bluuebunny/crossref_metadata_2025_split huggingface dataset:
Family Clusters of Shiga Toxin-producing Escherichia coli Infection
Authors: Luini Mario Vittorio , Colombo Rosaria , Dodaro Antonella , Vignati Chiara , Masia Carla , Arghittu Milena , Daprai Laura , Maisano Antonio Marco , Vezzoli Fausto , Bianchini Valentina , Spelta Chiara , Castiglioni Bianca , Bertasi Barbara , Ardissino Gianluigi 
Published: September 2020

Background:
The aim of the present work was to investigate family clusters of Shiga toxin-producing Escherichia coli (STEC) infection among the household members of STEC positive patients, identified within a screening program of bloody diarrhea (BD) for STEC in Northern Italy.

Methods:
Stool samples from patients with BD or BD-associated-hemolytic uremic syndrome (HUS) and related households were investigated by molecular and bacteriologic methods to detect and characterize the virulence profile of STEC and Pulsed Field Gel Electrophoresis analysis were done on isolates.

Results:
Thirty-nine cases of STEC infection (isolated BD in 16, BD-associated-HUS in 23) were considered, and a total of 130 stool samples from 1 to 8 households of the index patient were analyzed. The prevalence of positivity was higher in siblings (34.8%, 8/23) than in mothers (20%, 7/35), grandparents (9.5%, 2/21), fathers (8.8%, 3/34) or other households. In 14 clusters (36%), one or more household shared a STEC with the same virulence profile (stx, eae, serogroup) as the index case. In 7 clusters, STEC strains isolated from at least 2 subjects also shared identical Pulsed Field Gel Electrophoresis profile. The frequency of household infection does not appear to be associated to the index case’s illness (HUS or BD), nor with the serotype or with the virulence profile of the involved STEC (stx2 or stx1-stx2).

Conclusions:
Our study shows that STEC infections, most likely related to human-to-human transmission, are common among households of patients with STEC BD or HUS and underlines the importance of extending the epidemiologic investigations to all family members, as the index case may not always be the primary infection in the family.
Acute Ischemic Stroke as a Result of Paradoxical Embolus in a Patient with Renal Cell Carcinoma, Intravenous Tumor Thrombus Extension, and Patent Foramen Ovale
Authors: Gritsch David , Abdallah Amir , Taylor Abigail M. , Mesbah Zhubene , Demaerschalk Bart M. 
Published: September 2020

Introduction:
Patent foramen ovale is a common congenital cardiac abnormality. An association with acute ischemic stroke is well described. Extension of renal cell carcinoma (RCC) into the adjacent veins is common. Surgical resection is felt to be an effective approach to treatment, even in the setting of extensive venous involvement.

Case Report:
A 55-year-old woman with recently diagnosed right renal mass and cavoatrial tumor thrombus was transferred to our facility for surgical resection. She subsequently underwent open radical right nephrectomy, regional lymph node dissection, inferior vena cava and right atrial tumor thrombectomy, and resection of the infrahepatic vena cava. An intraoperative transesophageal echocardiogram confirmed the absence of tumor thrombus from the inferior vena cava and right atrium and also identified a patent foramen ovale (PFO). Upon weaning sedation, she was noted to be agitated and have left hemiplegia. Her National Institutes of Health Stroke Scale (NIHSS) was 30 and Glasgow Coma Scale (GCS) 6. The computerized tomography scan of head revealed extensive hypoattenuation right in the middle and left posterior cerebral artery territories. There was associated cerebral edema and 5-mm midline shift. In the setting of devastating neurological injury, her family elected to transition to comfort care and the patient died on the postoperative day 7.

Conclusions:
This is the first reported case of intraoperative paradoxical embolism in the setting of RCC with cavoatrial extension and PFO. The presence of PFO may be a risk factor for severe cerebrovascular complications in the surgical management of RCC with venous involvement.
Two Years of Improved Neurological Function With Nusinersen in a 48-Year-Old Patient With Spinal Muscular Atrophy Type 3
Authors: Shah Jaimin S. , Rubin Devon I. , Dimberg Elliot L. , Owens Christina R. , Gicalone Angelica R. , De Oliveira Gleydiane , Oskarsson Björn E. 
Published: September 2020

Introduction:
Nusinersen antisense oligonucleotide infusions have been shown to be effective in the treatment spinal muscular atrophy. The majority of the evidence has been collected in young type 1 and type 2 patients, and evidence of efficacy in adult patients is limited.

