bluuebunny/crossref_metadata_2025 huggingface dataset:
NATURAL HISTORY OF QUANTITATIVE AUTOFLUORESCENCE IN INTERMEDIATE AGE-RELATED MACULAR DEGENERATION
Authors: von der Emde Leon , Guymer Robyn H. , Pfau Maximilian , Caruso Emily , Sivarajah Pyrawy , Hodgson Lauren A. B. , McGuinness Myra B. , Sloan Kenneth R. , Wu Zhichao
Published: July 2020

Purpose:

To investigate differences in quantitative autofluorescence (qAF) imaging measurements between eyes with and without large drusen, and whether qAF measurements change over time in the eyes with large drusen.

Methods:

Eighty-five eyes from participants with bilateral large drusen and 51 eyes from healthy participants underwent qAF imaging at least once, and the age-related macular degeneration participants were reviewed 6-monthly. Normalized grey values at 9° to 11° eccentricity from the fovea were averaged to provide a summary measure of qAF values (termed qAF8).

Results:

In a multivariable model, qAF8 measurements were not significantly different between age-related macular degeneration eyes with large drusen and healthy eyes (P = 0.130), and qAF8 measurements showed a decline over time in the age-related macular degeneration eyes (P = 0.013).

Conclusion:

These findings add to the body of evidence that qAF levels are not increased in eyes with large drusen compared with healthy eyes, and qAF levels show a significant decline over time in the age-related macular degeneration eyes. These findings highlight how the relationship between qAF levels and retinal pigment epithelium health does not seem to be straightforward. Further investigation is required to better understand this relationship, especially if qAF levels are to be used as an outcome measure in intervention trials.
Malignant Phyllodes Tumor of the Breast With Metastasis to the Orbit: A Rare Case Report
Authors: Vempuluru Vijitha S , Mishra Dilip K , Kaliki Swathi
Published: July 2020

Phyllodes tumors are rare and account for 0.5% of all mammary neoplasms. They commonly present as lobulated breast tumors and have a variable clinical course. Histologically, phyllodes tumor is composed of 2 major elements: stromal element composed of spindle cells admixed with collagen and epithelial element in the form of epithelium lined cysts and clefts. Metastasis is rarely seen with phyllodes tumors. Sarcomatous component of phyllodes tumor metastasizes to lung, liver, adrenal, brain, and bones by hematogenous route. A thorough literature search did not reveal any report of orbital metastasis from malignant phyllodes tumor. Here, the authors describe a rare case of malignant phyllodes tumor of the breast with metastasis to the orbit in a 46-year-old female patient.
Uveal Melanoma Metastatic to the Cavernous Sinus: A Case Report
Authors: Assi Lama H. , Kheir Wajiha J. , Proia Alan D. , Materin Miguel Angel
Published: July 2020

A woman in her early 50s previously treated 7 years prior with iodine-125 plaque brachytherapy without a biopsy for gene expression profiling for uveal melanoma in the left eye presented with a 3-week history of intermittent diplopia and headache. Ophthalmic examination was significant for limitation in left eye upward gaze; otherwise, examination revealed a stable, regressed tumor in the left eye, and normal vision, pressure, and pupils in both eyes. Neuroimaging showed a left cavernous sinus lesion, suggestive of a meningioma. Excisional biopsy revealed metastatic melanoma. The patient was treated with radiotherapy, and her diplopia resolved. Slight enlargement of the lesion was noted on neuroimaging 20 months later, and was treated with stereotactic radiosurgery. Serial neuroimaging in the following 6 months did not reveal any recurrences or new metastases. This case demonstrates the importance of investigating persistent diplopia in a patient with a history of uveal melanoma, and the possibility of metastases occurring in organs besides the liver or lung.
Possible Association Between Apremilast Therapy and Increased Tearing
Authors: Fraunfelder Frederick T. , Fraunfelder Frederick W.
Published: July 2020

Purpose:

To evaluate a possible association between apremilast and increased tearing.

Methods:

A retrospective observational case series in which reports from VigiBase, the World Health Organization global database of Individual Case Safety Reports, and the literature involving apremilast were evaluated by the National Registry of Drug-Induced Ocular Side Effects for possible increased tearing.

Results:

A total of 45 cases of possible apremilast-induced increased tearing were identified. All patients were on the standard dose of 30 mg BID. There was no sex difference and ages ranged from 28 to 77 years with an average of 56 years ± 12. Time to onset of the increased tearing ranged from a few days to many months. There were 10 cases of positive dechallenge, 3 cases of positive rechallenge, and 1 case with double-positive rechallenge. In the cases with positive dechallenge and rechallenge, the increased tearing resolved as early as within 2 days after stopping the drug. Most cleared within 2 weeks. One case required 3 months for tearing to return to normal.

