bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative Genomics of Fusarium circinatum Isolates Used to Screen Southern Pines for Pitch Canker Resistance
Authors: Fulton James C. , Yu Pei-Ling , Smith Katherine E. , Huguet-Tapia Jose C. , Hudson Owen , Meeks April , Quesada Tania , McKeever Kathleen , Brawner Jeremy T.
Published: March 2022

Pitch canker, caused by the fungal pathogen Fusarium circinatum, is a global disease affecting many Pinus spp. Often fatal, this disease causes significant mortality in both commercially grown and natural pine forests and is an issue of current and growing concern. F. circinatum isolates collected from three locations in the U.S. state of Florida were shown to be virulent on both slash and loblolly pine, with two of the isolates causing equivalent and significantly larger lesions than those caused by the third isolate during pathogenicity trials. In addition, significant genetic variation in lesion length in the pedigreed slash pine population was evident and rankings of parents for lesion length were similar across isolates. Experimental data demonstrate that both host and pathogen genetics contribute to disease severity. High-quality genomic assemblies of all three isolates were created and compared for structural differences and gene content. No major structural differences were observed among the isolates; however, missing or altered genes do contribute to genomic variation in the pathogen population. This work evaluates in planta virulence among three isolates of F. circinatum, provides genomic resources to facilitate study of this organism, and details comparative genomic methods that may be used to explore the pathogen’s contribution to disease development.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Distinct Function of Mediator Subunits in Fungal Development, Stress Response, and Secondary Metabolism in Maize Pathogen Fusarium verticillioides
Authors: Zhou Zehua , Yan Huijuan , Kim Man S. , Shim Won Bo
Published: March 2022

Mediator is a nucleus-localized, multisubunit protein complex highly conserved across eukaryotes. It interacts with RNA polymerase II transcription machinery as well as various transcription factors to regulate gene expression. However, systematic characterization of the Mediator complex has not been performed in filamentous fungi. In our study, the goal was to investigate key biological functions of Mediator subunits in a mycotoxigenic plant pathogen Fusarium verticillioides. Although there is some level of divergence in the constituent subunits, the overall structure was conserved between Saccharomyces cerevisiae and F. verticillioides. We generated 11 Mediator subunit deletion mutants and characterized vegetative growth, conidia formation, environmental stress response, carbon and fatty acid use, virulence, and fumonisin B1 (FB1) biosynthesis. Each Mediator subunit deletion mutant showed deficiencies in at least three of the phenotypes tested, suggesting that each subunit has different principal functions in F. verticillioides development, metabolism, and virulence. The deletion of FvMed1 led to increased FB1 production, and we confirmed that FvMed1 is transported from the nucleus to the cytoplasm under fumonisin-producing conditions. Taken together, our study characterized various important functional roles for Mediator subunits in F. verticillioides and suggests that select subunits can perform unique cytoplasmic functions independent of the core Mediator in fungal nucleus.
Knee injuries associated with extraarticular tibial fractures and their impact on the clinical outcome of the patients: a prospective arthroscopic study
Authors: Sadeghifar Amirreza , Zandrahimi Farshad , Akbari Javar Moien , Ahmadzadeh Heshmati Afshin , Saied Alireza
Published: March 2022

Background:

Associated injuries in tibial shaft fractures are not investigated often, and their impact on patient outcome is not clear. In this study, associated knee injuries in tibial shaft fractures were arthroscopically investigated, and their impact on the outcomes of patients were evaluated.

Methods:

In a prospective study, 57 patients with closed tibial shaft fractures and without concomitant fibular fractures were included. Motor-vehicle accident was the most frequent mechanism of the injury. The fractures were treated with reamed and locked titanium intramedullary tibial nailing. The functional outcome was evaluated using the International Knee Documentation Committee score and compared between the patients with and without an ipsilateral associated injury.

Results:

The mean age of the patients was 33.2±13.2 years. The mean follow-up duration was 10.2±3.1 mo. In 35 patients (61.4%), at least one associated knee injury was detected. Chondral damage was the most frequent arthroscopic finding (n=23, 40.4%). The anterior cruciate ligament (ACL) injury was the second most frequent injury (n=7, 12.3%). No intervention was performed for chondral lesions and ACL tears. Meniscal injuries were detected in three (5.3%) patients only. The mean International Knee Documentation Committee score was 95.9±2.2 in patients with and 96.2±2.1 in patients without an arthroscopic finding (P=0.38). The severity of comminution was not correlated with the incidence of arthroscopic findings (r=0.089, P=0.45).

Conclusions:

Ipsilateral injuries are frequent in tibial shaft fractures. However, they do not seem to affect the functional outcome of patients, at least in short-term follow-up.

