bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence of metachronous gastric cancer after endoscopic submucosal dissection associated with eradication status of Helicobacter pylori
Authors: Ikeda Ryosuke , Hirasawa Kingo , Sato Chiko , Sawada Atsushi , Nishio Masafumi , Fukuchi Takehide , Kobayashi Ryosuke , Makazu Makomo , Kaneko Hiroaki , Maeda Shin
Published: June 2020

Objective:

This study compared the clinicopathological features and treatment outcomes of patients with primary early gastric cancers (EGCs) who had undergone Helicobacter pylori eradication and endoscopic submucosal dissection (ESD) with those of patients who were H. pylori-positive and had undergone ESD. Additionally, we investigated the incidence of metachronous cancer in these patients.

Methods:

We retrospectively analyzed 1849 EGCs in 1407 patients who underwent ESD whom 201 primary EGCs were detected after H. pylori eradication (eradication group) and 1648 primary EGCs were detected in patients infected with H. pylori (infection group). We evaluated the clinicopathological features and treatment outcomes of the first ESD. We next divided 938 patients whose follow-up periods were >1 year into three groups, an eradication group (n = 61), an infection group (n = 562), and an eradication after ESD group (n = 315). The groups’ cumulative metachronous occurrence rates were determined.

Results:

The eradication group’s median tumor size was significantly smaller, and the tumors were significantly more likely to be flat/depressed than those in the infection group. The groups did not differ regarding the treatment outcomes. The cumulative incidence of metachronous cancer was significantly higher in the eradication group than in the eradication after ESD group (P = 0.0454) and in the infection group than in the eradication after ESD group (P = 0.0233).

Conclusion:

The treatment outcomes for EGC in the eradication group were favorable. The higher incidence of metachronous cancer in the eradication group suggests that careful endoscopic follow-up examinations are required.
Germline mutations: many roles in leukemogenesis
Authors: Chen Kevin Z. , Kazi Rafi , Porter Christopher C. , Qu Cheng-Kui
Published: June 2020

Purpose of review

The purpose of this review is to summarize the current understanding of germline mutations as they contribute to leukemia development and progression. We also discuss how these new insights may help improve clinical management of germline mutations associated with leukemia.

Recent findings

Germline mutations may represent important initial mutations in the development of leukemia where interaction with somatic mutations provide further hits in leukemic progression. In addition, germline mutations may also contribute to leukemogenesis by impacting bone marrow stem-cell microenvironment and immune cell development and function.

Leukemia is characterized by the clonal expansion of malignant cells secondary to somatic or germline mutations in a variety of genes. Understanding somatic mutations that drive leukemogenesis has drastically improved our knowledge of leukemia biology and led to novel therapeutic strategies. Advances have also been made in identifying germline mutations that may affect leukemic development and progression. This review will discuss the biological and clinical relationship of germline mutations with clonal hematopoiesis, bone marrow microenvironment, and immunity in the progression of leukemia.
Small interfering RNA to proprotein convertase subtilisin/kexin type 9: transforming LDL-cholesterol-lowering strategies
Authors: Brandts Julia , Ray Kausik K.
Published: June 2020

Purpose of review

Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition is a new strategy to reduce LDL cholesterol (LDL-C), that is currently pursued by mAbs. A promising novel approach to target PCSK9 is using small interfering RNAs to inhibit hepatic PCSK9 synthesis. The first small interfering RNA developed for this purpose is inclisiran. Here, we review its clinical trial data and potential impact on patient management.

Recent findings

Inclisiran achieves sustained, additional 50% LDL-C reduction in patients receiving background statin therapy. Resulting LDL-C changes can be maintained by an infrequent dosing regimen with twice per year injections, that appear safe and well tolerated. Thus far, inclisiran has been studied in patients with established cardiovascular disease, high-risk primary prevention and in patients with familial hypercholesterolemia.

High and very high-risk individuals may benefit from the additional LDL-C-lowering effect of inclisiran when added to current lipid-lowering therapies. Furthermore, the simple dosing regimen may improve the convenience for users and facilitate patient adherence to therapy. The safety and convenience of inclisiran may offer new opportunities for population health.
Fusobacterium nucleatum Multiple Liver Abscesses in an Adolescent With Hemoglobin SC Disease
Authors: Pincez Thomas , Ovetchkine Philippe , Pastore Yves
Published: June 2020

Liver abscesses are poorly known in sickle cell disease. We report here multiple liver abscesses occurring in a 17-year-old patient with hemoglobin SC disease. A Fusobacterium nucleatum was identified on cyst puncture. Such complications have been described in only 11 children and young adults with hemoglobin SS/Sβ0-thalassemia diseases. Fusobacterium species are the most frequent pathogens reported and require anaerobic culture to be identified.
Use of CD19-directed CAR T-Cell Therapy in an Infant With Refractory Acute Lymphoblastic Leukemia
Authors: Breese Erin H. , Krupski Christa , Nelson Adam S. , Perentesis John P. , Phillips Christine L.
Published: June 2020

