bluuebunny/crossref_metadata_2025 huggingface dataset:
Some Complex Intuitionistic Uncertain Linguistic Heronian Mean Operators and Their Application in Multiattribute Group Decision Making
Authors: Garg Harish , Ali Zeeshan , Gwak Jeonghwan , Mahmood Tahir , Aljahdali Sultan
Published: May 2021

In this paper, a new decision-making algorithm has been presented in the context of a complex intuitionistic uncertain linguistic set (CIULS) environment. CIULS integrates the concept the complex of a intuitionistic fuzzy set (CIFS) and uncertain linguistic set (ULS) to deal with uncertain and imprecise information in a more proactive manner. To investigate the interrelation between the pairs of CIULSs, we combine the concept of the Heronian mean (HM) and the complex intuitionistic uncertain linguistic (CIUL) to describe some new operators, namely, CIUL arithmetic HM (CIULAHM), CIUL weighted arithmetic HM (CIULWAHM), CIUL geometric HM (CIULGHM), and CIUL weighted geometric HM (CIULWGHM). The main advantage of these suggested operators is that they considered the interaction between pairs of objects during the formulation process. Also, a number of distinct brief cases and properties of the operators are analyzed. In addition, based on these operators, we have stated a MAGDM (“multiattribute group decision-making”) problem-solving algorithm. The consistency of the algorithm is illustrated by a computational example that compares the effects of the algorithm with a number of well-known existing methods.
Identification of Pneumonia Disease Applying an Intelligent Computational Framework Based on Deep Learning and Machine Learning Techniques
Authors: Muhammad Yar , Alshehri Mohammad Dahman , Alenazy Wael Mohammed , Vinh Hoang Truong , Alturki Ryan
Published: May 2021

Pneumonia is a very common and fatal disease, which needs to be identified at the initial stages in order to prevent a patient having this disease from more damage and help him/her in saving his/her life. Various techniques are used for the diagnosis of pneumonia including chest X-ray, CT scan, blood culture, sputum culture, fluid sample, bronchoscopy, and pulse oximetry. Medical image analysis plays a vital role in the diagnosis of various diseases like MERS, COVID-19, pneumonia, etc. and is considered to be one of the auspicious research areas. To analyze chest X-ray images accurately, there is a need for an expert radiologist who possesses expertise and experience in the desired domain. According to the World Health Organization (WHO) report, about 2/3 people in the world still do not have access to the radiologist, in order to diagnose their disease. This study proposes a DL framework to diagnose pneumonia disease in an efficient and effective manner. Various Deep Convolutional Neural Network (DCNN) transfer learning techniques such as AlexNet, SqueezeNet, VGG16, VGG19, and Inception-V3 are utilized for extracting useful features from the chest X-ray images. In this study, several machine learning (ML) classifiers are utilized. The proposed system has been trained and tested on chest X-ray and CT images dataset. In order to examine the stability and effectiveness of the proposed system, different performance measures have been utilized. The proposed system is intended to be beneficial and supportive for medical doctors to accurately and efficiently diagnose pneumonia disease.
Neutralization of PD-L2 is Essential for Overcoming Immune Checkpoint Blockade Resistance in Ovarian Cancer
Authors: Miao Yu Rebecca , Thakkar Kaushik N. , Qian Jin , Kariolis Mihalis S. , Huang Wei , Nandagopal Saravanan , Yang Teddy Tat Chi , Diep Anh N. , Cherf Gerald Maxwell , Xu Yu , Moon Eui Jung , Xiao Yiren , Alemany Haizea , Li Tiane , Yu Wenhua , Wei Bo , Rankin Erinn B. , Giaccia Amato J.
Published: May 2021

Purpose:

Ovarian cancer represents a major clinical hurdle for immune checkpoint blockade (ICB), with reported low patient response rates. We found that the immune checkpoint ligand PD-L2 is robustly expressed in patient samples of ovarian cancers and other malignancies exhibiting suboptimal response to ICB but not in cancers that are ICB sensitive. Therefore, we hypothesize that PD-L2 can facilitate immune escape from ICB through incomplete blockade of the PD-1 signaling pathway.

Experimental Design:

We engineered a soluble form of the PD-1 receptor (sPD-1) capable of binding and neutralizing both PD-L2 and PD-L1 with ×200 and ×10,000 folds improvement in binding affinity over wild-type PD-1 leading to superior inhibition of ligand-mediated PD-1 activities.

Results:

Both in vitro and in vivo analyses performed in this study demonstrated that the high-affinity sPD-1 molecule is superior at blocking both PD-L1– and PD-L2–mediated immune evasion and reducing tumor growth in immune-competent murine models of ovarian cancer.

Conclusions:

The data presented in this study provide justification for using a dual targeting, high-affinity sPD-1 receptor as an alternative to PD-1 or PD-L1 therapeutic antibodies for achieving superior therapeutic efficacy in cancers expressing both PD-L2 and PD-L1.
Nuclear FGFR1 Regulates Gene Transcription and Promotes Antiestrogen Resistance in ER+ Breast Cancer
Authors: Servetto Alberto , Kollipara Rahul , Formisano Luigi , Lin Chang-Ching , Lee Kyung-Min , Sudhan Dhivya R. , Gonzalez-Ericsson Paula I. , Chatterjee Sumanta , Guerrero-Zotano Angel , Mendiratta Saurabh , Akamatsu Hiroaki , James Nicholas , Bianco Roberto , Hanker Ariella B. , Kittler Ralf , Arteaga Carlos L.
Published: May 2021

Purpose:

FGFR1 overexpression has been associated with endocrine resistance in ER+ breast cancer. We found FGFR1 localized in the nucleus of breast cancer cells in primary tumors resistant to estrogen suppression. We investigated a role of nuclear FGFR1 on gene transcription and antiestrogen resistance.

