bluuebunny/crossref_metadata_2025 huggingface dataset:
Transbronchial lung biopsy for the diagnosis of lymphangioleiomyomatosis: the severity of cystic lung destruction assessed by the modified Goddard scoring system as a predictor for establishing the diagnosis
Authors: Okamoto Shouichi , Suzuki Kazuhiro , Hayashi Takuo , Muraki Keiko , Nagaoka Tetsutaro , Nishino Koichi , Sekimoto Yasuhito , Sasaki Shinichi , Takahashi Kazuhisa , Seyama Kuniaki
Published: May 2020

Background

A guide of patient selection for establishing the diagnosis of lymphangioleiomyomatosis (LAM) by transbronchial lung biopsy (TBLB) has not been established, although the pathological confirmation of LAM by lung biopsy is desirable, particularly when patients have no additional test results except typical findings of computed tomography (CT) of the chest.

Methods

We retrospectively reviewed the medical records of LAM patients who visited at our hospital from January 2010 to September 2018. We found 19 patients who underwent TBLB and collected the following data to investigate which parameters could predict the TBLB diagnostic positivity for LAM: age, degree of exertional dyspnea, pulmonary function test, cystic lung destruction visually assessed by the modified Goddard scoring system (MGS), serum level of vascular endothelial growth factor-D, and TBLB-related data.

Results

The diagnosis of LAM was established by TBLB in 15 of 19 patients (78.9%) and no serious complications occurred. MGS was significantly higher in the TBLB-positive group than the TBLB-negative group. In LAM patients without pulmonary lymphatic congestion on CT (N = 16), multivariable logistic regression analysis revealed that MGS and FEV1/FVC were independent contributing parameters for TBLB diagnostic positivity. However, the analysis of Bayesian inference demonstrated that MGS is a better predictor than FEV1/FVC; the probability of establishing diagnosis exceeds 80% if MGS is > 2 (i.e., area of cystic destruction occupies > 25% of lung parenchyma on CT).

Conclusions

MGS may be a helpful and convenient tool to select candidates for TBLB to establish the diagnosis of LAM pathologically.
Socioeconomic impacts of elimination of onchocerciasis in Abu-Hamed focus, northern Sudan: lessons after elimination
Authors: Ahmed Ayman , Elbashir Anas , Mohamed Asgad A. , Alim Asha A. , Mubarak Asia , Abdelrahman Duaa , Mohammed Eilaf , Mohamed Nouh S. , Elaagip Arwa H. , Zarroug Isam M. A. , Mounkaila Noma , Tahir Hanan
Published: May 2020

Objectives

Onchocerciasis is one of the most devastating neglected tropical diseases and it is mostly prevalent in Africa. The disease has important heavy social and economic burdens on the infected populations including low productivity, unemployment, social isolation, and stigma. A cross-sectional study was implemented using a well-established questionnaire to investigate the socio-economic impacts of Onchocerciasis elimination in Abu-Hamed, River Nile State, Sudan in 2015; 512 participants in ten affected communities were interviewed.

Results

Our findings revealed that these communities are recovering from the social and economic burden of the diseases. Ninety percent of the research participants reported general satisfaction about elimination of the disease in their community, 48.3% of them attended secondary school or university. Only 0.6% reported unemployment. Also, 25.3% and 24.7% of the participants were workers and farmers respectively. Except about the vector biting and nuisance, the majority of the respondents (90%) had no complain related to the disease after the elimination. Also, 90.5% of the participants reported either stable or increase in their work performance during the last 12 months. About 93.8% of the respondents were engaged in normal daily life activities and involved in happy events like marriage and giving birth during the last 12 months.
Testing whether the progression of Alzheimer’s disease changes with the year of publication, additional design, and geographical area: a modeling analysis of literature aggregate data
Authors: Zhang Ningyuan , Zheng Xijun , Liu Hongxia , Zheng Qingshan , Li Lujin
Published: May 2020

Background

Our objectives were to develop a disease progression model for cognitive decline in Alzheimer’s disease (AD) and to determine whether disease progression of AD is related to the year of publication, add-on trial design, and geographical regions.

Methods

Placebo-controlled randomized AD clinical trials were systemically searched in public databases. Longitudinal placebo response (mean change from baseline in the cognitive subscale of the Alzheimer’s Disease Assessment Scale [ADAS-cog]) and the corresponding demographic information were extracted to establish a disease progression model. Covariate screening and subgroup analyses were performed to identify potential factors affecting the disease progression rate.

Results

A total of 134 publications (140 trials) were included in this model-based meta-analysis. The typical disease progression rate was 5.82 points per year. The baseline ADAS-cog score was included in the final model using an inverse U-type function. Age was found to be negatively correlated with disease progression rate. After correcting the baseline ADAS-cog score and the age effect, no significant difference in the disease progression rate was found between trials published before and after 2008 and between trials using an add-on design and those that did not use an add-on design. However, a significant difference was found among different trial regions. Trials in East Asian countries showed the slowest decline rate and the largest placebo effect.

