bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interleukin-7 Reverses Lymphopenia and Improves T-Cell Function in Coronavirus Disease 2019 Patient With Inborn Error of Toll-Like Receptor 3: A Case Report
Authors: Mazer Monty B. , Turnbull Isaiah R. , Miles Sydney , Blood Teresa M. , Sadler Brooke , Hess Annie , Botney Mitchell D. , Martin Robert S. , Bosanquet James P. , Striker David A. , Anand Nitin S. , Morre Michel , Caldwell Charles C. , Brakenridge Scott C. , Moldawer Lyle L. , Di Paola Jorge A. , Hotchkiss Richard S. , Remy Kenneth E. 
Published: July 2021

BACKGROUND:
Immunotherapy treatment for coronavirus disease 2019 combined with antiviral therapy and supportive care remains under intense investigation. However, the capacity to distinguish patients who would benefit from immunosuppressive or immune stimulatory therapies remains insufficient. Here, we present a patient with severe coronavirus disease 2019 with a defective immune response, treated successfully with interleukin-7 on compassionate basis with resultant improved adaptive immune function.

CASE SUMMARY:
A previously healthy 43-year-old male developed severe acute respiratory distress syndrome due to the severe acute respiratory syndrome coronavirus 2 virus with acute hypoxemic respiratory failure and persistent, profound lymphopenia. Functional analysis demonstrated depressed lymphocyte function and few antigen-specific T cells. Interleukin-7 administration resulted in reversal of lymphopenia and improved T-cell function. Respiratory function and clinical status rapidly improved, and he was discharged home. Whole exome sequencing identified a deleterious autosomal dominant mutation in TICAM1, associated with a dysfunctional type I interferon antiviral response with increased severity of coronavirus disease 2019 disease.

CONCLUSIONS:
Immunoadjuvant therapies to boost host immunity may be efficacious in life-threatening severe coronavirus disease 2019 infections, particularly by applying a precision medicine approach in selecting patients expressing an immunosuppressive phenotype.
Trends in ICU Mortality From Coronavirus Disease 2019: A Tale of Three Surges
Authors: Auld Sara C. , Harrington Kristin R. V. , Adelman Max W. , Robichaux Chad J. , Overton Elizabeth C. , Caridi-Scheible Mark , Coopersmith Craig M. , Murphy David J. ,   the Emory COVID-19 Quality and Clinical Research Collaborative
Published: July 2021

OBJECTIVES:
To determine the association between time period of hospitalization and hospital mortality among critically ill adults with coronavirus disease 2019.

DESIGN:
Observational cohort study from March 6, 2020, to January 31, 2021.

SETTING:
ICUs at four hospitals within an academic health center network in Atlanta, GA.

PATIENTS:
Adults greater than or equal to 18 years with coronavirus disease 2019 admitted to an ICU during the study period (i.e., Surge 1: March to April, Lull 1: May to June, Surge 2: July to August, Lull 2: September to November, Surge 3: December to January).

MEASUREMENTS AND MAIN RESULTS:
Among 1,686 patients with coronavirus disease 2019 admitted to an ICU during the study period, all-cause hospital mortality was 29.7%. Mortality differed significantly over time: 28.7% in Surge 1, 21.3% in Lull 1, 25.2% in Surge 2, 30.2% in Lull 2, 34.7% in Surge 3 (p = 0.007). Mortality was significantly associated with 1) preexisting risk factors (older age, race, ethnicity, lower body mass index, higher Elixhauser Comorbidity Index, admission from a nursing home); 2) clinical status at ICU admission (higher Sequential Organ Failure Assessment score, higher d-dimer, higher C-reactive protein); and 3) ICU interventions (receipt of mechanical ventilation, vasopressors, renal replacement therapy, inhaled vasodilators). After adjusting for baseline and clinical variables, there was a significantly increased risk of mortality associated with admission during Lull 2 (relative risk, 1.37 [95% CI = 1.03–1.81]) and Surge 3 (relative risk, 1.35 [95% CI = 1.04–1.77]) as compared to Surge 1.

CONCLUSIONS:
Despite increased experience and evidence-based treatments, the risk of death for patients admitted to the ICU with coronavirus disease 2019 was highest during the fall and winter of 2020. Reasons for this increased mortality are not clear.
Coronavirus Disease 2019 as Cause of Viral Sepsis: A Systematic Review and Meta-Analysis*
Authors: Karakike Eleni , Giamarellos-Bourboulis Evangelos J. , Kyprianou Miltiades , Fleischmann-Struzek Carolin , Pletz Mathias W. , Netea Mihai G. , Reinhart Konrad , Kyriazopoulou Evdoxia 
Published: July 2021

Objective:
Coronavirus disease 2019 is a heterogeneous disease most frequently causing respiratory tract infection, which can induce respiratory failure and multiple organ dysfunction syndrome in its severe forms. The prevalence of coronavirus disease 2019–related sepsis is still unclear; we aimed to describe this in a systematic review.