Case Report:
A 48-year-old woman with spinal muscular atrophy type 3 who has received the loading dose and 8 maintenance infusions over an 8-month period. Grip and pinch strength, measured by hand-held dynamometry measured at baseline and in 6 to 12 months interval improved over a 24-month period. She also reported multiple other subjective improvements in function.

Conclusions:
This is the first published case of nusinersen in a middle-aged adult with spinal muscular atrophy. Sustained clinically meaningful improvement may be possible with nusinersen initiation in mid adulthood.
Leukoencephalopathy With Brain Stem and Spinal Cord Involvement and Lactate Elevation (LBSL)
Authors: Yazici Gencdal Isil , Dincer Alp , Obuz Oguzhan , Yapici Zuhal 
Published: September 2020

Introduction:
Leukoencephalopathy with brain stem and spinal cord involvement and lactate elevation (LBSL) is caused by a recessive mutation in the DARS2 gene and can be recognized by specific magnetic resonance imaging patterns.

Case Report:
A girl who developed leg tremors at age 4 years was diagnosed at age 17 years with LBSL -after evolution of ataxia and sensory loss. Examination at age 29 revealed mild spastic gait, ataxia, and sensory loss, and she did not require assistance to walk.

Conclusion:
This report illustrates the clinical and magnetic resonance imaging characteristics of a slowly progressive long-term course of childhood-onset LBSL.
Acute Flaccid Myelitis in an Adult
Authors: Kazi Stephanie , Lommen Matthew , Persson Justin 
Published: September 2020

Introduction:
Acute flaccid myelitis (AFM) is a condition causing acute onset flaccid limb weakness primarily in children. Correlations with specific viral illnesses have been found, however, specific pathogenesis remains unknown.

Case Report:
A 21-year-old female individual presented with progressive weakness provoking multiple falls, severe fatigue, headaches, and body aches after an upper respiratory illness. Deep tendon reflexes were absent, and cerebrospinal fluid analysis was remarkable for lymphocytic pleocytosis and elevated protein. Magnetic resonance imaging revealed T2 hyperintensity extending from C1-T2 predominantly involving the anterior horns. Weakness continued to increase before subtly improving over the course of a 10-day hospital stay. Functional improvements had been achieved by the patient at 1-year follow-up with intensive physical therapy.

Conclusions:
AFM should be included in the differential for the presentation of acute weakness in adults and pediatric patients. As the incidence of AFM continues to rise, awareness of the condition and prompt obtainment of specimens in suspected patients is crucial to aid in the investigation.
Magnetic Resonance Imaging Availability Reduces Computed Tomography Use for Pediatric Appendicitis Diagnosis
Authors: James Natasha C. , Ahmadian Rosstin , Mckee Jason Q. , Sarangarm Dusadee , Bussmann Silas C. , Williamson Susan , Upham Bryan D. 
Published: September 2020

Objectives
To determine if introducing magnetic resonance imaging (MRI) as an imaging option for children with suspected appendicitis and an inconclusive ultrasound reduces computed tomography (CT) use.

Methods
This is a retrospective cohort study of patients aged 5 to 18 years who presented to a pediatric emergency department (ED) with suspected appendicitis. Rates of CT use 1 year before and 1 year after MRI availability are compared. Secondary outcomes include missed and negative appendectomies, imaging charges, time to antibiotics and surgery, time to radiology read, ED length of stay, and test characteristics of MRI and CT.

Results
Of the 981 patients screened, 499 patients met inclusion criteria. There was an absolute reduction of CT use of 25% from 38% in year 1 to 13% in year 2 (95% confidence interval, 18% to 33%). Advanced imaging charges were $371 higher in year 2 (MRI) than year 1 (CT), and median time to radiologist reads was longer in MRIs than CTs (129 versus 62 minutes; difference 53 minutes, 95% confidence interval, 23 to 74 minutes). All other secondary outcomes, including ED length of stay and test characteristics, were statistically similar.

