bluuebunny/crossref_metadata_2025 huggingface dataset:
Older Adults’ Drop in Cerebral Oxygenation on Standing Correlates With Postural Instability and May Improve With Sitting Prior to Standing
Authors: Fitzgibbon-Collins Laura K , Heckman George A , Bains Ikdip , Noguchi Mamiko , McIlroy William E , Hughson Richard L
Published: August 2020

Background

Impaired blood pressure (BP) recovery with orthostatic hypotension on standing occurs in 20% of older adults. Low BP is associated with low cerebral blood flow but mechanistic links to postural instability and falls are not established. We investigated whether posture-related reductions in cerebral tissue oxygenation (tSO2) in older adults impaired stability upon standing, if a brief sit before standing improved tSO2 and stability, and if Low-tSO2 predicted future falls.

Method

Seventy-seven older adults (87 ± 7 years) completed (i) supine–stand, (ii) supine–sit–stand, and (iii) sit–stand transitions with continuous measurements of tSO2 (near-infrared spectroscopy). Total path length (TPL) of the center of pressure sway quantified stability. K-cluster analysis grouped participants into High-tSO2 (n = 62) and Low-tSO2 (n = 15). Fall history was followed up for 6 months.

Results

Change in tSO2 during supine–stand was associated with increased TPL (R = −.356, p = .001). When separated into groups and across all transitions, the Low-tSO2 group had significantly lower tSO2 (all p < .01) and poorer postural stability (p < .04) through 3 minutes of standing compared to the High-tSO2 group. There were no effects of transition type on tSO2 or TPL for the High-tSO2 group, but a 10-second sitting pause improved tSO2 and enhanced postural stability in the Low-tSO2 group (all p < .05). During 6-month follow-up, the Low-tSO2 group had a trend (p < .1) for increased fall risk.

Conclusions

This is the first study to show an association between posture-related cerebral hypoperfusion and quantitatively assessed instability. Importantly, we found differences among older adults suggesting those with lower tSO2 and greater instability might be at increased risk of a future fall.
Association Between Region of Birth and Advance Care Planning Documentation Among Older Australian Migrant Communities: A Multicenter Audit Study
Authors: Sinclair Craig , Sellars Marcus , Buck Kimberly , Detering Karen M , White Ben P , Nolte Linda
Published: August 2020

Objectives

This study explored associations between birth region, sociodemographic predictors, and advance care planning (ACP) uptake.

Methods

A prospective, multicenter, cross-sectional audit study of 100 sites across 8 Australian jurisdictions. ACP documentation was audited in the health records of people aged 65 years or older accessing general practice (GP), hospital, and long-term care facility (LTCF) settings. Advance care directives (ACDs) completed by the person (“person completed ACDs”) and ACP documents completed by a health professional or other person (“health professional or someone else ACP”) were counted. Hierarchical multilevel logistic regression assessed associations with birth region.

Results

From 4,187 audited records, 30.0% (1,152/3,839) were born outside Australia. “Person completed ACDs” were less common among those born outside Australia (21.9% vs 28.9%, X2 (1, N = 3,840) = 20.3, p < .001), while “health professional or someone else ACP” was more common among those born outside Australia (46.4% vs 34.8%, X2 (1, N = 3,840) = 45.5, p < .001). Strongest associations were found for those born in Southern Europe: “person completed ACD” (odds ratio [OR] = 0.56, 95% confidence interval [CI] = 0.36–0.88), and “health professional or someone else ACP” (OR = 1.41, 95% CI = 1.01–1.98). English-language proficiency and increased age significantly predicted both ACP outcomes.

Discussion

Region of birth is associated with the rate and type of ACP uptake for some older Australians. Approaches to ACP should facilitate access to interpreters and be sensitive to diverse preferences for individual and family involvement in ACP.
Impact of 3-D Earth structure on W-phase CMT parameters
Authors: Morales-Yáñez Catalina , Duputel Zacharie , Rivera Luis
Published: August 2020

We investigate the impact of unmodelled 3-D structural heterogeneity on inverted W-phase source parameters. We generate a large data set of synthetic seismograms accounting for the Earths 3-D structure for 250 earthquakes globally distributed. The W-phase algorithm is then used to invert for earthquake CMT parameters, assuming a spherical Earth model. The impact of lateral heterogeneity is assessed by comparing inverted source parameters with those used to compute the 3-D synthetics. Results show that the 3-D structure mainly affects centroid location while the effect on the other source parameters remains small. Centroid mislocations present clear geographical patterns. In particular, W-phase solutions for earthquakes in South America are on average biased 17 km to the east of the actual centroid locations. This effect is significantly reduced using an azimuthally well balanced distribution of seismological stations. Source parameters are generally more impacted by mantle heterogeneity while the scalar moment of shallow earthquakes seems to be mainly impacted by the crustal structure. Shallow earthquakes present a variability of Mrθ and Mrϕ moment tensor elements, resulting both from the small amplitude and a larger uncertainty of the associated Green’s functions.
Dissection length-to-descending thoraco-abdominal aorta length ratio predicts abdominal aortic enlargement after thoracic endovascular aortic repair for type B aortic dissection involving the abdominal aorta
Authors: Wang Xinhao , Ge Yangyang , Ge Xiaohu , Miao Jianhang , Fan Weidong , Liu Jie , Rong Dan , Xue Yan , Liu Feng , Jia Xin , Liu Xiaoping , Guo Wei
Published: August 2020

OBJECTIVES

This study was performed to assess the association between the dissection length-to-descending thoraco-abdominal aorta length ratio (LLR) and abdominal aortic enlargement (AAE) (≥20% increase in total abdominal aortic volume) after thoracic endovascular aortic repair (TEVAR) in patients with type B aortic dissection.

