Miracle-dz/UniFAR-FTUs huggingface dataset:
Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation

Abstract Objectives Current knowledge of the pulmonary pathology of coronavirus disease 2019 (COVID-19) is based largely on postmortem studies. In most, the interval between disease onset and death is relatively short (<1 month). Information regarding lung pathology in patients who survive for longer periods is scant. We describe the pathology in three patients with severe COVID-19 who underwent antemortem examination of lung tissue at least 8 weeks after initial diagnosis. Methods We conducted a retrospective case series. Results The first patient developed acute respiratory failure and was started on extracorporeal membrane oxygenation (ECMO) on day 21, with subsequent hemothorax. Debridement (day 38) showed extensive lung infarction with diffuse alveolar damage and Candida overgrowth. The second patient developed acute respiratory failure requiring mechanical ventilation that did not improve despite ECMO. Surgical lung biopsy on day 74 showed diffuse interstitial fibrosis with focal microscopic honeycomb change. The third patient also required ECMO and underwent bilateral lung transplantation on day 126. The explanted lungs showed diffuse interstitial fibrosis with focal microscopic honeycomb change. Conclusions This series provides histologic confirmation that complications of COVID-19 after 8 weeks to 4 months of severe disease include lung infarction and diffuse interstitial fibrosis.
Psoriasis drugs in the medicare population: dermatologists’ spending and prescription patterns

Abstract Purpose Over the past decade, many new biologic and small-molecule drugs have been approved for psoriasis. These specialty drugs tend to be expensive and place financial burden on the healthcare system as well as patients. This study aims to explore trends in Medicare Part D spending and prescription patterns for psoriasis drugs by dermatologists. Methods The Centers for Medicare and Medicaid Services’ (CMS) Medicare Part D Public Use Files from 2013 to 2017 were utilized to examine prescription rates and pricing FDA-approved psoriasis drugs. Results From 2013 to 2017, psoriasis drugs accounted for 41% of total Medicare Part D spending by dermatologists in the database, of which biologics accounted for 86.5%. The proportion of psoriasis-related spending increased from 36% of total spending in 2013 to 53% in 2017. Prescriptions of etanercept decreased while prescribers of newly approved drugs increased significantly. The cost per day of biologics were significantly variable in 2013 but converged toward similar costs in 2017. Conclusion Psoriasis prescriptions comprise a large, increasing proportion of Medicare Part D spending related to dermatology. These increasing costs have significant implications for the healthcare system and affect out-of-pocket costs for patients who rely on such medications.
Citrate Supplementation Restores the Impaired Mineralisation Resulting from the Acidic Microenvironment: An In Vitro Study

Chronic metabolic acidosis leads to bone-remodelling disorders based on excessive mineral matrix resorption and inhibition of bone formation, but also affects the homeostasis of citrate, which is an essential player in maintaining the acid–base balance and in driving the mineralisation process. This study aimed to investigate the impact of acidosis on the osteogenic properties of bone-forming cells and the effects of citrate supplementation in restoring the osteogenic features impaired by the acidic milieu. For this purpose, human mesenchymal stromal cells were cultured in an osteogenic medium and the extracellular matrix mineralisation was analysed at the micro- and nano-level, both in neutral and acidic conditions and after treatment with calcium citrate and potassium citrate. The acidic milieu significantly decreased the citrate release and hindered the organisation of the extracellular matrix, but the citrate supplementation increased collagen production and, particularly calcium citrate, promoted the mineralisation process. Moreover, the positive effect of citrate supplementation was observed also in the physiological microenvironment. This in vitro study proves that the mineral matrix organisation is influenced by citrate availability in the microenvironment surrounding bone-forming cells, thus providing a biological basis for using citrate-based supplements in the management of bone-remodelling disorders related to chronic low-grade acidosis.
Soil Organic Carbon and Nitrogen Stocks under Tropical Organic and Conventional Cropping Systems in Northeastern Brazil

