bluuebunny/crossref_metadata_2025 huggingface dataset:
Thrombotic storm in inflammatory bowel disease
Authors: Alkhathami Mohammed , Alshehri Fayez , Nasiri Abdulrahman M.
Published: April 2021

Rationale:

Crohn's disease and ulcerative colitis are forms of inflammatory bowel disease (IBD) and are recognized causes of gastrointestinal diseases. Thromboembolism is known to be one of the extraintestinal complications of IBD. However, there have been no reports of a “thrombotic storm,” which is a rare form of thromboembolism, as the first manifestation of a case of previously unknown IBD. In this report, we describe a case of thrombotic storm as the initial presentation of IBD.

Patient concerns:

A 15-year-old girl with no known history of chronic medical illnesses presented to our clinic with complaints of infrequent loose bowel movements associated with occasional rectal bleeding 4 months prior.

Diagnoses:

Abdominal examination revealed tenderness upon superficial and deep palpation of the epigastrium and left lower quadrant of the abdomen. Digital rectal examination revealed no tenderness or masses in the rectal canal, but bloody stools were noted; imaging revealed extensive thrombosis. Sigmoidoscopy findings and histology were consistent with those of ulcerative colitis.

Interventions:

Anticoagulation therapy was initiated for the treatment of the thrombosis. Sigmoidoscopy and biopsy were also performed to ensure that an accurate diagnosis was made. The patient was placed on a therapy of methylprednisolone, mesalazine, and enoxaparin.

Outcomes: During follow-up, the patient's symptoms were found to have subsided, her test results had improved, and no further flare-ups of the ulcerative colitis were noted.

Lessons

: This case highlights the fact that thrombosis can precede IBD and can make the accurate diagnosis of such cases more challenging. The risk of thrombus propagation also poses a challenge in such cases.
Ecthyma gangrenosum with Pseudomonas aeruginosa bacteremia in an immunocompromised patient
Authors: Pereira Gabriela Sobreira , Tinoco Mariana Gomes , Fernandes Carlos Manuel Guimarães Simões , Cotter Jorge Berkeley
Published: April 2021

Rationale:

Ecthyma gangrenosum is an uncommon cutaneous manifestation and recognized for its association with Pseudomonas aerugninosa sepsis in immunocompromised patients, particularly if there is neutropenia. These lesions follow a certain pattern of presentation, from erythematous nodules to necrotizing ulcers with surrounding erythema.

Patient concerns:

We describe a case of an immunocompromised woman with recent breast cancer diagnosis, under chemotherapy treatment, who on admission presented painful erythematous nodules on her right thigh with 5 days of evolution and hemodynamically stable. The computed tomography scan of chest, abdomen, and pelvis showed nodular areas of densification of the subcutaneous tissue predominantly in the abdominal wall and nodular peripheral lesions in the pulmonary parenchyma, with recent onset, suggestive of possible septic embolization.

Diagnosis:

The diagnosis of ecthyma gangrenosum was confirmed after the isolation of Pseudomonas aeruginosa from the blood and wound culture samples, while a punch biopsy excluded other possible etiologies.

Interventions:

The patient completed 30 days of antibiotherapy, initially with piperacillin/tazobactam that was narrowed after 14 days of treatment to ciprofloxacin.

Outcomes:

Favorable evolution with complete clinical resolution was observed after 3months.

Lessons:

The early recognition and the prompt treatment with broad spectrum empiric antibiotic are the key for a good outcome in patients with ecthyma gangrenosum.
Comparative Effectiveness of Risk-adjusted Cumulative Sum and Periodic Evaluation for Monitoring Hospital Perioperative Mortality
Authors: Massarweh Nader N. , Chen Vivi W. , Rosen Tracey , Dong Yongquan , Richardson Peter A. , Axelrod David A. , Harris Alex H.S. , Wilson Mark A. , Petersen Laura A.
Published: April 2021

Background:

National surgical quality improvement (QI) programs use periodic, risk-adjusted evaluation to identify hospitals with higher than expected perioperative mortality. Rapid, accurate identification of poorly performing hospitals is critical for avoiding potentially preventable mortality and represents an opportunity to enhance QI efforts.

Methods:

Hospital-level analysis using Veterans Affairs (VA) Surgical Quality Improvement Program data (2011–2016) to compare identification of hospitals with excess, risk-adjusted 30-day mortality using observed-to-expected (O-E) ratios (ie, current gold standard) and cumulative sum (CUSUM) with V-mask. Various V-mask slopes and radii were evaluated—slope of 2.5 and radius of 1.0 was used as the base case.

Results:

Hospitals identified by CUSUM and quarterly O-E were identified midway into a quarter [median 47 days; interquartile range (IQR): 24–61 days before quarter end] translating to a median of 129 (IQR: 60–187) surgical cases and 368 (IQR: 145–681) postoperative inpatient days occurring after a CUSUM signal, but before the quarter end. At hospitals identified by CUSUM but not O-E, a median of 2 deaths within a median of 5 days triggered a signal. In some cases, these clusters extended beyond CUSUM identification date with as many as 8 deaths undetected using O-E. Sensitivity and negative predictive values for CUSUM relative to O-E were 71.9% (95% confidence interval: 66.2%–77.1%) and 95.5% (94.4%–96.4%), respectively.

