bluuebunny/crossref_metadata_2025 huggingface dataset:
A case report of a pregnant woman infected with coronavirus disease 2019 pneumonia
Authors: Peng Jing , Li Ruobing , Yin Heng , Tang Fei , Xie Hui , Li Min , Zhao Yun
Published: July 2020

Rationale:

Since the end of December 2019, the outbreak of coronavirus disease 2019 (COVID-19) epidemic has occurred and spread rapidly throughout China. At present, China's epidemic situation has been basically controlled, but the number of cases worldwide is increasing day by day. On March 11, the WHO officially announced that the COVID-19 had become a global pandemic. However, there are currently limited data on pregnant women with COVID-19 pneumonia and their infants. In this paper, a case of a pregnant woman infected with COVID-19 pneumonia is reported.

Patient concerns:

We report a clinically confirmed COVID-19 pregnant woman. The patient was tested negative 4 times in nucleic acid test, but immunoglobulin G was positive and immunoglobulin M was negative before delivery, suggesting a previous infection.

Diagnoses:

The pregnant woman underwent a computed tomography scan of both lungs at 29 + 2 weeks of pregnancy, and scattered stiffness and frosted glass shadows of both lungs were observed. According to the diagnostic criteria for COVID-19 pneumonia in the “New Coronavirus Prevention and Control Plan Fifth Edition” of the National Health Commission of China, she was diagnosed as a clinically confirmed case.

Interventions:

The pregnant women received nebulized inhalation and oral cephalosporin treatment in a community hospital and was discharged after the symptoms disappeared. After that, she was isolated at home.

Outcomes:

The pregnant woman gave birth to a healthy baby after being cured from COVID-19 infection. The nucleic acid test of the neonatal pharyngeal swab was negative, and the neonatal serum test showed positive for immunoglobulin G and negative for immunoglobulin M.

Lessons subsections:

The findings of this case report are useful for understanding the possible clinical features of COVID-19 infection in pregnant women, the duration of the antibody, and passive immunity of the fetus.
Optic disc melanocytoma with normal tension glaucoma and angle closure glaucoma
Authors: Kim Dae Sung , Park Hae Min , Lim Han Woong , Lee Won June
Published: July 2020

Rationale:

Optic disc melanocytoma is an ophthalmic tumor that arises from melanocytes, and is a variant of the melanocytic nevus. Here we report 2 cases of optic disc melanocytoma in Asian patient: one associated with normal tension glaucoma (NTG), and the other associated with angle closure glaucoma (ACG).

Patient concerns:

Case 1 is a 57-year-old Asian female presented to our department for a general ophthalmic examination. Incidentally, brownish pigmented lesion was found on dilated fundus examination of her right eye. The fundus examination and optical coherence tomography (OCT) examination revealed a mass within optic disc, and superotemporal retinal nerve fiber layer (RNFL) thinning. The Humphrey visual field test showed corresponding visual field defect. Fluorescein angiography showed no leakage around the lesion. Case 2 is a 78-year-old Asian woman presented with complaints of acute bilateral ocular pain. The initial examination revealed shallow anterior chamber. Under the impression of intermittent angle closure attack, prophylactic laser peripheral iridotomy were performed. On dilated fundus examination, black pigmented lesion was found at superior sector of optic disc. Further examination revealed bilateral superotemporal, inferotemporal RNFL thinning on OCT, and spatially corresponding visual field defects.

Diagnoses:

Clinical diagnosis of NTG was made for case 1 patient. Although it was a little distant from typical glaucomatous changes, nevertheless she had RNFL defect compatible with visual field defects. Considering her normal IOP and angle structures, we believe NTG was a probable diagnosis for the patient. In case 2, we made diagnosis of ACG presenting as intermittent angle closure attack because of her presenting symptoms, narrowing of anterior chamber and angle structures found on gonioscopic and slit lamp examinations.

Interventions:

In Case 1, we prescribe 0.005% latanoprost ophthalmic solution. In Case 2, at first prophylactic laser peripheral iridotomy was performed. Then, topical eyedrops administration was started, and the patient was examined periodically.

Outcomes:

In Case 1, at 6 months’ follow-up, OCT and visual field test showed no progression. In Case 2, to this date, the optic disc melanocytoma remains stable for over a 6-year-follow-up period.

Lessons:

The fact that NTG and ACG can coexist in patients with melanocytoma of optic disc should be recognized, and the possibility of such should appropriately be evaluated.
The association between body mass index and the risk of different urinary cancers
Authors: Zhao Wenli , Shi Jiyuan , Chen Yamin , Song Ziwei , Si Liangliang , Jiang Xin , Gu Yu
Published: July 2020

Background:

The relationship between cancer with body mass index has been extensively reported. However, association between urinary cancers with these risk factors remains unclear, with existing reports showing conflicting findings. The current review, therefore, sought to clarify the latter association by assessing the methodological and reporting quality of existing systematic reviews on the subject.

Methods:

We will screen PubMed, EMBASE, and Cochrane Library databases for relevant literature and subjected the resulting articles to meta-analysis. We will adopt the AMSTAR and PRISMA checklists for assessing methodological, and reporting quality, respectively. The association between BMI and different urinary cancers will be estimated by computing the pooled relative risk (RR) and its 95% confidence interval (CI), which will be calculated from the adjusted RR, odds ratio, or hazard ratio, and 95% CI offered in the studies. Heterogeneity between studies will be assessed with the I statistic as a measure of the proportion of total variation in estimates that is due to heterogeneity, where I values of 25%, 50%, and 75% correspond to cut-off points for low, moderate, and high degrees of heterogeneity. The random effects model will be used as the pooling method when significant heterogeneity existed and the fixed effect model will be used when no heterogeneity was observed. Possible publication bias will be tested by Begg and Egger test.