Soil organic matter (SOM) is an essential ecosystem component whose dynamics are affected by soil management practices. To evaluate the impact of two agricultural systems (organic and conventional) on soil organic carbon (C) and nitrogen (N) stocks in a sandy soil, samples were collected from the Amway Nutrilite Brazil farm and from the Central Pivot Horticultural Farmers Association farm, both situated in the Chapada da Ibiapaba region, Ceará State, Brazil. The first area has a large‐scale Caribbean Cherry fruit production system under organic management, whereas the second represented a conventional soil cultivation condition, characterized by the use of chisel plow and disc plow, mineral fertilization, and herbicides application. Plots with and without green manure fertilization were compared in the organically cultivated systems by using soil samples collected in the rows and between the rows. Areas under native forest were also sampled to determine the steady‐state condition. Total organic C and N contents in the soil (SOC, TN) and in the humic substances were determined at the 0‐ to 5‐, 5‐ to 15‐, 15‐ to 30‐, and 30‐ to 50‐cm soil layers. In addition, oxidizible organic C fractions were measured to calculate the carbon management index (CMI). In general, total SOC levels were low, ranging from 2.5 to 12.6 g kg−1 in the whole soil profile among the organic systems. In the upper soil layer, SOC and TN stocks were greater in the rows in response to organic fertilization. The conventional system presented lower variation on the SOC contents throughout soil layers when compared to the native forest area, indicating the direct effect of plowing on the downward SOC distribution. The CMI data confirmed the reestablishment of SOM levels in the rows of the organic managed systems in relation to the reference area, whereas the reduction of the CMI in the conventional system suggests a decline in the soil quality and greater potential for increased C losses to the atmosphere.
Liver Transplant Recipient, Caregiver, and Provider Perceptions of Cardiovascular Disease and Related Risk Factors After Transplant

Liver transplant recipients (LTRs) are at high risk for cardiovascular disease (CVD). We sought to characterize LTR, informal caregiver, and health care provider perceptions about CVD care after liver transplantation (LT) to inform the design of solutions to improve care. Participants included adult LTRs, their caregivers, and multispecialty health care providers recruited from an urban tertiary care network who participated in 90‐minute focus groups and completed a brief survey. Focus group transcripts were analyzed using thematic analysis, and survey data were analyzed using descriptive statistics. A total of 17 LTRs, 9 caregivers, and 22 providers participated in 7 separate focus groups. Most (93.3%) LTRs and caregivers were unaware of the risk of CVD after LT. Although 54.5% of providers were confident discussing CVD risk factors with LTRs, only 36.3% were confident managing CVD risk factors in LTRs, and only 13.6% felt that CVD risk factors in their LTR patients were well controlled. Barriers to CVD care for LTRs included (1) lack of awareness of CVD risk after LT, (2) lack of confidence in an ability to provide proper CVD care to LTRs, (3) reluctance to provide CVD care without transplant provider review, and (4) complexity of communication with the multidisciplinary LTR care team about CVD care. Participant recommendations included improved education for LTRs and caregivers about CVD risk factors, electronic health record alerts for providers, clearly defined CVD care provider roles, increased use of the transplant pharmacist, and multidisciplinary provider meetings to discuss care plans for LTRs. Multiple barriers to CVD care after LT were identified, and targeted recommendations were proposed by participants. Transplant centers should integrate participants’ recommendations when designing interventions to optimize CVD care for LTRs.
Influence of nitrogen rates on onion yield, quality and storability

A field experiment was carried out on onions ( Allium cepa ) using nitrogen rates ranging from 0 to 180 kg/ha. The highest yield and percentage of marketable production was obtained from applying 60 kg N/ha. Higher level of nitrogen decreased yield, while application of 180 kg N/ha gave yield that was even lower than that of treatment without nitrogen. The treatments with split application gave effects that were similar to those with single application. In addition, application of rates above 60 kg N/ha decreased market production percentage after storage of onion bulbs. Key Words: Onions; nitrogen; yield; storability Moor J. Agric. Res. Vol.4(1) 2003: 85-89
Antibacterial Multi-Layered Nanocellulose-Based Patches Loaded with Dexpanthenol for Wound Healing Applications

