bluuebunny/crossref_metadata_2025 huggingface dataset:
Mid-Term Results Comparing the Use of Artificial Chords Versus Native Chords for Mitral Valve Repair in Children
Authors: Sivalingam Sivakumar , Haranal Maruti , Moorthy Paneer Selvam Krishna , Dillon Jeswant , Kong Pau Kiew , Fariza Intan , Yakub Mohd. Azhari
Published: August 2020

Background:

Our study is aimed at evaluating the mid-term surgical outcomes of mitral valve repair in children using various chordal reconstructive procedures (autologous in situ chords or artificial chords).

Methods:

A retrospective analysis of 154 patients who underwent mitral valve repair using various chordal reconstructive procedures from 1992 to 2012. Patients were divided into group A and group B based on use of artificial chords and autologous in situ chords, respectively, for the repair. There were 102 (66.2%) patients in group A and 52 (33.8%) patients in group B. The mean age at repair was 11.1 ± 4.5 years. Associated cardiac anomalies were found in 94 (61%) patients.

Results:

The median follow-up period was 4.2 years (Interquartile range: 2.0-9.9). There were two (1.3%) early deaths and five (3.2%) late deaths. There was no significant difference in survival at 15 years between the two groups (group A: 91.8% vs group B: 95.1%; P = .66). There was no significant difference in the freedom from reoperation at 15 years between group A (79.4%) and group B (97.2%; P = .06). However, there was significant difference in freedom from valve failure between group A (56.5%) and group B (74.1%; P = .03). Carpentier functional class III and postoperative residual mitral regurgitation (2+ MR, ie, mild–moderate MR) were the risk factors for valve failure.

Conclusions:

Severity of the disease and its progression has profound effect on the valve repair than the technique itself. Both chordal reconstructive procedures can be used to produce satisfactory results in children.
Monocusp Valves Do Not Improve Early Operative Mortality in Tetralogy of Fallot: A Meta-Analysis
Authors: Awori Mark N. , Awori Jonathan A. , Mehta Nikita P. , Makori Obed
Published: August 2020

Monocusp valves are thought to reduce early operative mortality and morbidity associated with pediatric tetralogy of Fallot repair. As there are no published randomized clinical trials comparing outcomes with and without a monocusp valve, we performed a meta-analysis of observational studies in accordance with established protocols. After systematically searching PubMed, the Cochrane Library, and Google Scholar, 12 studies were included. The operative mortality was compared in 695 patients, and we found no difference between patients with and patients without a monocusp valve. Monocusp valves may not improve operative mortality of tetralogy of Fallot repair in pediatric patients.
Three-Dimensional Printing of Fetal Heart With d-Transposition of the Great Arteries From Ultrasound Imaging Data
Authors: Veronese Paola , Bertelli Francesco , Cattapan Claudia , Andolfatto Matteo , Gervasi Maria Teresa , Vida Vladimiro L.
Published: August 2020

We reconstructed and printed a 3D model of the fetal heart affected by d-transposition of the great arteries from prenatal ultrasound images. Our 3D model revealed to be very helpful in showing the basic anatomical features of fetal complex Congenital Heart Disease (CHD) and represents an interesting additional diagnostic tool to the current standard imaging armamentarium, improving the quality of prenatal parental counseling.
Neonates With Complex Cardiac Malformation and Congenital Diaphragmatic Hernia Born to SARS-CoV-2 Positive Women—A Single Center Experience
Authors: Goldshtrom Nimrod , Vargas Diana , Vasquez Angelica , Kim Faith , Desai Kinjal , Turner Mariel E. , Barry Oliver , Torres Alejandro , Levasseur Stéphanie , Strletsova Svetlana , Gupta Palka R. , Defazio Jennifer R. , Duron Vincent , Middlesworth William , Saiman Lisa , Miller Russell , Goffman Dena , Bacha Emile A. , Kalfa David , LaPar Damien J. , Krishnamurthy Ganga
Published: August 2020

Background:

Our understanding of the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on pregnancies and perinatal outcomes is limited. The clinical course of neonates born to women who acquired coronavirus disease 2019 (COVID-19) during their pregnancy has been previously described. However, the course of neonates born with complex congenital malformations during the COVID-19 pandemic is not known.

Methods:

We report a case series of seven neonates with congenital heart and lung malformations born to women who tested positive for SARS-CoV-2 during their pregnancy at a single academic medical center in New York City.

Results:

Six infants had congenital heart disease and one was diagnosed with congenital diaphragmatic hernia. In all seven infants, the clinical course was as expected for the congenital lesion. None of the seven exhibited symptoms generally associated with COVID-19. None of the infants in our case series tested positive by nasopharyngeal test for SARS-CoV-2 at 24 hours of life and at multiple points during their hospital course.

Conclusions:

In this case series, maternal infection with SARS-CoV-2 during pregnancy did not result in adverse outcomes in neonates with complex heart or lung malformations. Neither vertical nor horizontal transmission of SARS-CoV-2 was noted.
Multimorbidity and mortality in Ontario, Canada: A population-based retrospective cohort study
Authors: Ryan BL , Allen B , Zwarenstein M , Stewart M , Glazier RH , Fortin M , Wetmore SJ , Shariff SZ
Published: August 2020

Objective:

To examine the relationship between multimorbidity and mortality, and whether relationship varied by material deprivation/rural location and by age.

