bluuebunny/crossref_metadata_2025 huggingface dataset:
Quantitative Detection and Monitoring of Colletotrichum siamense in Rubber Trees Using Real-Time PCR
Authors: Du Yannan , Wang Meng , Zou Lijun , Long Mingteng , Yang Ye , Zhang Yu , Liang Xiaoyu
Published: April 2021

Colletotrichum siamense is one of the most important pathogens of rubber trees in Asia. The proper detection and quantification of C. siamense populations in rubber trees are of importance for monitoring the epidemics of the disease. In this study, we developed an internal transcribed spacer-based real-time PCR method to efficiently detect C. siamense infecting rubber trees, which reliably detected as little as 100 fg of genomic DNA, 100 copies of target DNA, and 20 conidia. The real-time PCR protocol recognized all C. siamense isolates collected from three provinces in China, whereas no amplification was observed with the rubber tree and its other pathogens. Detection and quantification of C. siamense were performed in artificially and naturally infected rubber leaves. We could still detect C. siamense in plant mixes, of which only 0.0001% of the tissue was infected. An accumulation of C. siamense DNA was observed during the whole infection process at all three leaf phenological stages, suggesting that the real-time PCR method can be used to monitor C. siamense development in rubber trees. Finally, the method allowed the detection of C. siamense in naturally infected and symptomless leaves of rubber trees in the fields. Compared with earlier detection methods, the real-time PCR method is more specific and more sensitive, and it will be of great use for studies aiming to gain a better understanding of the epidemiology of Colletotrichum leaf disease, as well as the prediction of disease risk and proposals to control it.
Aureoverticillactam, a Potent Antifungal Macrocyclic Lactam from Streptomyces aureoverticillatus HN6, Generates Calcium Dyshomeostasis-Induced Cell Apoptosis via the Phospholipase C Pathway in Fusarium oxysporum f. sp. cubense Race 4
Authors: Wang Lan-Ying , Zhang Yun-Fei , Yang De-You , Zhang Shu-Jing , Han Dan-Dan , Luo Yan-Ping
Published: April 2021

Extensive efforts have been made to discover new biofungicides of high efficiency for control of Fusarium oxysporum f. sp. cubense race 4, a catastrophic soilborne phytopathogen causing banana Fusarium wilt worldwide. We confirmed for the first time that aureoverticillactam (YY3) has potent antifungal activity against F. oxysporum f. sp. cubense race 4, with effective dose for 50% inhibition (EC50) of 20.80 μg/ml against hyphal growth and 12.62 μg/ml against spore germination. To investigate its mechanism of action, we observed the cellular ultrastructures of F. oxysporum f. sp. cubense race 4 with YY3 treatment and found that YY3 led to cell wall thinning, mitochondrial deformities, apoptotic degradation of the subcellular fractions, and entocyte leakage. Consistent with these variations, increased permeability of cell membrane and mitochondrial membrane also occurred after YY3 treatment. On the enzymatic level, the activity of mitochondrial complex III, as well as the ATP synthase, was significantly suppressed by YY3 at a concentration >12.50 μg/ml. Moreover, YY3 elevated the cytosolic Ca2+ level to promote mitochondrial reactive oxygen species (ROS) production. Cell apoptosis also occurred as expected. On the transcriptome level, key genes involved in the phosphatidylinositol signaling pathway were significantly affected, with the expression level of Plc1 increased approximately fourfold. The expression levels of two apoptotic genes, casA1 and casA2, were also significantly increased by YY3. Of note, phospholipase C activation was observed with YY3 treatment in F. oxysporum f. sp. cubense race 4. These findings indicate that YY3 exerts its antifungal activity by activating the phospholipase C calcium-dependent ROS signaling pathway, which makes it a promising biofungicide.
Strategies for Transfer From Methadone to Buprenorphine for Treatment of Opioid Use Disorders and Associated Outcomes: A Systematic Review
Authors: Lintzeris Nicholas , Mankabady Baher , Rojas-Fernandez Carlos , Amick Halle
Published: April 2021

Objectives:

To review the currently available evidence on transfer strategies from methadone to sublingual buprenorphine used in clinical trials and observational studies of medication for opioid use disorder treatment, and to consider whether any strategies yield better clinical outcomes than others.

Methods:

Six medical and public health databases were searched for articles and conference abstracts. The Cochrane Central Register of Controlled Trials and the World Health Organization International Clinical Trials Registry Platform were used to identify unpublished trial results. Records were dually screened, and data were extracted and checked independently. Results were summarized qualitatively and, when possible, analyzed quantitatively.

Results:

Eighteen studies described transfer from methadone to buprenorphine. Transfer protocols were extremely varied. Most studies reported successful rates of transfer, even among studies involving transfer from high methadone doses, although lower pretransfer methadone dose was significantly associated with higher rate of successful transfer. Precipitated withdrawal was not reported frequently. A range of innovative approaches to transfer from methadone to buprenorphine remains untested.

