bluuebunny/crossref_metadata_2025 huggingface dataset:
Detailed reconstruction of trees from terrestrial laser scans for remote sensing and radiative transfer modelling applications
Authors: Janoutová Růžena , Homolová Lucie , Novotný Jan , Navrátilová Barbora , Pikl Miroslav , Malenovský Zbyněk
Published: August 2021

This study presents a method for three-dimensional (3D) reconstruction of forest tree species that are, for instance, required for simulations of 3D canopies in radiative transfer modelling. We selected three forest species of different architecture: Norway spruce (Picea abies) and European beech (Fagus sylvatica), representatives of European production forests, and white peppermint (Eucalyptus pulchella), a common forest species of Tasmania. Each species has a specific crown structure and foliage distribution. Our algorithm for 3D model construction of a single tree is based on terrestrial laser scanning (TLS) and ancillary field measurements of leaf angle distribution, percentage of current-year and older leaves, and other parameters that could not be derived from TLS data. The algorithm comprises four main steps: (i) segmentation of a TLS tree point cloud separating wooden parts from foliage, (ii) reconstruction of wooden parts (trunks and branches) from TLS data, (iii) biologically genuine distribution of foliage within the tree crown and (iv) separation of foliage into two age categories (for spruce trees only). The reconstructed 3D models of the tree species were used to build virtual forest scenes in the Discrete Anisotropic Radiative Transfer model and to simulate canopy optical signals, specifically: angularly anisotropic top-of-canopy reflectance (for retrieval of leaf biochemical compounds from nadir canopy reflectance signatures captured in airborne imaging spectroscopy data) and solar-induced chlorophyll fluorescence signal (for experimentally unfeasible sensitivity analyses).
Using evolutionary functional–structural plant modelling to understand the effect of climate change on plant communities
Authors: de Vries Jorad
Published: August 2021

The ‘holy grail’ of trait-based ecology is to predict the fitness of a species in a particular environment based on its functional traits, which has become all the more relevant in the light of global change. However, current ecological models are ill-equipped for this job: they rely on statistical methods and current observations rather than the mechanisms that determine how functional traits interact with the environment to determine plant fitness, meaning that they are unable to predict ecological responses to novel conditions. Here, I advocate the use of a 3D mechanistic modelling approach called functional–structural plant (FSP) modelling in combination with evolutionary modelling to explore climate change responses in natural plant communities. Gaining a mechanistic understanding of how trait–environment interactions drive natural selection in novel environments requires consideration of individual plants with multidimensional phenotypes in dynamic environments that include abiotic gradients and biotic interactions, and their combined effect on the different vital rates that determine plant fitness. Evolutionary FSP modelling explicitly simulates the trait–environment interactions that drive eco-evolutionary dynamics from individual to community scales and allows for efficient navigation of the large, complex and dynamic fitness landscapes that emerge from considering multidimensional plants in multidimensional environments. Using evolutionary FSP modelling as a tool to study climate change responses of plant communities can further our understanding of the mechanistic basis of these responses, and in particular, the role of local adaptation, phenotypic plasticity and gene flow.
Fitness cost of vancomycin-resistant Enterococcus faecium plasmids associated with hospital infection outbreaks
Authors: Tedim Ana P , Lanza Val F , Rodríguez Concepción M , Freitas Ana R , Novais Carla , Peixe Luísa , Baquero Fernando , Coque Teresa M
Published: August 2021

Background

Vancomycin resistance is mostly associated with Enterococcus faecium due to Tn1546-vanA located on narrow- and broad-host plasmids of various families. This study’s aim was to analyse the effects of acquiring Tn1546-carrying plasmids with proven epidemicity in different bacterial host backgrounds.

Methods

Widespread Tn1546-carrying plasmids of different families RepA_N (n = 5), Inc18 (n = 4) and/or pHTβ (n = 1), and prototype plasmids RepA_N (pRUM) and Inc18 (pRE25, pIP501) were analysed. Plasmid transferability and fitness cost were assessed using E. faecium (GE1, 64/3) and Enterococcus faecalis (JH2-2/FA202/UV202) recipient strains. Growth curves (Bioscreen C) and Relative Growth Rates were obtained in the presence/absence of vancomycin. Plasmid stability was analysed (300 generations). WGS (Illumina-MiSeq) of non-evolved and evolved strains (GE1/64/3 transconjugants, n = 49) was performed. SNP calling (Breseq software) of non-evolved strains was used for comparison.

Results

All plasmids were successfully transferred to different E. faecium clonal backgrounds. Most Tn1546-carrying plasmids and Inc18 and RepA_N prototypes reduced host fitness (–2% to 18%) while the cost of Tn1546 expression varied according to the Tn1546-variant and the recipient strain (9%–49%). Stability of Tn1546-carrying plasmids was documented in all cases, often with loss of phenotypic resistance and/or partial plasmid deletions. SNPs and/or indels associated with essential bacterial functions were observed on the chromosome of evolved strains, some of them linked to increased fitness.

