bluuebunny/crossref_metadata_2025_split huggingface dataset:
Critical traumatic brain injury is associated with worse coagulopathy
Authors: Cucher Daniel , Harmon Laura , Myer Brian , Ngyuen Andrew , Rankin Timothy , Cook Alan , Hu Charles , Tesoriero Ronald , Scalea Thomas , Stein Deborah 
Published: May 2021

Objectives
As thromboelastography (TEG) becomes the standard of care in patients with hemorrhagic shock (HS), an association between concomitant traumatic brain injury (TBI) and coagulopathy by TEG parameters is not well understood and is thus investigated.

Methods
Retrospective analysis of trauma registry data at a single level 1 trauma center of 772 patients admitted with head Abbreviated Injury Scale (AIS) score of 3 and TEG studies between 2014 and 2017. Patients were stratified to moderate-severe TBI by head AIS scores of 3 and 4 (435 patients) and critical TBI by head AIS score of 5 (328 patients). Hemorrhagic shock was defined by base deficit of 4 or shock index of 0.9. Statistical analysis with unpaired t tests compared patients with critical TBI with patients with moderate-severe TBI, and patients were grouped by presence or absence of HS. A comparison of TBI data with conventional coagulation studies was also evaluated.

Results
In the setting of HS, critical TBI versus moderate-severe TBI was associated with longer R time (p = 0.004), longer K time (p < 0.05), less acute angle (p = 0.001), and lower clot strength and stability (maximum amplitude [MA]) (p = 0.01). Worse TBI did not correlate with increased fibrinolysis by clot lysis measured by the percentage decrease in amplitude at 30 minutes after MA (p = 0.3). Prothrombin time and international normalized ratio failed to demonstrate more severe coagulopathy, while partial thromboplastin time was found to correlate with severity of TBI (p = 0.01). In patients with critical TBI, the presence of HS correlated with a statistically significant worsening of all parameters (p < 0.05) except for clot lysis measured by the percentage decrease in amplitude at 30 minutes after MA (LY-30).

Conclusion
Thromboelastography demonstrates that, with and without hemorrhagic shock, critical TBI correlates with a significant worsening of traumatic coagulopathy in comparison with moderate/severe TBI. In HS, critical TBI correlates with impaired clot initiation, impaired clot kinetics, and impaired platelet-associated clot strength and stability versus parameters found in moderate-severe TBI. Hemorrhagic shock correlates with worse traumatic coagulopathy in all evaluated patient groups with TBI. Conventional coagulation studies underestimate TBI-associated coagulopathy. Traumatic brain injury–associated coagulopathy is not associated with fibrinolysis.

LEVEL OF EVIDENCE
Prognostic/epidemiological, level IV; prognostic/epidemiological, level III.
Use of regional analgesia and risk of delirium in older adults with multiple rib fractures: An Eastern Association for the Surgery of Trauma multicenter study
Authors: O’Connell Kathleen M. , Patel Kushang V. , Powelson Elisabeth , Robinson Bryce R.H. , Boyle Kelly , Peschman Jacob , Blocher-Smith Ethan C. , Jacobson Lewis , Leavitt Justin , McCrum Marta L. , Ballou Jessica , Brasel Karen J. , Judge Joshua , Greenberg Shannon , Mukherjee Kaushik , Qiu Qian , Vavilala Monica S. , Rivara Frederick , Arbabi Saman 
Published: May 2021

BACKGROUND
Single-center data demonstrates that regional analgesia (RA) techniques are associated with reduced risk of delirium in older patients with multiple rib fractures. We hypothesized that a similar effect between RA and delirium would be identified in a larger cohort of patients from multiple level I trauma centers.

METHODS
Retrospective data from seven level I trauma centers were collected for intensive care unit (ICU) patients 65 years or older with ≥3 rib fractures from January 2012 to December 2016. Those with a head and/or spine injury Abbreviated Injury Scale (AIS) score of ≥ 3 or a history of dementia were excluded. Delirium was defined as one positive Confusion Assessment Method for the Intensive Care Unit score in the first 7 days of ICU care. Poisson regression with robust standard errors was used to determine the association of RA (thoracic epidural or paravertebral catheter) with delirium incidence.

