bluuebunny/crossref_metadata_2025 huggingface dataset:
The Question of Pirate Trials in States Without a Crime of Piracy
Authors: Keyuan Zou , Jing Jin
Published: December 2020

Many States in the world such as China have no specific domestic laws providing for the crime of piracy, leading to the question whether these States have the competence to punish piracy as required by international law. This paper argues that the lack of a crime of piracy within a domestic legal system should not become an insurmountable obstacle for States to prosecute pirates. Prosecution of pirates without a crime of piracy is feasible in a State that has domestic criminal laws that deal with illicit activities similar to piracy by indicting perpetrators with other criminal offences. While it would be an ideal solution for that State to establish a specific crime of piracy in its domestic legal system, it is important to consider the difficulties in setting the definition of piracy and the degree of punishment appropriately, and realize that the major deficiencies in punishing pirates under other existing domestic crimes can be basically addressed within an existing domestic legal system. The main purpose of universal jurisdiction over piracy to punish criminals to the maximum extent and the changing situation of piracy also require States to always be ready to deal with piracy. Therefore, prosecuting pirates as another crime is a realistic compromise. Furthermore, for a State without a crime of piracy, it is more urgent for it to build up legal grounds for exercising universal jurisdiction over piracy and relevant procedural provisions on the exercise of extraterritorial jurisdiction over international crimes at sea.
Response Surface Methodology of Quantitative of Heterocyclic Aromatic Amines in Fried Fish Using Efficient Microextraction Method Coupled with High-Performance Liquid Chromatography: Central Composite Design
Authors: Omidi Narges , Barzegar Fatemeh , Abedi Abdol-Samad , Kamankesh Marzieh , Ghanati Kiandokht , Mohammadi Abdorreza
Published: December 2020

Meat and meat products are indispensable part of our diet. Heat processing of these tasty foods such as fried fish causes to form heterocyclic aromatic amines (HAAs). The sources of heating have directly affected on the level and type of HAAs. In this research, 2-amino-1-methyl-6-phenylimidazo [4‚5-b] pyridine (PhIP), 2-amino-3-methylimidazo [4,5-f]quinolone (IQ), 2-amino-3,4-dimethylimidazo [4,5-f] quinoline (MeIQ) and 2-amino-3,4-dimethylimidazo [4,5-f] quinoxaline (MeIQx) were determined using an efficient analytical methodology coupled with high-performance liquid chromatography. The effective parameters were optimized by central composite design. The results of this survey demonstrated that rang of relative standard deviation were between 4.5 and 8.2, extraction recoveries were obtained 86–97% and limits of detection were between 0.40 and 0.63 for 4 HAAs. The amounts of HAAs found in 20 different fried fish samples were between 0 and 4.8 ng g−1. PhIP with 1.57 ng g−1 and MeIQ with 2.08 ng g−1 have the lowest and highest average level of HAAs, respectively.
Clinical Factors Associated With Accurate Presumptive Treatment of Neisseria gonorrhoeae Infections in Men Who Have Sex with Men and Transgender Women
Authors: Anker Bryan , Jaffar Samia , Patani Henna , Bristow Claire C , Sukhija-Cohen Adam C
Published: December 2020

Background

Neisseria gonorrhoeae (N. gonorrhoeae) infections have increased among men who have sex with men and are high among transgender women. Presumptive treatment guidelines may lead to inaccurate treatments and possible antibiotic resistance. Using patient data from AIDS Healthcare Foundation sexually transmitted infection (STI) testing clinics in California and Florida, we identified clinical factors associated with accurate presumptive N. gonorrhoeae treatment.

Methods

Multivariable logistic regression analyses were conducted using patient visit data from 2013 to 2017. A sample of 42 050 patient encounters were analyzed. The primary outcome variable included accurate versus inaccurate presumptive treatment. Risk ratios were generated for particular symptoms, high-risk sexual behavior, and history of N. gonorrhoeae.

Results

Twelve percent (5051/42 050) of patients received presumptive N. gonorrhoeae treatment, and 46% (2329/5051) of presumptively treated patients tested positive for N. gonorrhoeae infection. Patients presenting with discharge or patients presenting with dysuria were more likely to receive accurate presumptive treatment.

Conclusions

Providers should continue to follow the Centers for Disease Control and Prevention guidelines and consider presumptive N. gonorrhoeae treatment based on specific symptoms. As the STI epidemic continues to rise in the United States, along with increased antibiotic resistance, it is imperative to accurately test, diagnose, and treat populations at risk for N. gonorrhoeae and other STIs.
Exercise training in dialysis patients: impact on cardiovascular and skeletal muscle health
Authors: Deligiannis Asterios , D’Alessandro Claudia , Cupisti Adamasco
Published: December 2020