Conclusion:

Our evidence synthesis will provide a new commentary on the current systematic review evidence for the association between BMI and the risk of different urinary cancers.

PROSPERO registration number:

CRD42019119459.
Water vapor thermal therapy for lower urinary tract symptoms secondary to benign prostatic hyperplasia
Authors: Miller Larry E. , Chughtai Bilal , McVary Kevin , Gonzalez Ricardo R. , Rojanasarot Sirikan , DeRouen Kyle , Bhattacharyya Samir
Published: July 2020

Background:

Water vapor thermal therapy (WVTT) is a minimally invasive procedure for treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH). There are no known systematic reviews reporting the effectiveness and safety of this increasingly common BPH therapy.

Methods:

We performed a systematic review and meta-analysis of studies utilizing WVTT for symptomatic BPH. The international prostate symptom score (IPSS), IPSS-quality of life (IPSS-QOL), BPH impact index (BPHII), and maximum flow rate (Qmax) were calculated as the weighted mean difference relative to baseline and reported in minimal clinically important difference (MCID) units. MCID thresholds were −3 for IPSS, −0.5 for IPSS-QOL, −0.5 for BPHII, and 2 mL/s for Qmax. The surgical retreatment rate was calculated using life-table methods.

Results:

We identified 5 cohorts treated with WVTT from 4 studies (514 patients; 40% with median lobe obstruction) with 2 years median follow-up (range: 6 months to 4 years). The IPSS, IPSS-QOL, BPHII, and Qmax significantly improved at all intervals between 3 months and 4 years; this benefit ranged from 3.3 to 3.8 MCID units for IPSS, 3.9 to 4.6 MCID units for IPSS-QOL, 6.8 to 8.2 MCID units for BPHII, and 1.5 to 3.0 MCID units for Qmax. The surgical retreatment rate was 7.0% at 4 years of follow-up data. Most adverse events were nonserious and transient; dysuria, urinary retention, and urinary tract infection were most common. No cases of de novo erectile dysfunction occurred.

Conclusions:

WVTT provided improvement in BPH symptoms that exceeded established MCID thresholds, preserved sexual function, and was associated with low surgical retreatment rates over 4 years.
Microcatheter infusion of bolus-dose tirofiban for acute ischemic stroke due to distal intracranial artery occlusion
Authors: Shao Shao Ju , Zhang Guo Zhen , Zhao Long , Huo Fa Rong , Ma Hong Bin , Zhu Ling , Yang Zhi Qi , Yin Rong
Published: July 2020

The utility of endovascular thrombectomy for acute occlusion of the distal intracranial artery (A2/A3/M2/M3/P2/P3) is unclear, and aspiration and stent thrombectomy are associated with risk of bleeding. We analyzed patients with acute occlusion of the distal intracranial artery to assess the safety and efficacy of microcatheter-based tirofiban infusion.

We retrospectively reviewed data of the endovascular thrombectomy registry of our center between January 2018 and June 2019. Patients with distal intracranial artery occlusion who underwent endovascular thrombectomy with microcatheter-based infusion of tirofiban were recruited.

Of 13 patients included, 1 presented with anterior cerebral artery occlusion, 2 with posterior cerebral artery occlusion, 2 with posterior inferior cerebellar artery occlusion, and 7 with middle cerebral artery M2 occlusion. The mean National Institute of Health Stroke scale score was 10.1 (3–19). Three patients (23.1%) underwent bridging treatment of intravenous thrombolysis with recombinant plasminogen activator and endovascular thrombectomy. The arithmetic mean onset-to-recanalization time was 696.3 minutes (140–1440) and average operating time was 47.1 minutes (30–80). After treatment, 10 patients (76.9%) underwent revascularization. No operative complications were observed in any case. All patients underwent angiography and were reviewed 7 to 14 days after surgery. Imaging revealed significant improvements in recanalization compared with the immediate postoperative period, with no reoccurrence of occlusion. The mean modified Rankin scale score at the 3-month follow-up was 0.54 (0–2).

Microcatheter-based infusion of bolus-dose tirofiban can result in safe and effective recanalization of acute occlusion of the distal artery in the case of a relatively light thrombotic load.
Anxiety and related factors in frontline clinical nurses fighting COVID-19 in Wuhan
Authors: Li Ruilin , Chen Youlin , Lv Jianlin , Liu Linlin , Zong Shiqin , Li Hanxia , Li Hong
Published: July 2020

The aim of this study was to examine the anxiety status of the frontline clinical nurses in the designated hospitals for the treatment of coronavirus disease 2019 (COVID-19) in Wuhan and to analyze the influencing factors, to provide data for psychologic nursing.

This study used a cross-sectional survey design and convenience sampling. The questionnaires were completed by 176 frontline clinical nurses. Anxiety was determined using the Hamilton anxiety scale. General data were collected using a survey. Correlation analyses were used.

Among the 176 frontline nurses, 77.3% (136/176) had anxiety. The anxiety scores of the frontline clinical nurse fighting COVID-19 were 17.1 ± 8.1. Anxiety symptoms, mild to moderate anxiety symptoms, and severe anxiety symptoms were found in 27.3%, 25%, and 25% of the nurses, respectively. Sex, age, marital status, length of service, and clinical working time against COVID-19 were associated with anxiety (P < .05).

