bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of candidemia in Shiraz, southern Iran: A prospective multicenter study (2016–2018)
Authors: Arastehfar Amir , Yazdanpanah Samira , Bakhtiari Mina , Fang Wenjie , Pan Weihua , Mahmoudi Shahram , Pakshir Keyvan , Daneshnia Farnaz , Boekhout Teun , Ilkit Macit , Perlin David S , Zomorodian Kamiar , Zand Farid
Published: July 2020

Systematic candidemia studies, especially in southern Iran, are scarce. In the current prospective study, we investigated candidemia in three major healthcare centers of Shiraz, the largest city in southern Iran. Yeast isolates from blood and other sterile body fluids were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and subjected to antifungal susceptibility testing (AFST) using the broth microdilution method. Clinical data were retrieved from patients’ medical records. In total, 113 yeast isolates were recovered from 109 patients, over 60% of whom received fluconazole. Antifungal drugs were prescribed without considering species identification or AFST. The all-cause mortality rate was 28%. Almost 30% of the patients were from intensive care units (ICUs). Candida albicans (56/113; 49.5%) was the most prevalent species followed by C. glabrata (26/113; 23%), C. parapsilosis (13/113; 11.5%), C. tropicalis (7/113; 6.2%), and C. dubliniensis (5/113; 4.4%). Only five isolates showed antifungal resistance or decreased susceptibility to fluconazole: one C. orthopsilosis isolate from an azole-naïve patient and two C. glabrata, one C. albicans, and one C. dubliniensis isolates from patients treated with azoles, who developed therapeutic failure against azoles later. Our results revealed a low level of antifungal resistance but a notable rate of azole therapeutic failure among patients with candidemia due to non-albicans Candida species, which threaten the efficacy of fluconazole, the most widely used antifungal in southern regions of Iran. Candidemia studies should not be confined to ICUs and treatment should be administered based on species identification and AFST results.
Successive line-locked C iv doublets in quasar SDSS J115122.14+020426.3
Authors: Lin Ying-Ru , Lu Wei-Jian
Published: July 2020

Rodríguez Hidalgo et al. (2013, ApJ, 775, 14) have reported the transition of a C iv mini-broad absorption line (mini-BAL) into a BAL in quasar SDSS J115122.14+020426.3 (hereafter J1151+0204). Based on the two-epoch spectra obtained from the Sloan Digital Sky Survey, we further investigate the three BAL systems (systems A, B and C) in J1151+0204. First, we confirm that the absorption-line variability in J1151+0204 is most likely caused by the change in ionization in response to the continuum variation, according to at least the following observational factors: coordinated strengthening is detected between multiple absorption troughs, and the continuum shows obvious weakening. According to photoionization simulations, asynchronized variability between the continuum and absorption lines indicates that the mini-BAL (system A) of J1151+0204 actually represents the state of a higher ionization level and lower C iv column density of the outflow, while its BAL identifies the state of a lower ionization level and higher C iv column density. Second, we find a rare case of a quintuple, which is due to four successive line-locked C iv doublets, within system C. This indicates that these outflow clouds have achieved a high degree of clumpiness, and that the radiative forces play a significant role in the acceleration process of these clumpy outflow clouds.
X-ray spectroscopy of the γ-ray brightest nova V906 Car (ASASSN-18fv)
Authors: Sokolovsky Kirill V , Mukai Koji , Chomiuk Laura , Lopes de Oliveira Raimundo , Aydi Elias , Li Kwan-Lok , Steinberg Elad , Vurm Indrek , Metzger Brian D , Kawash Adam , Linford Justin D , Mioduszewski Amy J , Nelson Thomas , Ness Jan-Uwe , Page Kim L , Rupen Michael P , Sokoloski Jennifer L , Strader Jay
Published: July 2020

Shocks in γ-ray emitting classical novae are expected to produce bright thermal and non-thermal X-rays. We test this prediction with simultaneous NuSTAR and Fermi/LAT observations of nova V906 Car, which exhibited the brightest GeV γ-ray emission to date. The nova is detected in hard X-rays while it is still γ-ray bright, but contrary to simple theoretical expectations, the detected 3.5–78 keV emission of V906 Car is much weaker than the simultaneously observed >100 MeV emission. No non-thermal X-ray emission is detected, and our deep limits imply that the γ-rays are likely hadronic. After correcting for substantial absorption (NH ≈ 2 × 1023 cm−2), the thermal X-ray luminosity (from a 9 keV optically thin plasma) is just ∼2 per cent of the γ-ray luminosity. We consider possible explanations for the low thermal X-ray luminosity, including the X-rays being suppressed by corrugated, radiative shock fronts or the X-rays from the γ-ray producing shock are hidden behind an even larger absorbing column (NH > 1025 cm−2). Adding XMM–Newton and Swift/XRT observations to our analysis, we find that the evolution of the intrinsic X-ray absorption requires the nova shell to be expelled 24 d after the outburst onset. The X-ray spectra show that the ejecta are enhanced in nitrogen and oxygen, and the nova occurred on the surface of a CO-type white dwarf. We see no indication of a distinct supersoft phase in the X-ray light curve, which, after considering the absorption effects, may point to a low mass of the white dwarf hosting the nova.
Nature of the DLA towards Q 0528−250: High pressure and strong UV field revealed by excitation of C i, H2, and Si ii
Authors: Balashev S A , Ledoux C , Noterdaeme P , Srianand R , Petitjean P , Gupta N
Published: July 2020