Dialysis patients show a high rate of reduced functional capacity, morbidity and mortality. Cardiovascular disorders, muscle atrophy and malnutrition play an essential role among the aetiological factors. Sedentary lifestyle characterizes them and contributes to the aggravation of the disorders. On the contrary, exercise training is an important preventive and therapeutic tool both for cardiovascular problems and for the appearance of muscle atrophy in dialysis patients. Regular exercise causes both central (cardiac) and peripheral (muscular) adaptations, improving functional capacity. In particular, circulatory system clinical trials in haemodialysis (HD) patients documented that exercise has favourable effects on heart function, promotes balance on the cardiac autonomic nervous system and contributes to the management of arterial hypertension. In the muscular system, it prevents muscle atrophy or contributes significantly to its treatment. The main preventive mechanisms of the beneficial effect of exercise on the muscles constitute the inhibition of the apoptotic processes and protein degradation. Exercise training in HD patients leads to an increase of muscle fibers, mitochondria and capillaries, and the combination of regular exercise and dietary strategies is even more effective in preventing or treating muscle atrophy. Finally, an improvement in functional capacity and quality of life was found also in peritoneal dialysis patients following exercise training.
The Genetics of Postoperative Recurrence in Crohn Disease: A Systematic Review, Meta-analysis, and Framework for Future Work
Authors: Dang Jerry T , Dang ThucNhi T , Wine Eytan , Dicken Bryan , Madsen Karen , Laffin Michael
Published: December 2020

Background

Recurrence following abdominal surgery in Crohn disease is over 50%. The impact of genetics on postoperative recurrence is not well defined.

Methods

A literature search was conducted where inclusion required an assessment, by genotype, of postoperative recurrence. The primary endpoint was odds of surgical recurrence.

Results

Twenty-eight studies identified a total of 6715 patients. Thirteen loci were identified as modifying the risk of recurrence. NOD2 was identified as a risk factor for recurrence by multiple works (cumulative odds ratio: 1.64, P = 0.003).

Conclusions

A NOD2 risk allele is associated with recurrence following surgery in Crohn disease. Progress in this area will require standardized reporting in future works.
Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis
Authors: Scudiero Fernando , Pitì Antonino , Keim Roberto , Parodi Guido
Published: December 2020

Background

Despite the fast-growing understanding of the coronavirus disease 2019 (COVID-19), patient management remains largely empirical or based on retrospective studies. In this complex scenario, an important clinical issue appears to be represented by the high prevalence of thromboembolic events, but the data regarding high-risk pulmonary embolism (PE) is still not available.

Case summary

A patient with COVID-19 developed sudden shortness of breath and hypoxia. Early echocardiographic diagnosis of high-risk PE related to right heart thrombus was performed. Systemic thrombolysis was administered with excellent clinical and haemodynamic response.

Discussion

Pulmonary thromboembolism is a common occurrence in severe COVID-19 infection. In our experience, systemic thrombolysis proved to be effective and for this reason may be considered for life-threatening PE in COVID-19 patients.
Tuberculous pericarditis with tamponade diagnosed concomitantly with COVID-19: a case report
Authors: Wong Shiun Woei , Ng Jessica Ke Xuan , Chia Yew Woon
Published: December 2020

Background

Tuberculous pericarditis is a rare manifestation of tuberculosis infection. COVID-19 pandemic poses a challenge in detecting uncommon diseases.

Case summary

A 47-year-old man was admitted with symptoms of COVID-19 infection. Rapid progression of cardiomegaly on radiograph with clinical deterioration were suggestive of pericardial tamponade. Urgent pericardiocentesis revealed haemoserous fluid, elevated adenosine deaminase, and positive tuberculous (TB) polymerase chain reaction (PCR). He was started on anti-TB therapy and Remdesivir with marked improvement of symptoms. Repeat echocardiogram and CT thorax showed resolution of pericardial fluid, and the patient remained well on discharge.

Discussion

This case highlights the difficulty in detecting a concomitant rare but important disease. The development of massive pericardial tamponade acutely is not pathognomonic for COVID-19, and a careful diagnostic process involving multi-modality imaging occurred to arrive at a diagnosis of tuberculosis.
Definity, an affinity for painful crisis: a case series describing vaso-occlusive pain crises in sickle cell patients undergoing echocardiogram with Definity contrast
Authors: D’Amico Alex , Mir Nabiel , Wilkerson Hunter , Andrikopoulou Efstathia , Kanter Julie
Published: December 2020

Background 

Individuals with sickle cell disease (SCD) are at risk for painful crises and long-term cardiopulmonary morbidity. Echocardiogram is recommended if signs or symptoms of cardiopulmonary disease develop in previously asymptomatic patients, or worsen in those with known disease. Second-generation echocardiogram contrast agents (ECAs) improve the diagnostic capacity of echocardiogram; however, these agents have risks in SCD populations that have yet to be investigated.

Case summary 

We report a case series of two patients who experienced vaso-occlusive crises following administration of the ECA, Definity. Both patients were referred for echocardiogram from our institution’s sickle cell clinic because of concern for SCD-related cardiopulmonary complications. Both patients were in their usual state of health at the time of their exams. The first patient experienced acute back and hip pain minutes after receiving Definity and was diagnosed with acute vaso-occlusive crisis requiring admission for 6 days for pain management. The second patient developed dyspnoea and chest pain within 90 min of her echocardiogram. She was diagnosed with acute chest syndrome and admitted for further management. Her hospitalization was complicated by hyper-haemolysis and multiple organ failure syndrome. After 13 days, she was discharged home.

Discussion 

The safety profile of ECAs has not been fully evaluated and warrants further study in individuals with SCD. Proposed mechanisms for our observations include the release of pro-inflammatory metabolites from Definity contrast agent’s shell and ultrasound-induced haemolysis secondary to ECA administration. Alternative imaging modalities and proper precautions should be considered when evaluating cardiopulmonary function in this patient population.
Modification of screen-printed gold electrode with 1,4-dithiothreitol: application to sensitive voltammetric determination of Sudan II
Authors: Karaboduk Kuddusi
Published: December 2020

Objectives

The aim of this study is to investigate the electrochemical behavior of Sudan II (SuII) using a screen-printed gold electrode (SPGE) modified with 1,4-dithiothreitol (DTT) and to determine the amount of Sudan II by voltammetry.

