bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Self-Reported Systemic Reactions Following SARS-CoV-2 Vaccination With Immunological Response in The Danish National Cohort Study of Effectiveness and Safety of SARS-CoV-2 Vaccines (ENFORCE)
Authors: Bannister Wendy P , Raben Dorthe , Valentiner-Branth Palle , Tolstrup Martin , Larsen Lykke , Tarp Britta , Brouw Iversen Mette , Schmeltz Søgaard Ole , Rye Ostrowski Sisse , Breinholt Stærke Nina , Jakobsen Marie Louise , Lindvig Susan Olaf , Juhl Maria Ruwald , Somuncu Johansen Isik , Mustafa Ahmed B , Østergaard Lars , Dam Larsen Fredrikke , Surland Knudsen Lene , Klastrup Vibeke , Wiese Lothar , Benfield Thomas , Toft Petersen Kristine , Iversen Kasper K , Nielsen Henrik , Reekie Joanne , Lundgren Jens ,   ENFORCE Study Group
Published: May 2023

Background

Side effects to SARS-CoV-2 vaccines are a key concern contributing to vaccine hesitancy, but more individuals may be encouraged if they were known to lead to a stronger immune response.

Methods

Adult participants were included from the Danish National Cohort Study of Effectiveness and Safety of SARS-CoV-2 Vaccines (ENFORCE), who completed a questionnaire to assess systemic reactions following SARS-CoV-2 vaccination (BTN162b2, mRNA-1273, ChAdOx1) and had SARS-CoV-2 spike IgG levels measured at baseline and post-vaccine. A symptom score was developed to measure severity of systemic adverse reactions (+1 for each moderate, +2 for each severe). Post-vaccination SARS-CoV-2 spike IgG levels were compared between participants with different scores using multivariable linear regression.

Results

A total of 6528 participants were included (56.3% females, median age 64 years [IQR 54-75]). After first vaccination, no association was found between symptom score and post-vaccine dose spike IgG level (p-value=0.575). Following second vaccination, significantly higher spike IgG levels were observed according to higher symptom score (p<0.001); adjusted geometric mean ratios (95% CIs) were 1.16 (1.04-1.30), 1.24 (1.09-1.41), 1.25 (1.06-1.46), and 1.21 (1.08-1.35), for scores of 2, 3, 4, ≥5, respectively, compared to a score of 0. After adjustment for pre-vaccine dose spike IgG, this association was attenuated.

Conclusions

An association was found between more severe adverse reactions and stronger antibody response after the second vaccination but not the first, likely attributed to higher levels of pre-existing immunity gained from response to first vaccination. Regardless of side effects, most people experienced an effective immune response following vaccination.
Proof of the transverse intersection of the stable and unstable manifolds in the two-dimensional area preserving map
Authors: Yamaguchi Yoshihiro , Tanikawa Kiyotaka
Published: May 2023

In this paper, we study the area preserving map T included in the Hénon family of maps. The map T defined on the plane is characterized by a parameter a (≥ 0). There exist the saddle fixed point P and the elliptic point Q at a > 0. Let u be the primary homoclinic point at which the unstable manifold Wu starting from the saddle fixed point P intersects the symmetry axis denoted by the dominant axis of Q. The stable manifold Ws also intersects Wu at u. At u, let ξu(u) be the inclination of Wu and ξs(u) be that of Ws. Using a new geometric method, we prove the transversality of the intersection for any value of a (> 0). Here, the transversality means that ξu(u) < ξs(u) holds.
The Efficiency of Bacterial Vaccines on Mortality during the ‘Spanish’ Influenza Pandemic of 1918–19
Authors: Roth David T
Published: May 2023

The worldwide ‘Spanish’ influenza pandemic of 1918–19, which extended into the 1920s, infected more than a third of the world’s population and killed an estimated 50–100 million people, more than the civilian and military casualties of World War I. Present-day medical scholars, journalists, and other commentators have often ignored, downplayed or treated with scepticism the role of bacterial vaccines in reducing mortality during the pandemic. There have been repeated claims in this century that these vaccines were ‘useless’, ‘concocted’, and possibly harmful. Focussing on the Australian scene, I show that bacterial vaccines from reputable sources did indeed reduce mortality, perhaps to a greater extent in some cases than modern anti-viral influenza vaccines.
Effects of sodium oxybate on hypocretin/orexin and locus coeruleus neurons
Authors: Wu Ming-Fung , Thannickal Thomas C , Li Songlin , McGregor Ronald , Lai Yuan-Yang , Siegel Jerome M
Published: May 2023

Long-term use of sodium oxybate (SXB), (also called gamma-hydroxybutyrate [GHB]) attenuates the cataplexy and sleepiness of human narcolepsy. We had previously found that chronic opiate usage in humans and long-term opiate administration to mice significantly increased the number of detected hypocretin/orexin (Hcrt) neurons, decreased their size, and increased Hcrt level in the hypothalamus. We also found that opiates significantly decreased cataplexy in human narcoleptics as well as in narcoleptic mice and that cessation of locus coeruleus neuronal activity preceded and was tightly linked to cataplectic attacks in narcoleptic dogs. We tested the hypothesis that SXB produces changes similar to opiates and now report that chronic SXB administration significantly increased the size of Hcrt neurons, the reverse of what we had seen with opiates in humans and mice. Levels of Hcrt in the hypothalamus were nonsignificantly lower, in contrast to the significant increase in hypothalamic Hcrt level after opiates. SXB decreased tyrosine hydroxylase levels in the locus coeruleus, the major descending projection of the hypocretin system, also the reverse of what we saw with opioids. Therefore despite some similar effects on narcoleptic symptomatology, SXB does not produce anatomical changes similar to those elicited by opiates. Analysis of changes in other links in the cataplexy pathway might further illuminate SXB’s mechanism of action on narcolepsy.
Hate as Backlash: A County-Level Analysis of White Supremacist Mobilization in Response to Racial and Gender “Threats”
Authors: Mills Colleen E , Schmuhl Margaret , Capellan Joel A , Silva Jason R
Published: May 2023

