bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelet-Rich Plasma for Androgenetic Alopecia in Women: A Single-Center Case Series Study in Qatar
Authors: Syed Mohamed Ahmed , Abushaikha Samya Sami A.S.
Published: November 2020

Objective:

Androgenetic alopecia (AA) is a progressive hair loss disorder mediated by systemic androgens and genetic factors. A variety of AA treatments have been investigated. Currently, there is emerging evidence and growing interest in the use of platelet-rich plasma (PRP) for AA. This study describes a single-center experience using PRP to treat AA in women.

Methods:

A retrospective observational study design was employed. The study cohort comprised 20 women >18 years of age who were diagnosed with AA. PRP was prepared using a commercially available PRP kit. Each patient received six PRP treatment sessions at 4-week intervals. The severity of alopecia tool (SALT) scoring system was used to measure the severity of alopecia, and a paired t-test was used to calculate significance levels.

Results:

The mean pre-intervention and post-intervention total SALT score was 27.5 ± 6.35 and 9.41 ± 3.71, respectively. The difference in the total mean SALT score was 18.33 ± 1.64 and the effect size was 3.52. The scalp area with the largest effect size was the vertex (Cohen d = 2.53). The effect size was similar across other scalp areas (Cohen d = 1.91–2.09). There were no serious adverse effects of the treatment; only mild transient adverse effects were reported.

Conclusion:

The present study demonstrated the efficacy and safety of PRP injections in treating AA in women. However, these findings require confirmation in well-designed studies using standardized treatment protocols and evaluation methods.
Reliability and Validity of the Korean Version of Stroke-Specific Quality of Life Questionnaire
Authors: Kim Minju , Lee Yerim
Published: November 2020

BACKGROUND: The number of stroke survivors is increasing worldwide, and because stroke survivors are usually living with sequelae, health-related quality of life is growing in importance. The stroke-specific quality of life (SSQOL) questionnaire was developed to assess the quality of life in stroke patients. This study aims to test the validity and reliability of the Korean version of the SSQOL (SSQOL-K). METHODS: This study used a descriptive survey design. The participants consisted of 250 stroke patients visiting Dong-A University Hospital in South Korea, who completed the SSQOL-K, the Korean version of the Modified Barthel Index, the Korean version of the Center for Epidemiological Studies Depression Scale, and the Korean version of the World Health Organization Quality of Life Scale Abbreviated Version. For data analysis, exploratory factor analyses with parallel analysis and reliability testing were performed using SPSS version 23.0. RESULTS: The mean total score for the SSQOL-K was 177.75 ± 40.83 (range, 49–245). In the exploratory factor analysis results, 4 subdomains were identified in the SSQOL-K and all items had a factor loading of greater than 0.30. The SSQOL-K was significantly correlated with the Korean version of the Modified Barthel Index, the Korean version of the Center for Epidemiological Studies Depression Scale, and the Korean version of the World Health Organization Quality of Life Scale Abbreviated Version. In reliability testing, the SSQOL-K showed Cronbach α of 0.98 in this study, and Cronbach α for the 4 subdomains were all 0.70 or greater. CONCLUSIONS: The SSQOL-K is a valid and reliable scale to assess health-related quality of life in Korean stroke patients.
Assessing Partner Services Provided by State and Local Health Departments, 2018
Authors: Cuffe Kendra M. , Gift Thomas L. , Kelley Kat , Leichliter Jami S.
Published: November 2020

Background

Surveillance reports have shown that reported sexually transmitted diseases (STDs) are increasing. The provision of partner services is an effective tool for preventing and reducing the spread of STDs. We examined partner services provided by health departments and assessed for associations with jurisdiction size, STD morbidity, and region.

Methods

We used stratified random sampling to select 668 local health departments (LHDs) and selected all (n = 50) state health departments (SHDs). Rao-Scott χ2 analyses were performed to examine partner services by health department type (SHD vs. LHD), region, jurisdiction size (LHD only), and STD morbidity (LHD only).

Results

Approximately 49.0% of LHDs and 88.0% of SHDs responded to the survey. Most LHDs (81.6%) and SHDs (79.5%) provided partner services for some STDs (P = 0.63). Compared with SHDs, a higher proportion of LHDs provided expedited partner therapy for chlamydia (66.8% vs. 34.2%, P < 0.01) and gonorrhea (39.3% vs. 22.9%, P = 0.09). Partner service staff performed other activities such as conducting enhanced surveillance activities (23.0% of LHDs, 34.3% of SHDs; P = 0.20) and participating in outbreak response and emergency preparedness (84.8% of LHDs, 80.0% of SHDs; P = 0.51). Associations were found when partner services were stratified by health department type, jurisdiction size, STD morbidity, and region. All LHDs in high-morbidity areas provided partner services and 45.4% performed serologic testing of syphilis contacts in the field.

Conclusions

A majority of STD programs in LHDs and SHDs provide a variety of partner services and partner service–related activities. It is imperative to continue monitoring the provision of partner services to understand how critical public health needs are being met.
Navigating the path to care and death at home—it is not always smooth: a qualitative examination of the experiences of bereaved family caregivers in palliative care
Authors: Lobb Elizabeth A. , Bindley Kristin , Sanderson Christine , MacLeod Roderick , Mowll Jane
Published: November 2020

Background:

Care and death at home are generally thought to be beneficial for families. However, there may be bereavement experiences and support needs, which are specific to family caregivers providing end-of-life care in their home. The Palliative Care Home Support Program in New South Wales, Australia, provides end-of-life care packages for patients who wish to die at home. These packages provide up to 48 hours of specialized supportive palliative home-based care, day or night, by community workers specifically trained for the task, working as part of existing community palliative care multidisciplinary teams. Care packages may include assistance with personal hygiene, carer respite, and domestic assistance.