Conclusions

The stability of E. faecium Tn1546-carrying plasmids in the absence of selective pressure and the high intra-species conjugation rates might explain the persistence of vancomycin resistance in E. faecium populations despite the significant burden they might impose on bacterial host strains.
Creation of a pharmacogenomics patient portal complementary to an existing institutional provider-facing clinical decision support system
Authors: Lipschultz Elizabeth , Danahey Keith , Truong Tien M , Schierer Emily , Volchenboum Samuel L , Ratain Mark J , O’Donnell Peter H
Published: August 2021

Background

Applied pharmacogenomics presents opportunities for improving patient care through precision medicine, particularly when paired with appropriate clinical decision support (CDS). However, a lack of patient resources for understanding pharmacogenomic test results may hinder shared decision-making and patient confidence in treatment. We sought to create a patient pharmacogenomics education and results delivery platform complementary to a CDS system to facilitate further research on the relevance of patient education to pharmacogenomics.

Methods

We conceptualized a model that extended the data access layer of an existing institutional CDS tool to allow for the pairing of decision supports offered to providers with patient-oriented summaries at the same level of phenotypic specificity. We built a two-part system consisting of a secure portal for patient use and an administrative dashboard for patient summary creation. The system was built in an ASP.NET and AngularJS architecture, and all data was housed in a HIPAA-compliant data center, with PHI secure in transit and at rest.

Results

The YourPGx Patient Portal was deployed on the institutional network in June 2019. Fifty-eight unique patient portal summaries have been written so far, which can provide over 4500 results modules to the pilot population of 544 patients. Patient behavior on the portal is being logged for further research.

Conclusions

To our knowledge, this is the first automated system designed and deployed to provide detailed, personalized patient pharmacogenomics education complementary to a clinical decision support system. Future work will expand upon this system to allow for telemedicine and patient notification of new or updated results.
Litterfall seasonality and adaptive strategies of tropical and subtropical evergreen forests in China
Authors: Dai Yuhang , Gong Fanxi , Yang Xueqin , Chen Xiuzhi , Su Yongxian , Liu Liyang , Wu Jianping , Liu Xiaodong , Sun Qingling
Published: August 2021

Tropical and subtropical evergreen broad-leaved forests (EBFs) and needle-leaved forests (ENFs) in China exhibit complex leaf shedding strategies in responses to soil water availability, vapor pressure deficits (VPDs) and sunlight availability. However, the seasonal variations and triggers of litterfall differ significantly in tropical/subtropical forests, and there are still many uncertainties. Herein, we aim to explore the distinct climatic factors of seasonal litterfall in a climate–phenology correlation framework. We collected seasonal litterfall data from 85 sites across tropical/subtropical China and used linear correlation coefficients between sunlight and rainfall to partition synchronous/asynchronous climates. Additional phase analysis and structural equation model analysis were conducted to model the climatic triggers of tropical phenology. Results indicated two types of tropical litterfall phenology under two types of climates. In synchronous climates, where seasonal sunlight and rainfall are positively correlated, the litterfall peak of the unimodal phenology and the first litterfall peak of the bimodal phenology both happen at the end of dry season. The second litterfall peak of the bimodal phenology occurs at the end of rainy season due to water stress. In asynchronous climates, where seasonal sunlight and rainfall are negatively correlated, VPD shows consistent seasonal variations with incoming sunlight. The leaf senescence is accelerated at the end of dry season by higher VPD; while soil water deficit is in anti-phase with sunlight and mainly controls the second litterfall peak of the bimodal phenology in EBF. Our findings provide an important reference for modeling tropical phenology in Earth system models.
Effects of Guitar Accompaniment Patterns on Hospitalized Infants: A Randomized Controlled Trial
Authors: Antonacci Kory , Steele Nicole , Wheatley Jacob , Weyant Donna M , Brozanski Beverly , Stone Brittany , Mingrone Teresa
Published: August 2021

A neonatal intensive care unit (NICU) can be an extremely stressful environment for infants receiving complex medical care at a pediatric facility. Music therapy can help address the stressful environment by increasing comfort and relaxation as well as decreasing a patient’s physiological response of heart rate and respiratory rate. A randomized controlled trial was completed, examining the effects of 2 guitar accompaniment patterns on infants (an arpeggiated pattern and a bass/chord pattern) in a NICU. There were 180 infants enrolled with mean chronological ages of 7.4 ± 6.1 weeks and postmenstrual ages (gestational age at birth + their chronological age) of 39.8 ± 7.9 weeks. All subject enrollees participated in a 12-minute initial music therapy session. Outcome measures included heart rate, respirations, and comfort responses. The results of the research study demonstrated that the arpeggiated guitar pattern had a lower mean heart rate and respiratory across all 3 data points (pre, during, and post intervention); however, the difference in means between the 2 accompaniment pattern groups was not statistically significant. Using the Neonatal Infant Pain Scale (NIPS) to measure comfort response, the results demonstrated no difference between the 2 group accompaniment patterns. Although the results show no significant differences among accompaniment pattern groups, the researchers describe the clinical significance that supports the use of both accompaniment patterns as suitable interventions for infants in the NICU receiving music therapy intervention.
Towards a computational phenomenology of mental action: modelling meta-awareness and attentional control with deep parametric active inference
Authors: Sandved-Smith Lars , Hesp Casper , Mattout Jérémie , Friston Karl , Lutz Antoine , Ramstead Maxwell J D
Published: August 2021

