bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscle strength and physical performance, rather than muscle mass, correlate with mortality in end-stage liver disease
Authors: Sidhu Sandeep Singh , Saggar Kavita , Goyal Omesh , Varshney Tarun , Kishore Harsh , Bansal Namita , Sidhu Samarth Singh
Published: May 2020

Objectives

Sarcopenia is characterized by the loss of skeletal muscle mass, strength and performance. The study aimed to provide cut off values of various Sarcopenia parameters [computerized tomography skeletal muscle index (SMI), handgrip strength (HGS), gait velocity and chair stand] to predict mortality in end-stage liver disease (ESLD).

Methods

The inclusion criteria were age 18–75 years, model for end-stage liver disease > 15. All patients with advanced heart, lung, kidney diseases, active malignancy were excluded from the study. Sarcopenia indices were compared between survivors and non-survivors to find cut off value for prediction of mortality in ESLD patients.

Results

One hundred sixty-one subjects suffering from ESLD were enrolled. The cutoff value of the SMI to identify high risk of mortality in sarcopenia patients is ≤21.2 cm2/m2, area under the curve (AUC) 0.537 [95% confidence interval (CI) 0.456–0.616]. The cutoff value of the hand grip strength to identify high-risk mortality is ≤25.3 kilogram-force, AUC 0.682 (95% CI 0.604–0.753). The cutoff value of the gait velocity for the same is as ≤0.84 m/s, AUC 0.551 (95% CI 0.459–0.641). The cutoff value of the chair stand is ≥20.9 seconds, AUC 0.956 (95% CI 0.910–0.983). In the multivariate analysis, HGS, gait velocity and chair stand correlated with mortality.

Conclusion

The current study is a comprehensive Asian study that gives the cut off values of Sarcopenia: muscle mass, strength and performance which identify high risk of mortality in ESLD patients. Muscle strength and performance correlated with mortality.
Validation of regional myocardial blood flow quantification using three-dimensional PET with rubidium-82: repeatability and comparison with two-dimensional PET data acquisition
Authors: Manabe Osamu , Klein Ran , Katoh Chietsugu , Magota Keiichi , deKemp Robert A. , Naya Masanao , Tamaki Nagara , Yoshinaga Keiichiro
Published: May 2020

Introduction

Three-dimensional (3D) data acquisition is now standard on PET/computed tomography scanners. The aim of this study was to evaluate the repeatability of myocardial blood flow (MBF) estimation with rubidium-82 (82Rb) 3D PET and to validate regional MBF measurements by comparison with two-dimensional (2D) PET.

Patients and methods

Fifteen healthy individuals (31.6 ± 11.4 years old) were enrolled for the evaluation of the short-term repeatability of rest 3D MBF quantification. Another 19 healthy individuals (35.3 ± 12.6 years old) underwent rest and pharmacological stress PET using 2D and 3D data acquisition within a 1-month interval. The injected dose was 1500 MBq for 2D and 555 MBq for 3D PET acquisition.

Results

MBF at rest showed good repeatability [whole left ventricular MBF; 0.54 ± 0.13 vs. 0.52 ± 0.13 mL/min/g, P = 0.98]. Rest MBF, stress MBF, and myocardial flow reserve (MFR) were not significantly different between 3D and 2D data acquisition. 3D MBF correlated well with 2D MBF over a wide flow range for both whole left ventricular (r = 0.97, P < 0.0001) and regional values (r = 0.61, P < 0.0001).

Conclusion

MBF measured with 3D PET showed very good test-retest repeatability. Whole left ventricular and regional MBF measurements obtained using lower 82Rb-dose 3D PET were highly correlated over a wide range with those from 2D PET. Therefore, MBF with 3D PET can be applied using a lower 82Rb dosage in clinical settings with reduced radiation exposure.
Transition from childhood to adolescence: steps to be taken
Authors: de Kort Laetitia M.O.
Published: May 2020

Purpose of review

The aim of this article is to give an overview of recent literature on transitional care of children with complex urological disease.

Recent findings

Most studies on transitional care concerned spina bifida patients. Assessment of current practices revealed that formalized clinics for transitional care may improve healthcare. However, there is still little consensus among healthcare providers on how to organize transitional care. A widely recognized problem is a lack of interested, dedicated, and well-trained staff for transitional care and lifelong follow-up of complex urological patients and also a lack of funding. The timing of the pediatric urologist's transfer to adult care may be helped by measuring transitional readiness in adolescent patients. Outcomes could also expose specific issues as were patients need assistance or education. Introduction of a transitional protocol made patients feel more ready for transition. However, even in established transitional clinics, there is a lack of disease-specific awareness of sexuality and fertility issues among patients.

Although there is growing awareness of the importance of well-organized and protocolled transitional care for young patients with complex urological disease, this is by no means sufficiently implemented. Furthermore, there is shortage of dedicated and experienced healthcare providers and a lack of funding.
Novel therapies for advanced urologic cancers
Authors: Heidenreich Axel
Published: May 2020

Purpose of review

Systemic treatment of advanced urogenital malignancies has changed significantly in recent years and it will continue to change rapidly in upcoming years. It is the scope of this review article to providing the reader with the most recently approved treatment strategies to be used in daily routine for the individualized and most optimal treatment of our patients.

