bluuebunny/crossref_metadata_2025 huggingface dataset:
Surrogate’s Personal Sense of Duty as a Crucial Element in Medical Decision Making
Authors: Feudtner Chris , Schall Theodore E. , Hill Douglas L.
Published: September 2021

Surrogates who must make medical decisions for other people—most often, loved ones—face difficult challenges not acknowledged in current models of medical decision making. Furthermore, medical decisions are typically not a single event, but an ongoing event that evolves over time. This chapter presents a broader conceptualization of medical decision making, highlighting that (1) surrogate decision makers often face multiple problems, not a single clear problem; (2) the path to the decision maker’s desired goal is often unclear and often constrained by past decisions; (3) the social relationships between the surrogate and the patient (parent, adult child, spouse) influence the decision making as surrogates try to fulfill their role as a good parent, good son/daughter, or good spouse; and (4) surrogate decision makers often judge themselves negatively in ways that influence their decisions and the outcome. Clinicians who recognize these complex influences on surrogate decision making may be better able to support surrogates through this difficult process.
The Role of Children and Adolescents in Decision Making About Life-Threatening Illness
Authors: Miller Victoria A. , Cousino Melissa K.
Published: September 2021

The concept of decision-making involvement (DMI) recognizes that children and adolescents can be involved in decision making in numerous ways and that parents and health care providers have an important role in supporting and guiding youth. Facilitating DMI may enhance youth decision-making skills, self-efficacy and control, treatment adherence, and satisfaction with care. Given the loss of control children and adolescents typically feel when diagnosed with a serious, life-threatening illness, DMI may be especially important. Parents and health care providers can facilitate child and adolescent involvement by seeking their opinions and concerns, soliciting questions, asking for information, and checking for understanding. Additional tools are available for facilitating youth involvement in decision making at the end of life. Future research is needed to develop and evaluate strategies to enhance different aspects of DMI in multiple settings and contexts across development.
Dimensions of Psychological Problems
Authors: Lahey Benjamin B.
Published: September 2021

A long-brewing revolution in how people think about psychological problems has finally reached a tipping point. Extensive scientific evidence now portrays psychological problems as problematic ways of thinking, feeling, and behaving that lie on continuous dimensions from insignificant to severe, with there being no hard line between “normal” and “abnormal.” These dimensions of psychological problems are highly correlated and overlapping. This means that people often experience psychological problems on more than one dimension at the same time. New longitudinal studies, in which the same people provide information about themselves over long parts of their lives, now indicate that the dimensions of psychological problems are dynamically changing rather than constant. Perhaps most important, these long-term studies reveal that psychological problems are commonplace and ordinary aspects of human lives. Surprisingly, nearly all people experience some distressing and impairing psychological problems at some time during their lives. These psychological problems range from simply uncomfortable to extremely distressing, problematic, and sometimes tragic. Nonetheless, psychological problems arise through the same natural processes as all aspects of behavior. That is, both adaptive and maladaptive patterns of psychological functioning are the result of the same natural interplay of genes and environments. Understanding these things about psychological problems should reduce people’s tendency to stigmatize these problems in themselves and in others. It will often be sensible for people to seek professional help to change them, but psychological problems are simply ordinary and commonplace parts of people’s lives.
'All manner of ingenuity and industry'
Authors: Compston Alastair
Published: September 2021

This book celebrates the quatercentenary of the birth of Thomas Willis on 27 January 1621. As a physician in Oxford, Willis’s work in the 1650s provides an example of rural medical practice in early modern England. As a member of the Oxford Philosophical Club that met from the 1640s, he was central to the development of new ideas on anatomy and physiology. As Sedleian professor of natural philosophy in Oxford, the surviving records of his lectures from the 1660s provide an example of teaching in medicine at that time. And, after moving to London in 1667, Willis continued to interact with a community of scientists and physicians who transformed ideas on respiration, muscular movement, and the nervous system.
Psychological interventions for cognitive dysfunction in MDD
Authors: Baune Bernhard T.
Published: September 2021

The chapter psychological interventions for cognitive function in MDD outlines promising cognitive training interventions that may yield neuropsychological, cognitive, emotional, and functional benefits for patients diagnosed with major depressive disorder (MDD). The chapter reviews how psychological interventions such as cognitive behavioural therapy are aimed to address cognitive biases, which include distorted information appraisal or attentional allocation towards negative and away from positive stimuli. It emphasizes that specific cognitive interventions target cognitive deficits and that the use of cognitive training represents a promising and novel therapeutic option which may yield neuropsychological, affective, functional, and behavioural improvements in patients with MDD.
Nonpharmacological biological interventions for emotional and cognitive dysfunction
Authors: Baune Bernhard T.
Published: September 2021

Nonpharmacological biological interventions for emotional and cognitive dysfunction extensively reviews the effects of stimulation-based therapies including electroconvulsive therapy, transcranial magnetic stimulation, and transcranial direct current stimulation on affective cognition. Several types and protocols of neurostimulation interventions can influence affective information-processing in patients with depression. For example, there is some evidence to suggest that electroconvulsive therapy increases the expression of brain-derived neurotrophic factor and therefore induces neuroplasticity. The chapter identifies several types and protocols of neurostimulation interventions with the ability to influence affective information-processing in patients with major depressive disorder. It discusses current research on stimulation-based therapies and highlights the need for further research on whether these protocol variations can counterbalance negative biases and whether they are causally involved in the clinical effects of the different treatments.
Definition of Apathy and Differential Diagnosis
Authors: Robert Philippe , Manera Valeria
Published: September 2021

