bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunodeficient patient experience of emergency switch from intravenous to rapid push subcutaneous immunoglobulin replacement therapy during coronavirus disease 2019 shielding
Authors: Morgan Clare , Jolles Stephen , Ponsford Mark J. , Evans Kimberly , Carne Emily
Published: September 2022

Purpose of review

Welsh immunodeficient patients on immunoglobulin replacement therapy (IgRT) who were considered high risk for severe coronavirus disease 2019 (COVID-19) were directed to shield. Consequently, patients receiving hospital-based intravenous immunoglobulin (IVIg) quickly transitioned to home-based self-administered subcutaneous immunoglobulin (SCIg). This evaluation aimed to assess patients’ perceptions and experiences and laboratory outcomes of emergency IgRT transition during COVID-19.

Recent findings

A quick transition from in-hospital IVIg to home-based rapid push SCIg is achievable, however, patient IgRT administration preference remains key outside of emergency shielding measures.

Subjective self-reported experiences (n = 23) and objective immunoglobulin G (IgG) concentration (n = 28) assessments were prospectively collected from patients pre/post-IgRT switch. In total, 41/55 (75%) patients transitioned from IVIg to rapid push SCIg and all completed training to self-administer subcutaneously within 24 days. Twenty-two percent (n = 5) of patients preferred SCIg and 35% (n = 8) wanted to return to hospital-based IVIg at 6 weeks post-transition. Mean IgG levels were similar pre vs. post-SCIg switch (10.3 g/l vs. 10.6 g/l, respectively). Patients reported greater infection anxiety during COVID-19 and adapted behaviours to mitigate risk. Although a third of patients wished to return to IVIg following cessation of shielding, over time the percentage electing to remain on SCIg rose from 22% to 59%.
Cost minimization analysis of the treatment of olecranon fracture in elderly patients: a retrospective analysis
Authors: Welch Jessica M. , Zhuang Thompson , Shapiro Lauren M. , Gardner Michael J. , Xiao Michelle , Kamal Robin N.
Published: September 2022

Background:

Operative treatment of olecranon fractures in the elderly can lead to greater complications with similar outcomes to nonoperative treatment. The purpose of this study was to analyze cost differences between operative and nonoperative management of isolated closed olecranon fractures in elderly patients.

Methods:

Using a United States Medicare claims database, the authors identified 570 operative and 1,863 nonoperative olecranon fractures between 2005 and 2014. The authors retrospectively determined cost of treatment from the payor perspective for a 1-year period after initial injury, including any surgical procedure, emergency room care, follow-up care, physical therapy, and management of complications.

Results:

One year after diagnosis, mean costs per patient were higher for operative treatment (United States dollars [US$]10,694 vs. US$2,544). Significant complications were noted in 31.05% of operative cases compared with 4.35% of nonoperative cases. When excluding complications, mean costs per patient were still higher for operative treatment ($7,068 vs. $2,320).

Conclusions:

These findings show that nonoperative management for olecranon fractures in the elderly population leads to fewer complications and is less costly. Nonoperative management may be a higher-value management option for this patient population. These results will help inform management of olecranon fractures as payors shift toward value-based reimbursement models in which quality of care and cost influence surgical decision-making.

Level of Evidence:

Level IV.
Long-term Exposure to Oxidant Gases and Mortality: Effect Modification by PM2.5 Transition Metals and Oxidative Potential
Authors: Toyib Olaniyan , Lavigne Eric , Traub Alison , Umbrio Dana , You Hongyu , Ripley Susannah , Pollitt Krystal , Shin Tim , Kulka Ryan , Jessiman Barry , Tjepkema Michael , Martin Randall , Stieb Dave M. , Hatzopoulou Marianne , Evans Greg , Burnett Richard T , Weichenthal Scott
Published: September 2022

Background:

Populations are simultaneously exposed to outdoor concentrations of oxidant gases (i.e., O3 and NO2) and fine particulate air pollution (PM2.5). Since oxidative stress is thought to be an important mechanism explaining air pollution health effects, the adverse health impacts of oxidant gases may be greater in locations where PM2.5 is more capable of causing oxidative stress.

Methods:

We conducted a cohort study of 2 million adults in Canada between 2001 and 2016 living within 10 km of ground-level monitoring sites for outdoor PM2.5 components and oxidative potential. Ox exposures (i.e., the redox-weighted average of O3 and NO2) were estimated using a combination of chemical transport models, land use regression models, and ground-level data. Cox proportional hazards models were used to estimate associations between 3-year moving average Ox and mortality outcomes across strata of transition metals and sulfur in PM2.5 and three measures of PM2.5 oxidative potential adjusting for possible confounding factors.

Results:

Associations between Ox and mortality were consistently stronger in regions with elevated PM2.5 transition metal/sulfur content and oxidative potential. For example, each interquartile increase (6.27 ppb) in Ox was associated with a 14.9% (95% CI = 13.0, 16.9) increased risk of nonaccidental mortality in locations with glutathione-related oxidative potential (OPGSH) above the median whereas a 2.50% (95% CI = 0.600, 4.40) increase was observed in regions with OPGSH levels below the median (interaction P value <0.001).

