bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tenecteplase-associated orolingual angioedema: A case report and literature review
Authors: Pitts Jeffrey K , Burns Dylan M , Patellos Kevin R 
Published: January 2024

Abstract

Purpose
Orolingual angioedema (OA) secondary to administration of thrombolytic therapy is a rare, but serious, known adverse effect. Despite the lack of robust evidence for their use, C1 esterase inhibitors are recommended by guidelines for the treatment of refractory thrombolytic-associated OA. This report highlights the use of a C1 esterase inhibitor in a patient with tenecteplase-associated OA unresolved by antihistamine and corticosteroid therapy.

Summary
A 67-year-old white male with a history of hypertension managed with lisinopril presented to the emergency department with acute onset of slurred speech and left-sided hemiparesis. Following workup, an outside hospital’s neurology stroke team suspected an acute infarct and determined the patient to be a candidate for tenecteplase. Approximately 1 hour after tenecteplase administration, the patient began complaining of dyspnea and mild oral angioedema. Immediate interventions for OA management included intravenous therapy with dexamethasone 10 mg, diphenhydramine 25 mg, and famotidine 20 mg. After an additional 30 minutes, the patient’s OA symptoms continued to progress and a C1 esterase inhibitor (Berinert) was administered. Shortly after administration of the C1 esterase inhibitor, the patient’s symptoms continued to worsen, ultimately leading to endotracheal intubation. Following intubation, symptom improvement was noted, and the patient was safely extubated after 30 hours.

Conclusion
Although rare, OA is a potentially life-threatening complication of tenecteplase therapy and requires prompt pharmacological intervention to optimize patient outcomes. Currently, no single agent or treatment algorithm exists that has shown significant efficacy or safety in the setting of thrombolytic-associated OA. Until data are available for C1 esterase inhibitors in this application, these inhibitors should only be considered if there is continued symptom progression after intravenous administration of corticosteroids and antihistamines.
The association between number of learners and pharmacist and technician levels of burnout
Authors: May Alisyn , Raber Hanna , Tingey Ben , Locke Amy B , Mullin Shantel , Nickman Nancy A , Qeadan Fares 
Published: January 2024

Abstract

Purpose
Little is known about the relationship between learner load and pharmacist and pharmacy technician burnout. Therefore, the purpose of this study was to examine the association between burnout and the number of learners (residents, students, and new employees) assigned to pharmacists or pharmacy technicians.

Methods
A validated survey to measure burnout and professional fulfillment was administered to employees of a university health system’s pharmacy service in 2019. A threshold analysis determined the optimal cutoff for number of learners trained that maximized the ability to predict binary outcomes. Chi-square and Fisher’s exact tests were used, and effect sizes between percentages were reported. Finally, the adjusted associations between number of learners and outcomes were assessed using logistic regression.

Results
A total of 448 pharmacy staff members were included in the analysis. Of those, 57% (n = 254) worked in ambulatory care, 27.4% (n = 122) worked in an inpatient setting, and 15.7% (n = 70) worked in infrastructure. Pharmacists working in an inpatient setting who reported training 4 or more learners per year indicated significantly higher rates of burnout than those training fewer learners on both a single-item burnout assessment (64.3% vs 31.0%; P = 0.01; effect size, 0.68) and a 10-item burnout assessment (54.8% vs 13.8%; P = 0.01; effect size, 0.91). Similar results were not observed in pharmacists working in ambulatory care and infrastructure positions or in pharmacy technicians.

Conclusion
Added precepting and training responsibilities may be associated with higher levels of burnout among pharmacy team members, particularly inpatient pharmacists.
Changes in frailty and incident cardiovascular disease in three prospective cohorts
Authors: He Di , Wang Zhaoping , Li Jun , Yu Kaixin , He Yusa , He Xinyue , Liu Yuanjiao , Li Yuhao , Fu Ruiyi , Zhou Dan , Zhu Yimin 
Published: January 2024

Abstract

Background and Aims
Previous studies found that frailty was an important risk factor for cardiovascular disease (CVD). However, previous studies only focused on baseline frailty status, not taking into consideration the changes in frailty status during follow-up. The aim of this study was to investigate the associations of changes in frailty status with incident CVD.