Conclusions:

Based on patterns and positive dechallenge and rechallenge data, apremilast possibly causes increased tearing on rare occasions.
Intraocular Migration of Porous Polyethylene Malar Implant Used for Treacher Collins Eyelid Reconstruction
Authors: Khalil Ali A. , Yassine Salma , Torbey Julien S. , Mehanna Carl Joe , Alameddine Ramzi M.
Published: July 2020

Lower eyelid colobomas associated with Treacher Collins syndrome can be challenging to repair because of associated orbital and midfacial dysostosis. Alloplastic implants such as porous polyethylene have been advocated as readily available malar implants to help improve eyelid retraction. The authors report the first case of porous polyethylene implant insidious migration into the orbit with subsequent scleral penetration. A 14-year-old male with Treacher Collins syndrome, presented with a 3-week history of left eye pain, redness, and eyelid swelling unresponsive to topical treatment. He previously had bilateral lower lid coloboma repair with alloplastic implant placement and full-thickness skin grafts. On exam, he had left eye injection and chemosis, with left hypotropia and complete restrictive ophthalmoplegia. Imaging revealed displacement of implant into the orbit with adherence and impingement on the eye globe.
Rothia Bacteremia
Authors: Gajdács Márió , Ábrók Marianna , Lázár Andrea , Burián Katalin
Published: July 2020

Background

The genus Rothia are nonmotile, aerobic or facultative anaerobic, non–spore-forming Gram-positive cocci, which are considered low-grade pathogens with relatively few known virulence determinants.

Methods

During our retrospective, single-center cohort study, microbiological data were collected corresponding to the 12-year period (January 1, 200 to December 31, 2017), at the Institute of Clinical Microbiology, University of Szeged.

Results

A total of 37 individual Rothia isolates were identified (3.1 ± 1.9/years; range, 0–6 isolates), 28 were Rothia dentocariosa, 9 were Rothia mucilaginosa. The affected patients presented with a slight female dominance (21 of 37; female/male ratio, 1:31); the median age of the affected patients was 57 years (range, 1–86 years). In the majority of blood cultures (n = 22), Rothia species were the only isolated microorganisms. All of the tested strains were susceptible to benzylpenicillin, vancomycin, ciprofloxacin, moxifloxacin, linezolid, and rifampicin.

Conclusions

Rothia species may readily be misidentified as staphylococci, streptococci, or corynebacteria, both the clinical microbiologists and physicians should be aware of the possible etiological role of these microorganisms during their clinical practice, especially if the relevant risk factors are present in these patients.
Influenza A Encephalitis in an Adult Patient
Authors: Gutman Michael Jason , Sharma Kumud , Basovic Lara , Shah Syed Omar
Published: July 2020

A 45-year-old woman presented with 7 days of worsening dyspnea, nonproductive cough, myalgias, and chills. The following day, the patient had acute respiratory failure, requiring mechanical ventilation, and eventually developed acute respiratory distress syndrome. Respiratory panel tested positive for influenza A. The patient's mental status progressively worsened to coma. Magnetic resonance imaging of the brain demonstrated relatively symmetrical bilateral T2 FLAIR abnormalities in the thalami, corpus callosum, pons, and cerebellum. Cerebrospinal fluid polymerase chain reaction was positive for influenza A. The patient was transitioned to high-dose oseltamivir and high-dose corticosteroids. Repeat magnetic resonance imaging demonstrated gross resolution of T2 FLAIR abnormalities. The patient's mental status continued to improve daily. At the time of discharge, 30 days after symptom onset, the patient was awake and following commands. Six months after hospitalization, the patient had successfully been able to return to her baseline function except for right homonymous quadrantanopia and some mild residual left upper extremity weakness.
Case Series of Staphylococcus aureus Bacteremia With Discordant Genotypic and Phenotypic Categorization of Methicillin Susceptibility
Authors: Gulliver Jessica , Jung-Hynes Brittney , Chen Derrick J.
Published: July 2020

Background

Methicillin-susceptible/methicillin-resistant Staphylococcus aureus (MSSA/MRSA) can be directly identified from positive blood culture bottles using molecular methods, but discrepancies with phenotypic testing occasionally occur. We sought to determine the incidence and clinical impact of these discrepancies.

Methods

Positive blood culture bottles are routinely tested in the hospital laboratory for mecA via the Xpert MRSA/SA blood culture assay which uses real-time polymerase chain reaction (PCR), and antimicrobial susceptibility testing (AST) via MicroScan PC33 is performed on recovered S. aureus isolates; discrepancies between the Xpert MRSA/SA blood culture assay and AST are resolved by repeat and supplemental testing. A retrospective review of medical and laboratory data from January 2015 to June 2018 was performed on all patients that had discordant Xpert MRSA/SA blood culture assay and AST results.

Results

Approximately 1410 PCR assays were performed, and there were 6 (0.4%) cases with discordant AST results. Five cases were classified as MSSA by PCR but MRSA by AST, and 1 case was classified as MRSA by PCR but MSSA by AST. For the former group, antimicrobial therapy was changed in 3 patients to cover MRSA, whereas the remaining 2 patients were already being treated for MRSA; for the latter case, the patient was treated for MRSA during the initial hospitalization but was later readmitted with disseminated MSSA. Discrepancies were likely due to presence of an staphylococcal cassette chromosome mec variant (n = 2), borderline oxacillin resistance (n = 1), heterogeneous MRSA (n = 1), or undetermined (n = 2).

Conclusions

Rapid identification of MRSA bacteremia via PCR provides actionable information to direct empiric treatment. The PCR results are highly accurate, though are infrequently not corroborated by AST due to various reasons.
Effect of Intravitreal Antibiotic Injections on Culture-Negative Keratitis-Induced Endophthalmitis
Authors: Sim Ha Eun , Kang Min-Ji , Kim Jae-Suk , Hwang Je-Hyung
Published: July 2020

Background

This study aimed to evaluate treatment outcomes of culture-negative keratitis-induced endophthalmitis (CNKE).

