Miracle-dz/UniFAR-FTUs huggingface dataset:
Early pregnancy overweight/obesity and length of residence among immigrants in Sweden: a pooled analysis of Swedish population registers between 1992 and 2012

Abstract Objective: To examine whether the association between women’s origin and early pregnancy overweight and obesity (OW/OB) varies by length of residence in Sweden. Design: This cross-sectional observational study used pooled Swedish population register data from 1992 to 2012. Logistic regression models were run to estimate odds ratios (OR) of early pregnancy OW/OB and 95 % confidence intervals (95 % CI), comparing Swedish-born and immigrants by length-of-residence categories while adjusting for covariates. Setting: Sweden. Participants: In total, 1 771 821 pregnant women, 315 992 of whom were immigrants. Results: With longer residence in Sweden, more immigrant women from various origins exhibited higher odds of experiencing early OW/OB compared with Swedish-born women. Findings specifically showed increased odds of early pregnancy OW/OB with increasing length of residence for women born in Latin America, Europe-27 and Southeast Asia. For example, immigrant women from Latin America residing in Sweden for < 6 years showed similar odds as Swedish-born (OR≤ 5 years 0·92, 95 % CI 0·87, 0·98), while their longer residing counterparts showed higher odds than Swedish-born women (OR6–15 years1·21, 95 % CI 1·14, 1·28 and OR≥ 16 years 1·68, 95 % CI 1·59, 1·78). Mixed results were found for other origins. Conclusions: The current study suggests that host country conditions might play an important role in explaining OW/OB among some groups of immigrant women. Although further studies are needed to disentangle the mechanisms that generate these health inequalities, policy efforts should focus on immigrant reception and early integration to prevent pregnancy-related OW/OB.
Prehospital Providers’ Perspectives about Online Medical Direction in Emergency End-of-Life Decision-Making

Abstract Background: End-of-life treatment decisions present special challenges for prehospital emergency providers. Paramedics regularly make value-laden choices that transcend technical judgment and professional skill, affecting the type of care, how and to whom it is provided. Changes in prehospital emergency care over the last decade have created new moral challenges for prehospital emergency providers; these changes have also accentuated the need for paramedics to make rapid and reasoned ethical judgments. Objective: The purpose of the study was to explore the decision-making process that occurs when prehospital emergency teams respond to an end-of-life call with a focus on how state authorized documents such as a Non-Hospital Do Not Resuscitate (NHDNR) or Medical/Physician’s Orders for Life-Sustaining Treatment (MOLST/POLST) or lack thereof inform decision-making. This paper presents the specific circumstances that informed the need for intervention from Online Medical Direction (OLMD) framed in the perspectives and words of the prehospital providers seeking that assistance. Methods: This study involved in-depth in-person interviews with 50 providers to elicit participants’ experiences in their own words using a semi-structured interview instrument. Interviews were audio recorded and transcribed with permission. Results: Five themes emerged that illuminated how and when OLMD was involved in emergency end-of-life decisions: Termination of Resuscitation (TOR); Family Revoked DNR; Missing Documents; No Documents and No CPR; and Unusual Situations. Participants illustrated how the decision to terminate efforts was best-supported when it was made by collaboration between the on-scene provider and OLMD. Participants described ethical dilemmas when families asked them to initiate CPR in the presence of DNR orders and cognitive dissonance when CPR has been initiated but a valid DNR/MOLST is subsequently located. Conclusions: The study findings demonstrate the invaluable contribution of OLMD for complex end-of-life care decisions by prehospital providers, especially when there are difficult legal, ethical, and logistical questions. OLMD provides far more than technical support.
Evaluation of the lifetime brain/central nervous system cancer risk associated with childhood head CT scanning in Japan