METHODS

We retrospectively analysed data from 184 consecutive patients with type B aortic dissection who underwent TEVAR from January 2011 to December 2016 at 4 hospitals as part of the Registry Of type B aortic dissection with Utility of STent graft study. Preoperative and postoperative computed tomography angiography images were reviewed to assess the LLR and AAE. Patients were stratified into tertiles according to the pre-TEVAR LLR: 0.7 to <1.0 (n = 61), 1.0 to <1.2 (n = 61) and 1.2 to <1.6 (n = 62). The thoracic and abdominal aorta were divided by the celiac trunk. The cumulative incidence of AAE was estimated using the Kaplan–Meier method. A multivariable Cox proportional hazards model was used to assess the independent association between the preoperative LLR and the post-TEVAR risk of AAE. The nonlinear relationship between the LLR and the risk of post-TEVAR AAE was fitted by the restricted cubic smoothing spline, and the inflection point on the fitting curve was determined using a piecewise linear regression model.

RESULTS

Baseline demographics, clinical features, preoperative anatomic characteristics and implanted devices were similarly distributed among the pre-TEVAR LLR tertile groups. At 24 months post-TEVAR, the estimated cumulative incidence of AAE significantly differed (P < 0.01) by LLR tertile group: 0.10 [95% confidence interval (CI) 0.00–0.21], 0.65 (95% CI 0.45–0.78) and 0.67 (95% CI 0.40–0.82), respectively. The pre-TEVAR LLR was an independent predictor of post-TEVAR AAE [hazard ratio (per unit increase) 1.03, 95% CI 1.01–1.04] following a nonlinear relationship with an inflection point at LLR = 1.0.

CONCLUSIONS

The risk of post-TEVAR AAE is highest when the length of the dissection is greater than or equal to the length of the descending aorta (LLR ≥ 1.0).
Opportunistic Invasive Infection by Group A Streptococcus During Anti–Interleukin-6 Immunotherapy
Authors: Wilde Shyra , Olivares Katherine L , Nizet Victor , Hoffman Hal M , Radhakrishna Suhas , LaRock Christopher N
Published: August 2020

Invasive group A Streptococcus (GAS) in immunocompetent individuals is largely linked to hypervirulent strains. Congenital immunodeficiencies and those acquired from chronic disease or immunosuppressant drugs also increase risk of severe illness. We recovered GAS from the blood of a patient receiving a biologic inhibitor of interleukin 6 (IL-6). Growth of this serotype M4 isolate in human blood or a murine bacteremia model was promoted by interleukin 1 or IL-6 inhibition. Hyperinvasive M1T1 GAS was unaffected by IL-6 in both models. These findings based on a natural experiment introduce IL-6 signaling deficiencies as a risk factor for invasive GAS.
Parents, Schools and Human Capital Differences Across Countries
Authors: De Philippis Marta , Rossi Federico
Published: August 2020

This paper studies the contribution of parental influence in accounting for cross-country gaps in human capital achievements. We argue that the cross-country variation in unobserved parental characteristics is at least as important as the one in commonly used observable proxies of parental socioeconomic background. We infer this through an indirect empirical approach, based on the comparison of the school performance of second-generation immigrants. We document that, within the same host country or even the same school, students whose parents come from high-scoring countries in standardized international tests do better than their peers with similar socioeconomic backgrounds. This finding is not driven by differential selection into emigration. We provide several pieces of evidence that support the transmission of cultural values as a leading channel behind the cross-country variation in the parental component. Unobserved parental characteristics account for about 15% of the cross-country variance in test scores, roughly doubling the overall contribution of parental influence.
Asymmetric drift of Andromeda analogues in the IllustrisTNG simulation
Authors: Quirk Amanda C N , Patel Ekta
Published: August 2020

We analyse the kinematics as a function of stellar age for Andromeda (M31) mass analogues from the IllustrisTNG cosmological simulation. We divide the star particles into four age groups: <1, 1–5, 5–10, and >10 Gyr, and compare the kinematics of these groups to that of the neutral gas cells. We calculate rotation curves for the stellar and gaseous components of each analogue from 2 to 20 kpc from the centre of mass. We find that the lag, or asymmetric drift (AD), between the gas rotation curve and the stellar rotation curve on average increases with stellar age. This finding is consistent with observational measurements of AD in the disc of the Andromeda galaxy. When the M31 analogues are separated into groups based on merger history, we find that there is a difference in the AD of the analogues that have had a 4:1 merger the last 4, 8, or 12 Gyr compared to analogues that have not experienced a 4:1 merger in the same time frame. The subset of analogues that have had a 4:1 merger within the last 4 Gyr are also similar to AD measurements of stars in M31’s disc, providing evidence that M31 may in fact have recently merged with a galaxy nearly one-fourth of its mass. Further work using high-resolution zoom-in simulations is required to explore the contribution of internal heating to AD.
The extreme colliding-wind system Apep: resolved imagery of the central binary and dust plume in the infrared
Authors: Han Y , Tuthill P G , Lau R M , Soulain A , Callingham J R , Williams P M , Crowther P A , Pope B J S , Marcote B
Published: August 2020

