High Severity Group Research Articles

Development of a single-step lateral flow immunoassay for penicillin G allergy screening.

Penicillin, a widely used narrow-spectrum antibiotic, remains the most frequently reported drug allergy. However, less than 20% of individuals reporting a penicillin allergy are truly allergic. Antibiotic allergy de-labeling is, therefore, essential to prevent adverse reactions and inappropriate treatments. We present the first single-step Lateral Flow Immunoassay for penicillin G allergy screening, offering real-time visual results at the point of care. The detection limit of 0.3IU/mL of the assay, equivalent to 0.72µg/L, determined in artificial human serum, enables the identification of class 0 allergy patients (< 0.35IU/mL) per the RAST scale, distinguishing between low, medium, and high allergy severity groups with a smartphone reader over a dynamic range of 0.3-10IU/mL. This lateral flow assay for penicillin allergy screening enables a shift in allergy diagnostics from centralized laboratories to more accessible point-of-care settings, including doctors' offices and self-testing.

Proactive Surgical Management and Outcomes of Unilateral Zygomaticomaxillary Complex Fractures in Major Trauma Patients: A National Level I Center Experience.

Managing facial trauma in patients with severe polytrauma presents significant challenges due to competing priorities, poor systemic conditions, and delayed surgical timing. At a national level I trauma center, the authors evaluated the feasibility and outcomes of proactive surgical intervention for unilateral zygomaticomaxillary complex (ZMC) fractures in severe trauma patients. This retrospective study included 81 patients with unilateral ZMC fractures treated at a regional level I trauma center between October 2019 and August 2021. Patients were categorized into high and low trauma severity groups based on the injury severity score (ISS). Three-dimensional (3D) computed tomography analyses were performed to evaluate surgical outcomes, including dimensional distances (Dx, Dy, and Dz) and the Asymmetry Index. Of the 81 patients, 52 underwent surgical intervention. No significant differences were observed in 3D distances (Dx, Dy, and Dz) between the high and low ISS groups, both preoperatively and postoperatively. However, postoperative symmetry was superior in the high ISS group (P < 0.010). The average delay from injury to surgery was slightly longer in the high ISS group (8.69 versus 7.35 d, P = 0.248). Complications such as diplopia and paresthesia were more common in the high ISS group, but no significant differences in overall complication rates were observed between the groups. Proactive surgical management of unilateral ZMC fractures in major trauma patients is effective. Despite the systemic challenges in this population, timely intervention resulted in superior postoperative symmetry in the high ISS group and comparable 3D outcomes across trauma severities.

Electrocortical Profiles in Relation to Childhood Adversity and Depression Severity: A Preliminary Report.

Objective: Assessment of electroencephalographic (EEG) activity in depression has provided insights into neural profiles of the illness. However, there is limited understanding on how symptom severity and risk factors, such as childhood adversity, influence EEG features. Methods: Eyes-closed EEG was acquired in N = 28 depressed individuals being treated in a tertiary psychiatric setting. Absolute alpha, beta, theta, and delta power and inter-/intra-hemispheric coherence were examined. Relations between the Montgomery-Åsberg Depression Scale (MADRS) and Adverse Childhood Experience (ACE) Questionnaire and EEG features were assessed. Results: Individuals in the high (MADRS≥30) versus lower (MADRS ≤ 29) symptom severity group exhibited greater overall beta power, and lower Fp1-Fp2 delta and theta coherence. Those with high (≥3) versus lower (≤2) ACE scores exhibited greater T7-T8 beta coherence. Lowest F3-F4 beta coherence was observed in those with high ACE/high depression severity. A negative correlation existed between F8-P8 alpha coherence and symptom severity. Conclusions: Those with higher depression severity exhibit increased beta power, possibly reflecting a hyper-vigilant state. Depression severity and ACE history may produce subtle alterations in frontal delta/theta and temporal/frontal beta coherence regions. Significance: This is the first study to examine the neural impact of depression severity and ACE-assessed childhood trauma in depressed individuals receiving treatment in a tertiary setting, accounting for the clinical reality of the prevalence of their co-occurrence.

