bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Management of CPAP After Otologic and Neurotologic Surgery
Authors: Cass Nathan D. , Babu Seilesh C.
Published: June 2020

Background:

Obstructive sleep apnea is a highly prevalent disorder often treated with continuous positive airway pressure (CPAP). CPAP transmits high pressures through the Eustachian tube, and has significant implications for patients undergoing surgery of the middle ear, inner ear, and lateral skull base. In such patients, nothing is known regarding the likelihood of surgical complications with CPAP use, or medical complications with its cessation. No consensus or guidelines exist for postoperative management of this vitally important but potentially hazardous therapy.

Objective:

To gain an understanding of the current state of practice with regards to postoperative CPAP management in patients undergoing middle ear, stapes, cochlear implant, and lateral skull base surgeries.

Methods:

An electronic survey was sent to all members of the American Neurotology Society via email.

Results:

The survey was completed by 54 neurotologists. Duration of postoperative CPAP limitation had similar distribution for surgery of the middle ear, stapes, and skull base: fewer surgeons recommend immediate use, with more advising ≤1 week and ≥2 week abstinence. For cochlear implantation, immediate use is most commonly advocated. The rationale for restricting postoperative CPAP use varied by surgery type. Subgroup analysis showed no variations by region; however, surgeons with >15 years of experience tend to advocate for earlier return to CPAP than those with less experience.

Conclusion:

Current neurotology practice varies widely concerning CPAP management after otologic and neurotologic surgeries, both with regard to duration of CPAP abstinence and in rationale for its limitation.
Scoring balloon predilation before bioresorbable vascular scaffold implantation in patients with in-stent restenosis: the RIBS VI ‘scoring’ study
Authors: Alfonso Fernando , Cuesta Javier , García del Blanco Bruno , Bosa Francisco , Pérez de Prado Armando , Masotti Mónica , Trillo Ramiro , Rumoroso José Ramón , Moreno Raul , Cequier Angel , Gutiérrez Hipólito , García Touchard Arturo , López-Mínguez José Ramón , Zueco Javier , Serra Antonio , Velázquez Maite , Morís César , Bastante Teresa , García-Guimaraes Marcos , Rivero Fernando , Fernández-Pérez Cristina
Published: June 2020

Background

Currently drug-eluting stents (DES) and drug-eluting balloons are recommended in patients with in-stent restenosis (ISR). However, the efficacy of bioresorbable vascular scaffolds (BVS) after scoring balloon (SCB) predilation in these patients is unknown.

Methods

RIBS VI (NCT02672878) and RIBS VI ‘Scoring’ (NCT03069066) are prospective multicentre studies assessing the value of BVS in patients with ISR. Inclusion and exclusion criteria were identical in both studies. Results of conventional BVS implantation (112 patients) were compared with those obtained with systematic SCB therapy before BVS (108 patients). Angiographic follow-up was scheduled for all patients.

Results

On late angiography (93% of eligible patients) the in-segment minimal lumen diameter (primary end-point) (1.88 ± 0.5 vs. 1.90 ± 0.4 mm, P = 0.81), % diameter stenosis (28 ± 17 vs. 29 ± 15%), late lumen loss (0.23 ± 0.4 vs. 0.22 ± 0.4 mm) and binary restenosis rate (8.5 vs. 9.3%) were similar in the conventional BVS and SCB + BVS groups, respectively. At 1-year follow-up (100% of patients) target lesion revascularization (TLR) requirement (9.8 vs. 11.1%) was similar with the two strategies. Freedom from cardiac death, myocardial infarction and TLR was 88% and 87%, respectively. Results remained unchanged after adjusting for potential baseline confounders and were consistent in 10 prespecified subgroups.

Conclusion

This study suggests that results of conventional BVS implantation in patients with ISR are not improved by systematic predilation with SCB. ClinicalTrials.gov ID: NCT02672878 (RIBS VI) and NCT03069066 (RIBS VI ‘Scoring’).
Can successful treatment by direct-acting antivirals improve depression in chronic HCV patients?
Authors: Abdel Moez Amal Tohamy , El Hawary Yomna Ahmed , Al Balakosy Amira Mahmoud
Published: June 2020

Background

Depression is the most common extrahepatic neuropsychiatric manifestation in chronic hepatitis C (CHCV) and is due to direct neuropathogenic mechanisms. Our aim is to evaluate the effect of viral clearance by directly acting antivirals (DAAs) on depression in CHCV patients.

Methods

One hundred fifty chronic HCV patients eligible for DAAs were assessed for depression using the Beck depression inventory (BDI) scale at baseline, 1 and 3 months after end of treatment (EOT). BDI ≥10 reliable in detecting depression in CHCV.

Results

All included patients received Sofosbuvir/Dacltasvir ± Ribavirin for 12 weeks and all achieved sustained virological response (SVR). Baseline BDI of all included patients was 10 ± 5 then decreased to 5.3 ± 5 and 3.5 ± 4.5 at 1 and 3 months after EOT (P = 0.001), respectively. After EOT, 20 patients (13.3%) had BDI >10 which were 11.35 ± 6.5 and 13.3 ± 3.2 at 1 and 3 months (SVR), respectively. A comparison between patients with high and low BDI after EOT showed that patients with persistent high score were older (60.6 ± 9.5vs 52.2 ± 10.6, P = 0.001) and included higher percentage of females (50% vs 22.3%, P = 0.01). Also high BDI patients had higher baseline FIB4 (3 ± 1.6 vs 2 ± 1.3, P = 0.006) and included more patients with significant fibrosis (40% vs 17.7%, P = 0.05), as well as lower baseline hemoglobin (13.6 ± 1.5 vs 14.4 ± 1.65, P = 0.04).

