bluuebunny/crossref_metadata_2025 huggingface dataset:
Cutaneous presentation of metastatic pancreatic cancer
Authors: Abdelaziz Mohammed , Thorley Daniel , Ahmed Waseem
Published: December 2022

Pancreatic cancer typically presents with a cholestatic picture of jaundice, bloating and bowel changes, secondary to the obstruction of the biliary system. In tail of pancreas metastases, this clinical presentation may be absent, meaning that the disease progression can be more insidious. Cutaneous spread in pancreatic malignancies is often iatrogenic due to direct spread from the tumour site during diagnostic sampling or surgery. Rarely, cutaneous spread can be noted at distant sites, which is associated with widespread disease dissemination and poor prognostic outcomes. Our case focusses on a patient who developed metastatic spread to the chin, as a first presentation, with no other significant associated symptoms identified.
Bertalign: Improved word embedding-based sentence alignment for Chinese–English parallel corpora of literary texts
Authors: Liu Lei , Zhu Min
Published: December 2022

Bertalign is designed to improve sentence alignment accuracy for Chinese–English parallel corpora of literary texts. Aligning bilingual literary texts is not trivial, since most of the translation is interpretative and not based on 1-to-1 mappings between source and target sentences. Existing alignment methods highlight 1-to-1 links while having difficulty coping with 1-to-many and many-to-many alignments that are common in literary texts. To overcome the weaknesses of current approaches, we propose a novel two-step algorithm for bilingual sentence alignment. The first step finds the optimal paths for 1-to-1 alignments based on the top-k most semantically similar target sentences for each source sentence using the bidirectional encoder representations from transformer-based cross-lingual word embeddings. The second step relies on search paths found in the previous step to recover all valid alignments with more than one sentence on each side of the bilingual text. A comprehensive experiment was conducted on a newly built Chinese–English literary parallel corpus and a large-scale publicly available bilingual corpus of the Bible to compare the performance of Bertalign with five baseline systems: Gale-Church, Hunalign, Bleualign, Bleurtalign, and Vecalign. The results show that Bertalign achieves the highest accuracy in terms of F1 score on the two evaluation datasets than previous methods.
Stylometric analysis of characters in Shakespeare’s plays
Authors: Savoy Jacques
Published: December 2022

Playwrights and screenwriters compose dialogues with characters from both genders. Assuming that men and women speak or write differently, can a great author take account of this difference? Previous studies have ascertained some stylistic markers that can discriminate between men and women either in writing or oral productions. The main aim of this study is to verify whether in Shakespeare’s plays female figures are talking in a distinct way compared with male ones. First, this study confirms the effectiveness of a set of predefined stylistic features using a tweet dataset extracted from CLEF-PAN corpora. Second, we demonstrate that the two genders present distinct styles when analyzing twenty-nine of Shakespeare’s plays, demonstrating that the author adopts a distinct style for each gender. Our experiments are grounded on two efficient classifiers (logistic regression and random forest) able to automatically identify short passages (500 or 1,000 word-tokens) corresponding to either a male or a female utterance with an accuracy of around 80%.
Leading a New Team: Critical Lessons Learned
Authors: Mitchell Natalie E , Calvano Tatjana P
Published: December 2022

Leading medical teams as a new attending physician can be a challenging task. This case highlights the important role of leaders in fostering a positive learning environment, developing interpersonal relationships, and establishing clear expectations with regular feedback to improve team function to deliver effective health care.
Long-term Small Population Size, Deleterious Variation, and Altitude Adaptation in the Ethiopian Wolf, a Severely Endangered Canid
Authors: Mooney Jazlyn A , Marsden Clare D , Yohannes Abigail , Wayne Robert K , Lohmueller Kirk E
Published: December 2022

Ethiopian wolves, a canid species endemic to the Ethiopian Highlands, have been steadily declining in numbers for decades. Currently, out of 35 extant species, it is now one of the world's most endangered canids. Most conservation efforts have focused on preventing disease, monitoring movements and behavior, and assessing the geographic ranges of sub-populations. Here, we add an essential layer by determining the Ethiopian wolf's demographic and evolutionary history using high-coverage (∼40×) whole-genome sequencing from 10 Ethiopian wolves from the Bale Mountains. We observe exceptionally low diversity and enrichment of weakly deleterious variants in the Ethiopian wolves in comparison with two North American gray wolf populations and four dog breeds. These patterns are consequences of long-term small population size, rather than recent inbreeding. We infer the demographic history of the Ethiopian wolf and find it to be concordant with historic records and previous genetic analyses, suggesting Ethiopian wolves experienced a series of both ancient and recent bottlenecks, resulting in a census population size of fewer than 500 individuals and an estimated effective population size of approximately 100 individuals. Additionally, long-term small population size may have limited the accumulation of strongly deleterious recessive mutations. Finally, as the Ethiopian wolves have inhabited high-altitude areas for thousands of years, we searched for evidence of high-altitude adaptation, finding evidence of positive selection at a transcription factor in a hypoxia-response pathway [CREB-binding protein (CREBBP)]. Our findings are pertinent to continuing conservation efforts and understanding how demography influences the persistence of deleterious variation in small populations.
PerformingNormal: Restless Reflections on Music’s Dis/Abling Potential
Authors: Bruce Cynthia
Published: December 2022