Methods:

Retrospective population-based cohort study conducted using 2013–14 data from previously created cohort of Ontario, Canada residents classified according to whether or not they had multimorbidity, defined as having 3+ of 17 chronic conditions. Adjusted rate ratios were calculated to compare mortality rates for those with and without multimorbidity, comparing rates by material deprivation/rural location, and by age group.

Results:

There were 13,581,191 people in the cohort ages 0 to 105 years; 15.2% had multimorbidity. Median length of observation was 365 days. Adjusted mortality rate ratios did not vary by material deprivation/rural location; overall adjusted mortality rate ratio was 2.41 (95% CI 2.37–2.45). Adjusted mortality rate ratios varied by age with ratios decreasing as age increased. Overall rate ratio was 14.7 (95% CI 14.48–14.91). Children (0–17 years) had highest ratio, 40.06 (95% CI 26.21–61.22). Youngest adult age group (18–24 years) had rate ratio of 9.96 (95% CI 7.18–13.84); oldest age group (80+ years) had rate ratio of 1.97 (95% CI 1.94–2.04).

Conclusion:

Compared to people without multimorbidity, multimorbidity conferred higher risk of death in this study at all age groups. Risk was greater in early and middle adulthood than in older ages. Results reinforce the fact multimorbidity is not just a problem of aging, and multimorbidity leads not only to poorer health and higher health care utilization, but also to a higher risk of death at a younger age.
Development of a Deep Neural Network for Speeding Up a Model of Loudness for Time-Varying Sounds
Authors: Schlittenlacher Josef , Turner Richard E. , Moore Brian C. J.
Published: August 2020

The “time-varying loudness” (TVL) model of Glasberg and Moore calculates “instantaneous loudness” every 1 ms, and this is used to generate predictions of short-term loudness, the loudness of a short segment of sound, such as a word in a sentence, and of long-term loudness, the loudness of a longer segment of sound, such as a whole sentence. The calculation of instantaneous loudness is computationally intensive and real-time implementation of the TVL model is difficult. To speed up the computation, a deep neural network (DNN) was trained to predict instantaneous loudness using a large database of speech sounds and artificial sounds (tones alone and tones in white or pink noise), with the predictions of the TVL model as a reference (providing the “correct” answer, specifically the loudness level in phons). A multilayer perceptron with three hidden layers was found to be sufficient, with more complex DNN architecture not yielding higher accuracy. After training, the deviations between the predictions of the TVL model and the predictions of the DNN were typically less than 0.5 phons, even for types of sounds that were not used for training (music, rain, animal sounds, and washing machine). The DNN calculates instantaneous loudness over 100 times more quickly than the TVL model. Possible applications of the DNN are discussed.
Hearing-Impaired Listeners Show Reduced Attention to High-Frequency Information in the Presence of Low-Frequency Information
Authors: Roverud Elin , Dubno Judy R. , Kidd Gerald
Published: August 2020

Many listeners with sensorineural hearing loss have uneven hearing sensitivity across frequencies. This study addressed whether this uneven hearing loss leads to a biasing of attention to different frequency regions. Normal-hearing (NH) and hearing-impaired (HI) listeners performed a pattern discrimination task at two distant center frequencies (CFs): 750 and 3500 Hz. The patterns were sequences of pure tones in which each successive tonal element was randomly selected from one of two possible frequencies surrounding a CF. The stimuli were presented at equal sensation levels to ensure equal audibility. In addition, the frequency separation of the tonal elements within a pattern was adjusted for each listener so that equal pattern discrimination performance was obtained for each CF in quiet. After these adjustments, the pattern discrimination task was performed under conditions in which independent patterns were presented at both CFs simultaneously. The listeners were instructed to attend to the low or high CF before the stimulus (assessing selective attention to frequency with instruction) or after the stimulus (divided attention, assessing inherent frequency biases). NH listeners demonstrated approximately equal performance decrements (re: quiet) between the two CFs. HI listeners demonstrated much larger performance decrements at the 3500 Hz CF than at the 750 Hz CF in combined-presentation conditions for both selective and divided attention conditions, indicating a low-frequency attentional bias that is apparently not under subject control. Surprisingly, the magnitude of this frequency bias was not related to the degree of asymmetry in thresholds at the two CFs.
A Compassionate Framework for Reducing Harm in Public Health Higher Education: Implications for the COVID-19 Pandemic
Authors: Burke Jessica G. , Egan James E. , Coulter Robert W. S. , Mitchell Shannon , Olaniyan Abisola , Hawk Mary
Published: August 2020

