bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraurethral Steroid Injection Following Visual Internal Uerthrotomy in the Management of Anterior Urethral Strictures
Authors: Abdallah H M , Abuelnaga M , Rasmy A G
Published: May 2020

Background

Urethral strictures can occur due to trauma, infection, ischemia, inflammation, or unknown causes. As a result, scar tissue forms in the epithelium, which leads to decrease in caliber of the urethral lumen.

Objective

to evaluate the effect of local intraurethral injection of steroid in treatment of urethral stricture after visual urethrotomy.

Patients and Methods

Our study was done at the Ain Shams University Hospitals and the Urology department of National institute of Nephrology and Urology. Thirty male Patients with anterior urethral strictures were divided into two groups: Group A (IU only) and Group B (IU+ corticosteroids).

Results

Our study revealed that internal urethrotomy for anterior urethral stricture with intrauretheral injection of 40 mg methyl prednisone acetate decrease the recurrence rate of the urethral stricture.

Conclusion

Intraurethral corticosteroids injections at stricture site follows VIU seems to be an effective modality of treatment in decreasing the incidence of recurrent stricture after VIU. However more studies with larger population and long interval follow up are required for better evaluation.
Ultrasound guided Extracorporeal Shock Wave Lithotripsy (SONO ESWL) versus fluoroscopy guided ESWL in patients with radiopaque renal stones; A comparative randomized study
Authors: Hegazy A S , Abdelfattah D M , Hassan H N
Published: May 2020

Background

Radiopaque stones in the upper urinary tract can often be visualized by both ultrasonography (US) and fluoroscopy (FS) during ESWL treatment. This prospective study was performed to compare the results of ESWL when both US and FS are possible and to evaluate efficacy and safety of ultrasound guided ESWL (SONO ESWL) in patients with radiopaque renal stone. The study was limited to renal calculi, since calculi in lower urinary tract may be difficult to visualize with ultrasonography.

Objective

To investigate whether the localization modality (u/s or fluoroscopy) affects clinical outcomes of ESWL or not.

Patients and Methods

Our study was conducted on 100 Patients with renal stones planned to have ESWL sessions attending urology outpatient clinic in Ain shams university hospitals and National Institute of Urology and Nephrology from February 2018 to January 2019 and divided into two equal groups; group A (ultrasound guided ESWL) and group B (fluoroscope guided ESWL).

Results

Our study revealed that the localization modality on ESWL (ultrasound or fluoroscopy) didn’t affect the clinical outcomes of ESWL.

Conclusion

Even in patients with radiopaque renal stones, ultrasound can be used to guide extracorporeal shock wave lithotripsy as effectively as fluoroscopy, without any risk of radiation.
Comparative Study between Tadalafil versus Tamsulosin versus Halphabarol with Terpenes Mixture as a Medical Expulsive Therapy for Lower Ureteric Stones
Authors: Teama K A H , Abdelsalam A Y K , Elmenyawee M E A
Published: May 2020

Background

urolithiasis is a health problem of worldwide importance. Urolithiasis is the third most common urological disease affecting the urinary tract after urinary tract infections and prostatic diseases. Ureteral stones account for 20% of urolithiasis, and 70% of ureteral stones are located in the lower third of the ureter. Ureteric stones have great bearing on the health as well as quality of life of the patient.

Aim of the Study

to compare the efficacy of tadalafil (a phosphodiesterase-5 inhibitor), tamsulosin (an alpha-1blocker) and halphabarol (Proximol) with terpenes mixture (Rowatinex) as a medical expulsive therapy for lower ureteric stones.

Patients and Methods

this was a prospective randomized comparative study conducted on 60 patients between the ages of 20 and 40 years and complaining of unilateral single lower ureteric stone less than or equal to 8 mm presented through the outpatient clinics of Urology in Ain Shams University Hospitals and Damanhour Medical National Institute over a period of 10 months (from November 2017 to August 2018). The patients were randomly divided into 3 equal groups: Group A (20 patients were treated by tadalafil 5 mg once daily), Group B (20 patients were treated by tamsulosin 0.4 mg once daily) and Group C (20 patients were treated by Proximol with Rowatinex three times daily). Therapy was given for a maximum of 3 weeks. The patients were followed-up until stone passage or the end of the study period.

Results

the results of this study indicate that the stone expulsion rate was significantly higher in tadalafil group and tamsulosin group than Proximol with Rowatinex group (75% vs. 75% vs. 40%, P value = 0.030). Also, the mean stone expulsion time was significantly shorter in tadalafil group and tamsulosin group than Proximol with Rowatinex group (10.20 ± 3.91 days vs. 10.80 ± 3.64 days vs. 14.25 ± 3.28 days, P value = 0.046). The number of patients who experienced renal colic episodes, the number of colic episodes and the number of injectable analgesic uses were significantly lower in tadalafil group and tamsulosin group than Proximol with Rowatinex group (P value < 0.05). The number of follow up ureteroscopic procedures was significantly lower in tadalafil group and tamsulosin group than Proximol with Rowatinex group (25% vs. 25% vs. 60%, P value = 0.030). Also, the drugs are safe with mild few side effects.

