bluuebunny/crossref_metadata_2025 huggingface dataset:
Extraterritorial forays by great tits are associated with dawn song in unexpected ways
Authors: Bircher Nina , van Oers Kees , Hinde Camilla A , Naguib Marc
Published: April 2020

Conspicuous male signals often play an important role in both attracting mates and deterring rivals. In territorial species with extrapair mating, female and male forays to other territories may be an important component underlying female choice and male mating success and might be influenced by male advertisement signals. Yet, whether off-territory foraying is associated with male signals is still not well understood. Here, we tested how female and male forays are associated with short-range visual and long-range acoustic signals (dawn song). We used an automated radio tracking system to follow the movements of wild great tits (Parus major) to other territories in relation to male dawn song, plumage ornaments, and extrapair paternity. We show that both sexes frequently forayed into others’ territories throughout the breeding period. Movements of both males and females were associated with male song but not with plumage ornaments. Contrary to our expectations, females stayed away from territories where males sang elaborately, whereas males were attracted to those territories. Moreover, neither female nor male forays were associated with the occurrence of extrapair offspring. Our results, thus, suggest that, although forays into other territories are associated with male dawn song, females may not be attracted and males not repelled by dawn song. This sheds a different light on the sex-specific effects of male advertisement signals, expanding the view on the selection pressures shaping such communication systems.
Overlap detection on long, error-prone sequencing reads via smooth q-gram
Authors: Song Yan , Tang Haixu , Zhang Haoyu , Zhang Qin
Published: April 2020

Motivation

Third generation sequencing techniques, such as the Single Molecule Real Time technique from PacBio and the MinION technique from Oxford Nanopore, can generate long, error-prone sequencing reads which pose new challenges for fragment assembly algorithms. In this paper, we study the overlap detection problem for error-prone reads, which is the first and most critical step in the de novo fragment assembly. We observe that all the state-of-the-art methods cannot achieve an ideal accuracy for overlap detection (in terms of relatively low precision and recall) due to the high sequencing error rates, especially when the overlap lengths between reads are relatively short (e.g. <2000 bases). This limitation appears inherent to these algorithms due to their usage of q-gram-based seeds under the seed-extension framework.

Results

We propose smooth q-gram, a variant of q-gram that captures q-gram pairs within small edit distances and design a novel algorithm for detecting overlapping reads using smooth q-gram-based seeds. We implemented the algorithm and tested it on both PacBio and Nanopore sequencing datasets. Our benchmarking results demonstrated that our algorithm outperforms the existing q-gram-based overlap detection algorithms, especially for reads with relatively short overlapping lengths.

Availability and implementation

The source code of our implementation in C++ is available at https://github.com/FIGOGO/smoothq.

Supplementary information

Supplementary data are available at Bioinformatics online.
Advancing PICO element detection in biomedical text via deep neural networks
Authors: Jin Di , Szolovits Peter
Published: April 2020

Motivation

In evidence-based medicine, defining a clinical question in terms of the specific patient problem aids the physicians to efficiently identify appropriate resources and search for the best available evidence for medical treatment. In order to formulate a well-defined, focused clinical question, a framework called PICO is widely used, which identifies the sentences in a given medical text that belong to the four components typically reported in clinical trials: Participants/Problem (P), Intervention (I), Comparison (C) and Outcome (O). In this work, we propose a novel deep learning model for recognizing PICO elements in biomedical abstracts. Based on the previous state-of-the-art bidirectional long-short-term memory (bi-LSTM) plus conditional random field architecture, we add another layer of bi-LSTM upon the sentence representation vectors so that the contextual information from surrounding sentences can be gathered to help infer the interpretation of the current one. In addition, we propose two methods to further generalize and improve the model: adversarial training and unsupervised pre-training over large corpora.

Results

We tested our proposed approach over two benchmark datasets. One is the PubMed-PICO dataset, where our best results outperform the previous best by 5.5%, 7.9% and 5.8% for P, I and O elements in terms of F1 score, respectively. And for the other dataset named NICTA-PIBOSO, the improvements for P/I/O elements are 3.9%, 15.6% and 1.3% in F1 score, respectively. Overall, our proposed deep learning model can obtain unprecedented PICO element detection accuracy while avoiding the need for any manual feature selection.

Availability and implementation

Code is available at https://github.com/jind11/Deep-PICO-Detection.
yacrd and fpa: upstream tools for long-read genome assembly
Authors: Marijon Pierre , Chikhi Rayan , Varré Jean-Stéphane
Published: April 2020

Motivation

Genome assembly is increasingly performed on long, uncorrected reads. Assembly quality may be degraded due to unfiltered chimeric reads; also, the storage of all read overlaps can take up to terabytes of disk space.

Results

We introduce two tools: yacrd for chimera removal and read scrubbing, and fpa for filtering out spurious overlaps. We show that yacrd results in higher-quality assemblies and is one hundred times faster than the best available alternative.

Availability and implementation

https://github.com/natir/yacrd and https://github.com/natir/fpa.

