

Methods

This systematic review adhered to PRISMA reporting guideline. For our inclusion criteria, we included any study that contained intraoperative and/or postoperative complication data, and revision rates on patients who had undergone revision reverse total shoulder arthroplasty due to a failed hemiarthroplasty. Complications include neurologic injury, deep surgical site infections, hardware loosening/prosthetic instability, and postoperative fractures (acromion, glenoid, and humeral fractures).

Results

The study contained 22 studies that assessed complications from shoulders that had revision reverse total shoulder arthroplasty from a hemiarthroplasty, with a total sample of 925 shoulders. We found that the most common complication to occur was hardware loosenings (5.3%), and of the hardware loosenings, humeral loosenings (3.8%) were the most common. The revision rate was found to be 10.7%.

Conclusion

This systematic review found that revision reverse total shoulder arthroplasty for failed hemiarthroplasty has a high overall complication and reintervention rates, specifically for hardware loosening and revision rates.
Does fluoroscopy improve baseplate position compared to conventional technique in reverse shoulder arthroplasty? A preliminary study
Authors: Galán-Olleros María , Lopiz Yaiza , Ciller Gabriel , Alcobía-Díaz Borja , García-Fernández Carlos , Marco Fernando
Published: June 2021

Background

Accurate placement of glenoid component in reverse shoulder arthroplasty remains a challenge for surgeons of all levels of expertise; however, no studies have evaluated the utility of fluoroscopy as a surgical assistance method.

Methods

Prospective comparative study of 33 patients undergoing primary reverse shoulder arthroplasty during a 12-month period. Fifteen patients had a baseplate placed using the conventional “free hand” technique (control group), and 18 patients using intraoperative fluoroscopy assistance group, in a case–control design. Postoperative glenoid position was evaluated on postoperative Computed Tomography (CT) scan.

Results

The mean deviation of version and inclination for fluoroscopy assistance vs. control group was 1.75° (0.675–3.125) vs. 4.2° (1.975–10.45) (p = .015), and 3.85° (0–7.225) vs. 10.35° (4.35–18.75) (p = .009). The distance from the central peg midpoint to the inferior glenoid rim (fluoroscopy assistance 14.61 mm/control 4.75 mm, p = .581) and the surgical time (fluoroscopy assistance 1.93 ± 0.57/control 2.18 ± 0.44 h, p = .400) showed no differences, with an average radiation dose of 0.45 mGy and fluoroscopy time of 14 s.

Conclusions

Accurate axial and coronal scapular plane positioning of glenoid component is improved with intraoperative fluoroscopy at the cost of a greater radiation dose and without differences in surgical time. Comparative studies are needed to determine whether their use in relation to more expensive surgical assistance systems result in similar effectiveness. Level of evidence: Level III, therapeutic study.
A Pilot Study Testing the Efficacy of a Brief, Bystander Bullying Intervention: Reducing Bullying Victimization Among High School Students
Authors: Doumas Diana M. , Midgett Aida , Hausheer Robin
Published: June 2021

This study examined the efficacy of a brief, bystander bullying intervention (STAC) among high school students using a randomized controlled design. Results indicate that intervention students reported significantly greater reductions in bullying victimization at a 30-day follow-up compared to control students. At 3 months, although the intervention group sustained initial effects, control students also reported significant reductions in victimization. Findings from this pilot study provide preliminary support for the intervention.
Determinants of patients’ safety culture practices in a tertiary hospital in Nigeria
Authors: Nnebue Chinomnso C , Ezeuko Amaka Y , Chukwujekwu Ndidiamaka P , Onah Stanley K , Obi-Okaro Alphonsus C , Chukwu-Osodiuru Emmanuel C
Published: June 2021

Background

There is growing concern towards ensuring that patients are safe. Despite this, factors influencing safety practices and outcomes in healthcare delivery systems in Nigeria have not been determined exhaustively.

Objective

To determine the factors affecting patient safety culture (PSC) practices in a tertiary hospital in Nigeria.