Conclusions:

CUSUM evaluation identifies hospitals with clusters of mortality in excess of expected more rapidly than periodic analysis. CUSUM represents an analytic tool national QI programs could utilize to provide participating hospitals with data that could facilitate more proactive implementation of local interventions to help reduce potentially avoidable perioperative mortality.
Comparing the Ecological Niches of Chlamydial and Gonococcal Infections in Winnipeg, Canada: 2007–2016
Authors: Shaw Souradet Y. , Elliott Lawrence J. , Nowicki Deborah L. , Green Christopher G. , Ross Craig P. , Reimer Joss N. , Wylie John L. , Plourde Pierre J. , Aral Sevgi O. , Becker Marissa L. , Blanchard James F.
Published: April 2021

Background

Previous studies have shown substantial differences in geographic clustering of sexually transmitted infections (STI), such as chlamydia (CT) and gonorrhea (NG), conditional on epidemic phase. Chlamydia and NG have recently shown resurgent epidemiology in the northern hemisphere. This study describes the recent epidemiology of CT and NG in Winnipeg, Canada, combining traditional surveillance tools with place-based analyses, and comparing the ecological niches of CT and NG, in the context of their evolving epidemiology.

Methods

Data were collected as part of routine public health surveillance between 2007 and 2016. Secular trends for CT and NG, and CT/NG coinfection were examined. Gini coefficients and population attributable fractions explored the distribution, and concentration of infections over time and space.

Results

Rates of CT increased from 394.9/100,000 population to 476.2/100,000 population from 2007 to 2016. Gonorrhea rates increased from 78.0/100,000 population to 143.5/100,000 population during the same period. Each pathogen had its own ecological niche: CT was widespread geographically and socio-demographically, while NG was clustered in Winnipeg's inner-core. CT/NG co-infections had the narrowest space and age distribution. NG was shown to be undergoing a growth phase, with clear signs of geographic dispersion. The expansion of NG resembled the geographic distribution of CT.

Conclusions

We demonstrated that NG was experiencing a growth phase, confirming theoretical predictions of geographic dispersion during a growth phase. During this phase, NG occupied similar geographic spaces as CT. Knowledge of different ecological niches could lead to better targeting of resources for subpopulations vulnerable to STIs.
Genital Human Papillomavirus Prevalence Over the Lifespan Among Females and Males in a National Cross-Sectional Survey, United States, 2013–2016
Authors: Lewis Rayleen M. , Gargano Julia W. , Unger Elizabeth R. , Querec Troy D. , Markowitz Lauri E.
Published: April 2021

Background

Patterns of human papillomavirus (HPV) prevalence by age differ by sex. To further the descriptive epidemiology of genital HPV, we analyzed prevalence by age for nonvaccine (non–4vHPV) type and vaccine (4vHPV) type HPV by sex using 2013–2016 National Health and Nutrition Examination Survey data, the first 4 years of national data from both sexes.

Methods

Penile and cervicovaginal swabs were self-collected from 15- to 59-year-olds and tested for 37 HPV types. The 4vHPV-type (6/11/16/18) and non–4vHPV-type (any of 33 other types) prevalences were estimated by 3-year age group and participant characteristics. Average percent changes (APCs) in prevalence were estimated using segmented log-binomial regression.

Results

Among females, a positive relationship between non–4vHPV-type prevalence and age was seen from 15–17 to 21–23 years (APC, 56.5), followed by a negative relationship through 30–32 years (APC, −13.2); thereafter, prevalence was not related to age. The 4vHPV-type prevalence was positively related to age through 24–26 years (APC, 56.9), then negatively related through 57–59 years (APC, −6.0). Among males, non–4vHPV-type prevalence had a positive relationship with age through 21–23 years (APC, 102.4) with a smaller positive relationship through 57–59 years (APC, 1.4). For both sexes, modeled joinpoints for 4vHPV-type prevalence occurred at older ages compared with joinpoints for non–4vHPV-type prevalence.

Conclusions

Sex differences in age-specific non–vaccine-type HPV prevalence may reflect natural history and sexual behavior. Differences in vaccine-type and non–vaccine-type modeling results suggest vaccine impact as joinpoints occur in mid-late 20s for vaccine-type HPV but early 20s for nonvaccine types. These data can assist in refining HPV vaccination models and inform HPV vaccination practices and policy.
ALK-Negative Anaplastic Large Cell Lymphoma (ALCL): Prognostic Implications of Molecular Subtyping and JAK-STAT Pathway
Authors: Parkhi Mayur , Bal Amanjit , Das Ashim , Kashyap Dharambir , Bhardwaj Sandeep , Prakash Gaurav , Malhotra Pankaj
Published: April 2021