Supplementary information

Supplementary data are available at Bioinformatics online.
Temporal changes in the corpus luteum during early pregnancy reveal regulation of pathways that enhance steroidogenesis and suppress luteolytic mechanisms†
Authors: Hughes C H K , Inskeep E K , Pate J L
Published: April 2020

Although rescue of the corpus luteum (CL) is required for pregnancy, luteal function during maternal recognition of pregnancy remains largely unexplored. CL were collected from pregnant cattle on days 14, 17, 20, and 23, to encompass the maternal recognition of pregnancy period. Next-generation sequencing was used to profile mRNA abundance during this time, while tandem mass spectrometry and nanostring technology were used to profile proteins and miRNA, respectively. A total of 1157 mRNA were differentially abundant, while 27 miRNA changed, and 29 proteins tended to change. mRNA that increased were regulators of interferon signaling and DNA repair, while those that decreased were associated with luteolytic processes, such as calcium signaling and matrix metallopeptidase (MMP) signaling, indicating inhibition of these processes. One of these, MMP12, was regulated by prostaglandin F2A in vitro. mRNA that were maximally abundant on day 20 were primarily associated with immune processes. Two of these, C-C motif chemokine ligand 1 and NFKB inhibitor alpha, were regulated by interferon tau in vitro. MiRNA that increased were predicted to inhibit phosphatidylinositol signaling, while those that decreased may be negative regulators of steroidogenesis. One protein that was greater on day 20 than on day 14 was aldehyde dehydrogenase 1 family member A1 (ALDH1A1), which synthesizes retinoic acid. Pharmacological inhibition of this enzyme, or of retinoic acid receptor signaling, led to suppression of progesterone production in vitro. Overall, these data indicate that there are changes in the CL of pregnancy that are important for continued luteal function.
The role of the inferior parietal lobule in writer’s cramp
Authors: Merchant Shabbir Hussain I , Frangos Eleni , Parker Jacob , Bradson Megan , Wu Tianxia , Vial-Undurraga Felipe , Leodori Giorgio , Bushnell M C , Horovitz Silvina G , Hallett Mark , Popa Traian
Published: April 2020

Humans have a distinguishing ability for fine motor control that is subserved by a highly evolved cortico-motor neuronal network. The acquisition of a particular motor skill involves a long series of practice movements, trial and error, adjustment and refinement. At the cortical level, this acquisition begins in the parieto-temporal sensory regions and is subsequently consolidated and stratified in the premotor-motor cortex. Task-specific dystonia can be viewed as a corruption or loss of motor control confined to a single motor skill. Using a multimodal experimental approach combining neuroimaging and non-invasive brain stimulation, we explored interactions between the principal nodes of the fine motor control network in patients with writer’s cramp and healthy matched controls. Patients and healthy volunteers underwent clinical assessment, diffusion-weighted MRI for tractography, and functional MRI during a finger tapping task. Activation maps from the task-functional MRI scans were used for target selection and neuro-navigation of the transcranial magnetic stimulation. Single- and double-pulse TMS evaluation included measurement of the input-output recruitment curve, cortical silent period, and amplitude of the motor evoked potentials conditioned by cortico-cortical interactions between premotor ventral (PMv)-motor cortex (M1), anterior inferior parietal lobule (aIPL)-M1, and dorsal inferior parietal lobule (dIPL)-M1 before and after inducing a long term depression-like plastic change to dIPL node with continuous theta-burst transcranial magnetic stimulation in a randomized, sham-controlled design. Baseline dIPL-M1 and aIPL-M1 cortico-cortical interactions were facilitatory and inhibitory, respectively, in healthy volunteers, whereas the interactions were converse and significantly different in writer’s cramp. Baseline PMv-M1 interactions were inhibitory and similar between the groups. The dIPL-PMv resting state functional connectivity was increased in patients compared to controls, but no differences in structural connectivity between the nodes were observed. Cortical silent period was significantly prolonged in writer’s cramp. Making a long term depression-like plastic change to dIPL node transformed the aIPL-M1 interaction to inhibitory (similar to healthy volunteers) and cancelled the PMv-M1 inhibition only in the writer’s cramp group. These findings suggest that the parietal multimodal sensory association region could have an aberrant downstream influence on the fine motor control network in writer’s cramp, which could be artificially restored to its normal function.
Enhancer Locus in ch14q23.1 Modulates Brain Asymmetric Temporal Regions Involved in Language Processing
Authors: Le Guen Yann , Leroy François , Philippe Cathy ,   IMAGEN Consortium, Mangin Jean-François , Dehaene-Lambertz Ghislaine , Frouin Vincent
Published: April 2020

Identifying the genes that contribute to the variability in brain regions involved in language processing may shed light on the evolution of brain structures essential to the emergence of language in Homo sapiens. The superior temporal asymmetrical pit (STAP), which is not observed in chimpanzees, represents an ideal phenotype to investigate the genetic variations that support human communication. The left STAP depth was significantly associated with a predicted enhancer annotation located in the 14q23.1 locus, between DACT1 and KIAA0586, in the UK Biobank British discovery sample (N = 16 515). This association was replicated in the IMAGEN cohort (N = 1726) and the UK Biobank non-British validation sample (N = 2161). This genomic region was also associated to a lesser extent with the right STAP depth and the formation of sulcal interruptions, “plis de passage,” in the bilateral STAP but not with other structural brain MRI phenotypes, highlighting its notable association with the superior temporal regions. Diffusion MRI emphasized an association with the fractional anisotropy of the left auditory fibers of the corpus callosum and with networks involved in linguistic processing in resting-state functional MRI. Overall, this evidence demonstrates a specific relationship between this locus and the establishment of the superior temporal regions that support human communication.
National Trends in Antibiotic Use in Australian Residential Aged Care Facilities, 2005–2016
Authors: Sluggett Janet K , Moldovan Max , Lynn David J , Papanicolas Lito E , Crotty Maria , Whitehead Craig , Wesselingh Steve L , Rogers Geraint B , Inacio Maria C
Published: April 2020

Background

Understanding current patterns of antibiotic use in residential aged care facilities (RACFs) is essential to inform stewardship activities, but limited utilization data exist. This study examined changes in prevalence and consumption of antibiotics in Australian RACFs between 2005–2006 and 2015–2016.