Conclusions:

Few studies have used designs that enable comparison of different approaches to transfer patients from methadone to buprenorphine. Most international clinical guidelines provide recommendations consistent with the available evidence. However, clinical guidelines should be perceived as providing “guidance” rather than “protocols,” and clinicians and patients need to exercise judgment when attempting transfers.
Blood Prestin Levels in Normal Hearing and in Sensorineural Hearing Loss: A Scoping Review
Authors: Iliadou Eleftheria , Kikidis Dimitrios , Pastiadis Konstantinos , Plack Christopher J. , Bibas Athanasios
Published: April 2021

Objectives:

Recently, it has been hypothesized that blood prestin concentration levels may reflect cochlear damage and thus serve as an easily measurable, early sensorineural hearing loss (HL) biomarker. This is a scoping review aiming to identify and critically appraise current evidence on prestin blood levels and their temporal variation in rodents and humans with normal hearing and with sensorineural HL.

Design:

This study was designed and held according to PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. With no limitation with regards to study type, animal and human studies focusing on prestin blood levels in normal hearing and in sensorineural HL were sought in major databases such as Medline, Central Scopus, PROSPERO, and Clinicaltrials.gov. Results were then hand-searched. A data charting form was developed including the parameters of interest.

Results:

Seven studies focusing on measuring prestin blood levels by means of ELISA in rodents and human subjects with normal hearing and noise-induced, drug-induced, or idiopathic sudden HL were found eligible and were included in the analysis. According to these proof-of-concept studies, prestin can be detected in the circulation of subjects with no HL; however, normal ranges remain unclear. After cochlear damage, blood prestin levels seem to initially rise and then return to near or below baseline. The degree of their change relates with subjects’ degree of HL, damaged cochlear region and recovery. Prestin blood levels and their temporal variation seem to correlate with cochlear damage; however, methodological weaknesses, such as small sample size, lack of detailed phenotyping, insufficient exclusion of confounding factors, and short follow-up, do not allow for robust conclusions.

Conclusions:

Current findings support the value of studying blood prestin levels in normal hearing and HL and highlight a need for larger-scale longitudinal research.
Humeral Head Ossification Growth Prediction: Can This Method Be Reproduced?
Authors: Lopyan Alexander H. , Gagnier Joel J. , Gagnet Paul , Wallace Nicholas , Stepanovich Matthew , Farley Frances , Li Ying
Published: April 2021

Background:

Radiographically assessing skeletal maturity is of paramount importance to guide appropriate management for patients with adolescent idiopathic scoliosis. The reported advantages of the Humeral Head Ossification System (HHOS) are an even distribution around peak growth age (PGA), the presence of an optimal view of the humeral head in most scoliosis radiographs, and an interobserver and intraobserver reliability of 0.95 and 0.96, respectively. The goal of this study was to determine whether similar reliability could be achieved at an institution other than the one at which the HHOS was originally described.

Methods:

Six raters used the HHOS to stage the humeral head on 30 deidentified posteroanterior spine radiographs. This process was repeated 2 weeks later. All raters were provided with a document demonstrating the radiographic parameters of each stage, as well as annotations to aid with classification. Intraclass coefficients were calculated. A secondary analysis was then performed grouping stages 1-2 as “pre-PGA” and 3-5 as “post-PGA.”

Results:

Fair to moderate interobserver and intraobserver reliability was achieved when determining each individual HHOS stage. This improved to good to excellent when the humeral was classified as pre-PGA or post-PGA. Subanalysis did not show any correlation between intraobserver reliability and level of orthopaedic experience.

Conclusions:

We found fair to moderate interobserver and intraobserver reliability with the HHOS and this was independent of level of orthopaedic experience. This is much lower than reported by the authors who developed the system, and suggests that the HHOS might not be as easy to incorporate into a scoliosis management algorithm as previously noted. The improved reliability achieved when staging the humeral head as pre-PGA or post-PGA might be the true benefit of this system.

Level of Evidence:

Level III—diagnostic.
Safety of Tumescent Liposuction Under Local Anesthesia in 9,002 Consecutive Patients
Authors: Boeni Roland , Waechter-Gniadek Paul v.
Published: April 2021

BACKGROUND

Liposuction has become one of the most popular aesthetic procedures today. Among the different anesthesia methods, tumescent local anesthesia (TLA) has been shown to be the safest. Liposuction is typically performed as an outpatient procedure under minimal oral sedation and without the need for any intravenous (IV) fluid administration.

OBJECTIVE

To record complications in a larger series of patients undergoing liposuction in TLA.

MATERIALS AND METHODS

Between 2003 and 2020, 9,002 consecutive patients underwent liposuction in TLA with the same team of surgeons. The occurrence of complications was recorded in detail.

RESULTS

There were neither fatal complications nor damage to deeper structures such as nerves, blood vessels, muscles, lungs, abdominal organs, nor permanent lymphedema. A total of 19 of the following side effects, mainly minor, required closer follow-up or intervention: allergic drug reaction to doxycycline (0.06%), seroma (0.04%), large hematoma (0.03%), erysipelas (0.02%), transient acrocyanosis (0.02%), deep vein thrombosis (0.01%), skin necrosis (0.01%), and generalized edema (0.01%)

CONCLUSION

Liposuction in TLA is a reliable and safe procedure if it is performed by an experienced surgeon and the guidelines of care are strictly followed.
Prospective Clinical Trial of the Latest Generation of Noninvasive Monopolar Radiofrequency for the Treatment of Facial and Upper Neck Skin Laxity
Authors: Angra Kunal , Alhaddad Marwan , Boen Monica , Lipp Michael B. , Kollipara Ramya , Hoss Elika , Goldman Mitchel P.
Published: April 2021

BACKGROUND

Aging of the face and upper neck is a complex process characterized by loss of collagen and elastic fibers, resulting in clinical skin laxity. Noninvasive interventions such as monopolar capacitively coupled radiofrequency (MRF) have gained popularity, offering a safer and more convenient alternative to traditional surgical face lift. The latest MRF device features larger tips, vibration, cooling, and impedance matching.

