bluuebunny/crossref_metadata_2025 huggingface dataset:
The Situation-Specific Theory of Heart Failure Self-care
Authors: Riegel Barbara , Dickson Victoria Vaughan , Vellone Ercole
Published: April 2022

Many studies of heart failure (HF) self-care have been conducted since the last update of the situation-specific theory of HF self-care.

Objective

The aim of this study was to describe the manner in which characteristics of the problem, person, and environment interact to influence decisions about self-care made by adults with chronic HF.

Methods

This study is a theoretical update. Literature on the influence of the problem, person, and environment on HF self-care is summarized.

Results

Consistent with naturalistic decision making, the interaction of the problem, person, and environment creates a situation in which a self-care decision is needed. Problem factors influencing decisions about HF self-care include specific conditions such as cognitive impairment, diabetes mellitus, sleep disorders, depression, and symptoms. Comorbid conditions make HF self-care difficult for a variety of reasons. Person factors influencing HF self-care include age, knowledge, skill, health literacy, attitudes, perceived control, values, social norms, cultural beliefs, habits, motivation, activation, self-efficacy, and coping. Environmental factors include weather, crime, violence, access to the Internet, the built environment, social support, and public policy.

Conclusions

A robust body of knowledge has accumulated on the person-related factors influencing HF self-care. More research on the contribution of problem-related factors to HF self-care is needed because very few people have only HF and no other chronic conditions. The research on environment-related factors is particularly sparse. Seven new propositions are included in this update. We strongly encourage investigators to consider the interactions of problem, person, and environmental factors affecting self-care decisions in future studies.
Clubfoot: Review on Assessment, Treatment, Challenges, and Engineering Aspects
Authors: Singh Shamsher , Mali Harlal Singh
Published: April 2022

Introduction

Clubfoot, mainly CTEV, is a complex three-dimensional deformity challenging physicians from ancient times. Among a thousand babies born, one to six suffer from clubfoot deformity; that is, in India alone, around 35,000 need treatment for clubfoot annually. This review summarizes the various practices of clubfoot assessment, noninvasive treatment, and engineering aspects of clubfoot treatment. The shortcomings of assessment methods and challenges with implementation of treatment methods are also presented.

Methods

A narrative review of all related research papers available to authors was carried out.

Results

Various clubfoot assessment methods have been developed to help physicians understand the severity of the problem and predict treatment parameters. The Pirani score and Dimeglio score are used predominantly for the assessment of deformity. However, these methods suffer from implementation-related limitations. Noninvasive methods, namely, Kite's method, functional physiotherapy method, and Ponseti method, are used in practice for treatment. The Ponseti method is the most popular with parents and physicians and is considered the gold standard for the treatment of clubfoot. However, it also suffers from various implementation issues, like treatment cost and lack of experts, particularly in low- and middle-income countries (LMICs). Engineers are using various technologies like computer-aided design (CAD)/computer-aided engineering (CAE) and additive manufacturing for modeling and analysis of clubfoot. Engineers have also attempted to develop corrective and maintenance orthosis for CTEV treatment.

Conclusions

Because newer and newer technologies are becoming accessible for interdisciplinary use, there is a need to apply contemporary technologies, especially to develop a corrective orthosis so that the current challenges of clubfoot assessment and treatment are addressed. The corrective orthosis should be based on Dr Ponseti's insights into clubfoot biomechanics.

Clinical Relevance

There is a need to explore contemporary technologies like data acquisition and CAD/CAE to address CTEV assessment–related issues. A corrective orthosis based on the understanding of the foot biomechanics for treatment can solve the various implementation-related challenges of the Ponseti method, particularly in low-resource settings.
Construction and validation of a robust ferroptosis-associated gene signature predictive of prognosis in lung adenocarcinoma
Authors: Zhou Mi , Zhu Xin
Published: April 2022

To construct and validate a ferroptosis-associated signature predictive of prognosis in lung adenocarcinoma (LUAD), and systematically evaluate the underlying molecular connections in cancer biology.

We retrieved mRNAs sequencing profiles of LUAD from the cancer genome atlas (TCGA) data portal and clinical information from the cBio Cancer Genomics Portal. The differentially expressed ferroptosis-associated genes (DEFAGs) were screened between normal samples and LUAD by packages “limma” in R. Then the total TCGA cohort was randomly divided into training set and testing set. Based on the training set, a DEFAG signature was built and further validated in the test set, the total TCGA cohort and other independent cohorts from the gene expression omnibus data portal. A nomogram was constructed and validated, and the correlation between high-risk group and cancer biology was further evaluated.

We initially identified 68 DEFAGs from TCGA cohort. A 6 DEFAG signature was built and further validated in the test set, the total TCGA cohort and other 2 independent cohorts including GSE31210 and GSE72094 from gene expression omnibus data portal. Further exploration indicated that high-risk group combined with TP53 mutation harbored the most unfavorable prognosis while low-risk group with TP53 wild-type status had the most favorable survival advantage over other groups. Moreover, high-risk group was associated with higher cancer stemness, tumor mutation burden, and CD274 (programmed cell death 1 ligand 1) expression.