Materials and methods

This cross-sectional descriptive study of care providers in a tertiary hospital in Nigeria was conducted from June to November, 2016. A self-administered structured questionnaire survey (QS) was used to assess PSC via 12 composites. Data were analysed using Statistical Package for Social Sciences version 22 and associations tested with Chi-square at p ≤ 0.05.

Results

Response rate is 87%, with a validity rate of 88%. Supervisor/manager expectations and actions promoting safety has the highest positive response of 70.7%, while Non-punitive response to error has the least, 43.1%. The overall PSC grade level is 62.3%. The knowledge of PSC is 54.5%, 54% never reports safety events. Knowledge of PSOP, Knowledge of the availability of PSU, Report of errors and Regular patient safety committee meetings (PSCM) influences the scores on four, three, two and seven PSC composite units ( p < 0.05 respectively).

Conclusions

This study finds an apparently fair overall PSC grade level. Knowledge of PSOP and availability of PSC unit, reports errors and regular PSCM positively influences PSC. There is need for composite targeted cum overall improvement on PSC in the setting.
Barriers to and facilitators of medication error reporting from the viewpoints of nurses and midwives working in gynecology wards of Tabriz hospitals
Authors: Mirghafourvand Mojgan , Hajizadeh Khadije , Kondori Jafar , Kamalifard Mahin , Bazaz Javid Ziba
Published: June 2021

Medication error reporting (MER) is an effective way to prevent their repetition in the future. The present study aimed to determine the frequency and factors associated with the causes of MEs and to identify barriers to and facilitators of MER. This descriptive-analytical cross- sectional study was conducted with proportional random sampling on 220 midwives or nurses working in public and private hospitals in Tabriz, Iran. In this study, data were collected using Haddon’s matrix. Data were analyzed using descriptive and inferential statistics. The prevalence of MEs in this study was 36.2%. The most common causes of MEs related to weakness of nurses, wards, management and physicians were nursing staff shortage (30.5%), ward work density (51.8%), low ratio of nurses and midwives per patient (70.7%), and illegible prescriptions (76.4%), respectively. Major barriers to MER reported by nurses and midwives were blaming the individual rather than the system (67.7%). Facilitators of MER were anonymous MRE system and feeling safe about working environment. Staff also reported that if reporting is beneficial (preventing future errors, correcting practice, increasing accountability), the odds of reporting MER will increase (54.5%). Given the underlying cause of MEs from the participants' point of view (staff shortage, fear of reprisal and reprimand), it is suggested that the system and health managers adopt appropriate strategies to reduce these important factors (reducing work density and creating a friendly environment).
Numerical study of non-isothermal analysis of exiting sheet thickness in the calendering of micropolar-Casson fluid
Authors: Abbas Zaheer , Khaliq Sabeeh
Published: June 2021

This theoretical analysis reports on the non-isothermal calendering process of micropolar-Casson fluid and studies the viscoplastic and microrotation effects by utilizing the lubrication approximation (LAT). Exact dimensionless velocity and pressure gradient solutions are achieved. Then a numerical integration technique determined other mechanical quantities. Implementing the finite difference approximations resolved the energy expression. Graphs show how material parameters influence the pressure, pressure gradient, leave-off distance, temperature distribution, force, and power function. Temperature distribution increases with increased coupling number N and decreased Casson parameter [Formula: see text]. Force and power function increase with increased coupling number and decreased Casson parameter. Both Casson and coupling number control the pressure distribution and exiting sheet thickness.
Light Guide Layer Thickness Optimization for Enhancement of the Light Extraction Efficiency of Ultraviolet Light–Emitting Diodes
Authors: Ye Zhi Ting , Cheng Yuan-Heng , Hung Li-Wei , Hsu Kung-Hsieh , Hu Yu Chang
Published: June 2021