We believe a harm reduction framework offers guidance for managing the student-teacher relationship in pandemic situations. This commentary defines the six principles of harm reduction (humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination) and describes how these principles can be applied within the public health higher educational system in the COVID-19 era. The key points are intended to stimulate thought and discussion about how to balance general uncertainty, concerns about what is best for population and personal health, the tensions between collectivism and individualism, and our commitment to training and protecting the health of the next generation of public health professionals. We recommend that educators, in public health and other higher education settings, use the harm reduction principles to guide their interactions with students and to build more compassionate and collectivist communities that allow people to learn and thrive.
Effect of Targeted Curricular Reform on the Learning Environment, Student Empathy, and Hidden Curriculum in a Medical School: A 7-Year Longitudinal Study
Authors: Zgheib Nathalie K , Dimassi Zakia , Arawi Thalia , Badr Kamal F , Sabra Ramzi
Published: August 2020

Objective:

The American University of Beirut Faculty of Medicine follows the American model of medical education. In 2013-2014, a carefully designed new curriculum replaced the previous, largely traditional curriculum, and aimed to improve student wellbeing, upgrade the learning environment, enhance student empathy, and counter the negative influences of the hidden curriculum. This longitudinal study assessed the effectiveness of the new curriculum in those domains over a period of 7 years.

Methods:

Three cohorts of medical students anonymously filled a paper-based survey at the end of years 1, 2, 3, and 4 of the 4-year curriculum. These included the Class of 2016, the last batch of students who followed the old curriculum, and 2 cohorts that followed the new curriculum (Class of 2017 and Class of 2019). The perceived learning environment was assessed by the Dundee Ready Education Environment Measurement survey; the student’s empathy was assessed by the Jefferson Scale of Physician Empathy-Student version; and the hidden curriculum was examined using a locally developed survey.

Results:

The scores on the learning environment survey were significantly higher among the cohorts following the new curriculum relative to those following the old curriculum. Similar significant results appeared when looking at each of the subscales for the learning environment. The students’ empathy scores were also significantly higher in both cohorts of the new curriculum when compared with the old curriculum. Nevertheless, there was a significant decrease in empathy in both third and fourth years relative to second year. The new curriculum also improved aspects of the students’ perceptions and responses to the hidden curriculum.

Conclusion:

In conclusion, a well-planned and well-researched curricular intervention, based on sound educational theories, practices, and standards can indeed transform the learning environment, as well as the attitudes, values, and experiences of medical students.
Mapping China’s regional economic activity by integrating points-of-interest and remote sensing data with random forest
Authors: Chen Qian , Ye Tingting , Zhao Naizhuo , Ding Mingjun , Ouyang Zutao , Jia Peng , Yue Wenze , Yang Xuchao
Published: August 2020

Nighttime light imageries are widely used for mapping the gross domestic product (GDP) over large areas. However, nighttime light imagery is inappropriate to disaggregate agricultural GDP and inadequate to differentiate the GDP from the secondary and tertiary sectors. Points-of-interest, a kind of geospatial big data with geographic locations and textual descriptions of the category, can effectively distinguish industrial and commercial areas, and therefore have the potential to improve the precise GDP mapping from secondary and tertiary sectors. In this study, a machine learning method, random forest, was used to disaggregate the 2010 county-level census GDP data of mainland China to 1 km × 1 km grids. Six Random Forest models were constructed for different economic sectors to explore the non-linear relationships between various geographic predictors and GDP from different sectors. By fusing points-of-interest of varying categories, the spatial distribution of economic activities from the secondary and tertiary sectors was effectively distinguished. Compared to previous studies, the strategy of developing specific Random Forest models for different sectors generated a more reasonable distribution of GDP. Our results highlight the feasibility of using point-of-interest data in disaggregating non-agricultural GDP by exploiting the complementary features of the different data sources.
Case Report: Watching and Waiting? A Case of Incomplete Glenosphere Seating With Spontaneous Reversal in Reverse Shoulder Arthroplasty
Authors: MacAskill Micah L , Thomas Rachel J , Barnes Leslie A
Published: August 2020

Introduction: Reverse shoulder arthroplasty is a useful procedure with broadening applications, but it has the best outcomes when used for rotator cuff tear arthropathy. However, this procedure is not without complications. While scapular notching and aseptic loosening are more common complications that have been extensively studied in the literature, dissociation of the glenoid component and incomplete glenosphere seating has not received much attention. Specifically, little research has explored appropriate management of incomplete seating of the glenosphere component, and no gold standard for treatment of this complication has emerged.

Methods: In the case described here, an elderly patient with an incompletely seated glenosphere component post-operatively opted to pursue conservative management in order to avoid revision surgery if possible.

Results: The partially engaged, superiorly directed components in this case exhibited spontaneous complete and symmetric seating of the glenosphere between six and twelve months post-operatively, indicating that conservative management of this complication in low-demand patients may be a viable option to avoid the risks associated with revision surgery.

Conclusion: Further research should be pursued to explore what patient and prosthesis design factors may be suited to observation with serial radiographs when incomplete seating of the glenosphere component occurs.
Optical Coherence Tomography Angiography Findings in Patients With Acute Syphilitic Posterior Placoid Chorioretinopathy
Authors: Farley Nathan , Pellegrini Marco , Marlow Elizabeth , Ruby Alan , Randhawa Sandeep
Published: August 2020

Purpose:

Acute syphilitic posterior placoid chorioretinopathy (ASPPC) is an uncommon and distinct manifestation of ocular syphilis necessitating immediate treatment. ASPPC is attributed to disruption of the choriocapillaris, retinal pigment epithelium, and photoreceptors. Optical coherence tomography angiography (OCTA) can evaluate choriocapillaris vascular flow and may provide further information about ASPPC’s disease process.

