bluuebunny/crossref_metadata_2025 huggingface dataset:
Abstract 14159: Characteristics and Outcomes in COVID-19 Pediatric In-Hospital Cardiac Arrest Patients
Authors: Lauridsen Kasper G , Sweberg Todd , Haskell Sarah E , Gawronski Orsola , Niles Dana E , Dewan Maya , Skellett Sophie , Duval-arnould Jordan M , Bottari Gabriella , Nadkarni Vinay M , Sen Anita
Published: December 2021

Introduction:
Survival of adult patients with COVID-19 who had an in-hospital cardiac arrest (IHCA) are poor. Characteristics and outcomes for pediatric IHCA patients with COVID-19 are unknown.

Hypothesis:
We hypothesized that pediatric COVID-19 patients would have worse survival outcomes when compared to non-COVID patients.

Methods:
A multicenter, multinational cohort of pediatric IHCA in the pediRES-Q collaborative were reviewed (March 1, 2020 - April 1, 2021). We characterized patients with COVID-19 compared to patients without COVID-19 and investigated whether COVID-19 was associated with survival outcomes using multivariate logistic regression with mixed effects.

Results:
We identified 362 pediatric IHCAs of which 14 were COVID-19 positive. For non-COVID-19 vs COVID-19 patients respectively, median [Q1; Q3] age was 1.0 [0.3; 7.1] vs. 7.1 [1.5; 14.0] years and 42% vs. 43% were female. Immediate cause of arrest was hypotension: 8% vs. 43%, respiratory decompensation: 19% vs. 21%, and hypoxia 22% vs. 36% for non-COVID-19 vs. COVID-19 patients. For non-COVID-19 vs COVID-19 patients, total CPR duration was 10 [4; 33] min vs 19 [5; 33] min (for non-return of spontaneous circulation (ROSC) cases only: 35 [20; 55] min vs 34 [24; 34] min). For non-COVID-19 vs COVID-19 patients, ROSC was 79% vs. 57%, aOR: 0.48 (95% CI: 0.24-0.98), survival to hospital discharge was 45% vs. 29%, aOR: 0.63 (95% CI: 0.25-1.57) and survival with favorable neurological outcome was 39% vs. 21%, aOR: 0.51 (95% CI: 0.16-1.65).

Conclusions:
In a pediatric resuscitation quality improvement collaborative, pediatric IHCA patients with COVID-19 were older when compared to non-COVID-19 patients. Median CPR duration was >30 minutes for COVID-19 non-survivors, COVID-19 patients had lower chance of ROSC when compared to non-COVID-19 patients but considerably better survival outcomes than those reported for adults.
Abstract 14218: Post-Cardiac Arrest Care Delivery Varies Widely Across Institutions Belonging to the PediRES-Q Collaborative
Authors: Barreto Jessica A , Wenger Jesse , Dewan Maya , Topjian Alexis A , Roberts Joan S
Published: December 2021

Introduction:
Despite national pediatric post-cardiac arrest care (PCAC) guidelines to improve survival and neurological outcomes, there are limited studies describing PCAC delivery in pediatric institutions. The objective of this study was to describe reported PCAC delivery in pediatric institutions. We hypothesized that there would be variability in PCAC processes across institutions.

Methods:
An IRB-approved REDCap survey was distributed electronically to the lead resuscitation investigator at each institution belonging to the international Pediatric Resuscitation Quality Improvement collaborative (PediRES-Q). Data were summarized using descriptive statistics. A chi-square test was used to compare categorical data.

Results:
Twenty-four of 47 centers completed the survey (51%). Most respondents (58%) belonged to large centers (≥1000 annual PICU admissions). Two-third (67%) of centers reported using no specific selection criteria to initiate PCAC with the other third employing order sets, paper forms, or institutional guidelines. Smaller centers (<1000 annual PICU admissions) more frequently reported the use of attending-directed care for PCAC initiation/delivery (80%) versus larger centers (57%), p = 0.04. Common PCAC targets included temperature (96%), glucose (75%), and age-based blood pressure (88%). Most PCAC included EEG (75%) but neuroimaging was only included at 46% of centers. Duration of PCAC was either tailored to clinical improvement and neurological exam (54%) or time-based (45%). Only 25% of centers reported having a mechanism for evaluating PCAC adherence. Common barriers to effective PCAC implementation included lack of time and limited training opportunities (Figure 1).

Conclusions:
There is wide variation in PCAC delivery among surveyed pediatric institutions. Targeting common themes such as standardization of PCAC initiation and bundle components and implementing adherence evaluation could improve PCAC.
Abstract 14456: Rethinking The Treatment Of Cardiac Arrest To Include Non-oxygen Metabolite Supplementation: Plasma Lysophosphatidylcholine Level Maintenance After Cardiac Arrest Is Critical For Survival
Authors: Shoaib Muhammad , Nishikimi Mitsuaki , Choudhary Rishabh , Yin Tai , Hayashida Kei , Miyara Santiago , Kim Nancy , Becker Lance B , Kim Junhwan
Published: December 2021

