bluuebunny/crossref_metadata_2025 huggingface dataset:
FLANNEL (Focal Loss bAsed Neural Network EnsembLe) for COVID-19 detection
Authors: Qiao Zhi , Bae Austin , Glass Lucas M , Xiao Cao , Sun Jimeng
Published: October 2020

Objective

The study sought to test the possibility of differentiating chest x-ray images of coronavirus disease 2019 (COVID-19) against other pneumonia and healthy patients using deep neural networks.

Materials and Methods

We construct the radiography (x-ray) imaging data from 2 publicly available sources, which include 5508 chest x-ray images across 2874 patients with 4 classes: normal, bacterial pneumonia, non–COVID-19 viral pneumonia, and COVID-19. To identify COVID-19, we propose a FLANNEL (Focal Loss bAsed Neural Network EnsembLe) model, a flexible module to ensemble several convolutional neural network models and fuse with a focal loss for accurate COVID-19 detection on class imbalance data.

Results

FLANNEL consistently outperforms baseline models on COVID-19 identification task in all metrics. Compared with the best baseline, FLANNEL shows a higher macro-F1 score, with 6% relative increase on the COVID-19 identification task, in which it achieves precision of 0.7833 ± 0.07, recall of 0.8609 ± 0.03, and F1 score of 0.8168 ± 0.03.

Discussion

Ensemble learning that combines multiple independent basis classifiers can increase the robustness and accuracy. We propose a neural weighing module to learn the importance weight for each base model and combine them via weighted ensemble to get the final classification results. In order to handle the class imbalance challenge, we adapt focal loss to our multiple classification task as the loss function.

Conclusion

FLANNEL effectively combines state-of-the-art convolutional neural network classification models and tackles class imbalance with focal loss to achieve better performance on COVID-19 detection from x-rays.
Osphranter rufus(Diprotodontia: Macropodidae)
Authors: Freedman Calli R , Rothschild Daniel , Groves Colin , Newman Amy E M
Published: October 2020

Osphranter rufus (Desmarest, 1822) is a macropod commonly called the red kangaroo and is the largest extant marsupial. Sexually dimorphic in size and coat color, this large macropod is one of four species in the genus Osphranter. In general, males are larger than females, and are reddish-brown in color, whereas females are bluish-gray. O. rufus is endemic to Australia, where it inhabits both arid and semiarid areas with wide habitat preferences that include open plains, open desert, grassland, woodland, or shrubland habitats. Although it is regularly harvested for its meat and hide, O. rufus is an abundant species that is not of special conservation concern and it is listed as “Least Concern” by the International Union for Conservation of Nature and Natural Resources.
DNA methylation based glioblastoma subclassification is related to tumoral T-cell infiltration and patient survival
Authors: Dejaegher Joost , Solie Lien , Hunin Zoé , Sciot Raf , Capper David , Siewert Christin , Van Cauter Sofie , Wilms Guido , van Loon Johan , Ectors Nadine , Fieuws Steffen , Pfister Stefan M , Van Gool Stefaan W , De Vleeschouwer Steven
Published: October 2020

Background

Histologically classified glioblastomas (GBM) can have different clinical behavior and response to therapy, for which molecular subclassifications have been proposed. We evaluated the relationship of epigenetic GBM subgroups with immune cell infiltrations, systemic immune changes during radiochemotherapy, and clinical outcome.

Methods

450K genome-wide DNA methylation was assessed on tumor tissue from 93 patients with newly diagnosed GBM, treated with standard radiochemotherapy and experimental immunotherapy. Tumor infiltration of T cells, myeloid cells, and Programmed cell death protein 1 (PD-1) expression were evaluated. Circulating immune cell populations and selected cytokines were assessed on blood samples taken before and after radiochemotherapy.

Results

Forty-two tumors had a mesenchymal, 27 a receptor tyrosine kinase (RTK) II, 17 RTK I, and 7 an isocitrate dehydrogenase (IDH) DNA methylation pattern. Mesenchymal tumors had the highest amount of tumor-infiltrating CD3+ and CD8+ T cells and IDH tumors the lowest. There were no significant differences for CD68+ cells, FoxP3+ cells, and PD-1 expression between groups. Systemically, there was a relative increase of CD8+ T cells and CD8+ PD-1 expression and a relative decrease of CD4+ T cells after radiochemotherapy in all subgroups except IDH tumors. Overall survival was the longest in the IDH group (median 36 mo), intermediate in RTK II tumors (27 mo), and significantly lower in mesenchymal and RTK I groups (15.5 and 16 mo, respectively).

Conclusions

Methylation based stratification of GBM is related to T-cell infiltration and survival, with IDH and mesenchymal tumors representing both ends of a spectrum. DNA methylation profiles could be useful in stratifying patients for immunotherapy trials.
Host- and Pathogen-Related Factors for Acute Cardiac Events in Pneumococcal Pneumonia
Authors: Rombauts Alexander , Abelenda-Alonso Gabriela , Càmara Jordi , Lorenzo-Esteller Laia , González-Díaz Aida , Sastre-Escolà Enric , Gudiol Carlota , Dorca Jordi , Tebé Cristian , Pallarès Natàlia , Ardanuy Carmen , Carratalà Jordi
Published: October 2020

Background

Acute cardiac events (ACEs) are increasingly being recognized as a major complication in pneumococcal community-acquired pneumonia (CAP). Information regarding host- and pathogen-related factors for ACEs, including pneumococcal serotypes and clonal complexes, is scarce.

