Validity of Apgar Score as an Indicator of Neonatal SARS-CoV-2 Infection: A Scoping Review

The coronavirus disease 2019 (COVID-19) pandemic has had profound impacts on healthcare systems worldwide, particularly regarding the care of pregnant women and their neonates. The use of the Apgar score—a discrete numerical index used to evaluate neonatal condition immediately following delivery that has been used ubiquitously as a clinical indicator of neonatal condition and widely reported in the literature for decades—has continued during the pandemic. Although health systems adopted protocols that addressed pregnant women and their neonates during the pandemic, limited research has assessed the validity of Apgar scores for determining neonatal conditions in the context of COVID-19. Therefore, this scoping review was conducted on the first 2 years of the pandemic and included mothers with reverse transcription-polymerase chain reaction confirmed COVID-19 and their resulting positive or negative neonates. In total, 1,966 articles were assessed for eligibility, yielding 246 articles describing 663 neonates. Neonates who tested negative had median Apgar scores of 9 and 9 at 1 and 5 mins, respectively, while test-positive neonates had median Apgar scores of 8 and 9 at the same time points. The proportions of test-negative neonates with Apgar scores below 7 were 29 (4%) and 11 (2%) at 1 and 5 mins, which was not statistically significant (p = 0.327, χ2 = 0.961). These proportions were even lower for positive neonates: 22 (3%) and 11 (2%) at 1 and 5 mins, respectively, which was not statistically significant (p = 1, χ2 = 0). The low proportion of Apgar scores below 7 suggests that low Apgar scores are likely to be associated with severe maternal COVID-19 symptoms during delivery rather than neonatal COVID-19. Therefore, this study indicated that Apgar scores are poor indicators of neonatal COVID-19 status.

Analysis of Gut Microbiota in Patients with Coronary Artery Disease and Hypertension

Cardiovascular and cerebrovascular diseases are characterized by high rates of morbidity and mortality. Microbiota is closely associated with cardiovascular disease. We aimed to comprehensively analyze the microbiotas of 300 healthy controls, 300 patients with high blood pressure (HBP), and 300 patients with coronary heart disease (CHD). The results indicated no significant difference in microbiota diversity among the three groups ( P > 0.05 ). However, differences in microbiota richness among the three groups were significant ( P < 0.05 ). Bacteroidetes and Bacteroidia were the dominant bacteria in the CHD group, Enterobacteriales and Escherichia-shigella in the HBP group, and Acidaminococcaceae and Phascolarctobacterium in the healthy control group. The prediction results of the random forest model indicated that the population with CHD displayed prominent features with high sensitivity, indicating that microbiota detection might become a novel clinical indicator to predict and monitor the risk of cardiovascular events. The prediction of microbiota function suggested differences in oxygen supply and chronic inflammation between populations with HBP/CHD and healthy populations. Although there is no difference in gut microbiota diversity among the three groups, each group has its dominant microbiota in terms of richness.

Frailty and Differences in Self-Reported Sexual Functioning Among Older Females and Males in National Social life, Health and Aging Project

Objective To understand the association of frailty with females’ and males’ self-reported sexual functioning. Methods Logistic regression on 5 domains of sexual function by frailty status (robust, pre-frail, frail) were analyzed from 2058 respondents to National Social Life, Health, and Aging Project (2010–2011). Results Females had similar frailty profiles to males, but more often reported low overall sexual functioning (12.9% v. 4.0%). Compared to robust, pre-frail and frail males had higher odds of sexual function-related: anxiety (pre-frail OR 1.91 95% CI [1.33, 2.74]; frail OR 2.13 95% CI [1.03, 4.41]), negative changes (pre-frail: OR 1.40, 95% CI [1.00, 1.96]; frail: OR 2.42, 95% CI [1.51, 3.89]), and erectile dysfunction (pre-frail: OR 1.81, 95% CI [1.23,2.68]; frail: 2.00, 95% CI [1.00,4.02]); frail females had 1.69 times higher odds (95% CI [1.16,2.48]) of negative changes. Discussion Frailty may be a clinical indicator of sexual functioning decline for males more than females.

Digital analysis of colposcopic images in papillomavirus infection

Acetowhite epithelium (AWE) is one of the main clinical indicator of papillomavirus infection in squamous cell lesions. AWE has a different intensity in various degree of the cervix papillomavirus infection. The digital approach gives the opportunity to estimate AWE intensity by numeric values. The investigation aim is a quantitative assessment of cervical surface changes in papillomavirus infection with digital analysis and computer technologies. The spread of AWE on the cervical surface area has a value of the cervix papillomavirus infection in squamous cell lesions. These two features provide to create the index intensity (IndInt) and index grey value (IndGV). Open-source software ImageJ was used to analysis of colposcopic images. The 8-bit mode was used for the estimation of the AWE grey value. The algorithm of digital analysis detected indicators that provide the severity of papillomavirus infection. The outcomes of an algorithm were the identification of the cervix surface condition severity by an objective quantification.