Meta-awareness refers to the capacity to explicitly notice the current content of consciousness and has been identified as a key component for the successful control of cognitive states, such as the deliberate direction of attention. This paper proposes a formal model of meta-awareness and attentional control using hierarchical active inference. To do so, we cast mental action as policy selection over higher-level cognitive states and add a further hierarchical level to model meta-awareness states that modulate the expected confidence (precision) in the mapping between observations and hidden cognitive states. We simulate the example of mind-wandering and its regulation during a task involving sustained selective attention on a perceptual object. This provides a computational case study for an inferential architecture that is apt to enable the emergence of these central components of human phenomenology, namely, the ability to access and control cognitive states. We propose that this approach can be generalized to other cognitive states, and hence, this paper provides the first steps towards the development of a computational phenomenology of mental action and more broadly of our ability to monitor and control our own cognitive states. Future steps of this work will focus on fitting the model with qualitative, behavioural, and neural data.
Explanatory profiles of models of consciousness - towards a systematic classification
Authors: Signorelli Camilo Miguel , Szczotka Joanna , Prentner Robert
Published: August 2021

Models of consciousness aim to inspire new experimental protocols and aid interpretation of empirical evidence to reveal the structure of conscious experience. Nevertheless, no current model is univocally accepted on either theoretical or empirical grounds. Moreover, a straightforward comparison is difficult for conceptual reasons. In particular, we argue that different models explicitly or implicitly subscribe to different notions of what constitutes a satisfactory explanation, use different tools in their explanatory endeavours and even aim to explain very different phenomena. We thus present a framework to compare existing models in the field with respect to what we call their ‘explanatory profiles’. We focus on the following minimal dimensions: mode of explanation, mechanisms of explanation and target of explanation. We also discuss the empirical consequences of the discussed discrepancies among models. This approach may eventually lead to identifying driving assumptions, theoretical commitments, experimental predictions and a better design of future testing experiments. Finally, our conclusion points to more integrative theoretical research, where axiomatic models may play a critical role in solving current theoretical and experimental contradictions.
In situ phase transitional polymeric vaccines for improved immunotherapy
Authors: Wang Jie , Wang Yi , Qiao Shenglin , Mamuti Muhetaerjiang , An Hongwei , Wang Hao
Published: August 2021

Cancer vaccines have exhibited immense potential in cancer treatment. Through activating the host's immune system, vaccines stimulate extensive functional T cells to eliminate cancer. However, the therapeutic efficacy of cancer vaccines is limited by their inferior lymph node delivery and inadequate uptake of dendritic cells. Herein, we propose an in situ phase transitional strategy on vaccine manufacturing to maximally enhance lymph node drainage while ensuring adequate dendritic cell uptake. The phase transitional vaccines, with dynamic size modulation property, retain a small size (24.4 ± 3.1 nm) during lymph node draining then transform into larger particles (483.0 ± 41.6 nm) on-site by external signal input. Results show that this strategy induced rapid and robust immune response in a mouse melanoma tumor model. Furthermore, a stronger humoral immune response was observed in mice when immunized with MHC-II restricted antigen, which demonstrated that lymph node-targeted cancer vaccine delivery could be effectively manipulated through dynamic size modulation.
Disease severity, flares and treatment patterns in adults with systemic lupus erythematosus in the UK: a real-world observational retrospective cohort analysis
Authors: Langham Julia , Barut Volkan , Samnaliev Mihail , Langham Sue , Weir Sharada , Wang Xia , Desta Barnabas , Hammond Edward
Published: August 2021

Objectives

The aim was to characterize disease severity, clinical manifestations, treatment patterns and flares in a longitudinal cohort of adults with SLE in the UK.

Methods

Adults with SLE were identified in the Clinical Practice Research Datalink–Hospital Episode Statistics database (1 January 2005–31 December 2017). Patients were required to have ≥12 months of data before and after the index date (earliest SLE diagnosis date available). SLE disease severity and flares were classified using adapted claims-based algorithms, which are based on SLE-related conditions, medications and health-service use.

Results

Of 802 patients, 369 had mild, 345 moderate and 88 severe SLE at baseline. A total of 692 initiated treatment in the first year after diagnosis. Five hundred and fifty-seven received antimalarials, 203 immunosuppressants and 416 oral CSs. Information on biologic use in hospitals was unavailable. The mean (S.d.) time to initiating any medication was 177 (385.3) days. The median time to first flare was 63 days (95% CI: 57, 71). At least one flare was experienced by 750 of 802 patients during follow-up; the first flare was mild for 549 of 750, moderate for 116 of 750 and severe for 85 of 750. The mean (S.d.) annual overall flare rate (year 1) was 3.5 (2.5). A shorter median time to first flare was significantly associated with moderate/severe disease (P < 0.001) and clinical manifestations (P < 0.001).

