bluuebunny/crossref_metadata_2025 huggingface dataset:
Pitfalls in the embolisation of a thyrocervical trunk bleeding: a case report
Authors: Perrucci Luca , Graziano Monica , Ferrante Zairo , Salviato Elisabetta , Carnevale Aldo , Galeotti Roberto
Published: May 2020

Introduction

An intrathoracic bleeding from the thyrocervical branch is not common in blunt trauma, but an interventional radiologist should be aware of the risks in order to prevent complications.

Case presentation

A 30-year-old male presented with a right pneumo-haemothorax due to active bleeding revealed at contrast-enhanced CT, as a consequence of a fall occurred in the previous week. The patient was treated with endovascular embolisation in an angiographic room with coils placement, since the right thyrocervical artery was found to be supplying the pneumo-haemothorax. A radiculo-medullary branch rose from the thyrocervical trunk, impeding the proximal embolization with microparticles and needing selective isolation of the bleeding artery with the catheter to avoid spinal cord injuries. The treatment had a successful result and the following CT control showed signs of recovering, without any complication.

Conclusion

Our paper presents a rare contingency, warning the operator to bear in mind the presence of arteries feeding the spinal cord. This crucial detail precludes the use of microparticles embolisation to prevent neurologic sequelae, whereas the use of endovascular coils for embolization should be mandatory. Moreover, this case reminds that the post-traumatic bleeding deriving from a cervical trauma may also occur later.
Whole-genome mate-pair sequencing of apparently balanced chromosome rearrangements reveals complex structural variations: two case studies
Authors: Tan Ya-Qi , Tan Yue-Qiu , Cheng De-Hua
Published: May 2020

Background

Apparently balanced chromosome rearrangements (ABCRs) in non-affected individuals are well-known to possess high reproductive risks such as infertility, abnormal offspring, and pregnancy loss. However, caution should be exercised in genetic counseling and reproductive intervention because cryptic unbalanced defects and genome structural variations beyond the resolution of routine cytogenetics may not be detected.

Case presentation

Here, we studied two familial cases of ABCRs were recruited in this study. In family 1, the couple suffered two abortions pregnancies and underwent labor induction. Single nucleotide polymorphism (SNP) array analysis of the aborted sample from the second pregnancy revealed a 10.8 Mb heterozygous deletion at 10q26.13q26.3 and a 5.5 Mb duplication at 19q13.41-q13.43. The non-affected father was identified as a carrier of three-way complex chromosomal rearrangement [t (6;10;19)(p22;q26;q13)] by karyotyping. Whole-genome mate-pair sequencing revealed a cryptic breakpoint on the derivative chromosome 19 (der19), indicating that the karyotype was a more complex structural rearrangement comprising four breakpoints. Three genes, FAM24B, CACNG8, and KIAA0556, were disrupted without causing any abnormal phenotype in the carrier. In family 2, the couple suffered from a spontaneous miscarriage. This family had an affected child with multiple congenital deformities and an unbalanced karyotype, 46,XY,der (11) t (6;11)(q13;p11.2). The female partner was identified as a balanced translocation carrier with the karyotype 46,XX,t (6;11)(q13;p11.2) dn. Further SNP array and fluorescent in situ hybridization (FISH) indicated a cryptic insertion between chromosome 6 and chromosome 11. Finally, whole-genome mate-pair sequencing revealed an extremely complex genomic structural variation, including a cryptic deletion and 12 breakpoints on chromosome 11, and 1 breakpoint on chromosome 6 .

Conclusions

Our study investigated two rare cases of ABCRs and demonstrated the efficacy of whole-genome mate-pair sequencing in analyzing the genome complex structural variation. In case of ABCRs detected by conventional cytogenetic techniques, whole genome sequencing (WGS) based approaches should be considered for accurate diagnosis, effective genetic counseling, and correct reproductive intervention to avoid recurrence risks.
Post-transplant cyclophosphamide after matched sibling, unrelated and haploidentical donor transplants in patients with acute myeloid leukemia: a comparative study of the ALWP EBMT
Authors:   Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation (EBMT), Sanz Jaime , Galimard Jacques-Emmanuel , Labopin Myriam , Afanasyev Boris , Angelucci Emanuele , Ciceri Fabio , Blaise Didier , Cornelissen Jan J. , Meijer Ellen , Diez-Martin J. L. , Koc Yener , Rovira Montserrat , Castagna Luca , Savani Bipin , Ruggeri Annalisa , Nagler Arnon , Mohty Mohamad
Published: May 2020

Background

The use of post-transplant cyclophosphamide (PTCy) is highly effective in preventing graft-versus-host disease (GVHD) in the haploidentical (Haplo) transplant setting and is being increasingly used in matched sibling (MSD) and matched unrelated (MUD) transplants. There is no information on the impact of donor types using homogeneous prophylaxis with PTCy.

Methods

We retrospectively compared outcomes of adult patients with acute myeloid leukemia (AML) in first complete remission (CR1) who received a first allogeneic stem cell transplantation (SCT) with PTCy as GVHD prophylaxis from MSD (n= 215), MUD (n= 235), and Haplo (n= 789) donors registered in the EBMT database between 2010 and 2017.