Given the resurgence and mainstreaming of the American far-right in recent years, there is an urgent need to better understand the etiology of recent white supremacist mobilization. In the current study, we investigate white supremacist mobilization primarily as a backlash against two threats perceived by white supremacists: racial threat and gender threat. This study extends the defended neighborhoods and feminist perspectives – frameworks previously used to explain hate and extremist violence – to explain legal white supremacist mobilization. Using data from the Anti-Defamation League, we utilize a series of negative binomial regressions analyzing white supremacist mobilization – as measured by propaganda incidents – at the county level between 2017 and 2020. Findings indicate that white supremacist mobilization is a backlash response to 1) the influx of nonwhite, Black, and Hispanic residents into white areas; 2) the presence of Jewish visibility as a measure of ethnoreligious minority group threat; and 3) gender equality in income, occupational status, and the labor force. Gender equality in education however does appear to have an ameliorative effect on white supremacist mobilization. On balance, the current study finds support for backlash explanations of white supremacist mobilization and demonstrates the utility of applying perspectives used to explain violence, including hate and extremist violence, to explain white supremacist mobilization.
Divine Struggles Among Those Doing God’s Work: A Longitudinal Assessment Predicting Depression and Burnout and the Role of Social Support in United Methodist Clergy
Authors: Upenieks Laura , Eagle David E
Published: May 2023

In this study, we examine the role of spiritual struggles among clergy, in the form of “divine struggle” or feelings of alienation from God and their associations with well-being (depressive symptoms and burnout) among clergy. Drawing from a life-stress perspective, we also test whether received and anticipated congregational support moderates these associations. Using two waves of data (2016–2019) of the Clergy Panel Health Survey of United Methodist clergy in North Carolina (n = 1,261), results suggest that it was clergy who increased in divine struggles over time who had the highest depressive symptom and burnout scores. However, clergy who received significant emotional support from members of their congregation were protected from elevated depressive symptoms and greater burnout. Anticipated congregational support only buffered the relationship between increasing divine struggles and one component of burnout (positive achievement). We offer some broader implications for supporting clergy well-being in the face of divine struggles.
Cost-effectiveness of peer-delivered physical activity promotion and maintenance programs for initially sedentary breast cancer survivors
Authors: Chen Brian K , Dunsiger Shira I , Pinto Bernardine M
Published: May 2023

The evidence for the survival and health benefits of physical activity (PA) among cancer survivors is well documented. However, it has been challenging to maintain PA among cancer survivors. To evaluate the cost-effectiveness of peer support to encourage maintenance of moderate-to-vigorous physical activity (MVPA) among breast cancer survivors. Participants were randomized into Reach Plus Message (weekly text/email messages), Reach Plus Phone (monthly phone calls) or Reach Plus (a self-monitoring intervention) over 6 months after an initial adoption phase. We calculated the incremental cost-effectiveness ratios (ICER) in terms of quality-adjusted years life years (QALYs) and self-reported MVPA, from the payer’s budgetary and societal perspectives over 1 year. Intervention costs were collected via time logs from the trainers and peer coaches, and participant costs from the participants via surveys. For our sensitivity analyses, we bootstrapped costs and effects to construct cost-effectiveness planes and acceptability curves. The intervention that provides weekly messages from peer coaches has an ICER of $14,446 per QALY gained and $0.95 per extra minute of MVPA per day over Reach Plus. Reach Plus Message has a 49.8% and 78.5% probability of cost-effectiveness respectively when decision makers are willing to pay approximately $25,000 per QALY and $10 per additional minute of MVPA. Reach Plus Phone, which requires tailored monthly telephone calls, costs more than Reach Plus Message but yields less QALY and self-reported MVPA at 1 year. Reach Plus Message may be a viable and cost-effective intervention strategy to maintain MVPA among breast cancer survivors.
A Mixed-Method Pilot Project
Authors: Hamilton William , Walters Colleen , Howington Zackery
Published: May 2023

Telehealth has become ubiquitous, and advanced practice nurses will need to be proficient in its use. Recent literature has shown that graduate nursing curricula may not fully prepare students for clinical telehealth practice. This article describes an interactive, module-based course that was built using instructional design principles for the training of graduate nursing students to prepare them to conduct telehealth encounters. The course was proven to be efficacious based on pre-post test results and critical reflections. The blueprint described can be used by nurse educators and administrators to prepare nurses to provide safe and effective telehealth services.
Attributable Perioperative Cost of Frailty after Major, Elective Noncardiac Surgery: A Population-based Cohort Study
Authors: McGinn Ryan , Agung Yonathan , Grudzinski Alexa L. , Talarico Robert , Hallet Julie , McIsaac Daniel I.
Published: May 2023

Background

Patients with frailty consistently experience higher rates of perioperative morbidity and mortality; however, costs attributable to frailty remain poorly defined. This study sought to identify older patients with and without frailty using a validated, multidimensional frailty index and estimated the attributable costs in the year after major, elective noncardiac surgery.