Methods
This study used data of three prospective cohorts: China Health and Retirement Longitudinal Study (CHARLS), English Longitudinal Study of Ageing (ELSA), and Health and Retirement Study (HRS). Frailty status was evaluated by the Rockwood frailty index and classified as robust, pre-frail, or frail. Changes in frailty status were assessed by frailty status at baseline and the second survey which was two years after the baseline. Cardiovascular disease was ascertained by self-reported physician-diagnosed heart disease (including angina, heart attack, congestive heart failure, and other heart problems) or stroke. Cox proportional hazard models were used to calculate the hazard ratio (HR) and 95% confidence interval (95% CI) after adjusting for potential confounders.

Results
A total of 7116 participants from CHARLS (female: 48.6%, mean age: 57.4 years), 5303 from ELSA (female: 57.7%, mean age: 63.7 years), and 7266 from HRS (female: 64.9%, mean age: 65.1 years) were included according to inclusion and exclusion criteria. The median follow-up periods were 5.0 years in the CHARLS, 10.7 years in the ELSA, and 9.5 years in the HRS. Compared with stable robust participants, robust participants who progressed to pre-frail or frail status had increased risks of incident CVD (CHARLS, HR = 1.84, 95% CI: 1.54–2.21; ELSA, HR = 1.53, 95% CI: 1.25–1.86; HRS, HR = 1.59, 95% CI: 1.31–1.92). In contrast, frail participants who recovered to robust or pre-frail status presented decreased risks of incident CVD (CHARLS, HR = 0.62, 95% CI: 0.47–0.81; ELSA, HR = 0.49, 95% CI: 0.34–0.69; HRS, HR = 0.70, 95% CI: 0.55–0.89) when compared with stable frail participants. These decreased risks of incident CVD were also observed in pre-frail participants who recovered to robust status (CHARLS, HR = 0.66, 95% CI: 0.52–0.83; ELSA, HR = 0.65, 95% CI: 0.49–0.85; HRS, HR = 0.71, 95% CI: 0.56–0.91) when compared with stable pre-frail participants.

Conclusions
Different changes in frailty status are associated with different risks of incident CVD. Progression of frailty status increases incident CVD risks, while recovery of frailty status decreases incident CVD risks.
Can the Safe Surgical Margin Be Narrowed in Early-Stage Facial Basal Cell Carcinoma?
Authors: Torun Mümtaz Taner , Yılmaz Gülden Taşova 
Published: January 2024

ABSTRACT

OBJECTIVE
To examine factors that affect the positive surgical margins of facial basal cell carcinoma (BCC) and investigate whether the surgical margin value can be narrowed in early-stage facial BCCs.

METHODS
Ninety-five patients were divided into the three groups based on prognosis: good (n = 48), mixed (n = 32), and poor (n = 15). The good prognosis group (group 1) included nodular and superficial subtypes; the mixed prognosis group (group 2) included nodular-infiltrative, nodular-micronodular, and nodular-sclerosing subtypes; and the poor prognosis group (group 3) included infiltrative and micronodular subtypes.

RESULTS
Groups 1 and 2 differed from each other significantly in terms of positive surgical margin (P = .002) and tumor thickness (P = .008), but group 3 did not (P = .851 and P = .804, respectively). With regard to surgical method (primary vs local flap repair), only tumor localization varied significantly (P < .001).

CONCLUSIONS
Groups differed significantly in terms of surgical margin positivity, the distance of the tumor to the surgical margin, and the tumor thickness. The intact surgical margin was 2 mm on average in this study, and the authors suggest that it may be possible to revise the surgical margin values recommended in the literature.
Echocardiography Does not Reduce Mortality in Sepsis: A Re-Evaluation Using the Medical Information Mart for Intensive Care IV Dataset*
Authors: Blank Sebastiaan P. , Blank Ruth M. 
Published: January 2024

OBJECTIVES:
Echocardiography is commonly used for hemodynamic assessment in sepsis, but data regarding its association with outcome are conflicting. The aim of this study was to evaluate the association between echocardiography and outcomes in patients with septic shock using the Medical Information Mart for Intensive Care IV database.

DESIGN:
Retrospective cohort study comparing patients who did or did not undergo transthoracic echocardiography within the first 5 days of admission for the primary outcome of 28-day mortality.

SETTING:
Admissions to the Beth Israel Deaconess Medical Center intensive care from 2008 to 2019.