Materials and Methods

A DTT-modified screen-printed gold electrode (DTT/SPGE) was fabricated and its application for differential pulse voltammetric (DPV) determination of SuII was reported. Fourier transform infrared spectroscopy (FT-IR), cyclic voltammetry and electrochemical impedance spectroscopy were used for the characterization of the modified electrode. The effects of instrumental and chemical parameters were optimized for the determination of SuII. The fabricated electrode was used for the analysis of SuII in fortified and real samples. High-performance liquid chromatography was preferred as a reference method for the evaluation of the obtained voltammetric results.

Results

The electrochemical studies and FT-IR demonstrated that the SPGE was modified with DTT. The obtained peak current at DTT/SPGE was 6.67 times higher than that recorded with SPGE. At the optimized conditions of DPV in pH = 2.5 of H2SO4, the oxidation peak current of SuII was proportional to its concentration in range: 0.001–1.500 μmol l–1 with a detection limit of 0.0002 μmol l–1 (S/N = 3). For the analysis of SuII, 101.67%–104.33% of recovery percentage was obtained.

Conclusions

A new electrode was successfully improved for the determination of SuII. This highly selective and sensitive electrode supplied the fast determination of SuII in ketchup, chili sauce and salsa dip sauce. In addition, voltammetric and chromatographic results are found to be consistent.
Effect of a combined microwave-assisted drying and air drying on improving active nutraceutical compounds, flavor quality, and antioxidant properties of Camellia sinensis L. (cv. Longjing 43) flowers
Authors: Shi Linzuo , Kim Eunhye , Yang Leiyu , Huang Yanmei , Ren Ning , Li Bo , He Puming , Tu Youying , Wu Yuanyuan
Published: December 2020

Drying tea flowers into a high-quality product is important to its commodity value. In the present work, a combination of microwave-assisted drying and air drying (MAD-AD) was applied in the processing of fresh tea flowers and its effects on flavor quality, active nutraceutical compounds, and antioxidant capacities were studied. The results showed that compared to air drying and freeze drying tea flowers, the MAD-AD tea flowers had higher amounts of active compounds such as catechins, flavonol glycosides, and triterpenoid saponins, and possessed high antioxidant activities. Moreover, this drying method improved the tea flowers’ color and preserved a more floral fragrance. This combined method could be of interest as an industrial method for drying tea flowers with the benefit of reduced processing time, more reserved active compounds and high quality of products.
Secure multiparty computations in floating-point arithmetic
Authors: Guo Chuan , Hannun Awni , Knott Brian , van der Maaten Laurens , Tygert Mark , Zhu Ruiyu
Published: December 2020

Secure multiparty computations enable the distribution of so-called shares of sensitive data to multiple parties such that the multiple parties can effectively process the data while being unable to glean much information about the data (at least not without collusion among all parties to put back together all the shares). Thus, the parties may conspire to send all their processed results to a trusted third party (perhaps the data providers) at the conclusion of the computations, with only the trusted third party being able to view the final results. Secure multiparty computations for privacy-preserving machine-learning turn out to be possible using solely standard floating-point arithmetic, at least with a carefully controlled leakage of information less than the loss of accuracy due to roundoff, all backed by rigorous mathematical proofs of worst-case bounds on information loss and numerical stability in finite-precision arithmetic. Numerical examples illustrate the high performance attained on commodity off-the-shelf hardware for generalized linear models, including ordinary linear least-squares regression, binary and multinomial logistic regression, probit regression and Poisson regression.
Save Our Species: A Blueprint for Restoring Butternut (Juglans cinerea) across Eastern North America
Authors: Pike Carolyn C , Williams Martin , Brennan Andrea , Woeste Keith , Jacobs James , Hoban Sean , Moore Melanie , Romero-Severson Jeanne
Published: December 2020

Butternut is a relatively uncommon hardwood tree native to eastern North America. The species’ abundance has declined over the past 50 years, primarily because of an invasive pathogen (Ophiognomonia clavigignenti-juglandacearum [Oc-j]) and loss of suitable habitat for regeneration. Although genetic diversity of butternut is highest along the southern range edge, genetic diversity rangewide is fairly high, except in small and isolated populations. Although there is little evidence for even moderate resistance in native butternut, hybrids with Japanese walnut, a closely related species, display enough tolerance to infection to persist on the landscape and bear abundant nut crops year after year. Cryostorage of native embryogenic axes has yielded promising initial results as a strategy for gene conservation, but additional action is needed to conserve the remaining native gene pool. We describe a strategy for canker-resistance breeding in butternut using naturally occurring hybrids, hybrids in research orchards, and sources of native trees from as many regions as possible. Forest managers are encouraged to find surviving trees and collect seed for planting in suitable habitat to develop actionable knowledge that will enable the restoration of butternut with enough resistance to be self-sustaining on the landscape.
Abdominoperineal anoplasty with use of a rectal fistula as a substitute vagina in a cloacal malformation associated with absence of the vagina: short-term follow-up
Authors: Tatekawa Yukihiro
Published: December 2020

