bluuebunny/crossref_metadata_2025 huggingface dataset:
Automatic Segmentation in Acute Ischemic Stroke: Prognostic Significance of Topological Stroke Volumes on Stroke Outcome
Authors: Wong Kelvin K. , Cummock Jonathon S. , Li Guihua , Ghosh Rahul , Xu Pingyi , Volpi John J. , Wong Stephen T.C.
Published: May 2022

Background:

Stroke infarct volume predicts patient disability and has utility for clinical trial outcomes. Accurate infarct volume measurement requires manual segmentation of stroke boundaries in diffusion-weighted magnetic resonance imaging scans which is time-consuming and subject to variability. Automatic infarct segmentation should be robust to rotation and reflection; however, prior work has not encoded this property into deep learning architecture. Here, we use rotation-reflection equivariance and train a deep learning model to segment stroke volumes in a large cohort of well-characterized patients with acute ischemic stroke in different vascular territories.

Methods:

In this retrospective study, patients were selected from a stroke registry at Houston Methodist Hospital. Eight hundred seventy-five patients with acute ischemic stroke in any brain area who had magnetic resonance imaging with diffusion-weighted imaging were included for analysis and split 80/20 for training/testing. Infarct volumes were manually segmented by consensus of 3 independent clinical experts and cross-referenced against radiology reports. A rotation-reflection equivariant model was developed based on U-Net and grouped convolutions. Segmentation performance was evaluated using Dice score, precision, and recall. Ninety-day modified Rankin Scale outcome prediction was also evaluated using clinical variables and segmented stroke volumes in different brain regions.

Results:

Segmentation model Dice scores are 0.88 (95% CI, 0.87–0.89; training) and 0.85 (0.82–0.88; testing). The modified Rankin Scale outcome prediction AUC using stroke volume in 30 refined brain regions based upon modified Rankin Scale-relevance areas adjusted for clinical variables was 0.80 (0.76–0.83) with an accuracy of 0.75 (0.72–0.78).

Conclusions:

We trained a deep learning model with encoded rotation-reflection equivariance to segment acute ischemic stroke lesions in diffusion- weighted imaging using a large data set from the Houston Methodist stroke center. The model achieved competitive performance in 175 well-balanced hold-out testing cases that include strokes from different vascular territories. Furthermore, the location specific stroke volume segmentations from the deep learning model combined with clinical factors demonstrated high AUC and accuracy for 90-day modified Rankin Scale in an outcome prediction model.
Soldiers' Dilemma: Foreign Military Training and Liberal Norm Conflict
Authors: Joyce Renanah Miles
Published: May 2022

The United States regularly seeks to promote the liberal norms of respect for human rights and deference to civilian authority in the militaries that it trains. Yet norm-abiding behavior often does not follow from liberal foreign military training. Existing explanations ascribe norm violations either to insufficient socialization or to interest misalignment between providers and recipients. One reason violations occur is because liberal training imparts conflicting norms. How do militaries respond when they confront the dilemma of conflict between the liberal norms of respect for human rights and civilian control of the military? The U.S. policy expectation is that trained militaries will prioritize human rights over obedience to civilian authorities. But when liberal norms clash, soldiers fall back on a third norm of cohesion, which refers to the bonds that enable military forces to operate in a unified, group- and missionoriented way. Cohesion functions as both a military norm (particularly at the individual level) and an interest (particularly at the institutional level). If a military prioritizes cohesion, then it will choose the path that best serves its organization, which may entail violating human rights, civilian control, or both. An exploration of the effects of norm conflict on military attitudes among the Armed Forces of Liberia uses an experiment embedded in a survey to probe the theory. Results provide preliminary evidence that norm conflict weakens support for human rights and democracy. Results are strongest among soldiers with more U.S. training.
Decline and Disintegration: National Status Loss and Domestic Conflict in Post-Disaster Spain
Authors: Ward Steven
Published: May 2022

Decline has long been a central concern of international relations scholarship, but analysts have only recently begun to investigate whether a change in international status influences a state's domestic politics. A new theoretical framework for understanding the domestic political consequences of relative national decline posits that eroding national status activates two sets of social psychological dynamics that contribute to domestic conflict inside declining states. First, eroding state status prompts some groups to strengthen their commitment to the state's status and dominant national identity, at the same time as it prompts other groups to disidentify from the state. Second, eroding status produces incentives for substate actors to derogate and scapegoat one another. These dynamics are particularly likely to contribute to center-periphery conflict in multinational states after instances of acute status loss. The plausibility of the argument is demonstrated by showing how the erosion of Spain's status (especially because of military failure in the 1898 Spanish-American War and the subsequent loss of its last colonies in the Americas) intensified domestic conflict in Spain during the first decades of the twentieth century. Findings indicate that decline may actually exacerbate domestic conflict, making it more difficult for states to adopt appropriate reforms.
The Response of a Baroclinic Anticyclonic Eddy to Relative Wind Stress Forcing
Authors: Wilder Thomas , Zhai Xiaoming , Munday David , Joshi Manoj
Published: May 2022