Conclusions

Our model successfully quantified AD disease progression by integrating baseline ADAS-cog score and age as important predictors. These factors and geographic location should be considered when optimizing future trial designs and conducting indirect comparisons of clinical outcomes.
Interleukin-17 promotes nitric oxide-dependent expression of PD-L1 in mesenchymal stem cells
Authors: Wang Shijia , Wang Guan , Zhang Liying , Li Fengying , Liu Keli , Wang Ying , Shi Yufang , Cao Kai
Published: May 2020

Background

Interleukin-17A (IL-17) is an evolutionary conserved cytokine and best known for its role in boosting immune response. However, recent clinical researches showed that abundant IL-17 in tumor microenvironment was often associated with poor prognosis and reduced cytotoxic T cell infiltration. These contradictory phenomena suggest that IL-17 may have unique target cells in tumor microenvironment which switch its biological consequences from pro-inflammatory to anti-inflammatory. Mesenchymal stem/stromal cells (MSCs) are a major component of the tumor microenvironment. Upon cytokine stimulation, MSCs can express a plenary of inhibitory molecules, playing a critical role in tumor development and progression. Therefore, we aim to investigate the role of IL-17 in MSC-mediated immunosuppression.

Results

We found IFNγ and TNFα, two major cytokines in tumor microenvironment, could induce programmed death-ligand 1 (PD-L1) expression in MSCs. Interestingly, IL-17 has a synergistic effect with IFNγ and TNFα in elevating PD-L1 expression in MSCs. The presence of IL-17 empowered MSCs with strong immunosuppression abilities and enabled MSCs to promote tumor progression in a PD-L1 dependent manner. The upregulated PD-L1 expression in MSCs was due to the accumulation of nitric oxide (NO). On one hand, NO donor could mimic the effects of IL-17 on MSCs; on the other hand, IL-17 failed to enhance PD-L1 expression in inducible nitric oxide synthase (iNOS) deficient MSCs or with iNOS inhibitor presence.

Conclusions

Our study demonstrates that IL-17 can significantly increase the expression of PD-L1 by MSCs through iNOS induction. This IL-17-MSCs-PD-L1 axis shapes the immunosuppressive tumor microenvironment and facilitates tumor progression.
Ensemble of convolutional neural networks to improve animal audio classification
Authors: Nanni Loris , Costa Yandre M. G. , Aguiar Rafael L. , Mangolin Rafael B. , Brahnam Sheryl , Silla Carlos N.
Published: May 2020

In this work, we present an ensemble for automated audio classification that fuses different types of features extracted from audio files. These features are evaluated, compared, and fused with the goal of producing better classification accuracy than other state-of-the-art approaches without ad hoc parameter optimization. We present an ensemble of classifiers that performs competitively on different types of animal audio datasets using the same set of classifiers and parameter settings. To produce this general-purpose ensemble, we ran a large number of experiments that fine-tuned pretrained convolutional neural networks (CNNs) for different audio classification tasks (bird, bat, and whale audio datasets). Six different CNNs were tested, compared, and combined. Moreover, a further CNN, trained from scratch, was tested and combined with the fine-tuned CNNs. To the best of our knowledge, this is the largest study on CNNs in animal audio classification. Our results show that several CNNs can be fine-tuned and fused for robust and generalizable audio classification. Finally, the ensemble of CNNs is combined with handcrafted texture descriptors obtained from spectrograms for further improvement of performance. The MATLAB code used in our experiments will be provided to other researchers for future comparisons athttps://github.com/LorisNanni.
Advancing mental health equality: a mapping review of interventions, economic evaluations and barriers and facilitators
Authors: Arundell Laura-Louise , Greenwood Helen , Baldwin Helen , Kotas Eleanor , Smith Shubulade , Trojanowska Kasia , Cooper Chris
Published: May 2020

Background

This work aimed to identify studies of interventions seeking to address mental health inequalities, studies assessing the economic impact of such interventions and factors which act as barriers and those that can facilitate interventions to address inequalities in mental health care.

Methods

A systematic mapping method was chosen. Studies were included if they: (1) focused on a population with: (a) mental health disorders, (b) protected or other characteristics putting them at risk of experiencing mental health inequalities; (2) addressed an intervention focused on addressing mental health inequalities; and (3) met criteria for one or more of three research questions: (i) primary research studies (any study design) or systematic reviews reporting effectiveness findings for an intervention or interventions, (ii) studies reporting economic evaluation findings, (iii) primary research studies (any study design) or systematic reviews identifying or describing, potential barriers or facilitators to interventions.

A bibliographic search of MEDLINE, HMIC, ASSIA, Social Policy & Practice, Sociological Abstracts, Social Services Abstracts and PsycINFO spanned January 2008 to December 2018.

Study selection was performed according to inclusion criteria. Data were extracted and tabulated to map studies and summarise published research on mental health inequalities. A visual representation of the mapping review (a mapping diagram) is included.

Results

Overall, 128 studies met inclusion criteria: 115 primary studies and 13 systematic reviews. Of those, 94 looked at interventions, 6 at cost-effectiveness and 36 at barriers and facilitators. An existing taxonomy of disparities interventions was used and modified to categorise interventions by type and strategy. Most of the identified interventions focused on addressing socioeconomic factors, race disparities and age-related issues. The most frequently used intervention strategy was providing psychological support. Barriers and associated facilitators were categorised into groups including (not limited to) access to care, communication issues and financial constraints.