RESULTS
Data of 574 patients with a median age of 75 years (interquartile range [IQR], 69–83), Injury Severity Score of 14 (IQR, 11–18), and ICU length of stay of 3 days (IQR, 2–6 days) were analyzed. Among the patients, 38.9% were women, 15.3% were non-White, and 31.4% required a chest tube. Regional analgesia was used in 19.3% patients. Patient characteristics did not differ by RA use; however, patients with RA had more severe chest injury (chest AIS, flail segment, hemopneumothorax, thoracostomy tube). In univariate analysis, there was no difference in the likelihood of delirium between the RA and no RA groups (18.9% vs. 23.8% p = 0.28). After adjusting for age, sex, Injury Severity Score, maximum chest AIS, thoracostomy tube, ICU length of stay, and trauma center, RA was associated with reduced risk of delirium (incident rate ratio [IRR], 0.65; 95% confidence interval [CI], 0.44–0.94) but not with in-hospital mortality (IRR, 0.42; 95% CI, 0.14–1.26) or respiratory complications (IRR, 0.70; 95% CI, 0.42–1.16).

CONCLUSION
In this multicenter cohort of injured older adults with multiple rib fractures, RA use was associated with a 35% lower risk of delirium. Further studies are needed to standardize protocols for optimal pain management and prevention of delirium in older adults with severe thoracic injury.

LEVEL OF EVIDENCE
Therapeutic, level IV; Epidemiologic, level III.
Preventing postnatal depression: a causal mediation analysis of a 20-year preconception cohort
Authors: Spry Elizabeth A. , Moreno-Betancur Margarita , Middleton Melissa , Howard Louise M. , Brown Stephanie J. , Molyneaux Emma , Greenwood Christopher J. , Letcher Primrose , Macdonald Jacqui A. , Thomson Kimberly C. , Biden Ebony J. , Olsson Craig A. , Patton George C. 
Published: May 2021

Postnatal depression (PND) is common and predicts a range of adverse maternal and offspring outcomes. PND rates are highest among women with persistent mental health problems before pregnancy, and antenatal healthcare provides ideal opportunity to intervene. We examined antenatal perceived social support as a potential intervention target in preventing PND symptoms among women with prior mental health problems. A total of 398 Australian women (600 pregnancies) were assessed repeatedly for mental health problems before pregnancy (ages 14–29 years, 1992–2006), and again during pregnancy, two months postpartum and one year postpartum (2006–2014). Causal mediation analysis found that intervention on perceived antenatal social support has the potential to reduce rates of PND symptoms by up to 3% (from 15 to 12%) in women with persistent preconception symptoms. Supplementary analyses found that the role of low antenatal social support was independent of concurrent antenatal depressive symptoms. Combined, these two factors mediated up to more than half of the association between preconception mental health problems and PND symptoms. Trialling dual interventions on antenatal depressive symptoms and perceived social support represents one promising strategy to prevent PND in women with persistent preconception symptoms. Interventions promoting mental health before pregnancy may yield an even greater reduction in PND symptoms by disrupting a developmental cascade of risks via these and other pathways.This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.
Allelic Variation inHLA-DRB1is Associated with Development of Anti-Drug Antibodies in Cancer Patients Treated with Atezolizumab that are Neutralizingin Vitro
Authors: Hammer Christian , Ruppel Jane , Hunkapiller Julie , Mellman Ira , Quarmby Valerie 
Published: May 2021