Level of Evidence:

Level III.
The Effect of Game-Based Clinical Nursing Skills Mobile Application on Nursing Students
Authors: Suh Donghee , Kim Hyekyung , Suh Eunyoung E. , Kim Hyunsun
Published: March 2022

Nursing education using mobile devices is emerging as a new educational method showing higher learning achievement than traditional nursing education. This study aimed to develop a game-based mobile application and evaluate nursing students' learning achievement and experiences using a mixed-methods design. The application was developed into eight games on different nursing skills. Thirty nursing students were instructed to use the application for a week in the one-group pretest-posttest study design. Their pretest and posttest knowledge, postlearning efficiency, satisfaction, and convenience were evaluated. The focus group interviews were conducted by dividing 15 students into three groups, and their experience of the application was analyzed using a qualitative thematic analysis. The nursing students' knowledge significantly improved after using the application (t = 4.71, P < .001). The efficiency was the number of days (3.3 ± 2.0), the number of use per login (5.3 ± 4.0), and the number of successes per login (2.7 ± 2.9). Satisfaction and convenience scores were 4.9 ± 1.3 and 4.7 ± 1.2 out of 7. In the thematic analysis, themes through which the students were motivated, made learning plans, and received feedback by efficient game-based interactive educational content were drawn. Game-based mobile nursing education could be an adjunct to traditional clinical education strategies and induce a positive learning effect.
E-MunDiabetes
Authors: Negreiros Francisca Diana da Silva , Flor Amanda Caboclo , Araújo Açucena Leal de , Cestari Virna Ribeiro Feitosa , Florêncio Raquel Sampaio , Moreira Tatiana Rebouças , Araújo Samila Torquato , Silva Lucilane Maria Sales da , Moreira Thereza Maria Magalhães
Published: March 2022

The COVID-19 pandemic caused tremendous disruption of health systems worldwide. Patients with diabetes are at a high risk of COVID-19 exposure because face-to-face consultations have been standard for diabetes management. This study describes the development and validation of a mobile application for nursing students on diabetes education during the COVID-19 pandemic. The application was developed by a certified diabetes educator nurse and by a freelance programmer and, in the next step, validated in terms of content and appearance by a group of expert nurses on diabetes (n = 29), nursing students (n = 40), and information technology experts (n = 11). Validity indexes of 0.99 for content and 0.92 for appearance were obtained, and usability values of 78.9 (±15.3) and 78.2 (±10.8) were obtained from nursing and information technology experts, respectively. The self-assessment and satisfaction items evaluated by nursing students had a total agreement of 96.3% and an intraclass correlation coefficient of 0.91. Both the content and the appearance of the application were considered adequate, and the usability scores indicate that the application is useful and easy to use.
A Pilot Study to Investigate the Role of Virtual Reality in the Preservice Training of Nursing Staff in Isolation Wards
Authors: Zhang Wenyan , Luo Mengdan , Liu Yu , Cai Sisi , Yang Qing , Huang Yi , Yu Xiaoyan
Published: March 2022

Healthcare providers without working experience in isolation wards experience enormous challenges. Traditional ward orientation is constrained by space, time, and even infection risk in particular periods (eg, the coronavirus disease 2019 pandemic). Virtual reality has been used widely, but rarely in wards. This study aimed to explore the experience of utilizing virtual reality for isolation ward training among nurses. In this study, nurses completed virtual reality training via an online platform and were then trained in isolation wards, after which their perceptions were explored by questionnaire and interviews. A total of 1868 participants completed the training. Most participants thought the preservice training was important and believed the virtual reality experience was consistent with the in-person training. Virtual reality was found not only to be convenient and valuable for training but also to have the benefits of occupational protection. However, whereas 50.48% of participants wanted to learn the ward via virtual reality, 87.21% of participants wanted to learn via in-person training before working in the wards. As a substitute for in-person training, virtual reality is a feasible and practical instrument to provide preservice training in particular periods. However, there is room for improvement due to general discomfort and technological problems.
Effect of Using a Technology-Based (Mobile Health) Nursing Protocol on Positive COVID-19 Patients' Dyspnea and Level of Activity
Authors: Abdrbo Amany Ahmed , Weheida Soheir , Shakweer Taghreed Talat , Abd-Elaziz Marwa
Published: March 2022

Nursing faced a challenge in caring for COVID-19 patients in terms of keeping their chests clear from secretions, which required much effort from already-exhausted patients, along with the tasks of minimizing dyspnea and cough, strengthening immunity status, and improving their activity levels. The present study aimed to evaluate improvement of dyspnea and activity levels after 1 week of applying a mobile health nursing protocol for positive COVID-19 patients. The study was conducted in quarantine hospitals in Cairo on 90 COVID-19–positive patients who agreed to participate in the study, were fully conscious, were themselves able to use mobile phone applications (or their accompanying relatives were), and were not in need of artificial ventilation. A self-administered online questionnaire was utilized via Google forms to collect data. Patients who agreed to participate in the study received a video on their WhatsApp application containing audio and visual explanations of how they would apply the nursing intervention protocol. The study's findings showed that the best level of dyspnea was only 10.59% of the sample prior to applying the nursing protocol and increased to 20.00% of the sample after applying the nursing protocol. Also, the highest level of activity was only 50.59% pre-protocol and increased post-protocol to become 70.59%.
Patterns of Use of Stereotactic Body Radiation Therapy Compared With Surgery for Definitive Treatment of Primary Early-stage Non–small Cell Lung Cancer
Authors: Jang Julie K. , Atay Scott M. , Ding Li , David Elizabeth A. , Wightman Sean C. , Kim Anthony W. , Ye Jason C.
Published: March 2022

Objective:

As stereotactic body radiation therapy (SBRT) becomes widely available for early-stage non–small cell lung cancer (NSCLC), there may be concerns in the surgical community that SBRT is being offered for patients with operable tumors, even though surgery is standard of care. We evaluated the trends in SBRT and surgery over time for patients with NSCLC.