Experimental Design:

Tumors from patients treated with letrozole were subjected to Ki67 and FGFR1 IHC. MCF7 cells were transduced with FGFR1(SP-)(NLS) to promote nuclear FGFR1 overexpression. FGFR1 genomic activity in ER+/FGFR1-amplified breast cancer cells ± FOXA1 siRNA or ± the FGFR tyrosine kinase inhibitor (TKI) erdafitinib was examined by chromatin immunoprecipitation sequencing (ChIP-seq) and RNA sequencing (RNA-seq). The nuclear and chromatin-bound FGFR1 interactome was investigated by mass spectrometry (MS).

Results:

High nuclear FGFR1 expression in ER+ primary tumors positively correlated with post-letrozole Ki67 values. Nuclear FGFR1 overexpression influenced gene transcription and promoted resistance to estrogen suppression and to fulvestrant in vivo. A gene expression signature induced by nuclear FGFR1 correlated with shorter survival in the METABRIC cohort of patients treated with antiestrogens. ChIP-Seq revealed FGFR1 occupancy at transcription start sites, overlapping with active transcription histone marks. MS analysis of the nuclear FGFR1 interactome identified phosphorylated RNA-Polymerase II and FOXA1, with FOXA1 RNAi impairing FGFR1 recruitment to chromatin. Treatment with erdafitinib did not impair nuclear FGFR1 translocation and genomic activity.

Conclusions:

These data suggest nuclear FGFR1 contributes to endocrine resistance by modulating gene transcription in ER+ breast cancer. Nuclear FGFR1 activity was unaffected by FGFR TKIs, thus supporting the development of treatment strategies to inhibit nuclear FGFR1 in ER+/FGFR1 overexpressing breast cancer.
Adjuvant Low-dose Statin Use after Radical Prostatectomy: The PRO-STAT Randomized Clinical Trial
Authors: Jeong In Gab , Lim Bumjin , Yun Sung-Cheol , Lim Ju Hyun , Hong Jun Hyuk , Kim Choung-Soo
Published: May 2021

Purpose:

Statin use is reportedly associated with the risk of prostate cancer, outcomes after treatment, and prostate cancer-specific mortality. We sought to determine the efficacy of adjuvant atorvastatin in prostate cancer after radical prostatectomy.

Patients and Methods:

In this randomized, double-blind trial, we assigned patients with pathologic high-risk prostate cancer to receive either low-dose atorvastatin (20 mg/day, n = 183) or placebo (n = 181) for 1 year after radical prostatectomy. The primary endpoint was the 1-year biochemical recurrence rate. The secondary endpoints included the 5-year biochemical recurrence-free survival and changes in lipid, testosterone, and sex hormone binding globulin levels.

Results:

From October 2012 through January 2019, a total of 364 patients underwent randomization. Among 59 total primary end points, 30 (16.4%) and 29 (16.0%) occurred in the atorvastatin and placebo groups, respectively. Atorvastatin did not significantly reduce the primary endpoint of 1-year biochemical recurrence [HR, 0.96; 95% confidence interval (CI), 0.58–1.60]. During a median follow-up of 24 months, 131 patients experienced biochemical recurrence (68 in the atorvastatin group and 63 in the placebo group), representing Kaplan–Meier estimated event rates of 24.0% and 25.4% in the atorvastatin and placebo groups, respectively, at 24 months (HR, 1.00; 95% CI, 0.71–1.41). We observed no significant between-group differences in the testosterone and sex hormone binding globulin levels.

Conclusions:

Among patients with high-risk pathologic features after radical prostatectomy for prostate cancer, 1-year adjuvant use of atorvastatin was not associated with a lower risk of disease recurrence compared with that for placebo. (ClinicalTrials.gov number, NCT01759836).

See related commentary by Murtola and Siltari, p. 4947
Establishment of the Risk Prediction Model for Significant Bacteriuria in Adult Patients with Automated Urine Analysis
Authors: He Hualin , Wang Zheng , Zuo Li , Zhang Ling , Liu Cheng , Dai Chuanxin , Shi Weiwei , Li Jun , Wang Rui , Yongjun Feng , Li Jianmin
Published: May 2021

Introduction: Urinary tract infections (UTIs) have been proven to be the most encountered bacterial infection in humans. We hope to establish a prediction model for significant bacteriuria by comprehensively analyzing the relevant parameters of age, gender, and urine automatic analysis data. Methods: A retrospective study was performed at Tai’an Central Hospital. All samples included in the study were tested for urine culture and urine automatic analysis. Data analysis was conducted with the SPSS. Results: The binary logistic regression module is used to establish the forecast formula, which gender, age, leukocyte count, bacterial count, leukocyte esterase, and nitrite were included. Receiver operating characteristic (ROC) curves showed that the area under ROC curve (AUC) of the prediction model was 0.878, bigger than the AUCs of the other 6 independent variables. The sensitivity and specificity of prediction model were 61.68 and 95.98%, respectively. The positive and the negative predictive values of the predictive model are 87.13 and 85.02%, respectively. Conclusions: The prediction formula obtained in our study can achieve good prediction effect for significant bacteriuria, which can effectively avoid the treatment delay or antibiotic abuse caused by the subjective judgment of doctors.
Management of Hepatocellular Carcinoma in Japan: JSH Consensus Statements and Recommendations 2021 Update
Authors: Kudo Masatoshi , Kawamura Yusuke , Hasegawa Kiyoshi , Tateishi Ryosuke , Kariyama Kazuya , Shiina Shuichiro , Toyoda Hidenori , Imai Yasuharu , Hiraoka Atsushi , Ikeda Masafumi , Izumi Namiki , Moriguchi Michihisa , Ogasawara Sadahisa , Minami Yasunori , Ueshima Kazuomi , Murakami Takamichi , Miyayama Shiro , Nakashima Osamu , Yano Hirohisa , Sakamoto Michiie , Hatano Etsuro , Shimada Mitsuo , Kokudo Norihiro , Mochida Satoshi , Takehara Tetsuo ,   HCC Expert Panel of the Japan Society of Hepatology
Published: May 2021

