bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence of a strong relationship between hemispheric asymmetry in solar coronal rotation and solar activity during solar cycle 24
Authors: Sharma Jaidev , Malik Anil K , Kumar Brajesh , Vats Hari Om
Published: September 2020

In this paper, we report evidence of a very strong and statistically significant relationship between hemispheric asymmetry in the solar coronal rotation rate and solar activity. Our approach is based on the cross-correlation of the hemispheric asymmetry index (AI) in the rotation rate with annual solar activity indicators. To obtain the hemispheric asymmetry in the solar rotation rate, we use solar full disc (SFD) images at 30.4-, 19.5- and 28.4-nm wavelengths for the 24th solar cycle, that is, for the period from 2008 to 2018, as recorded by the Solar Terrestrial Relations Observatory (STEREO) space mission. Our analysis shows that the hemispheric asymmetry in rotation rate is high during the solar maxima from 2011 to 2014. However, hemispheric asymmetry decreases gradually on both sides (i.e. from 2008 to 2011 and from 2014 to 2018). The results show that the AI leads sunspot numbers by ∼ 1.56 yr. This is a clear indication that hemispheric asymmetry triggers the formation of sunspots in conjunction with the differential rotation of the Sun.
Optimizing LSST observing strategy for weak lensing systematics
Authors: Almoubayyed Husni , Mandelbaum Rachel , Awan Humna , Gawiser Eric , Jones R Lynne , Meyers Joshua , Tyson J Anthony , Yoachim Peter ,   LSST Dark Energy Science Collaboration
Published: September 2020

The Legacy Survey of Space and Time (LSST) survey will provide unprecedented statistical power for measurements of dark energy. Consequently, controlling systematic uncertainties is becoming more important than ever. The LSST observing strategy will affect the statistical uncertainty and systematics control for many science cases; here, we focus on weak lensing (WL) systematics. The fact that the LSST observing strategy involves hundreds of visits to the same sky area provides new opportunities for systematics mitigation. We explore these opportunities by testing how different dithering strategies (pointing offsets and rotational angle of the camera in different exposures) affect additive WL shear systematics on a baseline operational simulation, using the ρ-statistics formalism. Some dithering strategies improve systematics control at the end of the survey by a factor of up to ∼3–4 better than others. We find that a random translational dithering strategy, applied with random rotational dithering at every filter change, is the most effective of those strategies tested in this work at averaging down systematics. Adopting this dithering algorithm, we explore the effect of varying the area of the survey footprint, exposure time, number of exposures in a visit, and exposure to the Galactic plane. We find that any change that increases the average number of exposures (in filters relevant to WL) reduces the additive shear systematics. Some ways to achieve this increase may not be favorable for the WL statistical constraining power or for other probes, and we explore the relative trade-offs between these options given constraints on the overall survey parameters.
New X-shaped bulge photometric model as a tool for measuring B/PS bulges and their X-structures in photometric studies
Authors: Smirnov Anton A , Savchenko Sergey S
Published: September 2020

Recent orbital studies of 3D bar structure in various numerical and analytical models show that X-structures that reside in boxy/peanut-shaped (B/PS) bulges are not delineated by some specific type of orbits, but are natural parts of them and formed by the same orbits that constitute such bulges. This implies that to accurately account for B/PS bulges and their X-structures in photometric studies, one needs the photometric model of B/PS bulge that includes an X-structure as its natural part. To find such a model, we considered a self-consistent numerical galaxy model where a typical B/PS bulge arises. Using spectral characteristics of particle-‘stars’, we decomposed the galaxy model on to the bar and non-bar components. We used the extracted 3D bar component to find an appropriate B/PS bulge photometric model, which can account for X-structures residing in such bulges. The resulted B/PS bulge photometric model has a truncated 2D Sersic profile with truncations introduced above (in the upper half-plane) and below (in the bottom half-plane) the rays of X-structures. We applied this model to represent B/PS bulges of various numerical models and some real galaxies. The comparison with previous works revealed that there are systematic shifts between the X-structure parameters of the same galaxies measured within the different approaches. We found that the geometric parameters of X-structures of real and modelled galaxies are consistent with each other if we measure them using our new model.
Human SIRT1 Multispecificity Is Modulated by Active-Site Vicinity Substitutions during Natural Evolution
Authors: Hendler Adi , Akiva Eyal , Sandhu Mahakaran , Goldberg Dana , Arbely Eyal , Jackson Colin J , Aharoni Amir
Published: September 2020

Many enzymes that catalyze protein post-translational modifications can specifically modify multiple target proteins. However, little is known regarding the molecular basis and evolution of multispecificity in these enzymes. Here, we used a combined bioinformatics and experimental approaches to investigate the evolution of multispecificity in the sirtuin-1 (SIRT1) deacetylase. Guided by bioinformatics analysis of SIRT1 orthologs and substrates, we identified and examined important amino acid substitutions that have occurred during the evolution of sirtuins in Metazoa and Fungi. We found that mutation of human SIRT1 at these positions, based on sirtuin orthologs from Fungi, could alter its substrate specificity. These substitutions lead to reduced activity toward K382 acetylated p53 protein, which is only present in Metazoa, without affecting the high activity toward the conserved histone substrates. Results from ancestral sequence reconstruction are consistent with a model in which ancestral sirtuin proteins exhibited multispecificity, suggesting that the multispecificity of some metazoan sirtuins, such as hSIRT1, could be a relatively ancient trait.
Learning the heterogeneous hypermutation landscape of immunoglobulins from high-throughput repertoire data
Authors: Spisak Natanael , Walczak Aleksandra M , Mora Thierry
Published: September 2020