Methods

The authors conducted a retrospective population-based cohort study of all patients 66 yr or older having major, elective noncardiac surgery between April 1, 2012, and March 31, 2018, using linked health data obtained from an independent research institute (ICES) in Ontario, Canada. All data were collected using standard methods from the date of surgery to the end of 1-yr follow-up. The presence or absence of preoperative frailty was determined using a multidimensional frailty index. The primary outcome was total health system costs in the year after surgery using a validated patient-level costing method capturing direct and indirect costs. Secondary outcomes included costs to postoperative days 30 and 90 along with sensitivity analyses and evaluation of effect modifiers.

Results

Of 171,576 patients, 23,219 (13.5%) were identified with preoperative frailty. Unadjusted costs were higher among patients with frailty (ratio of means 1.79, 95% CI 1.76 to 1.83). After adjusting for confounders, an absolute cost increase of $11,828 Canadian dollar (ratio of means 1.53; 95% CI, 1.51 to 1.56) was attributable to frailty. This association was attenuated with additional control for comorbidities (ratio of means 1.24, 95% CI, 1.22 to 1.26). Among contributors to total costs, frailty was most strongly associated with increased postacute care costs.

Conclusions

For patients with preoperative frailty having elective surgery, the authors estimate that attributable costs are increased 1.5-fold in the year after major, elective noncardiac surgery. These data inform resource allocation for patients with frailty.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
An evaluation of the methodological quality of published guidelines for the surgical treatment of pleural mesothelioma
Authors: Bertolaccini Luca , Bardoni Claudia , Maffeis Gabriele , Mohamed Shehab , Prisciandaro Elena , Diotti Cristina , Casiraghi Monica , Petrella Francesco , Spaggiari Lorenzo
Published: May 2023

Background

To benchmark their quality, a project was designed to analyze the methodology of previous guidelines and recommendations for malignant pleural mesothelioma projects.

Methods

A narrative literature search was conducted, and each guideline was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and rated on a seven-point scale for its many items and domains.

Results

Six guidelines that met the inclusion requirements were evaluated. Due to greater development rigor and editorial independence, the engagement of scientific societies was associated with an improvement in methodological quality.

Conclusion

According to the standards of AGREE II, the methodological quality of earlier guidelines was relatively low. Nonetheless, two previously published guidelines could serve as a template for the establishment of the most effective methodological quality guidelines.
Indocyanine green angiography of type 1 macular neovascularization in age-related macular degeneration and central serous chorioretinopathy reveals different disease mechanisms.
Authors: Zola Marta , Bousquet Elodie , Favard Catherine , Gigon Anthony , Mantel Irmela , Behar-Cohen Francine
Published: May 2023

Purpose:

To assess the rate of late phase hyperfluorescent plaque (LPHP) in type 1 macular neovascularization (MNV) in CSCR (central serous chorioretinopathy) and AMD (age-related macular degeneration) and to evaluate its prognostic value.

Methods:

Retrospective study including type 1 MNV in AMD and CSCR, from 2012 to 2020. Eyes with a late ICG-A image (>20mins) and clear visualization of MNV on OCTA were included. Quantitative and qualitative parameters on OCT and best corrected visual acuity were recorded at baseline, and after 3 monthly anti-VEGF injections.

Results:

Eighty-three eyes were included, 35 with CSCR and 48 with AMD. Patients in the CSCR group were significantly younger than in the AMD group (61.3 ± 10.4 vs. 80.2 ± 6.8 years respectively, p<0.001), predominantly male (68.6% CSCR vs 35.4% AMD; p=0.003) and with a thicker choroid (379 ± 93.3 μm vs 204.2 ± 93.2 μm; p<0.001). Type 1 MNV in CSCR showed fewer LPHP compared to AMD (31.4% vs 77.1%; p<0.001). Baseline visual acuity was lower in patients with LPHP (0.37± 0.22 vs 0.27 ±0.28 LogMAR, p=0.03). On multivariate analysis, AMD was associated with the presence of LPHP (p<0.001). No significant difference in the response to anti-VEGF was observed.

Conclusion:

Leakage of macromolecules from MNV and accumulation in the RPE and/or in the stroma imaged by the LPHP is less common in eyes with type 1 MNV in CSCR than in AMD. Late phase ICG-A imaging offers an insight into the metabolism of the dye and the environment surrounding the neovascular membrane.
Calcinosis Cutis and Calciphylaxis Mimicking Skin Infection
Authors: Chan Patrick , Greene John N.
Published: May 2023

Calcinosis cutis refers to the deposition of calcium salts into the skin or subcutaneous tissue, and when these calcium deposits involve the vasculature, it is known as calciphylaxis (http://www.ncbi.nlm.nih.gov/books/NBK448127/). These conditions can both mimic and predispose patients to infections; thus, diagnoses may be confused between the two. We present 3 cases involving cutaneous wounds due to calcium deposition and discuss their infectious considerations. The first case is a 74-year-old male patient with myeloid sarcoma and B-cell acute lymphoblastic leukemia who was evaluated for calciphylaxis of the bilateral lower extremities. The second case is a 70-year-old female patient with a history of squamous cell carcinoma with subsequent surgical resection and radiation therapy of the right elbow who presented with right elbow cellulitis. The third case is a 68-year-old male patient with a history of myositis ossificans and multiple surgical excisions of calcium deposits who presented with a draining wound of the left upper extremity.
A systematic review of genome-wide association studies for pain, nociception, neuropathy, and pain treatment responses
Authors: Li Song , Brimmers Annika , van Boekel Regina L.M. , Vissers Kris C.P. , Coenen Marieke J.H.
Published: May 2023