Methods:

OCTA images from 7 eyes of 4 patients with ASPPC were compared before and after treatment when available.

Results:

All eyes demonstrated increased choriocapillaris vascular flow voids in the distribution of the ASPPC lesions at initial testing. Following treatment, decreased placoid lesion size was associated with decreased flow voids on OCTA along with improved ellipsoid zone integrity in 2 patients.

Conclusions:

Disruption of choriocapillaris vascular flow in ASPPC that causes outer retinal changes can improve following treatment as suggested by OCTA imaging. Some cases may continue to demonstrate decreased flow even after appropriate therapy.
Assessing the Effect of Demographic Background on Barriers to Seek Medical Attention for Psoriasis
Authors: Bray Jeremy K. , Feldman Steven R.
Published: August 2020

Background:

Lack of treatment or undertreatment of psoriasis is a major issue. Demographics might be related to specific barriers to health care.

Objective:

To assess the association between demographic background and barriers to seek medical attention for individuals with psoriasis.

Methods:

A total of 152 subjects with self-reported psoriasis were recruited through Amazon Mechanical Turk and surveyed via Qualtrics to assess the impact of demographics on health care barriers. Subjects were presented with an image of a psoriatic plaque on an elbow and asked to rate how large of a barrier they would face to seek care on a 1 to 10 scale. Outcome measures were compared using multiple linear regression.

Results:

Demographics were correlated with high cost of care (F(6,107) = 3.38, P < .01, R 2 = 0.16), lack of availability of services (F(6,60) = 2.84, P = .01, R 2 = 0.22), and lack of understanding treatment options (F(6,61) = 2.18, P = .05, R 2 = 0.18).

Conclusion:

Some demographic groups face higher rates of barriers to seek medical attention. These barriers may contribute to undertreatment of psoriasis.
Oxidized Lipids and Lipoprotein Dysfunction in Psoriasis
Authors: Sorokin Alexander V. , Remaley Alan T. , Mehta Nehal N.
Published: August 2020

Background:

Psoriasis is a chronic immune-mediated inflammatory skin disease associated with increased development of metabolic abnormalities including obesity and dyslipidemia, as well as increased cardiovascular disease (CVD) risk. Shared pathophysiological mechanisms linking psoriasis to CVD include altered immune activation, elevated chronic systemic inflammation, and lipoprotein dysfunction characterized by oxidative damage to lipids and apolipoproteins.

Objective:

This review aims to provide evidence-based proof for existing relationships between psoriatic inflammation, lipid oxidation, and increased CVD risk.

Methods:

We included review articles and original research papers, published between 1980 and 2020, using the following key words: psoriasis, oxidized lipids, oxidation, dyslipidemia, and inflammation.

Results:

Systemic inflammation underlying psoriasis leads to increased skin accumulation of pro-inflammatory oxidized lipids, derived from the omega-6 fatty acids, along with counteracting anti-inflammatory lipid mediators, products of the omega-3 polyunsaturated fatty acids. Imbalance in these metabolites culminates in impaired inflammation resolution and results in multisystemic biological alterations. Sustained systemic inflammation results in excessive lipid oxidation, generating proatherogenic oxidized low- and high-density lipoproteins. Together, these pathophysiological mechanisms contribute to increased CVD risk associated with psoriasis disease.

Conclusion:

Available anti-inflammatory treatment showed promising clinical results in treating psoriasis, although further research is warranted on managing associated dyslipidemia and establishing novel cardiometabolic markers specific for both skin and vascular pathology.
Tildrakizumab Shows Significant Efficacy in Psoriasis Treatment With Comorbid Immunoglobulin A Nephropathy: A Case Report
Authors: Song Eingun James
Published: August 2020

Background:

Chronic kidney disease is a relative contraindication for conventional systemic therapy in patients with psoriasis. Although biologic agents may be suitable in these patients due to their elimination via endogenous metabolism and protein degradation, no dedicated studies have evaluated the safety of biologics in patients with psoriasis and chronic kidney disease. Tildrakizumab—an anti-interleukin-23p19 monoclonal antibody—is approved for treatment of moderate-to-severe plaque psoriasis.

Objective:

To evaluate efficacy and safety of tildrakizumab in a 56-year-old woman with moderate-to-severe plaque psoriasis and comorbid immunoglobulin A nephropathy.

Methods:

Subcutaneous tildrakizumab 100 mg was administered at weeks 0, 4, 20, 33, and 48. Assessments included body surface area affected, physician’s global assessment score, and laboratory assessments.