Results

The median follow-up was 2 years. Haplo-SCT carried a significantly increased risk of acute grade II–IV GVHD (HR 1.6; 95% CI 1.1–2.4) and NRM (HR 2.6; 95% CI 1.5–4.5) but a lower risk of relapse (HR 0.7; 95% CI 0.5–0.9) that translated to no differences in LFS (HR 1.1; 95% CI 0.8–1.4) or GVHD/relapse-free survival (HR 1; 95% CI 0.8–1.3). Interestingly, the use of peripheral blood was associated with an increased risk of acute (HR 1.9; 95% CI 1.4–2.6) and chronic GVHD (HR 1.7; 95% CI 1.2–2.4) but a lower risk of relapse (HR 0.7; 95% CI 0.5–0.9).

Conclusions

The use of PTCy in patients with AML in CR1 receiving SCT from MSD, MUD, and Haplo is safe and effective. Haplo-SCT had increased risk of acute GVHD and NRM and lower relapse incidence but no significant difference in survival.
Undertriage in trauma: an ignored quality indicator?
Authors: Jeppesen Elisabeth , Cuevas-Østrem Mathias , Gram-Knutsen Cathrine , Uleberg Oddvar
Published: May 2020

Background

Early identification of life-threatening injuries is essential to reduce morbidity and mortality in trauma patients. Failure to detect severe injury may cause delayed diagnosis and therapeutic interventions and is associated with increased morbidity. A national trauma system will contribute to ensure the optimal care for seriously injured patients throughout the treatment chain by, among other things, defining a sensitive triage tool for identifying severe injury and contribute to correct treatment destination. In 2017, a National trauma plan was implemented in Norway and several quality indicators were recommended to ensure an evaluation of potential gaps between achieved and desired quality, and thereby highlighting areas with potential for quality improvement. With this commentary, we want to draw attention to, what we believe is, an ignoring of an important quality indicator: undertriage in trauma.

Main body

Severely injured patients not met by a trauma team is commonly referred to as undertriage. An undertriage rate below 5 % is an internationally recognized quality indicator in trauma care and is emphasized in the Norwegian national trauma plan. However, whether hospitals measure and report data about undertriage, have received little attention. Therefore, a national survey was performed among Norwegian hospitals, where thirty-seven of forty trauma receiving hospitals contributed. The results of the survey showed that only half of Norwegian trauma hospitals were capable of providing these data. The results of this survey show that currently the national trauma system is not equipped to obtain important data on an important and specific quality indicator. An ongoing discussion at a national level is how to define severe injury, which may alter future definitions on undertriage.

Conclusions

Knowledge of undertriage in trauma is important to enhance patient safety, increase the precision of the triage tool and provide valuable learning information to individual hospitals and prehospital services. Currently only half of Norwegian hospitals who receive trauma patients report undertriage rates and unfortunately, only few hospital administrators request these data.
Acute respiratory failure in COVID-19: is it “typical” ARDS?
Authors: Li Xu , Ma Xiaochun
Published: May 2020

In December 2019, an outbreak of coronavirus disease 2019 (COVID-19) was identified in Wuhan, China. The World Health Organization (WHO) declared this outbreak a significant threat to international health. COVID-19 is highly infectious and can lead to fatal comorbidities especially acute respiratory distress syndrome (ARDS). Thus, fully understanding the characteristics of COVID-19-related ARDS is conducive to early identification and precise treatment. We aimed to describe the characteristics of COVID-19-related ARDS and to elucidate the differences from ARDS caused by other factors. COVID-19 mainly affected the respiratory system with minor damage to other organs. Injury to the alveolar epithelial cells was the main cause of COVID-19-related ARDS, and endothelial cells were less damaged with therefore less exudation. The clinical manifestations were relatively mild in some COVID-19 patients, which was inconsistent with the severity of laboratory and imaging findings. The onset time of COVID-19-related ARDS was 8–12 days, which was inconsistent with ARDS Berlin criteria, which defined a 1-week onset limit. Some of these patients might have a relatively normal lung compliance. The severity was redefined into three stages according to its specificity: mild, mild-moderate, and moderate-severe. HFNO can be safe in COVID-19-related ARDS patients, even in some moderate-severe patients. The more likely cause of death is severe respiratory failure. Thus, the timing of invasive mechanical ventilation is very important. The effects of corticosteroids in COVID-19-related ARDS patients were uncertain. We hope to help improve the prognosis of severe cases and reduce the mortality.
Revisited: Therapeutic and toxic blood concentrations of more than 1100 drugs and other xenobiotics
Authors: Schulz Martin , Schmoldt Achim , Andresen-Streichert Hilke , Iwersen-Bergmann Stefanie
Published: May 2020

In order to assess the significance of drug/substance levels measured in intensive care medicine and clinical and forensic toxicology as well as for therapeutic drug monitoring, it is essential that a comprehensive collection of data is readily available. We revisited and expanded our 2012 compilation of therapeutic and toxic plasma concentration ranges as well as half-lives of now more than 1100 drugs and other xenobiotics.

Data have been abstracted from original papers, text books, and previous compilations and have been completed with data collected in our own forensic and clinical toxicology laboratories. We compiled the data presented in the table and the corresponding annotations over the past 30+ years. A previous compilation was completely double-checked, revised, and updated, if necessary. In addition, more than 200 substances, especially drugs who have been introduced since 2012 to the market as well as illegal drugs and other xenobiotics which became known to cause intoxications were added. We carefully referenced all data. Moreover, the annotations providing details were updated and revised, when necessary.

For more than 1100 drugs and other xenobiotics, therapeutic (“normal”) and, if data was available, toxic, and comatose-fatal plasma/blood concentrations as well as elimination half-lives were compiled in a table.