The Clinical Practice Manual for Hepatocellular Carcinoma was published based on evidence confirmed by the Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma along with consensus opinion among a Japan Society of Hepatology (JSH) expert panel on hepatocellular carcinoma (HCC). Since the JSH Clinical Practice Guidelines are based on original articles with extremely high levels of evidence, expert opinions on HCC management in clinical practice or consensus on newly developed treatments are not included. However, the practice manual incorporates the literature based on clinical data, expert opinion, and real-world clinical practice currently conducted in Japan to facilitate its use by clinicians. Alongside each revision of the JSH Guidelines, we issued an update to the manual, with the first edition of the manual published in 2007, the second edition in 2010, the third edition in 2015, and the fourth edition in 2020, which includes the 2017 edition of the JSH Guideline. This article is an excerpt from the fourth edition of the HCC Clinical Practice Manual focusing on pathology, diagnosis, and treatment of HCC. It is designed as a practical manual different from the latest version of the JSH Clinical Practice Guidelines. This practice manual was written by an expert panel from the JSH, with emphasis on the consensus statements and recommendations for the management of HCC proposed by the JSH expert panel. In this article, we included newly developed clinical practices that are relatively common among Japanese experts in this field, although all of their statements are not associated with a high level of evidence, but these practices are likely to be incorporated into guidelines in the future. To write this article, coauthors from different institutions drafted the content and then critically reviewed each other’s work. The revised content was then critically reviewed by the Board of Directors and the Planning and Public Relations Committee of JSH before publication to confirm the consensus statements and recommendations. The consensus statements and recommendations presented in this report represent measures actually being conducted at the highest-level HCC treatment centers in Japan. We hope this article provides insight into the actual situation of HCC practice in Japan, thereby affecting the global practice pattern in the management of HCC.
Relationship between Nutritional Scales and Prognosis in Elderly Patients after Acute Ischemic Stroke: Comparison of Controlling Nutritional Status Score and Geriatric Nutritional Risk Index
Authors: Akimoto Takayoshi , Hara Makoto , Morita Akihiko , Uehara Shuichiro , Nakajima Hideto
Published: May 2021

Background/Aims: Undernutrition is common in patients after acute ischemic stroke (AIS) and predicts poor clinical outcomes. We assessed the relationship between undernutrition and prognosis after AIS. Methods: We retrospectively assessed consecutively hospitalized AIS patients aged ≥65 years. A poor prognosis for patients after AIS was defined as a modified Rankin Scale (mRS) score of ≥3 at discharge. Nutritional status was evaluated based on the degree and risk of undernutrition as determined by the Controlling Nutritional Status (UND-CONUT) and Geriatric Nutritional Risk Index (UNR-GNRI) scores. Results: Among 218 patients (male, 62.8%; median age, 77 years), 81 had a poor prognosis. A significant correlation was found between UND-CONUT and UNR-GNRI scores (p < 0.001, r = 0.433). Patients with a poor prognosis showed significant undernutrition based on UND-CONUT (p = 0.003) but not on UNR-GNRI (p = 0.218). Patients with undernutrition based on UND-CONUT showed poor outcomes: higher mRS scores at discharge, higher percentages of mRS scores of ≥2 and ≥3, and more complications associated with pneumonia. No significant differences were seen between cases with and without undernutrition risk based on UNR-GNRI. Conclusion: UND-CONUT appeared to be more useful than UNR-GNRI for predicting the prognosis of elderly patients with AIS at discharge.
Low Blood Flow Continuous Veno-Venous Haemodialysis Compared with Higher Blood Flow Continuous Veno-Venous Haemodiafiltration: Effect on Alarm Rates, Filter Life, and Azotaemic Control
Authors: Sansom Benjamin , Sriram Shyamala , Presneill Jeffrey , Bellomo Rinaldo
Published: May 2021

