bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute myeloid leukaemia presenting with ecthyma gangrenosum as the first manifestation
Authors: Hadano Yoshiro , Yoshida-Sakai Nao , Imamura Yutaka , Inoue Tomohiro , Koga Hitoshi 
Published: May 2021

Abstract

Rationale
Ecthyma gangrenosum (EG) is an uncommon cutaneous infection usually associated with Pseudomonas aeruginosa bacteremia in immunocompromised patients, particularly those with underlying malignant diseases. Despite its rarity, especially in immunocompetent or nondiagnosed immunodeficiency patients, EG can present as the first manifestation of an underlying immunosuppression.

Patient concerns
A 42-year-old Japanese man was admitted to our hospital with a 3-day history of a painless red macule on his right forearm and fever.

Diagnoses
Blood culture on admission revealed the presence of Pseudomonas aeruginosa, whereas pus culture of the skin lesion showed Pseudomonas aeruginosa and methicillin-susceptible Staphylococcus aureus positivity.

Interventions
Additional bone marrow aspirate examination and immunophenotyping were performed to confirm the diagnosis of acute promyelocytic leukaemia with PML-retinoic acid alpha receptor.

Outcomes
The patient was successfully treated with a 14-day course of antibiotics, and no evidence of relapse was noted. The patient achieved complete remission after treatment for acute promyelocytic leukaemia.

Lessons
It should be kept in mind that EG is an important cutaneous infection that is typically associated with P aeruginosa bacteremia and the presence of underlying immunodeficiency, such as acute leukaemia.
Continued Dangers From Bed Pole Mobility Devices
Authors: Byard Roger W. , Ritchey Donald 
Published: May 2021

Abstract
Bed poles are held in place by a frame that is inserted underneath a bed mattress and are designed to assist in moving an incumbent from a lying to an upright sitting position, or to help with turning, repositioning, or transferring. Two cases demonstrate, however, that lethal entrapment may be caused by such devices—a 76-year-old man and an 84-year-old woman were both found beside their beds hanging by their necks from bed poles. Gaps between bed poles and mattress/bed sides may provide potentially lethal confined spaces. Individuals at particular risk of such an event are elderly with limited strength and/or obesity with an incomplete awareness of environmental dangers and have a history of mobility issues and/or falls. Any railing used to assist with movement to and from, or within, a bed must sit flush with the bed/mattress side to minimize any chances of entrapment.
Self-Poisoning With Safer Insecticide
Authors: Naveen A. , Sahu Manas Ranjan , Padhi Kimi Soumya , Maharik Sasank Shekhar 
Published: May 2021

Abstract
Imidacloprid (IMI) is a systemic insecticide that belongs to the neonicotinoid group of insecticides. It is highly effective against sucking, boring, and root-feeding insects. Besides, it has a favorable toxicological profile on humans. Currently, IMI is the largest selling insecticide in the world by replacing organophosphates and carbamates. It acts as nicotinic acetylcholine receptor agonist in the central nervous system of insects. To date, there is no specific antidote available for IMI poisoning. Despite a better safety profile on humans, severe toxicity from IMI poisoning is not uncommon. Here, we report a series of 4 cases who were admitted to our tertiary care center with a history of IMI poisoning.
Multisite Veno-Venous Cannulation for Neonates and Nonambulatory Children*
Authors: Lillie Jon , Pienaar Alison , Budd Jenny , Speggiorin Simone , Gordon Anne , James Paul , Perkins Jo , Griffiths Benedict , Fine-Goulden Miriam , Austin Conal , Salih Caner , Agnew Nicola , Nyman Andrew G. 
Published: May 2021

OBJECTIVES:
Neonates with respiratory failure are ideally supported with veno-venous rather than veno-arterial extracorporeal membrane oxygenation due to the reduced rate of neurologic complications. However, the proportion of neonates supported with veno-venous extracorporeal membrane oxygenation is declining. We report multisite veno-venous extracorporeal membrane oxygenation, accessing the neck, returning to the inferior vena cava via the common femoral vein in neonates and children less than 10 kg.

DESIGN:
Retrospective case series with 1 year minimum follow-up.

PATIENTS:
Patients less than 10 kg supported with veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein

SETTING:
A 30-bed pediatric intensive care delivering extracorporeal membrane oxygenation to approximately 20 children annually.

INTERVENTIONS:
Veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein was delivered using two single lumen cannulae.