Cardiac arrest (CA) is a loss of circulation that curtails the supply of oxygen and non-oxygen metabolites to the whole body resulting in ischemia and death. Subsequent resuscitation is vital for survival, but also causes reperfusion injury. Oxygen deprivation as one arm of ischemia-reperfusion injury and its relationship with death is well-established, but its counterpart, metabolite dysfunction, is overlooked and poorly understood. We have previously shown that many metabolites are not normalized as efficiently or rapidly after resuscitation especially, particularly those that are severely decreased after CA. As such, we hypothesize that appropriate replenishment of certain metabolites is essential for survival. Lysophosphatidylcholine (LPC), an important family of phospholipids, is an example of such non-oxygen metabolites required post-CA. With multifactorial roles for maintaining homeostasis, such as acting as an energy substrate, maintaining membrane integrity, and functioning in inter- and intra-cellular signaling, decreased levels of LPC post-CA disrupts the various physiologic responsibilities resulting in profound systemic effects causing cellular and organ system injury. In this analysis, 1) phospholipid screening using HPLS-MS on plasma samples obtained from asphyxial-CA rats and human CA patients shows that LPC significantly decreases post-CA, especially during the reperfusion phase, and is strongly correlated with the duration of preceding CA and poor neurological/survival outcomes, and 2) individual supplementation of three species of LPC (LPC 18:0, LPC 18:1, and LPC 22:6) following resuscitation after 10 and 12 min rat CA helps improve survival and brain function as compared with vehicle. Overall, our study highlights that LPC is an essential, non-oxygen metabolite that is necessary to help promote survival after CA in rats that has therapeutic potential for human translation.
Abstract 14580: Methodological Challenges Conducting In Vitro Ischemia and Reperfusion: A Fundamental Problem in Cell Viability Determination
Authors: Miyara Santiago J , Shoaib Muhammad , Endo Yusuke , Choudhary Rishabh C , Hayashida Kei , Shinozaki Koichiro , Aoki Tomoaki , Kim Junhwan , Nishikimi Mitsuaki , Guevara Sara , Molmenti Ernesto P , Shore-lesserson Linda , Aronsohn Judith , Becker Lance B
Published: December 2021

Background:
Oxygen & Glucose Deprivation (OGD) and Reperfusion (OGD-R) is considered one of the best models for studying ischemia and reperfusion injury (IRI) in vitro. Cell viability (CV) experimentation can aid in estimating cell survival after IRI insults and potential benefits from therapeutic attempts. However, the different metabolites used in various CV assays may compromise the usefulness and validity of various CV tools. We conducted two independent cell viability assays (WST-8 & ATP) after OGD and OGD-R on neurons (NE) and astrocytes (AS).

Methods:
NE (HT-22) and AS (C8-D1A) were subjected to 6h OGD only and 6h OGD followed by 20h Reperfusion (OGD-R). OGD is based on the combination of chemical ischemia (standard culture media depleted of glucose and other energy sources) and severe hypoxia (O2 ~1.4 to 1.8%) for 6h, while 20h reperfusion consists of readdition of standard culture media and conditions (21% O2, 5% CO2, 37°C). CV was determined by WST-8 and ATP “CellTiter-Glo 2.0” assays.

Results:
By WST-8 assay, OGD decreased CV in NE (Fig. 1A, P value = 0.0121), but increased CV in AS (Fig. 1A, P value = 0.0079). OGD-R decreased CV in NE and AS (Fig. 2A, P value = 0.0010, 0.0146, respectively). By ATP assay, OGD decreased CV in NE (Fig. 1B, P value <0.0001) and AS (Fig. 1C, P value <0.0001). OGD-R also decreased CV in NE (Fig. 2B, P value <0.0001) and AS (Fig. 2C, P value = 0.0001).

Conclusions:
The current data reveals opposite CV results after OGD in AS when comparing WST-8 and ATP assays; OGD caused CV decrease in NE but increased in AS, which constitutes a paradoxical response based on previous literature. However, OGD-R caused similar injury patterns in NE and AS from WST-8 and ATP assays. It is unknown why OGD increased CV in AS through WST-8 after OGD, however, it can potentially occur due to AS hypermetabolism leading to increased NADPH+ production, which is the main substrate in this CV estimation. We conclude that CV should be carefully assessed with multiple, independent CV assays.
Abstract 16758: Unexplained Recurrent St-elevation Myocardial Infarction Complicated By Diffuse Alveolar Hemorrhage In Undiagnosed Granulomatosis With Polyangiitis
Authors: Benjanuwattra Juthipong , Mekraksakit Poemlarp , Abdelnabi Mahmoud
Published: December 2021

Case Presentation:
A 53-year-old man with a history of well-controlled hypertension and dyslipidemia presented with chest pain due to anterior STEMI for which a proximal LAD stent was placed. A week later, he presented with recurrent chest pain and ST elevation in the anterior chest leads. Coronary angiography showed in-stent thrombosis with heavy thrombus burden extending through the LAD. Manual thrombectomy with a second stent placement was done. He was discharged on triple therapy (aspirin, clopidogrel, and rivaroxaban), later, he presented to our medical facility with a 1-week history of hemoptysis. His clinical condition deteriorated requiring intubation. Laboratory work-up revealed elevated renal functions, proteinuria, and significant hematuria. CXR showed diffuse patchy opacities while CT chest was consistent with diffuse alveolar hemorrhage (Figure 1). Further work-up revealed elevated anti-proteinase 3 (c-ANCA) and low C4. Based on microscopic hematuria, renal impairment, and a positive c-ANCA, a diagnosis of granulomatosis with polyangiitis (GPA) was made. Induction with methylprednisolone, cyclophosphamide, and rituximab was initiated. His condition gradually improved, he was extubated successfully with marked improvement of renal functions. He was discharged on clopidogrel and scheduled for follow-up.

Discussion:
Few case reports have described STEMI as the initial presentation of GPA, likely attributed to vasculitis and accelerated atherosclerosis from systemic inflammation. Our patient had well-controlled cardiovascular risk factors and renal involvement with hematuria and elevated creatinine at the time of STEMI diagnosis, together with intermittent joint pains, suggesting ongoing systemic vasculitis. Clinicians should have a high index of suspicion for the possibility of non-atherosclerotic coronary stenosis as in cases of coronary vasculitis for early detection and management of a potentially reversible condition.
Abstract 17059: Ocrelizumab Induced Kounis Syndrome
Authors: Tanveer Ud Din Mian , Gajjar Kushani , Ivanova Valentyna
Published: December 2021

Kounis syndrome(KS), first described in 1991, is defined as concurrence of acute coronary syndrome and anaphylactic events. Primary mechanism of KS is interaction of mast cells with T-lymphocytes and macrophages via multidirectional stimuli leading to platelets activation.