In case of intoxications, the blood concentration of the substance and/or metabolite better predicts the clinical severity of the case when compared to the assumed amount and time of ingestion. Comparing and contrasting the clinical case against the data provided, including the half-life, may support the decision for or against further intensive care. In addition, the data provided are useful for the therapeutic monitoring of pharmacotherapies, to facilitate the diagnostic assessment and monitoring of acute and chronic intoxications as well as to support forensic and clinical expert opinions.
Efficacy of ultrasound-guided technique for radial artery catheterization in pediatric populations: a systematic review and meta-analysis of randomized controlled trials
Authors: Zhang Wen , Li Kunpeng , Xu Hui , Luo Dawei , Ji Changbin , Yang Keshi , Zhao Qinghua
Published: May 2020

Background

The use of an ultrasound-guided technique for radial arterial catheterization has not been well established in pediatric patients. We conducted a systematic review and meta-analysis to evaluate the efficacy of the ultrasound-guided technique for radial artery catheterization in pediatric populations.

Method

A systematic review of PubMed, Medline, Embase, and the Cochrane library was performed from their date of inception to December 2019. In this meta-analysis, we conducted online searches using the search terms “ultrasonography,” “ultrasonics,” “ultrasound-guided,” “ultrasound,” “radial artery,” “radial arterial,” “catheter,” “cannula,” and “catheterization.” The rate of the first-attempt and total success, mean attempts to success, mean time to success, and incidence of complications (hematomas) were extracted. Data analysis was performed with RevMan 5.3.5.

Results

From 7 relevant studies, 558 radial artery catheterizations were enrolled, including 274 ultrasound-guided and 284 palpation catheterizations. The ultrasound-guided technique could significantly improve the rate of first-attempt and total success (RR 1.78, 95% CI 1.46 to 2.18, P < 0.00001; RR 1.33; 95% CI 1.20 to 1.48; P < 0.00001). However, there was significant heterogeneity for the total success rate among the included studies (I2 = 67%). The ultrasound-guided radial artery catheterization was also associated with less mean attempts and mean time to success (WMD − 1.13, 95% CI − 1.58 to − 0.69; WMD − 72.97 s, 95% CI − 134.41 to − 11.52) and lower incidence of the hematomas (RR 0.17, 95% CI 0.07 to 0.41).

Conclusions

The use of the ultrasound-guided technique could improve the success rate of radial arterial catheterization and reduce the incidence of hematomas in pediatric patients. However, the results should be interpreted cautiously due to the heterogeneity among the studies.
Serum calprotectin: a promising biomarker in rheumatoid arthritis and axial spondyloarthritis
Authors:   on behalf of the physicians of the Swiss Clinical Quality Management (SCQM) registry, Jarlborg Matthias , Courvoisier Delphine S. , Lamacchia Céline , Martinez Prat Laura , Mahler Michael , Bentow Chelsea , Finckh Axel , Gabay Cem , Nissen Michael J.
Published: May 2020

Background

Calprotectin (S100A8/S100A9 protein) is known as a damage-associated molecular pattern (DAMP) protein and reflects mainly neutrophil activation. Serum calprotectin levels might be a good alternative to acute-phase protein as a biomarker in inflammatory rheumatic diseases. The aim of this study is to investigate the association of serum calprotectin with disease activity and severity in rheumatoid arthritis (RA), axial spondyloarthritis (axSpA), and psoriatic arthritis (PsA).

Methods

Serum calprotectin was measured in patients with RA, axSpA, and PsA from the prospective Swiss Clinical Quality Management (SCQM) registry. Asymptomatic first-degree relatives of RA patients were used as healthy controls (HC). Outcomes included swollen joint count (SJC), Disease Activity Score (DAS), Health Assessment questionnaire (HAQ), joint radiographs, and ultrasound power Doppler (USPD) score for RA; Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS) and coxitis for axSpA; and SJC and Disease Activity Index for PSoriatic Arthritis (DAPSA) for PsA. Comparison of outcomes by calprotectin quartile levels was performed using Kruskal-Wallis tests for continuous outcomes or trend tests for categorical outcomes.

Results

A total of 1729 subjects [RA = 969, axSpA = 451, PsA = 237, and HC = 72] were included. Median levels of serum calprotectin were higher in each disease group compared to HC (p < 0.01). In RA patients, all clinical outcomes were statistically different between quartiles of serum calprotectin, indicating an association between calprotectin levels and higher disease activity (SJC, DAS, and USPD scores) and severity (joint radiographs and HAQ). In axSpA, an association between calprotectin levels and ASDAS score (p < 0.01) and prevalence of coxitis (p = 0.02) was observed. For PsA patients, SJC and DAPSA did not differ across calprotectin quartiles.

Conclusions

This large study supports the association of serum calprotectin levels with disease activity in both RA and axSpA, but not in PsA.
Low levels of serum urate are associated with a higher prevalence of depression in older adults: a nationwide cross-sectional study in Korea
Authors: Kim Woo-Joong , Kim Hye Ri , Song Jung Soo , Choi Sang Tae
Published: May 2020

Background

Soluble urate has been shown to serve as an antioxidant, especially in the central nervous system. Although there are intriguing data suggesting that low levels of serum urate are associated with worse outcomes in neurodegenerative diseases, its impact on mental health has not been adequately assessed. Thus, we aimed to investigate the association between serum urate and depression using a large, nationally representative sample.

