bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ivermectin Accelerates Circulating Nonstructural Protein 1 (NS1) Clearance in Adult Dengue Patients: A Combined Phase 2/3 Randomized Double-blinded Placebo Controlled Trial
Authors: Suputtamongkol Yupin , Avirutnan Panisadee , Mairiang Dumrong , Angkasekwinai Nasikarn , Niwattayakul Kannika , Yamasmith Eakkawit , Saleh-arong Fadhil A-hamad , Songjaeng Adisak , Prommool Tanapan , Tangthawornchaikul Nattaya , Puttikhunt Chunya , Hunnangkul Saowalak , Komoltri Chulaluk , Thammapalo Suwich , Malasit Prida 
Published: November 2020

Abstract

Background
Dengue is the most significant mosquito-borne viral disease; there are no specific therapeutics. The antiparasitic drug ivermectin efficiently inhibits the replication of all 4 dengue virus serotypes in vitro.

Methods
We conducted 2 consecutive randomized, double-blind, placebo-controlled trials in adult dengue patients to evaluate safety and virological and clinical efficacies of ivermectin. After a phase 2 trial with 2 or 3 days of 1 daily dose of 400 µg/kg ivermectin, we continued with a phase 3, placebo-controlled trial with 3 days of 400 µg/kg ivermectin.

Results
The phase 2 trial showed a trend in reduction of plasma nonstructural protein 1 (NS1) clearance time in the 3-day ivermectin group compared with placebo. Combining phase 2 and 3 trials, 203 patients were included in the intention to treat analysis (100 and 103 patients receiving ivermectin and placebo, respectively). Dengue hemorrhagic fever occurred in 24 (24.0%) of ivermectin-treated patients and 32 (31.1%) patients receiving placebo (P = .260). The median (95% confidence interval [CI]) clearance time of NS1 antigenemia was shorter in the ivermectin group (71.5 [95% CI 59.9–84.0] hours vs 95.8 [95% CI 83.9–120.0] hours, P = .014). At discharge, 72.0% and 47.6% of patients in the ivermectin and placebo groups, respectively had undetectable plasma NS1 (P = .001). There were no differences in the viremia clearance time and incidence of adverse events between the 2 groups.

Conclusions
A 3-day 1 daily dose of 400 µg/kg oral ivermectin was safe and accelerated NS1 antigenemia clearance in dengue patients. However, clinical efficacy of ivermectin was not observed at this dosage regimen.
Environmental Contamination of Contact Precaution and Non-Contact Precaution Patient Rooms in Six Acute Care Facilities
Authors: Tanner Windy D , Leecaster Molly K , Zhang Yue , Stratford Kristina M , Mayer Jeanmarie , Visnovsky Lindsay D , Alhmidi Heba , Cadnum Jennifer L , Jencson Annette L , Koganti Sreelatha , Bennett Christina P , Donskey Curtis J , Noble-Wang Judith , Reddy Sujan C , Rose Laura J , Watson Lauren , Ide Emma , Wipperfurth Tyler , Safdar Nasia , Arasim Maria , Macke Colleen , Roman Patti , Krein Sarah L , Loc-Carrillo Catherine , Samore Matthew H 
Published: November 2020

Abstract

Background
Environmental contamination is an important source of hospital multidrug-resistant organism (MDRO) transmission. Factors such as patient MDRO contact precautions (CP) status, patient proximity to surfaces, and unit type likely influence MDRO contamination and bacterial bioburden levels on patient room surfaces. Identifying factors associated with environmental contamination in patient rooms and on shared unit surfaces could help identify important environmental MDRO transmission routes.

Methods
Surfaces were sampled from MDRO CP and non-CP rooms, nursing stations, and mobile equipment in acute care, intensive care, and transplant units within 6 acute care hospitals using a convenience sampling approach blinded to cleaning events. Precaution rooms had patients with clinical or surveillance tests positive for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, carbapenem-resistant Enterobacteriaceae or Acinetobacter within the previous 6 months, or Clostridioides difficile toxin within the past 30 days. Rooms not meeting this definition were considered non-CP rooms. Samples were cultured for the above MDROs and total bioburden.

Results
Overall, an estimated 13% of rooms were contaminated with at least 1 MDRO. MDROs were detected more frequently in CP rooms (32% of 209 room-sample events) than non-CP rooms (12% of 234 room-sample events). Surface bioburden did not differ significantly between CP and non-CP rooms or MDRO-positive and MDRO-negative rooms.

