bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early sonographic response to a new medical therapy is associated with future treatment response or failure in patients with inflammatory bowel disease
Authors: Smith Rebecca L. , Taylor Kirstin M. , Friedman Antony B. , Gibson David J. , Con Danny , Gibson Peter R. 
Published: March 2022

Objective
Gastrointestinal ultrasound (GIUS) accurately assesses inflammation and is responsive to changes in inflammatory bowel disease. This study aimed to determine the prognostic utility of sonographic response in the first 14 weeks of a newly-instituted therapy with therapeutic response at 46 weeks and to compare its performance with standard clinical assessment tools.

Methods
Patients with sonographic evidence of inflammation were assessed by GIUS, clinical activity, serum C-reactive protein and faecal calprotectin again 2, 6 and 14 weeks after commencing a new biologic or thiopurine. Treatment failure was defined as undergoing surgery, hospitalisation, escalation of dosage or introduction of new medication over 46-weeks’ follow-up. Sonographic response was defined as a decrease in bowel wall thickness and improved vascularity.

Results
In 31 patients (median age 49 years, 74% Crohn’s disease), sonographic response at 14 weeks [OR 19.3, 95% confidence interval (CI), 3.23–101.10; P = 0.0054] and faecal calprotectin (P = 0.018), but no clinical disease activity or C-reactive protein, were predictive of subsequent treatment response. Sonographic response alone was predictive at week 6 (P = 0.016), but not week 2. 16% reduction in bowel wall thickness at 6 weeks (area-under-the-receiver-operator-curve=0.86; P = 0.002; sensitivity 72%, specificity 90%), with similar performance for 10% at 14 weeks, was associated with treatment response.

Conclusion
Sonographic response as early as 6 weeks after initiation of a new therapy may accurately predict treatment outcomes over 46 weeks and is superior to other markers used to monitor disease activity.
Single-Center Retrospective Review of the Presentation and Initial Care of Esophageal Button Battery Impactions 2007–2020
Authors: Sinclair Elizabeth M. , Agarwal Maneesha , Santore Matthew T. , Sauer Cary G. , Riedesel Erica L. 
Published: March 2022

Objective
The aims of this study were to characterize the patient population and initial presentation and care of esophageal button battery ingestion and provide descriptive data including factors affecting accurate diagnosis, duration of battery exposure, and battery removal.

Methods
This was a retrospective cohort study from 2007 to 2020 at a single-center, large-volume, urban academic pediatric hospital system. Included participants were children 6 months to 18 years old who underwent removal of an esophageal button battery impaction at our institution.

Results
Our cohort comprised 63 patients; ages ranged from 7 to 87 months with a median of 27 months. Median button battery size was 2.12 cm with 59% lodged in the proximal esophagus. A prolonged impaction, greater than 12 hours, occurred in 46% of patients. Risk ratio analysis demonstrated that lack of caregiver suspicion of ingestion was associated with prolonged impaction (risk ratio, 3.39; confidence interval, 2.15–5.34). Misdiagnosis of button battery ingestion occurred in 10% of cases. The majority of patients, 87%, required transfer from a referring facility with a median total distance of 37 miles (range, 1.4–160 miles) from home to facility where battery was removed.

Conclusion and Relevance
This study describes the initial presentation and care of a large cohort of pediatric esophageal button battery ingestion. It emphasizes the continued need for primary prevention, prompt identification, and removal of these batteries. There are many challenges in caring for these patients involving multiple pediatric disciplines, and guidelines encompassing a multidisciplinary approach would be beneficial.
Impact of the COVID-19 Pandemic on the Severity of Diabetic Ketoacidosis Presentations in a Tertiary Pediatric Emergency Department
Authors: Jafari Kaileen , Koves Ildiko , Rutman Lori , Brown Julie C. 
Published: March 2022

Introduction:
More severe presentations of diabetic ketoacidosis (DKA) have been reported during the coronavirus disease 2019 (COVID-19) pandemic, possibly due to avoidance of healthcare settings or reduced access to care. To date, no studies have utilized statistical process control to relate temporal COVID-19 events with DKA severity. Our objectives were (1) to determine whether the severity of pediatric DKA presentations changed during COVID-19 and (2) to temporally relate changes in severity with regional pandemic events.