Infants with KMT2A-rearranged acute lymphoblastic leukemia (ALL) have historically poor outcomes despite maximal intensification of chemotherapy. Chimeric antigen receptor (CAR) T-cell therapy has revolutionized our approach to pediatric patients with relapsed/refractory ALL. Unfortunately, infants were excluded from early CAR T-cell trials due to concerns regarding the feasibility of T-cell collection and expansion. Here, we report the use of tisagenlecleucel in an infant with chemotherapy-refractory KMT2A-rearranged ALL. While CAR T-cell therapy was not curative for this patient, collection and expansion of T-cells proved feasible despite prior chemotherapy, he achieved minimal residual disease negative remission with excellent quality of life, and it facilitated a delay in hematopoietic stem cell transplantation.
Evaluation of a Community-Based Nurse Residency
Authors: Owings Clara R. , Gaskins Susan W.
Published: June 2020

Most nurse residency literature published on nurse residency evaluation comes from programs based in academic medical centers. Fewer studies exist on evaluation of nurse residencies in community hospitals. Secondary data analysis was used to evaluate a 12-month program based in a community hospital setting. Participants reported improvements in confidence, nursing skills, abilities, professional satisfaction, feeling supported, and decreased stress. Turnover decreased from 37% to <4% within 3 years.
Public Health Representation on Active Transportation Bodies Across US Municipalities
Authors: Omura John D. , Kochtitzky Christopher S. , Galuska Deborah A. , Fulton Janet E. , Shah Sagar , Carlson Susan A.
Published: June 2020

Context:

Municipal bodies such as planning or zoning commissions and active transportation advisory committees can influence decisions made by local governments that support physical activity through active transportation. Public health professionals are encouraged to participate in and inform these processes. However, the extent of such collaboration among US municipalities is currently unknown.

Objective:

To estimate the prevalence of active transportation bodies among US municipalities and the proportion with a designated public health representative.

Design:

A cross-sectional survey administered from May through September 2014.

Setting:

Nationally representative sample of US municipalities with populations of 1000 or more people.

Participants:

Respondents were the city or town manager, planner, or person with similar responsibilities (N = 2018).

Main Outcome Measures:

The prevalence of planning or zoning commissions and active transportation advisory committees among municipalities and whether there was a designated public health representative on them.

Results:

Approximately 90.9% of US municipalities have a planning or zoning commission, whereas only 6.5% of these commissions have a designated public health representative. In contrast, while 16.5% of US municipalities have an active transportation advisory committee, 22.4% of them have a designated public health representative. These active transportation bodies are less common among municipalities that are smaller, rural, located in the South, and where population educational attainment is lower. Overall, few US municipalities have a planning or zoning commission (5.9%) or an active transportation advisory committee (3.7%) that also has a designated public health representative.

Conclusions:

Approximately 9 in 10 US municipalities have a planning or zoning commission, whereas only 1 in 6 has an active transportation advisory committee. Public health representation on active transportation bodies across US municipalities is low. Increasing the adoption of active transportation advisory committees and ensuring a designated public health representative on active transportation bodies may help promote the development of activity-friendly communities across the United States.
Local Health Departments' Capacity for Workplace Health Promotion Programs to Prevent Chronic Disease: Comparison of Rural, Micropolitan, and Urban Contexts
Authors: Brown Meagan C. , Kava Christine , Bekemeier Betty , Ornelas India J. , Harris Jeffrey R. , Chan Kwun C. G. , Robertson Meg , Hannon Peggy A.
Published: June 2020

Objective:

To examine local health department (LHD) contexts, capacity for, and interest in partnering with employers on workplace health promotion programs (WHPPs) for chronic disease prevention.

Design:

Qualitative interviews with LHD directors.

Setting:

LHDs from 21 counties in 10 states.

Participants:

Twenty-one LHD directors.

Main Outcome Measures(s):

Experiences and perceptions of existing partnerships, decision making, funding, data needs, and organizational capacity for WHPP partnerships with employers.

Results:

We identified 3 themes: (1) LHDs see the value of partnering with employers but lack the capacity to do so effectively; (2) while LHDs base priorities on community need, funding ultimately drives decision making; and (3) rural, micropolitan, and urban LHDs differ in their readiness and capacity to work with employers.

Conclusions:

Understanding LHDs' partnership capacity and context is essential to the successful implementation of WHPP partnerships with employers. Expanding these partnerships may require additional financial investments, particularly among rural LHDs.
Ethnic and Racial Diversity in Academic Physical Medicine and Rehabilitation Compared with All Other Medical Specialties
Authors: Sanchez Ashley N. , Martinez Claudia I. , Stampas Argyrios , Pedroza Claudia , Escalon Miguel X. , Silver Julie K. , Frontera Joel , Verduzco-Gutierrez Monica
Published: June 2020

The primary aim of this study was to compare ethnic/racial diversity in academic physical medicine and rehabilitation (PM&R) with all other medical specialties in academia. The secondary aim was to characterize the ethnic/racial diversity of current PM&R program directors. Self-reported ethnicity/race information was collected from the Association of American Medical Colleges and Accreditation Council for Graduate Medical Education. Ethnicity/race was defined as white, Asian, African American, Hispanic, and other. Odds ratios (ORs) and Fisher’s exact tests were used to compare ethnic/racial differences at each career level between each specialty. In 2017, in PM&R, compared with whites, there was decreased odds of African Americans by 89% (OR, 0.11), 90% for Hispanics (OR, 0.10), 62% for Asians (OR, 0.38), and 73% for other (OR, 0.27) (all P < 0.001). This disparity increased in full professors: 99% (OR, 0.01), 96% (OR, 0.04), 87% (OR, 0.13), and 90% (OR, 0.10), respectively (all P < 0.001). In 2019, most PM&R program directors identified as white (51%) compared with Hispanic (4%) and African American (2%). Overall, ethnic/racial underrepresented minorities in medicine decreased with increasing academic rank. Therefore, more robust initiatives must be implemented to improve the exposure, recruitment, and retention of ethnic/racial underrepresented minorities at all levels of PM&R academia.
Clinical Use of Prazosin in a Patient With Acute Stress Disorder: A Case Report
Authors: SRIVASTAVA ANSHUMAN A. , OPLER DOUGLAS J.
Published: June 2020

