bluuebunny/crossref_metadata_2025_split huggingface dataset:
Atopic endotypes as a modulating factor for SARS-CoV-2 infection: mechanisms and implications
Authors: Huntley Kyle S. , Fine Lauren , Bernstein Jonathan A. 
Published: January 2021

Purpose of review
Asthma patients are typically at increased risk for severe outcomes from viral respiratory infections. However, asthma and atopy do not appear to be overrepresented comorbidities in COVID-19 patients, and hypotheses attempt to explain this observation. As COVID-19 continues to spread globally, it is imperative to understand how disease outcomes may be influenced in this population to guide patient care.

Recent findings
Angiotensin converting enzyme 2 (ACE2) is the principal host cell receptor for SARS-CoV-2 entry and Transmembrane Protease Serine 2 (TMRSS2) is the main priming protease. Models have linked atopic endotypes to reductions in ACE2 and increases in TMRSS2 on respiratory epithelia. Epidemiologic and experimental findings imply alterations in ACE2 expression correlate with clinical COVID-19 disease, but limitations restrict the ability to draw direct conclusions.

Summary
There is reasonable evidence to assert atopic endotypes modulate COVID-19 susceptibility, but it remains premature to classify this association as protective or deleterious. Asthma is a heterogeneous disease and epidemiologic studies should focus on investigating COVID-19 outcomes by underlying endotype. Direct experimental and clinical evidence is needed to draw definitive conclusions on how the complex interplay of ACE2 and TMRSS2 affect viral entry.

Video abstract

https://www.dropbox.com/sh/9sfwqhz2h78sio3/AAB0JYd4MFzM5JjDFcYwz4CXa?dl=0
Comparison of Psychological and Physiological Stress in NICU Nurses
Authors: Brand M. Colleen , Shippey Holly , Hagan Joseph , Hanneman Sandra K. , Levy Barbara , Range Stefany , Wongsuwan Nattaya , Zodin Amy , Walden Marlene 
Published: January 2021

Background:
Effects of unit design and shift worked on stress in neonatal intensive care unit (NICU) nurses have not been fully studied.

Purpose:
To compare stress in NICU nurses who work in single-family room (SFR) or open bay (OBY) units and on nonrotating day or night shift.

Methods:
Full-time registered nurses (RNs) (n = 72) from a 42-bed SFR and a 131-bed OBY NICU participated in this comparative cross-sectional study. The Nurse Stress Scale (NSS) and within-shift repeated salivary cortisol levels were used to measure stress. The relationship between NSS score and salivary cortisol level was examined using multiple linear regression. Salivary cortisol levels of day versus night shift were compared with mixed-effects linear models.

Results:
NSS scores were similar for SFR and OBY units (P = .672) and day versus night shift (P = .606). Changes in cortisol level over time (P = .764) and final cortisol level (P = .883) for SFR versus OBY were not significantly different after controlling for shift. Salivary cortisol level of day-shift nurses decreased significantly over time compared with night-shift nurses (P < .001). The final cortisol level was significantly higher for night-shift compared with day-shift nurses (P < .001).

Implications for Practice:
Psychological (NSS) and physiologic (salivary cortisol) stress of NICU nurses is similar in established SFR and OBY units. Cortisol levels are higher at the end of shift in nurses who work night shift and may reflect increased physiologic stress.

Implications for Research:
Strategies are needed for reducing stress in NICU nurses who work night shift.
Novel Acetabular Hemiarthroplasty for Palliation of Periacetabular Metastatic Disease With Articular Bone Loss
Authors: Nelson Philip C. , Lockey Stephen D. , Wodajo Felasfa M. 
Published: January 2021

Introduction:
Periacetabular metastatic disease is often successfully treated nonoperatively. Cases with extensive bone loss and the subchondral collapse of the acetabular dome require reconstruction to restore mobility. These procedures are associated with significant morbidity and postoperative complications.

Objectives:
The primary objective of this case study is to describe a novel “acetabular hemiarthroplasty” to manage the periacetabular metastatic disease with subchondral collapse and protrusio.