Methods:

As part of a larger longitudinal mixed-methods study, 28 bereaved caregivers who experienced a home death and/or received the care packages undertook in-depth interviews. Narrative thematic analysis was undertaken to explore their experiences at 6 months post death.

Results:

Twenty-eight caregivers were experienced or planned for a home death and 21 had a package in place. Five themes were identified: “the achievements of a home death”; “taking on the mantle”; “the burden of witnessing the dying process”; “home as our space/their space”; and “resistance or submission to the ideals of best place of care for family caregivers.”

Conclusions:

Bereaved caregivers provided accounts of their interactions with health care providers depicting a complex relationship with the care system. Some families struggled to manage boundaries of home and private space as care needs escalated. Ideals about best care and home death are sometimes conflicted, without easy consensus between patient, family, and service providers.

Significance:

Models of care based on assumptions that home death is straightforwardly beneficial may cause unintended consequences. For future policy, providing care in the private space of the home requires close attention to family concerns and outcomes.
Anxiety and depression in patients with early stage endometrial cancer: A longitudinal analysis from before surgery to 6-month post-surgery
Authors: Sanjida Saira , Kissane David , McPhail Steven M. , Obermair Andreas , Janda Monika
Published: November 2020

Background:

The prevalence of anxiety and depression, and psychological treatment received by patients with endometrial cancer has rarely been studied. The primary aim of this article was to determine the point prevalence and cumulative prevalence of anxiety and depression in patients with endometrial cancer and types of psychological treatment received. The secondary aim was to evaluate the sociodemographic and clinical factors associated with anxiety and depression from before surgery to 6-month post-surgery.

Methods:

Secondary data analysis of an international, multicenter, prospective randomized controlled trial of surgery for stage I endometrial cancer was conducted. Anxiety and depression was established by the Hospital Anxiety and Depression Scale-21 (HADS). Regression models were fitted to examine the association of sociodemographic and clinical characteristics of patients with anxiety and depression.

Results:

Based on a HADS subscale score of ≥11, the highest prevalence of anxiety occurred before surgery (16%, n = 51/318), and the highest prevalence of depression just after surgery (6%, n = 18/314), respectively. The cumulative incidence of anxiety only, depression only, or both anxiety and depression in women within a 6-month timeframe was 15.5% (n = 52/334), 1.8% (n = 6/334), and 7.2% (n = 24/334), respectively. Very few of these patients received mental health support. Comorbid conditions, prescriptions of antidepressants or anxiolytics already at baseline, and non-European ethnicity were associated with depression.

Conclusions:

Up to 16% of patients with endometrial cancer experienced anxiety or depression around the time of diagnosis and treatment, which is lower than reported in broader gynecological cancer samples. The majority of distressed patients did not receive psychological or pharmaceutical treatments. Further research should aim to identify reasons why patients did not receive support to alleviate anxiety and depression.
An implementation science primer for psycho-oncology: translating robust evidence into practice
Authors: Rankin Nicole M. , Butow Phyllis N. , Hack Thomas F. , Shaw Joanne M. , Shepherd Heather L. , Ugalde Anna , Sales Anne E.
Published: November 2020

Background:

It is broadly acknowledged that the next global challenge for psycho-oncology is the implementation of robust evidence-based treatments into routine clinical practice. There is little guidance or texts specific to psycho-oncology to guide researchers and clinicians about implementation science and how to optimally accelerate the translation of evidence into routine practice. This article aims to provide a primer in implementation science for psycho-oncology researchers and clinicians.

Methods:

We introduce core concepts and principles of implementation science. These include definitions of terms, understanding the quality gap and the need for solid evidence-based interventions.

Results:

The conceptual models, frameworks, and theories that are used in implementation research are outlined, along with evaluative study designs, implementation strategies, and outcomes. We provide a brief overview of the importance of engaging teams with diverse expertise in research and engaging key stakeholders throughout implementation planning, conduct, and evaluation. The article identifies opportunities to accelerate the implementation of evidence-based psychosocial interventions. Opportunities for greater collaboration across disciplines are highlighted. Examples from psycho-oncology and the broader oncology literature are included to help operationalize concepts.

Conclusion:

This article describes the fundamental concepts and principles of implementation science for a psycho-oncology audience, to increase the number and quality of implementation studies across the discipline.
Trends in cancer screening rates among individuals with serious psychological distress: an analysis of data from 2007 to 2016 Japanese national surveys
Authors: Fujiwara Masaki , Higuchi Yuji , Nakaya Naoki , Fujimori Maiko , Yamada Yuto , Wada Riho , Etoh Tsuyoshi , Kakeda Kyoko , Uchitomi Yosuke , Nakayama Tomio , Yamada Norihito , Inagaki Masatoshi
Published: November 2020

Background:

The aim of the present study was to examine whether the increasing trend in cancer screening rates over time in Japan differs between individuals with and without serious psychological distress (SPD).

