bluuebunny/crossref_metadata_2025 huggingface dataset:
Repeated bouts of pulmonary tuberculosis in a hunting cat: reinfection or recrudescence?
Authors: Albuquerque Carolina SC , Černá Petra , Gunn-Moore Danièlle A
Published: April 2021

Case summary

A 7-year-old neutered male Siamese cat was referred for investigation of weight loss and hypercalcaemia (3.3 mmol/l; reference interval 2–3 mmol/l). Haematology, serum biochemistry, thoracic imaging, bronchoalveolar lavage (BAL), Ziehl–Neelsen staining of the BAL fluid and interferon gamma release assay (IGRA) were compatible with pneumonia caused by the less pathogenic member of the Mycobacterium tuberculosis complex, that is, M microti (the ‘vole bacillus’), which is common in cats in the UK. Treatment with azithromycin, rifampicin and marbofloxacin was given for 2 months, followed by 4 months of azithromycin and marbofloxacin. Treatment recommendations for tuberculous pneumonia have since changed. The cat remained asymptomatic for 1 year but went on to develop M microti pneumonia on five other occasions, and was treated for 6–12 months on each occasion. The patient’s clinical signs, hypercalcaemia and radiographic/CT pulmonary pathology always resolved completely, and the IGRA became negative, before antimycobacterial treatment was stopped. This suggests cure followed by reinfection owing to avid hunting behaviour. Alternatively, this could represent recrudescence of dormant disease. This case has previously been included in a study that described a series of cases of feline tuberculosis.

Relevance and novel information

This case shows that M microti infection in cats can present as recurrent episodes of pneumonia, even after prolonged treatment courses.
Experiencing Algorithms: How Young People Understand, Feel About, and Engage With Algorithmic News Selection on Social Media
Authors: Swart Joëlle
Published: April 2021

The news that young people consume is increasingly subject to algorithmic curation. Yet, while numerous studies explore how algorithms exert power in citizens’ everyday life, little is known about how young people themselves perceive, learn about, and deal with news personalization. Considering the interactions between algorithms and users from an user-centric perspective, this article explores how young people make sense of, feel about, and engage with algorithmic news curation on social media and when such everyday experiences contribute to their algorithmic literacy. Employing in-depth interviews in combination with the walk-through method and think-aloud protocols with a diverse group of 22 young people aged 16–26 years, it addresses three current methodological challenges to studying algorithmic literacy: first, the lack of an established baseline about how algorithms operate; second, the opacity of algorithms within everyday media use; and third, limitations in technological vocabularies that hinder young people in articulating their algorithmic encounters. It finds that users’ sense-making strategies of algorithms are context-specific, triggered by expectancy violations and explicit personalization cues. However, young people’s intuitive and experience-based insights into news personalization do not automatically enable young people to verbalize these, nor does having knowledge about algorithms necessarily stimulate users to intervene in algorithmic decisions.
Is it possible to increase the amount of physical activity in patients isolated due to hematopoietic stem cell transplantation using a nursing intervention? A feasibility study
Authors: Vejby Sölvi , Eriksson Anna , Nordin Karin , Johansson Birgitta
Published: April 2021

Patients undergoing hematopoietic stem cell transplantation are isolated and commonly bedridden. Our aim was to investigate whether a nursing intervention is feasible to increase physical activity after a stem cell transplantation, compared to standard care. A secondary aim was to compare quality of life between the groups. A non-equivalent group pretest-posttest design was applied. Twenty-two patients were included in the standard care group and 21 in the intervention group. The intervention comprised physical activity support pre transplantation, daily during hospital stay, and 14 days post discharge. An activity diary, metabolic equivalent of tasks, the six-minute walking test and the FACT-Anaemia Scale were used for evaluation. This study is reported in accordance with the CONSORT statement. The intervention group was more physically active, walked further in six minutes and seemed to have a slightly better quality of life compared to patients receiving standard care. The nursing intervention increased physical activity and may be associated with a better quality of life in patients undergoing hematopoietic stem cell transplantation.
Understanding Social Accounting Based on Evidence
Authors: Retolaza Jose Luis , San-Jose Leire
Published: April 2021

This study aims to discuss the use of social accounting, supported by practice theory, and its contribution to social accounting theory. It is possible for stakeholder accounting to be carried out by various companies. It has been analyzed by multiple case studies, and the results will enable us to help the general public understand the social values that companies generate for society and the resulting impact on stakeholder, and therefore social well-being. The results of the analyses will provide companies with feedback on their social impact, which will help them to become more efficient. This study defines a framework that might guide the social value and nonfinancial information of organizations. Social accounting is seen as an accounting system based on accepted accounting principles, seeking to emphasize the notion of corporate accountability. From the analysis of more than 90 cases, we conclude that there is a possibility of systematically introducing stakeholder accounting or recalled socioemotional accounting (SĒA) into all organizations.
The Impact of High Fidelity Patient Simulation on the Level of Knowledge and Critical Thinking Skills in Code Blue Management Among Undergraduate Nursing Students in Malaysia
Authors: Ka Ling Fong , Lim Binti Abdullah Khatijah , Seng Chiew Gan , Danaee Mahmoud , Chan Caryn Mei Hsien
Published: April 2021