The anaplastic lymphoma kinase (ALK)-negative anaplastic large cell lymphoma (ALCL) is a clinically distinct but heterogeneous entity and lacks the specific immunophenotypic or genetic features compared with the ALK-positive ALCL. Recent molecular studies have provided genetic landscapes of ALK-negative ALCL that have prognostic significance. In this study, we subtyped ALK-negative ALCL based on DUSP22 rearrangements and TP63 expression and also looked for mutations in JAK-STAT pathway. The subtyping of the ALK-negative ALCL in relation to DUSP22 rearrangement and TP63 expression was done using fluorescence in situ hybridization and immunohistochemistry, respectively. The hotspot JAK-STAT mutations were analyzed using Sanger sequencing and amplification refractory mutation system polymerase chain reaction (PCR) and Signal transducer and activator of transcription 3 (STAT3) expression by immunohistochemistry. Forty-eight cases of ALCL were included with median age of 30 years and sex ratio of 1.8:1. The p63 expression was detected in 26.7% of ALK-negative ALCL cases. DUSP22 rearrangement was noted in 12.5% cases of p63-negative ALK-negative ALCLs. DUSP22 rearranged cases had better overall survival in contrast to p63 expressing and triple negative ALCLs. Triple negative ALCLs showed inferior overall survival rate. STAT3 expression was evident in 61.1% and 60% of ALK-positive and ALK-negative ALCLs, respectively. None of the cases subjected to Sanger sequencing as well as amplification refractory mutation system PCR for hotspot mutation analysis of JAK1 (exon 24) and STAT3 (exon 21) revealed any mutation. ALK-negative ALCL is a genetically heterogeneous disease with widely disparate clinical outcomes. Subtyping of ALK-negative ALCL based on DUSP22 rearrangement and p63 expression provides prognostic information.
The Likelihood of an Occult Fracture in Skeletal Surveys Obtained in Children More Than 2 Years Old With Concerns of Physical Abuse
Authors: McNamara Caitlin R. , Panigrahy Ashok , Sheetz Michael , Berger Rachel P.
Published: April 2021

Objectives

Skeletal surveys are necessary in the evaluation for physical abuse in children less than 2 years old, but when to obtain a skeletal survey in older children is less clear.

Methods

A retrospective study of patients older than 2 years who underwent skeletal survey over a 3-year period after implementation of an electronic health record physical abuse order set was conducted. Data were analyzed using descriptive statistics and compared with data from a cohort before order set implementation. The radiation dose of a skeletal survey in a 5-year old was calculated using a previously published technique.

Results

There were 325 skeletal surveys, a marked increase in the rate of skeletal surveys compared with before order set implementation. Less than 2% (6/325) of skeletal surveys demonstrated an occult fracture. Of the 6 patients with occult fractures, 4 were physically abused; in each case, the diagnosis of abuse was evident before the skeletal survey. The other 2 patients fell from windows. The radiation exposure was 0.34 mSv.

Conclusions

The rate of occult fractures on skeletal survey is significantly lower than previously reported. This is likely because our population included all children who underwent skeletal survey and not the subset referred to a child abuse pediatrician. In addition, our data demonstrate that in children older than 2 years, skeletal surveys are unlikely to assist in making a diagnosis of physical abuse. The radiation exposure in a 5-year-old is 70% greater than in an infant, but still a dose, which represents a negligible health risk.
Phase-Adapted Rehabilitation for Acute Coronavirus Disease-19 Patients and Patient With Long-term Sequelae of Coronavirus Disease-19
Authors: Gutenbrunner Christoph , Nugraha Boya , Martin Lidia Teixido
Published: April 2021

Since the beginning of the COVID-19 pandemic in early 2020, many papers have highlighted the need for the rehabilitation of patients with SARS-CoV-2 infection. Most papers refer to the need for respiratory rehabilitation in the acute phase; however, the fact that the infection also affects other organ systems has to be considered in rehabilitation interventions. Long-term symptoms in many cases severely limit activity and participation and alter quality of life, leading to rehabilitation needs. This article proposes a phase-adapted model of linking the acute, postacute, and long-term symptoms of COVID-19 with the well-established matrix of acute, postacute, and long-term rehabilitation services. A review of currently available recommendations for phase-adapted rehabilitation strategies, including the relevance of prehabilitation within this context, is provided.
Electrophysiological Study of the Tibial Nerve Across the Tarsal Tunnel in Distal Symmetric Diabetic Polyneuropathy
Authors: Mondelli Mauro , Aretini Alessandro , Ginanneschi Federica
Published: April 2021

Objective

The aim of the study was to demonstrate abnormalities of motor conduction of the tibial nerve across the tarsal tunnel in type 2 diabetes.

Design

One hundred twenty-four consecutive patients (mean age = 66.6 yrs, 62.1% male) with distal symmetric diabetic polyneuropathy clinically diagnosed were prospectively enrolled. Nerve conduction studies of deep peroneal, tibial, superficial peroneal, medial plantar, and sural nerves and standard needle electromyography in the lower limbs were performed. Demographic, anthropometric, and clinical findings were collected.

Results

Motor conduction velocity of the tibial nerve across tarsal tunnel was slowed in 60.5% of patients; another 4% showed conduction block across tarsal tunnel without reduction of motor conduction velocity. Overall percentage of abnormalities across tarsal tunnel (64.5%) exceeds that of the sensory conduction velocities of proximal sural and superficial peroneal nerves. Abnormal tibial motor conduction velocity across tarsal tunnel represents the most common abnormality among all motor nerve conduction study parameters and significantly correlates with hemoglobin level, diabetic neuropathic index score, and diabetic complications frequency.

Conclusions

Tibial conduction abnormalities across tarsal tunnel are the most sensitive motor parameter in distal symmetric diabetic polyneuropathy, second only to conduction abnormalities of sensory/mixed distal nerves of the feet. The use of nerve conduction studies across tarsal tunnel of the tibial nerve may be useful in the electrophysiological protocol to confirm the diagnosis of distal symmetric diabetic polyneuropathy.
Sex Differences in Patterns of Sleep Disorders Among Hospitalizations With Parkinson’s Disease: 2004–2014 Nationwide Inpatient Sample
Authors: Beydoun Hind A. , Hossain Sharmin , Huang Shuyan , Beydoun May A. , Alemu Brook T. , Eid Shaker M. , Zonderman Alan B.
Published: April 2021

Objective

This study aimed to examine patterns of sleep disorders among hospitalized adults 65 years and older as related to Parkinson’s disease (PD) status and to evaluate sex differences in the associations between PD with sleep disorders.

