bluuebunny/crossref_metadata_2025 huggingface dataset:
Case 13
Authors: Humphreys Hilary
Published: April 2020

There is an increasing number of opportunist pathogens that may cause acute pulmonary exacerbations of cystic fibrosis as the patient cohort survives longer. However, it can often be difficult to determine if the isolation of these bacteria represents colonization or true infection. Their identification from sputum samples in the microbiology laboratory is also challenging, requires significant scientific expertise, and is assisted by new technologies such as MALDI-TOF (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry). One such opportunist pathogen is Stenotrophomonas maltophilia, for which risk factors include increasing age and recent oral antibiotics, especially carbapenems. However, it is unclear if this bacterium is transmitted from patient to patient unlike with Pseudomonas aeruginosa, but all patients with cystic fibrosis should be admitted to a single room when hospitalization is required. Controversies exist regarding the optimal treatment which in the future may include a greater reliance on inhaled antibiotics.
Case 14
Authors: Humphreys Hilary
Published: April 2020

Cryptococcosis is an opportunist infection that should be considered in HIV/AIDS and in other at risk immunosuppressed patients such as those following solid organ transplantation. Cryptococcus neoformans is found in bird droppings and is the commonest cause in temperate climates but C. gattii is increasingly recognized in warmer climates. Diagnosis is usually via antigen detection, microscopy, and culture of blood, respiratory specimens and cerebrospinal fluid (CSF), in addition to histological analysis of appropriate tissue with specialised stains. New antigen assays facilitate point-of-care testing in resource-poor countries. Management includes initial treatment regimens with liposomal amphotericin B (the echinocandins have little activity) followed by follow-up antifungal therapy for up to a year, usually with fluconazole.
Case 19
Authors: Wong T H Nicholas
Published: April 2020

Norovirus is the major cause of viral gastroenteritis in the hospital setting worldwide. It affects people of all ages. Outbreaks in hospitals lead to major disruptions, sometimes leading to ward closures. Although Kaplan criteria have been used to determine the probability of a viral gastroenteritis outbreak, this is hampered by its low sensitivity. Reverse-transcriptase polymerase chain reaction (RT-PCR) is now the preferred method for detection with the greatest sensitivity. Management of individual cases remain supportive, although death has been associated with immunosuppression. Stringent infection control management, such as strict isolation and closure of affected bays, limiting non-essential personnel and visitors entering the ward, and adherence to soap and water handwashing are key to managing ward outbreaks.
Case 20
Authors: Irving Will
Published: April 2020

Chronic infection with hepatitis E virus (HEV) arises in immunosuppressed patients. It presents usually with raised transaminases and may lead to development of cirrhosis. Diagnostic tests must include HEV RNA detection, as serology may be unreliable in immunosuppressed patients. Treatment options include reduction of immunosuppression (if possible), and prolonged oral ribavirin. HEV exists as 4 main genotypes. Genotypes 1 and 2 are spread through the faecal-oral route, genotypes 3 and 4 are zoonoses acquired from eating undercooked meat, mostly processed pork products. Preventative measures include taking appropriate precautions with food and drink when travelling, ensuring adequate cooking of pork products, screening of blood donors (where viraemic rates are between 1 in 1000 and 1 in 10,000), and use of a recombinant vaccine. Acute infection may be fulminant (especially in pregnancy). Extrahepatic manifestations include a number of neurological syndromes (Guillain–Barre, acute brachial neuropathy), renal disease (glomerulonephritis), and acute pancreatitis.
Case 22
Authors: Ramasamy Maheshi
Published: April 2020

Pyelonephritis commonly presents with symptoms of flank pain and fever. Clinically, a patient may have leucocyte esterase and nitrites detectable on urinalysis. Urine microbiological culture commonly yields Gram-negative bacilli such as Escherichia coli as the causative agent. Predisposing factors for pyelonephritis include structural abnormalities of the renal tract, urinary catheters, and immunosuppressive states such as diabetes. Treatment options are guided by local antibiotic susceptibility profiles and whether the patient requires admission or can be managed in the community. Failure to respond to appropriate antibiotic therapy should prompt further investigation for a collection or abscess.
Case 25
Authors: Woodhouse Andrew
Published: April 2020

Schistosomiasis is a parasitic trematode infection. Depending on the species of fluke, gastrointestinal or genitourinary tract disease develops with occasional involvement of other organs including the central nervous system. The great burden of chronic disease is in endemic countries but travellers can become infected through exposure to contaminated water in lakes and rivers. An acute symptomatic infection is sometimes seen and needs to be considered in the appropriate clinical context in travellers returning from the tropics.
Case 26
Authors: Humphreys Hilary
Published: April 2020

Clinical signs suggestive of meningitis such as Kernig’s sign have low sensitivity in adults and fever, headache, neck stiffness, and altered mental status are the common clinical manifestations. Where possible, a sample of cerebrospinal fluid (CSF) should be taken and a combination of a third-generation cephalosporin and vancomycin started as empiric treatment. Amoxicillin should be added in the elderly or others at risk of listeriosis. Corticosteroids administered with antibiotics may reduce mortality from meningitis due to Streptococcus pneumoniae and severe hearing loss in children due to Haemophilus influenzae. Those over 65 years of age and patients in other risk groups should be vaccinated against invasive pneumococcal disease. Increasingly, there are recommendations that both the polysaccharide vaccine (PPV23) and conjugated vaccines (e.g. PCV13) should be used to maximize protection.
Case 28
Authors: Humphreys Hilary
Published: April 2020