The efficacy of high fidelity patient simulation (HFPS) over low fidelity patient manikins (LFPM) in improving learning outcomes among undergraduate nursing students in Malaysia remains unknown. The aim of this study is to compare learning outcomes (knowledge and critical thinking skills) using an adult code blue drill simulated program using HFPS versus LFPM among undergraduate nursing students in Malaysia. In an experimental study, final-year undergraduate nursing students ( N = 407) from three centers in Malaysia were trained in code blue management and assigned to either control (LFPM) or intervention (HFPS) group. Pre- and post-test assessment was conducted using 30-single best answer questions and the California Critical Thinking Disposition Inventory. A repeated-measures analysis of covariance (ANCOVA) showed significant differences in knowledge levels (intervention, η2 = 0.146; control, η2 = 0.130) and critical thinking skills (intervention, η2 = 0.119; control, η2 = 0.066). Simulation-based education using HFPS is advantageous over LFPM in increasing knowledge and critical thinking skills in code blue management among nursing students.
Disentangling Doubt and Checking Behaviors and Examining Their Association With Obsessive Compulsive Symptoms
Authors: Strauss Asher Y. , Fradkin Isaac , Huppert Jonathan D.
Published: April 2021

Experiencing doubt in an uncertain situation has been theorized to be an antecedent of compulsive checking. However, whether and when obsessive compulsive (OC) symptoms are associated with experiencing doubt and increased checking is unclear. In this study, we investigated the relationship between OC symptoms, the experience of doubt, and checking in a tone-discrimination task. Doubt was measured using mouse tracking, an indirect, unobtrusive measure. The results of two studies ( N = 119) showed that OC symptoms were associated with elevated experiences of doubt when uncertainty was low. However, OC symptoms were not associated with increased checking, but doubt was. Results highlight the utility of mouse-tracking measures to capture the tendency of individuals with OC symptoms to experience doubt even under neutral conditions. The unexpected null results concerning checking suggest some specific directions for research to determine the conditions under which doubt evolves into checking in obsessive compulsive disorder.
Clinical Outcomes and Prognostic Factors in Patients With Recurrent Patellar Lateral Dislocation Treated With Isolated Medial Patellofemoral Ligament Reconstruction: A Retrospective Single-Center Analysis
Authors: Zhao Zhidong , Wang Yuxing , Li Ji , Wang Haoran , Bai Xiaowei , Wang Qi , Li Zhongli
Published: April 2021

Background:

Medial patellofemoral ligament reconstruction (MPFLR) is widely used to treat patellofemoral instability. However, it is still unclear when a concomitant bony procedure is needed.

Purpose:

To evaluate the therapeutic efficacy of isolated MPFLR for recurrent patellar lateral dislocation and to identify the prognostic factors for clinical outcomes.

Study Design:

Case series; Level of evidence, 4.

Methods:

A total of 237 patients who had undergone unilateral isolated MPFLR between January 2011 and December 2016 were included. Patellar tracking (J sign) and radiologic information including patellar height, trochlear dysplasia, tibial tubercle–trochlear groove distance, and patellar tilt was collected preoperatively, and the Kujala and International Knee Documentation Committee (IKDC) functional scores were used to assess postoperative recovery. Failure was defined as redislocation or patient-reported and clinically confirmed patellar instability. The influence of radiologic features and the J sign on knee functional scores was explored via subgroup analysis. Potential prognostic factors were explored using univariate and multivariate regression analyses, and risk factors for a positive J sign were evaluated using Spearman coefficient correlation analysis.

Results:

The mean ± SD follow-up period was 70.67 ± 18.05 months (range, 36-108 months). From preoperatively to final follow-up, all patients had statistically and clinically significant improvements in the Kujala score (from 51.43 ± 6.87 to 88.52 ± 4.83; P < .001) and IKDC score (from 49.78 ± 6.05 to 81.16 ± 4.20; P < .001). Subgroup analysis indicated no significant difference in functional score improvements based on radiologic features or the J sign. Overall, 20 knees (8.4%) experienced postoperative failure: 11 with redislocation and 9 with patellar instability. A preoperative positive J sign was shown to be an independent prognostic factor for postoperative failure via logistic regression analyses: univariate (odds ratio, 3.340; 95% CI, 1.316-8.480; P = .011) and multivariate (odds ratio, 3.038; 95% CI, 1.179-7.827; P = .021). In addition, the J sign was closely associated with patellar height ( r S, 0.159; P = .014) and trochlear dysplasia ( r S, 0.235; P < .001).

Conclusion:

Isolated MPFLR appears to be an effective strategy for recurrent patellar lateral dislocation, with significant functional improvement and a low failure rate. A preoperative positive J sign was identified as a potential prognostic risk factor for postoperative failure.
The role of national culture as a lens for stakeholder evaluation of corporate social performance and its effect on corporate reputation
Authors: Pérez-Cornejo Clara , de Quevedo-Puente Esther , Delgado-García Juan-Bautista
Published: April 2021

Studies have shown that corporate social performance (CSP) is an antecedent of corporate reputation, acting as a signal that affects stakeholders’ perceptions and expectations about a firm’s future behavior. However, the perceptions, expectations, and interests of stakeholders may be affected by external factors, such as national culture, which shapes their beliefs about what role companies play in society. Drawing on institutional theory and Hofstede’s cultural dimensions, we analyze how stakeholders’ national culture moderates the relationship between CSP and corporate reputation. The results of the analysis of an international sample for the period 2010 to 2016 show that low individualism (i.e., collectivism), low masculinity (i.e., femininity), low power distance, and low uncertainty avoidance intensify the positive relationship between CSP and corporate reputation.

