bluuebunny/crossref_metadata_2025 huggingface dataset:
Transcranial direct current stimulation for improving ambulation after stroke: a systematic review and meta-analysis
Authors: Tien Hui-Hsun , Liu Wen-Yu , Chen Yi-Lin , Wu Yi-Chen , Lien Hen-Yu
Published: July 2020

Achieving a sufficient level of functional ambulation remains to be a challenge to most stroke survivors. Different modes of transcranial direct current stimulation (tDCS) have been applied for improving various aspects of walking and mobility following stroke. However, systematic reviews before 2017 provided only general effects of tDCS on limited walking outcomes. Therefore, the aims of this study were to update the evidence of tDCS for improving walking and mobility after stroke with emphasis on individual outcomes and to delineate the effects of different modes of tDCS in subgroup analysis. The systematic search of PubMed, Medline, PEDro, Scopus, and Cochrane databases for studies published up to January 2019 identified 14 eligible reports. The PEDro scale indicated a good methodological quality of the included studies (score 6.8). The meta-analysis of primary outcomes revealed that active tDCS had no better effect than sham on walking speed [n = 7, standardized mean difference (SMD) = 0.189, P = 0.252] and 6-minute walking distance (n = 3, SMD = 0.209, P = 0.453). Among the secondary outcomes, significant positive effects were found on functional ambulation category (FAC) (n = 5, SMD = 0.542, P = 0.008), Rivermead Mobility Index (n = 3, SMD = 0.699, P = 0.008), and timed up and go test (TUG) (n = 5, SMD = 0.676, P = 0.001), whereas non-significant positive effects were found on Tinetti test (n = 3, SMD = 0.441, P = 0.062) and Berg Balance Scale (n = 2, SMD = 0.408, P = 0.177). In subgroup analyses, anodal tDCS had significant positive effects on FAC (n = 4, SMD = 0.611, P = 0.005) and dual-hemispheric tDCS on TUG (n = 2, SMD = 1.090, P = 0.000). The results provide up-to-date evidence of variable effects of tDCS on walking and functional mobility after stroke.
Synovial Sarcoma of the Female Genital Tract
Authors: Kolin David L. , Crum Christopher P. , Baranov Esther , Cin Paola Dal , Chang Martin C. , Colgan Terence J. , Dickson Brendan C. , Hornick Jason L. , Nucci Marisa R.
Published: July 2020

Synovial sarcoma most commonly occurs in the extremities but has rarely been described in the female genital tract. In this series, we describe the clinical, morphologic, immunohistochemical, and molecular features of 7 cases of vulvovaginal synovial sarcoma (vulva, n=6; vagina, n=1). We emphasize their wide morphologic spectrum, which can overlap significantly with other more common tumors at these sites, as highlighted by 2 cases initially diagnosed as other entities (endometrioid carcinoma and malignant peripheral nerve sheath tumor). The average patient age was 41 (range: 23 to 62) years and tumor size ranged from 0.8 to 7 cm. Histologically, the tumors were biphasic (n=6) and monophasic (n=1). All cases were confirmed with fluorescence in situ hybridization or sequencing, and 5/5 cases were positive for the novel immunohistochemical markers SSX and SS18-SSX. In 3 cases with follow-up, 2 patients died of disease and 1 was alive with no evidence of disease. Previously described cases arising in the female genital tract are also reviewed. Vulvovaginal monophasic synovial sarcoma raises a broad differential diagnosis, including smooth muscle tumors, spindled carcinomas, and melanoma. Biphasic synovial sarcoma may mimic Müllerian carcinosarcoma, endometrioid carcinoma with spindled, corded, and hyalinized elements, and mesonephric-like adenocarcinoma. Awareness that synovial sarcoma can occur in the female genital tract with a wide variety of histologic appearances is critical for correctly diagnosing this rare entity. In particular, synovial sarcoma should be considered for any deeply situated “adenocarcinoma” in the vulva, with attention to subtle spindle cell differentiation.
A Simple Solution for Infractured Lateral Nasal Osteotomy Lines During Revision or Primary Rhinoplasty: Osseos Stabilization With Polydioxanone Sutures
Authors: Yasar Emrah Kagan , Demir Can Ilker , Alagoz Murat Sahin
Published: July 2020

In addition to precautions taken with perioperative surgical techniques, nasal packing and external nasal splinting are frequently employed to ensure the stability of the nasal bones following osteotomies performed during rhinoplasty. However, despite these precautions, nasal bone fragments, generally caused by trauma or healing problems, can approach the midline, progress in a posterior direction and heal with malunion in an infractured manner. Since cavities on the infractured side can result in asymmetries and/or airway narrowing, revision osteotomy is required to correct these problems. Subsequent potential recurrent infractures caused by nasal fragments can easily be prevented with late-absorbed sutures passing through the neighboring holes and opening near the osteotomy lines. This technique would be useful for both primary and secondary rhinoplasty, but especially in secondary rhinoplasty operations. (Level of Evidence: Level IV)
Airflow of the Two-Port Velopharyngeal Closure: Study Using Computational Fluid Dynamics
Authors: Huang Hanyao , Liao Rui , Yin Xing , Chen Nan , Huang Dantong , Yin Heng , Deng Chengdan , Zheng Qian , Shi Bing , Li Jingtao
Published: July 2020

