bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of plasma cyclooxygenase-2 levels and genetic polymorphisms with salt sensitivity, blood pressure changes and hypertension incidence in Chinese adults
Authors: Wang Yang , Zhou Qing , Gao Wei-Hua , Yan Yu , Chu Chao , Chen Chen , Yuan Yue , Wang Ke-Ke , Ma Qiong , Gao Ke , Hu Jia-Wen , Liao Yue-Yuan , Li Min , Sun Yue , Chang John , Zhang Jie , Xu Jing-Tao , Wang Dan , Zang Wei-Jin , Mu Jian-Jun
Published: June 2020

Objective:

Cyclooxygenase (COX)-2, an inducible isoform of the major rate-limiting enzymes that regulate the production of prostaglandins is associated with injury, inflammation and proliferation. We sought to examine whether plasma COX-2 levels and its genetic variants is associated with salt sensitivity, BP changes and/or hypertension in humans.

Methods:

Eighty participants (aged 18–65 years) were maintained sequentially either on a usual diet for 3 days, a low-salt diet (3.0 g) for 7 days, and a high-salt diet (18.0 g) for an additional 7 days. In addition, we studied participants of the original Baoji Salt-Sensitive Study, recruited from 124 families from seven Chinese villages in 2004 who received the same salt intake intervention, and evaluated them for the development of hypertension.

Results:

Plasma COX-2 levels were significantly decreased with reduction of salt intake from the usual to a low-salt diet and decreased further when converting from the low-salt to the high-salt diet. SNPs rs12042763 in the COX-2 gene was significantly associated with SBP responses to both low-salt and high-salt diet. SNPs rs689466 and rs12042763 were significantly associated with longitudinal changes in BPs. In addition, several COX-2 SNPs were significantly associated with incident hypertension over an 8-year follow-up. Gene-based analyses also supported the overall association of COX-2 with longitudinal changes in SBP and hypertension incidence.

Conclusion:

This study shows that dietary salt intake affects plasma COX-2 levels and that COX-2 may play a role in salt sensitivity, BP progression and development of hypertension in the Chinese populations studied.
Measurement of aortofemoral volume wave velocity during the routine 12-channel ECG: relation to age, physiological hemoglobin A 1C, triglycerides and SBP in healthy individuals
Authors: Skrabal Falko , Weber Thomas , Skrabal Katharina , Windhaber Jana , Ehsas Hasibullah , Stockinger Norbert , Boyer Johannes
Published: June 2020

Objective:

Measurements of pulse wave velocity are generally thought to be too impractical for clinical routine. This study aimed to develop a method that can be performed during routine 12-channel ECG.

Methods:

A 12-channel ECG simultaneously supplies arterial impedance plethysmographic signals from the extremities beside segmental multifrequency impedance measurements for obtaining body composition. The origin of the plethysmographic signal (volume wave) at the arms and legs was determined at the level of the elbows and the knees. The volume wave velocity (VWV) at the aorta and femoral arteries was calculated from the time difference of the plethysmographic signals between arms and legs.

Results:

Automated measurement of VWV was highly reproducible (r = 0.96). In 107 participants in perfect health, VWV in different models was positively related to age, physiological hemoglobin A 1C, triglycerides, normal standardized unattended blood pressure, but not to physiological low-density lipoprotein-cholesterol and high-density lipoprotein-cholesterol. Aortofemoral VWV was significantly higher in patients with established coronary artery disease than in healthy controls of the same age group (18.1 ± 5.8 vs. 11.9 ± 1.7 m/s, P < 0.001). VWV in study participants was higher than tonometrically determined pulse wave velocity as muscular arteries are included (13.2 ± 5.81 vs. 8.8 ± 2.98 m/s, n = 115, P < 0.001).

Conclusion:

These background arterial impedance plethysmographic measurements for the measurement of VWV made simultaneously during 12-channel ECG show promise for large-scale, routine clinical assessment of large artery function.
Maternal myocardial dysfunction after normotensive fetal growth restriction compared with hypertensive pregnancies: a speckle-tracking study
Authors: Orabona Rossana , Mohseni Zenab , Sciatti Edoardo , Mulder Eva G. , Prefumo Federico , Lorusso Roberto , Frusca Tiziana , Ghossein-Doha Chahinda , Spaanderman Marc E.A.
Published: June 2020

Objective:

Pregnancy complicated by preeclampsia and fetal growth restriction (FGR) relates to increased risk of cardiovascular disease later in life, but to different extents. Subclinical cardiac alterations precede eminent cardiovascular disease. Speckle-tracking echocardiography is an elegant method to assess subclinical myocardial dysfunction. We performed a myocardial speckle tracking study to evaluate the prevalence of subclinical myocardial dysfunction in former preeclampsia patients (with and without FGR) compared with normotensive women with FGR.

Methods:

For this cross-sectional study, we retrospectively selected women with a history of normotensive FGR (n = 17), preeclampsia with FGR (n = 26) and preeclampsia without FGR (n = 134) who underwent conventional echocardiography as part of the clinical cardiovascular work-up after complicated pregnancies between 6 months and 4 years postpartum in Maastricht, The Netherlands. We excluded women with chronic hypertension, hypercholesterolemia and obesity.

Results:

Women with normotensive FGR showed subclinical left ventricular (LV) impairment in systodiastolic function with concentric remodeling, slight alteration in right ventricular systolic function and left atrial strain, similarly to the preeclampsia group independently from the fetal growth. LV hypertrophy was only present in about 10% of cases who experienced preeclampsia (independently from the fetal growth) but not in those with normotensive FGR.

