bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient’s Perspective on Disease Burden, Remission Definition, and Symptoms Associated With Treatment Seeking: A Qualitative Study in Adult and Adolescent Patients With Crohn’s Disease
Authors: Kitchen Helen , Farrar Mallory , Al-zubeidi Tamara , Pegram Hannah , Hunter Theresa , Naegeli April N , Delbecque Laure , Jairath Vipul
Published: April 2020

Background

Disease burden, a definition of remission, and symptoms that drive treatment seeking were explored in a Crohn’s disease (CD) population.

Methods

A qualitative semistructured interview guide was developed, informed by published literature. Clinicians identified adolescents and adult patients with CD. Face-to-face interviews were audio-recorded and transcribed. Two rounds of interviews were conducted with patients. Transcripts were analyzed using thematic methods facilitated by ATLAS.ti.

Results

Twenty-four patients participated in the first round of interviews (n = 16 adults, mean age 50.3 years; n = 8 adolescents, mean age 15.6 years). Abdominal pain (n = 24), urgent bowel movements (n = 24), diarrhea (n = 23), and frequent bowel movements (n = 21) were the most frequently reported symptoms. CD affected patients’ physical functioning, daily activities, emotional wellbeing, social functioning, work/education, and relationships. No major difference in disease burden was observed between adolescents and adults. Twenty-three patients (96%) reported they would seek or had sought medical treatment for at least one symptom including abdominal pain (n = 19), diarrhea (n = 12), and blood in stools/rectal bleeding (n = 9). On a 0–10 scale (0 = no symptom and 10 = symptom at its worst possible), most patients (87%, 20/23) answered they would seek/had sought treatment when the symptom’s severity was at least 7. In the second round of interviews (n = 6 adults, mean age 51.5 years), 5/6 patients described that they did not require a complete absence of abdominal pain or loose/watery stools to consider their CD to be in remission.

Conclusions

CD is associated with substantial disease burden. Worsening of some symptoms drives treatment seeking. To some patients, remission is not defined as a complete absence of symptoms.
The effect of centre volume and procedure location on major complications and mortality from transvenous lead extraction: an ESC EHRA EORP European Lead Extraction ConTRolled ELECTRa registry subanalysis
Authors: Sidhu Baldeep S , Gould Justin , Bunce Catey , Elliott Mark , Mehta Vishal , Kennergren Charles , Butter Christian , Deharo Jean-Claude , Kutarski Andrzej , Maggioni Aldo P , Auricchio Angelo , Kuck Karl-Heinz , Blomström-Lundqvist Carina , Bongiorni Maria Grazia , Rinaldi Christopher A ,   on behalf of the ELECTRa Investigators Group
Published: April 2020

Aims 

Transvenous lead extraction (TLE) should ideally be undertaken by experienced operators in a setting that allows urgent surgical intervention. In this analysis of the ELECTRa registry, we sought to determine whether there was a significant difference in procedure complications and mortality depending on centre volume and extraction location.

Methods and results 

Analysis of the ESC EORP European Lead Extraction ConTRolled ELECTRa registry was conducted. Low-volume (LoV) centres were defined as <30 procedures/year, and high-volume (HiV) centres as ≥30 procedures/year. Three thousand, two hundred, and forty-nine patients underwent TLE by a primary operator cardiologist; 17.1% in LoV centres and 82.9% in HiV centres. Procedures performed by primary operator cardiologists in LoV centres were less likely to be successful (93.5% vs. 97.1%; P < 0.0001) and more likely to be complicated by procedure-related deaths (1.1% vs. 0.4%; P = 0.0417). Transvenous lead extraction undertaken by primary operator cardiologists in LoV centres were associated with increased procedure-related major complications including death (odds ratio 1.858, 95% confidence interval 1.007–3.427; P = 0.0475). Transvenous lead extraction locations varied; 52.0% operating room, 9.5% hybrid theatre and 38.5% catheterization laboratory. Rates of procedure-related major complications, including death occurring in a high-risk environment (combining operating room and hybrid theatre), were similar to those undertaken in the catheterization laboratory (1.7% vs. 1.6%; P = 0.9297).

Conclusion 

Primary operator cardiologists in LoV centres are more likely to have extractions complicated by procedure-related deaths. There was no significant difference in procedure complications between different extraction settings. These findings support the need for TLE to be performed in experienced centres with appropriate personnel present.
Cross-dressing, Male Intimacy and the Violence of Transgression in Third Reich Photography
Authors: Evans Jennifer , Mailänder Elissa
Published: April 2020

This co-authored article draws upon two distinct genres of photography, police mugshots and amateur soldier snapshots, to illustrate the value of queer visual culture methodologies for how to think about the visualization of violence, masculinity and desire. Building upon two vastly different depictions of male to female cross-dressing, one produced between 1934 and 1938 by the Berlin police and Gestapo of a transvestite and the other produced between 1940 and 1944 by cross-dressing Wehrmacht soldiers behind the lines, we argue that in searching for evidence of intact identities, we overlook important ambiguities. We first show how different photographic traditions have framed gender and sexual non-conformity in the historical record and then go deeper into an image analysis. Drawing upon cross-dressing as a polyvalent performance of masculinity, as play, camp and an identity category, we explore how photographic sources help us better appreciate the multiple and sometimes coexisting layers of feminized masculinity at work during the Third Reich. By queering Nazi history and reading the police mugshots and amateur Wehrmacht photographs within and beyond their visual frames, we point out the limits of reducing every image of cross-dressing to an expression of an inchoate gay or trans identity and argue for analysis that embraces the multiple layers of histories gathered around visual sources.
CO2-induced low pH in an eastern oyster (Crassostrea virginica) hatchery positively affects reproductive development and larval survival but negatively affects larval shape and size, with no intergenerational linkages
Authors: Clements Jeff C , Carver Claire E , Mallet Martin A , Comeau Luc A , Mallet André L
Published: April 2020