Materials and Methods:
Five consecutive patients with significant periacetabular bone loss and subchondral collapse were surgically managed with a novel acetabular hemiarthroplasty. The hospital records were retrospectively reviewed and outcomes at the most recent follow-up are reported.

Results:
Our findings suggest that acetabular hemiarthroplasty could be a valuable option for surgical palliation of periacetabular metastatic disease involving subchondral collapse and protrusio.

Conclusion:
This technique provides for the restoration of joint mechanics and weight bearing without the need for total hip arthroplasty. Compared with complex hip arthroplasty, the authors believe this novel acetabular hemiarthroplasty potentially reduces operative time and blood loss while substantially limiting the risk of dislocation.
Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China
Authors: Zhang He , Zheng Wen , Wu Shuo , Ma Jing-Jing , Wang Guang-Mei , Li Yong , Zheng Jia-Qi , Lyu Yuan , Xue Meng-Yang , Xu Feng , Wang Jia-Li , Chen Yu-Guo 
Published: January 2021

Abstract

Background:
Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China.

Methods:
We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI.

Results:
The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals.

Conclusions:
Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.
Evaluation of blood pressure lowering effect by generic and brand-name antihypertensive drugs treatment: a multicenter prospective study in China
Authors: Zhang Shu-Yuan , Tao Li-Yuan , Yang Yun-Yun , Kong Tao , Wu Cun-Jin , Wang Yang , Chen Jing-Zhou , Song Lei , Wang Yi-Bo , Hui Ru-Tai , Zhang Wei-Li 
Published: January 2021

Abstract

Background
Generic drugs are bioequivalent to their brand-name counterparts; however, concerns still exist regarding the effectiveness and safety of generic drugs because of small sample sizes and short follow-up time in most studies. The purpose of this study was to evaluate the long-term antihypertensive efficacy, cost-effectiveness and cardiovascular outcomes of generic drugs compared with brand-name drugs.

Methods
In a multicenter, community-based study including 7955 hypertensive patients who were prospectively followed up for an average of 2.5 years, we used the propensity-score-matching method to match the patients using brand-name drugs to those using generic drugs in a ratio of 1:2, 2176 patients using brand-name drugs and 4352 patients using generic drugs.

Results
There were no significant differences between generic drugs and brand-name drugs in blood pressure (BP)-lowering efficacy, BP control rate, and cardiovascular outcomes including coronary heart disease and stroke. The adjusted mean (95% confidence interval [CI]) of systolic BP (SBP)-lowering was –7.9 mmHg (95% CI, –9.9 to –5.9) in the brand-name drug group and –7.1 mmHg (95% CI, –9.1 to –5.1) in the generic drug group after adjusting for age, sex, body mass index, number of antihypertensive drugs and traditionally cardiovascular risk factors. Among patients aged <60 years, brand-name drugs had a higher BP control rate (47% vs. 41%; P = 0.02) and a greater effect in lowering SBP compared with generic drugs, with the between-group difference of 1.5 mmHg (95% CI, 0.2–2.8; P = 0.03). BP control rate was higher in male patients using brand-name drugs compared with those using generic drugs (46% vs. 40%; P = 0.01). Generic drugs treatment yielded an average annual incremental cost-effectiveness ratio of $315.4 per patient per mmHg decrease in SBP compared with brand-name drugs treatment.

Conclusions
Our data suggested that generic drugs are suitable and cost-effective in improving hypertension management and facilitating public health benefits, especially in low- and middle-income areas.
Type 2 Myocardial Infarction
Authors: Smer Aiman , Squires Ray W. , Aboeata Ahmed , Bowman Melissa J. , Mahlmeister Kasara A. , Medina-Inojosa Jose R. , Bonikowske Amanda R. , Patel Apurva , Del Core Michael , Williams Mark A. 
Published: January 2021

Background:
Type 2 myocardial infarction (T2MI) is commonly encountered in clinical practice, yet little is known about this challenging condition. Outpatient cardiac rehabilitation (CR) is an integral component in the care of patients with MI. However, specific recommendations for CR, information on the feasibility of participation, and outcome measures for patients with T2MI are lacking.