We constructed a robust ferroptosis-associated gene signature and a nomogram predictive of prognosis in LUAD, and provided a new perspective on associations between ferroptosis and cancer.
Correlation between polymorphism of vitamin D receptor TaqI and susceptibility to tuberculosis
Authors: Li Bin , Wen Fei , Wang Zhaofen
Published: April 2022

Background:

To investigate the association between TaqI polymorphism of the vitamin D receptor gene and tuberculosis (TB).

Methods:

A systematic search was performed in PubMed, Embase, Web of Science, Elsevier Science Direct, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang, and Chongqing VIP databases for case-control study on TaqI gene polymorphism and TB susceptivity. Quality assessment of studies was performed using the Newcastle–Ottawa Scale for the methodological assessment of case-control studies, and R 4.0.5 software was used for the meta-analysis.

Results:

Among the 243 selected articles, 27 in the meta-analysis. The meta-analysis showed that the TaqI gene polymorphism allene gene model (t vs T, odds ratio [OR]: 1.12, 95% confidence interval [CI]: 0.99–1.27); dominant model (tt + tT vs TT, OR: 1.12, 95% CI: 0.98–1.29); recessive model (tt vs tT + TT, OR: 1.25, 95% CI: 1.03–1.51); codominant A (tt vs TT, OR: 1.37, 95% CI: 1.00–1.87); codominant B (tT vs TT, OR: 1.09, 95% CI: 0.99–1.19). And subgroup dominant model (tt + tT vs TT, OR: 1.27, 95% CI: 1.03–1.55) in Indianas, recessive model (tt vs tT + TT, OR: 1.49, 95% CI: 1.05–2.11) in Iranians, co-dominant B (tT vs TT, OR: 1.28, 95% CI: 1.03–1.59; OR: 1.42, 95% CI: 1.05–1.93) in Indianas and Iranians.

Conclusion:

This meta-analysis suggests a significant association between TB and the risk of TaqI in Iranians and Indians, but the vitamin D receptor polymorphism TaqI was not associated with Chinese. Thus, validation studies will be required to confirm these findings.
Clinical features and predictive factors related to liver injury in SARS-CoV-2 Delta and Omicron variant-infected patients
Authors: Deng Haohui , Lin Haowei , Mai Yuzhen , Liu Huiyuan , Chen Weilie
Published: April 2022

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta and Omicron variants have become the dominant variants worldwide, and studies focused on liver injury in these patients are limited.

Materials and methods

In this study, 157 SARS-CoV-2-infected patients were enrolled, including 77 Delta variant-infected patients and 80 Omicron variant-infected patients. Liver injury data and clinical data were summarized and compared between patients infected with the two variants, additionally, patients with or without liver injury were also compared and multivariate analysis was performed to explore the predictive factors related to liver injury in SARS-CoV-2-infected patients.

Results

Liver injury was found in 18 (23.4%)/15 (18.8%) in Delta/Omicron variant-infected patients on admission, and 4 (5.2%)/1 (1.3%) in Delta/Omicron variant-infected patients during hospitalization, respectively. The ratios of liver injury did not differ between the two groups (χ
2 = 1.571; P = 0.210). Among these patients, 17 (77.3%) and 12 (75.0%) Delta and Omicron variant-infected patients were considered to be related to SARS-CoV-2 infection, the biomarkers of liver function were mildly elevated, dominated by the parameter of cholangiocyte injury: 76.5% (13/17) and 83.3% (10/12) in Delta and Omicron variant-infected patients, and most of these patients recovered to normal during follow-up. Multivariate analysis showed that male sex [odds ratio (OR), 4.476; 95% confidence interval (CI), 1.235–16.222; P = 0.023] and high levels of peak viral load in the nasopharynx (OR, 3.022; 95% CI, 1.338–6.827; P = 0.008) were independent factors related to liver injury.

Conclusion

Cholangiocyte injury biomarkers are dominated in Delta and Omicron variant-infected patients, male sex and high levels of peak viral load in the nasopharynx are predictive factors related to liver injury in SARS-CoV-2-infected patients.
The relation of esophagogastroduodenoscopy time and novel upper gastrointestinal quality measures
Authors: Romańczyk Marcin , Romańczyk Tomasz , Lesińska Magdalena , Barański Kamil , Hartleb Marek , Waluga Marek
Published: April 2022

Objectives

Various measures of esophagogastroduodenoscopy (EGD) quality have been proposed so far and the examination time was one of the first. The aim of the study was to compare the procedure time with novel novel quality measures – composite detection rate (CDR) and endoscopist biopsy rate (EBR).

Methods

It was prospective observational study. A total of 880 diagnostic EGDs conducted from 01.2019 to 07.2019 have been enrolled in the study.

Results

Median EGD time was 4.2 min. Procedures of longer duration were marked with higher CDR (26.3% vs. 11.8%; P < 0.0001), higher EBR (44.9% vs. 12.3%; P < 0.0001), and better upper gastrointestinal neoplasm (UGN) detection (1.8% vs. 0%; P = 0.004) in comparison with procedures of shorter duration. The procedures were divided into 4 groups based on the time quartiles (group 1 <3.3 min; group 2 3.3–4.2 min; group 3 4.2–5.3 min; group 4 >5.3 min). The odds ratios of groups 2, 3, and 4 for biopsy rate were 2.42 (95% CI, 1.33–4.55), 4.33 (95% CI, 2.46–7.94), and 5.51 (95% CI, 3.18–10.03), respectively, in comparison with group 1. The odds ratios of groups 2, 3, and 4 for CDR were 3.18 (95% CI, 2.03–4.97), 5.46 (95% CI, 3.51–8.50), and 23.44 (95% CI, 14.3–38.4), respectively, in comparison with group 1.