Posterior pharyngeal flap palatoplasty is used to restore the function of velopharyngeal (VP) closure, after which 2 ports remain between the nasal and oral cavity. The authors hypothesized that the airflow dynamics of the upper airway is different in PPF patients compared to health subjects, who only has 1 movable port. Twenty adults who have multislice spiral computed tomography scan were included in this study. Two cylinders (radius, 2.00 mm; height, 4.5 mm) were used to recapitulate the 2-port VP structure after PPF palatoplasty. The areas of ports were modified by changing the radius of 2 cylinders. Real-time computational fluid dynamics simulation was used to capture the airflow velocity and pressures through the 2 ports. The airflow velocity and pressure of upper airway were recorded as the total areas of 2 VP ports increased. The total orifice areas of the 2-port VP closure for 4 VP conditions, including adequate closure, adequate/borderline closure, borderline/inadequate closure, and inadequate closure, were demonstrated. Significant differences between the 2-port VP function for demonstrating PPF reconstruction and the 1-port VP function were found. Airflow dynamics is dependent on the VP structure. The 2-port airflow model for mimicking VP closure after PPF palatoplasty demonstrated airflow characteristics that were significantly different from the 1-port model in normal VP closure.
Learning Curves in Health Professions Education Simulation Research
Authors: Howard Neva M. , Cook David A. , Hatala Rose , Pusic Martin V.
Published: July 2020

Summary Statement

Learning curves are used in health professions education to graphically represent paths to competence and expertise. However, research using learning curves often omit important information. The authors conducted a systematic review of the reporting quality of learning curves in simulation-based education research to identify specific areas for improvement. Reviewers extracted information on graphical, statistical, and conceptual elements. The authors identified 230 eligible articles. Most learning curve elements were reported infrequently, including use of an optimal linking function, detailed description of feedback or learning intervention, use of advanced visualization techniques such as overlaying and stacking, and depiction of competency thresholds. Reporting did not improve over time for most elements. Reporting of learning curves in health professions education research is incomplete and often underutilizes their desirable properties. Recommendations for improvement of the statistical, graphical, and conceptual reporting of learning curves, as well as applications to simulation research and education, are presented.
Simulation in the Continuing Professional Development of Academic Emergency Physicians
Authors: Forristal Chantal , Russell Evan , McColl Tamara , Petrosoniak Andrew , Thoma Brent , Caners Kyla , Mastoras George , Szulewski Adam , Chaplin Timothy , Huffman James , Woolfrey Karen , Dakin Christa , Hall Andrew K.
Published: July 2020

Introduction

Simulation is becoming a popular educational modality for physician continuing professional development (CPD). This study sought to characterize how simulation-based CPD (SBCPD) is being used in Canada and what academic emergency physicians (AEPs) desire in an SBCPD program.

Methods

Two national surveys were conducted from March to June 2018. First, the SBCPD Needs Assessment Survey was administered online to all full-time AEPs across 9 Canadian academic emergency medicine (EM) sites. Second, the SBCPD Status Survey was administered by telephone to the department representatives (DRs)—simulation directors or equivalent—at 20 Canadian academic EM sites.

Results

Response rates for the SBCPD Needs Assessment and the SBCPD Status Survey were 40% (252/635) and 100% (20/20) respectively. Sixty percent of Canadian academic EM sites reported using SBCPD, although only 30% reported dedicated funding support. Academic emergency physician responses demonstrated a median annual SBCPD of 3 hours. Reported incentivization for SBCPD participation varied with AEPs reporting less incentivization than DRs. Academic emergency physicians identified time commitments outside of shift, lack of opportunities, and lack of departmental funding as their top barriers to participation, whereas DRs thought AEPs fear of peer judgment and inexperience with simulation were substantial barriers. Content areas of interest for SBCPD were as follows: rare procedures, pediatric resuscitation, and neonatal resuscitation. Lastly, interprofessional involvement in SBCPD was valued by both DRs and AEPs.

Conclusions

Simulation-based CPD programs are becoming common in Canadian academic EM sites. Our findings will guide program coordinators in addressing barriers to participation, selecting content, and determining the frequency of SBCPD events.
The Case of the Inadvertently Triggered Laser
Authors: Cooper Jeffrey B.
Published: July 2020

Summary Statement

This report describes an historical case example that illustrates how simulation used in investigating adverse events can identify underlying, remediable causes that otherwise may not be discovered. The event involved an operating room fire caused by inadvertent triggering of a laser. Guidelines for action after an adverse event were used to guide the postevent actions. An expert in operating room fires was engaged to conduct the investigation. Recommendations and considerations for conducting such investigations with simulation are offered. Simulation is likely underused for healthcare adverse event investigations; this case example may encourage more widespread application.
Laparoscopic Repair of Perforated Peptic Ulcer in the Elderly: An Interim Analysis of the FRAILESEL Italian Multicenter Prospective Cohort Study
Authors: Fransvea Pietro , Costa Gianluca , Lepre Luca , Podda Mauro , Giordano Alessio , Bellanova Giovanni , Agresta Ferdinando , Marini Pierluigi , Sganga Gabriele
Published: July 2020

Introduction:

The number of elderly patients requiring emergency surgical intervention has increased dramatically. Perforated peptic ulcer (PPU) complications, such as perforation, have remained relatively stable and associated morbidity remains between 10% and 20%. Advances in perioperative care have greatly improved the outcomes of laparoscopic emergency surgery, allowing increasing numbers of patients, even the elderly, to undergo safe repair. The aim of this study was to evaluate the feasibility, safety, and outcome of laparoscopic gastric repair in the elderly using the database of the FRAILESEL (Frailty and Emergency Surgery in the Elderly) study.