We present the detection of excited fine-structure energy levels of singly ionized silicon and neutral carbon associated with the proximate damped Lyman-α system at zabs = 2.811 towards Q 0528−250. This absorber has an apparent relative velocity that is inconsistent with the Hubble flow indicating motion along the line-of-sight towards the quasar, i.e. zabs > zem. We measure the metallicity of the system to be [Zn/H] = −0.68 ± 0.02. Using the relative populations of the fine-structure levels of Si ii and C i, as well as the populations of H2 rotational levels, we constrain the physical conditions of the gas. We derive hydrogen number densities of $n_{\rm H}=190^{+70}_{-50}$ cm−3 and $260^{+30}_{-20}$ cm−3 in two velocity components where both C i and H2 are detected. Taking into account the kinetic temperature in each component, ∼150 K, we infer high values of thermal pressure in the cold neutral medium probed by the observations. The strengths of the UV field in Draine’s unit are $I_{\rm UV} = 10^{+5}_{-3}$ and $14^{+3}_{-3}$ in each of these two components, respectively. Such enhanced UV fluxes and thermal pressure compared to intervening DLAs are likely due to the proximity of the quasar. The typical size of the absorber is ∼104 au. Assuming the UV flux is dominated by the quasar, we constrain the distance between the quasar and the absorber to be ∼150−200 kpc. This favours a scenario where the absorption occurs in a companion galaxy located in the group where the quasar-host galaxy resides. This is in line with studies in emission that revealed the presence of several galaxies around the quasar.
Determination of the relative inclination and the viewing angle of an interacting pair of galaxies using Convolutional Neural Networks
Authors: Prakash Prem , Banerjee Arunima , Perepu Pavan Kumar
Published: July 2020

Constructing dynamical models for interacting galaxies constrained by their observed structure and kinematics crucially depends on the correct choice of the values of their relative inclination (i) and viewing angle (θ) (the angle between the line of sight and the normal to the plane of their orbital motion). We construct Deep Convolutional Neural Network (DCNN) models to determine the i and θ of interacting galaxy pairs, using N-body + smoothed particle hydrodynamics (SPH) simulation data from the GalMer data base for training. GalMer simulates only a discrete set of i values (0°, 45°, 75°, and 90°) and almost all possible values of θ values in the range, [−90°, 90°]. Therefore, we have used classification for i parameter and regression for θ. In order to classify galaxy pairs based on their i values only, we first construct DCNN models for (i) 2-class (i  = 0 °, 45°) (ii) 3-class (i = 0°, 45°, 90°) classification, obtaining F1 scores of 99 per cent and 98 per cent respectively. Further, for a classification based on both i and θ values, we develop a DCNN model for a 9-class classification using different possible combinations of i and θ, and the F1 score was 97${{\ \rm per\ cent}}$. To estimate θ alone, we have used regression, and obtained a mean-squared error value of 0.12. Finally, we also tested our DCNN model on real data from Sloan Digital Sky Survey. Our DCNN models could be extended to determine additional dynamical parameters, currently determined by trial and error method.
An Evolutionarily Primitive and Distinct Auxin Metabolism in the Lycophyte Selaginella moellendorffii
Authors: Kaneko Shutaro , Cook Sam David , Aoi Yuki , Watanabe Akie , Hayashi Ken-Ichiro , Kasahara Hiroyuki
Published: July 2020

Auxin is a key regulator of plant growth and development. Indole-3-acetic acid (IAA), a plant auxin, is mainly produced from tryptophan via indole-3-pyruvate (IPA) in both bryophytes and angiosperms. Angiosperms have multiple, well-documented IAA inactivation pathways, involving conjugation to IAA-aspartate (IAA-Asp)/glutamate by the GH3 auxin-amido synthetases, and oxidation to 2-oxindole-3-acetic acid (oxIAA) by the DAO proteins. However, IAA biosynthesis and inactivation processes remain elusive in lycophytes, an early lineage of spore-producing vascular plants. In this article, we studied IAA biosynthesis and inactivation in the lycophyte Selaginella moellendorffii. We demonstrate that S. moellendorffii mainly produces IAA from the IPA pathway for the regulation of root growth and response to high temperature, similar to the angiosperm Arabidopsis. However, S. moellendorffii exhibits a unique IAA metabolite profile with high IAA-Asp and low oxIAA levels, distinct from Arabidopsis and the bryophyte Marchantia polymorpha, suggesting that the GH3 family is integral for IAA homeostasis in the lycophytes. The DAO homologs in S. moellendorffii share only limited similarity to the well-characterized rice and Arabidopsis DAO proteins. We therefore suggest that these enzymes may have a limited role in IAA homeostasis in S. moellendorffii compared to angiosperms. We provide new insights into the functional diversification of auxin metabolic genes in the evolution of land plants.
Perceptions of ICU Care Following Do-Not-Resuscitate Orders: A Military Perspective
Authors: Dishman Sydney E. , Driggers Kathryn E. , Johnson Laura S. , Olsen Cara H. , Ryan Andrea B. , McLawhorn Melissa M. , Chung Kevin K.
Published: July 2020

Objectives:

Although do-not-resuscitate orders only prohibit cardiopulmonary resuscitation in the case of cardiac arrest, the common initiation of this code status in the context of end-of-life care may lead providers to draw premature conclusions about other goals of care. The aim of this study is to identify concerns regarding care quality in the setting of do-not-resuscitate orders within the Department of Defense and compare differences in perceptions between members of the critical care team.

Design:

A cross sectional observational study was conducted.

Setting:

This study took place in the setting of critical care within the Department of Defense.

Subjects:

All members of the Uniformed Services Section of the Society of Critical Care Medicine were invited to participate.