Conclusions

The mapping review was useful in assessing the spread of literature and identifying highly researched areas versus prominent gaps. The findings are useful for clinicians, commissioners and service providers seeking to understand strategies to support the advancement of mental health equality for different populations and could be used to inform further research and support local decision-making.

Systematic review registration

Not applicable.
Do we need disasters to adopt more environmental policies?
Authors: Emam Sherief , Grebel Thomas , Tudor Ana-Despina
Published: May 2020

Background

In this paper, we try to shed light on the question whether natural disasters, such as nuclear accidents, have an impact on policy makers’ activity in passing new green energy policies. Disruptive moments like exogenous shocks reinforce society’s disapproval against polluting technologies and should open a window of opportunities to eventually initiate a change toward green energy.

Methods

Based on the data of 34 OECD countries, we disentangle the effect of disruptive exogenous shocks on countries’ policy activity. Starting with OLS regressions, we run several robustness checks by using a pre-sample mean approach, an ARDL technique called dynamic heterogeneous panel models (DHPM), which allows for the distinction between long- and short-run effects.

Results

The results corroborate the hypothesis that unexpected, disruptive events have a positive impact on the actual number of renewable energy policies. The fade-out time for shocks is about 7 years, leaving a positive long-term effect.

Conclusion

Exogenous events such as nuclear disasters act as “focusing event” and seem to offer policy makers a window of opportunities to initiate conducive policy measures toward a cleaner economy. Furthermore, a country’s capacity in green technologies is key to a pervasive diffusion of green technologies.
Penetration electric fields observed at middle and low latitudes during the 22 June 2015 geomagnetic storm
Authors: Hashimoto Kumiko K. , Kikuchi Takashi , Tomizawa Ichiro , Hosokawa Keisuke , Chum Jaroslav , Buresova Dalia , Nose Masahito , Koga Kiyokazu
Published: May 2020

Prompt penetration electric fields were detected during the intense geomagnetic storm on 22 June, 2015 by the HF Doppler sounders at middle and low latitudes; Prague (Czech Republic), Iitate, Oarai, Onna (Japan), and Zhongli (Republic of China). The storm was initiated by the storm sudden commencement (SC) at 1833 UT, immediately followed by the main phase with the minimum SYM-H of − 139 nT at 2017 UT. The convection electric field was found to be up to 5.1 mV/m at low latitudes, which is enough to cause ionospheric disturbances such as the enhancement of the total electron content, equatorial ionization anomaly and so on. The electric fields of the SC and main phase are westward in the night (0330 MLT), while eastward in the evening (1930 MLT). The main phase electric field intensified the eastward equatorial electrojets (EEJ) at Huancayo in South America on the dayside (1330 MLT) and the westward EEJ on the nightside at Guam in the western Pacific (0330 MLT) and Tirunelveli in India (00 MLT). The eastward direction of the evening-time electric field agrees with a feature of the evening anomaly of the penetration electric field, while the intensity is suppressed because of the sunlit condition in the evening in the summer solstice. The sudden northward turning of the interplanetary magnetic field (IMF) caused a transition from the main phase to the recovery phase, when the EEJ turned into the counterelectrojet (CEJ). It was found that the HF Doppler sounders detected an impulsive eastward overshielding electric field at 2005 UT on the nightside during the northward IMF-driven CEJ with the duration of 17 min and intensity of 8.0 mV/m at Iitate (0500 MLT) and 11.8 mV/m at Prague (2130 MLT). The impulsive overshielding electric field was accompanied by the anti-sunward plasma flows at middle latitude (50°–60° GML) equatorward of the dusk sunward convection as observed with SuperDARN, which signifies intensification of the Region-2 field-aligned currents at the flow reversal. Substorm signatures are identified with intensified westward auroral electrojet and magnetic dipolarization as detected by the geosynchronous orbit satellite, ETS-VIII. Consequently, the stormtime substorm may provide strong overshielding electric fields to the middle latitude ionosphere on the nightside.
Meniscus sizing using three-dimensional models of the ipsilateral tibia plateau based on CT scans – an experimental study of a new sizing approach
Authors: Beeler Silvan , Vlachopoulos Lazaros , Jud Lukas , Sutter Reto , Götschi Tobias , Fürnstahl Philipp , Fucentese Sandro F.
Published: May 2020

Purpose

Selection of a meniscus allograft with a similar three-dimensional (3D) size is essential for good clinical results in meniscus allograft surgery. Direct meniscus sizing by MRI scan is not possible in total meniscectomy and indirect sizing by conventional radiography is often inaccurate. The purpose of this study was to develop a new indirect sizing method, based on the 3D shape of the ipsilateral tibia plateau, which is independent of the meniscus condition.

Methods

MRI and CT scans of fifty healthy knee joints were used to create 3D surface models of both menisci (MRI) and tibia plateau (CT). 3D bone models of the proximal 10 mm of the entire and half tibia plateau (with / without intercondylar area) were created in a standardized fashion. For each meniscus, the best fitting “allograft” couple out of all other 49 menisci were assessed by the surface distance of the 3D meniscus (best available allograft), of the 3D tibia plateau (3D-CT) and by the radiographic method of Pollard (2D-RX).