Why Sitting by in Cyberbullying: The Measurement and Influencing Factors of Outsider Behavior.

Bystanders play an important role in cyberbullying, yet the majority of bystanders remain silent as outsiders. To date, research on the measurement and influencing factors of outsider behavior in the context of cyberbullying is lacking. This research first adapted a valid and reliable instrument to measure this construct and then examined its influencing factors based on the arousal: cost-reward model. In Study 1, a total of 901 participants (55% female, mean age = 20.84) were randomly divided into two subsamples: one for exploratory factor analysis (n = 450) and the other for confirmatory factor analysis (n = 451). The final eight-item measurement had good reliability and validity with a three-factor structure of self-disengagement, cautious avoidance, and victim blaming. Study 2 investigated the relationships among the severity of cyberbullying incidents, empathic concern, cost for help, and outsider behavior. Among 331 participants (57% female, mean age = 21.08), 168 participants were randomly assigned to the high-severity group. Results found that the severity has indirect effects on the three outsider behavioral orientations through the empathic concern. Severity also has indirect effects on outsider behaviors of cautious avoidance and victim blaming through the influence of empathic concern on cost for help.

Clinical correlates of irritability, anger, hostility, and aggression in posttraumatic stress disorder.

Although irritability, anger, and aggression are diagnostic symptoms of posttraumatic stress disorder (PTSD), their clinical significance and associations with psychopathology remain unclear. In a sample of community adults with probable PTSD (n = 151), we measured irritability, physical aggression, verbal aggression, anger, and hostility with the Brief Irritability Test and the Brief Aggression Questionnaire. Participants' psychopathology, including depression, attention deficit and hyperactivity disorder (ADHD), psychotic-like experiences, insomnia, as well as suicidal behaviors were also assessed. Correlation analysis showed that irritability and anger were modestly related to all PTSD dimensions; physical aggression was related to avoidance, negative alterations in cognitions and mood (NACM), and hyperarousal; hostility was related to reexperiencing, NACM, and hyperarousal; while verbal aggression was not significantly related to any PTSD dimensions. After adjustment for trauma exposure and PTSD symptoms, irritability was associated with almost all psychopathology and suicidal behaviors, however, anger, hostility, and aggression were sparsely related to some psychopathology or suicidal behaviors. Particularly, anger was only related to ADHD and insomnia. Latent profile analysis based on PTSD, irritability, anger, hostility, and aggression indicated two discrete subgroups: the high severity group (33.8%) and the low severity group (66.2%), with high severity group reporting higher rates of comorbidity and suicidal behaviors. The findings support irritability, aggression, anger, and hostility as separate constructs; moreover, irritability, anger, and aggression should be independently measured in PTSD. Our findings also suggest the significance of irritability as a separate hallmark of PTSD and the need to incorporate PTSD dimensions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Checkpoint for Considering Interleukin-6 as a Potential Target to Mitigate Secondary Brain Injury after Cardiac Arrest.

Interleukin-6 (IL-6) was suggested as a potential target for intervention to mitigate brain injury. However, its neuro-protective effect in post-resuscitation care has not been proven. We investigated the time-course of changes in IL-6 and its association with other markers (systemic inflammation and myocardial and neuronal injury), according to the injury severity of the cardiac arrest. This retrospective study analyzed IL-6 and other markers at baseline and 24, 48, and 72 h after the return of spontaneous circulation. The primary outcome was the association of IL-6 with injury severity as assessed using the revised Post-Cardiac Arrest Syndrome for Therapeutic Hypothermia scoring system (low, moderate, and high severity). Of 111 patients, 22 (19.8%), 61 (55.0%), and 28 (25.2%) had low-, moderate-, and high-severity scores, respectively. IL-6 levels were significantly lower in the low-severity group than in the moderate- and high-severity groups at baseline and at 24 h and 72 h (p < 0.005). While IL-6 was not independently associated with neuronal injury markers in the low-severity group, it was demonstrated to be associated with it in the moderate-severity (β [95% CI] = 4.3 [0.1-8.6], R2 = 0.11) and high-severity (β [95% CI] = 7.9 [3.4-12.5], R2 = 0.14) groups. IL-6 exhibits distinct patterns across severity and shows differential associations with systemic inflammation or neuronal injury.