Interventions:

A validated 31-question survey exploring the perceptions of care quality in the setting of do-not-resuscitate status was distributed.

Measurements and Main Results:

Exploratory factor analysis was used to categorically group survey questions, and average factor scores were compared between respondent groups using t tests. Responses to individual questions were also analyzed between comparison groups using Fisher exact tests. Factor analysis revealed no significant differences between respondents of different training backgrounds; however, those with do-not-resuscitate training were more likely to agree that active treatment would be pursued (p = 0.024) and that trust and communication would be maintained (p = 0.005). Although 38% of all respondents worry that quality of care will decrease, 93% agree that life-prolonging treatments should be offered. About a third of providers wrongly believed that a do-not-resuscitate order must be reversed prior to an operation.

Conclusions:

Although providers across training backgrounds held similar concerns about decreased care quality in the ICU, there is wide belief that the routine and noninvasive interventions are offered as indicated. Those with do-not-resuscitate training were more likely to believe that standards of care continued to be met after code status change.
Broadly neutralizing antibodies combined with latency-reversing agents or immune modulators as strategy for HIV-1 remission
Authors: Gunst Jesper Damsgaard , Højen Jesper Falkesgaard , Søgaard Ole Schmeltz
Published: July 2020

Purpose of review

Antiretroviral therapy (ART) is extremely effective in controlling HIV-1 infection; however, ART is not curative. Here, we review broadly neutralizing anti-HIV-1 antibodies (bNAbs) combined with latency-reversing agents (LRAs) or immune modulators as strategy for achieving long-term HIV-1 remission.

Recent findings

Clinical trials testing the effect of a single intervention such as a LRA ‘shock and kill’, immune modulator or bNAbs among HIV-1 infected individuals on long-term suppressive ART have not lead to long-term HIV-1 remission when ART is stopped. Novel combinations of interventions designed to eliminate infected cells and enhance immune-effector functions are being investigated. Findings in nonhuman primates (NHPs) of such combinations are very promising and clinical trials are now ongoing. These trials will provide the first indication of the efficacy of combinations of bNAbs and LRA or immune modulators for achieving durable HIV-1 remission.

bNAbs facilitate the elimination of HIV-1 infected cells and boost immune responses. Preclinical findings show that these effects can be harnessed by simultaneous administration of LRAs or immune modulators such as Toll-like receptor agonists. The clinical success of such combination strategies may be impacted by factors such as immune exhaustion, bNAbs sensitivity as well as the pharmacodynamics of the investigational compounds.
Visual Field Artifacts From Face Mask Use
Authors: Young Su Ling , Smith Margaret L. , Tatham Andrew J.
Published: July 2020

Purpose:

The coronavirus (COVID-19) pandemic has had a profound impact on how glaucoma care is delivered, necessitating reduced clinic flow, social distancing, and use of face coverings by patients and staff. This case highlights the need to be aware of improperly fitted face masks as a cause of artifact on standard automated perimetry (SAP).

Clinical Presentation:

A 32-year-old female underwent SAP with the 24-2 SITA Fast test of the Humphrey Field Analyzer wearing an ear-loop surgical face mask. At the end of testing, it was noted that the mask had ridden up the patient’s face. Small amounts of condensate were noted on the perimeter lens.

Clinical Findings:

SAP demonstrated good reliability indices but in both eyes, there was a marked reduction in sensitivity inferiorly. The glaucoma hemifield test was outside normal limits. It was ensured the upper border of the mask was well sealed with the loops secured around the ears and nasal strip of the mask pinched down. Visual fields were repeated and were found to be normal.

Conclusions:

Poorly fitting face masks represent a new cause of visual field artifact which may mimic pathologic field defects. Without careful attention during testing, the cause of such artifacts may not be apparent, especially as reliability indices may be normal. Adjustments to the fit of face masks may help prevent fogging or mask slippage and increase test reliability.
Henoch-Schönlein Purpura Associated With Diffuse Large B-cell Lymphoma of the Orbit
Authors: Bian Yandong , Oropesa Susel , Idowu Oluwatobi O. , Kudose Satoru , Husain Sameera , Bhagat Govind , Winn Bryan J.
Published: July 2020

The association between Henoch-Schönlein purpura (HSP) and neoplasia is rare and has been more commonly reported in cases of solid tumors rather than hemotological malignancies. To the authors’ knowledge, HSP in association with orbital lymphoma has not been previously reported. An 84-year-old man underwent anterior orbitotomy with biopsy for a rapidly growing orbital mass. Immediately following this procedure, he developed petechial rash, flash pulmonary edema, and kidney dysfunction with hematuria and proteinuria. Orbital biopsy revealed diffuse large B-cell lymphoma while skin and kidney biopsies showed features consistent with HSP. Multidisciplinary team involvement and treatment with chemotherapy and corticosteroid resulted in an excellent clinical response. Clinicians should be aware that HSP and orbital diffuse large B-cell lymphoma can co-occur, potentially leading to life-threatening rapid fluid shifts and metabolic derangements.
A Predictive Model for Temporal Artery Biopsy in the Setting of Suspected Giant Cell Arteritis: A Validation Study
Authors: Weis Ezekiel , Waite Chris , Roelofs Kelsey A.
Published: July 2020

Purpose:

A previously published predictive model based on threshold parameters for erythrocyte sedimentation rate, c-reactive protein, and platelet count demonstrated that 40% of patients who underwent biopsy may not have required it. The current study was performed to evaluate the model’s performance on an independent data set.