Methods

This population-based, repeated cross-sectional analysis included all long-term permanent residents of Australian RACFs between July 2005 and June 2016 who were aged ≥ 65 years. The yearly prevalence rate of antibiotic use and number of defined daily doses (DDDs) of systemic antibiotics per 1000 resident-days were determined annually from linked pharmaceutical claims data. Trends were assessed using ordinary least squares regression.

Results

This study included 502 752 residents from 3218 RACFs, with 424.9 million resident-days analyzed. Antibiotics were dispensed on 5 608 126 occasions during the study period, of which 88% were for oral use. Cefalexin, amoxicillin-clavulanic acid, and trimethoprim were the most commonly dispensed antibiotics. The annual prevalence of antibiotic use increased from 63.8% (95% confidence interval [CI], 63.3%–64.4%) to 70.3% (95% CI, 69.9%–70.7%) between 2005–2006 and 2015–2016 (0.8% average annual increase, P < .001). There was a 39% relative increase in total consumption of systemic antibiotics, with utilization increasing from 67.6 to 93.8 DDDs/1000 resident-days during the study period (average annual increase of 2.8 DDDs/1000 resident-days, P < .001).

Conclusions

This nationwide study showed substantial increases in both prevalence of use and total consumption of antibiotics in Australian RACFs between 2005 and 2016. The increasingly widespread use of antibiotics in Australian RACFs is concerning and points to a need for enhanced efforts to optimize antibiotic use in this setting.
Importance of Inclusion of Pregnant and Breastfeeding Women in COVID-19 Therapeutic Trials
Authors: LaCourse Sylvia , John-Stewart Grace , Adams Waldorf Kristina M
Published: April 2020

Investigators are employing unprecedented innovation in the design of clinical trials to rapidly and rigorously assess potentially promising therapies for coronavirus disease 2019 (COVID-19); this is in stark contrast to the continued near-universal regressive practice of exclusion of pregnant and breastfeeding women from these trials. The few trials that allow their inclusion focus on postexposure prophylaxis or outpatient treatment of milder disease, limiting the options available to pregnant women with severe COVID-19 to compassionate use of remdesivir, or off-label drug use of hydroxychloroquine or other therapies. These restrictions were put in place despite experience with these drugs in pregnant women. In this Viewpoint, we call attention to the need and urgency to engage pregnant women in COVID-19 treatment trials now in order to develop data-driven recommendations regarding the risks and benefits of therapies in this unique but not uncommon population.
Sequential Analysis of Viral Load in a Neonate and Her Mother Infected With Severe Acute Respiratory Syndrome Coronavirus 2
Authors: Han Mi Seon , Seong Moon-Woo , Heo Eun Young , Park Ji Hong , Kim Namhee , Shin Sue , Cho Sung Im , Park Sung Sup , Choi Eun Hwa
Published: April 2020

We report changes in viral load over time in a 27-day-old neonate with coronavirus disease 2019 who presented with fever, cough, and vomiting. Severe acute respiratory syndrome coronavirus 2 RNA was detected in the nasopharynx, oropharynx, stool, saliva, plasma, and urine. The highest viral RNA copies in nasopharynx decreased over time while viral load in stool remained high.
Innovation and Development of the China International Commercial Court
Authors: Fei Long
Published: April 2020

This article introduces several innovative features of the China International Commercial Court, including a composition of only senior judges, the International Commercial Expert Committee, first-instance-as-final jurisdiction, a ‘one-stop’ dispute resolution platform, flexibility in finding foreign laws, and the use of cutting-edge information technology.
Race, Interdependence and Healing in Toni Morrison’s God Help the Child
Authors: Gallego Mar
Published: April 2020

In Toni Morrison’s works, traumatized characters are victimized by the damaging, racist dominant ideology that still codifies black bodies as the non-human “Other” due to the long-lasting effects of slavery and diasporic dispersal. These individual and collective traumas seemingly hinder their articulation of healthy forms of subject formation and community-building efforts. My contention is that in God Help the Child (2015) Morrison explores the ramifications of early trauma in her characters’ lives but also, more importantly, an array of resistance strategies, which facilitate healing, within an ethics of interdependence. Hence, Morrison critiques fundamental inequities in American society and around the world, by paying attention to the intersections of race, gender, and age discourses.
Adverse Employment Histories, Later Health Functioning and National Labor Market Policies: European Findings Based on Life-History Data From SHARE and ELSA
Authors: Wahrendorf Morten , Hoven Hanno , Deindl Christian , Lunau Thorsten , Zaninotto Paola
Published: April 2020

Objectives

We investigate associations between adverse employment histories over an extended time period and health functioning in later life, and explore whether national labor market policies moderate the association.