Association between Mid-Term Functionality and Clinical Severity in Patients Hospitalized for Pulmonary Embolism.

The aim of this study is to evaluate the relationship between clinical severity and functionality, occupational performance, and health-related quality of life in patients hospitalized with pulmonary embolism. Pulmonary embolism patients were grouped by clinical severity using the Pulmonary Embolism Severity Index. Those scoring ≥160 were in the high-severity group (HSG); those scoring < 160 in the low-moderate group (LMSG). The main variables were functionality assessed by the World Health Organization Disability Assessment Schedule (WHODAS), self-perception of occupational performance assessed by the Canadian Occupational Performance Measure (COPM), pain and fatigue assessed by a Visual Analogue Scale (VAS), and health-related quality of life assessed by the EuroQol-5Dimensions (EQ-5D). Patients were evaluated at hospital admission and at 1-month and 3-month follow-up. At admission, there were significant differences between groups in the WHODAS and health-related quality of life in favor of the LMSG. At 1-month and at 3-month follow-up, there were significant differences between the LMSG and HSG in WHODAS, COMP, NRS pain, fatigue and EQ-5D scores in favor of the LMSG. An association exists between clinical severity and mid-term functionality, self-perception of occupational performance, pain, fatigue, and health-related quality of life in PE patients.

The influence of burn severity on dissolved organic carbon concentrations across a stream network differs based on seasonal wetness conditions

Abstract. Large, high-severity wildfires in many regions across the globe have increased concerns about their impacts on carbon cycling in watersheds. Altered sources of carbon and changes in catchment hydrology after wildfire can lead to shifts in dissolved organic carbon (DOC) concentrations in streams, which can have negative impacts on aquatic ecosystem health and downstream drinking-water treatment. Despite its importance, post-fire DOC responses remain relatively unconstrained in the literature, and we lack critical knowledge of how burn severity, landscape elements, and climate interact to affect DOC concentrations. To improve our understanding of the impact of burn severity on DOC concentrations, we measured DOC at 129 sites across a stream network extending upstream, within, and downstream of a large, high-severity wildfire in Oregon, USA. We collected samples across the study sub-basin during four distinct seasonal wetness conditions. We used our high-spatial-resolution data to develop spatial stream network (SSN) models to predict DOC across the stream network and to improve our understanding of the controls on DOC concentrations. Spatially, we found no obvious wildfire signal – instead, we observed a pattern of increasing DOC concentrations from the high-elevation headwaters to the sub-basin outlet, while the mainstem maintained consistently low DOC concentrations. This suggests that effects from large wildfires may be “averaged” out at higher stream orders and larger spatial scales. When we grouped DOC concentrations by burn severity group, we observed a significant decrease in the variability of DOC concentrations in the moderate and high burn severity sub-catchments. However, our SSN models were able to predict decreases in DOC concentrations with increases in burn severity across the stream network. Decreases in DOC concentrations were also highly variable across seasonal wetness conditions, with the greatest (−1.40 to −1.64 mg L−1) decrease occurring in the high-severity group during the wetting season. Additionally, our models indicated that in all seasons, baseflow index was more influential in predicting DOC concentrations than burn severity was, indicating that groundwater discharge can obscure the impacts of wildfire in a stream network. Overall, our results suggested that landscape characteristics can regulate the DOC response to wildfire. Moreover, our results also indicated that the seasonal timing of sampling can influence the observed response of DOC concentrations to wildfire.

Profiles of cannabis users and impact on cannabis cessation.