Antibacterial multi-layered patches composed of an oxidized bacterial cellulose (OBC) membrane loaded with dexpanthenol (DEX) and coated with several chitosan (CH) and alginate (ALG) layers were fabricated by spin-assisted layer-by-layer (LbL) assembly. Four patches with a distinct number of layers (5, 11, 17, and 21) were prepared. These nanostructured multi-layered patches reveal a thermal stability up to 200 °C, high mechanical performance (Young’s modulus ≥ 4 GPa), and good moisture-uptake capacity (240–250%). Moreover, they inhibited the growth of the skin pathogen Staphylococcus aureus (3.2–log CFU mL−1 reduction) and were non-cytotoxic to human keratinocytes (HaCaT cells). The in vitro release profile of DEX was prolonged with the increasing number of layers, and the time-dependent data imply a diffusion/swelling-controlled drug release mechanism. In addition, the in vitro wound healing assay demonstrated a good cell migration capacity, headed to a complete gap closure after 24 h. These results certify the potential of these multi-layered polysaccharides-based patches toward their application in wound healing.
Bone Mineral Density: Clinical Relevance and Quantitative Assessment

Bone mineral density (BMD) measurement by dual-energy x-ray absorptiometry (DXA) is an internationally accepted standard-of-care screening tool used to assess fragility-fracture risk. Society guidelines have recommended which populations may benefit from DXA screening and the use of the fracture risk assessment tool (FRAX) to guide decisions regarding pharmacologic treatment for osteoporosis. According to the U.S. National Osteoporosis Foundation guidelines, postmenopausal women and men at least 50 y old with osteopenic BMD warrant pharmacologic treatment if they have a FRAX-calculated 10-y probability of at least 3% for hip fracture or at least 20% for major osteoporotic fracture. Patients with osteoporosis defined by a clinical event, namely a fragility fracture, or with an osteoporotic BMD should also be treated. Patients who are treated for osteoporosis should be monitored regularly to track expected gains in BMD by serial DXA scans. With some drug therapies, BMD targets can be reached whereby further improvements in BMD are not associated with further reductions in fracture risk. Although reaching this target might suggest a stopping point for therapy, the reversibility of most treatments for osteoporosis, except for the bisphosphonates, has dampened enthusiasm for this approach. In the case of denosumab, it is now apparent that stopping therapy at any point can lead to an increase in multiple-fracture risk. For patients who do not respond to antiosteoporosis pharmacologic therapy with an improvement in BMD, or who have an incident fragility fracture on therapy, secondary causes of osteoporosis or non-compliance with medical therapy should be considered.
Text Mining Approaches for Postmarket Food Safety Surveillance Using Online Media

Food contamination and food poisoning pose enormous risks to consumers across the world. As discussions of consumer experiences have spread through online media, we propose the use of text mining to rapidly screen online media for mentions of food safety hazards. We compile a large data set of labeled consumer posts spanning two major websites. Utilizing text mining and supervised machine learning, we identify unique words and phrases in online posts that identify consumers’ interactions with hazardous food products. We compare our methods to traditional sentiment‐based text mining. We assess performance in a high‐volume setting, utilizing a data set of over 4 million online reviews. Our methods were 77–90% accurate in top‐ranking reviews, while sentiment analysis was just 11–26% accurate. Moreover, we aggregate review‐level results to make product‐level risk assessments. A panel of 21 food safety experts assessed our model's hazard‐flagged products to exhibit substantially higher risk than baseline products. We suggest the use of these tools to profile food items and assess risk, building a postmarket decision support system to identify hazardous food products. Our research contributes to the literature and practice by providing practical and inexpensive means for rapidly monitoring food safety in real time.
Ubiquitination of MHC Class II by March-I Regulates Dendritic Cell Fitness

Key Points MHC-II ubiquitination–mutant spleen DCs are functionally defective. MHC-II ubiquitination–mutant DCs have an altered gene expression profile. DC activation reverses the functional defects in MHC-II ubiquitination–mutant DCs. The expression and turnover of Ag-specific peptide–MHC class II (pMHC-II) on the surface of dendritic cells (DCs) is essential for their ability to efficiently activate CD4 T cells. Ubiquitination of pMHC-II by the E3 ubiquitin ligase March-I regulates surface expression and survival of pMHC-II in DCs. We now show that despite their high levels of surface pMHC-II, MHC class II (MHC-II) ubiquitination–deficient mouse DCs are functionally defective; they are poor stimulators of naive CD4 T cells and secrete IL-12 in response to LPS stimulation poorly. MHC-II ubiquitination–mutant DC defects are cell intrinsic, and single-cell RNA sequencing demonstrates that these DCs have an altered gene expression signature as compared with wild-type DCs. Curiously, these functional and gene transcription defects are reversed by activating the DCs with LPS. These results show that dysregulation of MHC-II turnover suppresses DC development and function.
Effect of repeated epilation for minor trachomatous trichiasis on lash burden, phenotype and surgical management willingness: A cohort study