Conclusion

Depression associated with CHCV improves after successful treatment with DAAs; however, it may persist in elderly females with significant fibrosis and low hemoglobin.
COVID-19 and the liver: overview
Authors: Amin Mona
Published: June 2020

On 12 March 2020, the WHO declared that the coronavirus disease 2019 (COVID-19) constitutes a pandemic. Cases of liver damage or dysfunction (mainly characterized by moderately elevated serum aspartate aminotransferase levels) have been reported among patients with COVID-19. However, it is currently uncertain whether the COVID-19 related liver damage/dysfunction is due mainly to the viral infection by itself or other coexisting conditions, such as the use of potentially hepatotoxic medications and the coexistence of systemic inflammatory response, respiratory distress syndrome-induced hypoxia, and multiple organ dysfunction. Individuals at high risk for severe COVID-19 are typical of older age and/or present with comorbid conditions such as diabetes, cardiovascular disease, and hypertension. This is also the same profile for those at increased risk for unrecognized underlying liver disease, especially nonalcoholic fatty liver disease. This could make them more susceptible to liver injury from the virus, medications used in supportive management, or hypoxia. So the aim of this review was to illustrate the clinical implications of COVID-19 on the liver in healthy and diseased states as well as the implications of common liver disorders on the outcome of COVID-19.
Coinfection With HIV and SARS-CoV-2 in Wuhan, China: A 12-Person Case Series
Authors: Hu Yifei , Ma Juntao , Huang Haojie , Vermund Sten H.
Published: June 2020

Background:

Given the magnitude of the global COVID-19 pandemic, persons living with HIV (PLWH) may become coinfected with SARS-CoV-2.

Setting:

We conducted a survey in Wuhan, China, to characterize the status of coinfected PLWH, their time to clinical improvement, and clinical prognoses.

Methods:

Using a Wuhan shipping service for antiretroviral medications, the Wuhan LGBT Center screened 2900 PLWH shipping addresses and cross-referenced 36 of them to quarantine sites or hospitals, suggesting possible COVID-19 cases. Through telephone calls and WeChat (social media) messaging, we conducted a survey after obtaining online informed consent.

Results:

We had 12 HIV-infected respondents (10 men and 2 women) who also reported COVID-19. The median age was 36 years (interquartile range: 33.0–56.3), mean age 42.4 years, and range 25–66 years of age. Nine of 10 persons on antiretroviral therapy (ART) presented with only mild COVID-19 symptoms. The 10th person on ART was a 56-year-old man who died at home early in the outbreak when health care services were overwhelmed. Two additional cases who had been in intensive care with acute COVID-19 were both men, aged 25 and 37 years; both were ART-naive until this hospitalization. Excluding the deceased man, 6 of 11 coinfected persons reported feeling depressed even after clinical improvements.

Conclusion:

Twelve coinfected persons were identified in Wuhan; 9 of 10 were on long-term ART and had favorable outcomes. Two men identified as having started ART only recently were found to have severe symptoms. Our case series suggests the value of ART for potential mitigation of COVID-19 coinfection.
Left Atrial Function Determined by Cardiac Computed Tomography Predicts Device-Detected Atrial High-Rate Episodes in Patients Treated With Cardiac Resynchronization Therapy
Authors: Witt Christoffer Tobias , Kronborg Mads Brix , Sommer Anders , Hansen Peter Bomholt , Nohr Ellen Aagaard , Nørgaard Bjarne Linde , Nielsen Jens Cosedis
Published: June 2020

Objective

The objective of this study was to examine whether left atrial (LA) volumes and function were associated with atrial high-rate episodes (AHREs) in patients with cardiac resynchronization therapy (CRT).

Methods

Ninety-two consecutive patients without prior atrial fibrillation underwent clinical evaluation, echocardiograms, and cardiac computed tomography (CT) before CRT implantation and after 6 months. Left atrial volumes and LA emptying fraction (LAEF) were derived by CT images reconstructed at 5% phase increments of the cardiac cycle. Cox regression was used to assess associations between AHRE and LA anatomical and functional variables.

Results

Twenty-two patients (24%) developed AHRE during 1.9 years (SD, 1 year) At baseline, higher LAEF was associated with a lower risk of AHRE (hazard ratio [HR], 0.94; 95% confidence interval [CI], 0.91–0.98; P = 0.003), and large LA minimal (LAmin) volume was related to higher risk of AHRE (HR, 1.03; 95% CI, 1.00–1.06; P = 0.04). When combining LAEF and LAmin volume, only LAEF remained associated with occurrence of AHRE. Higher passive LAEF was associated with lower risk of AHRE (HR, 0.95; 95% CI, 0.91–0.98; P = 0.003).

Conclusions

In patients with CRT, low preimplant LAEF measured by cardiac CT was independently associated with device-detected AHRE.
Clinical, Imaging Findings, Responses, and Outcomes of Patients With Classical Hodgkin Lymphoma and Non-Hodgkin Lymphoma Undergoing Immune Checkpoint Inhibitor Therapy: A Single-Institution Experience
Authors: Liput Joseph , Guler Ezgi , Smith Daniel A. , Tirumani Sree Harsha , Hoimes Christopher , Caimi Paolo F. , Ramaiya Nikhil H.
Published: June 2020

Objective

The aim of the study was to study clinical, imaging findings, response patterns, and immune-related adverse events in classical Hodgkin lymphoma (cHL) and non-Hodgkin lymphoma (NHL) patients treated with immune checkpoint inhibitors (ICIs).