Case presentation:
A 35 y.o. tennis coach with multiple sclerosis is admitted to the medical ICU with anaphylaxis after receiving Ocrelizumab infusion. Vital signs on presentation are significant for hypotension with blood pressure of 69/30 mm Hg, sinus tachycardia to 110 bpm and hypoxia with SatO2 88% on room air. Other investigations including chest x-ray, EKG and blood work are unrevealing for secondary pathological process outside of anaphylaxis. She undergoes fluid resuscitation followed by epinephrine drip for persistent hypotension. In addition methylprednisolone, famotidine and diphenhydramine are administered. She requires escalating doses of epinephrine and subsequently develops chest pain with troponin elevation to 0.29 ng/ml and EKG concerning for new ST depression and T wave inversion in II, III, aVF, V2 - V6 leads. Urgent echocardiography revealed normal biventricular function with no wall motion abnormalities and is only significant for moderate MR. Given excellent underlying functional capacity and no underlying cardiac risk factors, she was treated for Kounis syndrome by treating underlying anaphylaxis and weaning epinephrine as able with additional fluid resuscitation. Her chest pain resolved and EKG normalized with eventual discontinuation of epinephrine. Repeat echocardiography revealed preserved left ventricular (LV) function and mild MR.

Discussion:
KS is not a rare disease but easily overlooked and infrequently diagnosed. Our patient had the type I variant: endothelial dysfunction or microvascular angina in absence of cardiac risk factors. Inflammatory mediators can cause vasospasm and catecholamines used for treatment may potentiate it therefore requiring thoughtful dosing and appropriate duration of treatment. Prompt recognition is crucial for appropriate management of anaphylatic shock followed by that of ACS if LV function declines or risk factors for cardiac disease are present.
Abstract 17081: End Stage Mitochondrial Cardiomyopathy And Heart Transplantation Due To Pathogenic Biallelic C1QBP Variants
Authors: Wilcox Nicholas S , Prenner Stuart , Cevasco Marisa , Condit Courtney , Goldstein Amy , Peterson James T , Owens Anjali T , Pieretti Janice , Drivas Theodore , Reza Nosheen
Published: December 2021

Case Presentation:
A 29-year-old male with LVH diagnosed in childhood was admitted with acute HF. TTE showed LVEF 5-10% and LV thrombi for which he was anticoagulated. He received inappropriate ICD shocks due to T wave oversensing, leading to cardiogenic shock requiring VA-ECMO support. Serum lactate peaked at 17 mmol/L due to cardiac and metabolic decompensation. He underwent heart transplantation (HT) on hospital day (HD) 8 and tolerated standard immunosuppression. First endomyocardial biopsy showed acute cellular rejection requiring pulse steroids. He was discharged on HD 33. Trio whole exome and mitochondrial genome sequencing revealed biallelic variants in complement component 1Q subcomponent-binding protein (
C1QBP
), due to a maternally inherited likely pathogenic variant c.612C>G (p.F204L in exon 5) and an apparently de novo deletion of 17p13.2, spanning exons 4-6 of
C1QBP
and exon 6 of the
RPAIN
gene. Mitochondrial genome sequencing of the explanted heart revealed multiple large-scale mitochondrial DNA deletions at 33% heteroplasmy.

Discussion:
C1QBP
variants are associated with mitochondrial and multi-organ dysfunction. Only 12 patients exhibiting biallelic
C1QBP
variants are reported. Four died in the peripartum period due to fetal hydrops or HF; 5 exhibited early-onset cardiomyopathy (CM); 3 others had late-onset ophthalmoplegia without CM. The p.F204L variant has been reported in 1 patient with compound
C1QBP
p.F204L/p.C186S heterozygosity who died from hydrops fetalis and a second with p.F204L homozygosity with late-onset ophthalmoplegia and skeletal myopathy without CM. Differences in the size, heteroplasmy, and tissue distribution of mitochondrial genome secondary deletions may explain variability in disease onset and progression. We present the first patient with biallelic pathogenic
C1QBP
gene variants with mitochondrial CM to undergo HT and highlight the diagnosis and management of an exceptionally uncommon genetic disorder.
Abstract 17180: Complications Of A Severe Case Of Multisystem Inflammatory Syndrome In Children
Authors: Sganga Danielle , Maskatia Shiraz A
Published: December 2021

Case Presentation:
A 10 year old male with prior COVID-19 exposure presented with 7 days of fever, rash, cough, vomiting, and hypotension. Laboratory evaluation was notable for SARS-CoV2 antibodies, elevated cardiac enzymes, BNP, and inflammatory markers. Initial echocardiogram showed normal cardiac function and a small LAD coronary aneurysm. He was diagnosed with Multisystemic Inflammatory Syndrome in Children (MIS-C) and given methylprednisolone and IVIG. Within 24 hours, he developed severe LV dysfunction and progressive cardiorespiratory failure requiring VA-ECMO cannulation and anticoagulation with bivalirudin. Cardiac biopsy demonstrated lymphocytic infiltration consistent with myocarditis. On VA-ECMO, he had transient periods of complete AV block. With immunomodulator treatment (anakinra, infliximab) and 5 days of plasmapheresis, inflammatory symptoms and cardiac function improved. He weaned off ECMO, and anticoagulation was transitioned to enoxaparin. He had left sided weakness 5 days later, and brain MRI revealed an MCA infarct. Ten days later, he had focal right sided weakness and repeat MRI showed multiple hemorrhagic cortical lesions, thought to be thromboembolic with hemorrhagic conversion secondary to an exaggerated inflammatory response to an MSSA bacteremia in the setting of MIS-C. Enoxaparin was discontinued. After continued recovery and a slow anakinra and steroid wean, he has normal coronary arteries, cardiac function, and baseline ECG but requires ongoing neurorehabilitation.