Results:

At initial presentation, patient had predominantly plaque-type psoriasis involving 5% body surface area with a static physician’s global assessment score of 3. Patient failed an adequate trial of ultrapotent topical steroids. Baseline laboratory tests confirmed renal impairment with blood creatinine level of 2.0 mg/dL and an estimated glomerular filtration rate of 27.0 mL/min/1.73 m2. Administration of subcutaneous tildrakizumab 100 mg led to near-complete skin clearance by week 33, with a durable response to week 48. No treatment-related adverse events were reported through 48 weeks. Metabolic and hematological parameters remained grossly unchanged.

Conclusion:

Tildrakizumab was well tolerated and effective for treatment of moderate-to-severe plaque psoriasis in a patient with comorbid immunoglobulin A nephropathy.
Evaluation of the latent tuberculosis screening and treatment strategy for asylum seekers in Stockholm, Sweden 2015–2018: a record linkage study of the care cascade
Authors: Nederby Öhd Joanna , Hergens Maria-Pia , Luksha Yauheni , Buxbaum Charlotte , Shedrawy Jad , Jonsson Jerker , Bruchfeld Judith , Lönnroth Knut
Published: August 2020

Introduction

About 90% of active tuberculosis (TB) cases in Sweden are foreign born and are mainly due to latent TB infection (LTBI) reactivation. The aim of this study was to assess the current migrant LTBI screening programme with regards to test results and completion of the care cascade.

Method

A retrospective cohort of all 14173 individuals attending a health examination was established for the Stockholm Region 2015–2018 through record-linkage of data extracted from the Swedish Migration Authority and medical records. Screening results, referrals to specialist care and treatment initiation were ascertained through automated data extraction for the entire cohort. Detailed cascade steps, including treatment completion, were analysed through manual data extraction for a subsample of all persons referred to specialist care in the period 2016–2017.

Results

Of 5470 patients screened with an interferon-gamma release assay (IGRA), 1364 (25%) were positive, of whom 358 (26%) initiated LTBI treatment. An increased trend in IGRA-positivity was seen for increased age and TB-incidence in country of origin. Among the IGRA positive patients, 604 (44%) were referred to specialist care. Lower age was the main referral predictor. In the subsample of 443 patients referred to specialist care in 2016–2017, 386 (87%) were invited, of whom 366 (95%) attended. Of 251 patients (69%) recommended for LTBI treatment, 244 (97%) started such treatment and of those 221 (91%) completed it.

Conclusion

The low attrition in patient-dependent cascade steps shows that the voluntary approach works well. Low LTBI treatment attainment is due to the current conservative local treatment policy, which means the vast majority are IGRA-tested without an intention to treat for LTBI.
Type2 diabetes mellitus prediction using data mining algorithms based on the long-noncoding RNAs expression: a comparison of four data mining approaches
Authors: Kazerouni Faranak , Bayani Azadeh , Asadi Farkhondeh , Saeidi Leyla , Parvizi Nasrin , Mansoori Zahra
Published: August 2020

Background

About 90% of patients who have diabetes suffer from Type 2 DM (T2DM). Many studies suggest using the significant role of lncRNAs to improve the diagnosis of T2DM. Machine learning and Data Mining techniques are tools that can improve the analysis and interpretation or extraction of knowledge from the data. These techniques may enhance the prognosis and diagnosis associated with reducing diseases such as T2DM. We applied four classification models, including K-nearest neighbor (KNN), support vector machine (SVM), logistic regression, and artificial neural networks (ANN) for diagnosing T2DM, and we compared the diagnostic power of these algorithms with each other. We performed the algorithms on six LncRNA variables (LINC00523, LINC00995, HCG27_201, TPT1-AS1, LY86-AS1, DKFZP) and demographic data.

Results

To select the best performance, we considered the AUC, sensitivity, specificity, plotted the ROC curve, and showed the average curve and range. The mean AUC for the KNN algorithm was 91% with 0.09 standard deviation (SD); the mean sensitivity and specificity were 96 and 85%, respectively. After applying the SVM algorithm, the mean AUC obtained 95% after stratified 10-fold cross-validation, and the SD obtained 0.05. The mean sensitivity and specificity were 95 and 86%, respectively. The mean AUC for ANN and the SD were 93% and 0.03, also the mean sensitivity and specificity were 78 and 85%. At last, for the logistic regression algorithm, our results showed 95% of mean AUC, and the SD of 0.05, the mean sensitivity and specificity were 92 and 85%, respectively. According to the ROCs, the Logistic Regression and SVM had a better area under the curve compared to the others.

Conclusion

We aimed to find the best data mining approach for the prediction of T2DM using six lncRNA expression. According to the finding, the maximum AUC dedicated to SVM and logistic regression, among others, KNN and ANN also had the high mean AUC and small standard deviations of AUC scores among the approaches, KNN had the highest mean sensitivity and the highest specificity belonged to SVM. This study’s result could improve our knowledge about the early detection and diagnosis of T2DM using the lncRNAs as biomarkers.
Saving time maintaining reliability: a new method for quantification of Tetranychus urticae damage in Arabidopsis whole rosettes
Authors: Ojeda-Martinez Dairon , Martinez Manuel , Diaz Isabel , Santamaria M. Estrella
Published: August 2020

Background

The model species Tetranychus urticae produces important plant injury and economic losses in the field. The current accepted method for the quantification of the spider mite damage in Arabidopsis whole rosettes is time consuming and entails a bottleneck for large-scale studies such as mutant screening or quantitative genetic analyses. Here, we describe an improved version of the existing method by designing an automatic protocol. The accuracy, precision, reproducibility and concordance of the new enhanced approach are validated in two Arabidopsis accessions with opposite damage phenotypes. Results are compared to the currently available manual method.