Prazosin is an alpha-1 blocker that is commonly given to patients with posttraumatic stress disorder (PTSD) to reduce nightmares and flashbacks. Its use in acute stress disorder (ASD), however, has not been well characterized. There is a moderately positive correlation between ASD and the subsequent development of PTSD, which indicates that there may be some common neurobiological mechanisms that connect the 2 conditions. We present the case of a 51-year-old man who was experiencing symptoms of ASD following a motor vehicle accident that occurred a few days earlier. He was reporting flashbacks and nightmares of the accident, but after being treated with prazosin, his symptoms completely resolved. Prazosin may be effective in treating the symptoms of ASD and, by doing this, it may also play a role in inhibiting the progression of ASD to PTSD.
Contralateral Depressor Labii Inferioris Chemodenervation for Congenital Unilateral Lower Lip Palsy
Authors: Çam Osman Halit , Özücer Berke
Published: June 2020

Introduction:

Congenital unilateral lower lip palsy – also known as asymmetric crying facies – is isolated asymmetry of the lower lip unilaterally. It is characterized by isolated lower lip asymmetry during smiling and speech. Although etiology is unknown, depressor labii inferioris (DLI) weakness is hold responsible.

Aim:

Purpose of this study was to evaluate the effectiveness of contralateral depressor labii inferioris botulinum toxin injection on patients’ concern levels and patient satisfaction. Ten units of botulinum toxin A injection was carried out to the healthy contralateral side.

Methodology:

Eleven patients were treated. Patients’ pretreatment and posttreatment concern regarding asymmetry during speech and smiling was evaluated with a questionnaire. Patients’ perception of treatment satisfaction was also evaluated with a questionnaire.

Results:

Mean score related to concern about asymmetric appearance during smiling decreased from 1.6 ± 0.8 to 0.5 ± 0.5. Mean score related to concern about asymmetric appearance during speech decreased from 1.6 ± 0.5 to 0.4 ± 0.5. Eleven out of 11 patients reported improvement with speech whereas 10 out of 11 patients reported improvement with smiling. No weakness about oral competence was reported.

Conclusion:

Most congenital unilateral lower lip palsy patients are concerned regarding their asymmetric appearance while smiling or speaking. Chemodenervation of the contralateral DLI muscle reduces concern levels and has high patient satisfaction. Chemodenervation of the contralateral healthy DLI muscle is a valid, practical treatment option.
Participation in a System-Thinking Simulation Experience Changes Adverse Event Reporting
Authors: Sanko Jill S. , Mckay Mary
Published: June 2020

Introduction

System failures are contributing factors in the thousands of adverse events occurring in US healthcare institutions yearly. This study explored the premise that exposure to a simulation experience designed to improve system thinking (ST) would impact adverse event reporting patterns.

Methods

An intervention-control study was used to explore impacts of participation in a simulation designed to improve ST on adverse event reporting. Each summer Bachelor in Nursing Science students along with medical students participate in a week-long simulation-based interprofessional patient safety course. During the 2017 course, Friday Night in the ER, a table-top simulation designed to develop ST was included. As part of the school nursing's simulation program, students are asked to report adverse events observed or committed during simulation encounters into a simulated adverse event reporting system outside the simulation-based interprofessional patient safety course. Adverse event reporting system data were used to examine patterns of adverse event reporting in control and intervention groups studied.

Results

Findings demonstrated differences in proportions of reported adverse events. The proportion of reported adverse events by students with the second and terminal semesters of course work combined and the 2016 and 2018 control groups combined demonstrated statistically significant differences,P< 0.001. Additional analysis revealed that the intervention group reported more medication-related events, whereas the control group reported more failure to rescue and airway-related events.

Conclusions

Exposure to a simulation designed to develop ST seems to impact adverse event reporting. These findings support the idea that ST may change safety monitoring behaviors.
Role and Outcome of Laparoscopic/Minimally Invasive Surgery for Variety of Colorectal Emergencies
Authors: Ahmed Salman E. , Jha Anshu , Norman Sarah , Jha Madan , Garg Dharmendra
Published: June 2020

Background:

Recently, the laparoscopic or minimally invasive approach has become common practice for planned colorectal malignancies. Its use in the emergency setting is limited by various factors, including resource availability and surgical expertise. However, more recent evidence suggests a laparoscopic approach to colorectal emergencies, which is comparable with laparoscopic routine work, and often promising. In this study, authors have investigated the outcome of the laparoscopic approach in both benign and malignant colorectal emergencies.

Method:

Retrospective analysis of prospectively collected data (theater records, histology database, and discharge records) over the course of 9 years. The standard surgical approach included conventional laparoscopic and single-port technique (single-incision laparoscopic surgery). The outcome variables included in the final analysis were: success of the minimally invasive approach, conversion rate, postoperative complications, return to theater, and mortality.