Methods:

We analyzed a national representative cross-sectional dataset from the 2007, 2010, 2013, and 2016 Comprehensive Surveys of Living Conditions of Japan. We included people under the age of 69 years who met the national program criteria for each type of cancer screening (colorectal, gastric, and lung: n = 94,690, 94,957, and 94,751, respectively). SPD was defined as a score of ≥13 on the Kessler 6 scale. We calculated these cancer screening rates with 95% confidence intervals, stratified by presence or absence of SPD to determine whether cancer screening rates over time between 2007 and 2016 differ between individuals with and without SPD.

Results:

Cancer screening rates in the non-SPD group increased steadily over time from 2007 to 2016 (colorectal, gastric, and lung: 31.4%–46%, 37.2%–44.8%, and 32.1%–51.7%, respectively). They also increased similarly over time in individuals with SPD (colorectal, gastric, and lung: 24.5%–36.3%, 30.2%–37.8%, and 24.8%–39.9%, respectively); however, the rates remained significantly lower than those of people without SPD in all survey years.

Conclusions:

Between 2007 and 2016, cancer screening rates increased similarly over time in individuals with and without SPD. However, gaps in cancer screening in people with SPD remained unresolved.
“Maintaining hope:” challenges in counseling latino patients with advanced cancer
Authors: Costas-Muñiz Rosario , Garduño-Ortega Olga , Torres-Blasco Normarie , Castro-Figueroa Eida , Gany Francesca
Published: November 2020

Background:

Latino cancer patients are at risk of poor psychological adjustment. Therapeutic effectiveness in treating Latino cancer patients with advanced cancer requires managing distress, therapeutic skill, and cultural competency. This mixed-methods study explored mental health providers’ perceptions of the challenging aspects of counseling and caring for Latino patients with advanced cancer.

Methods:

Mental health providers providing services to Latino or Hispanic cancer patients received an emailed web-based survey with open- and closed-ended questions. Providers included psychiatrists, psychologists, social workers, counselors, and other mental health professionals. We invited 154 providers to participate from July 2015 to January 2017. One hundred and four accessed the survey, and 66 eligible providers responded, for a response rate of 43%. Analyses were used to explore whether clinical experience factors and training characteristics were associated with perceiving conversations about cancer (diagnosis, prognosis, and end-of-life) as challenging. Second, the challenging aspects of these conversations were explored qualitatively. Four independent coders coded responses; an inductive content analysis was utilized to analyze the data.

Results:

Mental health providers describe encountering many challenges in their therapeutic discussions with Latino cancer patients.

Conclusions:

It is imperative to understand the factors associated with the perceived difficulty of these conversations, as well as the characteristics of these conversations, to develop culturally sensitive interventions and programs for patients and training interventions for providers.
Admission Psychosocial Characteristics of Critically Ill Children and Acute Stress*
Authors: Nelson Lara P. , Lachman Sage E. , Goodman Kelsey , Gold Jeffrey I.
Published: November 2020

Objectives:

Children are at increased risk for developing acute stress and post-traumatic stress following admission to the PICU. The primary objective of this investigation was to explore the prehospitalization psychosocial characteristics of children admitted to the PICU and their association with acute stress.

Design:

Observational.

Setting:

The PICU at an urban, academic, pediatric medical center.

Patients:

Children, 8–17 years old with an expected PICU stay greater than 24 hours were recruited.

Measurements and Main Results:

During the admission, they completed questionnaires and a semistructured interview evaluating prehospitalization psychosocial symptoms, including prehospitalization post-traumatic stress, quality of life, and current acute stress. One hundred eleven children were enrolled (mean age = 12.9 yr; 60% male; 58% Latino). Half (51%) reported a prehospitalization history of trauma and nearly all (96%) of these children had post-traumatic stress. They had significant impairment on all domains of quality of life. Children reported high rates of acute stress during their hospitalization, 74.8% acute stress symptoms, and 6% met diagnostic criteria for acute stress disorder. Univariate analysis showed associations between child age, quality of life, chronic illness, and post-traumatic stress with more severe acute stress. Multiple linear regression modeling of acute stress was done accounting for child age, acute versus chronic illness, quality of life, and post-traumatic stress; prehospitalization quality of life and post-traumatic stress remained significantly associated with the development of inhospital acute stress and accounted for 34% of the variance of the model.

Conclusions:

The current investigation is a novel evaluation of the prehospitalization psychosocial characteristics of children admitted to a PICU. The children enrolled reported high rates of acute stress, which was associated with a history of post-traumatic stress and worsened quality of life. The relation with post-traumatic stress is consistent with prior research into complex post-traumatic stress disorder and increases concerns about long-term psychosocial outcomes. Our data advance understanding of the factors contributing to acute stress during hospitalizations and may add to recognizing the importance of models integrating psychosocial support.
Use of Prospective Audit and Feedback to Reduce Antibiotic Exposure in a Pediatric Cardiac ICU
Authors: Schwenk Hayden T. , Kruger Jenna F. , Sacks Loren D. , Wood Matthew S. , Qureshi Lubna , Bio Laura L.
Published: November 2020

Objectives:

We sought to determine whether a prospective audit and feedback intervention decreased antibiotic utilization in a pediatric cardiac ICU and to describe the characteristics of prospective audit and feedback audits and recommendations.