Conclusion

Our findings suggest some delay in the initiation of SLE treatment. Most patients experience a flare within 2 months of diagnosis. Early treatment might delay or reduce the severity of the first SLE flare and might translate to slower disease progression, lower accrual of organ damage and better outcomes.
Teacher–student neural coupling during teaching and learning
Authors: Nguyen Mai , Chang Ashley , Micciche Emily , Meshulam Meir , Nastase Samuel A , Hasson Uri
Published: August 2021

Human communication is remarkably versatile, enabling teachers to share highly abstracted and novel information with their students. What neural processes enable such transfer of information across brains during naturalistic teaching and learning? Here, a teacher was scanned in functional magnetic resonance imaging while giving an oral lecture with slides on a scientific topic followed by a review lecture. Students were then scanned while watching either the intact Lecture and Review (N = 20) or a temporally scrambled version of the lecture (N = 20). Using intersubject correlation, we observed widespread Teacher–Student neural coupling spanning sensory cortex and language regions along the superior temporal sulcus as well as higher-level regions including posterior medial cortex (PMC), superior parietal lobule, and dorsolateral and dorsomedial prefrontal cortex. Teacher–student alignment in higher-level areas was not observed when learning was disrupted by temporally scrambling the lecture. Moreover, teacher–student coupling in PMC was significantly correlated with learning: the more closely the student’s brain mirrored the teacher’s brain, the more the student improved their learning score. Together, these results suggest that the alignment of neural responses between teacher and students may reflect effective communication of complex information across brains in classroom settings.
Susceptibility of Rosaceous Pome and Stone Fruits to Postharvest Rot by Paecilomyces niveus
Authors: Wang Tristan W. , Hodge Kathie T.
Published: August 2021

Paecilomyces rot of apples is a postharvest disease caused by Paecilomyces niveus, a problematic spoiling agent of fruit juices and derivatives. Processing fruits infected with Paecilomyces rot can lead to juices contaminated with P. niveus ascospores. These ascospores are heat resistant and may survive food processing and germinate in finished products. Because the fungus produces the mycotoxin patulin, juice spoilage by P. niveus is an important health hazard. Little is known about the disease biology and control mechanisms of this recently described postharvest disease. The range of fruit products contaminated by P. niveus and patulin led us to hypothesize that the host range of Paecilomyces rot is broader than previously thought. Following Koch’s postulates, we determined that multiple untested rosaceous fruits and popular apple cultivars are susceptible to Paecilomyces rot infection and that these infected fruits contain significant levels of patulin. We also observed that two closely related food spoiling fungi, Paecilomyces fulvus and Paecilomyces variotti, were unable to infect, cause symptoms in, or grow in wounded fruits. Therefore, we challenge the assumption that P. niveus spoilage inoculum is introduced to foods solely through environmental sources, and we show that other economically important rosaceous fruits, peaches, pears, sweet cherries, and sour cherries, are susceptible to infection and can also be sources of spoilage inoculum. Our results highlight the unique abilities of P. niveus to infect a variety of fruits, produce patulin, and form resistant spores capable of spoiling normally shelf-stable products.
Exonic Circular RNAs Are Involved in Arabidopsis Immune Response Against Bacterial and Fungal Pathogens and Function Synergistically with Corresponding Linear RNAs
Authors: Wang Lin , Li Jiao , Guo Baohuan , Xu Le , Li Leyao , Song Xiaoning , Wang Xiaoyan , Zeng Xuebin , Wu Lihua , Niu Dongdong , Sun Kai , Sun Xiaoyong , Zhao Hongwei
Published: August 2021

Circular RNAs (circRNAs) are a group of covalently closed RNAs, and their biological function is largely unknown. In this study, we focused on circRNAs that are generated from exon back-splicing (exonic circRNAs). The linear RNA counterparts encode functional proteins so that we can compare and investigate the relationship between circular and linear RNAs. We compared circRNA expression profiles between untreated and Pseudomonas syringae-infected Arabidopsis and identified and experimentally validated differentially expressed exonic circRNAs by multiple approaches. We found that exonic circRNAs are preferentially enriched in biological processes that associate with biotic and abiotic stress responses. We discovered that circR194 and circR4022 are involved in plant response against P. syringae infection, whereas circR11208 is involved in response against Botrytis cinerea infection. Intriguingly, our results indicate that these exonic circRNAs function synergistically with their corresponding linear RNAs. Furthermore, circR4022 and circR11208 also play substantial roles in Arabidopsis tolerance to salt stress. This study extends our understanding of the molecular functions of plant circRNAs.
circFAM120A participates in repeated implantation failure by regulating decidualization via the miR‐29/ABHD5 axis
Authors: Zhou Tingting , Ni Tianxiang , Li Yan , Zhang Qian , Yan Junhao , Chen Zi‐Jiang
Published: August 2021

Repeated implantation failure (RIF) is a major problem that limits the pregnancy rate associated with assisted reproductive technology. However, the pathogenesis of RIF is still unknown. Recently, the expression levels of circular RNAs (circRNAs) were profiled in the endometrial tissues of patients with RIF. However, the exact role of circRNAs in RIF remains unclear. In our study, we found that circFAM120A levels were significantly down‐regulated in the endometrium at the window of implantation in RIF patients compared with non‐RIF controls. The suppression of circFAM120A expression inhibited decidualization in human endometrial stromal cells (hESCs). Furthermore, RNA‐seq analysis after circFAM120A knockdown revealed ABHD5 as a potential downstream target gene of circFAM120A. As expected, down‐regulating ABHD5 in hESCs also inhibited decidualization. Using the starBase and TargetScan databases, we predicted that miR‐29 may interact with ABHD5, based on nucleotide sequence matching. Luciferase reporter assay showed that miR‐29 bound to the 3′ UTR of ABHD5 at the predicted complementary sites. Moreover, miR‐29 mimics efficiently reduced ABHD5 expression levels and suppressed the decidualization process, whereas a miR‐29 inhibitor partly rescued ABHD5 mRNA expression level and decidualization reduced by the knockdown of circFAM120A. Therefore, circFAM120A modulated decidualization in RIF through the miR‐29/ABHD5 axis.
Cervical cancer screening guidelines
Authors: Shami Sarah , Coombs Jennifer
Published: August 2021