Conclusion

PDE5 inhibitors (tadalafil) are equally efficacious to alpha-1 adrenergic antagonists (tamsulosin) in expulsion of lower ureteric stones less than or equal to 8 mm without any serious side effects. Comparing to Proximol with Rowatinex, both tadalafil and tamsulosin increase significantly the stone expulsion rate, decrease significantly the stone expulsion time and provide significant control of renal colicky pain, significantly less analgesic requirements and significantly lower follow up ureteroscopic procedures.
Targeted photodynamic therapy selectively kills activated fibroblasts in experimental arthritis
Authors: Dorst Daphne N , Rijpkema Mark , Boss Marti , Walgreen Birgitte , Helsen Monique M A , Bos Desirée L , Brom Maarten , Klein Christian , Laverman Peter , van der Kraan Peter M , Gotthardt Martin , Koenders Marije I , Buitinga Mijke
Published: May 2020

Objective

In RA, synovial fibroblasts become activated. These cells express fibroblast activation protein (FAP) and contribute to the pathogenesis by producing cytokines, chemokines and proteases. Selective depletion in inflamed joints could therefore constitute a viable treatment option. To this end, we developed and tested a new therapeutic strategy based on the selective destruction of FAP-positive cells by targeted photodynamic therapy (tPDT) using the anti-FAP antibody 28H1 coupled to the photosensitizer IRDye700DX.

Methods

After conjugation of IRDye700DX to 28H1, the immunoreactive binding and specificity of the conjugate were determined. Subsequently, tPDT efficiency was established in vitro using a 3T3 cell line stably transfected with FAP. The biodistribution of [111In]In-DTPA-28H1 with and without IRDye700DX was assessed in healthy C57BL/6N mice and in C57BL/6N mice with antigen-induced arthritis. The potential of FAP-tPDT to induce targeted damage was determined ex vivo by treating knee joints from C57BL/6N mice with antigen-induced arthritis 24 h after injection of the conjugate. Finally, the effect of FAP-tPDT on arthritis development was determined in mice with collagen-induced arthritis.

Results

28H1-700DX was able to efficiently induce FAP-specific cell death in vitro. Accumulation of the anti-FAP antibody in arthritic knee joints was not affected by conjugation with the photosensitizer. Arthritis development was moderately delayed in mice with collagen-induced arthritis after FAP-tPDT.

Conclusion

Here we demonstrate the feasibility of tPDT to selectively target and kill FAP-positive fibroblasts in vitro and modulate arthritis in vivo using a mouse model of RA. This approach may have therapeutic potential in (refractory) arthritis.
Impairments in Probabilistic Prediction and Bayesian Learning Can Explain Reduced Neural Semantic Priming in Schizophrenia
Authors: Sharpe Victoria , Weber Kirsten , Kuperberg Gina R
Published: May 2020

It has been proposed that abnormalities in probabilistic prediction and dynamic belief updating explain the multiple features of schizophrenia. Here, we used electroencephalography (EEG) to ask whether these abnormalities can account for the well-established reduction in semantic priming observed in schizophrenia under nonautomatic conditions. We isolated predictive contributions to the neural semantic priming effect by manipulating the prime’s predictive validity and minimizing retroactive semantic matching mechanisms. We additionally examined the link between prediction and learning using a Bayesian model that probed dynamic belief updating as participants adapted to the increase in predictive validity. We found that patients were less likely than healthy controls to use the prime to predictively facilitate semantic processing on the target, resulting in a reduced N400 effect. Moreover, the trial-by-trial output of our Bayesian computational model explained between-group differences in trial-by-trial N400 amplitudes as participants transitioned from conditions of lower to higher predictive validity. These findings suggest that, compared with healthy controls, people with schizophrenia are less able to mobilize predictive mechanisms to facilitate processing at the earliest stages of accessing the meanings of incoming words. This deficit may be linked to a failure to adapt to changes in the broader environment. This reciprocal relationship between impairments in probabilistic prediction and Bayesian learning/adaptation may drive a vicious cycle that maintains cognitive disturbances in schizophrenia.
Coordinated Action of miR-146a and Parkin Gene Regulate Rotenone-induced Neurodegeneration
Authors: Jauhari Abhishek , Singh Tanisha , Mishra Saumya , Shankar Jai , Yadav Sanjay
Published: May 2020

Mitochondrial dysfunction is a common cause in pathophysiology of different neurodegenerative diseases. Elimination of dysfunctional and damaged mitochondria is a key requirement for maintaining homeostasis and bioenergetics of degenerating neurons. Using global microRNA (miRNA) profiling in a systemic rotenone model of Parkinson’s disease, we have identified miR-146a as upmost-regulated miRNA, which is known as inflammation regulatory miRNA. Here, we report the role of activated nuclear factor kappa beta (NF-kβ) in miR-146a-mediated downregulation of Parkin protein, which inhibits clearance of damaged mitochondria and induces neurodegeneration. Our studies have shown that 4-week rotenone exposure (2.5 mg/kg b.wt) induced oxidative imbalance-mediated NF-kβ activation in 1-year-old rat’s brain. Activated NF-kβ binds in promoter region of miR-146a gene and induces its transcription, which downregulates levels of Parkin protein. Decreased amount of Parkin protein results in accumulation of damaged and dysfunctional mitochondria, which further promotes the generation of reactive oxygen species in degenerating neurons. In conclusion, our studies have identified direct role of NF-kβ-mediated upregulation of miR-146a in regulating mitophagy through inhibition of the Parkin gene.
Reclassification of genus Izhakiella into the family Erwiniaceae based on phylogenetic and genomic analyses
Authors: Jiang Lingmin , Wang Dexin , Kim Ji-Sun , Lee Ju Huck , Kim Dae-Hyuk , Kim Suk Weon , Lee Jiyoung
Published: May 2020