Recent findings

Immunooncological therapy (IOT) has emerged as the treatment of choice in metastatic renal cell carcinoma and we describe the most relevant clinical trials and we will give some differential therapeutic recommendation who might be best treated with which combination therapy considering both oncological efficacy and treatment-related toxicity. New neoadjuvant treatment options for muscle-invasive bladder cancer are reported. With regard to metastatic prostate cancer, the landscape of medical therapy is continuously evolving and the new, and most relevant therapeutic strategies for metastatic hormone-naive and castration-resistant PCA are described. Last, but not least, we highlight latest developments in the management of advanced testis cancer.

The novel treatment options reported in this article are ready for use in daily routine and already represent or will shortly represent new guideline-recommended therapies.
Fibroblast growth factor receptors across urothelial carcinoma landscape
Authors: Ertl Iris E. , Shariat Shahrokh F. , Mostafaei Hadi , Ilijazi Dafina , Loriot Yohann
Published: May 2020

Purpose of review

Fibroblast growth factor receptor (FGFR) signalling, especially induced by FGFR3, is a crucial factor in the pathogenesis of urothelial carcinoma and was therefore extensively studied over the last decades. In this review, we summarize the most relevant findings of the past two years.

Recent findings

Recent studies support the concept that FGFR3 mediates a pathway of urothelial carcinogenesis associated with low malignant potential. FGFR3 may represent a highly accurate biomarker for diagnosis and prediction of recurrence, progression or therapy response. The pan FGFR-inhibitor erdafitinib was recently approved for urothelial carcinoma, whereas several other FGFR-targeted drugs are currently undergoing clinical trials.

Numerous recent studies focus on the role of FGFR3 in different urothelial carcinoma subtypes and its potential clinical application as noninvasive biomarker, as well as therapeutic target.
Essential Case Management Practices Amidst the Novel Coronavirus Disease 2019 (COVID-19) Crisis: Part 1
Authors: Tahan Hussein M.
Published: May 2020

Objectives:

This is the first of a 2-part article that discusses essential case management practices and strategies amidst the novel coronavirus disease 2019 (COVID-19). The series showcases the potential professional case managers have in support of managing during a crisis such as this global pandemic. Part I discusses reenvisioned roles and responsibilities of case managers and leaders known to address patients' needs during a crisis, with a special focus on telehealth, tele-case management, surge capacity, redeployment, discharge planning, and transitions of care.

Primary Practice Settings:

Applicable to the various case management practice settings across the continuum of health and human services, especially acute care.

Findings Conclusions

The COVID-19 global pandemic crisis has brought an unprecedented challenge to professional case managers and health care professionals. It also has provided opportunities for innovation and partnerships within and across health care organizations and the various care settings where patients/support systems access necessary services. Most importantly, it created a renewed interest in telehealth and facilitated a wider adoption of such approach to care delivery than ever before. This pandemic has also increased the use of nontraditional sites of care, most importantly those that operate virtually on electronic networks and health information system technologies such as remote visits, e-visits, virtual care, and tele-monitoring. Undoubtedly, these have provided new opportunities for tele-case management services and roles for professional case managers in the virtual world of health and human service delivery.

Implications for Case Management Practice:

Professional case managers are integral members of interprofessional health care teams. Their roles are even more necessary during a global pandemic such as COVID-19. The practice of case management will forever change—for the better. The experience of this crisis in health care has brought about ever-lasting implications for case management professionals. It has raised awareness to sites of care never were as popular before, resulting in an increased need and recognition for tele-case management practice and virtual case managers. It has also forced partnerships and collaborations among the diverse contexts of health care organizations (public, private, or both) and other industries, regardless of whether directly involved in the delivery of care or having a support service role. These new and innovative approaches in the provision of care and case management services will without a doubt become routine expectations beyond the current pandemic period. Of special note are the enhanced roles of case managers in discharge planning and transitions of care.
Failure to Rescue Deteriorating Patients: A Systematic Review of Root Causes and Improvement Strategies
Authors: Burke Joshua R. , Downey Candice , Almoudaris Alex M.
Published: May 2020

Objectives

“Failure to rescue” (FTR) is the failure to prevent a death resulting from a complication of medical care or from a complication of underlying illness or surgery. There is a growing body of evidence that identifies causes and interventions that may improve institutional FTR rates. Why do patients “fail to rescue” after complications in hospital? What clinically relevant interventions have been shown to improve organizational fail to rescue rates? Can successful rescue methods be classified into a simple strategy?

Methods

A systematic review was performed and the following electronic databases searched between January 1, 2006, to February 12, 2018: MEDLINE, PsycINFO, Cochrane Library, CINAHL, and BNI databases. All studies that explored an intervention to improve failure to rescue in the adult population were considered.

Results

The search returned 1486 articles. Eight hundred forty-two abstracts were reviewed leaving 52 articles for full assessment. Articles were classified into 3 strategic arms (recognize, relay, and react) incorporating 6 areas of intervention with specific recommendations.

Conclusions

Complications occur consistently within healthcare organizations. They represent a huge burden on patients, clinicians, and healthcare systems. Organizations vary in their ability to manage such events. Failure to rescue is a measure of institutional competence in this context. We propose “The 3 Rs of Failure to Rescue” of recognize, relay, and react and hope that this serves as a valuable framework for understanding the phases where failure of patient salvage may occur. Future efforts at mitigating the differences in outcome from complication management between units may benefit from incorporating this proposed framework into institutional quality improvement.
Performance and Acceptability of the FC2 Female Condom When Used With and Without a Silicone Placebo Vaginal Ring—A Randomized, Crossover Trial
Authors: Nel Annalene , Malherbe Mariëtte , van Niekerk Neliëtte , Beksinska Mags , Greener Ross , Smit Jennifer , Frezieres Ron , Walsh Terri
Published: May 2020

Background:

The silicone Dapivirine Vaginal Ring 25 mg, has been developed to provide an additional HIV prevention option for women. If approved for use, women will always be counselled to use condoms when using the vaginal ring for maximum protection. This paper evaluates the compatibility of female condoms with the ring.