Data Sources:
MEDLINE (PubMed), Cochrane, and Google Scholar databases were searched based on a prespecified protocol (International Prospective Register for Systematic Reviews: CRD42020202018).

Study Selection:
Studies reporting on patients with confirmed coronavirus disease 2019 diagnosed with sepsis according to sepsis-3 or according to the presence of infection-related organ dysfunctions necessitating organ support/replacement were included in the analysis. The primary end point was prevalence of coronavirus disease 2019–related sepsis among adults hospitalized in the ICU and the general ward. Among secondary end points were the need for ICU admission among patients initially hospitalized in the general ward and the prevalence of new onset of organ dysfunction in the ICU. Outcomes were expressed as proportions with respective 95% CI.

Data Extraction:
Two reviewers independently screened and reviewed existing literature and assessed study quality with the Newcastle-Ottawa Scale and the Methodological index for nonrandomized studies.

Data Synthesis:
Of 3,825 articles, 151 were analyzed, only five of which directly reported sepsis prevalence. Noting the high heterogeneity observed, coronavirus disease 2019–related sepsis prevalence was 77.9% (95% CI, 75.9–79.8; I
2 = 91%; 57 studies) in the ICU, and 33.3% (95% CI, 30.3–36.4; I
2 = 99%; 86 studies) in the general ward. ICU admission was required for 17.7% (95% CI, 12.9–23.6; I
2 = 100%) of ward patients. Acute respiratory distress syndrome was the most common organ dysfunction in the ICU (87.5%; 95% CI, 83.3–90.7; I
2 = 98%).

CONCLUSIONS:
The majority of coronavirus disease 2019 patients hospitalized in the ICU meet Sepsis-3 criteria and present infection-associated organ dysfunction. The medical and scientific community should be aware and systematically report viral sepsis for prognostic and treatment implications.
The Impact of Strict Public Health Restrictions on Pediatric Critical Illness*
Authors: Maddux Aline B. , Campbell Kristen , Woodruff Alan G. , LaVelle Jaime , Lutmer Jeffrey , Kennedy Curt E. , Malakooti Marcelo , McGuire John K. , Shekerdemian Lara , Harris Z. Leah , McCrory Michael C. , Carpenter Todd C. 
Published: July 2021

OBJECTIVES:
To characterize the impact of public health interventions on the volume and characteristics of admissions to the PICU.

DESIGN:
Multicenter retrospective cohort study.

SETTING:
Six U.S. referral PICUs during February 15, 2020–May 14, 2020, compared with the same months during 2017–2019 (baseline).

Patients:
PICU admissions excluding admissions for illnesses due to severe acute respiratory syndrome coronavirus 2 and readmissions during the same hospitalization.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Primary outcome was admission volumes during the period of stay-at-home orders (March 15, 2020–May 14, 2020) compared with baseline. Secondary outcomes were hospitalization characteristics including advanced support (e.g., invasive mechanical ventilation), PICU and hospital lengths of stay, and mortality. We used generalized linear mixed modeling to compare patient and admission characteristics during the stay-at-home orders period to baseline. We evaluated 7,960 admissions including 1,327 during March 15, 2020–May 14, 2020. Daily admissions and patients days were lower during the period of stay-at-home orders compared with baseline: median admissions 21 (interquartile range, 17–25) versus 36 (interquartile range, 30–42) (p < 0.001) and median patient days 93.0 (interquartile range, 55.9–136.7) versus 143.6 (interquartile range, 108.5–189.2) (p < 0.001). Admissions during the period of stay-at-home orders were less common in young children and for respiratory and infectious illnesses and more common for poisonings, endocrinopathies and for children with race/ethnicity categorized as other/unspecified. There were no differences in hospitalization characteristics except fewer patients received noninvasive ventilation during the period of stay-at-home orders.

CONCLUSIONS:
Reductions in PICU admissions suggest that much of pediatric critical illness in younger children and for respiratory and infectious illnesses may be preventable through targeted public health strategies.
Recognizing Vaccine-Induced Immune Thrombotic Thrombocytopenia
Authors: Iba Toshiaki , Levy Jerrold H. , Warkentin Theodore E. 
Published: July 2021

OBJECTIVES:
Vaccine-induced immune thrombotic thrombocytopenia is an unexpected consequence of the coronavirus disease 2019 pandemic era. We reviewed the pathogenesis, clinical presentation, diagnosis, and treatment of this rare side effect.