Motivation, initiation, interest, goal-directed behaviour, reward, and incentive are just some of the words associated with the concept of apathy in brain disorders. This vocabulary is even richer if we encompass different neuropsychiatric diseases, such as schizophrenia and major depression. This is a paradox for this concept, which is so difficult to capture and to define at the theoretical level, and at the same time easy to understand and observe in clinical practice. This chapter aims to summarize the different apathy definitions, present the diagnostic criteria for apathy in brain disorders, and discuss differential diagnosis and overlap with other conditions, such as anhedonia, fatigue, and depression.
Apathy
Authors: Levy Richard
Published: September 2021

‘Auto-activation’ deficit, the most severe form of apathy, is a model to approach apathy. Auto-activation deficit consists of a severe reduction in self-initiated actions contrasting with the sparing of externally driven ones under strong solicitations and the presence of automatic (stereotypic) behaviour. This severe apathy can be viewed as the consequence of a quantitative reduction of goal-directed behaviour. Auto-activation deficit is due to lesions in the prefrontal cortex (PFC)–basal ganglia circuitry, the brain system that generates and controls goal-directed behaviour. In this chapter it is proposed that several different mechanisms may be responsible for apathy. Damage to three PFC–basal ganglia circuits may explain most of the cases of apathy: (i) lesions in the orbital and ventromedial PFC–basal ganglia circuit lead to apathy through difficulties in evaluating the affective value of a given behavioural context (‘amotivation’); (ii) lesions in the lateral PFC–basal ganglia circuit contribute to apathy via an inability to generate or activate strategies required to successfully complete a given programme of actions (‘cognitive inertia’); (iii) lesions to the anterior cingulate cortex–basal ganglia circuit (located in an intermediary anatomical position between the ventral and lateral circuit) may lead to apathy via an inability to transfer the affective value of a given context (‘invigoration deficit’); (iv) the summation or the synergy of damage to these three circuits within the basal ganglia may lead to a frank decrease in the amplification of signals representing goal-directed behaviour that reach the PFC (‘empty mind’); and (v) if all three circuits are structurally intact, apathy may nevertheless occur via alterations of neurotransmission systems that modulate the activity of these circuits (i.e. dopamine, serotonin, and acetylcholine).
Oxford Textbook of the Newborn
Authors: Obladen Michael
Published: September 2021

This richly illustrated book fills a gap in the literature. It is not another history of famous researchers, but a history of endangered newborns and their fate in medicine and society from the earliest days of human thought, investigating what remained in medieval and persists in modern life. Each chapter rests on exhaustive research in hospital archives, libraries, churches, or excavation fields. With a global perspective, the book identifies technical, medical, social, and political conditions that improved—or compromised—the infant’s quality of life. The newborn’s history has multiple cultural implications. It depended on maternal care, breastfeeding, and cleanliness. Legislation had to protect babies from infanticide and to define the viability of preterm or malformed infants. By tracing the history of legal, philosophical, and social ideas about the newborn, the book develops three overarching themes across societies and times: (1) the newborn was not regarded as a complete human being, but as unfinished and endowed with only partial personhood; (2) rites of passage evolved everywhere, aiming to ‘complete’ the newborn and accept it in family and society; and (3) abandonment and infanticide suggest that many newborns were greeted with ambivalence, and that their frequent death was largely accepted by parents and societies. The book embraces all aspects of the transition from fetal to postnatal life. It will be of major interest to scholars, professionals, and students specializing in obstetrics, midwifery, paediatrics, and neonatology. Medical terminology has been used cautiously and a glossary makes the text accessible outside the health professions.
Management of congenital limb deficiency
Authors: Monsell Fergal
Published: September 2021

A broad range of abnormalities can affect the developing human limb. This chapter includes an overview of limb bud development, the mechanisms involved in normal growth, and congenital skeletal deficiencies of the lower limb. The use of ultrasonography in antenatal screening and the clinical and radiological features in childhood are also discussed in addition to management including surgical reconstruction and prosthetic use.
Clinical efficacy of belimumab in patients with systemic lupus erythematosus and headache. A report of two cases
Authors: Kodera Takao , Tsutsumi Tomomi , Oka Yumiko , Takeda Tomoki , Shirota Yuko , Kameoka Junichi
Published: September 2021

Intractable headache, one of the manifestations of neuropsychiatric systemic lupus erythematosus (SLE), is difficult to diagnose and decide on an appropriate treatment. In addition to conventional therapy based on the type of headache, the treatment should be conducted considering the disease activity of SLE rather than the headache. We report two patients with intractable headache who were successfully treated using belimumab therapy. The headaches in both patients were relieved after 2 weeks of belimumab administration. The neutralisation of B lymphocyte stimulator and reduced production of cytokines from B lymphocytes might contribute to the early effects. The potential benefits of using belimumab as an additional immunosuppressant for treating intractable headache complicated with SLE have been discussed.
Successful treatment of hidradenitis suppurativa with secukinumab in a patient with ankylosing spondylitis and Familial Mediterranean Fever
Authors: Unal Enginar Ayse , Gundogdu Mustafa
Published: September 2021