The recent discovery of a spectacular dust plume in the system 2XMM J160050.7–514245 (referred to as ‘Apep’) suggested a physical origin in a colliding-wind binary by way of the ‘Pinwheel’ mechanism. Observational data pointed to a hierarchical triple-star system, however, several extreme and unexpected physical properties seem to defy the established physics of such objects. Most notably, a stark discrepancy was found in the observed outflow speed of the gas as measured spectroscopically in the line-of-sight direction compared to the proper motion expansion of the dust in the sky plane. This enigmatic behaviour arises at the wind base within the central Wolf–Rayet binary: a system that has so far remained spatially unresolved. Here, we present an updated proper motion study deriving the expansion speed of Apep’s dust plume over a 2-year baseline that is four times slower than the spectroscopic wind speed, confirming and strengthening the previous finding. We also present the results from high angular resolution near-infrared imaging studies of the heart of the system, revealing a close binary with properties matching a Wolf–Rayet colliding-wind system. Based on these new observational constraints, an improved geometric model is presented yielding a close match to the data, constraining the orbital parameters of the Wolf–Rayet binary and lending further support to the anisotropic wind model.
Comparison of stellar populations in simulated and real post-starburst galaxies in MaNGA
Authors: Zheng Yirui , Wild Vivienne , Lahén Natalia , Johansson Peter H , Law David , Weaver John R , Jimenez Noelia
Published: August 2020

Recent integral field spectroscopic (IFS) surveys have revealed radial gradients in the optical spectral indices of post-starburst (PSB) galaxies, which can be used to constrain their formation histories. We study the spectral indices of post-processed mock IFS datacubes of binary merger simulations, carefully matched to the properties of the MaNGA IFS survey, with a variety of black hole (BH) feedback models, progenitor galaxies, orbits, and mass ratios. Based on our simulation sample, we find that only major mergers on prograde–prograde or retrograde–prograde orbits in combination with a mechanical BH feedback model can form galaxies with weak enough ongoing star formation, and therefore absent H α emission, to be selected by traditional PSB selection methods. We find strong fluctuations in nebular emission line strengths, even within the PSB phase, suggesting that H α selected PSBs are only a subsample of the underlying population. The global PSB population can be more robustly identified using stellar continuum-based approaches. The difficulty in reproducing the very young PSBs in simulations potentially indicates that new sub-resolution star formation recipes are required to properly model the process of star formation quenching. In our simulations, we find that the starburst peaks at the same time at all radii, but is stronger and more prolonged in the inner regions. This results in a strong time evolution in the radial gradients of the spectral indices that can be used to estimate the age of the starburst without reliance on detailed star formation histories from spectral synthesis models.
Boosting Monte Carlo sampling with a non-Gaussian fit
Authors: Amendola Luca , Gómez-Valent Adrià
Published: August 2020

We propose a new method, called Monte Carlo Posterior Fit, to boost the Monte Carlo sampling of likelihood (posterior) functions. The idea is to approximate the posterior function by an analytical multidimensional non-Gaussian fit. The many free parameters of this fit can be obtained by a smaller sampling than is needed to derive the full numerical posterior. In the examples that we consider, based on supernovae and cosmic microwave background data, we find that one needs an order of magnitude smaller sampling than in the standard algorithms to achieve comparable precision. This method can be applied to a variety of situations and is expected to significantly improve the performance of the Monte Carlo routines in all the cases in which sampling is very time consuming. Finally, it can also be applied to Fisher matrix forecasts and can help solve various limitations of the standard approach.
Unsupervised Inference of Protein Fitness Landscape from Deep Mutational Scan
Authors: Fernandez-de-Cossio-Diaz Jorge , Uguzzoni Guido , Pagnani Andrea
Published: August 2020

The recent technological advances underlying the screening of large combinatorial libraries in high-throughput mutational scans deepen our understanding of adaptive protein evolution and boost its applications in protein design. Nevertheless, the large number of possible genotypes requires suitable computational methods for data analysis, the prediction of mutational effects, and the generation of optimized sequences. We describe a computational method that, trained on sequencing samples from multiple rounds of a screening experiment, provides a model of the genotype–fitness relationship. We tested the method on five large-scale mutational scans, yielding accurate predictions of the mutational effects on fitness. The inferred fitness landscape is robust to experimental and sampling noise and exhibits high generalization power in terms of broader sequence space exploration and higher fitness variant predictions. We investigate the role of epistasis and show that the inferred model provides structural information about the 3D contacts in the molecular fold.
Sturnira parvidens (Chiroptera: Phyllostomidae)
Authors: Hernández-Canchola Giovani , León-Paniagua Livia
Published: August 2020

The little yellow-shouldered Mesoamerican bat, Sturnira parvidens Goldman, 1917, is a medium-sized yellow-shouldered bat with no tail, a vestigial uropatagium, and reddish or yellowish patches on the shoulders. It lives in tropical habitats associated with lower and mid-elevations from northern Costa Rica to Mexico, and it is one of 24 described species in the genus Sturnira. Although S. parvidens is more common in disturbed areas because it mainly feeds on pioneer plants, it uses day roosts located in mature forest or in areas with advanced successional stages. It is an abundant species and is listed as “Least Concern” by the International Union for Conservation of Nature and Natural Resources.
Extensive peritumoral edema and brain-to-tumor interface MRI features enable prediction of brain invasion in meningioma: development and validation
Authors: Joo Leehi , Park Ji Eun , Park Seo Young , Nam Soo Jung , Kim Young-Hoon , Kim Jeong Hoon , Kim Ho Sung
Published: August 2020

Background

Brain invasion by meningioma is a stand-alone criterion for tumor atypia in the 2016 World Health Organization classification, but no imaging parameter has yet been shown to be sufficient for predicting it. The aim of this study was to develop and validate an MRI-based radiomics model from the brain-to-tumor interface to predict brain invasion by meningioma.

