bluuebunny/crossref_metadata_2025 huggingface dataset:
The experience of the health care workers of a severely hit SARS-CoV-2 referral Hospital in Italy: incidence, clinical course and modifiable risk factors for COVID-19 infection
Authors: Colaneri Marta , Novelli Viola , Cutti Sara , Muzzi Alba , Resani Guido , Monti Maria Cristina , Rona Claudia , Grugnetti Anna Maria , Rettani Marco , Rovida Francesca , Zuccaro Valentina , Triarico Antonio , Marena Carlo
Published: October 2020

Background

During the COVID-19 pandemic, the health care workers (HCWs) at the frontline have been largely exposed to infected patients, running a high risk of being infected by the SARS-CoV-2 virus.

Since limiting transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in health care setting is crucial to avoid the community spread of SARS-CoV-2, we want to share our experience as an early hit hospital where standard infection control practices have been conscientiously applied and effective. We believe that our example, as first and hardest hit country, might be a warning and aid not only for those who have been hit later, but also for a second fearful wave of contagion. In addition, we want to offer an insight on modifiable risk factors for HWs-related infection.

Methods

Demographic, lifestyle, work-related and comorbidities data of 1447 HCWs, which underwent a nasopharyngeal swab for SARS-CoV-2, were retrospectively collected. For the 164 HCWs positive for SARS-CoV-2, data about safety in the workplace, symptoms and clinical course of COVID-19 were also collected. Cumulative incidence of SARS-CoV-2 infection was estimated. Risk factors for SARS-CoV-2 infection were assessed using a multivariable Poisson regression.

Results

The cumulative incidence of SARS-CoV-2 infection among the screened HCWs was 11.33% (9.72–13.21). Working in a COVID-19 ward, being a former smoker (versus being a person who never smoked) and BMI was positively associated with SARS-CoV-2 infection, whereas being a current smoker was negatively associated with this variable.

Conclusions

Assuming an equal accessibility and proper use of personal protective equipment of all the HCWs of our Hospital, the great and more prolonged contact with COVID-19 patients remains the crucial risk factor for SARS-CoV-2. Therefore, increased and particular care needs to be focused specifically on the most exposed HCWs groups, which should be safeguarded. Furthermore, in order to limit the risk of asymptomatic spread of SARS-CoV-2 infection, the HCWs mild symptoms of COVID-19 should be considered when evaluating the potential benefits of universal staff testing.
Myopia, or near-sightedness, is associated with delayed melatonin circadian timing and lower melatonin output in young adult humans
Authors: Chakraborty Ranjay , Micic Gorica , Thorley Lisa , Nissen Taylah R , Lovato Nicole , Collins Michael J , Lack Leon C
Published: October 2020

Study objectives

Myopia, or near-sightedness, is the most common refractive vision disorder and predisposes the eye to many blinding conditions in adulthood. Recent research has suggested that myopia is associated with increased endogenous melatonin production. Here we investigated the differences in melatonin circadian timing and output in young adult myopes and non-myopes (or emmetropes) as a pathogenesis for myopia.

Methods

A total of 18 myopic (refractive error [mean ± standard deviation] −4.89 ± 2.16 dioptres) and 14 emmetropic participants (−0.09 ± 0.13 dioptres), aged 22.06 ± 2.35 years were recruited. Circadian timing was assessed using salivary dim light melatonin onset (DLMO), collected half-hourly for 7 h, beginning 5 h before and finishing 2 h after individual average sleep onset in a sleep laboratory. Total melatonin production was assessed via aMT6s levels from urine voids collected from 06:00 pm and until wake-up time the following morning. Objective measures of sleep timing were acquired a week prior to the sleep laboratory visit using an actigraphy device.

Results

Myopes (22:19 ± 1.8 h) exhibited a DLMO phase-delay of 1 hr 12 min compared with emmetropes (21:07 ± 1.4 h), p = 0.026, d = 0.73. Urinary aMT6s melatonin levels were significantly lower among myopes (29.17 ± 18.67) than emmetropes (42.51 ± 23.97, p = 0.04, d = 0.63). Myopes also had a significant delay in sleep onset, greater sleep onset latency, shorter sleep duration, and more evening-type diurnal preference than emmetropes (all p < 0.05).

Conclusions

These findings suggest a potential association between circadian rhythms and myopia in humans.
SBM Mid-Career Leadership Institute
Authors: Affuso Olivia
Published: October 2020

My purpose for participating in the 2017 Society for Behavior Medicine (SBM) Leadership Institute was to redefine my career goals in an effort to do more work that mattered. I felt overwhelmed by the numerous tasks as a mid-level researcher, including leadership roles outside of my university to fill a desire to pursue activities that were purposeful but not valued by the academy. For example, I served on the Board of Girls on the Run (GOTR) where I was chair, leading a team of about 12 board members to provide a running-based life skills program for girls in Grades 3–5. After stepping down from the Board, I chose to develop a partnership between GOTR and the University of Alabama at Birmingham’s Center for Exercise Medicine (UCEM) that would provide an opportunity for me to lead an outreach effort extending the GOTR program into Birmingham City Schools. The goal was not only to reach more girls from disadvantaged backgrounds but also to also reach their family members. We used survey results to assess parent/family preferences for receiving physical activity training resources to be able to support their girls at the end-of-the program 5K celebration. The resources were made available via the UCEM website and a link was sent by GOTR to all families of participants in the program. Overall, the partnership allowed us to reach more girls and their families and I know that the SBM Leadership program contributed to my delegation and organizational skills coupled with coaching to reveal my strengths and blind spots.
Justification for species selection for pharmaceutical toxicity studies
Authors: Prior Helen , Haworth Richard , Labram Briony , Roberts Ruth , Wolfreys Alison , Sewell Fiona
Published: October 2020