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterised by pain, inflamed nodules, abscess, sinus tract, and fistula. HS is more common in patients with axial spondyloarthritis and Familial Mediterranean Fever (FMF) compared to the normal population. Mediterranean fever gene mutations are thought to be responsible for the relationship between these three diseases. Case reports of secukinumab treatment in HS have been reported. In this article, a case of successful treatment of HS with secukinumab in a patient with ankylosing spondylitis and FMF is presented.
Secukinumab therapy in reactive arthritis: Report of two cases
Authors: Padhan Prasanta , Maikap Debashis
Published: September 2021

Reactive arthritis (ReA) is an immune-mediated aseptic synovitis resulting either from genitourinary or gastrointestinal tract, commonly presenting as oligoarthritis of the lower limbs and rarely urethritis and conjunctivitis. The treatment options include nonsteroidal anti-inflammatory drugs, conventional disease-modifying antirheumatic drugs, and biologics in severe cases. We report successful use of secukinumab in two cases of chronic severe ReA who initially failed to treatment with tumour necrosis factor inhibitor.
Predominant mesangial IgM, C3, and λ light chain depositions and interstitial nephritis in a patient with overlap syndrome and positivity for anti-mitochondrial M2 antibody: a case report
Authors: Yamada Saeko , Kanda Hiroko , Abe Hiroyuki , Domoto Yukako Shintani , Yoshida Ryochi , Harada Hiroaki , Kubo Kanae , Ushiku Tetsuo , Fujio Keishi
Published: September 2021

Overlap syndrome refers to a group of conditions that have clinical features of more than one well-characterised rheumatic disease and meet the respective classification criteria. There are no typical renal histological findings in overlap syndrome. When patients with overlap syndrome develop renal dysfunction, various potential causes, including lupus nephritis (LN), renal crisis by systemic sclerosis, interstitial nephritis, and so on, need to be distinguished. Here, we report a 44-year-old woman with overlap syndrome involving systemic lupus erythematosus (SLE), diffuse cutaneous systemic scleroderma, and Sjogren’s syndrome, who was also positive for anti-mitochondrial M2 antibody. She developed glomerular haematuria, proteinuria, and increase in creatinine appeared gradually. Suspecting LN, renal biopsy was performed. However, in the interstitium, mild infiltration of lymphocytes and plasma cells and very partial fibrosis were observed. Immunofluorescence microscopy revealed predominant mesangial immunoglobulin M, C3, and λ light chain staining. Overall, LN was not diagnosed based on these findings. Renal dysfunction was normalised by glucocorticoid treatment for 3 months. This case suggests the importance of a renal diagnosis based on renal pathological findings, especially in a case of overlap syndrome including SLE.
F-box protein MdAMR1L1 regulates ascorbate biosynthesis in apple by modulating GDP-mannose pyrophosphorylase
Authors: Ma Songya , Li Huixia , Wang Lan , Li Baiyun , Wang Zhengyang , Ma Baiquan , Ma Fengwang , Li Mingjun
Published: September 2021

Ascorbate (Asc) is an important antioxidant in plants and humans that plays key roles in various physiological processes. Understanding the regulation of Asc content in fruit plants is important for improving plant resiliency and optimizing Asc in food. Here, we found that both the transcript level and protein abundance of Asc Mannose pathway Regulator 1 Like 1 (MdAMR1L1) was negatively associated with Asc levels during the development of apple (Malus × domestica) fruit. The overexpression or silencing of MdAMR1L1 in apple indicated that MdAMR1L1 negatively regulated Asc levels. However, in the leaves of MdAMR1L1-overexpressing apple lines, the transcript levels of the Asc synthesis gene Guanosine diphosphate-mannose pyrophosphorylase MdGMP1 were increased, while its protein levels and enzyme activity were reduced. This occurred because the MdAMR1L1 protein interacted with MdGMP1 and promoted its degradation via the ubiquitination pathway to inhibit Asc synthesis at the post-translational level. MdERF98, an apple ethylene response factor, whose transcription was modulated by Asc level, is directly bound to the promoter of MdGMP1 to promote the transcription of MdGMP1. These findings provide insights into the regulatory mechanism of Asc biosynthesis in apples and revealed potential opportunities to improve fruit Asc levels.
Using Internet-Derived Data to Measure Religion: Understanding How Google Can Provide Insight into Cross-National Religious Differences
Authors: Adamczyk Amy , Scott Jacqueline , Hitlin Steven
Published: September 2021