Title: Low blood flow continuous veno-venous haemodialysis (CVVHD) compared with higher blood flow continuous veno-venous haemodiafiltration (CVVHDF): effect on alarm rates, filter life, and azotaemic control. Introduction: Continuous renal replacement therapy (CRRT) can be delivered via convective, diffusive, or mixed approaches. Higher blood flows have been advocated for convective clearance efficiency and promotion of filter life. It is unclear whether a lower blood flow predominantly diffusive approach may benefit filter life and alarm rates. Materials and Methods: Sequential cohort study of 284 patients undergoing 874 CRRT circuits from January 2015 to August 2018 in a single university-associated tertiary referral hospital in Australia. Patients underwent a protocol of either CVVHDF at blood flow 200–250 mL/min or CVVHD at blood flow 100–130 mL/min. Machine and patient data were analysed. Outcomes of azotaemic control, filter life, and warning alarm rates were log transformed and analysed with mixed linear modelling with patient as a random effect. Results: Both groups had similar azotaemic control (effect estimate on log creatinine CVVHD vs. CVVHDF 1.04 [0.87–1.25], p = 0.68) and median filter life (CVVHDF 16.8 [8.4–90.5] h and CVVHD 16.4 [9.4–82.3] h, p = 0.97). However, circuit pressures were less extreme with a narrower distribution during CVVHD. Multivariate analysis showed CVVHD had a reduced risk of warning alarms (incidence risk ratio [IRR] 0.51 [0.38–0.70]) and femoral access placement also had a reduced risk of alarms (IRR 0.55 [0.41–0.73]). Conclusion: Low blood flow CVVHD and femoral vascular access reduce alarms while maintaining azotaemic control and circuit patency thus minimizing bedside clinician workload.
Influence of Pediatric Endoscopic Endonasal Skull Base Resections on Midface and Skull Base Development
Authors: Oviedo Parisa , Zamora Steven , Vinocur Daniel , Levy Michael L. , Nation Javan
Published: May 2021

Objective: The purpose of this study is to use imaging data to determine if endoscopic endonasal surgery (EES) for skull base tumor resection interrupts skull base growth and development, resulting in an atrophic midface skeletal structure, compared to matched normal controls. Methods: Data were collected by a retrospective chart review done on children aged 16 years and below who underwent endoscopic tumor resection and had pre- and postoperative magnetic resonance imaging with relevant midface anatomy. 121 normal controls were matched to 20 EES patients by age and gender. Three measurements related to midface anatomy were taken from 1 sagittal T1 slice and 1 axial T2 slice of each scan. Statistical analysis was used to compare growth measures between cases and controls. Results: Twenty patients who underwent EES between November 2015 and April 2018 met our inclusion criteria. The mean age of the patients, 11 males and 9 females, was 10 years, and 8 patients (38%) were aged 7 years or younger. Six patients who had a high-flow CSF leak obtained a nasoseptal flap. A student T test and multivariate regression analysis found that EES did not affect midface and skull base growth. Among the variables assessed, age appears to be the only driver of growth. Conclusion: There were no identified differences in craniofacial growth in pediatric patients undergoing EES for skull base tumor resection as compared to the control group. EES does not appear to significantly interfere with midface/skull base development and is a good surgical option for pediatric patients.
Portrait of My Father: Frida Kahlo’s Intimate Relation to Epilepsy
Authors: Carrazana Enrique J.
Published: May 2021

The painting Portrait of My Father (1951) by the Mexican painter, Frida Kahlo, is discussed by the author within the context of epilepsy and biographical events in the lives of both Frida and her father, the German Mexican photographer Guillermo Kahlo. The biographical accounts of the photographer’s seizures are suggestive of juvenile absence epilepsy but cannot discount the possibility of posttraumatic epilepsy of mesial frontal origin.
Evaluation of Helicobacter pylori Genotypes in Obese Patients with Gastric Ulcer, Duodenal Ulcer, and Gastric Cancer: An Observational Study
Authors: Farsimadan Marziye , Heravi Fatemah Sadeghpour , Emamvirdizadeh Alireza , Moradi Samaneh , Iranpour Hamidreza , Tabasi Ehsan , Eskandarion Mohammad Reza , Azizian Reza , Tabasi Mohsen
Published: May 2021

Introduction: Obesity is a well-known risk factor for a variety of gastrointestinal disorders (GID). Helicobacter pylori is associated with different GID, such as gastric cancer and chronic gastritis. In this study, we investigated the prevalence of dominant genotypes in H. pylori isolated from obese patients diagnosed with gastric ulcer, duodenal ulcer, and gastric cancer. Methods: A total of 222 H. pylori-positive samples were collected from patients with obesity. GID and gastric cancer were identified by endoscopy and histopathology, respectively. Three biopsy specimens from the gastric antrum were obtained from each patient for culture tests, histological examination, and identification of vacuolating cytotoxin A (vacA) (vacA s1, vacA s2, vacA m1, vacA m2, vacA s1m1 vacA s1m2, vacA s2m1, and vacA s2m2), cagA, cagE, iceA1, oipA, dupA, and babA2 using polymerase chain reaction. Results: vacA, cagE, cagA, iceA1, oipA, dupA, and babA2 genes were detected in 222 (100%), 171 (77%), 161 (72.5%), 77 (34.6%), 77 (34.6%), 137 (61%), and 69 (31%) patients with obesity, respectively. Our findings revealed that vacA, iceA1, oipA, and babA2 were significantly associated with a higher risk of GID, while cagE, cagA, and dupA indicated no correlation with the development of GID. Also, in the combination of s- and m-region genotypes, s1m2 (79%) was the most frequently identified genotype in patients with obesity. A significant association was also found between cagA and the presence of vacA genotypes (except for vacA m1 and babA2). Conclusions: This study indicated the high prevalence of different virulence genes in H. pylori isolated from obese patients and supported the significant role of H. pylori in the development of GID.
Mulheres no cinema de Helena Solberg: entre múltiplos olhares e vozes, os documentários A Entrevista (1966) e The Double Day (1975)
Authors: Silva Meire Oliveira
Published: May 2021