Methods

A cross-sectional study was conducted using 19,075,169 hospital discharge records (8,169,503 men and 10,905,666 women) from the 2004–2014 Nationwide Inpatient Sample databases. PD and sleep disorder diagnoses were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification coding. Logistic regression models were constructed for each sleep disorder as a correlate of PD status; adjusted odds ratios (aOR) with their 95% confidence intervals (CIs) were calculated taking into account patient and hospital characteristics.

Results

Period prevalences of PD and sleep disorder were estimated to be 2.1% and 8.1%, respectively. Most sleep disorder types, with the exception of sleep-related breathing disorders, were positively associated with PD diagnosis. Statistically significant interactions by sex were noted for associations of insomnia (men: aOR = 1.29, 95% CI = 1.24–1.36; women: aOR = 1.17, 95% CI = 1.12–1.22), parasomnia (men: aOR = 3.74, 95% CI = 3.44–4.07; women: aOR = 2.69, 95% CI = 2.44–2.96), sleep-related movement disorder (men: aOR = 1.09, 95% CI = 1.07–1.11; women: aOR = 1.22, 95% CI = 1.20–1.25), and any sleep disorder (men: aOR = 1.06, 95% CI = 1.05–1.08; women: aOR = 1.15, 95% CI = 1.13–1.17) with PD status.

Conclusions

Overall, hospitalized men are more likely to experience PD with insomnia or parasomnia, whereas hospitalized women are more likely to experience PD with sleep-related movement disorder or any sleep disorder. Prospective cohort studies are needed to replicate these cross-sectional findings.
Efficacy of Atorvastatin Plus Conventional Disease-Modifying Antirheumatic Drugs on Disease Activity in Rheumatoid Arthritis
Authors: Hou Jiqiu , Guo Qiaoyan , Dong Changqing , Wang Dongxue , Wu Linlin
Published: April 2021

Objective

The aim of this study was to evaluate the efficacy of atorvastatin plus disease-modifying antirheumatic drugs (DMARDs) in patients with rheumatoid arthritis (RA).

Methods

We queried the PubMed, Embase, Web of Science, and the CENTRAL (Cochrane Central Register of Controlled Trials) databases for this study. The pooled efficacy was evaluated using standardized mean differences. The inverse of the variance model was used for data pooling.

Results

Based on the search, we identified 9 randomized controlled trials. The trials included 258 patients in the atorvastatin plus DMARD groups and 246 patients in the DMARD alone groups. The primary outcome was the change from baseline in the 2018 (209:228 Disease Activity Score in 28 Joints). Based on the Disease Activity Score in 28 Joints, disease activity in RA patients decreased significantly in patients given atorvastatin plus DMARD compared with patients given DMARD alone (standardized mean difference, −2.46; 95% confidence interval, −3.98 to −0.95; p = 0.0015; I
2 = 97%; p < 0.01). Subgroup analysis did not identify any confounding factors, and no publication bias was detected in the meta-analysis.

Conclusions

The result supports that atorvastatin could be added to DMARDs to treat patients with RA.
COVID-19 in Patients With Rheumatic Diseases
Authors: Sachdeva Sonali , Manaktala Pritika , Malik Faizan Ahmad , Gupta Udita , Desai Rupak
Published: April 2021

Background/Objectives

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), first described in December 2019, has infected more than 33 million people and claimed more than 1 million deaths worldwide. Rheumatic diseases are chronic inflammatory diseases, the prevalence and impact of which in COVID-19 patients are poorly known. We performed a pooled analysis of published data intending to summarize clinical presentation and patient outcomes in those with established rheumatic disease diagnosis and concurrent COVID-19.

Methods

PubMed and Google Scholar were searched to identify studies reporting data about rheumatic disease patients who were diagnosed with SARS-CoV-2 infection and published until July 22, 2020. Random-effects models were used to estimate the pooled incidence and rates of hospitalization, intensive care unit admission, and mortality among these patients, and interstudy heterogeneity was identified using I
2 statistics with greater than 75% value indicating substantial interstudy variation.

Results

Twenty studies were included, giving a total sample size of 49,099 patients positive for SARS-CoV-2. Of 49,099 COVID-19 patients, a total of 1382 were also diagnosed with a rheumatic disease in the past. The random-effects pooled prevalence of COVID-19 among rheumatic disease patients was found to be 0.9%. The rates of hospitalization, intensive care unit admission, and mortality were 70.7%, 11.6%, and 10.2%, respectively.

Conclusions

Although the prevalence of SARS-CoV-2 infection is not dramatically high in rheumatic disease patients, concurrent COVID-19 does seem to play a role in determining disease severity and outcomes to some extent. Further studies are needed to give conclusive evidence about whether this subset of the population is at a higher risk of COVID-19 and related outcomes compared with the population at large.
Peter John Bell Clarricoats. 6 April 1932—17 January 2020
Authors: Snowden Christopher , Hao Yang
Published: April 2021

Peter Clarricoats made fundamental contributions as a microwave engineer in the fields of applied electromagnetics for microwave and optical waveguides, and microwave antenna feeds. Peter was also a pioneer of optical fibres, and established the theory of electromagnetic propagation on dielectric and ferrite structures. In the course of this, he discovered that such structures can, under some conditions, support ‘backward waves’ and that guides can propagate complex modes. Over 40 years of his academic career, Peter Clarricoats had numerous notable achievements, including pioneering designs for shaped reflectors, reconfigurable reflectors and especially corrugated horns for microwave antennas. The latter are now universally used in satellite ground stations and in spacecraft. He published what became standard reference texts on corrugated horns for microwave antennas, microwave horns and feeds.