In North America, studies regarding effects of CO2-induced low pH in bivalve aquaculture are largely restricted to the US Pacific coast. Studies on species from the northwest Atlantic are lacking. Furthermore, information on the roles of intergenerational exposure and biological sex in bivalve responses to low pH, particularly in an aquaculture-specific context, is scant. We tested if short-term (1 month) exposure to CO2-induced reductions in pHNBS affected the reproductive development of male and female eastern oysters (Crassostrea virginica) during hatchery-specific reproductive conditioning and whether maternal and/or paternal exposure influenced larval responses. Reduced pH (7.5–7.7) increased the rate of reproductive development in both males and females. There was no indication of intergenerational effects; adult pH conditions did not affect early larval development. In contrast, low pH conditions experienced by gametes during spawning, fertilization, and embryo incubation (48 h) resulted in higher larval survival (+6–8% from control), reduced shell height (−2 to 3 µm), and increased deformities (abnormal shell shape; +3–5%). We suggest that local adaptation to acidic land runoff may account for the positive effects of low pH observed in this study. Bioeconomic assessments are now needed to understand the implications of reduced pH on aquaculture operations in these regions of Atlantic Canada.
The Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program’s Response to the Opioid Epidemic
Authors: Chavis Nicole S , Klein Pamela W , Cohen Stacy M , Dempsey Antigone , Hauck Heather , Cheever Laura W
Published: April 2020

Background

The United States is in the midst of an unprecedented opioid crisis with increasing injection drug use (IDU)-related human immunodeficiency virus (HIV) outbreaks, particularly in rural areas. The Health Resources and Services Administration (HRSA)’s Ryan White HIV/AIDS Program (RWHAP) is well positioned to integrate treatment for IDU-associated HIV infections with treatment for drug use disorders. These activities will be crucial for the “Ending the HIV Epidemic: A Plan for America” (EHE) initiative, in which 7 southern states were identified with rural HIV epidemics.

Methods

The RWHAP Services Report data were used to assess the IDU population and substance use services utilization among RWHAP clients in 2017, nationally and in the 7 EHE-identified states. THe HRSA held a 1-day Technical Expert Panel (TEP) to explore how RWHAP can best respond to the growing opioid crisis.

Results

During the TEP, 8 key themes emerged and 11 best practices were identified to address opioid use disorder (OUD) among people with HIV. In 2017, among RWHAP clients with reported age and transmission category, 6.7% (31 683) had HIV attributed to IDU; among IDU clients, 6.3% (1988) accessed substance use services.

Conclusions

The TEP results and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care. These activities are critical to ending the HIV epidemic.
Mixed-Frequency Macro–Finance Factor Models: Theory and Applications*
Authors: Andreou Elena , Gagliardini Patrick , Ghysels Eric , Rubin Mirco
Published: April 2020

This article presents tests for the existence of common factors spanning two large panels/groups of macroeconomic and financial variables, and the estimation of common and group-specific factors. New analytical results are derived regarding (i) the difference in the asymptotic distribution of the test statistics when aggregating the data first and then extracting the principal components (PCs), or vice versa, as well as (ii) the estimation of the common factor and its asymptotic distribution, extending the work of Andreou et al. (2019). We find that although there is no empirical evidence for one common factor, with constant loadings, in the United States during the period 1963–2017, there is evidence of one common macro–finance factor during the pre- and post-Great Moderation regimes. The aforementioned approaches of estimating PCs yield almost identical common and group-specific (financial and macro) factors which turn out to be significant in predicting key economic indicators, such as real Gross Domestic Product (GDP) growth and the CBOE Volatility Index, among others.
Inflammatory Biomarkers, Hematopoietic Stem Cells, and Symptoms in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy
Authors: Shi Wei , Misra Shagun , Li Madeline , Su Jie , Chong Lisa P , McCuske Megan , Williams Justin , Xu Wei , Ghoraie Laleh S , Sutherland D Robert , Han Kathy , Minden Mark D , Bratman Scott V , Yip Kenneth W , Liu Fei-Fei
Published: April 2020

Background

Fatigue and insomnia are common symptoms experienced by breast cancer patients undergoing adjuvant radiation therapy (RT), yet the underlying mechanisms of these symptoms are unclear. In particular, the roles of hematopoietic stem cells (HSCs) and inflammatory cytokines remain to be elucidated.

Methods

Breast cancer patients (n = 147) completed questionnaires to longitudinally assess symptoms before, during, and after adjuvant RT. Phlebotomies were performed prior to RT, at the second and fifth treatment fractions, end of treatment (EOT), and 1 month after completing RT, assessing for CD34+, CD45+, full hematology, and 17 inflammatory cytokines. The associations between symptoms and all biomarkers were evaluated. All statistical tests were 2-sided.

