bluuebunny/crossref_metadata_2025 huggingface dataset:
Napoleonic Latin inscriptions
Authors: Turk Thomas N
Published: April 2020

Even though Napoleon Bonaparte was a mediocre Latin student, he made more extensive public use of that language throughout the French Empire than any secular ruler since Roman times. While Napoleon’s use of the images of imperial Rome to promote himself and his vision for France has been amply discussed elsewhere, the Latin inscriptions that accompanied this imperial imagery on medals and monuments have been largely overlooked. This article explores how Napoleon made use of these inscriptions for self-promotion and considers why Latin rather than French often appeared in public spaces. It also assesses who was responsible for the language and imagery of the inscriptions, where they appeared and who could read them and how.
Why Is Everyone Giving up on Our Son?
Authors: Ragsdale Lindsay B.
Published: April 2020

Understanding complex medical information can be challenging for patients and families. Especially with the large amount of information available online and in social media, maintaining clear communication and a concise plan of care can be challenging. Medical training teaches clinicians to ask questions pertaining to patients’ disease and symptoms, but this training commonly fails to prepare clinicians to assess how patients would choose to receive medical information. Medical teams should ask how patients and caregivers prefer to receive information and assess understanding of the information after tailoring the delivery to their preferences. They should allow for multiple routes of information exchange, which may vary between individuals in a family. Cultural and spiritual influences can impact understanding of medical information. Improved communication can clarify goals, improve patient care, and avoid conflicts.
You Can’t Stop the Machines!
Authors: Miller Elissa G.
Published: April 2020

It is not uncommon for families to request that providers “do everything” to help their dying child. However, there is no way a clinical team can do “everything”—families and care teams make choices and families must weigh the trade-offs inherent in those choices. By defining what “do everything” means to an individual patient or family and establishing goals of care, many families choose to follow the recommendations of a care team. However, some families continue to insist that “everything” must be done for their child. This chapter discusses working with patients and families who request “everything” and addresses some difficult scenarios in which families persist in their request, especially at end of life.
My Stomach Hurts
Authors: Flemig David
Published: April 2020

Pain is a subjective experience that can be attributed to a variety of sources, not all of them from underlying organic disease. Uncontrolled pain is common in pediatric patients with serious medical illness. A comprehensive approach, analyzing the various domains that contribute to the individual patient’s pain experience, is the starting point in determining a treatment plan. The treatment of physical pain is based on the etiology of the symptom and can be done with pharmacologic or nonpharmacologic means. When choosing a medication, it is important to consider treatment goals, the type of pain, and side effects of the available analgesic medications. This chapter explores a case of uncontrolled abdominal pain in a 14-year-old female.
The Withdrawn Child
Authors: Carroll Ricki , Levy Carly
Published: April 2020

The evaluation of pain in the neurologically impaired child can be difficult. Many of these children are unable to vocalize their symptoms and may instead exhibit a wide range of behaviors to indicate their discomfort. Pain occurs more frequently and at higher intensity for these children both because they are at risk for certain problems that are uncommon in typical childhood and because they can experience prolongation of symptoms due to challenges in locating the source. For many children within this population, a cause is not identified, and empiric medication trials and nonpharmacologic measures are utilized. This chapter presents a broad differential for suspected pain in the neurologically impaired child and discusses a range of interventions and therapies to consider.
Can’t Catch My Breath
Authors: O’Brien Juliana H.
Published: April 2020

Shortness of breath is one of the most common symptoms among pediatric palliative patients and can cause significant distress in patients and their caregivers. Dyspnea assessments highlight the patient’s subjective report as crucial to the evaluation and treatment of dyspnea. Symptom-directed treatments such as opioids and benzodiazepines should be given if disease-directed treatments are insufficient in providing dyspnea relief. In cases of dyspnea due to end-stage illness, palliative sedation or chronic mechanical ventilation via tracheostomy may need to be considered depending on the patient’s goals of care. This chapter presents a systems-based approach to evaluating and treating common causes of dyspnea in pediatric palliative care patients.
A Case of Refusing to Agree
Authors: Ellis Kelstan , Linebarger Jennifer
Published: April 2020

In the medical setting, a competent adult must give informed consent for medical interventions such as chemotherapy. Such a framework is designed to respect a person’s autonomy, often referred to as “respect of persons.” Consent requires the legal ability to enter into contract with adequate knowledge and information. As such, within pediatric medicine, consent is given by the legal guardian (typically the parents). A child’s ability to participate in medical decision-making can be complex. Multiple factors, such as age, disease and psychological state, prior experiences, and the significance of the decision, impact the child’s capability to participate in these decisions. Children may assent to treatments, whereas it is often their guardians who provide informed consent for treatments. This chapter distinguishes assent and consent, and it offers models for assessing capacity, soliciting assent, and navigating disagreements.
Gross Negligence Manslaughter in Healthcare: Time for a Restorative Justice Approach?
Authors: Farrell Anne-Maree , Alghrani Amel , Kazarian Melinee
Published: April 2020