Cervical cancer screening practices in the United States have been inefficient, with variable screening rates. Some women are screened too frequently, overmanaged, lost to follow-up, or are at risk and should be screened but are not. Timely screening, identification, and management of abnormal cervical cells is vital in order to prevent progression to cervical cancer. Educating, counseling, screening, and offering the human papillomavirus vaccine continue to be the primary methods of cervical cancer prevention practices. Guidelines and primary screening methods have been updated because of supporting evidence, and clinicians must stay up-to-date in order to provide effective patient care.
Is the high-dose influenza vaccine better for people over age 65 years?
Authors: Haley Anna , Urnoski Eric
Published: August 2021

Influenza vaccinations are one of the largest public health initiatives each year. The vaccine's components are varied, and the high-dose influenza vaccine was designed to provide better protection for older adults. Patients may request the high-dose vaccine due to a perceived superior benefit. This article describes the vaccine formulations and whether older adults require high-dose compared with standard-dose vaccinations.
Characteristics of Second-Line Investigations of Middle-Aged Athletes Who Failed Preparticipation Examinations
Authors: Neuman Gil , Milman Anat , Ziv-Baran Tomer , Dubnov-Raz Gal
Published: August 2021

Objective:

The role of exercise testing during preparticipation examinations (PPEs) of middle-aged athletes is uncertain. This study examined the characteristics of disqualifications after an initial PPE that includes an exercise test in competitive athletes older than 30 years. We investigated disqualification rates and reasons, second-line investigations performed, and final decisions regarding competitive sports participation.

Design:

Chart review.

Setting:

Sports medicine clinic.

Participants:

Athletes aged >30 years that performed an exercise test as part of their annual PPE at our sports medicine clinic (n = 866).

Independent Variables:

Age, sex, height, weight, sport type, cardiovascular risk factors, and abnormal PPE findings.

Main Outcome Measures:

Additional investigations performed, approval/disqualification regarding competitive sports participation.

Results:

The initial disqualification rate of athletes was 9.8%. Three (3.6%) athletes were disqualified following questionnaire and physical examination, 19 (22.4%) because of resting electrocardiogram findings, and 65 (76.5%) following the exercise test. After additional work-up, only 5 athletes (0.4%) were ultimately found ineligible for competitive sports. From those, only 2 athletes (0.2%) were disqualified because of exercise test findings, which were episodes of supraventricular tachycardia and not ischemia-related.

Conclusions:

The addition of an exercise test to the PPE of middle-aged athletes is of limited value. If exercise testing of older athletes is performed, arrhythmias are probably of higher significance than ST-T changes.
Rare Cause of Syncope in an Athlete, Matter of Brain and Heart Electricity
Authors: Navot-Mintzer Dalya , Ekstein Dana , Nof Eyal , Fogelman Rami , Beinart Roy , Honig Asaf , Constantini Naama
Published: August 2021

A 17-year-old elite triathlete presented with recurrent loss of consciousness events. Implantable loop recorder (ILR) documented sinus node asystoles of up to 21 seconds. She underwent cardiac neuromodulation ablation. After ablation, a generalized tonic–clonic seizure (GTCS) occurred, without concomitant asystole on the ILR. Temporal lobe seizures were diagnosed and supported by interictal epileptic activity on electroencephalogram. We assumed that the syncope episodes were ictal asystole (IA) and that the IA terminated the epileptic seizures early after their onset. The cardiac ablation prevented IA, enabling spread of seizure activity and development of GTCS. To the best of our knowledge, this is the first case of IA treated with cardiac ablation, allowing avoidance of cardiac pacing. This case raises the awareness to epileptic seizures as a cause of asystole in athletes, with an elusive and atypical presentation.
Comparative study on the clinical characteristics of local cases of COVID-19 and imported cases from abroad
Authors: Liu Jing-He , Chang Yu-Fei , Ma Shan-Fang , Wang Ling-Hang
Published: August 2021

It is presently unknown whether imported cases of the 2019 coronavirus disease (COVID-19) have different characteristics when compared with local cases. To compare the clinical characteristics of local cases of COVID-19 in China compared with those imported from abroad.

This was a retrospective study of confirmed cases of COVID-19 admitted at the Beijing Ditan Fever Emergency Department between February 29th, 2020, and March 27th, 2020. The clinical characteristics of the patients were compared between local and imported cases.

Compared with local cases, the imported cases were younger (27.3 ± 11.7 vs. 43.6 ± 22.2 years, P < .001), had a shorter interval from disease onset to admission (1.0 (0.0–2.0) vs 4.0 (2.0–7.0) days, P < .001), lower frequencies of case contact (17.4% vs 94.1%, P < .001), fever (39.1% vs 82.4%, P < .001), cough (33.3% vs 51.0%, P = .03), dyspnea (1.9% vs 11.8%, P = .01), fatigue (7.5% vs. 27.5%, P = 0.001), muscle ache (4.7% vs. 25.5%, P < 0.001), and comorbidities (P < .05). The imported cases were less severe than the local cases, with 40.4% versus 5.9% mild cases, 2.8% versus 15.7% severe cases, and no critical cases (P < .001). The length of hospital stay was longer in imported cases than in local cases (32.3 ± 14.5 vs 21.7 ± 11.2 days, P < .001). The imported cases showed smaller biochemical perturbations than the local cases. More imported cases had no sign of pneumonia at computed tomography (45.0% vs 14.9%, P = .001), and none had pleural effusion (0% vs 14.9%, P < .001).