Background WHO endorsed the use of epilation as an alternative treatment to surgery for the management of both minor unoperated TT (UTT) and postoperative TT (PTT). However, some trachoma control programmes hesitated to implement epilation citing concerns that it would hamper TT surgical acceptance and result in larger numbers of and stiffer trichiatic eyelashes than the original TT lashes. We investigated the burden and phenotypes of post-epilation trichiatic eyelashes, and willingness to accept surgical management separately in unoperated and postoperative TT cases. Methodology/Principal findings We recruited cases with minor (≤5 eyelashes from the upper eyelid touching the eye or evidence of epilation in <1/3rd of the upper eyelid) UTT (170) and PTT (169) from community-based screenings in Amhara Region, Ethiopia. Participants eyes were examined and data on present and future willingness to accept surgical management collected at baseline and every month for 6-months. Eyelashes touching the eye were counted and their phenotypes documented. Participants were trained on how to epilate. Epilation was done by the participants at home and by the examiner during follow-ups when requested by the participant. Follow-up rates were ≥97%. There was evidence of a significant reduction in the burden of trichiatic eyelashes in unoperated (mean difference = -0.90 [-1.11– -0.69]; RR = 0.50 [95% CI, 0.40–0.62]; p<0.0001), and postoperative (mean difference = -1.16 [-1.36– -0.95]; RR = 0.38 [95% CI, 0.31–0.48]; p<0.0001) cases 6-month after frequent epilation. Post-epilation trichiatic eyelashes at 6-months had higher odds of being thin (40.2% vs 55.8%, OR = 1.88 [95% CI, 1.21–2.93]; p = 0.0048), weak (39.8% vs 70.8%, OR = 3.68 [95%CI,2.30–5.88]; p<0.0001), and half-length (30.9% vs 43.3%, OR = 1.71 [1.09–2.68]; p = 0.020) than the pre-epilation trichiatic eyelashes in unoperated cases. There was a significant increase in the proportion of weak trichiatic eyelashes (OR = 1.99 [95% CI, 1.03–3.83; p = 0.039) in postoperative cases. In all 6 follow-up time points, 120/164 (73.2%) of unoperated and 134/163 (82.2%) of postoperative cases indicated that they would accept surgery if their trichiasis progressed. Conclusions/Significance In this study setting, frequent epilation neither hampers surgical acceptance nor results in more damaging trichiatic eyelashes than the pre-epilation lashes; and can be used as an alternative to the programmatic management of minor unoperated and postoperative TT cases.
Effect of the Central American Isthmus on gene flow and divergence of the American crocodile (Crocodylus acutus)

The final formation of the Central American Isthmus (CAI) about 3.5 million years ago altered global ocean circulation, connected North and South America terrestrial biotas, and established the Caribbean Sea. The nature of this event creates a natural scenario to test vicariance, divergence, and speciation by allopatry. Studies have shown the effect of the CAI on marine and terrestrial species, but none have examined a large‐bodied amphibious taxon. We used RAD sequencing on populations of the American crocodile (Crocodylus acutus) to study the genomic variation of C. acutus on both sides of the CAI, infer its demographic history, and measure the effect of the opening of the Panama Canal. Our results showed three genomic clusters: (1) Caribbean and the Panama Canal, (2) Pacific coast, and (3) Coiba island. The estimated divergence times between the Caribbean and Pacific populations are about 20,000 years ago, which is younger than the formation of the CAI, coinciding with the Last Glacial Maximum. We hypothesize the glacial/interglacial cycles facilitated gene flow between the Caribbean and Pacific crocodile populations after the formation of the CAI, masking any genomic divergence the CAI may have caused. There is no evidence of gene flow associated with the opening of the Panama Canal.
Angiotensin‐Converting Enzyme Inhibitors or Angiotensin Receptor Blockers Use and COVID‐19 Infection Among 824 650 Patients With Hypertension From a US Integrated Healthcare System