JEL CLASSIFICATION: M14, L14
Experiences of Patients With COVID-19 Admitted to the Intensive Care Units: A Qualitative Study
Authors: Norouzadeh Reza , Abbasinia Mohammad , Tayebi Zahra , Sharifipour Ehsan , Koohpaei Alireza , Aghaie Bahman , Asgarpour Hossein
Published: April 2021

This study aimed to describe the experiences of patients with COVID-19 admitted to the intensive care units (ICU). The data were analyzed by content analysis on 16 ICU patients with COVID-19. Data were collected by semi-structured interviews. Three categories were identified: (a) captured by a challenging incident with subcategories: perceived sudden and challenging death, fear of carelessness in overcrowding, worry about the family, and frustration with stigmatizing; (b) the flourishing of life with subcategories: spiritual-awakening, resilience in the face of life challenges, promoting health behaviors, and striving for recovery; and (c) honoring the blessings with subcategories: understanding the importance of nurses, realizing the value of family, and realizing the value of altruism. COVID-19 survivors experienced both positive and negative experiences. The results of this study could help health care providers identify the needs of ICU patients with COVID-19, including psychological, social, and spiritual support and design care models.
Inelastic response spectra of self-centering structures with the flag-shaped hysteretic response subjected to near-fault pulse-type ground motions
Authors: Dong Huihui , Han Qiang , Du Xiuli , Cheng Shoushan , He Haifang
Published: April 2021

Many studies on the inelastic response spectra have mainly focused on structures with the conventional hysteretic behavior. However, for self-centering structures with the flag-shaped (FS) hysteretic behavior, the corresponding study is limited. The primary aim of this study is to investigate the inelastic response spectra of self-centering structures with FS hysteretic behavior subjected to the near-fault pulse-type ground motion. To this end, the smooth FS hysteretic model based on Bouc–Wen model is developed, and the characteristics of pulse-type ground motions are described in detail. It is found that the general features of inelastic response spectra of the FS model are sensitive to the acceleration-, velocity-, and displacement-sensitive spectral regions of the ground motion. The inelastic displacement, velocity, acceleration, and ductility factor spectra of the FS hysteretic model for pulse-type ground motions are much larger than those for ordinary ground motions, while the residual displacement spectra under the two types of ground motions are both very small due to its self-centering capacity. Moreover, the inelastic response spectra are affected by the ground motion characteristics and structural hysteresis behavior, especially the large pulse period and peak ground velocity (PGV) significantly increase the inelastic displacement, velocity, and acceleration spectra.
Metamorphic gabbro and basalt in ophiolitic and continental nappes of the Zermatt region (Western Alps)
Authors: Bucher Kurt , Stober Ingrid
Published: April 2021

The composition of meta-gabbro and meta-basalt occurring abundant and widespread in all nappes of the nappe stack exposed in the Zermatt region of the Western Alp shows distinct patterns related to the geodynamic origin of metamorphic basic rocks. Eclogitic meta-basalts of the ophiolitic Zermatt-Saas Unit (ZSU) show enriched MORB signatures. The meta-basalts (eclogites) of the continental fragment of the Theodul Glacier Unit (TGU) derive from pre-Alpine metamorphic continental intraplate basalts. Meta-basalts (eclogites) from the continental basement of the Siviez-Mischabel nappe (SMN) derive from MORB thus a genetic relation to the TGU eclogites can be excluded. All basic igneous rocks experienced post-magmatic alteration by fluid-rock interaction ranging from processes at the seafloor, in the shallow crust, during subduction zone hydration, in the exhumation channel and late Alpine regional metamorphisms. The consequences of these alteration processes can be identified at various levels in the rock composition data. It was found that the REE data are little affected by fluid-rock alteration. Some trace elements, notably Cs, Rb, and Ba are typically massively altered relative to igneous compositions in all three groups of meta-basalts. Generally, meta-basalts from the TGU and the SMN preserved the features of the original composition whilst the ZSU meta-volcanic rocks experienced massive alteration. For the ZSU meta-volcanic rocks it is evident that Zr was gained and Y lost during high-pressure fluid-rock interaction indicating a mobile behavior of the two elements during HP-metamorphism in contrast to their behavior in hydrothermal near-surface fluid-rock interaction.
Application of network link prediction in drug discovery
Authors: Abbas Khushnood , Abbasi Alireza , Dong Shi , Niu Ling , Yu Laihang , Chen Bolun , Cai Shi-Min , Hasan Qambar
Published: April 2021

Background

Technological and research advances have produced large volumes of biomedical data. When represented as a network (graph), these data become useful for modeling entities and interactions in biological and similar complex systems. In the field of network biology and network medicine, there is a particular interest in predicting results from drug–drug, drug–disease, and protein–protein interactions to advance the speed of drug discovery. Existing data and modern computational methods allow to identify potentially beneficial and harmful interactions, and therefore, narrow drug trials ahead of actual clinical trials. Such automated data-driven investigation relies on machine learning techniques. However, traditional machine learning approaches require extensive preprocessing of the data that makes them impractical for large datasets. This study presents wide range of machine learning methods for predicting outcomes from biomedical interactions and evaluates the performance of the traditional methods with more recent network-based approaches.