Results:

A total of 202 (males, 110 and females, 92) emergency patients with a median age of 59 years underwent surgery between December 2009 and 2019. The mean operating time was 169 minutes and median American Society of Anesthesiology grade III. Single-incision laparoscopic surgery was used in 19 patients (9.4%). The conversion to open surgery was 12.3% (n=25). The majority of them had primary anastomosis (n= 132, 65.3%).

The complications from most to least frequent were:

Postoperative ileus (35%).

Postoperative respiratory complications (7.4%).

Intra-abdominal collection (9%); half of which were anastomotic leak (4.5%).

Major wound infection (3.9%).

Return to theater for laparotomy (2.9%).

Conclusion:

The favorable results obtained in this study underline the theme that with the availability of resources and expertise, it is possible to offer minimal invasive approach to emergency colonic pathology.
Risk Factors for Dislodgment of Vaginal Pessaries in Women With Pelvic Organ Prolapse: A Cohort Study
Authors: Coelho Suelene C. A. , Giraldo Paulo Cesar , de Castro Edilson Benedito , Brito Luiz G. O. , Juliato Cássia R. T.
Published: June 2020

Objective

The aim of the study was to evaluate the associated factors associated with pessary dislodgment in women with advanced pelvic organ prolapse (POP).

Methods

A cohort study with women (N = 98) with advanced POP who chose conservative treatment with ring pessary between December 2016 and 2018 identified by screening. Demographic data, history of POP, urinary, and/or bowel symptoms were collected. A medical visit was scheduled 3 and 6 months after pessary insertion to evaluate symptoms (vaginal discharge, bleeding, pain, discomfort, new-onset urinary, or fecal problems) and any pessary dislodgment. Two groups were created (women who were able to retain the pessary versus who were not able), and univariate and multivariate analysis were performed to look for risk factors for pessary dislodgment. Women who requested to have their pessaries removed during the 6-month follow-up were excluded.

Results

Ninety-three women included in the study, 78 successfully continued to use the pessary at 6 months, and 15 had pessary dislodgment (16.1%). Demographic characteristics were similar between the treatment group and the control group. After multivariate analysis, women who had their pessaries dislodged presented higher rates of previous surgery (odds ratio = 8.11; 95% confidence interval = 2.09–31.58; P = 0.003) with advanced Pelvic Organ Prolapse Quantification system staging (odds ratio, 13.41; confidence interval, 1.97–91.36; P = 0.008).

Conclusions

The presence of advanced apical POP and previous POP surgery are risk factors for ring pessary dislodgment. This information should guide physicians for counseling patients before pessary insertion.
Integrating computer-aided engineering and computer-aided design for DNA assemblies
Authors: Huang Chao-Min , Kucinic Anjelica , Johnson Joshua A. , Su Hai-Jun , Castro Carlos E.
Published: June 2020

Functional properties of modern engineering products result from merging the geometry and material properties of underlying components into sophisticated overall assemblies. The foundation of this design process is an integration of computer aided design (CAD) tools that allow rapid geometric modifications with robust simulation tools to guide design iterations (i.e. computer-aided engineering, CAE). Recently, DNA has been used to make nanodevices for a myriad of applications across fields including medicine, nanomanufacturing, synthetic biology, biosensing, and biophysics. However, currently these self-assembled DNA nanodevices rely primarily on geometric design, and hence, they have not demonstrated the same sophistication as real-life products. We present an iterative design pipeline for DNA assemblies that integrates CAE based on coarse-grained molecular dynamics with a versatile CAD approach that combines top-down automation with bottom-up control over geometry. This intuitive framework redefines the scope of structural complexity and enhances mechanical and dynamic design of DNA assemblies.
The prevalence of antibodies to SARS-CoV-2 in asymptomatic healthcare workers with intensive exposure to COVID-19
Authors: Xiong Shue , Guo Chunxia , Dittmer Ulf , Zheng Xin , Wang Baoju
Published: June 2020

The prevalence of asymptomatic SARS-CoV-2 infection in healthcare workers with intensive exposure to COVID-19 is unclear. In this study, we investigated the seroprevalence of SARS-CoV-2 in 797 asymptomatic healthcare workers with intensive exposure to COVID-19 patients in Wuhan, China. Positive IgG was detected from 35 asymptomatic healthcare workers, and the prevalence of antibodies to SARS-CoV-2 in asymptomatic healthcare workers was 4.39% (35/797). None of them developed COVID-19 until May 15. 33 of them have performed at least one chest CT scan showing no viral pneumonia features, and 16 have finished at least one-time SARS-CoV-2 RNA detection with negative results. When contacting with the patients, 15 of them dressed with full personal protective equipment (PPE), and 16 worn N95 mask and gown. To the best of our knowledge, this is the first investigation reported that the seroprevalence of SARS-CoV-2 was 4.39% in asymptomatic healthcare workers with applied PPE in a high epidemic area, which may provide useful information of estimating asymptomatic infection rate in general population.
Applying Heat and Humidity using Stove Boiled Water for Decontamination of N95 Respirators in Low Resource Settings
Authors: Doshi Siddharth , Banavar Samhita P. , Flaum Eliott , Kulkarni Surendra , Kumar Shailabh , Chen Tyler , Bhattacharya Arnab , Prakash Manu
Published: June 2020