Materials and Methods:

This is a retrospective analysis carried out on data of the FRAILESEL study. Data on all the elderly patients who underwent emergency abdominal surgery for PPU from January 2017 to December 2017 at 36 Italian surgical departments were analyzed. Patients who underwent PPU repair were further divided into a laparoscopic gastroduodenal repair (LGR) cohort and an open gastroduodenal repair (OGR) cohort, and the clinicopathologic features of the patients in both the groups were compared.

Results:

Sixty-seven patients fulfilled the inclusion criteria. Thirty-three patients (47.8%) underwent LGR. The LGR patients had less blood loss and shorter postoperative stay, even if the difference was not statistically significant. The mean operative time was significantively higher in the OGR (OGR 96.5±27.7 vs. LGR 78.6±16.3 P=0.000). The rate of death after laparoscopic surgery was similar to the rate of the open surgery. Multivariate analysis indicated that only age (P=0.018), admission haemoblogbin (Hb) level (P=0.006), platelet count (P=0.16), lactate level (P=0.47), and Mannheim Peritonitis Index (P=0.18) were independent variables associated with the risk of overall mortality.

Conclusions:

LGR is safe and feasible in elderly patients with PPU and it is associated with better perioperative outcomes. However, patient selection and preoperative frailty evaluation in the elderly population are the key to achieving better outcomes.
Thoracoscopic Repair of Esophageal Atresia With Distal Tracheoesophageal Fistula (Type C): Systematic Review
Authors: Iacona Roberta V. , Saxena Amulya K.
Published: July 2020

Aim:

This systematic review analyzed outcomes in thoracoscopic “primary” repair of type-C esophageal atresia.

Materials and Methods:

The Healthcare Database Advance Search, Embase, Medline, and Cochrane databases in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were researched by 2 independent reviewers. Non-English, mixed procedures (open/thoracoscopic) and staged-repair articles were excluded.

Results:

Between 2000 and 2018, 173 articles were identified of which 14 met the inclusion criteria and 382 neonates analyzed. Lowest reported age and weight were 28 gestational weeks and 830 g, respectively (gestational weeks: 28 to 41 wk; birth weight: 830 to 3960 g), with 136/382 (36%) having associated comorbidities. All procedures were performed in Cuschieri modified decubitus position with 3 ports (3.5 to 5 mm) and 30-degree scopes. Azygos vein sparing approach was reported in 4/14 (28.5%) articles; and if divided 70% preferred sealing/diathermy devices. Preferences for fistula ligation were sutures in 5/13 (38%) articles, clips or hemlock in 4/13 (30.7%), sutures with clips in 4/13 (30.7%) and no data in 1/14. Transanastomotic tubes placement was reported in 9/14 articles (others no data). Chest tube placement was preferred in 9/12 (75%) articles; 3/12 no chest tubes; and 2/14 no data. Intraoperative complications were reported in 9/382 (2.3%) neonates—respiratory instability (5/9), endoclip displacement (2/9), and anastomotic leak requiring conversion (2/9). Conversion to open thoracotomy was reported in 12/14 articles in 37/382 (9.6%) neonates. Postoperative complications were reported in 94/382 (25%); 79/94 (84%) anastomotic strictures, 40/94 (42.5%) anastomotic leaks and 5/94 (5.3%) recurrent fistulation. There were 17/382 (4.4%) lethal outcomes (cardiopulmonary failure, sepsis, and 1 intraoperative tracheal rupture).

Conclusions:

Thoracoscopic “primary” repair of type-C esophageal atresia is feasible in premature/term neonates with a 1:10 conversion rate. Around one third surgeons prefer azygous sparing approach and three fourth placement of chest tubes, but there is no unanimity on the fistula ligation technique. The procedure has morbidity in one fourth patients and 5% mortality.
Direct-to-Consumer Chat-Based Remote Care Before and During the COVID-19 Outbreak
Authors: Zeltzer Dan , Vodonos Alina , Paz Edo , Malka Roy
Published: July 2020

Objective

To compare the patient population, common complaints, and physician recommendations in direct-to-consumer chat-based consults, before and during the COVID-19 outbreak.

Data sources

Data on patient characteristics, patient complaints, and physician recommendations from 36,864 chat-based telemedicine consults with physicians in an online-clinic by patients from across the United States between April 2019 and April 2020.

Study Design

We perform a retrospective analysis comparing patient characteristics, visit characteristics, and physician recommendation before and after the COVID-19 outbreak. We examine patient age and gender, visit time, patient chief complains, and physician medical recommendation (including prescription drugs, reassurance, and referrals).

Principal Findings

Before March 2020, most patients were female (75 percent) and 18–44 years old (89 percent). Common complaints such as abdominal pain, dysuria, or sore throat suggested minor acute conditions. Most cases (67 percent) were resolved remotely, mainly via prescriptions; a minority were referred. Since March 2020, the COVID-19 emergency has led to a sharp (fourfold) increase in case volume, including more males (from 25 to 29 percent), patients aged 45 and older (from 11 to 17 percent), and more cases involving mental health complaints and complaints related to COVID-19. Across all symptoms, significantly more cases (78 percent) have been resolved remotely.