Discussion:
COVID-19 infection in children is often mild, but MIS-C is an evolving entity that can present with a wide range of features and severity. This case highlights two concepts. While first degree AV block is often reported in MIS-C, there is potential for progression to advanced AV block. Close telemetry monitoring is critical, especially if there is evidence of myocarditis. MIS-C shares features with Kawasaki disease, with a notable difference being a higher likelihood of shock and cardiac dysfunction in MIS-C. In MIS-C patients with cardiovascular collapse requiring ECMO, there is a risk for stroke. There should be a low threshold for neuroimaging and multidisciplinary effort to guide anticoagulation in these complex cases.
Abstract 17250: Novel Association Of Left Ventricular Outflow Tract Obstructions With Chromosome 5p Deletions
Authors: Mascho Kira , Yatsenko Svetlana , Lin Jiuann-huey I
Published: December 2021

Case Presentation:
Patient 1: Female infant diagnosed with Cri du Chat Syndrome (CdCS) (Fig. 1A), hypoplastic left heart syndrome variant (Fig. 1 B), duodenal atresia (Fig. 1 E, F), IUGR. Chromosomal microarray (CMA) showed a 4.3 Mb deletion at 5p15.33 (Fig. 1A) and a 32.2 Mb duplication of 5q32. Dysmorphisms including hypertelorism, low set ears, and micrognathia were noted. Echocardiogram showed a hypoplastic left ventricle, mitral valve dysplasia (Fig. 1B), dysplastic aortic valve (Fig. 1C), interrupted aortic arch (Fig. 1D). Patient 2: Male infant prenatally diagnosed with aortic valve stenosis, aortic arch hypoplasia (Fig. 1H, I), and IUGR. Multiple dysmorphic features including microcephaly, hypertelorism, down slanting palpebral fissures, and abnormal distal extremities. CMA revealed a large deletion at 5p13.33-p13.2 (Fig 1G). He underwent aortic valvuloplasty complicated by development of a posterior left ventricular wall pseudoaneurysm (Fig. 1J). He later underwent arch reconstruction. At 2 months of age, he was diagnosed with obstructive jaundice requiring a biliary drain (Fig.1K, L). He had been gaining weight and height steadily (Fig.1M, N). We identified 5 more patients with 5p deletions and left outflow tract obstructions (LVOTO) from the Cytogenomics of Cardiovascular Malformations Consortium (Table 1).

Discussion:
CdCS is the most common 5p deletion syndrome and is associated with mild congenital heart defects in 15-30% of individuals. There is no reported association between LVOTO and 5p deletions. These 7 patients did not all share the same deletions and had high mortality. Further studies are needed to better understand possible genetic etiologies.
Abstract 8894: Post-Resuscitation Diastolic Blood Pressure is a Better Predictive Factor for Outcomes of Cardiac Arrest Patients
Authors: Chi ChienYu , Chang Herman Chih-Heng , Tsai Min-Shan , HUANG CHIEN-HUA
Published: December 2021

Introduction:
Post-resuscitation hemodynamic level was associated with outcomes. Our study hypothesized that post-resuscitation diastolic blood pressure (DBP) was a better predictive factor for outcomes.

Methods:
Starting from TaIwan Network of Targeted Temperature ManagEment for CARDiac Arrest (TIMECARD) registry, we recruited 540 adult patients who received target temperature management (TTM) during January 2014 and September 2019. After excluding 37 patients with pre-arrest cerebral performance categories scale (CPC) 3-4 and 55 patients with extracorporeal membrane oxygenation support, 448 patients were analyzed. Patient’s characteristics, comorbidities, resuscitation factors, arrest etiologies, systolic blood pressure (SBP) and DBP after resuscitation were included for analysis. Primary outcomes were survival of discharge (SOD) and discharge with favorable neurologic outcomes (CPC 1-2). Univariate and multivariate analysis were performed to identify favorable predictors. Predictive values of SBP and DBP for both outcomes were compared by calculating area under receiver operating characteristic (AUC).

Results:
Among 448 patients, 182 (40.7%) patients had SOD and 89 (19.9%) patients had CPC 1-2. DBP was significantly higher in patients with SOD (p<0.001) and CPC 1-2 (p=0.003). In multivariate analysis, DBP was also an independent factor for SOD (p=0.004) and CPC 1-2 (p =0.048). When comparing SBP and DBP, DBP was a better predictor for CPC 1-2 (SBP AUC: 0.58 vs DBP AUC: 0.64, p=0.003). In subgroup analysis, DBP > 80 served as a favorable predictor for both SOD and CPC 1-2. When comparing patients with DBP <80 and SBP >80, patients with higher DBP values had significantly higher percentage of cardiac etiologies arrest and relative higher percentage of initial shockable rhythm.

Conclusion:
DBP is a better hemodynamic parameter than SBP for predicting outcomes. In multivariate model, DBP > 80 was an independent predictor for better survival and favorable neurologic outcomes.
Abstract 9439: Invasive Evaluation of Left Ventricular Hemodynamics with Veno-Arterial Extracorporeal Membrane Oxygenation
Authors: Kalra Rajat , Alexy Tamas , Bartos Jason , Elliott Andrea M , Prisco Anthony , Kosmopoulos Marinos , Maharaj Valmiki , Garcia Santiago , Raveendran Ganesh , Yannopoulos Demetris
Published: December 2021

Introduction:
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a frequently used hemodynamic support strategy, but considerable debate exists about its hemodynamic effects. We evaluated changes in left ventricular (LV) function, volumes, and work in patients treated with VA-ECMO using invasive LV catheterization and three-dimensional echocardiographic volumes.