Methods

Preoperative T2-weighted and contrast-enhanced T1-weighted imaging data were obtained from 454 patients (88 patients with brain invasion) between 2012 and 2017. Feature selection was performed from 3222 radiomics features obtained in the 1 cm thickness tumor-to-brain interface region using least absolute shrinkage and selection operator. Peritumoral edema volume, age, sex, and selected radiomics features were used to construct a random forest classifier–based diagnostic model. The performance was evaluated using the areas under the curves (AUCs) of the receiver operating characteristic in an independent cohort of 150 patients (29 patients with brain invasion) between 2018 and 2019.

Results

Volume of peritumoral edema was an independent predictor of brain invasion (P < 0.001). The top 6 interface radiomics features plus the volume of peritumoral edema were selected for model construction. The combined model showed the highest performance for prediction of brain invasion in the training (AUC 0.97; 95% CI: 0.95–0.98) and validation sets (AUC 0.91; 95% CI: 0.84–0.98), and improved diagnostic performance over volume of peritumoral edema only (AUC 0.76; 95% CI: 0.66–0.86).

Conclusion

An imaging-based model combining interface radiomics and peritumoral edema can help to predict brain invasion by meningioma and improve the diagnostic performance of known clinical and imaging parameters.
Responsive Neurostimulation of the Mesial Temporal White Matter in Bilateral Temporal Lobe Epilepsy
Authors: Nunna Ravi S , Borghei Alireza , Brahimaj Bledi C , Lynn Fiona , Garibay-Pulido Diego , Byrne Richard W , Rossi Marvin A , Sani Sepehr
Published: August 2020

BACKGROUND

Responsive neuromodulation (RNS) is a treatment option for patients with medically refractory bilateral mesial temporal lobe epilepsy (MTLE). A paucity of data exists on the feasibility and clinical outcome of hippocampal-sparing bilateral RNS depth lead placements within the parahippocampal white matter or temporal stem.

OBJECTIVE

To evaluate seizure reduction outcomes with at least a 1-yr follow-up in individuals with bilateral MTLE undergoing hippocampus-sparing implantation of RNS depth leads.

METHODS

A retrospective analysis of prospectively collected data was performed on patients at our institution with bilateral MTLE who were implanted with RNS depth leads along the longitudinal extent of bitemporal parahippocampal white matter or temporal stem. Baseline and postoperative seizure frequency, previous surgical interventions, and postimplantation electrocorticography and stimulation data were analyzed.

RESULTS

Ten patients were included in the study (7 male, 3 female). Overall seizure frequency declined by a median 44.25% at 3.13 yr (standard deviation 3.31) postimplantation. Four patients (40%) achieved 50% responder rate at latest follow-up. Two of four patients with focal onset bilateral tonic-clonic seizures became completely seizure-free. Forty percent of patients were previously implanted with a vagus nerve stimulator, and 20% underwent a prior temporal lobectomy. All depth lead placements were confirmed as radiographically located in the parahippocampal white matter or temporal stem without hippocampus violation. There were no cases of lead malposition.

CONCLUSION

Extrahippocampal or temporal stem white matter targeting during RNS surgery for bitemporal MTLE is feasible and allows for electrographic seizure detection. Larger controlled studies with longer follow-up are needed to validate these preliminary findings.
The Correlation Between Clinical Features and Viral RNA Shedding in Outpatients With COVID-19
Authors: Liao Tingting , Yin Zhengrong , Xu Juanjuan , Lv Zhilei , Wang Sufei , Duan Limin , Fan Jinshuo , Jin Yang
Published: August 2020

Background

Patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can shed virus, thereby causing human-to-human transmission, and the viral RNA shedding is commonly used as a proxy measure for infectivity.

Methods

We retrospectively reviewed confirmed cases of COVID-19 who attended the fever clinic of Wuhan Union Hospital from January 14 to February 24. In terms of the viral RNA shedding (median values) at first visit, patients were divided into a high–viral RNA shedding group and a low–viral RNA shedding group. Univariate and multivariate logistic regression analysis were performed to investigate the correlation between viral RNA shedding and clinical features.

Results

A total of 918 consecutive COVID-19 patients were enrolled, and severe patients made up 26.1%. After univariate and multivariate logistic regression, advanced age (odds ratio [OR], 1.02; 95% CI, 1.01–1.03; P = .001), having severe chronic diseases (OR, 1.44; 95% CI, 1.03–2.01; P = .04), and severe illness (OR, 1.60; 95% CI, 1.12–2.28; P = .01) were independent risk factors for high viral RNA shedding. Shorter time interval from symptom onset to viral detection was a protective factor for viral RNA shedding (OR, 0.97; 95% CI, 0.94–0.99; P = .01). Compared with mild patients, severe patients have higher virus shedding over a long period of time after symptom onset (P = .01).