Conclusions

The COVID-19 outbreak in the United States has been associated with a sharp increase in the use of chat-based telemedicine services, including by new patient demographics, an increase in both COVID-19 and mental health complains, and an increase in remote case resolutions.
COMPARATIVE SEROLOGIC PROFILES OF HEPATITIS B VIRUS (HBV) BETWEEN HIV/HBV CO-INFECTED AND HBV MONO-INFECTED PATIENTS IN ILE-IFE, NIGERIA
Authors: Osasona Oluwadamilola Gideon , Ariyo Olumuyiwa Elijah , Oguzie Judith , J.Olumade Testimony , George Uwem , Adewale-Fasoro Opeoluwa , Oguntoye Oluwatosin Oluwagbenga
Published: July 2020

Introduction

Hepatitis B virus(HBV) infects about 2 billion people globally and accounts for mortality of about 800,000 from liver cirrhosis and hepatocellular carcinoma. Sub-Saharan Africa accounts for 70% of Human Immunodeficiency Virus (HIV) global burden. HIV/HBV co-infection results in early development of HBV complications, alterations of serological biomarkers of HBV.

Methods

Two hundred and fifty patients with HIV/AIDS were screened for HBV and 20 (8%) were identified. Same number of HBV mono-infected individuals were recruited into the study and subsequently, HBV serological profiles which includes HBsAg, HBsAb, HBeAg, HBeAb,HBcAbIgM and HBcAbIgG were assayed using HBV ELISA kits.

Result

Mean age of patients in the HBV/HIV cohort was 45.5 years while the HBV mono-infected infected cohort was 30.5 years. Majority of the HBV/HIV co-infected individuals were females (85%). Frequency of HBeAg among HIV/HBV co-infected cohort was 25% and 15% for HBV mono-infected, while the frequency of HBeAb was higher (60%) among cohort of HBV/HIV co-infected patients in comparison with the HBV mono-infected cohorts(50%). Two patients among the HIV/HBV co-infected cohort have the isolated anti-HBcAg serologic pattern.

Conclusion

The study broadened the available evidence of comparative serologic profiles of Hepatitis B virus between cohorts of HBV/HIV co-infected individuals and HBV mono-infected patients in Nigeria.
Bioinformatic analysis of shared B and T cell epitopes amongst relevant coronaviruses to human health: Is there cross-protection?
Authors: Pacheco-Olvera Diana Laura , Remy-Hernández Stephanie Saint , Acevedo-Ochoa Ernesto , Arriaga-Pizano Lourdes , Cérbulo-Vázquez Arturo , Ferat-Osorio Eduardo , Rivera-Hernández Tania , López-Macías Constantino
Published: July 2020

Within the last 30 years 3 coronaviruses, SARS-CoV, MERS-CoV and SARS-CoV-2, have evolved and adapted to cause disease and spread amongst the human population. From the three, SARS-CoV-2 has spread world-wide and to July 2020 it has been responsible for more than 11 million confirmed cases and over half a million deaths. In the absence of an effective treatment or vaccine, social distancing has been the most effective measure to control the pandemic. However it has become evident that as the virus spreads the only tool that will allow us to fully control it is an effective vaccine. There are currently more than 150 vaccine candidates in different stages of development using a variety of viral antigens, with the S protein being the most targeted antigen. Although some new experimental evidence suggests cross-reacting responses between coronaviruses are present in the population, it remains unknown whether potential shared antigens between different coronaviruses could provide cross-protection. Given that coronaviruses are emerging pathogens and continue to represent a threat to global health, the development of a SARS-Cov-2 vaccine that could provide ‘universal’ protection against other coronaviruses should be pushed forward. Here we present a thorough review of reported B and T cell epitopes shared between SARS-CoV-2 and other relevant coronaviruses, in addition we used web-based tools to predict novel B and T cell epitopes that have not been reported before. Analysis of experimental evidence that is constantly emerging complemented with the findings of this study allow us support the hypothesis that cross-reactive responses, particularly those coming from T cells, might play a key role in controlling infection by SARS-CoV-2. We hope that with the evidence presented in this manuscript we provide arguments to encourage the study of cross-reactive responses in order to elucidate their role in immunity to SARS-CoV-2. Finally we expect our findings will aid targeted analysis of antigen-specific immune responses and guide future vaccine design aiming to develop a cross reactive effective vaccine against respiratory diseases caused by coronaviruses.
Multi-sample Full-length Transcriptome Analysis of 22 Breast Cancer Clinical Specimens with Long-Read Sequencing
Authors: Namba Shinichi , Ueno Toshihide , Kojima Shinya , Tanaka Yosuke , Inoue Satoshi , Kishigami Fumishi , Maeda Noriko , Ogawa Tomoko , Hazama Shoichi , Shiraishi Yuichi , Mano Hiroyuki , Kawazu Masahito
Published: July 2020

Although transcriptome alteration is considered as one of the essential drivers of carcinogenesis, conventional short-read RNAseq technology has limited researchers from directly exploring full-length transcripts, only focusing on individual splice sites. We developed a pipeline for Multi-Sample long-read Transcriptome Assembly, MuSTA, and showed through simulations that it enables construction of transcriptome from the transcripts expressed in target samples and more accurate evaluation of transcript usage. We applied it to 22 breast cancer clinical specimens to successfully acquire cohort-wide full-length transcriptome from long-read RNAseq data. By comparing isoform existence and expression between estrogen receptor positive and triple-negative subtypes, we obtained a comprehensive set of subtype-specific isoforms and differentially used isoforms which consisted of both known and unannotated isoforms. We have also found that exon-intron structure of fusion transcripts tends to depend on their genomic regions, and have found three-piece fusion transcripts that were transcribed from complex structural rearrangements. For example, a three-piece fusion transcript resulted in aberrant expression of an endogenous retroviral gene,ERVFRD-1, which is normally expressed exclusively in placenta and supposed to protect fetus from maternal rejection, and expression of which were increased in several TCGA samples withERVFRD-1fusions. Our analyses of real clinical specimens and simulated data provide direct evidence that full-length transcript sequencing in multiple samples can add to our understanding of cancer biology and genomics in general.
COVID-19 effective reproductive ratio determination: An application, and analysis of issues and influential factors
Authors: Baibás Luis Alfredo Bautista , Conesa Mario Gil , Caravaca Gil Rodríguez , Baibás Blanca Bautista
Published: July 2020