PATIENTS:
Adults 16 years old or older with septic shock requiring vasopressor support within 48 hours of admission. Readmissions and patients admitted to the coronary care unit or cardiovascular intensive care were excluded, as well as patients with ST-elevation myocardial infarction or cardiac arrest.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
Echocardiography was performed in 1,515 (27%) of 5,697 eligible admissions. The primary outcome was analyzed using a marginal structural model and rolling entry matching to adjust for baseline and time-varying confounders. Patients who underwent echocardiography showed no significant difference in 28-day mortality (adjusted hazard ratio 1.09; 95% CI, 0.95–1.25; p = 0.24). This was consistent across multiple sensitivity analyses. Secondary outcomes were changes in management instituted within 4 hours of imaging. Treatment changes occurred in 493 patients (33%) compared with 431 matched controls (29%), with the most common intervention being the administration of a fluid bolus.

CONCLUSIONS:
Echocardiography in sepsis was not associated with a reduction in 28-day mortality based on observational data. These findings do not negate the utility of echo in cases of diagnostic uncertainty or inadequate response to initial treatment.
Artificial intelligence-based analysis of tumor-infiltrating lymphocyte spatial distribution for colorectal cancer prognosis
Authors: Cai Ming , Zhao Ke , Wu Lin , Huang Yanqi , Zhao Minning , Hu Qingru , Chen Qicong , Yao Su , Li Zhenhui , Fan Xinjuan , Liu Zaiyi 
Published: January 2024

AbstractBackground:Artificial intelligence (AI) technology represented by deep learning has made remarkable achievements in digital pathology, enhancing the accuracy and reliability of diagnosis and prognosis evaluation. The spatial distribution of CD3+and CD8+T cells within the tumor microenvironment has been demonstrated to have a significant impact on the prognosis of colorectal cancer (CRC). This study aimed to investigate CD3CT(CD3+T cells density in the core of the tumor [CT]) prognostic ability in patients with CRC by using AI technology.Methods:The study involved the enrollment of 492 patients from two distinct medical centers, with 358 patients assigned to the training cohort and an additional 134 patients allocated to the validation cohort. To facilitate tissue segmentation and T-cells quantification in whole-slide images (WSIs), a fully automated workflow based on deep learning was devised. Upon the completion of tissue segmentation and subsequent cell segmentation, a comprehensive analysis was conducted.Results:The evaluation of various positive T cell densities revealed comparable discriminatory ability between CD3CTand CD3-CD8 (the combination of CD3+and CD8+T cells density within the CT and invasive margin) in predicting mortality (C-index in training cohort: 0.65vs.0.64; validation cohort: 0.69vs.0.69). The CD3CTwas confirmed as an independent prognostic factor, with high CD3CTdensity associated with increased overall survival (OS) in the training cohort (hazard ratio [HR] = 0.22, 95% confidence interval [CI]: 0.12–0.38,P<0.001) and validation cohort (HR = 0.21, 95% CI: 0.05–0.92,P= 0.037).Conclusions:We quantify the spatial distribution of CD3+and CD8+T cells within tissue regions in WSIs using AI technology. The CD3CTconfirmed as a stage-independent predictor for OS in CRC patients. Moreover, CD3CTshows promise in simplifying the CD3-CD8 system and facilitating its practical application in clinical settings.
High Incidence Rates of Early-onset Bacterial Sepsis in Infants Born in Two Brazilian Maternities: A 15-Year Retrospective Analysis
Authors: Okumura Maemi Casanas , Aragon Davi Casale , Carvalheiro Cristina Gardonyi , Quintana Silvana Maria , Mussi-Pinhata Marisa Márcia 
Published: January 2024

Background:
Data on the burden and etiology of neonatal early-onset bacterial sepsis (EOBS) in low-to-middle-income countries are scarce. Surveillance is critical for optimizing prevention and treatment strategies. We aimed to estimate the incidence of EOBS in 2 large Brazilian cohorts of neonates.

Methods:
Data were retrospectively obtained from 33,794 neonates born between 2009 and 2017 at low-risk (n = 17,981) and high-risk maternity centers (n = 15,813). Blood cultures were taken within 72 hours of life from neonates with perinatal risk factors for EOBS or suspected EOBS. A positive blood culture for a pathogenic microorganism and a compatible clinical evolution confirmed the diagnosis of EOBS.