Methods

We use harmonized life-history data from the Gateway to Global Aging Data on two European studies (SHARE and ELSA) linked to health beyond age 50 (men = 11,621; women = 10,999). Adverse employment histories consist of precarious, discontinued, and disadvantaged careers between age 25 and 50, and we use depressive symptoms, grip strength, and verbal memory as outcomes.

Results

Adverse employment histories between age 25 and 50 are associated with poor health functioning later in life, particularly repeated periods of unemployment, involuntary job losses, weak labor market ties, and disadvantaged occupational positions. Associations remain consistent after adjusting for age, partnership history, education and employment situation, and after excluding those with poor health prior to or during working life. We find no variations of the associations by national labor market policies.

Discussion

Our study calls for increased intervention efforts to improve working conditions at early career stages. Despite the importance in shaping employment histories, the role of national policies in modifying the impact of employment on health is less clear.
Large Extracellular Cord Formation in a Zebrafish Model of Mycobacterium kansasii Infection
Authors: Johansen Matt D , Kremer Laurent
Published: April 2020

Mycobacterium kansasii is a slow-growing nontuberculous mycobacteria responsible for coinfections particularly in patients with human immunodeficiency virus. To date, our knowledge of M. kansasii infection has been hampered owing to the lack of an effective animal model to study pathogenesis. In the current study, we showed that the zebrafish embryo is permissive to M. kansasii infection, resulting in chronic infection and formation of granulomas. On macrophage depletion, we identified M. kansasii forms extracellular cords, resulting in acute infection and rapid larval death. These findings highlight the feasibility of zebrafish for studying M. kansasii pathogenesis and for the first time identify extracellular cords in this species.
Antibiotic use and deprivation: an analysis of Welsh primary care antibiotic prescribing data by socioeconomic status
Authors: Adekanmbi Victor , Jones Hywel , Farewell Daniel , Francis Nick A
Published: April 2020

Objectives

To examine the association between socioeconomic status (SES) and antibiotic prescribing, controlling for the presence of common chronic conditions and other potential confounders and variation amongst GP practices and clusters.

Methods

This was an electronic cohort study using linked GP and Welsh Index of Multiple Deprivation (WIMD) data. The setting was GP practices contributing to the Secure Anonymised Information Linkage (SAIL) Databank 2013–17. The study involved 2.9 million patients nested within 339 GP practices, nested within 67 GP clusters.

Results

Approximately 9 million oral antibiotics were prescribed between 2013 and 2017. Antibiotic prescribing rates were associated with WIMD quintile, with more deprived populations receiving more antibiotics. This association persisted after controlling for patient demographics, smoking, chronic conditions and clustering by GP practice and cluster, with those in the most deprived quintile receiving 18% more antibiotic prescriptions than those in the least deprived quintile (incidence rate ratio = 1.18; 95% CI = 1.181–1.187). We found substantial unexplained variation in antibiotic prescribing rates between GP practices [intra-cluster correlation (ICC) = 47.31%] and GP clusters (ICC = 12.88%) in the null model, which reduced to ICCs of 3.50% and 0.85% for GP practices and GP clusters, respectively, in the final adjusted model.

Conclusions

Antibiotic prescribing in primary care is increased in areas of greater SES deprivation and this is not explained by differences in the presence of common chronic conditions or smoking status. Substantial unexplained variation in prescribing supports the need for ongoing antimicrobial stewardship initiatives.
Population pharmacokinetics of ceftazidime in critically ill children: impact of cystic fibrosis
Authors: Bui S , Facchin A , Ha P , Bouchet S , Leroux S , Nacka F , Fayon M , Jacqz-Aigrain E ,   network of Paediatric Clinical Investigation Centres, M Fayon Bordeaux , E Jacqz-Aigrain Paris , J Kanold Clermont-Ferrand , H Chevassus Montpellier , R Hankard Tours , B Kassai Lyon , Marc Bardou Dijon
Published: April 2020

Background

Pharmacokinetics data on ceftazidime are sparse for the paediatric population, particularly for children with cystic fibrosis (CF) or severe infections.

Objectives

To characterize the population pharmacokinetics of ceftazidime in critically ill children, identify covariates that affect drug disposition and evaluate the current dosing regimens.

Methods

The study was registered with Clinicaltrials.gov (NCT01344512). Children receiving ceftazidime were selected in 13 French hospitals. Plasma concentrations were determined by UPLC-MS/MS. Population pharmacokinetic analyses were performed using NONMEN software.

Results

One hundred and eight patients, aged 28 days to 12 years, with CF (n = 32), haematology and/or oncology disorders (n = 47) or severe infection (n = 29) were included. Ceftazidime was administered by continuous or intermittent infusions; 271 samples were available for analysis. A two-compartment model with first-order elimination and allometric scaling was developed and covariate analysis showed that ceftazidime pharmacokinetics were also significantly affected by CLCR and CF. Ceftazidime clearance was 82% higher in CF than in non-CF patients. Monte Carlo simulations showed that the percentage of target attainment (PTA) for the target of T>MIC = 65% was (i) lower in CF than in non-CF children with intermittent infusions and (ii) higher with continuous than intermittent infusion in all children.