An essential indicator of COVID-19 transmission is the effective reproduction number (Rt), the number of cases which an infected individual is expected to infect at a particular point in time; curves of the evolution of Rt over time (transmission curves) reflect the impact of preventive measures and whether an epidemic is controlled. We have created a Shiny/R web application (https://alfredob.shinyapps.io/estRO/) with user-selectable features: open data sources with daily COVID-19 incidences from all countries and many regions, customizable preprocessing options (smoothing, proportional increment, backwards distribution of negative corrections, etc), different MonteCarlo-Markov-Chain estimates of the generation time or serial interval distributions and state-of-the-art Rt estimation frameworks (EpiEstim, R0). We have analyzed the impact of these factors in the obtained transmission curves. We also have obtained curves at the national and sub-national level and analyzed the impact of epidemic control strategies, superspreading events, socioeconomic factors and outbreaks.

We conclude that country wealth and, to a lesser extent, mitigation strategies, were associated with poorer epidemic control. Dataset quality was an important factor, and sometimes dictated the necessity of time series smoothing. We couldn’t find conclusive evidence regarding the impact of alleged superspreading events. In the reopening phase, outbreaks had an impact on transmission curves. This application could be used interactively as a tool both to obtain transmission estimates and to perform interactive sensitivity analysis.
Risk factors mediating the effect of body-mass index and waist-to-hip ratio on cardiovascular outcomes: Mendelian randomization analysis
Authors: Gill Dipender , Zuber Verena , Dawson Jesse , Pearson-Stuttard Jonathan , Carter Alice R. , Sanderson Eleanor , Karhunen Ville , Levin Michael G. , Wootton Robyn E. ,   VA Million Veteran Program, Klarin Derek , Tsao Philip S. , Tsilidis Konstantinos K. , Damrauer Scott M. , Burgess Stephen , Elliott Paul
Published: July 2020

Background

Higher body-mass index (BMI) and waist-to-hip ratio (WHR) increase the risk of cardiovascular disease, but the extent to which this is mediated by blood pressure, diabetes, lipid traits and smoking is not fully understood.

Methods

Using consortia and UK Biobank genetic association summary data from 140,595 to 898,130 participants predominantly of European ancestry, MR mediation analysis was performed to investigate the degree to which genetically predicted systolic blood pressure (SBP), diabetes, lipid traits and smoking mediated an effect of genetically predicted BMI and WHR on risk of coronary artery disease (CAD), peripheral artery disease (PAD) and stroke.

Results

The 49% (95% confidence interval [CI] 39%-60%) increased risk of CAD conferred per 1-standard deviation increase in genetically predicted BMI attenuated to 34% (95% CI 24%-45%) after adjusting for genetically predicted SBP, to 27% (95% CI 17%-37%) after adjusting for genetically predicted diabetes, to 47% (95% CI 36%-59%) after adjusting for genetically predicted lipids, and to 46% (95% CI 34%-58%) after adjusting for genetically predicted smoking. Adjusting for all the mediators together, the increased risk attenuated to 14% (95% CI 4%-26%). A similar pattern of attenuation was observed when considering genetically predicted WHR as the exposure, and PAD or stroke as the outcomes.

Conclusions

Measures to reduce obesity will lower risk of cardiovascular disease primarily by impacting on downstream metabolic risk factors, particularly diabetes and hypertension. Reduction of obesity prevalence alongside control and management of its mediators is likely to be most effective for minimizing the burden of obesity.
Cultural adaptation and content validity of a Chinese translation of the “Person-Centered Primary Care Measure”: findings from cognitive debriefing
Authors: Tse Tsui Yee Emily , Lam Lo Kuen Cindy , Wong King Ho Carlos , Yee Chin Weng , Etz Rebecca S. , Zyzanski Stephen J. , Stange Kurt C.
Published: July 2020

Objectives

To develop an equivalent Chinese translation of the Person-Centered Primary Care Measure (PCPCM) and to establish its cultural adaptability and content validity through cognitive debriefing.

Design

The original English PCPCM was first translated into Chinese by double forward-translation by professional translators. The reconciliated Chinese version was then doubly back-translated into English by two other professional translators blinded to the forward-translation. Upon affirmation on its linguistic equivalence with the developers of the original English PCPCM, the reconciliated Chinese PCPCM was sent for cognitive debriefing with twenty Chinese-speaking primary care subjects by a trained interviewer using structured probing questions to collect their opinions on the clarity, comprehensibility and relevance of each item and response option in the Measure.

Setting

Subjects were invited from a primary care clinic in Hong Kong to undergo the cognitive debriefing interviews. The interviews were divided into four groups chronologically to allow revision of the items to be made in between.