Conclusions

The procedure time is related to novel metrics – CDR and EBR. It is also related to UGN. Based on our findings it could be concluded that EGD should not last less than 4.2 min.
Multicentre, retrospective study to assess long-term outcomes of chelator based treatment with trientine in Wilson disease patients withdrawn from therapy with d-penicillamine
Authors: Weiss Karl Heinz , Kruse Carlot , Manolaki Nina , Zuin Massimo , Ferenci Peter , van Scheppingen Daphne , Wijnberg Larissa , de Koning Constance E. , Dhawan Anil
Published: April 2022

Objectives

Trientine dihydrochloride (TETA-2HCl) has been used for the treatment of Wilson disease for over 30 years. The current study was designed to systematically evaluate existing data to further define the long-term outcome of the efficacy and tolerability of TETA-2HCl in Wilson disease patients.

Methods

Medical records of 77 Wilson disease patients were reviewed to collect data on hepatic and neurologic symptoms, copper (Cu) homeostasis and adverse events. Data were collected for 48 months after initiation of TETA-2HCl after withdrawal of D-penicillamine treatment.

Results

Mean duration of TETA-2HCl treatment was 8 years (range 5 months–32.5 years). Over the course of TETA-2HCl treatment, 35% of patients had no hepatic symptoms whereas in 49.4% of patients, hepatic symptoms improved. They remained unchanged in 10.4% of patients and worsened in 5.2% of patients. No patients progressed to acute hepatic failure or necessity of a liver transplant. During TETA-2HCl treatment, 46.7% of patients had no neurologic symptoms; in 14.3% of patients, neurologic symptoms improved whereas in 36.4% of patients, they remained stable and worsened in 2.6% of patients. During the evaluation period, 12 patients discontinued TETA-2HCl treatment due to: anemia (N = 1), inadequate hepatic response (N = 2), switch to zinc treatment (N = 8) and patient’s decision to withdraw from treatment (N = 1). Treatment-emergent adverse events were reported by 24.7% of the patients of which gastrointestinal disorders (9.1%) and nervous system disorders (5.2%) were most reported.

Conclusions

TETA-2HCl is well-tolerated and effective in Wilson disease patients following the withdrawal of treatment with D-penicillamine. ClinicalTrials.gov
Identifier: NCT02426905.
Threshold of Quantitative Cytomegalovirus DNA PCR for Preemptive Treatment in Pediatric Hematopoietic Stem Cell Transplant Recipients
Authors: Ahn Bin , Yun Ki Wook , Hong Kyung Taek , Choi Jung Yoon , Kang Hyoung Jin , Seong Moon-Woo , Kim Taek Soo , Ahn Sung Jin , Choi Eun Hwa
Published: April 2022

Background:

Consensus cytomegalovirus (CMV) DNA viral load thresholds for intervention in hematopoietic stem cell transplant (HSCT) recipients have not been established, especially in children. This study aimed at obtaining viral load thresholds of CMV DNA to guide preemptive management in pediatric HSCT recipients.

Materials and Methods:

A total of 465 blood samples from 177 children who received HSCT between 2015 and 2019 were included in a single center in Korea. The samples were analyzed for CMV infection by both antigenemia assay and quantitative DNA polymerase chain reaction. The 2 assay results were compared for the 233 samples which were collected when antiviral treatment has not been initiated. We determined the viral loads corresponding to the antigenemia of 5 pp65-positive cells/2×105 white blood cells (WBCs) as the level for initiating preemptive therapy.

Results:

Sixty percent of the samples were collected within 100 days (39.7% in 0 to 50 d, 60.2% in 0 to 100 d) from the graft infusion. The correlation between CMV DNA viral load and CMV antigenemia level increased significantly after 50 days from the graft infusion (r=0.71 vs. r=0.93, P<0.0001). The correlation was greater in the antiviral treatment-naive group than the treatment group (r=0.75 vs. r=0.66, P<0.0001). Under receiver operating characteristic curve analysis of the treatment-naive group, the estimated threshold CMV DNA viral loads corresponding to 5 pp65-positive cells/2×105 WBCs was 898 IU/mL.

Conclusions:

The CMV DNA levels that corresponded to 5 pp65-positive cells/2×105 WBCs was 900 IU/mL in the HSCT group. The proposed viral load thresholds can be used to guide preemptive therapy in pediatric HSCT recipients, especially in the preengraftment period.
Shwachman-Diamond Syndrome With Congenital Myogenic Ptosis: Case Report of a Rare Association?
Authors: Wang Nai-Wei , Georgara Natalia , Khan Haji S.
Published: April 2022

Background:

Shwachman-Diamond syndrome (SDS) is a multisystem disorder characterized by exocrine pancreatic insufficiency and bone marrow failure. There is considerable variation in the phenotypes of SDS. We present a case of an infant presenting with SDS and left-sided ptosis.

Observation:

We report a case of an infant who presented with 2 episodes of severe sepsis and cytopenia, without overt symptoms of exocrine pancreatic deficiency or skeletal abnormalities. Persistent left-sided ptosis was noted in both presentations. Genetic testing confirmed the diagnosis of SDS. The left-sided ptosis was diagnosed as congenital myogenic ptosis.