Conclusion:

Spatial variations in PM2.5 composition and oxidative potential may contribute to heterogeneity in the observed health impacts of long-term exposures to oxidant gases.
Active smoking is associated with the development of adverse events of biological therapy in patients with inflammatory bowel disease
Authors: Theodoraki Eirini , Orfanoudaki Eleni , Petroulaki Eleni , Foteinogiannopoulou Kalliopi , Koutroubakis Ioannis E.
Published: September 2022

Introduction

Smoking has been associated with lower levels of anti-TNF agents, higher antibodies and a reduced response to anti-TNF in patients with inflammatory bowel disease (IBD). The aim of this study was to investigate the possible association between smoking and adverse events (AEs) of biologics in patients with IBD.

Material and methods

Consecutive IBD patients under biologics from a prospective, longitudinal registry of a tertiary center were included. A specially designed questionnaire including a wide range of AEs associated with biologics was also used.

Results

A total of 147 patients with IBD under biologics [median age (IQR) 46 (32.5–56) years, Crohn’s disease (CD) 109 (74%), female 51 (35%), under combination with immunosuppressants 60 (41 %), under intensified biologic therapy 50 (34%), under anti-TNF 132 (89%), vedolizumab 11 (7.5%), ustekinumab 3 (2%)] who had completed the questionnaire forms for AEs were included. There were 52 (35%) active smokers and 33 (22.5%) ex-smokers. The prevalence of all AEs was 88% in smokers, 87% in ex-smokers and 79% in nonsmokers. Active smoking was significantly associated with the presence of arthralgias and skin rashes (P = 0.01 and 0.002, respectively). These correlations were the same for the CD and ulcerative colitis (UC), except for arthralgias where there was a significant correlation only with CD (P = 0.001). There were no significant associations between smoking and other AEs (P > 0.05).

Conclusion

Active smoking is associated with the development of dermatological manifestations (both in UC and CD) and arthralgias (in CD) in IBD patients under biologics.
Factors associated with the development of extrahepatic malignancy in patients with nonalcoholic fatty liver disease: a single-center longitudinal study
Authors: Gumussoy Mesut , Koc Ozge , Karatas Gokturk , Ozercan Mubin , Ellik Zeynep , Duman Serkan , Kiremitci Saba , Gokcan Hale , Elhan Atilla Halil , Savas Berna , Idilman Ramazan
Published: September 2022

Background and aims

The aim of the present study was to determine incident cases of extrahepatic malignancy in patients with nonalcoholic fatty liver disease (NAFLD) and to identify whether the factors are associated with cancer development.

Methods

Between 15 January 2001 and 14 March 2021, a total of 1365 patients had been diagnosed with NAFLD were enrolled in the study.

Results

The median follow-up period was 59.5 months. The mean age was 50.9 ± 10.9 years. The female gender was predominant (57%). During the follow-up period, 62 extrahepatic malignancies and 11 hepatocellular carcinomas were identified. Of all extrahepatic malignancies, 51 were solid organ malignancies and 11 were hematological malignancies. Female breast cancer was the most frequent (25.8%), followed by thyroid cancer (19.4%), lymphoma (12.9%), and lung cancer (9.7%). In univariate and multivariable analyses, after adjusting for age and sex, the presence of diabetes and high initial baseline gamma glutamyl transpeptidase (GGT) levels were significantly associated with the development of extrahepatic malignancies [hazard ratio (HR) = 1.82, 95% confidence interval (CI): 1.04–3.20, P = 0.036] and HR = 1.96, 95% CI: 1.14–3.38, P = 0.015, respectively). In 424 biopsy-proven NAFLD patients, the development of extrahepatic cancer was significantly associated with the severity of hepatic fibrosis (HR = 3.31, 95% CI: 1.36–8.07; P = 0.008).

Conclusion

Extrahepatic malignancies are frequently seen in patients with NAFLD. Diabetes mellitus, high baseline GGT levels, and significant hepatic fibrosis are associated with the development of extrahepatic cancer in patients with NAFLD.
British Nuclear Medicine Society Clinical Guideline for bone scintigraphy
Authors: Graham Richard , Little David , Cade Sarah , Redman Stewart
Published: September 2022

This guideline must be read in conjunction with the British Nuclear Medicine Society (BNMS) Generic guidelines. The purpose of this guideline is to assist specialists in Nuclear Medicine and Radionuclide Radiology in recommending, performing, interpreting and reporting the results of bone scintigraphy studies. This guideline could also be used to help individual departments formulate their own local protocols. This does not aim to be prescriptive regarding technical aspects of individual camera acquisitions, which should be developed in conjunction with the local medical physics expert.
The vermiform cecal appendix, expendable or essential? A narrative review
Authors: Vitetta Luis
Published: September 2022

Purpose of review

The vermiform cecal appendix is a small thin pouch-like tube of intestinal tissue situated in the lower right abdomen. It is attached at the junction of the large intestine between the ascending colon and small intestine. Historically, the appendix has been labeled redundant with no significant function, a remnant of evolution. This idea was thought to represent a function that may have been critical for survival that became nonsignificant over time. Evolutionary biologists deemed it to be a vestigial organ that early in human evolution was a dedicated organ that was useful and exploited by herbivorous ancestors.

Recent findings

Currently, the vermiform cecal appendix has generated significant renewed research interest. As such it has been reported to present a site with a high concentration of lymphoid tissue and a biofilm microbiome that approximately mirrors that which is found in the large bowel.

