bluuebunny/crossref_metadata_2025 huggingface dataset:
ESTIMATES OF PATIENT DOSES AND KERMA-AREA PRODUCT MONITORING IN DIGITAL RADIOGRAPHY
Authors: Kaushik Chanchal , Sandhu Inderjeet Singh , Srivastava A K
Published: April 2020

The application of the kerma-area product (PKA) meter is increased rapidly in dosimetry. This study presents measurements of PKA in adherence to the International Atomic Energy Agency protocol for 300 adult patients in digital radiographic procedures. Effective doses (ED) were calculated from PKA measurements and conversion coefficients (E-103/PKA) obtained from the International Commission on radiological protection 103. In skull posteroanterior (PA), skull lateral (LAT), cervical spine anteroposterior (AP), cervical spine LAT, chest PA, abdomen AP, lumbar spine AP, pelvis AP and lumbar spine LAT, the third-quartile PKA values were found to be 0.2, 0.28, 0.33, 0.19, 0.26, 0.95, 0.93, 0.96 and 3.15 Gycm2, and estimated mean EDs were 0.005, 0.008, 0.056, 0.021, 0.037, 0.146, 0.165, 0.097 and 0.258 mSv, respectively. The third-quartile PKA values were suggested as local diagnostic reference levels (LDRLs). Results were compared with the diagnostic reference levels (DRLs) of the UK, the European Commission, previously published LDRLs in Greece and China by Metaxas et al. and Zhang and Chu, respectively. The PKA (third-quartile) value for cervical spine AP was 120% higher than UK 2010 DRLs, lumbar spine LAT was 123% higher than LDRLs given by Metaxas et al. and chest PA was 160% higher than UK 2010 DRLs and 225% higher than Metaxas et al. provided LDRLs. The PKA results were lower than the UK, and two studies in Greece by Metaxas et al. except for chest PA, cervical spine AP and lumbar spine LAT showed the need for further optimization. The LDRLs reported in this study may further contribute to establishing future national DRLs.
Genome Resources of Three West African Strains of Pantoea ananatis Causing Bacterial Blight and Grain Discoloration of Rice
Authors: Kini Kossi , Lefeuvre Pierre , Poulin Lucie , Silué Drissa , Koebnik Ralf
Published: April 2020

Members of the genus Pantoea have been reported as pathogens for many economically important crops, including rice. Little is known about their host−pathogen interactions at the molecular level and the lack of comprehensive genome data impedes targeted breeding strategies toward resistant rice cultivars. Here, we describe the structural and functional annotation of the draft genome sequences of three rice-pathogenic Pantoea ananatis strains, ARC272, ARC310, and ARC311, which were isolated in Burkina Faso, Togo, and Benin, respectively. The genome sequences of these strains will help in developing molecular diagnostic tools and provide new insight into common traits that may enable P. ananatis to infect rice.
Precision Surgery for Placenta Previa Complicated with Placenta Percreta
Authors: Chen Juan-Juan , Yu Lin , Su Chun-Hong , Zhang Chun-Fang , Chen Yan-Hong , Zhou Yan-Mei , He Wen-Jun , He Fang , Song Ting , Wang Shou-Ping , Su Zhi-Yuan , Jiang Qing-Ping , Zou Zi-Hao , Yu Bin , Shen Xiao-Ya , Guan Xiao-Ming , Chen Dun-Jin
Published: April 2020

Objectives:

To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta (PPWPP).

Methods:

Patients diagnosed with PPWPP were assessed for pregnancy termination at 34–36 weeks of gestation. During the operation, we performed circular resection of the uterine tissue at the placental attachment part. Then the characteristics of the operation and the follow-ups were recorded.

Results:

During the operation, the vital signs were stable. The mean intraoperative blood loss, packed red blood cells units transfusion, fresh frozen plasma transfusion, and operation time were 2140 mL, 6 U, 440 mL, and 179.8 minutes, respectively. There was no bowel, ureter, or bladder injury. And there was no patient transferred to the ICU after operation. The mean postoperative blood loss was 458.6 mL. There was no fever, infection, intestinal obstruction, or other complications after operation during the hospitalization. The shape and the blood flow of the uterus were normal. After the patients were discharged, one had developed cesarean scar diverticulum. The mean lochia duration was 30 days. The menstrual cycle and volume were as before. The shape and the blood flow of the uterus and the ovarian were normal.

Conclusions:

The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP. It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.
Diagnosis of Gestational Diabetes Mellitus in China: Perspective, Progress and Prospects
Authors: Juan Juan , Yang Hui-Xia , Su Ri-Na , Kapur Anil
Published: April 2020

Gestational diabetes mellitus (GDM) is one of the most common complications during pregnancy. Despite extensive research in the past 50 years, the universal approach to diagnose GDM continues to be debated around the world and clinical practices vary from country to country and unit to unit within the same country. As new evidence emerges, the diagnostic criteria of GDM has continuously evolved since the 1990s. In 2011, after the announcement of the landmark International Association of Diabetes and Pregnancy Study Groups diagnostic criteria, many international organizations have accepted and advocated its use. However, there are differences in glucose metabolism among different ethnic groups, and the Hyperglycemia and Adverse Pregnancy Outcomes (HAPO) Study lacked data from mainland China. Whether the criteria developed based on the HAPO study are applicable to China remains to be further validated. In this current review, we will discuss the evolution of GDM diagnostic criteria and guidelines in China, and compare them to that in western countries to figure out the proper recommendations on the diagnosis of GDM among Chinese women.
The Management of Placenta Accrete Spectrum—Burning Questions to Be Solved
Authors: Ma Jing-Mei , Yang Hui-Xia
Published: April 2020