MEASUREMENTS AND MAIN RESULTS:
January 2015 to August 2019, 11 patients underwent veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein with median weight of 3.6 kg (interquartile range 2.8–6.1 kg), and median corrected gestational age of 13 days (interquartile range, 2–175 d). The smallest patient weighed 2.1 kg. Seven patients had comorbidities. Extracorporeal membrane oxygenation was technically successful in all patients with median flows of 126 mL/kg/min (interquartile range, 120–138 mL/kg/min) and median arterial oxygenation saturation of 94% (interquartile range, 91–98%) at 24 hours. Nine survived to home discharge, and two were palliated. Common femoral vein occlusion was observed in all patients on ultrasound post decannulation. There was no clinical or functional deficit in the cannulated limb at follow-up, a minimum of 1 year post extracorporeal membrane oxygenation.

CONCLUSIONS:
Veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein was performed safely in patients under 10 kg with the smallest patient weighing 2.1 kg. Although occlusion of the common femoral vein was observed in patients post decannulation, subsequent follow-up demonstrated no clinical implications. We challenge current practice that veno-venous extracorporeal membrane oxygenation accessing the jugular and returning to the femoral vein cannot be performed in nonambulatory patients and suggest that this strategy is preferred over veno-arterial extracorporeal membrane oxygenation in infants requiring extracorporeal membrane oxygenation for respiratory failure.
Thromboembolic Complications of Vascular Catheters Used for Pediatric Continuous Renal Replacement Therapy: Prevalence in a Single-Center, Retrospective Cohort*
Authors: Szeps Isabelle , Östlund Åsa , Norberg Åke , Fläring Urban , Andersson Andreas 
Published: May 2021

OBJECTIVES:
Pediatric venous thromboembolic events are commonly associated with in situ central venous catheters. The risk for severe venous thromboembolism increases if a larger portion of the vessel lumen is occupied by the central venous catheter. A functioning vascular catheter is required when the continuous renal replacement therapy is used in critically ill children. Due to the high blood flow required for continuous renal replacement therapy, the external diameter of the catheter needs to be larger than a conventional central venous catheter used for venous access, potentially increasing the risk of venous thromboembolism. However, children on continuous renal replacement therapy often receive systemic anticoagulation to prevent filter clotting, possibly also preventing venous thromboembolism. The frequency of catheter-related venous thromboembolic events in this setting has not been described. Our main objective was to determine the prevalence of catheter-related venous thromboembolism in pediatric continuous renal replacement therapy.

DESIGN:
Retrospective cohort study.

SETTING:
Tertiary multidisciplinary academic pediatric hospital.

PATIENTS:
Patients 0–18 years old with a vascular catheter used for continuous renal replacement therapy.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
In our series of 80 patients, we used 105 vascular catheters. The median age of the patients was 10 months and PICU mortality rate was 21%. Venous thromboembolic events were considered to be catheter related if located in the same vein as the vascular catheter and radiologically verified. Six (5.7%) catheter-related venous thromboembolic events were found. The clinically relevant complications of venous thromboembolism included superior vena cava syndrome and catheter dysfunction. In one patient, severe and life-threatening pulmonary embolism occurred. In comparison with patients without venous thromboembolism, venous thromboembolic events were associated with lower body weight (p = 0.03) and longer durations of continuous renal replacement therapy (p < 0.01), mechanical ventilation (p = 0.03), and PICU stay (p < 0.01). Five out of six venous thromboembolisms appeared in neonates.

CONCLUSIONS:
Catheter-related venous thromboembolism is a clinically relevant complication of pediatric continuous renal replacement therapy, with a prevalence of 5.7% in our cohort. Clinicians involved in pediatric continuous renal replacement therapy need to be vigilant for symptoms of venous thromboembolisms and initiate appropriate treatment as soon as possible.
Increasing hemoglobin concentration with an artificial oxygen carrier improves severe anemia-induced degraded cognitive function
Authors: Weiskopf Richard B. , Davenport Robertson , Cap Andrew P. , Reddy Vineet , Waters Jonathan H. , Cserti-Gazdewich Christine 
Published: May 2021