Internet and social media data provide new sources of information for examining social issues, but their potential for scholars interested in religion remains unclear. Focusing on cross-national religion data, we test the validity of measures drawn from Google and Twitter against well-known existing data. We find that Google Trend (GT) searches for the dominant religions’ major holidays, along with “Buddhism,” can be validated against traditional sources. We also find that GT and traditional measures account for similar amounts of variation, and the GT measures do not differ substantially from established ones for explaining several cross-national outcomes (e.g., fertility, circumcision, and alcohol use), as well as new ones (e.g., interest in religious buildings and sex). The Twitter measures do not perform as well. Our study provides insight into best practices for generating and using these measures, and offers evidence that internet-generated data can replicate existing measures that are less accessible and more expensive.
Greater Number of Microglia in Telencephalic Proliferative Zones of Human and Nonhuman Primate Compared with Other Vertebrate Species
Authors: Penna Elisa , Cunningham Christopher L , Saylor Stephanie , Kreutz Anna , Tarantal Alice F , Martínez-Cerdeño Verónica , Noctor Stephen C
Published: September 2021

Microglial cells, the innate immune cells of the brain, are derived from yolk sac precursor cells, begin to colonize the telencephalon at the onset of cortical neurogenesis, and occupy specific layers including the telencephalic proliferative zones. Microglia are an intrinsic component of cortical germinal zones, establish extensive contacts with neural precursor cells (NPCs) and developing cortical vessels, and regulate the size of the NPC pool through mechanisms that include phagocytosis. Microglia exhibit notable differences in number and distribution in the prenatal neocortex between rat and old world nonhuman primate telencephalon, suggesting that microglia possess distinct properties across vertebrate species. To begin addressing this subject, we quantified the number of microglia and NPCs in proliferative zones of the fetal human, rhesus monkey, ferret, and rat, and the prehatch chick and turtle telencephalon. We show that the ratio of NPCs to microglia varies significantly across species. Few microglia populate the prehatch chick telencephalon, but the number of microglia approaches that of NPCs in fetal human and nonhuman primate telencephalon. These data demonstrate that microglia are in a position to perform important functions in a number of vertebrate species but more heavily colonize proliferative zones of fetal human and rhesus monkey telencephalon.
Fusarium Head Blight of Small Grains in Pennsylvania: Unravelling Species Diversity, Toxin Types, Growth, and Triazole Sensitivity
Authors: Duffeck Maíra R. , Bandara Ananda Y. , Weerasooriya Dilooshi K. , Collins Alyssa A. , Jensen Philip J. , Kuldau Gretchen A. , Del Ponte Emerson M. , Esker Paul D.
Published: September 2021

Fusarium graminearum is the main causal species of Fusarium head blight (FHB) globally. Recent changes in the trichothecene (toxin) types in the North American FHB pathogens support the need for continued surveillance. In this study, 461 isolates were obtained from symptomatic spikes of wheat, spelt, barley, and rye crops during 2018 and 2019. These were all identified to species and toxin types using molecular-based approaches. An additional set of 77 F. graminearum isolates obtained from overwintering crop residues during winter 2012 were molecularly identified to toxin types. A subset of 31 F. graminearum isolates (15 15-acetyl-deoxynivalenol [15ADON] and 16 3-acetyl-deoxynivalenol [3ADON]) were assessed for mycelial growth, macroconidia, perithecia, and ascospore production, and sensitivity to two triazoles. Ninety percent of isolates obtained from the symptomatic spikes (n = 418) belonged to F. graminearum, with four other species found at a lower frequency (n = 39). The F. graminearum isolates from symptomatic spikes were mainly of the 15ADON (95%), followed by 3ADON (4%), nivalenol (0.7%), and NX-2 (0.3%) toxin types. All F. graminearum isolates obtained from overwintering residue were of the 15ADON type. The toxin types could not be differentiated based on the multivariate analysis of growth and reproduction traits. All isolates were sensitive to tebuconazole and metconazole fungicides in vitro. This study confirms the dominance of F. graminearum and suggests ecological and environmental factors, to be further identified, that lead to similar composition of toxin types in the northern United States. Our results may be useful to assess the sustainability of FHB management practices and provide a baseline for future FHB surveys.
Transmission of Areca Palm Velarivirus 1 by Mealybugs Causes Yellow Leaf Disease in Betel Palm (Areca catechu)
Authors: Zhang Huaiwen , Zhao Xue , Cao Xianmei , Khan Latif Ullah , Zhao Ruibai , Wang Hongxing , Huang Xi
Published: September 2021

Yellow leaf disease (YLD) is the most destructive disease of betel palm (Areca catechu). A strong association between YLD and areca palm velarivirus 1 (APV1) has been observed. However, the causal relationship between APV1 and disease, and the transmission mode, warrant further investigation. This work showed that APV1 was transmitted by both Ferrisia virgata and Pseudococcus cryptus mealybugs and caused YLD symptoms in betel palm seedlings; therefore, we demonstrate that APV1 is a causal agent of YLD. APV1 was detected in the stylets, foreguts, midguts, and hindguts of the vectors via both immunocapture reverse transcription PCR and immunofluorescence assays. APV1 was not transmitted transovarially from viruliferous female F. virgata to their progeny. In summary, the transmission of APV1 by F. virgata may occur in a noncirculative, semipersistent manner. This study fills important gaps in our knowledge of velarivirus transmission, which is critical for developing YLD management practices.
Fusarium graminearum Species Complex: A Bibliographic Analysis and Web-Accessible Database for Global Mapping of Species and Trichothecene Toxin Chemotypes
Authors: Del Ponte Emerson M. , Moreira Gláucia M. , Ward Todd J. , O’Donnell Kerry , Nicolli Camila P. , Machado Franklin J. , Duffeck Maíra R. , Alves Kaique S. , Tessmann Dauri J. , Waalwijk Cees , van der Lee Theo , Zhang Hao , Chulze Sofia N. , Stenglein Sebastian A. , Pan Dinorah , Vero Silvana , Vaillancourt Lisa J. , Schmale David G. , Esker Paul D. , Moretti Antonio , Logrieco Antonio F. , Kistler H. Corby , Bergstrom Gary C. , Viljoen Altus , Rose Lindy J. , van Coller Gert J. , Lee Theresa
Published: September 2021