Consider material machinability and lattice mismatch sapphire as substrates for the ultraviolet-C light-emitting diodes (UV-C LEDs) are commonly used, but their high refractive index can result in the total internal reflection (TIR) of light whereby some light is absorbed, therefore caused reducing light extraction efficiency (LEE). In this study, we propose a method to optimize the thickness of a sapphire substrate light guide layer through first-order optical design which used the optical simulation software Ansys SPEOS to simulate and evaluate the light extraction efficiency. AlGaN UV-C LEDs wafers with a light guide layer thickness of 150–700 μm were used. The simulation proceeded under a center wavelength of 275 nm to determine the optimal thickness design of the light guide layer. Finally, the experimental results demonstrated that the initial light guide layer thickness of 150 μm the reference output power of 13.53 mW, and an increased thickness of 600 um resulted in output power of 20.58 mW. The LEE can be increased by 1.52 times through light guide layer thickness optimization. We propose a method to optimize the thickness of a sapphire substrate light guide layer through first-order optical design. AlGaN UV-C LEDs wafers with a light guide layer thickness of 150–700 μm were used. Finally, the experimental results demonstrated that the LEE can be increased by 1.52 times through light guide layer thickness optimization.
Factors associated with the development of ocular candidiasis and ocular prognosis with echinocandin therapy for candidemia
Authors: Sakai Daiki , Matsumiya Wataru , Kusuhara Sentaro , Nakamura Makoto
Published: June 2021

Purpose

To evaluate the factors associated with the development of ocular candidiasis (OC) and ocular prognosis with echinocandin therapy for candidemia.

Methods

The medical records of 56 consecutive patients with a positive blood culture for Candida species between November 2016 and October 2019 were retrospectively reviewed. Information on patient characteristics, isolated Candida species, treatment details for candidemia, and ocular findings were extracted to identify factors associated with OC development.

Results

The leading pathogen of candidemia was Candida albicans (C.albicans) (41.1%). Of 56 patients, 18 (32.1%) were diagnosed with chorioretinitis, categorized as either probable (8 patients) or possible OC (10 patients). There was no case of endophthalmitis with vitritis. The incidence of probable OC was not significantly different between the groups treated with echinocandins and other antifungal drugs (15.2% vs. 11.1%, p = 1.00). In all probable OC cases, systemic antifungal therapy was switched from echinocandins to azoles, and no case progressed to endophthalmitis. A multivariate logistic analysis revealed that female sex (adjusted odds ratio [aOR], 8.93; 95% confidence interval [CI], 1.09–72.9) and C. albicans (aOR, 23.6; 95% CI, 1.8–281) were independent factors associated with the development of probable OC.

Conclusion

One-seventh of patients with candidemia developed probable OC. Given the evidence of female and C. albicans as the factors associated with OC development, careful ophthalmologic management is required with these factors, especially in candidemia. Although echinocandins had no correlation with OC development and did not lead to the deterioration of ocular prognosis, further investigation is required.
NUCOME: A comprehensive database of nucleosome organization referenced landscapes in mammalian genomes
Authors: Chen Xiaolan , Yang Hui , Liu Guifen , Zhang Yong
Published: June 2021

Background

Nucleosome organization is involved in many regulatory activities in various organisms. However, studies integrating nucleosome organization in mammalian genomes are very limited mainly due to the lack of comprehensive data quality control (QC) assessment and uneven data quality of public data sets.

Results

The NUCOME is a database focused on filtering qualified nucleosome organization referenced landscapes covering various cell types in human and mouse based on QC metrics. The filtering strategy guarantees the quality of nucleosome organization referenced landscapes and exempts users from redundant data set selection and processing. The NUCOME database provides standardized, qualified data source and informative nucleosome organization features at a whole-genome scale and on the level of individual loci.