Although cannabis was legalized in Canada in 2018 and is one of the most used substances in Canada, few studies have examined how individuals with different patterns of cannabis use differ in their attempts to decrease or abstain from cannabis. The current study examined how groups of cannabis users, which were formed on the basis of demographic characteristics, substance use patterns, mental health symptoms, and self-reported quality of life differed on their experiences with cannabis cessation. A sample of 147 Canadian adult participants who had attempted to decrease or quit cannabis were recruited from the community (n = 84, 57.14%) and crowdsourcing (n = 63, 42.86%). Four profiles of cannabis users emerged using a Latent Profile Analysis: low-risk (n = 62, 42.18%), rapidly escalating high-risk (n = 40, 27.21%), long-term high severity (n = 35, 23.81%), and long-term lower severity (n = 10, 6.80%). Individuals in the rapidly escalating profile had attempted to decrease their cannabis use more times compared to other profiles. More participants in the long-term high severity group found their use stayed the same or got worse after their last cessation attempt, compared to the low-risk group where more individuals indicated their use stopped. The results of the current study indicate that cannabis users differ in their attempts at reducing or ceasing cannabis use and that they may benefit from different intensity of cannabis interventions.

Impact of Coronavirus Disease 2019 on Unresectable Hepatocellular Carcinoma Treated with Atezolizumab/Bevacizumab.

(1) Background: The coronavirus disease 2019 (COVID-19) pandemic has proven challenging to the management of patients with cancer, particularly those receiving systemic therapy. This study aimed to evaluate the impact of COVID-19 on patients with unresectable hepatocellular carcinoma (HCC) treated with atezolizumab/bevacizumab. (2) Methods: Patients with unresectable HCC who started atezolizumab/bevacizumab treatment between June 2020 and December 2021 at a tertiary cancer center in Korea were included (n = 241) and classified according to their COVID-19 status and severity. (3) Results: Thirty-five (14.5%) patients with unresectable HCC were diagnosed with COVID-19 during atezolizumab/bevacizumab treatment; 26 (74.2%) and nine (25.7%) in the low- and high-severity groups, respectively. The high-severity group showed higher neutrophil-to-lymphocyte ratios and lactate dehydrogenase levels. Liver and kidney injuries were observed in 31.4% and 17.1% of total patients, respectively. Liver injury was more prominent in patients with pre-existing liver dysfunction at baseline, who were more prevalent in the high-severity group. Atezolizumab/bevacizumab treatment was delayed by a median of 0 (range, 0-21) day in the low-severity group and 12 (range, 0-35) days in the high-severity group. The high-severity group showed worse post-infection progression-free survival (1.1 vs. 4.8 months, p = 0.017) and overall survival (2.2 months vs. not reached, p = 0.004). (4) Conclusions: Patients with impaired liver function at baseline are more susceptible to high-severity COVID-19, which affects atezolizumab/bevacizumab treatment outcomes.

The clinical efficacy and suitable implementation of two extracorporeal blood purification therapies: AN69-oXiris versus PMX-HP.

In septic shock patients, pathogens and excessive endotoxins continuously overstimulate the host's immune system with a cytokine storm that can lead to multi-organ failure and even mortality. Various types of extracorporeal blood purification treatments have recently been introduced to remove excessive endotoxins and cytokines. Herein, we compared the clinical efficacy of two blood purification methods, PMX-HP and AN69-oXiris, and discussed their detailed indications according to disease severity. From December 2016 to April 2023, patients who underwent emergent surgery due to septic shock secondary to peritonitis and subsequently received blood purification treatment with AN69-oXiris or PMX-HP were enrolled. Propensity score (PS)-matching was conducted to adjust for baseline characteristics between the two groups, and the changes in clinical parameters and outcomes were compared. Clinical outcomes were assessed in subgroups of patients who underwent PMX-HP treatment divided according to SOFA scores into low (0-7), intermediate (8-13), and high (> 13) disease severity groups. Forty patients received blood purification therapy with either PMX-HP or AN69-oXiris during the study period. After 1:2 PS matching, six patients in the AN69-oXiris group and 12 patients in the PMX-HP group were finally analyzed. Vasoactive-inotropic scores (VISs) decreased in both groups after 48 h of treatment compared to the baseline values, but the change in VISs was more pronounced in the PMX-HP group {-57.6 [interquartile range (IQR) = -166.4 - (-10)] vs. -22.9 [IQR = -64-0], respectively, p = 0.041}. Decreases in cardiovascular SOFA scores were significantly pronounced in the PMX-HP group [-1.5 (IQR = -4 - 0) vs. 0 (IQR = -1 - 1), respectively, p = 0.035]. The 7-day mortality rate was significantly lower than the predicted mortality rate in a subgroup analysis of patients treated with PMX-HP in both the low disease severity group and the intermediate disease severity group. PMX-HP and AN69-oXiris could be therapeutic options for refractory septic shock patients with intra-abdominal origins, especially after the surgical elimination of the infectious sources. A tailored modality choice that takes into account patient characteristics, such as disease severity and cost burden, could optimize the efficacy of this strategy.