Global shortages of N95 respirators have led to an urgent need of N95 decontamination and reuse methods that are scientifically validated and available world-wide. Although several large scale decontamination methods have been proposed (hydrogen peroxide vapor, UV-C); many of them are not applicable in remote and low-resource settings. Heat with humidity has been demonstrated as a promising decontamination approach, but care must be taken when implementing this method at a grassroots level. Here we present a simple, scalable method to provide controlled humidity and temperature for individual N95 respirators which is easily applicable in low-resource settings. N95 respirators were subjected to moist heat (>50% relative humidity, 65-80°C temperature) for over 30 minutes by placing them in a sealed container immersed in water that had been brought to a rolling boil and removed from heat, and then allowing the containers to sit for over 45 minutes. Filtration efficiency of 0.3-4.99um incense particles remained above 97% after 5 treatment cycles across all particle size sub-ranges. This method was then repeated at a higher ambient temperature and humidity in Mumbai, using standard utensils commonly found in South Asia. Similar temperatures and humidities were achieved and filtration efficiencies consistently remained above 94%. Higher temperatures (>70°C) and longer treatment times (>40 minutes) were obtained by insulating the outer vessel. This simple yet reliable method can be performed even without electricity access using any heat source to boil water, from open-flame stoves to solar heating, and provides a low-cost route for N95 decontamination globally applicable in resource-constrained settings.
SARS-CoV-2 in environmental samples of quarantined households
Authors: Döhla Manuel , Wilbring Gero , Schulte Bianca , Kümmerer Beate Mareike , Diegmann Christin , Sib Esther , Richter Enrico , Haag Alexandra , Engelhart Steffen , Eis-Hübinger Anna Maria , Exner Martin , Streeck Hendrik , Schmithausen Ricarda Maria
Published: June 2020

The role of environmental transmission of SARS-CoV-2 remains unclear. Particularly the close contact of persons living together or cohabitating in domestic quarantine could result in high risk for exposure to the virus within the households. Therefore, the aim of this study was to investigate the whereabouts of the virus and whether useful precautions to prevent the dissemination can be given.

21 households under quarantine conditions were randomly selected for this study. All persons living in each household were recorded in terms of age, sex and time of household quarantine. Throat swabs for analysis were obtained from all adult individuals and most of the children. Air, wastewater samples and surface swabs (commodities) were obtained and analysed by RT- PCR. Positive swabs were cultivated to analyse for viral infectivity.

26 of all 43 tested adults (60.47 %) tested positive by RT-PCR. All 15 air samples were PCR- negative. 10 of 66 wastewater samples were positive for SARS-CoV-2 (15.15 %) as well as 4 of 119 object samples (3.36 %). No statistically significant correlation between PCR-positive environmental samples and the extent of infection spread inside the household could be observed. No infectious virus could be isolated under cell culture conditions.

As we cannot rule out transmission through surfaces, hygienic behavioural measures are important in the households of SARS-CoV-2 infected individuals to avoid potential transmission through surfaces. The role of the domestic environment, in particular the wastewater load in washbasins and showers, in the transmission of SARS CoV-2 should be further clarified.

Highlights

With public “shut downs” due to SARS-CoV-2, domestic infection is a main possible route of transmission.

All analysed air samples were tested negative for SARS-CoV-2.

15.15 % of all wastewater samples (washbasin, showers and toilets) were tested positive.

Only 3.36 % of all object samples were tested positive: one remote control, two metallic door knobs and one wooden stove overlay.

This study supports the hypothesis that indirect environmental transmission may only play a minor role, which needs clarifications in further studies.
Mycotoxin exposure biomonitoring in breastfed and non-exclusively breastfed Nigerian children
Authors: Ezekiel Chibundu N. , Abia Wilfred A. , Braun Dominik , Šarkanj Bojan , Ayeni Kolawole I. , Oyedele Oluwawapelumi A. , Michael-Chikezie Emmanuel C. , Ezekiel Victoria C. , Mark Beatrice N. , Ahuchaogu Chinonso P. , Krska Rudolf , Sulyok Michael , Turner Paul C. , Warth Benedikt
Published: June 2020

A multi-specimen, multi-mycotoxin approach involving ultra-sensitive LC-MS/MS analysis of breast milk, complementary food and urine was applied to examine mycotoxin co-exposure in 65 infants, aged 1–18 months, in Ogun state, Nigeria. Aflatoxin M1was detected in breast milk (4/22 (18%)), while six other classes of mycotoxins were quantified; including dihydrocitrinone (6/22 (27%); range: 14.0–59.7ng/L) and sterigmatocystin (1/22 (5%); 1.2ng/L) detected for the first time. Seven distinct classes of mycotoxins including aflatoxins (9/42 (21%); range: 1.0– 16.2µg/kg) and fumonisins (12/42 (29%); range: 7.9–194µg/kg) contaminated complementary food. Mycotoxins covering seven distinct classes with diverse structures and modes of action were detected in 64/65 (99%) of the urine samples, demonstrating ubiquitous exposure. Two aflatoxin metabolites (AFM1and AFQ1) and FB1were detected in 6/65 (9%), 44/65 (68%) and 17/65 (26%) urine samples, respectively. Mixtures of mycotoxin classes were common, including 22/22 (100%), 14/42 (33%) and 56/65 (86%) samples having 2–6, 2–4, or 2–6 mycotoxins present, for breast milk, complementary food and urine, respectively. Aflatoxin and/or fumonisin was detected in 4/22 (18%), 12/42 (29%) and 46/65 (71%) for breast milk, complimentary foods and urine, respectively. Furthermore, the detection frequency, mean concentrations and occurrence of mixtures were typically greater in urine of non-exclusively breastfed compared to exclusively breastfed infants. The study provides novel insights into mycotoxin co-exposures in early-life. Albeit a small sample set, it highlights transition to higher levels of infant mycotoxin exposure as complementary foods are introduced, providing impetus to mitigate during this critical early-life period and encourage breastfeeding.
Immunochromatographic assays for COVID-19 epidemiological screening: our experience
Authors: Bartolini Andrea , Scapaticci Margherita , Bioli Marina , Lazzarotto Tiziana , Re Maria Carla , Mancini Rita
Published: June 2020