Methods

Information on participants’ socio-demographic characteristics as well as physical and mental health conditions were retrieved from the Korea National Health and Nutrition Examination Survey (KNHANES) 2016 dataset. The Patient Health Questionnaire (PHQ)-9 was applied to identify depressive symptoms. Analyses were stratified by age: young adults (aged 19–39 years), middle-aged adults (aged 40–59 years), and older adults (aged 60 years and older).

Results

A total of 5332 participants were included. Serum urate concentrations were divided into sex-specific quartiles based on their distribution: ≤ 4.9 (Q1), 5.0–5.7 (Q2), 5.8–6.6 (Q3), and ≥ 6.7 (Q4) mg/dL in men and ≤ 3.7 (Q1), 3.8–4.3 (Q2), 4.4–4.9 (Q3), and ≥ 5.0 (Q4) mg/dL in women. There was a significant negative linear relationship between serum urate quartiles and PHQ-9 scores in older adults (p for trend = 0.020 in men and p for trend = 0.048 in women). Compared to high levels (Q3 and Q4) of serum urate, low levels (Q1 and Q2) were significantly associated with the overall burden of depression in older women (OR 1.78, 95% CI 1.21, 2.61) and clinically relevant depression in older men (OR 3.35, 95% CI 1.16, 9.70), even after adjustment.

Conclusions

Based on the KNHANES data, low levels of serum urate are associated with a higher prevalence of depression in older adults. This may have clinical implications for mental health.
One-repetition submaximal protocol to measure knee extensor muscle strength among older adults with and without sarcopenia: a validation study
Authors: Abdalla Pedro Pugliesi , Carvalho Anderson dos Santos , dos Santos André Pereira , Venturini Ana Claudia Rossini , Alves Thiago Cândido , Mota Jorge , Machado Dalmo Roberto Lopes
Published: May 2020

Background

Dynamic knee extensor muscle strength is a valid measure among healthy older adults but has not been tested in the sarcopenia condition. This study’s objective was to test the validity of a one-repetition submaximal strength protocol to measure dynamic knee extension strength in older adults with and without sarcopenia.

Methods

Ninety-four physically independent older adults (female: n = 64, 60 to 85 years; male: n = 29, 60 to 85 years) participated in this study in Brazil during 2016–2017. Sarcopenia was classified and isokinetic unilateral knee extension strength was measured at 60°/s. Bilateral dynamic knee extension strength was estimated with an extensor chair using one-repetition submaximal protocol. Validity was determined using Spearman’s correlation with isokinetic muscle strength.

Results

The frequency of sarcopenia was 11.7%. Sarcopenic individuals presented lower body mass, body mass index and skeletal muscle index. Only chronological age was higher among the sarcopenic individuals. A high correlation was found between isokinetic unilateral knee extension strength and bilateral estimated one-repetition with submaximal protocol (r = 0.74; p <  0.001), when the presence (r = 0.71; p = 0.014) and absence of sarcopenia (r = 0.74; p <  0.001) were considered. The validity of the one-repetition submaximal protocol for bilateral knee extension was confirmed.

Conclusions

The estimated measure of bilateral knee extension muscle strength can be used to monitor adaptations promoted by physical exercise for older adults with and without sarcopenia. The validation enable studies that will propose cutoff points to identify sarcopenia with this submaximal protocol. This will enable early diagnosis and better management of sarcopenia, a disease with adverse impacts for older adults.
Correction to: The International/Canadian Hereditary Angioedema Guideline
Authors: Betschel Stephen , Badiou Jacquie , Binkley Karen , Borici-Mazi Rozita , Hébert Jacques , Kanani Amin , Keith Paul , Lacuesta Gina , Waserman Susan , Yang Bill , Aygören-Pürsün Emel , Bernstein Jonathan , Bork Konrad , Caballero Teresa , Cicardi Marco , Craig Timothy , Farkas Henriette , Grumach Anete , Katelaris Connie , Longhurst Hilary , Riedl Marc , Zuraw Bruce , Berger Magdelena , Boursiquot Jean-Nicolas , Boysen Henrik , Castaldo Anthony , Chapdelaine Hugo , Connors Lori , Fu Lisa , Goodyear Dawn , Haynes Alison , Kamra Palinder , Kim Harold , Lang-Robertson Kelly , Leith Eric , McCusker Christine , Moote Bill , O’Keefe Andrew , Othman Ibraheem , Poon Man-Chiu , Ritchie Bruce , St-Pierre Charles , Stark Donald , Tsai Ellie
Published: May 2020

An amendment to this paper has been published and can be accessed via the original article.
Media views of the Stromboli 2002–2003 eruption and evacuation: a content analysis to understand framing of risk communication during a volcanic crisis
Authors: Calabrò Laura , Harris Andrew J. L. , Thouret Jean-Claude
Published: May 2020