Associations Between Gut Microbial Features and Sickness Symptoms in Kidney Transplant Recipients.

The study investigated the relationship of gut microbiome features and sickness symptoms in kidney transplant recipients. Employing a prospective, longitudinal design, we collected data from 19 participants who had undergone living-donor kidney transplant at three timepoints (pre-transplant and 1week and 3months post-transplant). Sickness symptom data and fecal specimens were collected at each timepoint. Participants were grouped either as high or low sickness symptom severity at baseline. Shotgun metagenomics sequencing characterized gut microbial structure and functional gene content. Fecal microbial features, including alpha (evenness and richness within samples) and beta (dissimilarities between samples) diversity and relative abundances, were analyzed using R statistical packages. Cross-sectional and longitudinal analyses examined relationships between gut microbial features and sickness symptoms. Although our exploratory findings revealed no significant differences in alpha and beta diversity between groups, the high-severity group showed lower microbial richness and evenness than the low-severity group. The high-severity group had enriched relative abundance of bacteria from the genera Citrobacter and Enterobacter and reduced relative abundance of bacteria from the genus Akkermansia across timepoints. No functional genes differed significantly between groups or timepoints. Kidney transplant recipients with high symptom burden displayed increased putative proinflammatory bacteria and decreased beneficial bacteria. This study provides an effect size that future large cohort studies can employ to confirm associations between gut microbial features and sickness symptom experiences in the kidney transplant population. The study findings also have implications for future interventional studies aiming to alleviate the sickness symptom burden in this population.

NETWORK ANALYSIS OF PHYSICAL SYMPTOMS OF OLDER ADULTS WITH COVID-19

Abstract Background COVID-19 can affect multiple organ systems in older adults, making it challenging to manage symptoms that involve different parts of the body. The objectives of our study were to generate symptom networks of COVID-19 physical symptoms in older adults and to explore the core symptoms and the relationships between complex symptoms from a mechanism-based perspective. Methods Data from 470 older adults (≥65 yrs) with COVID-19 were obtained from the Shenzhen Third People’s Hospital. Networks were constructed among 16 physical symptoms to describe relationships among symptoms. Subgroup network analyses were performed based on latent class analysis. We also conducted further analysis of the bridge symptoms among the symptom clusters. Results Fever (rs=4.37) had the highest strength value, followed by chills (rs=4.20) and muscle aches (rs=3.91). Based on the values of bridge strength centrality, dizziness (rbs=0.79), runny nose (rbs=0.71), and fatigue (rbs=0.62) were identified as bridge symptoms. Among the three subgroups of symptom networks, cough had the highest strength values in the high and low symptom severity groups (rs=3.93 and 2.82), while fever had the highest strength value in the moderate symptom severity group (rs=3.50). Conclusion We found that the core symptom was different in the high/low groups and moderate group, suggesting that personalized symptom management plans are essential to optimize the effectiveness of interventions. Keywords: COVID-19; Older adults; Physical symptom; Symptom network

Sepsis Inpatient Diagnostic Testing at Mid-Size Academic and Non-academic Health Systems