Methods

A retrospective study was conducted of a prospective cohort of patients hospitalized for CAP between 1996 and 2019. Logistic regression and funnel plot analyses were performed to determine host- and pathogen-related factors for ACEs.

Results

Of 1739 episodes of pneumococcal CAP, 1 or more ACEs occurred in 304 (17.5%) patients, the most frequent being arrhythmia (n = 207), heart failure (n = 135), and myocardial infarction (n = 23). The majority of ACEs (73.4%) occurred within 48 hours of admission. Factors independently associated with ACEs were older age, preexisting heart conditions, pneumococcal bacteremia, septic shock at admission, and high-risk pneumonia. Among 983 pneumococcal isolates, 872 (88.7%) were serotyped and 742 (75.5%) genotyped. The funnel plot analyses did not find any statistically significant association between serotypes or clonal complexes with ACEs. Nevertheless, there was a trend toward an association between CC230 and these complications. ACEs were independently associated with 30-day mortality (adjusted odds ratio, 1.88; 95% CI, 1.11–3.13).

Conclusions

ACEs are frequent in pneumococcal pneumonia and are associated with increased mortality. The risk factors defined in this study may help identify patients who must undergo close follow-up, including heart rhythm monitoring, and special care to avoid fluid overload, particularly during the first 48 hours of admission. These high-risk patients should be the target for preventive intervention strategies.
CHARACTERIZATION OF A LANTHANUM BROMIDE DETECTOR FOR EYE LENS DOSIMETRY AT THE CANDU NUCLEAR POWER PLANTS BASED ON DIRECT MEASUREMENTS OF THE GAMMA-RAY SPECTRA
Authors: Laranjeiro A S , Bohra F , Byun S H , Atanackovic J , Hanu A R
Published: October 2020

Gamma-ray spectra were measured using a LaBr$_{3}$(Ce) spectrometer during the outage periods, aiming at quantifying the gamma source term of radiation workers’ exposure, at the CANDU nuclear power reactors, for the purposes of eye lens dosimetry. The spectra were measured inside the boiler rooms, of the Bruce Power and Ontario Power Generation (OPG) CANDU nuclear power plants, where workers are exposed to relatively high dose rates radiation fields during the maintenance work. Prior to measurements at the CANDU reactors, the pulse shaping parameters of the gamma spectrometer were optimised for high rates gamma fields, up to an input rates of 120 kcps, in order to accomplish a high output rate with a reasonable energy resolution. In parallel, the response of the LaBr$_{3}$(Ce) detector was characterized by experiments and Monte Carlo simulations. The gamma spectra measured at the CANDU reactors were reported in terms of the gamma-ray fluence rate spectrum. In all measured data, $^{60}$Co and $^{95}$Nb were main contributors of the gamma fields. The measured spectra have been used to calculate the dosimetric quantities of interest: personal dose equivalents H$_{p}$(10) and H$_{p}$(0.07) and eye lens absorbed dose.
Brain Perfusion Mediates the Relationship Between miRNA Levels and Postural Control
Authors: Chen Yufen , Herrold Amy A , Martinovich Zoran , Bari Sumra , Vike Nicole L , Blood Anne J , Walter Alexa E , Harezlak Jaroslaw , Seidenberg Peter H , Bhomia Manish , Knollmann-Ritschel Barbara , Stetsiv Khrystyna , Reilly James L , Nauman Eric A , Talavage Thomas M , Papa Linda , Slobounov Semyon , Breiter Hans C ,   for the Concussion Neuroimaging Consortium
Published: October 2020

Transcriptomics, regional cerebral blood flow (rCBF), and a virtual reality-based spatial motor task were integrated using mediation analysis in a novel demonstration of “imaging omics.” Data collected in National Collegiate Athletic Association (NCAA) Division I football athletes cleared for play before in-season training showed significant relationships in 1) elevated levels of miR-30d and miR-92a to elevated putamen rCBF, 2) elevated putamen rCBF to compromised Balance scores, and 3) compromised Balance scores to elevated microRNA (miRNA) levels. rCBF acted as a consistent mediator variable (Sobel’s test P < 0.05) between abnormal miRNA levels and compromised Balance scores. Given the involvement of these miRNAs in inflammation and immune function and that vascular perfusion is a component of the inflammatory response, these findings support a chronic inflammatory model in these athletes with 11 years of average football exposure. rCBF, a systems biology measure, was necessary for miRNA to affect behavior.
Oral mucosa changes associated with chronic oral and inhalation exposure to 2,4-dichlorophenoxiacetic acid (2,4-D) in Wistar rats
Authors: Parizi José Luiz Santos , de Mello Odorizzi Gisele Aparecida Sales , Sato Grace Mitiko Rosati Hori , Patrão Isabela Bocardi , Nai Gisele Alborghetti
Published: October 2020

The respiratory tract and the oral mucosa are the first areas contaminated by pesticides. The herbicide dichlorophenoxyacetic acid (2,4-D) is a widely used pesticide across the world for both crops and gardens. The aim of this study was to evaluate oral mucosal damage after an experimental simulation of chronic oral and inhalational environmental exposure to 2,4-D formulation. Eighty male Wistar rats were exposed to three distinct concentrations of 2,4-D formulation (low—187.17 mg/m3; medium—313.31 mg/m3; and high—467.93 mg/m3). Oral exposure (through contaminated feed) or inhalation exposure lasted 6 months. Rat tongues were collected for cyto- and histopathology. There was a difference between exposure groups in the intensity of tissue congestion. Most rats exposed to 2,4-D presented mucosal inflammation at both cytology and histology (P < 0.05). Hyperkeratosis only occurred in rats exposed orally at the high concentration. There was an increase in the number of nucleoli-organizing regions in the dorsal epithelium as the 2,4-D concentration increased (P < 0.001). The inhalation route was more associated with increased mitosis figures and nucleoli-organizing region count (P < 0.05). Chronic oral and inhalation exposure to high concentrations of 2,4-D formulation caused an increase in the proliferation rate and thickness of the tongue epithelium and stimulated the inflammatory response in the tissue.
Putative Effector Genes Distinguish Two Pathogenicity Groups ofFusarium oxysporumf. sp.spinaciae
Authors: Batson Alexander M. , Fokkens Like , Rep Martijn , du Toit Lindsey J.
Published: October 2020