Fusarium graminearum is ranked among the five most destructive fungal pathogens that affect agroecosystems. It causes floral diseases in small grain cereals including wheat, barley, and oats, as well as maize and rice. We conducted a systematic review of peer-reviewed studies reporting species within the F. graminearum species complex (FGSC) and created two main data tables. The first contained summarized data from the articles including bibliographic, geographic, methodological (ID methods), host of origin and species, while the second data table contains information about the described strains such as publication, isolate code(s), host/substrate, year of isolation, geographical coordinates, species and trichothecene genotype. Analyses of the bibliographic data obtained from 123 publications from 2000 to 2021 by 498 unique authors and published in 40 journals are summarized. We describe the frequency of species and chemotypes for 16,274 strains for which geographical information was available, either provided as raw data or extracted from the publications, and sampled across six continents and 32 countries. The database and interactive interface are publicly available, allowing for searches, summarization, and mapping of strains according to several criteria including article, country, host, species and trichothecene genotype. The database will be updated as new articles are published and should be useful for guiding future surveys and exploring factors associated with species distribution such as climate and land use. Authors are encouraged to submit data at the strain level to the database, which is accessible at https://fgsc.netlify.app .
Comparison of Published Guidelines for the Diagnosis and the Management of Vaccine-Induced Immune Thrombotic Thrombocytopenia
Authors: Zazzeron Luca , Rosovsky Rachel P. , Bittner Edward A. , Chang Marvin G.
Published: September 2021

OBJECTIVES:

The development of thrombocytopenia and thrombosis after the administration of the AstraZeneca and Johnson & Johnson/Janssen vaccines has been recently described. This new condition has been called vaccine-induced immune thrombotic thrombocytopenia. The objective of this review is to summarize the clinical characteristics and therapeutic options of vaccine-induced immune thrombotic thrombocytopenia based on available published case series. Furthermore, we provide a comparison of the diagnostic pathway and treatment recommendations provided by six major medical societies.

DATA SOURCES:

We searched MEDLINE, PubMed, and Cochrane Central Register of Controlled Trials databases.

STUDY SELECTION:

We included case series and case reports on patients who developed vaccine-induced immune thrombotic thrombocytopenia. We also included guidelines for the diagnosis and management of vaccine-induced immune thrombotic thrombocytopenia from major medical societies.

DATA EXTRACTION:

We examined baseline risk factors, symptoms, physical signs, laboratory and imaging findings, and treatment in patients with vaccine-induced immune thrombotic thrombocytopenia reported in the case series. We also analyzed the diagnostic and treatment recommendations provided by major societal guidelines on the management of vaccine-induced immune thrombotic thrombocytopenia.

DATA SYNTHESIS:

Patients who developed vaccine-induced immune thrombotic thrombocytopenia were more likely to be young women (age 20–50) who were given the AstraZeneca or Johnson & Johnson/Janssen 4–28 days prior to presentation. Patients showed signs, symptoms, and imaging findings consistent with cerebral venous sinus thrombosis and splanchnic thrombosis. Laboratory findings showed thrombocytopenia, low fibrinogen, and elevate d-dimer levels, while positive platelet factor 4 antibodies were always positive. Major societal guidelines recommend avoidance of heparin and platelets. Treatment with nonheparin anticoagulants and IV immunoglobulin is also recommended.

CONCLUSIONS:

Vaccine-induced immune thrombotic thrombocytopenia is a rare but highly morbid complication related to the administration of the AstraZeneca and Johnson & Johnson/Janssen vaccines. Clinicians should be prepared for the early identification of patients with suspicious symptoms and prompt treatment should be initiated to avoid catastrophic deterioration. Major societal guidelines provide useful recommendations for the diagnosis and management of patients with vaccine-induced immune thrombotic thrombocytopenia.
Argatroban for Anticoagulation in Patients Requiring Venovenous Extracorporeal Membrane Oxygenation in Coronavirus Disease 2019
Authors: Sattler Lauren A. , Boster Joshua M. , Ivins-O’Keefe Kelly M. , Sobieszczyk Michal J. , Reel Bradley A. , Mason Phillip E. , Walter Robert J. , Sams Valerie G.
Published: September 2021

OBJECTIVES:

A significant proportion of patients with coronavirus disease 2019 requiring venovenous extracorporeal membrane oxygenation at our institution demonstrated heparin resistance, which in combination with a heparin shortage resulted in the transition to argatroban with or without aspirin as an alternative anticoagulation strategy. The optimal anticoagulation strategy for coronavirus disease 2019 patients requiring venovenous extracorporeal membrane oxygenation is unknown, and therefore, we sought to evaluate the efficacy and safety of argatroban with or without aspirin as an alternative anticoagulation strategy in this patient population.