Conclusions
Introducing MRI for as an imaging option for children with suspected appendicitis and an inconclusive ultrasound markedly reduced CT use, but did result in a small increase in imaging charges and time to preliminary radiology read.
Measuring Intertrochanteric Fracture Stability with a Novel Strain-Sensing Sliding Hip Screw
Authors: Carrington Nathan T. , Milhouse Paul W. , Behrend Caleb J. , Pace Tom B. , Anker Jeffrey N. , DesJardins John D. 
Published: September 2020

AbstractBackgroundBone healing after internal fixation of intertrochanteric hip fractures is difficult to monitor with radiography, particularly with internal fixation implants such as the sliding hip screw (SHS). In this study, we evaluate a robust, user-friendly device to non-invasively determine the loading on the screw implant. This will allow clinicians to better monitor the status of bone healing and take preventative steps if complications occur.MethodsA novel strain-sensing sliding hip screw (SS-SHS) was designed and refined using a finite element model of a simple intertrochanteric fracture and a standard SHS implant. The SS-SHS houses an internally fixed indicator rod, whose position relative to the screw body can be viewed on plain film radiographs to measure screw bending. Screw bending was assessed in an intact femur and an unstable A1 intertrochanteric fracture using a finite element computational model and compared with experimental axial loading of a femoral Sawbones composite and human cadaveric femur specimens. Indicator rod position relative to the screw was visually tracked using plain radiographs at each load state.ResultsThe indicator rod was found to displace linearly in response to implant strain in the unstable fracture. This movement was consistently visible and measurable using radiography throughout loading cycles across the mechanical and cadaveric fracture models. Sensor movement was not detected in healed fracture models. The slope of the curve was approximately equal in the computations, composite and cadaveric models (0.08 µm/N, 1.0 µm/N, 0.08 µm/N, respectively). The noise level was approximately 25 N in the composite model and 63 N in the cadaveric specimen and this was sufficient to see 1/10thof body weight or more for an 80 kg patient which is likely good enough to track fracture healing.ConclusionsIn current practice, clinicians must carefully monitor their patients for signs of implant failure after surgery. However, by the time signs of failure are apparent, it is often too late to avoid revision surgery. This device enables clinicians to quantitatively track fracture healing, and better communicate the process to the patient. Clinicians can also take preventive measures with at-risk patients before revision surgery is needed, thus reducing mortality risks.Clinical RelevanceBy augmenting an existing SHS system with an indicator rod, crucial information on the status of fracture healing can be ascertained from follow-up radiographs already taken with no additional risk to the patient.
Association between population density and infection rate suggests the importance of social distancing and travel restriction in reducing the COVID-19 pandemic
Authors: Yin Heliang , Sun Tong , Yao Lan , Jiao Yan , Ma Li , Lin Lin , Graff J Carolyn , Aleya Lotfi , Postlethwaite Arnold , Gu Weikuan , Chen Hong 
Published: September 2020

AbstractBackgroundCurrently, the 2019-nCoV has spread to most countries of the world. Understanding the environmental factors that affect the spread of the disease COVID-19 infection is critical to stop the spread of the disease. The purpose of this study is to investigate whether population density is associated with the infection rate of the COVID-19.MethodsWe collected data from official webpages of cities in China and in the US. The data were uploaded on Excel spreadsheets for statistical analyses. We calculated the morbidity and population density of cities and regions in these two countries. We then examined the relationship between the morbidity and other factors.ResultsOur analysis indicated that the population density in cities in Hubei province where the COVID-19 was severe was associated with a higher percentage of morbidity, with an r value of 0.62. Similarly, in the US, the density of 51 states and territories is also associated with morbidity from COVID-19 with an r value of 0.55. In contrast, as a control group, there is no association between the morbidity and population density in 33 other regions of China, where the COVID-19 epidemic is well under control. Interestingly, our study also indicated that these associations were not influenced by the first case of COVID-19. The rate of morbidity and the number of days from the first case in the US has no association, with an r value of -0.1288.ConclusionsPopulation density is positively associated with the percentage of patients with COVID-19 infection in the population. Our data support the importance of such as social distancing and travel restriction in the prevention of COVID-19 spread.
Social capital and psychological distress during Colombian coronavirus disease lockdown
Authors: Caballero-Domínguez Carmen Cecilia , De Luque-Salcedo Jeimmy , Campo-Arias Adalberto 
Published: September 2020