Methods

A retrospective search was performed to identify patients with relapsed/refractory cHL and NHL treated with ICIs from 2015 to 2019. Clinical and laboratory data were collected. Imaging studies were reviewed for treatment response and immune-related adverse events.

Results

Ten patients with relapsed/refractory cHL (median age, 41 years) and 14 patients with relapsed/refractory NHL (median age, 61 years) were identified. Overall response rate was 70% for cHL patients. None of the NHL patients demonstrated complete or partial response. One case of hyperprogression and one case with atypical response were radiologically detected in cHL patients. Hypothyroidism requiring treatment occurred in 2 (20%) of 10 cHL patients, one of which had imaging correlate. Of 14 NHL patients, 1 (7%) had radiologic evidence of pneumonitis and 1 (7%) had colitis.

Conclusions

This single-institution observational study demonstrated that overall response rate was higher in patients with cHL undergoing ICI. Immune checkpoint inhibitor therapy has unique response patterns and toxicities in both cHL and NHL patients that radiologists should keep in mind.
Computed Tomography Fluoroscopy–Guided Versus Conventional Computed Tomography–Guided Lung Biopsy: A Systematic Review and Meta-analysis
Authors: Fu Yu-Fei , Li Guang-Chao , Cao Wei , Wang Tao , Shi Yi-Bing
Published: June 2020

Purpose

This study aimed to compare the feasibility, safety, diagnostic accuracy, and radiation dose between computed tomography (CT) fluoroscopy (CTF)–guided and conventional CT (CCT)–guided lung biopsy.

Methods

Relevant articles up until February 2020 were identified within the PubMed, Embase, and Cochrane Library databases. Diagnostic accuracy rate, pneumothorax, and pneumothorax requiring chest tube served as primary end points, with technical success, hemoptysis, operative time, and radiation dose serving as secondary end points. Pooled odds ratios (ORs) were calculated for the dichotomous variables. Pooled estimates of the mean difference (MD) were measured for the continuous variables.

Results

This meta-analysis included 9 studies. Seven studies were retrospective, and 2 studies were randomized controlled trials. A total of 6998 patients underwent either CTF-guided (n = 3858) or CCT-guided (n = 3154) lung biopsy. The diagnostic accuracy rate was significantly higher in the CTF group compared with the CCT group (OR, 0.32; P < 0.00001). No significant differences were detected between the CTF and CCT groups in terms of incidence rates of pneumothorax (OR, 0.95; P = 0.84), rates of pneumothorax requiring chest tube insertion (OR, 0.95; P = 0.84), technical success rates (OR, 0.41; P = 0.15), incidence rates of hemoptysis (OR, 1.19; P = 0.61), operative time (MD, −4.38; P = 0.24), and radiation dose (MD, 158.60; P = 0.42). A publication bias was found for the end points of pneumothorax requiring chest tube insertion and operative time.

Conclusions

Compared with CCT-guided lung biopsy, CTF-guided lung biopsy could yield a higher diagnostic accuracy with similar safety and radiation exposure.
miR-187-3p participates in contextual fear memory formation through modulating SATB2 expression in the hippocampus
Authors: Zhao Cui , Zhou Bo , Cao Junjie , Zhang Yafang , Li Wei , Wang Miao , Zhang Xi , Wang Yiwei
Published: June 2020

Purpose

When threatened, fear is one of the most important responses that an organism exhibits. The mechanisms involved in forming fear memories include specific neurological structures, neural circuits and detailed molecular interactions.

Methods

MicroRNAs (miRNAs, small non-coding RNAs) act as endogenous functional small molecules that participate in or interfere with the formation of new fear memory by inhibiting the expression of mRNA targets. MicroRNA-187 (miR-187) is a newly reported miRNA that is related to cancer, but it has not been investigated regarding fear memory formation.

Results

In the present study, we observed a transient reduction in the level of miR-187 in the dorsal hippocampus after a classic contextual fear conditioning (CFC) training. Overexpression of miR-187-3p in the DH using miR-187-3p agomir was detrimental in the formation of CFC memory, whereas downregulation of miR-187-3p using antagomir enhanced the formation of CFC memory. Additionally, utilization of bioinformatic methods and luciferase reporter assay revealed that miR-187-3p targets SATB2, and therefore miR-187-3p agomir can decrease the protein level of SATB2. Furthermore, we determined that SATB2 plays a role in the formation of CFC memory by miR-187-3p, which can be mediated by altering SATB2 expression.

Conclusion

Altogether, evidence obtained from both in-vitro and in-vivo experiments indicated that miR-187-3p is involved in CFC memory formation through modulation of SATB2. Our data provides a basis for the potential therapeutic benefits of miR-187-3p/SATB2 in the treatment of anxiety disorders induced from fear memory.
Resource Document for Electroconvulsive Therapy in Adult Correctional Settings
Authors: Williams Joseph B. , Arvidson Megan M.
Published: June 2020