Nocardia are opportunist pathogens, especially affecting patients with T-cell deficiencies, such as those on prolonged high-dose corticosteroids. They are found in the environment, associated with ornamental fish, and Nocardia asteroids complex is most commonly associated with human disease. Infection may result in a brain abscess, pulmonary infection, or disseminated disease including involvement of the skin. Steriotactic aspiration or via a burr hole to obtain a sample are replacing open craniotomy, unless the brain abscess is large. Previously, laboratory confirmation was dependant on prolonged culture and stains for acid-and alcohol-fact bacilli, but increasingly, molecular techniques are used to diagnose this and other causes of brain abscess. Consensus and clinical experience suggest that co-trimoxazole with or without a carbapenem, are the initial empiric anti-infectives of choice for nocardiosis. Susceptibility testing should be carried out on available isolates as treatment is usually for 6 months or longer.
Case 32
Authors: Ramasamy Maheshi
Published: April 2020

Indwelling intravascular catheters are susceptible to colonization by bacteria and yeasts, with subsequent development of bloodstream infection. The management of these bloodstream infections is determined by the nature of the pathogenic organism and the type of line involved.
Case 36
Authors: Woodhouse Andrew
Published: April 2020

Human immunodeficiency virus (HIV) infection is a worldwide infection and new cases continue to occur. Recognizing features of acute HIV infection and also underlying conditions that might reflect longer-standing infection are key to diagnosis. This allows treatment to be started which can maintain or improve health and prevent further deterioration of immune function. Treatment is indicated for the majority of newly diagnosed cases irrespective of immune function status. Current treatment strategies are so effective and tolerable now compared to early antiretroviral regimens that HIV has become a long-term manageable condition for the majority of newly diagnosed people who are able to access antiretroviral therapy.
Case 39
Authors: Jeffery Katie
Published: April 2020

Viral infection in pregnancy can lead to adverse outcomes for both the mother and the foetus. This chapter examines the steps to be taken on exposure to viruses associated with rash illness in pregnancy. Consideration is given to the important points in the history, which viral infections are of concern in pregnancy (varicella-zoster, parvovirus B19, rubella, measles, and Zika), the possible outcomes of infection, diagnostic approaches, and the management of a confirmed case of Parvovirus B19 infection.
Case 42
Authors: Atkins Bridget
Published: April 2020

Diabetic foot infections (DFIs) need to be managed by a multidisciplinary team (MDT) including primary care physicians, infection specialists, diabetes specialists, dieticians, podiatrists, vascular surgeons, foot and ankle surgeons, and orthotics. Preventative measures such as good diabetic control, foot care, and foot wear are crucial. When DFIs occur, they should be managed promptly with urgent podiatry review, diagnostic sampling, antibiotics, attention to diabetic control, off-loading, and, where appropriate, vascular assessment, imaging, and surgery. If acutely unwell or the limb is threatened, patients should be urgently admitted to hospital for immediate management. Failure to adequately prevent, manage diabetic foot infections and to recognize severe infections may lead to amputation and/or severe sepsis/death.
Case 46
Authors: Woodhouse Andrew
Published: April 2020

Cytomegalovirus (CMV) is a β‎-herpes virus of particular importance in solid organ transplantation. CMV infection is associated with graft dysfunction and rejection and also predisposes to other opportunistic infections. Donor and recipient CMV status is important to know at the time of transplant. This information allows CMV risk stratification and selection of appropriate strategies to prevent development of symptomatic infection.
Estimating a non-neutral production function
Authors: Antonioli Davide , Gioldasis Georgios , Musolesi Antonio
Published: April 2020

In this article we estimate a production function that allows us to depart from the standard hypothesis of Hicks neutrality (HN) while also coping with the endogeneity of a dummy innovation variable. We consider specifications that relax HN, and we derive the testable conditions for common parametric approximations under which HN holds. The model is estimated using instrumental variable methods, allowing innovation to have a heterogeneous effect on the production process. The econometric analysis rejects HN and highlights three main features: a biased technical change (TC), with a higher ratio between the marginal product of labour and the marginal product of capital for innovative firms; a locally progressive TC; fully heterogeneous technologies when comparing innovative to non-innovative firms. We also address other issues, taking a closer look at the effect of process innovation and the role of sector heterogeneity and considering the potential endogeneity of labour input.
Transpetrous Clip Occlusion of a Giant Midbasilar Aneurysm Using Hypothermic Cardiac Arrest: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: April 2020