Toxicity studies using mammalian species are generally required to provide safety data to support clinical development and licencing registration for potential new pharmaceuticals. International regulatory guidelines outline recommendations for the order (rodent and/or non-rodent) and number of species, retaining flexibility for development of a diverse range of drug modalities in a manner relevant for each specific new medicine. Selection of the appropriate toxicology species involves consideration of scientific, ethical and practical factors, with individual companies likely having different perspectives and preferences regarding weighting of various aspects dependent upon molecule characteristics and previous experience of specific targets or molecule classes. This article summarizes presentations from a symposium at the 2019 Annual Congress of the British Toxicology Society on the topic of species selection for pharmaceutical toxicity studies. This symposium included an overview of results from a National Centre for the Replacement, Refinement and Reduction of Animals in Research (NC3Rs) and Association of British Pharmaceutical Industry (ABPI) international collaboration that reviewed the use of one or two species in regulatory toxicology studies and justification for the species selected within each programme. Perspectives from two pharmaceutical companies described their processes for species selection for evaluation of biologics, and justification for selection of the minipig as a toxicological species for small molecules. This article summarizes discussions on the scientific justification and other considerations taken into account to ensure the most appropriate animal species are used for toxicity studies to meet regulatory requirements and to provide the most value for informing project decisions.
A Novel Species-Level Group of Streptomyces Exhibits Variation in Phytopathogenicity Despite Conservation of Virulence Loci
Authors: Weisberg Alexandra J. , Kramer Charles G. , Kotha Raghavendhar R. , Luthria Devanand L. , Chang Jeff H. , Clarke Christopher R.
Published: October 2020

The genus Streptomyces includes several phytopathogenic species that cause common scab, a devastating disease of tuber and root crops, in particular potato. The diversity of species that cause common scab is unknown. Likewise, the genomic context necessary for bacteria to incite common scab symptom development is not fully characterized. Here, we phenotyped and sequenced the genomes of five strains from a poorly studied Streptomyces lineage. These strains form a new species-level group. When genome sequences within just these five strains are compared, there are no polymorphisms of loci implicated in virulence. Each genome contains the pathogenicity island that encodes for the production of thaxtomin A, a phytotoxin necessary for common scab. Yet, not all sequenced strains produced thaxtomin A. Strains varied from nonpathogenic to highly virulent on two hosts. Unexpectedly, one strain that produced thaxtomin A and was pathogenic on radish was not aggressively pathogenic on potato. Therefore, while thaxtomin A biosynthetic genes and production of thaxtomin A are necessary, they are not sufficient for causing common scab of potato. Additionally, results show that even within a species-level group of Streptomyces strains, there can be aggressively pathogenic and nonpathogenic strains despite conservation of virulence genes.
Assumptions About Competency-Based Medical Education and the State of the Underlying Evidence: A Critical Narrative Review
Authors: Brydges Ryan , Boyd Victoria A. , Tavares Walter , Ginsburg Shiphra , Kuper Ayelet , Anderson Melanie , Stroud Lynfa
Published: October 2020

Purpose

As educators have implemented competency-based medical education (CBME) as a framework for training and assessment, they have made decisions based on available evidence and on the medical education community’s assumptions about CBME. This critical narrative review aimed to collect, synthesize, and judge the existing evidence underpinning assumptions the community has made about CBME.

Method

The authors searched Ovid MEDLINE to identify empirical studies published January 2000 to February 2019 reporting on competence, competency, and CBME. The knowledge synthesis focused on “core” assumptions about CBME, selected via a survey of stakeholders who judged 31 previously identified assumptions. The authors judged, independently and in pairs, whether evidence from included studies supported, did not support, or was mixed related to each of the core assumptions. Assumptions were also analyzed to categorize their shared or contrasting purposes and foci.

Results

From 8,086 unique articles, the authors reviewed 709 full-text articles and included 189 studies reporting evidence related to 15 core assumptions. Most studies (80%; n = 152) used a quantitative design. Many focused on procedural skills (48%; n = 90) and assessed behavior in clinical settings (37%; n = 69). On aggregate, the studies produced a mixed evidence base, reporting 362 data points related to the core assumptions (169 supportive, 138 not supportive, and 55 mixed). The 31 assumptions were organized into 3 categories: aspirations, conceptualizations, and assessment practices.

Conclusions

The reviewed evidence base is significant but mixed, with limited diversity in research designs and the types of competencies studied. This review pinpoints tensions to resolve (where evidence is mixed) and research questions to ask (where evidence is absent). The findings will help the community make explicit its assumptions about CBME, consider the value of those assumptions, and generate timely research questions to produce evidence about how and why CBME functions (or not).
Learning Echocardiography in the Workplace: A Cognitive Load Perspective
Authors: Blissett Sarah , Rodriguez Sebastian , Qasim Atif , O’Sullivan Patricia
Published: October 2020

Purpose

Although workplace learning environments provide authentic tasks to promote learning, elements of clinical settings may distract trainees and impede learning. The characteristics of workplace learning environments that require optimization are ill-defined. Applying principles of cognitive load theory (CLT) to optimize learning environments by managing intrinsic load (complexity of the task matched to learner knowledge and skill), minimizing extraneous load (any aspect that is not part of task completion), and increasing germane load (processing for storage in long-term memory) could be advantageous. The authors explored trainee perceptions of characteristics that helped or impaired learning from a cognitive load perspective. Echocardiography interpretation was used as a model.