Conclusions

Outpatients who were old, had severe illness, and had severe underlying diseases had high viral RNA shedding.
PROPOSED NATIONAL DIAGNOSTIC REFERENCE LEVELS FOR STANDARD RADIOGRAPHIC X-RAY PROCEDURES IN SUDAN
Authors: Ahmed Nada A , Basheir E H , Farah A B , Mohammedzein T S , Suliman I I
Published: August 2020

This study aimed to calculate patient radiation doses for adults during the seven most commonly performed conventional X-ray procedures, and to propose national diagnostic reference levels (DRLs). A representative sample of patients from 29 hospitals was included. The entrance surface air kerma (ESAK) was calculated by measuring X-ray tube output and the corresponding technical and exposure factors for each patient. Third-quartile values of the mean ESAK distributions were proposed as DRL values. The DRLs in mGy were as follows: 0.6 for chest postero–anterior (PA), 3.5 for skull AP, 1.7 for skull lateral (LAT), 2.7 for abdominal, 2.6 for pelvic AP, 3.7 for lumbar spine AP and 8 for lumbar spine LAT. Compared with literature, the maximum percentages increase were in chest PA (329%) and skull AP (187%). Since the suggested DRL for chest PA was higher than literature values, dose optimization and a review of its value is recommended.
Exogenous GABA promotes adaptation and growth by altering the carbon and nitrogen metabolic flux in poplar seedlings under low nitrogen conditions
Authors: Chen Wei , Meng Chen , Ji Jing , Li Mai-He , Zhang Xiaoman , Wu Yanyan , Xie Tiantian , Du Changjian , Sun Jiacheng , Jiang Zeping , Shi Shengqing
Published: August 2020

Nitrogen (N) deficiency adversely affects tree growth. Additionally, γ-aminobutyric acid (GABA) is closely associated with growth and stress responses because of its effects on carbon (C) and N metabolism. However, little is known about its roles related to plant adaptations to N-deficient conditions. In this study, we analyzed the effects of GABA (0, 2 and 10 mM) applications on the growth traits and physiological responses of poplar (Populus alba × P. glandulosa ‘84K’) seedlings under high N (HN) and low N (LN) conditions. We found that the added GABA interacted with N to affect more than half of the studied parameters, with greater effects in LN plants than in HN plants. Under LN conditions, the GABA application tended to increase poplar growth, accompanied by increased xylem fiber cell length and xylem width. In stems, exogenous GABA increased the abundance of non-structural carbohydrates (starch and sugars) and tricarboxylic acid cycle intermediates (succinate, malate and citrate), but had the opposite effect on the structural C contents (hemicellulose and lignin). Meanwhile, exogenous GABA increased the total soluble protein contents in leaves and stems, accompanied by significant increases in nitrate reductase, nitrite reductase and glutamine synthetase activities in leaves, but significant decreases in those (except for the increased glutamate synthetase activity) in stems. A multiple factorial analysis indicated that the nitrate assimilation pathway substantially influences poplar survival and growth in the presence of GABA under LN conditions. Interestingly, GABA applications also considerably attenuated the LN-induced increase in the activities of leaf antioxidant enzymes, including peroxidase and catalase, implying that GABA may regulate the relative allocation of C and N for growth activities by decreasing the energy cost associated with stress defense. Our results suggest that GABA enhances poplar growth and adaptation by regulating the C and N metabolic flux under N-deficient conditions.
Using the Microbiome Amplification Preference Tool (MAPT) to Reveal Medicago sativa-Associated Eukaryotic Microbes
Authors: Moccia Katherine , Papoulis Spiridon , Willems Andrew , Marion Zachary , Fordyce James A. , Lebeis Sarah L.
Published: August 2020

Although our understanding of the microbial diversity found within a given system expands as amplicon sequencing improves, technical aspects still drastically affect which members can be detected. Compared with prokaryotic members, the eukaryotic microorganisms associated with a host are understudied due to their underrepresentation in ribosomal databases, lower abundance compared with bacterial sequences, and higher ribosomal gene identity to their eukaryotic host. Peptide nucleic acid (PNA) blockers are often designed to reduce amplification of host DNA. Here we present a tool for PNA design called the Microbiome Amplification Preference Tool (MAPT). We examine the effectiveness of a PNA designed to block genomic Medicago sativa DNA (gPNA) compared with unrelated surrounding plants from the same location. We applied mitochondrial PNA and plastid PNA to block the majority of DNA from plant mitochondria and plastid 16S ribosomal RNA genes, as well as the novel gPNA. Until now, amplifying both eukaryotic and prokaryotic reads using 515F-Y and 926R has not been applied to a host. We investigate the efficacy of this gPNA using three approaches: (i) in silico prediction of blocking potential in MAPT, (ii) amplicon sequencing with and without the addition of PNAs, and (iii) comparison with cultured fungal representatives. When gPNA is added during amplicon library preparation, the diversity of unique eukaryotic amplicon sequence variants present in M. sativa increases. We provide a layered examination of the costs and benefits of using PNAs during sequencing. The application of MAPT enables scientists to design PNAs specifically to enable capturing greater diversity in their system.
Preoperative assessment and optimization of cognitive dysfunction and frailty in the ambulatory surgical patient
Authors: Charipova Karina , Urits Ivan , Viswanath Omar , Urman Richard D.
Published: August 2020

Purpose of review

The number and the complexity of procedures taking place at ambulatory surgery centers is steadily increasing. The rate at which medically complex patients, including those with baseline neurocognitive disorders, are undergoing ambulatory procedures is seeing a concurrent rise. Given the significant physical and psychological stress associated with surgery even in the ambulatory setting, it is essential to evaluate the ability of a patient to acclimate to stressful triggers in order to assess risk of subpar medical outcomes and increased mortality. In this review, we discuss recent advances in the assessment of both cognition and frailty and describe the implementation of these tools in the ambulatory surgery setting.

Recent findings

Recent Society for Perioperative Assessment and Quality Improvement (SPAQI) recommendations for evaluating at-risk patients focus on a two-pronged approach that encompasses screening for both impaired cognition and frailty. Screening should ideally occur as early as possible, but tools such as the Mini-Cog examination and FRAIL Questionnaire are efficient and effective even when used the day of surgery in high-risk patients.