Fusarium wilt of spinach, caused by Fusarium oxysporum f. sp. spinaciae, is an important disease during warm conditions in production regions with acid soils, yet little is known about what confers pathogenicity to spinach in F. oxysporum f. sp. spinaciae genetically. To identify candidate fungal genes that contribute to spinach Fusarium wilt, each of 69 geographically diverse F. oxysporum isolates was tested for pathogenicity on each of three spinach inbreds. Thirty-nine isolates identified as F. oxysporum f. sp. spinaciae caused quantitative differences in disease severity among the inbreds that revealed two distinct pathogenicity groups of F. oxysporum f. sp. spinaciae. Putative effector gene profiles, predicted from whole-genome sequences generated for nine F. oxysporum f. sp. spinaciae isolates and five nonpathogenic, spinach-associated F. oxysporum (NPS) isolates, distinguished the F. oxysporum f. sp. spinaciae isolates from the NPS isolates, and separated the F. oxysporum f. sp. spinaciae isolates into two groups. Five of the putative effector genes appeared to be unique to F. oxysporum f. sp. spinaciae, as they were not found in 222 other publicly available genome assemblies of F. oxysporum, implicating potential involvement of these genes in pathogenicity to spinach. In addition, two combinations of the 14 known Secreted in Xylem (SIX) genes that have been affiliated with host pathogenicity in other formae speciales of F. oxysporum were identified in genome assemblies of the nine F. oxysporum f. sp. spinaciae isolates, either SIX8 and SIX9 or SIX4, SIX8, and SIX14. Characterization of these putative effector genes should aid in understanding mechanisms of pathogenicity in F. oxysporum f. sp. spinaciae, developing molecular tools for rapid detection and quantification of F. oxysporum f. sp. spinaciae, and breeding for resistance to Fusarium wilt in spinach.

[Formula: see text] Copyright © 2021 The Author(s). This is an open access article distributed under the CC BY 4.0 International license .
Efficacy of Copper-Based Texel Fabric in Preventing Root Escape from Pots and Improving Nematode Resistance Screening of Sugarcane Accession Lines in a Glasshouse
Authors: Bhuiyan Shamsul A. , Garlick Kylie
Published: October 2020

Plant-parasitic nematodes are major constraints in the production of sugarcane in Australia. Sugar Research Australia commenced a program to screen sugarcane germplasm accessions and commercial cultivars for nematode resistance in a glasshouse under a subirrigation system. Although the subirrigation system provided reasonable growth of sugarcane plants and significantly reduced the use of irrigation water in the glasshouse, it created a few issues. Sugarcane roots escaped through the bottom of the pots and created networks of roots under the fabrics used in the subirrigation system. This made it difficult to reduce cross contamination among the treatment pots and also facilitated nematodes to migrate outside of the pots. This research was undertaken to determine the effectiveness of two types of Texel fabrics (Tex-R commercial products) in mitigating sugarcane root escape from pots as well as impact on nematode population in the pots. Very few or no roots escaped from the pots placed on both types of Texel fabrics compared with other treatment methods, in which prolific root escape was evident at the bottom of the pots, forming a network of roots on or under the fabrics. Nematode numbers in pots placed on Texel fabrics were significantly higher (approximately 50,000 nematodes per pot) compared with other treatment methods (30,000 to 41,000 nematodes per pot). This research demonstrated that Texel fabrics were effective in stopping sugarcane root escape and preventing nematode migration from pots. This study also indicated that the nematode population inside the pots was not adversely impacted by the use of Texel fabrics.
Tracing the Origin and Evolutionary History ofPyricularia oryzaeInfecting Maize and Barnyard Grass
Authors: Pordel Adel , Ravel Sebastien , Charriat Florian , Gladieux Pierre , Cros-Arteil Sandrine , Milazzo Joelle , Adreit Henri , Javan-Nikkhah Mohammad , Mirzadi-Gohari Amir , Moumeni Ali , Tharreau Didier
Published: October 2020

Blast disease is a notorious fungal disease leading to dramatic yield losses on major food crops such as rice and wheat. The causal agent, Pyricularia oryzae, encompasses different lineages, each having a different host range. Host shifts are suspected to have occurred in this species from Setaria spp. to rice and from Lolium spp. to wheat. The emergence of blast disease on maize in Iran was observed for the first time in the north of the country in 2012. We later identified blast disease in two additional regions of Iran: Gilan in 2013 and Golestan in 2016. Epidemics on the weed barnyard grass (Echinochloa spp.) were also observed in the same maize fields. Here, we showed that P. oryzae is the causal agent of this disease on both hosts. Pathogenicity assays in the greenhouse revealed that strains from maize can infect barnyard grass and conversely. However, genotyping with simple sequence repeat markers and comparative genomics showed that strains causing field epidemics on maize and on barnyard grass are different, although they belong to the same previously undescribed clade of P. oryzae. Phylogenetic analyses including these strains and a maize strain collected in Gabon in 1985 revealed two independent host-range expansion events from barnyard grass to maize. Comparative genomics between maize and barnyard grass strains revealed the presence or absence of five candidate genes associated with host specificity on maize, with the deletion of a small genomic region possibly responsible for adaptation to maize. This recent emergence of P. oryzae on maize provides a case study to understand host range expansion. Epidemics on maize raise concerns about potential yield losses on this crop in Iran and potential geographic expansion of the disease.
Escape the Pharmacy: An Active Learning Strategy for the Nursing Pharmacology Classroom
Authors: Hadenfeldt Cindy J. , Naylor Heather M. , Aufdenkamp Marilee A.
Published: October 2020