Including the ocean surface current in the calculation of wind stress is known to damp mesoscale eddies through a negative wind power input and have potential ramifications for eddy longevity. Here, we study the spindown of a baroclinic anticyclonic eddy subject to absolute (no ocean surface current) and relative (including ocean surface current) wind stress forcing by employing an idealized high-resolution numerical model. Results from this study demonstrate that relative wind stress dissipates surface mean kinetic energy (MKE) and also generates additional vertical motions throughout the whole water column via Ekman pumping. Wind stress curl–induced Ekman pumping generates additional baroclinic conversion (mean potential to mean kinetic energy) that is found to offset the damping of surface MKE by increasing deep MKE. A scaling analysis of relative wind stress–induced baroclinic conversion and relative wind stress damping confirms these numerical findings, showing that additional energy conversion counteracts relative wind stress damping. What is more, wind stress curl–induced Ekman pumping is found to modify surface potential vorticity gradients that lead to an earlier destabilization of the eddy. Therefore, the onset of eddy instabilities and eventual eddy decay takes place on a shorter time scale in the simulation with relative wind stress.
Crystal chemistry and origin of REE-bearing mukhinite from carbonate veins of the Svetlinsky gold deposit, South Urals, Russia
Authors: Korinevsky Victor G. , Chukanov Nikita V. , Aksenov Sergey M. , Korinevsky Evgeniy V. , Kotlyarov Vasiliy A. , Zamyatin Dmitry А. , Ryanskaya Anastasiya D. , Kolisnichenko Sergey V. , Lebedeva Svetlana M. , Ermolaeva Vera N.
Published: May 2022

A rare earth element (REE)-, Cr- and Mg-bearing variety of the vanadium epidote-group mineral mukhinite occurs in a calcite–dolomite carbonatite dyke cutting metamorphosed volcano-sedimentary rocks exposed in the walls of the quarry of the Svetlinsky gold deposit, South Urals. This mineral was found in a paragene assemblage including native sulphur, phlogopite and fluorophlogopite, together with accessory pyrite, other sulfides and sulfosalts, gold, Cr- and V-bearing muscovite, margarite, Cr- and V-bearing dravite, fluoro-tremolite, actinolite, fluoro-pargasite, anhydrite, apatite, uranium hydroxides, V-rich titanite, V- and Nb-rich rutile, spinel and corundum. The contents of ΣREE2O3 and V2O3 in mukhinite vary in the ranges of 4.01–9.69 and 5.34–7.46 wt.%, respectively. A Raman spectrum of REE-rich mukhinite is provided. The main schemes of isomorphic substitutions in mukhinite are ΣREE + Mg ↔ Ca + Al and V+Cr ↔ Al. The crystal structure of REE-rich mukhinite has been studied by single-crystal X-ray diffraction analysis. The mineral is monoclinic, with the space group P21/m, and unit-cell parameters are: a = 8.8972(11) Å, b = 5.6221(6) Å, c = 10.1519(12) Å, β = 115.169° and V = 459.60(11) Å3. The crystal structure of REE-rich mukhinite is similar to that of its synthetic analogue; the refined crystal-chemical formula of the sample studied is (Z = 2): {A1CaA2(Ca0.8REE0.2)}{M1(Al0.95Cr0.05)M2AlM3[(V,Cr)3+0.40Al0.35Mg0.25]}(Si2O7)(SiO4)O(OH).
Enhancement of Electrochromic Properties of Polyaniline Induced by Copper Ions
Authors: Qin Ting , Deng Lianwen , Zhang Pin , Tang Min , Li Chen , Xie Haipeng , Huang Shengxiang , Gao Xiaohui
Published: May 2022

Driven by the urgent need for adaptive infrared (IR) electrochromic devices, the improvement in electrochromic performance based on polyaniline (PANI) conducting polymers has become an outstanding challenge. In recent years, the acid doping strategy has been proven to increase the IR modulation ability of PANI, in particular for the Bronsted acid doping. Herein, the effects of copper ions, a Lewis acid, on the structure and electrochromic properties of polyaniline were investigated. Compared to pure polyaniline, the Cu-doped PANI porous films show better IR modulation ability. With the increasing concentration of copper ions, the Cu-doped PANI porous films exhibit a trend in volcanic patterns for the emittance variation (∆ε), depending on the number of polarons and bipolarons. The optimal IR emissivity (ε) modulation obtained on Cu-doped PANI films shows the ∆ε modulation of 0.35 and 0.3 in the wavelength range of 8–14 µm and 2.5–25 µm, superior to previously reported pure sulfuric acid-doped PANI. Furthermore, a flexible IR electrochromic device was fabricated with the present Cu-doped PANI porous films. The modulation of the emittance variation varied between 0.513 and 0.834 (∆ε = 0.32 in ranges of wavelength 8–12 µm), suggesting the great potential for applications in military camouflage and intelligent IR thermal management. We believe that the results in this work will provide a novel perspective and avenue for improving the IR modulation ability of electrochromic devices based on polyaniline conducting polymers.
Design of GAA Nanosheet Ferroelectric Area Tunneling FET and Its Significance with DC/RF Characteristics Including Linearity Analyses
Authors: Thoti Narasimhulu , Li Yiming
Published: May 2022

This work reports an emerging structure of gate-all-around ferroelectric area tunneling field-effect transistor (FATFET) by considering ferroelectric and a n-epitaxial layer enveloped around the overlapped region of the source and channel to succeed with complete area of tunneling probability. To accomplish this, ferroelectric ($$\hbox{Hf}_{0.5}\hbox{Zr}_{0.5}\hbox{O}_2$$

Hf

0.5

Zr

0.5

O
2

) is exploited and modeled to boost the FATFET performance through internal-voltage ($$V_{{\rm int}}$$

V
int

) amplification. The corresponding modeling approach to estimate the ferroelectric parameters along with $$V_{{\rm int}}$$