Methods

We reviewed the medical records of 13 patients with CNKE, who underwent treatment from January 2011 to December 2017. All patients were referred from the emergency department or outpatient departments of local clinics. Outcome evaluation included the assessment of visual acuity and any need for evisceration/enucleation.

Results

Thirteen eyes of 13 patients were included in this study. The mean age of the patients was 75.0 ± 13.3 years. All patients had used antibiotic eye drops before the initial visit. Visual acuity values at the initial visit ranged from no light perception to 2/100; final visual acuity values ranged from no light perception to 2/100. All patients underwent a vitreous tap and intravitreal ceftazidime/vancomycin injection. Two eyes underwent evisceration after intravitreal injection.

Conclusions

Intravitreal antibiotic injections demonstrated favorable results for the treatment of patients with CNKE.
Role of gender in the survival outcome of acute phase of major trauma: A nationwide, population-based study
Authors: Lee Rong-Shou , Lin Wen-Chi , Harnod Dorji , Shih Hsin-Chin , Jeng Mei-Jy
Published: July 2020

Background:

Animal models of trauma have shown that females have better posttraumatic survival; however, results of previous studies on the influence of gender on major trauma patients have been controversial. This study aimed to evaluate the association between gender and survival in major trauma patients.

Methods:

We retrospectively analyzed patients registered in Taiwan’s National Health Insurance Research Database between 2008 and 2012 with the diagnosis codes 800-939 and 950-957 (International Classification of Diseases, ninth revision, clinical modification). Data on gender, age, catastrophic illness, and new injury severity score (NISS) ≥16 were collected for comparing patients’ mortality after trauma. Propensity score matching (PSM) was performed to eliminate dissimilarities in age, comorbidities, NISS, and primary traumatic regions between the genders.

Results:

Among 10 012 major trauma patients included in the study cohort, 28.8% (n = 2880) were women. The PSM patient group consisted of 50% (2876 of 5752) women. Women had a higher 30-day (15.4% of women vs 13.8% of men; p < 0.05) and hospital (16.1% of women vs 14.5% of men; p < 0.05) mortality and lower incidence rates of acute respiratory dysfunction (62.5% of women vs 65.9% of men; p < 0.005) and acute hepatic dysfunction (0.8% of women vs 2.1% of men; p < 0.001). However, the analysis of PSM patient groups showed lower mortality rates in women with moderate trauma (NISS 16–24) in the acute phase within three days (1.4% of women vs 2.7% of men, p = 0.03). Analysis of patients with an NISS of 16–24 who died within three days showed a higher NISS in women than in men (19.7 ± 2.3 vs 18.0 ±1.9, respectively, p <0.05).

Conclusion:

There is no gender difference in 30-day or hospital mortality among major trauma patients. However, women admitted for moderate major trauma had higher survival within three days of major trauma.
The relationship between coronary artery disease and clinical outcomes in COVID-19: a single-center retrospective analysis
Authors: Peterson Eric , Lo Kevin Bryan , DeJoy Robert , Salacup Grace , Pelayo Jerald , Bhargav Ruchika , Gul Fahad , Albano Jeri , Azmaiparashvili Zurab , Amanullah Aman , Patarroyo-Aponte Gabriel
Published: July 2020

Introduction

Recent studies have reported evidence that coronavirus disease 2019 (COVID-19) has disproportionately affected patients with underlying comorbidities. Our study aims to evaluate the impact of both cardiac and noncardiac comorbidities on a high-risk population with COVID-19 infection and coronary artery disease (CAD) compared to those without CAD.

Methods

This is a retrospective study of patients who tested COVID-19 positive via reverse transcriptase-PCR (RT-PCR) assay. We compared the characteristics and outcomes of patients with and without CAD. Population demographics, comorbidities and clinical outcomes were collected and analyzed. Multivariate logistic regression analysis was used to identify factors associated with inpatient mortality.

Results

A final sample population of 355 patients was identified, 77 of which had a known diagnosis of coronary artery disease. Our study population had a higher proportion of females, and those with CAD were significantly older. The rates of cardiovascular risk factors including hypertension, diabetes mellitus and chronic kidney disease, as well as heart failure and chronic obstructive pulmonary disease were significantly higher in the CAD population. Lactate dehydrogenase was the only inflammatory marker significantly lower in the CAD group, while troponin and brain natriuretic peptide were significantly higher in this population. Patients with CAD also had significantly higher inpatient mortality (31% vs 20%, P = 0.046) and need for renal replacement therapy (33% vs 11%, P < 0.0001) compared to the non-CAD group. However, only age [odds ratio 1.041 (1.017–1.066), P = 0.001] was significantly associated with mortality in the overall population after adjusting for demographics and comorbidities, while the presence of CAD was not independently associated with mortality.