We report herein a patient with a cloacal malformation and an absent vagina. The patient underwent colostomy on Day 1 of life. At 7 months of age, fistulography of the cloaca showed a common channel >3 cm in length; a vagina was not visible. At the age of 11 months, the patient underwent abdominoperineal anoplasty with the repurposing of her rectal fistula as a substitute vagina. Intraoperative examination revealed a bicornuate uterus and bilateral ovaries. The rectum was resected 7 cm at the confluence of the cloaca. The colonic stump was pulled through a newly created anal canal and an anoplasty was performed. Two months after this procedure, the patient experienced anal prolapse. At the age of 17 months, she underwent partial urogenital mobilization and a modified Delorme operation, and 5 months later the colostomy was closed. At present, this patient is 3 years old and doing well.
Immature teratoma of the ovary in a 1 year and 9-month-old child: a case report and review of the literature
Authors: Mremi Alex , Rwenyagila Doris , Chilonga Kondo , Sadiq Adnan , Msuya David , Lodhia Jay
Published: December 2020

Immature teratoma of the ovary is a rare malignant germ cell tumor whose etiology is unknown. Preoperative diagnosis and treatment of this tumor can be challenging for clinicians. We present a 1-year and 9-month female child who presented with a 1- month history of progressive nontender abdominal distension. Computed tomography scan of the abdomen revealed a huge well-defined heterogenous mass arising from the peritoneal cavity. Surgical resection was performed. Histopathology coupled with immunohistochemical analysis of the specimen confirmed it to be an ovarian immature teratoma, grade one. The child recovered well postoperatively. Surgery alone is curative for most children and adolescents with resectable ovarian immature teratoma thus avoiding the long-term effects of chemotherapy in most children with this disease.
Education of Infectious Diseases Fellows During the COVID-19 Pandemic Crisis: Challenges and Opportunities
Authors: Chirch Lisa M , Armstrong Wendy S , Balba Gayle P , Kulkarni Prathit A , Benson Constance A , Konold Victoria , Luther Vera P , Nnedu Obinna N , Perloff Sarah , Razonable Raymund R , Stead Wendy , Thompson George R , Melia Michael T
Published: December 2020

One of the many challenges that has befallen the Infectious Diseases and Graduate Medical Education communities during the coronavirus disease 2019 (COVID-19) pandemic is the maintenance of continued effective education and training of the future leaders of our field. With the remarkable speed and innovation that has characterized the responses to this pandemic, educators everywhere have adapted existing robust and safe learning environments to meet the needs of our learners. This paper will review distinct aspects of education and training of the Infectious Diseases fellows we believe the COVID-19 pandemic has impacted most, including mentoring, didactics, and wellness. We anticipate that several strategies developed in this context and described herein will help to inform training and best practices during the pandemic and beyond.
Self-Rated Smell Ability Enables Highly Specific Predictors of COVID-19 Status: A Case–Control Study in Israel
Authors: Karni Noam , Klein Hadar , Asseo Kim , Benjamini Yuval , Israel Sarah , Nammary Musa , Olshtain-Pops Keren , Nir-Paz Ran , Hershko Alon , Muszkat Mordechai , Niv Masha Y
Published: December 2020

Background

Clinical diagnosis of coronavirus disease 2019 (COVID-19) is essential to the detection and prevention of COVID-19. Sudden onset of loss of taste and smell is a hallmark of COVID-19, and optimal ways for including these symptoms in the screening of patients and distinguishing COVID-19 from other acute viral diseases should be established.

Methods

We performed a case–control study of patients who were polymerase chain reaction–tested for COVID-19 (112 positive and 112 negative participants), recruited during the first wave (March 2020–May 2020) of the COVID-19 pandemic in Israel. Patients reported their symptoms and medical history by phone and rated their olfactory and gustatory abilities before and during their illness on a 1–10 scale.

Results

 Changes in smell and taste occurred in 68% (95% CI, 60%–76%) and 72% (95% CI, 64%–80%) of positive patients, with odds ratios of 24 (range, 11–53) and 12 (range, 6–23), respectively. The ability to smell was decreased by 0.5 ± 1.5 in negatives and by 4.5 ± 3.6 in positives. A penalized logistic regression classifier based on 5 symptoms had 66% sensitivity, 97% specificity, and an area under the receiver operating characteristics curve (AUC) of 0.83 on a holdout set. A classifier based on degree of smell change was almost as good, with 66% sensitivity, 97% specificity, and 0.81 AUC. The predictive positive value of this classifier was 0.68, and the negative predictive value was 0.97.

Conclusions

Self-reported quantitative olfactory changes, either alone or combined with other symptoms, provide a specific tool for clinical diagnosis of COVID-19. A simple calculator for prioritizing COVID-19 laboratory testing is presented here.
Medicaid Expansion’s Impact on Human Immunodeficiency Virus Outcomes in a Nonurban Southeastern Ryan White HIV/AIDS Program Clinic
Authors: McManus Kathleen A , Srikanth Karishma , Powers Samuel D , Dillingham Rebecca , Rogawski McQuade Elizabeth T
Published: December 2020

Background

Although the Ryan White HIV/AIDS Program supports high-quality human immunodeficiency virus (HIV) care, Medicaid enrollment provides access to non-HIV care. People with HIV (PWH) with Medicaid historically have low viral suppression (VS) rates. In a state with previously high Qualified Health Plan coverage of PWH, we examined HIV outcomes by insurance status during the first year of Medicaid expansion (ME).