Conclusions
CP room surfaces are contaminated more frequently than non-CP room surfaces; however, contamination of non-CP room surfaces is not uncommon and may be an important reservoir for ongoing MDRO transmission. MDRO contamination of non-CP rooms may indicate asymptomatic patient MDRO carriage, inadequate terminal cleaning, or cross-contamination of room surfaces via healthcare personnel hands.
Factors Associated With Anxiety Symptoms in Australian Deaf or Hard of Hearing Children
Authors: Long Johanna , Attuquayefio Tuki , Hudson Jennifer L 
Published: November 2020

Abstract
Deaf/deaf or hard of hearing (DHH) children are at an increased risk of developing mental health problems, with growing evidence that they may experience greater anxiety symptoms than hearing peers. The present study investigated whether Australian children with varying degrees of hearing loss experienced increased anxiety symptoms compared to hearing children. Furthermore, we examined whether child anxiety symptoms were associated with known risk factors including psychological symptoms of anxiety and depression in parents, age at detection, early intervention and device fitting, type of hearing device, and peer problems. Participants were 65 parents of children with hearing loss aged between 4 and 11 years old (M = 6.05, SD = 1.60) seeking treatment for hearing loss at a specialized hearing clinic in Australia. Based on parent reports, we found that the children with hearing loss had fewer anxiety symptoms than their hearing peers (using normative data). Psychological distress of parents was the only factor that uniquely associated with child anxiety. Parents of children with hearing loss were found to experience greater emotional distress compared to parents of hearing children. This suggests parents may require additional support to cope with the social and economic strains associated with childhood hearing loss.
A comparison of the clinical efficacy of echocardiography and magnetic resonance for chronic aortic regurgitation
Authors: Postigo Andrea , Pérez-David Esther , Revilla Ana , Raquel Ladrón Abia , González-Mansilla Ana , Prieto-Arévalo Raquel , Espinosa M Ángeles , López-Jimenez Rosa Ana , Sevilla Teresa , Urueña Noelia , Martínez-Legazpi Pablo , Oliver José M , Fernández-Avilés Francisco , J. Alberto San Román , Bermejo Javier 
Published: November 2020

Abstract

Aims
Timing surgery in chronic aortic regurgitation (AR) relies mostly on echocardiography. However, cardiac magnetic resonance (CMR) may be more accurate for quantifying regurgitation and left ventricular (LV) remodelling. We aimed to compare the technical and clinical efficacies of echocardiography and CMR to account for the severity of the disease, the degree of LV remodelling, and predict AR-related outcomes.

Methods and results
We studied 263 consecutive patients with isolated AR undergoing echocardiography and CMR. After a median follow-up of 33 months, 76 out of 197 initially asymptomatic patients reached the primary endpoint of AR-related events: 6 patients (3%) were admitted for heart failure, and 70 (36%) underwent surgery. Adjusted survival models based on CMR improved the predictions of the primary endpoint based on echocardiography: R2 = 0.37 vs. 0.22, χ2 = 97 vs. 49 (P &lt; 0.0001), and C-index = 0.80 vs. 0.70 (P &lt; 0.001). This resulted in a net classification index of 0.23 (0.00–0.46, P = 0.046) and an integrated discrimination improvement of 0.12 (95% confidence interval 0.08–0.58, P = 0.02). CMR-derived regurgitant fraction (&lt;28, 28–37, or &gt;37%) and LV end-diastolic volume (&lt;83, 183–236, or &gt;236 mL) adequately stratified patients with normal EF. The agreement between techniques for grading AR severity and assessing LV dilatation was poor, and CMR showed better reproducibility.

Conclusions
CMR improves the clinical efficacy of ultrasound for predicting outcomes of patients with AR. This is due to its better reproducibility and accuracy for grading the severity of the disease and its impact on the LV. Regurgitant fraction, LV ejection fraction, and end-diastolic volume obtained by CMR most adequately predict AR-related events.
The MARVEL trial: a phase 2b randomised placebo-controlled trial of oral MitoQ in moderate ulcerative colitis
Authors: Gwyer Findlay Emily , Sutton Greg , Ho Gwo-Tzer 
Published: November 2020