The use of computed tomography (CT) scanning has increased worldwide over the decades, and Japan is one of the leading countries in annual frequency of diagnostic CT. Although benefits of CT scan are undisputable, concerns have been raised about potential health effects of ionizing radiation exposure from CT, particularly among children who are likely more susceptible to radiation than adults. Our study aims to evaluate the cumulated lifetime risk of the brain/central nervous system (CNS) cancer due to head CT examinations performed on Japanese children at age 0 to 10 years in 2012, 2015 and 2018. The frequency and dose distribution of head CT examinations were estimated based on information from recent national statistics and nationwide surveys. The lifetime risk attributable to exposure was calculated by applying risk models based on the study of Japanese atomic‐bomb survivors. In contrast to the overall increasing trend, the frequency of childhood CT, especially at age < 5, was decreasing, reflecting a growing awareness for efforts to reduce childhood CT exposure over the past decade. In 2018, 138 532 head CT examinations were performed at age 0 to 10, which would consequently induce a lifetime excess of 22 cases (1 per 6300 scans) of brain/CNS cancers, accounting for 5% of the total cases. More excess cases were estimated among men than among women, and excess cases could emerge at relatively young ages. These results would have useful implications as scientific basis for future large‐scale epidemiological studies and also as quantitative evidence to justify the benefits of CT vs risks in Japan.
Response to comments on: Glycerol-preserved corneal tissue in emergency corneal transplantation: An alternative for fresh corneal tissue in COVID-19 crisis.

Dear Editor, We thank the readers for their interest in our study. The authors would like to clarify a few points raised in the manuscript By Raj A et al.[1] Although the data presented in the study do not belong to the COVID era, it is very pertinent to this era as there was a sudden crisis of tissues due to the closure of eye banks in most parts of the world. So in our manuscript, we are extrapolating the result of our study in an emergency situation which the COVID crisis has precipitated and was imperative at this time to use GPC to save the eyes by doing the emergency corneal transplant as mentioned in the advisory of Eye Bank Association of India. [2]
Tumour Stroma Ratio Assessment Using Digital Image Analysis Predicts Survival in Triple Negative and Luminal Breast Cancer

Simple Summary Tumour stroma is known to predict outcome and play an important role in the growth and spread of solid tumours and their response to therapy. In breast cancer, there is evidence that the tumour stroma ratio (TSR) can predict outcome in aggressive triple negative breast cancer, but its value for the more common hormone receptor positive breast cancer is unclear. Using computerised image analysis and machine learning algorithms, we show that TSR is an important factor in predicting outcome for triple negative disease and hormone receptor positive cancer. However, its influence on good or poor outcome appears to depend on tumour type and the relative predominance of the stromal component. By better understanding the role of the tumour stroma in cancer growth, and its response to treatment, this study may help support the role of TSR as a new prognostic marker for breast cancer to guide clinical decision making. Abstract We aimed to determine the clinical significance of tumour stroma ratio (TSR) in luminal and triple negative breast cancer (TNBC) using digital image analysis and machine learning algorithms. Automated image analysis using QuPath software was applied to a cohort of 647 breast cancer patients (403 luminal and 244 TNBC) using digital H&E images of tissue microarrays (TMAs). Kaplan–Meier and Cox proportional hazards were used to ascertain relationships with overall survival (OS) and breast cancer specific survival (BCSS). For TNBC, low TSR (high stroma) was associated with poor prognosis for both OS (HR 1.9, CI 1.1–3.3, p = 0.021) and BCSS (HR 2.6, HR 1.3–5.4, p = 0.007) in multivariate models, independent of age, size, grade, sTILs, lymph nodal status and chemotherapy. However, for luminal tumours, low TSR (high stroma) was associated with a favourable prognosis in MVA for OS (HR 0.6, CI 0.4–0.8, p = 0.001) but not for BCSS. TSR is a prognostic factor of most significance in TNBC, but also in luminal breast cancer, and can be reliably assessed using quantitative image analysis of TMAs. Further investigation into the contribution of tumour subtype stromal phenotype may further refine these findings.
KIT Somatic Mutations and Immunohistochemical Expression in Canine Oral Melanoma