Methods:

This was a 2-period crossover, randomized noninferiority trial. Couples in 2 sites in the United States of America were randomized to FC2 Female Condom (FC2) with and without a placebo silicone ring and asked to use 4 female condoms in each period. The primary noninferiority endpoint was the clinical failure rate during intercourse or withdrawal (self-reported clinical breakage, slippage, misdirection, and invagination). Frequencies and percentages were calculated for each failure mode and differences in performance of the 2 periods, using the female condom without the ring as reference. Noninferiority was defined using an 8% margin at the 5% significance level. Safety and tolerability were also assessed.

Results:

Eighty-one couples were enrolled and 79 completed the trial using a total of 596 female condoms (297 and 299 with/without a ring inserted, respectively). Total female condom clinical failure was 14.1% and 15.7% in the presence and absence of a ring, respectively, with a difference of −2.1% (95% confidence interval: −7.8% to 3.6%), thereby demonstrating noninferiority when used with the ring. There were no differences in safety and tolerability between the 2 periods.

Discussion:

Concurrent use of the placebo silicone vaginal ring had no significant effect on female condom functionality or safety outcomes.
Associations Between Widespread Pain and Sleep Quality in People With HIV
Authors: Sabin Caroline A. , Harding Richard , Doyle Nicki , Redline Susan , de Francesco Davide , Mallon Patrick W. G. , Post Frank A. , Boffito Marta , Sachikonye Memory , Geressu Adam , Winston Alan , Kunisaki Ken M.
Published: May 2020

Background:

We investigate the association of widespread pain with sleep quality among people with HIV and HIV-negative controls.

Setting:

UK-based cohort.

Methods:

Pain information was collected through a pain mannikin identifying affected body sites; pain was classified as widespread if pain was reported in ≥4 of 5 body regions and in ≥7 of 15 body sites, and as regional otherwise. Sleep was assessed a median of 3.2 years later through 7-night actigraphy and through self-reported assessments of sleep quality. Chi-squared tests, Kruskal–Wallis tests, and linear/logistic regression considered associations between pain extent and sleep quality.

Results:

Of the 414 participants, 74 (17.9%) reported widespread and 189 (45.7%) regional pain. Although there were few clear associations between actigraphy outcomes and pain extent, those with widespread and regional pain consistently reported poorer sleep quality on all self-reported measures than those with no pain. Median (interquartile range) insomnia severity index and Patient-reported Outcomes Measurement Information System (PROMIS) for sleep disturbance and sleep-related impairment scores were 12 (7–16), 55.3 (48.0–58.9), and 57.2 (48.9–61.3), respectively, for those with widespread pain, 8 (4–13), 51.2 (45.5–58.3), and 50.3 (43.6–56.1) for those with regional pain, and 5 (2–9), 47.9 (42.9–54.3), and 45.5 (41.4–50.3) for those with no pain (all P values 0.0001). Associations remained strong after adjustment for HIV status and other confounders, and were reduced but remained significant, after adjustment for depressive symptoms.

Conclusions:

Widespread pain was not associated with objective measures of sleep but was strongly associated with self-reported assessments of sleep quality in people with HIV.
Spectrum of Frontotemporal Lobar Degeneration on 18F-FDG PET/CT Scan
Authors: Seniaray Nikhil , Verma Ritu , Ranjan Rajeev , Belho Ethel , Gupta Vanshika , Mahajan Harsh
Published: May 2020

FTLD (Frontotemporal lobar degeneration) is a clinically and pathologically heterogeneous group of degenerative disorders, characterized by predominantly asymmetric degeneration of frontal and temporal lobes with selective neuronal loss and gliosis. The disease presents with variable degrees of impairment in behavior, language, executive control, and motor symptoms with progressive loss of cognition. On the basis of presenting clinical symptoms, FTLD is further divided into behavioral variant, nonfluent/agrammatic variant primary progressive aphasia (PPA), semantic variant PPA, logopenic variant PPA, progressive supranuclear palsy, and corticobasal ganglionic degeneration. Here we illustrate the utility of FDG PET with statistical parametric analysis for evaluation of these patients.
Detection of Insulinomas Using Dual-Time-Point 68Ga-DOTA-Exendin 4 PET/CT
Authors: Michalski Kerstin , Laubner Katharina , Stoykow Christian , Omrane Mohamed Aymen , Maecke Helmut R. , Seufert Jochen , Goetz Christian , Meyer Philipp T. , Ruf Juri
Published: May 2020

Purpose

Insulinomas are predominantly benign neuroendocrine tumors originating from beta cells within the islets of Langerhans of the endocrine pancreas. Because surgical resection represents the only curative therapy option, exact tumor localization and discrimination of insulinomas from focal or diffuse manifestations of congenital hyperinsulinism are crucial for optimal treatment strategies. We investigated the diagnostic value of glucagon-like peptide 1 receptor PET/CT using 68Ga-DOTA-exendin 4 for detecting insulinomas and compared the diagnostic value of PET scans performed at 2 time points.