This analysis aims to bring disability issues and the realities of systemic ableism to the center of discourse and action related to music therapy and social justice. An account of my evolving understanding of how ableism shaped my relationship with music draws attention to the importance of understanding the subtle yet palpable ways that ableism can invade even the most positive aspects of disabled peoples’ lives and, therefore, contribute in disturbing ways to the perpetuation of normalcy as the human ideal. I begin by providing some essential context to center my activist disability identity and the struggle that underpins the current analysis. I then engage with the performance of normal and explore my discovery of disability as possibility—a discovery that ultimately made space for significant transformation. An explanation of critical disability studies and ableism as important transformative influences follows, and I conclude by articulating some possible implications for music therapy education and training, research, and practice.
Age-related changes in the ratio of Type I/III collagen and fibril diameter in mouse skin
Authors: Gao Jianping , Guo Zhenhu , Zhang Yang , Liu Yuying , Xing Fangyu , Wang Junjie , Luo Xi , Kong Yingjun , Zhang Guifeng
Published: December 2022

The content of type I collagen (COL-I) and type III collagen (COL-III) and the ratio between them not only affect the skin elasticity and mechanical strength, but also determine the fibril diameter. In this research, we investigated the age-related changes in COL-I/COL-III ratio with their formed fibril diameter. The experimental result was obtained from high performance liquid chromatography–mass spectrometer, hydroxyproline determination, picrosirius red staining and transmission electron microscopes (TEM), respectively. The result indicated that the COL-I/COL-III ratio in mouse skin increased with aging. From the 0th to 9th week, the COL-I/COLIII ratio increased from 1.3:1 to 4.5:1. From the 9th to the 18th week, it remained between 4.5:1 and 4.9:1. The total content of COL-I and COL-III firstly increased and then decreased with aging. The TEM result showed that the fibril diameter increased with aging. From the 0th to 9th week, the average fibril diameter increased from 40 to 112 nm; From the 9th to 18th weeks, it increased from 112 to 140 nm. After the 9th week. The fibril diameter showed obvious uneven distribution. Thus, the COL-I/COLIII ratio was proportional to the fibril diameter, but inversely proportional to the uniformity of fibril diameter.
Association between insomnia phenotypes and subclinical myocardial injury: the Multi-Ethnic Study of Atherosclerosis
Authors: Sigurdardottir Fjola D , Bertisch Suzanne M , Reid Michelle L , deFilippi Christopher R , Lima Joao A C , Redline Susan , Omland Torbjørn
Published: December 2022

Study Objectives

To assess whether the association between insomnia and subclinical myocardial injury, as measured by cardiac troponin T (cTnT), differs across insomnia phenotypes.

Methods

We measured cTnT in 2188 participants in the Multi-Ethnic Study of Atherosclerosis study who had completed sleep questionnaires and undergone unattended polysomnography (PSG) and 7-day actigraphy. Insomnia symptoms were defined as reporting at least one of the following ≥5 nights/week over the past 4 weeks: trouble falling asleep, waking up several times a night, having trouble getting back to sleep after waking up too early, or taking sleeping pills to help falling asleep. Obstructive sleep apnea (OSA) was defined as an apnea-hypopnea index (AHI >15 events/h). Participants were classified into insomnia phenotypes, including comorbid insomnia and OSA (COMISA) and insomnia associated with actigraphy-estimated short sleep (<6 h) or sleep fragmentation.

Results

The mean age was 68.8 (SD 9.2) years, 53.6% were male. In total, 47.8% met threshold levels for insomnia symptoms, and 43.1% had an AHI >15. In adjusted linear regression models COMISA (β 0.08 [standard error (SE) 0.03], p < .01) and insomnia with short sleep duration (β 0.07 [SE 0.03], p < .05) were each associated with higher cTnT compared to a reference group with no insomnia. Insomnia with fragmented sleep (β 0.03 [SE 0.02]) was not associated with higher cTnT (p > .05) in adjusted analyses. OSA was associated with higher cTnT (β 0.09 [SE 0.03], p < .01) in adjusted models.

Conclusions

COMISA and insomnia with short sleep duration, but not insomnia symptoms alone or fragmented sleep, were associated with increased circulating cTnT in older adults.
“Diversity Within”: The Problems with “Intersectional” White Feminism in Practice
Authors: Christoffersen Ashlee , Emejulu Akwugo
Published: December 2022

In intersectionality studies, debates about the additive versus constitutive nature of intersectionality are long-established. This article attempts to intervene in these conversations by examining how additive, “diversity within” intersectionality works in practice. Across feminist academia, advocacy, and policymaking, there is a widely held perception that among the nongovernmental organizations constituted around identity-based inequalities (feminist, racial justice, migrants, disability, and LGBTQI+ rights), it is the feminist sector that best advocates for and attempts to practice intersectionality. This is related to the appropriation of Black feminist theories of intersectionality which emerged from grassroots activism and Critical Race scholarship as “feminist” theory, wherein feminist is always-already constructed as white. Drawing on empirical research with equality organizations working with disabled women and trans women in England and Scotland, this article suggests that the opposite is true: the additive intersectionality practiced by the white-led feminist sector serves to uphold white supremacy and other structural inequalities.
Sugar concentrations and expression of SUTs suggest active phloem loading in tall trees of Fagus sylvatica and Quercus robur
Authors: Miehe Wiebke , Czempik Laura , Klebl Franz , Lohaus Gertrud
Published: December 2022

Phloem loading and sugar distribution are key steps for carbon partitioning in herbaceous and woody species. Although the phloem loading mechanisms in herbs are well studied, less is known for trees. It was shown for saplings of Fagus sylvatica L. and Quercus robur L. that the sucrose concentration in the phloem sap was higher than in the mesophyll cells, which suggests that phloem loading of sucrose involves active steps. However, the question remains whether this also applies for tall trees. To approach this question, tissue-specific sugar and starch contents of small and tall trees of F. sylvatica and Q. robur as well as the sugar concentration in the subcellular compartments of mesophyll cells were examined. Moreover, sucrose uptake transporters (SUTs) were analyzed by heterology expression in yeast and the tissue-specific expressions of SUTs were investigated.