Conclusion

Patients with CAD and COVID-19 have higher rates of comorbidities, inpatient mortality and need for renal replacement therapy compared to their non-CAD counterparts. However, CAD in itself was not associated with mortality after adjusting for other covariates, suggesting that other factors may play a larger role in the increased mortality and poor outcomes in these patients.
Pocket-creation method improves efficacy of colorectal endoscopic submucosal dissection: a system review and meta-analysis
Authors: Gong Jian , Chen Tong , Tan Yuyong , Liu Deliang
Published: July 2020

The pocket-creation method (PCM) is a new strategy for endoscopic submucosal dissection (ESD). The aim of this system review is to evaluate the clinical efficacy and safety of PCM-ESD compared to conventional ESD (C-ESD) for colorectal neoplasm lesions. We performed literature search using MEDLINE, EMBASE and CENTRAL database from inception to 15 February 2020. Studies provided comparison between PCM-ESD and C-ESD for colorectal neoplasm lesions were included. En bloc resection rate, R0 resection rate, occurrence rate of adverse events and operation speed/time were extracted from included studies. Pooled risk difference with 95% confidence intervals (CIs) was calculated in meta-analysis. Three cohort studies and one randomized control trial (RCT) were included, which contained 432 colorectal lesions removed by PCM-ESD and 959 lesions resected by C-ESD. PCM-ESD achieved significantly higher en bloc/R0 resection rate than C-ESD in cohort studies with pooled risk differences of 0.05 (CI, 0.03–0.07, I
2 = 34%) and 0.14 (CI, 0.04–0.24, I
2 = 83%). However, comparison of en bloc/R0 resection rate between two surgery strategies could not be estimated in RCT. Pooled results in cohort studies and data from RCT revealed comparable occurrence rate of adverse events between PCM-ESD and C-ESD. Measurements and outcomes of operation time/speed varied between the included studies and no consistent conclusion could be achieved in this aspect. The results indicate that PCM-ESD is an effective and well-tolerated treatment for colorectal neoplasm lesions and may be a superior treatment to C-ESD in en bloc/R0 resection rate.
Study of serology and genetics of celiac disease in patients with juvenile systemic lupus erythematosus ‘celiac in juvenile systemic lupus’
Authors: Shamseya Ayman M. , Elsayed Eman H. , Donia Hanaa M.
Published: July 2020

Introduction

Several case reports and case series have suggested a possible association between celiac disease (CD) and systemic lupus erythematosus (SLE). Patients with CD developing SLE and vice versa have been reported, highlighting a possible association. Up to 23% of patients with CD have raised anti-double-stranded DNA and likewise 5–22% of SLE patients are seropositive for CD.

Objective

Aim was to screen for CD in the serum of patients suffering from juvenile SLE (JSLE).

Methods

One hundred JSLE patients and 40 (age- and sex-matched) healthy subjects were subjected to laboratory screening for CD, endoscopic examination and histopathological examination of the duodenal biopsies to confirm CD diagnosis (in seropositive cases only).

Results

tTG Ab tested positive in 10% and negative in 90% of patients. tTG Ab correlated significantly with Systemic Lupus Erythematosus Disease Activity Index score (P < 0.001) and insignificantly with hemoglobin and C-reactive protein. Esophago-gastro-duodenoscopy was done to all 10 patients with positive serology for CD revealing six patients with manifest celiac (positive serology and positive endoscopy/biopsy) and four cases of latent celiac (positive serology and negative endoscopy/biopsy).

Conclusion

Most CD patients with articular symptoms remain undiagnosed, which makes screening justified in high-risk patients with autoimmune diseases. This study highlights the strong relationship between JSLE and CD and the need to screen JSLE patients and also other auto-immune rheumatic diseases for the concomitant existence of CD.
Coverage for Adults With Chronic Disease Under the First 5 Years of the Affordable Care Act
Authors: Myerson Rebecca , Crawford Samuel
Published: July 2020

Background:

A key goal of the Patient Protection and Affordable Care Act (ACA) was to increase health insurance coverage for people with chronic disease. Little is known about progress toward this goal over the first 5 years of ACA implementation.

Objective:

The objective of this study was to assess changes in coverage for nonelderly adults with and without chronic disease over the first 5 years of ACA implementation, and the effects of state-level Medicaid eligibility expansions on coverage for these populations.

Research Design:

Multivariable and difference-in-differences regression models.

Participants:

A total of 2,007,271 adults aged 18–64 years in the nationally representative Behavioral Risk Factor Surveillance System 2011–2018 data.

Measures:

Self-reported insurance coverage.

Results:

Over the first 5 years of ACA implementation, coverage increased among nonelderly adults with versus without chronic disease by 6.9 versus 5.4 percentage points, respectively (95% confidence interval: 6.1–7.6, P<0.001, and 4.4–6.3, P<0.001, respectively). State-level Medicaid eligibility expansions were associated with a coverage increase among people with chronic disease of 2.8 percentage points (95% confidence interval: 1.7–3.8, P<0.001). After ACA implementation diminished in 2017, coverage gains for people with chronic disease declined by 0.9 percentage points (P<0.001).

Conclusions:

Coverage significantly improved for people with chronic disease during the first 5 years of ACA implementation, with ACA Medicaid expansions increasing coverage further. After ACA implementation diminished in 2017, coverage gains decreased.
Rethinking strategies for blood transfusion in hip fracture patients
Authors: D’Amore Taylor , Loewen Michael , Gorczyca Michael T. , Judd Kyle , Ketz John P. , Soles Gillian , Gorczyca John T.
Published: July 2020

Objectives:

Most patients can tolerate a hemoglobin (Hgb) > 8 g per deciliter. In some cases, however, transfusion will delay physical therapy and hospital discharge. This study aims to review Hgb and transfusion data for a large volume of recent hip fracture patients in order to identify new opportunities for decreasing the length of hospital stay. Our hypotheses are that in some cases, earlier transfusion of more blood will be associated with shorter hospital stays, and that Hgb levels consistently decrease for more than 3 days postoperatively.