Results

General fatigue and insomnia worsened with RT, with peak levels observed at EOT, which remained statistically significant even after controlling for anxiety and depression (P < .05 for all). CD34+, CD45+, white blood cell, and lymphocyte counts decreased, with the lowest levels also observed at EOT (P < .001). Fatigue and insomnia were associated with changes in both interferon γ-induced protein 10 (IP-10) - (P = .03 and P = .01, respectively) and tumor necrosis factor receptor II (TNF-RII) (P = .02 and P = .006, respectively), while mental fatigue was associated with increased matrix metalloproteinases-2 (MMP-2) levels (P = .03). Patients who received prior chemotherapy demonstrated statistically significantly greater severity in all symptoms, with lower baseline HSC levels.

Conclusions

This is the first longitudinal study to examine linkages between symptoms, HSCs, and cytokines, demonstrating that fatigue and insomnia shared associations with increasing serum levels of IP-10 and TNF-RII, and mental fatigue was associated with increasing serum levels of MMP-2. Our findings highlight opportunities for further research into mechanisms and potential interventions for these symptoms.
The Moral Politics of LGBTI Asylum: How the State Deals with the SOGI Framework
Authors: Prearo Massimo
Published: April 2020

The article proposes a political ethnography of lesbian, gay, bisexual, trans and intersex (LGBTI) asylum founded on a fieldwork (2017–19) in an associative and activist context that supports LGBTI asylum applicants. Through the analysis of the narratives mobilized and produced during the interviews between asylum applicants and institutional agents in charge of receiving and assessing the requests for international protection, the article explores the institutional uses of the SOGI framework. The hypothesis that the article puts forward is that, far from concerning exclusively a confrontation/dispute among models of sexual orientation and gender identity, these interactions actually bring forth a logic of exchange of moral goods (vulnerability, feelings of shame and fear, identity, narratives). Given the impossibility for LGBTI asylum applicants to produce probatory documentation, this study exposes the strategies for determining legitimate from illegitimate LGBTI migrant subjects, ‘good’ from ‘bad’ migrant stories, and, therefore, the political and moral dimension of the institutional work and the grant of the right of asylum.
First record of Nassarius fuscus (Hombron & Jacquinot, 1848) from the west coast of India, with the description of its sister species Nassarius arewarensis n. sp. (Buccinoidea: Nassariidae)
Authors: Nerurkar Sayali , Shimpi Gaurav G , Apte Deepak
Published: April 2020

Nassarius Duméril, 1805 is the most diverse genus within the nassariid subfamily Nassariinae. Nonetheless, information on members of this genus from the Indian subcontinent, a major ecoregion of the western Indo-Pacific, is scarce. Here, we report Nassarius fuscus (Hombron & Jacquinot, 1848) for the first time from India and provide information on its morphology and ecology. This species has previously been recorded only from the central Indo-Pacific. We also describe a new species of Nassarius, N. arewarensis n. sp., which on the basis of our data is sister to N. fuscus. Both species were found within heterogeneous strands of mangroves in the shallow intertidal area of the Aare-Ware Creek, Ratnagiri, Maharashtra, India. Morphological comparisons as well as species delimitation analyses using the universal cytochrome c oxidase subunit I barcode indicated that these species are distinct. The present study enhances our understanding of the species composition and the diversity of Nassarius in India.
PvrA is a novel regulator that contributes to Pseudomonas aeruginosa pathogenesis by controlling bacterial utilization of long chain fatty acids
Authors: Pan Xiaolei , Fan Zheng , Chen Lei , Liu Chang , Bai Fang , Wei Yu , Tian Zhenyang , Dong Yuanyuan , Shi Jing , Chen Hao , Jin Yongxin , Cheng Zhihui , Jin Shouguang , Lin Jianping , Wu Weihui
Published: April 2020

During infection of a host, Pseudomonas aeruginosa orchestrates global gene expression to adapt to the host environment and counter the immune attacks. P. aeruginosa harbours hundreds of regulatory genes that play essential roles in controlling gene expression. However, their contributions to the bacterial pathogenesis remain largely unknown. In this study, we analysed the transcriptomic profile of P. aeruginosa cells isolated from lungs of infected mice and examined the roles of upregulated regulatory genes in bacterial virulence. Mutation of a novel regulatory gene pvrA (PA2957) attenuated the bacterial virulence in an acute pneumonia model. Chromatin immunoprecipitation (ChIP)-Seq and genetic analyses revealed that PvrA directly regulates genes involved in phosphatidylcholine utilization and fatty acid catabolism. Mutation of the pvrA resulted in defective bacterial growth when phosphatidylcholine or palmitic acid was used as the sole carbon source. We further demonstrated that palmitoyl coenzyme A is a ligand for the PvrA, enhancing the binding affinity of PvrA to its target promoters. An arginine residue at position 136 was found to be essential for PvrA to bind palmitoyl coenzyme A. Overall, our results revealed a novel regulatory pathway that controls genes involved in phosphatidylcholine and fatty acid utilization and contributes to the bacterial virulence.
Efficacy and safety of paediatric medicinal cannabis use: A scoping review
Authors: Pawliuk Colleen , Chau Briana , Rassekh S Rod , McKellar Terri , Siden Harold (Hal)
Published: April 2020

Introduction

The use of medicinal cannabis in the paediatric age group is increasing despite the lack of evidence for its efficacy or safety.