Methods:
In this case series, patients underwent evaluation due to persistent vasoplegia or poor LV function despite treatment with VA-ECMO. Hemodynamic parameters were reported as medians with interquartile ranges. Paired comparisons were done to evaluate hemodynamics at the baseline (highest) and lowest tolerated levels of VA-ECMO support.

Results:
Six patients aged 53.5 (41.8, 57.8) years were included. Three patients received VA-ECMO for refractory cardiogenic shock and three patients for extracorporeal cardiopulmonary resuscitation. The baseline LV ejection fraction was 22.1% (19.0%, 24.7%). The baseline and lowest VA-ECMO flows were 4.0 (4.0, 4.0) L/min and 1.0 (1.0, 1.5) L/min, respectively. Compared to the lowest flow, full VA-ECMO support reduced LV end-diastolic volume [116 (90, 153) versus 94 (58, 119) mL, p=0.03], LV end-diastolic pressure [16 (12, 24) versus 14 (9,15) mmHg, p=0.03], LV stroke work [2640 (1800, 4275) versus 1953 (759, 2179) mL*mmHg, p=0.03], and pressure-volume area [6864 (4038, 7715) versus 4575 (3142, 5888) mL*mmHg; p=0.046], respectively. The pressure-volume curves at the highest and lowest VA-ECMO flows are represented in blue and red, respectively (
Figure
). Mean arterial pressure and heart rate were similar at the lowest and highest flows (p=0.17 and p=0.60, respectively). All patients were decannulated from VA-ECMO. Four survived the index hospitalization.

Conclusion:
High flow VA-ECMO support significantly reduced LV end-diastolic volume, end-diastolic pressure, stroke work, and pressure-volume area compared to low flow.
Abstract 9450: Shockable Rhythm at Hospital Arrival as the Predictor of Favorable Neurological Outcome in Out-of-Hospital Cardiac Arrest Patients Receiving Extracorporeal Cardiopulmonary Resuscitation
Authors: Su Pei-I
Published: December 2021

Introduction:
For OHCA patients without ROSC under standard ALS, extracorporeal cardiopulmonary resuscitation (ECPR) was the only chance. However, ECPR was invasive and costed tremendous resources. This study aimed to analyze the predictor of favorable neurological outcome at hospital discharge (FO, cerebral performance category 1-2).

Hypothesis:
In OHCA patients receiving ECPR, shockable rhythm at hospital arrival could serve as predictor of FO.

Method:
This was a single center retrospective study which enrolled 126 OHCA patients receiving ECPR between January 2012 to December 2019. Primary outcome was FO at hospital discharge. Predictors of FO were assessed by multiple logistic regression. Patients with initial shockable rhythm were analyzed according to the cardiac rhythm at hospital arrival.

Result:
Among OHCA patients receiving ECPR, FO at hospital discharge was 21%. Certain variables were associated with FO: witnessed collapse (P=0.014), bystander CPR (P=0.05), shorter no flow time(P=0.008), and shockable rhythm at hospital arrival (78% vs. 49%;P=0.009). Initial shockable rhythm did not differ significantly (85% vs. 71% ;P=0.15). Multiple logistic regression showed that shockable rhythm at hospital arrival was the only predictor of FO (OR, 3.012; 95% CI, 1.06-8.53; P=0.038). Patients with initial shockable rhythm represented a heterogenous group. The group with shockable rhythm at hospital arrival had 30% of FO, which was significantly higher than 17% in PEA group, and 6% in asystole group (Graph 1). Patients who remained shockable had higher percentage of witnessed arrest, shorter arrest-hospital time, less metabolic disturbance, and hence higher percentage of FO.

Conclusion:
In OHCA patients receiving ECPR, shockable rhythm at hospital arrival could predict favorable neurological outcome at discharge more precisely than initial shockable rhythm. ECPR selection criteria should take the rhythm at hospital arrival into consideration.
Abstract 9876: Optimizing Public Naloxone Kit Locations Through Mathematical Modeling
Authors: Leung K.H. Benjamin , Grunau Brian , Lee May K , Buxton Jane , Helmer Jennie , Van Diepen Sean , Christenson Jim , Chan Timothy
Published: December 2021

Introduction:
Use of bystander-administered naloxone may lead to improved likelihood of recovery from opioid overdose. We sought to determine the accessibility of public access naloxone kits on nearby opioid overdose incidents if placed at public transit stops, compared to placing kits outside pharmacies or with existing public access automated external defibrillators (PADs).

Methods:
We included all incidents in Metro Vancouver, British Columbia responded to by British Columbia Emergency Health Services coded as a drug overdose with naloxone administered on-scene (Dec. 2014 to Aug. 2020). We geo-coded all public transit bus stops and used a mathematical optimization model to select bus stops where publicly accessible naloxone kits could be placed to maximize accessibility (defined as ≤100 m walking distance) to opioid overdoses. We evaluated accessibility on out-of-sample OHCAs using five-fold cross validation and compared against two baseline policies: placing publicly accessible naloxone kits at all pharmacies identified by the College of Pharmacists of British Columbia, and placing kits at all PADs identified by the British Columbia AED Registry. Statistical analysis was conducted using McNemar’s test.