Results

We applied a wide range of 32 different network-based machine learning models to five commonly available biomedical datasets, and evaluated their performance based on three important evaluations metrics namely AUROC, AUPR, and F1-score. We achieved this by converting link prediction problem as binary classification problem. In order to achieve this we have considered the existing links as positive example and randomly sampled negative examples from non-existant set. After experimental evaluation we found that Prone, ACT and $$LRW_5$$

L
R

W
5

are the top 3 best performers on all five datasets.

Conclusions

This work presents a comparative evaluation of network-based machine learning algorithms for predicting network links, with applications in the prediction of drug-target and drug–drug interactions, and applied well known network-based machine learning methods. Our work is helpful in guiding researchers in the appropriate selection of machine learning methods for pharmaceutical tasks.
Three in one: evolution of viviparity, coenocytic placenta and polyembryony in cyclostome bryozoans
Authors: Nekliudova U. A. , Schwaha T. F. , Kotenko O. N. , Gruber D. , Cyran N. , Ostrovsky A. N.
Published: April 2021

Background

Placentation has evolved multiple times among both chordates and invertebrates. Although they are structurally less complex, invertebrate placentae are much more diverse in their origin, development and position. Aquatic colonial suspension-feeders from the phylum Bryozoa acquired placental analogues multiple times, representing an outstanding example of their structural diversity and evolution. Among them, the clade Cyclostomata is the only one in which placentation is associated with viviparity and polyembryony—a unique combination not present in any other invertebrate group.

Results

The histological and ultrastructural study of the sexual polymorphic zooids (gonozooids) in two cyclostome species,Crisia eburneaandCrisiella producta, revealed embryos embedded in a placental analogue (nutritive tissue) with a unique structure—comprising coenocytes and solitary cells—previously unknown in animals. Coenocytes originate via nuclear multiplication and cytoplasmic growth among the cells surrounding the early embryo. This process also affects cells of the membranous sac, which initially serves as a hydrostatic system but later becomes main part of the placenta. The nutritive tissue is both highly dynamic, permanently rearranging its structure, and highly integrated with its coenocytic ‘elements’ being interconnected via cytoplasmic bridges and various cell contacts. This tissue shows evidence of both nutrient synthesis and transport (bidirectional transcytosis), supporting the enclosed multiple progeny. Growing primary embryo produces secondary embryos (via fission) that develop into larvae; both the secondary embyos and larvae show signs of endocytosis. Interzooidal communication pores are occupied by 1‒2 specialized pore-cells probably involved in the transport of nutrients between zooids.

Conclusions

Cyclostome nutritive tissue is currently the only known example of a coenocytic placental analogue, although syncytial ‘elements’ could potentially be formed in them too. Structurally and functionally (but not developmentally) the nutritive tissue can be compared with the syncytial placental analogues of certain invertebrates and chordates. Evolution of the cyclostome placenta, involving transformation of the hydrostatic apparatus (membranous sac) and change of its function to embryonic nourishment, is an example of exaptation that is rather widespread among matrotrophic bryozoans. We speculate that the acquisition of a highly advanced placenta providing massive nourishment might support the evolution of polyembryony in cyclostomes. In turn, massive and continuous embryonic production led to the evolution of enlarged incubating polymorphic gonozooids hosting multiple progeny.
Methamphetamine-induced changes in myocardial gene transcription are sex-dependent
Authors: Chavva Hasitha , Brazeau Daniel A. , Denvir James , Primerano Donald A. , Fan Jun , Seeley Sarah L. , Rorabaugh Boyd R.
Published: April 2021

Background

Prior work demonstrated that female rats (but not their male littermates) exposed to methamphetamine become hypersensitive to myocardial ischemic injury. Importantly, this sex-dependent effect persists following 30 days of subsequent abstinence from the drug, suggesting that it may be mediated by long term changes in gene expression that are not rapidly reversed following discontinuation of methamphetamine use. The goal of the present study was to determine whether methamphetamine induces sex-dependent changes in myocardial gene expression and whether these changes persist following subsequent abstinence from methamphetamine.

Results

Methamphetamine induced changes in the myocardial transcriptome were significantly greater in female hearts than male hearts both in terms of the number of genes affected and the magnitude of the changes. The largest changes in female hearts involved genes that regulate the circadian clock (Dbp, Per3, Per2, BMal1, andNpas2) which are known to impact myocardial ischemic injury. These genes were unaffected by methamphetamine in male hearts. All changes in gene expression identified at day 11 returned to baseline by day 30.