Research suggests that the vermiform cecal appendix may be the site of a safe-house biofilm that could re-inoculate the large bowel. Given that the appendix has no known role in digestion, the network of lymphoid tissue and microbiome could constitute an initial site of bacterial translocations that can influence early life ontology and immunological tolerance. A dysbiotic microbiome in the appendix is posited to trigger inflammatory sequelae.
A great disturbance in the force: IL-2 receptor defects disrupt immune homeostasis
Authors: Hernandez Joseph D. , Hsieh Elena W.Y.
Published: September 2022

Purpose of review

The current review highlights how inborn errors of immunity (IEI) due to IL-2 receptor (IL-2R) subunit defects may result in children presenting with a wide variety of infectious and inflammatory presentations beyond typical X-linked severe combined immune deficiency (X-SCID) associated with IL-2Rγ.

Recent findings

Newborn screening has made diagnosis of typical SCID presenting with severe infections less common. Instead, infants are typically diagnosed in the first days of life when they appear healthy. Although earlier diagnosis has improved clinical outcomes for X-SCID, atypical SCID or other IEI not detected on newborn screening may present with more limited infectious presentations and/or profound immune dysregulation. Early management to prevent/control infections and reduce inflammatory complications is important for optimal outcomes of definitive therapies. Hematopoietic stem cell transplant (HSCT) is curative for IL-2Rα, IL-2Rβ, and IL-2Rγ defects, but gene therapy may yield comparable results for X-SCID.

Defects in IL-2R subunits present with infectious and inflammatory phenotypes that should raise clinician's concern for IEI. Immunophenotyping may support the suspicion for diagnosis, but ultimately genetic studies will confirm the diagnosis and enable family counseling. Management of infectious and inflammatory complications will determine the success of gene therapy or HSCT.
Challenges in and ideas for diagnosing primary immunodeficiencies in Uganda
Authors: Barugahare Banson J.
Published: September 2022

Purpose of review

Primary immunodeficiencies (PIDs) lately referred to as inborn errors of immunity, are consequences of mutations that affect the immune integrity and function. Globally, severe PIDs are more common in infants and are fatal if not timely – appropriately diagnosed and managed. PID programmes and policies vary from country to country. The purpose of this review is to highlight PIDs initiatives and activities in Uganda with a focus on challenges and ideas for diagnosis.

Recent findings

It is now established that appropriate PID diagnosis leads to best treatment options for quality of life for the patients. However, there are still global disparities with these great milestones. PID awareness remains a fundamental global challenge. Autoimmune cytopenia, haemogram and peripheral blood film may be critical PIDs diagnostic markers and tests, respectively, for low-income countries.

As awareness is a master key to appropriate PID diagnosis and management, there is a need to design multidisciplinary and sustainable strategies. Complete blood counts and immunoglobulin profile tests may be less expensive alternatives for early diagnosis of PIDs in Uganda and other low-income countries.
Adherence in transplantation
Authors: Kuntz Kristin , Engel Kristy
Published: September 2022

Purpose of Review

Adequately managing a complex medical regimen is paramount to the success of organ transplants. When patients stray from their prescribed medical regimen posttransplant, graft rejection, and death can occur. Predictors of adherence have been studied for many years, and various factors have been identified as contributing to adequate or poor adherence. Both demographic and personal characteristics have been associated with adherence behavior. However, recent developments, such as the COVID-19 pandemic, increased use of mobile health interventions, and use of medical biomarkers have affected the way adherence is measured and applied.

Recent Findings

The COVID-19 pandemic affected patients’ comfort with accessing outpatient care and created a wider use of telehealth services. Measurement of adherence through serum lab levels continues to be reviewed as a potential objective assessment of adherence. Psychosocial factors continue to be identified as major contributors to nonadherence.

Adherence to antirejection medication, lab work, appointments, and exercise and dietary instructions remains critical to the health of the transplant patient. It is critical that providers involved in the selection process and posttransplant treatment of these patients remain well informed of potential new factors affecting adherence.
A Comparison of Shift Length and Nursing and Quality Outcomes in Acute Inpatient Mental Health Units
Authors: Beckman Rebecca J. , Hutton Scott , Czekanski Elizabeth , Vance Kelly , Mohr David C.
Published: September 2022

OBJECTIVE

This study compared outcomes between units that used either 8-hour or 12-hour shifts in acute inpatient mental health units.

BACKGROUND

Most hospitals continue to use 12-hour shifts despite research suggesting safety concerns with longer shifts. There is a gap in the literature on effects of shift lengths on nursing and patient outcomes in acute mental health units.

METHODS

This study is a retrospective comparative analysis of cross-sectional data between 32 inpatient mental health units that used 8-hour versus 12-hour shifts. Independent samples t test was used to examine differences on several staffing, quality, and safety measures.

RESULTS

A moderate effect size was found between the groups in quality and safety measures involving patient disruptive behaviors, with the 8-hour group having more desirable outcomes.