He served as vice-president of both the Institution of Engineering and Technology and the International Union of Radio Science, and from 1998 to 2000 was chairman of the Defence Scientific Advisory Council. He was appointed a CBE in 1996. He is the recipient of the 2001 Distinguished Achievement Award of the Institute of Electrical and Electronics Engineers Antennas and Propagation Society, and in 2015 he received the Sir Frank Whittle Gold Medal from the Royal Academy of Engineering.
Halomonas diversa sp. nov., isolated from deep-sea sediment of the Pacific Ocean
Authors: Wang Liping , Liu Xiupian , Lai Qiliang , Gu Li , Shao Zongze
Published: April 2021

A novel Gram-stain-negative, facultatively anaerobic, rod-shaped bacterium, designated as D167-6-1T, was isolated from deep-sea sediment collected from the Pacific Ocean. The cells were catalase- and oxidase-positive, and motile by means of peritrichous flagella. Growth occurred at NaCl concentrations ranging from 0 to 19 % (optimum, 2–8 %, w/v), from pH 6 to 11 (optimum, 7–8) and at temperatures between 4 and 45 °C (optimum, 33 °C). Phylogenetic analysis based on 16S rRNA, gyrB and rpoD gene sequences and its genome sequence revealed that strain D167-6-1T formed a monophyletic branch within the genus

Halomonas

and was most closely related to

Halomonas saliphila

,

Halomonas pellis

,

Halomonas kenyensis

,

Halomonas daqingensis

,

Halomonas desiderata

and

Halomonas lactosivorans

(with 98.5, 98.5, 98.4, 98.1, 97.5 and 97.8 % 16S rRNA sequence similarity, respectively). The complete genome size of strain D167-6-1T was 4.49 Mb, with a DNA G+C content of 62.8 mol%. The estimated averagenucleotide identity and DNA–DNA hybridization values between strain D167-6-1T and other closely related species were 77.59–85.35 % and 22.0–30.6 %, respectively. The principal cellular fatty acids (>5 %) were C18 : 1
 ω7c, C16 : 0, C19 : 0 cyclo ω8c, summed feature 3 (C16 : 1
 ω7c/C16 : 1
 ω6c) and C17 : 0 cyclo. The polar lipids were identified as diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol, phosphatidylcholine, an unidentified aminolipid, aminophospholipid and two unidentified phospholipids. The predominant respiratory quinones were Q-9 and Q-8. The combined genotypic and phenotypic data show that strain D167-6-1T represents a novel species of the genus

Halomonas

, for which the name Halomonas diversa sp. nov. is proposed, with the type strain D167-6-1T (=MCCC 1A13316T=KCTC 72441T).
Detection of local microvascular proliferation inIDHwild-type Glioblastoma using relative Cerebral Blood Volume
Authors: Álvarez-Torres María del Mar , Fuster-García Elies , Juan-Albarracín Javier , Reynés Gaspar , Aparici-Robles Fernando , Ferrer-Lozano Jaime , Juan Miguel García-Gómez
Published: April 2021

Background

The microvascular proliferation (MVP) and the microvessel area (MVA) are known as diagnostic and prognostic biomarkers for glioblastoma; nevertheless, its measurement is costly, labor-intense, and invasive. MRI perfusion biomarkers such as such as relative cerebral blood volume (rCBV) may be a feasible alternative to predict MVP and estimate MVA.

Purpose

This study aims to evaluate the detection capacity of MRI markers such as rCBV to detect local microvascular proliferation in IDH wild-type glioblastoma. In addition, we aim to analyze the association between rCBV values and the microvessel area in different regions of the tumor.

Study type

Retrospective study.

Population and subjects

Data from 71 tissue blocks belonging to 17IDHwild-type glioblastoma patients were compiled from the Ivy GAP database.

Field Strength/Sequence

1.5T or 3.0T. Pregadolinium and postgadolinium-based contrast agent-enhanced T1-weighted MRI, T2- and FLAIR T2-weighted, and dynamic susceptibility contrast (DSC) T2* perfusion.

Assessment

We analyzed preoperative MRIs to establish the association between the maximum and mean relative cerebral blood volume (rCBVmaxand rCBVmean) with the presence/absence of microvascular proliferation and with the microvessel area for each tumor block.

Statistical tests

Spearman’s correlation and Mann-Whitney test.

Results

Significant positive correlations were found between rCBV and MVA in the analyzed tumor blocks (p<0.001). Additionally, significant differences in rCBV were found between blocks with MVP and blocks without MVP (p<0.0001).

Data conclusion

The rCBV is shown as significantly different in those tissue blocks with microvascular proliferation from those blocks without it, and it is significantly correlated with microvessels area. This method allows a local detection and definition of MVP and MVA in different regions of the glioblastoma since the first diagnostic stage and in a non-invasive way.
Association of ABO blood group with COVID-19 severity, acute phase reactants and mortality
Authors: Ishaq Uzma , Malik Asmara , Malik Jahanzeb , Mehmood Asad , Qureshi Azhar , Laique Talha , Zaidi Syed Muhammad Jawad , Javaid Muhammad , Rana Abdul Sattar
Published: April 2021

Background and objective

The ABO blood group system has been associated with infectious and noninfectious disease, including dengue, hepatitis B virus (HBV), and severe respiratory syndrome coronavirus (SARS), etc. Coronavirus disease 2019 (COVID-19) is the ongoing pandemic with multitude of manifestations and association of ABO blood group in South-East Asian population needs to be explored.