The frontline nurses working in the designated hospitals for the treatment of COVID-19 in Wuhan had serious anxiety. Sex, age, length of service, and clinical working time against COVID-19 were associated with anxiety in those nurses. Psychologic care guidance, counseling, and social support should be provided to the nurses to reduce their physical and mental burden. Nursing human resources in each province should be adjusted according to each province's reality.
Clinical implications of agoraphobia in patients with panic disorder
Authors: Shin Jin , Park Doo-Heum , Ryu Seung-Ho , Ha Jee Hyun , Kim Seol Min , Jeon Hong Jun
Published: July 2020

Agoraphobia is frequently accompanied by panic disorder and causes considerable suffering. The aim of this study was to compare clinical features and treatment courses between patients with and without agoraphobia in panic disorder.

In this retrospective study, 87 patients with panic disorder were divided into two groups depending on the presence of agoraphobia: patients with agoraphobia (PDA, n = 41) and patients without agoraphobia (PD, n = 46). Agoraphobia subscale score of the Albany Panic and Phobia Questionnaire was used to identify correlations between agoraphobia and panic and affective symptoms.

The PDA group showed more severe panic and affective symptoms than the PD group. Patients with PDA were more likely to be younger at the age of onset, take benzodiazepines for longer durations, and be treated with antipsychotics augmentation. Agoraphobia subscale was associated with panic symptoms, depression, anxiety, and the duration of benzodiazepines use.

The findings suggest that patients with PDA experienced more severe panic symptoms, more profound psychiatric comorbidity, and worse illness progression than those with PD.
Optical coherence tomography angiography findings of choroidal neovascularization secondary to decalcified choroidal osteoma treated with intravitreal aflibercept
Authors: Yao Bangtao , Wang Fei , Zhao Xiaogui , Wang Bei , Liu Gang , Ding Yuhua
Published: July 2020

Introduction:

Choroidal osteoma (CO) is a rare benign ocular tumor characterized by ossifying choroid lesions. To the best of our knowledge, this is the first detailed report to describe the optical coherence tomography angiography (OCTA) findings of choroidal neovascularization (CNV) complicated by a rare decalcified CO following intravitreal aflibercept injection.

Patient concerns:

A 26-year-old woman presented with a spontaneous but painless reduction in visual acuity in her left eye that had commenced 5 days prior.

Diagnosis:

Clinical manifestations and multimodal imaging, including OCTA, spectral-domain optical coherence tomography, fundus fluorescein angiography and indocyanine green angiography, indicated decalcified CO with CNV.

Interventions:

After receiving an appropriately detailed explanation of the procedure, the patient was treated via intravitreal aflibercept(2.0 mg) injection once.

Outcomes:

One month after the therapy, OCTA revealed that the flow areas of CNV were narrowed, the best-corrected visual acuity was improved to 20/30, however, 2 months follow-up OCTA revealed that the CNV reoccurred, the best-corrected visual acuity was dropped to 20/50.

Conclusion:

Intravitreal aflibercept injection was an effective treatment for CO with CNV, but the effects may not last long. The OCTA findings provide a better appreciation of evaluating the effects of intravitreal aflibercept injection for CO complicating CNV.
Acute severe idiopathic lymphoid interstitial pneumonia
Authors: Lamkouan Youssef , Dury Sandra , Perotin Jeanne Marie , Picot Remi , Durlach Anne , Passouant Olivier , Sandu Sebastian , Dewolf Maxime , Dumazet Antoine , Lebargy François , Deslee Gaëtan , Launois Claire
Published: July 2020

Rationale:

Lymphoid interstitial pneumonia is a rare benign pulmonary lymphoproliferative disorder usually presenting with a sub-acute or chronic condition and frequently associated with autoimmune disorders, dysgammaglobulinemia, or infections.

Patient concerns:

A 74-year-old woman with no past medical history presented with acute dyspnea, nonproductive cough, hypoxemia (room air PaO2: 48 mmHg) and bilateral alveolar infiltrates with pleural effusion. Antibiotics and diuretics treatments did not induce any improvement. No underlying condition including cardiac insufficiency, autoimmune diseases, immunodeficiency, or infections was found after an extensive evaluation. Bronchoalveolar lavage revealed a lymphocytosis (60%) with negative microbiological findings. High-dose intravenous corticosteroids induced a mild clinical improvement only, which led to perform a surgical lung biopsy revealing a lymphoid interstitial pneumonia with no sign of lymphoma or malignancies.

Diagnoses:

Acute severe idiopathic lymphoid interstitial pneumonia.

Interventions:

Ten days after the surgical lung biopsy, the patient experienced a dramatic worsening leading to invasive mechanical ventilation. Antibiotics and a new course of high-dose intravenous corticosteroids did not induce any improvement, leading to the use of rituximab which was associated with a dramatic clinical and radiological improvement allowing weaning from mechanical ventilation after 10 days.

Outcomes:

Despite the initial response to rituximab, the patient exhibited poor general state and subsequent progressive worsening of respiratory symptoms leading to consider symptomatic palliative treatments. The patient died 4 months after the diagnosis of lymphoid interstitial pneumonia.

Lessons:

Idiopathic lymphoid interstitial pneumonia may present as an acute severe respiratory insufficiency with a potential transient response to rituximab.
Inter- and intraobserver agreement in standard and ultra-fast single-photon emission computed tomography/computed tomography for the assessment of bone metastases
Authors: Zacho Helle D. , Aleksyniene Ramune , Ejlersen June A. , Fledelius Joan , Petersen Lars J.
Published: July 2020

Objective

To investigate inter- and intraobserver agreement using standard (std)-single-photon emission computed tomography/computed tomography (SPECT/CT) or ultra-fast acquisition (UF)-SPECT/CT as an add-on to planar whole-body bone scintigraphy (WB-BS) for the detection of bone metastases in patients with known cancer.