Materials and Methods:

The National Cancer Database was queried for patients with node-negative NSCLC ≤5 cm from 2004 to 2016. The relationships between definitive local treatment modalities and year were analyzed using a multinomial regression model while controlling for other covariates.

Results:

Among the 202,367 patients who met the inclusion criteria, there was a steady decrease in mean tumor size in all treatment modalities, from 2.44 cm (SD=1.08) to 2.25 cm (SD=1.00) over the study period. In the multinomial model, the probability of receiving lobectomy demonstrated a slight decline from 58% (2004) to 53% (2016). The use of SBRT increased from 1% to 20%, while patients receiving no therapy declined from 27% to 16%. The likelihood of SBRT increased with year of diagnosis (P<0.0001) and decreasing tumor size (P<0.0001), compared with lobectomy. Age, race, income, facility, and Charlson-Deyo score were also associated with treatment modality.

Conclusions:

The mean tumor size of early-stage NSCLC decreased over the study period for all treatment modalities. SBRT use has increased, mostly among older patients with smaller tumors and Charlson-Deyo scores ≥3. The increase in SBRT contributed to the significant decline in patients who had no therapy.
Neurodevelopmetal effects of maternal blood pressure management with noradrenaline during general anaesthesia for nonobstetric surgery in the pregnant rabbit model
Authors: Bleeser Tom , Van Der Veeken Lennart , Basurto David , Valenzuela Ignacio , Brenders Arjen , Van Hoof Lucas , Emam Doaa , Vergote Simen , Van de Velde Marc , Devroe Sarah , Deprest Jan , Rex Steffen
Published: March 2022

BACKGROUND

In pregnant women, anaesthesia-induced hypotension is commonly treated using phenylephrine or noradrenaline, the rationale being to maintain uterine perfusion pressure and thereby uterine blood flow. Evidence for this strategy during general anaesthesia for nonobstetric surgery is absent.

OBJECTIVE

To analyse the effects of treating anaesthesia-induced hypotension with noradrenaline on brain development of rabbit foetuses of mothers subjected to general anaesthesia for nonobstetric surgery. We hypothesised that treatment of maternal hypotension would improve foetal outcomes.

DESIGN

Randomised controlled laboratory study using 21 pregnant rabbits (does) at 28 days of gestation.

INTERVENTION

Two hours of sevoflurane anaesthesia for a laparotomy without treatment of anaesthesia-induced hypotension (hypotension group) or with maintaining maternal mean arterial pressure above 80% of the awake value using noradrenaline (noradrenaline group). In the control group, does remained untouched. At term, all pups were delivered by caesarean section. One day later, the neurobehaviour of the pups was assessed and brains were harvested.

MAIN OUTCOMES

Neuron density in the frontal cortex for the comparison of noradrenaline groups versus hypotension groups was the primary outcome; the neurobehavioural scores and other histological outcomes were secondary outcomes.

RESULTS

In the noradrenaline groups and hypotension groups, neuron density in the frontal cortex was similar (1181 ± 162 versus 1189 ± 200 neurons mm−2, P 
= 0.870). However, significantly less foetal survival, lower sensory scores in neurobehavioural assessment and less proliferation were observed in the noradrenaline group when compared with the hypotension group. Neuron densities in other regions, total cell densities, biometrics and synaptogenesis were not affected. There were no differences between the control group and hypotension group.

CONCLUSION

During general anaesthesia for nonobstetric surgery in rabbits, treatment of anaesthesia-induced hypotension using noradrenaline did not affect neuron densities but was associated with impaired foetal outcomes according to several secondary outcome parameters. Further studies are needed to investigate any clinical relevance and to determine the target blood pressure in pregnant women during general anaesthesia.
Suicide Prevention in Your Pocket: A Systematic Review of Ecological Momentary Interventions for the Management of Suicidal Thoughts and Behaviors
Authors: Jiménez-Muñoz Laura , Peñuelas-Calvo Inmaculada , Díaz-Oliván Isaac , Gutiérrez-Rojas Luis , Baca-García Enrique , Porras-Segovia Alejandro
Published: March 2022

Background

This study reviews the evidence on ecological momentary interventions (EMIs) for managing and preventing suicidal thoughts and behaviors.

Methods

This review follows the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Its protocol was registered in the PROSPERO database. We conducted a systematic literature search of five databases: PubMed, EMBASE, Web of Science, PsycInfo, and Cochrane library. The most recent search date was 10 September 2021.

Results

After screening and full-text review, 27 studies were included, totaling 19 different interventions. Many of the available interventions have not yet been clinically tested. Those that have undergone effectiveness evaluation (10 interventions) showed good rates of effectiveness and feasibility, with some exceptions. The most widely used intervention model is the safety plan, which allows the user to implement coping and distracting strategies in case of suicidal ideation.