DESIGN:

Retrospective cohort.

SETTING:

Single-center tertiary-care facility in Fort Sam Houston, TX, from 2020 to 2021.

PATIENTS:

Twenty-four patients who were cannulated for venovenous extracorporeal membrane oxygenation due to respiratory failure secondary to coronavirus disease 2019.

INTERVENTIONS:

Argatroban, with or without aspirin, was substituted for heparin in coronavirus disease 2019 patients requiring venovenous extracorporeal membrane oxygenation.

MEASUREMENTS AND MAIN RESULTS:

Eighty percent of our coronavirus disease 2019 patients requiring venovenous extracorporeal membrane oxygenation demonstrated heparin resistance, and patients who were initially started on heparin were significantly more likely to require a change to argatroban than vice versa due to difficulty achieving or maintaining therapeutic anticoagulation goals (93.4% vs 11.1%; p < 0.0001). The time to reach the therapeutic anticoagulation goal was significantly longer for patients who were initially started on heparin in comparison with argatroban (24 vs 6 hr; p = 0.0173). Bleeding and thrombotic complications were not significantly different between the two cohorts.

CONCLUSIONS:

Argatroban, with or without aspirin, is an effective anticoagulation strategy for patients who require venovenous extracorporeal membrane oxygenation support secondary to coronavirus disease 2019. In comparison with heparin, this anticoagulation strategy was not associated with a significant difference in bleeding or thrombotic complications, and was associated with a significantly decreased time to therapeutic anticoagulation goal, likely as a result of high rates of heparin resistance observed in this patient population.
Prescription Opioid Misuse and Sports-Related Concussion Among High School Students in the United States
Authors: Tham See Wan , Palermo Tonya M. , Chrisman Sara P. D. , Groenewald Cornelius B.
Published: September 2021

Study Objective:

Concussion is highly prevalent in adolescents and associated with a higher risk of substance use. With the rising use of opioids among adolescents, one form of substance use of concern is the misuse of prescription opioids. This study aimed to examine the association between a history of sports-related concussion in the past year and current prescription opioid misuse among high school students in the United States.

Setting:

Secondary data analysis from the 2019 Youth Risk Behavior Survey.

Participants:

Nationally representative sample of high school students (n = 7314).

Design:

Cross-sectional study.

Main Measures:

Participants were asked whether they experienced any concussions related to sports or being physically active during the past 12 months and whether they had any prescription opioid misuse within the past 30 days.

Results:

Among this cohort, 14.0% reported sustaining a concussion in the past 12 months and 6% reported current prescription opioid misuse. The prevalence of prescription opioid misuse was higher among those with a history of concussion (9.9%) than among those without concussion (5.5%, P = .002). Controlling for covariates (sex, race/ethnicity, other substance use, depressive symptoms), the odds of prescription opioid misuse was 1.5 times higher for adolescents with concussion than those without (adjusted odds ratios [aOR] = 1.5; 95% CI, 1.0-2.3; P = .029).

Conclusion:

Concussion was associated with prescription opioid misuse among the US youth, even after accounting for depressive symptoms and other substance use. Longitudinal studies are needed to test causal relationships and understand biobehavioral mechanisms that underlie associations between concussion and opioid misuse in adolescents.
Scoping Review of Opioid Use After Traumatic Brain Injury
Authors: Starosta Amy J. , Adams Rachel Sayko , Marwitz Jennifer H. , Kreutzer Jeffrey , Monden Kimberley R. , Dams O'Connor Kristen , Hoffman Jeanne
Published: September 2021

Objective:

To summarize the current literature to identify what research has been conducted, examine the approaches used, and determine what is presently known about prescription and nonprescription opioid receipts and use among individuals with traumatic brain injury (TBI).

Data Sources:

The search strategy included the following: opioid; opiate; analgesics, opioid; opiate alkaloids; or opioid-related disorders; AND brain injury; brain injuries; brain injuries, traumatic; head injury; head injuries; head injuries, closed; head injuries, penetrating; brain concussion; diffuse axonal injury; diffuse axonal injuries; brain trauma/s; head trauma/s; concussion; craniocerebral trauma/s; or TBI. Filters included English and Adults (19+ years). Study Selection: Inclusion: English language, adults with stable TBI, and prescription opioid receipt or use after TBI. Exclusion: Animal models, populations with other acquired brain injury, acute TBI management, and non–peer-reviewed articles, theses, or conference abstracts. Multiple reviewers screened abstracts and full-text articles for eligibility. In total, 771 abstracts were screened, 183 full texts were reviewed, and 21 met eligibility criteria. Data Extraction: Relevant content was independently extracted by multiple observers, including authors, design, sample identification and data source/s, TBI severity, TBI assessment, opioid assessment, study population (demographics, N), military affiliation, comparison groups, date of data collection, and summary of findings.