A tentativa de estabelecer uma linha evolutiva em perspectiva comparada na análise das identidades e vivências de mulheres, a partir dos documentários A entrevista (1966) e The double day (1975), de Helena Solberg, é também a tentativa de apreender dois momentos distintos destas obras. Sua autora vivenciou a experiência de olhar e mergulhar na América Latina somente quando fora do Brasil, após o AI-5, e já radicada na capital norte-americana, Washington. No entanto, ao acompanhar a trajetória das trabalhadoras de cidades e vilarejos latino-americanos, em fábricas ou na mineração, ressaltam-se a força e a multiplicidade do ser-mulher. Sua filmografia então volta-se, definitivamente, para questões sociais que a acompanham até produções recentes, que mantêm as escolhas voltadas às mulheres, talvez, a sua principal temática.
Inequities in Hypertension Control in the United States Exposed and Exacerbated by COVID‐19 and the Role of Home Blood Pressure and Virtual Health Care During and After the COVID‐19 Pandemic
Authors: Bress Adam P. , Cohen Jordana B. , Anstey David Edmund , Conroy Molly B. , Ferdinand Keith C. , Fontil Valy , Margolis Karen L. , Muntner Paul , Millar Morgan M. , Okuyemi Kolawole S. , Rakotz Michael K. , Reynolds Kristi , Safford Monika M. , Shimbo Daichi , Stuligross John , Green Beverly B. , Mohanty April F.
Published: May 2021

The COVID‐19 pandemic is a public health crisis, having killed more than 514 000 US adults as of March 2, 2021. COVID‐19 mitigation strategies have unintended consequences on managing chronic conditions such as hypertension, a leading cause of cardiovascular disease and health disparities in the United States. During the first wave of the pandemic in the United States, the combination of observed racial/ethnic inequities in COVID‐19 deaths and social unrest reinvigorated a national conversation about systemic racism in health care and society. The 4th Annual University of Utah Translational Hypertension Symposium gathered frontline clinicians, researchers, and leaders from diverse backgrounds to discuss the intersection of these 2 critical social and public health phenomena and to highlight preexisting disparities in hypertension treatment and control exacerbated by COVID‐19. The discussion underscored environmental and socioeconomic factors that are deeply embedded in US health care and research that impact inequities in hypertension. Structural racism plays a central role at both the health system and individual levels. At the same time, virtual healthcare platforms are being accelerated into widespread use by COVID‐19, which may widen the divide in healthcare access across levels of wealth, geography, and education. Blood pressure control rates are declining, especially among communities of color and those without health insurance or access to health care. Hypertension awareness, therapeutic lifestyle changes, and evidence‐based pharmacotherapy are essential. There is a need to improve the implementation of community‐based interventions and blood pressure self‐monitoring, which can help build patient trust and increase healthcare engagement.
Clinicopathological patterns and survival outcomes of colorectal cancer among young adults in Malaysia: an institutional cohort study
Authors: Wong SW , Ling DY , Yeow RQ , Chong RW , Aziz R , Aziz NA , Poh KS , Roslani AC
Published: May 2021

INTRODUCTION This study aimed to investigate the clinicopathological patterns and survival outcomes of patients with young-onset colorectal cancer (CRC) in Malaysia. METHODS A total of 206 patients with young-onset CRC (age < 50 years at diagnosis) and 1,715 patients with late-onset CRC (age ≥ 50 years at diagnosis) diagnosed during 2002–2016 were included. The clinicopathological characteristics of patients with young-onset CRC were compared with those of patients with late-onset CRC during 2009–2013. Kaplan-Meier survival analysis was performed to determine the overall survival (OS) and disease-specific survival (DSS) in these patients. RESULTS The overall proportion of young-onset CRC was 10.7%. The mean age for young-onset CRC was 39.5 ± 7.4 years, with a male-to-female ratio of 1.2:1. There were more Malay patients with young-onset CRC than late-onset CRC (44.0% vs. 19.9%, p = 0.004). Most CRCs were diagnosed at an advanced stage in both groups. However, young-onset CRC showed more aggressive tumour characteristics, such as poorer differentiation and mucinous subtype. Despite such differences, the OS and DSS in both groups were similar (five-year OS for young-onset CRC vs. late-onset CRC: 44.2% vs. 49.0%, p = 0.40; five-year DSS for young-onset CRC vs. late-onset CRC: 48.8% vs. 57.6%, p = 0.53; mean survival of young-onset CRC vs. late-onset CRC: 4.9 years vs. 5.4 years, p = 0.15). Advanced stage at diagnosis and the treatment modality used were independent prognostic factors. CONCLUSION The unique ethnic and histological differences between patients with young- and late-onset CRC suggest that young-onset CRC may represent a distinct entity. However, despite such differences, both groups were equivalent.
Bone densitometry measurements in children with neurofibromatosis Type 1 using quantitative computed tomography
Authors: Tezol Ozlem , Balcı Yuksel , Alakaya Mehmet , Gundogan Begumhan , Cıtak Elvan Caglar
Published: May 2021

Introduction:

Neurofibromatosis type 1 (NF1) is an autosomal dominant neurocutaneous disease characterised by multisystemic involvement, including bone tissue. Deformities and reduced bone mass are the main bone manifestations in NF1. Quantitative computed tomography (QCT) provides true volumetric bone mineral density (BMD) measurement. This study aimed to evaluate bone metabolism parameters and BMD in children with NF1 using QCT.

Methods:

The data of 52 paediatric NF1 patients (23 female, 29 male) was evaluated retrospectively. We investigated anthropometric measurements, biochemical parameters like total calcium, phosphate, magnesium, alkaline phosphatase, 25-hydroxyvitamin D (25OHD), parathyroid hormone, calcitonin, urinary calcium/creatinine ratio, and QCT parameters like lumbar trabecular and cortical BMD, trabecular area and cortical thickness. Comparisons of gender and puberty status were performed.