Conclusion:

Similar to women with a history preeclampsia, women with a history of normotensive pregnancy but with FGR have abnormal myocardial function, shown with speckle-tracking echocardiography. Therefore, both preeclampsia and normotensive FGR should be viewed upon as risk indicator for subclinical myocardial impairment that may benefit from cardiovascular risk management.
Anxiety, depression, chronic inflammation and aortic stiffness in Crohn's disease: the brain--gut--vascular axis
Authors: Zanoli Luca , Tuttolomondo Antonino , Inserra Gaetano , Cappello Maria , Granata Antonio , Malatino Lorenzo , Castellino Pietro
Published: June 2020

Background:

Patients with Crohn's disease have an increased aortic stiffness, a known cardiovascular risk factor. Anxiety, a key factor of the brain--gut axis in patients with Crohn's disease, is implicated in the pathogenesis and progression of the disease, and is linked with aortic stiffening in other clinical settings.

Objectives:

Considering that depression is frequently linked to anxiety in Crohn's disease, we performed a mediation analysis to reveal the potential link between anxiety, depression and aortic stiffness in these patients.

Methods:

Multicentre observational cross-sectional study of 86 consecutive patients with Crohn's disease and 86 matched control individuals. The connections between anxiety, depression, disease duration, aortic pulse wave velocity (aPWV), brachial and central SBP were tested using partial least squares structural equations modelling.

Results:

In patients with Crohn's disease, anxiety (path coefficient: 0.220,P = 0.01) and disease duration (path coefficient: 0.270,P = 0.02) were associated with aPWV that in turn was associated with brachial SBP (path coefficient: 0.184,P = 0.03). These associations were even stronger in patients with active disease. The connection between anxiety and aPWV was in part mediated by central SBP (indirect effect: 0.090,P = 0.01; indirect-to-total effect ratio: 41%) as well as, in a pilot substudy, by sympathetic hyperactivity. Anxiety and depression were highly correlated in patients with Crohn's disease. Consequently, results were confirmed when anxiety was substituted by depression.

Conclusion:

The connections of anxiety, depression and chronic inflammation with aPWV and SBP could suggest the first evidence of a brain--gut--vascular axis and new potential targets for therapy in patients with Crohn's disease.
Viscodelamination of Localized Retrolental Plaques During Lens-Sparing Vitrectomy in Eyes With Pediatric Tractional Vitreoretinopathy
Authors: Lyu Jiao , Zhang Qi , Zhao Peiquan
Published: June 2020

Purpose:

To report viscodelamination of localized retrolental plaques during lens-sparing vitrectomy in eyes with pediatric tractional vitreoretinopathy.

Methods:

Viscodelamination of retrolental plaques was performed during 23-gauge lens-sparing vitrectomy in 11 eyes from 11 children with a median age (range) of 12 (4–58) months. There were five eyes with Stage 4 familial exudative vitreoretinopathy, one eye with Stage 4B retinopathy of prematurity, and five eyes with anterior–posterior persistent fetal vasculature syndrome. Retrolental plaques were separated from the posterior lens capsule by the tension of viscoelastic injection in the Berger's space.

Results:

In 10 of 11 eyes, retrolental plaques were removed from posterior surface of lens without capsular tearing. During the 12-month to 18-month follow-up period, lens clarity along the visual axis was retained in 5 eyes with familial exudative vitreoretinopathy, one eye with retinopathy of prematurity, and 2 of 5 eyes with persistent fetal vasculature. Atraumatic viscodelamination was associated with retrolental plaques that did not incorporate into the posterior lens capsule. Retinal dragging was reversed in all 11 eyes.

Conclusion:

Viscodelamination may be effective for the dissection of retrolental plaques related to pediatric vitreoretinopathy in selected cases.
CLINICAL UTILITY OF BETA-D-GLUCAN TESTING FOR ENDOGENOUS FUNGAL CHORIORETINITIS OR ENDOPHTHALMITIS
Authors: Ammar Michael J. , Carroll Robert , Kolomeyer Anton , Ying Gui-Shuang , Whitehead Gideon , Brucker Alexander J. , Kim Benjamin J.
Published: June 2020

Purpose:

To evaluate serum beta-D-glucan (BDG) as a biomarker for endogenous fungal eye infection.

Methods:

Retrospective case–control study of 88 patients with a BDG test and eye examination at UPenn (2013–2018). Cases had endogenous fungal chorioretinitis or endophthalmitis diagnosed by eye examination and confirmed with positive culture; controls were without these fungal eye findings. Charts were reviewed for BDG values, blood/vitreous cultures, and eye examinations. Outcomes were BDG sensitivity, specificity, positive predictive value, and negative predictive value for fungal chorioretinitis or endophthalmitis, using prespecified BDG cut-off points of ≥80, ≥250, and ≥500 pg/mL as test positive.

Results:

Cases included six chorioretinitis and four endophthalmitis patients. Controls included 78 patients without chorioretinitis or endophthalmitis. Defining BDG ≥80 pg/mL as test positive, the BDG sensitivity (95% confidence interval) was 66.7% (22.3%–95.7%) for chorioretinitis and 100% (39.8%–100%) for endophthalmitis. The specificity was 74.4% (63.2%–83.6%) when BDG values ≥80 pg/mL were test positive, and 85.9% (76.2%–92.7%) when values ≥250 pg/mL were test positive. For a 1% endophthalmitis prevalence and BDG cut-off value of ≥80 pg/mL, the positive predictive value was 3.8% (2.4%–5.2%) and negative predictive value was 100% (99.1%–100%).