Compared with local cases, the imported cases of COVID-19 presented with milder disease and less extensive symptoms and signs.
Ultrasound guided microwave ablation of thyroid nodular goiter and cystadenoma
Authors: Honglei Gao , Shahbaz Muhammad , Farhaj Zeeshan , Ijaz Muhammad , Kai Sun Yu , Davrieux Carlos Federico , Cheng Sun Zuo
Published: August 2021

Thyroid nodules are one of the most common entities that affect the thyroid gland. Traditionally, their treatment was surgery. Currently, ablation combination with percutaneous procedure became a good option.

To analyze safety, efficacy, and describe our experience in microwave-ablation using ultrasound-guidance for benign thyroid nodules.

A total of 304 patients with 1180 thyroid nodules (thyroid cystadenoma and nodular goiter) were studied retrospectively. Two hundred sixty-seven patients who underwent microwave-ablation successfully in our hospital were enrolled in this study. The baseline, follow-up nodule volume, thyroid function tests, thyroid antibodies, and posttherapy complications were analyzed. The informed written consent was obtained from patients or guardians. The study was approved by the ethics committee of our hospital.

The average age was 50.1 ± 11.7 (21–83 years), 214 were women (80.1%) and 53 (19.9%) were men. The average number of nodules per patient was 4.02 ± 1.8 (1–8), 9.86%, 6.13%, and 84% located in the right thyroid lobe, left lobe, and bilateral, respectively. The average size of the nodules was 5.28 cm2 ± 3.63 (0.09–23.45 cm2). The average ablation time was 11 minutes ± 5.36 (3–20 minutes). The hospitalization period was 24 hours ± 10.16 (7–48 hours). Eighteen complications were reported. Postablation volume reduction rate was 54.74% and 93.3% at 3 and 12 months follow-up respectively (P < .05). The thyroid function tests, pre and postablation showed no significant changes (P > .05).

Ultrasound-guided microwave-ablation of thyroid nodules is safe and effective. More clinical trials are needed to define the true use of microwave-ablation.
Maternal tobacco exposure during pregnancy and allergic rhinitis in offspring
Authors: Zhou Yaqian , Chen JunRong , Dong Yunpeng , Shen Jinhua , Tian Mei , Yang Yide , Song Liujiang , Li Jian
Published: August 2021

Background:

Maternal tobacco exposure during pregnancy is known to cause a potential hazard to the offspring's health. So far, published studies have shown no consistent results with whether tobacco exposure in utero is causally linked to the development of allergic rhinitis in offspring. The aim of this study was to comprehensively evaluate the association between maternal tobacco exposure during pregnancy and allergic rhinitis in offspring by meta-analysis and to provide reference for clinical work.

Methods:

Literatures were searched in CNKI, Wanfang Data, VIP, SinoMed, PubMed, Web of science and Embase up to September 30,2020. Screening, inclusion, quality assessment, data extraction and data analysis of the literatures were conducted. Meta-analysis was performed with Revman 5.3 and State15.1 software. Odds ratio (OR) and 95%CI were used as observation indicators.

Results:

We had retrieved 16 articles with 22 independent datasets and 11,49,879 sample size. When all the studies were analyzed together, the results showed that maternal smoking exposure during pregnancy would increase the risk of allergic rhinitis in offspring (OR = 1.13, 95%CI:1.02–1.26), especially maternal passive smoking during pregnancy (OR = 1.39, 95%CI:1.05–1.84). But subgroup analysis showed that maternal active smoking during pregnancy was only significantly associated with offspring allergic rhinitis in cross-sectional studies (OR = 1.24, 95%CI:1.07–1.45) and study done in America study (OR = 1.22, 95%CI:1.05–1.42).

Conclusions:

Tobacco exposure during pregnancy could increase the risk of allergic rhinitis in offspring. The importance of avoiding prenatal tobacco exposure should be emphasized more for the health of next generation in the public.
Clinical outcomes of esophagogastroduodenoscopy in critically ill patients using high-dose proton pump inhibitor for suspected bleeding
Authors: Kwack Won Gun
Published: August 2021

Esophagogastroduodenoscopy (EGD) is a useful procedure performed for gastrointestinal (GI) bleeding. No definite clinical guidelines recommend EGD implementation in intensive care unit (ICU) patients with suspected GI bleeding. The objective of this study was to compare the clinical effectiveness of EGD in critically ill patients who are using high-dose proton pump inhibitor (PPI) for suspected GI bleeding.

We retrospectively analyzed ICU patients using high-dose PPI for suspected GI bleeding from January 2012 to September 2020. Major cases of GI bleeding, such as those with hematemesis and hematochezia, were excluded, and 1:1 propensity score matching was performed. The change in hemoglobin level, requirement of red blood cell transfusion, re-suspected bleeding event, length of ICU stay, and ICU mortality were compared between the EGD and non-EGD groups.