Escape the Pharmacy is a fast-moving collaborative challenge for students in nursing and other health professions programs requiring coursework in pharmacology. Teams of students compete to solve a series of puzzles that reinforce knowledge of safe analgesic administration. Information regarding maximum dosing and adverse effects of opioids, nonsteroidal anti-inflammatories, and acetaminophen is included, as well as content on types of pain receptors. Recognition of opioid toxicity and symptoms of oversedation are all part of the challenge of escaping the pharmacy.
Relationship Between Second-to-Fourth Digit Ratio (as a Biomarker) and Tramadol Dependence
Authors: Khalifa Fatma N. , Shaheen Somaya H. , Magdi Mai M. , Basyoni Hoda A.
Published: October 2020

Objectives:

Digit ratio (2D:4D ratio), the ratio between the length of the second and fourth fingers, is considered a putative biomarker of prenatal testosterone exposure relative to estrogen exposure, consequently it has been linked to several behaviors within the personality such as academic performance, nicotine and alcohol misuse, and also with other behaviors. Our aim is to investigate any possible association between 2D:4D ratios and tramadol dependence.

Participants and Methods:

A group of 99 male patients with tramadol dependence [diagnosed by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)] were interviewed and their digital ratios were (2D:4D ratios) measured, then the findings were compared with 99 healthy males.

Results:

Patients with tramadol dependence had lower 2D:4D ratios of their right and left hands when compared with those without tramadol use disorder. There was no significant correlation between 2D:4D ratio and age of patients, age of onset, duration, and amount of tramadol use.

Conclusion:

These findings suggest that high prenatal exposure to testosterone levels could be associated with tramadol dependence as detected by a lower 2D:4D ratio.
Palliative Irradiation of Sacral Metastases
Authors: Soyfer Viacheslav , Gez Elihau , Novikov Ilya , Brautbar Oded , Corn Benjamin W.
Published: October 2020

Background and Purpose:

The sacrum as radiation target, raises a conceptual question: should the structure be regarded as a single unit or 5 distinct bones. If the entire sacrum must be irradiated there is a higher risk of rectal morbidity.

Materials and Methods:

Images of 53 patients with sacral metastases were reviewed. The extent of sacral involvement was documented. The location of the rectum was recorded relative to the individual sacral bones.

Results:

In 37.7% only S1 and S2 were involved by metastatic disease. In 41.5% there was metastatic involvement of S1-S3. In 1 patient there was involvement of S5 only. In 10 cases the entire sacrum was infested by metastatic disease. The rectum never extended to the height of S1. In 38% the upper pole of the rectum reached the S3 level. In toto, there were 64.2% where the inferior extension of sacral metastatic involvement did not overlap the upper pole of the rectum. Palliation of pain was achieved in 19/20 patients treated with partial sacral irradiation.

Conclusions:

The distal part of the sacrum is rarely involved in the metastatic process. Avoidance of radiation therapy to the lower sacrum simultaneously enables effective palliation and sparing of the adjacent rectum.
Osocimab: A Novel Agent in Preventing Venous Thromboembolism
Authors: Beavers Craig J. , Wayne Nathaniel B.
Published: October 2020

The nature of orthopedic surgery, and specifically total knee arthroplasty, lends itself to the development of venous thromboembolism given endothelial injury from the surgical procedure, promotion of an acute hypercoagulable state, and the prolonged period of immobilization after surgery promoting stasis; all factors of Virchow's triad. Current guidelines recommend the direct acting oral anticoagulants, enoxaparin, fondaparinux, and warfarin as options for venous thromboembolism prevention. However, these agents may still be prone to unacceptable bleeding risk, given they mostly target the extrinsic pathway of the clotting cascade, and have other characteristics which can be problematic for use. Investigators have determined patients with factor XI deficiency seem to be protected for thrombotic risk and seem to be devoid of bleeding sequelae. This has led to the development of osocimab, a fully humanized monoclonal G1 antibody designed specifically to functionally neutralize factor XIa. Phase 1 clinical trials have demonstrated an agent with a long half-life (∼30 days) with minimal requirement of renal elimination and hepatic metabolism. Phase 2 trials have identified that an optimal dose range, 0.6–1.2 mg/kg, as a 1-time dose preoperatively or postoperatively is effective in preventing thrombotic complications with minimal bleeding risk compared with standard of care for elective total knee arthroplasty patients. Future clinical development will be able to clearly outline the role this agent will play in the future.
Cardiopulmonary Rehabilitation in Pediatric Patients With Congenital and Acquired Heart Disease
Authors: McBride Michael G. , Burstein Danielle S. , Edelson Jonathan B. , Paridon Stephen M.
Published: October 2020

Background:

Heart disease in children and adolescents is common, approaching 1.0% of the population. In those patients with complex physiology and severe cardiac dysfunction, the inability to participate in physical activity results in significant obstacles to normal acts of daily living and significantly diminished quality of life. Attempts to study the practicality and benefits of cardiopulmonary rehabilitation (CR) programs in this population have been hampered by the heterogeneity of lesions, lack of facilities, and trained personnel to supervise these types of programs. Although there are numerous articles on CR in children with cardiac disease, all suffer from the same basic problems of small sample size, short duration of study, and heterogeneous study populations.