Simple Summary Malignant melanomas arising from mucosal sites are very aggressive neoplastic entities which affect both humans and dogs. The family of tyrosine kinase receptors has been increasingly studied in humans for this type of neoplasm, especially the gene coding for the proto-oncogene KIT, and tyrosine kinase inhibitors are actually available as treatment. However, KIT alteration status in canine oral melanoma still lacks characterization. In this study, we investigated the mutational status and the tissue expression of KIT through DNA sequencing and immunohistochemical analysis, respectively. A homogeneous cohort of 14 canine oral melanomas has been collected, and while tissue expression of the protein was detected, no mutations were identifiable, most likely attributing the dysregulation of this oncogene to a more complex pattern of genomic aberration. Abstract Canine oral melanoma (COM) is an aggressive neoplasm with a low response to therapies, sharing similarities with human mucosal melanomas. In the latter, significant alterations of the proto-oncogene KIT have been shown, while in COMs only its exon 11 has been adequately investigated. In this study, 14 formalin-fixed, paraffin-embedded COMs were selected considering the following inclusion criteria: unequivocal diagnosis, presence of healthy tissue, and a known amplification status of the gene KIT (seven samples affected and seven non-affected by amplification). The DNA was extracted and KIT target exons 13, 17, and 18 were amplified by PCR and sequenced. Immunohistochemistry (IHC) for KIT and Ki67 was performed, and a quantitative index was calculated for each protein. PCR amplification and sequencing was successful in 97.62% of cases, and no single nucleotide polymorphism (SNP) was detected in any of the exons examined, similarly to exon 11 in other studies. The immunolabeling of KIT was positive in 84.6% of the samples with a mean value of 3.1 cells in positive cases, yet there was no correlation with aberration status. Our findings confirm the hypothesis that SNPs are not a frequent event in KIT activation in COMs, with the pathway activation relying mainly on amplification.
Effects of screening for colorectal cancer: Development, documentation and validation of a multistate Markov model

Simulation models are a powerful tool to overcome gaps of evidence needed to inform medical decision‐making. Here, we present development and application of COSIMO, a Markov‐based Colorectal Cancer (CRC) Multi‐state Simulation Model to simulate effects of CRC screening, along with a thorough assessment of the model's ability to reproduce real‐life outcomes. Firstly, we provide a comprehensive documentation of COSIMO’s development, structure and assumptions. Secondly, to assess the model's external validity, we compared model‐derived cumulative incidence and prevalences of colorectal neoplasms to (a) results from KolosSal, a study in German screening colonoscopy participants, (b) registry‐based estimates of CRC incidence in Germany, and (c) outcome patterns of randomized sigmoidoscopy screening studies. We found that (a) more than 90% of observed prevalences in the KolosSal study were within the 95% confidence intervals of the model‐predicted neoplasm prevalences; (b) the 15‐year cumulative CRC incidences estimated by simulations for the German population deviated by 0.0% to 0.2% units in men and 0.0% to 0.3% units in women when compared to corresponding registry‐derived estimates; and (c) the time course of cumulative CRC incidence and mortality in the modeled intervention group and control group closely resembles the time course reported from sigmoidoscopy screening trials. Overall, COSIMO adequately predicted colorectal neoplasm prevalences and incidences in a German population for up to 25 years, with estimated patterns of the effect of screening colonoscopy resembling those seen in registry data and real‐world studies. This suggests that the model may represent a valid tool to assess the comparative effectiveness of CRC screening strategies.
Coccidioidomycosis: Changing Concepts and Knowledge Gaps

Although first described more than 120 years ago, much remains unknown about coccidioidomycosis. In this review, new information that has led to changing concepts will be reviewed and remaining gaps in our knowledge will be discussed. In particular, new ideas regarding ecology and epidemiology, problems and promises of diagnosis, controversies over management, and the possibility of a vaccine will be covered.
Meniscus cell regional phenotypes: Dedifferentiation and reversal by biomaterial embedding