OBJECTIVE

We performed the first open-label clinical trial, measuring the efficacy, safety, and patient satisfaction of this device for noninvasive lifting and tightening of the face and upper neck.

MATERIALS AND METHODS

Forty subjects 30 to 60 years of age with mild/moderate skin laxity of the face and upper neck were enrolled. After pretreatment with ketorolac 60 mg intramuscular injection, subjects underwent treatment with MRF. Follow-up evaluations were performed on Days 30, 60, and 180.

RESULTS

Our study demonstrated that the newest generation MRF produced statistically significant improvement in skin laxity 6 months post-treatment, especially in the jowls and melolabial folds. According to the Investigator Global Aesthetic Improvement Score, 73% of subjects had improvement at 6 months post-treatment. Subject satisfaction and improvement questionnaires supported these findings.

CONCLUSION

Our data coupled with the excellent adverse effect profile validates MRF as an attractive treatment modality for facial and upper neck skin laxity.
Moisture Response Films Versus the Starch Iodine Test for the Detection of Palmar Hyperhidrosis
Authors: Shehadeh Waseem , Bar-Ilan Efrat , Mehrabi Joseph N. , Sprecher Eli , Artzi Ofir
Published: April 2021

BACKGROUND

The starch iodine test (SIT) is the gold-standard diagnostic tool for primary palmar hyperhidrosis (PPH).

OBJECTIVE

This study aimed to evaluate the clinical effectiveness and safety profile of a novel approach for the detection of PPH by moisture response films (MRF) in comparison to the SIT.

METHODS

This prospective comparative study of the 2 tests was conducted on 17 patients with PPH. Disease severity was evaluated by the SIT and the MRF methods during 4 sessions (twice before and twice after botulinum toxin [BTX] injections) on different days and by different investigators. The physician's global assessment (PGA) scoring of the comparable visual results was evaluated by 2 blinded independent dermatologists. The Hyperhidrosis Disease Severity Scale (HDSS) scores of the patients at baseline and after the BTX injections were correlated with the SIT and MRF results.

RESULTS

The objective PGA scoring of the SIT results demonstrated poor correlation, whereas the objective PGA scoring of the MRF results correlated highly with the patients' HDSS scores both at baseline and after the BTX injections.

CONCLUSION

Analysis of palmar hyperhidrosis by means of MRF was superior to SIT and was demonstrated to be more efficient, convenient, and accurate.
Early Experience With Ahmed Clear Path Glaucoma Drainage Device in Childhood Glaucoma
Authors: Elhusseiny Abdelrahman M. , VanderVeen Deborah K.
Published: April 2021

Purpose:

The aim was to evaluate the short-term outcomes of Ahmed clear path (ACP) valveless glaucoma drainage device in childhood glaucoma.

Methods:

Retrospective chart review of all patients 16 years or below with childhood glaucoma who had ACP implantation at Boston Children’s Hospital from December 2019 to June 2020 with at least 6 months follow-up period.

Results:

The study included 7 eyes of 5 patients implanted by a single surgeon. The median follow-up was 12 months. The mean intraocular pressure (IOP) was reduced from 36±3.5 mm Hg on a mean of 2.7±0.6 glaucoma medications preoperatively to a mean IOP of 12.4±2.8 mm Hg (P<0.001) on a mean of 0.7±0.8 medications postoperatively at final follow-up (P=0.0009). Complete success was achieved in 4 eyes while qualified success was achieved in 3 eyes.

Conclusion:

The ACP glaucoma drainage device provided good short-term IOP control and technical advantages for implantation for pediatric eyes were observed.
Challenges in the Triage Care of Low-Risk Laboring Patients
Authors: Breman Rachel Blankstein , Phillippi Julia C. , Tilden Ellen , Paul Julie , Barr Erik , Carlson Nicole
Published: April 2021

Triage and the timing of admission of low-risk pregnant women can affect the use of augmentation, epidural, and cesarean. The purpose of this analysis was to explore these outcomes in a community hospital by the type of provider staffing triage. This was a retrospective cohort study of low-risk nulliparous women with a term, vertex fetus laboring in a community hospital. Bivariate and multivariable statistics evaluated associations between triage provider type and labor and birth outcomes. Patients in this sample (N = 335) were predominantly White (89.5%), with private insurance (77.0%), and married (71.0%) with no significant differences in these characteristics by triage provider type. Patients admitted by midwives had lower odds of oxytocin augmentation (adjusted odds ratio [aOR] = 0.50, 95% confidence interval [CI] = 0.29-0.87), epidural (aOR = 0.29, 95% CI = 0.12-0.69), and cesarean birth (aOR = 0.308, 95% CI = 0.14-0.67), compared with those triaged by physicians after controlling for patient characteristics and triage timing. This study provides additional context to midwives as labor triage providers for healthy, low-risk pregnant individuals; however, challenges persisted with measurement. More research is needed on the specific components of care during labor that support low-risk patients to avoid medical interventions and poor outcomes.
Clinically and Culturally Competent Care for Transgender and Nonbinary People
Authors: Roosevelt Lee K. , Pietzmeier Sarah , Reed Robinson
Published: April 2021