Results:

25% of patients had skeletal deformities and 42.3% had 25OHD inadequacy (<20 ng/mL). The frequency of 25OHD inadequacy was significantly higher in pubertal/postpubertal patients than prepubertal patients (61.9% vs. 29.0%, P = 0.019). Trabecular BMD Z-score was <−2.0 in 11.5% of patients; all with low BMD were at the pubertal/postpubertal stage. There was a significant negative correlation between age and trabecular Z-score (r = −0.41, P = 0.003). Mean cortical BMD was statistically similar between the genders and puberty groups. Puberty status, anthropometric Z-scores, and biochemical and QCT parameters were statistically similar between the genders (P > 0.05).

Conclusion:

Paediatric NF1 patients may present with low BMD and 25OHD inadequacy, especially at puberty. QCT may be a useful tool to evaluate trabecular and cortical bone separately in NF1 patients.
Machine learning in medicine: what clinicians should know
Authors: Sim Jordan Zheng Ting , Fong Qi Wei , Huang Weimin , Tan Cher Heng
Published: May 2021

With the advent of artificial intelligence (AI), machines are increasingly being used to complete complicated tasks, yielding remarkable results. Machine learning (ML) is the most relevant subset of AI in medicine, which will soon become an integral part of our everyday practice. Therefore, physicians should acquaint themselves with ML and AI, and their role as an enabler rather than a competitor. Herein, we introduce basic concepts and terms used in AI and ML, and aim to demystify commonly used AI/ML algorithms such as learning methods including neural networks/deep learning, decision tree and application domain in computer vision and natural language processing through specific examples. We discuss how machines are already being used to augment the physician’s decision-making process, and postulate the potential impact of ML on medical practice and medical research based on its current capabilities and known limitations. Moreover, we discuss the feasibility of full machine autonomy in medicine.
The Early Judeo-Persian Letter L3 from the Cairo Genizah (Cambridge University Library T-S 18J3.16)
Authors: Paul Ludwig
Published: May 2021

The article presents the edition and translation of an Early Judeo-Persian (EJP) private-commercial letter that was probably written around the late 10th or early 11th century C.E. It is the best-preserved and, with 51 lines, the longest from the ca. 25 EJP documents that were found in the Cairo Genizah. It is written in a cursive form of the Hebrew script and shows typical EJP archaic and dialectal features, as compared to the contemporaneous Early New Persian works that were written in Arabic script. Today, the letter is kept in Cambridge University Library as part of the Taylor-Schaechter collection.
Queering American Military History
Authors: Whitt Jacqueline E.
Published: May 2021

This historiographical article examines the state of the field of Lesbian, Gay, Bisexual, Transgender, and Queer (lgbtq) history in the United States military. It examines the field’s foundations and legacies from women’s history and the history of gender and sexuality as well as three threads that run through the field: sexuality and gender; sexuality, state control and citizenship; and sexuality and lived experience. The essay also explores interdisciplinary and theoretical connections and suggests areas for future research. The article argues that uncovering, centring, and mainstreaming lgbtq history – that is queering military history – is central to the broader field of military history because it relates to questions of power and the organisation of sexuality and gender performance and identity.
A new gypsicolous species of Launaea (Asteraceae, Cichorieae) from north Somalia

Authors: BALDESI GIACOMO , KILIAN NORBERT
Published: May 2021

Launaea calmadowensis from Saanag Region in north Somalia is described as a species new to science and illustrated, based on a single gathering known from a hitherto unidentified part of a collection made by R. Bavazzano & J. J. Lavranos in 1970/71 and preserved at FT Herbarium. It is inferred from the comparison of diagnostic morphological characters that this species from gypsaceous hills belongs to the L. angustifolia group of L. sect. Zollikoferia and is most closely related to the North African L. quercifolia.
A new species of Drosera section Arachnopus (Droseraceae) from the western Kimberley, Australia, and amendments to the range and circumscription of Drosera finlaysoniana

Authors: KRUEGER THILO , FLEISCHMANN ANDREAS
Published: May 2021

A new annual species of Drosera section Arachnopus, Drosera margaritacea, from the western Kimberley region (Western Australia) is described and illustrated, including detailed comparisons with the morphologically most similar species, D. finlaysoniana. The latter name is lectotypified here. The global range of D. finlaysoniana is provided, including a doubtful first record for Thailand, while the species, in contrast with statements made in some published references, does not occur in India, Laos, Cambodia and the Philippines. Additionally, the first record from Indonesia of the frequently misidentified D. aquatica is reported.
Miconia lorenaensis (Melastomataceae), a new species from Colombian Andes

Authors: MURILLO-SERNA JHON S. , LONDOÑO-ECHEVERRI YEISON , DAVID-HIGUITA HERIBERTO
Published: May 2021

A new species of Melastomataceae from the Andes of Colombia is described and illustrated. Miconia lorenaensis is part of Miconia sect. Amblyarrhena, and it differs from other species in this group by the combination of branches, petioles and leaves covered by scattered short dendritic trichomes, 7-nerved peltate leaves, acuminate or cuspidate apex with a circinate-thickened tip and flowers with completely inferior, 3-locular ovary. Comments about its distribution, habitat, phenology and taxonomic affinities are provided.
Phylloporia moricola sp. nov. (Hymenochaetales, Basidiomycota) from China

