bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right heart thrombus-in-transit in a patient with Evans syndrome
Authors: Yang Ya-Chen , Chen Yen-Yu 
Published: August 2021

Abstract

Introduction:
Right heart free-floating thrombus in the absence of structural heart disease or atrial fibrillation is rare. When it travels to the heart into the lung, called thrombus-in-transit, may cause cardiopulmonary collapse and sudden death. The clinical presentation varies from mild respiratory symptoms to sudden death; however, there are few clinical case reports of giant, free-floating thrombus in the right heart in an asymptomatic patient, and the optimal management options have not been established.

Patient concerns:
A 36-year-old Asian woman presented to the emergency department with complaints of worsening swelling of the left lower extremity over 12 hours.

Diagnosis:
Left leg deep vein thrombosis accompanied by an asymptomatic giant right atrial thrombus and pulmonary embolism with a rare autoimmune disease of Evans syndrome.

Interventions:
Emergent surgical thrombectomy under cardiopulmonary bypass for right atrial thrombus.

Outcomes:
The postoperative course was uneventful, and she was discharged on the eighth postoperative day with normal heart function and mild tricuspid regurgitation.

Conclusion:
An additional diagnostic workup in cases of deep vein thrombosis is necessary for the rapid diagnosis of right heart thrombus and pulmonary embolism without delay. This case report illustrates that early recognition of venous thromboembolism and emergent thrombectomy of right heart thrombus-in-transit is crucial to prevent mortality.
Basilar dolichoectasia with intermural hematoma accompanied by cerebral microbleeds and white matter hyperintensities
Authors: Xu Sui-yi , Wang Ruo-jun , Zhang Lei , Li Chang-xin 
Published: August 2021

Abstract

Rationale:
The clinical manifestations of basilar dolichoectasia (BD) are variable. The diagnosis is based on imaging measurements. Digital subtraction angiography displays only the dilated vascular lumen and lacks visualization of the arterial wall. High-resolution Magnetic resonance imaging (MRI) can identify intramural hematoma; therefore, it may be more suitable for the imaging evaluation of BD. However, most of the existing literature pertaining to BD lacks vascular wall assessment.

Patient concerns:
A 65-year-old Chinese man perceived weakness of the left upper and lower limb, double vision, dizziness, nausea, and vomiting was admitted to the emergency department. Fifteen years prior to this admission, he began taking levamlodipine besylate inconsistently for hypertension, but the level of blood pressure control was uncertain. The patient's father had a family history of hypertension.

Diagnoses:
An emergency axial computed tomography scan of the brain showed basilar artery (BA) dilation. Computed tomography angiography further indicated a maximum BA diameter of 38.94 mm. The length was >182 mm. MRI revealed acute infarctions of the right medulla oblongata and pons. Meanwhile, the patient had evidence of cerebral small vessel disease, including cerebral microbleeds and white matter hyperintensities. Whole-exome sequencing eliminated significant genetic variations consistent with clinical phenotypes. BD and intramural hematoma were further confirmed by high-resolution MRI of the arterial wall.

Interventions:
Atorvastatin was admitted according to the results of the high-resolution MRI of the arterial wall. Benidipine hydrochloride was selected as a long-term anti-hypertensive drug.

Outcomes:
The patient had no symptoms of neurological damage during 3-month follow-up.

Lessons:
Current evidence shows that BD has no obvious correlation with atherosclerosis. BA dissection and uncontrolled hypertension may be important factors in the progression of BD. BD-related stroke is likely to recur, and there are no standard secondary prevention measures. BD is often accompanied by cerebral microbleeds, and bleeding risk must be assessed during secondary prevention. When the BA diameter is greater than 10 mm, anti-platelet medication should be used with caution, blood pressure should be strictly controlled, and endovascular treatment should be considered.
The effect of acute and chronic iodine excess on thyroid profile and reproductive function of women using Lipiodol during hysterosalpingography and the potential impact on thyroid function of their offspring: The SELFI study protocol
Authors: Mathews Divya M. , Peart Jane M. , Sim Robert G. , Johnson Neil P. , O'Sullivan Susannah , Derraik José G.B. , Hofman Paul L. 
Published: August 2021

Abstract

Background:
Hysterosalpingography (HSG) is a radiological procedure using iodinated contrast media to assess tubal patency in women with infertility. HSG using Lipiodol, an oil-soluble contrast medium (OSCM) has been shown to improve pregnancy rates, so its therapeutic use has increased. However, OSCM can cause marked and prolonged iodine excess, potentially impacting thyroid function. If pregnancy occurs, there is also concern regarding possible neonatal hypothyroidism resulting from maternal iodine excess. This study aims to improve knowledge on the safety profile of OSCM HSG in the context of iodine excess.