Basilar trunk aneurysms are historically associated with extremely high morbidity. The complexity of circumflex perforator arteries responsible for the perfusion of the brainstem makes surgical intervention for these lesions particularly challenging. This patient had a giant midbasilar aneurysm that encompassed multiple perforators but was associated with progressive mass effect and debilitating morbidity. Therefore, a transpetrous approach was used with transposition of the facial nerve and sacrifice of the vestibulocochlear nerve to permit access to the aneurysm. Hypothermic cardiac arrest was used to permit dome manipulation with a tandem fenestrated clipping of the aneurysm. Postoperative imaging demonstrated a reduction in mass effect attributable to the significantly reduced dome size and persistence of flow via a reconstructed basilar trunk. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Surgical Clipping of an Unruptured Large Inferiorly Projecting Anterior Communicating Artery Aneurysm With Chiasmopathy: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: April 2020

Anterior communicating artery (ACoA) aneurysms are a frequently encountered cerebrovascular entity that is associated with a high rupture rate at a smaller size and debilitating morbidity and mortality following rupture. The surgical management of ACoA aneurysms is highly dependent on the spatial orientation of the saccular projection, which is categorized as inferior, superior, anterior, or posterior. The inferiorly projecting aneurysms constitute a minority of all aneurysms involving the ACoA. The adherence of the aneurysm dome near the chiasm predisposes these patients to dome avulsion during frontal lobe retraction. This patient presented with a 1-mo history of progressive vision loss and was found to have a large inferiorly projecting ACoA saccular aneurysm measuring 2.04 cm × 1.54 cm with resultant chiasmopathy. The lesion was approached via a right modified orbitozygomatic craniotomy, which can provide a more favorable maximal angle of approach to the ACoA complex to avoid brain retraction. Intraoperative adenosine was administered to provide relaxation of the aneurysm dome to augment clip placement. Postoperatively, the patient's chiasmopathy demonstrated near-complete resolution. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Excision of a Large Complex Left Middle Cerebral Artery Aneurysm With a Middle Cerebral Artery—Middle Cerebral Artery and Superficial Temporal Artery—Middle Cerebral Artery Bypass: 2-Dimensional Operative Video
Authors: Hendricks Benjamin K , Spetzler Robert F
Published: April 2020

Revascularization techniques for microsurgical manage-ment of middle cerebral artery (MCA) bifurcation aneurysms are often necessary for treatment of fusiform or giant aneurysms. Augmentation of the standard pterional approach to include an extended orbitozygomatic or modified orbitozygomatic approach provides a wider and more favorable approach to the MCA when attempting revascularization. Direct excision of a giant aneurysm (aneurysmectomy) with mobilization and reanastomosis of the MCA afterward has been reported. This patient had a giant MCA bifurcation aneurysm for which aneurysmectomy and distal reanastomosis were performed between the M1 and two M2 branches via a modified orbitozygomatic craniotomy. A second bypass between a third M2 branch at the ipsilateral superficial temporal artery was performed. Postoperative angiography confirmed patency of the bypasses. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Early Adolescent Health Problems, School Performance, and Upper Secondary Educational Pathways: A Counterfactual-Based Mediation Analysis
Authors: Mikkonen Janne , Remes Hanna , Moustgaard Heta , Martikainen Pekka
Published: April 2020

Early health problems predict lower educational attainment, but it remains unclear whether this is due to health problems weakening school performance or due to other mechanisms operating above and beyond school performance. We employed counterfactual-based mediation analysis on a register-based sample of Finnish adolescents born in 1988–1993 (n = 73,072) to longitudinally assess the direct (unexplained by school performance, as measured by grade point average) and indirect (pure mediation and mediated interaction via school performance) effects of early adolescent somatic and mental health problems on the noncompletion of upper secondary education and track choice (vocational vs. general). Mental disorders were associated with the largest increases in both noncompletion and choosing the vocational track, but somatic conditions also showed small but robust associations. Weakened school performance mediated up to one-third of the differences in noncompletion and around half of the differences in track choice. When the same analyses were conducted within sibships, the total effects of health problems on educational pathways were weaker, but the contribution of school performance remained similar. In counterfactual simulations that assigned everyone an above-median school performance—that is, eradicating below-median school performance—about 20–40 percent of the effects of mental disorders on educational pathways remained. Our results suggest that while impaired school performance is an important component in health-related selection to education, it does not fully explain the shorter and less academically oriented educational careers of adolescents with health problems. These adolescents may benefit from additional educational support regardless of their formal school performance.
Co-circulation of both low and highly pathogenic avian influenza H5 viruses in current poultry epidemics in Taiwan
Authors: Li Yao-Tsun , Chen Chen-Chih , Chang Ai-Mei , Chao Day-Yu , Smith Gavin J D
Published: April 2020

