bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenges Associated With Cervical Cancer Screening and Management in Obese Women: A Provider Perspective
Authors: Clarke Megan A. , Massad L. Stewart , Khan Michelle J. , Smith Katie M. , Guido Richard S. , Mayeaux EJ , Darragh Teresa M. , Huh Warner K. , Johnson Amanda L. , Gold Michael A. , Schiffman Mark , Wentzensen Nicolas
Published: April 2020

Objectives

Obese women are at increased risk of cervical cancer, partly due to missed detection of cervical precancers during routine cervical cancer screening. We administered a clinician survey to better understand specific challenges and identify potential solutions to performing cervical cancer screening and management in obese women.

Materials and Methods

We administered a web-based survey to 2,319 members of the American Society of Colposcopy and Cervical Pathology including questions related to challenges associated with cervical sampling and visualization in obese compared with normal weight women and potential strategies for improvement. We summarized providers' responses using descriptive statistics and used Fisher exact tests to evaluate associations between provider characteristics and challenges with cervical sampling, visualization, and biopsy.

Results

Of the 240 providers that completed the survey, 89% and 93% reported that cervical sampling and visualization are more challenging in obese women, respectively, whereas 80% reported that taking a biopsy was more challenging. Commonly reported barriers included vaginal prolapse, difficulty visualizing and accessing the cervix, and lack of long enough sampling devices and large enough speculums. Frequently used techniques to improve sampling and visualization included use of a condom or examination glove finger to sheath a speculum and using a tenaculum. Most providers identified training for cervical sampling and colposcopy in obese women as a learning gap, and only 8% reported receiving such training.

Conclusions

Cervical cancer screening and management are more challenging in obese compared with normal weight women. Major barriers to cervical sampling and visualization included lack of adequately sized equipment and lack of education and training.
Trends in Patient Demographics and Diagnostic Yield at an Academic Colposcopy Clinic From 2008 to 2018
Authors: Manning-Geist Beryl L. , Davis Michelle , Vitonis Allison F. , Feldman Sarah
Published: April 2020

Objective

The aim of the study was to review trends in colposcopy rates and diagnoses of high-grade dysplasia and cancer for the past 10 years at an academic colposcopy clinic.

Materials and Methods

A registry of patients seen January 2008 to December 2018 at an academic colposcopy clinic was queried to examine trends in patient characteristics, cytology and histology results, and interventions during the study period, which coincided with the implementation of revised national guidelines. Differences in characteristics were examined with analysis of variance and χ2 tests. Trends in diagnoses were examined with logistic regression. Trends in interventions were modeled with binomial distribution, logit link, Poisson distribution, and log link.

Results

Among 5,103 women referred for abnormal pap testing, human papillomavirus, or dysplasia, the mean age increased over time (30.6 in 2008 to 38.4 in 2018, p < .0001) and fewer pregnant patients were served (11.3% in 2008 vs 2.8% in 2018, p < .0001). There were decreased rates of low-grade cytology (81.3% in 2008 vs 73.6% in 2018, p = .006) and increased rates of human papillomavirus positivity (4.1% in 2008 vs. 14.4% in 2018, p < .0001) on referral. Fewer colposcopies were performed per patient per year (1.2 in 2008 vs. 0.7 in 2018, p < .0001), and with this targeted intervention, there was an increased percentage of patients diagnosed with high-grade histology over time (adjusted p = .05).

Conclusions

Over time, the number of colposcopies performed per patient decreased, especially in younger and pregnant women. Meanwhile, the percentage of patients diagnosed with high-grade histology increased, suggesting that guidelines decreased unnecessary procedures while increasing the percentage of patients diagnosed with precancerous lesions.
Explore structural and functional brain changes in insomnia disorder: A PRISMA-compliant whole brain ALE meta-analysis for multimodal MRI
Authors: Wu Yangyang , Zhuang Yuan , Qi Jun
Published: April 2020

Inconsistent results for comparison between insomnia disorder (ID) patients and healthy controls (HC) were obtained from previous neuroimaging studies. An activation likelihood estimation (ALE) meta-analysis was made for multimodal neuroimaging in ID. ALE analysis indicated that ID patients showed significant gray matter reductions in the right middle frontal gyrus (MFG), compared to HC. Regarding positron emission tomography studies, ALE analysis showed reduced relative cerebral glucose metabolism in the right amygdala, the right anterior cingulate cortex (ACC), and the right posterior cingulate gyrus (PCG) in ID patients, compared to HC. Regarding diffusion tensor imaging studies, the present study indicated that ID patients showed reduced fractional anisotropy values in the left putamen and the right caudate body, compared to HC. Additionally, ID patients showed reduced amplitude of low frequency fluctuations (ALFF) in the left fusiform gyrus (FG), the left middle temporal gyrus (MTG), the right MTG, the right anterior lobe (AL), and the left PCG, compared to HC. ID patients showed increased ALFF in the left MFG, compared to HC. ID patients showed reduced regional homogeneity (ReHo) in the left parahippocampal gyrus, the left sublobar, the left cuneus, the left precentral gyrus (PCG), the right AL, the right ACC, and the right PCG, compared to HC. ID patients showed increased ReHo in the left FG, the left precuneus, and the right cingulate gyrus, compared to HC. Moreover, the ALE analysis showed hypoactivation relative to HC in the left superior temporal gyrus (STG), the left MTG, the right inferior frontal gyrus, the right cuneus, and the right STG in ID patients. Via this ALE meta-analysis, we obtained these key regions suffering from deficits in ID.
Prognostic value of carbohydrate antigen125 and carcino embryonic antigen expression in patients with colorectal carcinoma and its guiding significance for chemotherapy
Authors: Mao Jie , Du Peng , Yang Han-teng , Hu Huan , Wang Shi-Yao , Wu Xia , Cheng Zhi-Bin
Published: April 2020

The aim of this study is to evaluate the predictive value of carbohydrate antigen125 (CA125) and carcino embryonic antigen (CEA) expression and its guiding role of choosing chemotherapy regimen in post-operation patients with colorectal carcinoma.