Conclusion:

The association of ptosis and other congenital bone marrow failure syndromes is well established, but this is the first description of SDS with ptosis. This association may expand our understanding of SDS phenotypes if similar cases are reported in the future.
Family Caregivers’ Experiences of Caring for Advanced Cancer Patients
Authors: Zhu Yuxuan , Pei Xianbo , Chen Xiaoli , Li Tong
Published: April 2022

Background

Advanced cancers qualify as severe stressors to family caregivers (FCGs), which can negatively impact caregivers’ psychological and physical well-being because of their association with high symptom burden, distress, and poor prognosis.

Objective

This review aims to synthesize FCGs’ experiences of caring for advanced cancer patients using a qualitative systematic review method.

Methods

A comprehensive search was conducted in 7 databases from inception until July 2020. Two reviewers independently screened and assessed each study using Joanna Briggs Institute instruments and subsequently undertook the meta-aggregation approach to synthesize findings.

Results

A total of 26 studies were included, refined to 37 findings, and integrated into 9 categories and 5 synthesized findings. When a loved one with advanced cancer faced deterioration near the end of their life, FCGs showed a tremendous sense of responsibility for care and concerted great efforts to alleviate their loved one’s suffering while lacking effective professional support. Cultural beliefs had a great impact on FCGs’ responsibility and role recognition. Ultimately, the caregiving helped FCGs achieve personal transcendence inherent in their unique experience.

Conclusions

Caring for advanced cancer patients is a unique, culture-specific experience marked by struggle. Effective professional support, including early palliative care, should be considered to improve the FCGs’ experience of caring for advanced cancer patients. Cultural beliefs should be considered to understand and develop appropriate strategies to support FCGs.

Implications for Practice

Healthcare providers need to ensure that individualized, multifaceted interventions considering FCGs’ needs are delivered at the optimal time with the appropriate approach.
A Case of TFE3-positive Non-neoplastic Pseudodecidualized Endometrium Presenting as a Cervical Mass
Authors: Serinelli Serenella , Hariri Dana , de la Roza Gustavo , Zaccarini Daniel J.
Published: April 2022

Transcription factor E3 (TFE3) represents a useful target for immunohistochemistry assays in routine surgical pathology practice. This protein has shown nuclear expression in a variety of normal tissues; however, this expression is usually at very low levels, while strong nuclear immunoreactivity of TFE3 has been seen almost exclusively in tumors. We present the case of a 30-year-old female on oral contraceptive pill (drospirenone/ethinylestradiol) and with complaints of dysmenorrhea and menorrhagia. She was found to have a cervical mass on pelvic ultrasound, and the biopsy showed fragments of benign squamous epithelium and polypoid endometrial tissue with stromal pseudodecidualization and abundant mixed inflammation. The pseudodecidualized stromal component showed moderate to strong nuclear staining in ~85% of stromal cells for TFE3. We discuss the intracellular role of TFE3 during inflammatory states and hypothesize that TFE3 expression can be associated with ongoing inflammation. Our case shed light upon the possibility that non-neoplastic environments with an inflammatory background could lead to increased nuclear expression of TFE3. Pathologists should be aware of the possibility of strong nuclear expression of TFE3 in non-neoplastic endometrium to avoid potential misdiagnosis.
Peripheral and Central/Intraosseous Vasoactive Infusions During and After Pediatric Critical Care Transport: Retrospective Cohort Study of Extravasation Injury*
Authors: Peshimam Niha , Bruce-Hickman Kara , Crawford Katrina , Upadhyay Gaurang , Randle Elise , Ramnarayan Padmanabhan , Jones Andrew J.
Published: April 2022

OBJECTIVES:

To compare the prevalence of adverse events related to vasoactive drug infusions administered via a peripheral venous catheter versus a central venous or intraosseous catheter.

DESIGN:

Retrospective observational study.

SETTING:

A pediatric critical care transport team, and the PICUs and regional hospitals within the North Thames and East Anglia regions of the United Kingdom.

PATIENTS:

Children (up to 18 yr old) transported by the Children’s Acute Transport Service receiving an infusion of a vasoactive drug (epinephrine, dobutamine, dopamine, norepinephrine, and vasopressin).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The medical records of all children transported between April 2017 and May 2020 receiving a vasoactive drug infusion were reviewed and cross-referenced with the service critical incident database. The outcome measure was anatomic catheter-related adverse events (including extravasation) reported during transport or in the first 24 hours on the PICU. During the study period, the service undertook 3,836 transports. Vasoactive drugs were administered during 558 patient transports (14.5%). During 198 of 558 transports (35.5%), vasoactive drugs were administered via a peripheral venous catheter, with seven of 198 (3.5%) adverse events. One extravasation event resulted in tissue necrosis. The median time to injury after the infusion was commenced was 60 minutes (interquartile range, 30–60 min). During 360 of 558 transports (64.5%), vasoactive infusions were administered by central venous or intraosseous catheter, with nine of 360 (2.5%) adverse events.