Conclusion:

For endogenous fungal endophthalmitis, BDG's sensitivity and specificity seem good and the negative predictive value is high; a larger ophthalmic study is indicated.
Differences in Growth of HIV-exposed Uninfected Infants in Ethiopia According to Timing of In-utero Antiretroviral Therapy Exposure
Authors: Ejigu Yohannes , Magnus Jeanette H. , Sundby Johanne , Magnus Maria Christine
Published: June 2020

Background:

There are concerns about the adverse effect of in-utero exposure to antiretroviral therapy (ART) on the growth of HIV exposed-uninfected (HEU) infants. We compared growth of HEU-infants according to the timing and type of ART exposure.

Methods:

A retrospective cohort study was conducted by abstracting clinical data from HIV-infected mothers and HEU-infants in Addis Ababa, Ethiopia between February 2013 and October 2016. Mixed-effects linear models were used to compare changes in weight and length and cox proportional hazard models were used to evaluate stunting (length-for-age z score <−2.0) and underweight (weight-for-age z score <−2.0).

Results:

A total of 624 HEU-infants were included in the analyses. Infants exposed to ART from conception had a lower rate of change in length [β = −0.54, 95% confidence interval (CI): −1.00 to −0.08] the first 3 months of life, as compared with infants exposed from late pregnancy. Risk of stunting was 51.9 per 100 person-years and risk of underweight was 26.7 per 100 person-years. Exposure to ART from conception was associated with a higher rate of stunting as compared with exposure from late pregnancy (adjusted hazard ratio = 1.95, 95% CI: 1.27–2.99). Infants born to mothers with advanced disease had a higher incidence of underweight compared with infants born to mothers with early-stage disease adjusted hazard ratio = 1.99, 95% CI: 1.32–3.03).

Conclusions:

In HEU-infants, exposure to ART from conception was associated with decrease growth during early infancy and higher incidence of stunting compared with treatment exposure later in pregnancy. Close monitoring of HEU-infants’ growth and prompt nutritional intervention is essential.
Properties of the Early Symptom Measurement of Post-Stroke Depression: Concurrent Criterion Validity and Cutoff Scores
Authors: LI Jufang , OAKLEY Linda Denise , BROWN Roger L. , LI Yun , LUO Yong
Published: June 2020

Background

Early-stage post-stroke depression (PSD) increases the risk of stroke-related disability and mortality in the first year of recovery. Presently available screening measures were developed to assess major depression, and none used a PSD screening criterion that was systematically developed and tested in populations of patients with acute stroke.

Purpose

The purpose of this study was to evaluate the concurrent criterion validity and cutoff scoring of the Early Symptom Measurement of Post-Stroke Depression (ESM-PSD) instrument in hospitalized patients with acute stroke.

Methods

Purposive recruitment of newly admitted patients yielded a qualified sample of 139 nonaphasic participants who were 7–30 days post mild-to-moderate stroke confirmed by computed tomography and magnetic resonance images. Participants responded to the ESM-PSD and Hamilton Rating Scale for Depression-24 (HAMD-24).

Results

The mean number of post-stroke days was 11.99 (SD = 7.68). Cronbach’s alpha estimates of internal consistency were ESM-PSD = .90 and HAMD-24 = .76. ESM-PSD measurement sensitivity and specificity were superior. The following three ESM-PSD cutoff scores, determined by the receiver operating characteristic curve, were used to assess clinically relevant early-symptom levels: no PSD < 14.5, low PSD = 14.5–25.5, moderate PSD = 25.5–45.5, high PSD ≥ 45.5.

Conclusion/Implications for Practice

ESM-PSD cutoff scores show the expected correspondence with mild–moderate–severe HAMD-24 symptoms, which was evidenced by the high area under the receiver operating characteristic curve. Planned follow-up research will assess the efficacy of using ESM-PSD scores to detect increased risk of major depression onset in patients with acute stroke.
The Effects of Shared Decision Making on Different Renal Replacement Therapy Decisions in Patients With Chronic Kidney Disease
Authors: HO Ya-Fang , CHEN Yu-Chi , HUANG Chiu-Chin , HU Wen-Yu , LIN Kuan-Chia , LI I-Chuan
Published: June 2020

Background

The prevalence and incidence of end-stage renal disease (ESRD) in Taiwan are the highest of any country in the world. The different renal replacement therapies that are adopted by patients with ESRD significantly affect their social roles and daily life. However, because of the complexities of different renal replacement therapies, patients may be unsure of which to choose.

Purpose

The aim of this study was to explore the effectiveness of a shared decision-making (SDM) program regarding different renal replacement therapies for patients with chronic kidney disease.

Methods

A quasi-experimental design was conducted at two similar regional hospitals in Miaoli County, Taiwan. One hospital hosted the intervention group, and the other hospital hosted the control group. The 31 participants in the intervention group took part in a SDM program. The 36 control group participants took part in the pre-ESRD care program. Data collection included demographic and disease characteristics, decisional conflict scale, and decision self-efficacy scale. Results were analyzed using independent t test, Fisher’s exact test, generalized estimating equation, and paired t tests.

Results

The study results revealed that the intervention group experienced a significant increase in decision self-efficacy and a significant decrease in decisional conflict at 1 month after receiving the SDM intervention in comparison to before and immediately after receiving the intervention. Moreover, the intervention group had higher decision self-efficacy and lower decisional conflict than the control group.