Somatic hypermutations of immunoglobulin (Ig) genes occurring during affinity maturation drive B-cell receptors’ ability to evolve strong binding to their antigenic targets. The landscape of these mutations is highly heterogeneous, with certain regions of the Ig gene being preferentially targeted. However, a rigorous quantification of this bias has been difficult because of phylogenetic correlations between sequences and the interference of selective forces. Here, we present an approach that corrects for these issues, and use it to learn a model of hypermutation preferences from a recently published large IgH repertoire dataset. The obtained model predicts mutation profiles accurately and in a reproducible way, including in the previously uncharacterized Complementarity Determining Region 3, revealing that both the sequence context of the mutation and its absolute position along the gene are important. In addition, we show that hypermutations occurring concomittantly along B-cell lineages tend to co-localize, suggesting a possible mechanism for accelerating affinity maturation.
Applying the Population Health Standard to the Regulation of Electronic Nicotine Delivery Systems
Authors: Cahn Zachary , Drope Jeffrey , Douglas Clifford E , Henson Rosemarie , Berg Carla J , Ashley David L , Eriksen Michael P
Published: September 2020

Regulatory authorities have devoted increasing attention and resources to a range of issues surrounding the regulation of novel nicotine and tobacco products. This review highlights the inherent complexity of evaluating prospective policies that pertain to products that heat solutions containing nicotine, but not tobacco leaf, sometimes referred to as electronic nicotine delivery systems (ENDS). The US Food and Drug Administration (FDA) is compelled to incorporate a set of public health criteria in their decision making, collectively referred to as the Population Health Standard. Adherence to this standard is necessary to estimate the impact of prospective ENDS policy decisions on net population harm associated with nontherapeutic nicotine products. For policies that are expected to decrease or increase ENDS use, application of the Population Health Standard requires a comprehensive assessment of the status quo impact of ENDS use on population health. Accordingly, this review first assesses the state of the evidence on the direct harms of ENDS and the indirect effects of ENDS use on smoking, particularly rates of initiation and cessation. After that, the example of flavor restrictions is used to demonstrate the further considerations that are involved in applying the Population Health Standard to a prospective ENDS policy.

Implications: This narrative review aims to inform regulatory considerations about ENDS through the prism of the Population Health Standard. More specifically, this review (1) describes and explains the importance of this approach; (2) provides guidance on evaluating the state of the evidence linking ENDS to the net population harm associated with nontherapeutic nicotine products; and (3) illustrates how this framework can inform policymaking using the example of flavor restrictions.
Mission-Oriented Policy for Innovation and the Fuzzy Boundary of Market Creation: the Brazilian Shipbuilding Case
Authors: Alves André C , Vonortas Nicholas S , Zawislak Paulo A
Published: September 2020

Recent literature has called attention to the significance of mission-oriented policies (MOPs) in setting the directions of change, market creation, and economic development. The aim of this article is to analyze and discuss the main challenges of setting MOPs in the context of developing countries. We do so by looking at the recent development of the Brazilian shipbuilding sector where an entire institutional setting was put in place to boost technological and industrial development. We investigate the policies set for the sector to create a market, stimulate the industry, and promote innovation. Results show that, while the set of policies emplaced was able to give an initial boost in the sector, coordination uncertainties and high capability-building costs precipitated the failure of the industry to catchup with international competitors. We argue that there is a fuzzy boundary between policy expectations for market creation and the actual possibilities of building an industry.
Experience and outcomes for PAs in a neonatal circumcision clinic
Authors: Colón-Sanchez Kaity , Middleton Tiernan , Ellsworth Pamela
Published: September 2020

Objective:

To evaluate the outcomes of neonatal circumcision performed by a PA in pediatric urology.

Methods:

A retrospective review was performed of infants evaluated for neonatal circumcision by a single PA in pediatric urology over 30 months. Technique, age and weight at circumcision, presence or absence of genital anomalies, and complications were gathered.

Results:

Of the 371 male infants evaluated for neonatal circumcision, 276 underwent the procedure. Complications included retained Plastibell (2.1%), penile adhesions (1.1%), swelling (1.8%), and cosmetic concerns (0.73%). Eighteen unanticipated postprocedure visits occurred—four in the ED and 14 in the outpatient clinic. No acute procedural complications occurred. One patient (0.3%) underwent lysis of penile adhesions at age 19 months.

Conclusion:

Neonatal circumcisions are commonly performed by nonsurgeons with variable formal circumcision training. These data support that well-trained PAs can perform neonatal circumcisions with low complication rates.
Analysis of Computed Tomography–Based Technique for Measuring Femoral Anteversion: Implications for Measuring Rotation After Femoral Intramedullary Nail Insertion
Authors: McAlister Ian P. , Marchand Lucas S. , Napora Joshua K. , Riedel Matthew D. , Shannon Steven S. , O'Hara Nathan N. , Langhammer Christopher G. , LeBrun Christopher , Nascone Jason W. , Sciadini Marcus F. , O'Toole Robert V.
Published: September 2020

Objectives:

To assess the reliability of the current computed tomography (CT)-based technique for determining femoral anteversion and quantify the prevalence and magnitude of side-to-side differences.

Design:

Cross-sectional cohort study.

Setting:

Academic trauma center.