Transgender and nonbinary people experience high rates of discrimination and stigma in healthcare settings, which have a deleterious effect on their health and well-being. While the preventative healthcare needs of transgender and gender nonbinary people are slowly starting to make their way into nursing curriculum, there is still a very little guidance on how to appropriately and respectfully care for this population during one of the most vulnerable interactions with the healthcare system, the perinatal period. Without exposure or education, nurses are challenged on how to provide compassionate and culturally competent care to transgender and nonbinary people. The focus of this review is to provide guidance to nurses caring for transgender and gender nonbinary people during the perinatal period. Terminology and respectful language, a discussion around the decision to parent, affirming approaches to physical examination, and care during pregnancy and the postpartum period are all discussed. By increasing the number of nurses who are trained to deliver high-quality and affirming care to transgender and nonbinary patients, challenging health inequities associated with provider discrimination can be mitigated.
Meeting the Challenge of Perinatal Care in Rural Communities
Authors: Barton Amy J. , Anderson Jessica L.
Published: April 2021

The complexities of providing quality perinatal care within rural communities provide significant challenges to providers and policy makers. Provision of healthcare in rural communities is challenging on individual as well as community-based levels. A quality improvement lens is applied to consider key challenges that pertain to patients, providers, place, and policy. Potential solutions from a provider perspective include nurse-midwifery care and inclusion of advanced practice providers in a variety of specialties in addition to creating care models for registered nurses to practice at the top of their scope. To enhance access in the rural place, telehealth and coordination activities are recommended. Finally, policy approaches such as Perinatal Care Collaboratives, Area Health Education Centers, and enhanced financial resources to eliminate socioeconomic disparities will enhance perinatal care in rural communities.
Current Key Challenges in Managing Maternal Sepsis
Authors: Roberts Emily , McMurtry Baird Suzanne , Martin Stephanie
Published: April 2021

Sepsis resulting from maternal infection is the second leading cause of pregnancy-related death. Although screening and initial care of a septic nonpregnant patient is standardized in nonpregnant adults, many challenges exist for early recognition and management of sepsis and septic shock in the obstetric population. Because most sepsis research excludes pregnant patients, there are many challenges that contribute to a lack of standardized approach to maternal sepsis. These challenges include inconsistent early warning sign criteria, lack of validated screening tools, adaptation of bundle components for maternal physiology, delivery considerations, and knowing when to transfer the patient to a higher level of care. To overcome these challenges, reduce variation in care, and improve patient outcomes, it is important for clinicians to plan, practice, and implement a maternal sepsis bundle.
Tissue Preservation Techniques for Bone-Anchored Hearing Aid Surgery
Authors: Holmes Sean , Hamiter Mickie , Berry Camille , Mankekar Gauri
Published: April 2021

Objective:

Compare outcomes of surgical techniques in percutaneous bone-anchored hearing implant surgery.

Study Design:

Matched retrospective cohort study.

Setting:

Tertiary referral center.

Patients:

Electronic review of adult and pediatric patients who underwent bone conduction device surgery by either the Minimally-invasive Ponto Surgery (MIPS) technique or the linear incision with no soft tissue removal (LnSTR) technique or between August 2015 and April 2018 at our facility.

Intervention:

Patients in MIPS group underwent Minimally invasive Ponto Surgery (MIPS) technique, while those in LnSTR group underwent LnSTR technique.

Main Outcome Measure:

Major outcome was presence/severity of localized skin reaction. Secondary outcomes included cosmetic outcome, revision surgery, minor adverse events, device utilization, and postoperative aided speech recognition thresholds (SRTs) across 250 to 4000 Hertz (Hz).

Results:

Fifty patients met inclusion criteria. There was a significantly lower rate of localized cutaneous reactions for the MIPS group (4.5%) compared with LnSTR group (33.3%; p = 0.026). Rate of revision surgery was significantly less for MIPS (13.6%) compared with LnSTR (20.8%; p = 0.008). Occurrence of poor cosmetic outcome was noted significantly less for the MIPS group (9.1%) compared with LnSTR patients (20.8%; p = 0.005). Minor adverse events and aided SRTs were comparable between groups.

Conclusions:

MIPS leads to a statistically significant decrease in localized cutaneous reaction compared with LnSTR. Both the LnSTR and MIPS techniques are safe and effective in the treatment of hearing loss, however MIPS may be superior in certain cases by offering improved healing, decreasing needs for wound care, and possibly decreasing need for frequent follow up.
Risk Factors for Facial Nerve and Other Nonauditory Side Effects Following Cochlear Implantation
Authors: Alnafjan Fadwa , Hasan Zubair , Sanli Halit , da Cruz Melville J.
Published: April 2021

Objective:

The purpose of this study was to characterize a cohort of patients with nonauditory side-effects (NASx) following cochlear implant (CI) surgery.

Study Design:

Retrospective case review.

Setting:

Tertiary referral center.

Patients:

One hundred twenty three multichannel CI recipients with intraoperative facial nerve stimulation (FNS).

Intervention(s):

Intraoperative electrical auditory brainstem responses (eABR) during CI surgery.

Main Outcome Measure(s):

Nonauditory side effects post-CI activation.

Results:

Intraoperative FNS was identified in 2.26% of patients (123/5441), of whom, 34% (42/123) experienced VII stimulation on CI activation. Pain was experienced by 22% (27/123) and vestibular dysfunction was experienced by 4% (5/123) of cases. All case who experienced pain and/or vestibular NASx also experienced VII stimulation. The majority of cases were managed by CI remapping or observation and habituation.