Placenta accreta spectrum disorders resulting in a series of maternal morbidity and mortality has raised attention worldwide including China. There is an urgent need to confront with the dilemma of less evidenced-based recommendation on management, especially the key issues of controversial topics, including accurate prediction, conservative management with adjunct approaches. Chinese academic society along with international exports are on the way to pursue sensible solutions.
Neurodevelopmental Outcome After Fetoscopic Laser Surgery for Twin-twin Transfusion Syndrome: A Systematic Review of Follow-up Studies from the Last Decade
Authors: Knijnenburg Patricia J.C. , Lopriore Enrico , Oepkes Dick , Vreeken Nienke , Tan Ratna N.G.B. , Rijken Monique , van Klink Jeanine M.M.
Published: April 2020

Objective:

To review the literature on long-term neurodevelopmental outcome after fetoscopic laser surgery for twin-twin transfusion syndrome (TTTS).

Methods:

A literature search in PubMed, Embase, Emcare, Web of Science, Cochrane library, and Academic Search Premier was performed. Inclusion criteria were studies between 2009 and 2019 in TTTS-survivors treated with fetoscopic laser surgery and followed-up after the neonatal period with cognitive developmental tests and neurologic exams. Exclusion criteria were non-English articles and reviews, case reports, letters, and guidelines.

Results:

Nineteen articles were included. Long-term severe neurodevelopmental impairment (NDI) was reported by seven and ranged from 4.0% to 18.0% with a mean of 9.7% (95% confidence interval (CI): 7.8–11.5). The prevalence of cerebral palsy ranged from 1.6% to 18.2%, with a mean of 5.1% (95%CI: 4.1–6.2). The mean prevalence of minor impairment was 13.7% (95%CI: 11.4–16.0). However, only 78.9% (15/19) studies used a validated neurodevelopmental test. As studies lack uniform definitions of primary outcome, timing of follow-up, inclusion criteria, and methods, adequate comparison is hampered.

Conclusion:

The prevalence of severe NDI and cerebral palsy after fetoscopic laser surgery for TTTS in the last decade remains stable around 9.7% and 5.1%, respectively. International agreements on primary outcomes, methods, and follow-up are necessary to improve the knowledge of NDI in TTTS-survivors.
Prior Preterm Birth and Birthweight Below the 5th Percentile are Independent Risk Factors for Recurrence of a Small for Gestational Age Neonate
Authors: Svorai Mor , Aricha Barak , Erez Offer
Published: April 2020

Objective:

This study aimed to determine: (1) whether recurrent deliveries of a small for gestational age (SGA) neonate are associated with increased obstetrical or neonatal complications; (2) whether the risk factors that can predict small for gestational age (SGA) recurrence.

Methods:

This study was based on Soroka Medical Center's Obstetrics electronic database. The database consisted of 109 022 women who had 320 932 deliveries between the year 1988–2014.The study cohort included 6.8% (7 368/109 022) of these patients who gave birth to a singleton SGA neonate on their first delivery and had more than one delivery. The study population was divided into two groups according to the outcome of the subsequent delivery: (1) women with sporadic SGA who delivered a non-SGA neonate (n = 5 416); (2) women with recurrent SGA (n = 1 952). SGA defined as birthweight <10th percentile. Maternal and neonatal complications were compared between the two groups. Logistic regression was used to determine independent risk factors for SGA recurrence.

Results:

The prevalence of birthweight <5th percentile was higher among the recurrent SGA group in the first delivery (P < 0.001). Bedouin ethnicity was more prevalent in the recurrent SGA group (P < 0.001). The rate of preterm delivery was higher in the first delivery of the recurrent SGA group (P = 0.015). The sporadic SGA group had a higher rate of perinatal mortality during the first pregnancy (P = 0.017). The rate of severe hypertension (P = 0.005), polyhydramnios, meconium-stained amniotic fluid, nonreassuring fetal heart rate and total perinatal mortality (P < 0.001) were higher in the second delivery of the recurrent SGA group. In a logistic regression model, preterm delivery and birthweight <5th percentile at the first delivery was found to be independent risk factors for recurrence of an SGA neonate in the subsequent birth (relative risks:1.530, confidence interval: 1.249–1.875; relative risks:1.826, confidence interval: 1.641–2.030, respectively).

Conclusion:

Women with recurrent SGA neonates have specific clinical characteristics. Among women who deliver an SGA neonate, preterm delivery, and birthweight <5th percentile are independent predictors for its recurrence.
Current Practice and Protocols: Endoscopic Laser Therapy for Twin-Twin Transfusion Syndrome
Authors: Pandya Viral M. , Stirnemann Julien , Colmant Claire , Ville Yves
Published: April 2020

The pathophysiology of twin-to-twin transfusion syndrome (TTTS) is complex, and its understanding has evolved along with the evolution and revolution of fetal diagnostic and therapeutic techniques. Over the last few decades, several therapeutic interventions have been researched for improving the outcomes in TTTS. We present a summary of the current protocols for surveillance, diagnosis, and staging of TTTS in monochorionic pregnancies. We also describe in detail the technique for treatment of TTTS by endoscopic laser photocoagulation.
The Relationship Between the Expression of Resistin and Apoptosis Factors in Placenta and the Pathogenesis of Gestational Diabetes Mellitus
Authors: Yu Jun , Su Xiao-Ling , Jia Jing , Zeng Yu , Zhang Jing-Yi , Wang Shao-Shuai , Feng Ling
Published: April 2020

Objective:

To detect the expression of caspase-3, baculoviral inhibitor of apoptosis repeat containing 5 (BIRC-5), vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), and the concentration of resistin protein in placental of patients with gestational diabetes mellitus (GDM) and normal pregnant women, and to explore its correlation with the pathogenesis of GDM and its significance.