The clinical data of all patients, including laboratory data and pathological data, were collected from the electronic medical records. Kaplan-Meier Log rank test, COX regression model and subgroup analyses were employed to assess the correlation between the expression of CA125 and CEA in patients with colorectal carcinoma and the survival, and the effect on chemotherapy efficacy.

Kaplan-Meier showed that CA125 expression is negatively related to the progression-free survival (PFS) of the post-operative patients, Median PFS was 1140 days in the patients with high expression, and Median PFS was 1387 days in the patients with low expression (χ

2
 = 4.715, P = .030); CEA expression is also negatively associated with the PFS of the post-operative patients, Median PFS was 1197 days in the patients with high expression, and Median PFS was 1424 days in the patients with low expression (χ

2
 = 4.992, P = .025). Subgroup analysis also showed that the patients with normal CA125 and CEA had better prognosis, median PFS was 1505 days, and the patients with CA125 and (or) CEA high expression had poor prognosis and median PFS was 1162 days (χ

2
 = 13.346, P = .001), and found that there was no statistical difference in patients with oxaliplatin plus capecitabine (XELOX) and oxaliplatin, 5-fluorouracil and Calcium folinate (FOLFOX) chemotherapy in patients with CA125 and CEA low expression. However, in these patients with CA125 or (and) CEA high expression, the median PFS of patients treated with XELOX was 1082 days, and the median PFS of patients treated with FOLFOX chemotherapy was 1335 (χ

2
 = 4.547, P = .033).

Expression of CA125 and CEA associated with the survival of patients, and have some guiding significance for chemotherapy in patients with colorectal cancer after operation; Compared with XELOX, FOLFOX chemotherapy is more effective for CA125 or (and) CEA high expression patients with colorectal carcinoma.
Association of resting heart rate with nonalcoholic fatty liver disease in postmenopausal women
Authors: Kim Hong-Bae , Lee Yong-Jae
Published: April 2020

Resting heart rate, a simple and useful indicator of autonomic function, and its imbalance has emerged as an independent predictor of cardio metabolic diseases. Nonalcoholic fatty liver disease (NAFLD) is increasingly being diagnosed worldwide and is strongly associated with the features of cardiometabolic diseases. This study aimed to examine the association between resting heart rate and NAFLD in postmenopausal women.

The cross-sectional study included 1017 postmenopausal women aged ≥46 years, who attended a health examination program. Resting heart rate and NAFLD were measured in all subjects who underwent a medical examination. Resting heart rate quartiles were categorized as follows: Q1: 56 to 65, Q2: 66 to 71, Q3: 72 to 78, and Q4: 79 to 99 beats/min. The odds ratios and 95% confidence intervals for NAFLD were calculated after adjusting for confounding variables across resting heart rate quartiles using multiple logistic regression analysis.

The prevalence of NAFLD increased with increasing resting heart rate quartiles: 28.2% for Q1, 31.5% for Q2, 33.4% for Q3, and 38.1% for Q4 (P < .001). Compared to the 1st quartile, the odds ratio (95% confidence intervals) of NAFLD in the 4th quartile of resting heart rates was 2.11 (1.17–3.42) after adjusting for age, body mass index, cigarette smoking, regular exercise, blood pressure, total cholesterol, triglyceride, aspartate aminotransferase, and alanine aminotransferase levels.

Resting heart rate was positively associated with NAFLD in postmenopausal women, suggesting that it could be a useful additional measure to assess the risk for NAFLD in postmenopausal women.
The characteristics of the whole pelvic morphology in slipped capital femoral epiphysis
Authors: Wako Masanori , Koyama Kensuke , Takayama Yoshihiro , Haro Hirotaka
Published: April 2020

Slipped capital femoral epiphysis (SCFE) is a very common disorder affecting the adolescent hip. The etiology of SCFE is multifactorial and mechanical force associated with the characteristic morphology of the hip is considered one of the causes of SCFE. We investigated the characteristics of whole pelvic morphology including pelvic incidence (PI) in patients with SCFE and compared it with pelvic morphology in healthy children. We retrospectively assessed the whole pelvic morphology of 17 patients with SCFE and 51 healthy children using their pelvic computed tomography data. We measured superior iliac angle, inferior iliac angle, and ischiopubic angle as the parameters of pelvic rotation. Additionally, we measured acetabular anteversion of the superior acetabulum (AVsup) and of the center of the acetabulum (AVcen), and measured anterior acetabular sector angle (AASA), posterior acetabular sector angle, and the superior acetabular sector angle (SASA) as parameters of acetabular coverage and PI. Each measurement was compared between the 2 groups. AASA and SASA of patients with SCFE were significantly greater than that of controls, and AVsup of patients with SCFE was significantly smaller. There were no significant differences in pelvic rotation, PI, or AVcen between the 2 groups. This is the 1st report to evaluate SCFE patients’ whole pelvic morphology including PI and pelvic rotation. Our results showed that patients with SCFE have excessive coverage of the anterior and superior acetabulum, and a more retroverted cranial acetabulum as compared with healthy control subjects. Such characteristic pelvic morphology may be involved in the onset of SCFE. To clarify the mechanical forces involved in SCFE onset, further investigations of pelvic morphology and alignment, including the femur and spine, are needed.
Effect of acupuncture on hormone level in patients with gastrointestinal dysfunction after general anesthesia
Authors: Liu Lisha , Yuan Xiuli , Yang Lei , Zhang Jingyuan , Luo Jing , Huang Guangqiang , Huo Jian
Published: April 2020