CONCLUSIONS

Nurse leaders in acute mental health units should consider the impacts of shift length on quality and safety when determining staffing patterns. More research is needed to evaluate correlations or causality.
The Correlation Between Histologic, Immunophenotypic, and Molecular Characteristics of Pulmonary Sarcomatoid Carcinoma Reveals That Sarcomatoid Change Is Potentially Derived From Epithelial Carcinoma Cells Undergoing Epithelial-Mesenchymal Transition
Authors: Huang Yan , Guo Junhong , Li Shaoling , Liu Jiafu , Xu Jianping , Ye Wei , Zhang Liping , Dong Zhengwei , Wu Wei , Wu Chunyan , Hou Likun
Published: September 2022

Pulmonary sarcomatoid carcinoma (PSC) is characterized by biphasic tumors with epithelial and mesenchymal phenotype. Little is known about the correlation between histologic, immunophenotypic features and the genetic profile of PSC. We analyzed the expression of epithelial-mesenchymal transition–related markers, adenocarcinoma (ADC) and squamous cell carcinoma lineage-specific markers of 205 PSC cases. The alteration of 5 targeted genes was detected by amplification-refractory mutation system-polymerase chain reaction. The intensity of cytokeratin staining was stronger in epithelial carcinoma (EC) than that of the sarcomatoid component (SC) of pleomorphic carcinoma, while vimentin was positive in only 16.3% (17/104) of EC of pleomorphic carcinoma. There is no significant difference between thyroid transcription factor 1 (TTF-1) expression in the SC (46.5%, 33/71) of pleomorphic carcinoma with ADC components and pure PSC (44.2%, 42/95) without p40 expression (P=0.858). Four cases with ALK rearrangement were confirmed to co-express ALK fusion protein in both the SC and EC. The incidence of EGFR/ALK/KRAS mutation was similar between pleomorphic carcinoma with ADC components (40.6%, 26/64) and TTF-1+ pure PSC (38.2%, 13/34) (P=0.583). However, higher proportions of TTF-1+/p40− PSC patients (44.8%, 39/87) had EGFR/ALK/KRAS mutation than those with TTF-1−/p40− PSC (16.7%, 4/24) (P=0.031). The incidence of EGFR mutation was significantly higher in TTF-1-positive (18.4%, 16/87) than TTF-1-negative (2.7%, 2/74) PSC (P=0.002). No EGFR and ALK abnormality were observed in 24 pleomorphic carcinoma cases with squamous cell carcinoma components or pure PSC with p40 expression. Our study reveals a close correlation between SC and EC components of pleomorphic carcinoma in terms of immunophenotypic and genetic features, which suggests that pleomorphic carcinoma is potentially derived from the sarcomatoid change of EC cells undergoing epithelial-mesenchymal transition.
Variations in Demonstrated Emotional Intelligence: Trainee to Experienced Faculty Member*
Authors: Loscalzo Steven M. , Lockman Justin L. , Spector Nancy D. , Boyer Donald L.
Published: September 2022

OBJECTIVES:

To identify differences in emotional intelligence (EI)–related competencies between fellows and faculty in a cohort of pediatric critical care physicians.

DESIGN:

Single-center, cross-sectional observation study.

SETTING:

Seventy-two-bed multidisciplinary pediatric critical care unit at a quaternary children’s hospital (Children’s Hospital of Philadelphia, Philadelphia, PA).

SUBJECTS:

Forty-seven critical care physicians, including 19 fellows and 28 faculty members, were assessed. A multidisciplinary team of 83 physicians, nurses, and nurse practitioners contributed to the assessments.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A multirater EI assessment tool (Emotional and Social Competency Inventory 360) was used to measure EI competencies of participating physicians across 12 core competencies. Utilizing a priori scoring definitions, physician EI competencies were classified as strengths or areas for growth. Results were stratified based on provider experience, generating comparisons between fellow and faculty cohorts. Ninety-four percent (177/188) of distributed assessments were completed. Fellow strengths were identified as organization awareness, achievement orientation, and teamwork; areas for growth were influence and emotional self-awareness. Compared with fellows, faculty members demonstrated additional strengths in the domains of adaptability, emotional self-control, coach and mentor, positive outlook, inspirational leadership, and influence.

CONCLUSIONS:

This study provides the first characterization of EI competencies among trainees and faculty members using a validated multirater assessment tool. The descriptions of physician EI, based on years of experience, are an important piece of the foundation for future explorations into the advancement of physician EI and effective leadership.
Trends in Cause-Specific Mortality Among Veterans With HIV: A 35-Year (1982–2016) Analysis of the HIV Atlanta VA Cohort Study
Authors: Vyas Kartavya J. , Marconi Vincent C. , Moanna Abeer , Rimland David , Guest Jodie L.
Published: September 2022

Background:

Causes of death and their trends among veterans with HIV (VWH) are different than those in the general population with HIV, but this has not been fully described. The objective was to understand the trends in, and risk factors for, all-cause and cause-specific mortality across eras of combination antiretroviral therapy (cART) among VWH.

Setting:

The HIV Atlanta VA Cohort Study includes all VWH who ever sought care at the Atlanta VA Medical Center.

Methods:

Age-adjusted all-cause and cause-specific mortality rates were calculated annually and compared between pre-cART (1982–1996), early-cART (1997–2006), and late-cART (2007–2016) eras. Trends were assessed using Kaplan–Meier curves, cumulative incidence functions, and joinpoint regression models. Risk factors were identified by Cox proportional hazards models.