Conclusions

The NUCOME provides valuable data resources for integrative analyses focus on nucleosome organization. The NUCOME is freely available at http://compbio-zhanglab.org/NUCOME.
Chemical map-based prediction of nucleosome positioning using the Bioconductor package nuCpos
Authors: Kato Hiroaki , Shimizu Mitsuhiro , Urano Takeshi
Published: June 2021

Background

Assessing the nucleosome-forming potential of specific DNA sequences is important for understanding complex chromatin organization. Methods for predicting nucleosome positioning include bioinformatics and biophysical approaches. An advantage of bioinformatics methods, which are based on in vivo nucleosome maps, is the use of natural sequences that may contain previously unknown elements involved in nucleosome positioning in vivo. The accuracy of such prediction attempts reflects the genomic coordinate resolution of the nucleosome maps applied. Nucleosome maps are constructed using micrococcal nuclease digestion followed by high-throughput sequencing (MNase-seq). However, as MNase has a strong preference for A/T-rich sequences, MNase-seq may not be appropriate for this purpose. In addition to MNase-seq-based maps, base pair-resolution chemical maps of in vivo nucleosomes from three different species (budding and fission yeasts, and mice) are currently available. However, these chemical maps have yet to be integrated into publicly available computational methods.

Results

We developed a Bioconductor package (named nuCpos) to demonstrate the superiority of chemical maps in predicting nucleosome positioning. The accuracy of chemical map-based prediction in rotational settings was higher than that of the previously developed MNase-seq-based approach. With our method, predicted nucleosome occupancy reasonably matched in vivo observations and was not affected by A/T nucleotide frequency. Effects of genetic alterations on nucleosome positioning that had been observed in living yeast cells could also be predicted. nuCpos calculates individual histone binding affinity (HBA) scores for given 147-bp sequences to examine their suitability for nucleosome formation. We also established local HBA as a new parameter to predict nucleosome formation, which was calculated for 13 overlapping nucleosomal DNA subsequences. HBA and local HBA scores for various sequences agreed well with previous in vitro and in vivo studies. Furthermore, our results suggest that nucleosomal subsegments that are disfavored in different rotational settings contribute to the defined positioning of nucleosomes.

Conclusions

Our results demonstrate that chemical map-based statistical models are beneficial for studying nucleosomal DNA features. Studies employing nuCpos software can enhance understanding of chromatin regulation and the interpretation of genetic alterations and facilitate the design of artificial sequences.
Functional examination of lncRNAs in allotetraploid Gossypium hirsutum
Authors: Wang Luyao , Han Jin , Lu Kening , Li Menglin , Gao Mengtao , Cao Zeyi , Zhao Ting , Chen Xue , Tao Xiaoyuan , Chen Quanjia , Guan Xueying
Published: June 2021

Background

An evolutionary model using diploid and allotetraploid cotton species identified 80 % of non-coding transcripts in allotetraploid cotton as being uniquely activated in comparison with its diploid ancestors. The function of the lncRNAs activated in allotetraploid cotton remain largely unknown.

Results

We employed transcriptome analysis to examine the relationship between the lncRNAs and mRNAs of protein coding genes (PCGs) in cotton leaf tissue under abiotic stresses. LncRNA expression was preferentially associated with that of the flanking PCGs. Selected highly-expressed lncRNA candidates (n = 111) were subjected to a functional screening pilot test in which virus-induced gene silencing was integrated with abiotic stress treatment. From this low-throughput screen, we obtained candidate lncRNAs relating to plant height and tolerance to drought and other abiotic stresses.

Conclusions

Low-throughput screen is an effective method to find functional lncRNA for further study. LncRNAs were more active in abiotic stresses than PCG expression, especially temperature stress. LncRNA XLOC107738 may take a cis-regulatory role in response to environmental stimuli. The degree to which lncRNAs are constitutively expressed may impact expression patterns and functions on the individual gene level rather than in genome-wide aggregate.
SLE strikes the heart! A rare presentation of SLE myocarditis presenting as cardiogenic shock
Authors: Raval Jaydeep J. , Ruiz Christina Rodriguez , Heywood James , Weiner Jason J.
Published: June 2021

Background

Although systemic lupus erythematosus (SLE) can affect the cardiovascular system in many ways with diverse presentations, a severe cardiogenic shock secondary to SLE myocarditis is infrequently described in the medical literature. Variable presenting features of SLE myocarditis can also make the diagnosis challenging. This case report will allow learners to consider SLE myocarditis in the differential and appreciate the diagnostic uncertainty.