Methods

Participants were PWH ages 18–63 who attended ≥1 HIV medical visit/year in 2018 and 2019. We estimated associations of sociodemographic characteristics with ME enrollment prevalence and associations between insurance status and engagement in care and VS.

Results

Among 577 patients, 151 (33%) were newly eligible for Medicaid, and 77 (51%) enrolled. Medicaid enrollment was higher for those with incomes <100% federal poverty level (adjusted prevalence ratio, 1.67; 95% confidence interval [CI], 1.00–1.86) compared with others. Controlling for age, income, and 2018 engagement, those with employment-based private insurance (adjusted risk difference [aRD], −8.5%; 95% CI, −16.9 to 0.1) and Medicare (aRD, −12.5%; 95% CI, −21.2 to −3.0) had lower 2019 engagement than others. For those with VS data (n = 548), after controlling for age and baseline VS, those with Medicaid (aRD, −4.0%; 95% CI, −10.3 to 0.3) and with Medicaid due to ME (aRD, −6.2%; 95% CI, −14.1 to −0.8) were less likely to achieve VS compared with others.

Conclusions

Given that PWH who newly enrolled in Medicaid had high engagement in care, the finding of lower VS is notable. The discordance may be due to medication access gaps associated with changes in medication procurement logistics.
Lessons Learned From Conducting Internet-Based Randomized Clinical Trials During a Global Pandemic
Authors: Pullen Matthew F , Pastick Katelyn A , Williams Darlisha A , Nascene Alanna A , Bangdiwala Ananta S , Okafor Elizabeth C , Hullsiek Katherine Huppler , Skipper Caleb P , Lofgren Sarah M , Engen Nicole , Abassi Mahsa , McDonald Emily G , Lee Todd C , Rajasingham Radha , Boulware David R
Published: December 2020

As the severe acute respiratory syndrome coronavirus 2 pandemic evolved, it was apparent that well designed and rapidly conducted randomized clinical trials were urgently needed. However, traditional clinical trial design presented several challenges. Notably, disease prevalence initially varied by time and region, and the pockets of outbreaks evolved geographically over time. Coupled with an occupational hazard from in-person study visits, timely recruitment would prove difficult in a traditional in-person clinical trial. Thus, our team opted to launch nationwide internet-based clinical trials using patient-reported outcome measures. In total, 2795 participants were recruited using traditional and social media, with screening and enrollment performed via an online data capture system. Follow-up surveys and survey reminders were similarly managed through this online system with manual participant outreach in the event of missing data. In this report, we present a narrative of our experience running internet-based clinical trials and provide recommendations for the design of future clinical trials during a world pandemic.
Integrase Strand Transfer Inhibitors Play the Main Role in Greater Weight Gain Among Men With Acute and Early HIV Infection
Authors: Wu Kuan-Sheng , Anderson Christy , Little Susan J
Published: December 2020

Background

The predictors of weight gain remain unclear in people with acute and early HIV infection (AEH).

Methods

Eligible antiretroviral-naïve men diagnosed with AEH from January 1, 2000, to December 31, 2019, were enrolled in an observational cohort study at the University California, San Diego. The study used multivariable mixed-effect linear regression models to analyze differences in the rate of weight gain over time between participants receiving early vs deferred antiretroviral therapy (ART) treatment, low vs high baseline CD4 count and HIV RNA, and different classes of ART.

Results

A total of 463 participants were identified, with mean CD4 cell count of 507 cells/μL and log HIV RNA of 5.0 copies/mL at study entry. There was no difference in the rate of weight gain between participants who did and did not receive ART within 96 weeks of incident HIV infection. Neither a baseline CD4 count of <350 cells/μL nor a baseline HIV RNA of >100 000 copies/mL was a predictor of weight gain. Compared with persons taking non-nucleoside reverse transcriptase inhibitor–based regimens, those who received integrase strand transfer inhibitor (INSTI)–based regimens showed greater weight gain over time.

Conclusions

Neither baseline CD4 count and HIV RNA nor early ART was associated with weight change in the first 96 weeks following incident HIV infection. Use of INSTI-based regimens represented a major driver of weight gain in men who initiated ART with relatively higher CD4 cell counts.
What Twitter Can Tell Us About #IDWeek2020
Authors: Medford Richard J , Saleh Sameh N
Published: December 2020

We used topic modeling, subjectivity analysis, and social graph theory to analyze 11 944 tweets relating to IDWeek 2020. Twitter is a rich medium that can successfully disseminate knowledge and allow users to engage in social networks during a medical conference, despite a virtual format.
A patient with sporadic Creutzfeldt–Jakob disease: challenges of rare diseases in the COVID-19 era
Authors: McMurran Christopher E , Chaggar Gurjeevun H , Ugoya Solomon O
Published: December 2020

We describe a patient who presented to hospital during the coronavirus disease 2019 (COVID-19) pandemic with sporadic Creutzfeldt–Jakob disease (sCJD). The case demonstrates the typical clinical, radiological and laboratory features of this condition. It also highlights some of the challenges associated with diagnosis and care of patients with rare diseases such as sCJD, and how these have been intensified by COVID-19.
Bronchoesophageal fistula formation after three courses of nivolumab for carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma
Authors: Nishiyama Akihiro , Sakaguchi Hiroyuki , Yanagimura Naohiro , Suzuki Chiaki , Otani Sakiko , Tanimoto Azusa , Yamashita Kaname , Takeuchi Shinji , Ohtsubo Koushiro , Ikeda Hiroko , Yano Seiji
Published: December 2020