Method

The authors conducted semistructured interviews between December 2018 and March 2019 with a purposeful sample of 10 cardiology trainees at the University of California, San Francisco, School of Medicine until thematic sufficiency was achieved. Participants represented a range of training levels (3 fourth-year trainees, 2 fifth-year trainees, 3 sixth-year trainees, and 2 advanced echocardiography fellows) and career aspirations (4 desired careers in imaging). Two independent coders analyzed interview transcripts using template analysis. Codes were mapped to CLT subcomponents.

Results

Trainees selected their own echocardiograms to interpret; if trainees’ skill levels and the complexity of the selected echocardiograms were mismatched, excess intrinsic load could result. Needing to look up information essential for task completion, interruptions, reporting software, and time pressures were characteristics that contributed to extraneous load. Characteristics that related to increasing germane load included the shared physical space (facilitating reading echocardiograms with attendings and just-in-time guidance from near peers) and the availability of final reports to obtain feedback independent of teachers.

Conclusions

As interpreted from a cognitive load perspective, findings highlight characteristics of workplace learning environments that could be optimized to improve learning. The findings have direct application to redesigning these learning environments.
The Relationship Between Burnout and Help-Seeking Behaviors, Concerns, and Attitudes of Residents
Authors: Dyrbye Liselotte N. , Leep Hunderfund Andrea N. , Winters Richard C. , Moeschler Susan M. , Vaa Stelling Brianna E. , Dozois Eric J. , Satele Daniel V. , West Colin P.
Published: October 2020

Purpose

To evaluate the relationship between help-seeking concerns and attitudes and burnout among residents.

Method

In 2019, all residents across the 4 Mayo Clinic sites were surveyed. The survey included 2 items from the Maslach Burnout Inventory, an item from the National Comorbidity Survey Replication about likelihood of seeking professional help for a serious emotional problem, and items developed to explore residents’ help-seeking behaviors and concerns. Multivariable logistic regression was conducted for each outcome variable and included age, gender, specialty, postgraduate year, site, and burnout.

Results

Of the 1,146 residents to whom surveys were sent, 762 (66.5%) responded. Nearly half (342/747, 45.8%) were concerned about negative consequence to their career if they went on medical leave, and one-third (247/753, 32.8%) were reluctant to seek professional help for a serious emotional concern. Of the 437 residents who had never attended a personal health appointment during scheduled work, 34.6% (151) thought it would be difficult to tell a supervising physician they needed to miss work due to a scheduled appointment. On multivariable analysis, burnout was independently associated with reporting it would be difficult to tell a supervising physician of a need to attend an appointment (odds ratio [OR] 2.32; 95% confidence interval [CI] 1.46, 3.67; P < .001), being concerned about negative consequence to their career if they went on medical leave (OR 2.09; 95% CI 1.49, 2.93; P < .001), and reluctance to seek professional care for a serious emotional problem (OR 1.65; 95% CI 1.17, 2.34; P = .004).

Conclusions

Barriers to self-care and help-seeking are common among residents and may be worse among those with burnout. Strategies to reduce stigma and promote a culture of well-being are needed.
Cardiac Rehabilitation Knowledge and Attitudes of Cardiology Fellows
Authors: Kellar Garrett , Hickey Gavin W. , Goss Fredric , Fertman Carl , Forman Daniel E.
Published: October 2020

Purpose:

Cardiac rehabilitation (CR) is underutilized with only 8-31% of eligible patients participating. Lack of referral and lack of physician endorsement are well-known barriers to participation. Physicians who lack insights regarding CR are less likely to refer patients and recommend it. Cardiology fellows are early career physicians who spend a significant amount of time treating patients eligible for CR. At one institution's cardiology fellowship program, we sought to assess fellow attitudes and knowledge base regarding CR and to determine their facilitators and barriers to CR endorsement and referral.

Methods:

University of Pittsburgh Department of Medicine Cardiology fellows were surveyed and interviewed to assess CR knowledge, attitudes, and perceived facilitators and barriers to CR endorsement and referral.

Results:

The cardiology fellows at this institution had strong belief in the benefits and cost-effectiveness of CR. Despite their support of CR, they had low CR knowledge scores. Perceived impediments to CR included complicated logistics of CR operations, limited communication between CR staff and fellows, limited time with patients, presumed patient barriers, perceived self-barriers, and poor understanding of referral processes (particularly as they varied in each hospital in which they rotated). Perceived supports to CR included greater awareness of evidence-based outcomes, awareness of patient-centered outcomes, pre-arranged order sets, and reminders for referral.

Conclusion:

This study revealed perceptions of cardiology fellows at one institution regarding CR that have not been considered previously. Key barriers to endorsement and referral to CR were exposed as well as opportunities to overcome them. Fellowship training affords an important opportunity to improve CR education, and to potentially improve participation of eligible patients for this important aspect of care.
Antihypertensive therapy and short-term blood pressure variability
Authors: de la Sierra Alejandro , Mateu Aina , Gorostidi Manuel , Vinyoles Ernest , Segura Julián , Ruilope Luis M.
Published: October 2020

Background and aim:

Blood pressure variability (BPV) is recognized as a prognostic contributor in hypertension. We aimed to assess differences in short-term BPV in treated hypertensive patients depending on the number, classes, combinations and individual compounds of the antihypertensive treatment.