Methods:

This study includes 30 pregnant women who chose cesarean section at Tongji Hospital of Tongji Medical College during May 2013 to February 2014: 15 GDM patients and 15 normal glucose tolerance patients. The expression of caspase-3, VEGF, HIF, and BIRC-5 in placenta of 15 patients with GDM (GDM group) and 15 normal late pregnancy (control group) was detected by real-time fluorescence quantitative polymerase chain reaction. The concentration of resistin protein in the placenta was detected by enzyme-linked immunosorbent assay.

Results:

Compared with the control group, the expression of caspase-3, HIF, VEGF, resistin in placenta of GDM group increased significantly (P < 0.05); the expression of BIRC-5 in placenta of GDM group decreased significantly (P < 0.05).

Conclusion:

The expression of caspase-3, BIRC-5, VEGF, HIF, and resistin in placenta of GDM patients and normal pregnant women are significantly different, which may be involved in the pathogenesis of GDM disease.
Ultrasound Screening of Fetal Anomalies at 11–13+6 Weeks
Authors: Ding Wen-Ping , Li Nan , Chen Min
Published: April 2020

During the past decades, early fetal ultrasound and diagnosis have increasingly gained attention in pregnancy care with the development of high-frequency transducers, which make it possible to obtain detailed images of the early fetus and its organs, and thus move part of the anatomy and anomaly scan from the second to the first-trimester. By transabdominal sonography or transvaginal sonography, or a combination of both approaches, it is now able to diagnose a wide variety of fetal abnormalities at 11–13+6 weeks.
Challenges for Obstetricians and the Countermeasures of COVID-19 Epidemic
Authors: Zhao Yin , Zou Li , Dong Ming-Hui , Liu Xiao-Xia , Liu Ya-Lan , Zhu Jian-Wen , Luo Qing-Qing , Gao Hui
Published: April 2020

Since the outbreak of the novel coronavirus in Wuhan, China, as obstetricians, we also face great challenges. We need to identify pregnant patients with 2019 coronavirus disease infection timely, and give them appropriate treatment in order to obtain a good maternal and infant prognosis. Here, we would like to share a case and provide some suggestions on how to screen, diagnose and treat pregnant women with 2019 coronavirus disease infection during the outbreak.
A Severe Seasonal Influenza Epidemic During 2017–2018 in China After the 2009 Pandemic Influenza: A Modeling Study
Authors: Fu Xiaofang , Zhou Yuqing , Wu Jie , Liu Xiaoxiao , Ding Cheng , Huang Chenyang , Deng Min , Shi Dongyan , Wang Chencheng , Xu Kaijin , Ren Jingjing , Ruan Bing , Li Lanjuan , Yang Shigui
Published: April 2020

Influenza viruses continue to cause epidemics worldwide every year. However, due to the lack of an effective assessment for the severity of influenza epidemics, it was extremely difficult to take preventative measures. Data were extracted from infectious diseases reports from 2011–2018. Joinpoint regression model and susceptible-exposed-infectious-recovered model were built to understand the characteristics and processes of the epidemic. The reported incidence of influenza was 1,913,698 from January 2011 to February 2018, with an average-yearly-reported-incidence-rate of 19.21 per 100,000. However, there had been a substantial nationwide epidemic of influenza after September 2017, when the average yearly reported incidence rate was 87.29 per 100,000 and an annual percentage change of 48.1%. The hemagglutinin genes of most influenza A (H1N1 and H3N2) viruses from the period of the epidemic had lower homology to those before August 2017. All the hemagglutinin of the recommended A (H3N2, H1N1) and B (Victoria) viruses for vaccines 2017/2018 had low matches with the epidemic viruses. The basic reproduction number was 1.53. The vaccination benefit was linearly related to vaccination coverage, while the quarantine measure had only significantly benefited when over 60% of the quarantined population. The most severe epidemic of influenza in China since 2011 occurred during the period from September 2017 to February 2018. Compared to quarantine, influenza vaccination is more effective way to prevent influenza, and strategies to increase vaccination coverage should be taken for the prevention of severe epidemics of influenza.
Multi-omic Microbiome Profiles in the Female Reproductive Tract in Early Pregnancy
Authors: Jean Sophonie , Huang Bernice , Parikh Hardik I. , Edwards David J. , Brooks J. Paul , Kumar Naren Gajenthra , Sheth Nihar U. , Koparde Vishal , Smirnova Ekaterina , Huzurbazar Snehalata , Girerd Philippe H. , Wijesinghe Dayanjan S. , Strauss Jerome F. , Serrano Myrna G. , Fettweis Jennifer M. , Jefferson Kimberly K. , Buck Gregory A.
Published: April 2020