Meniscus injuries are common and a major cause of long‐term joint degeneration and disability. Current treatment options are limited, so novel regenerative therapies or tissue engineering strategies are urgently needed. The development of new therapies is hindered by a lack of knowledge regarding the cellular biology of the meniscus and a lack of well‐established methods for studying meniscus cells in vitro. The goals of this study were to (1) establish baseline expression profiles and dedifferentiation patterns of inner and outer zone primary meniscus cells, and (2) evaluate the utility of poly(ethylene glycol) diacrylate (PEGDA) and gelatin methacrylate (GelMA) polymer hydrogels to reverse dedifferentiation trends for long‐term meniscus cell culture. Using reverse transcription‐quantitative polymerase chain reaction, we measured expression levels of putative meniscus phenotype marker genes in freshly isolated meniscus tissue, tissue explant culture, and monolayer culture of inner and outer zone meniscus cells from porcine knees to establish baseline dedifferentiation characteristics, and then compared these expression levels to PEGDA/GelMA embedded passaged meniscus cells. COL1A1 showed robust upregulation, while CHAD, CILP, and COMP showed downregulation with monolayer culture. Expression levels of COL2A1, ACAN, and SOX9 were surprisingly similar between inner and outer zone tissue and were found to be less sensitive as markers of dedifferentiation. When embedded in PEGDA/GelMA hydrogels, expression levels of meniscus cell phenotype genes were significantly modulated by varying the ratio of polymer components, allowing these materials to be tuned for phenotype restoration, meniscus cell culture, and tissue engineering applications.
Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis

Background: Shoulder arthroscopy is one of the most commonly performed orthopaedic procedures used to treat a variety of conditions, with >500,000 procedures performed each year. Purpose: To systematically review the randomized controlled trials (RCTs) on pain control after shoulder arthroscopy in the acute postoperative setting and to ascertain the best available evidence in managing pain after shoulder arthroscopy to optimize patient outcomes. Study Design: Systematic review and meta-analysis. Methods: A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Studies were included if they were RCTs evaluating interventions to reduce postoperative pain after shoulder arthroscopy: nerve blocks, nerve block adjuncts, subacromial injections, patient-controlled analgesia, oral medications, or other modalities. Meta-analyses and network meta-analyses were performed where appropriate. Results: Our study included 83 RCTs. Across 40 studies, peripheral nerve blocks were found to significantly reduce postoperative pain and opioid use, but there was no significant difference among the variable nerve blocks in the network meta-analysis. However, continuous interscalene block did have the highest P-score at most time points. Nerve block adjuncts were consistently shown across 18 studies to prolong the nerve block time and reduce pain. Preoperative administration was shown to significantly reduce postoperative pain scores (P < .05). No benefit was found in any of the studies evaluating subacromial infusions. Conclusion: Continuous interscalene block resulted in the lowest pain levels at most time points, although this was not significantly different when compared with the other nerve blocks. Additionally, nerve block adjuncts may prolong the postoperative block time and improve pain control. There is promising evidence for some oral medications and newer modalities to control pain and reduce opioid use. However, we found no evidence to support the use of subacromial infusions or patient-controlled analgesia.
Continuous-state branching processes and $\Lambda$-coalescents

We develop a connection between continuous-state branching processes and $\Lambda$-coalescents. In the one-dimensional case, this connection states that the coalescent structure associated with a continuous-state branching process with branching mechanism \begin{align*} \psi(\lambda) = - \kappa \lambda + \beta \lambda^2 + \int_0^\infty \left( e^{ - \lambda r} - 1 + \lambda r \mathrm{1}_{ r \leq 1 } \right) \nu ( \mathrm{d} r) \end{align*} may be described in terms of a $\Lambda$-coalescent with merger measure \begin{align*} \Lambda^\psi( x, \mathrm{d}s ) = \frac{2 \beta}{x} \delta_0( \mathrm{d} s) + s^2 T_x^{ \# } \nu( \mathrm{d} s). \end{align*} Here $\delta_0$ is the Dirac mass at zero, and $T_x^{ \#} \nu_c$ is the pushforward measure onto $[0,1)$ of the L\'evy measure $\nu$ via the map $T_x : [0,\infty) \to [0,1)$ given by $T_x(r) = \frac{r}{x+r}$, where $x$ is the population size. In fact, we work in multiple dimensions, connecting multidimensional CSBPs with multidimensional coalescent processes. The primary tool in our method, which we believe to be of independent interest, is a Poissonization approach relying on the simple observation that a uniform sample of size $k$ taken from a random set with positive Lebesgue measure has the same law as a mixture of Poisson samples with rate $\lambda$ and mixing measure $k\, \mathrm{d} \lambda/\lambda$.
The effect of COVID-19 lockdown on the incidence of deliberate self-harm injuries presenting to the emergency room