Significant relationships were found between etiology of hearing loss and presence of FNS upon initial activation (p < 0.05). No significance was found between FNS intraoperatively and at initial activation for all assumed mechanisms of hearing loss (p > 0.05) with the exceptions of acquired hearing loss of undetermined etiology and toxic etiology group (p < 0.05).

There was no significant impact of implant array design (p > 0.05).

Conclusions:

This study has characterized patients with NASx in a large cohort of CI patients. One third of cases identified with FNS intraoperatively, developed NASx post-CI activation. Risk factors for NASx postactivation include high-risk etiologies and intraoperative objective measures (i.e., eABR). This may assist surgeons and audiologists to identify at-risk patients who may need modifications in CI program planning.
Driving pressure monitoring during acute respiratory failure in 2020
Authors: Chen Lu , Jonkman Annemijn , Pereira Sérgio M. , Lu Cong , Brochard Laurent
Published: April 2021

Purpose of review

Assess the most recent studies using driving pressure (DP) as a monitoring technique under mechanical ventilation and describe the technical challenges associated with its measurement.

Recent findings

DP is consistently associated with survival in acute respiratory failure and acute respiratory distress syndrome (ARDS) and can detect patients at higher risk of ventilator-induced lung injury. Its measurement can be challenged by leaks and ventilator dyssynchrony, but is also feasible under pressure support ventilation. Interestingly, an aggregated summary of published results suggests that its level is on average slightly lower in patients with coronavirus disease-19 induced ARDS than in classical ARDS.

The DP is easy to obtain and should be incorporated as a minimal monitoring technique under mechanical ventilation.
How to monitor cardiovascular function in critical illness in resource-limited settings
Authors: Sivakorn Chaisith , Schultz Marcus J. , Dondorp Arjen M.
Published: April 2021

Purpose of review

Hemodynamic monitoring is an essential component in the care for critically ill patients. A range of tools are available and new approaches have been developed. This review summarizes their availability, affordability and feasibility for hospital settings in resource-limited settings.

Recent findings

Evidence for the performance of specific hemodynamic monitoring tools or strategies in low-income and middle-income countries (LMICs) is limited. Repeated physical examination and basic observations remain a cornerstone for patient monitoring and have a high sensitivity for detecting organ hypoperfusion, but with a low specificity. Additional feasible approaches for hemodynamic monitoring in LMICs include: for tissue perfusion monitoring: urine output, skin mottling score, capillary refill time, skin temperature gradients, and blood lactate measurements; for cardiovascular monitoring: echocardiography and noninvasive or minimally invasive cardiac output measurements; and for fluid status monitoring: inferior vena cava distensibility index, mini-fluid challenge test, passive leg raising test, end-expiratory occlusion test and lung ultrasound. Tools with currently limited applicability in LMICs include microcirculatory monitoring devices and pulmonary artery catheterization, because of costs and limited added value. Especially ultrasound is a promising and affordable monitoring device for LMICs, and is increasingly available.

A set of basic tools and approaches is available for adequate hemodynamic monitoring in resource-limited settings. Future research should focus on the development and trialing of robust and context-appropriate monitoring technologies.
The association of body temperature with antibiotic therapy and mortality in patients attending the emergency department with suspected infection
Authors: Schuttevaer Romy , Brink Anniek , Alsma Jelmer , de Steenwinkel Jurriaan E.M. , Verbon Annelies , Schuit Stephanie C.E. , Lingsma Hester F.
Published: April 2021

Background and importance

Previous studies found that septic patients with normothermia have higher mortality than patients with fever. We hypothesize that antibiotic therapy is less frequently initiated if infectious patients present with normothermia to the emergency department (ED).

Objectives

To examine the association of body temperature with the initiation of antibiotic therapy in patients attending the ED with suspected and proven infection. Additionally, the association of temperature with 30-day mortality was assessed.

Design, settings and participants

We conducted a retrospective cohort study between 2012 and 2016 at a tertiary university hospital. Adult patients attending the ED with a blood culture taken (i.e. suspected infection) and a positive blood culture (i.e. proven bacteremia) were included.

Exposure

Tympanic temperature at arrival was categorized as hypothermia (<36.1°C), normothermia (36.1–38.0°C) or hyperthermia (>38.0°C).

Outcome measures and analysis

Primary outcome was the initiation of antibiotic therapy. A secondary outcome was 30-day mortality. Multivariable logistic regression was used to control for covariates.

Main results

Of 5997 patients with a suspected infection, 45.8% had normothermia, 44.6% hyperthermia and 5.6% hypothermia. Patients with hyperthermia received more often antibiotic therapy (53.5%) compared to normothermic patients (27.6%, adjusted odds ratio [95% confidence interval], 2.59 [2.27–2.95]). Patients with hyperthermia had lower mortality (4.7%) than those with normothermia (7.4%, adjusted odds ratio [95% confidence interval], 0.50 [0.39–0.64]). Sensitivity analyses in patients with proven bacteremia (n = 934) showed similar results.