Conclusions

These data demonstrate that female rats are more sensitive than males to methamphetamine-induced changes in the myocardial transcriptome and that methamphetamine does not induce changes in myocardial transcription that persist long term after exposure to the drug has been discontinued.
Halotolerant bacteria mitigate the effects of salinity stress on soybean growth by regulating secondary metabolites and molecular responses
Authors: Khan Muhammad Aaqil , Sahile Atlaw Anbelu , Jan Rahmatullah , Asaf Sajjad , Hamayun Muhammad , Imran Muhammad , Adhikari Arjun , Kang Sang-Mo , Kim Kyung-Min , Lee In-Jung
Published: April 2021

Background

Salinity is a major threat to the agriculture industry due to the negative impact of salinity stress on crop productivity. In the present study, we isolated rhizobacteria and evaluated their capacities to promote crop growth under salt stress conditions.

Results

We isolated rhizospheric bacteria from sand dune flora of Pohang beach, Korea, and screened them for plant growth-promoting (PGP) traits. Among 55 bacterial isolates, 14 produced indole-3-acetic acid (IAA), 10 produced siderophores, and 12 produced extracellular polymeric and phosphate solubilization. Based on these PGP traits, we selected 11 isolates to assess for salinity tolerance. Among them, ALT29 and ALT43 showed the highest tolerance to salinity stress. Next, we tested the culture filtrate of isolates ALT29 and ALT43 for IAA and organic acids to confirm the presence of these PGP products. To investigate the effects of ALT29 and ALT43 on salt tolerance in soybean, we grew seedlings in 0 mM, 80 mM, 160 mM, and 240 mM NaCl treatments, inoculating half with the bacterial isolates. Inoculation with ALT29 and ALT43 significantly increased shoot length (13%), root length (21%), shoot fresh and dry weight (44 and 35%), root fresh and dry weight (9%), chlorophyll content (16–24%), Chl a (8–43%), Chl b (13–46%), and carotenoid (14–39%) content of soybean grown under salt stress. Inoculation with ALT29 and ALT43 also significantly decreased endogenous ABA levels (0.77-fold) and increased endogenous SA contents (6–16%), increased total protein (10–20%) and glutathione contents, and reduced lipid peroxidation (0.8–5-fold), superoxide anion (21–68%), peroxidase (12.14–17.97%), and polyphenol oxidase (11.76–27.06%) contents in soybean under salinity stress. In addition, soybean treated with ALT29 and ALT43 exhibited higher K+ uptake (9.34–67.03%) and reduced Na+ content (2–4.5-fold). Genes involved in salt tolerance, GmFLD19 and GmNARK, were upregulated under NaCl stress; however, significant decreases in GmFLD19 (3–12-fold) and GmNARK (1.8–3.7-fold) expression were observed in bacterial inoculated plants.

Conclusion

In conclusion, bacterial isolates ALT29 and ALT43 can mitigate salinity stress and increase plant growth, providing an eco-friendly approach for addressing saline conditions in agricultural production systems.
Experimental parameters and infarct size in closed chest pig LAD ischemia reperfusion models; lessons learned
Authors: Silvis Max J. M. , van Hout Gerardus P. J. , Fiolet Aernoud T. L. , Dekker Mirthe , Bosch Lena , van Nieuwburg Martijn M. J. , Visser Joyce , Jansen Marlijn S. , Timmers Leo , de Kleijn Dominique P. V.
Published: April 2021

Background

Preclinical models that resemble the clinical setting as closely as possible are essential in translating promising therapies for the treatment of acute myocardial infarction. Closed chest pig left anterior descending coronary artery (LAD) ischemia reperfusion (I/R) models are valuable and clinically relevant. Knowledge on the influence of experimental design on infarct size (IS) in these models is a prerequisite for suitable models. To this end, we investigated the impact of several experimental features (occlusion and follow-up time and influence of area at risk (AAR)) on IS.

Methods

A total of fifty-one female Landrace pigs were subjected to closed chest LAD balloon occlusion and evaluated in three substudies with varying protocols. To assess the relationship between time of occlusion and the IS, 18 pigs were subjected to 60-, 75- and 90 min of occlusion and terminated after 24 h of follow-up. Influence of prolonged follow-up on IS was studied in 18 pigs after 75 min of occlusion that were terminated at 1, 3 and 7 days. The relation between AAR and IS was studied in 28 pigs after 60 min of occlusion and 24 h of follow-up. The relation between VF, number of shocks and IS was studied in the same 28 pigs after 60 min of occlusion.

Results

Increasing occlusion time resulted in an increased IS as a ratio of the AAR (IS/AAR). This ranged from 53 ± 23% after 60 min of occlusion to 88 ± 2.2% after 90 min (P = 0.01). Increasing follow-up, from 1 to 3 or 7 days after 75 min of occlusion did not effect IS/AAR. Increasing AAR led to a larger IS/AAR (r2 = 0.34, P = 0.002), earlier VF (r2 = 0.32, P = 0.027) and a higher number of shocks (r2 = 0.29, P = 0.004) in pigs subjected to 60 min of occlusion.