Conclusions

The population pharmacokinetics model for ceftazidime in children was influenced by body weight, CLCR and CF. A higher PTA was obtained with continuous versus intermittent infusions. Further studies should explore the benefits of continuous versus intermittent infusion of ceftazidime, including current versus increased doses in CF children.
Agency Insight from Portugal’s Autoridade da Concorrência
Authors: Matos Rosa Margarida
Published: April 2020

2020 will be a landmark year for reasons that had not been anticipated. But it is also a critical year for the implementation, by national legislators in the European Union, of the ECN+ Directive. This will grant competition agencies stronger means of enforcement and will consecrate independence of enforcement decisions based on the pursuit of consumer welfare protection. Another developing topic in 2020 is industrial policy in the EU and its coexistence with competition policy. While the EU needs to remain pragmatic, it need not — must not, I would argue - lose its distinctive economic features.
Separation of RRR-α-Tocopherol by Chiral Chromatography
Authors: Gill Brendon D , Indyk Harvey E
Published: April 2020

Background

α-Tocopherol can exist as eight possible stereoisomers due to the presence of three chiral carbons. Regulations and industry guidelines necessitate that dietary vitamin E intakes be based on the vitamin E activity of RRR-α-tocopherol. Food products fortified with synthetic all-rac-α-tocopherol or all-rac-α-tocopheryl acetate during manufacturing will require chiral separation of the α-tocopherol stereoisomers for accurate estimation of vitamin E activity.

Objective

The development of an HPLC method utilizing a chiral column for the chromatographic separation of RRR-α-tocopherol from other α-tocopherol stereoisomers.

Method

Normal phase liquid chromatographic separation using a polysaccharide-based chiral column with fluorescence detection of α-tocopherol stereoisomers.

Results

The described chromatographic method achieves baseline resolution of RRR-α-tocopherol from its stereoisomers. Method selectivity, precision, and robustness were evaluated and acceptable performance was achieved.

Conclusions

The chromatographic method was found to be suitable for application where both RRR-α-tocopherol content and total α-tocopherol content are required for routine compliance testing.

Highlights

A robust and precise chomatographic method for the baseline resolution of RRR-α-tocopherol from its stereoisomers was acheived.
The Singaporean natural gas hub: reassembling global production networks and markets in Asia
Authors: Dodge Alexander
Published: April 2020

Recently, economic geographers have sought to account for how regional and national initiatives shape the strategic decisions of actors in global production networks (GPNs). In this article, I intend to discuss the political and institutional dynamics by which GPNs evolve, and the capacity of states to shape emerging organizational and spatial arrangements in dynamic GPNs. Building on assemblage thinking, I conceptualize these political and institutional dynamics as the unbundling of legal, regulatory and institutional components of nation-state authorities that govern GPNs, and the subsequent reassembling of these components through emerging interactions with finance, technology and new forms of private authority. These emerging global assemblages are both partially embedded in global cities and stretch across and within the borders of nation-states. Building on this conceptual framework, this article explains how the exclusive nation-state authorities that traditionally governed liquefied natural gas (LNG) trade and markets are becoming unbundled. The article focuses on the initiatives of public and private actors in Singapore who are attempting to shape evolutionary dynamics in GPNs by establishing a hub for LNG trading and speculative financing in Asia. The article finds that Singapore’s capacity to shape LNG production networks is dependent upon the capacity of public and private actors in Singapore to establish cross-border connectivity to markets in Southeast Asia.
Study on the prevention of infection in terminal cancer patients applying epidural analgesia by adding cefazolin to anesthetics: a randomized controlled trial
Authors: Xie Pengcheng , Li Zhanfang , Yang Jingli , Wu Yiming
Published: April 2020

Objective

To observe the antibacterial effect of adding cefazolin into anesthetics in patients with terminal cancer undergoing long-term epidural analgesia.

Methods

Patients undergoing epidural analgesia with terminal cancer were randomly divided into two groups: the conventional drug group (group C) and the cefazolin group (group G). Both groups were given levobupivacaine and morphine, while cefazolin was added to group G. The mean arterial pressure (MAP), heart rate (HR), respiratory rates (R), visual analogue scale (VAS) scores, satisfaction and complications of patients in the two groups were observed. 3 ml of the used analgesic was taken for bacterial culture when replacing the new analgesic case.

Results

HR, MAP, R, VAS scores, dosages of morphine, satisfaction of the analgesic and the complications were not significantly different between the two groups (P > 0.05). The overall satisfaction of patients in group G was significantly higher than that in group C (P < 0.05). One patient’s anesthetics in group C were infected with colibacillus. Four patients in group C got infected in their epidural puncture sites. There was no infection in group G (P < 0.05).