Methods:

This is a retrospective consecutive series of patients undergoing temporal artery biopsy (TAB) in a single health region in Canada. The model was applied to a multicenter cohort of patients undergoing TAB by a variety of surgical services. A centralized pathological database serving multiple institutions and surgical services was used to identify patients undergoing TAB.

Results:

Over a 7-year period, patients undergoing TAB were identified via a central pathological database. Those who had concurrent illnesses which would likely affect erythrocyte sedimentation rate, c-reactive protein, and platelet count, patients on steroids for >2 weeks by the time of biopsy, and those with missing serum markers were excluded. The previously developed model was applied to the 222 patients enrolled. The model correctly identified 29% of patients with a pretest probability of 0% for a positive biopsy and 9% with a pretest probability of 100%, suggesting that in total, 38% of patients could have avoided TAB.

Conclusion:

The results of this independent data set support the previously published predictive formula. Utilizing a simple, clinically applicable predictive model of the pretest probabilities, approximately 38% of TAB currently being performed may be avoided. The results suggest that evaluation with a prospective multicentre study would be appropriate.
Quantitative shadowgraphy of aerosol and droplet creation during oscillatory motion of the microkeratome amid COVID-19 and other infectious diseases
Authors: Khamar Pooja , Shetty Rohit , Balakrishnan Nikhil , Kabi Prasenjit , Roy Durbar , Basu Saptarshi , Sinha Roy Abhijit
Published: July 2020

Purpose:

To quantify the atomization of liquid over the cornea during flap creation using microkeratome using high-speed shadowgraphy.

Setting:

Laboratory study.

Design:

Laboratory investigational study.

Method:

In an experimental setup, flap creation was performed on enucleated goat's eyes (n = 8) mounted on a stand using One Use-Plus SBK Moria microkeratome (Moria SA) to assess the spread of aerosols and droplets using high-speed shadowgraphy. Two conditions were computed. A constant airflow assumed uniform air velocity throughout the room. A decaying jet assumed that local air velocity at the site of measurements was smaller than the exit velocity from the air duct.

Results:

With the advancement of the microkeratome across the wet corneal surface, the atomization of a balanced salt solution was recorded on shadowgraphy. The minimum droplet size was ∼90 μm. The maximum distance traversed was ∼1.8 m and ∼1.3 m assuming a constant airflow (setting of refractive surgery theater) and decaying jet condition (setting of an operating theater with air-handling unit), respectively.

Conclusions:

The microkeratome-assisted LASIK flap creation seemed to cause spread of droplets. The droplet diameters and velocities did not permit the formation of aerosols. Therefore, the risk of transmission of the virus to the surgeon and surgical personnel due to the microkeratome procedure seemed to be low.
Ground glass opacity on chest CT scans from screening to treatment: A literature review
Authors: Lin Yi-Han , Hsu Han-Shui
Published: July 2020

Lung cancer is the most common cause of cancer death in the world. However, recent studies have found that patients with pulmonary ground-glass opacity (GGO) have a better prognosis. Considering its low invasiveness, sublobar resection may be an appropriate treatment of choice. Low-dose computed tomography (CT) is recommended for the high-risk groups of lung cancer. Patients with nonsolid nodule are suggested to take annual low dose CT following-up. For part-solid or solid nodules, the solid component size less or more than 8 mm is the watershed of surgical treatment. Increasing tumor size is a hint of malignancy. Biopsy can be performed for clinically highly suspected malignant nodules. The endobronchial ultrasound biopsy, CT-guide biopsy, or surgical excision are the mainstream for the diagnosis of lung nodules. But for treatment, the sublobar resection is the mainstream of pulmonary GGO. A precise localization technique makes surgeons get enough resection margin and preserve more pulmonary function of the patients. The different localization technique is suitable for different kind nodular position. For patients with pure pulmonary GGO, annual low dose CT checkup is suitable. If the tumor size or solid part of the tumors increased gradually, adequate sublobar resection after tumor localization technique may provide good prognosis and preserve more pulmonary function of the patients.
Expanding the Molecular Spectrum of Secretory Carcinoma of Salivary Glands With a Novel VIM-RET Fusion
Authors: Skálová Alena , Banečkova Martina , Thompson Lester D.R. , Ptáková Nikola , Stevens Todd M. , Brcic Luka , Hyrcza Martin , Michal Michael , Simpson Roderick H.W. , Santana Thalita , Michal Michal , Vaněček Tomas , Leivo Ilmo
Published: July 2020

Background:

Secretory carcinoma (SC), originally described as mammary analogue SC, is a predominantly low-grade salivary gland neoplasm characterized by a recurrent t(12;15)(p13;q25) translocation, resulting in ETV6-NTRK3 gene fusion. Recently, alternative ETV6-RET, ETV6-MAML3, and ETV6-MET fusions have been found in a subset of SCs lacking the classic ETV6-NTRK3 fusion transcript, but still harboring ETV6 gene rearrangements.

Design:

Forty-nine cases of SC revealing typical histomorphology and immunoprofile were analyzed by next-generation sequencing using the FusionPlex Solid Tumor kit (ArcherDX). All 49 cases of SC were also tested for ETV6, RET, and NTRK3 break by fluorescence in situ hybridization and for the common ETV6-NTRK3 fusions using reverse transcription polymerase chain reaction.