Methods

Images from patients (n = 104) participating in a prospective trial comparing SPECT/CT as an add-on to WB-BS with two different acquisition methods (std-SPECT/CT; 20 s per view, 32 views and UF-SPECT/CT; 16 views of 10 s per view) were included. The combinations of WB-BS with the two different SPECT/CT acquisition methods were independently evaluated by two experienced observers using a three-point scale (M0: no metastases, Me: equivocal for bone metastases and M1: bone metastases). The observers re-evaluated the scans 6 months later. Inter- and intraobserver agreement was calculated using linear weighted kappa.

Results

The linear weighted kappa for the interobserver agreement was 0.78 [95% confidence interval (CI) 0.61–0.94] for WB-BS with std-SPECT/CT and 0.84 (95% CI 0.67–1.00) for WB-BS with UF-SPECT/CT. Similar values were observed for the intraobserver agreement, in which the linear weighted kappa was 0.76 (95% CI 0.60–0.92) and 0.73 (95% CI 0.57–0.90) for std-SPECT/CT and UF-SPECT/CT, respectively.

Conclusion

Satisfactory inter- and intraobserver agreement was seen for both acquisition methods, emphasizing that the use of SPECT/CT as an add-on to WB-BS is a robust method for the detection of bone metastases even when conducted with a very short acquisition time.
Identification of Distinct Profiles of Cancer-Related Fatigue and Associated Risk Factors for Breast Cancer Patients Undergoing Chemotherapy
Authors: Huang Qingmei , Geng Zhaohui , Fang Qiong , Stinson Jennifer , Yuan Changrong
Published: July 2020

Background

Cancer-related fatigue is a complex, multidimensional, subjective experience that affects patients physically, emotionally, and mentally. The interindividual variability in symptoms of cancer-related fatigue merits further exploration.

Objective

Our objective was to identify distinct profiles of cancer-related fatigue experienced by breast cancer patients undergoing chemotherapy and to evaluate how subgroups vary demographically in clinical characteristics and in modifiable factors such as physical activity, sleep quality, and exercise self-efficacy.

Methods

Fatigue was assessed with the Chinese Cancer-Related Fatigue Scale, and a latent class analysis was performed to identify subgroups of patients with distinct fatigue profiles.

Results

A total of 427 breast cancer patients were included in the data analyses. Five different fatigue profiles were identified: all low-risk fatigue, all high-risk fatigue, high-risk physical fatigue, high-risk emotional fatigue, and high-risk mental fatigue. Patients in different subgroups were characterized by different risk factors. For example, patients in the high-risk emotional fatigue group had less education, lower monthly household incomes, lower exercise self-efficacy scores, less sedentary behavior, poorer sleep, and poorer quality-of-life outcomes compared with those in the all low-risk fatigue group.

Conclusion

These findings reveal that breast cancer patients undergoing chemotherapy show significant heterogeneity in their experience of cancer-related fatigue.

Implications for Practice

Characteristics associated with different fatigue profiles, in particular the high-risk profiles, can be used by clinicians to target patients at greater risk of poorer symptom and quality-of-life outcomes to provide interventions tailored to their different needs.
Evaluation of Outcomes Before and After Implementation of a Standardized Postoperative Care Pathway in Pediatric Posterior Spinal Fusion Patients
Authors: Nelson Kembral L. , Locke Lindsey L. , Rhodes Leslie N. , Mabry William A. , Sawyer Jeffrey R. , Warner William C. , Jones Tamekia , Spence David D. , Kelly Derek M.
Published: July 2020

BACKGROUND:

Standardized pathways decrease variability and improve outcomes and safety.

PURPOSE:

The article aims to evaluate outcomes of a standardized postoperative care pathway compared with individual surgeon preference.

METHODS:

A review of patients prestandardization and poststandardization was performed. Patients between the ages of 10–21 years with adolescent idiopathic scoliosis (ICD-9 code 737.30) admitted to the hospital for posterior spinal fusion (CPT code 22630) were included in the study. The prestandardization group (25 patients) was enrolled from April 1, 2010, through March 30, 2011, and the poststandardization group (25 patients) from April 1, 2014, to March 30, 2015. Exclusion criteria were renal disease, epilepsy, neurological disorder, or postoperative complications that led to change in routine care including ileus or fever greater than 102 °F. Data were analyzed using the Wilcoxon signed rank test, with significance set at p < .001.

RESULTS:

The length of stay (p = .0166), time to ambulation (p < .0001), patient-controlled analgesia use (p < .0001), and postoperative time to resumption of regular diet (p < .0001) were all significantly decreased in the poststandardization group. There were no complications or readmissions in either group.