Conclusion

Adding cefazolin to local anesthetics could effectively prevent bacterial infection and ensured the safety of epidural analgesia for patients with terminal cancer.
Effectiveness of robust optimization in volumetric modulated arc therapy using 6 and 10 MV flattening filter-free beam therapy planning for lung stereotactic body radiation therapy with a breath-hold technique
Authors: Miura Hideharu , Ozawa Shuichi , Doi Yoshiko , Nakao Minoru , Kubo Katsumaro , Kenjo Masahiko , Nagata Yasushi
Published: April 2020

We investigated the feasibility of a robust optimization with 6 MV X-ray (6X) and 10 MV X-ray (10X) flattening filter-free (FFF) beams in a volumetric modulated arc therapy (VMAT) plan for lung stereotactic body radiation therapy (SBRT) using a breath-holding technique. Ten lung cancer patients were selected. Four VMAT plans were generated for each patient; namely, an optimized plan based on the planning target volume (PTV) margin and a second plan based on a robust optimization of the internal target volume (ITV) with setup uncertainties, each for the 6X- and 10X-FFF beams. Both optimized plans were normalized by the percentage of the prescription dose covering 95% of the target volume (D95%) to the PTV (1050 cGy × 4 fractions). All optimized plans were evaluated using perturbed doses by specifying user-defined shifted values from the isocentre. The average perturbed D99% doses to the ITV, compared to the nominal plan, decreased by 369.1 (6X-FFF) and 301.0 cGy (10X-FFF) for the PTV-based optimized plan, and 346.0 (6X-FFF) and 271.6 cGy (10X-FFF) for the robust optimized plan, respectively. The standard deviation of the D99% dose to the ITV were 163.6 (6X-FFF) and 158.9 cGy (10X-FFF) for the PTV-based plan, and 138.9 (6X-FFF) and 128.5 cGy (10X-FFF) for the robust optimized plan, respectively. Robust optimized plans with 10X-FFF beams is a feasible method to achieve dose certainty for the ITV for lung SBRT using a breath-holding technique.
Glucocorticoid use is associated with an increased risk of hypertension
Authors: Costello Ruth E , Yimer Belay B , Roads Polly , Jani Meghna , Dixon William G
Published: April 2020

Objectives

Patients with RA are frequently treated with glucocorticoids (GCs), but evidence is conflicting about whether GCs are associated with hypertension. The aim of this study was to determine whether GCs are associated with incident hypertension in patients with RA.

Methods

A retrospective cohort of patients with incident RA and without hypertension was identified from UK primary care electronic medical records (Clinical Practice Research Datalink). GC prescriptions were used to determine time-varying GC use, dose and cumulative dose, with a 3 month attribution window. Hypertension was identified through either: blood pressure measurements >140/90 mmHg, or antihypertensive prescriptions and a Read code for hypertension. Unadjusted and adjusted Cox proportional hazards regression models were fitted to determine whether there was an association between GC use and incident hypertension.

Results

There were 17 760 patients in the cohort. A total of 7421 (42%) were prescribed GCs during follow-up. The incident rate of hypertension was 64.1 per 1000 person years (95% CI: 62.5, 65.7). The Cox proportional hazards model indicated that recent GC use was associated with a 17% increased hazard of hypertension (hazard ratio 1.17; 95% CI: 1.10, 1.24). When categorized by dose, only doses above 7.5 mg were significantly associated with hypertension. Cumulative dose did not indicate a clear pattern.

Conclusion

Recent GC use was associated with incident hypertension in patients with RA, in particular doses ≥7.5 mg were associated with hypertension. Clinicians need to consider cardiovascular risk when prescribing GCs, and ensure blood pressure is regularly monitored and treated where necessary.
HOW MANY DOSEMETERS ARE NEEDED FOR CORRECT MEAN ORGAN DOSE ASSESSMENT WHEN PERFOMING PHANTOM DOSIMETRY? A PHANTOM STUDY EVALUATING LIVER ORGAN DOSE AND INVESTIGATING TLD NUMBERS AND WAYS OF DOSEMETER PLACEMENT
Authors: Pedersen Peter H , Petersen Asger G , Ostgaard Svend E , Tvedebrink Torben , Eiskjær Søren P
Published: April 2020

This study evaluated repeated mean organ dose measurements of the liver by phantom dosimetry and statistical modelling in order to find a way to reduce the number of dosemeters needed for precise organ dose measurements. Thermoluminescent dosemeters were used in an adult female phantom exposed to a biplanar x-ray source at three different axial phantom rotations. Generalised mixed linear effect modelling was used for statistical analysis. A subgroup of five to six organ-specific locations out of 28 yielded mean liver organ doses within 95% confidence intervals of measurements based on all 28 liver-specific dosemeter locations. No statistical difference of mean liver dose was observed with rotation of the phantom either 10° clockwise or counter-clockwise as opposed to the coronal plane. Phantom dosimetry handling time during organ dose measurements can be markedly reduced, in this case the liver, by 79% (22/28), while still providing precise mean organ dose measurements.
Understanding and Measuring the Social Inclusion of Syrian Refugees in Istanbul: The Case of Zeytinburnu
Authors: Narli Nilüfer , Özaşçılar Mine
Published: April 2020

Based on survey data collected during 2016–2017 from 380 Syrians in Zeytinburnu, an inner-city district of Istanbul, Turkey, this article uses multidimensional scaling to measure their social inclusion. The study shows how the level of social inclusion, treated as a dependent variable, changes with the refugees’ age, gender, education level, length of stay in Zeytinburnu, and health conditions. The sampled Syrians had high social inclusion index scores despite facing precarity at the time of survey. This study suggests that refugee-friendly social contexts and policies can improve social inclusion.
Severe Inflammation and Hyphema After Micropulse Diode Transscleral Cyclophotocoagulation
Authors: Dhanireddy Swetha , Yin Han Y. , Dosakayala Neelima , Kurochkin Philip , Gupta Neha , Cheng Anny M.S. , Fechtner Robert , Alpert Samuel
Published: April 2020

Purpose:

To describe vision-threatening complications after micropulse diode transscleral cyclophotocoagulation (MP-TSCPC).