Methods:
This is a prospective longitudinal study of 200 consecutively consenting women undergoing an OSCM HSG in Auckland, New Zealand. After informed consent, participants will undergo baseline thyroid function tests and measurement of urine iodine-to-creatinine ratio (UI/Cr) and anti-thyroid antibodies. During the HSG, the volume of OSCM used will be recorded, and a delayed radiograph obtained to check for further spill of the contrast and for a semi-quantitative assessment of peritoneal retention of OSCM. Thyroid function tests, UI/Cr and reproductive hormones will be serially monitored over the next 6 months. If the woman conceives within the study period, the offspring's thyroid function will be tested at 7 days of age, in addition to the routine newborn screening. The primary outcome will be development of subclinical hypothyroidism (SCH) in these women. Secondary outcomes will include the incidence of elevated iodine levels in these women, and a transient or permanent thyroid dysfunction in the neonates conceived within the study period. In addition, mixed-model analyses will attempt to identify ‘high-risk’ groups for thyroid dysfunction.

Discussion:
This study will explore the acute and chronic effects of iodine excess on thyroid function in women who undergo an OSCM HSG and in their offspring conceived in the immediate cycles following HSG. Further, this study will provide information on the profile of thyroid function abnormalities following an OSCM HSG, and help guide the establishment of international protocols for thyroid monitoring and management in women undergoing this procedure.

Trial registration:
Trial acronym–SELFI (Safety and Efficacy of Lipiodol in Fertility Investigations)

ACTRN:
ACTRN12620000738921, retrospectively registered on 14/07/2020
Cellular therapies in kidney transplantation
Authors: Leclerc Simon , Lamarche Caroline 
Published: August 2021

Purpose of review
Current immunosuppressive regimens used in kidney transplantation are sometimes ineffective and carry significant risks of morbidity and mortality. Cellular therapies are a promising alternative to prolong graft survival while minimizing treatment toxicity. We review the recently published breakthrough studies using cell therapies in kidney transplantation.

Recent findings
The reviewed phase I and II trials showed that cell therapies are feasible and safe in kidney transplantation, sometimes associated with less infectious complications than traditional regimens. Regulatory T cells and macrophages were added to the induction regimen, allowing for lower immunosuppressive drug doses without higher rejection risk. Regulatory T cells are also a treatment for subclinical rejection on the 6 months biopsy. Other strategies, like bone marrow-derived mesenchymal cells, genetically modified regulatory T cells, and chimerism-based tolerance are also really promising. In addition, to improve graft tolerance, cell therapy could be used to prevent or treat viral infection after transplantation.

Summary
Emerging data underline that cell therapy is a feasible and safe treatment in kidney transplantation. Although the evidence points to a benefit for transplant recipients, studies with standardized protocols, representative control groups, and longer follow-up are needed to answer the question definitively and guide future research.
Evidence-Based Wound Irrigation: Separating Fact from Fiction
Authors: Saeg Fouad , Schoenbrunner Anna R. , Janis Jeffrey E. 
Published: August 2021