Methods

It was a retrospective study of patients with real time polymerase chain reaction (RT-PCR) diagnosis of COVID-19 at Advanced Diagnostics and Liver Center between April 2020 to January 2021. Blood group A, B, O, and AB were identified in every participant, irrespective of their RH type and allotted groups 1, 2,3, and 4, respectively. Cox regression and logistic regression were used for inferential statistics.

Results

The cohort included 1067 patients: 521 (48.8%) of blood group O, 295 (27.6%) of blood group B, 202 (18.9%) of blood group A, and 49 (4.5%) of blood group AB. The majority of the patients were males 712 (66.7%) with an average body mass index (BMI) of 27.45 ± 3.53. Patients with AB blood group stayed a median (IQR) of 14 (5, 27) days while A blood group cohort stayed 13 (6,27) days and overall 10.6% COVID-19-related mortality was observed at our center, with 13.9% in blood group A as the majority of COVID-19 deaths. Regarding severity of COVID-19 disease, there was a trend towards critical disease in blood group A and O (n=83, 41.1%; n=183, 35.1%; OR, 11.34 (95% CI, 46.79-53.22); p<0.001). Logistic regression demonstrates blood group O and AB as predictors for severe COVID-19 disease (O: OR: 0.438 (95% CI: 0.168-1.139) p=0.090; AB: OR: 0.415 (95% CI: 0.165-1.046) p=0.062) and cause-specific hazards ratio (HR) for survival function was 3.206 (p=0.361) among all blood groups.

Conclusion

Although the prevalence of blood group O was higher in this cohort, hospital stay, severity of disease, and mortality were associated with blood group A. Further studies are needed for understanding the underlying mechanism behind the association of blood groups with COVID-19.
Locus Coeruleus Integrity from 7T MRI Relates to Apathy and Cognition in Parkinson’s Disease and Progressive Supranuclear Palsy
Authors: Ye Rong , O’Callaghan Claire , Rua Catarina , Hezemans Frank H. , Holland Negin , Malpetti Maura , Jones P. Simon , Barker Roger A. , Williams-Gray Caroline H. , Robbins Trevor W. , Passamonti Luca , Rowe James
Published: April 2021

Objective

The loss of noradrenergic neurons in the locus coeruleus contributes to neuropsychiatric symptoms in both Parkinson’s disease (PD) and progressive supranuclear palsy (PSP). This study aimed to characterise the spatial patterns of locus coeruleus pathological change in PD and PSP, and its relationship to cognitive and psychiatric symptoms.

Methods

Twenty-five patients meeting clinical criteria for idiopathic PD, fourteen probable PSP-Richardson’s syndrome and twenty-four age-matched healthy controls (HC) were recruited. All participants underwent clinical assessments for cognition and apathy, and high-resolution (0.08 mm3) 7T-magnetisation-transfer imaging to measure LC integrity in vivo. To establish spatial patterns of locus coeruleus change, we obtained sub-region summaries of mean contrast ratios and significant locus coeruleus clusters using voxelwise analyses (family-wise-corrected p<0.05); we further correlated the locus coeruleus contrast with measures of apathy and cognition.

Results

Reduced contrast was observed in the caudal locus coeruleus for both PD and PSP relative to controls, with significant regional and voxelwise differences (HC>PD, right caudal locus coeruleus, 37 voxels; HC>PSP, bilateral caudal locus coeruleus, 206 voxels). PSP and PD patients showed similar levels of locus coeruleus degeneration relative to controls, but this was spatially more extensive in PSP. Across both groups, variability of locus coeruleus integrity was associated with cognitive performance (MoCA: 200 voxels; ACE-R: 70 voxels) and apathy (Apathy Scale: 99 voxels).

Conclusions

The relationship between locus coeruleus structure and non-motor symptoms highlights a role for noradrenergic dysfunction across both PD and PSP, confirming the potential for noradrenergic therapeutic strategies to address transdiagnostic cognitive and behavioural features in neurodegenerative disease.
COVID-Nets: Deep CNN Architectures for Detecting COVID-19 Using Chest CT Scans
Authors: Alshazly Hammam , Linse Christoph , Abdalla Mohamed , Barth Erhardt , Martinetz Thomas
Published: April 2021

This paper introduces two novel deep convolutional neural network (CNN) architectures for automated detection of COVID-19. The first model, CovidResNet, is inspired by the deep residual network (ResNet) architecture. The second model, CovidDenseNet, exploits the power of densely connected convolutional networks (DenseNet). The proposed networks are designed to provide fast and accurate diagnosis of COVID-19 using computed tomography (CT) images for the multi-class and binary classification tasks. The architectures are utilized in a first experimental study on the SARS-CoV-2 CT-scan dataset, which contains 4173 CT images for 210 subjects structured in a subject-wise manner for three different classes. First, we train and test the networks to differentiate COVID-19, non-COVID-19 viral infections, and healthy. Second, we train and test the networks on binary classification with three different scenarios: COVID-19 vs. healthy, COVID-19 vs. other non-COVID-19 viral pneumonia, and non-COVID-19 viral pneumonia vs. healthy. Our proposed models achieve up to 93.96% accuracy, 99.13% precision, 94% sensitivity, 97.73% specificity, and a 95.80% F1-score for binary classification, and up to 83.89% accuracy, 80.36% precision, 82% sensitivity, 92% specificity, and a 81% F1-score for the three-class classification tasks. The experimental results reveal the validity and effectiveness of the proposed networks in automated COVID-19 detection. The proposed models also outperform the baseline ResNet and DenseNet architectures while being more efficient.
Pharmacovigilance Analysis on Cerebrovascular Accidents and Coronavirus disease 2019 Vaccines
Authors: Aggarwal Lt. Pushkar
Published: April 2021

Introduction

Recently, there have been reports of cerebrovascular accidents (CVA) occurring in individuals who have received the Coronavirus disease 2019 (COVID-19) vaccine.