Results:

Of the 4674 VWH in the HIV Atlanta VA Cohort Study, 1752 died; of whom, 1399 (79.9%), 301 (17.2%), and 52 (3.0%) were diagnosed with HIV in the pre-cART, early-cART, and late-cART eras, respectively. Significant increases were observed in rates of all-cause, AIDS-related, and non–AIDS-related mortality in the pre-cART era, followed by declines in the early-cART and late-cART eras. All-cause, AIDS-related, and non–AIDS-related mortality rates plummeted by 65%, 81%, and 45%, respectively, from the pre-cART to late-cART eras. However, VWH continue to die at higher rates due to AIDS-related infections, non–AIDS-related malignancies, respiratory disease, cardiovascular disease, and renal failure than those in the general population with HIV.

Conclusions:

In older populations with HIV, it is important that providers not only monitor for and treat diseases associated with aging but also intervene and address lifestyle risk factors.
Reduced Iodinated Contrast Media Administration in Coronary CT Angiography on a Clinical Photon-Counting Detector CT System
Authors: Emrich Tilman , O'Doherty Jim , Schoepf U. Joseph , Suranyi Pal , Aquino Gilberto , Kloeckner Roman , Halfmann Moritz C. , Allmendinger Thomas , Schmidt Bernhard , Flohr Thomas , Varga-Szemes Akos
Published: September 2022

Purpose

The aim of this study was to evaluate strategies to reduce contrast media volumes for coronary computed tomography (CT) angiography on a clinical first-generation dual-source photon-counting detector (PCD)-CT system using a dynamic circulation phantom.

Materials and Methods

Coronary CT angiograph is an established method for the assessment of coronary artery disease that relies on the administration of iodinated contrast media. Reduction of contrast media volumes while maintaining diagnostic image quality is desirable. In this study, a dynamic phantom containing a 3-dimensional-printed model of the thoracic aorta and coronary arteries was evaluated using a clinical contrast injection protocol with stepwise reduced contrast agent concentrations (100%, 75%, 50%, 40%, 30%, and 20% contrast media content of the same 50 mL bolus, resulting in iodine delivery rates of 1.5, 1.1, 0.7, 0.6, 0.4 and 0.3 gl/s) on a first-generation, dual-source PCD-CT. Polychromatic images (T3D) and virtual monoenergetic images were reconstructed in the range of 40 to 70 keV in 5-keV steps. Attenuation and noise were measured in the coronary arteries and background material and the contrast-to-noise ratio (CNR) were calculated. Attenuation of 350 HU and a CNR of the reference protocol at 70 keV were regarded as sufficient for simulation of diagnostic purposes. Vessel sharpness and noise power spectra were analyzed for the aforementioned reconstructions.

Results

The standard clinical contrast protocol (bolus with 100% contrast) yielded diagnostic coronary artery attenuation for all tested reconstructions (>398 HU). A 50% reduction in contrast media concentration demonstrated sufficient attenuation of the coronary arteries at 40 to 55 keV (>366 HU). Virtual monoenergetic image reconstructions of 40 to 45 and 40 keV allowed satisfactory attenuation of the coronary arteries for contrast concentrations of 40% and 30% of the original protocol. A reduction of contrast agent concentration to 20% of the initial concentration provided insufficient attenuation in the target vessels for all reconstructions. The highest CNR was found for virtual monoenergetic reconstructions at 40 keV for all contrast media injection protocols, yielding a sufficient CNR at a 50% reduction of contrast agent concentration.

Conclusions

Using virtual monoenergetic image reconstructions at 40 keV on a dual-source PCD-CT system, contrast media concentration could be reduced by 50% to obtain diagnostic attenuation and objective image quality for coronary CT angiography in a dynamic vessel phantom. These initial feasibility study results have to be validated in clinical studies.
Application of 3-Dimensional White-Light Scanning to Observe the Lip and Nose Morphology of Chinese Children
Authors: Zhang Songchunyuan , Zhang Shuai , Fang Cheng , Lan Dongyi , Dong Chenbin
Published: September 2022

Objective:

To establish a database and study the growth and development of Chinese children’s nasolabial units by 3-dimensional (3D) white-light scanning technology.

Materials and Methods:

From January 2018 to January 2019, 528 patients were selected preoperatively in our hospital, without cranial or maxillofacial deformities. The patients were placed in supine positions in a state of sedation, and the authors used a 3D white-light scanner to scan the children’s faces to measure the 3D morphological structure of their nasolabial areas. The results were presented with Graphpad Prism 8.0.2 to explore correlations and analyze trends.

Results:

The selected Chinese children consisted of 356 males (67.4%) and 172 females (32.6%). All nasolabial subunits grew fastest at 0 to 2 years old and at a slower rate from 2 to 15 years old, whereas the relevant growth of different sex was similar among contemporaries.

Conclusions:

Three-dimensional white-light scanning can quickly and accurately gain 3D imaging of nasolabial soft tissue to build a normal morphology database. Furthermore, every nasolabial subunit grows fastest at the age of 0 to 2 years.
How trauma patients die in low resource settings: Identifying early targets for trauma quality improvement
Authors: Christie S. Ariane , Zheng Dennis , Dissak-Delon Fanny , Kinge Thompson , Njock Richard , Nkusu Daniel , Tsiagadigui Jean-Gustave , Mbianyor Mbiarikai , Dicker Rochelle , Chichom-Mefire Alain , Juillard Catherine
Published: September 2022

BACKGROUND

Injury deaths in sub-Saharan Africa are among the world's highest, but hospital data rarely have sufficient granularity to direct quality improvement. We analyzed clinical care patterns among trauma patients who died in a prospective, multicenter sub-Saharan cohort to pinpoint trauma quality improvement intervention targets.