Methods

In 10 patients with clinically and biochemically suspected insulinoma, PET/CT was performed at 1 hour (PET1) and 2 hours (PET2) after injection of 68Ga-DOTA-exendin 4. In this retrospective analysis, tracer uptake was visually assessed in both scans by 2 independent readers. SUVmax and tumor-to-background ratio (TBR) of focal lesions were assessed. Imaging results were compared with histopathologic findings, if patients underwent resection.

Results

Increased focal 68Ga-DOTA-exendin 4 uptake was observed in 8 of 10 patients concordantly by both readers. Seven patients with focal uptake underwent surgery with tumor enucleation and histopathologic proof of insulinoma (7/8). Two of 10 patients without focal uptake were considered to suffer from diffuse form of congenital hyperinsulinism and consequently received medical treatment. A significant increase of tumoral SUVmax on PET2 (PET1: SUVmax 20.2 ± 8.2 g/mL; PET2: SUVmax 24.7 ± 7.9 g/mL; P = 0.0018) did not result in a significant improvement in TBR (PET1: TBR 4.9 ± 1.7; PET2: TBR 4.3 ± 1.2; P = 0.2892).

Conclusions

Focal uptake of 68Ga-DOTA-exendin 4 reliably indicated insulinomas as histopathologically confirmed in all patients undergoing consecutive surgery. The diagnostic value of PET2 was not found to be superior to PET1, indicating that a single 1-hour 68Ga-DOTA-exendin 4 PET/CT scan is a sufficient and convenient approach for patient care.
Understanding the mammalian TRAP complex function(s)
Authors: Russo Antonietta
Published: May 2020

In eukaryotic cells, about one-third of the synthesized proteins are translocated into the endoplasmic reticulum; they are membrane or lumen resident proteins and proteins direct to the Golgi apparatus. The co-translational translocation takes place through the heterotrimeric protein-conducting channel Sec61 which is associated with the ribosome and many accessory components, such as the heterotetrameric translocon-associated protein (TRAP) complex. Recently, microscopic techniques, such as cryo-electron microscopy and cryo-electron tomography, have enabled the determination of the translocation machinery structure. However, at present, there is a lack of understanding regarding the roles of some of its components; indeed, the TRAP complex function during co-translational translocation needs to be established. In addition, TRAP may play a role during unfolded protein response, endoplasmic-reticulum-associated protein degradation and congenital disorder of glycosylation (ssr4 CDG). In this article, I describe the current understanding of the TRAP complex in the light of its possible function(s).
Characterization of self-assembled silver nanoparticle ink based on nanoemulsion method
Authors: Hu Donghao , Ogawa Kazuyoshi , Kajiyama Mikio , Enomae Toshiharu
Published: May 2020

A well-dispersed self-assembled silver nanoparticles (AgNPs) ink with high purity was synthesized via AgNO
3
emulsion prepared by blending an AgNO
3
aqueous solution and a liquid paraffin solution of both polyoxyethylene (20) sorbitan monooleate (Tween 80) and sorbitan monooleate (Span 80). The ink remained as an emulsion at low temperatures; however, it produced AgNPs after sintering at about 60°C and showed a high stability at nanoscale sizes (with diameters ranging 8.6–13.4 nm) and a high conductivity. During the whole procedure, Tween 80 acted as a surfactant, reductant and stabilizer. Presumably, Tween 80 underwent an autoxidation process, where a free radical of an α-carbon of ether oxygen was formed by hydrogen abstraction. The mean diameter of emulsion droplets could be reduced by decreasing water content and increasing the ratio of surfactant and concentration of AgNO
3
aqueous solution. Consequently, the thermogravimetric analysis and X-ray diffraction result clarified the purity of the produced Ag
0
. Dynamic light scattering and ultraviolet-visible spectroscopy clarified that an increased concentration of AgNO
3
decreased the particle size.
Group dominance increases territory size and reduces neighbour pressure in wild chimpanzees
Authors: Lemoine Sylvain , Boesch Christophe , Preis Anna , Samuni Liran , Crockford Catherine , Wittig Roman M.
Published: May 2020

Territorial social species, including humans, compete between groups over key resources. This between-group competition has evolutionary implications on adaptations like in-group cooperation even with non-kin. An emergent property of between-group competition is group dominance. Mechanisms of group dominance in wild animal populations are difficult to study, as they require long-term data on several groups within a population. Here, using long-term data on four neighbouring groups of wild western chimpanzees, we test the hypothesis that group dominance impacts the costs and benefits of between-group competition, measured by territory size and the pressure exerted by neighbouring groups. Larger groups had larger territories and suffered less neighbour pressure compared with smaller groups. Within-group increase in the number of males led to territory increase, suggesting the role of males in territory acquisition. However, variation in territory sizes and neighbour pressure was better explained by group size. This suggests that the bisexually-bonded social system of western chimpanzees, where females participate in territorial behaviour, confers a competitive advantage to larger groups and that group dominance acts through group size in this population. Considering variation in social systems offers new insights on how group dominance acts in territorial species and its evolutionary implications on within-group cooperation.
Spatial synchrony is related to environmental change in Finnish moth communities
Authors: Dallas Tad A. , Antão Laura H. , Pöyry Juha , Leinonen Reima , Ovaskainen Otso
Published: May 2020