Immune checkpoint inhibitors (ICIs) are widely used in both monotherapy and combination chemotherapy for various types of cancers. Nivolumab is the most popular among ICIs, and the number of adapted malignant diseases for nivolumab is increasing. Bronchoesophageal fistula formation is a serious complication of the treatment for esophageal or lung cancer. However, the development of bronchoesophageal fistula as a complication of ICIs is obscure. A 59-year-old man who was diagnosed with carcinoma of unknown primary with a subgroup of lung squamous cell carcinoma had bronchoesophageal fistula formation after three cycles of nivolumab as the fourth line treatment. Before the initiation of nivolumab, he had received two esophageal stents and an angiogenesis inhibitor. These are known risk factors for fistula formation. This is a rare case showing that nivolumab monotherapy might induce bronchoesophageal fistulae. Therefore, clinicians should be aware of the factors related to fistula formation when using ICIs.
Clinical longitudinal evaluation of COVID-19 patients and prediction of organ-specific recovery using artificial intelligence
Authors: Wang Winston T , Zhang Charlotte L , Wei Kang , Sang Ye , Shen Jun , Wang Guangyu , Lozano Alexander X
Published: December 2020

Within COVID-19 there is an urgent unmet need to predict at the time of hospital admission which COVID-19 patients will recover from the disease, and how fast they recover to deliver personalized treatments and to properly allocate hospital resources so that healthcare systems do not become overwhelmed. To this end, we have combined clinically salient CT imaging data synergistically with laboratory testing data in an integrative machine learning model to predict organ-specific recovery of patients from COVID-19. We trained and validated our model in 285 patients on each separate major organ system impacted by COVID-19 including the renal, pulmonary, immune, cardiac, and hepatic systems. To greatly enhance the speed and utility of our model, we applied an artificial intelligence method to segment and classify regions on CT imaging, from which interpretable data could be directly fed into the predictive machine learning model for overall recovery. Across all organ systems we achieved validation set area under the receiver operator characteristic curve (AUC) values for organ-specific recovery ranging from 0.80 to 0.89, and significant overall recovery prediction in Kaplan-Meier analyses. This demonstrates that the synergistic use of an artificial intelligence (AI) framework applied to CT lung imaging and a machine learning model that integrates laboratory test data with imaging data can accurately predict the overall recovery of COVID-19 patients from baseline characteristics.
Large Postural Sways Prevent Foot Tactile Information From Fading: Neurophysiological Evidence
Authors: Fabre Marie , Antoine Marine , Robitaille Mathieu Germain , Ribot-Ciscar Edith , Ackerley Rochelle , Aimonetti Jean-Marc , Chavet Pascale , Blouin Jean , Simoneau Martin , Mouchnino Laurence
Published: December 2020

Cutaneous foot receptors are important for balance control, and their activation during quiet standing depends on the speed and the amplitude of postural oscillations. We hypothesized that the transmission of cutaneous input to the cortex is reduced during prolonged small postural sways due to receptor adaptation during continued skin compression. Central mechanisms would trigger large sways to reactivate the receptors. We compared the amplitude of positive and negative post-stimulation peaks (P50N90) somatosensory cortical potentials evoked by the electrical stimulation of the foot sole during small and large sways in 16 young adults standing still with their eyes closed. We observed greater P50N90 amplitudes during large sways compared with small sways consistent with increased cutaneous transmission during large sways. Postural oscillations computed 200 ms before large sways had smaller amplitudes than those before small sways, providing sustained compression within a small foot sole area. Cortical source analyses revealed that during this interval, the activity of the somatosensory areas decreased, whereas the activity of cortical areas engaged in motor planning (supplementary motor area, dorsolateral prefrontal cortex) increased. We concluded that large sways during quiet standing represent self-generated functional behavior aiming at releasing skin compression to reactivate mechanoreceptors. Such balance motor commands create sensory reafference that help control postural sway.
Considerations for a sustainability framework for neglected tropical diseases programming
Authors: Espinal Marcos , Kruk Margaret E , Mohamed Madame Cisse Mariama , Wainwright Emily
Published: December 2020

Addressing neglected tropical diseases (NTDs) is critical to achieving universal healthcare and the Sustainable Development Goals. Significant strides are being made to expand NTD programs, but these programs still need to be fully incorporated into national governance, financing, planning and service delivery structures. The World Health Organization has developed a sustainability framework that calls for governments to create a vision and a multisector plan to achieving sustainability. Several critical factors need to be considered to avoid undermining progress toward disease elimination and control targets, while merging program components into national systems.
Efficacy of Hypochlorite as a Disinfestant Against Fungal Pathogens in Agricultural and Horticultural Plant Production: A Systematic Review and Meta-Analysis
Authors: Copes Warren E. , Ojiambo Peter S.
Published: December 2020