Clinical Considerations:
The frequency of T2MI is markedly variable and depends on the studied population, disease definition, adjudication process, cardiac troponin assays, and cutoff values used to make the diagnosis of T2MI. Clinically, it is difficult to distinguish T2MI from type 1 MI or myocardial injury. Type 2 myocardial infarction occurs due to myocardial oxygen supply-demand mismatch without acute atherothrombotic plaque disruption and is associated with adverse short- and long-term prognoses. Currently, there are substantial gaps in knowledge regarding T2MI and there are no clear guidelines for the optimal management of these patients.

Summary:
In this article, we present important current concepts surrounding T2MI including the definition, pathophysiology, epidemiology, diagnosis, prognosis, and management. We also discuss referral patterns to CR and participation rates and provide our experience with a case series of 17 patients. Very few patients with T2MI are referred to and participate in CR. Our small case series indicated that patients with T2MI respond favorably to CR and that exercise training following standard guidelines appears safe and is well tolerated.
The V˙E/V˙co 2 Slope During Maximal Treadmill Cardiopulmonary Exercise Testing
Authors: Arena Ross , Myers Jonathan , Harber Mathew , Phillips Shane A. , Severin Richard , Ozemek Cemal , Peterman James E. , Kaminsky Leonard A. 
Published: January 2021

Purpose:
Cardiopulmonary exercise testing (CPX) is the gold standard approach for the assessment of cardiorespiratory fitness (CRF). The primary aim of the current study was to determine reference standards for the minute ventilation/carbon dioxide production (V˙E/V˙co
2) slope in a cohort from the “Fitness Registry and the Importance of Exercise: A National Database” (FRIEND) Registry.

Methods:
The current analysis included 2512 tests from 10 CPX laboratories in the United States. Inclusion criteria included CPX data on apparently healthy men and women: (1) age ≥20 yr; and (2) with a symptom-limited exercise test performed on a treadmill. Ventilation and V˙co
2 data, from the initiation of exercise to peak, were used to calculate the V˙E/V˙co
2 slope via least-squares linear regression. Reference values were determined for men and women by decade of life.

Results:
On average, V˙E/V˙co
2 slope values were lower in men and increased with age independent of sex. Fiftieth percentile values increased from 27.1 in the second decade to 33.9 in the eighth decade in men and from 28.5 in the second decade to 33.7 in the eighth decade in women. In the overall group, correlations with baseline characteristics and the V˙E/V˙co
2 slope were statistically significant (P < .05) although generally weak, particularly for age and body mass index.

Conclusion:
The results of the current study establish reference values for the V˙E/V˙co
2 slope when treadmill testing is performed, and all exercise data are used for the slope calculation. These results may prove useful in enhancing the interpretation of CPX results when assessing CRF.
Nonuniform Exposure to the Cornea from Millimeter Waves
Authors: Foster Kenneth R. , Laakso Ilkka , Chalfin Steven 
Published: January 2021

Abstract
This study examines the nonuniform exposure to the cornea from incident millimeter waves at 94-100 GHz. Two previous studies measured temperature increases in the rhesus cornea exposed to brief (1-6 s) pulses of high-fluence millimeter waves (94 GHz), one of which also estimated thresholds for corneal damage (reported as ED50, the dose resulting in a visible lesion 50% of the time). Both studies noted large variations in the temperature increase across the surface of the cornea due to wave interference effects. This study examines this variability using high-resolution simulations of mm-wave absorption and temperature increase in the human cornea from exposures to plane wave energy at 100 GHz. Calculations are based on an earlier study. The simulations show that the peak temperature increases in the cornea from short exposures (up to 10 s) to high-intensity mm-wave pulses are 1.7-2.8 times the median increase depending on the polarization of the incident energy. A simple one-dimensional “baseline” model provides a good estimate of the median temperature increase in the cornea. Two different estimates are presented for the thresholds for producing thermal lesions, expressed in terms of the minimum fluence of incident 100 GHz pulses. The first estimate is based on thresholds for thermal damage from pulsed infrared energy, and the second is based on a thermal damage model. The mm-wave pulses presently considered far exceed current IEEE or ICNIRP exposure limits but may be produced by some nonlethal weapons systems. Interference effects due to wave reflections from structures in and near the eye result in highly localized variations in energy absorbed in the cornea and surrounding facial tissues and are important to consider in a hazard analysis for exposures to intense pulsed millimeter waves.
Validation of a Dose Assessment Method to be Used in 18F FDG Loose Contamination Exercises
Authors: Chen Miles L. , Cochran Lainy D. , Marianno Craig M. 
Published: January 2021