V
int

calculations of the metal-ferroelectric-insulator (MFIS) option through capacitance equivalent method is addressed. Using these options the proposed device outperforms effectively in delivering superior DC and RF performance among possible options of the $$\hbox{Si}_{1-x}\hbox{Ge}_x$$

Si

1
-
x

Ge
x

ferroelectric TFETs. The significance of proposed design is examined with recently reported ferroelectric TFETs. Our results show 10-time advancement on the $$I_{{\rm on}}$$

I
on

, reduced steep or average subthreshold swing (< 25 mV/dec), frequencies higher than 150 GHz, and insignificant to linearity deviations at low bias points. Furthermore, 2-order reduction in energy efficiency is succeeded with the proposed design environment.
Hsa_circ_0000345 inhibits cell proliferation, migration and invasion of nasopharyngeal carcinoma cells via miR-513a-3p/PTEN axis
Authors: Jiang Chang , Li Hongyan , Liu Fei , Shi Linggai , Liu Jun , Li Yujie
Published: May 2022

Background

Hsa_circ_0000345 has been reported to be down-regulated in nasopharyngeal carcinoma (NPC). Whether hsa_circ_0000345 can exert antitumor effect in NPC remains unclear. This study aimed to investigate the possible biological role of hsa_cic_0000345 in suppressing the progression of NPC.

Methods

Hsa_circ_0000345 expression was detected in normal nasopharynx epithelial cells (NP69) and NPC cell lines (SUNE1, HONE1, 6-10B and HNE1). The influence of hsa_circ_0000345 on cell proliferation, migration and invasion of NPC cells was evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and transwell assays. Quantitative real-time PCR and western blot were performed to examine gene and protein expression, respectively. Luciferase reporter assay was carried out to verify the relationship among hsa_circ_0000345, miR-513a-3p and phosphatase and tensin homolog deleted on chromosome 10 (PTEN).

Results

Compared with NP69 cells, hsa_circ_0000345 was down-regulated in NPC cells. Moreover, hsa_circ_0000345 overexpression repressed cell proliferation, migration and invasion of SUNE1 cells, whereas hsa_circ_0000345 knockdown promoted cell proliferation, migration and invasion of 6-10B cells. Furthermore, hsa_circ_0000345 promoted PTEN expression by sponging miR-513a-3p. Both miR-513a-3p overexpression and PTEN knockdown promoted cell proliferation, migration and invasion of SUNE1 cells, which were effectively abolished by hsa_circ_0000345 up-regulation.

Conclusion

Hsa_circ_0000345 inhibits cell proliferation, migration and invasion of NPC cells via miR-513a-3p/PTEN axis, thereby suppressing the progression of NPC. Thus, this work suggests that hsa_circ_0000345 may be a potential biomarker for diagnosis and treatment of NPC.
Prider: multiplexed primer design using linearly scaling approximation of set coverage
Authors: Smolander Niina , Julian Timothy R. , Tamminen Manu
Published: May 2022

Background

Designing oligonucleotide primers and probes is one of the key steps of various laboratory experiments such as multiplexed PCR or digital multiplexed ligation assays. When designing multiplexed primers and probes to complex, heterogeneous DNA data sets, an optimization problem can arise where the smallest number of oligonucleotides covering the largest diversity of the input dataset needs to be identified. Tools that provide this optimization in an efficient manner for large input data are currently lacking.

Results

Here we present Prider, an R package for designing primers and probes with a nearly optimal coverage for complex and large sequence sets. Prider initially prepares a full primer coverage of the input sequences, the complexity of which is subsequently reduced by removing components of high redundancy or narrow coverage. The primers from the resulting near-optimal coverage are easily accessible as data frames and their coverage across the input sequences can be visualised as heatmaps using Prider’s plotting function. Prider permits efficient design of primers to large DNA datasets by scaling linearly to increasing sequence data, regardless of the diversity of the dataset.

Conclusions

Prider solves a recalcitrant problem in molecular diagnostics: how to cover a maximal sequence diversity with a minimal number of oligonucleotide primers or probes. The combination of Prider with highly scalable molecular quantification techniques will permit an unprecedented molecular screening capability with immediate applicability in fields such as clinical microbiology, epidemic virus surveillance or antimicrobial resistance surveillance.
Antimicrobial activity of supernatants produced by bacteria isolated from Brazilian stingless bee’s larval food
Authors: Santos Ana Carolina Costa , Malta Serena Mares , Dantas Raquel Cristina Cavalcanti , Coelho Rocha Nina Dias , Ariston de Carvalho Azevedo Vasco , Ueira-Vieira Carlos
Published: May 2022

Background

The discovery of new molecules with antimicrobial properties has been a promising approach, mainly when related to substances produced by bacteria. The use of substances produced by bees has evidenced the antimicrobial action in different types of organisms. Thus, the use of bacteria isolated from larval food of stingless bees opens the way for the identification of the new molecules. The effect of supernatants produced by these bacteria was evaluated for their ability to inhibit the growth of bacteria of clinical interest. Furthermore, their effects were evaluated when used in synergy with antibiotics available in the pharmaceutical industry.

Results

A few supernatants showed an inhibitory effect against susceptible and multiresistant strains in the PIC assay and the modulation assay. Emphasizing the inhibitory effect on multidrug-resistant strains, 7 showed an effect on multidrug-resistant Escherichia coli (APEC), Klebsiella pneumoniae carbapenemase (KPC), multidrug-resistant Pseudomonas aeruginosa, and multidrug-resistant Staphylococcus aureus (MRSA) in the PIC assay. Of the supernatants analyzed, some presented synergism for more than one species of multidrug-resistant bacteria. Nine had a synergistic effect with ampicillin on E. coli (APEC) or S. aureus (MRSA), 5 with penicillin G on E. coli (APEC) or KPC, and 3 with vancomycin on KPC.