Highly pathogenic avian influenza (HPAI) A(H5) viruses belonging to clade 2.3.4.4c of the A/goose/Guangdong/1/96-like (Gs/GD) lineage caused severe global outbreaks in domestic birds from 2014 to 2015, that also represented the first incursions of Gs/GD viruses into Taiwan and the USA. However, few studies have investigated the circulation of clade 2.3.4.4c viruses after 2015. Here, we describe Gs/GD clade 2.3.4.4c and Mexican-like H5N2 viruses that were isolated in Taiwan during active surveillance conducted in chicken farms from February to March 2019. Phylogenetic analysis demonstrated two distinct genome constellations of the clade 2.3.4.4c H5 viruses, with the internal genes of one of the new genotypes closely related to a virus isolated from a pintail (Anas acuta) in Taiwan, providing the first direct evidence that migratory birds play a role in importing viruses into Taiwan. Our study also confirmed the co-circulation of Gs/GD clade 2.3.4.4c and Mexican-like H5 lineage viruses in Taiwan, presenting a rare case where Gs/GD viruses developed sustained transmission alongside another enzootic H5 lineage, raising the possibility that homosubtypic immunity may mask virus transmission, potentially frustrating detection, and the implementation of appropriate control measures. To eradicate H5 viruses from poultry in Taiwan, further studies on the effect of co-circulation in poultry of low pathogenic avian influenza and HPAI viruses are needed. Furthermore, only with continued surveillance efforts globally can we fully discern dispersal patterns and risk factors of virus transmission both to and within Taiwan.
Manipulating Neural Circuits in Anesthesia Research
Authors: Melonakos Eric D. , Moody Olivia A. , Nikolaeva Ksenia , Kato Risako , Nehs Christa J. , Solt Ken
Published: April 2020

The neural circuits underlying the distinct endpoints that define general anesthesia remain incompletely understood. It is becoming increasingly evident, however, that distinct pathways in the brain that mediate arousal and pain are involved in various endpoints of general anesthesia. To critically evaluate this growing body of literature, familiarity with modern tools and techniques used to study neural circuits is essential. This Readers’ Toolbox article describes four such techniques: (1) electrical stimulation, (2) local pharmacology, (3) optogenetics, and (4) chemogenetics. Each technique is explained, including the advantages, disadvantages, and other issues that must be considered when interpreting experimental results. Examples are provided of studies that probe mechanisms of anesthesia using each technique. This information will aid researchers and clinicians alike in interpreting the literature and in evaluating the utility of these techniques in their own research programs.
Risk Factors for Failure to Rescue in Myocardial Infarction after Noncardiac Surgery
Authors: Mazzarello Sasha , McIsaac Daniel I. , Beattie W. Scott , Fergusson Dean A. , Lalu Manoj M.
Published: April 2020

Background

Compared to other perioperative complications, failure to rescue (i.e., death after suffering a complication) is highest after perioperative myocardial infarction (a myocardial infarction that occurs intraoperatively or within 30 days after surgery). The purpose of this study was to identify patient and surgical risk factors for failure to rescue in patients who have had a perioperative myocardial infarction.

Methods

Individuals who experienced a perioperative myocardial infarction after noncardiac surgery between 2012 and 2016 were identified from the American College of Surgeons (Chicago, Illinois) National Surgical Quality Improvement Program database. Multivariable logistic regression was used to identify risk factors for failure to rescue. Subgroup and sensitivity analyses evaluated the robustness of primary findings.

Results

The authors identified 1,307,884 individuals who had intermediate to high-risk noncardiac surgery. A total of 8,923 (0.68%) individuals had a perioperative myocardial infarction, of which 1,726 (19.3%) experienced failure to rescue. Strongest associations (adjusted odds ratio greater than 1.5) were age 85 yr or older (2.52 [95% CI, 2.05 to 3.09] vs. age younger than 65 yr), underweight body mass index (1.53 [95% CI, 1.17 to 2.01] vs. normal body mass index), American Society of Anesthesiologists class IV (1.76 [95% CI, 1.33 to 2.31] vs. class I or II) and class V (3.48 [95% CI, 2.20 to 5.48] vs. class I or II), and presence of: ascites (1.81 [95% CI, 1.15 to 2.87]), disseminated cancer (1.54 [95% CI, 1.18 to 2.00]), systemic inflammatory response syndrome (1.55 [95% CI, 1.26 to 1.90]), sepsis (1.75 [95% CI, 1.39 to 2.20]), septic shock (1.79 [95% CI, 1.34 to 2.37]), and dyspnea at rest (1.94 [95% CI, 1.32 to 2.86]). Patients who had emergency surgery, high-risk procedures, and postoperative complications were at higher risk of failure to rescue.

Conclusions

Routinely identified patient and surgical factors predict risk of failure to rescue after perioperative myocardial infarction.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Image Distortion in Biplanar Slot Scanning: Part 2 Technology-specific Factors
Authors: Sharp Jennifer , Bouton Daniel , Anabell Lucas , Degan Timothy , Sienko Susan , Welborn Michelle C.
Published: April 2020

Background:

Biplanar digital slot scanning technology has become the standard of care in the treatment of scoliosis. Yet, the amount of distortion and reproducibility of this type of imaging modality has yet to be fully investigated. In our paper “Image distortion in biplanar slot scanning: part 1 patient-specific factors” we found that there was potentially clinically impactful interimage distortion. The purpose of this study was to evaluate the degree to which this image distortion was secondary to the image acquisition process.

Methods:

Four 25 mm radio-opaque markers were placed at C3, T1, T12, and L5 on a full-length skeleton model. The skeleton was imaged in 10 different positions within the scanner. Five posteroanterior and 5 lateral images were obtained in each position. Two orthopaedic attending physicians and 3 orthopaedic resident physicians measured the markers for a total of 3200 measurements. Intraclass correlation coefficients (ICCs) and 95% confidence intervals were used to examine image distortion.