Of the 174 subjects included, 52 patients underwent EGD within 24 hours of PPI administration. In the EGD group, 22 (42.3%) patients showed normal findings, while esophagitis and gastritis were most common abnormal finding (n = 11, 21.2%), and 14 patients (26.9%) underwent a hemostatic procedure. While comparing the 2 groups, the EGD group required a higher amount of red blood cell transfusion (packs) than the non-EGD group for a week (3.04 ± 0.44 vs 2.07 ± 0.25, P = .01). There was no significant difference in the change in hemoglobin level after 1 week (P = .15). After propensity score matching, the EGD group showed similar the requirement of red blood cell transfusion and change in hemoglobin level for a week (P = .52, P = .97, respectively). In analyses for all patients and propensity score matched patients, there was no statistically significant difference in term of re-suspected bleeding event rate, duration of ICU stay, and ICU mortality. However, re-suspected bleeding event rate and ICU mortality were lower trend in the EGD group than the non-EGD group.

This study showed that EGD had no definite clinical benefit in ICU patients using high-dose PPI for suspected GI bleeding and aggressive EGD is not necessarily recommended. However, it is necessary to consider EGD in patients who are tolerant.
Sentinel lymph node mapping in early-stage cervical cancer
Authors: Wang Lijun , Liu Shanshan , Xu Ting , Yuan Linnan , Yang Xinyuan
Published: August 2021

Background:

The value of sentinel lymph node (SLN) mapping for early-stage cervical cancer remains controversial. Therefore, we collected data to investigate the feasibility and diagnostic accuracy of SLN in patients with early-stage (IA-IIA) cervical cancer.

Methods:

We searched Embase, PubMed, and the Cochrane Library databases issued before June 1, 2020. The sample size of the selected study was at least 10 patients with early-stage (IA-IIA) cervical cancer, the pooled detection rates and the separate detection rate (overall detection rate, bilateral detection rate) using blue dye with Tc, technetium 99 (Tc) and indocyanine green (ICG) technique of early-stage cervical cancer was reported. R-3.6.1 software was used to evaluate pooled detection rate and sensitivity.

Results:

Two thousand one hundred sixty-four patients included for analysis in 28 studies ranging from 12 to 405 patients. The combined overall detection rate of SLN mapping was 95% with a 72% pooled bilateral detection rate. The sensitivity of the combined overall detection rate of SLN mapping was 94.99% as well as a sensitivity of 72.43% bilateral detection rate. The overall detection rate of SLN was 96% for blue dye with Tc, 95% for Tc, 98% for ICG technique. The bilateral detection rate of SLN was 76% for blue dye with Tc, 63% for Tc, 85% for ICG technique. The sensitivity of the overall detection rate of SLN mapping was 97.76% as well as a sensitivity of 84.96% bilateral detection rate of ICG technique.

Conclusion:

In early-stage cervical cancer, overall detection rate of SLN mapping is elevated while bilateral detection rate is lower. The overall detection rate (98%) as well as bilateral rate (85%) of ICG seems to be a better SLN mapping technique among the method of SLN mapping (using blue dye with Tc, Tc or ICG). We believe SLN mapping may be considered contemporary technique which could provide additional benefits over traditional pelvic lymphadenectomy. While promising results in SLN mapping has been found, larger patient samples, including randomized studies, are required at the same time.
Second branchial cleft cyst with snoring during sleep as initial symptom
Authors: Xian Zhixiong , Chen Yongchao , Teng Yishu , Han Saihong , Li Lan
Published: August 2021

The second branchial cleft cyst lacks typical symptoms, and its clinical manifestations are complex and varied. Among them, the second branchial cleft cyst manifested by sleep snoring is relatively rare, and it can easily lead to missed diagnosis or misdiagnosis. This paper reports a case of a second branchial cleft abscess with snoring as the main manifestation. The branchial cleft cyst was removed using an endoscopic branchial cleft.
The usefulness of histopathology examples in teaching practical histology for medical students
Authors: Al Khader Ali , Odeh Hadeel , Salameh Muna A. , Kaddumi Ezidin G. , Al-Saghbini Mohamad , Obeidat Fatima N. , Abu Shahin Nisreen , Younes Nidal A.
Published: August 2021

Background:

Teaching histology as an image-intensive discipline is a major challenge to medical teachers. We compared knowledge retention and student preference after performing comparison-based and traditional methods of teaching practical histology.

Methods:

We performed a crossover randomized controlled trial. Eighty nine first-year and 37 second-year medical students were randomly assigned to comparison-based or traditional classes in which PowerPoint slides were used. Each teaching approach was then switched to another group for a second tissue set. Quantitative assessment was performed using multiple-choice questions and a questionnaire.

Results:

The first-year students’ overall examination scores were significantly higher in the comparison-based approach compared to the traditional approach for both tissue sets, with a large effect size. Interestingly, even for the second-year students, a significantly higher overall score for one set of tissue samples was observed in the comparison-based approach compared to the traditional approach. The students’ responses to all the elements in the questionnaire were significantly in favor of the comparison-based approach.