Conclusion

Normothermia in patients presenting with infection was associated with receiving less antibiotic therapy in the ED compared to presentations with hyperthermia. Moreover, normothermia was associated with a higher mortality risk than hyperthermia.
Impact of Obstetric Emergency High-Fidelity Simulation on Maternity Nurses' Self-Efficacy in the Rural Hospital Setting
Authors: Ehmke Sabrina , Swan Marilyn , Van Gelderen Stacey , Bourdeanu Laura
Published: April 2021

Purpose:

The purpose of this study was to explore the impact of an obstetric emergency high-fidelity simulation on maternity nurses' perceived self-efficacy levels at three different time points.

Study Design:

We used a quasi-experimental, repeated measures design.

Methods:

A convenience sample of maternity nurses recruited from three institutions within a single rural health care system participated in simulation exercises at an academic high-fidelity simulation center. They completed the Obstetric Nursing Self Efficacy survey before, immediately after, and 2 months following the simulation.

Results:

Twenty-nine nurses were included in the analysis. All were women and Caucasian. Most (72.4%) had a baccalaureate nursing degree, with an average nursing experience of 11 years (range 1 to 44 years), and <5 years of OB experience (55.1%). Self-efficacy scores were 55.62 (SD = 9.8), 58.93 (SD = 8.9), and 61.86 (SD = 9.5) for pre-, post-, and 2 months postsimulation, respectively. There were significant changes from self-efficacy scores before the simulation when compared with scores 2 months after the simulation (p < 0.001), with a medium effect size of .45.

Clinical Implications:

High-fidelity simulation can improve maternity nurses' perceived self-efficacy in managing emergency obstetric clinical situations. Health care institutions should consider investing in high-fidelity simulation education or partnering with academic institutions that have simulation centers to promote maternity nurses' self-efficacy that can potentially translate into improved clinical skills and improved patient outcomes.
Resilience and Burnout in Pediatric Nurses in a Tertiary Children's Hospital
Authors: Waterworth Susan , Grace Anna-Marie
Published: April 2021

Purpose:

To identify levels of burnout and resilience in pediatric nurses in a tertiary children's hospital in New Zealand.

Methods:

Registered nurses providing pediatric care participated in a survey that included the Connor-Davison resilience scale and Maslach burnout scale. Nurses identified specific factors related to workload stress and strategies for enhancing resilience.

Results:

Participants were 197 nurses. We found low levels of resilience and high levels of burnout, although personal accomplishment scores were high. Nurses with <10 years of experience who worked >40 hours per week had significantly higher levels of emotional exhaustion compared with those who had >10 or more years of experience or worked <40 hours per week. There were differences in resilience levels based on years of practice and hours worked. Levels of depersonalisation were higher in different ethnic groups.

Clinical Implications:

Burnout remains a significant problem for pediatric nurses. Job demands are likely to rise with the increased complexity of children with long-term conditions and families requiring support. Developing supportive plans to strengthen resilience and limit burnout are required. Further research is needed on how organizations can foster resilience practices and limit burnout, nurses feeling emotionally exhausted, reducing depersonalisation, and enhancing feelings of personal accomplishment. Nurse leaders can role-model positive resilience practices when engaging their teams in open conversations about preventing or reducing burnout.
Pan-TRK Immunohistochemistry Is Highly Correlated With NTRK3 Gene Rearrangements in Salivary Gland Tumors
Authors: Csanyi-Bastien Marie , Lanic Marie-Delphine , Beaussire Ludivine , Ferric Sandra , François Arnaud , Meseure Didier , Jardin Fabrice , Wassef Michel , Ruminy Philippe , Laé Marick
Published: April 2021

Aims:

Secretory carcinoma (SC) is characterized by ETV6 rearrangements, most often ETV6-NTRK3 fusion. Given its histologic overlap with other salivary gland tumors (SGTs), SCs can be difficult to diagnose without genetic confirmation. A recently developed pan‐TRK (tropomyosin receptor kinase) antibody shows promise for identifying tumors with NTRK (neurotrophic tyrosine kinase receptor 3) fusions. The aim of this study was to evaluate the utility of pan‐TRK immunohistochemistry in distinguishing SCs from mimics and selecting patients eligible for TRK inhibitor clinical trials. We examined whole‐tissue sections from 111 SGTs with molecular characterization, including 26 SCs (23 with ETV6-NTRK3 fusion and 3 with ETV6-RET fusion detected by ligation-dependent reverse transcription-polymerase chain reaction, next-generation sequencing and 85 non-SC SGTs (no ETV6-NTRK3 fusion). Immunohistochemistry was performed with a pan‐TRK rabbit monoclonal antibody. When any pan‐TRK staining (nuclear or cytoplasmic with any staining intensity) was considered to indicate positivity, 22 of 23 SCs with ETV6-NTRK3 fusion (95.7%) and 33 of 85 non‐SC (38.8%) salivary neoplasms were positive, mainly basal cell adenoma, pleomorphic adenomas, adenoid cystic carcinomas, and epithelial-myoepithelial carcinomas. All SCs with ETV6-RET fusion were entirely negative. When only nuclear pan-TRK staining with any staining intensity was considered positive, 18 of 23 SCs with ETV6-NTRK3 fusion (78.3%) were positive, 11 among them with diffuse staining (>30% of cells). All non-SCs and SCs with ETV6-RET fusion were entirely negative. In comparison to molecular analysis (ligation-dependent reverse transcription-polymerase chain reaction, next-generation sequencing), nuclear pan-TRK IHC has a sensitivity of 78.3% and a specificity of 100% for diagnosing SCs with ETV6-NTRK3 fusion, 69% and 100% for SCs (all fusions). Pan-TRK is a reasonable screening test for diagnosing SCs among SGTs when taking only nuclear staining into account. Although pan-TRK expression is not entirely sensitive for SCs, nuclear staining is highly specific for SCs with ETV6-NTRK3 fusion. The lack of pan-TRK immunoreactivity in a subset of SCs is suggestive of atypical exons 4 to 14 or exons 5 to 14 ETV6-NTRK3 fusion or non-NTRK alternative fusion partners such as ETV6-RET. Pan-TRK staining can serve as a strong diagnostic marker to distinguish SC from it mimics and to select patients eligible for TRK inhibitor clinical trials.
Realistic Kidney Tissue Surrogates for Multienergy Computed Tomography—Feasibility and Estimation of Energy-Dependent Attenuation Thresholds for Renal Lesion Enhancement in Low-kV and Virtual Monoenergetic Imaging
Authors: Euler André , Zadory Matthias , Breiding Philipe Sebastian , Sartoretti Thomas , Ghafoor Soleen , Froehlich Johannes Malta , Donati Olivio Fabrizio
Published: April 2021