Patients:

We reviewed CT scans from 120 patients with bilateral full-length axial cuts of both femurs. Two hundred forty femurs with no fractures or other identifying features in their femora were included. Ten unique data sets were created to measure anteversion of the left and right sides.

Main Outcome Measurements:

Intraobserver and interobserver reliability were calculated using intraclass correlation coefficients (ICCs) and pooled absolute differences. The mean absolute difference between the sides was determined using a fixed-effects model.

Results:

Interobserver reliability was high (ICC: 0.85, 95% confidence interval [CI]: 0.83–0.88). The pooled mean absolute magnitude of variation between reviewers was small at 1.6 degrees (95% CI: 1.4–1.8 degrees) per scan. The intraobserver reproducibility was high (ICC: 0.91, 95% CI: 0.88–0.93) with a mean error of 2.7 degrees (95% CI: 2.2–3.1 degrees) per repeat viewing of the same scan by the same person. The magnitude of side-to-side variation was 2.0 degrees (95% CI: 1.5–2.6 degrees). Twenty-one subjects (18%, 95% CI: 12%–25%) had a mean side-to-side calculated femoral anteversion difference of ≥10 degrees, whereas 6 (5%, 95% CI: 2–10) subjects had a calculated mean side-to-side difference of ≥15 degrees.

Conclusions:

CT based femoral anteversion measurement techniques demonstrate good precision. Only 1 in 20 patients had side-to-side differences of 15 degrees or more.
An Implementation Approach Comparison of a Child Care Center-Based Obesity Prevention Program
Authors: Natale Ruby A. , Atem Folefac , Weerakoon Sitara , Lebron Cynthia , Mathew M. Sunil , Sardinas Krystal , Chang Catherina , Shelnutt Karla P. , Spector Rachel , Altare Fiorella , Messiah Sarah E.
Published: September 2020

Objective:

To compare the effectiveness of the Healthy Caregivers-Healthy Children (HC2) phase 1 (2011–2014) and 2 (2015–2018) child care center (CCC)-based obesity prevention intervention(s) on child dietary practices and body mass index percentile (PBMI) outcomes over 2 years. Phase 1 was implemented via a university-based research team, and phase 2 was delivered via a train-the-trainers approach (university-based research team trains preschool-based coaches, who in turn train CCC teachers to implement and disseminate HC2).

Methods:

Phase 1 and 2 were both cluster randomized controlled trials of the HC2 obesity prevention intervention. Phase 1 was composed of 1224 children in 28 CCCs (12 intervention and 16 control). Phase 2 was composed of 825 children in 24 CCCs (12 intervention and 12 control). Both phases included CCCs serving low-resource, predominantly ethnic minority families.

Results:

The mean rate of weekly fruit consumption significantly increased (β = 0.16, p = 0.001) in phase 1, whereas vegetable intake significantly increased (β = 0.16, p = 0.002) in phase 2 intervention CCCs. Fried (β = −0.36, p < 0.001), fast (β = −0.16, p = 0.001), and other unhealthy food (β = −0.57, p < 0.001) consumption significantly decreased in phase 1 only. The mean rate of snack food consumption significantly decreased in phase 2 (β = −0.97, p < 0.001). Mean child PBMI remained in the healthy range over 2 years for all groups in both study phases.

Conclusion:

A university-based research team implementation and dissemination approach seemed to be more effective than a train-the-trainers implementation method in improving dietary intake patterns. This finding suggests that CCCs may need robust educational support beyond their existing internal resources for long-term positive dietary intake pattern changes.
Magnetic Resonance Imaging Evaluation of Changes in Gluteal Muscles After Treatments With the High-Intensity Focused Electromagnetic Procedure
Authors: Palm Melanie
Published: September 2020

BACKGROUND

High-intensity focused electromagnetic (HIFEM) field procedure induces changes in the gluteal muscles and improves the aesthetic appearance of the buttocks.

OBJECTIVE

This study aims to objectively assess the hypertrophic response of the gluteal muscles after HIFEM treatments.

MATERIALS AND METHODS

Seven subjects (40.00 ± 6.68 years) received 4, 30-minute HIFEM treatments of the buttocks. Magnetic resonance imaging of the pelvic region was obtained at baseline, 1-month, and 3-month follow-up to reconstruct 3D volumes of musculus
gluteus maximus, medius, and minimus. Volumetric changes were calculated and statistically analyzed. Standardized photographs, weight measurements, patient satisfaction, treatment comfort, and adverse events were also documented.

RESULTS

Volumetric analysis revealed a significant increase (p = .001) in the size of the examined muscles at 1-month (+10.81 ± 1.60%) and 3-month (+13.23 ± 0.91%) follow-up. A more profound hypertrophic effect was seen in the upper buttock region. This translated into a visible buttock lifting, also captured by patient photography. Gluteal adipose tissue was insignificantly affected. Patients were satisfied, and they found the treatments comfortable. No adverse events were observed.

CONCLUSION

Simultaneous enhancement of gluteal muscles was documented. This represents the first objective evaluation of the HIFEM-induced structural changes in the gluteal muscles and physiologic documentation of the aesthetic improvement previously reported by other authors.
Shorter Wait Times to Cardiac Rehabilitation Associated With Greater Exercise Capacity Improvements
Authors: Candelaria Dion , Zecchin Robert , Ferry Cate , Ladak Laila , Randall Sue , Gallagher Robyn
Published: September 2020

Purpose:

Comprehensive exercise-based cardiac rehabilitation (CR) results in improved, though highly variable, exercise capacity outcomes. Whether modifiable factors such as CR program wait time and session duration are associated with exercise capacity outcomes has not been adequately investigated.