This article explores the merits of employing a restorative justice approach in cases of gross negligence manslaughter involving healthcare professionals, in line with the recent policy turn towards developing a just culture in addressing episodes of healthcare malpractice within the National Health Service in England. It is argued that redress for victims and rehabilitation of offenders should operate as key values, underpinning the adoption of a restorative justice approach in such cases. It would also be vital that a structured pathway was designed that established suitable protocols and safeguards for both victims and offenders taking account of problematic issues such as the informality of the process, power asymmetries between parties, and the context in which the offence took place. Taking all such matters into account, we propose that consideration be given to establishing a pilot involving the use of restorative justice in cases of gross negligence manslaughter involving healthcare professionals, which would be subject to judicial and stakeholder oversight to ensure transparency and accountability, which in turn could inform future policy options.
Electromagnetic transients and gravitational waves from white dwarf disruptions by stellar black holes in triple systems
Authors: Fragione Giacomo , Metzger Brian D , Perna Rosalba , Leigh Nathan W C , Kocsis Bence
Published: April 2020

Mergers of binaries comprising compact objects can give rise to explosive transient events, heralding the birth of exotic objects that cannot be formed through single-star evolution. Using a large number of direct N-body simulations, we explore the possibility that a white dwarf (WD) is dynamically driven to tidal disruption by a stellar-mass black hole (BH) as a consequence of the joint effects of gravitational wave (GW) emission and Lidov–Kozai oscillations imposed by the tidal field of an outer tertiary companion orbiting the inner BH–WD binary. We explore the sensitivity of our results to the distributions of natal kick velocities imparted to the BH and WD upon formation, adiabatic mass loss, semimajor axes and eccentricities of the triples, and stellar-mass ratios. We find rates of WD–tidal disruption events (TDEs) in the range 1.2 × 10−3 − 1.4 Gpc−3 yr−1 for z ≤ 0.1, rarer than stellar TDEs in triples by a factor of ∼3–30. The uncertainty in the TDE rates may be greatly reduced in the future using GW observations of Galactic binaries and triples with LISA. WD–TDEs may give rise to high-energy X-ray or gamma-ray transients of duration similar to long gamma-ray bursts but lacking the signatures of a core-collapse supernova, while being accompanied by a supernova-like optical transient that lasts for only days. WD–BH and WD–NS binaries will also emit GWs in the LISA band before the TDE. The discovery and identification of triple-induced WD–TDE events by future time domain surveys and/or GWs could enable the study of the demographics of BHs in nearby galaxies.
Conscientious Objection and the Politics of Cake-Making
Authors: Moon Richard
Published: April 2020

In two recent cases, one in the USA and the other in the UK, courts have considered conscientious objection claims made by cake bakers who objected to providing a cake for the celebration/advocacy of same-sex marriage. I will argue that the issue in these cases is not the reasonable balance between the individual’s religious interests and the interests or rights of others in the community but is instead whether the individual’s religiously based objection should be viewed as an expression of personal religious conscience or as a (religiously grounded) civic position or action that falls outside the scope of religious freedom protection. In determining whether a conscientious objection should be viewed as a personal/spiritual matter or instead as a civic/political position, two factors are relevant. The first is whether the individual is being required to perform the particular act (to which she/he objects) because she/he holds a special position not held by others. The other factor is the relative remoteness/proximity of the act that the objector is required to perform from the act that she/he considers to be inherently immoral. The more remote the legally required action, the more likely we are to regard the objection as a political position.
Precision medicine in clinical oncology: the journey from IgG antibody to IgE
Authors: Fazekas-Singer Judit , Singer Josef , Jensen-Jarolim Erika
Published: April 2020

Purpose of review

Cancer is one of the leading causes of death and the incidence rates are constantly rising. The heterogeneity of tumors poses a big challenge for the treatment of the disease and natural antibodies additionally affect disease progression. The introduction of engineered mAbs for anticancer immunotherapies has substantially improved progression-free and overall survival of cancer patients, but little efforts have been made to exploit other antibody isotypes than IgG.

Recent findings

In order to improve these therapies, ‘next-generation antibodies’ were engineered to enhance a specific feature of classical antibodies and form a group of highly effective and precise therapy compounds. Advanced antibody approaches include among others antibody-drug conjugates, glyco-engineered and Fc-engineered antibodies, antibody fragments, radioimmunotherapy compounds, bispecific antibodies and alternative (non-IgG) immunoglobulin classes, especially IgE.

The current review describes solutions for the needs of next-generation antibody therapies through different approaches. Careful selection of the best-suited engineering methodology is a key factor in developing personalized, more specific and more efficient mAbs against cancer to improve the outcomes of cancer patients. We highlight here the large evidence of IgE exploiting a highly cytotoxic effector arm as potential next-generation anticancer immunotherapy.
Heterogenous Dose-escalated Prostate Stereotactic Body Radiation Therapy for All Risk Prostate Cancer
Authors: Parsai Shireen , Juloori Aditya , Sedor Geoffrey , Reddy Chandana A. , Thousand Richard , Magnelli Anthony , Berglund Ryan K. , Stovsky Mark , Klein Eric A. , Tendulkar Rahul D. , Stephans Kevin L.
Published: April 2020

Objectives:

Previous prostate stereotactic body radiation therapy studies delivered uniform doses of 35 to 40 Gy/5 fx. Attempts at uniform dose escalation to 50 Gy caused high rates of gastrointestinal (GI) toxicity. We hypothesize that heterogeneous dose escalation to regions nonadjacent to sensitive structures (urethra, rectum, and bladder) is safe and efficacious.