Sugar content in leaves of the canopy (11 and 26 m height) was up to 25% higher compared with that of leaves of small trees of F. sylvatica and Q. robur (2 m height). The sucrose concentration in the cytosol of mesophyll cells from tall trees was between 120 and 240 mM and about 4- to 8-fold lower than the sucrose concentration in the phloem sap of saplings.

The analyzed SUT sequences of both tree species cluster into three types, similar to SUTs from other plant species. Heterologous expression in yeast confirmed that all analyzed SUTs are functional sucrose transporters. Moreover, all SUTs were expressed in leaves, bark and wood of the canopy and the expression levels in small and tall trees were similar.

The results show that the phloem loading in leaves of tall trees of F. sylvatica and Q. robur probably involves active steps, because there is an uphill concentration gradient for sucrose. SUTs may be involved in phloem loading.
A global spatial analysis of factors associated with case and mortality rates for coronavirus disease 2019 during the first year of the pandemic
Authors: Chen Hsiang-Yeh , Lee Johnny Kuang-Wu , Lee Charles Tzu-Chi , Liu Chin-Mei
Published: December 2022

Background

A increasing number of studies have revealed associations between country-level determinants and coronavirus disease 2019 (COVID-19) outcomes. This ecological study was conducted to analyze country-level parameters related to COVID-19 infections and deaths during the first year of the pandemic.

Methods

The examined predictors comprised demographics, economic factors, disease prevalence and healthcare system status, and the relevant data were obtained from public databases. The index dates were set to 15 July 2020 (Time 1) and 15 December 2020 (Time 2). The adjusted spatial autoregression models used a first-order queen contiguity spatial weight for the main analysis and a second-order queen contiguity spatial weight for a sensitivity analysis to examine the predictors associated with COVID-19 case and mortality rates.

Results

Obesity was significantly and positively associated with COVID-19 case and mortality rates in both the main and sensitivity analyses. The sensitivity analysis revealed that a country's gross domestic product, population density, life expectancy and proportion of the population older than 65 y are positively associated with COVID-19 case and mortality rates.

Conclusions

With the increasing global prevalence of obesity, the relationship between obesity and COVID-19 disease at the country level must be clarified and continually monitored.
Vertebrate origins are informed by larval lampreys (ammocoetes): a response to Miyashitaet al., 2021
Authors: Mallatt Jon
Published: December 2022

This paper addresses a recent claim by Miyashita and co-authors that the filter-feeding larval lamprey is a new evolutionary addition to the lamprey life-cycle and does not provide information about early vertebrates, in contrast to the traditional view that this ammocoete stage resembles the first vertebrates. The evidence behind this revolutionary claim comes from fossil lampreys from 360–306 Mya that include young stages – even yolk-sac hatchlings – with adult (predacious) feeding structures. However, the traditional view is not so easily dismissed. The phylogeny on which the non-ammocoete theory is based was not tested in a statistically meaningful way. Additionally, the target article did not consider the known evidence for the traditional view, namely that the complex filter-feeding structures are highly similar in ammocoetes and the invertebrate chordates, amphioxus and tunicates. In further support of the traditional view, I show that ammocoetes are helpful for reconstructing the first vertebrates and the jawless, fossil stem gnathostomes called ostracoderms – their pharynx, oral cavity, mouth opening, lips and filter-feeding mode (but, ironically, not their mandibular/jaw region). From these considerations, I offer a scenario for the evolution of vertebrate life-cycles that fits the traditional, ammocoete-informed theory and puts filter feeding at centre stage.
Dega transiliac osteotomy in the treatment of advanced forms of Perthes’ disease: a literature review
Authors: Walczak Michał , Grzegorzewski Andrzej , Jóźwiak Marek
Published: December 2022

The work aims to revise the current views on the effectiveness of Dega’s pelvic osteotomy in preventing femoral head deformity in the course of Perthes’ disease in patients with late symptoms >8 years of age and withsignificant changes in the radiographic image (Catterall III/IV or Herring B, B/C, C). We did a literature review. Four articles from six found in ‘PubMed’ which combine Dega acetabuloplasty and Perthes’ disease words were fully read and analyzed. Kamegaya (2018), with a 9.5-year follow-up period, described differences comparing the group treated with femoral varus osteotomy with the group that was treated with a combined Dega acetabuloplasty and femoral varus osteotomy. A series of papers by Napiontek from 2004, with an average 8-year follow-up, also describes satisfactory results after Dega’s osteotomy, with 27 hips in groups I/II according to Stulberg. Another paper in the series, which analyzed operatively and non-operatively treated patients, shows no differences in the period of time of Perthes disease treatment between the analyzed groups. The last paper in the series from 2001, describes 10 patients treated primarily due to hip dysplasia, who was diagnosed with Perthes disease. Five of them underwent Dega acetabuloplasty obtaining a Stulberg score of I/II in the long-term follow-up. We think it seems reasonable to return to the treatment planning of Perthes’ disease using Dega acetabuloplasty as a method to improve the hip congruence in late-diagnosed and advanced forms of the disease.
The Environmental Impact of Spine Surgery and the Path to Sustainability
Authors: McNamee Conor , Rakovac Ana , Cawley Derek T.
Published: December 2022

Study Design.