CONCLUSIONS:

During pediatric critical care transport, we did not find a difference in prevalence of adverse events following the administration of vasoactive drugs via peripheral venous catheters or via central venous and intraosseous catheters.
Clinical Decision Support in the PICU: Implications for Design and Evaluation*
Authors: Dziorny Adam C. , Heneghan Julia A. , Bhat Moodakare Ashwini , Karavite Dean J. , Sanchez-Pinto L. Nelson , McArthur Jennifer , Muthu Naveen ,   on behalf of the Pediatric Data Science and Analytics (PEDAL) Subgroup of the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network
Published: April 2022

OBJECTIVES:

To assess the current landscape of clinical decision support (CDS) tools in PICUs in order to identify priority areas of focus in this field.

DESIGN:

International, quantitative, cross-sectional survey.

SETTING:

Role-specific, web-based survey administered in November and December 2020.

SUBJECTS:

Medical directors, bedside nurses, attending physicians, and residents/advanced practice providers at Pediatric Acute Lung Injury and Sepsis Network-affiliated PICUs.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The survey was completed by 109 respondents from 45 institutions, primarily attending physicians from university-affiliated PICUs in the United States. The most commonly used CDS tools were people-based resources (93% used always or most of the time) and laboratory result highlighting (86%), with order sets, order-based alerts, and other electronic CDS tools also used frequently. The most important goal providers endorsed for CDS tools were a proven impact on patient safety and an evidence base for their use. Negative perceptions of CDS included concerns about diminished critical thinking and the burden of intrusive processes on providers. Routine assessment of existing CDS was rare, with infrequent reported use of observation to assess CDS impact on workflows or measures of individual alert burden.

CONCLUSIONS:

Although providers share some consensus over CDS utility, we identified specific priority areas of research focus. Consensus across practitioners exists around the importance of evidence-based CDS tools having a proven impact on patient safety. Despite broad presence of CDS tools in PICUs, practitioners continue to view them as intrusive and with concern for diminished critical thinking. Deimplementing ineffective CDS may mitigate this burden, though postimplementation evaluation of CDS is rare.
Increased Fellow Scholarly Publication Rate After Implementation of a Comprehensive Research Curriculum and Milestone-Based Research Timeline for Pediatric Emergency Medicine Fellows
Authors: Schmucker Kyle A. , Zuckerbraun Noel S. , Vitale Melissa A. , Hickey Robert W. , Callaway Clifton W. , Pitetti Raymond D. , Saladino Richard A. , Manole Mionora D.
Published: April 2022

Objective

Pediatric subspecialty fellows are required to complete a scholarly product during training; however, many do not bring the work to publication. To amplify our fellows’ publication success, our pediatric emergency medicine fellowship program implemented a comprehensive research curriculum and established a milestone-based research timeline for each component of a project. Our objective was to assess whether these interventions increased the publication rate and enhanced the graduated fellows' perceived ability to perform independent research.

Methods

Our study was conducted at a tertiary children's hospital affiliated with an academic university, enrolling 3 fellows each year in its pediatric emergency medicine program. A comprehensive research curriculum and a milestone-based research timeline were implemented in 2011. We analyzed the publication rate of our graduating fellows before (2004–2011) and after (2012–2016) our intervention. In addition, in 2017 we surveyed our previous fellows who graduated from 2004 to 2016 and analyzed factors favoring manuscript publication and confidence with various research skills.

Results

During the study period, 38 trainees completed the fellowship program. Publication rate increased from 26% ± 17% to 87% ± 30 % (P < 0.05). When scoring the importance of various factors, fellows most valued mentorship (5 ± 0 vs 4.3 ± 1.0, P < 0.05, postintervention vs preintervention) for the completion of the fellowship study and manuscript. Fellows after the intervention reported greater confidence in performing an analysis of variance (89% vs 36%, odds ratio, 6.3; 95% confidence interval, 1.4–150.1).

Conclusions

Implementation of a comprehensive research curriculum and a milestone-based research timeline was associated with an increase in the publication rate within 3 years of graduation of our pediatric emergency medicine fellows. After implementation, fellows reported an increased importance of mentorship and greater confidence in performing an analysis of variance. We provide a comprehensive curriculum and a research timeline that may serve as a model for other fellowship programs.
Diagnosis of Internal Jugular Vein Septic Thrombophlebitis by Point-of-Care Ultrasound
Authors: Shah Aalap , Moake Matthew M.
Published: April 2022

Septic thrombophlebitis represents a rare but serious collection of diseases, which carry a high risk of morbidity and mortality requiring prompt and aggressive treatment. Diagnosis centers on identification of thrombus along with clinical and microbiologic data. We present a case where point-of-care ultrasound was used to diagnose septic thrombophlebitis of the internal jugular vein and expedite appropriate therapy. We further review the technique and literature for ultrasound diagnosis of venous thrombosis and associated thrombophlebitis.
Acute Acalculous Cholecystitis
Authors: Cortellazzo Wiel Luisa , Spezzacatene Anita , Gortani Giulia , Saccari Alessia , Taddio Andrea , Barbi Egidio
Published: April 2022

A 14-year-old adolescent girl presented with severe abdominal pain, tenderness, and guarding in the right upper quadrant associated with nonbilious vomiting, scleral icterus, and fever. Laboratory tests were consistent with acute hepatitis A virus–related cholestatic hepatitis. A point-of-care ultrasound showed mild gallbladder wall thickening with increased color Doppler flow and pericholecystic fluid collection, in the absence of gallstones or biliary ducts dilatation, thus suggesting acute acalculous cholecystitis. Both the clinical symptoms and the point-of-care ultrasound findings completely resolved within 1 week after admission with conservative treatment.
Point-of-Care Ultrasound for Pulse Checks in Pediatric Cardiac Arrest
Authors: Leviter Julie I. , Walsh Susan , Riera Antonio
Published: April 2022