Materials and Methods:

Patients were enrolled on a prospective pilot study. The primary endpoint was treatment-related GI and genitourinary (GU) toxicity. The secondary endpoints included quality of life (QOL) assessed by the EPIC-26 questionnaire and biochemical control. The target volume received 36.25 Gy/5 fx. The target >3 mm from sensitive was dose escalated to 50 Gy/5 fx.

Results:

Thirty-five patients were enrolled. Three patients had low, 14 intermediate, and 18 high-risk disease. The mean initial prostate specific antigen was 15.1 ng/mL. Androgen deprivation therapy was given to 19 patients. Median follow-up was 46 months. Urinary irritation/obstructive and urinary bother scores declined by minimal clinically important difference threshold from baseline at 6 weeks, but subsequently recovered by 4 months. No differences in QOL scores were observed for urinary incontinence, bowel domain, bloody stools, or sexual domain. One patient developed acute grade 4 GU toxicity and acute grade 4 GI toxicity. The incidence of late high grade toxicity was 1/35 for GU toxicity and 2/35 for GI toxicity. Freedom from biochemical failure at 3 years was 88.0%.

Conclusions:

Heterogeneous dose-escalated prostate stereotactic body radiation therapy is feasible with low rates of acute and late toxicities and favorable QOL outcomes in patients with predominantly intermediate-risk and high-risk prostate cancer.
Implementation of Maternal Blood Cell Free DNA Testing in Early Screening for Aneuploidies
Authors: Gil María del Mar , Nicolaides Kypros H.
Published: April 2020

In the past 9 years, several externally blinded validation and implementation studies have shown that it is now possible, through analysis of cell-free (cf) DNA in maternal blood, to effectively detect a high proportion of fetuses affected by trisomies 21, 18, and 13 at a much lower false positive rate than all other existing screening methods. This article aims to review the technical and clinical considerations for implementing cfDNA testing in routine practice, including methods of analysis, performance of the test, models for clinical implementation, and interpretation of results.
Positive Rate of Noninvasive Prenatal Screening for Pregnancies with Fetal Congenital Heart Disease and Its Impact on Pregnancy Outcome
Authors: Chen Yun , Lai Yun-Li , Shen Yi-Ping , Tian Xiao-Xian , Zheng Chen-Guang , Wei Hong-Wei
Published: April 2020

Objective:

To evaluate the clinical utility of noninvasive prenatal screening (NIPS) for fetuses with congenital heart disease (CHD) and impact of NIPS results on pregnancy outcome.

Methods:

This was a retrospective study of pregnant women with fetuses diagnosed with CHDs by sonographic examination, who willing to underwent NIPS as a side-test for fetal aneuploidies. From August 2016 to October 2017, in the sonographic examination center of Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region. NIPS was offered to 117 women who carried fetuses with CHD diagnosed by fetal ultrasound (mean gestational age = 24 weeks). The pregnancy outcomes were followed-up.

Results:

NIPS positive rate in our pregnancies with CHD fetuses’ cohort is 11.1% (13/117), and the positive predictive value for aneuploidies is 85.7% (6/7). In the NIPS positive group (n = 13), all pregnancies terminated, 76.9% (10/13) of those decisions were made on ultrasound finding alone. In the NIPS negative group (n = 104), 2 lost follow-up, 79 pregnancies terminated, among which 77.2% (61/79) of the decision was made by ultrasound results alone. Twenty-three pregnancies continued and 78.3% of those fetuses carried single type CHD. In terminated pregnancies that did not considered NIPS results (71/115), 73.2% (52/71) of those carried fetuses with two or more types of CHDs.

Conclusion:

NIPS can detect common aneuploidy associated with CHD with high positive predictive value and screening yield. The NIPS result played certain meaningful roles in determining pregnancy outcomes, particularly for fetus with simplex CHD; yet the parents’ decision of pregnancy was mainly made based on ultrasound findings.
Genetic Variants of Potassium Voltage-gated Channel Subfamily J Member 11 in Gestational Diabetes Mellitus: A Case-control Study
Authors: Wei Li-Jie , Zhou Xuan , Zhu Sheng-Lan , Li Jia-Qi , Zeng Yu , Yu Jun , Wang Shao-Shuai , Feng Ling
Published: April 2020

Objective:

To investigate the association of rs5210 in potassium voltage-gated channel subfamily J member 11 (KCNJ11) with gestational diabetes mellitus (GDM).

Methods:

Six hundred and thirty-two uncorrelated pregnancy females were recruited in Tongji hospital from October 2017 to June 2018, in which 241 pregnant women were identified as GDM, and 391 were non-GDM. All the pregnant women recruited in this study their peripheral venous blood of 5 mL were withdrawn, and DNA in the blood was extracted. rs5210 in KCNJ11 were genotyped using TaqMan Assays and genotype models were analyzed using logistic regression analyses.

Results:

After adjusting age and body mass index, the variant genotypes of rs5210 in genotype models were as follows: P for dominant model was 0.945, (odd ratio: 0.987, 95% confidence intervals (CI): 0.681–1.430); P for recessive model: 0.556, (odd ratio: 1.217, 95% CI: 0.633–2.343) and P for addictive model was 0.098 (genotype AA vs. GG), (odds ratio: 1.435, 95% CI: 0.936–2.201). Weight-gain during pregnancy and total cholesterol were significantly different in recessive model (P = 0.015, P = 0.022, respectively) of all participants.