Objective The World Health Organization declared COVID-19 a pandemic on 11th March 2020. The UK government introduced strict social distancing measures on 23rd March 2020, with the country put into a full lockdown to further halt the spread of the virus. The aims of this article are to ascertain whether there was a rise in the incidence of deliberate self-harm (DSH) presentations to the emergency department at a level one trauma center associated with the introduction of lockdown measures. Method An observational study from a level one trauma center was carried out. Retrospective data from 23rd March 2020 to 1st May 2020 was collected and compared to the same time period in 2019. Data was collected from coded electronic patient records. Results Total attendances to the Emergency Department (ED) reduced from 2019 to 2020 (5198 and 3059 respectively). There was a significant increase in the total number of self-harm presentations between 2019 and 2020 (103 vs 113, p-value <0.001) as well as paracetamol, NSAID and opiate overdoses, with more cases requiring hospital admission in 2020 vs 2019. Conclusions Societal lockdown measures secondary to the COVID-19 pandemic have had a significant effect on the mental health of patients. One way this can be detected is through an increased incidence and severity of deliberate self-harm injuries presenting to the ED. These findings, in conjunction with the available, literature provide valuable implications for community and emergency physicians and psychiatrists for any future wave of disease or pandemic.
Long Term Monitoring in Switzerland Reveals That Adalia bipunctata Strongly Declines in Response to Harmonia axyridis Invasion

Simple Summary The harlequin ladybird, Harmonia axyridis, is an Asian species that has invaded Europe and other continents, where it is suspected to cause the decline of native ladybirds through competition and predation. In north-western Switzerland, ladybirds were monitored for 11 years in four habitats (broadleaved hedges, meadows, pine and spruce stands) to assess the decline of native ladybirds following the invasion of the harlequin ladybird. These surveys showed that, on broadleaved hedges, the harlequin ladybird quickly became the most abundant species, representing 60–80% of all specimens collected in this habitat. One species, the two-spot ladybird, Adalia bipunctata, almost disappeared during this period, whereas it was the most abundant ladybird on broadleaved trees and shrubs when this study started. The other native species did not show any clear sign of decline. The harlequin ladybird was the second most abundant species in pine stands, and was not abundant in meadows and in spruce stands. The total number of ladybirds feeding on aphids did not decline during this period, suggesting that the arrival of the harlequin ladybird did not affect the predation pressure on aphids. Nevertheless, the severe decline of the two-spot ladybird deserves further investigations. Abstract A long-term monitoring was conducted at 40 sites in four different habitats in north-western Switzerland to observe changes in populations of native ladybirds, following the invasion of the Asian harlequin ladybird, Harmonia axyridis. From 2006 to 2017, the same trees and meadows were sampled at least seven times per year using standard protocols. On 15 broadleaved hedges, H. axyridis quickly became the dominant species, representing 60 to 80% of adult ladybirds collected. It was second in abundance at five pine (Pinus sylvestris) stands and was a minor component of the ladybird complex at five spruce (Picea abies) stands and in 15 meadows. This survey revealed the severe decline of Adalia bipunctata, which was the most abundant native ladybird on broadleaved trees in 2006–2009 and has almost disappeared since 2010. So far, other native ladybirds do not seem to decline significantly, including species occupying the same ecological niches as H. axyridis. The total number of aphidophagous ladybirds did not decline either, suggesting that the biological control function of ladybirds on aphids living in these habitats has not been affected by the arrival of H. axyridis. Recommendations are given to further assess the impact of H. axyridis on native ladybirds and aphids.