Conclusion

In summary, the results indicate that supernatants produced from microorganisms can synthesize different classes of molecules with potent antibiotic activity against multiresistant bacteria. Thus, suggesting the use of these microorganisms for use clinical tests to isolate the molecules produced and their potential for use.
Aspartic protease inhibitor enhances resistance to potato virus Y and A in transgenic potato plants
Authors: Osmani Zhila , Sabet Mohammad Sadegh , Nakahara Kenji S.
Published: May 2022

Background

Viruses are the major threat to commercial potato (Solanum tuberosum) production worldwide. Because viral genomes only encode a small number of proteins, all stages of viral infection rely on interactions between viral proteins and host factors. Previously, we presented a list of the most important candidate genes involved in potato plants’ defense response to viruses that are significantly activated in resistant cultivars. Isolated from this list, Aspartic Protease Inhibitor 5 (API5) is a critical host regulatory component of plant defense responses against pathogens. The purpose of this study is to determine the role of StAPI5 in defense of potato against potato virus Y and potato virus A, as well as its ability to confer virus resistance in a transgenic susceptible cultivar of potato (Desiree). Potato plants were transformed with Agrobacterium tumefaciens via a construct encoding the potato StAPI5 gene under the control of the Cauliflower mosaic virus (CaMV) 35S promoter.

Results

Transgenic plants overexpressing StAPI5 exhibited comparable virus resistance to non-transgenic control plants, indicating that StAPI5 functions in gene regulation during virus resistance. The endogenous StAPI5 and CaMV 35S promoter regions shared nine transcription factor binding sites. Additionally, the net photosynthetic rate, stomatal conductivity, and maximum photochemical efficiency of photosystem II were significantly higher in virus-infected transgenic plants than in wild-type plants.

Conclusion

Overall, these findings indicate that StAPI5 may be a viable candidate gene for engineering plant disease resistance to viruses that inhibit disease development.
Erector spinae plane block vs interscalene brachial plexus block for postoperative analgesia management in patients who underwent shoulder arthroscopy
Authors: Kapukaya Furkan , Ekinci Mursel , Ciftci Bahadir , Atalay Yunus Oktay , Gölboyu Birzat Emre , Kuyucu Ersin , Demiraran Yavuz
Published: May 2022

Background

Interscalene brachial plexus block (ISB) is the gold standard method used for postoperative analgesia after arthroscopic shoulder surgery. Ultrasound guided erector spinae plane block (ESPB) is an interfascial plane block. The aim of this study is to compare the analgesic efficacy of ESPB and ISB after shoulder arthroscopy. The primary outcome is the comparison of the perioperative and postoperative opioid consumptions.

Methods

Sixty patients with ASA score I-II planned for arthroscopic shoulder surgery were included in the study. ESPB was planned in Group ESPB (n = 30), and ISB was planned in Group ISB (n = 30). Intravenous fentanyl patient-controlled analgesia was administered to both groups in the postoperative period. Intraoperative and postoperative opioid and analgesic consumption of both groups, side effects and complications related to opioid use, postoperative pain scores and rescue analgesic use were recorded in the first 48 h postoperatively.

Results

Pain scores were significantly higher in the ESPB group in the first 4 h postoperatively than in the ISB group (p < 0.05). The total fentanyl consumption and number of patients using rescue analgesics in the postoperative period were significantly higher in the ESPB group (p < 0.05). The incidence of nausea in the postoperative period was significantly higher in the ESPB group (p < 0.05).

Conclusions

In our study, it was seen that ISB provided more effective analgesia management compared to ESPB in patients underwent shoulder arthroscopy surgery.
Nanomolar EP4 receptor potency and expression of eicosanoid-related enzymes in normal appearing colonic mucosa from patients with colorectal neoplasia
Authors: Feddersen Ulrike Ries , Hendel Sebastian Kjærgaard , Berner-Hansen Mark Alexander , Jepps Thomas Andrew , Berner-Hansen Mark , Bindslev Niels
Published: May 2022

Background

Aberrations in cyclooxygenase and lipoxygenase (LOX) pathways in non-neoplastic, normal appearing mucosa from patients with colorectal neoplasia (CRN), could hypothetically qualify as predisposing CRN-markers.

Methods

To test this hypothesis, biopsies were obtained during colonoscopy from macroscopically normal colonic mucosa from patients with and without CRN. Prostaglandin E2 (PGE2) receptors, EP1-4, were examined in Ussing-chambers by exposing biopsies to selective EP receptor agonists, antagonists and PGE2. Furthermore, mRNA expression of EP receptors, prostanoid synthases and LOX enzymes were evaluated with qPCR.

Results

Data suggest that PGE2 binds to both high and low affinity EP receptors. In particular, PGE2 demonstrated EP4 receptor potency in the low nanomolar range. Similar results were detected using EP2 and EP4 agonists. In CRN patients, mRNA-levels were higher for EP1 and EP2 receptors and for enzymes prostaglandin-I synthase, 5-LOX, 12-LOX and 15-LOX.