Case presentation

A 20-year-old Filipino male presented with acute dyspnea, pleuritic chest pain, fevers, and diffuse rash after being diagnosed with SLE six months ago and treated with hydroxychloroquine. Labs were notable for leukopenia, non-nephrotic range proteinuria, elevated cardiac biomarkers, inflammatory markers, low complements, and serologies suggestive of active SLE. Broad-spectrum IV antibiotics and corticosteroids were initiated for sepsis and SLE activity. Blood cultures were positive for MSSA with likely skin source. An electrocardiogram showed diffuse ST-segment elevations without ischemic changes. CT chest demonstrated bilateral pleural and pericardial effusions with dense consolidations. Transthoracic and transesophageal echocardiogram demonstrated reduced left ventricular ejection fraction (LVEF) 45% with no valvular pathology suggestive of endocarditis. Although MSSA bacteremia resolved, the patient rapidly developed cardiopulmonary decline with a repeat echocardiogram demonstrating LVEF < 10%. A Cardiac MRI was a nondiagnostic study to elucidate an etiology of decompensation given inability to perform late gadolinium enhancement. Later, cardiac catheterization revealed normal cardiac output with non-obstructive coronary artery disease. As there was no clear etiology explaining his dramatic heart failure, endomyocardial biopsy was obtained demonstrating diffuse myofiber degeneration and inflammation. These pathological findings, in addition to skin biopsy demonstrating lichenoid dermatitis with a granular “full house” pattern was most consistent with SLE myocarditis. Furthermore, aggressive SLE-directed therapy demonstrated near full recovery of his heart failure.

Conclusion

Although myocarditis during SLE flare is a well-described cardiac manifestation, progression to cardiogenic shock is infrequent and fatal. As such, SLE myocarditis should be promptly considered. Given the heterogenous presentation of SLE, combination of serologic evaluation, advanced imaging, and myocardial biopsies can be helpful when diagnostic uncertainty exists. Our case highlights diagnostic methods and clinical course of a de novo presentation of cardiogenic shock from SLE myocarditis, then rapid improvement.
Mitral valve regurgitation and endocarditis triggered by a needle
Authors: Liu Chuanzhen , Liu Yan , Li Jianhua , Cao Guangqing
Published: June 2021

Background

Cardiac foreign bodies are extremely rare in clinical patients, especially when foreign bodies damage the internal structure of the heart coincidentally after they penetrate the heart.

Case presentation

Here, we report the case of a two-year-old girl whose heart was penetrated by a needle, which triggered mitral valve regurgitation and endocarditis. After a comprehensive inspection, accurate judgment and surgical preparation, we removed the needle and repaired her mitral valve. Fortunately, she recovered postoperatively.

Conclusion

From this case, we can know that when cardiac foreign bodies are suspected, ultrasound is an important inspection method. Moreover, the approaches for handling each such case are different depending on the associated injuries.
Predicting mortality in adult patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review
Authors: Tong-Minh Kirby , Welten Iris , Endeman Henrik , Hagenaars Tjebbe , Ramakers Christian , Gommers Diederik , van Gorp Eric , van der Does Yuri
Published: June 2021

Background

Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED.

Methods

We performed a systematic search using MEDLINE, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the prognostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. We did not define biomarker cut-off values in advance.

Results

We included 18 articles in which a total of 35 combinations of biomarkers and clinical scoring systems were studied, of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality.

Conclusion

The studies we found in this systematic review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis. Future studies should focus on clinical scoring systems which require a limited amount of clinical parameters, such as the qSOFA score in combination with a biomarker that is already routinely available in the ED.
A case of peritoneal dialysis-associated peritonitis caused by Rhodococcus kroppenstedtii
Authors: Kang Yi , Chen Yuxin , Zhang Zhifeng , Shen Han , Zhou Wanqing , Wu Chao
Published: June 2021

Background

Rhodococcus kroppenstedtii is an aerobic, gram-positive bacterium firstly identified in the environment, which has not been reported in human-related infection. Herein, we reported the first case of peritoneal dialysis (PD)-associated peritonitis caused by R. kroppenstedtii which was identified by whole genome sequencing.