Pain is the leading cause of disability worldwide, imposing an enormous burden on personal health and society. Pain is a multifactorial and multidimensional problem. Currently, there is (some) evidence that genetic factors could partially explain individual susceptibility to pain and interpersonal differences in pain treatment response. To better understand the underlying genetic mechanisms of pain, we systematically reviewed and summarized genome-wide association studies (GWASes) investigating the associations between genetic variants and pain/pain-related phenotypes in humans. We reviewed 57 full-text articles and identified 30 loci reported in more than 1 study. To check whether genes described in this review are associated with (other) pain phenotypes, we searched 2 pain genetic databases, Human Pain Genetics Database and Mouse Pain Genetics Database. Six GWAS-identified genes/loci were also reported in those databases, mainly involved in neurological functions and inflammation. These findings demonstrate an important contribution of genetic factors to the risk of pain and pain-related phenotypes. However, replication studies with consistent phenotype definitions and sufficient statistical power are required to validate these pain-associated genes further. Our review also highlights the need for bioinformatic tools to elucidate the function of identified genes/loci. We believe that a better understanding of the genetic background of pain will shed light on the underlying biological mechanisms of pain and benefit patients by improving the clinical management of pain.
Learning curves in laparoscopic distal pancreatectomy: a different experience for each generation
Authors: van Ramshorst Tess M.E. , Edwin Bjørn , Han Ho-Seong , Nakamura Masafumi , Yoon Yoo-Seok , Ohtsuka Takao , Tholfsen Tore , Besselink Marc G. , Abu Hilal Mohammad
Published: May 2023

Background:

Learning curves of laparoscopic distal pancreatectomy (LDP) are mostly based on ‘self-taught’ surgeons who acquired sufficient proficiency largely through self-teaching. No learning curves have been investigated for ‘trained’ surgeons who received training and built on the experience of the ‘self-taught’ surgeons. This study compared the learning curves and outcome of LDP between ‘self-taught’ and ‘trained’ surgeons in terms of feasibility and proficiency using short-term outcomes.

Materials and methods:

Data of consecutive patients with benign or malignant disease of the left pancreas who underwent LDP by four ‘self-taught’ and four ‘trained’ surgeons between 1997 and 2019 were collected, starting from the first patient operated by a contributing surgeon. Risk-adjusted cumulative sum (RA-CUSUM) analyses were performed to determine phase-1 feasibility (operative time) and phase-2 proficiency (major complications) learning curves. Outcomes were compared based on the inflection points of the learning curves.

Results:

The inflection points for the feasibility and proficiency learning curves were 24 and 36 procedures for ‘trained’ surgeons compared to 64 and 85 procedures for ‘self-taught’ surgeons, respectively. In ‘trained’ surgeons, operative time was reduced after completion of the learning curves (230.5–203 min, P=0.028). In ‘self-taught’ surgeons, operative time (240–195 min, P≤0.001), major complications (20.6–7.8%, P=0.008), and length of hospital stay (9–5 days, P≤0.001) reduced after completion of the learning curves.

Conclusion:

This retrospective international cohort study showed that the feasibility and proficiency learning curves for LDP of ‘trained’ surgeons were at least halved as compared to ‘self-taught’ surgeons.
Transfer of Veno-venous Extracorporeal Membrane Oxygenation Patients With COVID-19 Associated Acute Respiratory Distress Syndrome
Authors: Mang Sebastian , Reichert Lena , Muellenbach Ralf M. , Riesner Jonathan , Lotz Christopher , Supady Alexander , Mutlak Haitham , Bals Robert , Rixecker Torben M. , Becker André P. , Leitner Maximilian , Zeiner Carsten , Danziger Guy , Meybohm Patrick , Seiler Frederik , Lepper Philipp M.
Published: May 2023

Interhospital transport of acute respiratory distress syndrome (ARDS) patients bears transport-associated risks. It is unknown how interhospital extracorporeal membrane oxygenation (ECMO) transfer of COVID-19 patients by mobile ECMO units affects ARDS mortality. We compared the outcome of 94 COVID-19 patients cannulated in primary care hospitals and retrieved by mobile ECMO-teams to that of 84 patients cannulated at five German ECMO centers. Patients were recruited from March 2020 to November 2021. Twenty-six transports were airborne, 68 were land-based. Age, sex, body-mass-index, Simplified Acute Physiology Score (SAPS) II, days invasively ventilated, and P/F-Ratio before ECMO initiation were similar in both groups. Counting only regional transports (≤250 km), mean transport distance was 139.5 km ± 17.7 km for helicopter (duration 52.5 ± 10.6 minutes) and 69.8 km ± 44.1 km for ambulance or mobile intensive care unit (duration 57.6 ± 29.4 minutes). Overall time of vvECMO support (20.4 ± 15.2 ECMO days for transported patients vs. 21.0 ± 20.5 for control, p = 0.83) and days invasively ventilated (27.9 ± 18.1 days vs. 32.6 ± 25.1 days, p = 0.16) were similar. Overall mortality did not differ between transported patients and controls (57/94 [61%] vs. 51/83 [61%], p = 0.43). COVID-19 patients cannulated and retrieved by mobile ECMO-teams have no excess risk compared with patients receiving vvECMO at experienced ECMO centers. Patients with COVID-19-associated ARDS, limited comorbidities, and no contraindication for ECMO should be referred early to local ECMO centers.
Acute Outflow Graft Occlusion—A Novel Predictable Complication of Lysis Therapy for the Treatment of Left Ventricular Assist Device Intra-Pump Thrombosis
Authors: Hoermandinger Christoph , Riedler Nadine , Stein Julia , Stawowy Philipp , Potapov Evgenij , Schoenrath Felix , Just Isabell A.
Published: May 2023