Results

Image acquisition experiments revealed that the automatic settings plus 10 values of brightness and the black background are the optimal conditions for a specific recognition of spider mite damage by software programs. Among the different tested methods, the Ilastik-Fiji tandem based on machine learning was the best procedure able to quantify the damage maintaining the differential range of damage between accessions. In addition, the Ilastik-Fiji tandem method showed the lowest variability within a set of conditions and the highest stability under different lighting or background surroundings. Bland-Altman concordance results pointed out a negative value for Ilastik-Fiji, which implies a minor estimation of the damage when compared to the manual standard method.

Conclusions

The novel approach using Ilastik and Fiji programs entails a great improvement for the quantification of the specific spider mite damage in Arabidopsis whole rosettes. The automation of the proposed method based on interactive machine learning eliminates the subjectivity and inter-rater-variability of the previous manual protocol. Besides, this method offers a robust tool for time saving and to avoid the damage overestimation observed with other methods.
Femoral neuropathy following venoarterial-extracorporeal membrane oxygenation therapy: a case report
Authors: Jang Albert Youngwoo , Oh Young Jun , Lee Seok In , Lim Oh Kyung , Suh Soon Yong
Published: August 2020

Background

Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one’s quality of life.

Case presentation

A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling.

Conclusion

The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.
Metastatic pancreatic adenocarcinomas could be classified into M1a and M1b category by the number of metastatic organs
Authors: Feng Fang , Cai Wei , Wang Gaoming , Chen Weigang , Yang Haochang , Sun Mingyu , Zhou Li
Published: August 2020

Background

With the improvement of treatment and prognosis for patients with late malignant diseases, certain malignancies with distant metastasis (M1 category) have been further classified into M1a (single metastatic site) and M1b (multiple metastatic sites) category in the staging system. We aimed to assess the feasibility of sub-classifying metastatic pancreatic adenocarcinoma (mPA) into M1a and M1b category depending on the number of metastatic organs.

Methods

Patient records were collected from the Surveillance, Epidemiology, and End Results (SEER) database (2010–2015). Univariable and multivariable analyses were performed using the Cox regression model. Then survival analysis was determined using the Kaplan–Meier method.

Results

A total of 11,885 patients were included in this analysis, including 9425 patients with single metastasis and 2460 patients with multiple metastases. Multivariable analysis showed that gender, age, marital status, grade, surgery, chemotherapy, and radiotherapy were independent prognostic factors for patients with single metastasis; gender, age, marital status, grade, chemotherapy and radiotherapy were independent prognostic factors for patients with multiple metastases. Notably, surgery was an independent prognostic factor for patients with single metastasis (P < 0.001) but not for patients with multiple metastases (P = 0.134). Kaplan–Meier analysis showed that patients with single metastasis (M1a) had better survival outcomes than patients with multiple metastases (M1b) (P < 0.001).

Conclusions

PA patients with M1 diseases could be divided into M1a (single metastasis) category and M1b (multiple metastases) category by the number of metastatic organs. The subclassification would facilitate individualized treatment for late PA patients. Surgery was associated with lower mortality in M1a patients but not significantly in M1b patients.
Assessment of early renal angina index for prediction of subsequent severe acute kidney injury during septic shock in children
Authors: Huang Linlin , Shi Ting , Quan Wei , Li Weiming , Zhang Lili , Liu Xueping , Huang Saihu , Li Ying , Li Xiaozhong
Published: August 2020

Background

Acute kidney injury (AKI) is independently related to the adverse outcome of septic shock, but it lacks effective early predictors. Renal anginal index (RAI) was used to predict subsequent severe AKI (AKIs) in critically ill patients. The application of RAI in children with septic shock has not been reported. This study aims to evaluate the efficacy of early RAI in predicting subsequent AKIs within 3 days after PICU admission in children with septic shock by comparing with early fluid overload (FO) and early creatinine elevation.

Methods

Sixty-six children admitted to PICU aged 1 month to 16 years old, with septic shock from January 2016 to December 2019 were analyzed retrospectively. According to the 2012 Kidney Disease Improving Global outcomes (KDIGO) criteria, AKIs was defined by the KDIGO stage ≥2 within 3 days after PICU admission. Early RAI positive (RAI+) was defined as RAI ≥ 8 within 12 h of PICU admission. Any elevation of serum creatinine (SCr) over baseline within 12 h after PICU admission was denoted as “Early SCr > base”. Early FO positive (FO+) was defined as FO > 10% within 24 h of PICU admission.