Conclusion:

No significant association between gene susceptibility of rs5210 in KCNJ11 and GDM occurrence in Chinese pregnant women. But the variant of rs5210 was associated with weight-gain during pregnancy and total cholesterol blood levels. However, more cases are needed in genetic study to check its susceptibility with GDM occurrence in Chinese women.
Metformin in Pregnancy with Diabetes—Opinions from Several Latest Guidelines
Authors: Feng Ye , Yang Hui-Xia
Published: April 2020

Pregnancy complicated with diabetes is associated with adverse maternal and fetal outcomes. Good control of glucose level during pregnancy contributes to improve maternal and fetal outcomes and break the vicious cycle of “diabetes begetting diabetes”. The first line antidiabetic drug in pregnancy is insulin, which is expensive and inconvenient to use. Lots of clinical trials and meta-analyses have constantly confirmed the safety and efficacy of metformin in pregnancy. Several guidelines across the world have been discussing metformin as an alternative to insulin in pregnancy. This article summarizes the opinions about metformin from several latest guidelines.
The Activation of Peroxisome Proliferator-activated Receptor γ Enhances Insulin Signaling Pathways Via Up-regulating Chemerin Expression in High Glucose Treated HTR-8/SVneo Cells
Authors: Zhou Xuan , Wei Li-Jie , Li Jia-Qi , Zhang Jing-Yi , Zhu Sheng-Lan , Zhang Hui-Ting , Jia Jing , Yu Jun , Wang Shao-Shuai , Feng Ling
Published: April 2020

Objective:

To investigate whether peroxisome proliferator-activated receptor γ (PPARγ) agonists, rosiglitazone and GW1929, activate the phosphatidylinositol 3-kinase (PI3K)-AKT/protein kinase B pathway and the mitogen-activated protein kinase (MAPK)/extracellular signal-regulated kinase1/2 (ERK1/2) pathway by upgrading the expression of chemerin.

Methods:

The HTR-8/SVneo trophoblastic cells were cultured in vitro in high glucose concentration (25 mmol/L) to mimic gestational diabetic phenotypes. We transfected small interfering RNA into HTR-8/SVneo cells to silence two receptors of chemerin, that are chemokine-like receptor 1 (CMKLR1) and G protein-coupled receptor1 (GPR1). And recombinant human chemerin, PPARγ agonists (rosiglitazone, 10 μmol/L and GW1929, 10 μmol/L) and PPARγ inhibitor (GW9662, 5 μmol/L) were additionally added to the medium, respectively. The existence of chemerin was verified by immunocytochemistry, and the expressions of PPARγ, chemerin, and its receptors as well as insulin signaling-related factors PI3K, AKT2, and MAPK (ERK1/2) were detected by real time quantitative-polymerase chain reaction and western blot.

Results:

Chemerin existed in the HTR-8/SVneo cells. Effects of chemerin on PI3K-AKT pathway and MAPK (ERK1/2) pathway were dependent on the density of chemerin. When rosiglitazone and GW1929 were added to the medium, the mRNA levels of PI3K, AKT2, and MAPK1 were upregulated (P < 0.05). Conversely, GW9662 downregulated the mRNA levels of AKT2 and MAPK1 (P < 0.05). Rosiglitazone and GW1929 increased the protein levels of PPARγ, chemerin, CMKLR1 and GPR1 (P < 0.05). Rosiglitazone and GW1929 had no effect on the expression of PI3K p110β and phospho-AKT2 without CMKLR1 (P 
> 0.05). Meanwhile, the expression of phospho-ERK2 remained unaffected in the absence of GPR1 (P 
> 0.05).

Conclusion:

Both rosiglitazone and GW1929 have the effect of improving insulin signaling pathways via upgrading the level of chemerin in high glucose treated HTR-8/SVneo cells.
Interactions Between Gut Microbiota and Hosts and Their Role in Infectious Diseases
Authors: Lv Long-Xian , Jiang Hui-Yong , Yan Ren , Li Lanjuan
Published: April 2020

Major infectious diseases, such as viral hepatitis, acquired immune deficiency syndrome, and tuberculosis, are difficult to eliminate within a short period. Dengue fever, global influenza pandemic, and ebola and other high-threat pathogens are now the main threats to human health as well. Therefore, it is particularly important to find new strategies for the prevention and treatment of infectious diseases. The human gut tract contains trillions of microbial cells, including bacteria, archaea, fungi and viruses. These microbes are defined as gut microbiota and play an important role in human development, immunity, metabolism and diseases. In this review, we analyzed the mechanisms by which alterations in gut microbiota affect infectious diseases and how infectious diseases regulate the structure and function of gut microbiota. Finally, we summarized and discussed methods used for the diagnosis, prevention and treatment of infectious diseases based on the alteration of gut microbiota.
Azithromycin Exerts Bactericidal Activity and Enhances Innate Immune Mediated Killing of MDR Achromobacter xylosoxidans
Authors: Ulloa Erlinda R. , Kousha Armin , Tsunemoto Hannah , Pogliano Joe , Licitra Carmelo , LiPuma John J. , Sakoulas George , Nizet Victor , Kumaraswamy Monika
Published: April 2020