CONCLUSION:

The standardized pathway resulted in shorter length of stay, decreased narcotic use, decreased time to regular diet, and decreased time to ambulation with no increase in complication rates.
Gout
Authors: Pascual Eliseo , Andres Mariano , Sivera Francisca
Published: July 2020

In the field of rheumatic and musculoskeletal diseases, no other condition has evolved so significantly since the mid-1950s as gout. In this period, the cause of gout has been firmly established; the close relationship with other conditions clarified; a rapid, unequivocal diagnostic test established; and agents effective in dissolving monosodium urate crystals and controlling inflammation made widely available. All these insights have ultimately led to deem gout as curable, an end point formerly considered out of reach. Unfortunately, diagnosis and management of gout in clinical practice have not paralleled the scientific advances and remain far from established quality standards. This paradox is the topic of the present review article, intending to increase the widespread interest of clinicians in gout.
Going Further: Comprehensive Disease Control of Rheumatoid Arthritis, Targeting Cytokines and Chemokines
Authors: Chavarria-Avila Efrain , Vazquez-Del Mercado Monica , Pizano-Martínez Oscar , Roman-Lugo German , Arrona-Rios Karla , Perez-Vazquez Felipe , De-La-Cruz Jeniffer P. , Calderon-Espinoza Ivette , Aguilar-Vazquez Andrea , Esesarte-Rodriguez Marisol , Rubio-Arrellano Edy D. , Duran-Barragan Sergio
Published: July 2020

Objectives

Mechanism of action of biological and synthetic disease-modifying antirheumatic drugs (DMARDs) includes the inhibition of specific proinflammatory cytokines. This study aimed to elucidate the cytokines and chemokines inhibited by different treatments (conventional synthetic DMARD [csDMARD], biological and targeted synthetic DMARD) in rheumatoid arthritis (RA).

Methods

Fifty-nine RA patients with low disease activity or remission included in a cross-sectional study were classified by treatment in groups: abatacept, certolizumab, rituximab (RTX), tocilizumab, tofacitinib (TOF), baricitinib (BAR), and csDMARD. Cytokine and chemokine serum levels were measured by LEGENDplex Human Inflammation panel. Quantitative variables were compared using Student t or Mann-Whitney U test as appropriate, whereas qualitative variables were compared using χ2 or Fisher exact test. p < 0.05 was considered significant.

Results

Certolizumab, RTX, tocilizumab, and TOF showed that most cytokine pathways inhibited: tumor necrosis factor α, interferon γ, interleukin 1β (IL-1β), IL-12, IL-18, and IL-23; in addition, csDMARDs showed a similar inhibition patron except for IL-23. Serum level of tumor necrosis factor α pathway was one of the most inhibited being undetectable in RTX, TOF, and BAR groups. Interleukin 6 was shown to be inhibited by abatacept, RTX, and TOF; however, higher levels were observed in 3 patients treated with tocilizumab. Abatacept, certolizumab, RTX, and TOF downregulated IL-10 in this group of patients but remained detectable in almost half of the subjects, with the highest levels in the BAR group. The active pathways that remained the most were CC chemokine ligand 2, IL-8, IL-17, and IL-33.

Conclusions

Understanding the cytokine chemokine pathways inhibition could help rheumatologists to prescribe a tailored therapy using the arsenal of DMARDs for individualized RA treatment in an evidence-based decision manner.
A Deep Learning Model for the Accurate and Reliable Classification of Disc Degeneration Based on MRI Data
Authors: Niemeyer Frank , Galbusera Fabio , Tao Youping , Kienle Annette , Beer Meinrad , Wilke Hans-Joachim
Published: July 2020

Objectives

Although magnetic resonance imaging–based formalized grading schemes for intervertebral disc degeneration offer improved reproducibility compared with purely subjective ratings, their intrarater and interrater reliability are not nearly good enough to be able to detect small to medium effects in clinical longitudinal studies. The aim of this study thus was to develop a method that enables automatic and therefore reproducible and reliable evaluation of disc degeneration based on conventional clinical image data and Pfirrmann's grading scheme.

Materials and Methods

We propose a classifier based on a deep convolutional neural network that we trained on a large, manually evaluated data set of 1599 patients (7948 intervertebral discs). To improve upon the status quo, we focused on the quality of the training data and performed extensive hyperparameter optimization. We assessed the potential benefits of optimizing loss functions beyond common cross-entropy loss, such as soft kappa loss, ordinal cross-entropy loss, or regression losses. We furthermore experimented with ways to mitigate class imbalance by pooling classes or using class-weighted loss functions. During model development and hyperparameter optimization, we used a fixed 90%/10% training/validation set split. To estimate real-world prediction performance, we performed 10-fold cross-validation.

Results

The evaluated image data results in a Gaussian degeneration grade distribution, and thus grades 1 and 5 are slightly underrepresented in the training set. Our default cross-entropy–based classifier achieves a reliability of κ = 0.92 (Cohen κ), an average sensitivity of 90.2%, and an average precision of 92.5%. In 99.2% of validation cases, the network's prediction deviates at most 1 Pfirrmann grades from the ground truth. Framed as an ordinal regression problem, the mean absolute error between the ground truth and the prediction is 0.08 Pfirrmann grade with a correlation of r = 0.96. The results of the 10-fold cross validation confirm those performance estimates, indicating no substantial overfitting. More sophisticated loss functions, class-based loss weighting, or class pooling did not lead to improved classification performance overall.

Conclusions

With a reliability of κ > 0.9, our system clearly outperforms average human interrater as well as intrarater reliability. With an average sensitivity of more than 90%, our classifier also surpasses state-of-the-art machine learning solutions for automatically grading disc degeneration.
Defect Reconstruction Using the Propeller Flaps Based on the Perforators Derived From the Lateral Circumflex Femoral Artery System
Authors: Zhu Shan , Zang Mengqing , Xu Boyang , Chen Bo , Li Shanshan , Han Tinglu , Liu Yuanbo
Published: July 2020

Background

Although propeller flaps are a useful option for soft tissue defect reconstruction, reports based on the perforators of the lateral circumflex femoral artery (LCFA) are rare. We aimed to present our experience in defect reconstruction using the propeller flaps based on perforators from different branches of LCFA and apply these flaps in soft tissue defect reconstruction of the lower extremities.