The recognition of at-risk patients using standardized screening and the use of this assessment to guide perioperative monitoring and interventions is essential for optimizing outcomes for the complex ambulatory surgery patient.
Psychiatric Disorders in Children of Parents With Substance Dependence Disorder
Authors: Okasha Tarek A. , Ibrahim Nesreen M. , Naguib Rehab M. , Khalil Kerolos B. , Hashem Reem E.
Published: August 2020

Objectives:

Children of addicted parents exhibit depression, anxiety, and elevated rates of psychiatric disorders more frequently than do children from nonaddicted families.

Hence, we conducted this research to illustrate the psychiatric illness of children of substance-dependent parents.

Materials and Methods:

The study included 50 children [25 with a parent diagnosed with substance use disorder according Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria (group A), and 25 whose parents had no psychiatric diagnosis according to general health questionnaire (group B)]. The subjects were recruited from the Heliopolis Psychiatric Hospital, which is a Ministry of Health Hospital. They were assessed using the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI KID) scale.

We, furthermore, assessed the relation between the Addiction Severity Index, type of substance used by group A parents, and the MINI KID scale.

Results:

Group A showed more significant diagnosis than group B (P=0.037) by the MINI KID scale (major depressive disorder, dysthymia, panic disorder, agoraphobia, and separation anxiety disorder) (P=0.018, 0.037, 0.042, 0.021, and 0.004, respectively). Hence, the substance abuse parent has a detrimental effect on their children’s well-being.

As regards the relation between addiction severity and result of MINI KID scale in group A, only “employment” was significant (P=0.025). Surprisingly, neither the severity of substance abused nor the type of substance abused by the parent had significant relation with the diagnosed psychiatric disorders in their children.

Conclusions:

Our study found that the prevalence of psychiatric disorders in children increases when their parents have substance use disorder. Moreover, the variation of the severity of parent addiction does not affect the risk for having psychiatric disorders in their children.
RAF1 Gene Fusions as a Possible Driver Mechanism in Rare BAP1-Inactivated Melanocytic Tumors: A Report of 2 Cases
Authors: Donati Michele , Martinek Petr , Kastnerova Liubov , Persichetti Paolo , Michal Michal , Kazakov Dmitry V.
Published: August 2020

BRCA1-associated protein (BAP1)-inactivated melanocytic tumor (BIMT) is a group of epithelioid melanocytic neoplasms characterized by the loss of function of BAP1, a tumor suppressor gene located on chromosome 3p21. They occur sporadically or in the setting of an autosomal-dominant cancer susceptibility syndrome that predisposes to the development of different internal malignancies. Most of these cutaneous lesions are associated with a BRAF-mutated melanocytic nevus and therefore are included in the group of combined nevi in the last WHO classification of skin tumors. Apart from a BRAF mutation, an NRAS mutation has been reported in rare cases, whereas in some lesions no driver mutation has been detected. Here, we report 2 cases of BIMTs with a BAP1 mutation and a RAF1 fusion. Both lesions proved to be BRAF and NRAS wild type and were associated with a conventional melanocytic nevus with dysplastic junctional features. We suggest that RAF1 fusions can represent an underlying driver genetic event in these cases. Our study extends the morphological and molecular spectrum in BIMTs.
Pseudolymphomatous Atypical Fibroxanthoma
Authors: Garcia Castro Rubén , Viñolas-Cuadros Alex , Moyano-Bueno David , Conde-Ferreiros Alberto , Cardeñoso Esther , Santos-Briz Angel
Published: August 2020

Atypical fibroxanthoma is a rare mesenchymal skin tumor of intermediate malignancy that typically occurs on sun-damaged skin of elderly patients. Histologically, it is composed of pleomorphic cells with hyperchromatic nuclei and abundant cytoplasm, commonly arranged in a spindle cell pattern. Different histologic variants have been described during the past years. We present a case of atypical fibroxanthoma containing a dense inflammatory infiltrate, which in conjunction with the existence of immunoblast-like and Reed-Sternberg-like neoplastic cells could be misinterpreted as a lymphoid neoplasm. Immunohistochemical studies revealed strong positivity of tumor cells for CD10 and negativity for cytokeratins, p63, p40, S100, SOX10, ERG, actin, desmin, B and T-cell markers, BCL6, CD15, and CD30. The inflammatory infiltrate contained a mixed reactive T- and B-cell population with negative T-cell receptor and immunoglobulin heavy rearrangements. We discuss the differential diagnosis of this entity in which clinical, immunohistochemical, and molecular features are essential to avoid the diagnosis of a lymphoproliferative disease.
Manifestations of Apprehension and Anxiety in a Sprague Dawley Cranial Defect Model
Authors: Andrews Brian T. , Barbay Scott , Tsau Sheila , Berkland Cory , Townsend Jakob , Detamore Michael , Tuchek Chad , Nudo Randolph J.
Published: August 2020

Background:

Syndrome of the trephined is a neurologic condition that commonly arises in patients who undergo craniectomy and have a prolonged cranial defect. Symptoms of this condition include headache, difficulties concentrating, diminished fine motor/dexterity skills, mood changes, and anxiety/apprehension. The authors hypothesize that an animal model demonstrating anxiety/apprehension in rats who undergo craniectomy is feasible utilizing standardized animal behavioral testing.