Abstract
Radiological emergency response may require responders to operate in contaminated environments. To provide more realistic training to these individuals, it has been proposed to disperse low amounts of short-lived radioactive material in simulated emergency scenarios. To demonstrate the applicability and safety of such activities, a limited exercise was conducted where 18F was sprayed in a small area and survey activities were executed. A pre-job external radiation exposure dose assessment was performed in preparation for this training. The research presented here compares participant external recorded doses to assessment results in order to validate the dose estimates. Two individuals were used during the dispersion, search, and survey activities. First, a radiation worker mixed 200 MBq Fludeoxyglucose 18F with 470 mL H2O in a weed sprayer and distributed it over a 3 m × 3 m area. After evaporation, an exercise participant performed search and survey activities in the area. Actual whole-body doses measured with optically stimulated luminescence dosimeters were 10 ± 1 μSv for both personnel. Whole-body digital dosimeters read 4.3 ± 0.2 μSv and 3.3 ± 0.5 μSv for the radiation worker and exercise participant, respectively. Actual extremity doses were below the dosimeters’ minimum detectable limits for the radiation worker (thermoluminescence dosimeter) and exercise participant (optically stimulated luminescence dosimeter). The dose assessment-predicted whole-body doses were 2.8 ± 0.4 μSv and 3.2 ± 0.1 μSv for the radiation worker and exercise participant, respectively. The estimated dose to the radiation worker’s hand was 21.8 ± 3.8 μSv, and the estimated dose to the exercise participant’s knee was 13.4 ± 0.6 μSv. The study provided substantial evidence for the validity of the dose assessment method, supporting its use for a larger training exercise.
Comparison of Neutron Organ and Effective Dose Coefficients for PIMAL Stylized Phantoms in Bent Postures in Cranial and Caudal Irradiation Geometries
Authors: Sivabhaskar Sruthi , Perry Alexander , Dewji Shaheen 
Published: January 2021

Abstract
Radiation dose estimations in the human body are performed using computational reference phantoms, which are anatomical representations of the human body. In previous studies, dose reconstructions have been performed focusing primarily on phantoms in an upright posture, which limits the accuracy of the dose estimations for postures observed in realistic work settings. In this work, the International Commission on Radiological Protection (ICRP) Publication 103 recommendations for monoenergetic neutron plane sources directed downward from above the head (cranial) and upward from below the feet (caudal) for adult female and male reference phantoms were used to calculate organ absorbed and effective dose coefficients. The Phantom with Moving Arms and Legs (PIMAL) and the Monte Carlo N-Particle (MCNP) radiation transport code were used to compute organ-absorbed dose and effective dose coefficients for the upright, half-bent (45°), and full-bent (90°) phantom postures. The doses calculated for each of the articulated positions were compared to those calculated for the upright posture by computing the ratios of the coefficients (45°/upright and 90°/upright). These ratios were used to assess the effectiveness of upright phantoms in providing a comparable estimate when conducting dose estimations and dose reconstructions for articulated positions. This work compiling neutron cranial and caudal posture-specific dose coefficients completes the series of dose coefficients computed for posture-specific ICRP Publication 116 irradiation geometries for monoenergetic photons and neutrons, in addition to cranial and caudal monoenergetic photons. Results reported demonstrated that organ-absorbed dose coefficients for most of the organs in the CRA and CAU irradiation geometries were significantly higher for the bent phantoms than for the upright phantom. Since the upright phantom underestimates the organ-absorbed dose, this demonstrates the impact of posture while performing dose calculations. Organ doses reported in past neutron dose coefficient data were found to omit effects from neutron resonances at energies of 0.435, 1.0, and 3.21 MeV from 16O in tissue. Reported data notes as high as 60% underestimation for neutron organ-absorbed doses, specifically at the neutron resonance energy region omitted by smoothing. Ongoing studies are examining the effect of resonances on reported neutron organ-absorbed dose coefficients in ICRP 116 geometries.
Exposure to Radon and Progeny in a Tourist Cavern
Authors: Anderson Jeri L. , Zwack Leonard M. , Brueck Scott E. 
Published: January 2021