Design:

Retrospective chart review.

Setting:

Two academic medical centers with Geriatric Fracture Programs.

Patients:

Data was collected from patients 50 years and older with hip fractures April 2015 and October 2017.

Intervention:

Operative stabilization of the hip fractures according to standard of care for the fracture type and patient characteristics. Transfusion according to established standards.

Main Outcome Measurements:

Electronic records were retrospectively reviewed for demographic information, Hgb levels, and transfusion events.

Results:

One thousand fifteen patients with femoral neck or intertrochanteric hip fractures were identified. Eight hundred sixty met the inclusion criteria. The average length of hospital stay was 6.7 days. The mean patient age was 82 years. The average American Society of Anesthesiologists score was 2.9. The average Hgb level consistently decreased for 5 days postoperatively before beginning to increase on day 6. There was poor consistency between intraoperative Hgb levels and preoperative or postoperative Hgb levels. Three hundred sixty-eight (42.8%) patients were transfused an average of 1.9 (range 1–6) units. One hundred five patients required a transfusion on postoperative day (POD) 1: 72 received only 1 unit of blood: 36 (50%) of the 72 required a second transfusion in the following days, compared to 9 of 33 (27%) who received 2 units on POD 1 (χ2 = 3.8898; P < .05). Patients who received transfusions on POD 3 or later had an average length of stay >2.5 days longer than those who received a transfusion earlier (P = 0.005).

Conclusions:

Our findings do not support earlier transfusion of more blood. Although in some cases, there is an association between earlier transfusion of more blood and shorter hospital stay, routine transfusion of more blood would incur higher transfusion risks in some patients who would not otherwise meet criteria for transfusion. After hip fracture surgery, the Hgb usually decreases for 5 days and does not begin to increase until POD 6. This information will provide utility in the population health management of hip fracture patients.

Level of Evidence:

Level III, Retrospective Cohort Study
Sudden Unexpected Death in MELAS Syndrome Due to Diabetic Ketoacidosis
Authors: Reed Erica M. , Swanson Amy A. , Roden Anja C. , Lin Peter T.
Published: July 2020

We present a case report of a 25 year-old man with MELAS (Mitochondrial Encephalopathy, Lactic Acidosis, and Stroke-like episodes) syndrome, who died suddenly and unexpectedly from diabetic ketoacidosis. This case report illustrates why it is important for medical examiners to be familiar with the clinical and autopsy features of MELAS syndrome and to be aware of the common complications, which may lead to sudden unexpected death.
Reclaiming the Autopsy as the Practice of Medicine
Authors: Weedn Victor W. , Menendez M.J.
Published: July 2020

The historically constricted forensic pathology workforce pipeline is facing an existential crisis. Pathology residents are exposed to forensic pathology through the American Council of Graduate Medical Education autopsy requirement. In 1950, autopsies were conducted in one half of the patients dying in American hospitals and 90% in teaching hospitals, but they have dwindled to fewer than 5%. Elimination of funding for autopsies is a major contributor to the lack of support for autopsies in departments of pathology. Funding may require reclaiming the autopsy as the practice of medicine. Funding of autopsies would rekindle interest in hospital autopsies and strengthen the forensic pathology workforce pipeline.
A Reevaluation of the Death of Vincent van Gogh
Authors: Arenberg I. Kaufman , Di Maio Vincent J.M. , Baden Michael M.
Published: July 2020

Vincent van Gogh died on July 29, 1890, from an apparent gunshot wound to the belly sustained approximately 30 hours earlier on July 27. Although little is known how Vincent sustained his mortal wound, art historians have long believed that the death was the result of a suicide, a widely accepted “truth” for the mysterious death of the then unknown and now iconic artist. The basis and validity of this suicide narrative is still very hotly debated among van Gogh scholars to this day. We dug deeper into all the circumstantial evidence and testimonies to arrive at a comprehensive overview of the probability that it was likely impossible for Vincent to self-inflict his mortal wound.

We used all the available circumstantial evidence related to the day Vincent van Gogh was wounded to present the information and conclusions as if we were before a judge as expert witnesses to answer the question: suicide or murder? If Vincent did not shoot himself in the belly (a red flag in and of itself), whoever inflicted that penetrating wound into his abdomen murdered him. In our study, results from firing the same model revolver that allegedly killed Vincent from various ranges (direct contact, intermediate, and distant) demonstrated within a reasonable degree of medical probability (greater than 50%) that it was not probable for Vincent van Gogh to shoot himself without a described powder burn.

With little forensic evidence to rely on 130 years after the suspicious event, many have suggested a respectful exhumation and graveside autopsy utilizing 21st century techniques to bring resolve to this 19th century cold case. This crime, whether suicide or murder, has generated renewed interest and numerous questions surrounding the suspicious death of the most iconic artist of the 19th century. These missing forensic facts will remain buried with all the secrets Vincent took with him to his grave, unless a definitive autopsy is performed. What an autopsy could add to our forensic fact basis and understanding of this intriguing cold case is enormous and further delineated as the next step to answer these difficult, otherwise unanswerable questions and allow us to finally sign off on his death certificate with certainty.