The vaginal microbiome likely influences host signaling compounds within the reproductive tract, including pro-inflammatory signals, which may play an important role during pregnancy. Vaginal lactobacilli are associated with positive pregnancy outcome, whereas bacterial vaginosis, a dysbiosis of the vaginal microbiome, is associated with an increased risk of adverse pregnancy outcomes including preterm birth. If the host response could be predicted based on the taxonomic composition of the vaginal microbiome, particularly early in pregnancy, then those predictions could potentially be used to personalize intervention methods to reduce preterm birth and other adverse events. In this proof of principle study, we apply multivariate strategies to analyze 16S rRNA-based taxonomic surveys in conjunction with targeted immuno-proteomic and lipidomic data from vaginal samples from 58 women enrolled in the Multi-Omic Microbiome Study-Pregnancy Initiative during early pregnancy. Relationships between the vaginal microbiome and the vaginal lipidome have not been previously reported. Results from this study reveal significant multiple pairwise associations between microbial taxa, specific eicosanoids and sphingomyelins, and cytokines. While the biologic significance of these associations is not yet known, these results support the utility of such multi-omic approaches as a means to predict the impact of the microbiome on the host.
Clinical and Epidemiological Characteristics of Vitiligo at Different Ages: An Analysis of 571 Patients in Northwest China
Authors: Zhang Jing-Zhan , Luo Dong , An Cai-Xia , Xu Chen , Zhao Ya-Nan , Li Jin-Xi , Yu Shi-Rong , Zhang De-Zhi , Kang Xiao-Jing
Published: April 2020

Objective:

This study was performed to elucidate the clinical and epidemiological characteristics of vitiligo patients of different ages in Northwest China.

Methods:

We retrospectively reviewed the case records and questionnaires of all patients diagnosed with vitiligo, who visited People's Hospital of Xinjiang Uygur Autonomous Region from May 2016 to December 2017. The clinical and epidemiological characteristics of these patients were analyzed by Pearson's χ2 test and Fisher's exact test.

Results:

In total, we collected data of 571 vitiligo patients with age of 32.9 ± 16.4 years. The prevalence of segmental vitiligo in children and adolescents ≤19 years old (24/175[13.7%]) was higher than that in adults aged from 20-59 years (23/370[6.2%]) and advanced patients aged ≥60 years (1/26[3.8%]) (P = 0.020). The prevalence of progressive vitiligo was higher in children and adolescents ≤19 years (72/175[41.1%]) and adults from 20–59 years (141/370[38.1%) than in patients ≥60 years (5/26[19.2%]) (P = 0.063). Children and adolescents ≤19 years with vitiligo had a higher rate of a family history of vitiligo (20/175[11.4%]) than adults (20/370[5.4%]) and advanced age (1/26[3.8%]) (P = 0.031).

Conclusions:

This study provides clinical evidence that vitiligo at different ages has different characteristics, mainly regarding an increased incidence of segmental vitiligo, a higher prevalence of atopic dermatitis and halo nevus, and a more common positive family history among children and adolescent patients.
Chinese Expert Consensus on the Diagnosis and Management of Food Allergy in Children With Atopic Dermatitis#
Authors: Wang Hua , Ma Lin , Tan Qi , Chen Ji , Li Ping , Tang Jian-Ping , Wang Liu-Hui , Guo Yi-Feng , Han Xiu-Ping , Xu Zi-Gang , Luo Xiao-Yan , Guo Yan-Ping , Wei Feng-Lei
Published: April 2020

The diagnosis of food allergy in clinical practice has not been standardized, and food allergy is overdiagnosed in patients with atopic dermatitis (AD). This overdiagnosis of food allergy leads to unnecessary elimination diets that may exert potential adverse effects on the health of children with AD. Unlike classic IgE-mediated food allergy, food allergy in patients with AD may manifest as non-eczematous reactions, isolated eczematous reactions, or a combination of these reactions. The diagnosis of food allergy in children with AD should be made based on a thorough clinical history (detailed allergic history and feeding history), clinical manifestations, and laboratory workup including skin prick testing, serum specific IgE measurement, atopy patch testing, and oral food challenges. Once an underlying food allergy is confirmed in a patient with AD, comprehensive management is generally recommended. Avoidance of the food allergen is the main treatment approach, but there is a need for regular clinical follow-up, including evaluation of the nutritional status and supervision of growth and development. Multidisciplinary cooperation between dermatologists, nutritionists, and pediatricians is required.
Smart Pooled sample Testing for COVID-19: A Possible Solution for Sparsity of Test Kits
Authors: Bukhari Syed Usama Khalid , Khalid Syed Safwan , Syed Asmara , Shah Syed Sajid Hussain
Published: April 2020

There is an exponential growth of COVID-19. The adaptation of preventive measures to limit the spread of infection among the people is the best solution to this health issue. The identification of infected cases and their isolation from healthy people is one of the most important preventive measures. In this regard, screening of the samples from a large number of people is needed which requires a lot of reagent kits for the detection of SARS-CoV-2. The use of smart pooled sample testing with the help of algorithms may be a quite useful strategy in the current prevailing scenario of the COVID-19 pandemic. With the help of this strategy, the optimum number of samples to be pooled for a single test may be determined based on the total positivity rate of the particular community.
Cytotoxicity evaluation of chloroquine and hydroxychloroquine in multiple cell lines and tissues by dynamic imaging system and PBPK model
Authors: Yang Jianling , Wu Meng , Liu Xu , Liu Qi , Guo Zhengyang , Yao Xueting , Liu Yang , Cui Cheng , Li Haiyan , Song Chunli , Liu Dongyang , Xue Lixiang
Published: April 2020