Methods:

We selected 38 188 treated patients from the Spanish Ambulatory BP Monitoring (ABPM) Registry. SBP and DBP standard deviations (SD) from 24-h, daytime and night-time, weighted SD (WSD), and average real variability (ARV) were calculated through ABPM. They were compared (after adjustment for clinical confounders and BP) depending on the number of antihypertensive drugs, antihypertensive drug classes and compounds (in 13 765 patients on monotherapy), or combinations (in 12 716 patients treated with two drugs and 7888 treated with three drugs).

Results:

Systolic and diastolic BPV significantly increased in patients treated with multiple drugs with respect to monotherapy. Among drug classes, calcium channel blockers, especially amlodipine, and diuretics were associated with lower systolic BPV, including daytime and night-time SD, WSD and ARV, compared with beta blockers, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers. Likewise, in patients treated with two-drug and three-drug combinations, those which included a calcium channel blocker showed lower BPV in comparison to those without such drug class.

Conclusion:

Treatment with calcium channel blockers, especially amlodipine, and with diuretics is associated with slight, but significant lower values of short-term BPV in comparison to other major drug classes, both in monotherapy and in combination. These results could be helpful when considering BPV reduction as an additional treatment target.
A novel method to assess valvulo-arterial load in patients with aortic valve stenosis
Authors: Hungerford Sara L. , Adji Audrey I. , Bart Nicole K. , Lin Linda , Namasivayam Mayooran J. , Schnegg Bruno , Jabbour Andrew , O’Rourke Michael F. , Hayward Christopher S. , Muller David W.M.
Published: October 2020

Introduction:

Ventricular function in elderly patients with aortic stenosis is impeded both by restricted aortic flow and arterial stiffening. A number of patients continue to have exertional intolerance after relief of aortic valvular obstruction due to unrecognized ventriculo-arterial coupling mismatch.

Hypothesis:

Quantification of valvulo-arterial load (VAL), using a simultaneous applanation tonometry/cardiac magnetic resonance (CMR) technique, can accurately assess the relative contributions of aortic stiffness and valve gradient in older patients with aortic stenosis.

Methods:

Elderly patients with aortic stenosis underwent a simultaneous applanation tonometry/CMR protocol. CMR provided left ventricular volume and aortic flow simultaneously with radial applanation tonometry pressure acquisition. Central aortic pressure was derived by transformation of the radial applanation tonometry waveform. VAL was determined as the relationship of derived aortic pressure to CMR aortic flow in frequency domain (central illustration).

Results:

Twenty patients (age 80 ± 9 years; 12 males; blood pressure 140/75 ± 20 mmHg) with aortic stenosis on transthoracic echocardiogram (16 severe; mean gradient 45 ± 16 mmHg; aortic valve area 0.8 ± 0.2 cm2) were enrolled. Derived aortic pressure and flow waveforms correlated well with invasive data. Increased VAL was significantly associated with advanced age (P = 0.04) and raised SBP (P < 0.01), irrespective of aortic stenosis severity.

Conclusion:

Difficulties in the measurement and accuracy of ventriculo-arterial coupling means that it is not routinely measured in patients with aortic stenosis. We describe a new noninvasive index that provides an accurate assessment of valvular and arterial load on the left ventricle. VAL may help detect those at risk of ventriculo-arterial coupling mismatch and assist in selection of those most likely to benefit from an invasive procedure.
Excess pressure as an analogue of blood flow velocity
Authors: Armstrong Matthew K. , Schultz Martin G. , Hughes Alun D. , Picone Dean S. , Black J. Andrew , Dwyer Nathan , Roberts-Thomson Philip , Sharman James E.
Published: October 2020

Introduction:

Derivation of blood flow velocity from a blood pressure waveform is a novel technique, which could have potential clinical importance. Excess pressure, calculated from the blood pressure waveform via the reservoir-excess pressure model, is purported to be an analogue of blood flow velocity but this has never been examined in detail, which was the aim of this study.

Methods:

Intra-arterial blood pressure was measured sequentially at the brachial and radial arteries via fluid-filled catheter simultaneously with blood flow velocity waveforms recorded via Doppler ultrasound on the contralateral arm (n = 98, aged 61 ± 10 years, 72% men). Excess pressure was derived from intra-arterial blood pressure waveforms using pressure-only reservoir-excess pressure analysis.

Results:

Brachial and radial blood flow velocity waveform morphology were closely approximated by excess pressure derived from their respective sites of measurement (median cross-correlation coefficient r = 0.96 and r = 0.95 for brachial and radial comparisons, respectively). In frequency analyses, coherence between blood flow velocity and excess pressure was similar for brachial and radial artery comparisons (brachial and radial median coherence = 0.93 and 0.92, respectively). Brachial and radial blood flow velocity pulse heights were correlated with their respective excess pressure pulse heights (r = 0.53, P < 0.001 and r = 0.43, P < 0.001, respectively).