Summary
Ulcerative colitis (UC) is an inflammatory disease of the large bowel which is characterised by dysregulated immunity and death to epithelial cells in the bowel, leading to prolonged inflammation. This can ultimately lead to surgery to remove the large bowel, with a risk of cancer developing if inflammation persists. Current therapies – which target the incoming immune cells or the cytokines they produce – are improving significantly but they are expensive and are immunosuppressive, leading to risk of infection. Here, we discuss a new trial which targets an early inducer of inflammation – the production of reactive oxygen species (ROS) by mitochondria. Previous work has shown that excessive mitochondrial ROS induces inflammatory signalling through the cGAS-STING pathway, leading to dysregulated immunity and death of epithelial cells. In this MARVEL trial (Mitochondrial Anti-oxidant therapy to Resolve Inflammation in Ulcerative Colitis) individuals with an active UC flare-up will be given a mitochondrial anti-oxidant (MitoQ) or placebo tablet in addition to standard medical treatment, in order to suppress inflammation as it develops. This phase 2b trial will repurpose MitoQ, which has been previously tested in other large trials in different disease settings, and will measure clinical response and markers of inflammation over 24 weeks. It is hoped that this trial will develop a new target for UC through re-purposing a relatively cheap, non-toxic and well-characterised drug.
DNAM1 and TIGIT balance the T cell response, with low T cell TIGIT expression corresponding to inflammation in psoriatic disease
Authors: Jacobs Marleen E , Pouw Juliëtte N , Olde Nordkamp Michel A , Radstake Timothy R D J , Leijten Emmerik F A , Boes Marianne 
Published: November 2020

Summary

Objectives
Signals at the contact site of antigen-presenting cells (APCs) and T cells help orchestrate the adaptive immune response. CD155 on APCs can interact with the stimulatory receptor DNAM1 or inhibitory receptor TIGIT on T cells. The CD155/DNAM1/TIGIT axis is under extensive investigation as immunotherapy target in inflammatory diseases including cancer, chronic infection and autoimmune diseases. We investigated a possible role for CD155/DNAM1/TIGIT signaling in psoriatic disease.

Methods
By flow cytometry, we analyzed peripheral blood mononuclear cells of patients with psoriasis (n = 20) or psoriatic arthritis (n = 21), and healthy individuals (n = 7). We measured CD155, TIGIT, and DNAM1 expression on leukocyte subsets and compared activation-induced cytokine production between CD155-positive and CD155-negative APCs. We assessed the effects of TIGIT and DNAM1 blockade on T cell activation, and related the expression of CD155/DNAM1/TIGIT axis molecules to measures of disease activity.

Results
High CD155 expression associates with tumor necrosis factor (TNF) production in myeloid and plasmacytoid dendritic cells (DC). In CD1c+ myeloid DC, activation-induced CD155 expression associates with increased HLA-DR expression. CD8 T cells – but not CD4 T cells – express high levels of TIGIT. DNAM1 blockade decreases T cell pro-inflammatory cytokine production, while TIGIT blockade increased T cell proliferation. Finally, T cell TIGIT expression shows an inverse correlation with inflammation biomarkers in psoriatic disease.

Conclusion
CD155 is increased on pro-inflammatory APCs, while the receptors DNAM1 and TIGIT expressed on T cells balance the inflammatory response by T cells. In psoriatic disease, low TIGIT expression on T cells is associated with systemic inflammation.
Vertebrae-Based Body Length Estimation in Crocodylians and Its Implication for Sexual Maturity and the Maximum Sizes
Authors: Iijima Masaya , Kubo Tai 
Published: November 2020

SynopsisBody size is fundamental to the physiology and ecology of organisms. Crocodyliforms are no exception, and several methods have been developed to estimate their absolute body sizes from bone measurements. However, species-specific sizes, such as sexually mature sizes and the maximum sizes were not taken into account due to the challenging maturity assessment of osteological specimens. Here, we provide a vertebrae-based method to estimate absolute and species-specific body lengths in crocodylians. Lengths of cervical to anterior caudal centra were measured and relations between the body lengths (snout–vent and total lengths [TLs]) and lengths of either a single centrum or a series of centra were modeled for extant species. Additionally, states of neurocentral (NC) suture closure were recorded for the maturity assessment. Comparisons of TLs and timings of NC suture closure showed that most extant crocodylians reach sexual maturity before closure of precaudal NC sutures. Centrum lengths (CLs) of the smallest individuals with closed precaudal NC sutures within species were correlated with the species maximum TLs in extant taxa; therefore, the upper or lower limit of the species maximum sizes can be determined from CLs and states of NC suture closure. The application of the current method to noncrocodylian crocodyliforms requires similar numbers of precaudal vertebrae, body proportions, and timings of NC suture closure as compared to extant crocodylians.
Test Utilization Proposal for Reflex Bilirubin Testing: Why Order Two Tests When One Will Do?
Authors: Katzman Brooke M , Karon Brad S 
Published: November 2020