Results

3D-CT sizing was significantly better by using only the half tibia plateau without the intercondylar area (p < 0.001). But neither sizing by 3D-CT, nor by 2D-RX could select the best available allograft. Compared to 2D-RX, 3D-CT sizing was significantly better for the medial, but not for the lateral meniscus.

Conclusions

Automatized, indirect meniscus sizing using the 3D bone models of the tibia plateau is feasible and more precise than the previously described 2D-RX method.. However, further technical improvement is needed to select always the best available allograft.
The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives
Authors: Ambrosio Luca , Vadalà Gianluca , Russo Fabrizio , Papalia Rocco , Denaro Vincenzo
Published: May 2020

The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19+ patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice.

In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.
A guided participation nursing intervention to theraupeutic positioning and care (GP_Posit) for mothers of preterm infants: protocol of a pilot randomized controlled trial
Authors: Lavallée Andréane , Aita Marilyn , Côté José , Bell Linda , Luu Thuy Mai
Published: May 2020

Background

In the NICU, interventions intended to enhance maternal sensitivity are indicated in order to optimize preterm infant development and long-term mother-infant attachment. A novel nursing intervention was developed following a theory-oriented methodology and is based upon the guided participation theory for mothers to participate in their preterm infant’s therapeutic POSITioning and care (GP_Posit). The primary objective of this study is to evaluate the feasibility and acceptability of (i) the study design; and (ii) the experimental GP_Posit nursing intervention during NICU hospitalization. The secondary objective is to estimate the preliminary effects of GP_Posit on maternal and preterm infant outcomes.

Methods

A pilot parallel-group randomized clinical trial (RCT) was designed where mother-preterm infant dyads are being recruited and randomized to a control group (usual care) or experimental group (GP_Posit intervention). Data collection includes feasibility and acceptability data as well as preliminary effects on maternal sensitivity and infant neurodevelopment. Ethical approval from the University Hospital ethical board was obtained in January 2018 (2017–1540).

Discussion

Data collection for this pilot study is expected to end in 2020. Results of this pilot study will inform about the feasibility and acceptability of the study design and GP_Posit intervention, a nursing intervention having the potential to favor maternal sensitivity and infant neurodevelopment in the NICU and guide the elaboration of a large-scale RCT.

Trial registration

clinicaltrial.gov,NCT03677752. Registered 19 September 2018.
A three-dimensional gas-kinetic flux solver for simulation of viscous flows with explicit formulations of conservative variables and numerical flux
Authors: Sun Y. , Yang L. M. , Shu C. , Teo C. J.
Published: May 2020

A truly three-dimensional (3D) gas-kinetic flux solver for simulation of incompressible and compressible viscous flows is presented in this work. By local reconstruction of continuous Boltzmann equation, the inviscid and viscous fluxes across the cell interface are evaluated simultaneously in the solver. Different from conventional gas-kinetic scheme, in the present work, the distribution function at cell interface is computed in a straightforward way. As an extension of our previous work (Sun et al., Journal of Computational Physics, 300 (2015) 492–519), the non-equilibrium distribution function is calculated by the difference of equilibrium distribution functions between the cell interface and its surrounding points. As a result, the distribution function at cell interface can be simply calculated and the formulations for computing the conservative flow variables and fluxes can be given explicitly. To validate the proposed flux solver, several incompressible and compressible viscous flows are simulated. Numerical results show that the current scheme can provide accurate numerical results for three-dimensional incompressible and compressible viscous flows.
Global left ventricular function assessment by ECG-gated multi-detector CT (MDCT): revised role in relation to 2D transthoracic echocardiography
Authors: Abdel Samea Mohammed Elsayed , Zytoon Ashraf Anas , Abo Mostafa Asmaa Mohamed Abd Elaziz , Hassanein Shaimaa Abdel-Hamid
Published: May 2020

Background

An accurate and reproducible way for determining the left ventricular function is crucial to provide diagnostic and prognostic aspects of the pump activity of the heart. The MDCT of the heart can be that modality. We compared the 128 MDCT of fifty patients with their 2D echocardiography performed on the same day.

Results

Mean EF, ESV, EDV, and LV mass were 61.22 ± 9.50%, 70.23 ± 38.35, 172.22 ± 53.57, 164.63 ± 52.57 respectively on MDCT, and 61.14 ± 10.90%, 72.13 ± 32.69, 173.76 ± 62.45, 198.32 ± 72.54 respectively on echocardiography with moderate correlation in EF and good correlation in ventricular volumes (p < 0.05) using linear regression analysis. A Bland-Altman analysis showed that MDCT had slightly lower LFEF, LVESV, and LVEDV values with mean value of differences of 0.8, 2.4, and 2.28 respectively.