The genus

Izhakiella

was established and designated as a member of the family

Enterobacteriaceae

in 2016. Although the taxonomical classification of most members in this family has been relatively resolved after two reclassifications in 2016 and 2017, the classification of the genus

Izhakiella

remains ambiguous. In this study, a polyphasic approach was used to provide evidence supporting the fact that the genus

Izhakiella

should no longer be considered a member of

Enterobacteriaceae

and proposes its reclassification into the family

Erwiniaceae

. The phylogenetic tree of type species in the families

Enterobacteriaceae

and

Erwiniaceae

based on the sequences of the 16S rRNA gene, rpoB housekeeping gene, and the whole-genome comprising the 92 core genes revealed that the genus

Izhakiella

forms a phylogenetic lineage within the family

Erwiniaceae

. The average nucleotide identity (ANI) value of the type species with genus

Izhakiella

was found to be higher for the family

Erwiniaceae

than that for the family

Enterobacteriaceae

. Notably, 12 conserved signature indels (CSIs) that are exclusively shared among the

Erwiniaceae

clade members were found in the type strains of the genus

Izhakiella

. Based on these analyses, this study suggests the reclassification of

I. capsodis

and

I. australiensis

into the family

Erwiniaceae

.
Epidemiology of yeast species causing bloodstream infection in Tehran, Iran (2015–2017); superiority of 21-plex PCR over the Vitek 2 system for yeast identification
Authors: Kord Mohammad , Salehi Mohammadreza , Khodavaisy Sadegh , Hashemi Seyed Jamal , Daie Ghazvini Roshanak , Rezaei Sassan , Maleki Ayda , Elmimoghaddam Ahmad , Alijani Neda , Abdollahi Alireza , Doomanlou Mahsa , Ahmadikia Kazem , Rashidi Niloofar , Pan Weihua , Boekhout Teun , Arastehfar Amir
Published: May 2020

Introduction. Given the limited number of candidaemia studies in Iran, the profile of yeast species causing bloodstream infections (BSIs), especially in adults, remains limited. Although biochemical assays are widely used in developing countries, they produce erroneous results, especially for rare yeast species.

Aim. We aimed to assess the profile of yeast species causing BSIs and to compare the accuracy of the Vitek 2 system and 21-plex PCR.

Methodology. Yeast blood isolates were retrospectively collected from patients recruited from two tertiary care training hospitals in Tehran from 2015 to 2017. Relevant clinical data were mined. Identification was performed by automated Vitek 2, 21-plex PCR and sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2).

Results. In total, 137 yeast isolates were recovered from 107 patients. The overall all-cause 30-day mortality rate was 47.7 %. Fluconazole was the most widely used systemic antifungal. Candida albicans (58/137, 42.3 %), Candida glabrata (30/137, 21.9 %), Candida parapsilosis sensu stricto (23/137, 16.8 %), Candida tropicalis (10/137, 7.3 %) and Pichia kudriavzevii (Candida krusei) (4/137, 2.9 %) constituted almost 90 % of the isolates and 10 % of the species detected were rare yeast species (12/137; 8.7 %). The 21-plex PCR method correctly identified 97.1 % of the isolates, a higher percentage than the Vitek 2 showed (87.6 %).

Conclusion.
C. albicans was the main cause of yeast-derived fungaemia in this study. Future prospective studies are warranted to closely monitor the epidemiological landscape of yeast species causing BSIs in Iran. The superiority of 21-plex PCR over automated Vitek 2 indicates its potential clinical utility as an alternative identification tool use in developing countries.
Theoretical Basis for an Edge-based, mHealth App to Guide Self-Management of Recurrent Medical Conditions
Authors: Kaizer Alexander M. , Moore Susan L. , Banaei-Kashani Farnoush , Bull Sheana , Rosenberg Michael A.
Published: May 2020

Background

N-of-1 trials have been proposed as an approach to identify the optimal individual treatment for patients with a number of recurrent medical conditions, including chronic pain and mental health. When inserted into mHealth applications, this approach holds great promise to provide an automated, efficient method to individualize patient care; however, prior to implementation, an understanding of the properties of the recurrent condition needed to draw conclusions with sufficient power is needed.

Methods

We applied simulation studies and power calculations to determine statistical properties of the N-of-1 approach employed by an mHealth application for self-management of chronic recurrent medical conditions called the iMTracker.

Results

In 1000 simulated patients with a single recurrent medical condition and 5 possible associated conditions, we found that ~90 days of data collection was sufficient to identify associated risk factors with odds ratio (OR > 5.0) at power ≥ 80%, with an absolute event rate of 50% being optimal. Power calculations based on Fisher’s Exact test showed that 90 days was also sufficient to detect a decrease of 20% in the rate of the primary outcome after an intervention, but that shorter data periods could be used to identify stronger effect sizes, down to 15 days with a 90% reduction in rate. Repeat analysis with Bayesian models did not significantly change power calculations, but did allow for a flexible approach that we leveraged to create a web-based tool to allow users to perform power calculations prior to using the iMTracker for self-management.