Results:

Of the 49 cases studied, 37 (76%) occurred in the parotid gland, 7 (14%) in the submandibular gland, 2 (4%) in the minor salivary glands, and 1 (2%) each in the nasal mucosa, facial skin, and thyroid gland. SCs were diagnosed more frequently in males (27/49 cases; 55%). Patients’ age at diagnosis varied from 15 to 80 years, with a mean age of 49.9 years. By molecular analysis, 40 cases (82%) presented the classic ETV6-NTRK3 fusion, whereas 9 cases (18%) revealed an alternate fusion. Of the 9 cases negative for the ETV6-NTRK3 fusion, 8 cases presented with ETV6-RET fusion. In the 1 remaining case in the parotid gland, next-generation sequencing analysis identified a novel VIM-RET fusion transcript. In addition, the analysis indicated that 1 recurrent high-grade case in the submandibular gland was positive for both ETV6-NTRK3 and MYB-SMR3B fusion transcripts.

Conclusions:

A novel finding in our study was the discovery of a VIM-RET fusion in 1 patient with SC of the parotid gland who could possibly benefit from RET-targeted therapy. In addition, 1 recurrent high-grade case was shown to harbor 2 different fusions, namely, ETV6-NTRK3 and MYB-SMR3B. The expanded molecular spectrum provides a novel insight into SC oncogenesis and carries important implications for molecular diagnostics, as this is the first SC-associated translocation with a non-ETV6 5′ fusion partner. This finding further expands the definition of SC while carrying implications for selecting the appropriate targeted therapy.
Uterine Tumor Resembling Ovarian Sex Cord Stromal Tumor (UTROSCT)
Authors: Bennett Jennifer A. , Lastra Ricardo R. , Barroeta Julieta E. , Parilla Megan , Galbo Filippo , Wanjari Pankhuri , Young Robert H. , Krausz Thomas , Oliva Esther
Published: July 2020

ESR1 and GREB1 fusions have recently been described in uterine tumor resembling ovarian sex cord tumor (UTROSCT). Thus far, recurrences have been documented in a subset of those harboring GREB1 fusions, but not in those with ESR1 rearrangements. Here we describe the clinicopathologic features of 3 recurrent UTROSCTs with striking rhabdoid morphology (an unusual feature of these tumors overall) and ESR1-NCOA2 fusions. The patients were 32, 37, and 54 years at initial diagnosis and first recurrence occurred at 7, 9, and 32 years. The primary tumors (available in two cases) were centered in the myometrium and showed infiltrative borders. They predominantly grew in sheets and cords, but also had a pseudopapillary appearance. Cells were uniformly epithelioid with eccentric nuclei, prominent nucleoli, abundant eosinophilic globular/glassy (rhabdoid) cytoplasm, and infrequent mitoses (≤4/10 high-power fields [HPFs]). Recurrences were morphologically identical to the primary tumors, but demonstrated brisk mitotic activity (≥16/10 HPFs). The third tumor (with only recurrences available) had multiple patterns, including diffuse, corded, trabecular, and a focal retiform growth. Rhabdoid cells were conspicuous, but only comprised ~50% of the tumor, and mitoses numbered up to 2/10 HPFs. All tumors were strongly and diffusely positive for WT1, CAM5.2, ER, and PR, but negative for inhibin. Diffuse calretinin and desmin expression, as well as focal melan-A positivity, was noted in one tumor, but was negative in the others. In all 3 tumors, INI-1 and BRG-1 were retained, and ESR1-NCOA2 fusions were detected by targeted RNA sequencing. This study is the first to highlight an association between UTROSCTs with extensive rhabdoid differentiation, ESR1-NCOA2 fusions, and aggressive behavior. UTROSCTs are considered neoplasms of uncertain malignant potential, but have a benign course in most cases. Thus, it is important to be aware of these specific features and recommend long-term follow-up due to their propensity for late recurrences.
Discharge Prescription Errors After the Implementation of a Prospective Pharmacist Review Process in a Pediatric Emergency Department
Authors: Waehner Erin N. , Weightman Stephanie , Castañeda Debora , Morse Rustin
Published: July 2020

Objectives

Pediatric emergency department (ED) patients are at an increased risk for experiencing a preventable medication error. Studies show that pharmacists are effective at decreasing medication errors on inpatient orders but there are few studies looking at error reduction on discharge prescriptions. Children's Health implemented a prospective pharmacist verification process on all ED discharge prescriptions. The objective of this study is to identify and describe the prescription errors leaving a pediatric ED after the implementation of this pharmacist review process.

Methods

An electronic medical database was utilized to identify all ED prescriptions between January 1, 2016, and June 30, 2016. A random number generator was used to select 750 prescriptions. Two pharmacists independently performed a chart review assessing prescriptions for errors. A third pharmacist was used to clarify discordant assessments between the 2 pharmacists. Errors were recorded and assessed for severity using the Taylor et al 2005 stratification. The primary objective of this study is to identify the errors leaving the ED. Secondary objectives include: error severity, error subtype, and readmission rates.

Results

Forty-one errors were identified from 750 randomly selected prescriptions for a total error rate of 5.5%. The most common subtypes of errors were missing duration (39%) and antimicrobial optimization (24.4%). When using the Taylor et al 2005 scale, no prescriptions were classified as severe or serious. None of the errors led to patient harm.
Posttraumatic Giant Intradiploic Epidermoid Cyst of Orbital Roof
Authors: Zhang Feng , Xu Yi-Nong , Zhao Wei , Wang Yu-Hai , He Jian-Qing
Published: July 2020