Results:

Studies were published between 1987 and 2019; most data were collected prior to 2015. The majority utilized administrative and electronic medical record data from the Department of Veterans Affairs and retrospective cohort designs, and most focused on prescription opioids. There were no studies evaluating interventions to reduce use of opioids in TBI populations. Preliminary findings suggest that prescription opioid receipt is strongly related to psychological symptoms, including comorbid depression, anxiety, and posttraumatic stress disorder.

Conclusions:

Despite increased awareness of opioid receipt and use following TBI, there is limited investigation on the examination of this issue. Future studies should include more varied patient populations as well as evaluate interventions to reduce opioid use following TBI.
Receipt of Concurrent VA and Non-VA Opioid and Sedative-Hypnotic Prescriptions Among Post-9/11 Veterans With Traumatic Brain Injury
Authors: Ashraf Alexandria J. , Gilbert Tess A. , Holmer Haley K. , Cook Lawrence J. , Carlson Kathleen F.
Published: September 2021

Objective:

Receipt of concurrent psychotropic prescription medications from both US Department of Veterans Affairs (VA) and non-VA healthcare providers may increase risk of adverse opioid-related outcomes among veterans with traumatic brain injury (TBI). Little is known about patterns of dual-system opioid or sedative-hypnotic prescription receipt in this population. We estimated the prevalence and patterns of, and risk factors for, VA/non-VA prescription overlap among post-9/11 veterans with TBI receiving opioids from VA providers in Oregon.

Setting:

Oregon VA and non-VA outpatient care.

Participants:

Post-9/11 veterans in Oregon with TBI who received an opioid prescription from VA providers between the years of 2014 and 2019.

Design:

Historical cohort study.

Main Measures:

Prescription overlap of VA opioids and non-VA opioids or sedative-hypnotics; proportions of veterans who received VA or non-VA opioid, benzodiazepine, and nonbenzodiazepine sedative-hypnotic prescriptions were also examined by year and by veteran characteristics.

Results:

Among 1036 veterans with TBI receiving opioids from the VA, 210 (20.3%) received an overlapping opioid prescription from a non-VA provider; 5.3% received overlapping benzodiazepines; and none received overlapping nonbenzodiazepine sedative-hypnotics. Proportions of veterans with prescription overlap tended to decrease over time. Veterans with other than urban versus urban addresses (OR = 1.4; 95% CI, 1.0-1.8), high versus medium average annual VA visits (OR = 1.7; 95% CI, 1.1-2.6), and VA service connection of 50% or more versus none/0% to 40% (OR = 4.3; 95% CI, 1.3-14.0) were more likely to have concurrent VA/non-VA prescriptions in bivariable analyses; other than urban remained associated with overlap in multivariable models. Similarly, veterans with comorbid posttraumatic stress disorder diagnoses were more likely to have concurrent VA/non-VA prescriptions in both bivariable and multivariable (OR = 2.1; 95% CI, 1.0-4.1) models.

Conclusion:

Among post-9/11 veterans with TBI receiving VA opioids, a considerable proportion had overlapping non-VA prescription medications. Providers and healthcare systems should consider all sources of psychotropic prescriptions, and risk factors for overlapping medications, to help mitigate potentially unsafe medication use among veterans with TBI.
Iatrogenic Venous Arterialization of the Posterior Tibial Vein Presenting as Overgrowth of the First Toe
Authors: El-Feghaly Jinia , Montenegro Matilde Krisha , Vivar Karina , Rajeswaran Shankar
Published: September 2021

Vascular malformations include a spectrum of clinical presentations with various radiologic and histologic findings. They can present a diagnostic and therapeutic challenge to clinicians and often require a multidisciplinary approach. Our patient’s imaging findings were not congruent with the clinical presentation of digital overgrowth prompting additional investigative studies. To the best of our knowledge, this is the first reported case of iatrogenic venous arterialization in a pediatric patient, with concomitant overgrowth of the first toe, treated successfully with coil embolization.
Infusion Parameters and Demographics of Patients With Chronic Inflammatory Demyelinating Polyneuropathy During Subcutaneous Immunoglobulin Self-Administration Training
Authors: Murphy Elyse , Vanname Chris , McNeill Robert , Bullock Melody , Barrett Lisa , Kafal Ayman
Published: September 2021

Subcutaneous immunoglobulin (SCIg) is approved for maintenance treatment of chronic inflammatory demyelinating polyneuropathy. SCIg allows self-administration of immunoglobulin G and is associated with fewer systemic adverse events than intravenous administration. This study aimed to determine if patients with chronic inflammatory demyelinating polyneuropathy transitioning from intravenous administration of immunoglobulin G to SCIg improved their infusion parameters during training with the Specialty Pharmacy Nurse Network and identify factors impacting training and ongoing treatment optimization. Of the 310 patients analyzed, most improved their infusion parameters during training. Setting patient expectations and providing education on SCIg technique may improve patients' ability to reach optimal infusion parameters and encourage individualization.
The rapid, massive growth of COVID-19 authors in the scientific literature
Authors: Ioannidis John P. A. , Salholz-Hillel Maia , Boyack Kevin W. , Baas Jeroen
Published: September 2021