Purpose:

The purpose of this review was to first evaluate the current rehabilitation literature on both congenital cardiac defects and acquired abnormalities—in this latter group placing a significant emphasis on cardiomyopathies, as well as the special populations in the peri-transplant period and/or mechanical circulatory support. Second, we discussed what is known about practical approaches to CR for the various types of pediatric-specific cardiac conditions. This limited data will be supplemented by the current approach of our institution to CR in these populations with the understanding that this is by no means a consensus approach to these patients. Finally, we summarized research goals for this growing group of patients.

Conclusion:

Cardiopulmonary rehabilitation in pediatric congenital and acquired heart disease is currently a field in its infancy. Significant strides have been made for complex heart disease and impaired myocardial function. Current research holds the promise for the development of programs that are practical, scalable, and can be implemented in most clinical sites within the foreseeable future.
CHORIOCAPILLARIS VASCULAR PARAMETERS IN NORMAL EYES AND THOSE WITH PACHYCHOROID WITH AND WITHOUT DISEASE
Authors: Spaide Richard F. , Ledesma-Gil Gerardo
Published: October 2020

Purpose:

To evaluate the vascular characteristics of the choriocapillaris in eyes with pachychoroid as compared with normal controls.

Methods:

Eyes with pachychoroid disease were defined as those with a history of central serous chorioretinopathy or peripapillary pachychoroid syndrome. Pachychoroid without disease was defined as eyes with no history of disease with a subfoveal choroidal thickness ≥ the age-adjusted 95th percentile thickness. Frame-averaged optical coherence tomography angiography images of the choriocapillaris obtained with a Zeiss Plex Elite were binarized, skeletonized, and evaluated for vascular branching parameters.

Results:

There were 7 normal control subjects, 10 subjects with pachychoroid without disease, and 17 pachychoroid disease subjects. Mean choriocapillaris vessel segment length was 12.19 µm in eyes with pachychoroid disease as compared with 11.48 µm in normal controls and 11.62 µm in pachychoroid without disease (P = 0.003 and P = 0.006, respectively). The branches per square millimeter were fewer in pachychoroid disease (1,215), as compared with normal controls (1,471) or pachychoroid without disease (1,384; P < 0.001, and P = 0.002, respectively). The choriocapillaris vessel diameter was larger, but the fractal dimension was smaller in pachychoroid disease eyes as compared with normal eyes or pachychoroid without disease eyes. There was no statistically significant difference between normal controls and pachychoroid without disease for any measured vascular parameter of the choriocapillaris.

Conclusion:

Choriocapillaris vascular parameters suggest that pachychoroid is not necessarily pathologic. It is possible that choroidal thickening is an epiphenomenon, and there are more significant vascular parameters that are related to disease. These concepts may help guide future prospective studies.
NONPERFUSION ASSESSMENT IN RETINAL VEIN OCCLUSION
Authors: Glacet-Bernard Agnès , Miere Alexandra , Houmane Badreddine , Tilleul Julien , Souied Eric
Published: October 2020

Purpose:

To compare widefield optical coherence tomography angiography (OCTA) to ultra-widefield fluorescein angiography (UWFA) in the assessment of nonperfusion in retinal vein occlusion (RVO).

Methods:

A cross-sectional study of 43 eyes of 43 patients with RVO examined using both widefield OCTA (PLEX Elite, Carl Zeiss Meditec, Dublin, CA) with a panoramic montage of five 12 × 12-mm images and UWFA (Optos, 200°). Qualitative analysis was performed according to nonperfusion areas (cutoff: three disk areas) on widefield OCTA. The quantitative analysis assessed the vascular density on the widefield OCTA and ischemic index on UWFA.

Results:

The ischemic index on UWFA and vascular density in the superficial and deep plexus correlated significantly (P = 0.019, r = 0.357 and P < 0.013, r = 0.375, respectively). The qualitative classification on widefield OCTA and ischemic index on UWFA correlated significantly (P < 0.001, r = 0.618). For the detection of marked nonperfusion (ischemic index ≥ 25%), widefield OCTA had a sensitivity of 100% and a specificity of 64.9%.

Conclusion:

The presence of nonperfusion on UWFA correlated with widefield OCTA. Optical coherence tomography angiography could help to identify high-risk RVO patients who might benefit from a further evaluation using fluorescein angiography.
The Effects of Glaucoma and Glaucoma Therapies on Corneal Endothelial Cell Density
Authors: Realini Tony , Gupta Preeya K. , Radcliffe Nathan M. , Garg Sumit , Wiley William F. , Yeu Elizabeth , Berdahl John P. , Kahook Malik Y.
Published: October 2020

A healthy corneal endothelium is required for corneal clarity. Both the glaucoma disease state and its various forms of treatment can have adverse effects on the corneal endothelium. Both the presence of glaucoma and the magnitude of intraocular pressure elevation are related to endothelial cell loss (ECL). Topical medical therapy, laser procedures, and both traditional surgeries—trabeculectomy and tube-shunts—and newer minimally invasive glaucoma surgeries have variable effects on ECL. This review will summarize the reported effects of glaucoma and its treatment on ECL. Concerns for corneal endothelial cell health should be part of the decision-making process when planning glaucoma therapy for lowering intraocular pressure, with added caution in case of planned device implantation in eyes with preexisting ECL and low endothelial cell density at high risk for corneal endothelial decompensation.
Per- and Polyfluoroalkyl Substance and Cardio Metabolic Markers in Firefighters
Authors: Khalil Naila , Ducatman Alan M. , Sinari Shripad , Billheimer Dean , Hu Chengcheng , Littau Sally , Burgess Jefferey L.
Published: October 2020

Objective:

To evaluate if serum polyfluoroalkyl substances (PFAS) were associated with cardiometabolic markers.