Design:

Before-after study.

Setting:

Pediatric cardiac ICU of a freestanding children’s hospital.

Patients:

All patients admitted to the cardiac ICU.

Interventions:

A prospective audit and feedback program was established in our hospital’s pediatric cardiac ICU on December 7, 2015. The antimicrobial stewardship program audited IV antibiotics, communicated prospective audit and feedback recommendations to the cardiac ICU, and regularly reviewed recommendation adherence. Mean monthly antibiotic utilization 18 months before (“preprospective audit and feedback”; from June 1, 2014 to November 30, 2015) and 24 months after (“prospective audit and feedback”; from January 1, 2016 to December 31, 2017) prospective audit and feedback implementation was compared. Antibiotic audit data during the prospective audit and feedback period were reviewed to capture the characteristics of prospective audit and feedback audits, recommendations, and adherence.

Measurements and Main Results:

Mean cardiac ICU IV antibiotic use decreased 20% (701 vs 880 days of therapy per 1,000 patient days, p = 0.001) during the prospective audit and feedback period compared with the preprospective audit and feedback period. There was no difference in mean cardiac ICU length of stay (p = 0.573), mean hospital length of stay (p = 0.722), or the rate of discharge due to death (p = 0.541). There were 988 antibiotic audits and 370 prospective audit and feedback recommendations (37% recommendation rate) during the study period. The most commonly audited antibiotic category was broad-spectrum gram-negative agents and the most common indication for use was sepsis. Broad-spectrum gram-positive agents were more likely to be associated with a recommendation.

Conclusions:

There was a significant reduction in antibiotic use following implementation of a prospective audit and feedback program in our pediatric cardiac ICU. Over one-third of antibiotics audited in our cardiac ICU were associated with a prospective audit and feedback recommendation, revealing important targets for future antimicrobial stewardship efforts in this population.
The Association of Laboratory Test Abnormalities With Mortality Risk in Pediatric Intensive Care*
Authors: Pollack Murray M. , Chamberlain James M. , Patel Anita K. , Heneghan Julia A. , Rivera Eduardo A. Trujillo , Kim Dongkyu , Bost James E.
Published: November 2020

Objectives:

To determine the bivariable associations between abnormalities of 28 common laboratory tests and hospital mortality and determine how mortality risks changes when the ranges are evaluated in the context of commonly used laboratory test panels.

Design:

A 2009–2016 cohort from the Health Facts (Cerner Corporation, Kansas City, MO) database.

Setting:

Hospitals caring for children in ICUs.

Patients:

Children cared for in ICUs with laboratory data.

Interventions:

None.

Measurements and Main Results:

There were 2,987,515 laboratory measurements in 71,563 children. The distribution of laboratory test values in 10 groups defined by population percentiles demonstrated the midrange of tests was within the normal range except for those measured predominantly when significant abnormalities are suspected. Logistic regression analysis at the patient level combined the population-based groups into ranges with nonoverlapping mortality odds ratios. The most deviant test ranges associated with increased mortality risk (mortality odds ratios > 5.0) included variables associated with acidosis, coagulation abnormalities and blood loss, immune function, liver function, nutritional status, and the basic metabolic profile. The test ranges most associated with survival included normal values for chloride, pH, and bicarbonate/total Co
2. When the significant test ranges from bivariable analyses were combined in commonly used test panels, they generally remained significant but were reduced as risk was distributed among the tests.

CONCLUSIONS:

The relative importance of laboratory test ranges vary widely, with some ranges strongly associated with mortality and others strongly associated with survival. When evaluated in the context of test panels rather than isolated tests, the mortality odds ratios for the test ranges decreased but generally remained significant as risk was distributed among the components of the test panels. These data are useful to develop critical values for children in ICUs, to identify risk factors previously underappreciated, for education and training, and for future risk score development.
Circumscribed Myositis Ossificans of the Masseter Muscle
Authors: Li Yang , Park Hong-Ju , Jung Seunggon , Kook Min-Suk
Published: November 2020

The authors report a case of myositis ossificans traumatica of the masseter muscles. A 21-year-old man developed masseter myositis after orthognathic surgery to treat facial asymmetry. The myositis may have been triggered by factors such as calcification of a hematoma, periosteum implantation after surgical trauma, and local soft tissue injury. An intraoral incision was made to excise the ectopic bone, resulting in resolution of the patient's symptoms including limited oral opening.
Serum Levels of Branched Chain Amino Acids Predict Duration of Cardiovascular Organ Failure in Septic Shock
Authors: Puskarich Michael A. , McHugh Cora , Flott Thomas L. , Karnovsky Alla , Jones Alan E. , Stringer Kathleen A.
Published: November 2020

Background:

Sepsis shifts cardiac metabolic fuel preference and this disruption may have implications for cardiovascular function. A greater understanding of the role of metabolism in the development and persistence of cardiovascular failure in sepsis could serve to identify novel pharmacotherapeutic approaches.

Methods:

Secondary analysis of prospective quantitative proton nuclear magnetic resonance (1H-NMR) metabolomic data from patients enrolled in a phase II randomized control trial of L-carnitine in septic shock. Participants with a sequential organ failure assessment (SOFA) score of > = 5, lactate > = 2, and requiring vasopressor support for at least 4 h were eligible for enrollment. The independent prognostic value of metabolites to predict survival with shock resolution within 48 h and vasopressor free days were assessed. Concentrations of predictive metabolites were compared between participants with and without shock resolution at 48 h.