Methods:
This study was a retrospective chart review of 175 patients younger than 18 years with DKA presenting to a pediatric emergency department in the United States between 5/1/2019 and 8/15/2020. As part of our ongoing clinical standard work in ED management of DKA, DKA severity measures, including presenting pH, the proportion of PICU admissions, and admission length of stay, were analyzed using statistical process control.

Results:
During COVID-19, we found special cause variation with a downward shift in the mean pH on DKA presentation from 7.2 to 7.1 for all patients. The proportion of DKA patients requiring PICU admission increased from 34.2% to 54.6%. Changes temporally corresponded to the statewide bans on large events (3/11/2020), school closures (3/13/2020), and a reduction in our institution’s emergency department volumes. Admission length of stay was unchanged.

Conclusions:
Pediatric DKA presentations were more severe from March to June 2020, correlating with regional COVID-19 events. Future quality improvement interventions to reduce delayed presentations during COVID-19 surges or other natural disasters should target accessibility of care and public education regarding the importance of timely care for symptoms.
Minimizing the “Kitchen Sink” Approach: De-implementation of Unnecessary Care for Patients with Anaphylaxis in a Pediatric Emergency Department
Authors: Vanston Laura , Ogawa Kaleigh , Freeman Julia , Bauer Maureen , Carel Kirsten , Topoz Irina 
Published: March 2022

Introduction:
Epinephrine is the only medication that prevents morbidity and mortality in anaphylaxis. Systemic corticosteroids and H2 receptor antagonists (H2RA) may benefit select cases but are not universally indicated. This study aims to de-implement the universal use of steroids and H2RAs and emphasize epinephrine-focused care for children with anaphylaxis during acute care visits. The study aims to reduce steroid and H2RA use from 81% and 60%, respectively, to 30% by December 2019.

Methods:
The primary outcome measures were the percent of patients receiving steroids and H2RAs in the emergency department (ED) or urgent care (UC). Process measure was the frequency of intravenous (IV) line placement. Balancing measures were ED/UC length of stay, admission rate, and ED/UC return visit rate. In addition, a multidisciplinary team designed the following interventions: (1) anaphylaxis clinical pathway to emphasize epinephrine-focused care, outline criteria for second-line therapies and a provider guideline for ED/UC observation; (2) standardize unit-based anaphylaxis medication kits; (3) optimize electronic medical record tools, including order sets and discharge instructions to be concordant with guideline recommendations.

Results:
The study included 870 patients. There was special cause variation in the use of steroids (81%–33%) and H2RAs (60%–11%), ED/UC Length of stay decreased (6.2–5.0 hours). There was no special cause variation in admission rates or ED/UC return visit rates.

Conclusion:
Universal use of systemic steroids and H2RAs can be safely de-implemented in pediatric patients with anaphylaxis using quality improvement methods.
The connection between the gut mycobiome community of natural black soldier fly populations and their environment
Authors: Vitenberg Tzach , Goldway Martin , Opatovsky Itai 
Published: March 2022

ABSTRACTIn contrast to interactions between prokaryotic organisms (e.g. bacteria) and insects, an understanding of the interactions between eukaryotic microorganisms (e.g. fungi) and insects is lacking. In this study, black soldier fly larvae were collected from natural populations in household composts. The mycobiome composition of the larval gut and environment was identified using next generation sequencing. The nutrient composition of the larvae’s environment was analyzed. The mycobiome composition was divided into three groups: the first included larvae from Kfar HaHoresh that comprised mostlyMeyerozymaand were influenced by the fiber and carbohydrate composition of the compost; the second included the compost samples from Kfar HaHoresh and Misgav Am that mainly comprised the Dipodascaceae family and were influenced by the fiber composition of the compost. The third group contained all the remaining compost and larvae samples and mainly comprised the genusCandida.Candidaspp. are the most common in the environment and may thus affect their abundance in the insect gut. However, this species may be adapted to the insect’s gut, providing the insect with a benefit that allows the insect to disperseCandidato new resource patches and thereby help increase its abundance in the environment. In cases where dominant species are not present, it seems that the important factor determining fungal composition in the insect gut is its diet. Understanding the metabolic effect of fungi, e.g.Candida, on the BSF larvae is still a black box which requires further study.IMPORTANCEThe research analyzed the mycobiome composition of BSF larvae from natural environments. It was found that the most dominant fungi in these communities is the Candida genus, which was found also dominant in the BSF environment (household compost) that differ in its nutrient composition. Understanding the metabolic effect of these fungi on the BSF larvae have the potential to dramatically affect the physiological condition of the insect. Revealing these metabolic interactions may help to increase the rearing efficiency of insects, such as the BSF, which is currently being reared at large scales as an alternative protein source.
Do amplifiers of selection maximise average fitness?
Authors: Sharma Nikhil , Traulsen Arne 
Published: March 2022