It is clearly impossible to definitively prove suicide or murder, but it is also impossible to disprove murder given the data and arguments offered in this analysis. A physician's opinion is based on the material available to him, and in this case, “our opinion as to the cause and manner of death is based on the limited amount of forensic information available. It is, therefore, our opinion, based on that limited information that in all medical probability, the cause of death is not a self-inflicted wound by Vincent van Gogh, and, thus, in all medical probability, a homicide.”
Methadone-based Multimodal Analgesia Provides the Best-in-class Acute Surgical Pain Control and Functional Outcomes With Lower Opioid Use Following Major Posterior Fusion Surgery in Adolescents With Idiopathic Scoliosis
Authors: Ye Jian , Myung Karen , Packiasabapathy Senthil , Yu Jeffrey S. , Jacobson Joseph E. , Whittaker Stephanie C. , Castelluccio Peter , Drayton Jackson Meghan , Sadhasivam Senthilkumar
Published: July 2020

Introduction:

Posterior spinal fusion for idiopathic scoliosis is extremely painful, with no superior single analgesic modality. We introduced a methadone-based multimodal analgesia protocol, aiming to decrease the length of hospital stay (LOS), improve pain control, and decrease the need for additional opioids.

Methods:

We analyzed 122 idiopathic scoliosis patients with posterior instrumented spinal fusion. They were matched by age, sex, surgeon, and the number of levels fused before and after the implementation of the new protocol. This analysis included 61 controls (intrathecal morphine, gabapentin, intravenous opioids, and adjuncts) and 61 patients on the new protocol (scheduled methadone, methocarbamol, ketorolac/ibuprofen, acetaminophen, and oxycodone with intravenous opioids as needed). The primary outcome was LOS. Secondary outcomes included pain scores, total opioid use (morphine milligram equivalents), time to a first bowel movement, and postdischarge phone calls.

Results:

New protocol patients were discharged earlier (median LOS, 2 days) compared with control patients (3 days; P < 0.001). Total inpatient morphine consumption was lower in the protocol group (P < 0.001). Pain scores were higher in the protocol group on the day of surgery, similar on postoperative day (POD) 1, and lower by POD 2 (P = 0.01). The new protocol also reduced the median time to first bowel movement (P < 0.001), and the number of postdischarge pain-related phone calls (P < 0.006).

Conclusion:

Methadone-based multimodal analgesia resulted in significantly lower LOS compared with the conventional regimen. It also provided improved pain control, reduced total opioid consumption, and early bowel movement compared with the control group.
Risks and Safety of Advanced Therapies and Biologics in Inflammatory Bowel Disease
Authors: Morvillo Cynthia , Vinci Katherine , Hedenschoug Lauren , Mancini Leah , Mize Carrie , Tugg Kayce , Stein Steven
Published: July 2020

Advanced therapies, including biologics, are a core component of managing inflammatory bowel disease, which is increasing in prevalence. These therapies may offer an improved safety and tolerability profile compared with conventional treatments. However, they can interact with a patient's immune system via different mechanisms. Healthcare providers need to be aware of the possible adverse effects, such as infection and immune-mediated reactions, as well as risk management methods, such as patient screening and vaccination. As central members of the multidisciplinary team, nurses have an important role in educating patients with inflammatory bowel disease on disease course, treatment options, monitoring patient adherence, and response to treatment. This narrative review summarizes key safety considerations for the treatment of inflammatory bowel disease with advanced therapies, including risk of infection and malignancy; immunologic, metabolic, and hematologic complications; and what nurses can do to manage these risks. Special considerations for pediatric, elderly, and pregnant populations are also discussed.
Professional Burnout Survey for Practicing Female Pelvic Medicine and Reconstructive Surgeons: A Cross-sectional Study
Authors: Hudson Patricia , James Kaitlyn , Von Bargen Emily
Published: July 2020

Objectives

The objective of this study was to determine the prevalence of burnout among active practicing members of the American Urogynecologic Society (AUGS).

Methods

This was an anonymous electronic survey of AUGS nontrainee physician members. Basic demographic, personal, and professional characteristics were collected. Levels of emotional exhaustion, depersonalization and personal accomplishment, as defined by the Maslach Burnout Inventory-Human Services Survey, were utilized to categorize participants into burnout profiles and to determine 2 alternative burnout definitions. Descriptive statistics and models were used to summarize provider characteristics and to explore differences among the burnout profiles.

Results

Of the 1039 active members of AUGS, 280 (26.9%) responded to the survey. Burnout profiles were delineated using the Maslach Burnout Inventory-Human Services Survey. Forty-three percent fit the Engaged profile, whereas 13% fit the Burnout profile. Significant differences were seen in the distribution of the burnout profiles for physicians who take call (P=0.015), have a current mentor (P=0.016), screen positive for major depression (P < 0.001), experience suicidal ideation (P=0.018), have a feeling of control regarding their schedule (P < 0.001) and those who would become a physician again (P < 0.001). The overall rate of burnout in female pelvic medicine and reconstructive surgery providers was significantly different depending on the definition utilized (P < 0.01) and ranged from as low as 6.5% to as high as 51.9%.