Epidermoid cysts are rare benign tumors that account for 0.3% to 1.8% of all intracranial space-occupying lesions. They are usually congenital in origin and are thought to derived from ectodermal cell inclusions occurring during closure of the neural tube around third to fifth week of gestation. They are most commonly located in the cerebellopontine angle and the parasellar area, and their location in the diploic space is very rare. In this article, a case of giant epidermoid cyst located in the orbital roof intradiploic space is presented with clinical, radiologic features and surgical treatment.
Utilizing Simulation to Identify Latent Safety Threats During Neonatal Magnetic Resonance Imaging Procedure
Authors: Wong Jonathan , Kalaniti Kaarthigeyan , Castaldo Michael , Whyte Hilary , Lee Kyong-Soon , Schroff Manohar , Campbell Douglas M.
Published: July 2020

Introduction

Transfer of infants for magnetic resonance imaging (MRI) from the neonatal intensive care unit (NICU) requires exposure to unfamiliar environments and involve multiple complex human and system interactions, which can compromise patient safety. In situ simulation (ISS) offers an opportunity to identify latent safety threats (LSTs) that may occur during this high-risk procedure. Our primary aim was to use ISS to identify modifiable LSTs during the MRI procedure: involving neonatal transport to/from NICU to the MRI and the MRI scan. Secondarily, we compared the overall performance and needs of specialized versus nonspecialized transport personnel.

Methods

In situ simulations of the MRI procedure (transport and scan) were performed for 9 months involving specialized and nonspecialized transport personnel. Two simulation scenarios were used, one involving an intubated infant and one nonintubated infant. After each simulation, participants underwent a standardized debriefing and answered questionnaires on safety threats and team function. The results were then used to identify and implement mitigation strategies.

Results

Among 10 simulations completed, 7 were by specialized and 3 by nonspecialized teams. In total, 116 LSTs were identified (22 involving medication, 12 equipment, and 82 resources/system issues). Preprocedure deliberation with anticipation/preparedness for patient deterioration, and the need for clinical checklists and protocols were identified as important requirements. After completion of the project, protocols (ie, sedation), checklists (ie, pretransport), and policies (ie, environmental orientation) were adapted to address the gaps.

Conclusions

In situ simulations were able to identify important safety risks during transport of neonatal patients from the NICU to the MRI suite, informing changes in MRI transport policy.
Community-level SARS-CoV-2 Seroprevalence Survey in urban slum dwellers of Buenos Aires City, Argentina: a participatory research
Authors: Figar Silvana , Pagotto Vanina , Luna Lorena , Salto Julieta , Manslau Magdalena Wagner , Mistchenko Alicia S. , Gamarnik Andrea , Saldaño Ana María Gómez , de Quirós Fernán González Bernaldo
Published: July 2020

Background

By July 1st, the incidence rate of RT-qPCR SARS-CoV-2 infection was 5.9% in Barrio Padre Mugica, one of the largest slums in Buenos Aires City. This study aimed to establish the seroprevalence of SARS-CoV-2 three months after the first case was reported.

Methods

Between June 10th and July 1st, a cross-sectional design was carried out on people over 14 years old, selected from a probabilistic sample of households. A finger prick sample was tested by ELISA to detect IgG-class antibodies against SARS-CoV-2. Multilevel model was applied to understand sector, household and individual conditions associated with seroconvert.

Results

Prevalence based on IgG was 53.4% (95%IC 52.8% to 54.1%). Among the IgG positive cases, 15% reported having compatible symptoms at some point in the past two months. There is evidence of within-household clustering effect (rho=0.52; 95% IC 0.36-0.67); living with a PCR-confirmed case doubled the chance of being SARS-CoV2 IgG positive (OR 2.13; 95% IC 1.17-3.85). The highest risk of infection was found in one of the most deprived areas of the slum, the “Bajo autopista” sector.

Discussion

High seroprevalence is shown, for each symptomatic RT-qPCR-confirmed diagnosis, 9 people were IgG positive, indicating a high rate of undetected (probable asymptomatic) infections. Given that transmission among family members is a leading driver of the disease’s spread, it is unsurprising that crowded housing situations in slums are directly associated with higher risk of infection and consequently high seroprevalence levels.

This study contributes to the understanding of population immunity against SARS-CoV2, its relation to living conditions and viral spread, for future decision making.
Contraceptive Method Skew in India 1992-2016
Authors: Chaurasia Aalok Ranjan
Published: July 2020

This paper analyses the contraceptive method skew in districts of India over more than two decades. The analysis reveals clear regional pattern in the method skew. In the northern and eastern regions, method skew is low and average but high or very high in the southern part of the country where factors such as poverty, education, social class, religion contributes little to deciding the method skew. In the central region, religious composition of the population has an impact on the method skew. In northern and eastern regions, poverty and education have an impact on the method skew. The analysis indicates that India has focussed on only one method - female sterilisation - to promote family planning, reduce fertility and curtail population growth. Increase in the prevalence of other family planning methods, especially, modern spacing methods, appears to be the need of the time. This requires improving the organisational efficiency and strengthening the administrative capacity of the official family planning services is the need of the time.
Bivalent binding of a fully human IgG to the SARS-CoV-2 spike proteins reveals mechanisms of potent neutralization
Authors: Wang Bei , Asarnow Daniel , Lee Wen-Hsin , Huang Ching-Wen , Faust Bryan , Ng Patricia Miang Lon , Ngoh Eve Zi Xian , Bohn Markus , Bulkley David , Pizzorno Andrés , Tan Hwee Ching , Lee Chia Yin , Minhat Rabiatul Adawiyah , Terrier Olivier , Soh Mun Kuen , Teo Frannie Jiuyi , Yeap Yvonne Yee Chin , Hu Yuanyu , Seah Shirley Gek Kheng , Maurer-Stroh Sebastian , Renia Laurent , Hanson Brendon John , Rosa-Calatrava Manuel , Manglik Aashish , Cheng Yifan , Craik Charles S. , Wang Cheng-I
Published: July 2020