Background:

Postoperative gastrointestinal dysfunction (PGD) refers to one of the common postoperative complications. Acupuncture can facilitate the recovery of PGD, whereas no therapeutic schedule of acupuncture has been internationally recognized for treating PGD. In the present study, a scientific trial protocol has been proposed to verify the feasibility of acupuncture in treating gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. We conduct this protocol to investigate whether acupuncture recovery gastrointestinal dysfunction by influencing the expression of gastrointestinal hormone.

Method:

The present study refers to a randomized, evaluator blinded, controlled, multi-center clinical trial; it was designed complying with the Consolidated Standards of Reporting Trials (CONSORT 2010) as well as the Standard for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be taken from the inpatients having undergone laparoscopic surgery of Mianyang Affiliated Hospital of Chengdu University of traditional Chinese medicine, Mianyang Third Hospital and Mianyang Anzhou Hospital. Based on the random number yielded using SPSS 25.0 software, the qualified subjects will be randomly classified to the experimental group and the control group. Therapies will be performed 30 min once after operation, the experimental group will be treated with acupuncture, while the control group will receive intravenous injection of granisetron. The major outcome will be the time to first flatus, and the secondary outcomes will include the time to first defecation, abdominal pain, dosage of analgesia pump, abdominal distention, nausea, vomiting, gastrointestinal hormone, as well as mental state. The efficacy and safety of acupuncture will be also assessed following the principle of Good Clinical Practice (GCP).

Discuss:

A standardized and scientific clinical trial is conducted to assess the efficacy and safety of acupuncture for gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. The aim is to objectively evidence and improves the clinical practice of acupoint prescription, as an attempt to promote the clinical application of this technology.
A Bayesian network meta-analysis of 5 different fusion surgical procedures for the treatment of lumbar spondylolisthesis
Authors: Tang Linjun , Wu Yong , Jing Daping , Xu Yong , Wang Cheng , Pan Jingjing
Published: April 2020

Lumbar fusion has been widely used to treat lumbar spondylolisthesis, which can be classified into 5 types according to its approach, including posterolateral fusion (PLF), posterior lumbar interbody fusion (PLIF), transforaminal lumbar interbody fusion (TLIF), posterolateral fusion plus anterior lumbar interbody fusion (PLFplusALIF), and posterolateral fusion plus posterior lumbar interbody fusion (PLFplusPLIF). Theoretically, each approach has its own advantages and disadvantages, however, no studies are available to compare them.

A network meta-analysis (NMA) was performed in this study and the results were illustrated by the mean difference (MD) or odds ratio (OR). Meanwhile, the preferable treatments were indicated using the surface under the cumulative ranking curve (SUCRA). All data were analyzed and graphs were plotted using R 3.4.1.

A total of 28 literatures were included in this meta-analysis. PLIF was the most effective treatment for pain relief. Conversely, TLIF was the most effective method for reducing vertebral slippage. For patients with isthmic spondylolisthesis (IS), PLIF performed the best in terms of Visual Analogue Scale (VAS) score, Oswestry Disability Index (ODI) score, fusion rate, blood loss, and complication rate. For patients with degenerative spondylolisthesis (DS), TLIF was the best from the points of view of VAS, complication rate, and vertebral slippage reduction.

PLIF and TLIF are identified as the optimal treatments for all lumbar spondylolisthesis cases, among which, PLIF may be the preferred choice for pain relief, while TLIF can offer the best outcomes in terms of vertebral slippage reduction. Furthermore, TLIF has displayed the best clinical outcomes and tolerability for DS patients.
A new radiographic finding of adult symptomatic discoid lateral meniscus
Authors: Lu Xin , Qian Jun , Yang Bo , Li Zheng , Fan Yu , Jiang Bo
Published: April 2020

Discoid lateral meniscus is one of the most common knee problems in clinical practice. Several radiographic findings have been reported to screen discoid lateral meniscus, but the diagnostic value of those signs varies.

We introduce a new method of measurement on plain radiograph for initial screening discoid lateral meniscus and describe its efficacy and correlation to symptomatic discoid lateral meniscus.

This is a retrospective case-control study.

Seventy-eight arthroscopic proven symptomatic discoid lateral meniscus adult patients plus 73 patients of matched control group were retrospectively reviewed at our institution between 2012 and 2017. We studied their standardized non-weight-bearing knee radiograph anterior-posterior view and measured the following parameters: lateral joint space height, lateral tibia spine height, fibular head height, lateral tibia plateau obliquity (LTPO), and lateral condyle convex angle (LCCA).

Significant statistical differences were found in the lateral joint space height, lateral tibia spine height, fibular head height, LTPO and LCCA measurements between the 2 groups (P < .05). Also, we found the phenomenon that angle parameters such as LTPO and LCCA had high sensitivities with relatively low specificities compared with height parameters.

We propose that LCCA is a new measurement which is statistically larger in discoid meniscus patients. Furthermore, it can be useful for screening discoid lateral meniscus on plain radiograph with its relative high sensitivity.