Conclusion:

Excess pressure is an analogue of blood flow velocity, thus affording the opportunity to derive potentially important information related to arterial blood flow using only the blood pressure waveform.
Methods for Cleaning and Managing a Nurse-Led Registry
Authors: Venkatachalam Aardhra M. , Perera Anjali , Stutzman Sonja E. , Olson DaiWai M. , Aiyagari Venkatesh , Atem Folefac D.
Published: October 2020

BACKGROUND: Clinical registries provide insight on the quality of patient care by providing data to identify associations and patterns in diagnosis, disease, and treatment. This has led to a push toward using large data sets in healthcare research. Nurse researchers are developing data registries, but most are unaware of how to manage a data registry. This article examines a neuroscience nursing registry to describe a quality control and data management process. DATA QUALITY PROCESS: Our registry contains more than 90 000 rows of data from almost 5000 patients at 4 US hospitals. Data management is a continuous process that consists of 5 phases: screening, data organization, diagnostic, treatment, and missing data. These phases are repeated with each registry update. DISCUSSION: The interdisciplinary approach to data management resulted in high-quality data, which was confirmed by missing data analysis. Most technical errors could be systematically diagnosed and resolved using basic statistical outputs, and fixed in the source file. CONCLUSION: The methods described provide a structured way for nurses and their collaborators to clean and manage registries.
Bivalirudin May Reduce the Need for Red Blood Cell Transfusion in Pediatric Cardiac Patients on Extracorporeal Membrane Oxygenation
Authors: Machado Desiree S. , Garvan Cynthia , Philip Joseph , Harrington Donald , Spiess Bruce , Kelly Brian , Campbell Christopher T. , Pelletier J. Peter R. , Islam Saleem , Peek Giles J. , Bleiweis Mark S.
Published: October 2020

We retrospectively compared anticoagulation with heparin and bivalirudin for 32 consecutive children under 18 years old during extracorporeal membrane oxygenation (ECMO) in our pediatric cardiac intensive care unit (PCICU). Between September 2015 and January 2018, 14 patients received heparin, 13 venoarterial (VA), and 1 venovenous (VV). From February 2018 to September 2019, 18 received bivalirudin (all VA). The mean (standard deviation [SD]) percentage of time with therapeutic activated partial thromboplastin time and activated clotting time was bivalirudin 54 (14%) and heparin 57 (11%), p = 0.4647, and percentage of time supratherapeutic was bivalirudin 18 (10%) and heparin 27 (12%), p = 0.0238. Phlebotomy-associated blood loss per hour of ECMO was double in the heparin compared with bivalirudin group 1.08 ml/h (0.20 ml/h), compared with 0.51 ml/h (0.07 ml/h), p = 0.0003, as well as interventions to control bleeding. Packed red blood cell (PRBC) transfusions significantly correlated with higher blood loss in the heparin group (Pearson correlation coefficient = 0.49, p = 0.0047). Overall amount of blood product utilization was not different between the groups. Survival to ECMO decannulation was 89% for bivalirudin and 57% for heparin, p = 0.0396, although 6 month survival was not significantly different (67% versus 57%, p = 0.5809). Heparin may increase the need for PRBC transfusions and strategies to attenuate bleeding when compared with bivalirudin for children receiving ECMO in PCICU.
Pure Bladder Malignant Rhabdoid Tumor Successfully Treated With Partial Cystectomy, Radiation, and Chemotherapy: A Case Report and Review of the Literature
Authors: Assadi Akram , Alzubaidi Ahmad , Lesmana Harry , Brennan Rachel C. , Saad Ali , Ortiz-Hernández Vanessa , Gleason Joseph M.
Published: October 2020

Background:

Extracranial pure malignant rhabdoid tumors (MRT) are aggressive tumors that carry a poor prognosis. Bladder MRTs are very rare and only 8 cases have been reported previously.

Observation:

We present a case of a child with bladder MRT. Despite the aggressive nature of the bladder tumor, it was successfully treated with bladder-sparing surgery, adjuvant radiotherapy, and chemotherapy.

Conclusions:

Our case, and review of 8 previously reported cases, suggests that bladder MRT seems to behave less aggressively when compared with other extracranial MRTs, and bladder preserving surgery should be considered when feasible.
Massive Brainstem and Cerebellum Infarction Due to Traumatic Extracranial Vertebral Artery Dissection in a Motor Traffic Accident
Authors: Wang Tao , Zhang Jianhua , Zou Donghua , Chen Yijiu
Published: October 2020

Traumatic unilateral vertebral artery (VA) injury can cause focal thrombosis and may block the basilar artery which can further lead to ischemic stroke and massive cerebral infarction and subarachnoid hemorrhage and even rapid death. Here, we present an autopsy case with a traumatic extracranial VA dissection in a motor traffic accident, and the identification of cause of death underwent 2 autopsies. A 62-year-old male pedestrian collided with the right rearview mirror of a car and fell down to the ground. He complained pains in the head and neck. Head computed tomography (CT) showed a right linear temporal bone fracture and a small left temporal subdural hematoma. Neck CT and magnetic resonance imaging (MRI) examination showed left transverse process fracture of the sixth cervical vertebra (C6) and left extracranial VA injury. After 6 days of hospitalization, the left temporal subdural hematoma had been nearly absorbed, and the man was discharged home. On day 15 after the traffic accident, the man suffered sudden unconsciousness accompanied by frequent vomiting at home. The man was taken to hospital, and there were no obvious abnormal findings by head CT examination. However, the man soon fell into a coma state and died 2 days later. The first autopsy was performed 7 days after death and confirmed a left transverse process fracture of C6 and that the deceased died of cerebral infarction and secondary subarachnoid hemorrhage caused by blunt force in the motor traffic accident. In the civil lawsuit, the traffic accident wrecker put forward the objection whether the deceased had fatal diseases. The second autopsy (84 days after the death) findings verified the left extracranial VA injury. Histopathological examination further showed intimal dissection and thrombus formation of the left extracranial VA and secondary basal arterial thromboembolism. Massive infarction of the brainstem and cerebellum was disclosed. Therefore, the deceased died of delayed massive brainstem and cerebellum infarction because of left extracranial VA dissection in the motor traffic accident.
Differences Between Central and Peripheral Postmortem Tryptase Levels
Authors: Garland Jack , Ondruschka Benjamin , Da Broi Ugo , Palmiere Cristian , Glenn Charley , Morrow Paul , Kesha Kilak , Stables Simon , Tse Rexson
Published: October 2020