Conclusions

In conclusion, normal appearing colonic mucosa from CRN patients demonstrates deviating expression in eicosanoid pathways, which might indicate a likely predisposition for early CRN development and furthermore that PGE2 potently activates high affinity EP4 receptor subtypes, supporting relevance of testing EP4 antagonists in colorectal neoplasia management.
Trajectories and determinants of emergency department use among nursing home residents: a time series analysis (2012–2019)
Authors: Giacomini Gianmarco , Minutiello Ettore , Politano Gianfranco , Dalmasso Marco , Albanesi Beatrice , Campagna Sara , Gianino Maria Michela
Published: May 2022

Background

Emergency department (ED) use among nursing home (NH) residents is an internationally-shared issue that is understudied in Italy. The long term care in Italy is part of the health system. This study aimed to assess trajectories of ED use among NH residents and determinants between demographic, health supply, clinical/functional factors.

Methods

A pooled, cross-sectional, time series analysis was performed in an Italian region in 2012/2019. The analysis measured the trend of ED user percentages associated with chronic conditions identified at NH admission. A GLM multivariate model was used to evaluate determinants of ED use. The variables collected were sex, age, assistance intensity, destination after discharge from NH, chronic conditions at NH admission, need for daily life assistance, degree of mobility, cognitive impairments, behavioural disturbances and were taken from two databases of the official Italian National Information System (FAR and C2 registries) that were combined to create a unique and anonymous code for each patient.

Results

A total of 37,311 residents were enrolled; 55.75% (20,800 residents) had at least one ED visit. The majority of the residents had cardiovascular (25.99%) or mental diseases (24.37%). In all pathologies, the percentage of ED users decreased and the decrease accelerated over time. These results were confirmed in the fixed effects regression model (coefficient for linear term (b = − 3.6177, p = 0, 95% CI = [− 5.124, − 2.1114]); coefficient for quadratic term = − 0.7691, p = 0.0046, 95% CI = [− 1.2953, − 0.2429]). Analysis showed an increased odds of ED visits involving males (OR = 1.27, 95% CI 1.24;1.30) and patients affected by urogenital diseases (OR = 1.16, 95% CI [1.031–1.314]). The lowest odds of ED visits were observed among subjects aged > 90 years (OR = 0.64, 95% CI [0.60–0.67]), who required assistance for their daily life activities (OR = 0.86; 95% CI = [0.82, 0.91]), or with serious cognitive disturbances (OR = 0.86; 95% CI = [0.84, 0.89]), immobile (OR = 0.93; 95% CI = [0.89, 0.96]), or without behavioural disturbances (OR = 0.92; 95% CI = [0.90, 0.94]).

Conclusions

The percentage of ED users has decreased, through support from the Italian disciplinary long-term care system. The demographic, clinical/functional variables associated with ED visits in this study will be helpful to develop targeted and tailored interventions to avoid unnecessary ED use.
Multi-site observational maternal and infant COVID-19 vaccine study (MOMI-vax): a study protocol
Authors: Munoz Flor M. , Beigi Richard H. , Posavad Christine M. , Richardson Barbra A. , Chu Helen Y. , Bok Karin , Campbell James , Cardemil Cristina , DeFranco Emily , Frenck Robert W. , Makhene Mamodikoe , Piper Jeanna M. , Sheffield Jeanne , Miller Ashley , Neuzil Kathleen M.
Published: May 2022

Background

Pregnant women were excluded from investigational trials of COVID-19 vaccines. Limited data are available to inform pregnant and postpartum women on their decisions to receive a COVID-19 vaccine.

Methods

The goal of this observational, prospective cohort study is to evaluate the immunogenicity and safety of various Emergency Use Authorization (EUA) or licensed COVID-19 vaccines administered to pregnant or lactating women and describe the transplacental antibody transfer and kinetics of antibodies in mothers and infants. The study is adaptive, allowing additional groups to be added as new vaccines or vaccine regimens are authorized. Up to 20 clinical research institutions in the United States (U.S.) will be included. Approximately 200 pregnant women and 65 postpartum women will be enrolled per EUA or licensed COVID-19 vaccine formulation in the U.S. This study will include pregnant and postpartum women of all ages with and without chronic medical conditions. Their infants will be enrolled and followed beginning at birth in the pregnant cohort and beginning at the earliest possible time point in the postpartum cohort. Blood samples will be collected for immunogenicity outcomes and pregnancy and birth outcomes assessed among women and infants. Primary analyses will be descriptive and done by vaccine type and/or platform.

Discussion

Given the long-standing and legitimate challenges of enrolling pregnant individuals into clinical trials early in the vaccine development pipeline, this study protocol describes our current study and provides a template to inform the collection of data for pregnant individuals receiving COVID-19 or other vaccines.

Trial registration

NCT05031468.
Characteristics of fetal physiological and pathological uterine effusion observed on prenatal ultrasonography: a case report
Authors: Wang Lei , Chen Lizhu , Li Dongmei , Wang Bing , Yang Zeyu
Published: May 2022

Background

The prenatal detection rate of fetal uterine effusion is very low, and current case reports mainly focus on pathological hydrometrocolpos. We presented two cases of fetal physiological uterine effusion with different ultrasonic characteristics and compared them with one case of hydrometrocolpos with the hope of identifying strategies to reduce misdiagnosis of fetal uterine effusion.

Case presentation

This paper reports the cases of two female fetuses with abnormal pelvic echoes in the third trimester, referred to a tertiary center to be screened for suspected pelvic teratoma and cystic mass, respectively. Ultrasound consultation revealed fetal uterine effusion. The two fetuses were delivered at our hospital after a full term. Re-examining the uterus and adnexa of the neonates revealed that the uterine effusion had subsided naturally. Another female fetus had a large cystic mass in the pelvic cavity in the third trimester, and prenatal examination indicated fetal hydrometrocolpos. The fetus was delivered at our hospital after a full term. The hydrometrocolpos existed even after birth. After consultation with a neonatal surgeon and gynecologist, the newborn was diagnosed with congenital imperforate hymen with hydrometrocolpos. Hymen puncture and open drainage led to a good prognosis.