Hypochlorite is often used as a disinfestant of fungal pathogens in a range of agricultural and horticultural settings. However, reports of its effectiveness are variable across studies and it is unclear what factors could potentially influence the reported estimates of its efficacy. A systematic review and meta-analysis was conducted to assess the efficacy of hypochlorite against fungal pathogens and explore factors that may explain the observed heterogeneity in estimates of efficacy. Standardized mean effect size, Hedges’ g, was calculated for each of the 109 selected studies, published from 1972 to 2019, that met the criteria defined for the systematic review. A random-effects model was used to estimate the overall mean effect size ([Formula: see text]) and determine the heterogeneity in g among studies. Hypochlorite resulted in a significant (P < 0.001) reduction in either disease intensity or propagule viability with [Formula: see text]= 2.25, suggesting a large overall effect. However, 95% prediction intervals ranged from −0.18 to 4.68, indicating that hypochlorite could be ineffective against some fungi or when targeting some substrate materials. An estimate of the within-study variability, τ2, was 1.48 and the proportion of heterogeneity in g among studies due to true effects was 71.5%. Inclusion of categorical moderator variables in the random effects model showed that hypochlorite treatments were significantly (P < 0.0062) more effective when used to disinfest spores in an aqueous solution ([Formula: see text]= 4.58) than when used on plastic ([Formula: see text]= 2.13), plant ([Formula: see text]= 2.13), and wood ([Formula: see text]= 0.79). Similarly, hypochlorite treatments were significantly (P < 0.0083) more effective in disinfesting fungal propagules of Thielaviopsis spp. ([Formula: see text]= 2.51) than those of Verticillium spp. ([Formula: see text]= 1.21). A meta-regression indicated that the effect of dose (β = −3.54; P = 0.0398) and contact time (β = −0.05; P = 0.0001) on [Formula: see text] were highly significant. Further, [Formula: see text]was significantly affected by the dose × time interaction (β = −0.017; P = 0.0269). In the meta-regression models, dose and time explained 0 and 16% of the variance in true effects, respectively. In meta-regression models with a continuous variable of dose or time, a categorical variable of target or genus and their interaction term, genus and target explained an additional 7 to 19% of the variance in true effects. These results show that although the current recommended dose and contact time for commercial bleach products are expected to result in effective disinfestation, the target material and genera of the fungal pathogen of interest will likely influence their efficacy.
Ultrasound for the Pregnant Person With Diabesity
Authors: MEI JENNY Y. , HAN CHRISTINA S.
Published: December 2020

Diabetes and obesity increase the risk of congenital anomalies, but the putative mechanisms of this increased risk are not fully elucidated. In this chapter, we delve into sonographic characteristics associated with diabetes and obesity, including fetal structural anomalies, functional cardiac alterations, and growth abnormalities. We will also discuss the technical challenges of imaging in the patient with diabesity and propose methodologies for optimizing imaging. Lastly, we will address the prevention of workplace-associated musculoskeletal disorders injury for sonographers.
Review of transapical off-pump mitral valve intervention with NeoChord implantation
Authors: Fatehi Hassanabad Ali , Kent William D.T. , Adams Corey
Published: December 2020

Purpose of review

Mitral valve repair surgery has recently shifted from resection-based techniques to leaflet sparing approaches using synthetic neochordae. This has facilitated the growth of a new strategy of transapical off-pump mitral valve intervention with neochord implantation.

Recent findings

Minimally invasive approaches for mitral valve repair with robotic or video-assisted mini-right anterolateral thoracotomy have been developed to mitigate the morbidity associated with conventional median sternotomy. Recently, an alternative, less invasive surgical strategy has emerged. This transapical off-pump technique employs the NeoChord DS1000 (NeoChord, Inc., Minneapolis, MN, USA) system to achieve repair with neochordae via a left minithoracotomy incision. With appropriate patient selection, advanced cardiac imaging, and training in device deployment are important for procedural success.

Early results suggest that transapical off-pump mitral valve intervention with NeoChord implantation is a safe procedure with favorable outcomes for select patients with degenerative mitral regurgitation. Continued experience and clinical trials will assess the potential of this minimally invasive strategy, but this technique is likely to become part of the surgical repertoire for managing chronic degenerative mitral valve disease.
Novel technologies in the management of heart failure with preserved ejection fraction: a promise during the time of disappointment from pharmacological approaches?
Authors: Nachman Dean , Asleh Rabea , Amir Offer
Published: December 2020

Purpose of review

Despite numerous attempts, none of a wide variety of tested drugs achieved meaningful improvement in the outcomes of heart failure with preserved ejection fraction (HFpEF), making new therapeutic strategies a major unmet medical need. The medical device industry embraced the challenge, developing novel technologies directed to face specific aspects of the pathophysiology of HFpEF. This review focuses on some of the most promising technologies attaining meaningful clinical progress recently in the field of HFpEF therapy.

Recent findings

Implantable pulmonary artery pressure, monitoring for optimization of medical therapy, proved to be beneficial in heart failure admissions in a large postmarketing clinical study. Investigational devices, such as inter-atrial shunts and transvenous phrenic nerve stimulators for the treatment of central sleep apnea with Cheyne–Stokes breathing, are currently being evaluated in HFpEF cohorts in recent trials.