Spatially distinct pairs of sites may have similarly fluctuating population dynamics across large geographical distances, a phenomenon called spatial synchrony. However, species rarely exist in isolation, but rather as members of interactive communities, linked with other communities through dispersal (i.e. a metacommunity). Using data on Finnish moth communities sampled across 65 sites for 20 years, we examine the complex synchronous/anti-synchronous relationships among sites using the geography of synchrony framework. We relate site-level synchrony to mean and temporal variation in climatic data, finding that colder and drier sites—and those with the most drastic temperature increases—are important for spatial synchrony. This suggests that faster-warming sites contribute most strongly to site-level estimates of synchrony, highlighting the role of a changing climate to spatial synchrony. Considering the spatial variability in climate change rates is therefore important to understand metacommunity dynamics and identify habitats which contribute most strongly to spatial synchrony.
‘What I cannot create, I do not understand’: functionally validated synergism of metabolic and target site insecticide resistance
Authors: Samantsidis George-Rafael , Panteleri Rafaela , Denecke Shane , Kounadi Stella , Christou Iason , Nauen Ralf , Douris Vassilis , Vontas John
Published: May 2020

The putative synergistic action of target-site mutations and enhanced detoxification in pyrethroid resistance in insects has been hypothesized as a major evolutionary mechanism responsible for dramatic consequences in malaria incidence and crop production. Combining genetic transformation and CRISPR/Cas9 genome modification, we generated transgenic
Drosophila
lines expressing pyrethroid metabolizing P450 enzymes in a genetic background along with engineered mutations in the voltage-gated sodium channel (
para
) known to confer target-site resistance. Genotypes expressing the yellow fever mosquito
Aedes aegypti Cyp9J28
while also bearing the
para
V1016G
mutation displayed substantially greater resistance ratio (RR) against deltamethrin than the product of each individual mechanism (RR
combined
: 19.85 > RR
Cyp9J28
: 1.77 × RR
V1016G
: 3.00). Genotypes expressing
Brassicogethes aeneus
pollen beetle
Cyp6BQ23
and also bearing the
para
L1014F
(
kdr
) mutation, displayed an almost multiplicative RR (RR
combined
: 75.19 ≥ RR
Cyp6BQ23
: 5.74 × RR
L1014F
: 12.74). Reduced pyrethroid affinity at the target site, delaying saturation while simultaneously extending the duration of P450-driven detoxification, is proposed as a possible underlying mechanism. Combinations of target site and P450 resistance loci might be unfavourable in field populations in the absence of insecticide selection, as they exert some fitness disadvantage in development time and fecundity. These are major considerations from the insecticide resistance management viewpoint in both public health and agriculture.
Mitigation Policies and Emergency Care Management in Europe's Ground Zero for COVID-19
Authors: Ciminelli Gabriele , Garcia-Mandicó Sílvia
Published: May 2020

This paper draws from daily death registry data on 4,000 Italian municipalities to investigate two crucial policies that can dramatically affect the toll of COVID-19: the shutdown of non-essential businesses and the management of the emergency care system. Our results, which are robust to controlling for a host of co-factors, offer strong evidence that the closure of service activities is very effective in reducing COVID-19 mortality - this was about 15% lower in municipalities with a 10 percentage points higher employment share in shut down services. Shutting down factories, instead, is much less effective, plausibly because factory workers engage in more limited physical interactions relative to those in the consumer-facing service sector. Concerning the management of the health care system, we find that mortality strongly increases with distance from the intensive care unit (ICU). Municipalities at 10 km from the closest ICU experienced up to 50% higher mortality. This effect - which is largest within the epicenter and in days of abnormally high volumes of calls to the emergency line - underscores the importance of improving pre-hospital emergency services and building ambulance capacity to ensure timely transportation of critical patients to the ICU.
A data first approach to modelling Covid-19
Authors: Prasad Jayanti
Published: May 2020

The primary data for Covid-19 pandemic is in the form of time series for the number of confirmed, recovered and dead cases. This data is updated every day and is available for most countries from multiple sources such as [Gar20b, iD20]. In this work we present a two step procedure for model fitting to Covid-19 data. In the first step, time dependent transmission coefficients are constructed directly from the data and, in the second step, measures of those (minimum, maximum, mean, median etc.,) are used to set priors for fitting models to data. We call this approach a “data driven approach” or “data first approach”. This scheme is complementary to Bayesian approach and can be used with or without that for parameter estimation. We use the procedure to fit a set of SIR and SIRD models, with time dependent contact rate, to Covid-19 data for a set of most affected countries. We find that SIR and SIRD models with constant transmission coefficients cannot fit Covid-19 data for most countries (mainly because social distancing, lockdown etc., make those time dependent). We find that any time dependent contact rate decaying with time can help to fit SIR and SIRD models for most of the countries. We also present constraints on transmission coefficients and basic reproduction number, as well as effective reproduction number. The main contributions of our work are as follows. (1) presenting a two step procedure for model fitting to Covid-19 data (2) constraining transmission coefficients as well asand, for a set of countries and (3) releasing a python packagePyCov19[Pra20b] that can used to fit a class of compartmental models, with time varying coefficients, to Covid-19 data.
Prevalence and Risk Factors of Diabetes Mellitus in People over 40 Years Old in Rural Areas of Central Hunan Province
Authors: Li Lan , Liao Yuan , Xiao Hao , Wang Tiantian , Liu Jing , Zhou Guijuan , Sun Guanghua , Li Kang , Huang Fujin , Feng Weibin , Zhou Jun
Published: May 2020

Objective

To explore the prevalence of diabetes mellitus in rural areas of central Hunan province, and to analyze the risk factors related to diabetes mellitus (DM).