METHODS

In-hospital trauma deaths in four Cameroonian hospitals between 2017 and 2019 were included. Trauma registry data on patient demographics, injury characteristics, and clinical care were analyzed to identify opportunities for systems improvements.

RESULTS

Among 9,423 trauma patients, there were 236 deaths. Overall, 83% of patients who died in the emergency department were living on arrival (LOA). Among 183 LOA patients, 30% presented with normal vital signs, but 11% had no vital signs taken, often because of lack of equipment (43%). Of LOA patients presenting with a Glasgow Coma Scale score of <9 (56%), few received neurosurgery consults (15%), C-collar placement (9%), or intubation (1%). The most common reason for lack of c-collar placement was failure to recognize that it was indicated (66%). Tracheal deviation, unequal breath sounds, or paradoxical chest movement were present in 63% of LOA patients, but only two patients had chest tubes placed. Hypotension or active bleeding was present in 80% of LOA patients; while crystalloid bolus was given to 96% of these patients, few received transfusion (8%), tourniquet placement for extremity injury (6%), or an operation (4%).

CONCLUSION

Primary survey interventions are underperformed in trauma nonsurvivors in Cameroon. Protocolizing early treatment for head injury, hemorrhagic shock, and chest wall trauma could reduce trauma mortality.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level III.
Use and Attitudes Concerning Total Imported Dietary Supplements and Its Factors in Chinese Urban Adults
Authors: Yang Chao , Wan Min , Lu Yifei , Xu Dengfeng , Liu Peipei , Sun Guiju , Yang Yuexin
Published: September 2022

This online cross-sectional survey investigated the use of dietary supplements (DSs) in Chinese urban adults. A 50-item survey on DSs was administered to 8012 participants from March to May 2019. The usage rate of total DSs was 71.3% and 57.7% on imported DSs (IDSs). Approximately 53.7% of participants bought IDSs, and the most frequently used was vitamins (83.2%). The largest source of imported IDSs was the United States (55.8%). Multivariate analysis showed that more developed areas, women, those with a higher educational background, those with higher incomes, and those categorized as workers and staff members and retirees were more likely to have taken DSs.
Promoting sleep and rest of infants using nonpharmacological interventions within the neonatal intensive care unit at Children's of Mississippi
Authors: Robinette Bethany , Palokas Michelle
Published: September 2022

Objective:

This project aimed to promote evidence-based practices regarding the promotion of sleep and rest using nonpharmacological interventions for infants in the neonatal intensive care unit (NICU) at Children's of Mississippi.

Introduction:

Sleep is a basic physiological need that plays a fundamental role in the growth and development of infants. Unfortunately, infants admitted to the NICU after birth may not receive adequate sleep and rest, especially when compared to infants discharged home after delivery.

Methods:

The project used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research in Practice audit tool for promoting change in healthcare practice. A baseline audit of NICU staff and patient caregivers was conducted and measured against five best practice recommendations, followed by implementation of targeted strategies and a follow-up audit.

Results:

The project team discovered two barriers to sleep promotion and rest in the NICU at Children's of Mississippi: lack of nurse knowledge of evidence-based practices for promotion of sleep and rest for infants in the NICU and a lack of location in the electronic health record to document sleep quality of infants. Strategies were implemented to address these barriers and compliance improved in four of the five audit criteria.

Conclusions:

Implementation of an educational PowerPoint that focused on sleep promotion of infants in the NICU was developed and distributed to all of the nurses and resulted in average increased compliance from 43% to 53% for all audit criteria.
Cilostazol as adjunctive therapy in treatment of children with autism spectrum disorders: a double-blind and placebo-controlled randomized trial
Authors: Ebrahimi Parnia , Seyedmirzaei Homa , Moradi Kamyar , Bagheri Sayna , Moeini Mahdi , Mohammadi Mohammad-Reza , Akhondzadeh Shahin
Published: September 2022

We aimed to evaluate cilostazol therapeutic effects on aberrant behaviors of autism spectrum disorder (ASD) children and its safety profile in a double-blind, randomized clinical trial. Sixty-six children with confirmed ASD were allocated to receive either daily 50-mg cilostazol (increased to 100 mg/day after 2 weeks) or matched placebo in addition to risperidone. The Aberrant Behavior Checklist-Community Edition (ABC-C) scale and a checklist of probable adverse effects were used to assess the behavioral outcomes and safety profile at weeks 0, 5, and 10 of the study. Sixty-one participants, with comparable baseline characteristics, completed the trial. Unlike other ABC-C subscales, repeated-measures analysis showed significant effect for time × treatment interaction in the hyperactivity subscale (P = 0.047; partial eta squared = 0.06). We used the median value for the baseline score hyperactivity subscale [median (interquartile range) = 31 (24–37)] to stratify participants to higher hyperactivity and lower hyperactivity subgroups and found that only participants with higher hyperactivity benefit from cilostazol adjunctive therapy (P = 0.028; partial eta squared = 0.14). Cilostazol could be considered as a safe agent with beneficial effects on hyperactivity in children with ASD and higher levels of hyperactivity.
Can bupropion treat COVID-19–induced brain fog? A case series
Authors: Reinfeld Samuel
Published: September 2022