Abstract

Background
Reflex testing algorithms are effective tools to reduce unnecessary laboratory testing. Direct (conjugated) bilirubin (DB) and total bilirubin (TB) are often ordered together at our institution. Therefore, the objective of our study was to evaluate the potential impact of performing reflex testing for DB when TB is elevated.

Methods
We performed a retrospective review of test orders (patients ≥18 years of age) for DB, TB, or for both DB and TB on the same accession number received in our stat laboratory from January through April 2017. The orders were binned into 4 categories depending on the results from each individual test: (a) DB normal and TB normal, (b) DB normal and TB high, (c) DB high and TB normal, and (d) DB high and TB high. The percentage of orders and median (range) test result for each category was calculated.

Results
During the months evaluated, a total of 4828 stat orders were placed for DB, TB, or both DB and TB. A total of 4296 stat orders (89%) were placed with both DB and TB on the same accession number for 4158 unique patients. Of those orders, the vast majority of tests (87.3%) contained normal results for both analytes; only 12.7% of orders contained ≥1 abnormal result.

Conclusions
The majority of all bilirubin tests ordered stat for emergency department and hospitalized patients have values within the reference interval. Consequently, if reflex testing were executed on elevated TB, a large number of DB tests could be avoided.
Detection of 30 Fentanyl Analogs by Commercial Immunoassay Kits
Authors: Wharton Rebekah E , Casbohm Jerry , Hoffmaster Ryan , Brewer Bobby N , Finn M G , Johnson Rudolph C 
Published: November 2020

Abstract
Health-care workers, laboratorians and overdose prevention centers rely on commercial immunoassays to detect the presence of fentanyl; however, the cross-reactivity of fentanyl analogs with these kits is largely unknown. To address this, we conducted a pilot study evaluating the detection of 30 fentanyl analogs and metabolites by 19 commercially available kits (9 lateral flow assays, 7 heterogeneous immunoassays and 3 homogenous immunoassays). The analogs selected for analysis were compiled from the Drug Enforcement Administration and National Forensic Laboratory Information System reports from 2015 to 2018. In general, the immunoassays tested were able to detect their intended fentanyl analog and some closely related analogs, but more structurally diverse analogs, including 4-methoxy-butyryl fentanyl and 3-methylfentanyl, were not well detected. Carfentanil was only detected by kits specifically designed for its recognition. In general, analogs with group additions to the piperidine, or bulky rings or long alkyl chain modifications in the N-aryl or alkyl amide regions, were poorly detected compared to other types of modifications. This preliminary information is useful for screening diagnostic, forensic and unknown powder samples for the presence of fentanyl analogs and guiding future testing improvements.
Born in the USA: The Cigar Box Guitar, Object Displacement and Performative DIY
Authors: Atkinson Paul 
Published: November 2020

Abstract
The cigar box guitar is a long-standing cultural artefact which, over the course of its history, has undergone a series of displacements. Initially an acoustic instrument made by impoverished people in the mid-nineteenth century to fulfil a social need to make music and help the singing of traditional folk songs, it soon became a simple do-it-yourself project associated largely with children, and later, in the 1990s, it was reimagined as a serious, electrified musical instrument employed in a particular, performative form of DIY. In this most recent incarnation, the Internet has enabled the cigar box guitar to break free of its American roots to become the focus of a global practice of Performative DIY and a vehicle through which physical and virtual communities of makers support each other, express themselves, explore their creativity and display their self-identities.
The Human Capital Legacy of a Trade Embargo
Authors: Chakravarty Abhishek , Parey Matthias , Wright Greg C 
Published: November 2020

AbstractWe estimate the effects of in-utero exposure to a trade embargo on survival and human capital in an import-dependent developing country. Using a regression discontinuity design, we find that a nearly comprehensive embargo imposed by India on Nepal in 1989 led to a large decline in reported live births, and increased early life mortality. The decline in births is concentrated in poorer, more remote districts, and is sharper for female births than male births, consistent with documented gender discrimination. Women survivors of exposure are more educated in adulthood than unexposed cohorts.
Clinical implication of psoas muscle mass measurement for predicting death within 3 months in patients with incurable uterine cervical or corpus malignancy
Authors: Kurosu Hiroyuki , Todo Yukiharu , Yamada Ryutaro , Minowa Kaoru , Tsuruta Tomohiko , Minobe Shinichiro , Matsumiya Hiroko , Kato Hidenori , Mori Yoichi 
Published: November 2020

Abstract

Objective
The aim of this study was to find a clinical marker for identifying refractory cancer cachexia.