Electroconvulsive therapy (ECT) has been used for decades for the treatment of mental illness. Despite its proven efficacy, ECT is rarely offered to individuals with psychiatric disorders who are incarcerated in jails and prisons. There are currently 2.2 million people confined in US correctional facilities. Research has demonstrated that the prevalence of serious mental illness among the US incarcerated population is 4 to 5 times what is observed in the community, and there can be no doubt that individuals currently exist within jails and prisons who would benefit from this treatment modality. One issue identified as a barrier to ECT being offered to this patient population is a lack of professional guidance on the administration of ECT to individuals who are incarcerated in correctional facilities. Indeed, very little information has been published on this subject in the medical literature. We offer this article as a resource document for the utilization of ECT within adult corrections. This resource document includes a protocol to assist correctional providers and administrators in navigating the ECT referral process, a review of options for delivery of ECT to adult inmate patients, and a discussion of topics related to correctional ECT that warrant special attention, such as informed consent, the perception of ECT use within corrections, ECT-associated cognitive impairment, involuntary ECT, and ECT for competence restoration. It is vital that this important therapy be made accessible to individuals in correctional settings who are experiencing mental illness.
Easy phylotyping of Escherichia coli via the EzClermont web app and command-line tool
Authors: Waters Nicholas R. , Abram Florence , Brennan Fiona , Holmes Ashleigh , Pritchard Leighton
Published: June 2020

The Clermont PCR method for phylotyping

Escherichia coli

remains a useful classification scheme even though genome sequencing is now routine, and higher-resolution sequence typing schemes are now available. Relating present-day whole-genome

E. coli

classifications to legacy phylotyping is essential for harmonizing the historical literature and understanding of this important organism. Therefore, we present EzClermont – a novel in silico Clermont PCR phylotyping tool to enable ready application of this phylotyping scheme to whole-genome assemblies. We evaluate this tool against phylogenomic classifications, and an alternative software implementation of Clermont typing. EzClermont is available as a web app at www.ezclermont.org, and as a command-line tool at https://nickp60.github.io/EzClermont/.
Phytoactinopolyspora mesophila sp. nov., isolated from a saline–alkaline soil
Authors: Feng Xue-Mei , Zhai Xue-Han , Liu Shao-Wei , Wang Chun-Miao , Sun Cheng-Hang , Zhou Xue , Zhang Ya-Jie , Li Xiao-Jun
Published: June 2020

A novel moderately halophilic, filamentous actinobacterium, designated as XMNu-373T, was isolated from a saline–alkaline soil sample collected from the Mongolia Plateau, Dongwu County, Inner Mongolia Autonomous Region, PR China. The isolate grew optimally at 28‒37 °C, pH 7.0‒8.0 and with 2–5 % (w/v) NaCl. The substrate mycelia fragmented into rod-like elements, and the white aerial mycelia formed spore chains at maturity. The predominant menaquinone was MK-9(H4). The polar lipids were diphosphatidylglycerol, three unidentified phosphoglycolipids, an unidentified aminophospholipid, two phosphatidylinositol mannosides, four unidentified phospholipids, phosphatidylglycerol and two unidentified lipids. The major cellular fatty acids were iso-C16 : 0, anteiso-C17 : 0 and anteiso-C15 : 0. The genomic DNA G+C content was 66.2 mol%. It shared high 16S rRNA gene sequence similarities to

Phytoactinopolyspora halotolerans

YIM 96448T (96.1 %) and

Phytoactinopolyspora endophytica

EGI 60009T (96.0 %). Phylogenetic trees based on 16S rRNA gene sequences revealed that strain XMNu-373T resided in the clade of family

Jiangellaceae

, and it formed a monophyletic branch distinct from four other recognized type species in the subclade of the genus

Phytoactinopolyspora

. On the basis of polyphasic taxonomic evidence, strain XMNu-373T represents a novel species of the genus

Phytoactinopolyspora

, for which the name Phytoactinopolyspora mesophila sp. nov. is proposed. The type strain is XMNu-373T (=JCM 33740T=CGMCC 4.7654T).
Advances in actinomycete research: an ActinoBase review of 2019
Authors: Prudence Samuel M.M. , Addington Emily , Castaño-Espriu Laia , Mark David R. , Pintor-Escobar Linamaría , Russell Alicia H. , McLean Thomas C.
Published: June 2020

The actinomycetes are Gram-positive bacteria belonging to the order

Actinomycetales

within the phylum

Actinobacteria

. They include members with significant economic and medical importance, for example filamentous actinomycetes such as

Streptomyces

species, which have a propensity to produce a plethora of bioactive secondary metabolites and form symbioses with higher organisms, such as plants and insects. Studying these bacteria is challenging, but also fascinating and very rewarding. As a Microbiology Society initiative, members of the actinomycete research community have been developing a Wikipedia-style resource, called ActinoBase, the purpose of which is to aid in the study of these filamentous bacteria. This review will highlight 10 publications from 2019 that have been of special interest to the ActinoBase community, covering 4 major components of actinomycete research: (i) development and regulation; (ii) specialized metabolites; (iii) ecology and host interactions; and (iv) technology and methodology.
A high-throughput strategy for COVID-19 testing based on next-generation sequencing
Authors: Huang Jian , Zhao Lan
Published: June 2020

COVID-19 testing as sufficient as needed is essential for healthcare workers, patients, and authorities to make informed decisions to confront and eventually defeat severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, diagnosis of COVID-19 relies on quantitative reverse-transcription PCR, which is low-throughput, laborious, and often false-negative, making it overwhelmingly challenging to meet testing needs even in industrialized countries. Here we propose a new strategy, which employs a modified loop-mediated isothermal amplification (LAMP) assay, a simple procedure requiring no sophisticated instruments, to index and amplify viral genes from individual specimens, of which the products are readily available for construction of multiplexed libraries for next-generation sequencing. Our strategy would allow precise diagnosis of thousands of specimens in 1-2 days with significantly lower operating expenses. Furthermore, this strategy will make it possible for patients to collect, process, and mail their own samples to facilities for a quick, reliable diagnosis at a population scale.
Relationships of gut microbiota, short-chain fatty acids, inflammation, and the gut barrier in Parkinson’s disease
Authors: Aho Velma T. E. , Houser Madelyn C. , Pereira Pedro A. B. , Chang Jianjun , Rudi Knut , Paulin Lars , Hertzberg Vicki , Auvinen Petri , Tansey Malú G. , Scheperjans Filip
Published: June 2020

Background

Previous studies have reported that gut microbiota, permeability, short-chain fatty acids (SCFAs), and inflammation are altered in Parkinson’s disease (PD), but how these factors are linked and contribute to disease processes and symptoms remains uncertain.