Circulating Tumor Cell Is a Clinical Indicator of Pretransplant Radiofrequency Ablation for Patients with Hepatocellular Carcinoma

Introduction. It is of great significance to confirm reliable indicators for the guidance of pretransplant radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). In this study, we aim to investigate whether circulating tumor cell (CTC) status is a clinical indicator for RFA before liver transplantation (LT) in HCC patients. Method. CTC analyses were measured in 79 HCC patients. Clinical outcomes including progression-free (PFS) and overall survival (OS) were compared and analyzed between patients with and without pretransplant RFA. Result. Forty-two patients were detected as CTC-positive and 18 patients received pretransplant RFA. Recurrence was correlated with CTC count ( P = 0.024 ), tumor number ( P = 0.035 ), liver cirrhosis ( P = 0.001 ), Milan criteria ( P = 0.003 ), and University of California San Francisco (UCSF) criteria ( P = 0.001 ). Kaplan–Meier analysis revealed that patients with CTC-positive had a lower PFS rate ( P = 0.0257 ). For CTC-positive patients, the PFS rate of the pretransplant RFA group was significantly higher than the non-pretransplant RFA group (100% vs. 46.7%, P = 0.0236 ). For CTC-negative patients, both PFS rate and OS rate were similar and without significant differences. In multivariate analysis, pretransplant RFA was the independent factor for PFS ( P = 0.025 ). Conclusion. Pretransplant CTC status can guide the administration of pretransplant RFA in HCC patients which can improve PFS in CTC-positive HCC patients.

State of the Art Dashboards for Reflective Practice Based on Clinical Indicator Data: A Scoping Review (Preprint)

BACKGROUND There is an increasing interest to use routinely collected electronic health data to support reflective practice and long-term professional learning. Studies have evaluated the impact of dashboards on clinician decision-making, task completion time, user satisfaction, and adherence to clinical guidelines. OBJECTIVE The scoping review will summarize the literature on dashboards based on patient administrative, medical, and surgical data for clinicians to support reflective practice. METHODS A scoping review was conducted using the Arksey and O’Malley framework. A search was conducted in five electronic databases (MEDLINE, EMBASE, Scopus, ACM Digital Library, Web of Science) to identify studies that meet the inclusion criteria. Study selection and characterization were performed by two independent reviewers. One reviewer extracted the data that was analyzed descriptively to map the available evidence. RESULTS A total of 18 dashboards from eight countries were assessed. Purposes for the dashboards were designed for performance improvement (n=10), to support quality and safety initiatives (n=6), and management and operations (n=4). Data visualizations were primarily designed for team use (n=12) rather than individual clinicians (n=4). Evaluation methods varied between asking the clinicians directly (n=11), observing user behavior through clinical indicator and usage log data (n=14), and usability testing (n=4). The studies reported high scores from standard usability questionnaires, favorable surveys, and interview feedback. Improvements to underlying clinical indicators were observed in seven of nine studies, while two studies reported no significant changes to performance. CONCLUSIONS This scoping review maps the current landscape of literature on dashboards based on routinely collected clinical indicator data. While there were common data visualization techniques and clinical indicators used across studies, there was diversity in the design of the dashboards and their evaluation. There was a lack of detail in design processes documented for reproducibility. We identified a lack of interface features to support clinicians to make sense of and reflect on their performance data for long-term professional learning.

Single-Cell Microwell Platform Reveals Circulating Neural Cells as a Clinical Indicator for Patients with Blood-Brain Barrier Breakdown

Central nervous system diseases commonly occur with the destruction of the blood-brain barrier. As a primary cause of morbidity and mortality, stroke remains unpredictable and lacks cellular biomarkers that accurately quantify its occurrence and development. Here, we identify NeuN+/CD45−/DAPI+ phenotype nonblood cells in the peripheral blood of mice subjected to middle cerebral artery occlusion (MCAO) and stroke patients. Since NeuN is a specific marker of neural cells, we term these newly identified cells as circulating neural cells (CNCs). We find that the enumeration of CNCs in the blood is significantly associated with the severity of brain damage in MCAO mice (p<0.05). Meanwhile, the number of CNCs is significantly higher in stroke patients than in negative subjects (p<0.0001). These findings suggest that the amount of CNCs in circulation may serve as a clinical indicator for the real-time prognosis and progression monitor of the occurrence and development of ischemic stroke and other nervous system disease.

MECHANISM OF INJURY IMPACTS CONCUSSION RECOVERY

Background: Approximately 2 million children sustain a concussion annually with the majority recovering within 28 days. However, some children take longer to recover suggesting more research is necessary to determine what factors prolonged return to activity/sport. Hypothesis/Purpose: The purpose of this study was to examine the relationship between mechanism of injury (MOI) and protracted recovery (>28 days). It was hypothesized that those who sustained a concussion via head-to-head or head-to-ground were at greater risk of recovery lasting longer than 28 days than other MOIs (head-to-body, head-to-object). Methods: Children aged 8-18 years who sustained a concussion were examined in an acute concussion clinic for diagnosis and treatment of injury. Patients were evaluated within seven days of injury and remained under clinical care until cleared to return to activity/sport. Average days of recovery along with crude hazard ratios were calculated based on MOI. Results: A total of 282 children (age: 13.9±2.2 years) were diagnosed with a concussion. Total recovery was 22.1±11.3 days overall, and by MOI was as follows: head-to-object (n=52, 22.1±12.7 days), head-to-body (n=36, 22.9±11.5 days), head-to-head (n=106, 21.3±10.9 days), head-to-ground (n=79, 22.7±11.0 days). Compared to a head-to-object MOI, the risk (95% CI) of delayed recovery by MOI was as follows: head-to-body (1.75, 0.65-4.70), head-to-head (1.66, 0.72-3.80), head-to-ground (1.70, 0.71-4.06). Conclusion: Contrary to our hypothesis, the head-to-head and head-to-ground MOIs were not associated with a greater risk of a protracted recovery in this sample of adolescents. These preliminary findings suggest that MOI may not be an important clinical indicator when being treated acutely in a specialty concussion clinic. Future research should consider angle and velocity of impact as a factor of recovery.