Azithromycin (AZM), the most commonly prescribed antibiotic in the United States, is thought to have no activity against multidrug-resistant Gram-negative pathogens such as Achromobacter xylosoxidans (AX) per standard minimum inhibitory concentration testing in cation-adjusted Mueller Hinton Broth. Here we provide the first report of AZM bactericidal activity against carbapenem-resistant isolates of AX, with a multifold decrease in minimum inhibitory concentration across 12 clinical isolates when examined under physiologic testing conditions that better recapitulate the in vivo human environment. This pharmaceutical activity, evident in eukaryotic tissue culture media, is associated with enhanced AZM intracellular penetration and synergistic killing with human whole blood, serum, and neutrophils. Additionally, AZM monotherapy inhibited preformed AX biofilm growth in a dose-dependent manner together with a reduction in viable bacteria. In an illustrative case, AZM in combination with piperacillin-tazobactam exerted clear therapeutic effects in a patient with carbapenem-resistant AX mediastinitis, sternal osteomyelitis, and aortic graft infection. Our study reinforces how current antimicrobial testing practices fail to recapitulate the host environment or host-pathogen interactions and may misleadingly declare complete resistance to useful agents, adversely affecting patient outcomes. We conclude that AZM merits further exploration in the treatment of drug-resistant AX infections. Novel approaches to antimicrobial susceptibility testing that better recapitulate the host environment should be considered, especially as infections caused by multidrug-resistant Gram-negative bacterial pathogens are expanding globally with high morbidity and mortality.
Scabies Evaluated by Dermoscopy and Fluorescence Microscopy: A Case Report
Authors: Zhang Li-Wen , Wang Wen-Ju , Liu Xue-Ying , Xu Lei , Zheng Lu , Li Cong-Hui , Lu Yong-Hong
Published: April 2020

Introduction:

Scabies is an infectious skin disorder caused by the mite Sarcoptes scabiei. The diagnosis of scabies is often confirmed by microscopic detection of scabies mites, eggs, or feces.

We herein describe the diagnosis of scabies in a boy with the assistance of dermoscopy and fluorescence microscopy.

Case presentation:

A 16-year-old Chinese boy presented with a 2-month history of extensive papules and excoriations with intense pruritus on the trunk and limbs. Dermoscopy showed a sinuous burrow in the finger webs with a brown jet-shaped triangular structure at the end. A fluorescence microscopy revealed a hatching egg and a mite. The boy was diagnosed with scabies and treated with 5% sulfur ointment.

Discussion:

The use of dermoscopy in patients with scabies reveals a sinuous burrow with a brown jet-shaped triangular structure composed of the pigmented head and anterior legs of the mite[1]. A fluorescence microscopy revealed mites and eggs with blue fluorescence after staining, allowing us to easily identify scabies.

Conlcusion:

The combination of dermoscopy-guided tape testing with fluorescence staining technology may enhance the diagnostic accuracy and efficiency of scabies.
Papillon-Lefèvre Syndrome: A Case Report
Authors: Zhao Yu-Lei , Feng Zhao , Hu Bin , Chen Liu-Qing
Published: April 2020

Introduction:

Papillon-Lefèvre syndrome (PLS) is an autosomal recessive disorder characterized by a diffuse palmoplantar hyperkeratosis and early periodontal destruction. Only a few PLS cases are reported by dermatological clinicians due to its rarity.

Here, we reported a 16-year-old Chinese boy presented with diffuse transgradient palmoplantar hyperkeratosis since 4 years of age.

Case presentation:

The patient had also experienced recurrent episodes of swollen gums with premature loss of teeth. He is treated with multidisciplinary approaches. On follow-up, he continued to have recurrent gingival inflammation.

Discussion:

The etiopathogenesis of PLS is obscure and its management presents a special challenge, which call for in-depth studies that will reveal the complex interactions of genetic, immunologic, and microbiological factors involved in pathogenesis of PLS.

Conclusion:

PLS is a very rare genodermatosis with characterized palmoplantar hyperkeratosis. Dermatological clinicians should be aware of this rare clinical entity to promote its early diagnosis.
Co-occurrence of Vitiligo and Psoriasis in an 11-Year-Old Girl: A Case Report
Authors: Li Rong , Zhang Jia-An , Jiang Yi-Qun , Wu Min-Zhi , Chen Kun
Published: April 2020

Introduction:

Vitiligo and psoriasis are common skin diseases, while its co-occurrence in one patient is rare. Here, we reported a patient with co-occurrence of vitiligo and psoriasis.

Case presentation:

An 11-year-old girl developed depigmented patches on her right chin for 6 months. The noticed areas of depigmented skin steadily increased in size with no clinical symptoms. Wood's lamp examination and laser scanning confocal revealed the clinical diagnosis of co-occurrence of vitiligo and psoriasis.

Discussion:

Speculations related to co-pathogenesis of vitiligo and psoriasis are still elusive, some explanations of this phenomenon like of isomorphic reaction, shared genetic basis of autoimmunity and inflammation, shared cellular immune pathways including Th1, Th17 and related cellular molecules such as TNF-α, IFN-α, IL-17 have been reported.

Conclusion:

The analysis and summary of the underlying association in co-occurrence of psoriasis and vitiligo may amplify future therapeutic options for both disease.Clinicians should pay attention to the methods that could simultaneously improve these two conditions.
Behçet Disease with Generalized Polymorphous Cutaneous Lesions: A Case Report
Authors: Wang Li-Wei , Luo Ling-Ling , Zhang Wei , Zeng Xue-Si , Cui Pan-Gen
Published: April 2020

Introduction:

Behçet disease is a chronic multisystem vasculitis disease, however generalized polymorphous cutaneous lesions are uncommon.