DATA SOURCES:
Online search of published medical literature through PubMed, Scopus, Web of Science, and Google Scholar using the terms “COVID-19,” “vaccine,” “thrombosis” was performed.

STUDY SELECTION:
Articles were chosen for inclusion based on their relevance to coronavirus disease 2019, vaccine, and thrombosis.

DATA SYNTHESIS:
Vaccine-induced immune thrombotic thrombocytopenia manifests most often as unusual thromboses (cerebral venous sinus thrombosis, splanchnic vein thrombosis) but sometimes also “usual” thromboses (arterial stroke, pulmonary embolism, deep-vein thrombosis), with oftentimes severe thrombocytopenia, that becomes clinically evident 5–30 days after adenovirus-vectored coronavirus disease 2019 vaccine administration. Most patients have disseminated intravascular coagulation. These features are the result of vaccine-triggered formation of anti-platelet factor 4 immunoglobulin G that activate platelets, clinically mimicking autoimmune heparin-induced thrombocytopenia. Early recognition based on thrombosis (sometimes, hemorrhage), thrombocytopenia, and d-dimer elevation within the day 5–30 postvaccine “window” is important given treatment with high-dose IV immunoglobulin plus nonheparin anticoagulation.

CONCLUSIONS:
Vaccine-induced immune thrombotic thrombocytopenia is a serious complication of vaccination that is not feasible to anticipate or prevent. When the patient presents with sustained headache, neurologic symptoms/signs, abdominal pain, dyspnea, or limb pain/swelling beginning 5–30 days post vaccination, platelet count and d-dimer must be measured, and imaging for thrombosis performed. Confirmation of vaccine-induced immune thrombotic thrombocytopenia diagnosis should be ordered (platelet factor 4/polyanion enzyme-linked immunosorbent assay; platelet factor 4–enhanced platelet activation testing) as treatment is initiated (nonheparin anticoagulation, IV immunoglobulin).
Preparing women experiencing symptoms of menopause for shared decision making about treatment
Authors: Dayaratna Sandra , Sifri Randa , Jackson Rebecca , Powell Rhea , Sherif Katherine , DiCarlo Melissa , Hegarty Sarah E. , Petrich Anett , Lambert Emily , Quinn Anna , Myers Ronald 
Published: July 2021

Abstract

Objective:
To develop a decision support intervention that can be used with women experiencing menopausal symptoms to facilitate treatment shared decision making.

Methods:
Our research team contacted patients with reported menopausal symptoms by telephone to obtain consent and administer a baseline survey. Subsequently, we sent participants a booklet on the treatment of menopausal symptoms. A nurse educator then contacted participants by telephone to review the booklet and guide them through a structured decision counseling exercise designed to help clarify treatment preference. A 60-day endpoint telephone survey was completed.

Results:
Forty-eight consenting participants completed the baseline survey and 37 (77%) also completed a decision counseling session. At baseline, 19 of the women who had decision counseling were not being treated for menopausal symptoms and 18 were being treated. After decision counseling, 13 (68%) participants who were not being treated and 14 (78%) who were being treated identified a preferred treatment. Comparison of baseline and endpoint survey data showed that participant treatment knowledge increased (P = 0.007) and treatment decisional conflict decreased (P < 0.001). Furthermore, 71% of participants reported that they had received new information about treatment and 94% said they believed better prepared to discuss treatment with their healthcare provider.

Conclusions:
Nurse-led decision counseling increased participant treatment knowledge, reduced treatment decisional conflict, and helped to clarify treatment preference. Implementation of this strategy could help to facilitate provider-patient shared decision making about the treatment of menopausal symptoms.
Risk Factors Associated With 30-Day Mortality Among Neonates With A. baumannii Sepsis
Authors: Thatrimontrichai Anucha , Tonjit Pichitra , Janjindamai Waricha , Dissaneevate Supaporn , Maneenil Gunlawadee , Phatigomet Manapat 
Published: July 2021

Background:

Acinetobacter baumannii sepsis constitutes an extreme threat with a poor prognosis and is a difficult infection to control, especially in Asia. Moreover, a knowledge gap in the risk of mortality in neonatal A. baumannii sepsis still exists.

Methods:
This study aimed to identify the risk factors of mortality in neonates with A. baumannii sepsis in Thailand from 1996 to 2019. A multivariable logistic regression model was analyzed for nonsurvivors and survivors of neonatal A. baumannii sepsis.