Abstract Introduction/Objective Comparison of clinical laboratory test and radiology imaging utilization for sepsis inpatients across multiple academic and non-academic health systems would be useful for healthcare resource utilization benchmarking. Methods/Case Report We compared laboratory and imaging utilization for adult patients hospitalized for sepsis procedures at mid-size (250-450 hospital beds), academic (N=12; 31,353 hospitalizations) and non-academic (N=18; 54,192 hospitalizations), hospitals using the Vizient Clinical Data Base™ over 3 years (2019-2021). We used Medicare Severity Diagnosis Related Groups (MSDRG), used by the US Centers for Medicare and Medicaid Services (CMS), to identify hospitalizations for sepsis (MSDRG triplet 870/871/872). We stratified patients by severity comorbid conditions and complications into high, moderate, and low severity groups. We compared the mean number of clinical laboratory (CPT codes 80000-89999) and imaging studies (CPT codes 70000-79999) per hospitalization and per hospital day. We also measured aggregate clinical Resource Intensity Weight (RIW) per hospitalization to quantify diagnostic resource consumption for each encounter. The RIW is based on the US Centers for Medicare and Medicaid Services (CMS) Ambulatory Payment Classification (APC) weights. Results (if a Case Study enter NA) Mean laboratory tests were significantly greater (p&amp;lt;.01) at academic hospitals per encounter (152.2 vs. 95.4 tests, 59.5% higher) and per hospital day (14.5 vs. 9.9 tests, 46.5% higher). Laboratory RIW was also higher per hospitalization (21.0 vs. 13.5 RIW, 55.6% higher) and per hospital day (2.0 vs. 1.4 RIW, 42.9% higher) at academic hospitals. Mean imaging studies at academic hospitals were higher per case (7.8 vs. 7.2 studies, 8.3% higher) but not different per day (0.80 for both hospital groups). Imaging RIW was not significantly different between academic and non-academic hospitals either by encounter (11.1 vs. 9.9, 12.1% higher) or per day (1.2 for both hospital groups). Imaging comparisons lacked statistical significance. Analysis of utilization after stratification for severity levels revealed a similar pattern with greater differences in the high severity group. Conclusion Mean laboratory tests and laboratory RIW per hospitalization are greater at academic hospitals. These differences persist after adjustment for hospital length of stay and severity level. Differences in imaging studies and imaging RIW were not significant.

Correlation Between Large-Scale Health System Operational Parameters and Laboratory Test Utilization

Abstract Introduction/Objective The extent of correlation between clinical laboratory test utilization and large-scale operational parameters would be helpful to adjust for these parameters when benchmarking utilization. Methods/Case Report We compared clinical laboratory and imaging utilization over 3 years (2019-2021) for adult patients hospitalized for specific surgical, medical, and obstetrics diagnoses at multiple academic hospitals (N=58; 625,436 hospitalizations) ranging in size from 250-1300 hospital beds. We queried the Vizient Clinical Data Base with permission from Vizient, Inc.® employing Medicare Severity Diagnosis Related Groups (MSDRG), used by the US Centers for Medicare and Medicaid Services (CMS), to identify hospitalizations for gastrointestinal (GI) surgery (MSDRG triplet 329/330/331), sepsis (MSDRG triplet 870/871/872), and vaginal delivery (MSDGR triplet 805/806/807). We stratified patients within each diagnostic group for comorbid conditions and complications into high, moderate, and low severity groups. We compared mean laboratory tests and Resource Intensity Weight (RIW) per hospitalization and hospital day. The RIW is based on the CMS Ambulatory Payment Classification (APC) weights. We measured correlation of laboratory utilization with hospital bed size as well as annual discharges (sepsis group), surgical procedures (GI surgery group), births (vaginal delivery group), and diagnosis-specific discharges. Results (if a Case Study enter NA) For sepsis hospitalizations, there were small significant (p&amp;lt;.01) negative correlations (r2 0.05-0.16) between laboratory utilization, measured as test numbers or RIW, and diagnosis-specific discharges for low and moderate severity groups; there was no significant correlation with either bed size or overall annual discharges. There were no consistent correlations of laboratory utilization with bed size, annual surgical procedures, or diagnosis-specific discharges for GI surgery patients. Hospitalizations for vaginal delivery demonstrated small negative correlations between laboratory utilization and bed size, annual births, and diagnosis- specific discharges. Conclusion For specific diagnostic groups, laboratory utilization (tests as well as laboratory RIW) exhibited negative correlations with large-scale hospital operational parameters. These correlations were typically weak with varying statistical significance. The findings suggest that laboratory test utilization efficiency may require evaluation of individual health systems on a case-by-case basis.