Objective

The objective of this analysis was to determine if a statistically significant signal exists in post-marketing safety reports between CVA and the three COVID-19 vaccines being administered in the United States of America (Pfizer, Moderna, Janssen).

Methods

A pharmacovigilance disproportionality analysis on adverse events reported with COVID-19 vaccines was conducted using data from Vaccine Adverse Event Reporting System.

Results

A statistically significant signal was found between CVA events and each of the three COVID-19 vaccines (Pfizer/BioNTech’s, Moderna’s and Janssen’s) in the VAERS database. Females and individuals of age 65 or older had higher number of case reports of CVA events with the COVID-19 vaccines. Females had also more COVID-19 adverse event reports in which a CVA was reported and resulted in the patient having permanent disability or death.

Limitations

Randomized controlled trials are needed to further analyze this signal.

Conclusion

Patients should be made aware of the risk-benefit and symptoms to watch out for that may indicate the onset of a CVA and informed to seek medical care as soon as possible if they develop these symptoms.
Men and sexual and reproductive healthcare in the Nordic countries: a scoping review
Authors: Baroudi Mazen , Stoor Jon Petter , Blåhed Hanna , Edin Kerstin , Hurtig Anna-Karin
Published: April 2021

Context

Men generally seek healthcare less often than women and, other than traditional gender norms, less is known about the explanation. The aim was to identify knowledge gaps and factors influencing men regarding sexual and reproductive healthcare (SRHC) in the Nordic countries.

Methods

We searched PubMed and SveMed+ for peer-reviewed articles published between 2010 and 2020. The analyses identified factors influencing men’s experiences of and access to SRHC.

Results

The majority of the 68 articles included focused on pregnancy, birth, infertility, and sexually transmitted infections including HIV. During pregnancy and childbirth, men were treated as accompanying partners rather than individuals with their own needs. The knowledge and attitudes of healthcare providers were crucial for their ability to provide SRHC and for the experiences of men. Organizational obstacles, such as women-centred SRHC and no assigned profession, hindered men’s access to SRHC. Lastly, the literature rarely discussed the impact of health policies on men’s access to SRHC.

Conclusions

The identified knowledge gap indicates the necessity of the improved health and medical education of healthcare providers, as well as of health system interventions.
The correlation between fetal frontal lobe development parameters and gestational week: A preliminary study
Authors: Pingping Xu , Dirong Zhang , Yu Shi , Dandan Li , Yuan Li , Fengbei Kong
Published: April 2021

Objective

To establish a reference range of developmental parameters related to the frontal lobe of normal fetuses in different gestational weeks, which can provide a basis for the evaluation of normal development of the frontal lobe and the diagnosis of suspected fetal microcephaly.

Methods

A prospective cross-sectional study was performed on 751 normal fetuses between 21 and 36 weeks, and the anterior-posterior diameter and transverse diameter of the frontal lobe were measured in transcerebellar plane. Linear regression analysis was performed by grouping different gestational weeks.

Results

Fetal anterior-posterior diameter and transverse diameter of the frontal lobe were positively correlated with gestational week with correlation coefficients 0.871 and 0.971 respectively. There was a linear relationship between gestational weeks and frontal lobe parameters, and the equations were simplified to obtain the simple correlation formula: fetal frontal lobe anterior-posterior diameter(mm)=14.5+0.7×(gestational week-21), frontal lobe transverse diameter (mm)=41+2.5×(gestational week-21).

Conclusion

The reference ranges of the frontal lobe anterior-posterior diameter and the frontal lobe transverse diameter of normal fetuses between 21 to 36 weeks in transcerebellar plane were established, which can provide valuable information for the evaluation of normal development of the frontal lobe and the diagnosis of suspicious fetal microcephaly.

What’s already known about this topic?

We currently lack a golden standard to diagnosis microcephaly and fetal frontal lobe dysplasia is a clue for prenatal diagnosis of microcephaly.

What does this study add?

This study presents a novel evaluation of the fetal frontal lobe to better assess brain development in the transcerebellar plane.

The fetal frontal lobe developmental diameters will be useful to aid diagnosis of suspicious microcephaly and other cortical developmental disorders.
Use of Ketamine Infusions for Treatment of Complex Regional Pain Syndrome: A Systematic Review
Authors: Patil Anand S. , Chitneni Ahish , Dalal Suhani , Ghorayeb Joe , Pham Yolanda , Grigoropoulos Gregory
Published: April 2021

Background

This systematic review aims to review clinical studies on the use of ketamine infusion for patients with treatment-resistant Complex Regional Pain Syndrome (CRPS).