Conclusion

It is reasonable to use MDCT alone to assess LV function in patients already underwent coronary CT angiography.
“Accepting Evolution Means You Can’t Believe in God”: Atheistic Perceptions of Evolution among College Biology Students
Authors: Barnes M. Elizabeth , Dunlop Hayley M. , Sinatra Gale M. , Hendrix Taija M. , Zheng Yi , Brownell Sara E.
Published: May 2020

In two studies, it was found that the perception that evolution is atheistic is related to less comfort while learning evolution, more perceived conflict between religious beliefs and evolution, and lower acceptance of evolution among religious undergraduate college biology students.
Integrating Genetic and Genomic Testing Into Oncology Practice
Authors: Domchek Susan M. , Mardis Elaine , Carlisle Jennifer W. , Owonikoko Taofeek K.
Published: May 2020

Genetic information, both germline and somatic, is an increasingly important consideration in therapeutic decision-making in cancer. Germline mutations in genes associated with increased cancer risk can identify those individuals without cancer who may benefit from enhanced screening and prevention strategies. In individuals with cancer, germline and somatic mutations may help to guide local and systemic management decisions. Here, we review considerations of these issues in selected cancer types.
Strategic Combinations to Prevent and Overcome Resistance to Targeted Therapies in Oncology
Authors: Gumusay Ozge , Vitiello Pietro Paolo , Wabl Chiara , Corcoran Ryan B. , Bardelli Alberto , Rugo Hope S.
Published: May 2020

Recent advances in the understanding of underlying molecular signaling mechanisms of cancer susceptibility and progression have led to an increase in the use of targeted therapies for cancer treatment. Despite improvements in survival with new treatment options in oncology, resistance to therapy is a major obstacle to the long-term effectiveness of targeted agents in metastatic cancer treatment, culminating in insensitivity to treatment and tumor outgrowth. Adaptive resistance can play an important role in primary and upfront resistance to therapy as well as in secondary or acquired resistance. By focusing on colorectal and breast tumors, we discuss how therapeutic combinations based on specific drivers of tumor biology can be used to overcome resistance. We present how monitoring tumor dynamics over time may allow early adaptation of treatment. Breast cancer is the most common malignancy in women worldwide, and the majority of these cancers are sensitive to endocrine therapy (ET) blocking the production of or response to estrogen. However, primary and acquired resistance limits efficacy. Recent combinations of agents targeted to pathways that drive tumor growth resistance with ET have resulted in remarkable improvements in disease response and control, improving survival in some settings. In this review, we summarize adaptive resistance mechanisms, approaches to combination strategies, and dynamic tumor monitoring to improve efficacy and overcome resistance. We provide examples of combination therapy to enhance the efficacy of targeted therapies in breast and colorectal tumors.
Implementation of Universal Tumor Screening of Colorectal Cancer for Detection of Lynch Syndrome at a Hispanic-Rich County Hospital
Authors: Snedden Tyler W. , McCracken Andrew , Vaidyanathan Anusha , Taranova Anna , Villarreal Roberto , Qamar Samina , Arora Sukeshi Patel
Published: May 2020

INTRODUCTION:

In 2014, a reflexive screening protocol for Lynch syndrome (LS) via an immunohistochemistry (IHC) assay was shown to be cost-effective; however, the screening rates at a predominant Hispanic-rich institution are unclear. We hypothesized that implementation of a universal tumor screening (UTS) protocol requiring screening for LS via IHC in patients with newly diagnosed colorectal cancer (CRC) at our Hispanic-rich institution would improve detection of LS by increasing screening rates.

METHODS AND MATERIALS:

This is a retrospective analysis of screening rates of 3 sequential cohorts of newly diagnosed patients with CRC between January 2012 and April 2016 at the University Health System and with follow-up at National Cancer Institute–designated Mays Cancer Center at University of Texas Health San Antonio. Cohort 1 consisted of patients screened using old screening guidelines (PRE). Cohort 2 consisted of patients screened when treating clinicians were receiving education on the new protocol (PERI). Cohort 3 consisted of patients screened after implementation of the UTS protocol (POST).

RESULTS:

The majority of 312 patients were Hispanic (62.5%), 18.1% were < 50 years, and 81.9% were ≥ 50 years of age (median age, 57 years). Of patients with CRC screened for LS via IHC, the PRE, PERI, and POST cohorts had screening rates of 31%, 64%, and 58%, respectively. We found significant differences when comparing the PRE with POST sequential cohorts ( P < .01).

CONCLUSION:

The quality of Lynch syndrome–related family histories and screening rates were significantly improved after implementation in our Hispanic-rich population. Future studies are warranted to provide insight into clinical effects of increased screening, provider and patient surveillance, and screening-related systemic barriers.
Management of Lung Cancer During the COVID-19 Pandemic
Authors: Singh Aditi P. , Berman Abigail T. , Marmarelis Melina E. , Haas Andrew R. , Feigenberg Steven J. , Braun Jennifer , Ciunci Christine A. , Bauml Joshua M. , Cohen Roger B. , Kucharczuk John C. , Shulman Lawrence N. , Langer Corey J. , Aggarwal Charu
Published: May 2020