Lysis therapy is an established treatment option for intra-pump thrombosis of left ventricular assist devices (LVADs). In clinical routine, we observed repeated cases of acute outflow graft occlusions (OGO) associated with lysis therapy with need for urgent intervention. The aim of this investigation was to gain understanding of this observation. We screened data of 962 HeartWare ventricular assist device (HVAD) patients. One hundred twenty (13.8%) had intra-pump thromboses; 58 were treated with recombinant tissue-type plasminogen activator (rtPA). Mean age was 53.0 ± 11.1 years; 84.9% were male. In 13 (24.5%) patients, OGO occurred following rtPA-lysis. These patients showed an increase in left ventricular function (18.45% ± 12.62% to 27.73% ± 10.57%; p = 0.056), more frequent 1:1 aortic valve opening (OGO+: +36.4%; OGO−: +7.4%; p = 0.026), a decrease in LVAD pulsatility within 12 months prior intra-pump thrombosis (OGO+: –0.8 L/min [interquartile range {IQR}, –1.4 to –0.4 L/min]; OGO−: –0.3 L/min [IQR, –0.9 to 0.1 L/min]; p = 0.038) and lower HVAD flows at admission (OGO+: 6.7 L/min [IQR, 6.1–7.4 L/min]; OGO−: 8.3 L/min [IQR, 6.9–9.3 L/min]; p = 0.013), indicating a subclinical OGO prior intra-pump thrombosis. There were no differences in implantation techniques, blood parameters, and lysis strategy. Subclinical OGO represented a major risk factor for acute OGO following rtPA lysis therapy. We here propose an algorithm for risk stratification and dealing with patients presenting this first-described complication. Further research is required to confirm our results and decipher the underlying pathomechanism.

http://links.lww.com/ASAIO/B97
Evaluation of Vasoactive-Inotropic Score and Survival to Decannulation in Adult Patients on Venoarterial Extracorporeal Life Support: An Observational Cohort Study
Authors: Dunton Kelly , Weeks Phillip A. , Gulbis Brian , Jumean Marwan , Kumar Sachin , Janowiak Lisa , Banjac Igor , Radovancevic Rajko , Gregoric Igor , Kar Biswajit
Published: May 2023

Extracorporeal life support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) is used to assist circulation in patients with severe cardiogenic shock or cardiac arrest. The vasoactive-inotropic score (VIS) is a standardized calculation of vasoactive medication support which uses coefficients for each medication that converts them to an equivalent value. The purpose of this study was to assess the VIS as an early prognostication tool for survival to decannulation patients on adult VA-ECMO support. This was a single-center, observational cohort study of adult patients who received VA-ECMO support compared based on their survival to decannulation. The primary endpoint was the VIS at hour 24 postcannulation. Among the 265 patients included in this study, 140 patients (52.8%) survived to decannulation of VA-ECMO. At 24 hours postcannulation, a lower VIS was observed in the group that survived decannulation (6.5 ± 7.5 vs. 12.3 ± 16.9; p < 0.001). Multivariate analysis performed also demonstrates an association between 24-hour VIS and survival to decannulation (odds ratio 0.95; 95% confidence interval, 0.91–0.95). This study suggests that the 24-hour VIS may be an early prognostic indicator in patients on VA-ECMO patients.

http://links.lww.com/ASAIO/B39
Comparison of omalizumab and mepolizumab treatment efficacy in patients with atopic and eosinophilic “Overlap” severe asthma: Biological agent preference in atopic-eosinophilic severe asthma
Authors: Tepetam Fatma Merve , Akyildiz Ali Burkan , Özden Şeyma , Örcen Cihan , Yakut Tuğçe , Atik Özge
Published: May 2023