Level of Evidence: Level III, Case-control study.
Cardiovascular outcomes in patients with co-existing coronary artery disease and rheumatoid arthritis
Authors: Wang Hong , Li Xinxin , Gong Guoping
Published: April 2020

Background:

Through this analysis, we aimed to systematically compare the cardiovascular outcomes observed in patients with co-existing coronary artery disease (CAD) and rheumatoid arthritis (RA).

Methods:

Mendeley, Web of Science (WOS), MEDLINE, Cochrane central, EMBASE, Google scholar, and http://www.ClinicalTrials.gov were searched for English-based publications on CAD and RA. Selective cardiovascular outcomes were the endpoints in this analysis. The statistical software RevMan 5.3 was used for data assessment. Risk ratios (RR) with 95% confidence intervals (CI) were used to represent each subgroup analysis.

Results:

One thousand four hundred forty six (1446) participants had co-existing CAD and RA whereas 205,575 participants were in the control group (only CAD without RA). This current analysis showed that the risk of asymptomatic or stable angina was similar in CAD patients with versus without RA (RR: 0.98, 95% CI: 0.84 – 1.14; P = .78). However, all-cause mortality (RR: 1.47, 95% CI: 1.34 – 1.61; P = 0.00001), cardiac death (RR: 1.51, 95% CI: 1.05 – 2.17; P = .03) and congestive heart failure (RR: 1.41, 95% CI: 1.27 – 1.56; P = .00001) were significantly higher in CAD patients with RA. However, multi-vessel disease (RR: 2.03, 95% CI: 0.57 – 7.26; P = .28), positive stress test (RR: 1.69, 95% CI: 0.70 – 4.08; P = .24), and ischemic events (RR: 1.18, 95% CI: 0.81 – 1.71; P = .40) were similar in both groups. The risk for myocardial infarction, repeated revascularization, and the probability of patients undergoing percutaneous coronary intervention (PCI) (RR: 1.20, 95% CI: 0.75 – 1.93; P = .45) were also similar in CAD patients with versus without RA. When we considered outcomes only in those patients who underwent revascularization by PCI, all-cause mortality (RR: 1.43, 95% CI: 1.29 – 1.60; P = .00001) was still significantly higher in CAD patients with RA.

Conclusions:

This analysis showed a significantly higher mortality risk in CAD patients with RA when compared to the control group. Congestive heart failure also significantly manifested more in CAD patients with co-existing RA. However, the risks all the other cardiovascular outcomes were similar in both groups. Nevertheless, due to the several limitations of this analysis, this hypothesis should be confirmed in forthcoming trials based on larger numbers of CAD patients with co-existing RA.
Co-occurrence of PML-RARA gene fusion, chromosome 8 trisomy, and FLT3 ITD mutation in a young female patient with de novo acute myeloid leukemia and early death
Authors: Tripon Florin , Crauciuc George Andrei , Bogliş Alina , Moldovan Valeriu , Sándor-Kéri Johanna , Benedek István Jr , Trifa Adrian Pavel , Bănescu Claudia
Published: April 2020

Rationale:

Co-occurrence of cytogenetic and molecular abnormalities is frequently seen in patients with acute myeloid leukemia (AML). The clinical outcome and genetic abnormalities of AML may vary; therefore, genetic investigation must be complex, using several techniques, to have an appropriate characterization of the AML genome and its clinical impact. The available molecular markers can predict prognosis only partially. Acute promyelocytic leukemia subtype M3 (AML M3) is a subtype of AML characterized by the presence of promyelocytic leukemia-retinoic acid receptor alpha (PML-RARA) genes fusion. Targeted treatment with all-trans-retinoic acid (ATRA) and ATRA combined with arsenic trioxide significantly improved the survival of AML M3 patients. Unknown prognostic factors could contribute to the early death of these patients.

Patient Concerns:

We present the case of a young female (20 years old) patient, who presented at the emergency department 5 months after giving birth to her first child, complaining of asthenia, fatigue, general musculoskeletal pain, and fever (38°C), symptoms having been present for the previous 6 days. The patient denied any chronic diseases in her medical and family history.

Diagnosis:

Laboratory analysis revealed severe pancytopenia. Cytogenetic and molecular analyzes revealed chromosomal abnormalities (trisomy 8), PML-RARA gene fusion, and fms-like tyrosine kinase 3 (FLT3) gene mutation. The immunophenotypic analysis was also suggestive for AML M3 according to the FAB classification.

Interventions:

Specific treatment was initiated for AML M3 and for secondary conditions. Molecular and cytogenetic analyzes were performed to have a more detailed characterization of the patient's genome.

Outcome:

Seventy-two hours after admission, she developed psychomotor agitation, confusion, coma, and convulsion. Subsequent deterioration and early death were caused by intracerebral hemorrhage with multiple localization and diffuse cerebral edema.

Lessons:

The presence of FLT3 internal tandem duplication (ITD) mutation may explain the rapid and progressive degradation of this AML M3 case and it may be used as a prognostic marker even when co-occuring with other markers such as PML-RARA gene fusion and trisomy 8. We consider that FLT3 ITD mutation analysis in young patients with AML should be performed as soon as possible. New strategies for patients’ education, AML (or cancers in general) prevention, and treatment are needed.
Serum ammonia as a non-invasive marker for early prediction of esophageal varices
Authors: Darweesh Samar K. , Elsabaawy Maha A. , Eltahawy Mahmoud A. , Ghanem Heba S. , Abdel-Razek Wael
Published: April 2020

Introduction:

There is a growing need for identification of non-endoscopic, non-invasive methods that can accurately predict esophageal varices (EV). Previous studies found an inconclusive correlation between blood ammonia level and the presence and size of EV.