Methods:

Retrospective case series. Medical charts of patients who underwent MP-TSCPC and developed visually significant inflammation and hyphema after the procedure were reviewed. Patients were seen at the Upstate Medical University Ophthalmology clinic between 2017 and 2019.

Results:

Out of 64 patients who underwent MP-TSCPC in the defined time period, 2 patients with postprocedure severe inflammation and hyphema were identified. One patient had severe-stage primary open-angle glaucoma (POAG). After MP-TSCPC, the patient was noted to have a large visually significant anterior chamber reaction and hyphema that occupied 80% of the anterior chamber on postprocedure day 1. The patient was treated with topical and oral corticosteroids, and topical atropine. The second patient had uncontrolled severe-stage POAG. The patient underwent MP-TSCPC. After the procedure, the patient was noted to have significant inflammation with fibrin and hyphema that filled 80% of the anterior chamber. The patient was treated with topical steroids.

Conclusions:

As with any intervention, complications are inevitable. Recognition of complications and its possible associations allow for better and more individualized risk versus benefit analysis of an intervention. In this case series, exuberant anterior segment inflammation and hyphema occurred in 2 patients who underwent MP-TSCPC. The authors’ goal is to raise awareness of severe anterior chamber inflammation and hyphema as complications occurring after laser treatment with a reputation of minimal or no side-effect profile and to better understand this relatively new laser advancement in the treatment of glaucoma.
Recurrent Tuberculosis in a Young Child
Authors: Dreesman Alexandra , Stévart Oriane , Adler Catherine , Mathys Vanessa , Mouchet Françoise
Published: April 2020

A young child, 19 months of age, presented with a second episode of tuberculosis after full recovery from initial tuberculosis disease 6 months earlier. Mycobacterium tuberculosis strains isolated from both episodes were genotyped and differed from one another. We present the first case of proven tuberculosis reinfection in a likely immunocompetent child, living in a high-risk environment favorable for exposition to M. tuberculosis but in a low-incidence country.
Parental Notification Via Text Messaging for Infant Sickle Screening Programs: Exploration of Feasibility and Acceptability in Uganda
Authors: Fashakin Victoria , Mathur Sanyukta , Kwagala Peter , Mupere Ezekial , Kiguli Sarah , Kitaka Sabrina B. , Henry Michael B. , Van Ells Luke , Tusuubira Sharifu , Mulumba Lukia , Duong Jimmy , Stockwell Melissa S. , LaRussa Philip , Green Nancy S.
Published: April 2020

Sickle cell disease (SCD) in Africa has high prevalence, morbidity, and early mortality. Difficulties in reaching parents following infant SCD screening dampen program effectiveness. Text messaging may support initial postscreening parental notification. We explored SCD awareness, and feasibility and acceptability of text messaging about screening follow-up among convenience samples of caretakers with children under 5 years (n=115) at 3 sites: a SCD family conference or 2 general pediatric clinics in urban or rural Uganda. Two thirds of the conference-based participants and 8% at clinic sites had affected children. At the clinics, 64% of caretakers were aware of SCD. In all, 87% claimed current possession of mobile phones; 89% previously had received messages. A sample text on the availability of screening results and need to bring their child to SCD clinic was at least partially understood by 82%. Overall, 52% preferred communication for initial follow-up by telephone over text message. Concerns about texting included phone access, privacy or cost, and readability of messages. Caretakers identified concerns about distance, cost, or preference for another clinic as additional barriers to SCD follow-up. Findings suggest that text messaging to caretakers may be feasible, but less acceptable compared with a telephone call about initial follow-up from newborn SCD screening.
Extracorporeal Membrane Oxygenation Support in Children With Hematologic Malignancies in Sweden
Authors: Ranta Susanna , Kalzén Håkan , Nilsson Anna , von Schewelov Katarina , Broman Lars M. , Berner Jonas , Fläring Urban , Norén-Nyström Ulrika , Svahn Johan E. , Palle Josefine , Törnudd Lisa , Karlsson Lene , Mellgren Karin , Abrahamsson Jonas , Harila-Saari Arja
Published: April 2020

Background:

Extracorporeal membrane oxygenation (ECMO) is used in severe respiratory and/or circulatory failure when conventional critical care fails. Studies on patients with hematologic malignancies on ECMO have shown contradictory results; immunosuppression and coagulopathy are relative contraindications to ECMO.

Observations:

This nationwide Swedish retrospective chart review identified 958 children with hematologic malignancies of whom 12 (1.3%) required ECMO support. Eight patients survived ECMO, 7 the total intensive care period, and 6 survived the underlying malignancy.