AbstractThe treatment of diseases with biologic agents can result in the formation of anti-drug antibodies (ADA). The occurrence of ADA were reported for atezolizumab, an anti-PD-L1 monoclonal antibody widely used as immunotherapeutic treatment in cancer patients. Although drivers for ADA formation are unknown, a role for antigen presentation is likely, and variation in human leukocyte antigen (HLA) genes has been shown to be associated with occurrence of ADA for several biologics. Here, we performed an HLA-wide association study in 1,982 patients treated with atezolizumab across 8 clinical trials. On average, 29.8% of patients were ADA positive (N = 591, range of 13.5% -38.4%), and 14.6% of patients were positive for ADA that were neutralizingin vitro(NAb, N = 278, range of 6.4% - 21.9%). We found statistically significant associations between HLA class II alleles and ADA status. The top-associated alleles wereHLA-DRB1*01:01for all ADA (p = 3.4*10−5, odds ratio = 1.96), andHLA-DQA1*01:01when considering NAb only (p = 2.8 x 10−7, OR = 2.31). Both alleles occur together on a common HLA haplotype, and the ADA association was explained by the NAb subset. In conclusion, our study showed that HLA class II genotype contributes to the risk of developing ADA, and specifically NAb, in patients treated with atezolizumab, but suggests that genetic factors are not sufficient as clinically meaningful predictors.
Rapid implementation of cross-sectional study: Post-acute sequelae of SARS-CoV-2 (PASC) in a racially and ethnically diverse sample in Illinois
Authors: Mermelstein Robin J. , Aiyer Meenakshy , Canfield Christine , Chestek David , Cook Judith A. , Rios Marina Del , Diviak Kathleen R. , Ellison Angela M. , Gordon Howard S. , Illendula Sai Dheeraj , Kandula Manasa , Klein Jonathan D. , Larimer Karen , Lash James , Lin Janet , Loeb Jeffrey A. , Lynch Teresa J. , Musick Hugh , Novak Richard M. , Prendergast Heather M. , Krishnan Jerry A. 
Published: May 2021

ABSTRACTLittle is known about the pattern and course of recovery following acute COVID-19. Increasing numbers of reports describe persistent illness following infection with SARS-COV-2, also known as Post-Acute Sequelae of SARS-CoV-2 (PASC). This report describes the methods and results of a multi-pronged strategy to rapidly identify and enroll, over a one week period in April 2021, a racially and ethnically diverse sample of individuals and to characterize PASC among a this diverse sample. Participants were recruited through community outreach, clinical registries, and research registries across four cities in Illinois to complete an online survey. We examined presence of symptoms among 246 individuals who were at least three months past testing positive for SARS-CoV-2. Respondents were 70% female; 48% Hispanic/Latinx; 18% Black, and 28% White. Most had mild illness (78% were not hospitalized), and 26% reported they had not yet returned to their usual health within 3 months of their diagnosis. The most prevalent symptoms persisting 3-months following COVID-19 diagnosis included fatigue (20%), difficulty thinking (19%), problems with taste or smell (15%), and muscle or body aches (15%). In a multivariable logistic regression model, older age (40-59 vs. 18-39 years: adjusted odds ratio [aOR] = 0.46 [95% confidence interval, 0.24 to 0.90]) and having been hospitalized with COVID-19 (vs. not hospitalized: aOR = 0.28 [0.12 to 0.64]) were independently associated with a lower likelihood of recovery within 3 months. Compromised health continued well beyond the acute phase of COVID-19 in our ethnically diverse sample, especially among older individuals and those who were hospitalized. The partnerships with community- and faith-based organizations developed for the current study offer the potential to broadly disseminate study findings and to further understand and mitigate underlying determinants of risk, severity, and duration of PASC.
The impact of vaccination on the spread patterns of the COVID epidemic
Authors: Below D. , Mairanowski F. 
Published: May 2021

AbstractA modified model of the epidemic under conditions of mass vaccination was developed. A comparison of the model results with statistical observations in Israel shows good agreement.Model calculations are performed on the efficacy of limiting the development of an epidemic by both lockdown and vaccination. Mass vaccination of the population is the most radical method of limiting the growth of the epidemic. The introduction of a lockdown cannot completely prevent the development of an epidemic. The likelihood of the emergence of new strains of the virus is assessed. Without vaccination, the probability of more than two new virus strains per year affecting the epidemic growth process is found to be about 60%. A controlled calculation was made of the effect of the timing of changes in lockdown conditions during the vaccination period on the development of the epidemic. It was particularly shown that the cancellation of the lockdown together with the start of vaccination did not reduce the maximum number of new infections. A controlling calculation was made of the effects of gradually cancelling lockdown. On the basis of these calculations, it is possible to assess the development of the epidemic in different variants of partial lockdown cancellation.Three dimensionless complexes, made up of the intensities of transmission, vaccination and lockdown restrictions, are found to determine the epidemic’s development.The intensity of the coronavirus epidemic depends on climatic characteristics, in particular air temperature and the UV index. A relationship is given to estimate the influence of these factors on infection growth.The way forward for further development of the model is outlined. The immediate goal of modifying the model is to use it for each age group in the population and to find out the links between vaccination rates and the psychological state of the population, i.e. people’s readiness for mass vaccination.
Cost-Effectiveness Analysis of Statins for Treatment of Hospitalized COVID-19 Patients
Authors: Chow Ronald , Prsic Elizabeth Horn , Shin Hyun Joon 
Published: May 2021