Conclusions

Ecological momentary interventions provide certain advantages, such as their wide availability, versatility, and potential for customization. These interventions can be useful complements to traditional care, especially in situations in which face-to-face care is not possible. Evidence on the effectiveness of such interventions is still scarce. Furthermore, barriers limiting implementation in clinical practice remain. The constant advance of technology means that these interventions have great potential for improvement in the coming years.
Novel technical and privacy-preserving technology for artificial intelligence in ophthalmology
Authors: Lim Jane S. , Hong Merrelynn , Lam Walter S.T. , Zhang Zheting , Teo Zhen Ling , Liu Yong , Ng Wei Yan , Foo Li Lian , Ting Daniel S.W.
Published: March 2022

Purpose of review

The application of artificial intelligence (AI) in medicine and ophthalmology has experienced exponential breakthroughs in recent years in diagnosis, prognosis, and aiding clinical decision-making. The use of digital data has also heralded the need for privacy-preserving technology to protect patient confidentiality and to guard against threats such as adversarial attacks. Hence, this review aims to outline novel AI-based systems for ophthalmology use, privacy-preserving measures, potential challenges, and future directions of each.

Recent findings

Several key AI algorithms used to improve disease detection and outcomes include: Data-driven, imagedriven, natural language processing (NLP)-driven, genomics-driven, and multimodality algorithms. However, deep learning systems are susceptible to adversarial attacks, and use of data for training models is associated with privacy concerns. Several data protection methods address these concerns in the form of blockchain technology, federated learning, and generative adversarial networks.

AI-applications have vast potential to meet many eyecare needs, consequently reducing burden on scarce healthcare resources. A pertinent challenge would be to maintain data privacy and confidentiality while supporting AI endeavors, where data protection methods would need to rapidly evolve with AI technology needs. Ultimately, for AI to succeed in medicine and ophthalmology, a balance would need to be found between innovation and privacy.
Advances in the epidemiology, clinical features, diagnosis, clinical management and prevention of coronavirus disease 2019
Authors: Hui David S.C. , Zumla Alimuddin
Published: March 2022

Purpose of review

The current article reviews the latest information on the epidemiology, clinical features, diagnostics, clinical management and prevention of coronavirus disease 2019 (COVID-19).

Recent findings

Atypical pneumonia due to severe acute respiratory syndrome coronavirus-2 emerged in December 2019 in a market in Wuhan, China and rapidly evolved into a pandemic in March 2020. Viral loads of patients with COVID-19 peak in the first week of illness around day 2-4 and hence there is very high-transmission potential causing community outbreaks. Asymptomatic and presymptomatic transmission is a hallmark of COVID-19. Several variants of concern (VOC) have emerged over the last 2 years and Omicron is the predominant variant in many countries. PCR is the standard diagnostic test while rapid antigen test is a useful supplementary test. Serology tests provide indirect evidence of infection 1 -2 weeks after the onset of symptoms. Molnupiravir and nirmatrelvir are oral antiviral agents that may reduce the risk of hospitalization and deaths if administered early to high-risk subjects. Remdesivir, baricitinib, anti-IL-6 tocilizumab and dexamethasone are frequently used for treatment of patients with respiratory failure.

COVID-19 pandemic progresses relentlessly with substantial morbidity and mortality especially in unvaccinated subjects. Mass COVID-19 vaccinations are the most important measure for control of the COVID-19 pandemic.
A New Force-Activated Separation Device for the Prevention of Peripheral Intravenous Restarts
Authors: Panza Gregory A. , Steere Lee , Steinberg Adam C.
Published: March 2022

The high failure rate (46%) of peripheral intravenous catheters (PIVCs) is well-documented. There is limited research examining the effect of forces/pulls on PIVC complications. New breakaway connectors called force-activated separation devices (FASD) separate when a damaging force is placed on a PIVC. In a randomized, controlled trial, patients were assigned 1:1 to a control group receiving PIVC standard of care (SOC) or SOC with FASD added to the catheter. The primary outcome was total mechanical complications requiring a PIVC restart. Secondary outcomes were delay in therapy, PIVC restarts, and adverse events. Outcomes were compared in an intention-to-treat analysis (N = 302) and per-protocol analysis (N = 287). There were less total mechanical complications in FASD compared with SOC (22 vs 41, respectively; P < .01). The treatment group was a predictor of total delay in therapy (minutes), indicating a greater estimated total delay in therapy in SOC than FASD (B = 69.53; 95% CI, 28.32–110.73; P = .001). There were more adverse events in SOC (127) than FASD (76; P = .001). Results were consistent in the per-protocol analysis. Use of a FASD showed a reduction in total mechanical complications. These results support use of the FASD as a safer and time-saving alternative to current SOC.
Autologous Conditioned Serum Increases Fat Graft Viability More than Platelet-Rich Plasma in a Controlled Rat Model
Authors: Baykara Gokay , Sungur Nezih , Ozer Kadri , Atan Oguz , Caydere Muzaffer , Kosar Pinar Nercis , Kocer Ugur
Published: March 2022

Background:

Platelet-rich plasma has been used to support fat graft retention, but it may include inflammatory mediators such as interleukin-1β. Autologous conditioned serum also contains high levels of various anti-inflammatory cytokines. The authors hypothesized that combining autologous conditioned serum with fat graft would increase fat graft survival more than platelet-rich plasma.