Aim:

We aimed at assessing the value of serum ammonia as a non-invasive method for early prediction of EV.

Patient and methods:

The study included 204 patients with HCV-related cirrhosis. The selected patients were categorized into two groups: patients with EV and those without, also patients with no or small EV and with large EV group. All patients underwent a complete biochemical workup, ultrasound and upper GI endoscopy. Child-Pugh class, Model of End-Stage Liver Disease (MELD) score and platelet count/splenic diameter ratio, and serum ammonia level.

Results:

There was a statistical difference between the two groups of patients regarding the following parameters: serum ammonia, international normalized ratio, portal vein diameter, spleen diameter, Child-Pugh class, MELD score, platelet count/splenic diameter ratio, aspartate aminotransferase-to-platelet ratio index, alanine aminotransferase-to-aspartate aminotransferase ratio, Forns index, FIB-4 and King’s score. Serum ammonia could predict the presence of EV using a cutoff value of 82 (µmol/L) with a sensitivity of 92.3%, specificity 92%. In addition, a cutoff of 95.5 (µmol/L) could predict large EV with a sensitivity of 92.7% and a specificity of 92.3%. Serum Ammonia in cirrhosis with large EV was 143 ± 39 µmol/L and in cirrhosis with small/without EV was 80.7 ± 9.7 µmol/L (P < 0.0001). Platelet/spleen ratio was 555.9 ± 187.3 in cirrhosis with EV and 694.4 ± 74.2 in cirrhosis without EV (P < 0.0001). Platelet/spleen ratio was 407.7 ± 107.1 in cirrhosis with large EV and 690.4 ± 103.7 in cirrhosis with small/without EV (P < 0.0001).

Conclusion:

Serum ammonia can accurately predict the presence and the size of EV in patients with liver cirrhosis with high sensitivity and specificity.
Symptoms and demographic factors associated with early-onset colorectal neoplasia among individuals undergoing diagnostic colonoscopy
Authors: Krigel Anna , Zhou Margaret , Terry Mary Beth , Kastrinos Fay , Lebwohl Benjamin
Published: April 2020

Background:

The incidence and mortality of colorectal cancer (CRC) are increasing in adults under 50 years. Risk factors associated with early-onset colorectal neoplasia (CRN) are uncertain. We aimed to identify clinical predictors associated with the presence of CRN detected by diagnostic colonoscopy in symptomatic individuals under 50 years of age.

Methods:

We used a single-center endoscopy database to identify symptomatic patients 18–49 years of age who underwent ambulatory colonoscopy between 2007 and 2017. Pathology reports identified CRN as adenomas, advanced adenomas (based on size or histology), or adenocarcinomas. Multivariable analysis was used to determine factors associated with CRN.

Results:

We identified 4333 eligible patients of whom 363 (8.4%) had any CRN and 48 (1.1%) had advanced neoplasia (advanced adenoma or adenocarcinoma). Factors associated with any CRN on multivariable analysis included male sex [odds ratio (OR) 1.50 (1.19–1.88)], older age group [compared to 18–29 years, OR for 30–39: 3.12 (1.93–5.04); OR for 40–49: 4.68 (2.97–7.36)], obesity [OR for BMI 30–34.9 compared to 18–24.9: 1.44 (1.04–2.01)], and any tobacco use [OR 1.63 (1.18–2.23)]. Anemia was associated with advanced neoplasia [OR 3.11 (1.32–7.34)]. Of the advanced neoplastic lesions, 38 of 48 (79.2%) were located in the distal colon.

Conclusions:

In the largest study to date of symptomatic individuals under 50 years of age undergoing colonoscopy in the USA, advanced CRN was most often detected in the distal colon and was associated with anemia, but not with abnormal bowel habits or abdominal pain. We also found that patients with CRN under 50 years of age were more likely to be male, smokers, and obese. These findings should prompt further investigation of these risk factors alone and in combination.
A systematic review with subset meta-analysis of studies exploring memory recall biases for pain-related information in adults with chronic pain
Authors: Schoth Daniel E. , Radhakrishnan Kanmani , Liossi Christina
Published: April 2020

Pain-related memory biases have been frequently explored in individuals with chronic pain, and along with attentional and interpretation biases are hypothesised to contribute to the onset and/or maintenance of chronic pain. The aim of this review is to provide a systematic review and synthesis of studies exploring memory recall biases for pain-related information in individuals with chronic pain relative to healthy controls and the recall of neutral information. Studies were identified through a search of Medline, PsychINFO, Web of Science, CINAHL, Cochrane Library, and Open Grey databases. Search terms were memory, recall, recognition, and bias*, intersected with pain. Eighteen studies meeting the inclusion criteria were included. Subset meta-analyses are also reported from 12 studies with relevant between-groups data (comparing recall in chronic pain vs healthy control groups) and 12 studies with relevant within-groups data (eg, comparing recall of pain-related/emotional vs neutral words). Between-groups analysis revealed significantly weaker recall bias for affective-pain words in individuals with chronic pain relative to healthy controls, but only when nondepressed chronic pain individuals were included. No significant differences were found between groups in the recall of sensory-pain, illness-related, or depression-related words. Within-groups analysis revealed individuals with chronic pain show a significant recall bias favouring sensory-pain words relative to neutral and affective-pain words, and a bias for illness-related words relative to depression-related words. A recall bias favouring neutral words was found in healthy individuals. Evidence for the presence of pain-related memory biases in patients with chronic pain is inconclusive. Further methodologically rigorous research is required.
Poly-4-Hydroxybutyric Acid Mesh Compares Favorably With Acellular Dermal Matrix in Tissue Expander–Based Breast Reconstruction
Authors: Levy Adam S. , Bernstein Jaime L. , Xia Jimmy J. , Otterburn David M.
Published: April 2020