Conclusions

Prenatal ultrasonography plays an important role in diagnosing and differentiating between physiological and pathological fetal uterine effusion. It can help reduce misdiagnoses that can lead to incorrect clinical decisions.
Utilization of radiation therapy and predictors of noncompliance among Syrian refugees in Turkey
Authors: Sayan Mutlay , Eren Mehmet Fuat , Kilic Sarah Sabrine , Kotek Ayse , Kaplan Sedenay Oskeroglu , Duran Ozge , Cukurcayır Funda , Babalıoglu Ibrahim , Or Ozlem Derinalp , Ozturk Gul Aysen , Eroglu Celalettin , Teke Fatma , Kurtul Neslihan , Kutuk Tugce , Bicakci Beyhan Ceylaner , Senyurek Sukran , Aktan Meryem , Mamidanna Swati , Ohri Nisha , Haffty Bruce , Atalar Banu
Published: May 2022

Background

Access to cancer care is a problem that continues to plague refugees displaced from their home countries. The turbulent political crisis in Syria, which has led to millions of refugees seeking asylum in Turkey, merits further attention. We aimed to study the rate of utilization of radiation therapy among Syrian refugees with cancer living in Turkey in an attempt to identify the contributing factors predictive of non-compliance with prescribed RT.

Methods

In this retrospective review of 14 institutional databases, Syrian refugee patients in Turkey with a cancer diagnosis from January 2015 to December 2019 who were treated with RT were identified. The demographic data, treatment compliance rates, and toxicity outcomes in these patients were surveyed. Variable predictors of noncompliance such as age, sex, diagnosis, treatment length, and toxicity were studied. The association between these variables and patient noncompliance was determined.

Results

We identified 10,537 patients who were diagnosed with cancer during the study period, of whom 1010 (9.6%) patients were treated with RT. Breast cancer (30%) and lung cancer (14%) were the most common diagnoses with up to 68% of patients diagnosed at an advanced stage (Stage III, IV). 20% of the patients were deemed noncompliant. Treatment with concurrent chemoradiotherapy (OR 1.61, 95% CI 1.06–2.46, p = 0.023) and living in a refugee camp (OR 3.62, 95% CI 2.43–5.19, p < 0.001) were associated with noncompliance. Age, sex and treatment length were not significantly associated with noncompliance.

Conclusions

Noncompliance with radiotherapy among Syrian refugees in Turkey remains an area of concern with a multitude of factors contributing to these alarming numbers. Further studies to better ascertain the finer nuances of this intricately complex problem and a global combination of efforts can pave the way to providing a solution.
GECOP-MMC: phase IV randomized clinical trial to evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) with mytomicin-C after complete surgical cytoreduction in patients with colon cancer peritoneal metastases
Authors: Pereira Fernando , Serrano Angel , Manzanedo Israel , Pérez-Viejo Estibalitz , González-Moreno Santiago , González-Bayón Luis , Arjona-Sánchez Alvaro , Torres Juan , Ramos Isabel , Barrios Maria E. , Cascales Pedro , Morales Rafael , Boldó Enrique , García-Fadrique Alfonso , Arteaga Xabier , Gutierrez-Calvo Alberto , Sánchez-García Susana , Asensio Enrique , Ramírez Cesar P. , Artiles Manuel , Vaqué Javier , Parra Pedro A. , Villarejo Pedro , Muñoz-Casares Cristóbal , Turienzo Estrella , Calero Alicia , Torrejimeno Isabel Jaén , Prieto Isabel , Galindo Julio , Borrego Vicente , Marcello Manuel E. , Rihuete Cristina , Carrasco Joaquin , Gomez-Quiles Luis
Published: May 2022

Background

The French PRODIGE 7 trial, published on January 2021, has raised doubts about the specific survival benefit provided by HIPEC with oxaliplatin 460 mg/m2 (30 minutes) for the treatment of peritoneal metastases from colorectal cancer. However, several methodological flaws have been identified in PRODIGE 7, specially the HIPEC protocol or the choice of overall survival as the main endpoint, so its results have not been assumed as definitive, emphasizing the need for further research on HIPEC. It seems that the HIPEC protocol with high-dose mytomicin-C (35 mg/m2) is the preferred regime to evaluate in future clinical studies.

Methods

GECOP-MMC is a prospective, open-label, randomized, multicenter phase IV clinical trial that aims to evaluate the effectiveness of HIPEC with high-dose mytomicin-C in preventing the development of peritoneal recurrence in patients with limited peritoneal metastasis from colon cancer (not rectal), after complete surgical cytoreduction. This study will be performed in 31 Spanish HIPEC centres, starting in March 2022. Additional international recruiting centres are under consideration. Two hundred sixteen patients with PCI ≤ 20, in which complete cytoreduction (CCS 0) has been obtained, will be randomized intraoperatively to arm 1 (with HIPEC) or arm 2 (without HIPEC). We will stratified randomization by surgical PCI (1–10; 11–15; 16–20). Patients in both arms will be treated with personalized systemic chemotherapy. Primary endpoint is peritoneal recurrence-free survival at 3 years. An ancillary study will evaluate the correlation between surgical and pathological PCI, comparing their respective prognostic values.