Results:

Average marker size was 24.77, with a standard error of measurement of 0.00493. Image distortion and standard error of measurement accounted for ∼0.5% to 1.5% of total the measurement. Overall, there was good reliability and consistency when looking at markers in different views (ICC 0.790), planes, and locations within the image. Horizontal measurements were found to be more consistent and have better reliability (ICC 0.881) than vertical measurements (ICC 0.386). Position within the scanner had minimal impact on the accuracy of the measurements.

Conclusions:

This study demonstrates that there is minimal error due to image acquisition and measurement when using a biplanar slot scanner. Biplanar slot scanning technology tended to underestimate the size of the marker; however, the least accurate measurements only erred by 1.5% from the true length. This indicates that unlike traditional radiographs the sources of error in biplanar slot scanning images are not due to parallax and are likely due to patient-specific factors and rather than the technology itself.
Two-incision Approach for the Open Reduction Internal Fixation of Intra-articular Hamate Body Fractures Using a Cannulated Headless Compression Screw
Authors: Ha Austin Y. , Booth Matthew , Pet Mitchell A.
Published: April 2020

Fractures of the hamate are relatively rare and there is a paucity of literature describing their natural history, indications for operative fixation, surgical techniques, and outcomes. Most authors recommend operative fixation of displaced intra-articular coronal hamate body fractures, and a dorsal approach with Kirschner wires has most commonly been recommended to achieve this. In this report, a 2-incision approach to the hamate is presented that facilitates rigid internal fixation of coronal hamate body fractures with a cannulated headless compression screw and minimizes the possibility of iatrogenic injury to critical branches of the ulnar nerve. The authors summarize a series of 2 patients with displaced, intra-articular coronal hamate body fractures of differing severity treated successfully with the proposed approach.
Acute Aortic Occlusion and Its Sequelae
Authors: Hines George L. , Liu Helen H.
Published: April 2020

Acute occlusion of the abdominal aorta is a catastrophic occurrence that results in high risk of limb loss and death. The etiology has historically been either acute embolism obstructing the aortic bifurcation in 8% to 75% of patients, or thrombosis of existing aorta-iliac occlusive disease in 35% to 84% of patients. Other etiologies include thrombosis of either a previously placed endograft or aortic graft or acute dissection. The most common symptoms are severe pain in almost 100% of patients or lower extremity paralysis/paresis in up to 80% of patients. Evaluation in the past was by angiography, but presently, computed tomography angiography is the preferred imaging study. Treatment is dependent on the etiology and includes embolectomy, aorta femoral bypass, axillary femoral bypass, and endovascular techniques. The aim of intervention is to restore flow in the shortest time period. Mortality rates vary widely from 17% to 52%, amputation occurs in up to 30% of patients. Paraplegia can occur in 40% of patients, renal insufficiency in 40% to 70%, and visceral ischemia in 6% to 14%. Both mortality and morbidity are affected by the duration of ischemia and the local and systemic complications of reperfusion injury. Complications of acute aortic occlusion can be reduced by a more prompt diagnosis, rapid intervention, and a more rapid and complete reestablishment of perfusion.
ASSESSMENT OF HYPERREFLECTIVE FOCI AFTER BEVACIZUMAB OR DEXAMETHASONE TREATMENT ACCORDING TO DURATION OF MACULAR EDEMA IN PATIENTS WITH BRANCH RETINAL VEIN OCCLUSION
Authors: Do Jae Rock , Park Su Jin , Shin Jae Pil , Park Dong Ho
Published: April 2020

Purpose:

To evaluate the association between hyperreflective foci (HRF) on spectral domain optical coherence tomography and therapeutic effect of intravitreal bevacizumab (IVB) or intravitreal dexamethasone implants (IVD) according to macular edema (ME) duration in branch retinal vein occlusion.

Methods:

Consecutive treatment-naive patients received IVB or IVD for at least 6 months. Each group was subdivided according to ME duration (<3 months vs. ≥3 months). Hyperreflective foci and best-corrected visual acuity were compared.

Results:

Of 139 eyes (139 patients), 69 received IVB and 70 received IVD. At baseline, eyes with ME ≥ 3 months had more outer and total retinal HRF than eyes with ME < 3 months (P < 0.001 and P = 0.001). At 6 months, the IVD group exhibited a greater reduction in outer retinal HRF than the IVB group in both ME duration subgroups (P = 0.015 and P < 0.001). In the ME ≥ 3 months group, IVD resulted in greater best-corrected visual acuity improvement than IVB (P = 0.017).