In March 2020, the World Health Organization (WHO) declared a pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Due to the absence of effective treatment or biomedical prevention, understanding potential post infection immunity has important implications for epidemiologic assessments. For this reason, increasing number of in vitro diagnostic companies are developing serological assays to detect antibodies against SARS-CoV-2, but most of them lack the validation by third parties in relation to their quality, limiting their usefulness. We submitted to serological screening by two different immunochromatographic (IC) rapid testing for detection of IgG and IgM against SARS-CoV-2, 151 asymptomatic or minimally symptomatic healthcare workers previously tested positive for SARS-CoV-2 RT-PCR in order to evaluate the performance of rapid assays. Results showed discrepancies between molecular and IC results, and an inconsistency of immunoglobulins positivity patterns when compared to ELISA/CLIA results, highlighting the absolute necessity of assays performance validation before their marketing and use, in order to avoid errors in the results evaluation at both clinical and epidemiological level.
Effect of Dry Heat and Autoclave Decontamination Cycles on N95 FFRs
Authors: Meisenhelder Cole , Anderegg Loïc , Preecha Andrew , Ngooi Chiu Oan , Liao Lei , Xiao Wang , Chu Steven , Cui Yi , Doyle John M.
Published: June 2020

Current shortages of Filtering Facepiece Respirators (FFRs) have created a demand for effective methods for N95 decontamination and reuse. Before implementing any reuse strategy it is important to determine what effects the proposed method has on the physical functioning of the FFR. Here we investigate the effects of two potential methods for decontamination; dry heat at 95 °C, and autoclave treatments. We test both fit and filtration efficiency for each method. For the dry heat treatment we consider the 3M 1860, 3M 1870, and 3M8210+ models. After five cycles of the dry heating method, all three FFR models pass both fit and filtration tests, showing no degradation. For the autoclave tests we consider the 3M 1870, and the 3M 8210+. We find significant degradation of the FFRs following the 121 °C autoclave cycles. The molded mask tested (3M 8210+) failed fit testing after just 1 cycle in the autoclave. The pleated (3M 1870) mask passed fit testing for 5 cycles, but failed filtration testing. The 95 °C dry heat cycle is scalable to over a thousand masks per day in a hospital setting, and is above the temperature which has been shown to achieve the requisite 3 log kill of SARS-CoV-2[1], making it a promising method for N95 decontamination and reuse.
Syncope at SARS-CoV-2 onset due to impaired baroreflex response
Authors: Canetta Ciro , Accordino Silvia , Buscarini Elisabetta , Benelli Gianpaolo , La Piana Giuseppe , Scartabellati Alessandro , Viganò Giovanni , Assandri Roberto , Astengo Alberto , Benzoni Chiara , Gaudiano Gianfranco , Cazzato Daniele , Rossi Davide Sebastiano , Usai Susanna , Tramacere Irene , Lauria Giuseppe
Published: June 2020

We describe clinical and laboratory findings in 35 consecutive patients tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction on nasopharyngeal swab that presented one or multiple syncopal events at disease onset. Neurological examination and electrocardiographic findings were normal. Chest computed tomography showed findings consistent with interstitial pneumonia. Arterial blood gas analysis showed low pO2, pCO2, and P/F ratio indicating hypocapnic hypoxemia, while patients did not show the expected compensatory heart rate increase. Such mechanism could have led to syncope. We speculate that SARS-CoV-2 could have caused angiotensin-converting enzyme-2 (ACE2) receptor internalization in the nucleus of the solitary tract (NTS), thus altering the baroreflex response and inhibiting the compensatory tachycardia during acute hypocapnic hypoxemia.
POOLING FOR SARS-COV-2 CONTROL IN CARE INSTITUTIONS
Authors: Cabrera Jorge J , Rey Sonia , Pérez Sonia , Martínez-Lamas Lucía , Cores-Calvo Olaia , Torres Julio , Porteiro Jacobo , García-Comesaña Julio , Regueiro Benito
Published: June 2020

Workers and residents in Care Homes are considered at special risk for the acquisition of SARS-CoV-2 infection, due to the infectivity and high mortality rate in the case of residents, compared to other containment areas. The aims of the present study, based in our local experience, were (a) to describe SARS-CoV-2 prevalence in institutionalized people in Galicia (Spain) during the Coronavirus pandemic and (b) to evaluate the expected performance of a pooling strategy using RT-PCR for the next rounds of screening of institutionalized people.