Methods

A cross-sectional study was conducted by using questionnaires (gender, age, occupation, degree of education, exercise habits, smoke status, alcohol consumption, hypertension, cardiovascular disease, family history of diabetes), anthropometric measurements (height, weight, waist circumference, blood pressure) and biochemical indexes test (fasting blood-glucose, glycosylated hemoglobin, blood lipids). Villagers over 40 years old from a community in rural areas of central Hunan Province were investigated.

Results

A total of 410 clinical data were collected. The prevalence of diabetes mellitus in 410 (177 in male and 233 in female) villagers was 13.41%, including 13 males with a prevalence rate of 7.34% and 42 females with a prevalence rate of 15.16%. The prevalence of impaired fasting glucose (IFG) was 11.95%, 21 males (11.86% of males) and 28 females (10.11% of females). And the results of glycosylated hemoglobin test showed that 64% villagers with diabetes mellitus had hemoglobin A1c(HbA1c) above 6.5%. Univariate analysis suggested that gender, smoke status, alcohol consumption, family history of diabetes mellitus, hypercholesterolemia and hypertension were involved in diabetes mellitus (P<0.05). Multivariate logistic regression analysis showed that family history of diabetes (OR: 1.759; 95% CI: 1.010-3.065), hypercholesterolemia (OR: 3.819; 95% CI: 1.27-11.486) and hypertension (OR: 2.074; 95% CI: 1.130-3.809) were independent risk factors for diabetes mellitus, and the differences were statistically significant (P < 0.05).

Conclusion

The prevalence of diabetes mellitus in rural areas of central Hunan Province is higher. Family history of diabetes, hypercholesterolemia and hypertension are major risk factors for diabetes mellitus. The knowledge of diabetes should be strengthened. Related interventions should be given based on the diabetes epidemic status of local.
The transmission of SARS-CoV-2 is likely comodulated by temperature and by relative humidity
Authors: Raines Kevin S. , Doniach Sebastian , Bhanot Gyan
Published: May 2020

Inferring the impact of climate upon the transmission of SARS-CoV-2 has been confounded by variability in testing, unknown disease introduction rates, and changing weather. Here we present a data model that accounts for dynamic testing rates and variations in disease introduction rates. We apply this model to data from Colombia, whose varied and seasonless climate, central port of entry, and swift, centralized response to the Covid-19 pandemic present an opportune environment for assessing the impact of climate factors on the spread of Covid-19. We observe strong attenuation of transmission in climates with sustained daily temperatures above 30 degrees Celsius and simultaneous mean relative humidity below 78%, with outbreaks occurring at high humidity even where the temperature is high. We hypothesize that temperature and relative humidity comodulate the infectivity of SARS-CoV-2 within respiratory droplets.
Impaired T cell functions along with elevated activated Tregs at the early stage of asymptomatic SARS-CoV-2 infection
Authors: Yang Jingyi , Zhang Ejuan , Zhong Maohua , Yang Qingyu , Hong Ke , Shu Ting , Zhou Dihan , Xiang Jie , Xia Jianbo , Zhou Xi , Zhang Dingyu , Huang Chaolin , Shang You , Yan Huimin
Published: May 2020

Background

Limited data are available on the T cell responses for the asymptomatic SARS-CoV-2 infection case.

Methods

An imported SARS-CoV-2 infection case in Wuhan was admitted in hospital for quarantine and observation. The T cell responses were followed up by flow cytometry analysis of the peripheral blood nonnuclear cells (PBMCs) at days 7, 13, 22, and 28 after admission.

Findings

We found the imported SARS-CoV-2 infection in Wuhan is an asymptomatic case. His T cell differentiation, proliferation and activation matched the classical kinetics of T cell responses induced by viral infection, but the activation maintained at a relatively low level. Function analysis indicated frequencies of IFN-γ producing CD4+ and CD8+ T cells were notably lower than that of the healthy controls (HC) at day 7, and then rebound gradually. But IFN-γ+CD8+ T cells were detained at a significant lower level even at day 28, when the SARS-CoV-2 virus had already become undetectable for 3 weeks. Moreover, percentage of IL-17 producing CD4+ T cells was also detained constantly at a much lower level compared to HC. At day 7, although percentage of Tregs was in normal range, the frequency of activated Treg (aTreg) was remarkably as high as 4·4-fold of that in HC.

Interpretation

The T cell activation in the asymptomatic SARS-CoV-2 infection experienced a significant suppression and presented impairment of Th1/Th17 and CD8+ T cell functions. Early elevation of the aTregs might play role in the activation and function of T cells in the asymptomatic SARS-CoV-2 infection.
Prediction of mechanical properties and optimization of process parameters in friction-stir-welded dissimilar aluminium alloys
Authors: T. Senthilnathan , B. Sujay Aadithya , K. Balachandar
Published: May 2020

Purpose

This study aims to predict the mechanical properties such as equivalent tensile strength and micro-hardness of friction-stir-welded dissimilar aluminium alloy plates AA 6063-O and AA 2014-T6, using artificial neural network (ANN).