Conclusions

We found that the N-of-1 approach employed in the iMTracker app for self-management of recurrent medical conditions is statistically feasible, given the right conditions. More work is needed to examine the impact of autocorrelation, seasonality, and trends in data, on statistical validity and power calculations.
A Simple Early Warning Signal for COVID-19
Authors: Ceriani Lidia , Hernandez-Suarez Carlos , Verme Paolo
Published: May 2020

The paper provides some initial evidence that daily mortality rates (for any cause) by municipality or province can be used as a statistically reliable predictor of looming COVID-19 crises. Using recently published deaths figures for 1,689 Italian municipalities, we estimate the growth in daily mortality rates between the period 2015–2019 and 2020 by province. All provinces that experienced a major COVID-19 shock in mid-March 2020 had increases in mortality rates of 100% or above already in early February 2020. This increase was particularly strong for males and older people, two recognizable features of COVID-19. Using a panel fixed effect model, we show that the association between these early increases in mortality for any cause and the March 2020 COVID-19 shock is strong and significant. We conclude that the growth in mortality rates can be used as a statistically reliable predictor of COVID-19 crises.
Warmer weather and global trends in the coronavirus COVID-19
Authors: Li Hong , Xiao Hongwei , Zhu Renguo , Sun Chengxing , Liu Cheng , Xiao Hua-Yun
Published: May 2020

Predicting COVID-19 epidemic development in the upcoming warm season has attracted much attention in the hope of providing helps to fight the epidemic. It requires weather (environmental) factors to be included in prediction models, but there are few models to achieve it successfully. In this study, we proposed a new concept of environmental infection rate (RE), based on floating time of respiratory droplets in the air and inactivation rate of virus to solve the problem. More than half of the particles in the droplets can float in the atmosphere for 1–2 hours. The prediction results showed that high RE values (>3.5) are scattered around 30°N in winter (Dec.-Feb.). As the weather warms, its distribution area expands and extends to higher latitudes of northern hemisphere, reaching its maximum in April, and then shrinking northward. These indicated that the spread of COVID-19 in most parts of the northern hemisphere is expected to decline after Apr., but the risks in high latitudes will remain high in May. In the south of southern hemisphere, the RE values tend to subside from Apr. to July. The high modeled RE values up to July, however, suggested that warmer weather will not stop COVID-19 from spreading. Public health intervention is needed to overcome the outbreak.
The performance of national COVID-19 ‘Symptom Checkers’: A comparative case simulation study
Authors: Mansab F , Bhatti S , Goyal D
Published: May 2020

Introduction

The response to COVID-19 differs from nation to nation. There are likely a number of factors one can attribute to such disparity, not least of which is differing healthcare models and approaches. Here, we examine the COVID-19 community triage pathways employed by four nations, specifically comparing the safety and efficacy of national online ‘symptom checkers’ utilised within the triage pathway.

Methods

A simulation study was conducted on current, nationwide, patient-led symptom checkers from four countries (Singapore, Japan, USA and UK). 52 cases were simulated to approximate typical COVID-19 presentations (mild, moderate, severe and critical), and COVID-19 mimickers (e.g. sepsis and bacterial pneumonia). The same simulations were applied to each of the four country’s symptom checkers, and the recommendations to refer on for medical care or to stay home were recorded and compared.

Results

The symptom checkers from Singapore and Japan advised onward healthcare contact for the majority of simulations (88% and 77% respectively). The USA and UK symptom checkers triaged 38% and 44% of cases to healthcare contact, respectively. Both the US and UK symptom checkers consistently failed to identify severe COVID-19, bacterial pneumonia and sepsis, triaging such cases to stay home.

Conclusion

Our results suggest that whilst ‘symptom checkers’ may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. The key features of the well performing symptom checkers are discussed.

What is already known?

The availability and use of symptom checkers are increasing.

Symptom checkers are currently in use at a national level to help in the healthcare response to COVID-19.

There is limited evidence to support the effectiveness or safety of symptom checkers as triage tools during a pandemic response.

What does this paper add?

This study compares performance of symptom checkers across different countries, revealing marked variation between national symptom checkers.

The symptom checkers employed by Japan and Singapore are twice as likely to triage cases onward for clinical assessment than those of the US or UK.

The US and UK symptom checkers frequently triaged simulated cases of sepsis, bacterial pneumonia and severe COVID-19 to stay home with no further healthcare contact.