Methods

Twenty nine patients (32 flaps) underwent defect reconstruction using propeller flaps based on the perforator of the LCFA. Defects were located from the groin to the proximal leg. According to the source vessels from which the perforator originated, flaps were categorized into types I, II, III and IV, which represented perforators from the transverse, descending, oblique, and rectus femoris branches, respectively. Type II flaps were subdivided into types IIa and IIb flaps based on antegrade and reverse flows of the descending branch.

Results

Flap sizes ranged from 12 × 6 cm to 30 × 15 cm (average, 22.69 × 9.19 cm) with the length of the vascular pedicle ranging from 3 to 7 cm (average, 4.86 cm). Flaps were rotated from 60° to 180° (average, 144.06°). There were 3 type I, 10 type IIa, 4 type IIb, 13 type III and, and 2 type IV flaps. Twenty-nine flaps survived after surgery. Total flap necrosis and venous congestion of the distal flap portion occurred in 1 and 2 patients, respectively.

Conclusions

Reconstruction using propeller flaps based on perforators of the LCFA is a safe, reliable, and versatile option for defect reconstruction of the lower extremities; however, it requires meticulous surgical dissection and patience.
The effects of human prothrombin complex concentrate on hemorrhagic shock-induced lung injury in rats: Implications for testing human blood products in rodents
Authors: Potter Daniel R. , Trivedi Alpa , Lin Maximillian , Miyazawa Byron Y. , Vivona Lindsay R. , McCully Belinda , Nair Alison , Schreiber Martin A. , Pati Shibani
Published: July 2020

BACKGROUND

Hemorrhagic shock (HS) and trauma can result in an endotheliopathy of trauma, characterized by endothelial compromise, inflammation, and aberrant coagulation. Kcentra, a prothrombin concentrate, has been demonstrated to mitigate pulmonary vascular leak in a murine model of HS. We investigated the effects of Kcentra in a rat model of HS, to achieve physiologic endpoints of relevance.

METHODS

Rats subjected to a grade intravenous splenic injury and controlled hemorrhage for 60 minutes were resuscitated with shed volumes of (1) Lactated Ringer’s (LR) solution, (2) LR + 20 IU/kg Kcentra, (3) LR + 50 IU/kg Kcentra, (4) rat fresh frozen plasma (RFFP), or (5) human fresh frozen plasma (HFFP). Blood was harvested for monitoring metabolic and coagulation function. Rat lungs were evaluated for lung injury and permeability.

RESULTS

Animals resuscitated with LR displayed a significant increase in pulmonary vascular permeability (sham, 407.9 ± 122.4; shock + LR, 2040 ± 1462). Resuscitation with RFFP (606.5 ± 169.3) reduced leak; however, treatment with Kcentra (HS + Kcentra [20 IU/kg]: 1792 ± 903.4, HS + Kcentra [50 IU/kg]: 1876 ± 1103), and HFFP (1450 ± 533.2) had no significant effect on permeability. Kcentra modestly altered clotting parameters. Metabolic measures, such as lactate, pH, and base deficit, were restored to baseline levels by both RFFP and HFFP, but not Kcentra or LR.

CONCLUSION

Kcentra did not alter pulmonary vascular permeability, but modestly increased clotting potential in injured rats. This suggests that there may be a xenogenic reaction of human products in rats and that the effects of Kcentra on vascular stability may be distinct from its ability to modulate clotting. Our data indicate that the species chosen and utilized for in vivo preclinical testing of human derived blood products is of critical importance in determining their efficacy in animal models and is the primary impetus to communicate these results.
Kidney Rejection Following Simultaneous Liver-kidney Transplantation
Authors: Shah Sapna , Suddle Abid , Callaghan Christopher , Karydis Nicholas , Shaw Olivia , Horsfield Catherine , Koffman Geoff , Heaton Nigel
Published: July 2020

Background.

Donor-specific antibodies are reported to increase the risk of rejection and reduce allograft survival following simultaneous liver-kidney transplantation. Optimal immunosuppression regimens to reduce this risk and to treat rejection episodes are underinvestigated.

Methods.

Cohort analysis of the first 27 simultaneous liver-kidney transplant recipients, between 2014 and 2018 at our unit, is performed under a new risk stratification policy. Those with donor-specific antibodies to class II HLA with a mean fluorescence intensity >10 000 are considered high risk for antibody-mediated rejection (AMR). These patients received immunosuppression, which consisted of induction therapy, tacrolimus, mycophenolate mofetil, and prednisolone. All other patients are considered low risk and received tacrolimus and prednisolone alone.

Results.

Three patients were high risk for rejection, and 2 of these patients developed AMR, which was treated with plasma exchange and intravenous immunoglobulin. At 1 y, their estimated glomerular filtration rate (eGFR) were 50 and 59 mL/min. Two other patients developed AMR, which was similarly treated, and their 1-y eGFR was 31 and 50 mL/min. The overall histologically proven acute rejection rate within the first year was 33%, and median eGFR, for the 27 patients, at 1 y was 52 mL/min and at 2 y was 49 mL/min.

Conclusions.