Abstract
The primary objective of this work was to characterize employee exposure to radon and progeny while performing guide/interpretation and concessions duties in a tourist cavern. Radon gas and progeny concentrations, fraction of unattached progeny, and other environmental parameters were evaluated in a popular tourist cavern in Southeastern New Mexico. Alpha-track detectors were used to measure radon gas in several cavern locations during a 9-mo period. Additionally, radon gas and attached and unattached fractions of radon progeny were measured at three primary cavern work locations during a 1-d period using a SARAD EQF 3220. Radon gas concentrations in the cavern were elevated due to extremely low air exchange rates with substantial seasonal variation. Mean measured radon concentrations ranged from 970 to 2,600 Bq m−3 in the main cavern and from 5,400 to 6,000 Bq m−3 in a smaller cave associated with the regional cave system. Measurements of unattached fractions (0.40-0.60) were higher than those commonly found in mines and other workplaces, leading to the potential for relatively high worker dose. Although radon gas concentrations were below the Occupational Safety and Health Administration Permissible Exposure Limit, employees working in the cavern have the potential to accrue ionizing radiation dose in excess of the annual effective dose limit recommended by the National Council on Radiation Protection and Measurements due to a high unattached fraction of radon progeny. There was a strong negative correlation between unattached fractions and equilibrium factors, but these parameters should be further evaluated for seasonal variation. Introduction of engineering controls such as ventilation could damage the cavern environment, so administrative controls, such as time management, are preferred to reduce employee dose.
Predisposing Factors, Clinical Presentations, and Outcomes of Contact Lens–Related Pythium Keratitis
Authors: Nonpassopon Manachai , Jongkhajornpong Passara , Aroonroch Rangsima , Koovisitsopit Atit , Lekhanont Kaevalin 
Published: January 2021

Purpose:
To describe predisposing factors, clinical presentations, and treatment outcomes of contact lens (CL)–related Pythium keratitis.

Methods:
This was an 11-year retrospective study of CL-related Pythium keratitis conducted from 2009 to 2019. Six eyes of 6 patients were identified. Demographics, predisposing factors, CL history, clinical presentation, diagnostic tests, treatments, and outcomes were reviewed.

Results:
Mean age of the patients was 34 years (SD 16.3 years) with equal proportion between male and female patients. Five of 6 patients (83.3%) used soft CL, whereas 1 patient used rigid gas permeable lens. All patients had a history of water contamination (tap water and water from river and sea). Mean duration from the onset was 7.8 days (range 4–14 days). Mean size of the corneal lesion was 3.33 mm (SD 1.31 mm) in width. The typical feature of tentacle-like lesions radiating in a reticular pattern was observed in all patients. Feathery edge (1 eye), satellite lesions (2 eyes), and radial keratoneuritis (2 eyes) were also found. Every patient received therapeutic penetrating keratoplasty because of failed medical treatments. One patient subsequently underwent enucleation. Globe salvage was achieved in 5 patients (83.33%).

Conclusions:
Awareness of the history of water contamination, recognition of specific clinical features of Pythium keratitis, and performing surgical treatment are key for achieving globe salvage in patients with CL-related Pythium keratitis.