We discuss the key aspects of the well-performing triage systems.
COVID-19 herd immunity strategies: walking an elusive and dangerous tightrope
Authors: Brett Tobias S , Rohani Pejman
Published: May 2020

The rapid growth in cases of COVID-19 has threatened to overwhelm healthcare systems in multiple countries. In response, severely affected countries have had to consider a range of public health strategies achieved by implementing non-pharmaceutical interventions. Broadly, these strategies have fallen into two categories: i) “mitigation”, which aims to achieve herd immunity by allowing the SARS-CoV-2 virus to spread through the population while mitigating disease burden, and ii) “suppression”, aiming to drastically reduce SARS-CoV-2 transmission rates and halt endogenous transmission in the target population. Using an age-structured transmission model, parameterised to simulate SARS-CoV-2 transmission in the UK, we assessed the prospects of success using both of these approaches. We simulated a range of different non-pharmaceutical intervention scenarios incorporating social distancing applied to differing age groups. We found that it is possible to suppress SARS-CoV-2 transmission if social distancing measures are sustained at a sufficient level for a period of months. Our modelling did not support achieving herd immunity as a practical objective, requiring an unlikely balancing of multiple poorly-defined forces. Specifically, we found that: i) social distancing must initially reduce the transmission rate to within a narrow range, ii) to compensate for susceptible depletion, the extent of social distancing must be vary over time in a precise but unfeasible way, and iii) social distancing must be maintained for a long duration (over 6 months).
Modeling and predicting the spread of COVID-19 in Lebanon: A Bayesian perspective
Authors: Kharroubi Samer A
Published: May 2020

In this article, we investigate the problem of modelling the trend of the current Coronavirus disease 2019 pandemic in Lebanon along time. Two different models were developed using Bayesian Markov chain Monte Carlo simulation methods. The models fitted included Poisson autoregressive as a function of a short-term dependence only and Poisson autoregressive as a function of both a short-term dependence and a long-term dependence. The two models are compared in terms of their predictive ability using root mean squared error and deviance information criterion. The Poisson autoregressive model that allows to capture both short and long term memory effects performs best under all criterions. The use of such a model can greatly improve the estimation of number of new infections, and can indicate whether disease has an upward/downward trend, and where about every country is on that trend, so that containment measures can be applied and/or relaxed.
Describing the COVID-19 Outbreak Fitting Modified SIR models to Data
Authors: Ianni Aldo , Rossi Nicola
Published: May 2020

In this paper we fit simple modifications of the SIR compartmental model to the COVID-19 outbreak data, available from official sources for Italy and other countries. Even if the complexity of the pandemic can not be easily modelled, we show that our model, at present, describes the time evolution of the data in spite of the application of the social distancing and lock-down procedure. Finally, we discuss the reliability of the model predictions, under certain conditions, for estimating the near and far future evolution of the COVID-19 outbreak. The conditions for the applicability of the proposed models are discussed.
Cross-talk between the airway epithelium and activated immune cells defines severity in COVID-19
Authors: Chua Robert Lorenz , Lukassen Soeren , Trump Saskia , Hennig Bianca P. , Wendisch Daniel , Pott Fabian , Debnath Olivia , Thürmann Loreen , Kurth Florian , Kazmierski Julia , Timmermann Bernd , Twardziok Sven , Schneider Stefan , Machleidt Felix , Müller-Redetzky Holger , Krannich Alexander , Schmidt Sein , Balzer Felix , Liebig Johannes , Loske Jennifer , Eils Jürgen , Ishaque Naveed , von Kalle Christof , Hocke Andreas , Witzenrath Martin , Goffinet Christine , Drosten Christian , Laudi Sven , Lehmann Irina , Conrad Christian , Sander Leif-Erik , Eils Roland
Published: May 2020

The clinical course of COVID-19 is highly variable, however, underlying host factors and determinants of severe disease are still unknown. Based on single-cell transcriptomes of nasopharyngeal and bronchial samples from clinically well-characterized patients presenting with moderate and critical severities, we reveal the different types and states of airway epithelial cells that are vulnerable for SARS-CoV-2 infection. In COVID-19 patients, we observed a two- to threefold increase of cells expressing the SARS-CoV-2 entry receptorACE2within the airway epithelial cell compartment.ACE2is upregulated in epithelial cells through Interferon signals by immune cells suggesting that the viral defense system may increase the number of potentially susceptible cells in the respiratory epithelium. Infected epithelial cells recruit and activate immune cells by chemokine signaling. Recruited T lymphocytes and inflammatory macrophages were hyperactivated and showed a strong interaction with epithelial cells. In critical patients, increased expression ofCCL2, CCL3, CCL5, CXCL9, CXCL10, IL8, IL1BandTNFin macrophages was identified as a likely cause of a hyperinflammatory lung pathology. Moreover, we observed exacerbated epithelial cell death, likely leading to lung injury and respiratory failure in fatal cases. Our study provides novel insights into the pathophysiology of COVID-19 and suggests an immunomodulatory therapy along the CCL2, CCL3/CCR1 axis as promising option to prevent and treat critical course of COVID-19.
Is physical rehabilitation superior to no physical rehabilitation following total knee arthroplasty? A systematic review and meta-analysis
Authors: Mark-Christensen Troels , Juhl Carsten , Thorborg Kristian , Bandholm Thomas
Published: May 2020