Conclusion:

Increased outer retinal HRF at baseline in eyes with ME ≥ 3 months together with a greater reduction in HRF at 6 months and better visual outcomes after IVD suggests that the inflammatory aspect of disease should be considered in the treatment of ME. Thus, IVD injection could be more appropriate for patients with a longer ME duration after branch retinal vein occlusion.
Role of dipeptidyl peptidase-4 inhibitors in patients with diabetes infected with coronavirus-19
Authors: Chen Chun-Fan , Chien Chian-Hsu , Yang Yi-Ping , Chou Shih-Jie , Wang Mong-Lien , Huo The-Ia , Lin Chih-Ching
Published: April 2020

The pandemic infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is widely increasing the patients affiliated with coronavirus disease 2019 (COVID-19) from last December of 2019. It is reported that the entry receptor of SARS-CoV-2 has been confirmed to be angiotensin-converting enzyme 2 (ACE2). Notably, whether the ACE-related inhibitors or drugs modulated ACE2 activity in affecting the viral activity and disease severity of SARS-CoV-2 is still an open question. Dipeptidyl peptidase-4 (DDP-4), a well-known anti-diabetic drug, has been widely used to control the glycemic condition in patients with diabetes. In this article, we are focusing on the impact of ACE inhibitors (ACEI) and DPP4 inhibitors used on SARS-CoV-2 activity and discussions about those drugs that may be related to infectious condition of COVID-19 diseases.
FuMeGA Criteria for Visual Assessment of Postoperative 18F-Fluorocholine PET in Patients With Glioma
Authors: García Vicente Ana María , Pena Pardo Francisco José , Lozano Setien Elena , Sandoval Valencia Hernán , Villena Martín Maikal
Published: April 2020

Postoperative assessment is crucial in the imaging follow-up and prognosis in patients with glioma. Whereas grade of resection is defined attending to the gadolinium enhancement in early postoperative MRI, no metabolical criteria exist for postoperative PET interpretation. Based on our prospective and multicenter FuMeGA (Functional and Metabolic Glioma Analysis) ongoing study, we propose criteria for the visual interpretation of 18F-fluorocholine PET scans in patients undergoing brain tumor resection. The different imaging characteristics between MRI and PET may explain the discordances regarding to the postresection status with both techniques.
Potential therapeutic treatments of cancer-induced bone pain
Authors: Ellingson Holly M. , Vanderah Todd W.
Published: April 2020

Purpose of review

The treatment of cancer-induced bone pain (CIBP) has been proven ineffective and relies heavily on opioids, the target of highly visible criticism for their negative side effects. Alternative therapeutic agents are needed and the last few years have brought promising results, detailed in this review.

Recent findings

Cysteine/glutamate antiporter system, x

c

−, cannabinoids, kappa opioids, and a ceramide axis have all been shown to have potential as novel therapeutic targets without the negative effects of opioids.

Review of the most recent and promising studies involving CIBP, specifically within murine models. Cancer pain has been reported by 30–50% of all cancer patients and even more in late stages, however the standard of care is not effective to treat CIBP. The complicated and chronic nature of this type of pain response renders over the counter analgesics and opioids largely ineffective as well as difficult to use due to unwanted side effects. Preclinical studies have been standardized and replicated while novel treatments have been explored utilizing various alternative receptor pathways: cysteine/glutamate antiporter system, x

c

−
, cannabinoid type 1 receptor, kappa opioids, and a ceramide axis sphingosine-1-phosphate/sphingosine-1-phosphate receptor 1.
The Israel Defense Forces Trauma Registry: 22 years of point-of-injury data
Authors: Tsur Avishai M. , Nadler Roy , Lipsky Ari M. , Levi Diana , Bader Tarif , Benov Avi , Glassberg Elon , Chen Jacob
Published: April 2020

BACKGROUND

Trauma is the leading cause of death among casualties between 1 and 44 years. A large proportion of trauma deaths occurs even before arriving at a medical facility. The paucity of prehospital data is a major reason for the lagging development of prehospital trauma care research. This study aims to describe the Israel Defense Forces Prehopistal Trauma Registry, the steps taken to improve data collection and quality, the resulting trends, and the registry's contribution to policymaking.

METHODS

This study explores the quantity and quality of point of injury and prehospital data in the registry between the years 1997 and 2018. We assessed the number of recorded casualties per year, casualties characteristics, and documentation variables in the registry, with a specific focus on documentation of vital signs throughout the years.

RESULTS

Overall, 17,905 casualties were recorded. Most casualties were young males (88.6%)—military personnel (52.7%), Syrian refugees (16.2%), Israeli civilians (11.5%), and Palestinians (9.0%). The median number of annual records from 2006 onward was significantly higher compared with before 2006 (1,000 [IQR, 792–1,470] vs. 142 [IQR, 129–156]). Between 2010 and 2018, documentation rate increased in all vital signs investigated including heart rate (56.3% vs. 1.0%), level of consciousness (55.1% vs. 0.3%), respiratory rate (51.8% vs. 0.3%), blood oxygen saturation (50.0% vs. 1.0%), Glasgow Coma Scale (48.2% vs. 0.4%), systolic blood pressure (45.7% vs. 0.8%), and pain (19.1% vs. 0.5%).

CONCLUSION

Point of injury and prehospital documentation are rare yet essential for ongoing improvement of combat casualty care. The Israel Defense Forces Trauma Registry is one of the largest and oldest prehospital computerized military trauma registries in the world. This study shows a major improvement in the quantity and then in the quality of prehospital documentation throughout the years that affected guidelines and policy. Further work will focus on improving data completeness and accuracy.