The 2002–2003 eruption of Stromboli (Aeolian Islands, Italy) was one of Stromboli’s most important effusive events of the last two centuries and began on 28 December 2002. On 30 December 2002, two days after the beginning of the eruption, a landslide entered the sea and caused a tsunami that struck Stromboli’s coastal areas. The events of 30 December led to a “voluntary evacuation” by Stromboli’s inhabitants. To understand the role of the media in framing risk and the evacuation,we analyzed the content of five newspapers, including two national newspapers (Il Corriere della Sera and La Repubblica) and three regional newspapers (La Gazzetta del Sud, La Sicilia and Il Giornale di Sicilia), published during the period covering the onset of the eruption, the tsunami and the voluntary evacuation (28 December 2002–18 January 2003). Our aim was to assess the type of hazard information given, how it was delivered, and how this may have helped (or not) with the population’s resilience, especially in regard to viewing a potential need to evacuate in a favorable light. News regarding the eruption covered a total area of 12,000 cm2for the national newspapers (~ 6000 cm2/paper) against 41,700 cm2for the regionals (14,000 cm2/paper); making the regional newspapers the more important sources by quantity. For both newspaper categories, most of this area was occupied by interviews with experts, followed by quotes from residents and tourists, and, finally, those involved in the response (i.e., hazard managers, including civil protection and local government). Out of a total of 9286 words analyzed, the most popular was “tsunami” (426 cases), with the word “volcano” being repeated 315 times (the 6th most popular word); so it would have been difficult for the population not to have known there was a potential risk of tsunami associated with the volcano. In texturally framing the eruptive crisis, negative words, such as “fear”, “terror” and “apocalypse”, were much more frequent than positive words, which were rare and even not present in some newspapers. The reporting focused on the tsunami threat with little link back to the eruption and other hazards, and contrasted with imagery (that took up 41% of the reporting space) which comprised relaxing pictures of a tranquil island surrounded by a calm blue sea. This, coupled with a confused message through selection of quoted expert sources, may have led to an exaggerated and alarmist frame for the eruption and attendant hazards. This was in spite of widespread use of scientific sources, as well as pleas from the population itself, to the journalists and published in the newspapers themselves, to tone the reporting down. The newspaper agenda was, thus, plainly not compatible with effective communication in support of disaster management.
Land cover classification combining Sentinel-1 and Landsat 8 imagery driven by Markov random field with amendment reliability factors
Authors: Shi Xiaofei , Deng Zhiyu , Ding Xing , Li Li
Published: May 2020

Reliability factors in Markov random field (MRF) could be used to improve classification performance for synthetic aperture radar (SAR) and optical images; however, insufficient utilization of reliability factors based on characteristics of different sources leaves more room for classification improvement. To solve this problem, a Markov random field (MRF) with amendment reliability factors classification algorithm (MRF-ARF) is proposed. The ARF is constructed based on the coarse label field of urban region, and different controlling factors are utilized for different sensor data. Then, ARF is involved into the data energy of MRF, to classify the sand, vegetation, farmland, and urban regions, with the gray level co-occurrence matrix textures of Sentinel-1 imagery and the spectral values of the Landsat 8 imagery. In the experiments, Sentinel-1 and Landsat-8 images are used with overall accuracy and Kappa coefficient to evaluate the proposed algorithm with other algorithms. Results show that the overall accuracy of the proposed algorithm has the superiority of about 20% in overall precision and at least 0.2 in Kappa coefficient than the comparison algorithms. Thus, the problem of insufficient utilization of different sensors data could be solved.
Robust non-negative least mean square algorithm based on step-size scaler against impulsive noise
Authors: Fan Kuangang , Qiu Haiyun , Pei Chunyang , Chen Yuhang
Published: May 2020

Conventional non-negative algorithms restrict the weight coefficient vector under non-negativity constraints to satisfy several inherent characteristics of a specific system. However, the presence of impulsive noise causes conventional non-negative algorithms to exhibit inferior performance. Under this background, a robust non-negative least mean square (R-NNLMS) algorithm based on a step-size scaler is proposed. The proposed algorithm uses a step-size scaler to avoid the influence of impulsive noise. For various outliers, the step-size scaler can adjust the step size of the algorithm, thereby eliminating the large error caused by impulsive noise. Furthermore, to improve the performance of the proposed algorithm in sparse system identification, the inversely-proportional R-NNLMS (IP-RNNLMS) algorithm is proposed. The simulation result demonstrates that the R-NNLMS algorithm can eliminate the influence of impulsive noise while showing fast convergence rate and low steady-state error under other noises. In addition, the IP-RNNLMS algorithm has faster convergence rate compared with the R-NNLMS algorithm under sparse system.
Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: the role of colonization and contaminated cots and mothers’ hands in cross-transmission of multidrug resistant Gram-negative bacteria
Authors: Silago Vitus , Kovacs Dory , Msanga Delfina R. , Seni Jeremiah , Matthews Louise , Oravcová Katarina , Zadoks Ruth N. , Lupindu Athumani M. , Hoza Abubakar S. , Mshana Stephen E.
Published: May 2020

Background

Multidrug resistance (MDR) is a major clinical problem in tertiary hospitals in Tanzania and jeopardizes the life of neonates in critical care units (CCUs). To better understand methods for prevention of MDR infections, this study aimed to determine, among other factors, the role of MDR-Gram-negative bacteria (GNB) contaminating neonatal cots and hands of mothers as possible role in transmission of bacteremia at Bugando Medical Centre (BMC), Mwanza, Tanzania.

Methods

This cross-sectional, hospital-based study was conducted among neonates and their mothers in a neonatal intensive care unit and a neonatology unit at BMC from December 2018 to April 2019. Blood specimens (n = 200) were sub-cultured on 5% sheep blood agar (SBA) and MacConkey agar (MCA) plates. Other specimens (200 neonatal rectal swabs, 200 maternal hand swabs and 200 neonatal cot swabs) were directly inoculated on MCA plates supplemented with 2 μg/ml cefotaxime (MCA-C) for screening of GNB resistant to third generation cephalosporins, r-3GCs. Conventional biochemical tests, Kirby-Bauer technique and resistance to cefoxitin 30 μg were used for identification of bacteria, antibiotic susceptibility testing and detection of MDR-GNB and screening of potential Amp-C beta lactamase producing GNB, respectively.