Methods:

Sprague Dawley rats were the stratified to 1 of 2 groups for comparison of neurobehavioral outcomes. Group #1 (closed cranial group) had their cranial trephination immediately closed with acrylic to restore normal cranial anatomy and Group #2 (open cranial group) had their cranial trephination enlarged to represent a decompressive hemicraniectomy immediately. Anxiety/apprehension was studied using a standardized rodent open field test. Statistical comparison of differences among the 2 groups was performed.

Results:

Ten rats were studied with 5 rats in each group. Standard rodent open field testing of anxiety demonstrated no difference among the 2 groups at 1 week. Rats in the “Open cranial group” demonstrated progressively more anxiety over the following 3-month period. Rats in the “Open cranial group” demonstrated increasing anxiety levels as compared with rats in the “Closed cranial group.” At week 16, the “Open cranial group” anxiety levels were significantly greater than week 4 (t = 2.24, P = 0.04) demonstrating a significant linear trend over time (R
2 = 0.99; P = 0.002). The “Closed cranial group” did not show this trend (R
2 = 07; P = 0.74).

Conclusion:

Our study demonstrates that anxiety and apprehension are more prevalent in rats with an open, prolonged cranial defect in comparison to those with a closed cranium. This correlates with similar finds in humans with syndrome of the trephined.
Comparison of Two Methods for Presurgical Volumetric Evaluation of Alveolar Cleft Bone Defects Using Computer-Aided Engineering
Authors: Liu Bing , Yin Ning B. , Xiao Ran , Li Hai D. , Chen Shu X. , Li Si L. , Wang Yong Q.
Published: August 2020

Precise volumetric evaluation of the alveolar cleft facilitates accurate preparation of bone substitutes and reduces donor site morbidity. This study investigates 2 advanced presurgical volumetric assessment methods that use computer-aided engineering (CAE) software. Preoperative computed tomography (CT) scans from 20 unilateral alveolar cleft patients undergoing secondary alveolar bone grafting (SABG) were analyzed by CAE software. Cleft defect volumes were calculated using the mirror-reversed technique and the subtraction method. The mirror-reversed technique determines defect volume by reversing the noncleft side to the cleft side. The subtraction method determines defect volume by subtracting a mask of the preoperative cleft from a mask generated after simulated cleft filling. The mean defect volumes and calculation times of the mirror-reversed technique (1.27 ± 0.35 cm3; 11.80 ± 1.79 seconds) and the subtractive method (1.23 ± 0.32 cm3; 9.43 ± 1.35 seconds) did not differ significantly. In Bland–Altman analysis the 2 methods were equivalent for alveolar cleft defect assessment. Both methods exhibited acceptable interobserver reliability, high precision, clinical convenience, time efficiency, and high reproducibility, and can serve as valuable tools for the planning and execution of SABG. The subtraction method has broader potential applicability and can simulate intraoperative bone grafting more effectively.
Effectiveness of Flow Volume Measurement Training Using a Custom-Made Doppler Flow Simulator
Authors: Lee Hyung Seok , Park Pyoungju , Han Sohee , Joo Narae , Song Young Rim , Kim Jwa Kyung , Kim Cheolsu , Kim Hyung Jik , Kim Sung Gyun
Published: August 2020

Introduction

This study was conducted to analyze the effectiveness of a custom-made Doppler ultrasound (DUS) flow simulator, vascular phantom, and Doppler test fluid in the training of dialysis staff in flow volume (FV) measurements for arteriovenous (AV) access in hemodialysis (HD) patients.

Methods

A DUS flow simulator was constructed using a continuous renal replacement therapy machine. Vascular phantoms were constructed using a rubber enema tube and keyboard cleaning gel. The Doppler test fluid consisted of freeze-dried instant coffee granules and 0.9% saline. This easy and affordable simulator was used to train 12 dialysis staff members, with no previous experience in DUS FV measurement. After a 3-day lecture course, the staff members performed DUS analyses on the AV access of HD patients. Thereafter, they underwent a 3-day training course using the simulator and then performed the DUS analyses of the AV access again. Each staff member assessed the FV 3 times, and the mean values of the measurements pretraining and posttraining were analyzed using paired t tests.

Results

The difference in the mean value of FV measurements and the reference value decreased from 131.6 mL/min to 62.5 mL/min (95% confidence interval = 30.0–108.0, P = 0.002), and the standard deviation of the FV measurements decreased from 96.9 mL/min to 47.0 mL/min (95% confidence interval = 7.9–91.8, P = 0.023) after DUS training with the simulator.

Conclusions

The accuracy and reproducibility of FV measurements markedly improved after training with the simulator; it may be helpful for medical practitioners involved in AV access for HD treatment.
Apples before the fall: does shape stability coincide with maturity?
Authors: Christodoulou Maria D , Culham Alastair
Published: August 2020

Fruit shape is the result of the interaction between genetic, epigenetic, environmental factors, and stochastic processes. As a core biological descriptor both for taxonomy and horticulture, the point at which shape stability is reached becomes paramount in apple cultivar identification, and authentication in commerce. Twelve apple cultivars were sampled at regular intervals from anthesis to harvest over two growing seasons. Linear and geometric morphometrics were analyzed to establish if and when shape stabilized and whether fruit asymmetry influenced this. Shape stability was detected in seven cultivars, four asymmetric and three symmetric. The remaining five did not stabilize. Shape stability, as defined here, is cultivar-dependent, and when it occurs, it is late in the growing season. Geometric morphometrics detected stability more readily than linear, especially in symmetric cultivars. Key shape features are important in apple marketing, giving the distinctness and apparent uniformity between cultivars expected at point of sale.
Dissecting mutational mechanisms underpinning signatures caused by replication errors and endogenous DNA damage
Authors: Zou Xueqing , Koh Gene Ching Chiek , Nanda Arjun Scott , Degasperi Andrea , Urgo Katie , Roumeliotis Theodoros I. , Agu Chukwuma A , Side Lucy , Brice Glen , Perez-Alonso Vanesa , Rueda Daniel , Badja Cherif , Young Jamie , Gomez Celine , Bushell Wendy , Harris Rebecca , Choudhary Jyoti S. , Jiricny Josef , Skarnes William C , Nik-Zainal Serena
Published: August 2020