Results

Of 66 eligible cases, the ratio of early RAI+, early SCr > base, early FO+ was 57.57, 59.09 and 16.67% respectively. The incidence of AKIs in early RAI+ group (78.94%) was higher than that in early RAI- group (21.42%) (p = 0.04), and there was no significant difference compared with the early FO+ group (71.79%) and early SCr > base group (81.82%) (P > 0.05). After adjustment for confounders, early RAI+ was independently associated with the occurrence of AKIs within 3 days (OR 10.04, 95%CI 2.39–42.21,p < 0.01). The value of early RAI+ (AUC = 0.78) to identify patients at high risk of AKIs was superior to that of early SCr > base (AUC = 0.70) and early FO+ (AUC = 0.58). A combination of serum lactate with early RAI+ improved the predictive performance for assessing AKIs (AUC = 0.83).

Conclusions

Early RAI could be used as a more convenient and effective index to predict the risk of AKIs in children with septic shock within 3 days. Early RAI+ combined with serum lactate improved the predictive performance for assessing AKIs.
PRediction of acute coronary syndrome in acute ischemic StrokE (PRAISE) – protocol of a prospective, multicenter trial with central reading and predefined endpoints
Authors: Nolte Christian H. , von Rennenberg Regina , Litmeier Simon , Scheitz Jan F. , Leistner David M. , Blankenberg Stephan , Dichgans Martin , Katus Hugo , Petzold Gabor C. , Pieske Burkert , Regitz-Zagrosek Vera , Wegscheider Karl , Zeiher Andreas M. , Landmesser Ulf , Endres Matthias
Published: August 2020

Background

Current guidelines recommend measurement of troponin in acute ischemic stroke (AIS) patients. In AIS patients, troponin elevation is associated with increased mortality and worse outcome. However, uncertainty remains regarding the underlying pathophysiology of troponin elevation after stroke, particularly regarding diagnostic and therapeutic consequences. Troponin elevation may be caused by coronary artery disease (CAD) and more precisely acute coronary syndrome (ACS). Both have a high prevalence in stroke patients and contribute to poor outcome. Therefore, better diagnostic algorithms are needed to identify those AIS patients likely to have ACS or other manifestations of CAD.

Methods/design

The primary goal of the “PRediction of Acute coronary syndrome in acute Ischemic StrokE” (PRAISE) study is to develop a diagnostic algorithm for prediction of ACS in AIS patients. The primary hypothesis will test whether dynamic high-sensitivity troponin levels determined by repeat measurements (i.e., “rise or fall-pattern”) indicate presence of ACS when compared to stable (chronic) troponin elevation.

PRAISE is a prospective, multicenter, observational trial with central reading and predefined endpoints guided by a steering committee. Clinical symptoms, troponin levels as well as findings on electrocardiogram, echocardiogram, and coronary angiogram will be recorded and assessed by central academic core laboratories. Diagnosis of ACS will be made by an endpoint adjudication committee. Severe adverse events will be evaluated by a critical event committee. Safety will be judged by a data and safety monitoring board. Follow-up will be conducted at three and twelve months and will record new vascular events (i.e., stroke and myocardial infarction) as well as death, functional and cognitive status.

According to sample size calculation, 251 patients have to be included.

Discussion

PRAISE will prospectively determine the frequency of ACS and characterize cardiac and coronary pathologies in a large, multicenter cohort of AIS patients with troponin elevation. The findings will elucidate the origin of troponin elevation, shed light on its impact on necessary diagnostic procedures and provide data on the safety and diagnostic yield of coronary angiography early after stroke. Thereby, PRAISE will help to refine algorithms and develop guidelines for the cardiac workup in AIS.

Trial registration

NCT03609385registered 1st August 2018.
Comprehensive analysis of prognostic tumor microenvironment-related genes in osteosarcoma patients
Authors: Hu Chuan , Liu Chuan , Tian Shaoqi , Wang Yuanhe , Shen Rui , Rao Huili , Li Jianyi , Yang Xu , Chen Bo , Ye Lin
Published: August 2020

Background

Tumor microenvironment (TME) plays an important role in malignant tumors. Our study aimed to investigate the effect of the TME and related genes in osteosarcoma patients.

Methods

Gene expression profiles and clinical data of osteosarcoma patients were downloaded from the TARGET dataset. ESTIMATE algorithm was used to quantify the immune score. Then, the association between immune score and prognosis was studied. Afterward, a differential analysis was performed based on the high- and low-immune scores to determine TME-related genes. Additionally, Cox analyses were performed to construct two prognostic signatures for overall survival (OS) and disease-free survival (DFS), respectively. Two datasets obtained from the GEO database were used to validate signatures.

Results

Eighty-five patients were included in our research. The survival analysis indicated that patients with higher immune score have a favorable OS and DFS. Moreover, 769 genes were determined as TME-related genes. The unsupervised clustering analysis revealed two clusters were significantly related to immune score and T cells CD4 memory fraction. In addition, two signatures were generated based on three and two TME-related genes, respectively. Both two signatures can significantly divide patients into low- and high-risk groups and were validated in two GEO datasets. Afterward, the risk score and metastatic status were identified as independent prognostic factors for both OS and DFS and two nomograms were generated. The C-indexes of OS nomogram and DFS nomogram were 0.791 and 0.711, respectively.