Distribution of SARS-CoV-2 infection at Care Houses was uneven. As the virus circulation global rate was low in our area, the number of people at risk of acquiring the infection continues to be very high. In this work, we have successfully demonstrated that pooling of different groups of samples at low prevalence clusters, can be done with a small average delay on quantification cycle (Cq) values. A new surveillance system with guaranteed protection is required for small clusters, previously covered with individual testing. Our proposal for Care Houses, once prevalence zero is achieved, would include successive rounds of testing using a pooling solution for transmission control preserving testing resources. Scale-up of this method may be of utility to confront larger clusters to avoid the viral circulation and keeping them operative.
coronapp: A Web Application to Annotate and Monitor SARS-CoV-2 Mutations
Authors: Mercatelli Daniele , Triboli Luca , Fornasari Eleonora , Ray Forest , Giorgi Federico M.
Published: June 2020

The avalanche of genomic data generated from the SARS-CoV-2 virus requires the development of tools to detect and monitor its mutations across the world. Here, we present a webtool,coronapp, dedicated to easily processing user-provided SARS-CoV-2 genomic sequences and visualizing current worldwide status of SARS-CoV-2 mutations.

The webtool allows users to highlight mutations and categorize them by frequency, country, genomic location and effect on protein sequences, and to monitor their presence in the population over time.

The tool is available athttp://giorgilab.unibo.it/coronapp/for the worldwide dataset and athttp://giorgilab.unibo.it/coronannotator/for the annotation of user-provided sequences. The full code is freely shared athttps://github.com/federicogiorgi/giorgilab/tree/master/coronapp

Data Availability Statement

The data that support the findings of this study derive from the GISAID consortium and are openly available in Github, in Rdata format for the R environment, in files results.rda and metadata.rda, at the following link:https://github.com/federicogiorgi/giorgilab/tree/master/coronapp/data
Evolution of colonial life history in styelids tunicates involves changes in complexity patterns
Authors: Gutierrez Stefania
Published: June 2020

Biological complexity is defined as the number of modules that compose an organism or a biological system, the type of interactions between these modules, and new hierarchies that describe these interactions. These patterns in biological complexity are changing during the evolution of life-histories, such as the evolution of coloniality in animals. In relation to coloniality, it is possible to observe an increment in all the aspects defined in the concept of biological complexity. First, in colonial animals, there is an increment in the modules that compound the system (i.e. zooids) compared with a solitary organism in which the multicellular individual a unity. Consequently, this transformation of the multicellular individual, in a component of the modular architecture in colonies, involves an increase in the regulatory processes of colonial system. This is precisely the case of the colonial life history evolution from solitary ancestors in the Styelids tunicates. Therefore, the main question of this study is How is the regulation of the asexual developmental processes that occurred simultaneously in the modules of the colonies? This question was studied, by the research of colonial strategy in the styelidSymplegma.Using in vivo observations of the budding process, description and classification of the extra-corporeal blood vessels system and the blood cells, by cytohistological assays. The conclusion is that the regulation of the simultaneous developmental processes that occurred inSymplegmacolonies is mediated by the system of extra-corporeal blood vessels, which maintain physically the cohesion of the individuals, the plasma, and migratory blood cells transport signals between the individuals of the colonies.
Environmental Contamination of SARS-CoV-2 in a Non-Healthcare Setting Revealed by Sensitive Nested RT-PCR
Authors: Wong Judith Chui Ching , Hapuarachchi Hapuarachchige Chanditha , Arivalan Sathish , Tien Wei Ping , Koo Carmen , Mailepessov Diyar , Kong Marcella , Nazeem Mohammad , Lim Merrill , Ng Lee Ching
Published: June 2020

Fomite-mediated transmission has been identified as a possible route for disease spread of the COVID-19 pandemic. In healthcare settings, evidence of environmental contamination by SARS-CoV-2 has been found in patients’ rooms and toilets. Here, we investigate environmental contamination of SARS-CoV-2 in non-healthcare settings and assessed the efficacy of cleaning and disinfection in removing SARS-CoV-2 contamination. A total of 428 environmental swabs and six air samples was taken from accommodation rooms, toilets and elevators that have been used by COVID-19 cases. Through the use of a sensitive nested RT-PCR assay, we found two SARS-CoV-2 RNA positive samples from the room resided by a COVID-19 case, highlighting the risk of fomite-mediated transmission in non-healthcare settings and the importance of surface disinfection of spaces occupied by cases. Of note, we did not find evidence for air-borne transmission, nor of environmental contamination of elevators, which were transiently exposed to infected persons.
The Effect of Ultraviolet C Radiation Against SARS-CoV-2 Inoculated N95 Respirators
Authors: Ozog David M. , Sexton Jonathan Z. , Narla Shanthi , Pretto-Kernahan Carla D. , Mirabelli Carmen , Lim Henry W. , Hamzavi Iltefat H. , Tibbetts Robert J. , Mi Qing-Sheng
Published: June 2020

Since March 31st, 2020, during the height of the pandemic, we have decontaminated thousands of 3M 1860 respirators with Ultraviolet C (UVC) for our frontline workers. There is no published peer-reviewed data regarding the dose required to effectively disinfect SARS-CoV-2 on N95 filtering facepiece respirators (FFRs). Four different locations (facepiece and strap) on 5 different N95 FFR models (3M 1860, 8210, 8511, 9211; Moldex 1511) were inoculated with a 10 μL drop of SARS-CoV-2 viral stock (8 × 107 TCID50/mL). The outside-facing and wearer-facing surfaces of the respirators were each irradiated with a dose of 1.5 J/cm2 UVC (254 nm).