Conclusions:

ECMO may be considered in children with hematologic malignancy. Short-term and long-term survival, in this limited group, was similar to that of children on ECMO at large.
Expression of HER2 and EGFR Proteins in Advanced Stage High-grade Serous Ovarian Tumors Show Mutual Exclusivity
Authors: Crasta Julian , Ravikumar Gayatri , Rajarajan Savitha , Gali Sumangala , Kulkarni Kiran A. , Vallikad Elizabeth , Prabhu Jyoti
Published: April 2020

Human epidermal growth factors play an important role in ovarian carcinogenesis and are evaluated for prognostic and possible therapeutic roles in high-grade serous ovarian malignancies. The present study was undertaken to evaluate the expression of human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR) in advanced stage serous carcinoma and their influence on prognosis. The expression of HER2 and EGFR was studied in 59 cases of stage III and IV ovarian serous carcinomas by immunohistochemistry and fluorescent in situ hybridization. Of the 48 interpretable tumors for HER2, 6 tumors (12.5%) were scored as positive, 14 (29%) as equivocal and 28 tumors (58.5%) were negative by immunohistochemistry, while only 2/48 (4%) showed frank amplification by fluorescent in situ hybridization with ≥4 copies per cell. HER2 gene expression measured by quantitative polymerase chain reaction had good positive correlation with both protein expression and gene amplification. Although EGFR expression was seen in 32% of tumors, none of the tumors positive for HER2 protein or gene amplification had co-expression of EGFR indicating mutual exclusivity of their expression. Gene expression of both proteins also confirmed their inverse correlation (Pearsons CC=−0.15, P=0.3). Further there was no influence of protein or gene expression of these markers on the overall survival. In conclusion, HER2 and EGFR are expressed in a small percentage of tumors and the mutual exclusivity of these markers precludes the possibility of dual targeting with anti-HER2 and anti-EGFR therapy in advanced stage high-grade serous ovarian carcinoma.
Nationwide Analysis of Changes in Medical Utilization Before and After a New Panic Disorder Diagnosis
Authors: Chang Hu-Ming , Pan Chun-Hung , Chen Pao-Huan , Chen Yi-Lung , Su Sheng-Siang , Tsai Shang-Ying , Chen Chiao-Chicy , Kuo Chian-Jue
Published: April 2020

Objective

Panic disorder (PD) is associated with somatization and high medical utilization in primary care settings. Treatment of PD could reduce the frequency of panic attacks and visits to emergency departments, but the associated change in medical utilization is unknown. This study investigated the change in medical utilization before and after a PD diagnosis.

Method

This study identified 8722 patients with PD enrolled in the National Health Insurance Research Database in Taiwan between January 1, 2000, and December 31, 2012. We used a case-crossover study design to compare medical utilizations with a 1-year time window before and after new PD diagnoses, including medical examinations, specialty visits, and medication used. A conditional logistic regression model was used to estimate changes in comorbidity before and after new PD diagnoses.

Results

The utilization of examinations—including electrocardiography, radiography, and sonography—decreased within 1 year after PD diagnosis compared with 1 year before PD diagnosis. Outpatient and emergency department visits to nonpsychiatric departments decreased (risk ratio [RR] = 0.989 [95% confidence interval {CI} = 0.985–0.993] and RR = 0.924 [95% CI = 0.894–0.956], respectively), whereas outpatient visits to psychiatric departments increased (RR = 1.193, 95% CI = 1.171–1.215). PD diagnosis is associated with increased use of antidepressants (RR = 12.65) and benzodiazepines (RR = 11.63), an increased ratio of comorbid depressive disorder (RR = 3.06) and bipolar disorder (RR = 1.77), and a decreased ratio of nonpanic anxiety disorder (RR = 0.69).

Conclusions

New PD diagnoses are associated with decreased laboratory examination and nonpsychiatric service utilization, along with increased psychiatric service utilization. We suggest that PD should be detected earlier for mitigating potentially unnecessary use of nonpsychiatric examinations and services.
Lung function in men with and without HIV
Authors: Kunisaki Ken M. , Nouraie Mehdi , Jensen Robert L. , Chang Dong , D'Souza Gypsyamber , Fitzpatrick Meghan E. , McCormack Meredith C. , Stosor Valentina , Morris Alison
Published: April 2020

Objectives:

Initial studies suggest HIV-positive persons may be at increased risk for chronic lung diseases such as chronic obstructive pulmonary disease, but have commonly relied on single-center designs, lacked HIV-negative controls, or assessed lung function with only spirometry. We tested differences in spirometry and single-breath diffusing capacity for carbon monoxide (DLCO) in persons with and without HIV.

Design:

Cross-sectional, observational study.

Methods:

Participants were enrolled from the Multicenter AIDS Cohort Study, a longitudinal cohort study of men who have sex with men (both HIV-positive and HIV-negative) at four sites in the United States. Standardized spirometry and DLCO testing were performed in all eligible, consenting participants at routine study visits. We tested associations between HIV status and spirometry and DLCO results, using linear and logistic regression.

Results:

Among 1067 men, median age was 57 years, prevalence of current marijuana (30%), and cigarette (24%) use was high, and another 45% were former cigarette smokers. Median forced expiratory volume in 1 s was 97% of predicted normal and DLCO was 85% of predicted normal. HIV-positive persons demonstrated no statistical difference in forced expiratory volume in 1 s compared with HIV-negative persons, but had worse DLCO (adjusted difference −2.6% of predicted; 95% confidence interval: −4.7 to −0.6%) and a higher risk of DLCO impairment (odds ratio for DLCO < 60% of predicted 2.97; 95% confidence interval: 1.36–6.47). Lower DLCO was associated with lower nadir CD4+ cell counts.

Conclusion:

HIV-positive men are at increased risk of abnormal gas exchange, indicated by low DLCO, compared with men without HIV.