Results:
One-third of the infants born from high-risk and 18.5% from low-risk maternities were investigated for EOBS. Overall, EOBS was more incident in neonates born in the high-risk facilities [66 cases or 4.2/1000 (95% CI: 3.2–5.3)] than in the low-risk facilities [24 cases or 1.3/1000 (95% CI: 0.9–2.0)]. The incidence rate of EOBS increased with decreasing gestational age (<32 weeks: 20.5/1000; 32–36 weeks: 5.6/1000; ≥37 weeks: 1.5/1000). Group B Streptococcus (GBS) was the agent more frequently identified in high-risk and low-risk maternities: 1.8/1000 (95% CI: 1.1–2.4) and 0.4/1000 (95% CI: 0.2–0.9), respectively. EOBS’s overall case fatality rate was 17.8% for all the agents and 22% for GBS.

Conclusions:
EOBS remains unacceptably high and is frequently fatal in preterm and term infants cared for in high- or low-risk maternities. Because GBS has emerged as the most frequent causative agent, preventive strategies are urgently needed.
The Cascade of Care for Early Infant Diagnosis in Zimbabwe: Point of Care HIV Testing at Birth and 6–8 Weeks
Authors: Aitcheson Nancy , Sacks Emma , Nyamundaya Tichaona H. , Muchuchuti Cephas , Cohn Jennifer 
Published: January 2024

Background:
Routine birth testing of HIV-exposed infants (HEI) using point of care (POC) nucleic acid testing may allow for earlier diagnosis and treatment of infants living with HIV, but more data are needed on retention in care for those diagnosed at birth and re-testing for those with a negative HIV birth test.

Methods:
POC birth testing (within 48 hours of birth) was offered to all HEI born at 10 public maternities in Zimbabwe from November 2018 to July 2019. Data were abstracted from routine registers, including information on re-testing at 6–8 weeks for infants testing HIV-negative at birth and 6-month retention in care among infants diagnosed with HIV at birth.

Results:
Of 2854 eligible HEIs, 2806 (98.3%) received POC HIV birth testing. Thirty-nine infants with HIV were identified (1.4%), and 23 (59%) were started on antiretroviral therapy (ART). Twenty infants (51%) remained on ART at 6 months. Of the 2694 infants who tested negative at birth, 1229 (46.5%) had a documented retest at 6–8 weeks. 7 (0.6%) of those infants tested HIV-positive.

Conclusions:
The uptake of POC birth testing was high in study facilities, but low rates of ART initiation after a positive birth test, despite high retention on ART through 6 months, diminish the impact of POC birth testing and must be addressed. Among infants who tested negative at birth, rates of testing at 6–8 weeks of life (46%) were slightly lower than national rates of testing at the same age without a birth test (56%) during the study period. Improving infant HIV testing rates at 6–8 weeks, regardless of birth testing, should be a priority.
Activities, Motivations and Demographics of Provaccine Advocates
Authors: Kerns Mattie E. , O’Leary Sean T. , Cataldi Jessica R. 
Published: January 2024

Background:
Vaccine hesitancy is a growing public health concern and has been classified as a major threat to global health by the World Health Organization. While there has been extensive research on the attitudes of vaccine-hesitant individuals, little is known about provaccination advocates. Our objectives were to describe the characteristics, attitudes, activities and motivations of provaccination advocates.

Methods:
An internet survey was conducted in July–November 2019. US vaccine advocacy groups were invited to partner in survey distribution. Participants were recruited from a convenience sample of their members. Advocacy activities were categorized as policy related, in-person or online.

Results:
Respondents (n = 1239) were mostly female (82%), White (87%) and highly educated (90%). Most reported Democratic political affiliation (66%). The most common occupation was health care practitioner (38%). Most respondents (90%) agreed that a policy that did not allow patients to refuse or spread-out vaccines would encourage them to choose that clinic. The most common policy-related activity was contacting an elected official about vaccines. The most common in-person activity was speaking with a friend or family member about vaccines. The most reported online activity was using social media to advocate for vaccines. The most common motivation for vaccine advocacy was a sense of responsibility as a community member.

Conclusions:
Provaccine individuals engaged in a variety of advocacy activities and were motivated by responsibility to their community in addition to other factors. Continued work to better understand and motivate vaccine advocates may inform efforts to bolster vaccine confidence and influence those who accept vaccines to become advocates.
Comparison of clinical outcomes in patients with mixed angina and pure vasospastic angina
Authors: Song Zhao Yan , Kim Moo Hyun , Lee Kwang Min 
Published: January 2024

Objective
This study investigated differences in clinical outcomes between mixed angina (MA) and pure vasospastic angina (PVA).