Discussion

HIPEC with high-dose mytomicin-C, in patients with limited (PCI ≤ 20) and completely resected (CCS 0) peritoneal metastases, is assumed to reduce the expected risk of peritoneal recurrence from 50 to 30% at 3 years.

Trial registration

EudraCT number: 2019–004679-37; Clinicaltrials.gov: NCT05250648 (registration date 02/22/2022, ).
Perioperative treatment in resectable gastric cancer with spartalizumab in combination with fluorouracil, leucovorin, oxaliplatin and docetaxel (FLOT): a phase II study (GASPAR)
Authors: Dos Santos Mélanie , Lequesne Justine , Leconte Alexandra , Corbinais Stéphane , Parzy Aurélie , Guilloit Jean-Marc , Varatharajah Sharmini , Brachet Pierre-Emmanuel , Dorbeau Marine , Vaur Dominique , Weiswald Louis-Bastien , Poulain Laurent , Le Gallic Corentin , Castera-Tellier Marie , Galais Marie-Pierre , Clarisse Bénédicte
Published: May 2022

Background

Perioperative chemotherapy and surgery are a standard of care for patients with resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma. However, the prognosis remains poor for this population. The FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) regimen is considered as the new standard chemotherapy regimen for perioperative strategy, despite associated with a 5-year overall survival rate (OS) amounting 45% following radical surgery.

Immunotherapy with antibodies that inhibit PD-1/ PD-L1 interaction has recently emerged as a new treatment option with promising and encouraging early trial results for patients with advanced or metastatic gastric or GEJ adenocarcinoma. Currently, no trials have investigated the impact of perioperative immunotherapy in combination with chemotherapy for resectable gastric or GEJ adenocarcinoma.

Methods

GASPAR trial is a multicenter open-label, nonrandomized, phase II trial to evaluate the efficacy and safety of Spartalizumab in combination with the FLOT regimen as perioperative treatment for resectable gastric or GEJ adenocarcinoma. The main endpoint is the proportion of patients with pathological complete regression (pCR) in the primary tumour after preoperative treatment.

Systemic treatment will include a pre-operative neoadjuvant and a post-operative adjuvant treatment, during which FLOT regimen will be administered every two weeks for 4 cycles and Spartalizumab every four weeks for 2 cycles.

For patients with confirmed tumor resectability on imaging assessment, surgery will be realized within 4–6 weeks after the last dose of preoperative chemotherapy. Post-operative systemic treatment will then be initiated within 4–10 weeks after surgery.

Using a Simon’s two-stage design, up to 67 patients will be enrolled, including 23 in the first stage.

Discussion

Currently, no trials have investigated the impact of immunotherapy in combination with FLOT chemotherapy as perioperative treatment for resectable gastric or GEJ adenocarcinoma. Some studies have suggested a change in the tumor immune micro-environment following neoadjuvant chemotherapy in this setting, reinforcing the relevance to propose a phase II trial evaluating efficacy and safety of Spartalizumab in combination with perioperative chemotherapy, with the aim of improving treatment efficacy and survival outcomes.

Trial registration

NCT04736485, registered February, 3, 2021.
Unusual neurological presentation of second stage African trypanosomiasis in a young boy: a case report
Authors: Ibrahim Etedal Ahmed A. , Elmahal Mohammed Gasm Elseed M. , Ahmed Khabab Abbasher Hussien Mohamed , Hasabo Elfatih A. , Omer Mohammed Eltahier Abdalla
Published: May 2022

Background

In South Sudan, sleeping sickness is a frequent condition caused by human African trypanosomiasis. There are two stages that are well-known. When the CNS is affected, especially with Trypanosoma gambiense infection, the early hemolymphatic stage and the late encephalitic stage have been observed, including mental, motor, and sensory symptoms. In this case, second-stage African trypanosomiasis manifested itself in an atypical neurological manner.

Case presentation

A 16-year-old boy from South Sudan referred to Sudan National Centre for Neurological Sciences, Khartoum, Sudan suffering from non-convulsive status epilepticus, mental deterioration and behavioral changes for the last nine months. He was conscious but disorientated. Low hemoglobin concentration, elevated ESR, enlarged spleen and positive card agglutination test for trypanosomiasis was found in this patient. Electro-encephalogram (EEG) found an on-going generalized seizure activity. The patient showed improvement after management with carbamazepine and tonic.

Conclusion

Our case highlights that late second stage African trypanosomiasis with neurological complications such as non-convulsive status epilepticus should be suspected in any patient who developed progressive cognitive decline and behavioral changes following long standing history of African Trypanosomiasis and routine Electro-encephalogram EEG is the best tool to diagnose non convulsive status epilepticus.
Geographical disparities in infant mortality in the rural areas of China: a descriptive study, 2010–2018
Authors: Yu Xue , Wang Yanping , Kang Leni , Miao Lei , Song Xiaowei , Ran Xuemei , Zhu Jun , Liang Juan , Li Qi , Dai Li , Li Xiaohong , He Chunhua , Li Mingrong
Published: May 2022

Background

The infant mortality rate (IMR) is considered a basic measure of public health for countries around the world. The specific aim of our study was to provide an updated description of infant mortality rate among different regions in rural China, and assess the trends and causes of the IMR geographical disparities.

Methods

Data were collected from China’s Under-5 Child Mortality Surveillance System(U5CMSS). The annual number of deaths and causes of death were adjusted using a 3-year moving average underreporting rate based on annual national data quality control results. The average annual decline rate (AADR) and the relative risk (RR) of the IMR and cause-specific infant mortality were calculated by Poisson regression and the Cochran–Mantel–Haenszel method. Data analysis was completed by SAS software.