Objective

To map the available evidence on the efficacy and safety of medicinal cannabis in children and adolescents.

Methods

We conducted a scoping review and searched six electronic databases and grey literature. A study was eligible for inclusion when it investigated the efficacy or safety of medicinal cannabis for any condition, more than half of the participants were 0 to 18 years old, and had any study design except single case reports.

Results

We included 36 studies in our final analysis, 32 of which investigated the efficacy or safety of cannabis in treatment-resistant epilepsy. The remaining 4 studies examined patients with cancer, dysautonomia, Epidermolysis Bullosa, and motor disorders.

Conclusions

There is a lack of evidence on the efficacy and safety of medicinal cannabis in most paediatric conditions.
Engineering Trienoic Fatty Acids into Cottonseed Oil Improves Low-Temperature Seed Germination, Plant Photosynthesis and Cotton Fiber Quality
Authors: Gao Lihong , Chen Wei , Xu Xiaoyu , Zhang Jing , Singh Tanoj K , Liu Shiming , Zhang Dongmei , Tian Lijun , White Adam , Shrestha Pushkar , Zhou Xue-Rong , Llewellyn Danny , Green Allan , Singh Surinder P , Liu Qing
Published: April 2020

Alpha-linolenic acid (ALA, 18:3Δ9,12,15) and γ-linolenic acid \ (GLA, 18:3Δ6,9,12) are important trienoic fatty acids, which are beneficial for human health in their own right, or as precursors for the biosynthesis of long-chain polyunsaturated fatty acids. ALA and GLA in seed oil are synthesized from linoleic acid (LA, 18:2Δ9,12) by the microsomal ω-3 fatty acid desaturase (FAD3) and Δ6 desaturase (D6D), respectively. Cotton (Gossypium hirsutum L.) seed oil composition was modified by transforming with an FAD3 gene from Brassica napus and a D6D gene from Echium plantagineum, resulting in approximately 30% ALA and 20% GLA, respectively. The total oil content in transgenic seeds remained unaltered relative to parental seeds. Despite the use of a seed-specific promoter for transgene expression, low levels of GLA and increased levels of ALA were found in non-seed cotton tissues. At low temperature, the germinating cottonseeds containing the linolenic acid isomers elongated faster than the untransformed controls. ALA-producing lines also showed higher photosynthetic rates at cooler temperature and better fiber quality compared to both untransformed controls and GLA-producing lines. The oxidative stability of the novel cottonseed oils was assessed, providing guidance for potential food, pharmaceutical and industrial applications of these oils.
Do Children With Spinal Deformity Who Have Metal Implants and Frequent Exposure to X-Rays Increase Their Risk of Cancer?
Authors: Cundy Peter J. , Venugopal Kamalesh , Antoniou Georgia , Brooks Francis , Freeman Brian J. C. , D’Onise Katina
Published: April 2020

Study Design.

Spinal surgery cohort.

Objective.

The authors assess the risk of cancer in children who have undergone frequent radiographs and have metal implants for the treatment of spinal deformity.

Summary of Background Data.

Concerns have been raised regarding the cancer risk to children exposed to repeated radiological examinations as part of routine surveillance to monitor progression of spinal deformity. Additionally, there are reports of increased cancer risk in adults having joint replacement with metal implants causing raised metal ion levels in the blood.

Methods.

A large number of consecutive children undergoing instrumented spinal surgery since 1979 were examined for their development of malignancy. High quality data on all invasive cancers from the South Australian Cancer Registry and deaths were linked to the spinal surgery cohort with the calculation of standardized incidence ratios (SIRs) using the Quinquinquennium method.

Results.

The study cohort was formed by 865 children. The average follow-up time from date of surgery to either death or censoring date was 18 years with a maximum of 36 years. A total of 15,921 person years were examined. There was no increased rate of cancer in these patients. For the total cohort, the SIR was 1.00 (95% confidence interval [CI] 0.50–1.79). For females the SIR was 0.83 (95% CI 0.33–1.70) and for males the SIR was 1.33 (95% CI 0.36–3.40). The male SIR reflected an expected cancer incidence of three cases, when four cases were observed, and was not statistically significant.

Conclusion.

This study has found that radiation exposure and possible exposure to circulating metal ions as a result of routine instrumented spine surgery in children since 1979 is not associated with an increased risk of cancer in up to 36 years of follow up.

Level of Evidence: 2
Selecting the C7-LIV Line Vertebra as the Upper Instrumented Vertebra for Adolescent Idiopathic Scoliosis Lenke Type 1A Curves
Authors: Munakata Ryo , Koseki Michihiko , Oba Hiroki , Ikegami Shota , Uehara Masashi , Kuraishi Shugo , Yamato Yu , Ohba Tetsuro , Seki Shoji , Takizawa Takashi , Hatakenaka Terue , Ebata Shigeto , Haro Hirotaka , Matsuyama Yukihiro , Takahashi Jun
Published: April 2020

Study Design.

Retrospective multicenter cohort study.

Objective.

We evaluated a new upper instrumented vertebra (UIV) selection method that used the modified Shinshu line (MSL) to establish the selected UIV as the MSL vertebra (MSLV).

Summary of Background Data.