Methods

The following systematic review was registered on PROSPERO (CRD42021228470). Studies for the systematic review were identified through 3 databases; PubMed, CINAHL, and Cochrane Review. Inclusion criteria for studies consisted of randomized clinical trials or cohort studies that conducted trials on the use of ketamine infusion for pain relief in patients with Complex Regional Pain Syndrome (CRPS). Exclusion criteria for studies included any studies that were systematic review, meta-analyses, case reports, literature reviews, or animal studies. In the included studies, the primary outcome of interest was post drug administration pain score.

Results

In this systematic review, 14 studies met the inclusion criteria and were reviewed. In these studies, the dosage of ketamine infusion used ranged from 0.15 mg/kg to 7mg/kg with primary indication being treatment of Complex Regional Pain Syndrome (CRPS). In 13 of the studies, ketamine infusion resulted in a decrease in pain scores and relief of symptoms.

Conclusions

Patients who received Ketamine infusion for treatment-resistant CRPS self-reported adequate pain relief with treatment. This suggests that ketamine infusion may be a useful form of treatment for patients with no significant pain relief with other conservative measures. Future large-scale studies, including randomized double-blind placebo-controlled trials on the use of ketamine infusion for CRPS must be conducted in a large-scale population to further assess the effectiveness of ketamine infusion in these populations.
Brain disconnectome mapping and serum neurofilament light levels in multiple sclerosis
Authors: Rise Henning H. , Brune Synne , Chien Claudia , Berge Tone , Bos Steffan D. , Andorra Magi , Valdeolivas Irene Pulido , Beyer Mona K. , Sowa Piotr , Scheel Michael , Brandt Alexander U. , Asseyer Susanna , Blennow Kaj , Pedersen Mads L. , Zetterberg Henrik , de Schotten Michel Thiebaut , Cellerino Maria , Uccelli Antonio , Paul Friedemann , Villoslada Pablo , Harbo Hanne F. , Westlye Lars T. , Høgestøl Einar A.
Published: April 2021

The pathophysiological mechanisms for classical plaque characteristics and their predictive value for clinical course and outcome in multiple sclerosis is unclear. Connectivity-based approaches incorporating the distribution and magnitude of the extended brain network aberrations caused by lesions may offer higher sensitivity for axonal damage. Using individual brain disconnectome mapping, we tested the longitudinal associations between putative brain network aberrations and levels of serum neurofilament light chain (sNfL) as a neuroaxonal injury biomarker.

Multiple sclerosis patients (n= 328, mean age 42.9 years, 71 % female) were prospectively enrolled at four European multiple sclerosis centres, and reassessed after two years (n = 280). Post-processing of 3 Tesla (3T) MRI data was performed at one centre using a harmonized pipeline, and disconnectome maps were calculated using BCBtoolkit based on individual lesion maps. Global disconnectivity (GD) was defined as the average disconnectome probability in each patient’s white matter. Serum NfL concentrations were measured by single molecule array (Simoa). Robust linear mixed models (rLMM) with GD or T2-lesion volume (T2LV) as dependent variables, patient and centre as a random factor, sNfL, age, sex, timepoint for visit, diagnosis, and treatment as fixed factors were run.

Robust LMM revealed significant associations between higher levels of GD and increased sNfL (t= 2.30,β= 0.03,p= 0.02), age (t= 5.01,β= 0.32,p< 5.5 × 10−7), and diagnosis progressive multiple sclerosis (PMS);t= 1.97,β= 1.06,p= 0.05), but not for sex (t= 0.78,p= 0.43), treatments (effective;t= 0.85,p= 0.39, highly-effective;t= 0.86,p= 0.39) or sNfL change between base line and two-year follow up (t= −1.65,p= 0.10). Voxel-wise analyses revealed distributed associations in cerebellar and brainstem regions.

In our prospective multi-site multiple sclerosis cohort, rLMMs demonstrated that the extent of global brain disconnectivity is sensitive to a systemic biomarker of axonal damage, sNfL, in patients with multiple sclerosis. These findings provide a neuropathological correlate of advanced disconnectome mapping and provide a platform for further investigations of the functional and clinical relevance in patients with brain disorders.
VGsim: scalable viral genealogy simulator for global pandemic
Authors: Shchur Vladimir , Spirin Vadim , Sirotkin Dmitry , Burovski Evgeni , De Maio Nicola , Corbett-Detig Russell
Published: April 2021

Accurate simulation of complex biological processes is an essential component of developing and validating new technologies and inference approaches. As an effort to help contain the COVID-19 pandemic, large numbers of SARS-CoV-2 genomes have been sequenced from most regions in the world. More than 5.5 million viral sequences are publicly available as of November 2021. Many studies estimate viral genealogies from these sequences, as these can provide valuable information about the spread of the pandemic across time and space. Additionally such data are a rich source of information about molecular evolutionary processes including natural selection, for example allowing the identification of new variants with transmissibility and immunity evasion advantages. To our knowledge, there is no framework that is both efficient and flexible enough to simulate the pandemic to approximate world-scale scenarios and generate viral genealogies of millions of samples. Here, we introduce a new fast simulator VGsim which addresses the problem of simulation genealogies under epidemiological models. The simulation process is split into two phases. During the forward run the algorithm generates a chain of population-level events reflecting the dynamics of the pandemic using an hierarchical version of the Gillespie algorithm. During the backward run a coalescent-like approach generates a tree genealogy of samples conditioning on the population-level events chain generated during the forward run. Our software can model complex population structure, epistasis and immunity escape. The code is freely available at https://github.com/Genomics-HSE/VGsim.