Methods:

Serum PFAS were evaluated in 38 Arizona firefighters and 49 participants from the 2009 to 2010 National Health and Nutrition Examination Survey (NHANES). Cardiometabolic markers including carotid intima-medial thickness (CIMT) were measured in the firefighters.

Results:

Firefighters had elevated perfluorohexane sulfonic acid (PFHxS) and lower perfluorononanoic acid (PFNA) and perfluoroundecanoic acid (PFUA) compared to NHANES participants; for nine of the other 12 PFAS the values were not significantly different. There were significant negative associations among firefighters between perfluorodecanoic acid (PFDeA) and total cholesterol and PFUA and interleukin-6. PFAS concentrations were not associated with CIMT.

Conclusion:

PFHxS levels were elevated in firefighters compared to NHANES subjects. Serum PFAS concentrations were not associated with increased cardiometabolic risk measures in this population of firefighters.
Comparison of 81mKrypton and 99mTc-Technegas for ventilation single-photon emission computed tomography in severe chronic obstructive pulmonary disease
Authors: de Nijs Robin , Sijtsema Nienke D. , Kruis Matthijs F. , Jensen Claus Verner , Iversen Martin , Perch Michael , Mortensen Jann
Published: October 2020

Introduction

Ventilation and perfusion single-photon emission computed tomography combined with computed tomography (SPECT/CT) is a powerful tool to assess the state of the lungs in chronic obstructive pulmonary disease (COPD). 81mKrypton is a gaseous ventilation tracer and distributes similarly to air, but is not widely available and relatively expensive. 99mTc-Technegas is cheaper and has wider availability, but is an aerosol, which may deposit in hot spots as the severity of COPD increases. In this study, 81mKrypton and 99mTc-Technegas were compared quantitatively in patients with severe COPD.

Methods

The penetration ratio, the heterogeneity index (with and without band filtering for relevant clinical sizes) and hot spot appearance were assessed in eleven patients with severe COPD that underwent simultaneous dual-isotope ventilation SPECT/CT with both 99mTc-Technegas and 81mKrypton.

Results

Significant differences were found in the penetration ratio for the medium energy general purpose (MEGP) collimators, but not for the low energy general purpose (LEGP) collimators. The difference in the overall and the band filtered heterogeneity index was significant in most cases. All patients suffered from 99mTc-Technegas hot spots in at least one lung. Comparison of MEGP 81mKrypton and LEGP Technegas scans revealed similar results as the comparison for the MEGP collimators.

Conclusion

Caution should be taken when replacing 81mKrypton with 99mTc-Technegas as a ventilation tracer in patients with severe COPD as there are significant differences in the distribution of the tracers over the lungs. Furthermore, this patient group is prone to 99mTc-Technegas hot spots and might need additional scanning if hot spots severely hamper image interpretation.
Ileo-colonic lymphoma: presentation, diagnosis, and management
Authors: Panneerselvam Kavea , Goyal Shreya , Shirwaikar Thomas Anusha
Published: October 2020

Purpose of review

The gut-associated lymphoid tissue (GALT), the bulk of which is located in the ileo-colonic region comprises the lymphoid cells of the gastrointestinal tract and confers specific immunological responses. Repetitive antigenic stimulation of these cells predispose to a monoclonal proliferation of this tissue and the eventual development of lymphoma. The gastrointestinal tract is the most commonly involved site of extranodal lymphomas. This review will focus primarily on lymphomas of the ileo-colonic region (defined as the terminal ileum, the colon, and the rectum). We will discuss the epidemiology, pathogenesis, and presentation as well as current practices in diagnosis and management.

Recent findings

Despite the majority of the GALT to be located in the ileo-colonic region of the gut, the lymphomas in this location are relatively rare. However, the overall annual incidence of ileo-colonic lymphomas is steadily increasing. This entity has a varied spectrum of clinical presentations. Ileo-colonoscopy with adequate targeted biopsies can serve as a gold standard for definitive diagnosis. Ileo-colonic lymphomas may be managed with chemotherapy alone while surgery is reserved for highly aggressive tumors or clinical emergencies. Radiation is not a preferred adjuvant treatment for lymphomas in this location of the gut. Adequate endoscopic surveillance measures and tools to potentially prevent recurrence and improve the overall prognosis of this disease are lacking.

Ileo-colonic lymphomas are rare and can present with varied symptoms and signs. Endoscopy with adequate sampling can aid in making a definitive diagnosis. Chemotherapy can be highly effective in management while surgery is indicated for emergency presentations. Adequate endoscopic surveillance tools are lacking, yet imperative to prevent recurrence and improve prognosis.
What is the truth about proton pump inhibitors?
Authors: Albarki Hashm , Pun Amy , Paddle Paul M.
Published: October 2020

Purpose of review

This review explores the recent evidence and established scientific literature surrounding proton pump inhibitors in the context of laryngology.