No reports have addressed optimal UIV selection according to the lower instrumented vertebra (LIV) for good trunk balance in Lenke 1A curves.

Methods.

Forty-five consecutive patients (44 female, 14.4 ± 2.4 yrs) receiving posterior spinal fusion (PSF) for a Lenke 1A adolescent idiopathic scoliosis (AIS) curve were analyzed. We defined the novel MSL as the line between the center of the spinous process of C7 and that of the spinous process of the LIV. The vertebral body with which the MSL first contacted proximally was defined as the MSLV. The groups in which the UIV was at, proximal to, or distal to the MSLV were defined as the matched group (M-group; 15 cases [15 female], 14.7 ± 2.1 yrs), proximal group (P-group; 20 cases, [19 female], 15.0 ± 2.2 yrs), and distal group (D-group; 10 case [10 female], 14.8 ± 2.5 yrs), respectively. We measured Cobb angle, main thoracic (MT) curve correction rate, and C7 plumb line absolute value (C7PL) at pre- and 2 years postoperatively for comparisons using Dunnett test, with the M-group as the control.

Results.

In the M-group, P-group, and D-group, the Cobb angle correction rate between pre- and postoperative time points were 65.3 ± 1.3%, 62.4 ± 1.6%, and 52.8 ± 6.8%, respectively, and comparable apart from a smaller correction tendency in the D-group versus the M-group (P = 0.08). At 2 years postoperatively, C7PL was 0.5 ± 0.4, 1.0 ± 0.6, and 1.3 ± 0.9 cm, respectively, and significantly smaller for the M-group (both P < 0.05).

Conclusion.

Better trunk balance were obtained without reducing correction rate by setting the novel MSLV as the UIV in PSF for Lenke type 1A curves.

Level of Evidence: 3
Later Surgical Start Time Is Associated With Longer Length of Stay and Higher Cost in Cervical Spine Surgery
Authors: Neifert Sean N. , Lamb Colin D. , Gal Jonathan S. , Martini Michael L. , Nistal Dominic A. , Rothrock Robert J. , Gilligan Jeffrey , Maron Samuel Z. , Caridi John M.
Published: April 2020

Study Design.

Retrospective study of a surgical cohort from a single, large academic institution.

Objective.

The aim of this study was to investigate associations between surgical start time, length of stay, cost, perioperative outcomes, and readmission.

Summary of Background Data.

One retrospective study with a smaller cohort investigated associations between surgical start time and outcomes in spine surgery and found that early start times were correlated with shorter length of stay. No examinations of perioperative outcomes or cost have been performed.

Methods.

All patients undergoing anterior cervical discectomy and fusion (ACDF) and posterior cervical decompression and fusion (PCDF) were queried from a single institution from January 1, 2008 to November 30, 2016. Patients undergoing surgery that started between 12:00 am and 6:00 am were excluded due to their likely emergent nature. Cases starting before and after 2:00 pm were compared on the basis of length of stay and cost as the primary outcomes using multivariable logistic regression.

Result.

The patients undergoing ACDF and PCDF were both similar on the basis of comorbidity burden, preoperative diagnosis, and number of segments fused. The patients undergoing ACDF starting after 2 pm had longer LOS values (adjusted difference of 0.65 days; 95% confidence interval [CI]: 0.28–1.03; P = 0.0006) and higher costs of hospitalization (adjusted difference of $1177; 95% CI: $549–$1806; P = 0.0002). Patients undergoing PCDF starting after 2 pm also had longer LOS values (adjusted difference of 1.19 days; 95% CI: 0.46–1.91; P = 0.001) and higher costs of hospitalization (adjusted difference of $2305; 95% CI: $826–$3785; P = 0.002).

Conclusion.

Later surgical start time is associated with longer LOS and higher cost. These findings should be further confirmed in the spine surgical literature to investigate surgical start time as a potential cost-saving measure.

Level of Evidence: 3
Therapeutic Hypothermia in Critically Ill Patients: A Systematic Review and Meta-Analysis of High Quality Randomized Trials*
Authors: Kim Jun Hyun , Nagy Ádám , Putzu Alessandro , Belletti Alessandro , Biondi-Zoccai Giuseppe , Likhvantsev Valery V. , Yavorovskiy Andrey G. , Landoni Giovanni
Published: April 2020

Objectives:

To investigate the effect of the application of therapeutic hypothermia (32–35°C) on survival and major clinical endpoints in critically ill patients.

Data Sources:

We searched online database and clinical trial registries dated up to April 30, 2019, and references of relevant studies.

Study Selection:

Low risk of bias randomized trials which compared hypothermia applied for at least 24 hours and conventional therapy in critically ill patients were included. We excluded trials investigating therapeutic hypothermia in indications already supported by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns) or intraoperative hypothermia.

Data Extraction:

Titles and abstracts were reviewed independently by two authors. If the articles seemed eligible, full-text articles were reviewed, and data were abstracted using a structured template.

Data Synthesis:

Our search retained 14 low risk of bias randomized trials (2,670 patients) performed in three different settings: traumatic brain injury, serious infections, and stroke. Therapeutic hypothermia was associated with an increase in mortality at longest follow-up available (432/1,375 [31%] vs 330/1,295 [25%]; risk ratio, 1.24; 95% CI, 1.10–1.39; p = 0.0004; I
2 = 0%). Pooled results showed no difference of good neurologic outcome among survivors between the two treatment arms (493/1,142 [43%] vs 486/1,067 [46%]; risk ratio, 1.04; 95% CI, 0.97–1.12; p = 0.27; I
2 = 1%). Arrhythmias were significantly increased among patients undergoing therapeutic hypothermia. We found no difference between groups in pneumonia, serious infections, any infection, hemorrhage, renal failure, deep vein thrombosis, and uncontrollable intracranial hypertension.