Conclusions

There were some differences in respondent characteristics seen among the burnout profiles. The chosen definition of burnout significantly affected the purported rate of burnout, complicating comparisons among provider populations.
Stationary distributions of systems with discreteness-induced transitions
Authors: Bibbona Enrico , Kim Jinsu , Wiuf Carsten
Published: July 2020

We provide a theoretical analysis of some autocatalytic reaction networks exhibiting the phenomenon of discreteness-induced transitions. The family of networks that we address includes the celebrated Togashi and Kaneko model. We prove positive recurrence, finiteness of all moments and geometric ergodicity of the models in the family. For some parameter values, we find the analytic expression for the stationary distribution and discuss the effect of volume scaling on the stationary behaviour of the chain. We find the exact critical value of the volume for which discreteness-induced transitions disappear.
Deep learning improves taphonomic resolution: high accuracy in differentiating tooth marks made by lions and jaguars
Authors: Jiménez-García Blanca , Aznarte José , Abellán Natalia , Baquedano Enrique , Domínguez-Rodrigo Manuel
Published: July 2020

Taphonomists have long struggled with identifying carnivore agency in bone accumulation and modification. Now that several taphonomic techniques allow identifying carnivore modification of bones, a next step involves determining carnivore type. This is of utmost importance to determine which carnivores were preying on and competing with hominins and what types of interaction existed among them during prehistory. Computer vision techniques using deep architectures of convolutional neural networks (CNN) have enabled significantly higher resolution in the identification of bone surface modifications (BSM) than previous methods. Here, we apply these techniques to test the hypothesis that different carnivores create specific BSM that can enable their identification. To make differentiation more challenging, we selected two types of carnivores (lions and jaguars) that belong to the same mammal family and have similar dental morphology. We hypothesize that if two similar carnivores can be identified by the BSM they imprint on bones, then two more distinctive carnivores (e.g. hyenids and felids) should be more easily distinguished. The CNN method used here shows that tooth scores from both types of felids can be successfully classified with an accuracy greater than 82%. The first hypothesis was successfully tested. The next step will be to differentiate diverse carnivore types involving a wider range of carnivore-made BSM. The present study demonstrates that resolution increases when combining two different disciplines (taphonomy and artificial intelligence computing) in order to test new hypotheses that could not be addressed with traditional taphonomic methods.
Mechanisms and measures for the ductility of materials failure
Authors: Christensen Richard M.
Published: July 2020

An operational definition for the ductility of failure is given. Many examples illustrate the procedure for specific applications. The ductile/brittle transition is an integral part of the formalism. Further applications are made to the solids forming elements in the Periodic Table. The cases of graphene and diamond are used to verify the procedure. Bond bending and bond stretching are shown to provide an atomic scale criterion for ductile versus brittle failure behaviours.
Inert gas bubble formation in magnetron sputtered thin-film CdTe solar cells
Authors: Hatton Peter , Abbas Ali , Kaminski Piotr , Yilmaz Sibel , Watts Michael , Walls Michael , Goddard Pooja , Smith Roger
Published: July 2020

Cadmium telluride (CdTe) solar cells are deposited in current production using evaporation-based tech- niques. Fabricating CdTe solar cells using magnetron sputtering would have the advantage of being more cost-efficient. Here, we show that such deposition results in the incorporation of the magnetron working gas Ar, within the films. Post deposition processing with CdCl2improves cell efficiency and during which stacking faults are removed. The Ar then accumulates into clusters leading to the creation of voids and blisters on the surface. Using molecular dynamics, the penetration threshold energies are determined for both Ar and Xe, with CdTe in both zinc-blende and wurtzite phases. These calculations show that more Ar than Xe can penetrate into the growing film with most penetration across the (111) surface. The mechanisms and energy barriers for interstitial Ar and Xe diffusion in zinc-blende are determined. Barriers are reduced near existing clusters, increasing the probability of capture-based cluster growth. Barriers in wurtzite are higher with non-Arrhenius behaviour observed. This provides an explanation for the increase in the size of voids observed after stacking fault removal. Blister exfoliation was also modelled, showing the formation of shallow craters with a raised rim.
Endpoint PCR Detection of Sars-CoV-2 RNA
Authors: Moses Samuel , Warren Claire , Robinson Phil , Curtis Jon , Asquith Steve , Holme John , Jain Nisha , Brookes Keeley J , Hanley Quentin S.
Published: July 2020

Quantitative real-time PCR methods have been used to perform approximately 278 million tests for COVID-19 up to mid-July 2020. Real-time PCR involves a rate limiting step where the samples are measured in situ during each PCR amplification cycle. This creates a bottleneck limiting scalability and as a consequence reducing access to inexpensive reliable testing at national and international scales. We investigated endpoint PCR for the qualitative detection of SARS-CoV-2 sequences on synthetic RNA standards and hospital patient samples. The endpoint PCR detection limit is constrained only by the stochastics of low copy numbers and reliably detected single copies of synthetic RNA standards. On a set of 30 patient samples, endpoint PCR found one additional positive sample and was able to confirm an indeterminate sample as negative. These results were found using 4 μl reagent and 1 μl of sample representing an 80% reduction in required RNA extract input and PCR reagent volumes relative to the NHS protocol (20 μl reagent and 5 μl sample). These results indicate that endpoint PCR should be the method of choice for large scale testing programmes. Based on the experience from ultra-high throughput genotyping efforts a single workflow using 384-well plates has similar PCR capacity (250 Million) to that required for all testing done worldwide during the first 7 month of the pandemic.
Discovery of populations endemic to a marine biogeographical transition zone
Authors: Golla Tirupathi Rao , Pieterse Leishe , Jooste Candice M. , Teske Peter R.
Published: July 2020

Aim

Biogeographical transition zones are areas of overlap between the faunas of adjacent biogeographical entities. Particularly, the well-defined transition zones along linear coastlines are interesting natural laboratories to study dispersal and incipient speciation. Few studies have explored whether marine biogeographical transition zones harbour biodiversity that is distinct from that of the biogeographical entities they separate. The Wild Coast in eastern South Africa is a poorly-studied transition zone between region’s warm-temperate and subtropical faunas, and is generally considered to be an area of faunal overlap.