Results

The prevalence of culture confirmed bacteremia was 34.5% of which 85.5% were GNB. Fifty-five (93.2%) of GNB isolated from neonatal blood specimens were r-3GCs. On the other hand; 43% of neonates were colonized with GNB r-3GCs, 32% of cots were contaminated with GNB r-3GCs and 18.5% of hands of neonates’ mothers were contaminated with GNB r-3GCs. The prevalences of MDR-GNB isolated from blood culture and GNB r-3GCs isolated from neonatal colonization, cots and mothers’ hands were 96.6, 100, 100 and 94.6%, respectively. Significantly, cyanosis (OR[95%CI]: 3.13[1.51–6.51], p = 0.002), jaundice (OR[95%CI]: 2.10[1.07–4.14], p = 0.031), number of invasive devices (OR[95%CI]: 2.52[1.08–5.85], p = 0.031) and contaminated cot (OR[95%CI]: 2.39[1.26–4.55], p = 0.008) were associated with bacteremia due to GNB. Use of tap water only (OR[95%CI]: 2.12[0.88–5.09], p = 0.040) was protective for bacteremia due to GNB.

Conclusion

High prevalence of MDR-GNB bacteremia and intestinal colonization, and MDR-GNB contaminating cots and mothers’ hands was observed. Improved cots decontamination strategies is crucial to limit the spread of MDR-GNB. Further, clinical presentations and water use should be considered in administration of empirical therapy whilst awaiting culture results.
Multi-proxy analyses of a mid-15th century Middle Iron Age Bantu-speaker palaeo-faecal specimen elucidates the configuration of the ‘ancestral’ sub-Saharan African intestinal microbiome
Authors: Rifkin Riaan F. , Vikram Surendra , Ramond Jean-Baptiste , Rey-Iglesia Alba , Brand Tina B. , Porraz Guillaume , Val Aurore , Hall Grant , Woodborne Stephan , Le Bailly Matthieu , Potgieter Marnie , Underdown Simon J. , Koopman Jessica E. , Cowan Don A. , Van de Peer Yves , Willerslev Eske , Hansen Anders J.
Published: May 2020

Background

The archaeological incidence of ancient human faecal material provides a rare opportunity to explore the taxonomic composition and metabolic capacity of the ancestral human intestinal microbiome (IM). Here, we report the results of the shotgun metagenomic analyses of an ancient South African palaeo-faecal specimen.

Methods

Following the recovery of a single desiccated palaeo-faecal specimen from Bushman Rock Shelter in Limpopo Province, South Africa, we applied a multi-proxy analytical protocol to the sample. The extraction of ancient DNA from the specimen and its subsequent shotgun metagenomic sequencing facilitated the taxonomic and metabolic characterisation of this ancient human IM.

Results

Our results indicate that the distal IM of the Neolithic ‘Middle Iron Age’ (c. AD 1460) Bantu-speaking individual exhibits features indicative of a largely mixed forager-agro-pastoralist diet. Subsequent comparison with the IMs of the Tyrolean Iceman (Ötzi) and contemporary Hadza hunter-gatherers, Malawian agro-pastoralists and Italians reveals that this IM precedes recent adaptation to ‘Western’ diets, including the consumption of coffee, tea, chocolate, citrus and soy, and the use of antibiotics, analgesics and also exposure to various toxic environmental pollutants.

Conclusions

Our analyses reveal some of the causes and means by which current human IMs are likely to have responded to recent dietary changes, prescription medications and environmental pollutants, providing rare insight into human IM evolution following the advent of the Neolithicc. 12,000 years ago.
Hydroxymethylation and tumors: can 5-hydroxymethylation be used as a marker for tumor diagnosis and treatment?
Authors: Xu Tianmin , Gao Haoyue
Published: May 2020

5-Methylcytosine (5mC) is considered as a common epigenetic modification that plays an important role in the regulation of gene expression. At the same time, 5-hydroxymethylcytosine (5hmC) has been found as an emerging modification of cytosine bases of recent years. Unlike 5mC, global 5hmC levels vary from tissues that have differential distribution both in mammalian tissues and in the genome. DNA hydroxymethylation is the process that 5mC oxidates into 5hmC with the catalysis of TET (ten-eleven translocation) enzymes. It is an essential option of DNA demethylation, which modulates gene expression by adjusting the DNA methylation level. Various factors can regulate the demethylation of DNA, such as environmental toxins and mental stress. In this review, we summarize the progress in the formation of 5hmC, and obtaining 5hmC in a cell-free DNA sample presents multiple advantages and challenges for the subject. Furthermore, the clinical potential for 5hmC modification in dealing with cancer early diagnosis, prognostic evaluation, and prediction of therapeutic effect is also mentioned.
Genetic perspective on the synergistic connection between vesicular transport, lysosomal and mitochondrial pathways associated with Parkinson’s disease pathogenesis
Authors: Smolders Stefanie , Van Broeckhoven Christine
Published: May 2020