Conclusions:

High-quality randomized evidence indicates that therapeutic hypothermia is associated with higher mortality and no difference in good neurologic outcome compared with normothermia in critically ill patients. Although there still might be a possibility that therapeutic hypothermia is beneficial in a specific setting, routine application of therapeutic hypothermia would better be avoided outside the settings indicated by international guidelines (adult cardiac arrest and hypoxic-ischemic encephalopathy of newborns).
Can preventive hyperbaric oxygen therapy optimise surgical outcome?
Authors: Boet Sylvain , Martin Leonardo , Cheng-Boivin Olivia , Etherington Cole , Louge Pierre , Pignel Rodrigue , Pellégrini Michel , Magnan Marie-Anne , Bennett Michael
Published: April 2020

BACKGROUND

A primary underlying cause of postoperative complications is related to the surgical stress response, which may be mitigated by hyperbaric oxygen therapy (HBOT), the intermittent administration of oxygen at a pressure higher than the atmospheric pressure at sea level. Promising clinical studies have emerged suggesting HBOT's efficacy for reducing some postoperative complications. Notwithstanding, the effectiveness (if any) of HBOT across a range of procedures and postoperative outcomes has yet to be clearly quantified.

OBJECTIVE

This systematic review aimed to summarise the existing literature on peri-operative HBOT to investigate its potential to optimise surgical patient outcome.

DESIGN

A systematic review of randomised controlled trials (RCTs) with narrative summary of results.

DATA SOURCES

MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials were searched without language restrictions through to 19 June 2018.

ELIGIBILITY CRITERIA

Studies were included if they involved patients of any age undergoing any surgical procedure and provided with at least one HBOT session in the peri-operative period. Two independent reviewers screened the initial identified trials and determined those to be included. Risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs.

RESULTS

The search retrieved 775 references, of which 13 RCTs were included (627 patients). Ten RCTs (546 patients) reported treatment was effective for improving at least one of the patient outcomes assessed, while two studies (55 patients) did not find any benefit and one study (26 patients) found a negative effect. A wide range of patient outcomes were reported, and several other methodological limitations were observed among the included studies, such as limited use of sham comparator and lack of blinding.

CONCLUSION

Peri-operative preventive HBOT may be a promising intervention to improve surgical patient outcome. However, future work should consider addressing the methodological weaknesses identified in this review.

TRIAL REGISTRATION

The protocol (CRD42018102737) was registered with the International ProspectiveRegister of Systematic Reviews (PROSPERO).
Less Invasive Management of Tissue Deficits for Deep Sternal Wound Infections
Authors: Watanabe Hidetaka , Uemura Tetsuji , Yanai Tetsu , Kurokawa Masato , Harada Yoshimi , Ishihara Yasuhiro , Chuman Takahiro , Kawano Hiroshige
Published: April 2020

Background:

The frequency of sternomyelitis after cardiovascular surgery has been reported to be 0.4% -5%.

Methods:

The treatment method used for 47 patients (29 male and 18 female) who developed sternomyelitis after sternotomy with tissue defects in the chest was examined retrospectively.

Results:

Of the original conditions, the most frequent was coronary artery disease undergoing bypass grafting (22 cases, 46.8%), followed by acute aortic dissection (10 cases, 21.3%). The number of times debridement was performed was: once, 35 cases; twice, 11 cases; 7 times, 1 case; and unknown, 2 cases. The most frequent time of occurrence of sternomyelitis was within 2 weeks after surgery (12 patients, 25.5%). A residual internal thoracic artery remained on both sides in 28 cases (59.6%), and only on the right side in 17 cases (36.2%); there was no remaining one in 2 cases (4.2%). The reconstruction method was a pectoralis major musculocutaneous flap in 31 cases (66.0%), internal mammary artery perforator flap in 7 cases (14.9%), rectus abdominis musculocutaneous flap in 4 cases (8.5%), omentum transplant in 3 cases (6.4%), superior epigastric artery perforator flap in 2 cases (4.3%), external abdominal oblique muscle flap in 1 case (2.1%), and latissimus dorsi musculocutaneous flap in 1 case (2.1%). The internal mammary artery perforator flap and the superior epigastric artery perforator flap have been effective treatment.

Conclusions:

In 47 patients, our method of treatment for tissue defects of the chest wall after sternal osteomyelitis was examined, and an algorithm using less invasive management was proposed.
Considerations for STI Clinics During the COVID-19 Pandemic
Authors: Napoleon Siena C. , Maynard Michaela A. , Almonte Alexi , Cormier Kevin , Bertrand Thomas , Ard Kevin L. , Chan Philip A.
Published: April 2020

Coronavirus disease (COVID-19) is responsible for a global pandemic. It is important to balance the need for access to healthcare services, including testing and treatment for sexually transmitted infections. Sexually transmitted infection programs must consider how to use limited resources and implement novel approaches to provide continued access to care.
Traumatic Pneumoperitoneum After Vaginal Intercourse
Authors: Thomas John W. , Buckley Clifford James
Published: April 2020

Objectives

Pneumoperitoneum with peritonitis, although uncommon, is a serious injury encountered in the pediatric emergency department. Although the patients may often appear ill or toxic, they can have normal vital signs at initial presentation. Patients with such injury can present with a variety of complaints because of the nature of referred pain. As a result, some patients may be more or less straightforward, thus illustrating the importance of obtaining a detailed history and performing a thorough physical examination.