Objectives

This study sought to compare and identify associations among these factors in PD patients and controls to elucidate their interrelations and links to clinical manifestations of PD.

Methods

Stool and plasma samples and clinical data were collected from 55 PD patients and 56 controls. Levels of stool SCFAs and stool and plasma inflammatory and permeability markers were compared between patients and controls and related to one another and to the gut microbiota.

Results

Calprotectin was increased and SCFAs decreased in stool in PD in a sex-dependent manner. Inflammatory markers in plasma and stool were neither intercorrelated nor strongly associated with SCFA levels. Age at PD onset was positively correlated with SCFAs and negatively correlated with CXCL8 and IL-1β in stool. Fecal zonulin correlated positively with fecal NGAL and negatively with PD motor and non-motor symptoms. Microbiota diversity and composition were linked to levels of stool SCFAs, inflammation, and zonulin. These relationships differed somewhat between patients and controls and by sex.

Conclusions

Intestinal inflammatory responses and reductions in fecal SCFAs occur in PD, are related to the microbiota and to disease onset, and are not reflected in plasma inflammatory profiles. Some of these relationships are PD- and sex-dependent. Alterations in microbiota-host interactions and links between intestinal inflammation and reduced SCFA levels and earlier PD onset warrant further investigation.
Development and External Validation of a Diagnostic Model for Intra-Procedural Hypotension during Primary Percutaneous Coronary Intervention
Authors: Li Yong
Published: June 2020

Background

Intra-procedural hypotension weaken the benefit of primary percutaneous coronary intervention (PPCI) and worsens the prognosis of acute ST elevation myocardial infarction (STEMI) patients.

Objectives

To develop and externally validate a diagnostic model of intra-procedural hypotension.

Methods

Design:Multivariable logistic regression of a cohort of acute STEMI patients. Setting: Emergency department ward of a university hospital. Participants: Diagnostic model development: Totally 1239 acute STEMI patients who were consecutively treated with PPCI from November 2007 to December 2013. External validation: Totally 1294 acute STEMI patients who were treated with PPCI from January 2014 to June 2018. Outcomes: Intra-procedural hypotension. Intra-procedural hypotension was defined as pre-procedural systolic blood pressure (SBP) was > 90mmHg, intra-procedural SBP less than or equal to 90 mmHg persistent or transient.

Results

Totally 121(9.8%) patients presented intra-procedural hypotension in the development dataset; 123 (9.5%) patients presented intra-procedural hypotension in the validation dataset. The strongest predictors of intra-procedural hypotension were no-reflow, the culprit vessel was not left anterior descending, complete occlusion of culprit vessel, using thrombus aspiration devices during operation, and without history of diabetes. We developed a diagnostic model of intra-procedural hypotension. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.685 ± 0.022, 95% CI = 0.641 ~ 0.729 in the development set. We constructed a nomogram using the development database based on predictors of intra-procedural hypotension. The AUC was 0.718 ±0.022, 95% CI = 0.674 ~ 0.761 in the validation set. Discrimination, calibration, and decision curve analysis were satisfactory.

Conclusions

We developed and externally validated a diagnostic model of intra-procedural hypotension during PPCI. We can use the formula or nomogram to predict intra-procedural hypotension.

This study was registered with WHO International Clinical Trials Registry Platform (ICTRP) on 6 September 2019 (registration number:ChiCTR1900025706).http://www.chictr.org.cn/edit.aspx?pid=42913&htm=4.
Dupilumab-associated ocular surface disease: incidence, management and long-term sequelae
Authors: Popiela Magdalena Z , Barbara Ramez , Turnbull Andrew M J , Corden Emma , Matinez-Falero Beatrice Suarez , O’Driscoll Daniel , Ardern-Jones Michael R , Hossain Parwez N
Published: June 2020

Objective

To determine the incidence of ocular surface disease in patients with atopic dermatitis (AD) treated with dupilumab at a tertiary, university hospital. To describe the features of dupilumab-associated ocular surface disease, establish the need for treatment and report any long-term effects on the ocular surface.

Methods

A retrospective analysis of consecutive patients treated with dupilumab for AD between January 2017 and August 2019 was undertaken. Data was collected on demographics, incidence and type of ocular disease features, natural history and treatment.

Results

50% (14/28) patients developed ocular symptoms with a mean time of onset of 6.75 (+/- 6.1) weeks from starting dupilumab. 69% of these (9/13) were diagnosed with conjunctivitis - associated with cicatrisation in two patients and periorbital skin changes in four. Of these nine, four had prior history of atopic keratoconjunctivitis. All were treated with topical steroids; two required additional ciclosporin drops. 67% (6/9) patients developed chronic ocular inflammation requiring maintenance drops at a mean of 16 (+/- 6.9) months of follow up. All patients had improvement in their AD severity; only one patient discontinued dupilumab due to ocular side effects.