Results:
In a 24-year period, 91 neonates with A. baumannii sepsis were reviewed. The median (interquartile range) gestational age and birth weight were 33 (28.5, 37.5) weeks and 1740 (987.5, 2730.0) g, respectively. The 30-day case fatality rate was 36.3% (33/91). In univariable analysis, nonsurvivors of neonatal A. baumannii sepsis was associated with smaller neonates, lower Apgar scores, septic shock, mechanical ventilation, umbilical catheterization, neutropenia, severe thrombocytopenia, carbapenem-resistant A. baumannii sepsis, inadequate empiric antimicrobial therapy, and acute kidney injury. In multivariable analysis, nonsurvivors of neonatal A. baumannii sepsis were associated with septic shock (adjusted odds ratio [OR] = 41.38; 95% confidence intervals [CI]: 3.42–501.13; P = 0.003), severe thrombocytopenia (adjusted OR = 33.70; 95% CI: 3.44–330.55; P = 0.002), and inadequate empiric antimicrobial therapy (adjusted OR = 10.05; 95% CI: 1.40–71.98; P = 0.02).

Conclusion:
In high multidrug-resistant areas, empiric treatment with broader spectrum antimicrobials should be considered in neonates with sepsis shock or severe thrombocytopenia.
Effect of abatacept treatment on serum osteoclast-related biomarkers in patients with rheumatoid arthritis (RA)
Authors: Kawashiri Shin-Ya , Endo Yushiro , Nishino Ayako , Okamoto Momoko , Tsuji Sosuke , Takatani Ayuko , Shimizu Toshimasa , Sumiyoshi Remi , Koga Tomohiro , Iwamoto Naoki , Ichinose Kunihiro , Tamai Mami , Nakamura Hideki , Origuchi Tomoki , Aramaki Toshiyuki , Ueki Yukitaka , Yoshitama Tamami , Eiraku Nobutaka , Matsuoka Naoki , Okada Akitomo , Fujikawa Keita , Hamada Hiroaki , Nagano Shuji , Tada Yoshifumi , Kawakami Atsushi 
Published: July 2021

Abstract
We evaluated the effect of abatacept treatment on osteoclast-related biomarkers and explored whether the biomarkers are associated with the therapeutic response in rheumatoid arthritis (RA) patients treated with abatacept.
We enrolled 44 RA patients treated with abatacept from a multicenter prospective ultrasound cohort study of patients who received biologic or targeted synthetic disease-modifying antirheumatic drug therapy. We evaluated the disease activity score (DAS) 28-CRP (C-reactive protein), musculoskeletal ultrasound scores including the total grayscale score (GS)/power Doppler (PD) score and the serum concentrations of isoform 5b of tartrate-resistant acid phosphate (TRACP-5b) and soluble receptor activator of nuclear factor-κB ligand (sRANKL) at baseline and at 3 and 6 months of treatment. “PD responder” was defined as a patient whose Δtotal PD score over 6 months was greater than the median change of that.
Abatacept significantly improved DAS28-CRP as well as the total GS/PD score over 6 months. Serum TRACP-5b was significantly elevated and serum sRANKL was significantly decreased at 6 months (P < .0001 and P < .01, respectively). At 6 months, serum sRANKL was significantly decreased in the patients who achieved DAS28-CRP remission and the PD responders but not in those who did not. However, serum TRACP-5b rose regardless of the therapeutic response.
Among RA patients treated with abatacept, serum sRANKL decreased in the patients with a good therapeutic response, but serum TRACP-5b elevated paradoxically regardless of the therapeutic response.
Evaluation of the position of the needle tip during thoracentesis
Authors: Shimoda Masafumi , Morimoto Kozo , Tanaka Yoshiaki , Yoshimori Kozo , Ohta Ken 
Published: July 2021

Abstract

Introduction:
Thoracentesis is performed to both diagnose and/or treat pleural effusion, and several important complications of thoracentesis are occasionally observed. To assess precise thoracentesis procedures, we evaluated the position of the needle tip during thoracentesis by using a thoracentesis unit, comparing experienced and inexperienced groups.

Methods:
Twenty eight physicians (19 board-certified pulmonologists as an experienced group and the remaining 9 as an inexperienced group) participated at Fukujuji Hospital in January 2021. All participants performed 2 punctures with a handmade thoracentesis unit and measured the needle‘s angle to the midline.