ABSTRACT
Before death, patients commonly experience impaired consciousness for a significant period, frequently preventing family and others from final interactions with the patient. Some of these episodes of cognitive impairment may be treatable, with treatment not offered owing to the perception of ultimate futility or expense, or both. One of the causes of terminal loss of consciousness or decreased lucidity can be inadequate cerebral oxygen delivery. We report five cases from four institutions where an infusion of a hemoglobin-based oxygen carrier to patients who were unconscious or not lucid owing to acute severe anemia (hemoglobin range, 2.1–5.2 g/dL) resulted in awakening or lucidity. We review briefly human cognitive function and anemia and remark about the use of a hemoglobin-based oxygen carrier for acute severe anemia when red cell transfusion is not an option.
Increased mortality with resuscitative endovascular balloon occlusion of the aorta only mitigated by strong unmeasured confounding: An expanded analysis using the National Trauma Data Bank
Authors: Linderman George C. , Lin Winston , Becher Robert D. , Maung Adrian A. , Bhattacharya Bishwajit , Davis Kimberly A. , Schuster Kevin M. 
Published: May 2021

BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is being increasingly adopted to manage noncompressible torso hemorrhage, but a recent analysis of the 2015 to 2016 Trauma Quality Improvement Project (TQIP) data set showed that placement of REBOA was associated with higher rates of death, lower extremity amputation, and acute kidney injury (AKI). We expand this analysis by including the 2017 data set, quantifying the potential role of residual confounding, and distinguishing between traumatic and ischemic lower extremity amputation.

METHODS
This retrospective study used the 2015 to 2017 TQIP database and included patients older than 18 years, with signs of life on arrival, who had no aortic injury and were not transferred. Resuscitative endovascular balloon occlusions of the aorta placed after 2 hours were excluded. We adjusted for baseline variables using propensity scores with inverse probability of treatment weighting. A sensitivity analysis was then conducted to determine the strength of an unmeasured confounder (e.g., unmeasured shock severity/response to resuscitation) that could explain the effect on mortality. Finally, lower extremity injury patterns of patients undergoing REBOA were inspected to distinguish amputation indicated for traumatic injury from complications of REBOA placement.

RESULTS
Of 1,392,482 patients meeting the inclusion criteria, 187 underwent REBOA. After inverse probability of treatment weighting, all covariates were balanced. The risk difference for mortality was 0.21 (0.14–0.29) and for AKI was 0.041 (−0.007 to 0.089). For the mortality effect to be explained by an unmeasured confounder, it would need to be stronger than any observed in terms of its relationship with mortality and with REBOA placement. Eleven REBOA patients underwent lower extremity amputation; however, they all suffered severe traumatic injury to the lower extremity.

CONCLUSION
There is no evidence in the TQIP data set to suggest that REBOA causes amputation, and the evidence for its effect on AKI is considerably weaker than previously reported. The increased mortality effect of REBOA is confirmed and could only be nullified by a potent confounder.

LEVEL OF EVIDENCE
Therapeutic/care management, level IV.
The art and craft of biliary T-tube Use
Authors: Padmore Greg , Sutherland Francis R. , Ball Chad G. 
Published: May 2021

INTRODUCTION
Since the universal adoption of Hans Kehr’s biliary T-tube in the early twentieth century, use has shifted from routine towards highly selective. Improved interventional endoscopy, percutaneous techniques, and hepato-pancreato-biliary (HPB) training have resulted in less T-tube experience within general surgery. The aim of this technical review is to discuss T-tube indications, technical nuances, and management.

METHODS
Peer-reviewed literature, combined with high volume HPB experience by the authors, was utilized to construct a 10-step conceptual pathway for safe T-tube usage.

RESULTS
Essential concepts surrounding T-tube use include: 1. Contemporary indications for T-tube insertion (disease-, patient-, and anatomy-based); 2. Correct instrument availability (open and laparoscopic); 3. T-tube selection and mechanical preparation; 4. Atraumatic T-tube insertion and security; 5. Immediate postoperative management and meticulous T-tube care; 6. Imaging biliary T-tubes; 7. Optimal timing of T-tube removal; 8. Technical aspects of T-tube removal; 9. Management of potential T-tube inpatient complications; and 10. Management of T-tube complications in the outpatient setting.

CONCLUSIONS
Although their use has decreased substantially, the role of biliary T-tubes in some patients is essential. Given the reality of less frequent experience with T-tube insertion and management, this 10-step pathway will provide an adequate mental and technical framework for safe biliary T-tube use.