Approximately 1-third of patients with severe asthma are candidates for both omalizumab and mepolizumab treatment. We aimed to compare the clinical, spirometric and inflammatory efficacy of these 2 biologics in atopic and eosinophilic “overlap” severe asthma patients. In our 3-center retrospective cross-sectional observational study, the data of patients who received omalizumab or mepolizumab for at least 16 weeks to treat severe asthma were examined. Atopic (perennial allergen sensitivity and total IgE level 30–1500 IU/mL) and eosinophilic (blood eosinophil counts ≥150 cells/µL in admission; or ≥300 cells/µL in the previous year) patients with asthma suitable for both biologics were included in the study. Post-treatment changes in the asthma control test (ACT) score, number of attacks, forced expiratory volume in 1 second (FEV1), and eosinophil count were compared. The rates of any biological responder patient were compared according to whether they had high eosinophil counts (≥500 cells/µL vs <500 cells/µL). Total of 181 patients data were evaluated, of the 74 atopic and eosinophilic overlap patients included in the study, 56 were receiving omalizumab and 18 were receiving mepolizumab. When omalizumab and mepolizumab treatment efficacies were compared, there was no difference in terms of the reduction in attacks and improvement in ACT. The decrease in eosinophil levels in patients in the mepolizumab arm was significantly higher than that in patients in the omalizumab arm (46.3% vs 87.8%; P < .001). The improvement in FEV1 was greater with mepolizumab treatment, although the difference was not significant (215 mL vs 380 mL; P = .053). It has been shown that having high eosinophil counts does not affect the clinical and spirometric responder patient rates for either biological condition. The success of omalizumab and mepolizumab treatment is similar in patients with atopic and eosinophilic overlap with severe asthma. However, because the baseline patient inclusion criteria are not compatible, head-to-head studies comparing both biological agents are required.
A novel F8 variant in a Chinese hemophilia A family and involvement of X-chromosome inactivation: A case report
Authors: Zhang Honghong , Li Yinjie , Lv Xiaojuan , Mao Yuchan , Sun Yixi , Xu Ting
Published: May 2023

Rationale:

Hemophilia A (HA) is an X-linked recessive bleeding disorder, which shows factor VIII (FVIII) deficiency caused by genetic variant in F8 gene.

Patient concerns:

Males with F8 variants are affected, whereas female carriers with a wide range of FVIII levels are usually asymptomatic, it is possible that different X-chromosome inactivation (XCI) may effect the FVIII activity.

Diagnoses:

We identified a novel variant F8: c.6193T > G in a Chinese HA proband, it was inherited from the mother and grandmother with different FVIII levels.

Interventions:

We performed Androgen receptor gene (AR) assays and RT-PCR.

Outcomes:

AR assays revealed that the X chromosome with the F8 variant was severely skewed inactivated in the grandmother with higher FVIII levels, but not in the mother with lower FVIII levels. Further, RT-PCR of mRNA confirmed that only the wild allele of F8 was expressed in the grandmother, with lower expression in the wild allele of the mother.

Lessons:

Our findings suggest that F8: c.6193T > G could be the cause of HA and that XCI affected the FVIII plasma levels in female carriers.
PADI4 and IL-33 gene polymorphisms with susceptibility to systemic lupus erythematosus and juvenile idiopathic arthritis, a systematic review and meta-analysis
Authors: Zheng Bo , Cai Pingping , Chen Yangjun , Wu Yuechao , Liu Hongyan
Published: May 2023

Background:

This study evaluated the association between peptidyl arginine deiminase type IV (PADI4) and interleukin 33 (IL-33) with systemic lupus erythematosus (SLE) and juvenile idiopathic arthritis (JIA).

Method:

We searched the PubMed, Web of Science, Embase and Cochrane Library databases to retrieve articles published up to January 20, 2023. Stata/SE 17.0 (College Station, TX) software was used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs). The cohort study, case-control study focusing on the PADI4, IL-33 polymorphism, and SLE, JIA were retrieved. The data included basic information of each study and the genotypes and allele frequencies.

Results:

Studies in PADI4 rs2240340 = 2 and 3 IL-33(rs1891385 = 3, rs10975498 = 2, rs1929992 = 4) were found in 6 articles. Overall, only the IL-33 rs1891385 show significant association between SLE in all 5 models. The results were OR (95% CI) = 1.528 (1.312, 1.778), P = .000 in Allele model (C vs A), OR (95% CI) =1.473 (1.092, 1.988), P = .000 in Dominant model (CC + CA vs AA), 2.302 (1.583, 3.349), P = .000 in Recessive model (CC vs CA + AA), 2.711 (1.845, 3.983), P = .000 in Homozygote model (CC vs AA), 5.568 (3.943, 7.863), P = .000 in Heterozygote model (CA vs AA). PADI4 rs2240340, IL-33 rs10975498, IL-33 rs1929992 were not found to be association with the risk of SLE and JIA. In gene model, statistically significant association was found between IL-33 rs1891385 and SLE in sensitivity analysis. Egger’s publication bias plot showed there was no publication bias (P = .165). Only in recessive model the heterogeneity test was significant (I
2 = 57.9%, P ≤ .093) of IL-33 rs1891385.

Conclusion:

The current study suggests that in all 5 model, IL-33 rs1891385 polymorphism may be associated with genetic susceptibility to SLE. There was unclear association found between PADI4 rs2240340, IL-33 rs10975498, and IL-33 rs1929992 polymorphisms and SLE and JIA. Due to the limitations of included studies and the risk of heterogeneity, additional research is required to confirm our findings.

PROSPERO registration number:

CRD42023391268.
Primary bacterial intercostal pyomyositis diagnosis: A case report
Authors: Toyoshima Hirokazu , Tanigawa Motoaki , Ishiguro Chiaki , Tanaka Hiroyuki , Nakanishi Yuki , Sakabe Shigetoshi , Hisatsune Junzo , Kutsuno Shoko , Iwao Yasuhisa , Sugai Motoyuki
Published: May 2023

Rationale:

Pyomyositis is a microbial infection of the muscles and contributes to local abscess formation. Staphylococcus aureus frequently causes pyomyositis; however, transient bacteremia hinders positive blood cultures and needle aspiration does not yield pus, especially at the early disease stage. Therefore, identifying the pathogen is challenging, even if bacterial pyomyositis is suspected. Herein, we report a case of primary pyomyositis in an immunocompetent individual, with the identification of S aureus by repeated blood cultures.