Prediction of the neurological outcomes post-cardiac arrest: A prospective validation of the CAST and rCAST

IntroductionThe neurologic prognosis of out-of-hospital cardiac arrest (OHCA) patients in whom return of spontaneous circulation (ROSC) is achieved remains poor. The aim of this study was to externally and prospectively validate two scoring systems developed by us: the CAST score, a scoring system to predict the neurological prognosis of OHCA patients undergoing targeted temperature management (TTM), and a simplified version of the same score developed for improved ease of use in clinical settings, the revised CAST (rCAST) score. MethodsThis study was a prospective, multicenter, observational study conducted using the SOS KANTO 2017 registry, an OHCA registry involving hospitals in the Kanto region (including Tokyo) of Japan. The primary outcome was favorable neurological outcome (defined as Cerebral Performance Category score of 1 or 2) at 30 days and the secondary outcomes were favorable neurological outcome at 90 days and survival at 30 and 90 days. The predictive accuracies of the original CAST (oCAST) and rCAST scores were evaluated by using area under the receiver operating characteristic curve (AUC). ResultsOf 9909 OHCA patients, 565 showed ROSC and received TTM. Of these, we analyzed the data of 259 patients in this study. The areas under the receiver operating characteristic curve (AUCs) of the oCAST and rCAST scores for predicting a favorable neurological outcome at 30 days were 0.86 and 0.87, respectively, and those for predicting a favorable neurological outcome at 90 days were 0.87 and 0.88, respectively. The rCAST showed a higher predictive accuracy for the neurological outcome as compared with the NULL-PLEASE score. The patients with a favorable neurological outcome who had been classified into the high severity group based on the rCAST tended to have hypothermia at hospital arrival and to not show any signs of loss of gray-white matter differentiation on brain CT. Neurological function at 90 days was correlated with the rCAST (r = 0.63, p < 0.001). ConclusionsrCAST showed high predictive accuracy for the neurological prognosis of OHCA patients managed by TTM, comparable to that of the oCAST score. The scores on the rCAST were strongly correlated with the neurological functions at 90 days, implying that the rCAST is a useful scale for assessing the severity of brain injury after cardiac arrest.

Differences in Cerebral Metabolism between Moderate- and High-Severity Groups of Patients with Out-of-Hospital Cardiac Arrest Undergoing Target Temperature Management.

The aim of this study was to investigate the differences in cerebral metabolism and the prognostic value of cerebrospinal fluid (CSF) lactate 24 h after the return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA). CSF lactate and pyruvate levels were measured immediately and every 2 h for 24 h after the ROSC. The distribution of cerebral mitochondrial dysfunction (MD) and cerebral ischemia was also evaluated. In the moderate-severity group, the absence of cerebral MD or ischemia was observed in six patients (40.0%) immediately after ROSC and in nine patients (60.0%) 24 h after the ROSC. In the high-severity group, the absence of cerebral MD or ischemia was observed in four patients (30.8%) immediately after ROSC and in three patients (23.1%) 24 h after the ROSC. The distribution of cerebral metabolism over time varied depending on the severity of the OHCA. The predictive value of CSF lactate levels for a poor neurological prognosis was better for patients in the moderate-severity group than for the overall patient cohort. Therefore, the severity in the patients with OHCA should be considered when studying cerebral metabolism or using CSF lactate as a prognostic tool.

The effect of fragmented cancer care and change in nurse staffing grade on cancer patient mortality.