Methods

We discuss an uncommon case report of pneumoperitoneum with peritonitis in an adolescent patient presenting with vaginal bleeding and abdominal pain hours after vigorous coitus.

Results

Examination under anesthesia, flexible sigmoidoscopy, and exploratory laparoscopy revealed a vaginal laceration and a 2- to 3-cm perforated area at the left edge of the vaginal laceration that involved the rectovaginal septum entering the peritoneal cavity.

Conclusions

Pneumoperitoneum resulting from vaginal intercourse in an otherwise healthy adolescent female is a rare cause of peritonitis. Although it has been described in the adult literature, this case illustrates the importance of considering sexual history as a contributory factor in pediatric patients presenting with an acute abdomen.
A Quality Improvement Project to Reduce Combination Acetaminophen-opioid Prescriptions to Pediatric Orthopedic Patients
Authors: Caruso Thomas J. , Trivedi Sunny , Chadwick Whitney , Gaskari Shabnam , Wang Ellen , Marquez Juan , Lagasse Sara , Bailey Madison , Shea Kevin
Published: April 2020

Background:

Acetaminophen-opioid analgesics are among the most commonly prescribed pain medications in pediatric orthopedic patients. However, these combined opioid analgesics do not allow for individual medication titration, which can increase the risk of opioid misuse and hepatoxicity from acetaminophen. The primary aim of this quality improvement project was to alter the prescribing habits of pediatric orthopedic providers at our institution from postoperative acetaminophen-opioid analgesics to independent acetaminophen and opioids.

Methods:

The study took place in a level 1 trauma center at a children’s hospital. A multidisciplinary team of health professionals utilized lean methodology to develop a project plan. Guided by a key driver diagram, we removed acetaminophen-oxycodone products from hospital formulary, implemented a revised inpatient and outpatient electronic order set, and conducted multiple education efforts. Outcomes included inpatient and outpatient percent combined acetaminophen-opioid orders by surgical providers over 27 months.

Results:

Before the intervention, inpatient acetaminophen-opioid products accounted for an average of 46% of all opioid prescriptions for orthopedic patients. After the intervention and multiple educational efforts, we reported a reduction in the acetaminophen-opioid products to 2.9%. For outpatient prescriptions, combined analgesics accounted for 88% before the intervention, and we reported a reduction to 15% after the intervention.

Conclusions:

By removing acetaminophen-oxycodone products from hospital formulary, educating the medical staff, and employing revised electronic order sets, the prescribing practice of pediatric orthopedic surgeons changed from the routine use of acetaminophen-opioid analgesics to independent medications.
A deeper look at COVID-19 CFR: health care impact and roots of discrepancy
Authors: Dehkordi Amirhoshang Hoseinpour , Nemati Reza , Tavousi Pouya
Published: April 2020

Abstract

Intensive care capacity and proper testing play a paramount role in the COVID-19 Case Fatality Rate (CFR). Nevertheless, the real impact of such important measures has not been appreciated due to the lack of proper metrics. In this work, we have proposed a method for estimating a lower bound for the number of positive cases by using the reported data on the oldest age group and the regions’ population distributions. The proposed estimation method improved the expected similarity between the age-distribution of positive cases and regions’ population. Further, we have provided a quantitative measure for the impact of intensive care on the critical cases by comparing the CFR among those who did and did not receive intensive care. Our findings showed that the chance of living among non-ICU receivers is less than half of ICU receivers (∼24% vs ∼60%).
Estimation of the actual incidence of coronavirus disease (COVID-19) in emergent hotspots: The example of Hokkaido, Japan during February–March 2020
Authors: Akhmetzhanov Andrei R. , Mizumoto Kenji , Jung Sung-mok , Linton Natalie M. , Omori Ryosuke , Nishiura Hiroshi
Published: April 2020

Following the first report of coronavirus disease 2019 (COVID-19) in Sapporo City, Hokkaido Prefecture, Japan on 14 February 2020, a surge of cases was observed in Hokkaido during February and March. As of 6 March, 90 cases were diagnosed in Hokkaido. Unfortunately, many infected persons may not have been recognized as cases due to having mild or no symptoms. We therefore estimated the actual number of COVID-19 cases in (i) Hokkaido Prefecture and (ii) Sapporo City using data on cases diagnosed outside these areas. The estimated cumulative incidence in Hokkaido as of 27 February was 2297 cases (95% confidence interval [CI]: 382, 7091) based on data on travelers outbound from Hokkaido. The cumulative incidence in Sapporo City as of 28 February was estimated at 2233 cases (95% CI: 0, 4893) based on the count of confirmed cases within Hokkaido. Both approaches resulted in similar estimates, indicating higher incidence of infections in Hokkaido than were detected by the surveillance system. This quantification of the gap between detected and estimated cases can help inform public health response as it provides insight into the possible scope of undetected transmission.
Genetic structure of SARS-CoV-2 in Western Germany reflects clonal superspreading and multiple independent introduction events
Authors: Walker Andreas , Houwaart Torsten , Wienemann Tobias , Vasconcelos Malte Kohns , Strelow Daniel , Senff Tina , Hülse Lisanna , Adams Ortwin , Andree Marcel , Hauka Sandra , Feldt Torsten , Jensen Björn-Erik , Keitel Verena , Kindgen-Milles Detlef , Timm Jörg , Pfeffer Klaus , Dilthey Alexander T
Published: April 2020