COVID-19–induced neurocognitive complications that include brain fog have affected a large portion of individuals who survived COVID-19. These symptoms can include inattention, mental fatigue, forgetfulness, amotivation, and distractibility. This can cause significant anxiety and depression, which may worsen disease progression. To date, there are no known specific treatments that target COVID-19-related brain fog. Here, two patients are presented that develop symptoms of brain fog that persisted after they recovered from an acute COVID-19 infection. Both had memory impairment, mental exhaustion, and inattention with associated depressed mood. They were given bupropion extended release and though varied with dosing and time to resolution, they recovered dramatically. The dopamine and norepinephrine reuptake inhibitor is known to have effects on the brain that may treat symptoms of brain fog including blocking hippocampal cell loss, increased neural activity in the cingulate cortex, and decreasing proinflammatory cytokines. Bupropion may be a possible option for those suffering from this growing and debilitating post-COVID-19 complication.
The fundamental benefits of multiplexity in ecological networks
Authors: Meng Yu , Lai Ying-Cheng , Grebogi Celso
Published: September 2022

A tipping point presents perhaps the single most significant threat to an ecological system as it can lead to abrupt species extinction on a massive scale. Climate changes leading to the species decay parameter drifts can drive various ecological systems towards a tipping point. We investigate the tipping-point dynamics in multi-layer ecological networks supported by mutualism. We unveil a natural mechanism by which the occurrence of tipping points can be delayed by multiplexity that broadly describes the diversity of the species abundances, the complexity of the interspecific relationships, and the topology of linkages in ecological networks. For a double-layer system of pollinators and plants, coupling between the network layers occurs when there is dispersal of pollinator species. Multiplexity emerges as the dispersing species establish their presence in the destination layer and have a simultaneous presence in both. We demonstrate that the new mutualistic links induced by the dispersing species with the residence species have fundamental benefits to the well-being of the ecosystem in delaying the tipping point and facilitating species recovery. Articulating and implementing control mechanisms to induce multiplexity can thus help sustain certain types of ecosystems that are in danger of extinction as the result of environmental changes.
Lady Gwillim and the birds of Madras
Authors: Dickenson Victoria
Published: September 2022

In 1924 Casey Wood, founder of the Blacker Wood Library at McGill University in Montreal, acquired a large portfolio of paintings of Indian birds from an antiquarian dealer in London, England. In addition to 121 watercolours of birds, the portfolio contained a dozen botanical sketches and 31 watercolours of Indian fish. After further research, Wood concluded that the birds had been painted by Lady Elizabeth Gwillim (1763–1807), the wife of a Supreme Court justice in Madras (now Chennai), during the brief period from her arrival in 1801 until her death six years later. The bird paintings that so impressed Wood were created through the intersection of three different stories: the first, the work of a particularly focused Englishwoman who arrived in Madras prepared to paint its natural productions, especially its birds; the second, the story of the Indian bird catchers and the long history of fowling in India; and the third, the story of the birds themselves, their migrations, forced and otherwise, and their entrapments, which brought them into relationship with the bird catchers and the painter.
The Kuramoto–Lohe model and collective absorption of a photon
Authors: Scholes Gregory D.
Published: September 2022

Light absorption by molecular exciton states in disordered networks is studied. The main purpose of this paper is to look at how phases of the intermediate ground–excited state superposition interfere during the absorption process. How does this phase average enable, or suppress, absorption to a delocalized state? To address this question, a theory for phase oscillators is used to predict the purity of the collective excited state of the network. The results of the study suggest that collective absorption by molecular exciton states requires a sufficiently large electronic coupling between molecules in the network compared to the random distribution of transition energies at the sites, even when the molecular network is completely isolated from the environment degrees of freedom. The ‘dividing line’ between absorption to a mixture of, essentially, localized excited states and coherent excitation of a pure delocalized exciton state is suggested to be predicted by the threshold of phase synchronization.
Comparative genomics of Rothia species reveals diversity in novel biosynthetic gene clusters and ecological adaptation to different eukaryotic hosts and host niches
Authors: Oliveira Isabela M. Fernandes de , Ng Duncan Y. K. , van Baarlen Peter , Stegger Marc , Andersen Paal Skytt , Wells Jerry M.
Published: September 2022

Rothia

species are understudied members of the phylum Actinobacteria and prevalent colonizers of the human and animal upper respiratory tract and oral cavity. The oral cavity, including the palatine tonsils, is colonized by a complex microbial community, which compete for resources, actively suppress competitors and influence host physiology. We analysed genomic data from 43 new porcine

Rothia

isolates, together with 112 publicly available draft genome sequences of

Rothia

isolates from humans, animals and the environment. In all

Rothia

genomes, we identified biosynthetic gene clusters predicted to produce antibiotic non-ribosomal peptides, iron scavenging siderophores and other secondary metabolites that modulate microbe–microbe and potentially microbe–host interactions. In vitro overlay inhibition assays corroborated the hypothesis that specific strains produce natural antibiotics.