Conclusion

The rate of dupilumab-associated ocular surface disease was 32%. Periorbital skin changes and conjunctival cicatrisation were noted in association with conjunctivitis. Ocular surface disease improved on topical steroids and ciclosporin but 67% of patients needed on-going treatment. Patients should be referred to an ophthalmologist prior to starting dupilumab as a large proportion develops chronic ocular inflammation.
COVID-19 projections for reopening Connecticut
Authors: Crawford Forrest W. , Li Zehang Richard , Morozova Olga
Published: June 2020

Key Points

Closure of schools and the statewide “Stay Safe, Stay Home” order have effectively reduced COVID-19 transmission in Connecticut, with model projections estimating incidence at about 1,300 new infections per day.

If close interpersonal contact increases quickly in Connecticut following reopening on May 20, the state is at risk of a substantial increase of COVID-19 infections, hospitalizations, and deaths by late Summer 2020.

Real-time metrics including case counts, hospitalizations, and deaths may fail to provide enough advance warning to avoid resurgence.

Substantial uncertainty remains in our knowledge of cumulative COVID-19 incidence, the proportion of infected individuals who are asymptomatic, infectiousness of children, the effects of testing and contact tracing on isolation of infected individuals, and how contact patterns may change following reopening.
Potential involvement of monoamine oxidase activity in delirium onset and SARS-COV2 infection
Authors: Cuperlovic-Culf Miroslava , Cunningham Emma L. , Surendra Anu , Pan Xiaobei , Bennett Steffany A.L. , Jung Mijin , McGuiness Bernadette , Passmore Anthony Peter , McAuley Danny , Beverland David , Green Brian D.
Published: June 2020

Delirium is an acute change in attention and cognition occurring in ~65% of severe SARS-CoV-2 cases. It is also common following surgery and an indicator of brain vulnerability and risk for the development of dementia. In this work we analyzed the underlying role of metabolism in delirium-susceptibility in the postoperative setting using metabolomic profiling of cerebrospinal fluid and blood taken from the same patients prior to planned orthopaedic surgery. Significant concentration differences in several amino acids, acylcarnitines and polyamines were found in delirium-prone patients leading us to a hypothesis about the significance of monoamine oxidase B (MAOB) in predisposition to delirium. Subsequent computational structural comparison between MAOB and angiotensin converting enzyme 2 as well as protein-protein docking analysis showed possibly strong binding of SARS-CoV-2 spike protein to MAOB resulting in a hypothesis that SARS-CoV-2 influences MAOB activity possibly lead to many observed neurological and platelet-based complications of SARS-CoV-2 infection. This proposition is possibly of significance for diagnosis, treatment and prevention of vulnerabilities causing delirium, dementias and severe COVID-19 response.
The effect of the COVID-19 induced lockdown on nutrition, health and lifestyle patterns among adults in Zimbabwe
Authors: Matsungo Tonderayi M , Chopera Prosper
Published: June 2020

Background

The 2019 coronavirus disease (COVID-19) is a global public health emergency resulting in lockdowns, associated diet and lifestyle changes and constraint public health delivery.

Objective

To investigate the impacts of the COVID-19 induced lockdown in Zimbabwe on nutrition, physical activity, alcohol consumption and smoking among Zimbabwean population aged ≥18years.

Methods

A cross-sectional online survey was conducted using a structured questionnaire to collect information on demographics (age, gender, place of residence, current employment), food system dimensions, diet and physical activity patterns, stress and anxiety, body image perceptions, lifestyle behaviours like smoking, alcohol intake, screen time, and ease of access to health services. The study obtained ethical clearance from the Medical Research Council of Zimbabwe (MRCZ/B/1920).

Results

The participants (n=507) were mostly female (63.0%) between the ages of 31-40 years (48.1%) and had tertiary education (91.3%). The lockdown resulted in increase in food prices (94.8%) and decrease in availability of nutritious foods (64%). Most (62.5%) of the participants reported a reduction in their physical activity levels. The prevalence of Generalised Anxiety Disorder (GAD) was 40.4% and mostly affecting females [63.5%, P=0.909), 31-40 years age group (49.6%, P=0.886). Based on the BMI-based Silhouette Matching Test (BMI-SMT) 44.5% gained weight, 24.3% lost weight and 31.2% did not have weight change. The paired samples T test showed that there was a significant increase in perceived body weight (P<0.001). More than half (59.6%) reported having difficulties accessing medicinal drugs and 37.8% growth monitoring services.

Conclusions

The lockdown period was associated with increase in food prices, decrease in dietary diversification, elevated stress, disrupted diet and consumption patterns. There were low levels of physical activity and perceived weight gained during the lockdown period, thus increasing the risk of overweight and obesity. Further studies incorporating participants of different socio-economic status are warranted to get more conclusive results.

What this paper adds?