Results:
The median distance from the needle tip to the midline when the needle was inserted 5 cm (D5) was 0.47 cm (range 0.06–1.05), and the median difference between D5 on the 1st puncture (D51st) and D5 on the 2nd puncture (D52nd) was 0.22 cm (range 0.00–0.69). D5 was shorter in the experienced group than in the inexperienced group (median 0.40 cm (range 0.06–0.66) vs 0.58 cm (range 0.44–1.05), P < .001). There were no significant differences in the D51st and D52nd distances between the experienced and inexperienced groups (median 0.22 cm (range 0.00–0.40) vs 0.41 cm (range 0.04–0.69), P = .094). When 4 areas were divided by the x-axis and y-axis, 32 punctures (55.2%) deviated to the right-upper quadrant, and 25 (86.2%) of participants made the 1st puncture and 2nd puncture in the same direction.

Conclusions:
All doctors should know that the needle direction might shift by approximately 1 cm, and more than half of the practitioners punctured towards the upper right.
Cardiovascular disease and prevention among people living with HIV in South Florida
Authors: Pyarali Fahim , Iordanov Roumen , Ebner Bertrand , Grant Jelani , Vincent Louis , Toirac Alexander , Haque Tahir , Zablah Gerardo , Kapoor Kunal , Powell Alexis , Boulanger Catherine , Hurwitz Barry , Alcaide Maria , Martinez Claudia 
Published: July 2021

Abstract
Antiretroviral therapy (ART) has improved survival of patients living with HIV (PLWH); however, this has been accompanied by an increase in cardiovascular disease (CVD). Although preventative measures for CVD among the general population are well described, information is limited about CVD prevention among PLWH. The goal of this study was to characterize the prevalence of CVD in our population and to assess the use of primary and secondary prevention.
We performed a retrospective review of PLWH receiving primary care at a large academic center in Miami, Florida. We characterized the prevalence of CVD, CVD risk, and the use of aspirin and statins for primary and secondary CVD prevention.
A total of 985 charts were reviewed (45% women, 55% men). Average age was 52.2 years. Average CD4 count was 568 cells/microL. 92.9% were receiving ART, and 71% were virologically suppressed. The median 10-year ASCVD risk was 7.3%. The prevalence of CVD was 10.4% (N = 102). The odds of having CVD was lower in patients on ART (OR 0.47, 95% CI: 0.25–0.90, P = .02). The use of medications for primary and secondary prevention of CVD based on current guidelines was low: 15% and 37% for aspirin respectively, and 25% and 44% for statins.
CVD risk and rates of CVD are high among PLWH and receiving ART could protect against CVD. However, the use of medications for primary and secondary prevention is low. Increased awareness of CVD risk-reduction strategies is needed among providers of PLWH to decrease the burden of CVD.
BCL7B is a potential novel diagnosis and prognosis biomarker for sarcomas using bioinformatics analysis
Authors: Yang Dinglong , Gu Xiaodong , Li Chunjiang , Shi Junjun , Chen Yujing , Dong Mingjie , Zhang Zhiqiang 
Published: July 2021

Abstract
BCL7B plays a potential role in the progression of various cancers, while its role in sarcomas is unknown. We aimed to evaluate BCL7B's diagnostic and prognostic value, and potential BCL7B-related mechanisms in sarcomas based on The Cancer Genome Atlas (TCGA) database. We collected patients with sarcoma from TCGA. Wilcoxon rank sum test was used to compare the expression of BCL7B in sarcoma samples with different clinical-pathologic features. Univariate Cox regression analysis and multivariate Cox regression analysis were used to evaluate prognosis factors for sarcoma. Gene set enrichment analysis (GSEA) was conducted to elucidate the significant functions and pathways associated with BCL7B. BCL7B was a potential biomarker for distinguishing normal and tumor tissues with the analysis of ROC curve (AUC = 0.588). Low BCL7B expression was significantly correlated with tumor multifocal (OR = 0.39 for yes vs no), larger residual tumor (OR = 0.40 for R1,R2 vs RO), male gender (OR = 0.48 for male vs female) and White race (OR = 0.29 for White vs Asian, Black or African American). High BCL7B expression was correlated with leiomyosarcoma histological type (OR = 6.08 for leiomyosarcoma vs dedifferentiated liposarcoma, pleomorphic sarcoma). Univariate and multivariate Cox regression analysis showed that low BCL7B expression was independently associated with poor overall survival (P = .008). GSEA showed that GPCR (G protein-coupled receptors) ligand binding, secreted factors, class A1 rhodopsin-like receptors, extracellular matrix organization, core matrisome, Fc epsilon receptor I mediated NF-κB activation, and WNT signaling pathway were differentially enriched in BCL7B low expression phenotype (|NES| > 1, adjusted P value <.05, and FDR value <0.25). BCL7B may play an important role in sarcoma progression and may be a potential biomarker for prognosis and diagnosis in sarcomas.