Background

Acellular dermal matrix (ADM) is commonly used during immediate expander-based breast reconstruction, with potential advantages of greater intraoperative expansion, decreased time to complete expansion, and decreased rates of capsular contracture. However, ADM is associated with increased infection rate, seroma, and subsequent reconstructive failure. Poly-4-hydroxybutyric acid (P4HB) mesh is a large pore, biosynthetic scaffold shown to fully resorb and incorporate host tissues within 18 months. We sought to compare outcomes between the use of P4HB and ADM in immediate retropectoral expander-based reconstruction.

Methods

One hundred ninety-two consecutive cases (107 patients) of breast reconstruction using ADM were compared with a subsequent cohort of 112 cases (62 patients) using P4HB mesh. In all patients, reconstruction was performed immediately after mastectomy by a single surgeon, and outcomes were compared between groups.

Results

Baseline characteristics were similar between the P4HB and ADM groups. Overall infection rates were lower, but not significantly with P4HB (11% vs 17%, P = 0.18). Time to drain removal was significantly lower with P4HB (15 vs 18 days, P = 0.008), although there was no difference in rates of seroma (0.9% vs 3%, P = 0.43). Similar numbers of patients underwent external beam radiation (22% vs 24%) and received chemotherapy in each group (48% vs 45%). By univariate analysis, all odds ratios were decreased with use of P4HB, including risk of major complications (0.55), seroma (0.17), infection (0.59), need for reoperation (0.78), and skin necrosis (0.77).

Conclusions

Initial findings suggest P4HB mesh to be a safe alternative to ADM in expander-based breast reconstruction, with trends toward decreased rates of infection, seroma, and need for device removal using P4HB mesh. Although our results are limited to a small series of initial patients, P4HB mesh may be a promising novel technique to decrease complications inherent to use of ADM at a reduced material cost.
Fingertip Reconstruction Using a Lateral Flap Based on the Distal Transverse Arch of the Digital Artery
Authors: Cui Manyi , Wang Peiji
Published: April 2020

Purpose

Fingertip defect is more common in emergency hand trauma in the hospital, and most of them are accompanied by defects of the phalanx and nail bed. There are many methods in clinic for the repair of Yamano zone I fingertip injury. This article reports the repair of this type of injury using a lateral flap based on the distal transverse arch of the digital artery.

Methods

From January 2015 to May 2018, the flap was used in 32 digits of 32 patients who had a fingertip injury. There were 23 men and 9 women with a mean age of 37.6 years. The injured fingers requiring reconstruction included 6 thumb, 11 index fingers, 9 middle fingers, 4 ring fingers, and 2 little fingers. Soft tissue defect range from 1.5 cm × 1.0 cm to 2.5 cm × 2.1 cm. The time of injury to emergency surgery was 1 to 7.5 hours, with a mean time of 3.2 hours. Fingertip reconstruction was performed using a lateral flap based on the distal transverse arch of the digital artery.

Results

All flaps survived completely after 1 to 1.5 years of follow-up, without evidence of postoperative insufficiency of blood supply or venous congestion. Healing of all donor sites was uncomplicated. No infectious complications were observed. The range of motion of the 32 fingers was excellent; For sweating, 17 fingers were excellent, 10 were good, and 5 were fair (poor sweating was found in the grafting site of the finger). The mean static 2-point discrimination scores on the reconstructed pulp were 5.2 mm (range, 3–9 mm). According to the Cold Intolerance Severity Score, 28 patients reported no cold intolerance, 3 reported mild cold intolerance, and 1 reported moderate cold intolerance. On the basis of the visual analog scale, 30 patients had no pain, 1 reported mild pain, and 1 experienced moderate pain. Positive Tinel sign was found in only 1 reconstructed finger.

Conclusion

It is a new surgical technique that provides good shape and sensory function to the fingers and is simple to operate.
Harnessing the 100,000 Genomes Project whole genome sequencing data - an unbiased systematic tool to filter by biologically validated regions of functionality
Authors: Xiao Sihao , Kai Zhentian , Brown David ,   Genomics England Research Consortium, Shovlin Claire L
Published: April 2020