First diet and lifestyle survey in Zimbabwe documenting negative effects of lockdown on the urban elite on diets and lifestyles;

The COVID-19 induced lockdown was associated with elevated anxiety, disruptions of food supply chains and consumption patterns;

Most of the participants were less active and gained weight in the lockdown period, thus increasing the risk of overweight and obesity an emerging risk factor for severe COVID-19 complications.
A longitudinal study of immune cells in severe COVID-19 patients
Authors: Payen Didier , Cravat Maxime , Maadadi Hadil , Didelot Carole , Prosic Lydia , Dupuis Claire , Losser Marie-Reine , De Carvalho Bittencourt Marcelo
Published: June 2020

Little is known about the time-dependent immune responses in severe COVID-19. Data of 15 consecutive patients were sequentially recorded from intensive care unit admission. Lymphocyte subsets and total monocyte and subsets counts were monitored as well as the expression of HLA-DR. For 5 patients, SARS-CoV-2-specific T-cell polyfunctionality was assessed against Spike and Nucleoprotein SARS-CoV-2 peptides. Non-specific inflammation markers were increased in all patients. Median monocyte HLA-DR expression was below the 8,000 AB/C threshold defining acquired immunodepression. A “V” trend curve for lymphopenia, monocyte numbers, and HLA-DR expression was observed with a nadir between days 11-14 after symptoms’ onset. Intermediate CD14++CD16+monocytes increased early with a reduction in classic CD14++CD16-monocytes. Polyfunctional SARS-Cov-2-specific CD4 T-cells were present and functional, whereas virus-specific CD8 T-cells were less frequent and not efficient. We report a temporal variation of both innate and adaptive immunity in severe COVID-19 patients, helpful in guiding therapeutic decisions (e.g. anti-inflammatoryvs. immunostimulatory ones). We describe a defect in virus-specific CD8 T-cells, a potential biomarker of clinical severity. These combined data also provide helpful knowledge for vaccine design.

Trial registration number

NCT04386395
Contributing Factors to Advanced Brain Aging in Depression and Anxiety Disorders
Authors: Han Laura K.M. , Schnack Hugo G. , Brouwer Rachel M. , Veltman Dick J. , van der Wee Nic J.A. , van Tol Marie-José , Aghajani Moji , Penninx Brenda W.J.H.
Published: June 2020

Brain aging has shown to be more advanced in patients with Major Depressive Disorder (MDD). This study examines which factors underlie this older brain age. Adults aged 18-57 years from the Netherlands Study of Depression and Anxiety underwent structural MRI. A pre-trained brain age prediction model based on >2,000 samples from the ENIGMA consortium was applied to predict age in 65 controls and 220 patients with current MDD and/or anxiety disorder. Brain-predicted age differences (brain-PAD) were calculated (predicted brain age minus chronological age) and associated with clinical, psychological, and biological factors. After correcting for antidepressant use, brain-PAD was significantly higher in MDD (+2.78 years) and anxiety patients (+2.91 years) compared to controls. Findings further indicate unique contributions of higher severity of somatic depression symptoms to advanced brain aging and a potential protective effect of antidepressant medication (-2.53 years).
Association of hypertension, diabetes, stroke, cancer, kidney disease, and high-cholesterol with COVID-19 disease severity and fatality: a systematic review
Authors: Zaki Nazar , Alashwal Hany , Ibrahim Sahar
Published: June 2020

Objective

To undertake a review and critical appraisal of published/preprint reports that offer methods of determining the effects of hypertension, diabetes, stroke, cancer, kidney issues, and high-cholesterol on COVID-19 disease severity.

Data sources

Google Scholar, PubMed, COVID-19 Open Research Dataset: a resource of over 128,000 scholarly articles, including over 59,000 articles with full text related to COVID-19, SARS-CoV-2, and coronaviruses.

Methods

A search was conducted by two authors independently on the freely available COVID-19 Open Research Dataset (CORD-19). We developed an automated search engine to screen a total of 59,000 articles in a few seconds. The search engine was built using a retrieval function that ranks a set of documents based on the query terms appearing in each document regardless of their proximity within the document. Filtering of the articles was then undertaken using keywords and questions, e.g. “Effects of diabetes on COVID/normal coronavirus/SARS-CoV-2/nCoV/COVID-19 disease severity, mortality?”. The search terms were repeated for all the comorbidities considered in this paper. Additional articles were retrieved by searching via Google Scholar and PubMed.

Findings

A total of 54 articles were considered for a full review. It was observed that diabetes, hypertension, and cholesterol levels possess an apparent relation to COVID-19 severity. Other comorbidities, such as cancer, kidney disease, and stroke, must be further evaluated to determine a strong relationship to the virus. Reports associating cancer, kidney disease, and stroke with COVID-19 should be carefully interpreted, not only because of the size of the samples, but also because patients could be old, have a history of smoking, or have any other clinical condition suggesting that these factors might be associated with the poor COVID-19 outcomes rather than the comorbidity itself. Such reports could lead many oncologists and physicians to change their treatment strategies without solid evidence and recommendations. Further research regarding this relationship and its clinical management is warranted. Additionally, treatment options must be examined further to provide optimal treatment and ensure better outcomes for patients suffering from these comorbidities. It should be noted that, whether definitive measurements exist or not, the care of patients as well as the research involved should be largely prioritized to tackle this deadly pandemic.
How many medications do doctors in primary care use? An observational study of the DU90% indicator in primary care in England.
Authors: Chiedozie Chiamaka , Murphy Mark , Fahey Tom , Moriarty Frank
Published: June 2020

Aim: To apply the DU90% indicator (the number of unique drugs which make up 90% of a doctor's prescribing) to GP practices prescribing in England to examine time trends, practice-level variation, and relationships with practice characteristics

Method: This is an observational cohort study of all general practices in England. It utilises publicly available prescribing data from the National Health Service (NHS) Digital platform for 2013-2017. The DU90% was calculated on an annual basis for each practice based on medication BNF codes. Descriptive statistics were generated per year on time trends and practice-level variation in the DU90%. Multi-level linear regression was used to examine the practice characteristics (relating to staff, patients, and deprivation of the practice area).