Cardiac arrest is an infrequent but high-stakes scenario in pediatrics. Manual central pulse checks are unreliable. Point-of-care ultrasound is a noninvasive technique to visualize the heart and central vessels during resuscitation. We describe 2 cases in which point-of-care ultrasound helped aid management decisions in pediatric cardiac arrest.
Usability and Accessibility of Publicly Available Patient Safety Databases
Authors: Sheehan Julia G. , Howe Jessica L. , Fong Allan , Krevat Seth A. , Ratwani Raj M.
Published: April 2022

Objectives

The aims of the study were to identify publicly available patient safety report databases and to determine whether these databases support safety analyst and data scientist use to identify patterns and trends.

Methods

An Internet search was conducted to identify publicly available patient safety databases that contained patient safety reports. Each database was analyzed to identify features that enable patient safety analyst and data scientist use of these databases.

Results

Seven databases (6 hosted by federal agencies, 1 hosted by a nonprofit organization) containing more than 28.3 million safety reports were identified. Some, but not all, databases contained features to support patient safety analyst use: 57.1% provided the ability to sort/compare/filter data, 42.9% provided data visualization, and 85.7% enabled free-text search. None of the databases provided regular updates or monitoring and only one database suggested solutions to patient safety reports. Analysis of features to support data scientist use showed that only 42.9% provided an application programing interface, most (85.7%) provided batch downloading, all provided documentation about the database, and 71.4% provided a data dictionary. All databases provided open access. Only 28.6% provided a data diagram.

Conclusions

Patient safety databases should be improved to support patient safety analyst use by, at a minimum, allowing for data to be sorted/compared/filtered, providing data visualization, and enabling free-text search. Databases should also enable data scientist use by, at a minimum, providing an application programing interface, batch downloading, and a data dictionary.
Differentiation of Small Hepatic Abscess From Hepatic Metastasis With a Combination of Imaging Parameters
Authors: Lee Chul-min , Kang Bo-Kyeong , Kim Mimi
Published: April 2022

Objective

We aimed to evaluate the diagnostic performance of the combination imaging features to differentiate small (the lesion size of 3 cm or less) hepatic abscess from metastasis.

Methods

This retrospective study included patients with preexisting malignancy and small hepatic lesions who underwent contrast-enhanced computed tomography (CT) and gadoxetic acid–enhanced magnetic resonance imaging (MRI) within 4 days between March 2017 and July 2020. Two radiologists independently evaluated the imaging features of each focal hepatic lesion. Laboratory parameters were also recorded. Significant parameters differentiating hepatic abscess from hepatic metastasis were identified by univariate generalized estimating equation regression. We compared the diagnostic performances of laboratory parameters, imaging features, and their combinations.

Results

We included 16 patients (10 males and 6 females) with 35 hepatic abscesses and 21 patients (13 males and 8 females) with 62 metastases with a mean age of 70.3 years in this study. Abnormal segmental neutrophil, pathy parenchymal enhancement on CT, and absence of dark rim on MRI were associated with hepatic abscess (all P < 0.01). The combination of CT and MRI parameters showed significantly higher specificity and positive predictive value than CT alone (P ≤ 0.031), without significant difference in sensitivity and negative predictive value.

Conclusions

We have demonstrated that the combination of CT and MRI imaging features is helpful for the differentiation of small hepatic abscess from metastasis.
Image Quality Evaluation in Dual-Energy CT of the Chest, Abdomen, and Pelvis in Obese Patients With Deep Learning Image Reconstruction
Authors: Fair Eric , Profio Mark , Kulkarni Naveen , Laviolette Peter S. , Barnes Bret , Bobholz Samuel , Levenhagen Maureen , Ausman Robin , Griffin Michael O. , Duvnjak Petar , Zorn Adam P. , Foley W. Dennis
Published: April 2022

Objective

The aim of this study was to evaluate image quality in vascular and oncologic dual-energy computed tomography (CT) imaging studies performed with a deep learning (DL)–based image reconstruction algorithm in patients with body mass index of ≥30.

Methods

Vascular and multiphase oncologic staging dual-energy CT examinations were evaluated. Two image reconstruction algorithms were applied to the dual-energy CT data sets: standard of care Adaptive Statistical Iterative Reconstruction (ASiR-V) and TrueFidelity DL image reconstruction at 2 levels (medium and high). Subjective quality criteria were independently evaluated by 4 abdominal radiologists, and interreader agreement was assessed. Signal-to-noise ratio (SNR) and contrast-to-noise ratio were compared between image reconstruction methods.

Results

Forty-eight patients were included in this study, and the mean patient body mass index was 39.5 (SD, 7.36). TrueFidelity-High (DL-High) and TrueFidelity-Medium (DL-Med) image reconstructions showed statistically significant higher Likert scores compared with ASiR-V across all subjective image quality criteria (P < 0.001 for DL-High vs ASiR-V; P < 0.05 for DL-Med vs ASiR-V), and SNRs for aorta and liver were significantly higher for DL-High versus ASiR-V (P < 0.001). Contrast-to-noise ratio for aorta and SNR for aorta and liver were significantly higher for DL-Med versus ASiR-V (P < 0.05).