This study confirms that there is a risk of AMR following simultaneous liver-kidney transplantation despite increased immunosuppression. This can be effectively treated with plasma exchange and intravenous immunoglobulin.
Early Experiences With COVID-19 Testing in Transplantation
Authors: Boyarsky Brian J. , Massie Allan B. , Love Arthur D. , Werbel William A. , Durand Christine M. , Avery Robin K. , Jackson Kyle R. , Kernodle Amber B. , Thomas Alvin G. , Ronin Matthew , Altrich Michelle , Niles Patricia , Trahan Chad , Hewlett Jonathan , Segev Dorry L. , Garonzik-Wang Jacqueline M.
Published: July 2020

Background.

The early effects of coronavirus disease 2019 (COVID-19) on transplantation are dramatic: >75% of kidney and liver programs are either suspended or operating under major restrictions. To resume transplantation, it is important to understand the prevalence of COVID-19 among transplant recipients, donors, and healthcare workers (HCWs) and its associated mortality.

Methods.

To investigate this, we studied severe acute respiratory syndrome coronavirus 2 diagnostic test results among patients with end-stage renal disease or kidney transplants from the Johns Hopkins Health System (n = 235), and screening test results from deceased donors from the Southwest Transplant Alliance Organ Procurement Organization (n = 27), and donors, candidates, and HCWs from the National Kidney Registry and Viracor-Eurofins (n = 253) between February 23 and April 15, 2020.

Results.

We found low rates of COVID-19 among donors and HCWs (0%–1%) who were screened, higher rates of diagnostic tests among patients with end-stage renal disease or kidney transplant (17%–20%), and considerable mortality (7%–13%) among those who tested positive.

Conclusions.

These findings suggest the threat of COVID-19 for the transplant population is significant and ongoing data collection and reporting is critical to inform transplant practices during and after the pandemic.
Bioinformatical dissection of fission yeast DNA replication origins
Authors: Masuda Koji , Renard-Guillet Claire , Shirahige Katsuhiko , Sutani Takashi
Published: July 2020

Replication origins in eukaryotes form a base for assembly of the pre-replication complex (pre-RC), thereby serving as an initiation site of DNA replication. Characteristics of replication origin vary among species. In fission yeast
Schizosaccharomyces pombe
, DNA of high AT content is a distinct feature of replication origins; however, it remains to be understood what the general molecular architecture of fission yeast origin is. Here, we performed ChIP-seq mapping of Orc4 and Mcm2, two representative components of the pre-RC, and described the characteristics of their binding sites. The analysis revealed that fission yeast efficient origins are associated with two similar but independent features: a ≥15 bp-long motif with stretches of As and an AT-rich region of a few hundred bp. The A-rich motif was correlated with chromosomal binding of Orc, a DNA-binding component in the pre-RC, whereas the AT-rich region was associated with efficient binding of the DNA replicative helicase Mcm. These two features, in combination with the third feature, a transcription-poor region of approximately 1 kb, enabled to distinguish efficient replication origins from the rest of chromosome arms with high accuracy. This study, hence, provides a model that describes how multiple functional elements specify DNA replication origins in fission yeast genome.
Aerosol filtering efficiency of respiratory face masks used during the COVID-19 pandemic
Authors: Loupa Glykeria , Karali Dimitra , Rapsomanikis Spyridon
Published: July 2020

The spread of the COVID-19 pandemic, effected the imposition of personal protection measures in a large number of countries. The use of commercially available personal face masks was widely accepted as such a protective measure. Since the quality of the face masks scanned the spectrum from surgical to the home made fabric ones, it was considered appropriate to experimentally establish their effectiveness for stopping aerosol in entering the respiratory system of the bearer. Presently, only eight masks were tested with polydisperse indoor air. Their effectiveness was examined for aerosol of aerodynamic diameters of 0.006 μm to 10 μm. Of these masks, only two were effective for the whole range of aerosol. Cloth masks were found to be ineffective for the assigned task.
Pre-crastination: time uncertainty increases walking effort
Authors: Tiew E Hong , Seethapathi Nidhi , Srinivasan Manoj
Published: July 2020

In many circumstances, humans walk in a manner that approximately minimizes energy cost. Here, we performed human subject experiments to examine how having a time constraint affects the speeds at which humans walk. First, we measured subjects’ preferred walking speeds to travel a given distance in the absence of any time constraints. Then, we asked subjects to travel the same distance under different time constraints. That is, they had to travel the given distance within the time duration provided – they can arrive early, but not late. Under these constraints, subjects systematically arrived earlier than necessary. Surprisingly, even when the time duration provided was large enough to walk at their unconstrained preferred speeds, subjects walked systematically faster than their unconstrained preferred speed. We propose that this faster-than-energy optimal speeds may be due to human uncertainty in time estimation. We show that a model assuming that humans perform stochastic optimal feedback control to arrive on time with high probability while minimizing expected energy costs predicts walking speeds higher than energy optimal, as observed in experiment.
A New Mathematical Approach for the Estimation of epidemic Model Parameters with Demonstration on COVID-19 Pandemic in Libya
Authors: Saleh Mohamed Elmehdi , Saleh Zeinab Elmehdi
Published: July 2020

Background

The SEIR model or a variation of it is commonly used to study epidemic spread and make predictions on how it evolves. It is used to guide officials in their response to an epidemic. This research demonstrates an effective and simple approach that estimates the parameters of any variations of the SEIR model. This new technique will be demonstrated on the spread of COVID-19 in Libya.

Methods

A five compartmental epidemic model is used to model the COVID-19 pandemic in Libya. Two sets of data are needed to evaluate the model parameters, the cumulative number of symptomatic cases and the total number of active cases. This data along with the assumption that the cumulative number of symptomatic cases grows exponentially, to determine most of the model parameters.