Authors: WU SHENG-HUA , CHANG CHIUNG-CHIH , WEI CHIA-LING , JIANG GUO-ZHENG
Published: May 2021

Phylloporia moricola is described as a new species based on collections from Sichuan Province, China. All studied basidiocarps grow on trunks of Morus sp. This new species is supported by morphological features and phylogenetic analyses of DNA sequences inferred from a dataset of nuc 28S rDNA. P. moricola is characterized by having effused-reflexed to pileate basidiocarps, pores 7–9 per mm, duplex context with a black line when young, dimitic hyphal system, and brownish, slightly thick-walled basidiospores generally measuring 3.4–4 × 2.7–3.2 μm. Phylloporia moricola is phylogenetically most closely related to Phylloporia mori, that also occurs on Morus sp., but that species differs from P. moricola in having hymenial setae and larger basidiospores (4–4.8 × 3.1–3.8 μm).
A new species of Metaruncina (Gastropoda: Heterobranchia: Runcinida) from Vietnam with a discussion on the so-called rudimentary radula in runcinids
Authors: CHERNYSHEV ALEXEI V.
Published: May 2021

Marine heterobranch slugs of the order Runcinida comprise 61 species, most of which inhabit the Atlantic Ocean and are referred to the genus Runcina. The Runcinida of the Pacific Ocean have been much less studied to date: only 12 species, from the genera Metaruncina Baba, 1967, Rfemsia Chernyshev, 1999, Runcinida Burn, 1963, Runcinella Odhner, 1924, Pseudoilbia M. C. Miller & Rudman, 1968, and Runcina Forbes [in Forbes and Hanley], 1851, have been described from the region. Metaruncina, Rfemsia, and Runcinida are found in the Pacific Ocean only (Baba 1954, 1967; Burn 1963; Gosliner 1991; Chernyshev 1998, 1999, 2005, 2006). The genus Metaruncina, endemic from the Pacific coast of Asia, includes two species: M. setoensis (Baba, 1954) and M. nhatrangensis Chernyshev, 2005. The latter is the only runcinid described from the coastal waters of the South China Sea, where it was found in the bays of Nha Trang and Van Phong (Chernyshev 2005). During subsequent expeditions to the coastal waters of Vietnam, this species was also recorded from off Tho Chu Island (09°19’N, 103°30’E) and off Nam Du Island (09°43′ N, 104°23′ E). However, in addition to this common species, an undescribed species of Metaruncina was collected. A description of this new species is provided in the present paper. Type material was deposited at the Museum of the A.V. Zhirmunsky National Scientific Center of Marine Biology FEB RAS, Vladivostok, Russia (MIMB).
A review of the Glossogobius giuris complex in Australia, with wider discussion on nomenclature and possible synonymies
Authors: HOESE DOUGLASS F. , HAMMER MICHAEL P.
Published: May 2021

Two species that had previously been referred to as Glossogobius giuris from Australia are redescribed and tentatively treated as Glossogobius giuris and Glossogobius laticeps. The two species are largely allopatric in Australia with G. laticeps found on the east coast of Queensland and some rivers of the Northern Territory, while G. giuris is distributed from the Northern Territory to rivers of the west coast of Western Australia. The two species are known to be genetically distinct and with some differences in colour patterns. Morphological features separating the species are minor and there is considerable overlap in many of the characters separating them. High variation in the Hammersley Ranges and Kimberley region of Western Australia further complicates separation of the species. The status of the Glossogobius giuris group from India is discussed as a key area to resolving an overall “giuris” species complex. Information is provided on the current identity of a number of species that had previously been considered synonyms of Glossogobius giuris. Extant types and difficulties assigning the types of known species are also discussed. A key is provided to aid identification of Australian species of Glossogobius.
Pediatric Surgical Reentry Strategy Following the COVID-19 Pandemic: A Tiered and Balanced Approach
Authors: Pickens Ryan C. , Kao Angela M. , Williams Mark A. , Herman Andrew C. , Kneisl Jeffrey S.
Published: May 2021

Background

In response to the COVID-19 pandemic, children’s hospitals across the country postponed elective surgery beginning in March 2020. As projective curves flattened, administrators and surgeons sought to develop strategies to safely resume non-emergent surgery. This article reviews challenges and solutions specific to a children’s hospital related to the resumption of elective pediatric surgeries. We present our tiered reentry approach for pediatric surgery as well as report early data for surgical volume and tracking COVID-19 cases during reentry.

Methods

The experience of shutdown, protocol development, and early reentry of elective pediatric surgery are reported from Levine’s Children’s Hospital (LCH), a free-leaning children’s hospital in Charlotte, North Carolina. Data reported were obtained from de-identified hospital databases.

Results

Pediatric surgery experienced a dramatic decrease in case volumes at LCH during the shutdown, variable by specialty. A tiered and balanced reentry strategy was implemented with steady resumption of elective surgery following strict pre-procedural screening and testing. Early outcomes showed a steady thorough fluctuating increase in elective case volumes without evidence of a surgery-associated positive spread through periprocedural tracking.