Recent findings

Proton pump inhibitors are often associated with gastroenterology; however, they also have a place in laryngology. Several laryngopharyngeal disorders are treated with proton pump inhibitors, though limited evidence regarding effectiveness, dosing and length of treatment exists. With the recent influx of articles reporting possible adverse effects of proton pump inhibitors, the appropriate prescribing of them has come under scrutiny. These reported risks include cancer, stroke, myocardial infarction, kidney disease and cognitive decline. It should be noted though that many of these studies by nature, are fraught with potential confounding. Regardless, clinicians ought to be aware of any risks associated with treatment regimens and prescribe the optimal dosage and duration.

Proton pump inhibitor treatment should be dose-appropriate and for a limited duration. Concerning potential adverse effects, the limitations of retrospective cohort studies must be taken into consideration when reviewing the evidence.
Predictors of High Psychosocial Functioning in Bipolar Disorder
Authors: Lomastro María Julieta , Valerio Marina P. , Blasco Maira Belén , Tagni María Florencia , Martino Diego J.
Published: October 2020

The aim of this study was to identify predictors of high psychosocial functioning in patients with bipolar disorder (BD). One hundred forty-five outpatients with BD and 50 healthy controls were included. Patients were categorized as having high psychosocial functioning if they concomitantly met three conditions: a) General Assessment of Functioning greater than 90, b) full-time employment, and c) full functional recovery. Clinical, demographical, and neurocognitive variables were assessed and considered as potential predictors of high functioning in regression models. We found that 22.8% (n = 33) of patients exhibited high psychosocial functioning. BD type II, higher educational level, and better performance in verbal memory, attention, and executive functions were independent predictors of high psychosocial functioning. Our results provide evidence that functional outcomes are heterogeneous in BD, including a percentage of patients who maintain good to excellent psychosocial functioning despite their illness. Neurocognitive functioning could be one of the most influential factors to explain this heterogeneity.
A Standardized Protocol for the Management of Appendicitis in Children Reduces Resource Utilization
Authors: Pennell Christopher , Meckmongkol Teerin , Arthur L. Grier , Ciullo Sean , Prasad Rajeev , Lindholm Erika , Grewal Harsh
Published: October 2020

Introduction:

Appendicitis is the most common condition requiring emergency surgery in children. We implemented a standardized protocol (SP) for treating children with appendicitis to provide more uniform care and reduce resource utilization.

Methods:

All patients younger than 21 years were managed with the SP beginning in January 2017. We compared data from 22 months before and after implementation. The primary outcomes included the length of stay (LOS), antibiotic days, discharge on intravenous antibiotics, utilization of peripherally inserted central catheters lines, and postoperative imaging. Secondary outcomes were protocol adherence and the rates adverse events, including postoperative abscess, return to emergency department or operating room, surgical site infection, and readmission.

Results:

Protocol adherence was 92.3%. For uncomplicated cases (n = 412), LOS (P = 0.010) and postoperative antibiotic days (P < 0.001) were significantly reduced. There was no difference in the rates of any adverse event (6.7% versus 2.7%; P = 0.058), postoperative abscess (0.4% versus 0.0%; P = 0.544), return to emergency department (6.3% versus 2.7%; P = 0.084), readmission (1.8% versus 0.5%; P = 0.245), or postoperative ultrasound (0.4% versus 0.5%; P = 0.705) and computed tomography (0.0% versus 0.5%; P = 0.456). For complicated cases (n = 229), the post-SP cohort had a shorter LOS (P = 0.015), fewer peripherally inserted central catheters lines (26.9% versus 2.7%; P < 0.001), fewer postoperative ultrasounds (8.4% versus 1.8%; P = 0.027), and fewer discharges on intravenous antibiotics (17.6% versus 0.9%; P < 0.001). There were no differences in adverse events before and after the SP (16.0% versus 18.3%; P = 0.633).

Conclusion:

Implementing an SP for appendicitis in children reduced resource utilization, and by inference healthcare costs, for both uncomplicated and complicated cases without adversely affecting clinical outcomes.
Frequency, Risk Factors, and Mediators of Frailty Transitions During Long-Term Follow-Up Among People With HIV and HIV-Negative AGEhIV Cohort Participants
Authors: Verheij Eveline , Wit Ferdinand W. , Verboeket Sebastiaan O. , Schim van der Loeff Maarten F. , Nellen Jeannine F. , Reiss Peter , Kirk Gregory D.
Published: October 2020

Background:

We previously demonstrated a higher prevalence of frailty among AGEhIV-cohort participants with HIV (PWH) than among age- and lifestyle-comparable HIV-negative participants. Furthermore, frailty was associated with the development of comorbidities and mortality. As frailty may be a dynamic state, we evaluated the frequency of transitions between frailty states, and explored which factors were associated with transition toward frailty in this cohort.

Methods:

The study enrolled 598 PWH and 550 HIV-negative participants aged ≥45 years. Of those, 497 and 479 participants, respectively, participated in ≥2 consecutive biennial study-visits between October 2010 and October 2016, contributing 918 and 915 visit-pairs, respectively. We describe the frequency, direction, and risk factors of frailty transitions. Logistic regression models with generalized estimating equations were used to evaluate determinants for transition to frailty, including HIV-status, socio-demographic, behavioral, HIV-related factors, and various inflammatory and related biomarkers.

Results:

Transitioning between frailty states in any direction occurred in 36% of a total of 1833 visit-pairs. The odds of nonfrail participants transitioning toward frailty were significantly higher for PWH, occurring in 35 PWH (7.3%) and 25 (5.2%) HIV-negative nonfrail participants, respectively (odd ratioHIV 2.19, 95% confidence interval 1.28 to 3.75). The increased risk among PWH was attenuated when sequentially adjusting for waist–hip ratio, number of pre-existent comorbidities, and the presence of depressive symptoms.