Coronavirus disease 2019 (COVID-19) has had a devastating impact around the world. With high rates of transmission and no curative therapies or vaccine yet available, the current cornerstone of management focuses on prevention by social distancing. This includes decreased health care contact for patients. Patients with lung cancer are a particularly vulnerable population, where the risk of mortality from cancer must now be balanced by the potential risk of a life-threatening infection. In these unprecedented times, a collaborative and multidisciplinary approach is required to streamline but not compromise care. We have developed guidelines at our academic cancer center to standardize management of patients with lung cancer across our health care system and provide guidance to the larger oncology community. We recommend that general principles of lung cancer treatment continue to be followed in most cases where delays could result in rapid cancer progression. We recognize that our recommendations may change over time based on clinical resources and the evolving nature of the COVID-19 pandemic. In principle, however, treatment paradigms must continue to be individualized, with careful consideration of risks and benefits of continuing or altering lung cancer–directed therapy.
Osteoporosis in Premenopausal Women: A Clinical Narrative Review by the ECTS and the IOF
Authors: Pepe Jessica , Body Jean-Jacques , Hadji Peyman , McCloskey Eugene , Meier Christian , Obermayer-Pietsch Barbara , Palermo Andrea , Tsourdi Elena , Zillikens M Carola , Langdahl Bente , Ferrari Serge
Published: May 2020

Context

Consensus regarding diagnosis and management of osteoporosis in premenopausal women (PW) is still lacking due to few studies carried out in this population.

Design

The European Calcified Tissue Society and the International Osteoporosis Foundation convened a working group to produce an updated review of literature published after 2017 on this topic.

Results

Fragility fractures in PW are rare and mostly due to secondary osteoporosis (ie, in presence of an underlying disease such as hormonal, inflammatory, or digestive disorders). In absence of another disorder, low bone mineral density (BMD) together with fragility fractures qualifies as idiopathic osteoporosis. In contrast, low BMD alone does not necessarily represent osteoporosis in absence of bone microarchitectural abnormalities. BMD increases in PW with osteoporosis when the underlying disease is treated. For example, in celiac disease, an increase of 9% in radius trabecular volumetric density was achieved after 1 year of gluten-free diet, while anti-tumor necrosis factor alpha improved BMD in PW with inflammatory bowel diseases. In amenorrhea, including anorexia nervosa, appropriately delivered estrogen replacement therapy can also improve BMD. Alternatively, antiresorptive or anabolic therapy has been shown to improve BMD in a variety of conditions, the range of improvement (3%-16%) depending on skeletal site and the nature of the secondary cause. No studies were powered to demonstrate fracture reduction. The effects of bisphosphonates in childbearing women have been scantly studied and caution is needed.

Conclusion

The majority of PW with osteoporosis have an underlying disease. Specific therapy of these diseases, as well as antiresorptive and anabolic drugs, improve BMD, but without evidence of fracture reduction.
Effects of Dietary Carbohydrate Content on Circulating Metabolic Fuel Availability in the Postprandial State
Authors: Shimy Kim J , Feldman Henry A , Klein Gloria L , Bielak Lisa , Ebbeling Cara B , Ludwig David S
Published: May 2020

Context

According to the carbohydrate-insulin model of obesity, an elevated insulin-to-glucagon ratio in response to a high-carbohydrate diet directs metabolic fuels toward storage, resulting in lower circulating energy.

Objective

To determine differences in total circulating energy post-meal related to dietary carbohydrate.

Design

Ancillary study within the Framingham State Food Study.

Setting

University community.

Participants

29 adults (aged 20 to 65 years) with overweight or obesity (body mass index ≥25 kg/m2)

Intervention

After achieving 10% to 14% weight loss on a run-in diet, participants were randomized to weight-loss-maintenance test diets varying in carbohydrate content (high-carbohydrate, 60% of total energy, n = 11; moderate-carbohydrate, 40%, n = 8; low-carbohydrate, 20%, n = 10) and controlled for protein (20%). During 24-hour metabolic ward admissions between 10 and 15 weeks on the test diets, metabolic fuels and hormones were measured.

Main Outcome Measure

Energy availability (EA) based on energy content of blood glucose, beta-hydroxybutyrate, and free fatty acids, in the late postprandial period (180 to 300 minutes). Insulin at 30 minutes into the test meal (Meal Insulin-30) was measured as an effect modifier.

Results

Insulin-to-glucagon ratio was 7-fold higher in participants on the high- vs low-carbohydrate diet (2.5 and 0.36, respectively). Late postprandial EA was 0.58 kcal/L lower on the high- vs low-carbohydrate diet (P < 0.0001), primarily related to suppression of free fatty acids. Early postprandial EA (30 to 180 minutes) declined fastest in the high-carbohydrate group, and Meal Insulin-30 modified this diet effect.

Conclusions

During weight-loss maintenance on a high-carbohydrate diet, late postprandial EA is reduced, consistent with the carbohydrate-insulin model.
Residual Weakness and Recurarization After Sugammadex Administration in Pediatric Patients: A Case Series
Authors: Lorinc Amanda N. , Lawson Katheryne C. , Niconchuk Jonathan A. , Modes Katharina B. , Moore John D. , Brenn Bruce R.
Published: May 2020

While shown to be safe for administration in pediatric patients, sugammadex has recently been associated with residual weakness or recurarization. We describe 4 additional cases of pediatric patients with residual or recurrent weakness following rocuronium reversal with sugammadex. Two infant patients developed postoperative ventilatory distress, which was possibly related to recurarization after sugammadex reversal. A third patient received sugammadex with apparent waning of clinical effect and subsequently required neostigmine reversal. A fourth patient was observed to have residual weakness, which led to prolonged intubation despite appropriate train-of-four results after reversal with sugammadex.
Modifying a Full-Face Snorkel Mask to Meet N95 Respirator Standards for Use With Coronavirus Disease 2019 Patients
Authors: Kechli Mohamad Karim , Lerman Jerrold , Ross Mary M.
Published: May 2020