Conclusions

TrueFidelity DL image reconstruction provides improved image quality compared with ASiR-V in dual-energy CTs obtained in obese patients.
Electroconvulsive Therapy in Patients With Cardiac Implantable Electronic Devices
Authors: Purohith Abhiram Narasimhan , Vaidyanathan Sivapriya , Udupa Suma T. , Munoli Ravindra N. , Agarwal Sheena , Prabhu Mukund A. , Praharaj Samir Kumar
Published: April 2022

Objective

The aims of the study were to report the case of a 54-year-old man with recurrent depressive disorder with multiple medical comorbidities having a dual-chamber pacemaker, treated successfully with 11 sessions of electroconvulsive therapy, and to conduct a systematic review of published cases documenting the use of electroconvulsive therapy (ECT) in patients with cardiac implantable electronic devices (CIEDs) for treating major psychiatric disorders.

Methods

We searched electronic databases (MEDLINE, PubMed, Google Scholar, Embase, Cochrane Library, PsycINFO, and Crossref) and included studies reporting on the use of electroconvulsive therapy in patients with CIEDs.

Results

Thirty-five publications across 53 years (1967–2021) reported on 76 patients (including current report) who received a pooled total of 979 modified ECT sessions. The most common adverse events were premature ventricular contraction and hypertension. There have been no reports of serious adverse effects that necessitated the cessation of ECT.

Conclusions

Electroconvulsive therapy is a safe and efficacious treatment for major psychiatric disorders, and the presence of CIEDs should not delay or deter the use of ECT in these patients.
Nonremission After Electroconvulsive Therapy in Individuals With Major Depression
Authors: Hein Matthieu , Mungo Anaïs , Loas Gwenolé
Published: April 2022

Objectives

The aim of the present study was to investigate the risk of nonremission following electroconvulsive therapy (ECT), as associated with borderline personality disorder, in individuals with major depression in the context of the contradictory data available in the literature.

Methods

We analyzed demographic and clinical data from 210 individuals with major depression who were treated with ECT. Study participants were recruited from the medical records database of the Psychiatry Department at Erasme Hospital. Only individuals with major depression who were in remission, as demonstrated during the systematic psychiatric interview performed at the end of ECT (ie, with a >60% reduction in their 24-item Hamilton Depression Rating Scale score, combined with a score of <10), were included in the “remission” group. Logistic regression analyses were used to determine the risk of nonremission following ECT.

Results

Nonremission following ECT occurred frequently (42.9%) in our sample. Moreover, after adjusting for major confounding factors, multivariate logistic regression analyses demonstrated that borderline personality disorder was a risk factor for nonremission following ECT in individuals with major depression.

Conclusions

We demonstrated that borderline personality disorder was associated with a higher risk of nonremission following ECT in individuals with major depression. This finding seems to justify more systematic screening as well as more adequate management of this personality disorder in individuals with major depression who are treated with ECT to allow for attaining better remission rates in this subpopulation.
Halorhabdus amylolytica sp. nov. and Halorhabdus salina sp. nov., isolated from hypersaline environments
Authors: Wang Rui , Chen Feilong , Wang Jianzhong , Liu Aimin , Ke Lixia , Wan Fengying , Chen Shaoxing
Published: April 2022

Two novel extremely halophilic archaeal strains, designated H27T and FL145T, were isolated from a salt mine and a kelp salt sample, respectively. Cells of both strains were Gram-stain-negative, motile and pleomorphic. The 16S rRNA and rpoB′ gene sequence similarities between strains H27T and FL145T were 96.60 and 88.77%. Strains H27T and FL145T were both closely related to

Halorhabdus rudnickae

WSM-64T,

Halorhabdus tiamatea

SARL4BT and

Halorhabdus utahensis

AX-2T, with a 16S rRNA gene sequence similarities of 98.14, 96.34 and 96.27% for strain H27T and 96.42, 95.82 and 96.17% for strain FL145T. The genome-based average nucleotide identity (ANI) values between strains H27T and FL145T, and these three species were 83.93, 79.79 and 79.09% (for strain H27T), and 78.32, 77.95 and 77.05% (for strain FL145T), respectively. The ANI value between strains H27T and FL145T was 78.65 %. The digital DNA–DNA hybridization values between strains H27T and FL145T, and these three species were less than 27.40%, which were below the recommended threshold for membership of the same species. The major polar lipids of both strains were found to consist of sulfated diglycosyl diether, triglycosyl diether, phosphatidylglycerol phosphate methyl ester and phosphatidylglycerol. The DNA G+C content was determined from genome to be 62.10 mol% for strain H27T and 61.51 mol% for strain FL145T. Based on phylogenetic, phenotypic, chemotaxonomic and genomic analyses, these two new isolates should be classified as representing two novel species in the genus