Summary:
The relationship between wound irrigation and healing has been recognized for centuries. However, there is little evidence and no official recommendations from any health care organization regarding best wound irrigation practices. This is the first review of wound irrigation that systematically summarizes the literature using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and distills the evidence into a practical format. In this comprehensive review, the authors outline the irrigation fluids and delivery methods used in the identified studies, analyze reported treatment outcomes, summarize irrigation effectiveness, and propose evidence-based guidelines to improve wound healing outcomes and enhance the consistency of wound irrigation. Thirty-one high-quality studies with a combined total of 61,808 patients were included. Based on the current evidence provided by this review, the authors propose the following guidelines: (1) acute soft-tissue wounds should receive continuous gravity flow irrigation with polyhexanide; (2) complex wounds should receive continuous negative-pressure wound therapy with instillation with polyhexanide; (3) infected wounds should receive continuous negative-pressure wound therapy with instillation with silver nitrate, polyhexanide, acetic acid, or povidone-iodine; (4) breast implant wounds should receive gravity lavage with povidone-iodine or antibiotics; and (5) surgical-site infection rates can be reduced with intraoperative povidone-iodine irrigation.
A Quantitative Evaluation of the Flow-Increasing Effect of Flow-Through Arterial Anastomosis in the Vascular Pedicle of Free Flaps: A Prospective Clinical Before-and-After Study
Authors: Kagaya Yu , Arikawa Masaki , Akazawa Satoshi , Miyamoto Shimpei 
Published: August 2021

Background:
The clinical application of flow-through anastomosis has been reported in various studies; however, no studies have quantitatively evaluated and compared the actual hemodynamics in flow-through anastomosis and end-to-end anastomosis. This study quantitatively evaluated the blood inflow (volumetric flow rate) and vascular resistance (pulsatility index) of flow-through arterial anastomosis using an ultrasonic flowmeter, and compared these values with those of end-to-end anastomosis in actual clinical settings. In addition, factors affecting the outcomes have also been examined.

Methods:
Twenty-eight patients who underwent free flap reconstruction after tumor resection were subjected to flow-through arterial anastomosis and flow examination. First, in the end-to-end state, the proximal anastomotic site was measured. This was followed by the opening of the distal arterial clamp, and measurement was then continued (in the flow-through state).

Results:
In flow-through arterial anastomosis compared with end-to-end anastomosis, the volumetric flow rate was significantly increased (18.9 ± 14.1 ml/minute versus 6.0 ± 6.3 ml/minute) and the pulsatility index was significantly decreased (5.2 ± 3.7 versus 13.6 ± 10.2), when comparing paired data. Multiple regression analyses revealed that a perforator flap (versus a musculocutaneous flap) was independently associated with both reduced volumetric flow rate and increased pulsatility index in end-to-end anastomosis, and that hypertension was independently associated with an increased pulsatility index in end-to-end anastomosis. However, no factors in flow-through anastomosis were significantly associated with those values.

Conclusion:
In terms of blood flow and vascular resistance, flow-through arterial anastomosis was considered to have promising quantitative effects and should be performed when the conditions of both the donor and recipient vessels meet the requirements.

CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
A Case of Post-COVID-19–Associated Paracentral Acute Middle Maculopathy and Giant Cell Arteritis-Like Vasculitis
Authors: Jonathan Go L. , Scott Fair M. , Matthew Kay D. 
Published: August 2021

Abstract:
A 47-year-old man with a history of COVID-19 infection 2 months before presentation, presented with a scotoma of the paracentral visual field of the right eye. After thorough testing and evaluation, a diagnosis of paracentral acute middle maculopathy (PAMM) was established. Two months later, the patient developed temporal headache and jaw claudication. High-dose steroids were initiated, and workup for giant cell arteritis (GCA) was undertaken. The patient experienced resolution of the symptoms within 24 hours of steroid initiation. ESR, CRP, and temporal artery biopsy results were normal, although all were obtained more than 2 weeks after steroid initiation. To the best of our knowledge, our patient represents the first individual to date to potentially implicate COVID-19 in both small and large vessel vasculitis in the ophthalmic setting.
The relationships between ongoing COVID-19 lockdown and the financial and mental health experiences of Australian families
Authors: Price Anna M. H. , Contreras-Suárez Diana , Zhu Anna , Schreurs Natalie , Measey Mary-Anne , Woolfenden Sue , Burley Jade , Bryson Hannah , Efron Daryl , Rhodes Anthea , Goldfeld Sharon 
Published: August 2021