Narrative literature review.

Objective.

The aim of this study was to review published literature discussing sustainable health care and to identify aspects that pertain to spine surgery.

Summary of Background Data.

In recent years, research has investigated the contribution of surgical specialties to climate change. To our knowledge, no article has yet been published discussing the impact specific to spinal procedures and possible mitigation strategies.

Methods.

A literature search was performed for the present study on relevant terms across four electronic databases. References of included studies were also investigated.

Results.

Spine surgery has a growing environmental impact. Investigations of analogous specialties find that procurement is the single largest source of emissions. Carbon-conscious procurement strategies will be needed to mitigate this fully, but clinicians can best reduce their impact by adopting a minimalist approach when using surgical items. Reduced wastage of disposable goods and increased recycling are beneficial. Technology can aid remote access to clinicians, and also enable patient education.

Conclusions.

Spine-surgery–specific research is warranted to evaluate its carbon footprint. A broad range of measures is recommended from preventative medicine to preoperative, intraoperative, and postoperative spine care.

Level of Evidence.

5.
Changing roles of CD3+CD8low T cells in combating HIV-1 infection
Authors: Zhang Xin , Wang Xiuwen , Qin Ling , Lu Xiaofan , Liu Zhiying , Li Zhen , Yuan Lin , Wang Rui , Jin Junyan , Ma Zhenglai , Wu Hao , Zhang Yonghong , Zhang Tong , Su Bin
Published: December 2022

Background:

Cluster of differentiation 8 (CD8 T) cells play critical roles in eradicating human immunodeficiency virus (HIV)-1 infection, but little is known about the effects of T cells expressing CD8 at low levels (CD8low) or high levels (CD8high) on HIV-1 replication inhibition after HIV-1 invasion into individual.

Methods:

Nineteen patients who had been acutely infected with HIV-1 (AHI) and 20 patients with chronic infection (CHI) for ≥2 years were enrolled in this study to investigate the dynamics of the quantity, activation, and immune responses of CD3+CD8low T cells and their counterpart CD3+CD8high T cells at different stages of HIV-1 infection.

Results:

Compared with healthy donors, CD3+CD8low T cells expanded in HIV-1-infected individuals at different stages of infection. As HIV-1 infection progressed, CD3+CD8low T cells gradually decreased. Simultaneously, CD3+CD8high T cells was significantly reduced in the first month of AHI and then increased gradually as HIV-1 infection progressed. The classical activation of CD3+CD8low T cells was highest in the first month of AHI and then reduced as HIV-1 infection progressed and entered the chronic stage. Meanwhile, activated CD38−HLA-DR+CD8low T cells did not increase in the first month of AHI, and the number of these cells was inversely associated with viral load (r = −0.664, P = 0.004) but positively associated with the CD4 T-cell count (r = 0.586, P = 0.014). Increased programmed cell death protein 1 (PD-1) abundance on CD3+CD8low T cells was observed from the 1st month of AHI but did not continue to be enhanced, while a significant T cell immunoreceptor with immunoglobulin and immunoreceptor tyrosine-based inhibition motif (ITIM) domains (TIGIT) abundance increase was observed in the 12th month of infection. Furthermore, increased PD-1 and TIGIT abundance on CD3+CD8low T cells was associated with a low CD4 T-cell count (PD-1: r = −0.456, P = 0.043; TIGIT: r = −0.488, P = 0.029) in CHI. Nonetheless, the nonincrease in PD-1 expression on classically activated CD3+CD8low T cells was inversely associated with HIV-1 viremia in the first month of AHI (r = −0.578, P = 0.015). Notably, in the first month of AHI, few CD3+CD8low T cells, but comparable amounts of CD3+CD8high T cells, responded to Gag peptides. Then, weaker HIV-1-specific T-cell responses were induced in CD3+CD8low T cells than CD3+CD8high T cells at the 3rd and 12th months of AHI and in CHI.

Conclusions:

Our findings suggest that CD3+CD8low T cells play an anti-HIV role in the first month of infection due to their abundance but induce a weak HIV-1-specific immune response. Subsequently, CD3+CD8low T-cell number decreased gradually as infection persisted, and their anti-HIV functions were inferior to those of CD3+CD8high T cells.
Effect and safety of anaprazole in the treatment of duodenal ulcers: a randomized, rabeprazole-controlled, phase III non-inferiority study
Authors: Zhu Huiyun , Pan Xue , Zhang Li , Sun Hongxin , Fan Huizhen , Pan Zhongwei , Huang Caibin , Shi Zhenwang , Ding Jin , Wang Qi , Du Yiqi , Lyu Nonghua , Li Zhaoshen
Published: December 2022

Background:

The pharmacokinetic and clinical behaviors of many proton pump inhibitors (PPIs) in peptic ulcer treatment are altered by CYP2C19 genetic polymorphisms. This non-inferiority study evaluated the efficacy and safety of the novel PPI anaprazole compared with rabeprazole. We also explored the influence of Helicobacter pylori (H. pylori) infection status and CYP2C19 polymorphism on anaprazole.