Methods:

Twenty-seven adult, male, Sprague-Dawley rats were divided into three groups of nine. Ten nonstudy rats were used to prepare platelet-rich plasma, autologous conditioned serum, and fat grafts. Next, 0.7-ml fat graft with a combination of 0.2 ml of autologous conditioned serum, platelet-rich plasma, or phosphate-buffered saline was applied to their dorsa. Fat graft volume was assessed on postoperative day 2 and on the day of euthanization at 1, 3, and 5 months postoperatively. Histopathologic analysis was performed to measure integrity, inflammation, fibrosis, and vascularization.

Results:

The median volume percentages and interquartile ranges at 1 month postoperatively were 97.3 percent (77.3 to 119.6 percent), 40.4 percent (30.9 to 46.9 percent), and 72.1 percent (53.6 to 84.9 percent) in autologous conditioned serum plus fat graft, phosphate-buffered saline plus fat graft, and platelet-rich plasma plus fat graft, respectively (p < 0.05); at 3 months postoperatively, values were 82.3 percent (70.3 to 88.3 percent), 36.6 percent (29.4 to 43.1 percent), and 48.3 percent (31.4 to 57.9 percent) (p < 0.001); and at 5 months postoperatively, values had increased to 83.9 percent (58.3 to 102.4 percent), 40.3 percent (20.1 to 50.6 percent), and 56.3 percent (37.7 to 74.9 percent), respectively (p < 0.05).

Conclusions:

Autologous conditioned serum and platelet-rich plasma improved fat graft outcomes compared to saline, whereas autologous conditioned serum was associated with less inflammation, greater fat viability, and more integrity.

Clinical Relevance Statement:

Combining fat graft with autologous conditioned serum may be a better option to minimize resorption rate and improve graft survival.
Anatomical Analysis of the Lateral Femoral Cutaneous Nerve and Its Passage beneath the Inguinal Ligament
Authors: Mandal Patrick , Russe Elisabeth , Schwaiger Karl , Wechselberger Gottfried , Feigl Georg
Published: March 2022

Background:

Meralgia paraesthetica is a mononeuropathy of the lateral femoral cutaneous nerve. According to the literature, the nerve travels beneath the inguinal ligament 1.3 to 5.1 cm medial to the anterior superior iliac spine. Compression at this site may cause pain and paresthesia. The aim of this study was to provide more accurate measurements to improve the diagnostic and surgical management of meralgia paraesthetica.

Methods:

The lateral femoral cutaneous nerve was dissected bilaterally in 50 Thiel-embalmed human cadavers. Measurements were performed with a standard caliper at the superior and inferior margins of the inguinal ligament. The distance from the inner lamina of the anterior superior iliac spine to the medial margin of the lateral femoral cutaneous nerve was measured. Data were collected and statistical analysis was performed with R.

Results:

Ninety-three lateral femoral cutaneous nerves of 50 cadavers were dissected. In 6 percent of cadavers, the lateral femoral cutaneous nerve could not be found. The mean distance from the inner lamina of the anterior superior iliac spine to the lateral femoral cutaneous nerve’s medial border was 2.1 ± 1.3 cm (range, 0.2 to 6.4 cm; 95 percent CI, 1.8 to 2.4 cm) at the superior margin of the inguinal ligament and 1.9 ± 1.4 cm (range, 0.2 to 3.0 cm; 95 percent CI, 1.6 to 2.2 cm) at the inferior border of the inguinal ligament.

Conclusion:

This anatomical study shows that the majority of the lateral femoral cutaneous nerve passes beneath the inguinal ligament in a very narrow area of 0.6 cm.
The Effect of Anticoagulation on the Treatment of Dupuytren Contracture with Collagenase
Authors: Noland Shelley S. , Paul Aaron W. , Pflibsen Lacey R. , Rizzo Marco
Published: March 2022

Background:

There have been no formal studies of the use of collagenase clostridium histolyticum (Xiaflex; Endo Pharmaceuticals, Malvern, Pa.) in the anticoagulated patient. Previous study on its use excluded patients receiving anticoagulation therapy. This study reviewed the effects of anticoagulation use in patients undergoing collagenase clostridium histolyticum injection and cord rupture to determine safety and efficacy.

Methods:

The authors retrospectively reviewed patients receiving collagenase clostridium histolyticum injections for Dupuytren contracture between 2010 and 2017. Outcomes included type of anticoagulation, skin tear, tendon rupture, lymphadenopathy, sensory abnormality, hematoma, and bleeding.

Results:

A total of 388 injections were performed in 197 patients. The average clinical follow-up was 311 days. Fifty-two percent of patients (n = 201) were anticoagulated. The vast majority were taking aspirin (acetylsalicylic acid) (n = 182), followed by warfarin (n = 27), clopidogrel (n = 9), apixaban (n = 8), rivaroxaban (n = 4), and dabigatran (n = 2). There were 42 skin tears, 21 in the anticoagulated group. One tendon rupture occurred in the anticoagulated group (acetylsalicylic acid) and none occurred in the nonanticoagulated group (p = 0.34). No patients experienced sensory abnormalities, a hematoma requiring intervention, or uncontrollable bleeding.