Introduction: Physical rehabilitation is widely used following total knee arthroplasty (TKA), while no consensus has been reached regarding the optimal dosage, frequency and modality. Before a standardized protocol can be established, it is important to investigate the true efficacy for physical rehabilitation following TKA.
Objective: To examine if physical rehabilitation is superior to no physical rehabilitation following total knee arthroplasty in terms of patient-reported outcomes for function and pain.
Methods: The search strategy was conducted in five databases (MEDLINE, Embase, Cinahl, CENTRAL and SPORTDiscus) with eligibility criteria for inclusion being: Randomised controlled trials comparing patients receiving physical rehabilitation with a group receiving no physical rehabilitation following unilateral TKA. Potential sources of bias were assessed according to the Cochrane Risk of Bias Tool. The Consensus on Exercise Reporting Template (CERT) was used to extract and report exercise interventions from the included trials.
Results: Only two of 3254 identified trials fulfilled the eligibility criteria and were included. The two trials were judged as being of moderate to good methodological quality, but lacking in the reporting of their exercise interventions. Difference in outcome measurements and interventions makes between-study comparison inconclusive.
Conclusions: No conclusion regarding the superiority of physical rehabilitation to no-intervention following TKA can be drawn from the results of this systematic review. Further research is required to establish the true effectiveness of physical rehabilitation following TKA.
Systematic review registration number: PROSPERO 2018 CRD42018094785.
Development of HPV 16/18 E6 oncoprotein paper-based nanokit for enhanced detection of HPV 16/18 E6 oncoprotein in cervical cancer screening
Authors: Mwai Lucy Muthoni , Kyama Mutinda C. , Ngugi Caroline W. , Walong Edwin
Published: May 2020

Cervical cancer caused mainly by high risk human papillomavirus (HPV) 16 and 18 strains is the second most prevalent cancer of women in Kenya. It is often diagnosed late when treatment is difficult due to very low percentage of women attending screening thus, mortalities remain high. The most available tests in low-and-middle-income countries (LMICs) have relatively low specificity, low sensitivity, require a laboratory setting and huge technical and financial support not readily available. HPV 16/18 E6 oncoprotein has been identified as a potential biomarker in a more specific early diagnosis of cervical cancer. This retrospective cross-sectional study developed a paper-based nanokit with enhanced detection of HPV 16/18 E6 oncoprotein for cervical cancer screening. The HRP labelled antibodies HPV 16 E6/18 E6-HRP (CP15) passively conjugated to citrate stabilized 20nm gold nanoparticles were evaluated for immune sensing mechanism using a recombinant viral HPV E6 protein. The diagnostic accuracy was evaluated using 50 tissue lysates from formalin fixed paraffin embedded cervical biopsy, including control (n=10), Mild Dysplasia (n=10), Cervical intraepithelial neoplasia 3 (CIN3) (n=10), Cervical intraepithelial neoplasia 4 (CIN4) (n=10) and invasive carcinoma (n=10). The molecular technique used was dot blot molecular assay. A positive result was generated by catalytic oxidation of peroxidase enzyme on 3,3’,5,5’-Tetramethylbenzidine (TMB) substrate. The gold nanoparticles were used to enhance the signal produced by peroxidase activity of horseradish peroxidase (HRP) enzyme giving a more sensitive assay as compared to use of non-conjugated antibody. This study provides a significantly high and reliable diagnostic accuracy for precancerous and cancerous lesions with a sensitivity of 90%, a specificity of 90%, a likelihood ratio for positive and negative tests as 9:1 and 1:9 respectively, a Positive Predictive Value of 97.3% and a Negative Predictive Value of 69.2%. This study avails a sensitive, rapid test using paper-based nanotechnology which can be utilised in community-based screening outreaches particularly in low- and middle-income countries.
Whole-brain computational modeling reveals disruption of microscale brain dynamics in HIV infected individuals
Authors: Zhuang Yuchuan , Zhang Zhengwu , Tivarus Madalina , Qiu Xing , Zhong Jianhui , Schifitto Giovanni
Published: May 2020

In this study, we adopted the relaxed mean-field dynamic modeling to investigate structural and functional connectivity in forty-two HIV-infected subjects before and after 12-week of combination antiretroviral therapy (cART) and compared them with forty-six age-matched healthy subjects. Microscale brain dynamics were modeled by a set of parameters including two region-specific microscale brain properties, recurrent connection strengths, and subcortical inputs. We also analyzed the relationship between the model parameters (i.e. the recurrent connection and subcortical inputs) and functional network topological characterizations. The results show that untreated HIV-infected individuals have disrupted local brain dynamics that in part correlate with network topological measurements. Notably, after 12 weeks of cART, both the microscale brain dynamics and the network topological measurements improved and were closer to those in the healthy brain. This was also associated with improved cognitive performance, suggesting that improvement in local brain dynamics translates into clinical improvement.
Antibody Profiling and Prevalence in the US population during the SARS-CoV2 Pandemic
Authors: Krishnamurthy Hari Krishnan , Jayaraman Vasanth , Krishna Karthik , Rajasekaran Karenah E. , Wang Tianhao , Bei Kang , Rajasekaran John J. , Yaskin Inna , Rai Alex J. , Choung Rok Seon , Murray Joseph A.
Published: May 2020

Background

Antibody diagnostics play an important role in disease detection and can potentially aid in monitoring of the immune responses to see if an individual has developed immunity. Developing high throughput diagnostics which does not involve handling of infectious material becomes imperative in the case of pandemics such as the recent outbreak of SARS-CoV2.

Methods

A protein microarray technology was used to detect the plurality of antibody response to four novel antigens namely S1 glycoprotein, Receptor binding domain (RBD), S2 glycoprotein and Nucleoprotein of the novel coronavirus named SARS-CoV2 using serum samples. A DBS card was additionally used to compare its performance with a venipuncture-based serum separator tube (SST) draw.