In vitro antibody selection against pathogens from naïve combinatorial libraries can yield various classes of antigen-specific binders that are distinct from those evolved from natural infection1–4. Also, rapid neutralizing antibody discovery can be made possible by a strategy that selects for those interfering with pathogen and host interaction5. Here we report the discovery of antibodies that neutralize SARS-CoV-2, the virus responsible for the COVID-19 pandemic, from a highly diverse naïve human Fab library. Lead antibody 5A6 blocks the receptor binding domain (RBD) of the viral spike from binding to the host receptor angiotensin converting enzyme 2 (ACE2), neutralizes SARS-CoV-2 infection of Vero E6 cells, and reduces viral replication in reconstituted human nasal and bronchial epithelium models. 5A6 has a high occupancy on the viral surface and exerts its neutralization activity via a bivalent binding mode to the tip of two neighbouring RBDs at the ACE2 interaction interface, one in the “up” and the other in the “down” position, explaining its superior neutralization capacity. Furthermore, 5A6 is insensitive to several spike mutations identified in clinical isolates, including the D614G mutant that has become dominant worldwide. Our results suggest that 5A6 could be an effective prophylactic and therapeutic treatment of COVID-19.
Coagulopathy in patients with Coronavirus Disease 2019 (COVID-19): A systematic review and meta-analysis
Authors: Zhang Xiaolin , Yang Xue , Jiao Hongmei , Liu Xinmin
Published: July 2020

Patients with COVID-19 frequently manifest coagulation abnormalities and thrombotic events. In this meta-analysis, we aimed to explore the role of coagulopathy on the severity differences in patients with COVID-19. We conducted systematic literature search via Pubmed, Embase, Cochrane, WanFang Database, CNKI, and medRxiv from December 1, 2019 to May 1, 2020, to identify all original studies that reports on coagulation parameters (D-dimer, PLT, PT, APTT, and FIB) during COVID-19 infection. Thereafter, we compared the coagulation parameters between less severe and more severe cases. All Statistical analyses were performed via Stata14.0 software. A total of 3,952 confirmed COVID-19 infected patients were included from 25 studies. Patients with severe COVID-19 infection exhibited significantly higher levels of D-dimer, PT, and FIB (SMD 0.83, 95% CI: 0.70-0.97, I2 56.9%; SMD 0.39, 95% CI: 0.14-0.64, I2 77.9%; SMD 0.35, 95% CI: 0.17-0.53, I242.4% respectively). However, difference in PLT and APTT levels between less severe and more severe patients was not statistically significant (SMD-0.26, 95% CI:-0.56-0.05, I2 82.2%; SMD-0.14,95% CI: −0.45-0.18, I2 75.5% respectively) This meta-analysis revealed coagulopathy is associated with the severity of COVID-19. Notably, D-dimer, PT, and FIB are the dominant parameters that should be considered in evaluating coagulopathy in COVID-19 patients.
Diagnostic performance and prediction of clinical progression of plasma phospho-tau181 in the Alzheimer’s Disease Neuroimaging Initiative
Authors: Karikari Thomas K. , Benedet Andréa L. , Ashton Nicholas J. , Rodriguez Juan Lantero , Snellman Anniina , Suárez-Calvet Marc , Chaudhuri Paramita Saha , Lussier Firoza , Kvartsberg Hlin , Rial Alexis Moscoso , Pascoal Tharick A. , Andreasson Ulf , Schöll Michael , Rosa-Neto Pedro , Blennow Kaj , Zetterberg Henrik ,   for the Alzheimer’s Disease Neuroimaging Initiative
Published: July 2020

Whilst cerebrospinal fluid (CSF) and positron emission tomography (PET) biomarkers for amyloid-β (Aβ) and tau pathologies are accurate for the diagnosis of Alzheimer’s disease (AD), their broad implementation in clinical and trial settings are restricted by high cost and limited accessibility. Plasma phosphorylated-tau181 (p-tau181) is a promising blood-based biomarker that is specific for AD, correlates with cerebral Aβ and tau pathology, and predicts future cognitive decline. In this study, we report the performance of p-tau181 in >1,000 individuals from the Alzheimer’s Disease Neuroimaging Initiative (ADNI), including cognitively unimpaired (CU), mild cognitive impairment (MCI) and AD dementia patients characterized by Aβ PET. We confirmed that plasma p-tau181 is increased at the preclinical stage of Alzheimer and further increases in MCI and AD dementia. Individuals clinically classified as AD dementia but having negative Aβ PET scans did not show increased plasma p-tau181. Despite being a multicenter study, plasma p-tau181 demonstrated high diagnostic accuracy to identify AD dementia (AUC=85.3%; 95% CI, 81.4%-89.2%), as well as to distinguish between Aβ- and Aβ+ individuals along the Alzheimer’scontinuum(AUC=76.9%; 95% CI, 74.0%-79.8%). Higher baseline concentrations of plasma p-tau181 accurately predicted future dementia and performed comparably to the baseline prediction of CSF p-tau181. Longitudinal measurements of plasma p-tau181 revealed low intra-individual variability, which could be of potential benefit in disease-modifying trials seeking a measurable response to a therapeutic target. This study adds significant weight to the growing body of evidence in the use of plasma p-tau181 as a non-invasive diagnostic and prognostic tool for AD, regardless of clinical stage, which would be of great benefit in clinical practice and a large cost-saving in clinical trial recruitment.
Causal analysis of COVID-19 observational data in German districts reveals effects of mobility, awareness, and temperature
Authors: Steiger Edgar , Mußgnug Tobias , Kroll Lars Eric
Published: July 2020