Results:
We identified 14,318 opioid overdoses, 8,972 bus stops, 736 pharmacies, and 425 PADs. Accessibility of public naloxone kits for opioid overdose locations was 5.1% when placed at all pharmacies and 3.5% when placed with all existing PADs. Optimized naloxone kit placement using bus stops as candidate locations resulted in significantly higher accessibility than both pharmacy and PAD-based placement at 14.8% with 10 optimized locations (P<0.001), increasing to 36.7% with 500 locations (P<0.001).

Conclusion:
Optimizing placement of public access naloxone kits at select public transit locations can provide significantly higher accessibility to opioid overdose locations compared to placement at pharmacies or at existing PAD locations.
Convolution-Based Model-Solving Method for Three-Dimensional, Unsteady, Partial Differential Equations
Authors: Zha Wenshu , Zhang Wen , Li Daolun , Xing Yan , He Lei , Tan Jieqing
Published: December 2021

Neural networks are increasingly used widely in the solution of partial differential equations (PDEs). This letter proposes 3D-PDE-Net to solve the three-dimensional PDE. We give a mathematical derivation of a three-dimensional convolution kernel that can approximate any order differential operator within the range of expressing ability and then conduct 3D-PDE-Net based on this theory. An optimum network is obtained by minimizing the normalized mean square error (NMSE) of training data, and L-BFGS is the optimized algorithm of second-order precision. Numerical experimental results show that 3D-PDE-Net can achieve the solution with good accuracy using few training samples, and it is of highly significant in solving linear and nonlinear unsteady PDEs.
Bridging the Gap Between Neurons and Cognition Through Assemblies of Neurons
Authors: Papadimitriou Christos H. , Friederici Angela D.
Published: December 2021

During recent decades, our understanding of the brain has advanced dramatically at both the cellular and molecular levels and at the cognitive neurofunctional level; however, a huge gap remains between the microlevel of physiology and the macrolevel of cognition. We propose that computational models based on assemblies of neurons can serve as a blueprint for bridging these two scales. We discuss recently developed computational models of assemblies that have been demonstrated to mediate higher cognitive functions such as the processing of simple sentences, to be realistically realizable by neural activity, and to possess general computational power.
Validation of the Modified Rhinoplasty Assessment Scale (Photographic)
Authors: Bayrak Sinehan B. , Penn Joseph , Hu Jinxiang , David Kriet John , Humphrey Clinton D.
Published: December 2021

Objective:

To validate the modified Rhinoplasty Assessment Scale (Photographic) (mRASP).

Study Design:

Retrospective cohort study.

Methods:

Study design—Photographs for 100 rhinoplasty patients from 2 facial plastic surgeons were compiled. Photos included 6 views. Each facial plastic surgeon reviewed all views. Nasal appearance was evaluated using the mRASP. Statistical analysis—A validation study was conducted, including descriptive statistics, reliability, and construct validity. Mean and standard deviations were used to describe the scores.

Results:

Eighty female (mean RASP score = 14.89, SD = 7.04) and 20 male (mean RASP score = 19.83, SD = 10.09) patients were included. The mean of the total score on the instrument was 15.88 (SD = 7.98). Cronbach’s alpha was .81, and inter-rater reliability measured as a Pearson product-moment correlation was .74. The CFA model fit the frontal view (χ2 = 32.47 ( P = .04), CFI = .99, TLI = .99, RMSEA = .05, SRMR = .05), basal view (χ2 = 4.55 ( P = .33), CFI = .98, TLI = .96, RMSEA = .03, SRMR = .23), and lateral view (χ2 = 39.52 ( P = .40), CFI = 1.0, TLI = 1.0, RMSEA = .0, SRMR = .05) data well.

Conclusion:

The mRASP is a reliable instrument that can be used to assess nasal form via frontal, lateral, and basal photographs of patients. This provides facial plastic surgeons with a validated tool to evaluate rhinoplasty outcomes.
Multicultural Classrooms: Culturally Responsive Teaching Self-Efficacy among A Sample of Canadian Preservice Teachers
Authors: Chahar Mahali Saghar , Sevigny Phillip R.
Published: December 2021

Many teachers enter classrooms with limited cross-cultural awareness and low levels of confidence to accommodate cultural diversity. Therefore, teaching a heterogeneous body of students requires teachers to have culturally responsive teaching self-efficacy (CRTSE). The investigation of factors impacting teachers’ self-efficacy in teaching diverse students has produced mixed results. The purpose of the current study was to explore the determinants of CRTSE in a sample of Canadian preservice teachers. One hundred and ten preservice teachers from a medium-sized public Canadian University completed measures of political orientation, CRTSE, cross-cultural experiences, and teacher burnout. Higher levels of preservice teachers’ CRTSE were predicted by lower levels of Emotional Exhaustion (i.e., a key aspect of burnout syndrome) and more frequent cross-cultural experiences in their childhood and adolescence. Implications for training preservice teachers are discussed.
HBCUs Matter: A Review of Behavioral Health at Historically Black Colleges and Universities
Authors: Asher BlackDeer Autumn , Beeler-Stinn Sara , Patterson Silver Wolf David A. , Van Schuyver Jenifer
Published: December 2021

Nearly one-fourth of all undergraduate degrees received by Black students are from historically Black colleges and universities (HBCUs). HBCUs have both historical significance and present-day relevance in the promotion of Black excellence in higher education, especially in the consideration of behavioral health. The purpose of this work is to examine the present state of research surrounding behavioral health within HBCUs. A scoping review was conducted of the EbscoHost database, yielding a total of 252 articles. A total of 39 articles met the inclusion criteria and were examined within this work. Six studies informed the prevalence of behavioral health issues on campus, while the remaining articles covered a broad range of research from psychological and physical wellbeing, sexual health, violence, identity, and ideology, and finally programs and policies. Gaps and future recommendations for research and practice are discussed.
“I Have No Words”: A Qualitative Study About the Traumatic Experience of Violent Death
Authors: Bolaséll Laura Teixeira , Castro da Cruz Oliveira Vitoria , Frimm Vitor Corrêa , Menda Cynthia Castiel , Maria Rodrigues Caroline Santa , Kristensen Christian Haag
Published: December 2021