Conclusions

These experiments describe the association of occlusion time, follow-up duration, AAR and VF with IS in closed chest pig LAD I/R models. These results have important implications for future I/R studies in pigs and can serve as a guideline for the selection of appropriate parameters and the optimal experimental design.
Clinical characteristics and outcome of influenza virus infection among adults hospitalized with severe COVID-19: a retrospective cohort study from Wuhan, China
Authors: Tong Xunliang , Xu Xiaomao , Lv Guoyue , Wang He , Cheng Anqi , Wang Dingyi , Fan Guohui , Zhang Yue , Li Yanming
Published: April 2021

Background

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease that rapidly spreads worldwide and co-infection of COVID-19 and influenza may occur in some cases. We aimed to describe clinical features and outcomes of severe COVID-19 patients with co-infection of influenza virus.

Methods

Retrospective cohort study was performed and a total of 140 patients with severe COVID-19 were enrolled in designated wards of Sino-French New City Branch of Tongji Hospital between Feb 8th and March 15th in Wuhan city, Hubei province, China. The demographic, clinical features, laboratory indices, treatment and outcomes of these patients were collected.

Results

Of 140 severe COVID-19 hospitalized patients, including 73 patients (52.14%) with median age 62 years were influenza virus IgM-positive and 67 patients (47.86%) with median age 66 years were influenza virus IgM-negative. 76 (54.4%) of severe COVID-19 patients were males. Chronic comorbidities consisting mainly of hypertension (45.3%), diabetes (15.8%), chronic respiratory disease (7.2%), cardiovascular disease (5.8%), malignancy (4.3%) and chronic kidney disease (2.2%). Clinical features, including fever (≥38 °C), chill, cough, chest pain, dyspnea, diarrhea and fatigue or myalgia were collected. Fatigue or myalgia was less found in COVID-19 patients with IgM-positive (33.3% vs 50/7%,P = 0.0375). Higher proportion of prolonged activated partial thromboplastin time (APTT) > 42 s was observed in COVID-19 patients with influenza virus IgM-negative (43.8% vs 23.6%,P = 0.0127). Severe COVID-19 Patients with influenza virus IgM positive have a higher cumulative survivor rate than that of patients with influenza virus IgM negative (Log-rankP = 0.0308). Considering age is a potential confounding variable, difference in age was adjusted between different influenza virus IgM status groups, the HR was 0.29 (95% CI, 0.081–1.100). Similarly, difference in gender was adjusted as above, the HR was 0.262 (95% CI, 0.072–0.952) in the COX regression model.

Conclusions

Influenza virus IgM positive may be associated with decreasing in-hospital death.
Informing the public health response to COVID-19: a systematic review of risk factors for disease, severity, and mortality
Authors: Flook M. , Jackson C. , Vasileiou E. , Simpson C. R. , Muckian M. D. , Agrawal U. , McCowan C. , Jia Y. , Murray J. L. K. , Ritchie L. D. , Robertson C. , Stock S. J. , Wang X. , Woolhouse M. E. J. , Sheikh A. , Stagg H. R.
Published: April 2021

Background

Severe Acute Respiratory Syndrome coronavirus-2 (SARS-CoV-2) has challenged public health agencies globally. In order to effectively target government responses, it is critical to identify the individuals most at risk of coronavirus disease-19 (COVID-19), developing severe clinical signs, and mortality. We undertook a systematic review of the literature to present the current status of scientific knowledge in these areas and describe the need for unified global approaches, moving forwards, as well as lessons learnt for future pandemics.

Methods

Medline, Embase and Global Health were searched to the end of April 2020, as well as the Web of Science. Search terms were specific to the SARS-CoV-2 virus and COVID-19. Comparative studies of risk factors from any setting, population group and in any language were included. Titles, abstracts and full texts were screened by two reviewers and extracted in duplicate into a standardised form. Data were extracted on risk factors for COVID-19 disease, severe disease, or death and were narratively and descriptively synthesised.

Results

One thousand two hundred and thirty-eight papers were identified post-deduplication. Thirty-three met our inclusion criteria, of which 26 were from China. Six assessed the risk of contracting the disease, 20 the risk of having severe disease and ten the risk of dying. Age, gender and co-morbidities were commonly assessed as risk factors. The weight of evidence showed increasing age to be associated with severe disease and mortality, and general comorbidities with mortality. Only seven studies presented multivariable analyses and power was generally limited. A wide range of definitions were used for disease severity.

Conclusions

The volume of literature generated in the short time since the appearance of SARS-CoV-2 has been considerable. Many studies have sought to document the risk factors for COVID-19 disease, disease severity and mortality; age was the only risk factor based on robust studies and with a consistent body of evidence. Mechanistic studies are required to understand why age is such an important risk factor. At the start of pandemics, large, standardised, studies that use multivariable analyses are urgently needed so that the populations most at risk can be rapidly protected.

Registration

This review was registered on PROSPERO as CRD42020177714.
An Eschar-like souvenir from a journey to Colombia: Ecthyma gangrenosum as a differential diagnosis of tropical diseases in immunocompromised patients – a case report
Authors: Wiedemann Gabriela M. , Schneider Jochen , Verbeek Mareike , Konukiewitz Björn , Spinner Christoph D. , Einwächter Henrik , Schmid Roland M. , Rothe Kathrin
Published: April 2021

Background

Ecthyma gangrenosum (EG) is a cutaneous infectious disease characterized by eschar-like skin ulcers typically caused by Pseudomonas aeruginosa. Here, we report a case of relapsing EG in a patient who had returned from a trip to Colombia, thus establishing EG as an important differential diagnosis of tropical diseases, and demonstrating that even long-term antibiotic treatment can result in only partial remission of EG.