Chloroquine (CQ) and hydroxychloroquine (HCQ) have been used in treating COVID-19 patients recently. However, both drugs have some contradictions and rare but severe side effects, such as hypoglycemia, retina and cardiac toxicity. To further uncover the toxicity profile of CQ and HCQ in different tissues, we evaluated the cytotoxicity of them in 8 cell lines, and further adopted the physiologically-based pharmacokinetic models (PBPK) to predict the tissue risk respectively. Retina, myocardium, lung, liver, kidney, vascular endothelium and intestinal epithelium originated cells were included in the toxicity evaluation of CQ and HCQ respectively. The proliferation pattern was monitored in 0-72 hours by IncuCyte S3, which could perform long-term continuous image and video of cells upon CQ or HCQ treatment. CC50 and the ratio of tissue trough concentrations to CC50 (RTTCC) were brought into predicted toxicity profiles. The CC50 at 24 h, 48 h, 72 h of CQ and HCQ decreased in the time-dependent manner, which indicates the accumulative cytotoxic effect. HCQ was found to be less toxic in 7 cell types except cardiomyocytes H9C2 cells (CC50-48 h=29.55 μM; CC50-72 h=15.26 μM). In addition, RTTCCis significant higher in CQ treatment group compared to HCQ group, which indicates that relative safety of HCQ. Both CQ and HCQ have certain cytotoxicity in time dependent manner which indicates the necessity of short period administration clinically. HCQ has the less impact in 7 cell lines proliferation and less toxicity compared to CQ in heart, liver, kidney and lung.
Organising outpatient dialysis services during the COVID-19 pandemic. A simulation and mathematical modelling study
Authors: Allen Michael , Bhanji Amir , Willemsen Jonas , Dudfield Steven , Logan Stuart , Monks Thomas
Published: April 2020

Background

This study presents two simulation modelling tools to support the organisation of networks of dialysis services during the COVID-19 pandemic. These tools were developed to support renal services in the South of England (the Wessex region caring for 650 patients), but are applicable elsewhere.

Methods

A discrete-event simulation was used to model a worst case spread of COVID-19 (80% infected over three months), to stress-test plans for dialysis provision throughout the COVID-19 outbreak. We investigated the ability of the system to manage the mix of COVID-19 positive and negative patients, and examined the likely effects on patients, outpatient workloads across all units, and inpatient workload at the centralised COVID-positive inpatient unit. A second Monte-Carlo vehicle routing model estimated the feasibility of patient transport plans and relaxing the current policy of single COVID-19 patient transport to allow up to four infected patients at a time.

Results

If current outpatient capacity is maintained there is sufficient capacity in the South of England to keep COVID-19 negative/recovered and positive patients in separate sessions, but rapid reallocation of patients may be needed (as sessions are cleared of negative/recovered patients to enable that session to be dedicated to positive patients). Outpatient COVID-19 cases will spillover to a secondary site while other sites will experience a reduction in workload. The primary site chosen to manage infected patients will experience a significant increase in outpatients and in-patients. At the peak of infection, it is predicted there will be up to 140 COVID-19 positive patients with 40 to 90 of these as inpatients, likely breaching current inpatient capacity (and possibly leading to a need for temporary movement of dialysis equipment).

Patient transport services will also come under considerable pressure. If patient transport operates on a policy of one positive patient at a time, and two-way transport is needed, a likely scenario estimates 80 ambulance drive time hours per day (not including fixed drop-off and ambulance cleaning times). Relaxing policies on individual patient transport to 2-4 patients per trip can save 40-60% of drive time. In mixed urban/rural geographies steps may need to be taken to temporarily accommodate renal COVID-19 positive patients closer to treatment facilities.

Conclusions

Discrete-event simulation simulation and Monte-Carlo vehicle routing model provides a useful method for stress-testing inpatient and outpatient clinical systems prior to peak COVID-19 workloads.
LEVEL OF FOOD CONSUMPTION SCORE AND ASSOCIATED FACTORS AMONG PREGNANT WOMEN AT SHEGAW MOTTA HOSPITAL, NORTHWEST ETHIOPIA
Authors: Birhan Mehariw , Worku Tsegahun , Taddele Mekuanint , Aderaw Zewdie
Published: April 2020

Background

All populations are at risk for poor food consumption, but pregnant women are the most vulnerable groups for poor food consumption particularly for those in resource limiting settings like Ethiopia. However, there is a lack of literature for food consumption score in these population groups and study area. Therefore, the results of this study may give information for local decision makers.

Objective

To assess level of food consumption score and associated factors among pregnant women attending antenatal service at Shegaw Motta Hospital, Northwest Ethiopia, 2018.

Method

Institution based cross-sectional study design was conducted among 422 pregnant women attending antenatal care service at Shegaw Motta Hospital from February 23, 2018-April 3, 2018. A systematic random sampling technique was used to select study participants. Data were collected using interviewer administered structured questionnaire and coded and entered to Epi-Data version 3.1 then exported to SPSS version 23 for analysis. Binary Logistic Regression was used for analysis.

Result

A total of 422 pregnant women with response a rate of 100% participated in the study. The overall food consumption score among pregnant women was found to be eight of study participants [1.9% (95% CI: 0.7, 3.3)] reported that their food consumption score were poor, seventy of them [16.6% (95% CI: 13.0, 20.4)] were borderline and the remaining 81.5 % (95% CI: 77.5, 85.1) of them had acceptable food consumption score. Residence, being rural or urban [AOR=4.594(95% CI: 1.871, 11.283)], religion status, being an Orthodox or others [AOR= 0.073(95% CI: 0.021, 0.254)], were factors associated with food consumption score.

Conclusion and recommendation

Food consumption scores among pregnant women was found to be highly unacceptable. Residence and religion were factors associated with food consumption score. Therefore, appropriate nutrition education should be given.
Nowcasting and Forecasting the Spread of COVID-19 in Iran
Authors: Masjedi Hamidreza , Rabajante Jomar F. , Bahranizadd Fatemeh , Zare Mohammad Hosein
Published: April 2020

Introduction

As of early December 2019, COVID-19, a disease induced by SARS-COV-2, has started spreading, originated in Wuhan, China, and now on, have infected more than 2 million individuals throughout the world.