Design/methodology/approach

The ANN model used for the experiment was developed through back propagation algorithm. The input parameter of the model consisted of tool rotational speed and weld-traverse speed whereas the output of the model consisted of mechanical properties (tensile strength and hardness) of the joint formed by friction-stir welding (FSW) process. The ANN was trained for 60% of the experimental data. In addition, the impact of the process parameters (tool rotational speed and weld-traverse speed) on the mechanical properties of the joint was determined by Taguchi Grey relational analysis.

Findings

Subsequently, testing and validation of the ANN were done using experimental data, which were not used for training the network. From the experiment, it was inferred that the outcomes of the ANN are in good agreement with the experimental data. The result of the analyses showed that the tool rotational speed has more impact than the weld-traverse speed.

Originality/value

The developed neural network can be used to predict the mechanical properties of the weld. Results indicate that the network prediction is similar to the experiment results. Overall regression value computed for training, validation and testing is greater than 0.9900 for both tensile strength and microhardness. In addition, the percentage error between experimental and predicted values was found to be minimal for the mechanical properties of the weldments. Therefore, it can be concluded that ANN is a potential tool for predicting the mechanical properties of the weld formed by FSW process. Similarly, the results of Taguchi Grey relational analysis can be used to optimize the process parameters of the weld process and it can be applied extensively to ascertain the most prominent factor. The results of which indicates that rotational speed of 1,270 rpm and traverse speed of 30 mm/min are to be the optimized process parameters. The result also shows that tool rotational speed has more impact on the mechanical properties of the weld than that of traverse speed.
Comparative transcriptomic analyses of Chromera and Symbiodiniaceae
Authors: Mohamed Amin R. , Chan Cheong Xin , Ragan Mark A. , Zhang Jia , Cooke Ira , Ball Eldon E. , Miller David J.
Published: May 2020

Reef‐building corals live in a mutualistic relationship with photosynthetic algae (family Symbiodiniaceae) that usually provide most of the energy required by the coral host. This relationship is sensitive to temperature stress; as little as a 1°C increase often leads to the collapse of the association. This sensitivity has led to an interest in the potential of more stress‐tolerant algae to supplement or substitute for the normal Symbiodiniaceae mutualists. In this respect, the apicomplexan‐like microalga Chromera is of particular interest due to its greater temperature tolerance. We generated a de novo transcriptome for a Chromera strain isolated from a GBR coral (‘GBR Chromera’) and compared with those of the reference strain of Chromera (‘Sydney Chromera’), and to those of Symbiodiniaceae (Fugacium kawagutii, Cladocopium goreaui and Breviolum minutum), as well as the apicomplexan parasite, Plasmodium falciparum. In contrast to the high sequence divergence amongst representatives of different genera within the family Symbiodiniaceae, the two Chromera strains featured low sequence divergence at orthologous genes, implying that they are likely to be conspecifics. Although KEGG categories provide few criteria by which true coral mutualists might be identified, they do supply a molecular rationalization that explains the ecological dominance of Cladocopium spp. amongst Indo‐Pacific reef corals. The presence of HSP20 genes may contribute to the high thermal tolerance of Chromera.
Is radical resection of hilar cholangiocarcinoma plus partial resection of pancreatic head justified for advanced hilar cholangiocarcinoma?
Authors: Liu Fei , Hu Hai‐Jie , Ma Wen‐Jie , Wang Jun‐Ke , Ran Cong‐Dun , Regmi Parbatraj , Li Fu‐Yu
Published: May 2020

Background

To outline our experience with the radical resection of hilar cholangiocarcinoma (HCCA) combined with the partial resection of the pancreatic head (RRHCCAPRPH) as a treatment for HCCA with distal bile duct involvement and to appraise the feasibility of this challenging procedure.

Methods

Between 2007 and 2017, 205 patients with HCCA who underwent curative surgery at our hospital were included. Among the patients, extrahepatic bile duct resection combined with hepatectomy (EBDRH), RRHCCAPRPH and hepatopancreaticoduodenectomy (HPD) was performed in 168, 21 and 16 patients, respectively. Clinical pathological factors, post‐operative complications and survival were compared between the three groups.

Results

There was a significant difference in operative blood loss, operative time, post‐operative hospital stay and tumour size between EBDRH group, RRHCCAPRPH group and HPD group (P < 0.05). In terms of post‐operative complications, there was no statistical difference between the three groups (P = 0.177). Further analysis showed that the incidence of pancreatic fistula (43.8%) and delayed gastric emptying (25%) after HPD were significantly higher than the other two groups. The median survival time and overall survival rate for 172 patients with R0 resection were 33 months and 85.5% at 1 year, 47.7% at 3 years, 28.4% at 5 years. Furthermore, the 1‐, 3‐ and 5‐year survival rates of patients with EBDRH, RRHCCAPRPH and HPD after R0 resection were 86.2%, 48.7%, 29.2%; 85.0%, 44.0%, 24.7% and 78.6%, 42.9%, 22.9%, respectively (P = 0.948).

Conclusion

The RRHCCAPRPH in some selected patients can actually replace HPD as a surgical treatment for HCCA with distal bile duct involvement.
Interdisciplinary approach to enhance trauma residents education of Extended‐Focused Assessment for Sonography in Trauma in the emergency department
Authors: Haney Rachel M. , Graglia Sally , Schleifer Jessica , Mendoza April , Frasure Sarah E. , Shokoohi Hamid , Huang Calvin , Liteplo Andrew S.
Published: May 2020

Background

Despite the utilization of point‐of‐care ultrasound (POCUS) by trauma surgeons, formal POCUS requirements do not exist for general surgery residents. We sought to evaluate surgery resident comfort with performing and interpreting of Extended‐Focused Assessment for Sonography in Trauma (E‐FAST) scans after a brief educational session.