LEVEL OF EVIDENCE

Retrospective study, level III.
Instantaneous R calculation for COVID-19 epidemic in Brazil
Authors: Felix Francisco H. C. , Fontenele Juvenia
Published: April 2020

COVID-19 pandemic represents a major challenge to health systems of all countries. Brazilian regions habe been showing marked differences in onset and number of cases. Health authorities instituted widespread social distancing and lockdown measures but their implementation has also varied. The authors used data on confirmed cases of COVID-19 in Brazil and its states to calculate the value of instantaneous reproduction number at these regions. The results show a reduction of instantaneous reproduction number with time, probably due to social distancing measures put in place in the last weeks by brazillian authorities. It seems logical to maintain restrictions to social contact until the epidemic peak has occurred in Brazil.
Atypical atrial flutter: a new methodology for critical isthmi identification?
Authors: Adragão Pedro , Matos Daniel , Costa Francisco Moscoso , Carmo Pedro , Cavaco Diogo , Rodrigues Gustavo , Carmo João , Morgado Francisco , Mendes Miguel
Published: April 2020

Introduction

Atypical atrial flutter is a supraventricular arrhythmia that can be treated with catheter ablation. However, the best approach is still to be defined and this strategy has suboptimal results. The Carto® electroanatomical mapping (EAM) system can display a histogram of the local activation times (LAT) of the tachycardia cycle length (TCL). This study aimed to assess the ability of this new tool to identify the critical isthmus of this arrhythmia.

Methods

Retrospective analysis of a unicentric registry of individuals who underwent left AFL ablation during a 1-year period with Carto® EAM. All patients with non-left AFL, lack of high-density EAM, less than 2000 collected points or lack of mapping in any of the left atrium walls or structures were excluded. We compared the ablation sites of arrhythmia termination to the sites of histogram valleys (LAT-Valleys), defined as areas of low-voltage (<0.3mV) with 10% or more of the TCL and less than 20% density points relative to the highest density zone. The longest LAT-Valley was designated as the primary valley, while additional valleys were named as secondary.

Results

A total of 9 patients (6 men, median age 75 IQR 71-76 years) were included. All patients presented with left AFL and 66% had a previous atrial fibrillation and/or flutter ablation. The median TCL and number collected points were 254 (220─290) milliseconds and 3300 (IQR 2410─3926) points, respectively. All AFL presented with at least 1 LAT-Valley in the analysed histograms, which corresponded to heterogeneous low-voltage areas (<0.3mV). All arrhythmias were effectively terminated after undergoing radiofrequency ablation in the primary LAT-Valley location.

Conclusion

A low-density and prolonged LAT-Valley in a heterogeneous low-voltage area compose an electrophysiologic triad that allows the identification of the AFL critical isthmus. Further studies are needed to assess the usefulness of this tool for improving catheter ablation outcomes.
Return To Sporting Activity After Total Hip Arthroplasty - An Irish Experience
Authors: Patrick Moloney Darren , Vukanic Danilo , Kearney Ronan , Grant-Freemantle Marc C , Quinlan John F
Published: April 2020

Objective

Total hip arthroplasty (THA) is traditionally an operation of the elderly. In the past few decades we have seen younger patient cohorts undergoing THA and increased activity levels in elderly cohorts. Guidelines have not been developed on return to sporting activity after THA. At present return to sport is dictated by surgeon preference and advice. The aim of this paper is to assess attitudes and practices toward return to sport after THA in Irish surgeons performing a minimum of forty total hip replacements per annum.

Design

Web-based survey, level of evidence 5

Methods

Current practices in the Irish orthopaedic community were assessed through a web-based survey. The questionnaire was issued via the Royal College of Surgeons Ireland to consultants involved with higher specialist training. Of 90 consultants surveyed, 35 responded. 8 respondents did not perform greater than forty THA operations per annum and thus were excluded from the later part of the survey.

Results

The majority of respondents (61.54%) would use an uncemented design for a patient planning on returning to sport. 26.92% would use a hybrid design. 3.85% would opt for a resurfacing arthroplasty. The majority of surgeons (73.08%) would use an uncemented femoral implant. 92.81% would use a ceramic on polyethylene bearing surface. 57.69% of surgeons would perform a posterolateral approach and 30.77% would opt for a anterolateral approach. All respondents would allow patients to return to low impact sports such as golf, swimming and walking following THA. Significantly more variance was seen across surgeons when considering a return to medium impact and high impact sports.