Case presentation

A 69-year-old man was admitted to hospital with abdominal pain and fever. Over the last 2 years, he had been undergoing continuous ambulatory peritoneal dialysis (CAPD) due to end-stage renal disease. Clinical symptom and sign in combination with laboratory examinations supported the clinical diagnosis of PD-associated peritonitis. Thus, ceftizoxime and teicoplanin were empirically used after PD effluent was collected for bacterial culture. A gram-positive bacterium was found from the PD effluent culture, which could not be identified by either Vitek 2 Compact ANC card or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The strain was finally confirmed to be R. kroppenstedtii by whole genome sequencing (WGS) through the average nucleotide identity (ANI) analysis. With a continuous treatment with teicoplanin and imipenem for 15 days and intraperitoneal catheter removed, the infection symptom was improved evidenced by a normal body temperature, also with white blood cell count (WBC), procalcitonin (PCT) and C-reactive protein (CRP) dropped to normal levels. Peritoneal dialysis effluent culture showed a negative result. Then, hemodialysis and arteriovenous fistula angioplasty were performed, but the patient developed a progressive blood pressure loss, accompanied by multiple organ disorder, and died on Feb 25, 2020.

Conclusions

To the best of our knowledge, this is the first time to report a peritoneal dialysis-associated peritonitis caused by R. kroppenstedtii which was identified by average nucleotide identity analysis based on WGS.
It may cost an arm and a leg: workers value and occupational fatality rates in the U.S.
Authors: Klos Leah S. , Giordano Frank B. , Stoffregen Stacy A. , Azuma Miki C. , Lee Jin
Published: June 2021

Background

The present study aims to observe how societal indicators of workers’ values at the state-level are related to health and safety outcomes, particularly major injuries and fatalities in the U.S. Underscoring workforce flexibility and workability over workforce stability and safety might be indicative of the worth of workers which can be associated with occupational safety and health concerns.

Methods

Linear regression analysis with a log-transformed dependent variable was adopted to examine how the state-level indicators of worker value in terms of 1) minimum wage, using data from 2015; 2) average of workers’ compensations for the loss of an arm, hand, leg, or foot in 2015 were concurrently and prospectively associated with occupational fatality rates averaged across 2015, 2016 and 2017. Socioeconomic contextual variables such as education level, GDP per capita, and population at the state-level were controlled for.

Results

The present study showed that state-level quantitative indicators of how workers are valued at work, namely minimum wage and workers’ compensation benefits, were significantly and negatively associated with fatality rates in the following year.

Conclusions

The present study illustrates the gap in how workers are valued across the U.S. The study speaks to the importance of contextual factors regarding worker value, as they can affect outcomes of health and safety culminating at a state-level.
Comparison of electronic versus conventional assessment methods in ophthalmology residents; a learner assessment scholarship study
Authors: Hasani Hamidreza , Khoshnoodifar Mehrnoosh , Khavandegar Armin , Ahmadi Soleyman , Alijani Saba , Mobedi Aidin , Tarani Shaghayegh , Vafadar Benyamin , Tajbakhsh Ramin , Rezaei Mehdi , Parvari Soraya , Shamsoddini Sara , Silbert David I.
Published: June 2021

Background

Assessment is a necessary part of training postgraduate medical residents. The implementation of methods located at the “shows how” level of Miller’s pyramid is believed to be more effective than previous conventional tools. In this study, we quantitatively compared electronic and conventional methods in assessing ophthalmology residents.

Methods

In this retrospective study, eight different conventional methods of assessment including residents’ attendance, logbook, scholarship and research skills, journal club, outpatient department participation, Multiple Choice Question (MCQ), Objective Structured Clinical Examination (OSCE), and professionalism/360-degree (as one complex) were used to assess 24 ophthalmology residents of all grades. Electronic media consisting of an online Patient Management Problem (e-PMP), and modified electronic OSCE (me-OSCE) tests performed 3 weeks later were also evaluated for each of the 24 residents. Quantitative analysis was then performed comparing the conventional and electronic assessment tools, statistically assessing the correlation between the two approaches.