AbstractEvolutionary dynamics on graphs has remarkable features: For example, it has been shown that amplifiers of selection exist that – compared to an unstructured population – increase the fixation probability of advantageous mutations, while they decrease the fixation probability of disadvantageous mutations. So far, the theoretical literature has focused on the case of a single mutant entering a graph structured population, asking how the graph affects the probability that a mutant takes over a population and the time until this typically happens. For continuously evolving systems, the more relevant case is when mutants constantly arise in an evolving population. Typically, such mutations occur with a small probability during reproduction events. We thus focus on the low mutation rate limit. The probability distribution for the fitness in this process converges to a steady-state at long times. Intuitively, amplifiers of selection are expected to increase the population’s mean fitness in the steady-state. Similarly, suppressors of selection are expected to decrease the population’s mean fitness in the steady-state. However, we show that another category of graphs, called suppressor of fixation, can attain the highest population mean fitness. The key reason behind this is their ability to efficiently reject deleterious mutants. This illustrates the importance of the deleterious mutant regime for the long-term evolutionary dynamics, something that seems to have been overlooked in the literature so far.
Psychometric properties of the Kessler psychological scales in a Swiss young‐adult community sample indicate poor suitability for community screening for mental disorders
Authors: Osman Naweed , Chow Winnie S. , Michel Chantal , Meisenzahl Eva , Schimmelmann Benno G. , Schultze‐Lutter Frauke 
Published: March 2022

AbstractAimThe Kessler psychological distress scales (K10 and K6) are used as screening tools to assess psychological distress related to the likely presence of a mental disorder. Thus, we studied the psychometric properties of their German versions in a Swiss community sample to evaluate their potential usefulness to screen for mental disorders or relevant mental problems in the community and, relatedly, for low threshold transdiagnostic German‐speaking services.MethodsThe sample consisted of 829 citizens of the Swiss canton Bern of age 19–43 years. K10/K6 were validated against mini‐international neuropsychiatric interview (M.I.N.I.) diagnoses, questionnaires about health status and quality of life. Receiver operating characteristic (ROC) curve analyses were used to test for general discriminative ability and to select optimal cut‐offs of the K10 and K6 for non‐psychotic full‐blown and subthreshold mental disorders.ResultsCronbach's alphas were 0.81 (K10) and 0.70 (K6). ROC analyses indicated much lower optimal thresholds than earlier suggested; 10 for K10 and 6 for K6. At these thresholds, against M.I.N.I. diagnoses, Cohen's κ (≤0.173) and correspondence rates (≤58.14%) were insufficient throughout. Values were higher at the earlier suggested threshold, yet, at the cost of sensitivity that was below 0.5 in all but three, and below 0.3 in all but six cases.ConclusionsFor the lack of sufficient validity and sensitivity, respectively, our findings suggest that both K10 and K6 would only be of limited use in a low‐threshold transdiagnostic mental health service for young adults in Switzerland and likely other German‐speaking countries.
THE ENDLESS ACCUMULATION OF HISTORY IN FINANCIAL TIMES
Authors: Biltoft C. N. 
Published: March 2022