Participants

Ten males of age ranged from twenty-eight to sixty-eight and ten females of age ranged from thirty-seven to seventy completed the cognitive interviews. They were all Cantonese-speaking Chinese recruited by convenience sampling. Subjects with cognitive impairment, could not read Chinese, too old or too sick to complete the interviews were excluded from the study.

Results

An average of 3.3 minutes (range 3 to 4 minutes) was required for the subjects to self-complete the Measure. All items were generally perceived to be easily understood and relevant. Modifications were made to items with the content validity index on clarity or understanding <0.8 in each round of the interviews or if a majority of the subjects suggested rewording. Revisions were made to two items in the Chinese PCPCM throughout the whole cognitive debriefing process before the final version was confirmed. The average content validity index (CVI) on clarity of the Chinese PCPCM items ranged from 0.75 to 1. The average CVI on understanding ranged from 0.7 to 1. The average CVI on relevance ranged from 0.55 to 1.

Conclusions

The content validity of the PCPCM was good enough to allow further testing of its psychometric properties in a larger population.

Key Points

Question

Is our Chinese translation of The Person-Centered Primary Care Measure (PCPCM) a culturally adaptable and valid measure?

Finding

Our Chinese version of the PCPCM was confirmed to be culturally adaptable. It showed high content validity indices regarding its clarity, understanding and relevance through cognitive debriefing.

Meaning

This Chinese version of the PCPCM is ready for further testing of its psychometric properties in a larger population.
Patient acceptability of ctDNA testing in endometrial cancer follow-up
Authors: Relton A , Collins A , Guttery DS , Gorsia D , McDermott HJ , Moss EL
Published: July 2020

Objective

Circulating tumour DNA (ctDNA) is emerging as a potential option to detect disease recurrence in many cancer types however, ensuring patient acceptability of changing clinical practice and the introduction of new technology is paramount. This study aimed to explore women’s opinions on the acceptability of ctDNA to monitor for endometrial cancer (EC) recurrence.

Methods

Women enrolled on a non-intervention cohort study determining the ability of ctDNA to detect recurrent endometrial cancer were invited to participate in a semi-structured interview. Data was analysed using Template Analysis.

Results

Eighteen women were interviewed. Participants represented a mix of cases, including early stage high-risk EC, metastatic disease at diagnosis and EC recurrence, to ensure a wide range of participant experiences were captured. A ctDNA blood test was viewed by participants as more physically and psychologically acceptable than clinical examination to monitor for EC recurrence. In particular, participants expressed overwhelming preference for a blood test rather than pelvic examination. Although participants acknowledged that an abnormal ctDNA result could cause anxiety, they expressed a preference to be informed of their results, even if a recurrence was too small to detect radiologically. Explanations for these opinions were a desire for certainty whether their cancer would recur or not, and knowledge would help them be more aware of symptoms that should be reported to their clinician.

Conclusions

ctDNA monitoring to identify EC recurrence appears to be acceptable to patients, and for many, may be preferable to clinical examination.
Possible fates of the dispersion of SARS-COV-2 in the Mexican context
Authors: Santamaría-Holek I. , Castaño V.
Published: July 2020

The determination of the adequate time for house confinement and when social distancing restrictions should end are now two of the main challenges that any country has to face in an effective battle against. The possibility of a new outbreak of the pandemic and how to avoid it is, nowadays, one of the primary objectives of epidemiological research. In this work, we go deep in this subject by presenting an innovative compartmental model, that explicitly introduces the number of active cases, and employing it as a conceptual tool to explore the possible fates of the dispersion of SARS-COV-2 in the Mexican context. We incorporated the impact of starting, inattention, and end of restrictive social policies on the time evolution of the pandemics via time-in-run corrections to the infection rates. The magnitude and impact on the epidemic due to post-social restrictive policies are also studied. The scenarios generated by the model can help authorities to determine an adequate time and population load that may be allowed to reassume normal activities.
Estimate of airborne transmission of SARS-CoV-2 using real time tracking of health care workers
Authors: Hota Bala , Stein Brian , Lin Michael , Tomich Alex , Segreti John , Weinstein Robert A.
Published: July 2020

BACKGROUND

Whether and to what degree SARS-CoV-2 is spread via the airborne route is unknown. Using data collected from health care worker interactions with hospitalized patients with COVID-19 illness, we calculated the transmissibility of SARS-CoV-2 via the airborne route.

OBJECTIVES/METHODS

Healthcare worker interaction with SARS-CoV-2 infected patients were tracked using a real time location system between March 18 and March 31. A value for q, the transmissibility expressed as quanta per hour, was estimated using a well-established model for airborne transmission.

RESULTS

SARS-CoV-2 infection prevalence among tracked HCWs was 2.21% (0.07-4.35). Transmissibility was estimated to be 0.225 quanta per hour, well below other well-characterized airborne pathogens. Simulations demonstrated that risk of infection is substantially reduced with increased ventilation of rooms.

CONCLUSIONS

Overall, our findings suggest that SARS-CoV-2 is not well transmitted via the airborne route in controlled conditions. We speculate that SARS-CoV-2 may be only opportunistically airborne, with most transmission occurring via droplet methods.