Purpose

This study aimed to nowcast the COVID-19 outbreak throughout Iran and to forecast the trends of the disease spreading in the upcoming month.

Methods

The cumulative incidence and fatality data were extracted from official reports of the National Ministry of Health and Medical Educations of Iran. To formulate the outbreak dynamics, six phenomenological models, as well as a modified mechanistic Susciptible-Exposed-Infectious-Recovered (SEIR) model, were implemented. The models were calibrated with the integrated data, and trends of the epidemic in Iran was then forecasted for the next month.

Results

The final outbreak size calculated by the best fitted phenomenological models was estimated to be in the range of 68,486 to 118,923 cases; however, the calibrated SEIR model estimated that the outbreak would rage again, starting from April 26. Moreover, projected by the mechanistic model, approximately half of the infections have undergone undetected.

Conclusion

Although the advanced phenomenological models perfectly fitted the data, they are incapable of applying behavioral aspects of the outbreak and hence, are not reliable enough for authorities’ decision adoptions. In contrast, the mechanistic SEIR model alarms that the COVID-19 outbreak in Iran may peak for the second time, consequent to lifting the control measures. This implies that the government may implement a more granular decision making to control the outbreak.
Deep Neural Networks can Predict Incident Atrial Fibrillation from the 12-lead Electrocardiogram and may help Prevent Associated Strokes
Authors: Raghunath Sushravya , Pfeifer John M. , Ulloa-Cerna Alvaro E. , Nemani Arun , Carbonati Tanner , Jing Linyuan , vanMaanen David P. , McCarty Bern E. , Hartzel Dustin N. , Ruhl Jeffery A. , Stoudt Nathan J. , Johnson Kipp W. , Zimmerman Noah , Leader Joseph B. , Kirchner H. Lester , Griessenauer Christoph , Hafez Ashraf , Good Christopher W. , Fornwalt Brandon K. , Haggerty Christopher M.
Published: April 2020

Background

Atrial fibrillation (AF) is associated with substantial morbidity, especially when it goes undetected. If new onset AF could be predicted, targeted population screening could be used to find it early. We hypothesized that a deep neural network could predict new onset AF from the resting 12-lead electrocardiogram (ECG) and that this prediction may help prevent AF-related stroke.

Methods

We used 1.6M resting 12-lead ECG voltage-time traces from 430k patients collected from 1984-2019 in this study. Deep neural networks were trained to predict new onset AF (within 1 year) in patients without a history of AF. Performance was evaluated using areas under the receiver operating characteristic curve (AUROC) and precision-recall curve (AUPRC). We performed an incidence-free survival analysis for a period of 30 years following the ECG stratified by model predictions. To simulate real-world deployment, we trained a separate model using all ECGs prior to 2010 and evaluated model performance on a test set of ECGs from 2010 through 2014 that were linked to our stroke registry. We used standard metrics to explore different prediction thresholds for the model and also calculated how many AF-related strokes might be potentially prevented.

Results

The AUROC and AUPRC were 0.83 and 0.21, respectively, for predicting new onset AF within 1 year of an ECG. Adding age and sex improved the AUROC to 0.85 and the AUPRC to 0.23. The hazard ratio for the predicted high- vs. low-risk groups over a 30-year span was 7.2 [95% confidence interval: 6.9 – 7.6]. In a simulated deployment scenario, using the F2 score to select the risk prediction threshold, the model predicted new onset AF at 1 year with a sensitivity of 69%, specificity of 81%, and positive predictive value (PPV) of 12%. This model correctly predicted new onset AF in 62% of all patients that experienced an AF-related stroke within 3 years of the ECG.

Conclusions

Deep learning can predict new onset AF from the 12-lead ECG in patients with no prior history of AF. This prediction may prove useful in preventing AF-related strokes.
Predicting the Dengue Epidemic in Guangzhou, China by Meteorological Parameter Methods
Authors: Chen Jing , Liu Kang-Kang , Xiao Hui , Hu Gang , Xiao Xiang , Lin Yu , Yue Qian , Han Yan , Mao Xiao-Fei , Dong Guang-Hui , Bu Jin
Published: April 2020

This study was aimed to determine dengue season, and further establish a prediction model by meteorological methods. The dengue and meteorological data were collected from Guangdong Meteorological Bureau and Guangdong Provincial Center for Disease Prevention and Control, respectively. We created a sliding accumulated temperature method to accurately calculate the beginning and ending day of dengue season. Probabilistic Forecast model was derived under comprehensive consideration of various weather processes including typhoon, rainstorm, and so on. We found: 1) The dengue fever season enters when effective accumulated temperature of a continuing 45 days (T45) ≥0 °C, and it finishes when effective accumulated temperature of a continuing 6 days (T6) <0 °C. 2) A Probabilistic Forecast Model for dengue epidemic was established with good forecast effects, which were verified by the actual incidence of dengue in Guangzhou. The Probabilistic Forecast Model provides markedly improved forecasting techniques for dengue prediction.
Modeling geographical spread of COVID-19 in India using network-based approach
Authors: Kumar Ankush
Published: April 2020