Rothia

genomes encode a large number of carbohydrate-active enzymes (CAZy), with varying CAZy activities among the species found in different hosts, host niches and environments. These findings reveal competition mechanisms and metabolic specializations linked to ecological adaptation of

Rothia

species in different hosts.
A guide for membrane potential measurements in Gram-negative bacteria using voltage-sensitive dyes
Authors: Buttress Jessica A. , Halte Manuel , te Winkel J. Derk , Erhardt Marc , Popp Philipp F. , Strahl Henrik
Published: September 2022

Transmembrane potential is one of the main bioenergetic parameters of bacterial cells, and is directly involved in energizing key cellular processes such as transport, ATP synthesis and motility. The most common approach to measure membrane potential levels is through use of voltage-sensitive fluorescent dyes. Such dyes either accumulate or are excluded from the cell in a voltage-dependent manner, which can be followed by means of fluorescence microscopy, flow cytometry, or fluorometry. Since the cell’s ability to maintain transmembrane potential relies upon low and selective membrane ion conductivity, voltage-sensitive dyes are also highly sensitive reporters for the activity of membrane-targeting antibacterials. However, the presence of an additional membrane layer in Gram-negative (diderm) bacteria complicates their use significantly. In this paper, we provide guidance on how membrane potential and its changes can be monitored reliably in Gram-negatives using the voltage-sensitive dye 3,3′-dipropylthiadicarbocyanine iodide [DiSC3(5)]. We also discuss the confounding effects caused by the presence of the outer membrane, or by measurements performed in buffers rather than growth medium. We hope that the discussed methods and protocols provide an easily accessible basis for the use of voltage-sensitive dyes in Gram-negative organisms, and raise awareness of potential experimental pitfalls associated with their use.
Generative Editing via Convolutional Obscuring (GECO): A Generative Adversarial Network for MRI de-artifacting
Authors: Bagley Bryce Allen , Petrov Sergei , Cheng Ge , Armanasu Matei , Fischbein Nancy , Jiang Bin , Iv Michael , Tranvinh Eric , Zeineh Michael , Gevaert Olivier
Published: September 2022

Magnetic resonance imaging (MRI) is the dominant diagnostic technique to non-invasively image the brain, and deep learning has proven a powerful tool for analyzing these images. However, machine learning models trained on such MRI data have empirically shown an ability to detect complex and invisible artifacts, such as which type of machine a scan was taken from to a high degree of accuracy. Such artifacts are potentially invisible to the human eye, but can be identified by machine learning systems, leading them to focus on irrelevant features rather than scientifically and/or medically useful ones. For example, machine learning systems can often “shortcut” past the actual features researchers would like to detect and utilize separate spurious correlations to make predictions. Several such undesired features have been reported to interfere with cross-institutional medical imaging deep learning research, and more are likely to be identified as time goes on. Here, we develop a method capable of removing these spurious correlations in an unsupervised manner, leveraging generative techniques to produce images which maintain image quality while learning how to remove technical artifacts. Generative Adversarial Networks are a class of deep learning architectures which have shown impressive efficacy in image generation and editing tasks, and our work builds upon this success. Here, we propose Generative Editing via Convolutional Obscuring (GECO), a Generative Adverserial Network for MRI deartifacting. GECO is based on a CycleGAN, a GAN architecture designed for image-to-image translation that is transforming an input image into a new image with one or more desirable properties. By formulating the CycleGAN loss as a two-player game with a regularization term and incentivizing the generator to erase spurious correlations the original image quality can be better preserved. Beginning with classifiers trained on original images to identify images based on artifacts of interest, GECO reduced the classifiers’ ability to detect these spurious correlations from 97% down to a difference which is nearly equal to a classifier making purely random guesses. We also observe over 98% structural similarity between the original and deartifacted images, indicating the preservation of the vast majority of non-spurious information contained in the original images. In addition to solving the known problem of avoiding artifacts from scanner type, this method opens the door to potentially removing many other types of spurious correlations from medical images and other data modalities across many fields.

Software availability

https://github.com/gevaertlab/GECO1.
Multimodal data fusion of adult and pediatric brain tumors with deep learning
Authors: Steyaert Sandra , Qiu Yeping Lina , Zheng Yuanning , Mukherjee Pritam , Vogel Hannes , Gevaert Olivier
Published: September 2022

The introduction of deep learning in both imaging and genomics has significantly advanced the analysis of biomedical data. For complex diseases such as cancer different data modalities may reveal different disease characteristics, and the integration of imaging with genomic data has the potential to unravel additional information then when using these data sources in isolation. Here, we propose a DL framework that by combining histopathology images with gene expression profiles can predict prognosis of brain tumors. Using two separate cohorts of 783 adult and 305 pediatric brain tumors, the developed multimodal data models achieved better prediction results compared to the single data models, but also leads to the identification of more relevant biological pathways. Importantly, when testing our adult models on a third independent brain tumor dataset, we show our multimodal framework is able to generalize and performs better on new data from different cohorts. Furthermore, leveraging the concept of transfer learning, we demonstrate how our multimodal models pre-trained on pediatric glioma can be used to predict prognosis for two more rare (less available samples) pediatric brain tumors, i.e. ependymoma and medulloblastoma. To summarize, our study illustrates that a multimodal data fusion approach can be successfully implemented and customized to model clinical outcome of adult and pediatric brain tumors.