Purpose

The aims of this study were to assess if kidney tissue surrogates (KTSs) are superior to distilled water-iodine solutions in the emulation of energy-dependent computed tomography (CT) attenuation characteristics of renal parenchyma and to estimate attenuation thresholds for definite lesion enhancement for low-kV single-energy and low-keV dual-energy virtual monoenergetic imaging.

Methods

A water-filled phantom (diameter, 30 cm) with multiple vials was imaged on a dual-source dual-energy CT (DS-DE) and a single-source split-filter dual-energy CT (SF-DE), both in single-energy mode at 80, 100, 120, 140 kVp and in dual-energy mode at 80/Sn150, 90/Sn150, and 100/Sn150 kVp for DS-DE and AuSn120 kVp for SF-DE. Single-energy images, linear-blended dual-energy images, and virtual monoenergetic imaging at energy levels from 40 to 190 keV were reconstructed. First, attenuation characteristics of KTS in solid and liquid consistencies were compared. Second, solid KTSs were developed to match the CT attenuation of unenhanced renal parenchyma at 120 kVp as retrospectively measured in 100 patients. Third, CT attenuation of KTS-iodine and water-iodine solutions at 8 different iodine concentrations (0–10 mg I/mL) were compared as a function of tube voltage and of keV level using multiple linear regression models. Energy-dependent attenuation thresholds for definite lesion enhancement were calculated.

Results

Unenhanced renal parenchyma at 120 kVp measured on average 30 HU on both scanners in the patient cohort. Solid KTS with a water content of 80% emulated the attenuation of unenhanced renal parenchyma (30 HU) more accurately compared with water-iodine solutions (0 HU). Attenuation difference between KTS-iodine and water-iodine solutions converged with increasing iodine concentration and decreasing x-ray energy due to beam-hardening effects. A slight attenuation difference of approximately 2 HU was found between the 2 CT scanners. Attenuation thresholds for definite lesion enhancement were dependent on tube voltage and keV level and ranged from 16.6 to 33.2 HU and 3.2 to 68.3 HU for single-energy and dual-energy CT scan modes for DS-DE and from 16.1 to 34.3 HU and 3.3 to 92.2 HU for SF-DE.

Conclusions

Kidney tissue surrogates more accurately emulate the energy-dependent CT attenuation characteristics of renal parenchyma for multienergy CT compared with conventional water-iodine approaches. Energy-dependent thresholds for definite lesion enhancement could facilitate lesion characterization when imaging at different energies than the traditional 120 kVp.
Robotic Distal Gastrectomy With a Novel “Preemptive Retropancreatic Approach” During Dissection of Suprapancreatic Lymph Nodes for Gastric Cancer
Authors: Ebihara Yuma , Kurashima Yo , Murakami Soichi , Shichinohe Toshiaki , Hirano Satoshi
Published: April 2021

Introduction:

Abrogating contact with the pancreas in suprapancreatic lymph nodes dissection for gastric cancer can prevent pancreatic fistula because of postoperative pancreatic damage. Our novel “Preemptive retropancreatic approach” is a useful technique that minimizes pancreatic compression during robotic distal gastrectomy (RDG) with multijointed forceps. Here, we report the usefulness of RDG for gastric cancer surgery using our novel “Preemptive retropancreatic approach”.

Materials:

“Preemptive retropancreatic approach”: initial dissection of the bilateral retropancreatic space, the adherence between the retroperitoneum surface and the pancreas (fusion fascia) is released, providing a good operative field and hindering contact with the pancreas in suprapancreatic lymph nodes dissection during RDG. We herein reported consecutive 30 patients with gastric cancer who underwent RDG at Hokkaido University from September 2014 to March 2020.

Results:

All operations were performed by a single surgeon (Y.E.). The median operating time was 281 minutes (132 to 415). The median intraoperative bleeding was 0 ml of blood (0 to 255). There were 2 incidences of postoperative complications (≥Clavien-Dindo classification II), and there were no cases of postoperative pancreas-related complications. The median length of hospital stay after the surgery was 10 days (6 to 33).