Results

There was an apparent decrease in infant mortality in rural China from 2010 to 2018, at the AADR of 11.0% (95%CI 9.6–12.4), 11.2% (95%CI 10.3–12.1) and 6.6% (95%CI 6.0–7.3) in the eastern, central and western rural areas, respectively. The IMR was highest in the western rural area, followed by the central and eastern rural areas. Compared with the eastern rural area, the RR of infant mortality in the central rural area remained at 1.4–1.6 and increased from 2.4 (95%CI 2.3–2.6) in 2010–2012 to 3.1 (95% CI 2.9–3.4) in 2016–2018 in the western rural area. Pneumonia, preterm birth /LBW and birth asphyxia were the leading causes of infant deaths in the western rural area. Mortality rates of these three causes fell significantly in 2010–2018 but contributed to a higher proportion of deaths in the western rural area than in the central and western rural ares.

Conclusions

Our study indicated that the infant mortality rate dropped significantly from 2010 to 2018, however, geographical disparities of IMR in rural China are still persist. Therefore, there is an urgent need for public health programmes and policy interventions for infants in western rural China.
Performance of a new single-use bronchoscope versus a marketed single-use comparator: a bench study
Authors: Lamb Carla R. , Yavarovich Ekaterina , Kang Vincent , Servais Elliot L. , Sheehan Lori B. , Shadchehr Sara , Weldon James , Rousseau Matthew J. , Tirrell Gregory P.
Published: May 2022

Background

Single-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench study aimed to compare the performance of a new single-use bronchoscope (Boston Scientific EXALT Model B) to a marketed single-use comparator (Ambu aScope 4), each in slim, regular and large diameters.

Methods

Three bronchoscopy tasks were performed: water suction and visualization, “mucus” mass (synthetic mucoid mixture) suctioned in 30 s, and “mucus” plug (thicker mucoid mixture) suction. Suction ability, task completion times, and subjective ratings of visualization and overall performance on a scale of one to 10 (best) were compared. All bronchoscopy tasks were completed by 15 physicians representing diversity in specialization including pulmonary, interventional pulmonary, critical care, anesthesia, and thoracic surgery. Each physician utilized the six bronchoscope versions with block randomization by bronchoscope and task.

Results

Aspirated mean mass of “mucus” using EXALT Model B Regular was comparable to that for an aScope 4 Large (41.8 ± 8.3 g vs. 41.5 ± 5.7 g respectively, p = 0.914). In comparisons of scopes with the same outer diameter, the aspirated mean mass by weight of water and “mucus” was significantly greater for EXALT Model B than for aScope 4 (p < 0.001 for all three diameters). Mean ratings for visualization attributes were significantly better for EXALT Model B compared to aScope 4 (p-value range 0.001−0.029).

Conclusion

A new single-use bronchoscope provided strong suction capability and visualization compared to same-diameter marketed single-use comparators in a bench model simulation.
Incubation period, clinical and lung CT features for early prediction of COVID-19 deterioration: development and internal verification of a risk model
Authors: Peng Hongbing , Hu Chao , Deng Wusheng , Huang Lingmei , Zhang Yushan , Luo Baowei , Wang Xingxing , Long Xiaodan , Huang Xiaoying
Published: May 2022

Background

Most severe, critical, or mortal COVID-19 cases often had a relatively stable period before their status worsened. We developed a deterioration risk model of COVID-19 (DRM-COVID-19) to predict exacerbation risk and optimize disease management on admission.

Method

We conducted a multicenter retrospective cohort study with 239 confirmed symptomatic COVID-19 patients. A combination of the least absolute shrinkage and selection operator (LASSO), change-in-estimate (CIE) screened out independent risk factors for the multivariate logistic regression model (DRM-COVID-19) from 44 variables, including epidemiological, demographic, clinical, and lung CT features. The compound study endpoint was progression to severe, critical, or mortal status. Additionally, the model's performance was evaluated for discrimination, accuracy, calibration, and clinical utility, through internal validation using bootstrap resampling (1000 times). We used a nomogram and a network platform for model visualization.

Results

In the cohort study, 62 cases reached the compound endpoint, including 42 severe, 18 critical, and two mortal cases. DRM-COVID-19 included six factors: dyspnea [odds ratio (OR) 4.89;confidence interval (95% CI) 1.53–15.80], incubation period (OR 0.83; 95% CI 0.68–0.99), number of comorbidities (OR 1.76; 95% CI 1.03–3.05), D-dimer (OR 7.05; 95% CI, 1.35–45.7), C-reactive protein (OR 1.06; 95% CI 1.02–1.1), and semi-quantitative CT score (OR 1.50; 95% CI 1.27–1.82). The model showed good fitting (Hosmer–Lemeshow goodness, X2(8) = 7.0194,P = 0.53), high discrimination (the area under the receiver operating characteristic curve, AUROC, 0.971; 95% CI, 0.949–0.992), precision (Brier score = 0.051) as well as excellent calibration and clinical benefits. The precision-recall (PR) curve showed excellent classification performance of the model (AUCPR = 0.934). We prepared a nomogram and a freely available online prediction platform (https://deterioration-risk-model-of-covid-19.shinyapps.io/DRMapp/).

Conclusion

We developed a predictive model, which includes the including incubation period along with clinical and lung CT features. The model presented satisfactory prediction and discrimination performance for COVID-19 patients who might progress from mild or moderate to severe or critical on admission, improving the clinical prognosis and optimizing the medical resources.