COVID-19 pandemic is a global concern, due to its high spreading and alarming fatality rate. Mathematical models can play a decisive role in mitigating the spread and predicting the growth of the epidemic. India is a large country, with a highly variable inter-state mobility, and dynamically varying infection cases in different locations; thus, the existing models, based solely on the aspects of growth rates, or generalized network concepts, may not provide desired predictions. The internal mobility of a country must be considered, for accurate prediction. Herein, we propose a framework for predicting the geographical spread of COVID-19, using reported COVID-19 cases, census migration data, and monthly airline data of passengers. We discover that spreading depends on the spatial distribution of existing cases, human mobility patterns, and administrative decisions. In India, the mobility towards professional sites can surge incoming cases at Maharastra and Karnataka, while migration towards the native places can risk Uttar Pradesh and Bihar. We anticipate that the state Kerala, with one of the highest cases of COVID-19, may not receive significant incoming cases, while Karnataka and Haryana may receive the challenge of high incoming cases, with medium cases so far. Using airline passenger’s data, we also estimate the number of potential incoming cases at various airports. The study predicts that the airports located in the region of north India are vulnerable, whereas in northeast India and in some south India are relatively safe. The detailed analysis in this direction will guide policymakers for prior planning of transport, and minimize the spread of COVID-19.
Geo-social gradients in predicted COVID-19 prevalence and severity in Great Britain: results from 2,266,235 users of the COVID-19Symptoms Tracker app
Authors: Bowyer Ruth C E , Varsavsky Thomas , Sudre Carole H. , Murray Benjamin A K , Freidin Maxim B , Yarand Darioush , Ganesh Sajaysurya , Capdevila Joan , Thompson Ellen J , Bakker Elco , Cardoso M. Jorge , Davies Richard , Wolf Jonathan , Spector Tim D , Ourselin Sebastien , Steves Claire J , Menni Cristina
Published: April 2020

Understanding the geographical distribution of COVID-19 through the general population is key to the provision of adequate healthcare services. Using self-reported data from 2,266,235 unique GB users of theCOVID Symptom Tracker app, we find that COVID-19 prevalence and severity became rapidly distributed across the UK within a month of the WHO declaration of the pandemic, with significant evidence of “urban hot-spots”. We found a geo-social gradient associated with disease severity and prevalence suggesting resources should focus on urban areas and areas of higher deprivation. Our results demonstrate use of self-reported data to inform public health policy and resource allocation.
Estimating population immunity without serological testing
Authors: Lesniewski Andrew
Published: April 2020

We propose an approximate methodology for estimating the overall level of immunity against COVID-19 in a population that has been affected by the recent epidemic. The methodology relies on the currently available mortality data and utilizes the properties of the SIR model. We illustrate the application of the method by estimating the recent levels of immunity in 10 US states with highest case numbers of COVID-19.
A biorefinery concept for the production of fuel ethanol, probiotic yeast and whey protein from a by-product of the cheese industry
Authors: Pendón María Dolores , Madeira José V. , Romanin David E. , Rumbo Martín , Gombert Andreas K. , Garrote Graciela L.
Published: April 2020

1.

Agroindustrial by-products and residues can be transformed into valuable compounds in biorefineries. Here we present a new concept: production of fuel ethanol, whey protein and probiotic yeast from cheese whey. An initial screening under industrially relevant conditions, involving thirtyKluyveromyces marxianusstrains, was carried out using spot assays to evaluate their capacity to grow on cheese whey or on whey permeate (100 g lactose/L), under aerobic or anaerobic conditions, in the absence or presence of 5% ethanol, at pH 5.8 or pH 2.5. The four best growingK. marxianusstrains were selected and further evaluated in a miniaturized industrial fermentation process using reconstituted whey permeate (100 g lactose/L) with cell recycling (involving sulfuric acid treatment). After five consecutive fermentation cycles, the ethanol yield on sugar reached 90% of the theoretical maximum in the best cases, with 90% cell viability. Cells harvested at this point displayed probiotic properties such as capacity to survive the passage through the gastrointestinal tract and capacity to modulate innate immune response of intestinal epithelium, bothin vitro. Furthermore, the CIDCA 9121 strain was able to protect against histopathological damage in an animal model of acute colitis. Our findings demonstrate thatK. marxianusCIDCA 9121 is capable of efficiently fermenting the lactose present in whey permeate to ethanol and that the remaining yeast biomass has probiotic properties, enabling an integrated process for the obtainment of whey protein, fuel ethanol and probiotics from cheese whey.

2.

Importance

Cheese whey is the liquid remaining following the precipitation and removal of milk casein during cheese-making. This by-product represents about 85-95% of the milk volume and retains 55% of milk nutrients so it can be exploited as a source of valuable end products. However, at a global level around 50% of cheese whey is wasted, representing an important environmental impact and indicating the need to develop alternative processes to recover value.Kluyveromyces marxianusis capable of fermenting lactose, generally regarded as safe, and has been explored separately as an ethanol producer and as a viable bioactive microorganism. The significance of our research is to establish the proof of concept that a biorefinery for fuel ethanol production using whey andK. marxianuscan also be exploited to obtain viable probiotic biomass, conferring an added value to the process and providing an alternative to reduce environmental impact.
Phytochrome mediated responses inAgrobacterium fabrum: growth, swimming, plant infection and interbacterial competition
Authors: Xue Peng , Bai Yingnan , Rottwinkel Gregor , Averbukh Elizaveta , Ma Yuanyuan , Roeder Thomas , Scheerer Patrick , Krauß Norbert , Lamparter Tilman
Published: April 2020