Results:

Serum 1H-NMR metabolomics data from 228 patients were analyzed. Eighty-one (36%) patients met the primary outcome; 33 (14%) died prior to 48 h. The branched chain amino acids (BCAA), valine, leucine, and isoleucine were univariate predictors of the primary outcome after adjusting for multiple hypothesis testing, while valine remained significant after controlling for SOFA score. Similar results were observed when analyzed based on vasopressor free days, and persisted after controlling for confounding variables and excluding non-survivors. BCAA concentrations at 48 h significantly discriminated between those with shock resolution versus persistent shock.

Conclusions:

Among patients with septic shock, BCAA concentrations independently predict time to shock resolution. This study provides hypothesis generating data into the potential contribution of BCAAs to the pathophysiology of cardiovascular failure in sepsis, opening areas for future investigations.
Implications of Tumor Characteristics and Treatment Modality on Local Recurrence and Functional Outcomes in Children With Chest Wall Sarcoma
Authors: Harris Courtney J. , Helenowski Irene , Murphy Andrew J. , Mansfield Sara A. , LaQuaglia Michael P. , Heaton Todd E. , Cavalli Michele , Murphy Joseph T. , Newman Erika A. , Overmen Richard E. , Kartal Tanvi T. , Cooke-Barber J. , Donaher Addison , Malek Marcus M. , Kalsi Ranjeet , Kim Eugene S. , Zobel Michael J. , Goodhue Catherine J. , Naik-Mathuria Bindi J. , Jefferson Imory N. , Roach Jonathan P. , Mata Claudia , Piché Nelson , Joharifard Shahrzad , Sultan Serge , Short Scott S. , Meyers Rebecka L. , Bleicher Josh , Le Hau D. , Janek Kevin , Bütter Andreana , Davidson Jacob , Aldrink Jennifer H. , Richards Holden W. , Tracy Elisabeth T. , Commander Sarah J. , Fialkowski Elizabeth A. , Troutt Misty , Dasgupta Roshni , Lautz Timothy B.
Published: November 2020

Objective:

To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development, and (3) patient-reported quality of life in children with sarcoma of the chest wall.

Summary of Background Data:

Children with chest wall sarcoma require multimodal therapy including chemotherapy, surgery, and/or radiation. Despite aggressive therapy which places them at risk for functional impairment and scoliosis, these patients are also at significant risk for local recurrence.

Methods:

A multi-institutional review of 175 children (median age 13 years) with chest wall sarcoma treated at seventeen Pediatric Surgical Oncology Research Collaborative institutions between 2008 and 2017 was performed. Patient-reported quality of life was assessed prospectively using PROMIS surveys.

Results:

The most common diagnoses were Ewing sarcoma (67%) and osteosarcoma (9%). Surgical resection was performed in 85% and radiation in 55%. A median of 2 ribs were resected (interquartile range = 1–3), and number of ribs resected did not correlate with margin status (P = 0.36). Local recurrence occurred in 23% and margin status was the only predictive factor

(HR 2.24, P = 0.039). With a median follow-up of 5 years, 13% developed scoliosis (median Cobb angle 26) and 5% required corrective spine surgery. Scoliosis was associated with posteriorrib resection (HR 8.43; P= 0.003) and increased number of ribs resected (HR 1.78; P = 0.02). Overall, patient-reported quality of life is not impaired after chest wall tumor resection.

Conclusions:

Local recurrence occurs in one-quarter of children with chest wall sarcoma and is independent of tumor type. Scoliosis occurs in 13% of patients, but patient-reported quality of life is excellent.
Language Mapping With Magnetoencephalography: An Update on the Current State of Clinical Research and Practice With Considerations for Clinical Practice Guidelines
Authors: Bowyer Susan M. , Zillgitt Andrew , Greenwald Margaret , Lajiness-O'Neill Renee
Published: November 2020

Numerous studies have shown that language processing is not limited to a few brain areas. Visual or auditory stimuli activate corresponding cortical areas, then memory identifies the word or image, Wernicke's and Broca's areas support the processing for either reading/listening or speaking and many areas of the brain are recruited. Determining how a normal person processes language helps clinicians and scientist to understand how brain pathologies such as tumor or stroke can affect changes in language processing. Patients with epilepsy may develop atypical language organization. Over time, the chronic nature of epileptic activity, or changes from a tumor or stroke, can result in a shift of language processing area from the left to the right hemisphere, or re-routing of language pathways from traditional to non-traditional areas within the dominant left hemisphere. It is important to determine where these language areas are prior to brain surgery. MEG evoked responses reflecting cerebral activation of receptive and expressive language processing can be localized using several different techniques: Single equivalent current dipole, current distribution techniques or beamformer techniques. Over the past 20 years there have been at least 25 validated MEG studies that indicate MEG can be used to determine the dominant hemisphere for language processing. The use of MEG neuroimaging techniques is needed to reliably predict altered language networks in patients and to provide identification of language eloquent cortices for localization and lateralization necessary for clinical care.
Auditory Mapping With MEG: An Update on the Current State of Clinical Research and Practice With Considerations for Clinical Practice Guidelines
Authors: Shvarts Vladimir , Mäkelä Jyrki P.
Published: November 2020