AbstractIntroductionThis study aims to establish the association between low capital social (CS) with some indicators of psychological distress.MethodsA cross-sectional study was carried out using an online questionnaire that evaluated demographic variables, social capital, coronavirus disease perceived stress, depression risk, insomnia risk, and suicide risk. SC was taken as an independent variable, and symptoms indicating psychological distress was handed as dependent variables. Odds ratios (OR) were established with 95% confidence intervals (CI), using binary logistic regression analysis.ResultsA group of 700 adults participated in the survey; they were aged between 18 and 76 years (M = 37, SD = 13). Low SC was associated with depression risk (OR = 2.00, 95%CI 1.34-2.97), elevated suicide risk (OR = 2.62, 95%CI 1.40-4.91) high perceived stress related to coronavirus disease (OR = 2.08, 95%CI 1.15-3.76), and insomnia risk (OR = 2.42, 95%CI 1.69-3.47).ConclusionsLow CS was associated with indicators of psychological distress represented in depression risk, elevated suicide risk, high perceived stress related to coronavirus disease and insomnia risk. SC is a community social resource that could help mitigate the impact of the coronavirus disease quarantine amidst the Colombian population’s psychological health. It is necessary to deepen the SC role in psychological well-being during and after the coronavirus disease epidemic.
Strategies for exiting COVID-19 lockdown for workplace and school: a scoping review protocol
Authors: D’Angelo Daniela , Coclite Daniela , Napoletano Antonello , Fauci Alice Josephine , Latina Roberto , Iacorossi Laura , Di Nitto Marco , Iannone Primiano 
Published: September 2020

AbstractObjectiveThe main objectives of this review are to summarise the existing literature and to identify strategies for exiting lockdown during the COVID-19 pandemic, with a focus on reopening schools and returning to work.IntroductionAfter months of strict quarantine, several countries are planning exit strategies to progressively lift social restrictions without giving rise to an increase in the number of COVID-19 cases. Although several strategies have been studied in terms of how and when to relax such stringent constraints, there is a lack of consensus on the optimal strategy for managing the pandemic beyond lockdown. The risks posed by delaying return to work and school openings are real and sizeable, particularly for relevant working sectors and for students from low-income familiesInclusion criteriaThis review will consider studies that focussed on relaxation strategies for lockdown exit among workers and students facing an epidemic /pandemic crisis.MethodsThe searches will be conducted across four databases (MEDLINE, EMBASE, SciSearch, Google Scholar), and the bibliography of all selected studies will be hand-searched. In addition, because the topic is new, relevant literature will be checked using daily, updated COVID-19 collections from NCBI (LitCovid) and MedRxiv servers. Studies published in English, German, Spanish, Italian and French will be included, with no limits on publication dates. This review will consider all study designs, regardless of their rigor. The review method will be based on a two-phase approach: a title and abstract screening, and a full-text review performed by two independent researchers. Data will be summarised and categorised, and results will be presented in a tabular/diagrammatic form.
Efficacy assessment of newly-designed and locally-produced filtering facemasks during the SARS-CoV-2 pandemic
Authors: Boogaard Bob , Tas Ali , Nijssen Joep , Broeren Freek , van der Dobbelsteen John , Verhoeven Vincent , Pluim Jip , Dekker Sing , Snijder Eric , van Hemert Martijn , Herfst Sander 
Published: September 2020

AbstractThe SARS-CoV-2 pandemic resulted in shortages of production and test capacity of FFP2-respirators. Such facemasks are required to be worn by healthcare professionals when performing aerosol-generating procedures on COVID-19 patients. In response to the high demand and short supply, we designed three models of facemasks that are suitable for local production. As these facemasks should meet the requirements of an FFP2-certified facemask, the newly-designed facemasks were tested on the filtration efficiency of the filter material, inward leakage, and breathing resistance with custom-made experimental setups. In these tests, the locally-produced facemasks were benchmarked against a commercial FFP2 facemask. Furthermore, the protective capacity of the facemasks was tested for the first time with coronavirus-loaded aerosols under physiologically relevant conditions. This multidisciplinary effort resulted in the design and production of facemasks that meet the FFP2 requirements, and which can be mass-produced at local production facilities.
The link between vitamin D deficiency and Covid-19 in a large population
Authors: Israel Ariel , Cicurel Assi , Feldhamer Ilan , Dror Yosef , Giveon Shmuel M , Gillis David , Strich David , Lavie Gil 
Published: September 2020