The soil bacteriumAgrobacterium fabrumC58 infects plants by a unique DNA transfer mechanism.A. fabrumhas two phytochrome photoreceptors, Agp1 and Agp2. We found that DNA transfer into plants byA. fabrumis down regulated by light and that phytochrome knockout mutants have diminished DNA transfer rates. The regulation pattern matches with that of bacterial conjugation reported earlier. Growth, swimming and interbacterial competition were also affected in phytochrome knockout mutants, although these effects were often not affected by light. We can thus distinguish between light-regulated and light-independent phytochrome responses. In microarray studies, transcription of only 4 genes was affected by light, indicating that most light responses are regulated post-transcriptionally. In a mass spectrometery-based proteomic study, 24 proteins were different between light and dark grown bacteria, whereas 382 proteins differed between wild type and phytochrome knockout mutants, pointing again to light-dependent and light-independent roles of Agp1 and Agp2.
Pancreatic beta-cell specific deletion of VPS41 causes diabetes due to defects in insulin secretion
Authors: Burns Christian H. , Yau Belinda , Rodriguez Anjelica , Triplett Jenna , Maslar Drew , An You Sun , van der Welle Reini E.N. , Kossina Ross G. , Fisher Max R. , Strout Gregory W. , Bayguinov Peter O. , Veenendaal Tineke , Chitayat David , Fitzpatrick James A.J. , Klumperman Judith , Kebede Melkam A. , Asensio Cedric S.
Published: April 2020

Insulin secretory granules (SGs) mediate the regulated secretion of insulin, which is essential for glucose homeostasis. The basic machinery responsible for this regulated exocytosis consists of specific proteins present both at the plasma membrane and on insulin SGs. The protein composition of insulin SGs thus dictates their release properties, yet the mechanisms controlling insulin SG formation, which determines this molecular composition, remain poorly understood. VPS41, a component of the endo-lysosomal tethering HOPS complex, was recently identified as a cytosolic factor involved in the formation of neuroendocrine and neuronal granules. We now find that VPS41 is required for insulin SG biogenesis and regulated insulin secretion. Loss of VPS41 in pancreatic β-cells leads to a reduction in insulin SG number, changes in their transmembrane protein composition, and defects in granule regulated exocytosis. Exploring a human point mutation, identified in patients with neurological but no endocrine defects, we show that the effect on SG formation is independent of HOPS complex formation. Finally, we report that mice with a deletion of VPS41 specifically in β-cells develop diabetes due to severe depletion of insulin SG content and a defect in insulin secretion. In sum, our data demonstrate that VPS41 contributes to glucose homeostasis and metabolism.
State-selective Modulation of Heterotrimeric Gαs Signaling with Macrocyclic Peptides
Authors: Dai Shizhong A. , Hu Qi , Gao Rong , Peacock Hayden , Blythe Emily E. , Zhang Ziyang , von Zastrow Mark , Suga Hiroaki , Shokat Kevan M.
Published: April 2020

The G protein-coupled receptor (GPCR) cascade leading to production of the second messenger cAMP is replete with pharmacologically targetable receptors and enzymes with the exception of the Gα subunit, Gαs. GTPases remain largely undruggable given the difficulty of displacing high-affinity guanine nucleotides and the lack of other drug binding sites. We explored a chemical library of 1012cyclic peptides in order to expand the chemical search for inhibitors of this enzyme class. We identified two macrocyclic peptides, GN13 and GD20, that antagonize the active and inactive states of Gαs, respectively. Both macrocyclic peptides fine-tune Gαs activity with high nucleotide-binding-state selectivity and G protein class-specificity. Co-crystal structures reveal that GN13 and GD20 distinguish the conformational differences within the switch II/α3 pocket and block effector interactions. The Gαs inhibitors showed strong activity in cellular contexts through binding to crystallographically defined pockets. The discovery of cyclic peptide inhibitors targeting Gαs provides a path for further development of state-dependent GTPase inhibitors.
Heterologous production of 1-tuberculosinyladenosine inMycobacterium kansasiimodels pathoevolution towards the transcellular lifestyle ofMycobacterium tuberculosis
Authors: Ghanem Marwan , Dubé Jean-Yves , Wang Joyce , McIntosh Fiona , Houle Daniel , Domenech Pilar , Reed Michael B. , Raman Sahadevan , Buter Jeffrey , Minnaard Adriaan J. , Moody D. Branch , Behr Marcel A.
Published: April 2020

Mycobacterium kansasiiis an environmental non-tuberculous mycobacterium that causes opportunistic tuberculosis-like disease. It is one of the most closely related species to theM. tuberculosiscomplex. UsingM. kansasiias a proxy for theM. kansasii-M. tuberculosis-common ancestor, we asked whether introducing theM. tuberculosis-specific gene pairRv3377c-Rv3378cintoM. kansasiiaffects the course of experimental infection. Expression of these genes resulted in the production of an adenosine-linked lipid species, known as 1-tuberculosinyladenosine (1-TbAd), but did not alter growthin vitrounder standard conditions. Production of 1-TbAd enhanced growth ofM. kansasiiunder acidic conditions through a bacterial cell-intrinsic mechanism independent of controlling pH in the bulk extracellular and intracellular spaces. Production of 1-TbAd led to greater burden ofM. kansasiiin the lung of C57Bl/6 mice during the first 24 hours after infection andex vivoinfections of alveolar macrophages recapitulated this phenotype within the same time frame. However, in long-term infections, production of 1-TbAd resulted in impaired bacterial survival in both C57Bl/6 mice andCcr2-/-mice. We have demonstrated thatM. kansasiiis a valid surrogate ofM. tuberculosisto study virulence factors acquired by the latter organism, yet shown the challenge inherent to studying the complex evolution of mycobacterial pathogenicity with isolated gene complementation.

IMPORTANCE

This work sheds light on the role of the lipid 1-tuberculosinyladenosine in the evolution of an environmental ancestor toM. tuberculosis. On a larger scale, it reinforces the importance of horizontal gene transfer in bacterial evolution and examines novel models and methods to provide a better understanding of the subtle effects of individualM. tuberculosis-specific virulence factors in infection settings that are relevant to the pathogen.