Methods:

Patients with coronary heart disease (±primary and elective percutaneous coronary interventions, cardiac surgery) who participated in CR programs involved in a three-state audit (n = 32 sites) were eligible. Exercise capacity was measured using the 6-min walk test before and after a 6- to 12-wk supervised exercise program. CR program characteristics were also recorded (wait time, number of sessions). Correlations and linear mixed-effects models were used to identify associations between sociodemographic and CR program characteristics and change in exercise capacity.

Results:

Patients (n = 894) had a mean age of 65.9 ± 11.8 yr, 71% were males, 33% were referred for cardiac surgery, and median wait time was 16 d (interquartile range 9, 26). Exercise capacity improved significantly and clinically (mean increase 70.4 ± 61.8 m). After adjusting for statistically significant factors including younger age (<50 vs ≥80 yr [β = 52.07]), female sex (β = −15.86), exercise capacity at CR entry (β = 0.22) and those nonsignificant (ethnicity, risk factors, and number of sessions), shorter wait time was associated with greater exercise capacity improvement (β = 0.23).

Conclusions:

This study confirms that greater exercise capacity improvements occur with shorter wait times. Coordinators should prioritize implementing strategies to shorten wait time to optimize the benefits of CR.
Improved Outcome of Pythium Keratitis With a Combined Triple Drug Regimen of Linezolid and Azithromycin
Authors: Sane Sayali S. , Madduri Bhagyasree , Mohan Nitin , Mittal Ruchi , Raghava J. V. , Fernandes Merle
Published: September 2020

Purpose:

To describe the clinical features, microbiological profile, and outcome of a series of cases of Pythium keratitis treated with topical and oral linezolid and topical azithromycin eye drops.

Methods:

This was a retrospective interventional case series of microbiologically and/or histopathologically proven cases of Pythium keratitis seen between October 2016 and December 2019. All patients received a combination of topical linezolid and/or azithromycin eye drops with oral linezolid. Analysis of demographic data, predisposing risk factors, microbiological results, treatment regimen, visual acuity, surgical intervention, and final outcome was performed. A subgroup analysis of cases >6 mm in size was performed. Success was defined as complete resolution on medical management. Failure was defined as worsening of infection necessitating therapeutic penetrating keratoplasty or evisceration.

Results:

Of 21 cases, 2 were lost to follow up, 1 was diagnosed on histopathology, and 1 received only topical linezolid. Characteristic microbiological features were noted on 10% potassium hydroxide calcofluor white wet mount in 20/21 (95.23%) and Gram stain in 18/21 (85.71%). On triple drug regimen, 14/17 cases (82.35%) resolved. Average time to resolution was 87.64 ± 44.44 days. More than 60% infiltrates (13/21) were large, and 66.66% infiltrates resolved in 109.3 ± 57.06 days. Of the 5 failures, 4 needed therapeutic keratoplasty and 1 needed evisceration. All grafts failed.

Conclusions:

The dual topical drug regimen with oral linezolid has good cure rates (over 80%) for Pythium keratitis over prolonged duration. It is recommended to persevere with medical therapy even in large infiltrates because more than two thirds resolved.
Age-Related Corneal Transparency Changes Evaluated With an Alternative Method to Corneal Densitometry
Authors: Consejo Alejandra , Jiménez-García Marta , Rozema Jos J.
Published: September 2020

Purpose:

To compare densitometry distribution analysis (DDA), a platform-independent method to assess corneal transparency, with traditional corneal densitometry.

Methods:

A total of 196 healthy participants aged 43.3 ± 18.0 years (range 18–79 years) were recruited for assessment. All participants were assessed using the corneal densitometry analysis add-on to the standard software of the Oculus Pentacam HR. In addition, the Scheimpflug image corresponding to the horizontal meridian of each participant was exported for further analysis. For each image, corneal pixel intensities were statistically modeled. The estimated output parameters, α and β, were compared with the corresponding densitometry values. The analysis was performed considering 3 concentric areas and 3 layers defined at fixed corneal depths. To demonstrate the platform independence of the DDA method, a randomly selected subset of 80 participants also had their eye measured with Oculus Corvis ST.

Results:

α and β were found to be well correlated with densitometry, especially α (overall cornea; r = 0.89, P < 0.001), independent of the corneal region investigated. Changes in α, β, and corneal densitometry were correlated with age.

Conclusions:

In this work, we presented the relationship of DDA with age and traditional corneal densitometry. The α and β parameters, the output of DDA, are platform independent and can be used to investigate corneal clarity objectively.
Outbreak of Enterovirus D68 Among Children in Japan—Worldwide Circulation of Enterovirus D68 Clade B3 in 2018
Authors: Ikuse Tatsuki , Aizawa Yuta , Yamanaka Takayuki , Habuka Rie , Watanabe Kanako , Otsuka Taketo , Saitoh Akihiko
Published: September 2020

Background:

Enterovirus D68 (EV-D68) causes asthma-like respiratory infection in children. Several EV-D68 outbreaks have been reported worldwide since the largest outbreak occurred in the United States in 2014. We experienced an accumulation of pediatric cases with asthma-like respiratory illness in Niigata, Japan, in 2018.