Case presentation

A 77-year-old man with underlying chronic lymphocytic leukemia (CLL) on ibrutinib treatment was admitted because of a superinfected mosquito bite on the left ear and multiple partially necrotic skin lesions disseminated all over the entire body five days after returning from a trip to Colombia. The initial clinical suspicion of a tropical disease (leishmaniosis, systemic mycosis, or others) could not be confirmed. During the diagnostic workup, microbiological cultures of the skin biopsies and bronchoalveolar lavage revealed Pseudomonas aeruginosa, leading to a diagnosis of EG. Initial antibiotic treatment resulted in partial remission. However, the patient had to be re-admitted due to a relapse 3–4 weeks after the first episode. Finally, the patient was successfully treated with a combined approach consisting of antibiotics, recurrent surgical incisions, and administration of immunoglobulins.

Conclusions

In conclusion, EG should be considered as a differential diagnosis in immunosuppressed patients presenting with eschar-like skin ulcers. A combined treatment approach seems to be the best choice to achieve clinical cure and avoid relapse.
CT perfusion based ASPECTS improves the diagnostic performance of early ischemic changes in large vessel occlusion
Authors: Wang Tiegong , Chen Luguang , Jin Xianglan , Yuan Yuan , Zhang Qianwen , Shao Chengwei , Lu Jianping
Published: April 2021

Background

ASPECTS scoring method varies, but which one is most suitable for predicting the prognosis still unclear. We aimed to evaluate the diagnostic performance of Automated (Auto)-, noncontrast CT (NCCT)- and CT perfusion (CTP) -ASPECTS for early ischemic changes (EICs) in acute ischemic stroke patients with large vessel occlusion (LVO) and to explore which scoring method is most suitable for predicting the clinical outcome.

Methods

Eighty-one patients with anterior circulation LVO were retrospectively enrolled and grouped as having a good (0–2) or poor (3–6) clinical outcome using a 90-day modified Rankin Scale score. Clinical characteristics and perfusion parameters were compared between the patients with good and poor outcomes. Differences in scores obtained with the three scoring methods were assessed. Diagnosis performance and receiver operating characteristic (ROC) curves were used to evaluate the value of the three ordinal or dichotomized ASPECTS methods for predicting the clinical outcome.

Results

Sixty-three patients were finally included, with 36 (57.1%) patients having good clinical outcome. Significant differences were observed in the ordinal or dichotomized Auto-, NCCT- and CTP-ASPECTS between the patients with good and poor clinical outcomes (all p < 0.01). The areas under the curves (AUCs) of the ordinal and dichotomized CTP-ASPECTS were higher than that of the other two methods (all p < 0.01), but the AUCs of the Auto-ASPECTS was similar to that of the NCCT-ASPECTS (p > 0.05).

Conclusions

The CTP-ASPECTS is superior to the Auto- and NCCT-ASPECTS in detecting EICs in LVO. CTP-ASPECTS with a cutoff value of 6 is a good predictor of the clinical outcome at 90-day follow-up.
Development and testing of the hemodialysis symptom distress scale (HSD-22) to identify the symptom cluster by using exploratory factor analysis
Authors: Chen Mei-Chu , Ho Ya-Fang , Lin Chiu-Chu , Wu Chia-Chen
Published: April 2021

Background

Patients receiving hemodialysis (HD) often experience multiple symptoms concurrently and these symptoms may impact their quality of life. A valid and reliable tool is needed to assess the symptom distress of patients receiving HD in terms of the perspective of symptom clusters. Although many studies have explored symptom clusters related to patients receiving HD, the clusters formed had problems with overlapping, vagueness, lack of cluster-specificity, and difficulty in discerning their common mechanism under the cluster.

Aims

To develop reliable measurement tool to identify the symptom clusters of patients undergoing HD.

Design

A cross-sectional descriptive study.

Methods

To examine the physiological properties of the HD symptom distress (HSD) scale, 216 participants were recruited from a HD center of a medical university hospital in southern Taiwan from February 2019 to April 2019. Construct validity was evaluated by exploratory factor analysis (EFA), and the internal consistency and test–retest reliability were estimated by Cronbach’s alpha and intraclass correlation coefficient (ICC).

Results

The CVI value of the HSD was 0.89. The HSD scale was composed of five factors with 22 items, including insufficient energy/vitality, cardiac–pulmonary distress, sleep disturbance, musculoskeletal distress, and gastrointestinal distress, with factor loading ranging from 0.62 to 0.87, explaining 65.5% of the total variance. Cronbach’s alpha coefficient of the HSD total scale was 0.93, and five subscales ranged from 0.73 to 0.89. The test-retest reliability was 0.92 (p < 0.001) by using the intraclass correlation coefficient (ICC) for the HSD-22 scale.