Conclusions:

Anticoagulation is commonly encountered by hand surgeons treating Dupuytren contracture. There is no significant difference in complications in the anticoagulated patient versus the nonanticoagulated patient. It is safe to perform collagenase clostridium histolyticum injections for Dupuytren contracture in the anticoagulated patient, regardless of the type of anticoagulation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Extracorporeal Life-support for Out-of-hospital Cardiac Arrest: A Nationwide Multicenter Study
Authors: Jeong Daun , Lee Gun Tak , Park Jong Eun , Chang Hansol , Kim Taerim , Cha Won Chul , Yoon Hee , Hwang Sung Yeon , Shin Tae Gun , Sim Min Sub , Jo IkJoon , Lee Seung-Hwa , Shin Sang Do , Choi Jin-Ho
Published: March 2022

Background:

Despite potential clinical roles of extracorporeal life support (ECLS) for out-of-hospital cardiac arrest (OHCA) compared to that of conventional cardiopulmonary resuscitation (CCPR), use of ECLS for OHCA is not strongly endorsed by current clinical guidelines.

Objective:

The purpose of this study is to investigate the clinical roles of extracorporeal life support (ECLS) compared with that of conventional cardiopulmonary resuscitation (CCPR) for out-of-hospital cardiac arrest (OHCA) patients.

Methods:

The outcomes of OHCA between 2015 and 2020, enrolled in the Korean Cardiac Arrest Research Consortium (KoCARC), a multicenter OHCA patient registry including 65 participating hospitals throughout the Republic of Korea (ClinicalTrials.gov, number NCT03222999). Differences in clinical features were adjusted by matching the propensity for ECLS. The primary outcome was 30-day neurologically favorable survival with cerebral performance category of 1 or 2. Restricted mean survival time (RMST) was used to compare outcomes between groups.

Results:

Of 12,006 patients included, ECLS was applied to 272 patients (2.2%). The frequency of neurologically favorable survival was higher in the ECLS group than the CCPR group (RMST difference, 5.5 days [95% CI, 4.1–7.0 days], P < 0.001). In propensity score-matched 271 pairs, the clinical outcome of ECLS and CCPR did not differ to a statistically significant extent (RMST difference, 0.4 days [95% CI –1.6 to 2.5 days], P = 0.67). Subgroup analyses revealed that the clinical roles of ECLS was evident in patients with nonshockable rhythm or CPR time ≥20 min (RMST difference, 2.7 days [95% CI 0.5–4.8 days], P = 0.015), but not in patients without these features (RMST difference, –3.7 days [95% CI –7.6 to 0.2 days], P = 0.07).

Conclusions:

In this real-world data analysis, ECLS compared to CCPR did not result in better overall clinical outcomes of OHCA. The clinical efficacy of ECLS may be limited to a subgroup of high-risk patients.
Association of trauma severity with antibody seroconversion in heparin-induced thrombocytopenia: A multicenter, prospective, observational study
Authors: Fujita Motoo , Maeda Takuma , Miyata Shigeki , Mizugaki Asumi , Hayakawa Mineji , Miyagawa Noriko , Ushio Noritaka , Shiraishi Atsushi , Ogura Takayuki , Irino Shiho , Sekine Kazuhiko , Fujinami Yoshihisa , Kiridume Kazutaka , Hifumi Toru , Kushimoto Shigeki
Published: March 2022

BACKGROUND

Heparin administration can induce the production of anti–platelet factor 4 (PF4)/heparin antibodies with platelet-activating properties, causing heparin-induced thrombocytopenia (HIT). Previous studies have suggested that trauma severity influences HIT immune responses, but their relationship has not been fully explained. This study aimed to clarify this association by multicenter prospective observational study.

METHODS

Trauma patients who met the criteria of age 18 years or older and Injury Severity Scores (ISSs) of ≥9 from March 2018 to February 2019 were included. Patients who did not receive any heparin and those who received it as flushes or for treatment were also included. Patients were divided into three groups based on trauma severity (to mild [ISS 9–15], moderate [ISS 16–24], and severe injury groups [ISS ≥25]) and were compared by the seroconversion time and rate, as well as the disappearance rate of antibodies on day 30.

RESULTS

A total of 184 patients were included: 55, 62, and 67 patients were classified into the mild, moderate, and severe injury groups, respectively. Overall, the seroconversion rates of anti-PF4/heparin immunoglobulin G (IgG) and HIT antibodies by washed platelet activation assay were 26.6% and 16.3%, respectively. There was a significant difference in the seroconversion rates of anti-PF4/heparin IgG (p = 0.016) and HIT antibodies (p = 0.046) among the groups. Seroconversion rates in both assays increased with increasing trauma severity. The time required to achieve seroconversion was similar (between 5 and 10 days of trauma onset) regardless of heparin administration. Anti-PF4/heparin IgG and HIT antibodies were no longer detected on day 30 in 28.6% and 60.9% of seroconverted patients, respectively.