Methods:

In this multicenter, randomized, double-blind, double-dummy, positive-drug parallel-controlled, phase III study, Chinese patients with duodenal ulcers were randomized 1:1 to receive rabeprazole 10 mg + anaprazole placebo or rabeprazole placebo + anaprazole 20 mg once daily for 4 weeks. The primary efficacy endpoint was the 4-week ulcer healing rate assessed by blinded independent review. Secondary endpoints were the proportion of patients with improved overall and individual duodenal ulcer symptoms at 4 weeks. Furthermore, exploratory subgroup analysis of the primary endpoint by H. pylori status and CYP2C19 polymorphism was conducted. Adverse events were monitored for safety. Non-inferiority analysis was conducted for the primary endpoint.

Results:

The study enrolled 448 patients (anaprazole, n = 225; rabeprazole, n = 223). The 4-week healing rates were 90.9% and 93.7% for anaprazole and rabeprazole, respectively (difference, −2.8% [95% confidence interval, −7.7%, 2.2%]), demonstrating non-inferiority of anaprazole to rabeprazole. Overall duodenal ulcer symptoms improved in 90.9% and 92.5% of patients, respectively. Improvement rates of individual symptoms were similar between the groups. Healing rates did not significantly differ by H. pylori status or CYP2C19 genotype for either treatment group. The incidence of treatment-emergent adverse events was similar for anaprazole (72/220, 32.7%) and rabeprazole (84/219, 38.4%).

Conclusions:

The efficacy of anaprazole is non-inferior to that of rabeprazole in Chinese patients with duodenal ulcers.

Registration:

ClinicalTrials.gov, NCT04215653.
Intravascular Lithotripsy in Peripheral Artery Disease
Authors: Vazquez Sosa Carlos E. , Malik Aaqib , Sreenivasan Jayakumar , Shah Avisha , Jayasree Rajendran Rakendu , Gupta Rahul , Ahmad Hasan , Mateo Romeo , Frishman William H. , Aronow Wilbert S.
Published: December 2022

Peripheral artery disease affects millions of people worldwide, and it is associated with significantly higher morbidity and mortality. In addition, it represents a significant challenge for the interventional operators to appropriately and successfully revascularize heavily calcified stenoses. There are several established atherectomy devices with the risk of procedural complications including dissection and perforation, among others. Intravascular lithotripsy (IVL) is a novel tool with relatively less procedural risk compared to the existing modalities. It is a device that emits high-energy ultrasound waves mounted on a balloon catheter that causes fractures on the calcium plaques allowing balloon expansion and luminal gain. Five trials have been published showing the safety and effectiveness of IVL, including one trial evaluating the device in common femoral artery and infrapopliteal arteries. The available data from the limited number of trials are very encouraging and demonstrates minimal risk. Additional studies on a larger scale are needed further to understand the its long-term effects and possible risks.
Infusion port site tumor seeding after Pars Plana Vitrectomy-assisted Biopsy of Choroidal Melanoma
Authors: Azarcon Corrina P. , Williams Parker J. , Grossniklaus Hans E. , Bergstrom Chris , Wells Jill R.
Published: December 2022

Purpose:

To report a rare case of infusion port site tumor seeding of choroidal melanoma after pars plana vitrectomy-assisted biopsy and successful treatment with second plaque brachytherapy.

Methods:

Observational case report with clinical data and diagnostic images.

Results:

A 55-year-old Caucasian woman diagnosed with choroidal melanoma of the left eye was found to have a second intraocular tumor thirty months after plaque brachytherapy and pars plana vitrectomy-assisted tumor biopsy. The second melanoma developed at the 5 o’clock vitrectomy infusion port site. The tumor regressed after plaque brachytherapy and the patient has not developed systemic metastasis five years after diagnosis of intraocular seeding.

Conclusion:

Intraocular seeding into the infusion port site, although rare, may be encountered after pars plana vitrectomy-assisted biopsy of choroidal melanoma.
Multisystem Inflammatory Syndrome in Children Presenting as Acute Appendicitis
Authors: Saritas Nakip Ozlem , Kesici Selman , Talay Mehmet Nur , Kangin Murat , Bayrakci Benan
Published: December 2022

Background

The majority of multisystemic inflammatory syndrome in children (MIS-C) patients presented with gastrointestinal symptoms. To draw attention to association of MIS-C and acute appendicitis, we reported a number of patients presented with localized symptoms as appendicitis but later diagnosed as MIS-C. The main goal of this study was to point out that localized presentation of MIS-C, and the secondary outcome was to compare 2 different treatment modalities of MIS-C.

Methods

The patients admitted to intensive care units of 2 tertiary hospitals, with diagnosis of MIS-C and accompanying clinically or radiologically suspected or confirmed appendicitis, were included. Data were retrospectively analyzed. The patients were examined in 2 groups as intravenous immunoglobulin (IVIG)-only and combined therapy. The combined therapy was defined as at least 2 immunomodulatory treatments of which included IVIG, steroid, Anakinra, and plasmapheresis.