Conclusion:

PWH are at increased risk of transitioning to frailty, and thereby at increased risk of adverse health outcomes. Whether optimizing the management of obesity, comorbidity, or depressive symptoms may modify the risk of becoming frail requires further investigation.
Embedding a Linkage to Preexposure Prophylaxis Care Intervention in Social Network Strategy and Partner Notification Services: Results From a Pilot Randomized Controlled Trial
Authors: Teixeira da Silva Daniel , Bouris Alida , Ramachandran Arthi , Blocker Olivia , Davis Billy , Harris James , Pyra Maria , Rusie Laura K. , Brewer Russell , Pagkas-Bather Jade , Hotton Anna , Ridgway Jessica P. , McNulty Moira , Bhatia Ramona , Schneider John A.
Published: October 2020

Background:

Increased preexposure prophylaxis (PrEP) uptake among black men who have sex with men and black transgender women (BMSM/TW) is needed to end the HIV epidemic. Embedding a brief intervention in network services that engage individuals in HIV transmission networks for HIV/ sexually transmitted infections testing may be an important strategy to accelerate PrEP uptake.

Setting:

Partner Services PrEP study is a pilot, randomized, control trial to improve linkage to PrEP care among BMSM/TW presenting for network services in Chicago, IL, from 2015 to 2017.

Methods:

BMSM/TW (N = 146) aged 18–40 years were recruited from network services (partners services and social network strategy services). Intervention participants developed an individualized linkage plan based on the information–motivation–behavioral skills model and received minibooster sessions. Control participants received treatment as usual. Sociodemographic, behavioral, and clinical factors were examined at baseline and 3- and 12-month postintervention. Intent-to-treat analyses examined linkage to PrEP care within 3-month postintervention (primary outcome). Secondary outcomes were PrEP initiation, time to linkage to PrEP care, and time to PrEP initiation.

Results:

Compared with control participants, a significantly greater proportion of the intervention participants were linked to PrEP care within 3 months (24% vs. 11%; P = 0.04) and initiated PrEP (24% vs. 11%; P = 0.05). Among those linked to PrEP care within the study period, intervention participants were linked significantly sooner than control participants [median (interquartile range) days, 26.5 (6.0–141.8) vs. 191.5 (21.5–297.0); P = 0.05].

Conclusion:

Study results support the preliminary efficacy of Partner Services PrEP to improve linkage to PrEP care and PrEP initiation among BMSM/TW.
Clinical Manifestations and Diagnosis of Axial Spondyloarthritis
Authors: Walsh Jessica A. , Magrey Marina
Published: October 2020

Background

Axial spondyloarthritis (axSpA) is a chronic, rheumatic disease characterized by inflammation of the sacroiliac joint, spine, and entheses. Axial spondyloarthritis affects up to 1.4% of adults in the United States and is associated with decreased quality of life, increased mortality, and substantial health care–related costs, imposing a high burden on patients, their caregivers, and society.

Summary of Work

Diagnosing axSpA can be difficult. In this review, we seek to help rheumatologists in recognizing and diagnosing axSpA.

Major Conclusions

A discussion of challenges associated with diagnosis is presented, including use and interpretation of imaging, reasons for diagnostic delays, differences in disease presentation by sex, and differential diagnoses of axSpA.

Future Research Directions

The early diagnosis of axSpA and advances in available therapeutic options have improved patient care and disease management, but delays in diagnosis and treatment remain common. Additional research and education are critical for recognizing diverse axSpA presentations and optimizing management early in the course of disease.
Fibroids and Urinary Symptoms Study (FUSS)
Authors: Bochenska Katarzyna , Lewitt Tessa , Marsh Erica E. , Pidaparti Mahati , Lewicky-Gaupp Christina , Mueller Margaret G. , Kenton Kimberly
Published: October 2020

Objective

The aims of the study were to characterize pelvic floor and urinary symptoms in women seeking treatment for uterine fibroids and to explore the association between uterine/fibroid size and pelvic floor symptoms.

Methods

Women seeking treatment for uterine fibroids at a single academic center were enrolled in this cross-sectional study. All participants underwent pelvic imaging and completed the Symptom Severity Subscale of the Uterine Fibroid Symptom and Health-Related Quality of Life Questionnaire (UFS-QOL) and the Pelvic Floor Distress Inventory (PFDI-20).

Results

One hundred ninety-five women with a mean age of 41 ± 6 years and body mass index of 29 ± 7 kg/m2 were included. In this cohort, 58% identified as Black and 38% had at least 1 vaginal delivery. Women attributed pelvic pain (68%), dyspareunia (37%), and urinary incontinence (31%) to their fibroids. The mean ± SD UFS-QOL score was 48.7 ± 25.4, and 63% of participants reported being at least “somewhat bothered” by tightness/pressure in pelvic area, 60% by frequent daytime urination, and 47% by nocturia. The mean PFDI-20 score was 45.5 ± 31.9. Women reported being at least “somewhat bothered” by heaviness/dullness in the pelvis (60%), frequent urination (56%), pelvic pain or discomfort (48%), and sensation of incomplete bladder emptying (43%). The PFDI-20 and UFS-QOL scores were not correlated with uterine volume (r = 0.12, P = 0.12, and r = 0.06, P = 0.44) or fibroid size (r = 0.09, P = 0.26, and r = 0.01, P = 0.92).

Conclusions

Women presenting for evaluation and treatment of fibroids report high rates of pelvic floor symptoms, particularly urinary frequency and pelvic pressure. However, uterine size and fibroid size are not associated with pelvic floor symptom bother.