AbstractObjectivesIn 2020, Australia’s successful COVID-19 public health restrictions comprised a national ‘initial lockdown’ (March-May), and ‘ongoing lockdown’ (July-November) for metropolitan Victorian residents only. We evaluated the relationships between ongoing lockdown and family finances and mental health.MethodsIn the June and September 2020 Royal Children’s Hospital National Child Health Polls, caregivers of children in Victoria and New South Wales reported: job/income loss; material deprivation (inability to pay for essential items); income-poverty; mental health (Kessler-6); perceived impact on caregiver/child mental health; and caregiver/child coping. Data from N=1207/902 caregivers in June/September were analysed using Difference-in-Difference modelling (New South Wales provided the comparator).ResultsDuring Victoria’s ongoing lockdown, job/income loss increased by 11% (95%CI: 3-18%); Kessler-6 poor mental health by 6% (95%CI: -0.3-12%) and perceived negative mental health impacts by 14% for caregivers (95%CI: 6-23%) and 12% for children (95%CI: 4-20%). Female (versus male) caregivers, metropolitan (versus regional/rural) families, and families with elementary school-aged children (versus pre-/high-school) were most affected.ConclusionsOngoing lockdown was associated with negative experiences of mental health, employment, and income, but not deprivation or poverty, likely because of government income supplements introduced early in the pandemic. Future lockdowns require planned responses to outbreaks, and evidence-informed financial and mental health supports.
Determinants of dietary salt intake in adults: A protocol for Scoping Review
Authors: Nagi Raunaq Singh , Prasad Pankaj , Kumar Sanjeev 
Published: August 2021

AbstractObjectiveThe objective of this scoping review is to methodically review the current literature and identify the factors/determinants of dietary salt consumption in adults.IntroductionHigh dietary salt intake has been identified as a risk factor for non-communicable diseases and conditions. Despite continuous and rigorous efforts, dietary salt intake still remain above the recommended adult daily dose of 5g, both locally and globally. This indicates existence of unidentified or unaddressed behavioural factors that diminish efficiency of salt reduction efforts targeted towards public.Inclusion CriteriaThis review will include global literature dealing with factors associated with dietary salt intake in adults. Qualitative, quantitative and ecological studies on behavioural, psychosocial and environmental factors associated with awareness regarding dietary salt intake and barrier to its reduction will be considered. Studies published only in English language, without any limits on date of publication will be considered for this review.MethodsA comprehensive search across databases namely, MEDLINE, ScienceDirect, JSTOR, ERIC, DOAJ and OATD will be carried out to retrieve and identify relevant literature. Two reviewers will screen the titles followed by abstracts and subsequently full-length texts according to the inclusion and exclusion criterion, removing unrelated studies and finally compiling and extracting information from chosen studies in data extraction forms. Descriptive statistics will be used to represent the data. Thematic analysis of extracted data using deductive approach will be conducted.
COVID-19 Incidence and Hospitalization During the Delta Surge Were Inversely Related to Vaccination Coverage Among the Most Populous U.S. Counties
Authors: Harris Jeffrey E. 
Published: August 2021

AbstractWe tested whether COVID-19 incidence and hospitalization rates during the Delta variant-related surge were inversely related to vaccination coverage among the 112 most populous counties in the United States, together comprising 44 percent of the country’s total population. We measured vaccination coverage as the percent of the county population fully vaccinated as of July 15, 2021. We measured COVID-19 incidence as the number of confirmed cases per 100,000 population during the 14-day period ending August 12, 2021 and hospitalization rates as the number of confirmed COVID-19 admissions per 100,000 population during the same 14-day period. In log-linear regression models, a 10-percentage-point increase in vaccination coverage was associated with a 28.3% decrease in COVID-19 incidence (95% confidence interval, 16.8 - 39.7%), a 44.9 percent decrease in the rate of COVID-19 hospitalization (95% CI, 28.8 - 61.0%), and a 16.6% decrease in COVID-19 hospitalizations per 100 cases (95% CI, 8.4 - 24.8%). Inclusion of demographic covariables, as well as county-specific diabetes prevalence, did not weaken the observed inverse relationship with vaccination coverage. A significant inverse relationship between vaccination coverage and COVID-19 deaths per 100,000 during August 20 – September 16 was also observed. The cumulative incidence of COVID-19 through June 30, 2021, a potential indicator of acquired immunity due to past infection, had no significant relation to subsequent case incidence or hospitalization rates in August. Higher vaccination coverage was associated not only with significantly lower COVID-19 incidence during the Delta surge, but also significantly less severe cases of the disease.
Accurate predictions of individual differences in task-evoked brain activity from resting-state fMRI using a sparse ensemble learner
Authors: Zheng Ying-Qiu , Farahibozorg Seyedeh-Rezvan , Gong Weikang , Rafipoor Hossein , Jbabdi Saad , Smith Stephen 
Published: August 2021