One Sentence Summary

We calculated the airborne transmissibility (q) of SARS-CoV-2 and the impact of masks and ventilation in a hospital setting.
Altered Toxicological Endpoints in Humans with Quaternary Ammonium Compound Exposure
Authors: Hrubec Terry C , Seguin Ryan P , Xu Libin , Cortopassi Gino A , Datta Sandipan , McDonald Valerie A , Healy Claire A , Musse Najaha A , Anderson Tyler C , Williams Richard T
Published: July 2020

Humans are extensively exposed to Quaternary Ammonium Compounds (QACs). QACs are ubiquitously used in medical settings, restaurants, and homes as cleaners and disinfectants. They are also used on food and in personal care products as preservatives. Despite their prevalence, nothing is known about the health effects associated with chronic low-level exposure. Chronic QAC toxicity was recently identified in mice and resulted in developmental and reproductive deficits and altered immune function. Cell based studies show that QACs increase inflammation, disrupt cholesterol synthesis, and decrease mitochondria function. If these studies translate to human toxicity, multiple physiological functions could be affected. QAC concentrations in humans have not been monitored previously. This study tested whether QAC concentrations could be detected in the blood of 43 random volunteers, and whether QAC concentrations were associated with markers of inflammation, mitochondrial function, and cholesterol synthesis in a dose dependent manner. QAC concentrations were detected in 80% of study participants, and were associated with decreased mitochondrial function and an increase in inflammatory cytokines in a dose dependent manner. Cholesterol synthesis pathway intermediaries were generally increased, indicating disruption in cholesterol homeostasis. This is the first study to demonstrate that chronic exposure to QACs results in measurable concentrations in human blood, and to also demonstrate significant correlations between QAC level and meaningful biomarkers related to health.
Local Gazetteers Reveal Contrasting Patterns of Historical Distribution Changes between Apex Predators and Mesopredators in Eastern China
Authors: Hu Kaijin
Published: July 2020

Background

Humans have been causing the sixth wave of mass extinction of biodiversity. The situation of predators, especially of carnivores, is a key indicator of biodiversity, and the mesopredator release is a typical phenomenon in ecosystem recess. Local gazetteers are a rich resource for historical biodiversity research. However there are obvious biases in previous studies focusing only on presence records and neglecting the absence records. I recollected and analyzed the records by fixed methods to research historical biodiversity change.

Methods

Innovatively, this research used both presence and absence records from local gazetteers to reconstruct the distribution of 8 kinds of mammalian predators (i.e. large carnivores: tigers, leopards, and bears; medium-sized carnivores: wolves, foxes, civets, dholes, and mustelids) in eastern China from 1573C.E.(Common Era) to 1949C.E. (sorted into 4 periods). Then by utilizing statistics methods, e.g. Partial Least Squares Structural Equation Modeling(PLS-SEM), I analyzed the distribution changes(overall and sorted into 5 altitude groups), and the relation between carnivores and the influence from humans.

Results & Conclusions

I reconstructed the specific distribution changes of the carnivores and found the changes match the mesopredator release phenomenon. Furthermore, I found the specific relation(e.g. trade-off effect) between carnivores and the influence of humans. Besides, I found that bears and civets may be potential members of the “Tigers - Leopards - Dholes” predator guild.

Prospects

I have also collected records for other wild animals from local gazetteers in China. Based on this collection, I have built the Database of Wild Mammal Records in Chinese Local Gazetteers and am building the Database of Wild Bird Records in Chinese Local Gazetteers. I aim to continue relevant studies using these databases in the future.
GPR183 regulates interferons and bacterial growth duringMycobacterium tuberculosisinfection: interaction with type 2 diabetes and TB disease severity
Authors: Bartlett Stacey , Gemiarto Adrian Tandhyka , Dao Ngo Minh , Sajiir Haressh , Hailu Semira , Sinha Roma , Foo Cheng Xiang , Kleynhans Léanie , Tshivhula Happy , Webber Tariq , Bielefeldt-Ohmann Helle , West Nicholas P. , Hiemstra Andriette M. , MacDonald Candice E. , von Voss Christensen Liv , Schlesinger Larry S. , Walzl Gerhard , Rosenkilde Mette Marie , Mandrup-Poulsen Thomas , Ronacher Katharina
Published: July 2020

Oxidized cholesterols have emerged as important signaling molecules of immune function, but little is known about the role of these oxysterols during mycobacterial infections. We found that expression of the oxysterol-receptor GPR183 was reduced in blood from patients with tuberculosis (TB) and type 2 diabetes (T2D) compared to TB patients without T2D and was associated with TB disease severity on chest x-ray. GPR183 activation by 7α,25-hydroxycholesterol (7α,25-OHC) reduced growth ofMycobacterium tuberculosis(Mtb) andMycobacterium bovisBCG in primary human monocytes, an effect abrogated by the GPR183 antagonist GSK682753. Growth inhibition was associated with reduced IFN-β and IL-10 expression and enhanced autophagy. Mice lacking GPR183 had significantly increased lung Mtb burden and dysregulated IFNs during early infection. Together, our data demonstrate that GPR183 is an important regulator of intracellular mycobacterial growth and interferons during mycobacterial infection.