Results

Libya’s epidemic start-date was estimated asto= −18 · 5 days, corresponding to May 5th. We mathematically demonstrated that the number of active cases follows two competing exponential distributions: a positive exponential function, measuring how many new cases are added, and a negative exponential function, measuring how many cases recovered. From this distribution we showed that the average recovery time is 48 days, and the incubation period is 15.2 days. Finally, the productive number was estimated as R0= 7·6.

Conclusions

With only the cumulative number of cases and the total number of active cases of COVID19, several important SEIR model parameters can be measured effectively. This approach can be applied for any infectious disease epidemic anywhere in the world.
Gamma oscillations in primate primary visual cortex are severely attenuated by small stimulus discontinuities
Authors: Shirhatti Vinay , Ravishankar Poojya , Ray Supratim
Published: July 2020

Gamma oscillations have been hypothesized to play an important role in feature binding, based on the observation that continuous long bars induce stronger gamma in the visual cortex than bars with a small gap. Recently, many studies have shown that natural images, that have discontinuities in several low-level features, do not induce strong gamma oscillations, questioning their role in feature binding. However, the effect of different discontinuities on gamma has not been well studied. To address this, we recorded spikes and local field potential from two monkeys while they were shown gratings with discontinuities in space, orientation, phase or contrast. Gamma, but not spiking activity, drastically reduced with small discontinuities in all cases, suggesting that gamma could be a resonant phenomenon. An excitatory-inhibitory population model with stimulus-tuned recurrent inputs showed such resonant properties. Therefore, gamma could be a signature of excitation-inhibition balance, which gets disrupted due to discontinuities.
Genomic GC content drifts slowly downward in most bacterial genomes
Authors: Ely Bert
Published: July 2020

In every kingdom of life, GC->AT transitions occur more frequently than any other type of mutation due to the spontaneous deamination of cytidine. In eukaryotic genomes, this slow loss of GC base pairs is counteracted by biased gene conversion which increases genomic GC content as part of the recombination process. However, this type of biased gene conversion has not been observed in bacterial genomes so we hypothesized that GC->AT transitions cause a reduction of genomic GC content in prokaryotic genomes on an evolutionary time scale. To test this hypothesis, we used a phylogenetic approach to analyze triplets of closely related genomes representing a wide range of the bacterial kingdom. The resulting data indicate that genomic GC content is slowly declining in bacterial genomes where GC base pairs comprise 40% or more of the total genome. In contrast, genomes containing less than 40% GC base pairs have fewer opportunities for GC->AT transitions to occur so genomic GC content is relatively stable or actually increasing at a slow rate. It should be noted that this observed change in genomic GC content is the net change in shared parts of the genome and does not apply to parts of the genome that have been lost or acquired since the genomes being compared shared common ancestor. However, a more detailed analysis of twoCaulobactergenomes revealed that the acquisition of mobile elements by the two genomes actually reduced the total genome content as well.
Computational optimization of the SARS-CoV-2 receptor-binding-motif affinity for human ACE2
Authors: Polydorides S. , Archontis G.
Published: July 2020

The coronavirus SARS-CoV-2, that is responsible for the COVID-19 pandemic, and the closely related SARS-CoV coronavirus enter cells by binding at the human angiotensin converting enzyme 2 (hACE2). The stronger hACE2 affinity of SARS-CoV-2 has been connected with its higher infectivity. In this work, we study hACE2 complexes with the receptor binding domains (RBDs) of the human SARS-CoV-2 and human SARS-CoV viruses, using all-atom molecular dynamics (MD) simulations and Computational Protein Design (CPD) with a physics-based energy function. The MD simulations identify charge-modifying substitutions between the CoV-2 and CoV RBDs, which either increase or decrease the hACE2 affinity of the SARS-CoV-2 RBD. The combined effect of these mutations is small, and the relative affinity is mainly determined by substitutions at residues in contact with hACE2. Many of these findings are in line and interpret recent experiments. Our CPD calculations redesign positions 455, 493, 494 and 501 of the SARS-CoV-2 RBM, which contact hACE2 in the complex and are important for ACE2 recognition. Sampling is enhanced by an adaptive importance sampling Monte Carlo method. Sequences with increased affinity replace CoV-2 glutamine by a negative residue at position 493, and serine by nonpolar, aromatic or a threonine at position 494. Substitutions at positions positions 455 and 501 have a smaller effect on affinity. Substitutions suggested by our design are seen in viral sequences encountered in other species, including bat and pangolin. Our results might be used to identify potential virus strains with higher human infectivity and assist in the design of peptide-based or peptidomimetic compounds with the potential to inhibit SARS-CoV-2 binding at hACE2.

SIGNIFICANCE

The coronavirus SARS-CoV-2 is responsible for the current COVID-19 pandemic. SARS-CoV-2 and the earlier, closely related SARS-CoV virus bind at the human angiotensin converting enzyme 2 (hACE2) receptor at the cell surface. The higher human infectivity of SARS-CoV-2 may be linked to its stronger affinity for hACE2. Here, we study by computational methods complexes of hACE2 with the receptor binding domains (RBDs) of viruses SARS-CoV-2 and SARS-CoV. We identify residues affecting the affinities of the two domains for hACE2. We also propose mutations at key SARS-CoV-2 positions, which might enhance hACE2 affinity. Such mutations may appear in viral strains with increased human infectivity and might assist the design of peptide-based compounds that inhibit infection of human cells by SARS-CoV-2.