Conclusions/Implications for Practice

The SDM program may be an effective intervention for complex decision-making processes, such as the process involved in making renal replacement treatment decisions. The SDM program group intervention improved decisional conflict and decision self-efficacy. Thus, to improve patients’ decision-making processes, the application of an SDM program focused on the personal values and opinions of patients with ESRD will be necessary. Physicians and case managers of patients with ESRD should act in complementary and cooperative roles in SDM programs.
Association Between Residential Neighborhood Social Conditions and Health Care Utilization and Costs
Authors: Zhang Yongkang , Ancker Jessica S. , Hall Jaclyn , Khullar Dhruv , Wu Yiyuan , Kaushal Rainu
Published: June 2020

Background:

Social factors are important drivers of health. However, it is unclear to what extent neighborhood social conditions are associated with total and preventable health care utilization and costs.

Objectives:

To examine the association of neighborhood social conditions with total annual and potentially preventable Medicare costs.

Research Design and Subjects:

Retrospective cohort study. Medicare claims data from 2013 to 2014 linked with neighborhood social conditions at the US census block group level of 2013 for 93,429 Medicare fee-for-service and dually eligible patients.

Measures:

Neighborhood social conditions were measured by Area Deprivation Index at the census block group level, categorized into quintiles. Outcomes included total annual and potentially preventable utilization and costs.

Results:

After adjustment for demographics and comorbidities, patients with the least disadvantaged social conditions had higher total annual Medicare costs [$427; 95% confidence interval (CI), $200–$655] and similar potentially preventable costs (−$23; 95% CI, −$56 to $10) as compared with patients with the intermediate level social conditions. Patients with the most disadvantaged social conditions had similar total Medicare costs (−$22; 95% CI, −$342 to $298) but higher potentially preventable costs ($53; 95% CI, $1–$104) than patients with the intermediate level social conditions.

Conclusions:

Disadvantaged neighborhood conditions are associated with lower total annual Medicare costs but higher potentially preventable costs after controlling for demographic, medical, and other patient characteristics. Socioeconomic barriers may limit access and use of primary care and disease management services, resulting in a higher proportion of their health care costs going to potentially preventable care.
The How Matters
Authors: Lee Yuna S.H. , King Marissa D. , Anderson Daren , Cleary Paul D. , Nembhard Ingrid M.
Published: June 2020

Background:

Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management.

Objective:

To assess how PCP communication with their care team relates to patients’ health.

Research Design:

Longitudinal study of how 3 aspects of PCP-care team communication—participation, time spent listening, and uninterrupted speaking length—relate to disease management of patients with hypertension or diabetes, and the effect of these team communication behaviors on PCP-patient communication as a pathway by which this relationship might exist. We used multilevel regression models.

Subjects:

Twenty-seven PCPs and 98 team members, and 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites.

Measures:

Primary data on communication collected using sociometric sensors worn by PCPs and team members, patient-PCP communication data collected with surveys, and patient health, PCP and patient characteristics extracted from electronic records.

Results:

PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. PCP participation, listening, and length of uninterrupted speaking time were associated with significantly higher odds that their patients had controlled hypertension and diabetes and improvements in disease control over time. PCP-patient communication mediates this relationship.

Conclusions:

PCP-team communication is associated with patient health management. How team members speak with one another may be as important as the content of their communication.
Prognostic value of metabolic tumor volume and total lesion glycolysis in breast cancer: a meta-analysis
Authors: Pak Kyoungjune , Seok Ju Won , Kim Hyun Yul , Nguyen Tuong Linh , Kim Keunyoung , Kim Seong Jang , Kim In-Joo , Hopper John
Published: June 2020

Objectives

PET using 18F-fluorodeoxyglucose (FDG) has proven to be valuable in staging and monitoring of treatment response in breast cancer. We aimed to assess the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in patients with breast cancer.

Methods

A systematic search of MEDLINE and EMBASE was performed using the keywords of breast cancer, PET, and volume. Inclusion criteria were 18F-FDG PET used as an initial imaging tool; studies limited to patients with breast cancer who had not undergone any treatment before PET scans; and studies reporting survival data. Event-free survival (EFS) and overall survival (OS) were considered markers of outcome.

Results

Nine studies comprising 975 patients were included in this study. The pooled hazard ratio (HR) for adverse events was 33.73 (P < 0.00001; I2 = 0%) with MTV from primary tumor and 2.89 (P < 0.00001; I2 = 45%) with TLG from primary tumor, meaning that primary tumors with high volumetric parameters were associated with progression or recurrence. However, the combined HRs for EFS of MTV, and TLG, and those for OS of MTV from whole-body tumor were NS. The pooled HR for OS of TLG from whole-body tumor was 2.95 (P = 0.18; I2 = 71%).