Results

Between June 2020 and December 2020, 9 patients were enrolled in the study. The mean age was 8.7 ± 3.4 years. All patients had delayed diagnosis because of investigations focusing on abdominal pathologies such as appendicitis. Four patients had typical ultrasonographic findings of appendicitis and 2 were complicated with perforation. All patients had cardiovascular compromise accompanying at least 1 more organ dysfunction. In the IVIG only group, the median lymphocyte count was 480 cells/mm3 and the median levels of ferritin, C-reactive protein (CRP), procalcitonin, and interleukin 6 were 955 pg/mL, 17.4 mg/dL, 33.9 ng/mL, and 136.3 pg/mL, respectively. In the combined therapy group, the median lymphocyte count was 1200 cells/mm3 and the median levels of ferritin, CRP, procalcitonin, and interleukin 6 were 1650 pg/mL, 28 mg/dL, 47.8 ng/mL, and 56.7 pg/mL, respectively. The median pediatric risk of mortality 3 and pediatric logistic organ dysfunction scores of the combined therapy group were higher than IVIG-only group. The IVIG-only patients were more lymphopenic at presentation (P = 0.014), while ferritin, CRP, and procalcitonin levels of combined therapy group were higher than IVIG-only group (P = 0.376, P = 0.181, and P = 0.346, respectively). The mean length of stay in pediatric intensive care unit of combined therapy group was shorter than IVIG-only group.

Conclusions

Multisystemic inflammatory syndrome in children should be kept in mind in the differential diagnosis of patients with localized gastrointestinal symptoms, such as acute appendicitis. Early diagnosis and proper treatment of MIS-C may have a critical role in the patient's outcome.
Circulation of SARS-CoV-2 Among Asylum Seekers: A Real-Life Experience to Address Health Equity in Piacenza, Italy
Authors: Colpani Agnese , Donisi Alessandra , De Vito Andrea , Zauli Beatrice , Fanelli Chiara , Fiore Vito , Babudieri Sergio , Madeddu Giordano
Published: December 2022

Aim of the Study

We aimed to evaluate the virus spreading among a migrant population previously excluded by community surveillance programs.

Methods

We conducted a retrospective study, collecting data about people without SARS-CoV-2–related symptoms who attended the outpatient clinic for undocumented migrants from November 1, 2020, to April 30, 2021. Patients who performed a nasopharyngeal swab and serologic test to evaluate the presence of antibody anti–SARS-CoV-2 were enrolled.

Results

Overall, 240 people were included in our study. Of them, 15 (6.3%) were female, with a median age of 27.0 years (interquartile range [IQR], 24.3–32.1 years). Thirty-seven patients (15.4%) tested positive for SARS-CoV-2 at the nasopharyngeal swab during the study period. Of these, 16 had positive or low positive results for immunoglobulin G (IgG) and 3 tested positive for both IgG and IgM. Besides, 22 participants (9.2%) resulted positive to serological testing, but negative to polymerase chain reaction testing.

The median age of SARS-CoV-2 positive patients (n = 59) was significantly higher than negative (29.6 [IQR, 25.0–35.0] vs 26.8 [IQR, 24.2–31.5], P = 0.022). Among positive patients, the most frequent nationality was Bangladeshi, with 24 people (40.7%, P < 0.001). The highest percentage of positive was found among the same nationality (51.1% of Bangladeshi tested positive).

Conclusions

Our data underline the significantly higher prevalence of SARS-CoV-2 infection in the undocumented migrant population in respect of the general population of Piacenza province in the same period (15.4% vs 5.9%, P < 0.001). The extension of surveillance programs to the whole population, thus including undocumented people, is crucial to curb the spreading of the virus.
Does COVID-19 Vaccine Impact the Soul? A Pre-post Vaccination Comparison of Health Care Workers’ Infection Control Practices and Perspectives
Authors: Khalid Imran , Akhtar Muhammad Ali , Imran Manahil , Imran Maryam , Mujalli Musaab Ahmed , Qashqari Moayad Sami , Alshukairi Abeer N , Nisar Amina , Khalid Tabindeh Jabeen
Published: December 2022

Background

It is unclear how COVID-19 vaccines have impacted the behavioral and physical infection control practices of health care workers (HCWs), both in the hospital and community. We conducted our study to explore this issue.

Methods

A comprehensive survey of 4 sections and 40 questions was administered to 146 HCWs 6 months apart, before and after COVID-19 vaccination. Besides demographics, the 4 sections evaluated the “behavioral” and “physical” infection control practices of HCWs in the hospital, infection control precautions in the community and their emotional stress. Each question was scored on a 4-point scale from 0 to 3.

Results

One hundred four of the HCWs (71%) completed both surveys. Respondents were mostly female, middle-aged nurses. Only 21% were confident that vaccine would prevent them from hospitalization or death. Despite some statistical improvement in some of the perspectives and practices, the intensity scores remained moderate-to-high for majority of the questions after vaccination. The HCWs remained worried about contracting COVID-19 infection in hospital and community, continued zealous precautionary measures, maintained social distancing both inside and outside of the hospital, avoided touching surfaces, and minimized contact with COVID-19 patients (P ≥ 0.08). Their emotional stress also did not improve after vaccination (P > 0.24).