ABSTRACTIntroductionA recent systematic review and meta-analysis by our group reported on thirteen published cohorts investigating 110,078 patients. Patients administered statins after their COVID-19 diagnosis and hospitalization were found to have a lower risk of mortality. Given this reported superiority, a logical next question would be whether statins are cost-effective treatment options for hospitalized COVID-19 patients. In this paper, we report on a cost-effectiveness analysis of statin-containing treatment regimens for hospitalized COVID-19 patients, from a United States healthcare perspective.MethodsA Markov model was used, to compare statin use and no statin use among hospitalized COVID-19 patients. The cycle length was one week, with a time horizon of 4 weeks. A Monte Carlo microsimulation, with 20,000 samples were used. All analyses were conducted using TreeAge Pro Healthcare Version 2021 R1.1.ResultsTreatment of hospitalized COVID-19 patients with statins was both cheaper and more effective than treatment without statins; statin-containing therapy dominates over non-statin therapy.ConclusionStatin for treatment of COVID-19 should be further investigated in RCTs, especially considering its cost-effective nature. Optimistically and pending the results of future RCTs, statins may also be used broadly for treatment of hospitalized COVID-19 patients.
Relationships between freezing of gait severity and cognitive deficits in Parkinson’s disease
Authors: Scholl Jamie L. , Espinoza Arturo I. , Rai Wijdan , Leedom Matt , Baugh Lee A. , Berg-Poppe Patti , Singh Arun 
Published: May 2021

AbstractObjectiveEvidence supports an association between freezing of gait (FOG) severity and cognitive functioning in patients with Parkinson’s disease (PD); however, results are varied. Here we sought to explore the differences in cognitive measurements via multivariable statistical models in patients with PD.MethodsPD patients with (PDFOG+, n=41) and without FOG (PDFOG–, n=39) and control healthy subjects (n=41) participated in the study. The NIH toolbox cognition battery, Montreal cognitive assessment (MoCA), and interval timing task were used to test cognitive domains. Measurements were compared between groups using multivariable models and adjusting for covariates. Correlation analyses, linear regression, and mediation models were applied to examine relationships among disease duration and severity, FOG severity, and cognitive functioning.ResultsSignificant differences were observed between controls and PD patients for all cognitive domains. PDFOG+ and PDFOG– exhibited differences in the dimensional change card sort (DCCS) test, interval timing task, and MoCA scores. After adjusting for covariates in two different models, PDFOG+ and PDFOG– differed in both MoCA and DCCS scores. In addition, significant relationships between FOG severity and cognitive function (MoCA, DCCS, and interval timing) were also found. Regression models suggest that FOG severity may be a predictor of cognitive impairment, and mediation models show the effects of cognitive impairment on the relationship between disease severity and FOG severity.ConclusionsOverall, this study provides insight into the relationship between cognitive and FOG severity in patients with PD, which could aid in the development of therapeutic interventions to manage both.
Transition in learning approach for undergraduate medical students of Bangladesh in Covid 19 pandemic: A situation analysis
Authors: Jeenia Fatiha Tasmin , Uddin Tanin Md Jamal , Ferdoush Jannatul , Johora Fatema , Hoque Afroza , Abbasy Asma Akter , Sadia Halima , Urmi Rehnuma , Moitra Priyanka , Sarah Quazi Saheli , Ata Maliha , Parveen Kohinoor 
Published: May 2021