Device-based therapies for HFpEF demonstrated encouraging safety and efficacy results in various stages of the disease. Further efforts are needed to ensure that these devices will reach clinical use and contribute to the management of HFpEF patients.
Arterial hypertension and morphologic abnormalities of cardiac chambers: results from the Copenhagen General Population Study
Authors: Fuchs Andreas , Kühl J. Tobias , Sigvardsen Per E. , Knudsen Andreas D. , Nilsson Emma Julia P. , Stisen Zara R. , Jeppesen Jørgen L. , Nordestgaard Børge G. , Køber Lars V. , Kofoed Klaus F.
Published: December 2020

Objectives:

In patients with arterial hypertension (AH), hypertension-mediated organ damage may be manifested by cardiac chamber enlargement and/or remodeling. Cardiac computed tomography imaging has emerged as an important method for morphological assessment of cardiac chambers. We tested the hypothesis that prevalence of cardiac chamber abnormalities is specifically related to clinical categories of AH in the general population.

Methods:

We studied 4747 individuals, mean age was 60 years (range: 40–93), 46% were men, undergoing 320-detector computed tomography in the Copenhagen General Population Study. Clinical categories of AH were: normotensive (n = 2484), untreated hypertensive (n = 1301), treated controlled hypertensive (n = 412) and treated uncontrolled hypertensive (n = 550). Chamber abnormalities in the form of left ventricular (LV) concentric remodeling, LV eccentric hypertrophy, LV concentric hypertrophy or left atrial enlargement were assessed, in addition to LV or right ventricular enlargement.

Results:

Chamber abnormalities were present in 23% of all individuals. Combined LV and left atrial abnormalities were rare (<2%). LV concentric remodeling (10%) was the most prevalent abnormality, and most commonly found in individuals with treated hypertension. LV and right ventricular enlargements were unrelated to hypertension. The highest frequencies of chamber abnormalities were found in individuals of elevated blood pressure (BP) with (40%) or without (32%) treatment, as opposed to individuals of normal BP with (27%) or without (14%) treatment, P less than 0.0001.

Conclusion:

In a general population cohort, untreated or inadequately treated AH was associated with the highest prevalence of cardiac chamber enlargement and remodeling. These observations suggest a strong link between elevated BPs and development of hypertension-mediated organ damage.
Why Does Hip Arthroscopy Fail? Indications and PEARLS for Revision Success
Authors: Ross James R. , Clohisy John C. , Bedi Asheesh , Zaltz Ira
Published: December 2020

The surgical treatment of femoroacetabular impingement has been shown to have successful early and mid-term clinical outcomes. Despite these favorable clinical outcomes that have been published in the literature, there is a subgroup of patients that present with continued or recurrent symptoms after surgical treatment. Not only has there been an increase in the number of hip arthroscopy procedures, but also there has been a corresponding increase in the number of revision hip arthroscopy and hip preservation surgeries. Previous studies have reported residual deformity to be the most common reason for revision hip arthroscopy. However, chondral, labral, and capsular considerations also are important when addressing patients not only in the primary but also, the revision setting. In this review, we outline the evaluation and treatment of the patient that presents with continued hip and groin pain after undergoing a hip.
A Case Report of Ependymoma in a Pregnant Client With Thoracic and Lumbopelvic Pain
Authors: Fischer Melissa , Boissonnault Jill , Colquitt Jose
Published: December 2020

Background:

Literature exists for both management of lumbopelvic pain during pregnancy and physical therapy medical screening for cancer. However, little has been written on spinal cord tumors masked by pregnancy-related thoracic or lumbopelvic pain. This case presents management of a client with pregnancy-related back pain complaints and also highlights how a spinal tumor can mimic many common pregnancy symptoms.

Case Description:

This case describes the physical therapy (PT) management of a pregnant client presenting with thoracic and lumbopelvic pain. Initially, treatment focused on core and pelvic girdle strengthening along with postural retraining and stretching. The client attended a total of 5 PT visits after which point progressive neurological symptoms developed. Medical examination, including imaging, revealed arachnoid cysts secondary to an ependymoma, a rare spinal tumor.

Outcomes:

The client delivered a viable preterm infant and passed away 2 months after her initial diagnosis secondary to the malignancy.

Discussion:

This case describes how systemic disease may present as pregnancy-related musculoskeletal dysfunction. Recognition of non–mechanical-based symptom complaints may assist in the detection of occult pathology. There are, however, rare occurrences when red flag signs appear only in the final stages of the disease with irreversible tumor expansion and metastases, ultimately leading to death.

Informed Consent:

This case is unique as the individual under discussion is deceased and therefore unable to provide consent.
Unprecedented: the toxic synergism of Covid-19 and climate change
Authors: Joshi Manish , Caceres Jose , Ko Steven , Epps Sarenthia M. , Bartter Thaddeus
Published: December 2020

Purpose of review

To review and compare the constellations of causes and consequences of the two current pandemics, Covid-19 and climate change.

Recent findings

There has been a transient counterbalancing, in which the response to Covid-19 has briefly mitigated pollution and greenhouse gasses. This divergence belies multiple commonalities of cause and effect.

The convergence of these two pandemics is unprecedented. Although at first glance, they appear to be completely unrelated, they share striking commonalities. Both are caused by human behaviors, and some of those behaviors contribute to both pandemics at the same time. Both illustrate the fact that isolation is not an option; these are global issues that inescapably affect all persons and all nations. Both incur prodigious current and anticipated costs. Both have similar societal impacts, and disproportionately harm those with lesser resources, widening the gap between the ‘haves and the have-nots.’ One can only hope that the devastation caused by these unprecedented pandemics will lead to increased awareness of how human beings have helped to create them and how our responses can and will shape our future.