Methods
We analyzed computed tomography imaging data, which included the third lumbar vertebra, from 94 patients who died of uterine cervix or corpus malignancy. The time between the date of examination and date of death was the most important attribute for this study, and the computed tomography images were classified into &gt;3 months before death and ≤ 3 months before death. Psoas muscle mass index was defined as the left–right sum of the psoas muscle areas (cm2) at the level of third lumbar vertebra, divided by height squared (m2).

Results
A data set of 94 computed tomography images was obtained at baseline hospital visit, and a data set of 603 images was obtained at other times. One hundred (16.6%) of the 603 non-baseline images were scanned ≤3 months before death. Mean psoas muscle mass index change rates at &gt;3 months before death and ≤3 months before death were −1.3 and −20.1%, respectively (P &lt; 0.001). Receiver operating characteristic curve analysis yielded a cutoff value of −13.0%. The area under the curve reached a moderate accuracy level (0.777, 95% confidence interval 0.715–0.838). When we used the cutoff value to predict death within 3 months, sensitivity and specificity were 74.0 and 82.1%, respectively.

Conclusions
Measuring change in psoas muscle mass index might be useful for predicting cancer mortality within 3 months. It could become a potential tool for identifying refractory cancer cachexia.
Isolated Mononeuropathy From Rucksack Palsy: A Case Series
Authors: McShea Jameson P , Powell Jordan E , Dolomisiewicz Edward A , Pasquina Paul F , Miller Matthew E 
Published: November 2020

Abstract
Although there is increasing awareness of brachial plexopathy secondary to rucksack use, isolated mononeuropathies have been less well described. Three cases of mononeuropathy secondary to rucksack use in military personnel are presented, including injuries to the long thoracic and spinal accessory nerves. We also review several different factors in the proper construction, components, and fitting of the rucksack that should be considered in order to prevent rucksack palsy and provide a concise suggestion for rucksack use and education.
Laboratory Acquired Zika Virus Infection Through Mouse Bite: A Case Report
Authors: Talon de Menezes Mariane , Rilo Christoff Raíssa , Higa Luiza M , Pezzuto Paula , Rabello Moreira Filipe Romero , Ribeiro Liane de Jesus , Maia Richard Araujo , Ferreira Júnior Orlando da Costa , Tanuri Amilcar , Pestana Garcez Patrícia , Santana Aguiar Renato 
Published: November 2020

Abstract
Zika virus is an arthropod-borne flavivirus mainly transmitted by the bite of infected mosquitoes. However, alternative transmission routes can occur. In this study, we show the accidental transmission of virus from an infected mouse to a human during the experimental manipulation. This study describes the patient clinical manifestations and virus genome identification.
Large-vessel thrombotic stroke despite concurrent therapeutic anticoagulation in COVID-19-positive patient
Authors: Shoukry Andrew , Kite Thomas A 
Published: November 2020

ABSTRACT
The current COVID-19 pandemic caused by the novel SARS-CoV-2 virus is now recognized to be associated with a coagulopathy that can result in arterial and venous thromboses. In this report, we describe a case of large-vessel cerebrovascular thrombus in a therapeutically anticoagulated 89-year-old male admitted with COVID-19 infection. Despite clinical improvement following COVID-19 pneumonitis, symptoms of an acute left-sided total anterior circulation stroke rapidly developed 10 days after initial COVID-19 symptom onset. Computed tomography angiography imaging confirmed acute large-vessel thrombus in the terminal segment of the internal carotid artery resulting in acute right middle cerebral artery territory infarction. Thromboembolic events in the context of COVID-19 infection have recently been described in critically unwell patients. However, to the best of our knowledge, this is one of the first cases of large-vessel thrombus in a patient with COVID-19 infection receiving concurrent therapeutic anticoagulation.