Study design:

To determine whether EV-D68 was responsible for the case accumulation, this prospective observational study evaluated children hospitalized in 1 of 8 hospitals with asthma-like respiratory illness in Niigata, Japan, during October and November 2018. Diagnoses were made by EV-D68–specific RT-PCR using nasopharyngeal samples. The clade was identified by sequence analyses, and a phylogenetic tree was created. To evaluate seasonal variation, data from pediatric cases with asthma-like respiratory illness in 2018 were retrospectively analyzed.

Results:

In 2018, 114 children were hospitalized with asthma-like respiratory illness in October and November, and 47 nasopharyngeal samples were collected. EV-D68 was detected in 22/47 (47%) patients during the study period. The phylogenetic tree revealed that all strains belonged to the clade B3 branch, which has been detected worldwide every 2 years since 2014.

Conclusions:

EV-D68 was the associated pathogen for asthma-like respiratory illness in children in Japan in 2018. Clade B3, the dominant clade in outbreaks worldwide, was responsible for the outbreak. Detection and detailed virologic analysis of EV-D68 is important as part of worldwide surveillance, as it will aid in understanding the epidemiologic characteristics of EV-D68 infection.
Maternal, Perinatal and Neonatal Outcomes With COVID-19: A Multicenter Study of 242 Pregnancies and Their 248 Infant Newborns During Their First Month of Life
Authors: Marín Gabriel Miguel A , Reyne Vergeli Mar , Caserío Carbonero Sonia , Sole Laia , Carrizosa Molina Tamara , Rivero Calle Irene , Cuadrado Pérez Irene , Álvarez Fernández Blanca , Forti Buratti Azul , Fernández-Cañadas Morillo Aurora ,   on behalf of the Neo-COVID-19 Research Group
Published: September 2020

Background:

Our aim was to describe the clinical features of mothers with coronavirus disease 2019 (COVID-19) infection during gestation or delivery, and the potential vertical transmission. We also wish to evaluate the possible horizontal transmission after hospital discharge, by means of a follow-up of all the newborns included at 1 month of age.

Methods:

This multicenter descriptive study involved 16 Spanish hospitals. We reviewed the medical records of 242 pregnant women diagnosed with COVID-19 from March 13 to May 31, 2020, when they were in their third trimester of pregnancy. They and their 248 newborn infants were monitored until the infant was 1 month old.

Results:

Caesarean sections (C-sections) were performed on 63 (26%) women. The initial clinical symptoms were coughing (33%) and fever (29.7%). Mothers hospitalized due to COVID-19 pathology had a higher risk of ending their pregnancy via C-section (P = 0.027). Newborns whose mothers had been admitted due to their COVID-19 infection had a higher risk of premature delivery (P = 0.006). We admitted 115 (46.3%) newborn infants to the neonatal unit, of those, 87 (75.6%) were only admitted due to organizational circumstances. No infants died and no vertical or horizontal transmission was detected. Regarding type of feeding, 41.7% of the newborns received exclusive breast-feeding at discharge and 40.4% at 1 month.

Conclusions:

We did not detect COVID-19 transmission during delivery or throughout the first month of life in the newborns included in our study. Exclusive breast-feeding rates at discharge and at 1 month of age were lower than expected.
Tomographically normal partner eye in very asymmetrical corneal ectasia: biomechanical analysis
Authors: Fraenkel Doris , Hamon Loïc , Daas Loay , Flockerzi Elias , Suffo Shady , Eppig Timo , Seitz Berthold
Published: September 2020

Purpose:

To point out the biomechanical changes of the topographically and tomographically normal partner eye (NPE) in patients with very asymmetrical corneal ectasia.

Setting:

Department of Ophthalmology, Saarland University Medical Center in Homburg/Saar, Germany.

Design:

Retrospective study.

Methods:

The topographical and tomographical results of the NPE were assessed using the Pentacam HR and the biomechanical corneal properties using the Ocular Response Analyzer (keratoconus match index [KMI], corneal hysteresis [CH], and corneal resistance factor [CRF]) and the Corvis ST (topographic biomechanical index [TBI] and Corvis biomechanical index) and compared those results with a normal control group (CG).

Results:

The clinical records of 26 patients recruited from the Homburg Keratoconus Center diagnosed with a very asymmetrical corneal ectasia were reviewed. The NPE (8.5 ± 1.5 mm Hg) showed a significantly more pathological CH (P < .001) compared with the CG. The CRF was also significantly more pathological (P = .04) for the NPE (8.3 ± 1.5 mm Hg) compared with the CG. The NPE (0.62 ± 0.32) showed a nonsignificant (P = .08) more pathological KMI compared with the CG. Nineteen (73.1%) of 26 NPE had a KMI less than 0.72 and were considered pathological. Compared with the CG, the TBI of the NPE (0.19 ± 0.25) did not differ significantly overall (P = .57). However, 5 (19.2%) of 26 eyes had a TBI more than 0.29 and were considered pathological.