Conclusion

Volumetric parameters from 18F-FDG PET are significant prognostic factors for outcome in patients with breast cancer. Patients with a high MTV or TLG from primary tumor have a higher risk of adverse events. Patients with a high TLG from whole-body tumor have a higher risk of deaths.
A De Novo Mutation in MYH9 in a Child With Severe and Prolonged Macrothrombocytopenia
Authors: Li Kun , Jin Runming , Xu Wenfu , Shen Yaqing , Lu Ke , Wu Xiaoyan
Published: June 2020

Congenital macrothrombocytopenia is a diverse group of hereditary disorders caused by mutations in the MYH9 gene, which encodes the nonmuscle myosin heavy chain-A, an important motor protein in hemopoietic cells. Thus, the term MYH9-related disease has been proposed, but the clinicopathologic basis of MYH9 mutations has been poorly investigated. Here, we report a sporadic case of Epstein syndrome, an MYH9 disorder, in a 4-year-old Chinese boy who presented with macrothrombocytopenia. He had no family history of thrombocytopenia, hearing loss, or renal failure. A de novo heterozygous MYH9 mutation, c.287C>T; p. (Ser96Leu), was found in this patient. Genotype-phenotype analysis of all reported mutations suggested a domain-specific relationship between the location of the MYH9 mutation and the penetrance of the nonhematologic characteristics of MYH9-related disorders. Our study highlights the importance of suspecting MYH9-related disease even in cases of chronic macrothrombocytopenia without a family history or extrahematologic symptoms.
Challenges in the Early Infant HIV Diagnosis and Treatment Cascade
Authors: Mofenson Lynne M. , Cohn Jennifer , Sacks Emma
Published: June 2020

The first step in improving morbidity and mortality among children living with HIV is the timely and early identification of HIV infection, which must be followed by rapid engagement in care and provision of antiretroviral therapy. However, in 2018, only 59% of HIV-exposed infants received an infant nucleic acid diagnostic test by age 2 months and only 54% of children living with HIV received treatment. Because infant diagnosis requires molecular techniques to detect viral nucleic acid, programs for early diagnosis of infection in infants are more complex than those in adults and often require coordination and management of multiple health facilities as well as logistic, financial, and human resource challenges. This article will discuss challenges at each step in the early infant diagnosis cascade and innovations that may help overcome these challenges.
“We Need it the Same Day”: A Qualitative Study of Caregivers and Community Members' Perspectives Toward the Use of Point-of-Care Early Infant Diagnosis
Authors: Katirayi Leila , Ochuka Bernard , Mafaune Haurovi , Chadambuka Addmore , Baffour Theresa , Sacks Emma
Published: June 2020

Background:

Only half of the infants tested for HIV ever receive results, leading to low uptake of treatment and increased mortality and morbidity rates. Point-of-care (POC) nucleic acid diagnostic machines allow for the possibility of same-day results. In Kenya and Zimbabwe, as part of an evaluation comparing standard of care with POC testing for early infant diagnosis, a qualitative substudy was undertaken to understand the acceptability of POC among caregivers of HIV-exposed infants and community members.

Setting:

Kenya and Zimbabwe.

Methods:

In Kenya, 74 interviews were conducted with caregivers, and 6 focus group discussions were conducted with male and female community members and elders. In Zimbabwe, we conducted 85 interviews and 8 focus group discussions. Data were collected in 2 rounds: 1 before the introduction of POC platforms and 1 after the platforms had been in use for at least 3 months. Interviews were conducted in local languages, and content analysis and constant comparison were used to identify key themes.

Results:

Reduced time to receive test results lowered caregiver anxiety about the child's HIV status and allowed families to put children on treatment earlier. Printed POC results were seen by some as more trustworthy than conventional handwritten results, believing this reduced the chance of human error; a few distrusted HIV results were generated too quickly. Community awareness of POC was lower among caregivers of HIV-exposed infants.

Conclusion:

Caregivers are generally very accepting of receiving POC HIV test results; however, additional sensitization among influential community members about the benefits of POC testing is needed.
Effectiveness of Maternal Transmission Risk Stratification in Identification of Infants for HIV Birth Testing: Lessons From Zimbabwe
Authors: Mafaune Haurovi W. , Sacks Emma , Chadambuka Addmore , Musarandega Reuben , Tachiwenyika Emmanuel , Simmonds Francis M. , Nyamundaya Tichaona , Cohn Jennifer , Mahomva Agnes , Mushavi Angela
Published: June 2020

Background:

In 2017, Zimbabwe adopted a modified version of the World Health Organization 2016 recommendation on HIV birth testing by offering HIV testing at birth only to infants at “high risk” of HIV transmission. There is limited evidence on the effectiveness of this approach. Our study assessed the sensitivity and specificity of birth testing “high risk” infants only.

Methods:

We conducted a cross-sectional study at 10 health facilities from November 2018 to July 2019. A nucleic acid test for HIV was performed on all HIV-exposed infants identified within 48 hours of life, irrespective of risk status. Univariate and bivariate analyses were used to estimate the performance of the risk screening tool.

Results:

HIV nucleic acid test was successfully performed on 1970 infants (95%), of whom 266 (13.5%) were classified as high-risk infants. HIV prevalence for all infants tested was 1.5% (95% CI: 1% to 2%), whereas prevalence among high-risk infants and low-risk infants was 6.8% (95% CI: 3.7% to 9.8%) and 0.6% (95% CI: 0.3% to 1%) respectively. Sensitivity and specificity of the maternal risk screening tool was at 62.1% (95% CI: 44.4% to 79.7%) and 87.2% (95% CI: 85.7% to 88.7%), respectively; positive and negative predictive values were 6.8% (95% CI: 3.7% to 9.8%) and 99.4% (95% CI: 99.0% to 99.7%) respectively.