AbstractBACKGROUNDRecent studies suggest a link between vitamin D deficiency and Covid-19 infection. In our population we observe major differences in Covid-19 incidence in ethnic groups and genders in each group.METHODSWe carried out a population-based study among 4.6 million members of Clalit Health Services (CHS). We collected results from vitamin D tests performed between 2010 and 2019 and used weighted linear regression to assess the relationship between prevalence of vitamin D deficiency and Covid-19 incidence in 200 localities. Additionally, we matched 52,405 infected patients with 524,050 control individuals of the same sex, age, geographical region and used conditional logistic regression to assess the relationship between baseline vitamin D levels, acquisition of vitamin D supplements in the last 4 months, and positive Covid-19.RESULTSWe observe a highly significant correlation between prevalence of vitamin D deficiency and Covid-19 incidence, and between female-to-male ratio for severe vitamin D deficiency and female-tomale ratio for Covid-19 incidence in localities (P<0.001). In the matched cohort, we found a significant association between low vitamin D levels and the risk of Covid-19, with the highest risk observed for severe vitamin D deficiency. A significant protective effect was observed for members who acquired liquid vitamin D formulations (drops) in the last 4 months.CONCLUSIONIn this large observational population study, we show a strong association between vitamin D deficiency and Covid-19 occurrence. After adjustment for baseline characteristics and prior vitamin D levels, acquisition of liquid vitamin D formulations is associated with decreased risk for Covid-19 infection.
Trans-ethnic analysis reveals genetic and non-genetic associations with COVID-19 susceptibility and severity
Authors: Shelton Janie F. , Shastri Anjali J. , Ye Chelsea , Weldon Catherine H. , Filshtein-Somnez Teresa , Coker Daniella , Symons Antony , Esparza-Gordillo Jorge ,   Team The 23andMe COVID-19 Team, Aslibekyan Stella , Auton Adam 
Published: September 2020

AbstractCOVID-19 presents with a wide range of severity, from asymptomatic in some individuals to fatal in others. Based on a study of over one million 23andMe research participants, we report genetic and non-genetic associations with testing positive for COVID-19, respiratory symptoms, and hospitalization. Risk factors for hospitalization include advancing age, male sex, elevated body mass index, lower socio-economic status, non-European ancestry, and pre-existing cardio-metabolic and respiratory conditions. Using trans-ethnic genome-wide association studies, we identify a strong association between blood type and COVID-19 diagnosis, as well as a gene-rich locus on chr3p21.31 that is more strongly associated with outcome severity. While non-European ancestry was found to be a significant risk factor for hospitalization after adjusting for socio-demographics and pre-existing health conditions, we did not find evidence that these two primary genetic associations explain differences between populations in terms of risk for severe COVID-19 outcomes.
Sleep quality in the chronic stage of concussion is associated with poorer recovery: A systematic review
Authors: Ludwig Rebecca , Nelson Eryen , Vaduvathiriyan Prasanna , Rippee Michael A. , Siengsukon Catherine 
Published: September 2020

AbstractObjectiveTo examine the association between sleep quality during the chronic stage of concussion and post-concussion outcomes.Literature SurveyLiterature searches were performed during July 1st to August 1st, 2019 in selected databases along with searching grey literature. Out of the 733 results, 702 references were reviewed after duplicate removal.MethodologyThree reviewers independently reviewed and consented on abstracts meeting eligibility criteria (n = 35). The full-text articles were assessed independently by two reviewers. Consensus was achieved, leaving four articles. Relevant data from each study was extracted using a standard data-extraction table. Quality appraisal was conducted to assess potential bias and the quality of articles.SynthesisOne study included children (18–60 months) and three studies included adolescents and/or adults (ranging 12 years to 35). The association between sleep and cognition (two studies), physical activity (one study), and emotion symptoms (one study) was examined. Sleep quality was associated with decreased cognition and emotional symptoms, but not with meeting physical activity guidelines 6 months post-concussion injury.ConclusionsThe heterogeneity in age of participants and outcomes across studies and limited number of included studies made interpretations difficult. Future studies may consider if addressing sleep quality following concussion will improve outcomes.