Location

The South African portion of the Western Indian Ocean

Methods

Sequences of the DNA barcoding marker COI were generated from 306 estuarine sandprawns (Callichirus kraussi) collected at 13 sites. Genetic structure and evolutionary history were assessed using a haplotype network and a Bayesian discrete phylogeographic analysis.

Result

Two populations were identified whose ranges are centred on the Wild Coast, a rare one in the northern portion and a more common one in the central and southern portion of this biogeographical transition zone. These populations are not closely related to each other, but descend from subtropical and warm-temperate sister populations, respectively.

Conclusions

This is the first study to indicate that the Wild Coast marine biogeographical transition zone is not merely an area of faunal overlap, and one of very few studies to have discovered genetically unique populations within a marine biogeographical transition zone. The Wild Coast may harbour additional unique biodiversity that remains to be discovered, including rare species that require protection. More research is required to understand how this environmentally dynamic marine biogeographical transition zone differs from the adjacent biogeographical provinces.
Efficacy and tolerability of bevacizumab in patients with severe Covid -19
Authors: Pang Jiaojiao , Xu Feng , Aondio Gianmarco , Li Yu , Fumagalli Alberto , Lu Ming , Valmadre Giuseppe , Wei Jie , Bian Yuan , Canesi Margherita , Damiani Giovanni , Zhang Yuan , Yu Dexin , Chen Jun , Ji Xiang , Sui Wenhai , Wang Bailu , Wu Shuo , Kovacs Attila , Revera Miriam , Wang Hao , Zhang Ying , Chen Yuguo , Cao Yihai
Published: July 2020

On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesized that the anti-VEGF drug bevacizumab might be beneficial for treating Covid-19 patients. We recruited 26 patients from 2-centers (China and Italy) with confirmed severe Covid-19, with respiratory rate ≥ 30 times/min, oxygen saturation ≤ 93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100mmHg and ≤ 300 mmHg, and diffuse pneumonia confirmed by chest radiological imaging. This trial was conducted from Feb 15 to April 5, 2020, and followed up for 28 days. Relative to comparable control patients with severe Covid-19 admitted in the same centers, bevacizumab showed clinical efficacy by improving oxygenation and shortening oxygen-support duration. Among 26 hospitalized patients with severe Covid-19 (median age, 62 years, 20 [77%] males), bevacizumab plus standard care markedly improved the PaO2/FiO2 ratios at days 1 and 7 (elevated values, day 1, 50.5 [4.0,119.0], p<0.001; day 7, 111.0 [85.0,165.0], p<0.001). By day 28, 24 (92%) patients showed improvement in oxygen-support status, 17 (65%) patients were discharged, and none showed worsen oxygen-support status nor died. Significant reduction of lesion areas and ratios were shown in chest CT or X-ray analysis within 7 days. Of 14 patients with fever, body temperature normalized within 72 hours in 13 (93%) patients. Lymphocyte counts in peripheral blood were significantly increased and CRP levels were markedly decreased as shown in available data. Our findings suggested bevacizumab plus standard care was highly beneficial for treating patients with severe Covid-19. Clinical efficacy of bevacizumab warrants double blind, randomized, placebo-controlled trials.

TRIAL REGISTRATION:ClinicalTrials.gov Identifier: NCT04275414, URL: https://clinicaltrials.gov/ct2/show/NCT04275414.
Magnetic bead-based ELISA allow inexpensive, rapid and quantitative detection of human antibodies against SARS-CoV-2
Authors: Huergo Luciano Fernandes , Conzentino Marcelo Santos , Marques Gerhardt Edileusa Cristina , Schenberger Santos Adrian Richard , Pedrosa Fabio Oliveira , Souza Emanuel Maltempi , Nogueira Meri Bordignon , Forchhammer Karl , Moraes Rego Fabiane Gomes , Raboni Sônia Mara , Reis Rodrigo Arantes
Published: July 2020

Here we describe a novel immunogenic method to detect COVID-19. The method is a chromogenic magnetic bead-based ELISA which allows inexpensive and quantitative detection of human IgG or IgM antibodies against SARS-CoV-2 in serum or whole blood samples in just 12 minutes. As a proof of concept, we compared the performance of our new method to classical ELISA. Person correlation between optical densities obtained using the two methods was 0.98, the color intensity observed in the novel method correlated with antibody titers determined by classical ELISA. The novel magnetic bead-based ELISA correctly classified all 6 positive COVID-19 samples tested and showed 100% specificity as judged by the analysis of a cohort of 26 negative samples. The magnetic bead-based ELISA performed better than classic ELISA to discriminate COVID-19 positive serum with low antibody titer. The chromogenic magnetic bead-based ELISA method described here can be applied to both point of care and high throughput analysis. The method is readily adaptable to be used with other protein and peptide-based antigens.