Conclusions:

Despite high negative predictive value, sensitivity was relatively low, with potential of missing 2 in every 5 HIV infected infants. Given the potential benefits of early ART initiation for all exposed infants, where feasible, universal testing for HIV-exposed infants at birth may be preferred to reduce missing infected infants.
Review of Chest Radiograph Findings of COVID-19 Pneumonia and Suggested Reporting Language
Authors: Litmanovich Diana E. , Chung Michael , Kirkbride Rachael R. , Kicska Gregory , Kanne Jeffrey P.
Published: June 2020

The diagnosis of coronavirus disease 2019 (COVID-19) is confirmed by reverse transcription polymerase chain reaction. The utility of chest radiography (CXR) remains an evolving topic of discussion. Current reports of CXR findings related to COVID-19 contain varied terminology as well as various assessments of its sensitivity and specificity. This can lead to a misunderstanding of CXR reports and makes comparison between examinations and research studies challenging. With this need for consistency, we propose language for standardized CXR reporting and severity assessment of persons under investigation for having COVID-19, patients with a confirmed diagnosis of COVID-19, and patients who may have radiographic findings typical or suggestive of COVID-19 when the diagnosis is not suspected clinically. We recommend contacting the referring providers to discuss the likelihood of viral infection when typical or indeterminate features of COVID-19 pneumonia on CXR are present as an incidental finding. In addition, we summarize the currently available literature related to the use of CXR for COVID-19 and discuss the evolving techniques of obtaining CXR in COVID-19-positive patients. The recently published expert consensus statement on reporting chest computed tomography findings related to COVID-19, endorsed by the Radiological Society of North American (RSNA), the Society of Thoracic Radiology (STR), and American College of Radiology (ACR), serves as the framework for our proposal.
The Carbon Footprint of Surgical Operations
Authors: Rizan Chantelle , Steinbach Ingeborg , Nicholson Rosamond , Lillywhite Rob , Reed Malcolm , Bhutta Mahmood F.
Published: June 2020

Summary of background data and objectives:

Operating theatres are typically the most resource-intensive area of a hospital, 3–6 times more energy-intensive than the rest of the hospital and a major contributor of waste. The primary objective of this systematic review was to evaluate existing literature calculating the carbon footprint of surgical operations, determining opportunities for improving the environmental impact of surgery.

Methods:

A systematic review was conducted in accordance with PRISMA guidelines. The Cochrane Database, Embase, Ovid MEDLINE, and PubMed were searched and inclusion criteria applied. The study endpoints were extracted and compared, with the risk of bias determined.

Results:

A total of 4604 records were identified, and 8 were eligible for inclusion. This review found that the carbon footprint of a single operation ranged 6–814 kg carbon dioxide equivalents. The studies found that major carbon hotspots within the examined operating theatres were electricity use, and procurement of consumables. It was possible to reduce the carbon footprint of surgery through improving energy-efficiency of theatres, using reusable or reprocessed surgical devices and streamlining processes. There were significant methodological limitations within included studies.

Conclusions:

Future research should focus on optimizing the carbon footprint of operating theatres through streamlining operations, expanding assessments to other surgical contexts, and determining ways to reduce the footprint through targeting carbon hotspots.
A Multicenter Randomized Controlled Trial Comparing Safety, Efficacy, and Cost-effectiveness of the Surgisis Anal Fistula Plug Versus Surgeon's Preference for Transsphincteric Fistula-in-Ano
Authors: Jayne David G. , Scholefield John , Tolan Damian , Gray Richard , Senapati Asha , Hulme Claire T. , Sutton Andrew J. , Handley Kelly , Hewitt Catherine A. , Kaur Manjinder , Magill Laura
Published: June 2020

Objective:

To undertake a randomized comparison of the Biodesign Surgisis anal fistula plug against surgeon's preference in treating cryptoglandular transsphincteric fistula-in-ano.

Summary Background Data:

The efficacy of the Biodesign Surgisis anal fistula plug in healing anal fistulae is uncertain.

Methods:

Participants were randomized to the fistula plug with surgeon's preference (advancement flap, cutting seton, fistulotomy, Ligation of the Intersphincteric Fistula Tract procedure). The primary outcome was faecal incontinence quality of life (FIQoL) at 12-months. Secondary outcomes were fistula healing, incontinence rates, and complication and reintervention rates.

Results:

Between May 2011 and March 2016, 304 participants were randomized to fistula plug or surgeon's preference. No differences were seen in FIQoL between the 2 groups at 12 months. Clinical fistula healing was reported in 66/122 (54%) of the fistula plug and 66/119 (55%) of the surgeon's preference groups at 12 months. Fecal incontinence rates improved marginally in both the groups. Complications and reinterventions were frequent, with significantly more complications in the fistula plug group at 6-weeks (49/142, 35% vs 25/137, 18%; P=0.002). The mean total costs were £2738 (s.d. £1151) for the fistula plug and £2308 (s.d. £1228) for the surgeon's preference group (mean difference +£430, P=0.0174). The average total quality adjusted life years (QALYs) gained was marginally higher in the fistula plug group. The fistula plug was 35% to 45% likely to be cost-effective across a willingness to pay threshold of £20,000 to £30,000 / QALY.