Results

The three main subclasses of antibodies IgM, IgA and IgG were analyzed to see the variations in immune responses in the affected population and compared to their microbial RT-PCR based NP swab results. The clinical sensitivity and specificity were determined to be 98.1% and 98.6%. In the matrix comparison study, which would enable patients to test without risk of transmitting the virus, DBS matched with higher than 98% accuracy to a venipuncture-based SST collection.

Conclusion

Multiplex testing enables higher sensitivity and specificity which is essential while establishing exposure on a population scale. This flexible platform along with a discrete collection methodology would be crucial and broadly useful to scale up testing in current and future pandemics. Minimum sample volume that can be collected using DBS cards can be processed in this multiplex pillar plate format enabling the capacity to provide the reliability of high throughput analyzers while having the ease of collection similar to rapid tests.
Detection of mTBI in pediatric populations using BrainCheck, a tablet-based cognitive testing software
Authors: Ye Siao , Ko Brian , Phi Huy , Eagleman David M. , Flores Benjamin , Katz Yael , Huang Bin , Ghomi Reza Hosseini
Published: May 2020

Aim

Despite its high frequency of occurrence, mild traumatic brain injury (mTBI), or concussion, is difficult to recognize and diagnose, particularly in pediatric populations. Conventional methods to diagnose mTBI primarily rely on clinical questionnaires and sometimes include imaging such as computed tomography (CT) or pencil and paper neuropsychological testing. However, these methods are time consuming, require administration/interpretation from health professionals, and lack adequate test sensitivity and specificity. We explore the use of BrainCheck, a computerized neurocognitive test that is available on iPad, iPhone or computer desktop, for mTBI assessment. The BrainCheck battery consists of 6 gamified traditional neurocognitive tests that assess areas of cognition vulnerable to mTBI such as attention, processing speed, executing functioning, and coordination.

Methods

We administered BrainCheck to 10 participants diagnosed with mTBI at the emergency department (ED) of Children’s hospital within 96 hours of admittance to the ED, and 126 normal controls at a local high school. Statistical analysis included Chi-Square tests, Analysis of Variance (ANOVA), independent sample t-tests, and Hochberg tests to examine differences between mTBI, diagnoses by current gold standard clinical exam, and control groups on each assessment in the battery. Significant metrics from these assessments were used to build a logistic regression model that distinguishes mTBI from non-mTBI participants.

Results

BrainCheck was able to detect significant differences in coordination, Flanker, Stroop, Digital Symbol, Immediate/Delayed recall and recognition assessments between normal people and mTBI patients. Receiver operator score (ROC) analysis of our logistic regression model found a sensitivity of 84% and specificity of 80%.

Conclusions

BrainCheck has potential in distinguishing mTBI from non-mTBI participants, by providing a shorter, gamified test battery to assess cognitive function after brain injury, while also providing a method for tracking recovery with the opportunity to do so remotely from a patient’s home.
Homegrown Ultraviolet Germicidal Irradiation for Hospital-Based N95 Decontamination during the COVID-19 Pandemic
Authors: Schnell Eric , Harriff Melanie J. , Yates Jane E. , Karamooz Elham , Pfeiffer Christopher D. , McCarthy James F. , Trapp Christopher L. , Frazier Sara K. , Dodier John E. , Smith Stephen M.
Published: May 2020

Coronavirus disease (COVID-19), the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, is responsible for the 2020 global pandemic and characterized by high transmissibility and morbidity. Healthcare workers (HCWs) are at risk of contracting COVID-19, and this risk is mitigated through the use of personal protective equipment such as N95 Filtering Facepiece Respirators (FFRs). The high demand for FFRs is not currently met by global supply chains, potentially placing HCWs at increased exposure risk. Effective FFR decontamination modalities exist, which could maintain respiratory protection for HCWs in the midst of the current pandemic, through the decontamination and re-use of FFRs. Here, we present a locally-implemented ultraviolet-C germicidal irradiation (UVGI)-based FFR decontamination pathway, utilizing a home-built UVGI array assembled entirely with previously existing components available at our institution. We provide recommendations on the construction of similar systems, as well as guidance and strategies towards successful institutional implementation of FFR decontamination.
Beyond Deaths per Capita: Comparative CoViD-19 Mortality Indicators
Authors: Heuveline Patrick , Tzen Michael
Published: May 2020

The number of CoViD-19 deaths is a lagged but more reliable indicator of the disease progression across populations than the number of confirmed cases. With substantial age and sex differences in CoViD-19 mortality, that number should be adjusted for the age-and-sex composition of the population as well as its total size. Following well-established practices in demography, this article discusses several period measures based on cumulative numbers of CoViD-19 deaths up to a point in time and illustrate them with weekly-updated data from 386 national and subnational populations. First is an unstandardized occurrence-exposure rate comparable to the Crude Death Rate. The peak estimate for New York exceeded the state most recent annual Crude Death Rate and remains the highest on record. Second, an indirectly standardized rate is shown to perform quite like a directly standardized rate but without requiring an age-and-sex breakdown of CoViD-19 deaths. Relative to the US, standardization lowers death rates in European populations and increases them in most other populations, with the highest standardized rates currently found in subnational Mexican and Peruvian populations. Last, projected end-of-the-year CoViD-19 death tallies can be translated into reductions in 2020 life expectancies, which could exceed two and a half years in Peru and Ecuador, and in various subnational entities from Baja California to Madrid and New York. To put these in perspective, the 1.5-year projected reduction for the US would bring 2020 life expectancy at birth to its lowest level since 2003 and induce its largest annual decline since World War II.
Evaluating the Utility of UV Lamps to Mitigate the Spread of Pathogens in the ICU
Authors: Gostine Andrew L , Gostine David , Short Jack , Rustagi Arjun , Cadnum Jennifer , Donskey Curtis , Angelotti Tim
Published: May 2020