Auditory evoked fields (AEFs) are well suited for studies of auditory processing in patients. Their sources have been localized to Heschl's gyri and to the supratemporal auditory cortices. Auditory evoked fields are known to be modulated by peripheral and central lesions of auditory pathways and to reflect group-level pathophysiology of neurodevelopmental and psychiatric disorders. They are useful in lateralization of language processes for planning neurosurgery and for localization of language-related cortex. The recently developed artifact rejection and movement compensation methods will enhance and extend the use of AEFs in studies of clinical patients and pediatric groups. New pediatric magnetoencephalography systems will facilitate clinical AEF studies of developmental disorders. In addition to their established use in planning neurosurgery, AEF findings in several new clinical patient groups suffering, e.g., from developmental, neurodegenerative, or psychiatric disorders have been reported. Several recent investigations report the correlations with clinical symptoms and sensitivity and specificity profiles of AEFs in studies of these disorders; this development is mandatory in gaining wider clinical approval for the use of AEFs in clinical practice dealing with individual patients. Most promising future research lines of clinical applicability of AEFs focus on developmental and psychiatric disorders.
Rapid Sepsityper in clinical routine: 2 years’ successful experience
Authors: Cordovana Miriam , Zignoli Anna , Ambretti Simone
Published: November 2020

Introduction. Rapid identification of the causative agent of sepsis is crucial for patient outcomes.

Aim. The Sepsityper sample preparation method enables direct microbial identification of positive blood culture samples via matrix-assisted laser desorption ionization/time-of-flight mass spectrometry (MALDI-TOF MS).

Hypothesis/Gap statement. The implementation of the Sepsityper method in the routine practice could represent a fundamental tool to achieve a prompt identification of the causative agent of bloodstream infections, and therefore accelerate the adoption of the proper antibiotic treatment.

Methodology. In this study, the novel rapid workflow of the MALDI Biotypr Sepsityper kit (Bruker Daltonik GmbH, Germany) was evaluated using routine samples from a 2-year period (n=6918), and dedicated optimized protocols for the microbial groups that were more difficult to identify were developed. Moreover, the use of the residual bacterial pellet to perform susceptibility testing using different methods (commercial broth microdilution, disc diffusion, gradient diffusion) was investigated.

Results. The rapid Sepsityper protocol allowed the identification of 5470/6338 (86.3 %) monomicrobial samples at species level, with very good performance for all of the clinically most significant pathogens (2510/2592 enterobacteria, 631/669

Staphylococcus aureus

and 223/246 enterococci were identified).

Streptococcus pneumoniae

,

Bacteroides fragilis

and yeasts were the most troublesome to identify, but the application of specific optimized protocols significantly improved their rate of identification (from 14.7–71.5 %, 47.8–89.7 % and 37.1–89.5 %, respectively). Specificity was 100 % (no identification was made for the false-positive samples). Further, the residual pellet proved to be suitable to investigate susceptibility to antimicrobials, enabling us to simplify the workflow and shorten the time to report.

Conclusion. The Rapid Sepsityper workflow proved to be a reliable sample preparation method for identification and susceptibility testing directly from positive blood cultures, providing novel approaches for accelerated diagnostics of bloodstream infections.
Sticks and Stones, a conserved cell surface ligand for the Type IIa RPTP Lar, regulates neural circuit wiring inDrosophila
Authors: Bali Namrata , Lee Hyung-Kook (Peter) , Zinn Kai
Published: November 2020

Control of tyrosine phosphorylation is an essential element of many cellular processes, including proliferation, differentiation neurite outgrowth, and synaptogenesis. Receptor-like protein-tyrosine phosphatases (RPTPs) have cytoplasmic phosphatase domains and cell adhesion molecule (CAM)-like extracellular domains that interact with cell-surface ligands and/or co-receptors. We identified a new ligand for theDrosophilaLar RPTP, the immunoglobulin superfamily CAM Sticks and Stones (Sns). Lar is orthologous to the three Type IIa mammalian RPTPs, PTPRF (LAR), PTPRD (PTPδ), and PTPRS (PTPσ). Lar and Sns bind to each other in embryos andin vitro. The human Sns ortholog, Nephrin, binds to PTPRD and PTPRF. Genetic interaction studies show that Sns is essential to Lar’s functions in several developmental contexts in the larval and adult nervous systems. In the larval neuromuscular system,Larandsnstransheterozygotes (Lar/snstranshets) have synaptic defects like those seen inLarmutants and Sns knockdown animals. Lar and Sns reporters are both expressed in motor neurons and not in muscles, so Lar and Sns likely act incis(in the same neurons).Larmutants andLar/snstranshets have identical axon guidance defects in the larval mushroom body in which Kenyon cell axons fail to stop at the midline and do not branch. Pupal Kenyon cell axon guidance is similarly affected, resulting in adult mushroom body defects. Lar is expressed in larval and pupal Kenyon cells, but Sns is not, so Lar-Sns interactions in this system must be intrans(between neurons). Lastly, R7 photoreceptor axons inLarmutants andLar/snstranshets fail to innervate the correct M6 layer of the medulla in the optic lobe. Lar acts cell-autonomously in R7s, while Sns is only in lamina and medulla neurons that arborize near the R7 target layer. Therefore, the Lar-Sns interactions that control R7 targeting also occur intrans.
Direct detection of Dengue viruses without extraction of RNA on the mobile real-time PCR device
Authors: Muraoka Masaaki , Tanoi Yukiko , Tada Tetsutaro , Tabata Aya , Mizukoshi Mikio , Kawaguchi Osamu
Published: November 2020

Dengue virus (DENV) is the cause of dengue / severe dengue and a virus of the Flaviviridae family, furthermore, dengue fever has rapidly spread in the world in recent decades. DENV is transmitted by female mosquitoes, mainly of the specie Aedes aegypti. The main method to control or prevent the transmission of DENV is to combat the mosquito vectors. Among these, one of important methods is to monitor the DENVs in the mosquito vectors.