Conclusions:

The Biodesign Surgisis anal fistula plug is associated with similar FIQoL and healing rates to surgeon's preference at 12 months. Higher costs and highly uncertain gains in QALYs mean that the fistula plug may not be considered as a cost-effective treatment in the UK NHS.
Is there a role for sarcolipin in avian facultative thermogenesis in extreme cold?
Authors: Stager Maria , Cheviron Zachary A.
Published: June 2020

Endotherms defend their body temperature in the cold by employing shivering (ST) and/or non-shivering thermogenesis (NST). Although NST is well documented in mammals, its importance to avian heat generation is unclear. Recent work points to a prominent role for the sarco/endoplasmic reticulum Ca
2+
ATPase (SERCA) in muscular NST. SERCA's involvement in both ST and NST, however, posits a tradeoff between these two heat-generating mechanisms. To explore this tradeoff, we assayed pectoralis gene expression of adult songbirds exposed to chronic temperature acclimations. Counter to mammal models, we found that cold-acclimated birds downregulated the expression of sarcolipin (
SLN
), a gene coding for a peptide that promotes heat generation by uncoupling SERCA Ca
2+
transport from ATP hydrolysis, indicating a reduced potential for muscular NST. We also found differential expression of many genes involved in Ca
2+
cycling and muscle contraction and propose that decreased
SLN
could promote increased pectoralis contractility for ST. Moreover,
SLN
transcript abundance negatively correlated with peak oxygen consumption under cold exposure (a proxy for ST) across individuals, and higher
SLN
transcript abundance escalated an individual's risk of hypothermia in acute cold. Our results therefore suggest that SLN-mediated NST may not be an important mechanism of—and could be a hindrance to—avian thermoregulation in extreme cold.
Evolution of moult-migration is directly linked to aridity of the breeding grounds in North American passerines
Authors: Pageau Claudie , Tonra Christopher M. , Shaikh Mateen , Flood Nancy J. , Reudink Matthew W.
Published: June 2020

To avoid energy allocation conflicts, birds generally separate breeding, migration and moult during the annual cycle. North American passerines typically moult on the breeding grounds prior to autumn migration. However, some have evolved a moult-migration strategy in which they delay moult until stopping over during autumn migration. Rohweret al. (2005) proposed the ‘push–pull hypothesis' as an explanation for the evolution of this moult strategy, but it has not been empirically tested. Poor conditions on the breeding grounds at the end of the summer would push birds to depart prior to moult, while productive stopover locations would pull them. We tested for a relationship between moult-migration and breeding grounds aridity as measured by the normalized difference vegetation index. Our results strongly support the ‘push' aspect of the push–pull hypothesis and indicate that arid breeding grounds, primarily in western North America, would drive species to evolve stopover moult-migration, although this relationship may depend upon migration distance.
Sphingomonas chungangi sp. nov., a bacterium isolated from garden soil sample
Authors: Akter Shahina , Huq Md. Amdadul
Published: June 2020

A novel bacterial strain, designated MAH-6T, was isolated from a garden soil sample. Cells were Gram-stain-negative, aerobic, non-motile and rod-shaped. The colonies were light yellow, smooth, circular and 0.6–1.2 mm in diameter when grown on nutrient agar for 3 days. Strain MAH-6T grew at 15–35 °C, at pH 5.0–7.0 and with 0–0.5 % NaCl. Cell growth occurred on nutrient agar and Reasoner's 2A (R2A) agar. The strain was positive for both catalase and oxidase tests. Cells were able to hydrolyse starch, aesculin, Tween 20 and Tween 80. According to 16S rRNA gene sequence comparisons, the isolate was identified as a member of the genus

Sphingomonas

and was most closely related to

Sphingomonas polyaromaticivorans

B2-7T (98.2 % sequence similarity),

Sphingomonas oligoaromativorans

SY-6T (96.9 %) and

Sphingomonas morindae

NBD5T (96.6 %). The novel strain MAH-6T has a draft genome size of 4 370 740 bp (28 contigs), annotated with 4199 protein-coding genes, 46 tRNA and three rRNA genes. The genomic DNA G+C content of the strain was determined to be 66.2 mol% and the predominant isoprenoid quinone is Q-10. The major fatty acids were identified as summed feature 8 (comprising C18 : 1
 ω7c and/or C18 : 1
 ω6c), C14 : 0 2OH and C16 : 0. The main polar lipids were phosphatidylcholine, sphingoglycolipid, phosphatidylethanolamine, phosphatidylglycerol and diphosphatidylglycerol. Based on the results of phenotypic, genotypic, chemotaxonomic and DNA–DNA hybridization studies, strain MAH-6T represents a novel species, for which the name Sphingomonas chungangi sp. nov. is proposed, with MAH-6T as the type strain (=KACC 19292T=CGMCC1.13654T).
Magnitude and kinetics of anti-SARS-CoV-2 antibody responses and their relationship to disease severity
Authors: Lynch Kara L , Whitman Jeffrey D , Lacanienta Noreen P , Beckerdite Erica W , Kastner Shannon A , Shy Brian R , Goldgof Gregory M , Levine Andrew G , Bapat Sagar P , Stramer Susan L , Esensten Jonathan H , Hightower Allen W , Bern Caryn , Wu Alan HB
Published: June 2020

Background

SARS-CoV-2 infection can be detected indirectly by measuring the host immune response. Anti-viral antibody concentrations generally correlate with host protection and viral neutralization, but in rare cases, antibodies can promote disease progression. Elucidation of the kinetics and magnitude of the SARS-CoV-2 antibody response is essential to understand the pathogenesis of COVID-19 and identify potential therapeutic targets.

Methods

Sera (n=533) from patients with RT-PCR confirmed COVID-19 (n=153) were tested using a high-throughput quantitative IgM and IgG assay that detects antibodies to the spike protein receptor binding domain and nucleocapsid protein. Individual and serial samples covered the time of initial diagnosis, during the disease course, and following recovery. We evaluated antibody kinetics and correlation between magnitude of the response and disease severity.