LEVEL OF EVIDENCE
Expert opinion, level V.
Association between the initial serum phosphate level and 30-day mortality in blunt trauma patients
Authors: Kim Dong Won , Jung Woo Jin , Lee Dong Keon , Lee Kui Ja , Choi Hyo Ju 
Published: May 2021

BACKGROUND
Studies on patients with cardiac arrest or sepsis have reported that high initial phosphate levels are associated with poor outcomes. However, no previous study has investigated the association between initial phosphate levels and outcomes in blunt trauma patients.

METHODS
This study was a retrospective observational study conducted on blunt trauma patients who had been treated at the single regional trauma center between January 2016 and December 2017. Patients’ demographic data, initial vital signs, trauma scores, and laboratory parameters including phosphate levels were collected from the trauma registry. The primary outcome was set to 30-day mortality. The secondary outcomes were the total volume of blood transfused, 30-day hospital-free days, and 30-day intensive care unit–free days.

RESULTS
Of the 1,907 included patients, 1,836 were in the survival group, and 71 were in the nonsurvival group. The nonsurvival group had a significantly higher phosphate level than the survival group. Patients in the hyperphosphatemia group had a higher 30-day mortality, fewer 30-day intensive care unit–free days, and higher transfusion volume than those in the other groups. In multivariable logistic regression analysis, hyperphosphatemia was independently associated with 30-day mortality. The receiver operating characteristic curve analysis showed that the area under the curve with the inclusion of phosphate in addition to Injury Severity Score, Revised Trauma Score, and age was 0.911. Area under the curve was also increased when phosphate was simply added to Injury Severity Score and Revised Trauma Score.

CONCLUSION
In blunt trauma patients, hyperphosphatemia was associated with an increased 30-day mortality.

LEVEL OF EVIDENCE
Prognostic, level III.
Genetic overlap between major depression, bipolar disorder and Alzheimer’s Disease
Authors: Dos Santos Fernanda C. , Mendes-Silva Ana Paula , Nikolova Yuliya S. , Sibille Etienne L. , Diniz Breno Satler 
Published: May 2021

ABSTRACTBackgroundMood disorders, including major depression (MD) and bipolar disorder (BD), are risk factors for Alzheimer’s disease (AD) and possibly share an overlapping genetic architecture. However, few studies have investigated the shared loci and potential pleiotropy among these disorders.MethodsWe carried out a systematic analytical pipeline using GWAS data and three complementary (genome-wide, single variant, and gene-level) statistical approaches to investigate the genetic overlap among MD, BD, and AD.ResultsGWAS summary statistics data from 679,973 individuals were analyzed herein (59,851 MD cases and 113,154 controls; 20,352 BD cases and 31,358 controls; and 71,880 AD cases and 383,378 controls). We identified a significant positive genetic correlation between MD and AD (rG = 0.162; s.e. = 0.064; p = 0.012), and between BD and AD (rG = 0.162; s.e. = 0.068; p = 0.018). We also identified two pleiotropic candidate genes for MD and AD (TMEM106B and THSD7A) and three forBD and AD (MTSS2, VAC14, and FAF1), and reported candidate biological pathways associated with all three disorders.DiscussionOur study identified genetic loci and mechanisms shared by mood disorders and AD. These findings could be relevant to better understand the higher risk for AD among individuals with mood disorders, and to propose new interventions.
A hemagglutination-based, semi-quantitative test for point-of-care determination of SARS-CoV-2 antibody levels
Authors: Kruse Robert L. , Huang Yuting , Lee Alyssa , Zhu Xianming , Shrestha Ruchee , Laeyendecker Oliver , Littlefield Kirsten , Pekosz Andy , Bloch Evan M. , Tobian Aaron A.R. , Wang Zack Z. 
Published: May 2021