Conclusions:

Topographically and tomographically NPEs in very asymmetrical corneal ectasia frequently showed biomechanical changes. This should be considered before planning any type of refractive corneal surgery in such patients.
Congenital iris coloboma repair with excision of colobomatous sphincter muscle
Authors: Ogawa Gregory S.H.
Published: September 2020

Congenital iris colobomas do not usually present a major optical issue until the time of cataract surgery, when an intraocular lens is placed in the eye that is roughly half the diameter of the crystalline lens. Leaving the coloboma unrepaired or sutured closed without addressing the sphincter muscle in the coloboma often creates visual challenges for the eye postoperatively. The problem has previously been addressed, in part, with a technique that creates a scissor snip between the normal iris sphincter and the colobomatous iris sphincter, but still requires notable peripheral iris traction and root disinsertion for closure of the defect. The technique presented here removes all iris sphincter from the sides of the coloboma allowing closure of the colobomatous defect without the need to create iridodialyses. In certain cases, the use of iris diathermy can be used to create focal iris contraction to maximize sphericity and centration of the pupil.
Systematic review and meta-analysis of the effectiveness and safety of hydroxychloroquine in treating COVID-19 patients
Authors: Yang Tzu-Han , Chou Chian-Ying , Yang Yi-Fan , Chien Chian-Shiu , Yarmishyn Aliaksandr A. , Yang Tzu-Ying , Liu Cheng-Hsuan , Chang Kao-Jung , Yang Yi-Ping , Chang Yuh-Lih
Published: September 2020

Background:

Since COVID-19 outbreak, hydroxychloroquine (HCQ) has been tested for effective therapies, and the relevant researches have shown controversial results.

Methods:

Systematic review and meta-analysis were conducted after a thorough search of relevant studies from databases. Trials that have evaluated HCQ for COVID-19 treatment were recruited for statistical analysis with fixed- and random-effect models.

Results:

Nine trials involving 4112 patients were included in present meta-analysis. It was seen that HCQ-azithromycin (HCQ-AZI) combination regimen increased the mortality rate in COVID-19 (odds ratio [OR], 2.34; 95% confidence interval [CI], 1.63–3.36) patients; however, it also showed benefits associated with the viral clearance in patients (OR, 27.18; 95% CI, 1.29–574.32). HCQ-alone when used as a therapy in COVID-19 did not reveal significant changes in mortality rate, clinical progression, viral clearance, and cardiac QT prolongation. Subsequent subgroup analysis showed that HCQ treatment could decrease mortality rate and progression to severe illness in severely infected COVID-19 patients (OR, 0.27; 95% CI, 0.13–0.58). A lower risk of mortality rate was also noted in the stratified group of >14 days follow-up period (OR, 0.27; 95% CI, 0.13–0.58) compared to ≤14 days follow-up period group that conversely showed an increased mortality rate (OR, 2.09; 95% CI, 1.41–3.10).

Conclusion:

Our results indicated that HCQ-AZI combination treatment increased mortality rate in patients with COVID-19, but it also showed benefits associated with viral clearance in patients. HCQ-alone used for treatment has revealed benefits in decreasing the mortality rate among severely infected COVID-19 group and showed potential to be used for COVID-19 treatment in long-term follow-up period group. Accordingly, more rigorous, large-scale, and long follow-up period studies in patients with COVID-19 are needed.
XEN45 Gel Stent implantation in eyes with primary open angle glaucoma: A study from a single hospital in Taiwan
Authors: Chao Yu-Jang , Ko Yu-Chieh , Chen Mei-Ju , Lo Kang-Jung , Chang Yu-Fan , Liu Catherine Jui-Ling
Published: September 2020

Background:

To evaluate the effectiveness and safety of the XEN45 Gel Stent in East Asian patients with primary open angle glaucoma (POAG).

Methods:

We retrospectively reviewed 37 medically uncontrolled POAG patients who received XEN45 Gel Stent. The primary outcomes were reduction in intraocular pressure (IOP) and in the number of glaucoma medications 12 months after surgery. The secondary outcomes were requirement for intervention and further glaucoma surgery. The adverse intraoperative and postoperative events were investigated.

Results:

At the 12-month postoperative follow-up, the mean IOP was significantly reduced from the preoperative value of 21.7 ± 7.7 mmHg to 15.0 ± 2.0 mmHg (p = 0.001). The mean number of glaucoma medications decreased from 3.4 ± 0.9 to 1.3 ± 1.5 (p < 0.001). Seventeen patients (45.9%) required postoperative interventions. Four patients (10.8%) received additional glaucoma surgery. Postoperative IOP at month 1 was significantly associated with outcomes at the 12-month follow-up and the need for subsequent intervention and additional glaucoma surgery.

Conclusion:

The XEN45 Gel Stent effectively reduced the IOP values and number of glaucoma medications in East Asian patients with POAG. No major complications were observed, but almost half of the eyes in the study required intervention for wound healing modification. Postoperative IOP at month 1 was a predictor of surgical success at 12 months after surgery.
Gay and Bisexual Men in the US Lack Basic Information About Anal Cancer
Authors: Wheldon Christopher W. , Maness Sarah B. , Islam Jessica Y. , Deshmukh Ashish A. , Nyitray Alan G.
Published: September 2020

Objective

The purpose of this study was to assess knowledge of human papillomavirus (HPV) as a cause of anal cancer among at-risk gay, bisexual, and other men who have sex with men (GBM).

Materials and Methods

Secondary analysis was conducted of cross-sectional data from 3 cycles of the Health Information National Trends Survey (2017, 2018, 2019). Results were reported for the subset of adults who identified as GBM (N = 212). Knowledge that HPV can cause anal cancer was the main outcome. Differences in knowledge were evaluated (using χ2 and multiple logistic regression) by demographic, health information factors, and access to care.