Individuals bereaved by violent death have a higher risk of developing psychopathology. Consistent data concerning the subjective experience during the traumatic event of the death are still scarce. This study aimed to explore the traumatic experience of the violent death of a loved one. Nine reports of patients bereaved by violence were selected and transcribed. Reports were analyzed using Bardin’s Content Analysis. Two final categories were generated. It was observed that most participants remembered details about the traumatic event or the time they were told about the violent death. There were two factors described as important when coping with the loss, social support during the traumatic event, and receiving detailed information from the authorities and others present in that moment. This study provides relevant data for future interventions during violent situations by health and security professionals.
Effects of Low Back Pain Exercises on Pain Symptoms and Activities of Daily Living: A Systematic Review and Meta-Analysis
Authors: Zhang Shi-kun , Yang Yong , Gu Mei-ling , Mao Su-jie , Zhou Wen-Sheng
Published: December 2021

Our objective in this paper was to systematically review evaluations of the effects of exercises on pain symptoms and activities of daily living (ADL) in middle-aged and elderly patients with low back pain (LBP). We searched Web of Science, PubMed, EBSCO, and China National Knowledge Internet (CNKI) databases for randomized controlled trials (RCTs) on this topic. We evaluated the methodological quality of included articles using the Physiotherapy Evidence Database (PEDro) scale, and we statistically analyzed these studies using RevMan software. We reviewed 18 RCTs (23 comparison groups) with a total of 910 participants, and our meta-analysis confirmed that exercises significantly improved both pain and ADLs measured on visual analog scales (VAS) (SMD = −0.91, 95% CI: [−1.3, −0.52], p < 0.00001) and on the Oswestry Disability Index (ODI) (SMD = −2.07, 95% CI: [−3.19, −0.96], p < 0.00001). We conclude that exercises can reduce pain severity and improve ADL capacity in middle-aged and elderly persons with LBP, confirming that exercise can serve as a medical intervention for these indivdiuals. However, given the high heterogeneity of responses among individual participants, there remains a need for further study.
The secret of egg white fabric: an investigation of its fabrication and properties
Authors: Yao Mei Yu , Lau Yin Shan , Li Li
Published: December 2021

The egg white fabric of the Dong Minority exemplifies their wisdom and represents rich regional features. It is renowned for its superior properties, especially its fabulous luster and excellent handle. However, the production method is rarely documented and instead has been handed down mostly by oral communication, and thus it is shrouded in mystery. In addition, due to low economic efficiency, a secret prescription and the challenges brought about by modern technology, this unique ethnic costume is threatened by extinction. Should this traditional handicraft be preserved or sacrificed? In this study, the secret of egg white fabric is solved by investigating its fabrication and properties. It is obvious that making egg white fabric involves complicated handiwork and numerous processes, including dyeing, fixation, brightening and starching; nevertheless, it has good physical properties. The experimental results indicated that egg white fabric has excellent texture, good thermal insulation, abrasion property and color fastness to laundering. Hence, this provides valuable inspiration for designers and manufacturers to produce unique and sustainable products.
Mental State of Students During the Pandemic and Affecting Factors: A Cross-Sectional Study
Authors: Nehir Sevgi , Gungor Tavsanli Nurgul
Published: December 2021

Evaluation of the psychological symptoms in healthcare students and the development of new strategies to improve their mental health are of great importance. The study was aimed at determining the mental state of students, prospective healthcare workers, during the pandemic, and the influencing factors. The descriptive cross-sectional study was conducted at a Manisa Celal Bayar University Faculty of Health in Turkey. The sociodemographic characteristics questionnaire, Fear of COVID-19 Scale, and Brief Symptom Inventory were used to collect data. The study was conducted with 828 students. In study, variables such as sleep, negative news about COVID-19, sex, income status, presence of social support, department students attend, choosing the profession willingly, and having a physical/mental illness were determined to have an effect on the mental state. The results of this study suggest that there is a relationship between the fear of COVID-19 and mental health state of the students.
A Qualitative Focus Group Study for the Exploration of Knowledge and Attitudes of Informal Caregivers Toward Breast Cancer: Perceptions of Informal Caregivers and Healthcare Professionals in Three European Countries
Authors: Tsitsi Theologia , Christou Andri , Christodoulou-Fella Maria , Beccati Sara , Boccaletti Licia , Palermo Alessia , Alves José , Teixeira Ana , Charalambous Andreas
Published: December 2021

Breast cancer (BC) early screening and detection is a main component for the outcome of the treatment and overall survival. Informal caregivers (ICGs) are less likely to initiate early BC screening methods and utilize health services. The purpose of this study was to explore ICGs’ knowledge and perceptions, including educational and training opportunities or barriers, in promoting early detection practices for BC, as well as healthcare professionals’ (HCP) respective perceptions concerning ICGs in order to identify the need of selected health literacy interventions. A qualitative focus group study was implemented in 3 European countries, using a purposive sampling technique. In total, 26 ICGs and 18 HCPs were involved. The themes that emerged from the focus groups interviews included knowledge, perceptions, attitudes, and beliefs concerning BC; motivational factors and barriers that influence early screening practices and personal involvement. Motivators and barriers concerning BC screening adherence were linked to knowledge, beliefs and perceptions. Health promotion strategies and user-friendly tools should be developed, targeting on the implementation of BC early detection practices among informal caregivers.
Bioabsorbable dressing impregnated with betamethasone and ciprofloxacin after endoscopic sinus surgery: A randomized, double-blind, placebo-controlled study
Authors: Wierzchowska Małgorzata , Kalińczak-Górna Paulina , Grześkowiak Błażej , Radajewski Kamil , Burduk Jakub , Burduk Paweł
Published: December 2021

Background

In addition to its hemostatic and stabilization role, biodegradable nasal packing can be used as a carrier for drugs after functional endoscopic sinus surgery (FESS). The aim of this study was to compare the influence of biodegradable synthetic polyurethane foam (NasoPore) soaked with ciprofloxacin, or betamethasone, or both to the same foam soaked with saline after FESS.