Introduction:
While commonly associated with vaccinations, herd immunity can be applied to aseptic strategies in the hospital. The more decontaminated surfaces in a hospital the greater immunity conferred to patients against the spread of infections. The aim of this study was to evaluate UV lights in preventing the spread of a DNA tracer in an ICU.
Methods:
In a prospective trial, a non-pathogenic DNA virus was inoculated onto surfaces in an ICU patient room. Investigators swabbed frequently touched surfaces in non-inoculated ICU rooms at 24, 48, and 96-hours post inoculation. Culture specimens were analyzed for the presence of viral DNA via PCR. After baseline data was obtained, UV lights were deployed on to vitals monitors, ventilators, keyboards, and IV pumps. Inoculation and culturing were then repeated.
Results:
Prior to UV implementation, the DNA tracer disseminated to 10.1% of tested surfaces in non-inoculated rooms at 48 hours. Post UV light deployment, only 1.2% of surfaces tested positive for the DNA tracer after 48 hours.
Conclusion:
UV decontamination significantly retarded the spread of the virus DNA, with a relative reduction in 90% at 48-hours from 10.10% of surfaces pre-UV to 1.20% of surfaces post-UV (p < 0.0001). UV decontamination holds the potential to confer protection to patients by reducing the number of surfaces that can serve as a nidus for transmission.
Efficacy of smoking cessation in spirometry results of COPD smokers: a randomized controlled clinical trial
Authors: alipour abbas , zarghami mehran , sharifpour ali , taghizadeh fatemeh
Published: May 2020

Background

Nicotine replacement therapy (NRT) may be more effective if it is combined with short cognitive-behavioral interventions for smoking cessation in chronic obstructive pulmonary diseasesmokers.

Material and methods

To examine the effectiveness of guided self-change (GSC), in a randomized controlled clinical trial, 57 men ranging from 45 to 77 years old were randomly assigned to three 19-member groups (GSC, NRT, and combined GSC-NRT).

The primary data on smoking cessation and pulmonary functions were examined during 29 weeks using General Linear (GEE) Model status, intention-to-treat analysis, and repeated measures ANOVA test.

Results

A total of 9 (47.4%) of the participants in the GSC and combined groups and 4 (21.1%) participants in the NRT group reported total abstinence rate from smoking by the end of 29 weeks. Daily cigarette number was changed from 24 to 4 in GSC group, 26 to 11 in NRT group, and 20 to 6 in combined group. The GEE model revealed that this variable decreased in GSC group more than two other groups significantly (P=0.003). Moreover, the FVC level of the NRT group was lower than the GSC group (P=0.04), and the FEV in the NRT group was lower than GSC group (P=0.02). Furthermore, the level of FEV1/FVC act/pred in the NRT group was lower than GSC group (−6, 95% CI: -10.4-(−1.5), P=0.008) and it was also lower in the combined group than the GSC group (−6, 95% CI: -11.3-(−0.5), PV=0.03).

Conclusion

GSC and combined GSC-NRT treatments were equally effective in abstinence rate. Moreover Daily cigarette and the FEV1/FVC act/pred in GSC group was more than two other groups, indicating the health professionals can apply GSC alone in smoking cessation and improve lung function of COPD smokers.
Changes in access to Australian disability support benefits during a period of social welfare reform
Authors: Collie Alex , Sheehan Luke R , Lane Tyler J
Published: May 2020

The Disability Support Pension (DSP) is the major Australian government financial benefit program for people of working age with medical conditions and disabilities that restrict work capacity. Between 2012 and 2018 a series of policy reforms sought to restrict the growth in DSP payments and encourage more people with some work capacity to seek employment. We characterise changes in three markers of access to disability financial support over the reform period (1) DSP recipient rates (2) DSP grant (approval) rates and (3) the rate of unemployment benefit receipt in people with impaired work capacity. Results demonstrate a significant reduction in DSP receipt and grant rates, and significant increase in the rate of unemployment benefit receipt in working-age Australians with work disabling medical conditions and disability. These changes were not distributed uniformly. People whose primary medical condition was a musculoskeletal or circulatory system disorder demonstrated greater declines in DSP receipt and grant rates, while there was a more rapid increase in unemployment benefit receipt among people with primary mental health conditions. Some trend changes occur in periods during which new disability assessment and pension eligibility policies were introduced, though our ability to attribute changes to specific policy changes is limited.

FUNDING AND ACKNOWLEDGMENTS

This study was supported by an Australian Research Council Future Fellowship awarded to the first author (FT190100218). De-identified, aggregate data for the study was provided by the Australian Government Department of Human Services and Department of Social Services.