For the detection of DENV, nucleic acid amplification tests (NAAT) were recommended, of which criterion standard is real-time RT-PCR with highly sensitive and specific. However, it takes long time as to judge the result per a reaction, besides the necessity of the treatment of RNA in advance, example of extraction, concentration and purification.

It was our object in this time to develop the method of real-time RT-PCR detecting DENVs in shorter time, moreover without especial treatment of RNA from the mosquito in advance. Besides, this work was performed with combing the mobile real-time PCR device with the one-step RT-PCR reagent.

Firstly, we succeeded in shortening the time of real-time RT-PCR for the detection of DENV per one reaction, so that the judgement needed less than 20 minutes if genomic RNA treated in advance. Moreover, each value on the real-PCR device was quantitatively correlated with the positive control RNA from 1.0 × 10 ^ 3 copies to 1.0 × 10 ^ 0 copies per reaction (This correlation coefficient R2 > 0.95). Additionally, it made sure that this method could be applied to each DENV serotype.

Secondly, we established the basis of procedure for the real-time RT-PCR without the treatment in advance so-called “direct”. As the result that the positive control RNA additive was utilized instead of the real DENV, spiked into the mosquito homogenized and sampled the supernatant without treatment, it was possible to detect on the real-time RT-PCR even if mosquitoes immediately after blood-feeding. For this reason, this method might be able to utilize in human sera, too.

According to the results of this work, we could suggest the method is possible to detect DENV more quickly and more simply than heretofore. The Real-time “direct” RT-PCR, especially, could be performed with mobile real-time PCR PCR1100 device and one step RT-PCR reagent only. This method must help to detect some viruses other than DENV, too.
Point-of-care detection of SARS-CoV-2 in nasopharyngeal swab samples using an integrated smartphone-based centrifugal microfluidic platform
Authors: Soares Ruben R. G. , Akhtar Ahmad S. , Pinto Inês F. , Lapins Noa , Barrett Donal , Sandh Gustaf , Yin Xiushan , Pelechano Vicent , Russom Aman
Published: November 2020

With its origin estimated around December 2019 in Wuhan, China, the ongoing 2020 SARS-CoV-2 pandemic is a major global health challenge, resulting in more than 45 million infections and 1.2 million deaths. The demand for scalable, rapid and sensitive viral diagnostics is thus particularly pressing at present to help contain the rapid spread of infection and prevent overwhelming the capacity of health systems. While high-income countries have managed to rapidly expand diagnostic capacities, such is not the case in resource-limited settings of low- to medium-income countries.

Aiming at developing cost-effective viral load detection systems for point-of-care COVID-19 diagnostics in resource-limited and resource-rich settings alike, we report the development of an integrated modular centrifugal microfluidic platform to perform loop-mediated isothermal amplification (LAMP) of viral RNA directly from heat-inactivated nasopharyngeal swab samples. The discs were pre-packed with dried n-benzyl-n-methylethanolamine modified agarose beads used as a versatile post-nucleic acid amplification signal enhancement strategy, allowing fluorescence detection via a smartphone camera and simple optics. The platform provided sample-to-answer analysis within 1 hour from sample collection and a detection limit between 100 and 1000 RNA copies in 10 μL reaction volume. Furthermore, direct detection of non-extracted SARS-CoV-2 RNA in nasopharyngeal swab samples from patients with Ct values below 26 (n=25 plus 6 PCR negative samples) was achieved with ∼94% sensitivity and 100% specificity, thus being fit-for-purpose to diagnose patients with a high risk of viral transmission. These results show significant promise towards bringing routine point-of-care COVID-19 diagnostics closer to resource-limited settings.
Biometric covariates and outcome in COVID-19 patients: Are we looking close enough?
Authors: Fritsch Sebastian , Sharafutdinov Konstantin , Marx Gernot , Schuppert Andreas , Bickenbach Johannes
Published: November 2020

Background

The impact of biometric covariates on risk for adverse outcomes of COVID-19 disease was assessed by numerous observational studies on unstratified cohorts, which show great heterogeneity. However, multilevel evaluations to find possible complex, e. g. non-monotonic multi-variate patterns reflecting mutual interference of parameters are missing. We used a more detailed, computational analysis to investigate the influence of biometric differences on mortality and disease evolution among severely ill COVID-19 patients.

Methods

We analyzed a group of COVID-19 patients requiring Intensive care unit (ICU) treatment. For further analysis, the study group was segmented into six subgroups according to BMI and age. To link the BMI/age derived subgroups with risk factors, we performed an enrichment analysis of diagnostic parameters and comorbidities. To suppress spurious patterns, multiple segmentations were analyzed and integrated into a consensus score for each analysis step.