Postmortem tryptase is a commonly used biochemical test to aid in the diagnosis of fatal anaphylaxis, which is currently recommended to be sampled from peripheral (femoral) veins because of a research showing comparatively elevated levels from central blood sources. Previous studies have used nonstandardized or nondocumented sampling methods; however, more recent research demonstrates that tryptase levels may vary depending on the sampling method. This study used the recommended sampling method of aspirating the femoral vein after clamping and compared in a pairwise comparison with aspiration of central venous and arterial blood sources (inferior vena cava and aorta) in 2 groups of 25 nonanaphylactic deaths. We found no statistically significant differences in postmortem tryptase between central and femoral vein blood; however, sporadic outliers in central blood (particularly aortic blood reaching levels above documented cutoffs for fatal anaphylaxis) were observed. Our findings provide evidence for the existing recommendations that femoral vein blood remains the preferred sample for postmortem tryptase over central blood.
Prevalence of Reintubation Within 24 Hours of Extubation in Bronchiolitis: Retrospective Cohort Study Using the Virtual Pediatric Systems Database*
Authors: Badruddin Salar S. , Clayton Jason A. , McKee Bryan P. , Slain Katherine N. , Rotta Alexandre T. , Malay Sindhoosha , Shein Steven L.
Published: October 2020

OBJECTIVES:

High-flow nasal cannula and noninvasive positive pressure ventilation are used to support children following liberation from invasive mechanical ventilation. Evidence comparing extubation failure rates between patients randomized to high-flow nasal cannula and noninvasive positive pressure ventilation is available for adult and neonatal patients; however, similar pediatric trials are lacking. In this study, we employed a quality controlled, multicenter PICU database to test the hypothesis that high-flow nasal cannula is associated with higher prevalence of reintubation within 24 hours among patients with bronchiolitis.

DESIGN:

Secondary analysis of a prior study utilizing the Virtual Pediatric Systems database.

SETTING:

One-hundred twenty-four participating PICUs.

PATIENTS:

Children less than 24 months old with a primary diagnosis of bronchiolitis who were admitted to one of 124 PICUs between January 2009 and September 2015 and received invasive mechanical ventilation.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 759 patients, median age was 2.4 months (1.3–5.4 mo), 41.2% were female, 39.7% had greater than or equal to 1 comorbid condition, and 43.7% were Caucasian. Median PICU length of stay was 8.7 days (interquartile range, 5.8–13.7 d) and survival to PICU discharge was 100%. Median duration of intubation was 5.5 days (3.4–9.0 d) prior to initial extubation. High-flow nasal cannula was used following extubation in most (656 [86.5%]) analyzed subjects. The overall prevalence of reintubation within 24 hours was 5.9% (45 children). Extubation to noninvasive positive pressure ventilation was associated with greater prevalence of reintubation than extubation to high-flow nasal cannula (11.7% vs 5.0%; p = 0.016) and, in an a posteriori model that included Pediatric Index of Mortality 2 score and comorbidities, was associated with increased odds of reintubation (odds ratio, 2.43; 1.11–5.34; p = 0.027).

CONCLUSIONS:

In this secondary analysis of a multicenter database of children with bronchiolitis, extubation to high-flow nasal cannula was associated with a lower prevalence of reintubation within 24 hours compared with noninvasive positive pressure ventilation in both unmatched and propensity-matched analysis. Prospective trials are needed to determine if post-extubation support modality can mitigate the risk of extubation failure.
Primary Intestinal Lymphangiectasia
Authors: Pascal Pierre , Malloizel Julie , Lairez Olivier , de Volontat Marie Danjoux , Bournet Barbara
Published: October 2020

Primary intestinal lymphangiectasia is an unusual cause of protein losing enteropathy due to either congenital malformation or obstruction of lymphatics of intestine. The disease can affect all or only a small part of the small intestine. Peripheral lymphedema may be associated. The diagnosis is based on endoscopic and histopathological findings. A 30-year-old woman presents lower extremity edema with hypoproteinemia, hypoalbuminemia, and hypogammaglobulinemia. 99mTc-labeled human serum albumin nanocolloid lymphoscintigraphy of the lower extremity demonstrated a dermal backflow in the right extremity consistent with lymphedema and an unusual ileal uptake on SPECT/CT. Diagnosis is confirmed on histopathological evaluation of biopsy of ileum.
Peripheral Photopenia on Whole-Body PET/CT Imaging With 18F-FDG in Patients With Compartment Syndrome and Mesenteric Venous Thrombosis
Authors: te Beek Erik T. , Tangkau Peter L. , van Esser Stijn , Brouwer Rolf E. , ten Broek Marc R. J.
Published: October 2020