Parkinson’s disease (PD) and atypical parkinsonian syndromes (APS) are symptomatically characterized by parkinsonism, with the latter presenting additionally a distinctive range of atypical features. Although the majority of patients with PD and APS appear to be sporadic, genetic causes of several rare monogenic disease variants were identified. The knowledge acquired from these genetic factors indicated that defects in vesicular transport pathways, endo-lysosomal dysfunction, impaired autophagy-lysosomal protein and organelle degradation pathways, α-synuclein aggregation and mitochondrial dysfunction play key roles in PD pathogenesis. Moreover, membrane dynamics are increasingly recognized as a key player in the disease pathogenesis due lipid homeostasis alterations, associated with lysosomal dysfunction, caused by mutations in several PD and APS genes. The importance of lysosomal dysfunction and lipid homeostasis is strengthened by both genetic discoveries and clinical epidemiology of the association between parkinsonism and lysosomal storage disorders (LSDs), caused by the disruption of lysosomal biogenesis or function. A synergistic coordination between vesicular trafficking, lysosomal and mitochondria defects exist whereby mutations in PD and APS genes encoding proteins primarily involved one PD pathway are frequently associated with defects in other PD pathways as a secondary effect. Moreover, accumulating clinical and genetic observations suggest more complex inheritance patters of familial PD exist, including oligogenic and polygenic inheritance of genes in the same or interconnected PD pathways, further strengthening their synergistic connection.

Here, we provide a comprehensive overview of PD and APS genes with functions in vesicular transport, lysosomal and mitochondrial pathways, and highlight functional and genetic evidence of the synergistic connection between these PD associated pathways.
Study on streamflow response to land use change over the upper reaches of Zhanghe Reservoir in the Yangtze River basin
Authors: Chen Yuqi , Niu Jun , Sun Yuqing , Liu Qi , Li Sien , Li Peng , Sun Liqun , Li Qinglan
Published: May 2020

The Zhanghe Reservoir in Yangtze River basin plays a key role in fulfilling the crop water requirements of the irrigation area in its downstream region. This study employs the SWAT (Soil and Water Assessment Tool) model to simulate the variations of Zhanghe Reservoir inflow. The model performed well at monthly timescale, with the values of both NSE and R2 above 0.7. The land use distribution and the structure changes in 1990, 2000, and 2015 are employed to study the reservoir inflow responses to the land use changes in the contributed basin area. In the historical period (1990–2000), the streamflow was decreased by 0.4%, accompanied by the reductions of farmland and grassland area, and the increase of forestry area. The land use scenarios are further designed for considering possible future land use alterations. The low flow responses to the completely forestry cover for the basin is more obvious to the completely grassland cover. Accordingly, the further afforestation may aggravate the drought situation due to the low flow reduction. In addition, the high flow responses are reversed to these two land cover situations. The obtained results are useful for designing future sustainable development strategies for the region.
Thoracoscopic surgery combined with endoscopic creation of a submucosal tunnel for a large complicated esophageal leiomyoma
Authors: Oyama Koki , Ohuchida Kenoki , Shindo Koji , Moriyama Taiki , Hata Yoshitaka , Wada Masafumi , Ihara Eikichi , Nagai Shuntaro , Ohtsuka Takao , Nakamura Masafumi
Published: May 2020

Background

The standard surgical method for symptomatic submucosal tumors (SMTs) or tumors with unclear biological behavior is enucleation. Minimally invasive approaches are usually considered appropriate for surgical enucleation; thus, thoracoscopic and laparoscopic enucleation is performed widely and safely. However, it is sometimes difficult to enucleate large and complicated esophageal tumors using thoracoscopic surgery, and even if rare, there is the risk of requiring thoracotomy or esophagectomy. In the present case, we enucleated a large and complicated leiomyoma safely using a new combined method with endoscopic and thoracoscopic procedures.

Case presentation

A 42-year-old woman presented to our hospital for a detailed examination of an abnormal finding in her health check-up chest X-ray images. She complained of upper abdominal pain after eating, and computed tomography revealed an esophageal tumor measuring 60 mm in length surrounding her lower thoracic esophagus. Esophagogastroduodenoscopy revealed a huge complicated SMT at the esophagogastric junction. Cytological examination with endoscopic ultrasound-guided fine-needle aspiration showed that the tumor was a leiomyoma. To enucleate this large and complicated esophageal SMT safely and without damaging the esophageal mucosa, we performed endoscopic and thoracoscopic procedures. We created a submucosal tunnel, endoscopically, and then performed thoracoscopic surgery to enucleate the tumor completely from the esophageal muscularis. Using these combined procedures, we were able to easily mobilize even a complicated tumor of this size from the mucosa and completed the surgery thoracoscopically without difficulty. As a result, the tumor was dissected safely with a minimal defect in the muscularis and without damaging the mucosa. Finally, we closed the defect in the esophageal muscularis with continuous sutures, thoracoscopically, and closed the entry of the submucosal tunnel using clips, endoscopically.

Conclusions

Using these combined procedures, we safely enucleated a huge complicated esophageal SMT. The increased mobility of the tumor after creating the submucosal tunnel contributed to the minimal defect in the muscular layer and prevented injury to the esophageal mucosa, possibly leading to fewer postoperative complications such as esophageal stenosis and local infection.
Where is the policy? A bibliometric analysis of the state of policy research on medical tourism
Authors: Virani Altaf , Wellstead Adam M. , Howlett Michael
Published: May 2020

Background

It is imperative that researchers studying medical tourism connect their work with policy, so that its real-world challenges can be better understood, and more effectively addressed. This article gauges the scope and evolution of policy thinking in medical tourism research through a bibliometric review of published academic literature, to establish the extent to which researchers apply public policy theories and frameworks in their investigation of medical tourism, or consider the policy imperatives of their work.