Here, we reported a case of Behçet disease with multiple parts of the body and complex lesions, which may lead to misjudging in clinical diagnosis.

Case report:

A 69-year-old man presented with a seven-year history of recurrent generalized polymorphous mucocutaneous lesions (erythematous papules, nodules, ulcers, and necrosis) over his entire body, and the lesions had been painful for the past three years. Based on the past medical history, clinical presentation, histological examination excluded other diseases, and the 2014-amended International Criteria for Behget disease, the patient had a score of 6 points and was diagnosed as Behçet disease.

Discussion:

The common clinical feature in patients with Behçet syndrome is the presence of recurrent and usually painful mucocutaneous ulcers. Other clinical manifestations of this disorder are more variable among different patients. A diagnosis of generalized polymorphous cutaneous lesions should remain on the list of differential diagnosis of Behçet disease after excluding other diseases.

Conclusion:

The mucocutaneous lesions of Behçet disease are often preceded by other manifestations, and timely diagnosis may benefit early treatment and prognosis.
Bullous Pemphigoid With Nail Damage Associated With Kaposi Sarcoma: A Case Report
Authors: Hu Feng-Xia , Liang Jun-Qin , Abudoureyimu Dilinuer , Wu Cao-Ying , Kang Xiao-Jing
Published: April 2020

Introduction:

Bullous pemphigoid is an acquired autoimmune bullous skin disease that occurs in the elderly, and nail involvement is relatively rare. Kaposi sarcoma(KS) is a rare opportunistic tumor in patients with iatrogenic immunosuppression and is rarely associated with autoimmune bullotic disease.

Here we reported of a 73-year-old female with bullous pemphigoid with nail damage and KS.

Case presentation:

The patient was diagnosed with bullous pemphigoid based on her history, bullous pemphigoid antibody, and skin pathological examination. And nail involvement occurred 20 days prior to the recurrence of the disease. Moreover, KS occurred during high-dose glucocorticoid therapy in this patient.

Discussion:

The patient was admitted to hospital because of a five-month history of erythema and blisters and a one-month history of nodules and plaques. The diagnosis of bullous pemphigoid was followed by treatment with glucocorticoids and intravenous gamma globulin. During treatment, the disease recurred due to discontinuation of glucocorticoids. There were erythema and blisters all over the body, and purple nodules, plaques appeared in the base of some blisters. Pathological examination of nodules was consistent with KS. In addition, nail involvement occurred 20 days before recurrence. The particularity of this case lies in the simultaneous occurrence of nail involvement, bullous pemphigoid, and KS.

Conclusion:

Patients with autoimmune bullous skin disease may suddenly develop abnormal nails, and such patients should be vigilant about recurrence of the disease. Doctors should be aware of the possibility of KS when rapidly progressing purplish red plaques or nodules appear in patients receiving high doses of corticosteroids or immunosuppressants.
Automated Contact Tracing: a game of big numbers in the time of COVID-19
Authors: Kim Hyunju , Paul Ayan
Published: April 2020

One of the more widely advocated solutions for slowing down the spread of COVID-19 has been automated contact tracing. Since proximity data can be collected by personal mobile devices, the natural proposal has been to use this for automated contact tracing providing a major gain over a manual implementation. In this work, we study the characteristics of voluntary and automated contact tracing and its effectiveness for mapping the spread of a pandemic due to the spread of SARS-CoV-2. We highlight the infrastructure and social structures required for automated contact tracing to work. We display the vulnerabilities of the strategy to inadequate sampling of the population, which results in the inability to sufficiently determine significant contact with infected individuals. Of crucial importance will be the participation of a significant fraction of the population for which we derive a minimum threshold. We conclude that relying largely on automated contact tracing without population-wide participation to contain the spread of the SARS-CoV-2 pandemic can be counterproductive and allow the pandemic to spread unchecked. The simultaneous implementation of various mitigation methods along with automated contact tracing is necessary for reaching an optimal solution to contain the pandemic.
Modeling COVID-19 Growing Trends to Reveal the Differences in the Effectiveness of Non-Pharmaceutical Interventions among Countries in the World
Authors: Chen You , Feng Yubo , Yan Chao , Zhang Xinmeng , Gao Cheng
Published: April 2020

Objective

We hypothesize that COVID-19 case growth data reveals the efficacy of NPIs. In this study, we conduct a secondary analysis of COVID-19 case growth data to compare the differences in the effectiveness of NPIs among 16 representative countries in the world.

Methods

This study leverages publicly available data to learn patterns of dynamic changes in the reproduction rate for sixteen countries covering Asia, Europe, North America, South America, Australia, and Africa. Furthermore, we model the relationships between the cumulative number of cases and the dynamic reproduction rate to characterize the effectiveness of the NPIs. We learn four levels of NPIs according to their effects in the control of COVID-19 growth and categorize the 16 countries into the corresponding groups.

Results

The dynamic changes of the reproduction rate are learned via linear regression models for all of the studied countries, with the average adjusted R-squared at 0.96 and the 95% confidence interval as [0.94 0.98]. China, South Korea, Argentina, and Australia are at the first level of NPIs, which are the most effective. Japan and Egypt are at the second level of NPIs, and Italy, Germany, France, Netherlands, and Spain, are at the third level. The US and UK have the most inefficient NPIs, and they are at the fourth level of NPIs.