Results

Twenty-four ophthalmology residents of different grades were included in this study. In the electronic assessment, average e-PMP scores (48.01 ± 12.40) were much lower than me-OSCE (65.34 ± 17.11). The total average electronic score was 56.67 ± 11.28, while the total average conventional score was 80.74 ± 5.99. Female and male residents’ average scores in the electronic and conventional method were (59.15 ± 12.32 versus 83.01 ± 4.95) and (55.19 ± 10.77 versus 79.38 ± 6.29), respectively. The correlation between modified electronic OSCE and all conventional methods was not statistically significant (P-value >0.05). Correlation between e-PMP and six conventional methods, consisting of professionalism/360-degree assessment tool, logbook, research skills, Multiple Choice Questions, Outpatient department participation, and Journal club active participation was statistically significant (P-value < 0.05). The overall correlation between conventional and electronic methods was significant (P-value = 0.017).

Conclusion

In this study, we conclude that electronic PMP can be used alongside all conventional tools, and overall, e-assessment methods could replace currently used conventional methods. Combined electronic PMP and me-OSCE can be used as a replacement for currently used gold-standard assessment methods, including 360-degree assessment.
Current developments in delivering customized care: a scoping review
Authors: Minvielle Etienne , Fourcade Aude , Ricketts Thomas , Waelli Mathias
Published: June 2021

Background

In recent years, there has been a growing interest in health care personalization and customization (i.e. personalized medicine and patient-centered care). While some positive impacts of these approaches have been reported, there has been a dearth of research on how these approaches are implemented and combined for health care delivery systems. The present study undertakes a scoping review of articles on customized care to describe which patient characteristics are used for segmenting care, and to identify the challenges face to implement customized intervention in routine care.

Methods

Article searches were initially conducted in November 2018, and updated in January 2019 and March 2019, according to Prisma guidelines. Two investigators independently searched MEDLINE, PubMed, PsycINFO, Web of Science, Science Direct and JSTOR, The search was focused on articles that included “care customization”, “personalized service and health care”, individualized care” and “targeting population” in the title or abstract. Inclusion and exclusion criteria were defined. Disagreements on study selection and data extraction were resolved by consensus and discussion between two reviewers.

Results

We identified 70 articles published between 2008 and 2019. Most of the articles (n = 43) were published from 2016 to 2019. Four categories of patient characteristics used for segmentation analysis emerged: clinical, psychosocial, service and costs. We observed these characteristics often coexisted with the most commonly described combinations, namely clinical, psychosocial and service. A small number of articles (n = 18) reported assessments on quality of care, experiences and costs. Finally, few articles (n = 6) formally defined a conceptual basis related to mass customization, whereas only half of articles used existing theories to guide their analysis or interpretation.

Conclusions

There is no common theory based strategy for providing customized care. In response, we have highlighted three areas for researchers and managers to advance the customization in health care delivery systems: better define the content of the segmentation analysis and the intervention steps, demonstrate its added value, in particular its economic viability, and align the logics of action that underpin current efforts of customization. These steps would allow them to use customization to reduce costs and improve quality of care.
Effects of hospital funding reform on wait times for hip fracture surgery: a population-based interrupted time-series analysis
Authors: Pincus Daniel , Widdifield Jessica , Palmer Karen S. , Paterson J. Michael , Li Alvin , Huang Anjie , Wasserstein David , Lapointe-Shaw Lauren , Brown Adalsteinn , Taljaard Monica , Ivers Noah M.
Published: June 2021

Background

Health care funding reforms are being used worldwide to improve system performance but may invoke unintended consequences. We assessed the effects of introducing a targeted hospital funding model, based on fixed price and volume, for hip fractures. We hypothesized the policy change was associated with reduction in wait times for hip fracture surgery, increase in wait times for non-hip fracture surgery, and increase in the incidence of after-hours hip fracture surgery.