Methods

120 adults with chronic rhinosinusitis, with and without polyps, directed for bilateral full-house FESS were enrolled for the study. The patients were randomized and blinded into 3 groups, depending on the type of postoperative procedure applied. Thus, NasoPore soaked with antibiotic was provided to the first group; in the second group, the steroid was used; and the combination of both, in the third group. In each case, the aforementioned procedure was administered on one side of the nose, while NasoPore was soaked in saline on the other, at the end of the surgery, respectively. The patients were requested to complete a questionnaire during their postoperative visits at 2, 10, 30, 90, and 180 days, scoring the level of complaints on the VAS scale, separately for each side. The evaluation of the healing process was performed at each visit using rigid endoscopy and subsequently rated on numerical scales.

Results

Decreased mucosal edema and secretion; reduced Lund-Kennedy score; and favorable influences on facial pressure, nasal blockage, and smell were most evidently seen in the group receiving the antibioticsteroid combination.

Conclusions

The application of biodegradable nasal packing with betamethasone and ciprofloxacin in sino-nasal surgery has positive effects not only on the healing process but also impacts patient’s comfort. To optimize it, however, further research is needed.
Proteomic Analysis of Subchronic Furan Exposure in the Liver of Male Fischer F344 Rats
Authors: Gill Santokh , Kavanagh Meghan , Poirier Christine , Xie Ruixi , Koerner Terry
Published: December 2021

Furan is a volatile compound formed during the thermal processing of foods. Chronic exposure has been shown to cause cholangiocarcinoma and hepatocellular tumors in rodent models. We conducted a 90 day subchronic study in Fisher 344 rats exposed to various doses by gavage to determine the NOAEL. Previous reports have outlined changes in the liver using gross necropsy examination, histopathology, clinical biochemistry, hematology, immunohistochemistry, and toxicogenomics. The data revealed that males were more sensitive than females. The focus of this study was to evaluate the toxicoproteomic changes by 2-dimensional differential in gel electrophoresis followed by mass spectrometry analysis. To compliment previous studies, protein expression changes were evaluated of male animals after 90 days of exposure to doses of 0, 0.03, 0.5, and 8.0 mg/kg bw/d. Significant statistical treatment-related changes compared to the controls identified 45 protein spots containing 38 unique proteins. Proteins identified are implicated in metabolism, redox regulation, protein folding/proteolysis as well as structural and transport proteins. At lower doses, multiple cytoprotective pathways are activated to maintain a homeostasis but ultimately the loss of protein function and impairment of several pathways could lead to adverse health effects at higher doses of furan administration.
Sensory Deprivation and Psychiatric Disorders: Association, Assessment and Management Strategies
Authors: Sahoo Swapnajeet , Naskar Chandrima , Singh Ajaypal , Rijal Rika , Mehra Aseem , Grover Sandeep
Published: December 2021

Background:

Sensory deprivation (SD) is a widely prevalent condition that leads to various health-related consequences and is also an important cause of disability worldwide. Earlier, SD experiments were used as research modalities to alter human behavior. In recent years, the focus has shifted to understand how SD can affect the mental health of individuals (with congenital or acquired sensory impairments). This narrative review focuses on the current understanding about the association of SD and psychiatric disorders.

Methods:

A comprehensive literature search was done PubMed, Scopus, PsycINFO, and Google Scholar and in the cross-references of relevant articles. Keywords included “sensory deprivation,” “blindness,” “deafness,” “mental illness,” “psychiatric disorders,” “prevalence,” “assessment,” and “management” in various combinations. Only original articles (abstract and full text) published in English till October 2020 were included.

Results:

The prevalence of anxiety, depression, dementia, suicidality, and psychosis in persons with SD is higher than the general population (highest being in persons with dementia with comorbid SD). Several mechanisms/hypotheses have been proposed to explain these associations. Assessment of SD includes a thorough history taking, with adequate awareness about the difficulties faced during a psychiatric interview in this population. Modifications in the psychometric assessment procedures are warranted. Management depends on a multi-disciplinary approach that includes proper referral to specialties, pharmacological management (depending on diagnosis as well as taking care of ototoxic/ocular side-effect profile of the drugs), and nonpharmacological supportive measures.

Conclusions:

SD is a complex condition, and evidence suggests that persons with SD have higher psychiatric morbidity. A comprehensive assessment, along with holistic management approach is warranted.
Pierre Bourdieu: E-Special Issue Introduction
Authors: Robbins Derek
Published: December 2021

This e-special issue explores the reception of Bourdieu’s work in one journal, Theory, Culture & Society, which commenced at about the same time that Bourdieu was beginning to acquire an international reputation. It offers a case-study of the English representation of Bourdieu’s work through almost 40 years and focuses on the role of the journal in carrying Bourdieu’s work across cultural boundaries. It introduces the scope of that work but, primarily, it is designed to encourage reference to his texts in the contexts of their production and reception in order to invite new reflection and new evaluation in relation to contemporary problems.