We present 2 cases that demonstrate photopenia in peripheral areas on whole-body PET/CT imaging with 18F-FDG as a sign of absent perfusion with severe short-term complications. The scan of the first patient shows photopenia in the right ankle and foot, resulting from compartment syndrome, caused by hemolytic group A streptococcus bacteremia with endocarditis and septic emboli, necessitating lower leg amputation. The scan of the second patient shows photopenia in the transverse colon, resulting from mesenteric venous thrombosis caused by polycythemia vera, leading to necrosis and perforation of the transverse colon, necessitating transverse and right hemicolectomy.
68Ga–Prostate-Specific Membrane Antigen Focal Pulmonary Activity With No Corresponding CT Abnormality
Authors: Sasikumar Arun , Thampan Sam , Thomas Nivya , Paul Retcy
Published: October 2020

We describe a case of 68Ga–prostate-specific membrane antigen PET/CT scan with focal tracer concentration in the lung without any abnormalities in the CT part. 18F-FDG focal uptake in lungs without corresponding CT lesions is described. Two possible mechanisms proposed to explain this finding in FDG PET/CT scans are iatrogenic pulmonary microembolism and 18F-FDG–avid infection or inflammation that precedes structural findings. Logically, these proposed mechanisms seem to be applicable to 68Ga–prostate-specific membrane antigen as well. In our case, there were no features of any lung infection/inflammation, and the most plausible explanation would be iatrogenic microembolism.
Is 68Ga–Prostate-Specific Membrane Antigen PET/CT Superior than 18F-FDG PET/CT for Evaluation of Metastatic Osteosarcoma?
Authors: Can Canan , Gündoğan Cihan , Kömek Halil
Published: October 2020

We present the case of a 75-year-old man with osteosarcoma of the sternum in whom 68Ga-prostate-specific membrane antigen (PSMA) PET/CT showed high radiotracer activity in the primary tumor and metastatic lesions than 18F-FDG PET/CT. The present case shows that 68Ga-PSMA PET/CT is very useful for staging of osteosarcoma due to in vivo expression of PSMA. 68Ga-PSMA PET/CT can have potential effects on prognosis and in response assessment following treatment in osteosarcoma. The use of PSMA-targeted radioligand treatments may be beneficial especially in metastatic chemorefractory osteosarcoma.
Facial Nerve Canal Paraganglioma
Authors: Arsovic Emina , Montava Marion , Lavieille Jean-Pierre , Pacak Karel , Varoquaux Arthur , Taïeb David
Published: October 2020

We report the case of a 72-year-old woman presenting with a progressive left peripheral facial paralysis and a facial canal mass extending through the stylomastoid foramen along the posterior edge of the parotid gland. On MRI, the early and intense enhancement was highly suggestive of paraganglioma but could not rule out a nonossifying hemangioma. Laboratory analysis showed normal plasma metanephrines. On 18F-FDOPA PET/CT, the mass exhibited a typical paraganglioma feature with a marked tumor uptake. Our case demonstrates that 18F-FDOPA plays a vital role in this rare entity and can avoid any further confirmatory invasive procedure.
Humongous Seminal Vesicles on 68Ga-DOTATOC PET/CT
Authors: Hendriks Romee A. , Hoogendoorn Stefan P. , van Gemert Willemijn A.M. , Kaal Suzanne E.J. , Arens Anne I.J.
Published: October 2020

A 24-year-old man presented with decreased appetite, fatigue, abdominal pain, and acute renal insufficiency. Ultrasound showed bilateral hydronephrosis. CT of the abdomen revealed enlarged seminal vesicles causing bilateral hydronephrosis, mesenteric and peritoneal metastases, liver lesions, and enlarged lymph nodes in the retroperitoneum. A biopsy from a peritoneal lesion demonstrated metastasis of a neuroendocrine tumor grade 2. A 68Ga-DOTATOC PET/CT scan was performed, which showed enhanced uptake in all lesions including the enlarged seminal vesicles. This case illustrates the very rare presentation of involved seminal vesicles in neuroendocrine tumors.
17β-Estradiol Treatment Protects Lungs Against Brain Death Effects in Female Rat Donor
Authors: Ricardo-da-Silva Fernanda Yamamoto , Armstrong Roberto , Vidal-dos-Santos Marina , Correia Cristiano de Jesus , Coutinho e Silva Raphael dos Santos , da Anunciação Lucas Ferreira , Moreira Luiz Felipe Pinho , Leuvenink Hendrik Gerrit Derk , Breithaupt-Faloppa Ana Cristina
Published: October 2020

Background.

Brain death (BD) affects the viability of lungs for transplantation. A correlation exists between high-lung inflammation after BD and the decrease in female sex hormones, especially estradiol. Therefore, we investigated the effects of 17β-estradiol (E2) treatment on the lungs of female brain dead rats.

Methods.

Female Wistar rats were divided into 4 groups: BD (submitted to BD for 6 h), sham (false operated), E2-T0 (treated with E2 immediately after BD; 50 μg/mL, 2 mL/h), and E2-T3 (treated with E2 after 3 h of BD; 50 μg/mL, 2 mL/h). Lung edema, hemorrhage, and leukocyte infiltration were analyzed. Adhesion molecules were evaluated, and analysis of NO synthase gene and protein expression was performed using real-time PCR and immunohistochemistry, respectively. Release of chemokines and matrix degradation in the lungs was analyzed.

Results.