Methods

This was a population-based, interrupted time series analysis of 49,097 surgeries for hip fractures, 10,474 for ankle fractures, 1,594 for tibial plateau fractures, and 40,898 for appendectomy at all hospitals in Ontario, Canada between April 2012 and March 2017. We used segmented regression analysis of interrupted monthly time series data to evaluate the impact of funding reform enacted April 1, 2014 on wait time for hip fracture repair (from hospital presentation to surgery) and after-hours provision of surgery (occurring between 1700 and 0700 h). To assess potential adverse consequences of the reform, we also evaluated two control procedures, ankle and tibial plateau fracture surgery. Appendectomy served as a non-orthopedic tracer for assessment of secular trends.

Results

The difference (95 % confidence interval) between the actual mean wait time and the predicted rate had the policy change not occurred was − 0.46 h (-3.94 h, 3.03 h) for hip fractures, 1.46 h (-3.58 h, 6.50 h) for ankle fractures, -3.22 h (-39.39 h, 32.95 h) for tibial plateau fractures, and 0.33 h (-0.57 h, 1.24 h) for appendectomy (Figure 1; Table 3). The difference (95 % confidence interval) between the actual and predicted percentage of surgeries performed after-hours − 0.90 % (-3.91 %, 2.11 %) for hip fractures, -3.54 % (-11.25 %, 4.16 %) for ankle fractures, 7.09 % (-7.97 %, 22.14 %) for tibial plateau fractures, and 1.07 % (-2.45 %, 4.59 %) for appendectomy.

Conclusions

We found no significant effects of a targeted hospital funding model based on fixed price and volume on wait times or the provision of after-hours surgery. Other approaches for improving hip fracture wait times may be worth pursuing instead of funding reform.
Novel combined variants of WT1 and TET2 in a refractory and recurrent AML patient
Authors: Ma Qiang , Guo Yixian , Lan Xiaoxi , Wang Guoxiang , Sun Wanling
Published: June 2021

Background

Somatic mutations in Wilms' tumor 1 (WT1) and tet methylcytosine dioxygenase 2 (TET2) genes were separately perceived as contributors to hematopoietic disorders and usually thought to have a mutually exclusive effect in acute myeloid leukemia (AML). However, we found novel WT1 and TET2 variants persistently co-existed in a refractory and recurrent AML patient with t(9;11)(p21.3;q23.3); KMT2A-MLLT3, and were only detectable genetic alteration in early recurrence. Hence, these two novel variants were further investigated in patient’s family, and the potential effect on disease progression was evaluated at follow-up.

Case presentation

A 27-year-old male was diagnosed with AML, having t(9;11)(p21.3;q23.3); KMT2A-MLLT3, accompanied by WT1 (NM_024426.6:exon7:c.1109G>C:p.Arg370Pro) and TET2 (NM_001127208.3:exon11:c.5530G>A:p.Asp1844Asn) variants. After two cycles of induction chemotherapy, complete remission was achieved. A consolidation treatment was then completed. However, the evaluation of the bone marrow revealed that early recurrence, WT1 (p.Arg370Pro) and TET2 (p.Asp1844Asn) variants still detectable, instead of KMT2A-MLLT3. Subsequently, these two variants were proved to be germline variants, which inherited from father and mother respectively. And the patient's elder brother also carried TET2 (p.Asp1844Asn) variant. A sequential allogeneic HLA-matched sible hematopoietic stem cell transplantation (allo-HSCT) was carried out, and the donor is the patient's elder brother, the original two variants of patient were replaced by the donor-derived TET2 (p.Asp1844Asn) variant after allo-HSCT; the patient has remained in complete remission with regular follow-up.

Conclusions

In brief, it is firstly reported that WT1 p.Arg370Pro and TET2 p.Asp1844Asn variants co-existed in a refractory and recurrent AML patient by inheritance. These two variants of the patient were replaced with donor-derived TET2 p.Asp1844Asn after allo-HSCT, and the patient has remained in complete remission with regular follow-up.