Results

We analyzed 81 COVID-19 patients, of whom 67 required MV. Mean mortality was 35.8 %. We found a complex, non-monotonic interaction between age, BMI and mortality. A subcohort of patients with younger age and intermediate BMI exhibited a strongly reduced mortality risk (p < 0.001), while differences in all other groups were not significant. Univariate impacts of BMI or age on mortality were missing. Comparing MV with non-MV patients, we found an enrichment of baseline CRP, PCT and D-Dimers within the MV-group, but not when comparing survivors vs. non-survivors within the MV patient group.

Conclusions

The aim of this study was to get a more detailed insight into the influence of biometric covariates on the outcome of COVID-19 patients with high degree of severity. We found that survival in MV is affected by complex interactions of covariates differing to the reported covariates, which are hidden in generic, non-stratified studies on risk factors. Hence, our study suggests that a detailed, multivariate pattern analysis on larger patient cohorts reflecting the specific disease stages might reveal more specific patterns of risk factors supporting individually adapted treatment strategies.
Post-acute COVID-19 syndrome negatively impacts health and wellbeing despite less severe acute infection
Authors: Tabacof Laura , Tosto-Mancuso Jenna , Wood Jamie , Cortes Mar , Kontorovich Amy , McCarthy Dayna , Rizk Dahlia , Mohammadi Nicki , Breyman Erica , Nasr Leila , Kellner Christopher , Putrino David
Published: November 2020

Introduction

One of the noted features of COVID-19 is the spectrum of expressivity in symptoms among those with the disease, ranging from no or mild symptoms that may last a small number of days, to severe and/or longer lasting symptoms. It is emerging that many patients have long lasting symptoms, several months after initial infection with COVID-19. The aim of this research was to characterize post-acute COVID-19 syndrome (PACS).

Methods

This was a retrospective cross-sectional observational study. Participants were patients recovering from COVID-19 infection, enrolled in Mount Sinai Hospital’s COVID-19 Precision Recovery Program (PRP). Inclusion criteria were confirmed or probable (based on World Health Organization criteria) initial diagnosis of COVID-19; post-acute COVID-19 syndrome (defined as experiencing symptoms > 6 weeks since acute symptom onset) and being currently enrolled in the PRP during the months of July and August 2020. Study survey data were collected using REDCap. Demographic data, COVID-19 clinical data and patient-reported outcomes for breathlessness (Medical Research Council Breathlessness Scale), fatigue and quality of life (EuroQoL 5D-5L) were collected.

Results

84 individuals with PACS were included. Symptoms persisted at mean (range) 151 (54 to 255) days. The most prevalent persistent symptoms were fatigue (92%), loss of concentration/memory (74%), weakness (68%), headache (65%) and dizziness (64%). Most participants reported increased levels of disability associated with breathlessness, increased fatigue and reduced quality of life.

Conclusions

Persistent symptoms following COVID-19 infection are prevalent, debilitating and appear to affect individuals regardless of acute infection severity or prior health status. More detailed research is required in order to identify specific symptom clusters associated with PACS, and to devise effective interventional strategies.
Don’t wait, re-escalate: delayed action results in longer duration of COVID-19 restrictions
Authors: Hurford Amy , Watmough James
Published: November 2020

Non-pharmaceutical public health interventions have significant economic and social costs, and minimizing their duration is paramont. Assuming that interventions are sufficient to reduce infection prevalence, we use a simple linear SIR model with case importation to determine the relationship between the timing of restrictions, duration of measures necessary to return the incidence to a set point, and the final size of the outbreak. The predictions of our linear SIR model agree well with COVID-19 data from Atlantic Canada, and are consistent with the predictions of more complex deterministic COVID-19 models. We conclude that earlier re-escalation of restrictions results in shorter disruptions, smaller outbreaks, and consequently, lower economic and social costs. Our key message is succinctly summarized as ‘don’t wait, re-escalate’ since delaying re-escalation of restrictions results in not only more infections, but also longer periods of restrictions.
SARS-Cov-2 Viral Load as an Indicator for COVID-19 Patients’ Hospital Stay
Authors: Ali Salman Al , AbdulRahman AbdulKarim , Yaghi Omar , Janahi Essam M. , Al-Qahtani Manaf
Published: November 2020

Background/objective

The novel coronavirus disease 2019 (COVID-19) pandemic poses a global threat to the public health. There is a challenge in measuring the patient’s length of hospital stay and managing the healthcare resources to handle the situation successfully. Our objective is to use the qPCR cycle of threshold (Ct) as a tool in evaluating the severity of the infection and hence the length of hospital stay to better utilize and manage the healthcare resources.

Methods

This cross sectional study was carried out on 306 patients who admitted to COVID-19 care centers in Kingdom of Bahrain from 20th March 2020 to 5th April 2020. Standard qPCR was used to estimate the viral load and data were analyzed to investigate the relationship between Ct values and various variables.

Results

Out of 306 patients, 2 deaths, 1 active stable case and 303 recovered cases were reported. Ct value was significantly and negatively associated (P value <0.001) with length of hospital stay. The viral clearance was also inversely associated with the Ct values.

Conclusion

Ct value was inversely associated with hospital stay duration (and time to viral clearance), higher the Ct value is indicative of faster time to viral clearance. This association could help to better manage the infection and resources allocation.