Conclusions

COVID-19 case growth data provides evidence to demonstrate the effectiveness of the NPIs. Understanding the differences in the efficacy of the NPIs among countries in the world can give guidance for emergent public health events.
Association between environmental pollution and prevalence of coronavirus disease 2019 (COVID-19) in Italy
Authors: Lippi Giuseppe , Sanchis-Gomar Fabian , Henry Brandon M.
Published: April 2020

The novel coronavirus disease 2019 (COVID-19) has recently been upgraded to a pandemic by the World Health Organization due to the alarming levels of spread and severity. Since several lines of evidence also attest that Lombardy region has an extraordinarily high level of environmental pollution, we aimed to explore the potential epidemiological association between the number of cases of COVID-19 and environmental pollution in Italy. Data on environmental pollution in Italy were retrieved from the 2019 annual report of the organization Legambiente (League for the Ambient). The adjusted correlation between the number of days in which environmental pollutants exceeded established limits and the overall number of COVID-19 cases reveals the existence of a highly significant positive association (r=0.66; 95% CI, 0.48-0.79; p<0.001). The association remained statistically significant even when the number of days above pollutant limits was correlated with the number of COVID-19 cases per 1000 inhabitants (r=0.43; 95% CI, 0.18-0.62; p=0.001). Living in a province with over 100 days per year in which environmental pollutants were exceeded was found to be associated with a nearly 3-fold higher risk of being positive for COVID-19 (0.014 vs. 0.005 COVID-19 cases per 1000 inhabitants; OR, 2.96; 95% 2.12-4.13; p<0.001). Reinforced restrictive measures shall be considered in areas with higher air pollution, where the virus is more likely to find a fertile biological or environmental setting.
GC-MS Analysis of Smokeless tobacco (Shamma): Toxicological Evaluation
Authors: Alzahrani Hamzah S. , Alamoudi Tariq S. , Aloudah Khaled S. , Alghamdi Fahad S. , Alghamdi Khalel S. , Ali Haytham A.
Published: April 2020

Background

Smoking is a badly addictive habit due to nicotine contents in tobacco. Shammah is one way of smokeless tobacco that is homely made and it use resulting in multiple medical issues.

Aim

The aim of the present study were to chemically analyze the content of various types of Shammah using GC-MS analysis with clinical biochemical investigation of some cases usually used shamma in Makkah region, Saudi Arabia.

Methods

Three samples from two main different types ofshamma (black and yellow)were collected from local providers and analyzed by Gas Chromatography Mass Spectrometry (GC/MS). Eighteen blood samples were also collected from apparently healthy male peoples (30-45 years) classified into 3 groups; group 1 (control) people who doesn’t smoke or use any type of shamma, second and third groups were people who usually used black and yellow shamma respectively; CBC and biochemical analysis were performed.

Results

In GC-MS Analysis, the nicotine represents the major constituent in all samples. Total RBCs count, Hemoglobin (HGB) Conc., eosinophil % and iron, total cholesterol, HDL-c concentrations were significantly decreased in peoples using either black or yellow shamma whereas serum levels of ALT, AST and ALP enzyme activities, BUN and creatinine levels were significantly increases.

Conclusion

Different shamma samples contains different concentrations of various toxic compounds that can produced a serious health problems as hypochromic anemia due to iron deficiency, decrease in eosinophil %, with hepatic and renal cell injuries detected as increase ALT, AST, ALP, BUN, and creatinine levels.
Small-sample estimation of the mutational support and the distribution of mutations in the SARS-Cov-2 genome
Authors: Rana Vishal , Chien Eli , Peng Jianhao , Milenkovic Olgica
Published: April 2020

Abstract

The problem of estimating unknown features of viral species using a limited collection of observations is of great relevance in computational biology. We consider one such particular problem, concerned with determining the mutational support and distribution of the SARS-Cov-2 viral genome and its open reading frames (ORFs). The mutational support refers to the unknown number of sites that is expected to be eventually mutated in the SARS-Cov-2 genome. It may be used to assess the virulence of the virus or guide primer selection for real-time RT-PCR tests during the early stages of an outbreak. Estimating the unknown distribution of mutations in the genome of different subpopulations while accounting for the unseen may aid in discovering adaptation mechanisms used by the virus to evade the immune system. To estimate the mutational support in the small-sample regime, we use GISAID sequencing data and new state-of-the-art polynomial estimation techniques based on weighted and regularized Chebyshev approximations. For distribution estimation, we adapt the well-known Good-Turing estimator. We also perform a differential analysis of mutations and their sites across different populations. Our analysis reveals several findings: First, the mutational supports exhibit significant differences in the ORF6 and ORF7a regions (older vs younger patients), ORF1b and ORF10 regions (females vs males) and as may be expected, in almost all ORFs (for Asia versus Europe and North America). Second, despite the fact that the N region of SARS-Cov-2 has a predicted 10% mutational support, almost all observed mutations fall outside of the two regions of paired primers recommended for testing by the CDC.