Mobility, awareness, and weather are suspected to be causal drivers for new cases of COVID-19 infection. Correcting for possible confounders, we estimated their causal effects on reported case numbers. To this end, we used a directed acyclic graph (DAG) as a graphical representation of the hypothesized causal effects of the aforementioned determinants on new reported cases of COVID-19. Based on this, we computed valid adjustment sets of the possible confounding factors. We collected data for Germany from publicly available sources (e.g. Robert Koch Institute, Germany’s National Meteorological Service, Google) for 401 German districts over the period of 15 February to 8 July 2020, and estimated total causal effects based on our DAG analysis by negative binomial regression. Our analysis revealed favorable causal effects of increasing temperature, increased public mobility for essential shopping (grocery and pharmacy), and awareness measured by COVID-19 burden, all of them reducing the outcome of newly reported COVID-19 cases. Conversely, we saw adverse effects of public mobility in retail and recreational areas, awareness measured by searches for “corona” in Google, and higher rainfall, leading to an increase in new COVID-19 cases. This comprehensive causal analysis of a variety of determinants affecting COVID-19 progression gives strong evidence for the driving forces of mobility, public awareness, and temperature, whose implications need to be taken into account for future decisions regarding pandemic management.
Short-term analysis and long-term predictions for the COVID-19 epidemic in a seasonality regime: the Italian case
Authors: Simoni Giulia , Fochesato Anna , Reali Federico , Giordano Giulia , Domenici Enrico , Marchetti Luca
Published: July 2020

As of July 14th, COVID-19 has caused in Italy 34.984 deaths and 243.344 infection cases. Strict lockdown policies were necessary to contain the first outbreak wave and prevent the Italian healthcare system from being overwhelmed by patients requiring intensive care. After the progressive reopening, predicting how the epidemic situation will evolve is urgent and fundamental to control any future outbreak and prevent a second wave. We defined a time-varying optimization procedure to repeatedly calibrate the SIDARTHE model1 with data up to June 24th. The computed parameter distributions allow us to robustly analyse how the epidemic situation evolved and outline possible future scenarios. Assuming a seasonal regime for COVID-19, we tested different lockdown policies. Our results suggest that an intermittent lockdown where six “open days” are allowed every other week may prevent a resurgent exponential outbreak and, at the same time, ease the societal burden of an extensive lockdown.
Inference of COVID-19 epidemiological distributions from Brazilian hospital data
Authors: Hawryluk Iwona , Mellan Thomas A. , Hoeltgebaum Henrique H , Mishra Swapnil , Schnekenberg Ricardo P , Whittaker Charles , Zhu Harrison , Gandy Axel , Donnelly Christl A. , Flaxman Seth , Bhatt Samir
Published: July 2020

Knowing COVID-19 epidemiological distributions, such as the time from patient admission to death, is directly relevant to effective primary and secondary care planning, and moreover, the mathematical modelling of the pandemic generally. We determine epidemiological distributions for patients hospitalised with COVID-19 using a large dataset (N = 21,000 – 157,000) from the Brazilian Sistema de Informação de Vigilancia Epidemiológica da Gripe database. A joint Bayesian subnational model with partial pooling is used to simultaneously describe the 26 states and one federal district of Brazil, and shows significant variation in the mean of the symptom-onset-to-death time, with ranges between 11.2-17.8 days across the different states, and a mean of 15.2 days for Brazil. We find strong evidence in favour of specific probability density function choices: for example, the gamma distribution gives the best fit for onset-to-death and the generalised lognormal for onset-to-hospital-admission. Our results show that epidemiological distributions have considerable geographical variation, and provide the first estimates of these distributions in a low and middle-income setting. At the subnational level, variation in COVID-19 outcome timings are found to be correlated with poverty, deprivation and segregation levels, and weaker correlation is observed for mean age, wealth and urbanicity.
New insight of adrenal responses in premature neonates versus full term neonates in critical care setting
Authors: Razik Suzan Abd , Hashem Heba Ezzat , Ahmed Wafaa Osman
Published: July 2020

Background

Adequate adrenocortical function is essential for survival of critically ill neonates. Although most of them display elevated plasma cortisol concentrations, which reflects activation of the hypothalamic pituitary adrenal axis (HPA), yet; adrenocortical insufficiency is seen in septic shock. Objectives: Evaluate the HPA response in critically ill neonates with shock.

Methods

this prospective observational Participant: a total of 60 neonates divided into 3 groups;(A) 30 critical ill neonates with septic shock on inotropic support, (B)15 patients with sepsis with no inotropic support and(C) control group(n=15). Intervention: a single diurnal ACTH reading and two readings for serum cortisol level (diurnal and nocturnal).

Results

Gram negative organism was more prevalent among the patients; 53%, 63% in groups A and B respectively. Group A showed Significant statistical hypotension before vasopressor drug administration (p<0.001) as compared to both groups. Group A showed Significant statistical improvement of blood pressure after vasopressor drug administration (p<0.001) as compared to both groups B, C. Serum cortisol was significantly higher in group A(57.21±24.31) and B (48.01±18.27), while it was lower in group C(19.57±16.05). A highly statistically significant rise of serum cortisol level(p=0.000) and ACTH(p=0.000) in group A when was compared to the other two groups.

Conclusion

This study introduced a new pattern of serum cortisol response in neonates ranging from very high cortisol level to a near normal values; highlighting a state of glucocorticoid resistance in neonates and relative adrenal insufficiency.