We whole-genome sequenced 55 SARS-CoV-2 isolates from Western Germany and investigated the genetic structure of SARS-CoV-2 outbreaks in the Heinsberg district and Düsseldorf. While the genetic structure of the Heinsberg outbreak indicates a clonal origin, reflective of superspreading dynamics during the carnival season, distinct viral strains are circulating in Düsseldorf, reflecting the city’s international links. Limited detection of Heinsberg strains in the Düsseldorf area despite geographical proximity may reflect efficient containment and contact tracing efforts.
Informative Ranking of Stand Out Collections of Symptoms: A New Data-Driven Approach to Identify the Strong Warning Signs of COVID 19
Authors: AlMomani Abd AlRahman , Bollt Erik
Published: April 2020

We develop here a data-driven approach for disease recognition based on given symptoms, to be efficient tool for anomaly detection. In a clinical setting and when presented with a patient with a combination of traits, a doctor may wonder if a certain combination of symptoms may be especially predictive, such as the question, “Are fevers more informative in women than men?” The answer to this question is, yes. We develop here a methodology to enumerate such questions, to learn what are the stronger warning signs when attempting to diagnose a disease, called Conditional Predictive Informativity, (CPI), whose ranking we call CPIR. This simple to use process allows us to identify particularly informative combinations of symptoms and traits that may help medical field analysis in general, and possibly to become a new data-driven advised approach for individual medical diagnosis, as well as for broader public policy discussion. In particular we have been motivated to develop this tool in the current environment of the pressing world crisis due to the COVID 19 pandemic. We apply the methods here to data collected from national, provincial, and municipal health reports, as well as additional information from online, and then curated to an online publically available Github repository.
Public perceptions of COVID-19 in Australia: perceived risk, knowledge, health-protective behaviours, and vaccine intentions
Authors: Faasse Kate , Newby Jill
Published: April 2020

Widespread and sustained engagement with health-protective behaviours (i.e., hygiene and distancing) is critical to successfully managing the COVID-19 pandemic. Evidence from previous emerging infectious disease outbreaks points to the role of perceived risk, worry, media coverage, and knowledge in shaping engagement with health-protective behaviours as well as vaccination intentions. The current study examined these factors in 2,174 Australian residents. An online survey was completed between 2-9 March 2020, at an early stage of the COVID-19 outbreak in Australia. Results revealed that two thirds of respondents were at least moderately worried about a widespread COVID-19 outbreak in Australia (which subsequently occurred). Worry about the outbreak and closely following media coverage were consistent predictors of health-protective behaviours (both over the previous month, and intended behaviours in the case of a widespread outbreak) as well as vaccination intentions. Health-behaviour engagement over the previous month was lower in some demographic groups, including males and younger individuals (18-29 age group). These was a substantial mismatch between respondents’ expected symptoms of infection and emerging evidence that a meaningful proportion of people who contract the novel coronavirus will experience asymptomatic infection (i.e., they will not experience symptoms associated with COVID-19). Only 0.3% of those in the current study believed that they personally would not experience any symptoms if they were infected. Uncertainty and misconceptions about COVID-19 were common, including one third of respondents who reported being unsure whether people are likely have natural or existing immunity. There was also uncertainty around whether specific home remedies (e.g., vitamins, saline rinses) would offer protection, whether the virus could spread via the airborne route, and whether the virus was human made and deliberately released. Such misconceptions are likely to cause concern for members of the public. These results point to areas of uncertainty that could be usefully targeted by public education campaigns, as well as psychological and demographic factors associated with engagement with health-protective behaviours. These findings offer potential pathways for interventions to encourage health-protective behaviours to reduce the spread of COVID-19.
Systematic review of international guidelines for tracheostomy in COVID-19 patients
Authors: Chiesa-Estomba Carlos M. , Lechien Jérome R. , Calvo-Henríquez Christian , Fakhry Nicolas , Karkos Petros D. , Peer Shazia , Sistiaga-Suarez Jon A. , Gónzalez-García José A. , Cammaroto Giovanni , Mayo-Yánez Miguel , Parente-Arias Pablo , Saussez Sven , Ayad Tareck
Published: April 2020

At this moment, the world leaves under the SARS-CoV-2 outbreak pandemic. As Otolaryngologists - Head & Neck Surgeons, we need to perform and participate in examinations and procedures within the head and neck region and airway that are at particularly high risk of exposure and infection because of aerosol and droplet contamination. One of those surgical procedures on demand at this moment is tracheostomy, due the increasing admission in ICU departments and the increased need of ventilatory support secondary to respiratory distress syndrome. This review of international guidelines for tracheostomy in COVID-19 infected patients, aiming to summarize in a systematic way the available recommendations from 18 guidelines from all over the world.