Conclusion:

Our findings indicate that the simple implementation of a few histopathology examples can yield a tremendous improvement in first-year medical students’ understanding, enjoyment, and engagement in practical histology classes.
The co-expression of CBX8 and PD-L1 and prognostic value in cervical cancer
Authors: Zhou Hui , Li Anhong , Li Chuan , Wu Mingyong , Jin Dan , Shui Mingcai
Published: August 2021

Chromobox homolog 8 (CBX8) plays an important role in the occurrence and development of various tumors, and is closely related to the prognosis of patients with cancer. However, the occurrence, development, and prognostic value of CBX8 in cervical cancer have not been reported yet.

In this study, immunohistochemistry was used to detect the expression of CBX8 in cervical cancer tissues and the corresponding normal tissues adjacent to the tumor. Furthermore, the relationship between CBX8 and programmed death-ligand 1 (PD-L1) expression, clinicopathological characteristics, and prognosis of cervical cancer were explored, and the prognostic value of CBX8 in cervical cancer was clarified.

In this study, the results of immunohistochemistry using tissue chips obtained from patients with cervical cancer showed that CBX8 was highly expressed in cervical cancer tissues, and its expression was proportional to the international federation of gynecology and obstetrics (FIGO) stage. Disease-free and overall survival of patients with high CBX8 expression in cervical cancer were significantly shorter than those of patients with low CBX8 expression. Thus, CBX8 was found to be an independent prognostic factor for patients with cervical cancer. In addition, CBX8 and PD-L1 co-expression model could better predict the prognosis of patients with cervical cancer, and its area under the receiver operating characteristic curve was similar to that of FIGO stage.

CBX8 may be an independent prognostic factor for cervical cancer. Moreover, the CBX8 and PD-L1 co-expression model could predict the postoperative survival of patients with cervical cancer objectively and reliably, which will aid clinicians to shunt patients with cervical cancer based on the risk of death, develop a reasonable treatment plan, and provide personalized prognosis.
Evaluating the impact of integrated behavioral health intervention
Authors: Thapa Bishnu Bahadur , Laws M. Barton , Galárraga Omar
Published: August 2021

There has been a historic separation between systems that address behavioral health problems and the medical care system that addresses other health issues. Integration of the 2 has the potential to improve care.

The aim of this study was to evaluate the impact of Integrated Behavioral Health program on health care utilization and costs.

Claims data between 2015 and 2018 from Rhode Island's All Payers Claims Database representing 42,936 continuously enrolled unique patients.

Retrospective study based on propensity score–matched difference-in-differences framework.

Utilization (emergency department visits, office visits, and hospitalizations) and costs (total, inpatient, outpatient, professional, and pharmacy).

Integrated Behavioral Health intervention in Rhode Island was associated with reduction in healthcare utilization. Emergency department visits reduced by 6.4 per 1000 people per month and office visits reduced by 29.8 per 1000 people per month, corresponding to a reduction of 7% and 6%, respectively. No statistically significant association was observed between the intervention and hospitalizations. The evidence was mixed for cost outcomes, with negative association recorded between the intervention and the likelihood of incurring non-zero cost but no significant association was observed between the intervention and the level of costs. This relationship held true for most of the cost measures considered.

Integrated Behavioral Health intervention in Rhode Island was associated with significant reductions in emergency department visits and office visits, with no effects on hospitalizations. In terms of the cost outcomes, we found evidence that the intervention negatively affected the likelihood of incurring any non-zero costs but did not affect the level of costs.
Sex steroid hormones are associated with mortality in COVID-19 patients
Authors: van Zeggeren Ingeborg E. , Boelen Anita , van de Beek Diederik , Heijboer Annemieke C. , Vlaar Alexander P.J. , Brouwer Matthijs C.
Published: August 2021

In patients with coronavirus disease 2019 (COVID-19), men are more severely affected than women. Multiple studies suggest that androgens might play a role in this difference in disease severity. Our objective was to assess the association between sex hormone levels and mortality in patients with severe COVID-19.

We selected patients from the Amsterdam University Medical Centers COVID-19 Biobank, in which patients admitted to hospital in March and April 2020, with reverse transcription-polymerase chain reaction proven severe acute respiratory syndrome-coronavirus-2 infection, were prospectively included. Specifically, we included postmenopausal women (>55 years) and age-matched men, with a mortality of 50% in each group. Residual plasma samples were used to measure testosterone, estradiol, sex hormone binding globulin (SHBG), and albumin. We investigated the association of the levels of these hormones with mortality in men and women.

We included 16 women and 24 men in March and April 2020 of whom 7 (44%) and 13 (54%), respectively, died. Median age was 69 years (interquartile range [IQR] 64–75). In men, both total and free testosterone was significantly lower in deceased patients (median testosterone 0.8 nmol/L [IQR 0.4–1.9] in deceased patients vs 3.2 nmol/L [IQR 2.1–7.5] in survivors; P < .001, and median free testosterone 33.2 pmol/L [IQR 15.3–52.2] in deceased patients vs 90.3 pmol/L [IQR 49.1–209.7] in survivors; P = .002). SHBG levels were significantly lower in both men and women who died (18.5 nmol/L [IQR 11.3–24.3] in deceased patients vs 34.0 nmol/L [IQR 25.0–48.0] in survivors; P < .001). No difference in estradiol levels was found between deceased and surviving patients.

Low SHBG levels were associated with mortality rate in patients with COVID-19, and low total and free testosterone levels were associated with mortality in men. The role of testosterone and SHBG and potential of hormone replacement therapy needs further exploration in COVID-19.