Conclusion

TME was associated with the prognosis of osteosarcoma patients. Prognostic models based on TME-related genes can effectively predict OS and DFS of osteosarcoma patients.
Tissue mechanics and expression of TROP2 in oral squamous cell carcinoma with varying differentiation
Authors: Zhang Baoping , Gao Shuting , Li Ruiping , Li Yiting , Cao Rui , Cheng Jingyang , Guo Yumeng , Wang Errui , Huang Ying , Zhang Kailiang
Published: August 2020

Background

Trophoblast cell surface antigen 2 (TROP2) is overexpressed in many squamous cell carcinomas and promotes tumor development and invasion. The association between TROP2 expression and occurrence and development of oral squamous cell carcinoma (OSCC) remains to be understood.

Methods

We investigated the role of TROP2 in OSCC patients using a combination of biophysical approaches. A total of 108 OSCC patient specimens with varying degrees of differentiation were subjected to hematoxylin and eosin staining, immunohistochemistry, Kaplan-Meier survival curve analysis, and atomic force microscopy to analyze TROP2 expression, morphology, and mechanical properties of OSCC tissues.

Results

TROP2 was overexpressed in 34% of poorly differentiated OSCC samples. High levels of TROP2 were associated with 10.2% survival rate lower than 45.4% and patient age (odds ratio [OR] = 0.437, P = 0.039, 95% confidence interval [CI, 0.198–0.966]), tumor size (OR = 13.148, P = 0.000, 95% CI [5.060–34.168]), and TNM stage (OR = 0.141, P = 0.000, 95% CI [0.082–0.244]). Average surface roughness of low, medium, and highly differentiated OSCC tissues were 448.9 ± 54.8, 792.7 ± 83.6, and 993.0 ± 104.3 nm, respectively. The Pearson coefficient revealed a negative association between tumor stiffness and TROP2 expression (r = − 0.84, P < 0.01).

Conclusion

Overexpression of TROP2 negatively associated with patient survival, degree of tumor differentiation, and tissue mechanics. Taken together, our findings demonstrated that TROP2 may be an indicator of OSCC differentiation leading to the altered mechanical properties of OSCC tissues.
DLBCL with amplification of JAK2/PD-L2 exhibits PMBCL-like CNA pattern and worse clinical outcome resembling those with MYD88 L265P mutation
Authors: Xue Xuemin , Huang Wenting , Qiu Tian , Guo Lei , Ying Jianming , Lv Ning
Published: August 2020

Background

Recently, copy number alteration (CNA) of 9p24.1 were demonstrated in 10% of diffuse large b-cell lymphoma (DLBCL), with gene expression and mutation profiles that were similar to those of primary mediastinal large B-cell lymphoma (PMBCL). However, their CNA-based profile and clinical impact still remain unclear.

Methods

Multiplex ligation-dependent probe amplification were employed to investigate the prevalence of JAK2/PD-L2 amplification in DLBCL and their CNA-based pattern of driver genes. The clinical outcome and characteristics were also analyzed.

Results

Using unsupervised hierarchical clustering, a small group of DLBCL (10.5%, 8/76) was clustered together with PMBCL as Cluster_2, demonstrating amplification of JAK2 (100%,8/8) and PD-L2 (75.0%,6/8). This subgroups of DLBCL demonstrated significant higher expression of PD-L1 than those with MYD88 L265P mutation(p = 0.024). And they exhibited dismal OS and PFS as compared with DLBCL_others(p = 0.003 and 0.001, respectively), which is similar to DLBCL with MYD88 L265P mutation.

Conclusions

DLBCL with amplification of JAK2/PD-L2 exhibits CNA pattern that is similar to PMBCL, and demonstrates unfavorable clinical outcome that resembles those with MYD88 L265P mutation. It is essential to identify this subgroup of DLBCL who may acquire more benefits from the JAK2 and PD-L1 signaling inhibition.
Bone impaction grafting with trabecular metal augments in large defects in young patients: unravelling a new perspective in surgical technique
Authors: De la Torre-Escuredo Basilio , Gómez-García Eva , Álvarez-Villar Salvador , Bujan Julia , Ortega Miguel A.
Published: August 2020

Background

Acetabular reconstruction with bone impaction grafting in large defects has yielded conflicting results.

Methods

This was a retrospective study of a case series of five patients with a young age (≤50 years) at the time of surgery who had large acetabular defects reconstructed by bone impaction grafting and trabecular metal augments. The mean follow-up was 79 months. We describe the surgical technique in detail.

Results

Improvement was significant on the WOMAC and SF-36 scales (p < 0.05). The radiographs taken at the last follow-up examination showed no migration of the polyethylene cup (p = 0.31) or differences in the abduction angle (p = 0.27) compared to the radiographs from the immediate postoperative period. One patient presented two dislocation episodes as a complication.

Conclusion

The combination of trabecular metal augments with the bone impaction grafting technique in young patients with large acetabular defects provides satisfactory results in the long term and restores the bone stock.