Patient concerns:

A 21-year-old healthy man presented with fever and pain from the left chest to the shoulder during motion. Physical examination revealed tenderness in the left chest wall that was focused on the subclavicular area. Ultrasonography showed soft tissue thickening around the intercostal muscles, and magnetic resonance imaging with short-tau inversion recovery showed hyperintensity at the same site. Oral nonsteroidal anti-inflammatory drugs for suspected virus-induced epidemic myalgia did not improve the patient’s symptoms. Repeated blood cultures on days 0 and 8 were sterile. In contrast, inflammation of the soft tissue around the intercostal muscle was extended on ultrasonography.

Diagnoses:

The blood culture on day 15 was positive, revealing methicillin-susceptible S aureus JARB-OU2579 isolates, and the patient was treated with intravenous cefazolin.

Interventions:

Computed tomography-guided needle aspiration from the soft tissue around the intercostal muscle without abscess formation was performed on day 17, and the culture revealed the same clone of S aureus.

Outcomes:

The patient was diagnosed with S aureus-induced primary intercostal pyomyositis and was successfully treated with intravenous cefazolin for 2 weeks followed by oral cephalexin for 6 weeks.

Lessons:

The pyomyositis-causing pathogen can be identified by repeated blood cultures even when pyomyositis is non-purulent but suspected based on physical examination, ultrasonography, and magnetic resonance imaging findings.
Strategies for expanding patient and public involvement into under-served head and neck cancer communities
Authors: Lawton Michelle , Crane Julie , Killen Vince , Patterson J. M.
Published: May 2023

Purpose of review

In this review, we discuss two case studies in which we summarize the process of expanding patient and public involvement (PPI) representation specific to the head and neck cancer population, highlighting the challenges and successes within each project. The first case study reports on the expansion of HaNC PPI membership, a long-established PPI forum which supports Liverpool Head and Neck Centre research. The second case study describes the establishment of a novel palliative care network in head and neck cancer in the North of England, in which PPI was central to the project's success.

Recent findings

Whilst recognizing diversity is important, it is imperative to acknowledge the contribution of existing members. Engagement with clinicians to reduce issues of gatekeeping is essential. A central theme is that the development of sustainable relationships is critical.

The case studies highlight the challenge of identifying and accessing such a diverse population, particularly in the context of palliative care. Successful PPI is dependent on building and maintaining relationship with PPI members, ensuring flexibility in terms of timing, platforms and venues. Relationships formation should not be restricted to the academic-PPI representative dyad but should consider both clinical-academic and community partnerships to ensure those who are part of under-served communities are afforded the opportunities to become involved in research.
You're Not Who You Used to Be
Authors: Young Stephanie , Smith Marilyn , Shafique Saima , Piamjariyakul Ubolrat
Published: May 2023

Heart failure and vascular dementia have similar underlying pathologies, so it is not uncommon for one condition to exist in the presence of the other. In-home management of each condition is challenging for patients and their family caregivers, but when both conditions are present, those challenges are amplified. The purpose of this case report is to describe one family's experience managing heart failure and vascular dementia at home. A mixed method of semistructured interviews and short surveys was used to examine the health status and well-being of the patient and family caregiver. Data were derived from individual interviews and standardized measures. Survey results revealed the patient had worsening dementia, poor heart failure-related quality of life, poor spiritual well-being, depression, and diminished self-care. The caregiver reported poor physical and mental health. Interview data revealed frustration dealing with worsening symptoms, inadequate information about disease progression, and fear of an unknown future. Additionally, the patient suggested strategies to deal with challenges. Families managing heart failure and vascular dementia need easy-to-understand education from healthcare providers, on-going assessments, and early referrals to support services including those provided by social workers and chaplains.
Assessing Pain in Older Adults
Authors: Horgas Ann L. , Bruckenthal Patricia , Chen Shaoshuai , Herr Keela A. , Young Heather M. , Fishman Scott
Published: May 2023

This article is part of a series, Supporting Family Caregivers: No Longer Home Alone, published in collaboration with the AARP Public Policy Institute. Results of focus groups, conducted as part of the AARP Public Policy Institute's No Longer Home Alone video project, supported evidence that family caregivers aren't given the information they need to manage the complex care regimens of family members. This series of articles and accompanying videos aims to help nurses provide caregivers with the tools they need to manage their family member's health care at home.

This new group of articles provides practical information nurses can share with family caregivers of persons living with pain. To use this series, nurses should read the articles first, so they understand how best to help family caregivers. Then they can refer caregivers to the informational tear sheet—Information for Family Caregivers—and instructional videos, encouraging them to ask questions. For additional information, see Resources for Nurses. Cite this article as: Horgas, A.L., et al. Assessing Pain in Older Adults. Am J Nurs 2022; 122 (12): 42-48.
Targeted Muscle Reinnervation
Authors: Henderson Joshua T. , Koenig Zachary A. , Climov Mihail , Gelman Jack
Published: May 2023

Introduction/Background

Despite inspiring improvements in postamputation pain and prosthetic control, targeted muscle reinnervation (TMR) continues to be underused. With some consistency for recommended nerve transfers developing in the literature, it is necessary to systematize these techniques and simplify their incorporation into routine amputation and neuroma care. This systematic review explores the coaptations reported in the literature to date.