We evaluated a full-face snorkel mask with an airway circuit filter to protect health care providers against airborne pathogens. First, a quantified N95 fit test was performed using aerosolized saline. Second, cardiorespiratory variables (heart rate, peripheral oxygen saturation, end-tidal carbon dioxide tension, and inspired fraction of carbon dioxide) were measured at rest and during moderate exercise. The modified mask passed the United States Occupational Safety and Health Administration (OSHA) N95 respirator (N95) fit test requirements with a fit factor of 142. Neither hypercapnia nor hypoxemia occurred. This modified mask has the potential to protect providers who care for patients with coronavirus disease 2019 (COVID-19).
Reducing Aerosol Generation During Ventilator Weaning in a Coronavirus Disease 2019 Patient Using a Supraglottic Airway: A Case Report
Authors: Ozaki Masayuki , Yasuda Yuma , Jingushi Naruhiro , Goto Yukari , Numaguchi Atsushi
Published: May 2020

We report weaning from mechanical ventilation with no coughing in a patient with coronavirus disease 2019 (COVID-19). Substituting the endotracheal tube for a supraglottic airway (SGA), which is less stimulating to the trachea, can reduce coughing with weaning from mechanical ventilation and extubation. Personal protective equipment is in short supply worldwide. Reducing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is beneficial in terms of occupational health of health care workers.
A novel Cre-enabled tetracycline-inducible transgenic system for tissue-specific cytokine expression in the zebrafish: CETI-PIC3
Authors: Ibrahim Sara , Harris-Kawano Arianna , Haider Isra , Mirmira Raghavendra G. , Sims Emily K. , Anderson Ryan M.
Published: May 2020

Maladaptive signaling by pro-inflammatory cytokines (PICs), such as TNFα, IL1β and IFNɣ, can activate downstream signaling cascades that are implicated in the development and progression of multiple inflammatory diseases. Despite playing critical roles in pathogenesis, the availability of in vivo models in which to model tissue-specific induction of PICs is limited. To bridge this gap, we have developed a novel multi-gene expression system dubbed Cre-enabled and tetracycline-inducible transgenic system for conditional, tissue-specific expression of pro-inflammatory cytokines (CETI-PIC3). This binary transgenic system permits the stoichiometric co-expression of proteins Tumor necrosis factor a (Tnfa), Interleukin-1 beta (Il1b) and Interferon gamma (Ifng1), and H2B-GFP fluorescent reporter in a dose-dependent manner. Furthermore, cytokine misexpression is enabled only in tissue domains that can be defined by Cre recombinase expression. We have validated this system in zebrafish using an insulin:cre line. In doubly transgenic fish, quantitative real-time polymerase chain reaction demonstrated increased expression levels of tnfa, il1b and ifng1 mRNA. Moreover, specific expression in pancreatic β cells was demonstrated by both Tnfa immunofluorescence and GFP fluorescence. Cytokine-overexpressing islets elicited specific responses: β cells exhibited increased expression of genes associated with reactive oxidative species-mediated stress and endoplasmic reticulum stress, surveilling and infiltrating macrophages were increased, and β cell death was promoted. This powerful and versatile model system can be used for modeling, analysis and therapy development of diseases with an underlying inflammatory etiology.

This article has an associated First Person interview with the first author of the paper.
Effects of membrane fatty acid composition on cellular metabolism and oxidative stress in dermal fibroblasts from small and large breed dogs
Authors: Jimenez Ana Gabriela , Winward Joshua D. , Walsh Kenneth E. , Champagne Alex M.
Published: May 2020

There is ample evidence that cell membrane architecture contributes to metabolism and aging in animals, however the aspects of this architecture that determine the rate of metabolism and longevity are still being debated. The “membrane pacemaker” hypotheses of metabolism and aging, respectively, suggest that increased lipid unsaturation and large amounts of polyunsaturated fatty acids (PUFAs) in cell membranes increases the cellular metabolic rate as well as the vulnerability of the cell to oxidative damage, thus increasing organismal metabolic rate and decreasing longevity. Here, we test these hypotheses by experimentally altering the membrane fatty acid composition of fibroblast cells derived from small and large breed dogs by incubating them in a medium enriched in the monounsaturated fatty acid (MUFA) oleic acid (OA, 18:1) to decrease the total saturation. We then measured cellular metabolic parameters and correlated these parameters with membrane fatty acid composition and oxidative stress. We found that cells from small dogs and OA incubated cells had lower maximal oxygen consumption and basal oxygen consumption rates, respectively, which are traits associated with longer lifespans. Furthermore, although we did not find differences in oxidative stress, cells from small dogs and OA treated cells exhibited reduced ATP coupling efficiency, suggesting that these cells are less prone to producing reactive oxygen species. Membrane fatty acid composition did not differ between cells from large and small dogs, but cells incubated with OA had more monounsaturated fatty acids and a higher number of double bonds overall despite a decrease in PUFAs. Our results suggest that increasing the mono-unsaturation of dog cell membranes may alter some metabolic parameters linked to increases in longevity.
A novel microRNA and its PFK target control growth length in the freshwater shrimp (Neocaridina heteropoda)
Authors: Li Ran , Weng Jieyang , Ren Liqi , Wang Xin , Meng Qinghao , Wang Liyan , Sun Jinsheng
Published: May 2020