Whole genome sequencing (WGS) is championed by the UK National Health Service (NHS) to identify genetic variants that cause particular diseases. The full potential of WGS has yet to be realised as early data analytic steps prioritise protein-coding genes, and effectively ignore the less well annotated non-coding genome which is rich in transcribed and critical regulatory regions. To address, we developed a filter, which we call GROFFFY, and validated in WGS data from hereditary haemorrhagic telangiectasia patients within the 100,000 Genomes Project. Before filter application, the mean number of DNA variants compared to human reference sequence GRCh38 was 4,867,167 (range 4,786,039-5,070,340), and one-third lay within intergenic areas. GROFFFY removed a mean of 2,812,015 variants per DNA. In combination with allele frequency and other filters, GROFFFY enabled a 99.56% reduction in variant number. The proportion of intergenic variants was maintained, and no pathogenic variants in disease genes were lost. We conclude that the filter applied to NHS diagnostic samples in the 100,000 Genomes pipeline offers an efficient method to prioritise intergenic, intronic and coding gDNA variants. Reducing the overwhelming number of variants while retaining functional genome variation of importance to patients, enhances the near-term value of WGS in clinical diagnostics.
Characterization and treatment of SARS-CoV-2 in nasal and bronchial human airway epithelia
Authors: Pizzorno Andrés , Padey Blandine , Julien Thomas , Trouillet-Assant Sophie , Traversier Aurélien , Errazuriz-Cerda Elisabeth , Fouret Julien , Dubois Julia , Gaymard Alexandre , Lescure François-Xavier , Dulière Victoria , Brun Pauline , Constant Samuel , Poissy Julien , Lina Bruno , Yazdanpanah Yazdan , Terrier Olivier , Rosa-Calatrava Manuel
Published: April 2020

In the current COVID-19 pandemic context, proposing and validating effective treatments represents a major challenge. However, the lack of biologically relevant pre-clinical experimental models of SARS-CoV-2 infection as a complement of classic cell lines represents a major barrier for scientific and medical progress. Here, we advantageously used human reconstituted airway epithelial models of nasal or bronchial origin to characterize viral infection kinetics, tissue-level remodeling of the cellular ultrastructure and transcriptional immune signatures induced by SARS-CoV-2. Our results underline the relevance of this model for the preclinical evaluation of antiviral candidates. Foremost, we provide evidence on the antiviral efficacy of remdesivir and the therapeutic potential of the remdesivir-diltiazem combination as a rapidly available option to respond to the current unmet medical need imposed by COVID-19.

One Sentence Summary

New insights on SARS-CoV-2 biology and drug combination therapies against COVID-19.
Intergenerational pathogen-induced diapause inC. elegansis modulated bymir-243
Authors: Gabaldon Carolaing , Legüe Marcela , Palominos M. Fernanda , Verdugo Lidia , Gutzwiller Florence , Calixto Andrea
Published: April 2020

The interaction and communication between bacteria and their hosts modulate many aspects of animal physiology and behavior. Dauer entry as a response to chronic exposure to pathogenic bacteria inCaenorhabditis elegansis an example of a dramatic survival response. This response is dependent on the RNAi machinery, suggesting the involvement of sRNAs as effectors. Interestingly, dauer formation occurs after two generations of interaction with two unrelated moderately pathogenic bacteria. Therefore, we sought to discover the identity ofC. elegansRNAs involved in pathogen-induced diapause. Using transcriptomics and differential expression analysis of coding and long and small non-coding RNAs, we found thatmir-243-3pis the only transcript continuously upregulated in animals exposed to both,P. aeruginosaorS. entericafor two generations. Phenotypic analysis of mutants showed thatmir-243is required for dauer formation under pathogenesis but not under starvation. Moreover, DAF-16, a master regulator of defensive responses in the animal and required for dauer formation was found to be necessary formir-243expression. This work highlights the role of a small non-coding RNA in the intergenerational defensive response against pathogenic bacteria and inter-kingdom communication.

Importance

Persistent infection of the bacterivore nematodeC. eleganswith bacteria such asP. aeruginosaandS. entericamakes the worm diapause or hibernate. By doing this, the worm closes its mouth avoiding infection. This response takes two generations to be implemented. In this work, we looked for genes expressed upon infection that could mediate the worm diapause triggered by pathogens. We identifymir-243-3pas the only transcript commonly upregulated when animals feed onP. aeruginosaandS. entericafor two consecutive generations. Moreover, we demonstrate thatmir-243-3pis required for pathogen-induced dauer formation, a new function that has not been previously described for this miRNA. We also find that the transcriptional activators DAF-16, PQM-1 and CRH-2 are necessary for the expression ofmir-243under pathogenesis. Here we establish a relationship between a small RNA and a developmental change that ensures the survival of a percentage of the progeny.
Research on the Influence of Information Diffusion on the Transmission of the Novel Coronavirus (COVID-19)
Authors: Lin Shanlang , Ma Chao , Lin Ruofei , Huang Junpei , Xu Ruohan , Yuan Aini
Published: April 2020

With the rapid development of mobile Internet in China, the information of the epidemic is full-time and holographic, and the role of information diffusion in epidemic control is increasingly prominent. At the same time, the publicity of all kinds of big data also provides the possibility to explore the impact of media information diffusion on disease transmission. This paper explores the mechanism of the influence of information diffusion on the spread of the novel coronavirus, develops a model of the interaction between information diffusion and disease transmission based on the SIR model, and empirically tests the role and mechanism of information diffusion in the spread of COCID-19 by using econometric method. The result shows that there was a significant negative correlation between the information diffusion and the spread of the novel coronavirus; The result of robust test shows that the spread of both epidemic information and protection information hindered the further spread of the epidemic.
Importance of suppression and mitigation measures in managing COVID-19 outbreaks
Authors: Hochberg Michael E.
Published: April 2020