Background Previous reports suggest that the use of angiotensin‐converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) may upregulate angiotensin‐converting enzyme 2 receptors and increase severe acute respiratory syndrome coronavirus 2 infectivity. We evaluated the association between ACEI or ARB use and coronavirus disease 2019 (COVID‐19) infection among patients with hypertension. Methods and Results We identified patients with hypertension as of March 1, 2020 (index date) from Kaiser Permanente Southern California. Patients who received ACEIs, ARBs, calcium channel blockers, beta blockers, thiazide diuretics (TD), or no therapy were identified using outpatient pharmacy data covering the index date. Outcome of interest was a positive reverse transcription polymerase chain reaction test for COVID‐19 between March 1 and May 6, 2020. Patient sociodemographic and clinical characteristics were identified within 1 year preindex date. Among 824 650 patients with hypertension, 16 898 (2.0%) were tested for COVID‐19. Of those tested, 1794 (10.6%) had a positive result. Overall, exposure to ACEIs or ARBs was not statistically significantly associated with COVID‐19 infection after propensity score adjustment (odds ratio [OR], 1.06; 95% CI, 0.90–1.25) for ACEIs versus calcium channel blockers/beta blockers/TD; OR, 1.10; 95% CI, 0.91–1.31 for ARBs versus calcium channel blockers/beta blockers/TD). The associations between ACEI use and COVID‐19 infection varied in different age groups (P‐interaction=0.03). ACEI use was associated with lower odds of COVID‐19 among those aged ≥85 years (OR, 0.30; 95% CI, 0.12–0.77). Use of no antihypertensive medication was significantly associated with increased odds of COVID‐19 infection compared with calcium channel blockers/beta blockers/TD (OR, 1.32; 95% CI, 1.11–1.56). Conclusions Neither ACEI nor ARB use was associated with increased likelihood of COVID‐19 infection. Decreased odds of COVID‐19 infection among adults ≥85 years using ACEIs warrants further investigation.
Health Literacy Interventions to Improve Health Outcomes in Low- and Middle-Income Countries

Background: Health care systems in many low- and middle-income countries (LMICs) face considerable challenges in providing high-quality, affordable, and universally accessible care. Feasible solutions to these issues require health literacy (HL) interventions for people who live in LMICs. Low HL is a significant problem in many LMICs because of the low levels of general literacy and poorly resourced and functioning health systems. A comprehensive understanding of HL interventions is essential to determine whether these interventions meet the health information needs of people who live in LMICs and to develop other effective HL interventions specifically for people who live in LMICs, improve health outcomes, and reduce inequalities. Methods: A medical research librarian developed and implemented search strategies to identify relevant evidence. Included studies needed to contain HL in LMICs component to understand or evaluate HL interventions that target people who live in LMICs. Two reviewers selected studies, conducted quality assessments, and extracted data by using standard forms. Discussion or third-party adjudication resolved disagreements. The collected data include the design of the study, type of HL intervention, target audience, theoretical influences, approaches to evaluating the intervention delivered, intervention received, intervention fidelity, intervention reach, data analysis, and study outcomes. Key Results: The reviewers systematically analyzed the data from 23 published research studies, including 20 quantitative, 1 qualitative, and 2 mixed-method studies, on HL interventions to improve the health outcomes in LMICs. The various HL interventions for different groups of the population depend on the health outcomes of the study. The reviewers identified four themes: traditional HL interventions, art-based HL interventions, interactive learning strategies, and technology-based HL interventions. The researchers of a few studies also used multicomponent interventions to improve the HL of the population. Discussion: Despite global improvements in health indicators over time, such as decreased mortality and morbidity, significant challenges remain regarding the quality of the delivery of health care in many LMICs. All of the HL interventions were effective and significantly improved the knowledge and awareness of the population. However, based on the literature review, the reviewers found significant evidence that only a limited number of HL interventions are delivered through innovative and technological learning strategies. In addition, the sustainability and scalability of these interventions is not clear. Therefore, future research on sustainability measures for effective HL interventions in LMICs is still needed. [HLRP: Health Literacy Research and Practice. 2020;4(4):e250–e266. ]