Methods
A total of 524 vasospastic angina patients who did or did not have >50% coronary artery stenosis from January 2005 to January 2021 were divided into two groups (Group 1: PVA, N = 399; Group 2: MA, N = 125) and then three groups [Group 1: PVA, N = 399; Group 2: MA without percutaneous coronary intervention (PCI), N = 67; Group 3: MA with PCI, N = 58] for assessment. We recorded the incidence of major adverse cardiac and cerebrovascular events (MACCE: the composite of death, myocardial infarction, nonfatal stroke or rehospitalization) during 3-year clinical follow-up.

Results
Compared to the PVA group, there were significant differences in MACCE (20.8% vs. 11.8%, P = 0.011) and rehospitalization (20.0% vs. 9.8%, P = 0.002) in the MA group. Kaplan–Meier analysis showed that patients in the MA with PCI group had the highest cumulative incidence rate of MACCE during the 3-year follow-up (log-rank P < 0.001).

Conclusion
Compared with the PVA patients, MA patients had significantly worse clinical outcomes during long-term follow-up.
Validation of a Method to Identify Frailty Transitions Among Community-Dwelling Older People During the Coronavirus Disease-2019 Pandemic in Japan
Authors: Shinohara Tomoyuki , Saida Kosuke , Tanaka Shigeya , Murayama Akihiko , Higuchi Daisuke 
Published: January 2024

Aim:We previously described a method to identify frailty transitions during the coronavirus disease-2019 pandemic. This study aimed to validate this method during a different period.Methods:In a 2-wave cohort study, self-reported questionnaires were distributed to 1953 community-dwelling older adults. In addition, we analyzed the data of nonfrail participants at baseline to indicate the predictive ability for frailty transition.Results and Conclusions:For the combined factors of older than 75 years and subjective leg muscle weakness, the sensitivity was 0.522 and the specificity was 0.637 to discriminate frailty transition. This method can be used with questionnaires without physical contact.
Marinimicrococcus flavescens gen. nov., sp. nov., a new member of the family Geminicoccaceae, isolated from a marine sediment of the South China Sea
Authors: Yang Zu-Zhen , Xiong Lian-Shuang , Yuan Qing , Zuo Shu-Ya , Chen Xue-Mei , Jiang Ming-Guo , Tian Xin-Peng , Jiang Cheng-Lin , Jiang Yi 
Published: January 2024

A Gram-stain-negative, catalase-positive and oxidase-positive, nonmotile, aerobic, light yellow, spherical-shaped bacterial strain with no flagella, designated strain YIM 152171T, was isolated from sediment of the South China Sea. Colonies were smooth and convex, light yellow and circular, and 1.0–1.5×1.0–1.5 µm in cell diameter after 7 days of incubation at 28°C on YIM38 media supplemented with sea salt. Colonies could grow at 20–45°C (optimum 28–35°C) and pH 6.0–11.0 (optimum, pH 7.0–9.0), and they could proliferate in the salinity range of 0–6.0 % (w/v) NaCl. The major cellular fatty acids were summed feature 8 (C18 : 1
ω7c/C18 : 1 ω6c), C18 : 1 ω7c 11-methyl, C16 : 0, C16 : 1 ω11c, C16 : 1 ω5c, C17 : 1 ω6c and C18 : 1 ω5c. The respiratory quinone was ubiquinone 10, and the polar lipid profile included diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylcholine, phosphatidylinositol mannoside, one unidentified phospholipid and one unidentified aminolipid. Phylogenetic analyses based on the 16S rRNA gene sequences placed strain YIM 152171T within the order

Rhodospirillales

in a distinct lineage that also included the genus

Geminicoccus

. The 16S rRNA gene sequence similarities of YIM 152171T to those of

Arboricoccus pini

,

Geminicoccus roseus

and

Constrictibacter antarcticus

were 92.17, 89.25 and 88.91 %, respectively. The assembled draft genome of strain YIM 152171T had 136 contigs with an N50 value of 134704 nt, a total length of 3 001 346 bp and a G+C content of 70.27 mol%. The phylogenetic, phenotypic and chemotaxonomic data showed that strain YIM 152171T (=MCCC 1K08488T=KCTC 92884T) represents a type of novel species and genus for which we propose the name Marinimicrococcus gen. nov., sp. nov.