AbstractBackgroundThe outbreak of Covid-19 pandemic has fundamentally transformed the landscape of medical education system upside down worldwide. This unanticipated transition without any pre build infrastructure has made this altered prospect more challenging in Bangladesh. Though many countries across the world utilize Web Based Learning (WBL), but medical students of Bangladesh are mostly unfamiliar and unaccustomed with this newly imposed online learning avenue. Therefore, this study has evaluated the familiarity, usage, attitude of students towards online class and figured out the barriers witnessed by students in Bangladesh prospect.MethodsThis cross sectional, questionnaire based study was conducted in medical colleges across Bangladesh. A questionnaire linked to google form were distributed to undergraduate medical students all over Bangladesh through different social platforms. The answered questionnaires were automatically stored in Google drive in a specific email ID.ResultsA total of 1708 students participated. Among the respondents 45.1% were satisfied with online class. Though most students (45.8%) think online class is not effective like traditional lectures but 47.4% agrees to the point that online class should have complementary role in medical education. One of the strong attitude of medical students revealed that, most of them undoubtedly in unison (49.5% disagree, 30.3% strongly disagree) with that online class can never replace traditional class. 77.2% students responded that web based learning is interactive. 54.9% students pointed out interrupted internet connections with low speed during class which is a barrier to WBL. 83.2% of the respondents complained about facing audio visual problem in class which is attributed to poor network connectivity. Most students (74.8%) found online classes costly and 53.8% needed technical supports for online class.ConclusionThis study finding can suggest a potential reform for online class in Bangladesh. Addressing the obstacles and expectations can execute a fruitful web based learning in Bangladesh.
SARS-CoV-2 bearing a mutation at the S1/S2 cleavage site exhibits attenuated virulence and confers protective immunity
Authors: Sasaki Michihito , Toba Shinsuke , Itakura Yukari , Chambaro Herman M. , Kishimoto Mai , Tabata Koshiro , Intaruck Kittiya , Uemura Kentaro , Sanaki Takao , Sato Akihiko , Hall William W. , Orba Yasuko , Sawa Hirofumi 
Published: May 2021

AbstractSevere Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) possesses a discriminative polybasic cleavage motif in its spike protein that is recognized by host furin protease. Proteolytic cleavage activates the spike protein and influences both the cellular entry pathway and cell tropism of SARS-CoV-2. Here, we investigated the impact of the furin cleavage site on viral growth and pathogensis using a hamster animal model infected with SARS-CoV-2 variants bearing mutations at the furin cleavage site (S gene mutants). In the airway tissues of hamsters, the S gene mutants exhibited a low growth property. In contrast to parental pathogenic SARS-CoV-2, hamsters infected with the S gene mutants showed no body weight loss and only a mild inflammatory response, indicating the attenuated variant nature of S gene mutants. We reproduced the attenuated growth of S gene mutants in primary differenciated human airway epithelial cells. This transient infection was enough to induce protective neutralizing antibodies crossreacting with different SARS-CoV-2 lineages. Consequently, hamsters inoculated with S gene mutants showed resistance to subsequent infection with both the parental strain and the currently emerging SARS-CoV-2 variants belonging to lineages B.1.1.7 and P.1. Together, our findings revealed that the loss of the furin cleavage site causes attenuation in the airway tissues of SARS-CoV-2 and highlights the potential benefits of S gene mutants as potential immunogens.
BNT162b2 mRNA Covid-19 vaccine does not impair sperm parameters
Authors: Safrai Myriam , Reubinoff Benjamin , Ben-Meir Assaf 
Published: May 2021

AbstractMass vaccination using newly approved vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has begun globally. However, their effect on fertility have not yet been investigated. Previous studies demonstrate that SARS-CoV-2 infection may impair sperm parameters. In this study, we are the first to assess the effect of the BNT162b2 mRNA Covid-19 vaccine on sperm parameters. Our results demonstrate that the vaccine does not impair sperm parameters. Thus, we recommend that couples desiring to conceive should vaccinate, as vaccination does not affect sperm whereas SARS-CoV-2 infection does impair sperm.