Continuity of patient care ensures timely and appropriate care and is associated with better patient outcomes among cancer patients. However, the impact of nurse staffing grade changes on patient outcomes remains unknown. This retrospective cohort study aimed to evaluate the effect of fragmented care and changes in nurse staffing grade on the survival of colorectal cancer patients who underwent surgery. This study included 2228 newly diagnosed colorectal cancer patients. Fragmented care was defined as the receipt of treatment in multiple hospitals and was divided into three categories based on changes in nurse staffing grade. Five-year survival rates were used to evaluate the effect of fragmented care and nurse staffing grade on outcomes of cancer patients. Survival analysis was performed by adjusting for covariates using the Cox proportional hazards model for 5-year mortality. Approximately 18.5% of patients died within 5 years; the mortality rate during cancer treatment was higher in patients who received fragmented care, especially in those transferred to hospitals with fewer nurses. Patients who received fragmented care had shorter survival times, and those transferred to hospitals with fewer nurses had higher risks of 5-year mortality (hazard ratio: 1.625; 95% CI: [1.095, 2.412]). Transfers to hospitals with fewer nurses were associated with increased mortality rates in low-income patients, hospitals located in metropolitan and rural areas, and high-severity groups. Receipt of fragmented care and change in nurse staffing grade due to patients' transfer to different hospitals were associated with increased mortality rates in cancer patients, thus underlining the importance of ensuring continuity and quality of care. Patients from rural areas, from low-income families, and with high disease severity may have better outcomes if they receive treatment in well-staffed hospitals.

APRI has Utility as a Biomarker of COVID-19 Severity in Patients with Nonalcoholic Fatty Liver Disease.

Patients with NAFLD are reported to have greater coronavirus disease 19 (COVID-19) severity compared to patients without NAFLD. Previous studies have reported that noninvasive liver fibrosis scores, including the FIB-4 index, NAFLD fibrosis score (NFS), and AST to platelet ratio index (APRI), have utility in predicting COVID-19 mortality and disease severity in patients without NAFLD. However, the utility of liver fibrosis scores in predicting COVID-19 mortality and disease severity among patients with NAFLD infected with SARS-CoV-2 has yet to be evaluated. This retrospective observational study comprised 126 patients with NAFLD and active SARS-CoV-2 infection. Patients were classified into low COVID-19 severity (mild or moderate I disease) and high COVID-19 severity (moderate II or severe disease) groups based on the therapeutic guideline implemented by the Ministry of Health, Labour and Welfare of Japan. Of the 126 patients, only one had been diagnosed with NAFLD before admission. Age; levels of serum aspartate aminotransferase, γ-glutamyl transpeptidase, lactate dehydrogenase, blood urea nitrogen, serum CRP, FIB-4 index; NFS; and APRI levels on admission were higher in the high COVID-19 severity group compared to the low COVID-19 severity group. Serum albumin levels, platelet counts, and lymphocyte counts on admission were lower in the high COVID-19 severity group compared to the low COVID-19 severity group. Univariate and multivariate analysis revealed that APRI values were significantly associated with COVID-19 severity and hospitalization duration for COVID-19. APRI was independently associated with COVID-19 severity and hospitalization duration for COVID-19 in patients with NAFLD.

How to model the impact of vaccines for policymaking when the characteristics are uncertain: A case study in Thailand prior to the vaccine rollout during the COVID-19 pandemic

Thailand faced a dilemma of which groups to prioritise with a limited first tranche of COVID-19 vaccinations in early 2021, at a time when there was low incidence and low mortality in the country. A mathematical modelling analysis was performed to compare the potential short-term impact of allocating the available doses to either the high severity group (over 65-year-olds) or the high transmission group (aged 20–39). At the time of the analysis, there was uncertainty about the precise characteristics of the vaccines available, in terms of their potential impact on transmission and reductions to the severity of infection. As such, a range of vaccine characteristic scenarios, with differing levels of severity and transmission reductions were explored. Using the evidence available at the time regarding severity reduction of infection due to the vaccines, the model suggested that vaccinating high severity group should be the priority if reductions in deaths is the priority. Vaccinating this group was found to have a direct impact on reducing the number of deaths, while the incidence and hospitalisations remained unchanged. However, the model found that vaccinating the high transmission group with a vaccine with sufficiently high protection against infection (more than 70%) could provide enough herd effects to delay the expected epidemic peak, resulting in both case and death reductions in both target groups. The model explored a 12-month time horizon. These analyses helped to inform the vaccination strategy in Thailand throughout 2021 and can inform future modelling studies for policymaking when the characteristics of vaccines are uncertain.