Results

Sixty-eight percent of GBM were aware of HPV. Knowledge that HPV causes anal cancer was low (<20%) in the overall sample and sample of GBM (17.9%; 95% CI = 11.0–24.7). Gay, bisexual, and other men who have sex with men were no more knowledgeable that HPV causes anal cancer than heterosexual men (14.8%; 95% CI = 12.9–16.9; p = .376). College-educated GBM had higher odds (adjusted odds ratio = 3.50; 95% CI = 1.02–11.97) of knowing HPV causes anal cancer than GBM with no college degree. No other factors were associated with knowledge.

Conclusions

Gay, bisexual, and other men who have sex with men are largely unaware that HPV can cause anal cancer, despite high awareness of HPV itself. This is concerning given that GBM are at increased risk of HPV-associated anal cancer than the general population. Our findings suggest that information about anal cancer and health information about the benefits of HPV vaccination for anal cancer prevention are only reaching a small subset of college-educated GBM. Targeted anal cancer education programs are needed.
Association between history of cancer and major adverse cardiovascular events in patients with chest pain presenting to the emergency department: a secondary analysis of a prospective cohort study
Authors: Faramand Ziad , Li Hongjin , Al-Rifai Nada , Frisch Stephanie O. , Abu-Jaradeh Omar , Mahmoud Ahmad , Al-Zaiti Salah
Published: September 2020

Objectives

Cancer survivorship status among patients evaluated for chest pain at the emergency department (ED) warrants high degree of suspicion. However, it remains unclear whether cancer survivorship is associated with different risk of major adverse cardiac events (MACE) compared to those with no history of cancer. Furthermore, while HEART score is widely used in ED evaluation, it is unclear whether it can adequately triage chest pain events in cancer survivors. We sought to compare the rate of MACE in patients with a recent history of cancer in remission evaluated for acute chest pain at the ED to those with no history of cancer, and compare the performance of a common chest pain risk stratification score (HEART) between the two groups.

Methods

We performed a secondary analysis of a prospective observational cohort study of chest pain patients presenting to the EDs of three tertiary care hospitals in the USA. Cancer survivorship status, HEART scores, and the presence of MACE within 30 days of admission were retrospectively adjudicated from the charts. We defined patients with recent history of cancer in remission as those with a past history of cancer of less than 10 years, and currently cured or in remission.

Results

The sample included 750 patients (age: 59 ± 17; 42% females, 40% Black), while 69 patients (9.1%) had recent history of cancer in remission. A cancer in remission status was associated with a higher comorbidity burden, older age, and female sex. There was no difference in risk of MACE between those with a cancer in remission and their counterparts in both univariate [17.4 vs. 19.5%, odds ratio (OR) = 0.87 (95% confidence interval (CI), 0.45–1.66], P = 0.67] and multivariable analysis adjusting for demographics and comorbidities [OR = 0.62 (95% CI, 0.31–1.25), P = 0.18]. Patients with cancer in remission had higher HEART score (4.6 ± 1.8 vs. 3.9 ± 2.0, P = 0.006), and a higher proportion triaged as intermediate risk [68 vs. 56%, OR = 1.67 (95% CI, 1.00–2.84), P = 0.05]; however, no difference in the performance of HEART score existed between the groups (area under the curve = 0.86 vs. 0.84, P = 0.76).

Conclusions

There was no difference in rate of MACE between those with recent history of cancer in remission compared to their counterparts. A higher proportion of patients with cancer in remission was triaged as intermediate risk by the HEART score, but we found no difference in the performance of the HEART score between the groups.
Nurses' Role in Providing Comprehensive Communication, Prognostication, and Palliative Care During the COVID-19 Pandemic
Authors: Koch Amie , Mantzouris Stephen
Published: September 2020

This article presents the case of a mother of young children who has terminal stage IV cancer with whom providers had not discussed goals of care and prognostication. Communications about prognostication and goals of care are commonly initiated by physicians. Adolescents and young and middle-age adults with complex chronic or terminal illness often are not provided with timely, clear, complete information or palliative care support. Early palliative care for chronically ill patients facilitates discussions of prognostication and goals of care, in addition to providing symptom management. Such discussions do not diminish hope but rather allow patients to adjust hope to attain an optimal quality of life. Nurses can become active, confident advocates for patients with terminal illness of any age, and they are well positioned to assess patients and engage in goals of care and end-of-life conversations. It is especially important that palliative care nurses promote and maintain these early and comprehensive discussions during the COVID-19 pandemic because this population is at a high risk of complications from the coronavirus.
Neo-Sagittal Suture Formation After Cranial Vault Remodeling in Sagittal Craniosynostosis
Authors: Chaisrisawadisuk Sarut , Anderson Peter J. , Moore Mark H.
Published: September 2020

Craniosynostosis is a condition where the cranial sutures are early fused. Sagittal suture synostosis is found to be the most prevalent. Many techniques ranging from simple suture excision to wide suturectomy have been developed for treating this condition. While repeated fusion of previously excised involved sutures is common, neosuture formation has been identified in many recent reports after craniosynostosis surgery. In this case report, the authors present a finding of the neosuture formation in a patient presented with sagittal craniosynostosis after wide suturectomy with total cranial vault remodeling so that the pathologically fused suture can be reversed.
Emotional Traumatic Brain Injury
Authors: Shulman Lisa M.
Published: September 2020