Conclusion / implication

Theoretical testing from our study indicated that the HSD-22 scale had satisfactory validity and reliability. Therefore, this assessment tool can be employed to identify the symptom clusters of patients receiving HD in the clinical setting. Such identification enables healthcare professionals to provide interventions to release patients’ symptom distress efficiently.
Necrotizing funisitis and calcification of umbilical vein: case report and review
Authors: Wang Wendi , Zhang Miao , Gong Liyun , Wu Qingqing
Published: April 2021

Background

Necrotising funisitis (NF) is a rare, chronic stage of funisitis, a severe inflammation of the umbilical cord and an important risk factor for fetal adverse outcomes. NF is characterized by yellow-white bands running parallel to the umbilical blood vessels. These bands consist of inflammatory cells, necrotic debris, and calcium deposits. Calcification is visible in ultrasonography, which makes it possible to suspect NF when umbilical vascular wall calcification is detected by prenatal ultrasonography.

Case presentation

Ultrasonography revealed calcification of the umbilical venous wall in an expectant 31-year-old woman who was gravida 1, para 0. The woman required emergency cesarean section because of fetal distress and suspected umbilical cord torsion at 31 weeks gestation. The root of the umbilical cord was quite fragile and broke during the operation. The pathological results on the placenta showed histologic chorioamnionitis and NF. The infant was diagnosed to have neonatal sepsis and acidosis after delivery but was discharged without severe complications after a one-month hospitalization that included antibiotic and supportive therapy.

Conclusion

NF is a rare and severe inflammation of the umbilical cord. Umbilical vascular wall calcification discovered in prenatal ultrasonography is diagnostically helpful.
Imaging manifestations of Caroli disease with autosomal recessive polycystic kidney disease: a case report and literature review
Authors: Yao Xiuzhen , Ao Weiqun , Fang Jianhua , Mao Guoqun , Chen Chuanghua , Yu Lifang , Cai Huaijie , Xu Chenke
Published: April 2021

Background

Both Caroli disease (CD) and autosomal recessive polycystic kidney disease (ARPKD) are autosomal recessive disorders, which are more commonly found in infants and children, for whom surviving to adulthood is rare. Early diagnosis and intervention can improve the survival rate to some extent. This study adopted the case of a 26-year-old pregnant woman to explore the clinical and imaging manifestations and progress of CD concomitant with ARPKD to enable a better understanding of the disease.

Case presentation

A 26-year-old pregnant woman was admitted to our hospital for more than 2 months following the discovery of pancytopenia and increased creatinine. Ultrasonography detected an enlarged left liver lobe, widened hepatic portal vein, splenomegaly, and dilated splenic vein. In addition, both kidneys were obviously enlarged and sonolucent areas of varying sizes were visible, but color Doppler flow imaging revealed no abnormal blood flow signals. The gestational age was approximately 25 weeks, which was consistent with the actual fetal age. Polyhydramnios was detected but no other abnormalities were identified. Magnetic resonance imaging revealed that the liver was plump, and polycystic liver disease was observed near the top of the diaphragm. The T1 and T2 weighted images were the low and high signals, respectively. The bile duct was slightly dilated; the portal vein was widened; and the spleen volume was enlarged. Moreover, the volume of both kidneys had increased to an abnormal shape, with multiple, long, roundish T1 and T2 abnormal signals being observed. Magnetic resonance cholangiopancreatography revealed that intrahepatic cystic lesions were connected with intrahepatic bile ducts. The patient underwent a genetic testing, the result showed she carried two heterozygous mutations in PKHD1. The patient was finally diagnosed with CD with concomitant ARPKD. The baby underwent a genetic test three months after birth, the result showed that the patient carried one heterozygous mutations in PKHD1, which indicated the baby was a PKHD1 carrier.

Conclusions

This case demonstrates that imaging examinations are of great significance for the diagnosis and evaluation of CD with concomitant ARPKD.
Applicability of somatic monitoring instructions in clinical practice guidelines on antipsychotic drug use
Authors: Brouwer Jurriaan M. J. L. , Olde Hengel Erien , Risselada Arne J. , van Roon Eric N. , Mulder Hans
Published: April 2021

Background

Clinical practice guidelines (CPGs) recommend the monitoring of somatic parameters in patients treated with antipsychotic drugs in order to detect adverse effects. The objective of this study was to assess, in adult and (frail) elderly populations, the consistency and applicability of the somatic monitoring instructions recommended by established CPGs prior to and during antipsychotic drug use.

Methods

A search for national and international CPGs was performed by querying the electronic database PubMed and Google. Somatic monitoring instructions were assessed for adult and (frail) elderly populations separately. The applicability of somatic monitoring instructions was assessed using the Systematic Information for Monitoring (SIM) score. Somatic monitoring instructions were considered applicable when a minimum SIM score of 3 was reached.

Results

In total, 16 CPGs were included, with a total of 231 somatic monitoring instructions (mean: 14; range: 0–47). Of the somatic monitoring instructions, 87% were considered applicable, although critical values and how to respond to aberrant values were only present in 28 and 52% of the available instructions respectively. Only 1 CPG presented an instruction specifically for (frail) elderly populations.

Conclusions

We emphasize the need for a guideline with somatic monitoring instructions based on the SIM definition for both adult and (frail) elderly populations using antipsychotic drugs. In addition, CPGs should state that clear agreements should be made regarding who is responsible for interventions and somatic monitoring prior to and during antipsychotic drug use.