MicroRNAs (miRNAs) are small non-coding RNAs that negatively regulate gene expression and play roles in a wide range of physiological processes, including ontogenesis. Herein, we discovered a novel microRNA, novel miR-26, which inhibits translation of the phosphofructokinase (PFK) gene by targeting the 3’ untranslated region (UTR) of pfk directly, thereby inhibiting the molting and body length growth of the freshwater shrimp (Neocaridina heteropoda). Lowering expression of the PFK gene by RNA interference (RNAi) led to a longer ecdysis cycle and smaller individuals. This phenotype was mirrored in shrimps injected with novel miR-26 agomirs, but the opposite phenotype occurred in shrimps injected with novel miR-26 antagomirs (i.e., the ecdysis cycle was shortened and body length was increased). After injection of 20-hydroxyecdysone (ecdysone 20E), expression of the novel miR-26 was decreased, while expression of the PFK gene was up-regulated, and the fructose-1,6-diphosphate metabolite of PFK accumulated correspondingly. Furthermore, expression of eIF2 (eukaryotic initiation factor 2) increased under stimulation of fructose-1,6-diphosphate, suggesting that protein synthesis was stimulated during this period. Taken together, our results suggest that the novel miR-26 regulates expression of the PFK gene and thereby mediates the molting and growth of N. heteropoda.
Discrete modulation of antipredatory and agonistic behaviors by sensory communication signals in juvenile crayfish
Authors: Exum Alexis C. , Sun Lucky M. , Herberholz Jens
Published: May 2020

We investigated how the exchange of sensory signals modulates the individual behaviors of juvenile crayfish in an anti-predatory context as well as during intraspecific agonistic encounters. We first compared crayfish housed in total sensory isolation or in pairs with access to chemical and visual cues. After one week of housing, we analyzed their individual responses to a visual danger signal while they were foraging. We found that crayfish previously housed in pairs with exchange of sensory signals responded to a simulated predator attack predominately with freezing behavior, whereas animals deprived of all sensory communication mostly responded by performing escape tail-flips. Next, we used the same housing conditions in-between repeated fights in pairs of crayfish. Aggressive and submissive behaviors increased in subsequent fights both after total isolation and after exchange of olfactory and visual signals. Thus, unlike responses to simulated predator attacks, intraspecific agonistic behavior was not modulated by exposure to the same sensory signals. However, when we tested the effects of olfactory or visual communication independently, aggression increased dramatically after the exchange of olfactory signals, which also led to a high number of rank reversals in second fights, suggesting a destabilization of the original dominance relationship. Exposure to visual cues during the one-week separation, however, produced the opposite effect reducing agonistic behaviors and rank reversals. These findings demonstrate that exchange of sensory signals modulate future anti-predatory decision-making and intraspecific agonistic behaviors discretely, suggesting that the effect of these signals on shared neural circuitry is context-dependent.
The Menopause Alters Aerobic Adaptations to High-Intensity Interval Training
Authors: NIO AMANDA Q. X. , ROGERS SAMANTHA , MYNORS-WALLIS RACHEL , MEAH VICTORIA L. , BLACK JANE M. , STEMBRIDGE MIKE , STÖHR ERIC J.
Published: May 2020

Introduction

Postmenopausal women have lower resting cardiac function than premenopausal women, but whether the menopause influences maximal cardiac output and hence exercise capacity is unclear. It is possible that premenopausal and postmenopausal women achieve similar improvements in maximal aerobic capacity (V˙O2max) and cardiac output with exercise training via different regional left ventricular muscle function (“LV mechanics”), as suggested by in vitro and animal studies. The aim of this study was to investigate the effects of the menopause on LV mechanics and adaptations to exercise training.

Methods

Twenty-five healthy untrained middle-age women (age, 45–58 yr; 11 premenopausal, 14 postmenopausal) completed 12 wk of exercise training. Before and after exercise training, (i) V˙O2max and blood volume were determined, and (ii) LV mechanics were assessed using echocardiography at rest and during two submaximal physiological tests — lower-body negative pressure and supine cycling.

Results

The increase in V˙O2max after exercise training was 9% smaller in postmenopausal than premenopausal women, concomitant with a smaller increase in blood volume (P < 0.05). However, cardiac output and LV volumes were not different between premenopausal and postmenopausal women (P > 0.05) despite altered regional LV muscle function, as indicated by higher basal mechanics in premenopausal women during the physiological tests after exercise training (P < 0.05).

Conclusions

These findings are the first to confirm altered LV mechanics in postmenopausal women. In addition, the reduced aerobic adaptability to exercise training in postmenopausal women does not appear to be a central cardiac limitation and may be due to altered blood volume distribution and lower peripheral adaptations.