Viable SARS-CoV-2 was quantified by a median tissue culture infectious dose assay (TCID50). UVC delivered using a dose of 1.5 J/cm2, to each side, was an effective method of decontamination for the facepieces of 3M 1860 and Moldex 1511, and for the straps of 3M 8210 and the Moldex 1511. This dose is an appropriate decontamination method to facilitate reuse of respirators for healthcare personnel when applied to certain models/materials. Increasing the dose may improve decontamination for the other models and straps; however, UVC radiation can degrade certain polymers in a dose dependent manner, and the effects may vary greatly between different models. Therefore, fit-testing of UVC decontaminated respirators must be performed each time a new model and/or dose is introduced into the healthcare system.
Respiratory Failure in Covid19 is associated with increased monocyte expression of complement receptor 3
Authors: Gupta Rajeev , Alasdair Vanya , Gant Bryan Williams , Enver Tariq
Published: June 2020

A key question in COVID-19 infection is why some previously healthy patients develop severe pulmonary failure and some ultimately die. Initial pulmonary failure does not exhibit classical features of ARDS; hypercoagulability is a common laboratory feature, and pulmonary thrombotic microangiopathy has been reported post mortem1,2,3. Biomarkers cannot robustly identify such patients pre-emptively and no specific interventions exist to mitigate clinical deterioration. Mononuclear phagocytic cells are key immune cells and bind fibrinogen through the CD11b/CD18 dimer CR3, whose activated form can initiate microthrombus formation. Accordingly, we profiled circulating monocyte CD11b/CD18 cell surface density from COVID-19 infected adults who were (i) symptomatic but breathless, (ii) requiring ventilatory support, and (iii) recovering following ICU care for hypoxia.
Contribution of mitochondrial DNA heteroplasmy to the phenotypic variability in maternally transmitted 22q11.2 deletion syndrome
Authors: Rebolledo-Jaramillo Boris , Obregon Maria Gabriela , Huckstadt Victoria , Gomez Abel , Repetto Gabriela M.
Published: June 2020

22q11.2 deletion syndrome (22q11DS) has an incidence of 1 in 4,000. Most cases occur de novo, but about 10–15% of cases are inherited. Features include congenital heart disease, cleft palate, developmental delay, and other characteristics that can vary even among family members. The presence of nuclear mitochondrial genes in the deleted region, and the requirement of mitochondrial function for proper embryonic development, suggests that intrafamilial variability in maternally transmitted 22q11DS could be explained, at least partially, by variation in mitochondrial DNA (mtDNA). Thus, we sequenced the mtDNA of seventeen 22q11DS mother-child pairs. We identified 29 heteroplasmic variants at the 1% level, and compared the intrafamilial allele frequency change between phenotypically concordant and discordant pairs. We observed a statistically significant difference for the palatal phenotype: p-value = 0.048 (permutation test, 8 concordant vs. 9 discordant pairs), but not for the cardiac phenotype: p-value = 0.568 (6 vs. 11).

Mitochondrial function has been primarily studied in mouse models of neurological 22q11DS phenotypes. Our study sets a precedent for considering human mitochondrial variation as a genetic modifier of congenital defects in this syndrome, and although our results are limited by sample size, they suggest a role for mitochondrial variation in the palatal phenotype.
Environmental and social analysis as risk factors for the spread of the novel coronavirus (SARS-CoV-2) using remote sensing, GIS and analytical hierarchy process (AHP): Case of Peru
Authors: Badillo-Rivera Edwin , Fow-Esteves Anthony , Alata-López Fernando , Virú-Vásquez Paul , Medina-Acuña Martha
Published: June 2020

The novel coronavirus disease (COVID-19) generated by the SARS-CoV-2 virus was originated in the city of Wuhan (China) in December 2019, the virus began to spread in other regions of China until it spread to the rest of the world. In this research, an analysis was made of environmental factors (tropospheric column of NO2, vertical airflow, percentage of solid waste disposed of in open dumps and percentage of the population without any mechanism of faeces disposal) and social factors (levels of monetary poverty, percentage of the number of hospitals per population and vulnerable population) that could directly and indirectly affect the spread of SARS-CoV-2 virus in the regions of Peru. Remote sensing techniques, geographic information systems and an analysis under the multi-parametric statistical approach proposed by Saaty were used to determine which regions present greater susceptibility, vulnerability and risk of spreading the SARS-CoV-2 virus. The results show that the prevalence of high values of tropospheric NO2and values close to 0 Pa/s of the vertical airflow were directly related to the number of positive cases by COVID-19. In addition, it was found that 68% of the regions of Peru are at a “high” and “very high” risk of spreading SARS-CoV-2 virus, and most of them are in northern and central Peru (Callao, Tumbes, Piura, Loreto, Lambayeque, Huancavelica, Amazonas, Cajamarca, Ucayali, Huanuco and among others), therefore, special care should be taken with the measures adopted after social isolation in order to avoid the resurgence and collapse of the of health systems. It concludes that public policies on air quality management, integrated solid waste management and sanitation services should be improved in order to reduce the risk of spreading the SARS-CoV-2 virus. This research can be replicated on a longer scale, including more variables.

HIGHLITGHS

68% of the regions are at a “high” and “very high” risk of spreading of SARS-CoV-2

Tropospheric NO2 concentration and number of cases of COVID-19 are related directly

Cases of COVID-19 are linked to tropospheric NO2 and vertical airflow to 0 Pa/s

Environmental and social factors are analyzed together in the regions of Peru