Conclusions

COVID-19 vaccines have only a modest impact on the physical and behavioral infection control practices and emotional stress of HCWs. Additional measures are needed to influence HCW “souls” so they can reclaim their life of normalcy.
Extrapulmonary Pneumocystis jirovecii Infection in an Immunocompromised Patient With Concomitant Cytomegalovirus Reactivation: A Case Report and Literature Review
Authors: Fabiani Silvia , Amadori Francesco , Tiseo Giusy , Del Bono Laura , Moneta Sara , Pisano Roberta , Borrelli Valerio , Guadagni Simone , Ciancia Eugenio Mario , Ferranti Simone , Falcone Marco
Published: December 2022

Pneumocystis jirovecii is commonly associated with a potentially fatal pneumonia in acquired immune deficiency syndrome patients, but its spread outside lungs is uncommon and poses a diagnostic challenge. Clinical awareness is therefore needed to start promptly adequate therapy.

In this review, we report the case of an acquired immune deficiency syndrome patient with rapidly progressive disseminated pneumocystosis and subsequently analyze 189 other cases of extrapulmonary pneumocystosis described in literature.

The most common extrapulmonary sites of Pneumocystosis jirovecii infection were spleen, lymph nodes, liver, kidneys, and eyes; clinical manifestations, which may occur either with or without lung involvement, ranged from asymptomatic incidental findings to a multifaceted disease with multisystem involvement.

Human immunodeficiency virus (HIV) infection was documented in the majority of cases (91.6%), and concurrent or subsequent immunodeficiency-related conditions other than Pneumocystosis jirovecii were reported in 63.4% of patients, with cytomegalovirus (CMV) infection as the most common.

In conclusion, disseminated pneumocystosis is a rare, little-known, but life-threatening opportunistic infection that must be taken into account, together with other immunodeficiency-related conditions such as Cytomegalovirus infection, to draw up an adequate diagnostic algorithm, establish a timely diagnosis, and ensure proper treatment.
Hospitalizations for or Complicated by Syphilis at an Urban, Single-Institution Center
Authors: Hunt Travis J. , DePaola Rosalie V. , Ferranti Mary E. , Ahmed Maliha , Weber Devin M.
Published: December 2022

Background

In recent years, the number of cases of syphilis has been increasing at both local and global levels. In this study, we sought to profile how this increase in cases has translated to the inpatient setting by examining inpatient admissions due to or complicated by syphilis at any stage.

Methods

At a single-center, multisite health institution, charts for patients older than 18 years admitted between April 2017 and October 2020 with a diagnosis of syphilis were reviewed. Cases were characterized into stages of primary, secondary, latent, tertiary, and neuro/ocular syphilis, with all neuro/ocular cases categorized together despite the potential for neuro/ocular syphilis at any stage. Medical history, laboratory data, hospital course, and treatment outcomes were recorded.

Results

Eighty-one charts met inclusion, with a mean age of 49 years. Seventy-two percent were cisgender men, 42% were documented as men who have sex with men, and 49% were of Black race. Thirty-three percent had been previously diagnosed with syphilis, and 70% of that group had previously received treatment. Forty-one percent were HIV+. Fifty-one percent were cases of neurosyphilis, and 42% were latent. The mean LOS was 10 days, with 11% readmitted within 30 days.

Conclusions

These results formulate a profile for the outlook and course of hospitalizations for or complicated by syphilis in an urban setting. In light of these findings, and given the rising incidence of syphilis in the world, opportunities for further investigation into prevention, impact, and outcome quality are more necessary than ever.
Assessing the Efficacy of Telemedicine in High-Risk Populations by Evaluating Emergency Department Visits and Hospitalizations
Authors: Pappan Nikos , Austin Scarlett , Bosah Arinze , Wedgeworth Patrick , Venkat Divya
Published: December 2022

Introduction

Advances in telemedicine have allowed physicians to provide quality care to high-risk patients with multiple comorbidities who would otherwise be unable to attend an in-person visit. Barriers to the routine use of telemedicine include access to the appropriate devices and understanding how to use applications or software. We hypothesize that patients who were contacted and seen via telemedicine did not have more emergency department visits or hospitalizations compared with patients who had office visits.

Methods

We conducted an observational quality improvement study with retrospective administrative data collection and analysis. This study took place in an inner-city internal medicine residency primary care clinic. The patient population was defined as those patients 65 years and older with predetermined chronic medical conditions or patients younger than 65 years with chronic health conditions who had not yet had an office, telephone, or video visit within 6 months of March 23, 2020.

Results

A total of 1340 high-risk individuals were considered for analysis. There were a total of 441 emergency department visits and 254 inpatient hospital admissions within this group. We did not detect a statistically significant difference between emergency department visits or inpatient hospital admissions between telephone, video, or office visits.

Conclusions

Providing patients with an alternative to an in-office visit may prevent exposures to high-risk patients during the pandemic and provide alternative healthcare access to patients who may struggle with attending their primary care in-office visits.
Genetic Sequencing of Breakthrough Severe Acute Respiratory Syndrome Coronavirus 2 Infections in Fully Vaccinated Healthcare Workers
Authors: Haddad Sara , Zurlo John , Wang Zi-Xuan , Richards Bonnie , Badjatia Nitika , Coppock Dagan
Published: December 2022

Introduction

Since the identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), several efforts have been made to prevent infection, culminating in the development of highly effective vaccines. However, as genetic variants of the virus have emerged, concerns have arisen regarding potential limitations of available vaccines.