Graphical Abstract
Precise transcriptional control of cellular quiescence by BRAVO/WOX5 complex in Arabidopsis roots
Authors: Betegón-Putze Isabel , Mercadal Josep , Bosch Nadja , Planas-Riverola Ainoa , Marquès-Bueno Mar , Vilarrasa-Blasi Josep , Frigola David , Burkart Rebecca Corinna , Martínez Cristina , Stahl Yvonne , Prat Salomé , Ibañes Marta , Caño-Delgado Ana I.
Published: July 2020

Root growth and development are essential features for plant survival and the preservation of terrestrial ecosystems. In the Arabidopsis primary root apex, stem-cell specific transcription factors BRAVO and WOX5 co-localize at the Quiescent Center (QC) cells, where they repress cell division so that these cells can act as a reservoir to replenish surrounding stem cells, yet their molecular connection remains unknown. Here, by using empirical evidence and mathematical modeling, we establish the precise regulatory and molecular interactions between BRAVO and WOX5. We found that BRAVO and WOX5 regulate each other besides forming a transcription factor complex in the QC necessary to preserve overall root growth and architecture. Our results unveil the importance of transcriptional regulatory circuits at the quiescent and stem cells to the control of organ initiation and growth of plant tissues.
Decreased utilization of allocentric coordinates during reaching movement in individuals with autism spectrum disorder
Authors: Umesawa Yumi , Atsumi Takeshi , Fukatsu Reiko , Ide Masakazu
Published: July 2020

Despite numerous reports of abnormalities in limb motor controls in spatial orientation in individuals with autism spectrum disorder (ASD), the underlying mechanisms have not been elucidated. We studied the influence of allocentric coordinates on ongoing reaching movements, which has been reported to strongly affect the reaching movements of typically developing (TD) individuals. ASD and TD participants observed a target presented randomly on one of the four corners of a frame on a screen. After it disappeared, another frame was presented slightly shifted leftward/rightward. The participants touched the memorized position of the target relatively congruent with a reference frame (allocentric condition) or ignoring it (egocentric condition). Results suggested that touch positions were less affected by shift directions of reference frame in the allocentric condition in ASD participants, so that they tended to reach in egocentric manner. Our findings demonstrate that decreased utilization of visual landmarks in ongoing movement may underlie motor disabilities in autism.
An amended potassium persulfate ABTS antioxidant assay used for medicinal plant extracts revealed variable antioxidant capacity based upon plant extraction process
Authors: Mingle Cody E. , Newsome Anthony L.
Published: July 2020

Use of potassium persulfate (K2S208) for oxidation of 7.0 mM ABTS to a stable ABTS radical for antioxidant studies was first reported in 1999. A feature of this popular antioxidant assay has been the requirement of an overnight reaction (6 to 12 h) for the formation of a stable ABTS colored radical. It is now reported that when the concentration of ABTS is lowered to 0.7 mM, complete oxidation to the stable cation radical occurs in 30 min, thus circumventing the necessary overnight step. Using this format, it is now possible to accurately assess antioxidant activity based on the potassium persulfate/ABTS format in less than one hour which includes formation time of a stable ABTS radical. This methodology documented the presence of antioxidant properties of plant extracts used in Traditional Chinese Medicine. The degree of antioxidant activity was directly related to the extraction method. Greater antioxidant activity was associated with butanol extraction. When incorporated into a microtiter plate format, it supported rapid assessment of multiple determinations of dilutions of plant extracts in less than one hour which included time required for formation of a stable ABTS radical. The ease, improved time prerequisites, and minimal reagent needs with the microtiter plate format, makes this design attractive. It would prove of particular interest to individuals engaged in both smaller and high-volume throughput antioxidant assays of food and health products, and other biological fluids and tissues.
Antigenic variation of SARS-CoV-2 in response to immune pressure
Authors: Forni Diego , Cagliani Rachele , Pontremoli Chiara , Mozzi Alessandra , Pozzoli Uberto , Clerici Mario , Sironi Manuela
Published: July 2020

The ongoing evolution of SARS-CoV-2 is expected to be at least partially driven by the selective pressure imposed by the human immune system. We exploited the availability of a large number of high-quality SARS-CoV-2 genomes, as well as of validated epitope predictions, to show that B cell epitopes in the spike glycoprotein (S) and in the nucleocapsid protein (N) have higher diversity than non-epitope positions. Similar results were obtained for other human coronaviruses. Conversely, in the SARS-CoV-2 population, epitopes for CD4+and CD8+T cells were not more variable than non-epitope positions. A significant reduction in epitope variability was instead observed for some of the most immunogenic proteins (S, N, ORF8, and ORF3a). Analysis over longer evolutionary time-frames indicated that this effect is not due to differential constraints. These data indicate that SARS-CoV-2 is evolving to elude the host humoral immune response, whereas recognition by T cells might benefit the virus.
HistoFlow: Label-Efficient and Interactive Deep Learning Cell Analysis
Authors: Henning Tim , Bergner Benjamin , Lippert Christoph
Published: July 2020

Instance segmentation is a common task in quantitative cell analysis. While there are many approaches doing this using machine learning, typically, the training process requires a large amount of manually annotated data. We present HistoFlow, a software for annotation-efficient training of deep learning models for cell segmentation and analysis with an interactive user interface.

It provides an assisted annotation tool to quickly draw and correct cell boundaries and use biomarkers as weak annotations. It also enables the user to create artificial training data to lower the labeling effort. We employ a universal U-Net neural network architecture that allows accurate instance segmentation and the classification of phenotypes in only a single pass of the network. Transfer learning is available through the user interface to adapt trained models to new tissue types.

We demonstrate HistoFlow for fluorescence breast cancer images. The models trained using only artificial data perform comparably to those trained with time-consuming manual annotations. They outperform traditional cell segmentation algorithms and match state-of-the-art machine learning approaches. A user test shows that cells can be annotated six times faster than without the assistance of our annotation tool. Extending a segmentation model for classification of epithelial cells can be done using only 50 to 1500 annotations.

Our results show that, unlike previous assumptions, it is possible to interactively train a deep learning model in a matter of minutes without many manual annotations.