CONCLUSION

Development of HIT antibodies was observed commonly in severely injured trauma patients. Heparin-induced thrombocytopenia antibody development may be related to trauma severity, with a high disappearance frequency on day 30.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
The Pathological and Clinical Diversity of Acute Vascular Rejection in Kidney Transplantation
Authors: Nankivell Brian J. , Shingde Meena , P’Ng Chow H.
Published: March 2022

Background.

Vascular rejection (VR) is characterized by arteritis, steroid resistance, and increased graft loss but is poorly described using modern diagnostics.

Methods.

We screened 3715 consecutive biopsies and retrospectively evaluated clinical and histological phenotypes of VR (n = 100) against rejection without arteritis (v0REJ, n = 540) and normal controls (n = 1108).

Results.

Biopsy sample size affected the likelihood of arterial sampling, VR diagnosis, and final Banff v scores (P < 0.001). Local v and cv scores were greatest in larger arteries (n = 258). VR comprised 15.6% of all rejection episodes, presented earlier (median 1.0 mo, interquartile range, 0.4–8 mo) with higher serum creatinine levels and inferior graft survival, versus v0REJ (P < 0.001). Early VR (≤1 mo) was common (54%) and predicted by sensitization, delayed function, and prior corticosteroid use, with associated acute dysfunction and optimal therapeutic response, independent of Banff v score. Late VR followed under-immunosuppression in 71.4% (noncompliance 38.8%, iatrogenic 32.6%), and was associated with chronic interstitial fibrosis, incomplete renal functional recovery and persistent inflammation using sequential histopathology. The etiology was “pure” antibody-mediated VR (n = 21), mixed VR (n = 36), and “pure” T cell–mediated VR (n = 43). Isolated VR (n = 34, Banff i < 1 without tubulitis) comprised 24 T cell–mediated VR and 10 antibody-mediated VR, presenting with mild renal dysfunction, minimal Banff acute scores, and better graft survival compared with inflamed VR. Interstitial inflammation influenced acute renal dysfunction and early treatment response, whereas chronic tubulointerstitial damage determined long-term graft loss.

Conclusions.

VR is a heterogenous entity influenced by time-of-onset, pathophysiology, accompanying interstitial inflammation and fibrosis. Adequate histological sampling is essential for its accurate diagnostic classification and treatment.
An evolutionary perspective on chordate brain organization and function: insights from amphioxus, and the problem of sentience
Authors: Lacalli Thurston
Published: March 2022

The similarities between amphioxus and vertebrate brains, in their regional subdivision, cell types and circuitry, make the former a useful benchmark for understanding the evolutionary innovations that shaped the latter. Locomotory control systems were already well developed in basal chordates, with the ventral neuropile of the dien-mesencephalon serving to set levels of activity and initiate locomotory actions. A chief deficit in amphioxus is the absence of complex vertebrate-type sense organs. Hence, much of vertebrate story is one of progressive improvement both to these and to sensory experience more broadly. This has two aspects: (i) anatomical and neurocircuitry innovations in the organs of special sense and the brain centres that process and store their output, and (ii) the emergence of primary consciousness, i.e. sentience. With respect to the latter, a bottom up, evolutionary perspective has a different focus from a top down human-centric one. At issue: the obstacles to the emergence of sentience in the first instance, the sequence of addition of new contents to evolving consciousness, and the homology relationship between them. A further question, and a subject for future investigation, is how subjective experience is optimized for each sensory modality.

This article is part of the theme issue ‘Systems neuroscience through the lens of evolutionary theory’.
Phase variation in the glycosyltransferase genes of Pasteurella multocida associated with outbreaks of fowl cholera on free-range layer farms
Authors: Omaleki Lida , Blackall Patrick J. , Cuddihy Thom , White Rhys T. , Courtice Jodi M. , Turni Conny , Forde Brian M. , Beatson Scott A.
Published: March 2022

Fowl cholera caused by

Pasteurella multocida

has re-emerged in Australian poultry production since the increasing adoption of free-range production systems. Currently, autogenous killed whole-cell vaccines prepared from the isolates previously obtained from each farm are the main preventative measures used. In this study, we use whole-genome sequencing and phylogenomic analysis to investigate outbreak dynamics, as well as monitoring and comparing the variations in the lipopolysaccharide (LPS) outer core biosynthesis loci of the outbreak and vaccine strains. In total, 73 isolates from two different free-range layer farms were included. Our genomic analysis revealed that all investigated isolates within the two farms (layer A and layer B) carried LPS type L3, albeit with a high degree of genetic diversity between them. Additionally, the isolates belonged to five different sequence types (STs), with isolates belonging to ST9 and ST20 being the most prevalent. The isolates carried ST-specific mutations within their LPS type L3 outer core biosynthesis loci, including frameshift mutations in the outer core heptosyltransferase gene (htpE) (ST7 and ST274) or galactosyltransferase gene (gatG) (ST20). The ST9 isolates could be separated into three groups based on their LPS outer core biosynthesis loci sequences, with evidence for potential phase variation mechanisms identified. The potential phase variation mechanisms included a tandem repeat insertion in natC and a single base deletion in a homopolymer region of gatG. Importantly, our results demonstrated that two of the three ST9 groups shared identical rep-PCR (repetitive extragenic palindromic PCR) patterns, while carrying differences in their LPS outer core biosynthesis loci region. In addition, we found that ST9 isolates either with or without the natC tandem repeat insertion were both associated with a single outbreak, which would indicate the importance of screening more than one isolate within an outbreak. Our results strongly suggest the need for a metagenomics culture-independent approach, as well as a genetic typing scheme for LPS, to ensure an appropriate vaccine strain with a matching predicted LPS structure is used.
The Acoustic Dissection of Cough: Diving into Machine Listening-based COVID-19 Analysis and Detection
Authors: Ren Zhao , Chang Yi , Bartl-Pokorny Katrin D. , Pokorny Florian B. , Schuller Björn W.
Published: March 2022