ABSTRACTThis essay engages with Amin Samman's incisive 2019 text, History in Financial Times, which unfolds a philosophy of history for contemporary “financial times.” I turn first to Samman's concept of the strange loops of financial history, and so to the historical turn initiated by the subprime crisis of 2008. Then, I add the concept of strange portraiture to Samman's idea of strange history. Borrowing a metaphor from Oscar Wilde's The Picture of Dorian Gray, I trace the oscillating appearance of the linked faces of homo historia and homo economicus, which each offer distinct explanatory frameworks “under the sign of finance.” In this way, I suggest that we can also observe how capitalism transformed the meaning and possible trajectories of something like fate from invented origins to imagined destinies. In that frame, I explore how the loops that Samman underscores are also bound to the ways in which history and economics have competed and continue to compete for ascendency as modern sense‐making epistemes with different time‐binding effects.
Morphologic, immunophenotypic, and molecular genetic comparison study in patients with clonal cytopenia of undetermined significance, myelodysplastic syndrome, and acute myeloid leukemia with myelodysplasia‐related changes: A single institution experience
Authors: Gao Linlin , Hyter Stephen , Zhang Da , Kelting Sarah , Woodroof Janet , Abdallah Al‐Ola , Yacoub Abdulraheem , McGuirk Joseph , Abdelhakim Haitham , Godwin Andrew K. , Cui Wei 
Published: March 2022

AbstractIntroductionNext‐generation sequencing (NGS) analysis showed clonal cytopenia of undetermined significance (CCUS) as an immediate precursor to myelodysplastic syndrome (MDS).MethodsWe evaluated and compared morphologic, multiparametric flow cytometry (MFC), and molecular genetic findings in patients with CCUS (n = 37), MDS (n = 75), and acute myeloid leukemia with myelodysplasia‐related changes (AML‐MRC, n = 24).ResultsCCUS patients showed variable MFC abnormalities including >2% CD34+ myeloblasts (5.8%), altered antigen expression on myeloblasts, monocytes, and granulocytes (1.2, 1.5, and 0.2/case), abnormal maturation of myeloblasts (45.8%), decreased hematogones (17.6%), and decreased side scatter (SSC) of granulocytes (11.4%). CCUS patients with high‐risk mutations showed significantly more MFC abnormalities. However, CCUS patients with >20% variant allelic fraction (VAF) did not show more MFC aberrations than the rest of the group. MDS patients showed significantly more MFC abnormalities compared with CCUS patients (p = 7.8E‐05–0.047). Low‐grade MDS patients showed significantly fewer MFC abnormalities compared with high‐grade MDS or AML‐MRC patients (p = 1.89E‐05–0.04). AML‐MRC patients showed significantly elevated blast counts, more antigen aberrations, decreased hematogones, and decreased SSC of granulocytes compared with CCUS patients (p = 2.0E‐05–0.01). CCUS patients carried predominantly TET2/DNMT3A/ASXL1 mutations. They harbored fewer mutations in gene coding splicing factors compared with MDS patients (p = .0001–.02) and fewer mutations in tumor suppressor and transcription factor genes compared with AML‐MRC patients (p = .0006–.02).ConclusionsCCUS is an immediate precursor to low‐grade MDS. The progression from CCUS to MDS to AML‐MRC is a stepwise process that requires acquisition of mutations in splicing, transcription factor, and tumor suppressor genes with accumulations of additional MFC abnormalities.
Worth the risk? Contemporary indications, yield and complications of lumbar punctures in a metropolitan Australian health service
Authors: Cody Ross , Mohsenifard Mahsa , Yip Gary , Aldridge Emogene , Bridge Francesca , Datta Mineesh , Guy Stephen , Jordan Peter , Kyndt Chris , Newnham Evan , Ng Mark , Paul Elizabeth , Roodenburg Owen , Senanayake Channa , Sparham Sarah , Steele Michelle , Dewey Helen 
Published: March 2022