Conclusion:

As RDG for gastric cancer is still in its early introductory phase, its superiority has yet to be definitively established. However, we believe that “Preemptive retropancreatic approach” may reduce postoperative pancreatic-related complications in suprapancreatic lymph nodes dissection.
Whole genome sequencing as an investigational device for return of hereditary disease risk and pharmacogenomic results as part of the All of Us Research Program
Authors: Venner E , Muzny D , Smith JD , Walker K , Neben CL , Lockwood CM , Empey PE , Metcalf GA ,   The All of Us Research Program Regulatory Working Group, Mian S , Musick A , Rehm H , Harrison S , Gabriel S , Gibbs R , Nickerson D , Zhou AY , Doheny K , Ozenberger B , Topper SE , Lennon NJ
Published: April 2021

The All of Us Research Program (AoURP, ‘the program’) is an initiative, sponsored by the National Institutes of Health (NIH), that aims to enroll one million people (or more) across the United States. Through repeated engagement of participants, a research resource is being created to enable a variety of future observational and interventional studies. The program has also committed to genomic data generation and returning important health-related information to participants. To do so, whole genome sequencing (WGS), variant calling processes, data interpretation, and return-of-results procedures had to be created and receive an Investigational Device Exemption (IDE) from the United States Food and Drug Administration (FDA). The performance of the entire workflow was assessed through the largest known cross-center, WGS-based, validation activity that was refined iteratively through interactions with the FDA over many months. The accuracy and precision of the WGS process as a device for the return of certain health-related genomic results was determined to be sufficient, and an IDE was granted. We present here both the process of navigating the IDE application process with the FDA and the results of the validation study as a guide to future projects which may need to follow a similar path. Future supplements to the IDE will be submitted to support additional variant classes, sample types, and any expansion to the reportable regions.
Longitudinal changes in physical activity during and after the first national lockdown due to the COVID-19 pandemic in England
Authors: Bu Feifei , Bone Jessica K , Mitchell John J , Steptoe Andrew , Fancourt Daisy
Published: April 2021

Background

Recent studies have shown reduced physical activity at early stages of the COVID-19 pandemic. However, there is a lack of investigation on longitudinal changes in physical activity beyond lockdowns and stay at home orders. Moreover, it is unclear if there is heterogeneity in physical activity growth trajectories. This study aimed to explore longitudinal patterns of physical activity and factors associated with them.

Methods

Data were from the UCL COVID -19 Social Study. The analytical sample consisted of 35,915 adults in England who were followed up for 22 weeks from 24th March to 23rd August 2020. Data were analysed using growth mixture models.

Findings

Our analyses identified six classes of growth trajectories, including three stable classes showing little change over time (62.4% in total), two classes showing decreasing physical activity (28.6%), and one class showing increasing physical activity over time (9%). A range of factors were found to be associated the class membership of physical activity trajectories, such as age, gender, education, income, employment status, and health.

Interpretation

There is substantial heterogeneity in longitudinal changes in physical activity during the COVID-19 pandemic. However, a substantial proportion of our sample showed persistent physical inactivity or decreasing physical activity. Given the well-established linked between physical activity and health, persistent or increased physical inactivity is likely to have both immediate and long-term implications for people’s physical and mental health, as well as general wellbeing. More efforts are needed to promote physical activity during the pandemic and beyond.

Funding

Nuffield Foundation, UK Research and Innovation, Wellcome Trust
“Immunogenetics of resistance to SARS-CoV-2 infection in discordant couples”
Authors: Castelli Erick C. , de Castro Mateus V. , Naslavsky Michel S. , Scliar Marilia O. , Silva Nayane S. B. , Andrade Heloisa S. , Souza Andreia S. , Pereira Raphaela Neto , Castro Camila F. B. , Mendes-Junior Celso T. , Meyer Diogo , Nunes Kelly , Matos Larissa R. B. , Silva Monize V. R. , Wang Jaqueline T. W. , Esposito Joyce , Coria Vivian R. , Bortolin Raul H. , Hirata Mario H. , Magawa Jhosiene Y. , Cunha-Neto Edecio , Coelho Verônica , Santos Keity S. , Marin Maria Lucia C. , Kalil Jorge , Neto Miguel Mitne , Maciel Rui M. B. , Passos-Bueno Maria Rita , Zatz Mayana
Published: April 2021

Background

Despite the high number of individuals infected by SARS-CoV-2 who develop COVID-19 symptoms worldwide, many exposed individuals remain asymptomatic and/or stay uninfected. This could be explained by a combination of environmental (exposure, previous infection), epigenetic, and genetic factors. Aiming to identify genetic variants involved in SARS-CoV-2 resistance, we analyzed 86 discordant Brazilian couples where one was infected and symptomatic while the partner remained asymptomatic and seronegative despite sharing the same bedroom during the infection. The discordant partners had comparable ages, and genetic ancestry proportions.

Methods

Whole-exome sequencing followed by a state-of-the-art method to call genotypes and haplotypes across the highly polymorphic MHC and LRC.

Results

We observed a minor impact in antigen-presentation genes and KIR genes associated with resistance. Interestingly, genes related to immune modulation, mainly involved in NK cell killing activation/inhibition harbor variants potentially contributing to infection resistance. We hypothesize that individuals prone to produce higher amounts of MICA (possibly soluble), LILRB1, LILRB2, and low amounts of MICB, would be more susceptible to infection.

Conclusion

According to this hypothesis, quantitative differences in these NK activity-related molecules could contribute to resistance to COVID-19 down regulating NK cell cytotoxic activity in infected individuals but not in resistant partners.