Results: A total of 7,623 GP practices were included. The mean DU90% ranged from 130.1 to 133.4 across study years, and variation between practices was low (with a 1.4 fold difference between the lowest and highest 5% of practices). A range of medications were included in the DU90% of virtually all practices, including atorvastatin, levothyroxine, omeprazole, ramipril, amlodipine, simvastatin and aspirin. A higher volume of prescribing was associated with a lower DU90%, while having more patients, higher proportions of patients who are female or aged 65+, higher number of GPs working in the practice, and being in a more deprived area were associated with a higher DU90%.

Conclusion: GP practices typically use 130 different medications in the bulk of their prescribing. Increasing use of personal formularies may enhance prescribing quality and reduce costs.
Machine learning for identifying relevant publications in updates of systematic reviews of diagnostic test studies
Authors: Lange Toni , Schwarzer Guido , Datzmann Thomas , Binder Harald
Published: June 2020

Background

Updating systematic reviews is often a time-consuming process involving a lot of human effort and is therefore not carried out as often as it should be. Our aim was therefore to explore the potential of machine learning methods to reduce the human workload, and to particularly also gauge the performance of deep learning methods as compared to more established machine learning methods.

Methods

We used three available reviews of diagnostic test studies as data basis. In order to identify relevant publications we used typical text pre-processing methods. The reference standard for the evaluation was the human-consensus based binary classification (inclusion, exclusion). For the evaluation of models various scenarios were generated using a grid of combinations of data preprocessing steps. Furthermore, we evaluated each machine learning approach with an approach-specific predefined grid of tuning parameters using the Brier score metric.

Results

The best performance was obtained with an ensemble method for two of the reviews, and by a deep learning approach for the other review. Yet, the final performance of approaches is seen to strongly depend on data preparation. Overall, machine learning methods provided reasonable classification.

Conclusion

It seems possible to reduce the human workload in updating systematic reviews by using machine learning methods. Yet, as the influence of data preprocessing on the final performance seems to be at least as important as choosing the specific machine learning approach, users should not blindly expect good performance just by using approaches from a popular class, such as deep learning.
Assessing the impact of coordinated COVID-19 exit strategies across Europe
Authors: Ruktanonchai N.W. , Floyd J.R. , Lai S. , Ruktanonchai C.W. , Sadilek A. , Rente-Lourenco P. , Ben X. , Carioli A. , Gwinn J. , Steele J.E. , Prosper O. , Schneider A. , Oplinger A. , Eastham P. , Tatem A.J.
Published: June 2020

As rates of new COVID-19 cases decline across Europe due to non-pharmaceutical interventions such as social distancing policies and lockdown measures, countries require guidance on how to ease restrictions while minimizing the risk of resurgent outbreaks. Here, we use mobility and case data to quantify how coordinated exit strategies could delay continental resurgence and limit community transmission of COVID-19. We find that a resurgent continental epidemic could occur as many as 5 weeks earlier when well-connected countries with stringent existing interventions end their interventions prematurely. Further, we found that appropriate coordination can greatly improve the likelihood of eliminating community transmission throughout Europe. In particular, synchronizing intermittent lockdowns across Europe meant half as many lockdown periods were required to end community transmission continent-wide.

One Sentence Summary

EU coordination in easing restrictions is key to preventing resurgent COVID-19 outbreaks and stopping community transmission.
Improved Global Response Outcome After Intradetrusor Injection of Adult Muscle-Derived Cells for the Treatment of Underactive Bladder
Authors: Gilleran Jason , Diokno Ananias C. , Ward Elijah , Sirls Larry , Hasenau Deborah , Giordano Jennifer , Shea Evelyn , Bartolone Sarah N. , Lamb Laura E. , Chancellor Michael B.
Published: June 2020

We report on the first regulatory approved clinical trial of a prospective open-label physician-initiated study assessing the safety and efficacy of intradetrusor injected Autologous Muscle Derived Cells (AMDC) treatment for underactive bladder (UAB).

20 non-neurogenic UAB patients were treated. Approximately 50-250 mg of quadriceps femoris muscle was collected using a spirotome 8-gauge needle. The muscles biopsy samples were sent to Cook MyoSite (Pittsburgh, PA) for processing, isolation, and propagation of cells. Research patients received approximately 30 intradetrusor injections of 0.5 mL delivered to the bladder, for a total of 15 mL and 125 million AMDC, performed utilizing a flexible cystoscope under direct vision using topical local anesthesia. Follow-up assessments included adverse events and efficacy via voiding diary and urodynamic testing at 1, 3, 6 & 12-month post-injection. An optional second injection was offered at the end of the 6 months visit.

20 patients received the first injection and all 20 patients requested and received a second injection. Median patient age was 65 years old (range 41-82 years). There were 16 male (80%) and 4 female (20%) patients. Etiology included 7 men (35%) with persistent urinary retention after transurethral resection of the prostate for benign prostatic hyperplasia and 13 patients (65%) with idiopathic chronic urinary retention. At the primary outcome time point of 12 months, 11/19 patients (58%) reported a global response assessment (GRA) ≥ 5, showing slight to marked improvement in their UAB symptoms, compared to 6/20 (30%) patients at 3-months post-injection. No serious procedure or treatment-related adverse events occurred. Noted improvements included: decreased post void residual urine volume, increased voiding efficiency, and decreased catheter use.

Intradetrusor injected AMDC as a treatment for UAB was successfully completed in a 20-patient trial without serious adverse event and with signal of efficacy. Cellular therapy may be a promising novel treatment for catheter dependent chronic urinary retention. A multicenter controlled trial is needed to further assess the promise of regenerative medicine in the treatment of lower urinary tract dysfunction.