Summary/Conclusion

This survey has shown that there is still a lack of consensus on return to sport after THA. This survey of some of the most eminent arthroplasty surgeons practicing in Ireland will hopefully allow for consolidation of guidelines on return to sport after THA.
Variation of positiveness to enhance testing of specimens during an epidemic
Authors: Kadri Usama
Published: April 2020

Rapid testing of appropriate specimens from patients suspected for a disease during an epidemic, such as the current Coronavirus outbreak, is of a great importance for the disease management and control. We propose a method to enhance processing large amounts of collected samples. The method is based on mixing samples in testing tubes in a specific configuration, as opposed to testing single samples in each tube, and accounting for natural virus amounts in infected patients from variation of positiveness in test tubes. To illustrate the efficiency of the suggested method we carry out numerical tests for actual scenarios under various tests. Applying the proposed method enhances the number of tests by order of magnitudes, where all positives are identified with no false negatives, and the effective testing time can be reduced drastically even when the uncertainty in the test is relatively high.
COVID-19 data analysis and modeling in Palestine
Authors: Abdeljaoued-Tej Ines
Published: April 2020

We estimate an actual number of infected cases in Palestine based on the 18-day effect from infection to death. We find that the number of cases in April 22 varies between 506 and 2 026 infected cases. We also focus on the reproductive number in Palestine based on population dynamics with two SEIR models. Dataset is from 5 March to 22 April 2020. With a transmission rate equal to 4.55 10−6, on May 22, the simulations predict 11 014 total infected cases in the optimistic scenario and 113 171 in the worst one. The crest of the pandemic is from 22 to 27 May 2020. The reproductive number ℛ0 is equal to 1.54 for a fixed fraction of 0.6 of symptomatic cases that are reported and for a removal rate of 7. Palestinian COVID-19 mortality number is equal to 6 per million. It is small compared to countries neighboring Palestine. The infected number is equal to 88.4 per million, which is less than most of its neighbors. The basic reproduction number is still greater than 1. Changes to the transmission rate (over time) would be advisable, to fall ℛ0 below the critical threshold.
The reproductive index from SEIR model of Covid-19 epidemic in Asean
Authors: Udomsamuthirun Pongkeaw , Chanilkul Grittichon , Tongkhonburi Pongkarn , Meesubthong Chatcharawan
Published: April 2020

As we calculate analytic to link the coefficient of third-order polynomial equations from raw data of an Asean to the SEIR model. The Reproductive index depending on the average incubation period and the average infection period and the coefficient polynomial equations fitted from raw are derived. We also consider the difference of the average incubation period as 5 days and 3 days with the average infection period as 10 day of an Asean. We find that the value of R0 are Indonesia (7.97), Singapore (6.22), Malaysia (3.86), Thailand (2.48), respectively. And we also find that Singapore has 2 values of R0 as 1.54 (16 Feb to 37 March) and 6.22 (31 March-4 April).The peak of infection rate are not found for Singapore and Indonesia at the time of consideration. The model of external stimulus is added into raw data of Singapore and Indonesia to find the maximum rate of infection. We find that Singapore need more magnitude of external stimulus than Indonesia. And the external stimulus for 14 days can stimulate to occur the peak of infected daily case of both country.
Fecal Short Chain Fatty Acid ratios are related to both Depressive and Gastrointestinal Symptoms in Young Adults
Authors: Müller Bettina , Rasmusson Annica J. , Just David , Jayarathna Shishanthi , Moazzami Ali , Novicic Zorana Kurbalija , Cunningham Janet L.
Published: April 2020

Objective

Short chain fatty acids (SCFAs) are produced by the gut microbiota and may reflect health. Gut symptoms are common in individuals with depressive disorders and recent data indicates relationships between gut microbiota and psychiatric health. We aimed to investigate potential associations between SCFAs and self-reported depressive and gut symptoms in young adults.

Method

Fecal samples from 164 individuals, of which 125 were patients with psychiatric disorders, were analyzed for the short chain fatty acids (SCFA) acetate, butyrate and propionate by nuclear magnetic resonance (NMR) spectroscopy. We then compared SCFA ratios to dimensional measures of self-reported depressive and gut symptoms.

Results

Depressive symptoms showed a positive association to acetate levels and negative associations to both butyrate and propionate levels in relation to total SCFA levels. Furthermore, symptoms of diarrhea and bloating showed positive associations to acetate and negative associations to propionate in relation to total SCFA levels. Cluster analysis revealed a heterogeneous pattern where shifts in SCFA ratios were seen for individuals with either elevated levels of depressive symptoms, elevated levels of gut symptoms or both.

Conclusion

Shifts in SCFAs may have relevance for both depressive symptoms and gut symptoms in young adults.
Reacting to outbreaks at neighboring localities
Authors: Eksin Ceyhun , Ndeffo-Mbah Martial , Weitz Joshua S.
Published: April 2020

We study the dynamics of epidemics in a networked metapopulation model. In each subpopulation, representing a locality, the disease propagates according to a modified susceptible-exposed-infected-recovered (SEIR) dynamics. In the modified SEIR dynamics, individuals reduce their number of contacts as a function of the weighted sum of cumulative number of cases within the locality and in neighboring localities. We consider a scenario with two localities where disease originates in one locality and is exported to the neighboring locality via travel of exposed (latently infected) individuals. We establish a lower bound on the outbreak size at the origin as a function of the speed of spread. Using the lower bound on the outbreak size at the origin, we establish an upper bound on the outbreak size at the importing locality as a function of the speed of spread and the level of preparedness for the low mobility regime. We evaluate the critical levels of preparedness that stop the disease from spreading at the importing locality. Finally, we show how the benefit of preparedness diminishes under high mobility rates. Our results highlight the importance of preparedness at localities where cases are beginning to rise such that localities can help stop local outbreaks when they respond to the severity of outbreaks in neighboring localities.