I employ a simple mathematical model of an epidemic process to evaluate how four basic quantities: the reproduction number (ℛ), the numbers of sensitive (S) and infectious individuals (I), and total community size (N) affect strategies to control COVID-19. Numerical simulations show that strict suppression measures at the beginning of an epidemic can create low infectious numbers, which thereafter can be managed by mitigation measures over longer periods to flatten the epidemic curve. The stronger the suppression measure, the faster it achieves the low numbers of infections that are conducive to subsequent management. Our results on short-term strategies point to a two-step control strategy, following failed mitigation, that begins with suppression of the reproduction number, ℛC, below 1.0, followed by renewed mitigation measures that manage the epidemic by maintaining the effective reproduction number ℛCeff≈ ℛCS/N at approximately 1.0. The objectives of the full sequence of measures observed in a number of countries, and likely to be seen in the longer term, can be symbolically represented as: ℛ0→ ℛC<ℛ0→ℛC<1.0 → ℛCeff≈1.0. We discuss the predictions of this analysis and how it fits into longer-term sequences of measures, including misconceptions about ‘flattening the curve’ and how the herd immunity concept can be used to ‘leverage’ immunity.
Correction of Artifacts Induced by B0 Inhomogeneities in Breast MRI using Reduced Field-of-View Echo-Planar Imaging and Enhanced Reverse Polarity Gradient Method
Authors: Rodríguez-Soto Ana E. , Park Helen , Holland Dominic , Keenan Kathryn E. , Bartsch Hauke , Kuperman Joshua , Wallace Anne M. , Hahn Michael , Ojeda-Fournier Haydee , Dale Anders M. , Rakow-Penner Rebecca
Published: April 2020

Purpose

Diffusion weighted (DW) echo-planar imaging (EPI) is prone to geometric and intensity distortions due to B0 inhomogeneities. Pulse sequences that excite spins within a reduced field-of-view (FOV) in the phase encoding (PE) direction have been developed to decrease such distortions. In addition, use of the reverse polarity gradient (RPG) method, a retrospective approach to correct distortion artifacts, has been shown to improve the localization of tumor lesions. The purpose of this work was to evaluate the performance of reduced-FOV acquisition and RPG in decreasing distortion artifacts for breast imaging.

Methods

EPI data were acquired with full and reduced-FOV in a breast phantom and in a group of 170 women at 3T. The performance of RPG in correcting distortion artifacts in EPI data was evaluated using the mutual information (MI) metric between EPI and anatomical low-distortion images before and after distortion correction.

Results

RPG corrected distortions by 61% in full-FOV EPI and 48% in reduced-FOV EPI in a breast phantom. In patients, MI increased on average 13±8% and 8±6% for both full and reduced-FOV EPI data after distortion correction, respectively. The 95th percentile and maximum displacement between uncorrected and corrected full-FOV EPI datasets were 0.8±0.3cm and 1.9±0.3cm, and for reduced-FOV were 0.4±0.2cm and 1.3±0.3cm.

Conclusion

Minimal distortion was achieved with RPG applied to reduced-FOV EPI data. RPG improved distortions for full-FOV, but with more modest improvements and limited correction near the nipple.
Knowledge and behaviors toward COVID-19 among U.S. residents during the early days of the pandemic
Authors: Clements John M
Published: April 2020

Objective

To test the hypothesis that knowledge of COVID-19 influences participation in different behaviors including self-reports of purchasing more goods than usual, attending large gatherings, and using medical masks.

Methods

Cross-sectional online survey of 1,034 U.S. residents age 18+ conducted on March 17, 2020.

Results

For every point increase in knowledge, the odds of participation in purchasing more goods (OR=0.88, 95% CI:0.81-0.95), attending large gatherings (OR=0.87, 95%CI: 0.81-0.93), and using medical masks (OR=0.56, 95% CI:0.50-0.62) decreased by 12%, 13%, and 44%, respectively. Gen X and Millennial participants had 56% to 76% higher odds, respectively, of increased purchasing behavior, compared to Baby Boomers. Results suggest politicization of response recommendations. Democrats had 30% lower odds of attending large gatherings (OR=0.70, 95% CI:0.50-0.97), and 48% lower odds of using medical masks (OR=0.52, 95% CI:0.34-0.78), compared to Republicans.

Conclusions

This survey is one of the first attempts to study determinants of knowledge and behaviors in response to the COVID-19 pandemic in the U.S. A national, coordinated effort at pandemic response may ensure better compliance with behavioral recommendations to address this public health emergency.
BAdabouM: a genomic structural variations discovery tool for polymorphism analyses
Authors: Cumer Tristan , Pompanon François , Boyer Frédéric
Published: April 2020

Genomic Structural Variations (SVs) are known to impact the evolution of genomes and to have consequences on individual’s fitness. Nevertheless, they remain challenging to detect in whole genome re-sequencing (WGS) data. Lots of methods detecting SVs are described in the literature but they might be hard to install, have non-trivial settings, do not detect all SVs categories and have generally high levels of false positive.

Here we introduce BAdabouM, a fast (C written) and easy to install SVs discovery tool. BAdabouM auto evaluates read length, library size and mean coverage to set thresholds specific to each experiment. BAdabouM interprets multiple SVs signatures (reads aligned with a split, non-concordant mapped pairs or uneven coverage) to detect insertions, deletions, copy number variations, inversions, and translocations at single-nucleotide resolution.

When compared with two widely used methods on simulated and real datasets, BAdabouM was faster, exhibited a similar accuracy with a good concordance on SVs detected, and detected significantly more insertions. BAdabouM was more reproducible to detect independently SVs across individuals, which is a clear advantage when characterizing population polymorphism. Furthermore, BAdabouM demonstrated a superior ability to detect breakpoints with a base pair resolution.

BAdabouM proved to be efficient, fast and accurate to detect SVs, and handle. BAdabouM is a complementary method to be used for a more comprehensive detection of SVs, and is especially suited for studying polymorphism for all types of SVs with a high accuracy.