Purpose

The coronavirus disease 2019 (COVID-19) has caused a crisis worldwide. Amounts of efforts have been made to prevent and control COVID-19’s transmission, from early screenings to vaccinations and treatments. Recently, due to the spring up of many automatic disease recognition applications based on machine listening techniques, it would be fast and cheap to detect COVID-19 from recordings of cough, a key symptom of COVID-19. To date, knowledge on the acoustic characteristics of COVID-19 cough sounds is limited, but would be essential for structuring effective and robust machine learning models. The present study aims to explore acoustic features for distinguishing COVID-19 positive individuals from COVID-19 negative ones based on their cough sounds.

Methods

With the theory of computational paralinguistics, we analyse the acoustic correlates of COVID-19 cough sounds based on the COMPARE feature set, i. e., a standardised set of 6,373 acoustic higher-level features. Furthermore, we train automatic COVID-19 detection models with machine learning methods and explore the latent features by evaluating the contribution of all features to the COVID-19 status predictions.

Results

The experimental results demonstrate that a set of acoustic parameters of cough sounds, e. g., statistical functionals of the root mean square energy and Mel-frequency cepstral coefficients, are relevant for the differentiation between COVID-19 positive and COVID-19 negative cough samples. Our automatic COVID-19 detection model performs significantly above chance level, i. e., at an unweighted average recall (UAR) of 0.632, on a data set consisting of 1,411 cough samples (COVID-19 positive/negative: 210/1,201).

Conclusions

Based on the acoustic correlates analysis on the COMPARE feature set and the feature analysis in the effective COVID-19 detection model, we find that the machine learning method to a certain extent relies on acoustic features showing higher effects in conventional group difference testing.
Machine Learning for Real-Time Aggregated Prediction of Hospital Admission for Emergency Patients
Authors: King Zella , Farrington Joseph , Utley Martin , Kung Enoch , Elkhodair Samer , Harris Steve , Sekula Richard , Gillham Jonathan , Li Kezhi , Crowe Sonya
Published: March 2022

Machine learning for hospital operations is under-studied. We present a prediction pipeline that uses live electronic health-records for patients in a UK teaching hospital’s emergency department (ED) to generate short-term, probabilistic forecasts of emergency admissions. A set of XGBoost classifiers applied to 109,465 ED visits yielded AUROCs from 0.82 to 0.90 depending on elapsed visit-time at the point of prediction. Patient-level probabilities of admission were aggregated to forecast the number of admissions among current ED patients and, incorporating patients yet to arrive, total emergency admissions within specified time-windows. The pipeline gave a mean absolute error (MAE) of 4.0 admissions (mean percentage error of 17%) versus 6.5 (32%) for a benchmark metric. Models developed with 104,504 later visits during the Covid-19 pandemic gave AUROCs of 0.68-0.90 and MAE of 4.2 (30%) versus a 4.9 (33%) benchmark. We discuss how we surmounted challenges of designing and implementing models for real-time use, including temporal framing, data preparation, and changing operational conditions.
Gaps in mobility data and implications for modelling epidemic spread: a scoping review and simulation study
Authors: Wardle Jack , Bhatia Sangeeta , Kraemer Moritz U G , Nouvellet Pierre , Cori Anne
Published: March 2022

Reliable estimates of human mobility are important for understanding the spatial spread of infectious diseases and the effective targeting of control measures. However, when modelling infectious disease dynamics, data on human mobility at an appropriate temporal or spatial resolution are not always available, leading to the common use of model-derived mobility proxies. In this study we reviewed the different data sources and mobility models that have been used to characterise human movement in Africa. We then conducted a simulation study to better understand the implications of using human mobility proxies when predicting the spatial spread and dynamics of infectious diseases.

We found major gaps in the availability of empirical measures of human mobility in Africa, leading to mobility proxies being used in place of data. Empirical data on subnational mobility were only available for 17/54 countries, and, in most instances, these data characterised long-term movement patterns, which were unsuitable for modelling the spread of pathogens with short generation times (time between infection of a case and their infector). Results from our simulation study demonstrated that using mobility proxies can have a substantial impact on the predicted epidemic dynamics, with complex and non-intuitive biases. In particular, the predicted times and order of epidemic invasion, and the time of epidemic peak in different locations can be underestimated or overestimated, depending on the types of proxies used and the country of interest.

Our work underscores the need for regularly updated empirical measures of population movement within and between countries to aid the prevention and control of infectious disease outbreaks. At the same time, there is a need to establish an evidence base to help understand which types of mobility data are most appropriate for describing the spread of emerging infectious diseases in different settings.