AbstractSerologic, point-of-care tests to detect antibodies against SARS-CoV-2 are an important tool in the COVID-19 pandemic. The majority of current point-of-care antibody tests developed for SARS-CoV-2 rely on lateral flow assays, but these do not offer quantitative information. To address this, we developed a new method of COVID-19 antibody testing employing hemagglutination tested on a dry card, similar to that which is already available for rapid typing of ABO blood groups. A fusion protein linking red blood cells (RBCs) to the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was placed on the card. 200 COVID-19 patient and 200 control plasma samples were reconstituted with O-negative RBCs to form whole blood and added to the dried protein, followed by a stirring step and a tilting step, 3-minute incubation, and a second tilting step. The sensitivity for the hemagglutination test, Euroimmun IgG ELISA test and RBD-based CoronaChek lateral flow assay was 87.0%, 86.5%, and 84.5%, respectively, using samples obtained from recovered COVID-19 individuals. Testing pre-pandemic samples, the hemagglutination test had a specificity of 95.5%, compared to 97.3% and 98.9% for the ELISA and CoronaChek, respectively. A distribution of agglutination strengths was observed in COVID-19 convalescent plasma samples, with the highest agglutination score (4) exhibiting significantly higher neutralizing antibody titers than weak positives (2) (p<0.0001). Strong agglutinations were observed within 1 minute of testing, and this shorter assay time also increased specificity to 98.5%. In conclusion, we developed a novel rapid, point-of-care RBC agglutination test for the detection of SARS-CoV-2 antibodies that can yield semi-quantitative information on neutralizing antibody titer in patients. The five-minute test may find use in determination of serostatus prior to vaccination, post-vaccination surveillance and travel screening.
A polygenic score-based approach to identify gene-drug interactions stratifying breast cancer risk
Authors: Marderstein Andrew R. , Kulm Scott , Peng Cheng , Tamimi Rulla , Clark Andrew G. , Elemento Olivier 
Published: May 2021

AbstractAn individual’s genetics can dramatically influence breast cancer (BC) risk. While clinical measures for prevention do exist, non-invasive personalized measures for reducing BC risk are limited. Commonly-used medications are a promising set of modifiable factors, however no previous study has explored whether a range of widely-taken approved drugs modulate BC genetics. In this study, we describe a quantitative framework for exploring the interaction between the genetic susceptibility of BC and medication usage among UK Biobank women. We computed BC polygenic scores (PGS) that summarize BC genetic risk, and find that the PGS explains nearly three-times greater variation in disease risk within corticosteroid users compared to non-users. We map 35 genes significantly interacting with corticosteroid use (FDR < 0.1), highlighting the transcription factor NRF2 as a common regulator of gene-corticosteroid interactions in BC. Finally, we discover a novel regulatory variant strongly stratifying BC risk according to corticosteroid use. Within risk allele carriers, 18.2% of women taking corticosteroids developed BC, compared to 5.1% of the non-users (with a HR = 3.41 per-allele within corticosteroid users). Overall, this work highlights the clinical relevance of gene-drug interactions in disease risk, and provides a roadmap for repurposing biobanks in drug repositioning and precision medicine.
The impact of BNT162b2 mRNA vaccine on adaptive and innate immune responses
Authors: Föhse Konstantin , Geckin Büsra , Zoodsma Martijn , Kilic Gizem , Liu Zhaoli , Röring Rutger J. , Overheul Gijs J. , van de Maat Josephine S. , Bulut Ozlem , Hoogerwerf Jacobien J. , Oever Jaap ten , Simonetti Elles , Schaal Heiner , Adams Ortwin , Müller Lisa , Ostermann Philipp Niklas , van de Veerdonk Frank L. , Joosten Leo A.B. , Haagmans Bart L. , van Crevel Reinout , van Rij Ronald P. , GeurtsvanKessel Corine , de Jonge Marien I. , Li Yang , Domínguez-Andrés Jorge , Netea Mihai G. 
Published: May 2021

AbstractThe mRNA-based BNT162b2 protects against severe disease and mortality caused by SARS-CoV-2 through induction of specific antibody and T-cell responses. Much less is known about its broad effects on immune responses against other pathogens. In the present study, we investigated the specific adaptive immune responses induced by BNT162b2 vaccination against various SARS-CoV-2 variants, as well as its effects on the responsiveness of human immune cells upon stimulation with heterologous viral, bacterial, and fungal pathogens. BNT162b2 vaccination induced effective humoral and cellular immunity against SARS-CoV-2 that started to wane after six months. We also observed long-term transcriptional changes in immune cells after vaccination, as assessed by RNA sequencing. Additionally, vaccination with BNT162b2 modulated innate immune responses as measured by the production of inflammatory cytokines when stimulated with various microbial stimuli other than SARS-CoV-2, including higher IL-1/IL-6 release and decreased production of IFN-α. Altogether, these data expand our knowledge regarding the overall immunological effects of this new class of vaccines and underline the need of additional studies to elucidate their effects on both innate and adaptive immune responses.