AbstractBackgroundPerforming lumbar punctures carries a risk of harm to the patient, but the information cerebrospinal fluid provides often makes this procedure necessary. Clinicians in the Australian setting would benefit from having more information on these procedures, in order to help them in a risk versus benefit analysis.AimsTo describe the contemporary indications, cerebrospinal fluid findings and complications of lumbar punctures in a metropolitan Australian health service.MethodsRetrospective electronic medical records audit of lumbar punctures performed on 525 adults within three acute hospitals between 1 July 2018 and 30 June 2019. Main outcome measures include frequency of indication for lumbar puncture by category, normal versus abnormal cerebrospinal fluid for each category, and frequency, severity and type of complications of lumbar punctures.ResultsOf 525 adult lumbar punctures that were assessed in this study, 466 were performed for a diagnostic indication. The most common diagnostic indications were acute severe headache (156 procedures; 33.5%) and encephalopathy (128 procedures; 27.5%). The yield of abnormal results varied by indication category, with the above indications yielding abnormal results in 85 (54.5%) and 72 (56.3%) cases respectively. A complication was recorded in 54 (10.3% of total) procedures. The majority (45; 8.6%) of complications were minor in severity and most frequently consisted of post‐dural puncture headache (PDPH).ConclusionsIn the era of an increased reliance on high quality neuroimaging, lumbar puncture has a high diagnostic yield with a low rate of major complications. The most common complication is PDPH, which is mild and self‐limiting in most cases.
Dual targeting of PI3K and BCL‐2 overcomes ibrutinib resistance in aggressive mantle cell lymphoma
Authors: Ye Haige , Huang Shengjian , Liu Yang , Chen Zhihong , Wang Michael , Jiang Vivian Changying 
Published: March 2022

AbstractDespite significant efficacy of ibrutinib therapy in mantle cell lymphoma (MCL), about one‐third of MCL patients will display primary resistance. In time, secondary resistance occurs almost universally with an unlikely response to salvage chemotherapy afterwards. While intense efforts are being directed towards the characterization of resistance mechanisms, our focus is on identifying the signalling network rewiring that characterizes this ibrutinib resistant phenotype. Importantly, intrinsic genetic, epigenetic and tumour microenvironment‐initiated mechanisms have all been shown to influence the occurrence of the ibrutinib resistant phenotype. By using in vitro and in vivo models of primary and secondary ibrutinib resistance as well as post‐ibrutinib treatment clinical samples, we show that dual targeting of the BCL‐2 and PI3‐kinase signalling pathways results in synergistic anti‐tumour activity. Clinically relevant doses of venetoclax, a BCL‐2 inhibitor, in combination with duvelisib, a PI3Kδ/γ dual inhibitor, resulted in significant inhibition of these compensatory pathways and apoptosis induction. Our preclinical results suggest that the combination of venetoclax and duvelisib may be a therapeutic option for MCL patients who experienced ibrutinib failure and merits careful consideration for future clinical trial evaluation.
Dysfunctional breathing diagnosed by cardiopulmonary exercise testing in ‘long COVID’ patients with persistent dyspnoea
Authors: Frésard Isabelle , Genecand Léon , Altarelli Marco , Gex Grégoire , Vremaroiu Petrut , Vremaroiu-Coman Andreea , Lawi David , Bridevaux Pierre-Olivier 
Published: March 2022

Background‘Long COVID’-associated dyspnoea may persist for months after SARS-CoV-2 infection. Among the causes of persistent dyspnoea, dysfunctional breathing (DB), defined as an erratic or inappropriate ventilation at rest or exercise, has been observed, but little is known about its occurrence and pathophysiology among individuals with ‘long COVID’. We aimed to describe the occurrence and identify clinical predictors of DB among patients following SARS-CoV-2 infection.MethodsCardiopulmonary exercise testing (CPET) was performed in 51 SARS-CoV-2 patients (median age, 64 years (IQR, 15)); male, 66.7%) living with ‘long COVID’ and persistent dyspnoea. CPET was classified into three dominant patterns: respiratory limitation with gas exchange abnormalities (RL); normal CPET or O2delivery/utilisation impairment (D); and DB. Non-parametric and χ2tests were applied to analyse the association between CPET dominant patterns and demographics, pulmonary function tests and SARS-CoV-2 severity.ResultsAmong 51 patients, DB mostly without hyperventilation was found in 29.4% (n=15), RL in 54.9% (n=28) and D in 15.7% (n=8). When compared with RL individuals, patients with DB were younger, had significantly less severe initial infection, a better transfer capacity for carbon monoxide (median 85% (IQR, 28)), higher oxygen consumption (22.9 mL/min/kg (IQR, 5.5)), a better ventilatory efficiency slope (31.6 (IQR, 12.8)), and a higher SpO2(95% (IQR, 3)).ConclusionsOur findings suggest that DB without hyperventilation could be an important pathophysiological mechanism of disabling dyspnoea in younger outpatients following SARS-CoV-2 infection, which appears to be a feature of COVID-19 not described in other viral diseases.