Halorhabdus

, with strain H27T (=CGMCC 1.16342T=NBRC 113589T) as the type strain of a new species for which we propose the name Halorhabdus amylolytica sp. nov., and strain FL145T (=CGMCC 1.13888T=NBRC 114260T) as the type strain of another new species for which we propose the name Halorhabdus salina sp. nov.
Transient developmental increase in cortical projections to amygdala GABAergic neurons contribute to circuit dysfunction following early life stress
Authors: Haikonen Joni , Englund Jonas , Amarilla Shyrley Paola , Kharybina Zoia , Shintyapina Alexandra , Kegler Kristel , Garcia Marta Saez , Atanasova Tsvetomira , Taira Tomi , Hartung Henrike , Lauri Sari E.
Published: April 2022

Early life stress (ELS) results in enduring dysfunction of the cortico-limbic circuitry, underlying emotional and social behavior. However, the neurobiological mechanisms by which ELS affects development of the circuitry remain elusive. Here, we have combined viral tracing and electrophysiological techniques to study the effects of maternal separation (MS) on fronto-limbic connectivity and function in young (P14-21) rats. We report that aberrant prefrontal (mPFC) inputs to basolateral amygdala (BLA) GABAergic interneurons transiently increase the strength of feedforward inhibition in the BLA, which raises LTP induction threshold in MS treated male rats. The enhanced GABAergic activity after MS exposure associates with lower functional synchronization within prefrontal-amygdala networks in vivo. Intriguingly, no differences in these parameters were detected in females, which were also resistant to MS dependent changes in anxiety-like behaviors. Impaired plasticity and synchronization during the sensitive period of circuit refinement may contribute to long-lasting functional changes in the prefrontal-amygdaloid circuitry that predispose to neuropsychiatric conditions later on in life.
Potato virus X -delivered CRISPR activation programs lead to strong endogenous gene induction and transient metabolic reprogramming inNicotiana benthamiana
Authors: Selma S , Gianoglio S , Uranga M , Vázquez-Vilar M , Espinosa-Ruiz A , Drapal M , Fraser PD , Daròs JA , Orzaez D
Published: April 2022

Programmable transcriptional regulators based on CRISPR architecture are promising tools for the control of plant gene expression. In plants, CRISPR gene activation (CRISPRa) has been shown effective in modulating development processes, such as the flowering time, or customising biochemical composition. The most widely used method for delivering the CRISPR components into the plant isAgrobacterium tumefaciens-mediated genetic transformation, either transient or stable. However, due to their versatility and their ability to move, virus-derived systems have emerged as an interesting alternative for supplying the CRISPR components to the plant, in particular the gRNA, which represents the variable component in CRISPR strategies. In this work we describe aPotato virus X(PVX)-derived vector that, upon agroinfection inN. benthamiana, serves as a vehicle for gRNAs delivery, producing a highly specific Virus-Induced Gene Activation (VIGA). The system works in combination with aNicotiana benthamianatransgenic line carrying the remaining complementary CRISPRa components, specifically the dCasEV2.1 cassette, which has previously been shown to mediate strong programmable transcriptional activation in plants. Using an easily scalable, non-invasive spraying method, we show here that gRNAs-mediated activation programs move locally and systemically generating a strong activation response in different target genes. Furthermore, by activating three different endogenous MYB transcription factors, we demonstrate that this PVX-based virus-induced gene reprogramming (VIGR) strategy results in program-specific metabolic fingerprints inN. benthamianaleaves characterized by distinctive phenylpropanoid-enriched metabolite profiles.
Critical interventions for demand generation in Zambia, Nepal, and Senegal with regards to the 5C psychological antecedents of vaccination
Authors: Hester Kyra A , Sakas Zoe , Ogutu Emily Awino , Dixit Sameer , Ellis Anna S. , Yang Chenmua , Chanda Chama , Freeman Matthew C. , Orenstein Walter A. , Sarr Moussa , Bednarczyk Robert A.
Published: April 2022

Introduction

Childhood vaccination is an effective intervention for lowering the burden of infectious disease. Progress was made to increase coverage globally, but vaccine hesitancy and refusal has threatened to erode said increases. The 5C psychological antecedents of vaccination (“5C”) model provides a validated measure of “vaccine hesitancy or confidence” to assess individual thoughts and behaviors behind vaccination. Our purpose was to investigate population-level factors that contributed to high and sustained vaccination coverage via interventions in Zambia, Nepal, and Senegal, and alignment with the 5Cs.

Methods

FDGs and KIIs were collected at the national, regional, district, health facility, and community levels. We assessed the demand environment, as relayed by participants, and identified interventions that key informants reported as successful for demand generation, then retroactively aligned the interventions with the 5C constructs.

Results

Demand was positively correlated with high confidence and collective responsibility. Psychological constraints sometimes impacted demand. Physical constraints created barriers in some communities, particularly difficult to access (i.e., mountainous). Occasionally, physical constraints did not affect vaccination behavior - parents believed the benefits of vaccination worth pursuing. Factors negatively correlated with demand and intent, complacency and calculation, had limited impact. The most critical interventions were: targeted and tailored health education activities (i.e., media partnerships, school outreach); community engagement; community ownership; and involvement of community (i.e., community health workers, leaders, religious figures).

Conclusion

We found similar interventions were used to generate demand, and those strategies aligned with the 5C constructs. Categorizing interventions by drivers of demand may help strategic planning and the division of resources; decision makers may choose to implement our suggested interventions. Assessing the 5Cs allows for decision-makers to operationalize demand generation into concrete interventions and policies, and determine the individual impact of these constructs on the population and focus efforts on interventions tailored to a specific need.