Methods

In this article, we evaluated SARS-CoV-2 breakthrough infections among 520 healthcare workers in a 950-bed hospital from March 1, 2021, to October 31, 2021, and stratified them according to the type of vaccine received. We tested for associations between Alpha and Delta strains of SARS-CoV-2 and clinical characteristics.

Results

During the study period, only 0.85% of the patients with breakthrough infection vaccinated with messenger RNA (mRNA)-1273 required hospitalization, whereas none of patients vaccinated with BNT162b2 required admission. No association was noted between the variant isolated and the type of vaccination (P = 0.474). The cycle threshold was significantly lower for Delta strain infections compared with Alpha strain infections (P = 0.0144 for gene N1 and P = 0.0271 for gene N2), reflecting a significantly higher viral burden at the time of diagnosis of Delta strain infection. We observed that, at the time of diagnosis, almost all vaccinated patients had developed antispike antibodies, whereas slightly more than half had anti-N antibodies.

Discussion

We noted that vaccination remains an important preventive measure to protect patients from severe SARS-CoV-2 infection. The mRNA-1273 and BNT162b2 mRNA vaccines seem equally effective in minimizing the severity of breakthrough infections. Serologic patterns suggest that antispike antibodies may be more critical for protection than antinucleocapsid antibodies.
Adenovirus Enterocolitis in Hematopoietic Stem Cell Transplant Patients
Authors: LeMay Daniel , Handley Guy , Baluch Aliyah , Greene John N.
Published: December 2022

Adenovirus is a major pathogen implicated in infections among the immunocompromised, particularly patients who have undergone hematopoietic stem cell transplantation (HSCT). These infections may be life-threatening in patients with altered immune status, and recognition of the presence of adenovirus is crucial for patient management. Adenoviruses can infect many organ systems common to other pathogens and may even present similarly to noninfectious causes of disease in immunosuppressed groups, such as graft-versus-host disease. Understanding the prevalence, risk factors, presentations, diagnostic methods, and treatment options for adenovirus should guide clinicians toward recognition and, when necessary, treatment. In this article, we will review the literature on adenovirus infections with an emphasis on gastrointestinal infections in the setting of HSCT, as well as present 2 cases seen at our cancer center.
Intussception in Patients With Leukemia
Authors: Senapati Sidhartha Gautam , Greene John N.
Published: December 2022

Intussusception is a very rare complication of typhlitis in the setting of neutropenia. We present a case of intussception with typhlitis, associated with extended-spectrum β-lactamase Escherichia coli bacteremia in the setting of neutropenia in a patient with acute leukemia. The causative organisms, infectious pathogenesis, complications of neutropenic enterocolitis, and different diagnostic modalities for investigating one of its rare complications, intussusception, is emphasized in the case study.
Nurse Students' Knowledge and Skills in Respiratory Care During COVD-19 Pandemic
Authors: Benedetti Tiziana , Gasperini Beatrice , Sarti Donatella , Saudelli Sara , Silvestrini Antonella , Nicoletti Stefania , Riminucci Franca , Cesaretti Matteo , Prospero Emilia
Published: December 2022

Background

SARS-CoV-2 pandemic forced final-year nurse students to start working to reinforce the healthcare system in caring of COVID-19 patients.

Methods

This study aimed to assess the self-perception of third-year nurse students about the knowledge and skills acquired during their study course that were most useful for them when working with COVID-19 patients and which were the topics that they would improve, before and after they started to work. An online questionnaire was administered to third-year nurse students of nursing degree course, Polytechnic University of Marche, in March 2020. The questionnaire was sent again after they started to work, in May 2020. Pareto charts were used to prioritize the main useful knowledge and skills acquired and needed topics that they would improve when they were students and workers.

Results

Response rate was 100% in March and 70.8% in May. Nurses showed more interest in improving their basic knowledge on personal protective equipment management and disposal when they were students, whereas they were more interested in COVID-19 patient's management, in particular, in respiratory care (ventilation techniques, emergencies management, rhinopharyngeal swab execution, and pneumology) after they started to work.

Conclusions

The self-perception of the most useful knowledge and skills and the educational needs changed significantly after starting to work for nurse students. The nurse curriculum should take in account the weaknesses in education as perceived from students and workers.
Clinician Perceptions of Receiving Different Forms of Feedback on their Opioid Prescribing
Authors: Klaiman Tamar , Nelson Maria N. , Yan Xiaowei S. , Navathe Amol S. , Patel Mitesh S. , Refai Farah , Delgado M. Kit , Pagnotti David R. , Liao Joshua M.
Published: December 2022

Opioid misuse represents a major public health issue in the United States. One driver is overprescription for acute pain, with the size of initial prescription associated with subsequent long-term use. However, little work has been done to elicit clinician feedback about interventions to reduce opioid prescribing. To address this knowledge gap, qualitative analyses were conducted with clinicians who participated in a randomized controlled trial in which clinicians received monthly emailed feedback notifications about their opioid prescribing behaviors. Semistructured telephone interviews were conducted (N = 12) with urgent care (N = 7) and emergency department (N = 5) clinicians who participated in the trial between November 2020 and April 2021. Clinicians appreciated feedback about their prescribing behavior and found comparative data with peer clinicians to be most useful. Sharing opioid prescribing feedback data with clinicians can be an acceptable way to address opioid prescribing among emergency and urgent care clinicians.