Methods

A systematic review of the literature was performed to collect all reports describing nerve transfers in the upper extremity. The preference was directed toward original studies presenting surgical techniques and coaptations used in TMR. All target muscle options were presented for each nerve transfer in the upper extremity.

Results

Twenty-one original studies describing TMR nerve transfers throughout the upper extremity met inclusion criteria. A comprehensive list of transfers reported for major peripheral nerves at each upper extremity amputation level was included in tables. Ideal nerve transfers were suggested based on convenience and frequency with which certain coaptations were reported.

Conclusions

Increasingly frequent studies are published with convincing outcomes with TMR and numerous options for nerve transfers and target muscles. It is prudent to appraise these options to provide patients with optimal outcomes. Certain muscles are more consistently targeted and can serve as a baseline plan for the reconstructive surgeon interested in incorporating these techniques.
Attending to Motivation During Vocabulary Interventions for Students With or at Risk for Learning Disabilities
Authors: Louick Rebecca , Emery Alyssa , Muenks Katherine , O'Grady Madeline
Published: May 2023

Evidence indicates that well-planned vocabulary interventions can be highly effective in helping students with language-based learning disabilities to develop the necessary vocabulary skills for literacy success. Although many researchers recognize the general importance of attending to psychological factors such as student motivation in developing successful interventions, the role that these factors play in vocabulary interventions designed specifically for students with learning disabilities has not yet been sufficiently considered. In this review, we synthesized the extant literature regarding when and how motivational components are addressed in vocabulary interventions for P–12 students with or at risk for learning disabilities. We found that successful vocabulary intervention programs for this student population most frequently address motivation through the constructs of goal setting and interest. Furthermore, operationalizing terms such as “motivation” (and related constructs) using theories established in the field of educational psychology may allow researchers to develop interventions that have positive, long-lasting impact by encouraging students with learning disabilities to persist at challenging tasks and by enabling them to more clearly see linkages between vocabulary learning and their personal and career goals.
Motivational Practices in Reading Interventions for Students With or at Risk for Dyslexia
Authors: Cho Eunsoo , Dahl-Leonard Katlynn , Kehoe Karen , Capin Philip , Hall Colby , Solari Emily
Published: May 2023

The purposes of this study were to (a) describe the extent to which motivational practices are incorporated in foundational reading interventions for students with or at risk for dyslexia in kindergarten through Grade 5 (K–5) and (b) explore whether the presence and type of motivational practices (i.e., supports vs. strategies) within foundational reading interventions influenced the magnitude of the intervention effects on reading outcomes. We analyzed the same set of studies as Hall et al. (2022), who meta-analyzed experimental and quasi-experimental research of reading interventions implemented with K–5 students with or at risk for dyslexia from 1980 to 2020. Results of the current study show that only 44% of the interventions included motivational practices. The majority (84%) of those interventions addressed student motivation and engagement through motivational supports, such as game-like activities, paired work, and setting improvement goals. A much smaller percentage (16%) provided explicit motivational strategy instruction. Results indicated that reading interventions that include direct motivational strategy instruction tend to have larger effects on reading outcomes than both interventions without any motivational practices and those that include motivational supports only. The positive effect of motivational strategy instruction was stronger on measures of word reading than overall reading or reading comprehension outcomes. These findings highlight the need to address motivational challenges of students with reading difficulties and lend insight into how foundational reading skills interventions can be bolstered through incorporating motivational strategy instruction.
Serum CXCL8 Concentration Can Be Used as a Noninvasive Marker of Subclinical Rejection After Pediatric Liver Transplantation
Authors: Zhang Zhixin , Wang Zhenglu , Dong Chong , Sun Chao , Zheng Weiping , Wang Kai , Zhang Wei , Song Zhuolun , Zhao Shengqiao , Si Zhuyuan , Gao Wei , Shen ZhongYang
Published: May 2023

Background.

This study aimed to explore whether serum CXCL8 concentration can be used as a noninvasive marker of subclinical rejection (SCR) after pediatric liver transplantation (pLT).

Methods.

Firstly, RNA sequencing (RNA-seq) was performed on 22 protocol liver biopsy samples. Secondly, several experimental methods were used to verify the RNA-seq results. Finally, the clinical data and serum samples of 520 LT patients in the Department of Pediatric Transplantation of Tianjin First Central Hospital from January 2018 to December 2019 were collected.

Results.

RNA-seq results indicated that CXCL8 was significantly increased in the SCR group. The results of the 3 experimental methods were consistent with RNA-seq results. According to the 1:2 propensity score matching, 138 patients were divided into the SCR (n = 46) and non-SCR (n = 92) groups. Serological test results indicated that there was no difference in preoperative CXCL8 concentration between the SCR and non-SCR groups (P > 0.05). However, during protocol biopsy, CXCL8 in the SCR group was significantly higher than in the non-SCR group (P < 0.001). In diagnosing SCR, receiver operating characteristic curve analysis showed that the area under the curve of CXCL8 was 0.966 (95% confidence interval, 0.938-0.995), sensitivity was 95%, and specificity was 94.6%. In differentiating nonborderline from borderline rejection, the area under the curve of CXCL8 was 0.853 (95% confidence interval, 0.718-0.988), sensitivity was 86.7%, and specificity was 94.6%.

Conclusions.

This study demonstrates that serum CXCL8 concentration has high accuracy for the diagnosis and disease stratification of SCR after pLT.