BD increased leukocyte infiltration, as shown by intravital microscopy (P = 0.017), bronchoalveolar lavage cell count (P = 0.016), the release of inflammatory mediators (P = 0.02), and expression of adhesion molecules. BD also increased microvascular permeability and the expression and activity of matrix metalloproteinase-9 in the lungs. E2 treatment reduced leukocyte infiltration, especially in the E2-T3 group, release of inflammatory mediators, adhesion molecules, and matrix metalloproteinase activity in the lungs.

Conclusions.

E2 treatment was successful in controlling the lung inflammatory response in females submitted to BD. Our results suggest that E2 directly decreases the release of chemokines, restraining cell traffic into the lungs. Thus, E2 has a therapeutic potential, and its role in improving donor lung quality should be explored further.
Evolutionary history and current distribution of the West Mediterranean lineage of Brucella melitensis in Italy
Authors: Janowicz Anna , De Massis Fabrizio , Zilli Katiuscia , Ancora Massimo , Tittarelli Manuela , Sacchini Flavio , Di Giannatale Elisabetta , Sahl Jason W. , Foster Jeffrey T. , Garofolo Giuliano
Published: October 2020

Ovine and caprine brucellosis, caused by

Brucella melitensis

, is one of the world’s most widespread zoonoses and is a major cause of economic losses in domestic ruminant production. In Italy, the disease remains endemic in several southern provinces, despite an ongoing brucellosis eradication programme. In this study, we used whole-genome sequencing to detail the genetic diversity of circulating strains, and to examine the origins of the predominant sub-lineages of

B. melitensis

in Italy. We reconstructed a global phylogeny of

B. melitensis

, strengthened by 339 new whole-genome sequences, from Italian isolates collected from 2011 to 2018 as part of a national livestock surveillance programme. All Italian strains belonged to the West Mediterranean lineage, which further divided into two major clades that diverged roughly between the 5th and 7th centuries. We observed that Sicily serves as a brucellosis burden hotspot, giving rise to several distinct sub-lineages. More than 20 putative outbreak clusters of ovine and caprine brucellosis were identified, several of which persisted over the 8 year survey period despite an aggressive brucellosis eradication campaign. While the outbreaks in Central and Northern Italy were generally associated with introductions of single clones of

B. melitensis

and their subsequent dissemination within neighbouring territories, we observed weak geographical segregation of genotypes in the southern regions. Biovar determination, recommended in routine analysis of all

Brucella

strains by the World Organisation for Animal Health (OIE), could not discriminate among the four main global clades. This demonstrates a need for updating the guidelines used for monitoring

B. melitensis

transmission and spread, both at the national and international level, and to include whole-genome-based typing as the principal method for identification and tracing of brucellosis outbreaks.
Variable optical properties of light-harvesting complex II revisited
Authors: Iwai Masakazu , Chen Jie-Jie , Park Soomin , Yoneda Yusuke , Schmid Eva M. , Fletcher Daniel A. , Fleming Graham R. , Niyogi Krishna K.
Published: October 2020

Understanding photosynthetic light harvesting requires knowledge of the molecular mechanisms that dissipate excess energy in thylakoids. However, it remains unclear how the physical environment of light-harvesting complex II (LHCII) influences the process of chlorophyll de-excitation. Here, we demonstrate that protein-protein interactions between LHCIIs affect the optical properties of LHCII and thus influence the total energy budget. Aggregation of LHCII in the dark altered its absorption properties, independent of the amount of prior light exposure. We also revisited the triplet excited state involved in light-induced fluorescence quenching and found another relaxation pathway involving emission in the green region, which might be related to triplet excited energy transfer to neighboring carotenoids and annihilation processes that result in photoluminescence. LHCII- containing liposomes with different protein densities exhibited altered fluorescence and scattering properties. Our results suggest that macromolecular reorganization affects overall optical properties, which need to be addressed to compare the level of energy dissipation.
Selection on ancestral genetic variation fuels parallel ecotype formation in bottlenose dolphins
Authors: Louis M. , Galimberti M. , Archer F. , Berrow S. , Brownlow A. , Fallon R. , Nykänen M. , O’Brien J. , Roberston K. M. , Rosel P. E. , Simon-Bouhet B. , Wegmann D. , Fontaine M.C. , Foote A.D. , Gaggiotti O.E.
Published: October 2020

What are the mechanisms that allow species to extend their ranges and adapt to the novel environmental conditions they find in the newly available habitat? The study of parallel adaptation of pairs of populations to similar environments can provide great insights into this question. Here, we test for parallel evolution driven by niche specialization in a highly social marine mammal, the common bottlenose dolphin,Tursiops truncatus, and investigate the origins of the genetic variation driving local adaptation. Coastal ecotypes of common bottlenose dolphins have recurrently emerged in multiple regions of the world from pelagic ecotype populations, when novel habitat became available. Analyzing the whole genomes of 57 individuals using comparative population genomics approaches, we found that coastal ecotype evolution was relatively independent between the Atlantic and Pacific, but related between different regions within the Atlantic. We show that parallel adaptation to coastal habitat was facilitated by repeated selection on ancient alleles present as standing genetic variation in the pelagic populations. Genes under parallel adaptation to coastal habitats have roles in cognitive abilities and feeding. Therefore, parallel adaptation in long-lived social species may be driven by a combination of ecological opportunities, selection acting on ancient variants, and stable behavioural transmission of ecological specialisations. Tried and tested genetic variation that has been subject to repeated bouts of selection, may promote linked adaptive variants with minimal pleiotropic effects, thereby facilitating their persistence at low frequency in source populations and enabling parallel evolution.