Methods

A Boolean search of the Web of Science (WoS) Core Collection was performed to identify policy-related publications on medical tourism. We analyzed the results using bibliometrics and a data visualization software called VOSviewer to identify patterns in knowledge production and underlying network linkages in policy research on the subject.

Results

Our findings suggest that only a small proportion of medical tourism research explicitly addresses policy issues or applies policy paradigms in their study approach. Field-specialized journals serving practitioners publish less research as compared to interdisciplinary social and health policy journals. Moreover, there are significant geographical and disciplinary disparities in the policy-orientation of research, and a predilection towards select policy areas such as reproductive and transplant tourism to the neglect of more holistic governance and health system considerations.

Conclusion

This article is a call to action for greater engagement by policy scholars on medical tourism, and for health researchers to more explicitly consider how their research might contribute to the understanding and resolution of contemporary policy challenges of medical tourism. Failure to clearly and consistently make the policy connection is a lost opportunity for researchers to frame the public debate, and influence policy thinking on medical tourism.
Research on optical 32QAM-OFDM-PON access scheme with different numbers of sub-carriers using DMT modulation
Authors: Shao Yufeng , Long Ying , Wang Anrong , Tan Zefu , Lei Guoping , Hu Zhengquan , Liu Yu , Hu Qinzheng , Wang Zhuang , Yang Jie
Published: May 2020

An optical 32QAM-OFDM-PON system with different numbers of sub-carriers using discrete multitone (DMT) modulation and demodulation is designed and demonstrated by experiment. Electron-optic generation, directly photoelectric detection, and electrical self-mixing reception of 32QAM-OFDM downstream signals are achieved. 5Gb/s 32QAM-OFDM downlink signals with different numbers of sub-carriers are successfully transmitted over 42 km SMF-28. Peak-to average power ratio (PAPR) characteristic, computational complexity and bit error rate (BER) performance are analyzed. The results show that the sub-carriers numbers of 32QAM-OFDM downlink signals should be carefully selected according to the actual requirements, if spectral efficiency, PAPR characteristic, computational complexity and receiver sensitivity are considered.
Protocol for two-arm pragmatic cluster randomized hybrid implementation-effectiveness trial comparing two education strategies for improving the uptake of noninvasive ventilation in patients with severe COPD exacerbation
Authors: Stefan Mihaela S. , Pekow Penelope S. , Shea Christopher M. , Hughes Ashley M. , Hill Nicholas S. , Steingrub Jay S. , Lindenauer Peter K.
Published: May 2020

Background

COPD is the fourth leading cause of death in the US, and COPD exacerbations result in approximately 700,000 hospitalizations annually. Patients with acute respiratory failure due to severe COPD exacerbation are treated with invasive (IMV) or noninvasive mechanical ventilation (NIV). Although IMV reverses hypercapnia/hypoxia, it causes significant morbidity and mortality. There is strong evidence that patients treated with NIV have better outcomes, and NIV is recommended as first line therapy in these patients. Yet, several studies have demonstrated substantial variation in the use of NIV across hospitals, leading to preventable morbidity and mortality. Through a series of mixed-methods studies, we have found that successful implementation of NIV requires physicians, respiratory therapists (RTs), and nurses to communicate and collaborate effectively, suggesting that efforts to increase the use of NIV in COPD need to account for the complex and interdisciplinary nature of NIV delivery and the need for team coordination. Therefore, we propose to compare two educational strategies: online education (OLE) and interprofessional education (IPE) which targets complex team-based care in NIV delivery.

Methods and design

Twenty hospitals with low baseline rates of NIV use will be randomized to either the OLE or IPE study arm. The primary outcome of the trial is change in the hospital rate of NIV use among patients with COPD requiring ventilatory support. In aim 1, we will compare the uptake change over time of NIV use among patients with COPD in hospitals enrolled in the two arms. In aim 2, we will explore mediators’ role (respiratory therapist autonomy and team functionality) on the relationship between the implementation strategies and implementation effectiveness. Finally, in aim 3, through interviews with providers, we will assess acceptability and feasibility of the educational training.

Discussions

This study will be among the first to carefully test the impact of IPE in the inpatient setting. This work promises to change practice by offering approaches to facilitate greater uptake of NIV and may generalize to other interventions directed to seriously-ill patients.

Trial registration

Name of registry: ClinicalTrials.gov

Trial registration number:NCT04206735

Date of Registration: December 20, 2019
Bumblebees land remarkably well in red-blue greenhouse LED light conditions
Authors: de Vries Lana J. , van Langevelde Frank , van Dooremalen Coby , Kornegoor Ilse G. , Lankheet Martin J. , van Leeuwen Johan L. , Naguib Marc , Muijres Florian T.
Published: May 2020

Red-blue emitting LEDs have recently been introduced in greenhouses to optimize plant growth. However, this spectrum may negatively affect the performance of bumblebees used for pollination, because the visual system of bumblebees is more sensitive to green light than to red-blue light. We used high-speed stereoscopic videography to 3D track and compare landing manoeuvres of Bombus terrestris bumblebees in red-blue light and in regular, broad-spectrum white light. In both conditions, the landing approaches were interspersed by one or several hover phases, finally followed by leg extension and touchdown. The time between leg extension and touchdown was 25% (0.05 s) longer in red-blue light than in white light, caused by a more tortuous flight path in red-blue light. However, the total landing duration, specified as the time between the first hover phase and touchdown, did not differ between the light conditions. This suggests that the negative effects of red-blue light on the landing manoeuvre are confined to the final phase of the landing.