Results

Patterns of SARS-CoV-2 antibody production varied considerably. Among 52 patients with 3 or more serial specimens, 44 (84.6%) and 42 (80.8%) had observed IgM and IgG seroconversion at a median of 8 and 10 days, respectively. Compared to those with milder disease, peak measurements were significantly higher for patients admitted to the intensive care unit for all time intervals between 6 and 20 days for IgM, and all intervals after 5 days for IgG.

Conclusions

High sensitivity assays with a robust dynamic range provide a comprehensive picture of host antibody response to SARS-CoV-2. IgM and IgG responses were significantly higher in patients with severe than mild disease. These differences may affect strategies for seroprevalence studies, therapeutics and vaccine development.
Timecourse and convergence of abstract and concrete knowledge in the anterior temporal lobe
Authors: Vignali L. , Xu Y. , Turini J. , Collignon O. , Crepaldi D. , Bottini R.
Published: June 2020

How is conceptual knowledge organized and retrieved by the brain? Recent evidence points to the anterior temporal lobe (ATL) as a crucial semantic hub integrating both abstract and concrete conceptual features according to a dorsal-to-medial gradient. It is however unclear when this conceptual gradient emerges and how semantic information reaches the ATL during conceptual retrieval. Here we used a multiple regression approach to magnetoencephalography signals of spoken words, combined with dimensionality reduction in concrete and abstract semantic feature spaces. Results showed that the dorsal-to-medial abstract-to-concrete ATL gradient emerges only in late stages of word processing: Abstract and concrete semantic information are initially encoded in posterior temporal regions and travel along separate cortical pathways eventually converging in the ATL. The present finding sheds light on the neural dynamics of conceptual processing that shape the organization of knowledge in the anterior temporal lobe.
Impact of trimethoprim on the river microbiome and antimicrobial resistance
Authors: Delaney J. , Raguideau S. , Holden J. , Zhang L. , Tipper H.J. , Hill G.L. , Klümper U. , Zhang T. , Cha C.J. , Lee K. , James R. , Travis E. , Bowes M.J. , Hawkey P.M. , Lindstrom H.S. , Tang C. , Gaze W.H. , Mead A. , Quince C. , Singer A. , Wellington E.M.H.
Published: June 2020

Recent evidence suggests that anthropogenic activity can increase the levels of antimicrobial resistance (AMR) in the environment. Rivers and waterways are significant examples of environmental settings that have become repositories of antibiotics and antibiotic resistance genes (ARGs). Our recent study quantified drug concentrations in freshwater samples taken at a range of sites located on the Thames catchment; the highest levels of antibiotics and other drugs were recorded downstream of waste water treatment plants (WWTPs). One specific antibiotic: Trimethoprim (TMP) was shown at elevated concentrations reaching 2000ng/L at particular sites. We have also shown a correlative relationship between the residue of TMP and the prevalence of sulfonamide antibiotic resistance genes such as sul1. Despite this, there is still no evidence of a causative relationship between TMP concentrations and the prevalence of the ARGs at river sites. The aim of the current study was to conduct in-depth analysis using a combination of large metagenomic, geospatial and chemical datasets, in order to conduct a comparison between those sites with the highest TMP and lowest TMP levels across the Thames catchment. We aimed to establish the proximity of these sites to WWTPs, their population equivalence (PE) and land coverage. A secondary aim was to investigate seasonal variation in TMP and ARGs. Exploring these factors will help to decipher the clinical relevance of ARG accumulation at river sites. A significant correlation was shown between TMP levels at river sites and their distance downstream from a WWTP. Three sites located on the Rivers Cut and Ray showed significantly higher TMP concentrations in winter compared to summer. The population equivalence (PE) for sites with the highest TMP levels was significantly higher than those with the lowest levels. The land coverage of sites with the highest TMP levels was significantly more urban/suburban than sites with the lowest TMP concentrations, which were found to be significantly more arable. Five ARGs relevant to TMP and sulfonamides were identified across the Thames catchment. The most prevalent ARG was sul1, which was significantly more prevalent in winter compared to summer. By contrast sul2 was found to be significantly more prevalent in summer compared to winter at a site on the River Coln. The prevalence of the class 1 integron marker gene (inti1) did not differ significantly by season or between sites with the highest/lowest TMP levels.
Hospital practice in COVID-19 times: perceptions of the midwifery interns in Peru
Authors: Rojas-Silva Jessica , Damacen-Oblitas Valery , Castro-Gomez Diayan , Rojas-Vega Jennifer , Barja-Ore John , Vila-Arevalo Randol , Moquillaza-Alcantara Victor
Published: June 2020

Objective

To evaluate the perception of midwifery interns regarding hospital practices during COVID-19.

Material and methods

Study of qualitative approach, of phenomenological design, where 80 midwifery interns from the different regions of Peru participated, who are also representatives of their hospital headquarters. An in-depth interview was applied where the perception of hospital practices was addressed according to: i) current problems and ii) solution proposals.

Results

Midwifery interns have been removed from hospital practices, mainly due to the absence of personal protective equipment and health insurance, financially affecting those who must continue to make rent and food payments; Likewise, a large part of the universities have not offered proposals for solutions to the delay in internships, raising concerns about delays in administrative procedures, even more so for students from non-licensed universities. Among the proposals, those who are close to graduating suggest being exempted from the months when there were no activities, so as not to delay future processes such as tuition and rural service; likewise, suspend payment for these months and strengthen knowledge through the discussion of clinical cases, which could be virtual.

Conclusions

The cessation of hospital practice responds to a lack of guarantees in the health care of the student, generating economic repercussions and a negative perception regarding university management. Finally, solutions that could be considered for the next decisions made by the institutions are reported.