Author Summary

We introduce the new problem of small-sample estimation of the number of mutations and the distribution of mutations in viral and bacterial genomes, and in particular, in the SARS-Cov-2 genome. The approach is of interest due to the fact that it aims to predict which regions in the genome will mutate in the future and with what frequency, given only a very limited number of complete viral sequences. This setting is usually encountered during the early stages of an outbreak when it is critical to assess the potential of the virus to gain mutations advantageous for its spreading. The results may also be used to guide the selection of genomic (primer) regions that are not subject to mutational pressure and can consequently be used as identifiers in the process of testing for the disease. They can also highlight differences in the mutation rates and locations of the SARS-Cov-2 virus affecting diverse subpopulations and therefore potentially suggest the role of certain mutations in evading the immune system. Our approach uses a new class of estimation methods that may find other applications in bioinformatics.
ICU and ventilator mortality among critically ill adults with COVID-19
Authors: Auld Sara C. , Caridi-Scheible Mark , Blum James M. , Robichaux Chad , Kraft Colleen , Jacob Jesse T. , Jabaley Craig S. , Carpenter David , Kaplow Roberta , Hernandez-Romieu Alfonso C. , Adelman Max W. , Martin Greg S. , Coopersmith Craig M. , Murphy David J. ,   the Emory COVID-19 Quality and Clinical Research Collaborative
Published: April 2020

We report preliminary data from a cohort of adults admitted to COVID-designated intensive care units from March 6 through April 17, 2020 across an academic healthcare system. Among 217 critically ill patients, mortality for those who required mechanical ventilation was 29.7% (49/165), with 8.5% (14/165) of patients still on the ventilator at the time of this report. Overall mortality to date in this critically ill cohort is 25.8% (56/217), and 40.1% (87/217) patients have survived to hospital discharge. Despite multiple reports of mortality rates exceeding 50% among critically ill adults with COVID-19, particularly among those requiring mechanical ventilation, our early experience indicates that many patients survive their critical illness.
Joint antibiotic and phage therapy: addressing the limitations of a seemingly ideal phage for treatingStaphylococcus aureusinfections
Authors: Berryhill Brandon A. , Huseby Douglas L. , McCall Ingrid C. , Hughes Diarmaid , Levin Bruce R.
Published: April 2020

In response to increasing frequencies of antibiotic-resistant pathogens, there has been a resurrection of interest in the use of bacteriophage to treat bacterial infections: phage therapy. Here we explore the potential of a seemingly ideal phage, PYOSa, for combination phage and antibiotic treatment ofStaphylococcus aureusinfections. (i) This K-like phage has a broad host range; all 83 tested clinical isolates ofS.aureustested were susceptible to PYOSa. (ii) Because of the mode of action of PYOSaS. aureusis unlikely to generate classical receptor-site mutants resistant to PYOSa; none were observed in the 13 clinical isolates tested. (iii) PYOSakillsS. aureusat high rates. On the downside, the results of our experiments and tests of the joint action of PYOSaand antibiotics raise issues that must be addressed before PYOSais employed clinically. Despite the maintenance of the phage, PYOSadoes not clear the populations ofS. aureus. Due to the ascent of a phenotypically diverse array of small colony variants following an initial demise, the bacterial populations return to densities similar to that of phage-free controls. Using a combination of mathematical modeling andin vitroexperiments, we postulate and present evidence for a mechanism to account for the demise–resurrection dynamics of PYOSaandS. aureus. Critically for phage therapy, our experimental results suggest that treatment with PYOSafollowed by bactericidal antibiotics can clear populations ofS. aureusmore effectively than the antibiotics alone.

Significance Statement

The increasing frequency of antibiotic-resistant pathogens has fostered a quest for alternative means to treat bacterial infections. Prominent in this quest is a therapy that predates antibiotics: bacteriophage. This study explores the potential of a phage, PYOSa, for treatingStaphylococcus aureusinfections in combination with antibiotics. On first consideration, this phage, isolated from a commercial therapeutic cocktail, seems ideal for this purpose. The results of this population dynamic and genomic analysis study identify a potential liability of using PYOSafor therapy. Due to the production of potentially pathogenic atypical small colony variants, PYOSaalone cannot eliminateS. aureuspopulations. However, we demonstrate that by following the administration of PYOSawith bactericidal antibiotics, this limitation and potential liability can be addressed.
Comparison of Commercially Available and Laboratory Developed Assays for in vitro Detection of SARS-CoV-2 in Clinical Laboratories
Authors: Lieberman Joshua A. , Pepper Gregory , Naccache Samia N. , Huang Meei-Li , Jerome Keith R. , Greninger Alexander L.
Published: April 2020

Multiple laboratory developed tests and commercially available assays have emerged to meet diagnostic needs related to the SARS-CoV-2 pandemic. To date, there is limited comparison data for these different testing platforms. We compared the analytical performance of a laboratory developed test (LDT) developed in our clinical laboratory based on CDC primer sets and four commercially available, FDA emergency use authorized assays for SARS-CoV-2 (Cepheid, DiaSorin, Hologic Panther, and Roche Cobas) on a total of 169 nasopharyngeal swabs. The LDT and Cepheid Xpert Xpress SARS-CoV-2 assays were the most sensitive assays for SARS-CoV-2 with 100% agreement across specimens. The Hologic Panther Fusion, DiaSorin Simplexa, and Roche Cobas 6800 only failed to detect positive specimens near the limit of detection of our CDC-based LDT assay. All assays were 100% specific, using our CDC-based LDT as the gold standard. Our results provide initial test performance characteristics for SARS-CoV-2 RT-PCR and highlight the importance of having multiple viral detection testing platforms available in a public health emergency.