Conclusion

Reentry of non-emergent pediatric surgical care requires unique considerations including the impact of COVID-19 on children, each children hospital structure and resources, and preventing undue delay in intervention for age- and disease-specific pediatric conditions. A carefully balanced strategy has been critical for safe reentry following the anticipated surge. Ongoing tracking of resource utilization, operative volumes, and testing results will remain vital as community spread continues to fluctuate across the country.
Drug dosing using estimated glomerular filtration rate: Misclassification due to metamizole interference in a creatinine assay
Authors: Bojko Luana , Ripka Gustavo de Paula , Dionísio Laura Mattana , Borges Celso Luiz , Borato Danielle Cristyane Kalva , Moss Mariane de Faria
Published: May 2021

Background

The estimated glomerular filtration rate is a rather important measurement for patients under intensive care, since they often receive several drugs, and impaired renal function may result in misleading dosing. The estimated glomerular filtration is derived from mathematical models using serum creatinine, a measurement that suffers interference of some drugs, such as metamizole. This study intended to evaluate the impact on patient stratification for dose adjustment of two antimicrobials (meropenem and vancomycin) caused by metamizole interference in creatinine measurement by dry chemistry.

Methods

A cross-sectional study was conducted with a group of 108 hospitalized patients under metamizole prescriptions at fixed intervals. Serum creatinine concentrations were determined by enzymatic dry chemistry and Jaffé assays, and the estimated glomerular filtration rate was calculated through the CKD-EPI equation. Patients were stratified in groups according to their estimated glomerular filtration rate for drug dosing of vancomycin and meropenem.

Results

Creatinine values were significantly lower in measurements performed by the dry chemistry method in comparison to Jaffé assay ( P < 0.0001) when patients are under metamizole treatment. A significant bias (–40.3%) was observed between those two methods, leading to a significant difference ( P < 0.0001) in patient classification according to renal function using the CKD-EPI equation for dosing adjustment.

Conclusions

During the validity of metamizole treatment, the stratification for drug dosing by the estimated glomerular filtration rate is not reliable if the creatinine measurement is done through dry chemistry. Clinical and laboratory staff must be aware of these limitations and cooperate to optimize pharmacotherapy.
Routine use of natriuretic peptides: Lessons from a big data analysis
Authors: Goudot FX , Msadek S , Boukertouta T , Schischmanoff PO , Meune C
Published: May 2021

Background

Natriuretic peptides have broad indications during heart failure and the detection of left ventricular dysfunction in high-risk patients. They can also be used for the diagnosis/management of other cardiac diseases. However, very little is known regarding their use in routine practice.

Methods

We examined all biological tests performed from February 2010 to August 2015 in two districts from the French Brittany, covering 13,653 km2 and including 22,265 physicians. We report the settings and conditions of N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements (the only locally natriuretic peptide available).

Results

From a total of 3,606,432 tests requested in 557,650 adult (older than 20 years) patients, only 56,653 (1.6%) included at least one NT-proBNP measurement. NT-proBNP measurements gradually increased, from 9188 in 2011 to 12,938 in 2014 ( P < 0.001). Most NT-proBNP tests were measured in urban laboratories (72.7%) and in private (62.9%) non-hospital/clinics laboratories; they were mostly ordered by general practitioners (66% compared with 11% by cardiologists). The number of NT-proBNP measurements increased with age up to 80–90 years, and 70.3% of tests were measured in ≥75 years patients. Creatinine and electrolytes were not associated with NT-proBNP in 15.8% and 19.7% of tests, respectively.

Conclusion

Among a very large cohort, we observed that natriuretic peptides remain largely undermeasured. NT-proBNP is mostly measured in elderly patients, and its interpretation may be hazardous in up to 16% of all individuals because no measurement of creatinine was associated to NT-proBNP.
Neural, behavioural and real-life correlates of social context sensitivity and social reward learning during interpersonal interactions in the schizophrenia spectrum
Authors: Hanssen Esther , van Buuren Mariët , Van Atteveldt Nienke , Lemmers-Jansen Imke LJ , Fett Anne-Kathrin J
Published: May 2021

Objective:

Recent findings suggest that diminished processing of positive contextual information about others during interactions may contribute to social impairment in the schizophrenia spectrum. This could be due to general social context processing deficits or specific biases against positive information. We studied the impact of positive and negative social contextual information during social interactions using functional neuroimaging and probed whether these neural mechanisms were associated with real-life social functioning in schizophrenia spectrum disorders.

Methods:

Patients with a schizophrenia spectrum disorder ( N = 23) and controls disorder ( N = 25) played three multi-round trust games during functional magnetic resonance imaging scanning, with no, positive and negative information about the counterpart’s trustworthiness, while all counterparts were programmed to behave trustworthy. The main outcome variable was the height of the shared amount in the trust game, i.e. investment, representing an indication of trust. The first investment in the game was considered to be basic trust, since no behavioural feedback was given yet. We performed region-of-interest analyses and examined the association with real-life social functioning using the experience sampling method.

Results:

Social contextual information had no effect on patients’ first investments, whereas controls made the lowest investment after negative and the highest investments after positive contextual information was provided. Over trials, patients decreased investments, suggesting reduced social reward learning, whereas controls increased investments in response to behavioural feedback in the negative context. Patients engaged the dorsolateral prefrontal cortex less than controls during context presentation and showed reduced activity within the caudate during repayments. In patients, lower investments were associated with more time spent alone and social exclusion and lower caudate activation was marginally significantly associated with higher perceived social exclusion.

Conclusion:

The failure to adapt trust to positive and negative social contexts suggests that patients have a general insensitivity to prior social information, indicating top-down processing impairments. In addition, patients show reduced sensitivity to social reward, i.e. bottom-up processing deficits. Moreover, lower trust and lower neural activation were related to lower real-life social functioning. Together, these findings indicate that improving trust and social interactions in schizophrenia spectrum needs a multi-faceted approach that targets both mechanisms.