The definition of traumatic brain injury (TBI) has expanded to include mild TBI and postconcussive syndrome. This evolution has resulted in difficulty disentangling the physical trauma of mild TBI from the emotional trauma of posttraumatic stress disorder (PTSD). Advances in stress neurobiology and knowledge of brain injury at the macroscopic, microscopic, biochemical, and molecular levels call for a redefinition of TBI that encompasses both physical and emotional TBI. Conceptualizing a spectrum of TBI with both physical and emotional causation resolves the irreconcilable tangle between diagnostic categories and acknowledges overlapping forms of brain injury and shared systemic effects due to hormonal and inflammatory mediators. Recognizing emotional TBI shifts the interpretation of emotional trauma from a confound to a comorbid, related cause of brain injury. The mechanism of emotional TBI includes the intricate actions of stress hormones on diverse brain functions due to changes in synaptic plasticity, where chronically elevated hormone levels reduce neurogenesis, resulting in dendritic atrophy and impaired cognition. The overlapping effects of physical and emotional trauma are seen in neuropathology (ie, reduction of hippocampal volume in TBI and PTSD); fMRI (similar regional activations in physical and emotional pain); and systemic sequelae, including changes in proinflammatory cytokine levels and immune cell function. Accumulating evidence favors a change in the definition of TBI to encompass emotional TBI. The definition of TBI will be strengthened by the inclusion of both physical and emotional trauma that result in diverse and overlapping forms of brain injury with sequelae for physical and mental health.
Nocardioides flavescens sp. nov., isolated from soil of Gaoligong Mountain, PR China
Authors: Zhang Kun , Jiang Long-Qian , An De-Feng , Lang Lei , Li Gui-Ding , Jiang Ming-Guo , Li Qin-Yuan , Jiang Cheng-Lin , Jiang Yi
Published: September 2020

A Gram-stain-positive, non-motile, aerobic, rod-shaped, golden yellow-pigmented actinobacterium, designated strain YIM 123512T, was isolated from soil sampled at Gaoligong Mountain, Yunnan Province, PR China. The strain grew at 10–40 °C (optimum, 28 °C), with 0–3.0 % (w/v) NaCl (optimum, 0–1.0 %) and at pH 5.0–11.0 (optimum, pH 7.0). The major menaquinone was MK-8(H4) and the major cellular fatty acids (>10 %) were identified as iso-C16 : 0 and C17 : 1
 ω8c. Strain YIM 123512T had ll-2, 6-diaminopimelic acid as the diagnostic cell-wall diamino acid. The major polar lipids were found to be diphosphatidylglycerol, phosphatidylglycerol, two unknown phospholipids and one unknown lipid. The genomic DNA G+C content of strain YIM 123512T was 72.7 mol% based on its draft genome sequence. Phylogenetic analysis based on the 16S rRNA gene sequence indicated that strain YIM 123512T appeared to be most closely related to

Nocardioides halotolerans

KCTC 19274T (97.7 % sequence similarity) and to belong to the genus

Nocardioides

. The sequence similarity values of strain YIM 123512T to other currently described type strains of the genus

Nocardioides

were less than 97.0 %. Based on the draft genome sequence, the novel strain showed an average nucleotide identity value of 80.2 % and a digital DNA–DNA hybridization value of 23.1 % with the reference strain

N. halotolerans

KCTC 19274T. The results of the polyphasic taxonomic study including phenotypic, chemotaxonomic and phylogenetic analyses show that strain YIM 123512T represents a novel species of the genus

Nocardioides

, for which the name Nocardioides flavescens sp. nov. is proposed. The type strain is YIM 123512T (=KCTC 49303T=CGMCC 4.7628T).
Azoarcus halotolerans sp. nov., a novel member of Rhodocyclaceae isolated from activated sludge collected in Hong Kong
Authors: Li Shuyang , Zhao Lin , Han Jingyi , Liu Shuangyuan , Dai Jingcheng , Fu Guiping , Qiu Dongru
Published: September 2020

A floc-forming bacterial strain, designated HKLI-1T, was isolated from the activated sludge of a municipal sewage treatment plant in Hong Kong SAR, PR China. Cells of this strain were Gram-stain-negative, strictly aerobic, catalase- and oxidase-positive, rod-shaped and motile by means of a single polar flagellum. Growth occurred at 18–37 °C (optimum, 28 °C), pH 5.5–9.0 (optimum, pH 7.5) and with 0–8.0 % (w/v) NaCl (optimum, 1–1.5 %) concentration. The major fatty acids of strain HKLI-1T were C16 : 0 and summed feature 3 (C16 : 1 ω7c and/or C16 : 1 ω6c). The polar lipid profile contained diphosphatidylglycerol, phosphatidylethanolamine, phosphatidylglycerol and three unidentified lipids. The DNA G+C content was 63.5 mol% from whole genomic sequence analysis. Based on the results of 16S rRNA gene sequences analysis, this strain should be assigned to the genus

Azoarcus

and is closely related to

Azoarcus olearius

DQS-4T (94.93 % 16S rRNA gene sequence pairwise similarity),

Azoarcus toluclasticus

MF63T (94.91 %) and

Azoarcus communis

SWub3T (94.01 %), but separate from them by large distances in different phylogenetic trees. Based on whole genome analysis, the orthologous average nucleotide identity and in silico DNA–DNA hybridization values against four of the closest relatives were 73.03–74.83 and 17.2–23.0 %, respectively. The phylogenetic, genotypic, phenotypic and chemotaxonomic data demonstrated that strain HKLI-1T could be distinguished from its phylogenetically related species, and that this strain represented a novel species within the genus

Azoarcus

, for which the name Azoarcus halotolerans sp. nov. is proposed. The type strain is HKLI-1T (= 72659T=CCTCC AB 2019312T).