ABSTRACTModelling and predicting individual differences in task-evoked FMRI activity can have a wide range of applications from basic to clinical neuroscience. It has been shown that models based on resting-state activity can have high predictive accuracy. Here we propose several improvements to such models. Using a sparse ensemble leaner, we show that (i) features extracted using Stochastic Probabilistic Functional Modes (sPROFUMO) outperform the previously proposed dual-regression approach, (ii) that the shape and overall intensity of individualised task activations can be modelled separately and explicitly, (iii) training the model on predicting residual differences in brain activity further boosts individualised predictions. These results hold for both surface-based analyses of the Human Connectome Project data as well as volumetric analyses of UK-biobank data. Overall, our model achieves state of the art prediction accuracy on par with the test-retest reliability of tfMRI scans, suggesting that it has potential to supplement traditional task localisers.
Parallel pathways for rapid odor processing in lateral entorhinal cortex: Rate and temporal coding by layer 2 subcircuits
Authors: Bitzenhofer Sebastian H. , Westeinde Elena A. , Zhang Han-Xiong Bear , Isaacson Jeffry S. 
Published: August 2021

SummaryOlfactory information is encoded in lateral entorhinal cortex (LEC) by two classes of layer 2 (L2) principal neurons: fan and pyramidal cells. However, the functional properties of L2 neurons are unclear. Here, we show in awake mice that L2 cells respond rapidly to odors during single sniffs and that LEC is essential for discrimination of odor identity and intensity. Population analyses of L2 ensembles reveals that while rate coding distinguishes odor identity, firing rates are weakly concentration-dependent and changes in spike timing represent odor intensity. L2 principal cells differ in afferent olfactory input and connectivity with local inhibitory circuits and the relative timing of pyramidal and fan cell spikes underlies odor intensity coding. Downstream, intensity is encoded purely by spike timing in hippocampal CA1. Together, these results reveal the unique processing of odor information by parallel LEC subcircuits and highlight the importance of temporal coding in higher olfactory areas.
Harbor porpoise losing its edges: genetic time series suggests a rapid population decline in Iberian waters over the last 30 years
Authors: Ben Chehida Yacine , Stelwagen Tjibbe , Hoekendijk Jeroen P. A. , Ferreira Marisa , Eira Catarina , Pereira Andreia T. , Nicolau Lidia , Thumloup Julie , Fontaine Michael C. 
Published: August 2021

AbstractImpact of climate changes on species is expected to be especially visible at the extremities of the species distribution, where they meet sub-optimal conditions. In Mauritania and Iberia, two genetically isolated populations of harbor porpoises form a distinct ecotype and are presumably locally adapted to the upwelling waters. By analyzing the evolution of mitochondrial genetic variation in the Iberian population between two temporal cohorts (1990-2002 vs. 2012-2015), we report a dramatic decrease in genetic diversity. Phylogenetic analyses including neighboring populations identified two porpoises in southern Iberia carrying a divergent haplotype close to the Mauritanian population, yet forming a distinctive lineage. This suggests that Iberian porpoises may not be as isolated as previously thought with immigration from Mauritania or an unknown population in between, but none from the northern ecotype. The rapid decline in the Iberian mitochondrial diversity may be driven by either genetic drift, or by a dramatic decline in census population size possibly resulting from environmental stochasticity, prey depletion, or acute fishery bycatches. These results illustrate the value of genetics time series to inform demographic trends and emphasize the urgent need for conservation measures to ensure the viability of this small harbor porpoise population in Iberia.