Mutational signatures are imprints of pathophysiological processes arising through tumorigenesis. Here, we generate isogenic CRISPR-Cas9 knockouts (Δ) of 43 genes in human induced pluripotent stem cells, culture them in the absence of added DNA damage, and perform wholegenome sequencing of 173 daughter subclones. ΔOGG1, ΔUNG, ΔEXO1, ΔRNF168, ΔMLH1, ΔMSH2, ΔMSH6, ΔPMS1, and ΔPMS2produce marked mutational signatures indicative of being critical mitigators of endogenous DNA changes. Detailed analyses reveal that 8-oxo-dG removal by different repair proteins is sequence-context-specific while uracil clearance is sequencecontext-independent. Signatures of mismatch repair (MMR) deficiency show components of C>A transversions due to oxidative damage, T>C and C>T transitions due to differential misincorporation by replicative polymerases, and T>A transversions for which we propose a ‘reverse template slippage’ model. ΔMLH1, ΔMSH6, and ΔMSH2signatures are similar to each other but distinct from ΔPMS2. We validate these gene-specificities in cells from patients with Constitutive Mismatch Repair Deficiency Syndrome. Based on these experimental insights, we develop a classifier, MMRDetect, for improved clinical detection of MMR-deficient tumors.
Multi-platforms approach for plasma proteomics: complementarity of Olink PEA technology to mass spectrometry-based protein profiling
Authors: Petrera Agnese , von Toerne Christine , Behler Jennifer , Huth Cornelia , Thorand Barbara , Hilgendorff Anne , Hauck Stefanie M.
Published: August 2020

The plasma proteome is the ultimate target for biomarker discovery. It stores an endless amount of information on the pathophysiological status of a living organism, which is however still difficult to comprehensively access. The high structural complexity of the plasma proteome can be addressed by either a system-wide and unbiased tool such as mass spectrometry (LC-MS/MS) or a highly sensitive targeted immunoassay such as the Proximity Extension Assays (PEA). In order to address relevant differences and important shared characteristics, we tested the performance of LC-MS/MS in data-dependent and -independent acquisition modes and PEA Olink to measure circulating plasma proteins in 173 human plasma samples from a Southern German population-based cohort. We demonstrated the measurement of more than 300 proteins with both LC-MS/MS approaches applied, mainly including high abundance plasma proteins. By the use of the PEA technology, we measured 728 plasma proteins, covering a broad dynamic range with high sensitivity down to pg/ml concentrations. In a next step, we quantified 35 overlapping proteins with all three analytical platforms, verifying the reproducibility of data distributions, measurement correlation and gender-based differential expression. Our work highlights the limitations and the advantages of both, targeted and untargeted approaches, and prove their complementary strengths. We demonstrated a significant gain in proteome coverage depth and subsequent biological insight by platforms combination – a promising approach for future biomarker and mechanistic studies.
IN-HOSPITAL MORTALITY AND THE PREDICTIVE ABILITY OF THE MODIFIED EARLY WARNING SCORE IN GHANA
Authors: Abbey Enoch Joseph , Mammen Jennifer Sophie , Soghoian Sari , Cadorette Maureen , Ariyo Promise
Published: August 2020

BACKGROUND

The modified early warning score (MEWS) is an objective measure of illness severity that promotes early recognition of clinical deterioration in critically ill patients. Its primary use is to; facilitate faster intervention or increase the level of care. Despite, its adoption in some African countries, MEWS is not standard of care in Ghana. We assessed the validity of MEWS as a predictor of mortality, among medically ill in-patients at the Korle-Bu Teaching Hospital (KBTH), Accra – Ghana. We sought to identify the predictive ability of MEWS in detecting clinical deterioration among medical in-patients and its comparability to the routinely measured vital signs.

METHOD

This was a retrospective study of medical in-patients, aged ≥13 years and admitted at KBTH from January 2017 – March 2019. Vital signs at 48 hours post-admission were coded using MEWS criteria, to obtain a limited MEWS score (LMEWS) and the level of consciousness imputed to obtain a full MEWS score (MEWS). A predictive model comparing mortality among patients with “significant” MEWS (L/MEWS ≥4) and “non-significant” MEWS (L/MEWS <4) scores was designed using multiple logistic regression. Internally validated for predictive accuracy, using the Receiver Operating Characteristic (ROC) curve.

RESULTS

112 patients were included in the study. The adjusted odds of death comparing patients with a “significant” MEWS to patients with “non-significant” MEWS was 6.33(95% Cl 1.96 – 20.48). Similarly, the adjusted odds of death comparing patients with “significant” versus “non-significant” LMEWS was 8.22(95% CI 2.45 – 27.56). The ROC curve for each analysis had a C-static of 0.83 and 0.84 respectively.

CONCLUSION

LMEWS is a good predictor of mortality and comparable to MEWS. Adoption of LMEWS can identify medical in-patients at risk of deterioration and death.