Methods

A pre‐survey, sent to PGY‐2 and ‐3 surgical residents before their trauma rotation, evaluated comfort with eight components of the E‐FAST. Residents were then required to watch a 15‐min online video and attend a 1‐h bedside training session moderated by emergency medicine ultrasound fellows during which residents practised E‐FAST image acquisition and interpretation. After the rotation, residents completed a post‐survey evaluating their comfort with the E‐FAST.

Results

All 27 residents rotating on the trauma service during the 2017–2018 academic year were eligible and, therefore, approached by the study team. Twenty‐one (77.78%) residents completed the pre‐survey, training and post‐survey. Initially, only 52% (13/25) of residents reported feeling confident in performing the E‐FAST. After the session, all (100%) reported feeling confident in their training in E‐FAST. Self‐reported mean comfort with each of the eight components of the E‐FAST showed a statistically significant (P < 0.01) increase from pre–post survey for all residents. Isolating only the residents who initially reported feeling confident in E‐FAST still showed a statistically significant (P < 0.01) increase in mean comfort.

Conclusion

A single POCUS training programme has been shown to improve surgical residents' comfort in performing and interpreting the E‐FAST. This interdisciplinary approach can enhance collaboration and bridge gaps between emergency medicine and surgery residency programmes.
Review article: withdrawal of 5‐aminosalicylates in inflammatory bowel disease
Authors: Chapman Thomas P. , Frias Gomes Catarina , Louis Edouard , Colombel Jean‐Frédéric , Satsangi Jack
Published: May 2020

Background

5‐aminosalicylates (5‐ASA) are widely used in inflammatory bowel disease (IBD), but emerging evidence suggests that they may be safely withdrawn in significant subsets of patients. This is important to address: 5‐ASA therapy accounts for up to 25% of total healthcare costs in ulcerative colitis (UC), while almost a third of patients with Crohn's disease (CD) receive long‐term 5‐ASA despite no clear evidence of benefit. Further, rationalising medication burden may improve overall adherence and outcome.

Aims

To summarise the rationale for 5‐ASA withdrawal, review the current evidence in both UC and CD and consider the data surrounding colorectal cancer (CRC) prevention, guiding an evidence‐based withdrawal strategy.

Methods

PubMed was searched to identify relevant studies. Only papers published in English were reviewed, with priority given to randomised clinical trials and meta‐analyses.

Results

For patients with UC, consideration of 5‐ASA withdrawal should be made on a case‐by‐case basis, but it appears safest for those in deep remission without any of the following risk factors: younger age (<40 years), remission for less than 2 years, a history of multiple flares, extensive disease. 5‐ASA withdrawal should also be considered in patients with UC escalated to biologic therapy who have achieved remission and in all patients with CD. Although 5‐ASA therapy may have chemopreventive benefits for CRC, the cost‐benefit ratio appears significant, and this indication is not justified by evidence in those who have achieved remission and are continuing therapy with other agents, or in those in sustained remission without a history of extensive disease.

Conclusions

Although the majority of patients with IBD receive 5‐ASA during their disease course, safe withdrawal appears possible in many, with important implications for both health economics and patient experience. A number of unanswered questions, however, remain.
Development and validation of a prediction model (AHC) for early identification of refractory thrombotic thrombocytopenic purpura using nationally representative data
Authors: Gui Ruo‐Yun , Huang Qiu‐Sha , Cai Xuan , Wu Jin , Liu Hui‐Xin , Liu Yi , Yang Lin‐Hua , Zhang Jing‐Yu , Cheng Yun‐Feng , Jiang Ming , Mao Min , Fang Mei‐Yun , Liu Hui , Wang Li‐Ru , Wang Zhao , Zhou He‐Bing , Lan Hai , Jiang Zhong‐Xing , Shen Xu‐Liang , Zhang Lei , Fan Sheng‐Jin , Li Yueying , Wang Qian‐Fei , Huang Xiao‐Jun , Zhang Xiao‐Hui
Published: May 2020

Immune‐mediated thrombotic thrombocytopenic purpura (iTTP) is a rare and life‐threatening haematological emergency. Although therapeutic plasma exchange together with corticosteroids achieve successful outcomes, a considerable number of patients remain refractory to this treatment and require early initiation of intensive therapy. However, a method for the early identification of refractory iTTP is not available. To develop and validate a model for predicting the probability of refractory iTTP, a cohort of 265 consecutive iTTP patients from 17 large medical centres was retrospectively identified. The derivation cohort included 94 patients from 11 medical centres. For the validation cohort, we included 40 patients from the other six medical centres using geographical validation. An easy‐to‐use risk score system was generated, and its performance was assessed using internal and external validation cohorts. In the multivariable logistic analysis of the derivation cohort, three candidate predictors were entered into the final prediction model: age, haemoglobin and creatinine. The prediction model had an area under the curve of 0.886 (95% CI: 0.679–0.974) in the internal validation cohort and 0.862 (95% CI: 0.625–0.999) in the external validation cohort. The calibration plots showed a high agreement between the predicted and observed outcomes. In conclusion, we developed and validated a highly accurate prediction model for the early identification of refractory iTTP. It has the potential to guide tailored therapy and is a step towards more personalized medicine.