We examined the extent to which the scientific workforce in different fields was engaged in publishing COVID-19-related papers. According to Scopus (data cut, 1 August 2021), 210 183 COVID-19-related publications included 720 801 unique authors, of which 360 005 authors had published at least five full papers in their career and 23 520 authors were at the top 2% of their scientific subfield based on a career-long composite citation indicator. The growth of COVID-19 authors was far more rapid and massive compared with cohorts of authors historically publishing on H1N1, Zika, Ebola, HIV/AIDS and tuberculosis. All 174 scientific subfields had some specialists who had published on COVID-19. In 109 of the 174 subfields of science, at least one in 10 active, influential (top 2% composite citation indicator) authors in the subfield had authored something on COVID-19. Fifty-three hyper-prolific authors had already at least 60 (and up to 227) COVID-19 publications each. Among the 300 authors with the highest composite citation indicator for their COVID-19 publications, most common countries were USA (
n
= 67), China (
n
= 52), UK (
n
= 32) and Italy (
n
= 18). The rapid and massive involvement of the scientific workforce in COVID-19-related work is unprecedented and creates opportunities and challenges. There is evidence for hyper-prolific productivity.
In vitro antifungal effect of a plant-based product, CIN-102, on antifungal resistant filamentous fungi and their biofilms
Authors: D'agostino Maurine , Tesse Nicolas , Lavergne Rose Anne , Le Pape Patrice , Frippiat Jean Pol , Machouart Marie , Debourgogne Anne
Published: September 2021

Introduction. The increase of invasive fungal infections (IFIs) and associated treatment failure in populations at risk is driving us to look for new treatments.

Hypothesis. The CIN-102 compound, derived from cinnamon essential oil, could be a new antifungal class with an activity, in particular, on strains resistant to current antifungals but also on biofilms, a factor of virulence and resistance of fungi.

Aim. The aim of this study is to show the activity of CIN-102 on various strains resistant to current antifungals, on the biofilm and to determine the possibility of resistance induced with this compound.

Methodology. We studied the MIC of CIN-102 and of current antifungals (voriconazole and amphotericin B) using CLSI techniques against eight different strains of three genera of filamentous fungi involved in IFIs and having resistance phenotypes to current antifungals. We also determined their effects on biofilm formation, and the induced resistance by voriconazole (VRC) and CIN-102.

Results. MIC values determined for CIN-102 were between 62.5 and 250 µg ml−1. We demonstrated the antifungal effect of CIN-102 on biofilm, and more particularly on its formation, with 100 % inhibition achieved for most of the strains. CIN-102 at a sub-inhibitory concentration in the medium did not induce resistance in our strains, even after 30 generations.

Conclusions. In this study we show that CIN-102 is effective against resistant filamentous fungi and against biofilm formation. In addition, our strains did not acquire a resistance phenotype against CIN-102 over time, unlike with VRC. CIN-102 is therefore an interesting candidate for the treatment of IFIs, including in cases of therapeutic failure linked to resistance, although further studies on its efficacy, safety and mechanism of action are needed.
Long-term corticosteroid therapy for patients with severe coronavirus disease 2019 (COVID-19)
Authors: Calcaianu George , Degoul Samuel , Payen Thibault , Michau Bénédicte , Calcaianu Mihaela , Lawson Bree , Bresson Didier , Debieuvre Didier
Published: September 2021

earlier and longer corticosteroid therapy with methylprednisolone could reduce the mortality and/or rate of ICU admission by 26% in patients with severe COVID-19, hospitalized in conventional medical ward.

Background

Low dose of dexamethasone reduced mortality in hospitalized COVID-19 patients who required respiratory support. Less is known about the efficacy of other corticosteroids in severe COVID-19 patients. This study was designed to determine if longer and earlier corticoid therapy in severe COVID-19 patients is associated with reduced mortality and/or reduced rate of ICU admission for worsening of respiratory state.

Methods

We performed a retrospective study with patients aged ≥ 18 years, with epidemiological and/or radiological suspected COVID-19, hospitalized in a regional hospital GHRMSA Mulhouse, France. Twenty-three patients received methylprednisolone (MP) as compassionate use, 1 mg/kg/day for seven days followed by prednisolone at a gradually reduced dosage, for 4 to 6 weeks. MP was started one week after COVID-19 symptoms first appeared. The primary composite outcome was mortality and/or ICU admission during hospitalisation.

Results

Between March 14th to June 5th 2020, 255 patients were screened, 181 were included, and 92 were analysed, 23 patients treated with MP and 69 received standard care. SARS-CoV2 infection was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR) in 82.3%. The overall composite outcome was higher in the control group: 42/69 patients (60.9%) versus 8/23 (34.8%) in the interventional group (p= 0.018). The correction of lymphopenia between days 1 to 7 was associated with better outcome (p=0.006).

Conclusion

These results suggest that earlier and longer corticosteroid therapy with methylprednisolone could reduce the mortality and/or rate of ICU admission in patients with severe COVID-19, hospitalized in conventional medical ward.