bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA Breaks-Mediated Fitness Cost Reveals RNase HI as a New Target for Selectively Eliminating Antibiotic-Resistant Bacteria
Authors: Balbontín Roberto , Frazão Nelson , Gordo Isabel
Published: April 2021

Antibiotic resistance often generates defects in bacterial growth called fitness cost. Understanding the causes of this cost is of paramount importance, as it is one of the main determinants of the prevalence of resistances upon reducing antibiotics use. Here we show that the fitness costs of antibiotic resistance mutations that affect transcription and translation in Escherichia coli strongly correlate with DNA breaks, which are generated via transcription–translation uncoupling, increased formation of RNA–DNA hybrids (R-loops), and elevated replication–transcription conflicts. We also demonstrated that the mechanisms generating DNA breaks are repeatedly targeted by compensatory evolution, and that DNA breaks and the cost of resistance can be increased by targeting the RNase HI, which specifically degrades R-loops. We further show that the DNA damage and thus the fitness cost caused by lack of RNase HI function drive resistant clones to extinction in populations with high initial frequency of resistance, both in laboratory conditions and in a mouse model of gut colonization. Thus, RNase HI provides a target specific against resistant bacteria, which we validate using a repurposed drug. In summary, we revealed key mechanisms underlying the fitness cost of antibiotic resistance mutations that can be exploited to specifically eliminate resistant bacteria.
Traditional African Religion as a Neglected Form of Monotheism
Authors: Metz Thaddeus , Molefe Motsamai
Published: April 2021

Our aims are to articulate some core philosophical positions characteristic of Traditional African Religion and to argue that they merit consideration as monotheist rivals to standard interpretations of the Judeo-Christian-Islamic tradition. In particular, we address the topics of how God’s nature is conceived, how God’s will is meant to bear on human decision making, where one continues to exist upon the death of one’s body, and how long one is able to exist without a body. For each of these topics, we note how Traditional African Religion posits claims that clash with mainstream Judaism, Christianity, and Islam and that, being prima facie plausible, indicate the need for systematic cross-cultural philosophical debate.
Direct vs Indirect Revascularization in a North American Cohort of Moyamoya Disease
Authors: Lai Pui Man Rosalind , Patel Nirav J , Frerichs Kai U , Patel Aman B , Aziz-Sultan M Ali , Ogilvy Christopher S , Du Rose
Published: April 2021

BACKGROUND

In adults with ischemic moyamoya disease (MMD), the efficacy of direct vs indirect revascularization procedures remains a matter of debate.

OBJECTIVE

To investigate the outcomes of ischemic MMD in a North American cohort treated by direct and indirect revascularizations.

METHODS

We retrospectively reviewed medical records of adult patients with MMD with ischemic presentation from 1984 to 2018 at the Brigham and Women's Hospital and Massachusetts General Hospital who underwent either direct or indirect bypasses. Early postoperative events and outcome at more than 6 mo postoperatively were evaluated using multivariable logistic regression analyses. Multivariable Cox proportional hazards regression analyses were used to evaluate delayed ischemic and hemorrhagic events. Analyses were performed per hemisphere.

RESULTS

A total of 95 patients with MMD and 127 hemispheres were included in this study. A total of 3.5% and 8.6% of patients had early surgical complications in the direct and indirect bypass cohorts, respectively (P = .24). Hemispheres with direct bypasses had fewer long-term ischemic and hemorrhagic events at latest follow-up (adjusted hazard ratio [HR] 0.19, 95% confidence interval [CI] 0.058-0.63, P = .007; median follow-up 4.5 [interquartile range, IQR 1-8] yr). There was no difference between the direct and indirect bypass groups when the endpoint was limited to infarction and hemorrhage only (P = .12). There was no difference in outcome (modified Rankin Scale [mRS] ≥ 3) between the 2 cohorts (P = .92).

CONCLUSION

There was no difference in early postoperative events, long-term infarction or hemorrhage, or clinical outcome between direct and indirect revascularization. However, there was a significant decrease in all ischemic and hemorrhagic events combined in direct revascularizations compared to indirect revascularizations.
Foramen Magnum Dural Arteriovenous Fistula Presenting With Thoracic Myelopathy: Technical Case Report With 2-Dimensional Operative Video
Authors: Gadot Ron , Gopakumar Sricharan , Wagner Kathryn , Xu David S , Raper Daniel M S , Burkhardt Jan-Karl , Ropper Alexander E
Published: April 2021

BACKGROUND AND IMPORTANCE

Dural arteriovenous fistulas (dAVFs) are vascular abnormalities of the central nervous system that can cause a wide array of neurological dysfunction depending on their location, flow, and propensity to rupture. Symptomatic dAVFs at the cranio-cervical junction usually result in hemorrhage or cervical myelopathy. Distantly located dAVFs of the foramen magnum are a rare cause of thoracic intrinsic myelopathy.

CLINICAL PRESENTATION

An 83-yr-old man presented with progressive lower extremity weakness, numbness, and difficulty walking along with episodes of bowel incontinence. Magnetic resonance imaging of the cervical spine demonstrated multilevel cervical disc disease with stenosis and longitudinal cervical cord signal change extending into the upper thoracic spinal cord. Cerebral and spinal angiography revealed a dAVF in the lateral foramen magnum region. Given the location, feeding vasculature, and morphology of the fistula, endovascular embolization was not attempted. Microsurgical resection with confirmative indocyanine green fluorescent imaging was performed with adequate obliteration of the fistula. The patient's neurological baseline was preserved postoperatively with improvement of lower extremity numbness.

CONCLUSION

We present a brief overview of this neuropathologic entity and demonstrate microsurgical resection of a foramen magnum dAVF through operative video. Craniocervical dAVFs should remain on the differential diagnosis of patients presenting with progressive thoracolumbar myelopathy.
Subaxial Cervical Pedicle Screw Placement With Direct Visualization of Pedicle Borders: 2-Dimensional Operative Video
Authors: Farber S Harrison , Bohl Michael A , Xu David S , Uribe Juan S , Kakarla U Kumar , Turner Jay D
Published: April 2021

Pedicle screws provide superior fixation of the subaxial cervical spine to other techniques. However, a high degree of accuracy is required for safe placement given the proximity of pedicles to critical neurovascular structures. A variety of techniques are described to maximize accuracy, including freehand, fluoroscopy-guided, and neuronavigation-based methods.

 We present a technique for the placement of pedicle screws in the subaxial cervical spine using direct visualization of the pedicle in a patient who required an occipito-cervical fusion construct in the setting of a C2 chordoma. A laminotomy or laminectomy is performed laterally to allow for visualization of the medial, superior, and inferior walls of the pedicle. The entry point for screw placement is determined based on pedicle anatomy and is typically 1 to 2 mm lateral to the midpoint of the lateral mass, just below the base of the superior articulating process. Screw trajectory is determined by visualizing the pedicle borders and is aimed at the junction of the medial pedicle wall, with the posterior vertebral body down the pedicle axis. Tactile feedback (loss of resistance) is used to assess for a breach while drilling. The cannulation is then tapped, and the screw is placed in a standard fashion.

 Direct visualization of pedicle anatomy can be a useful adjunct to guide the safe placement of subaxial pedicle screws when superior fixation is required or when normal anatomy is distorted. The technique may be combined with fluoroscopic or navigation-based techniques to provide real-time anatomic guidance during screw placement. The patient provided informed, written consent for this procedure before surgery. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.
Resection of a Lumbar Intradural Extramedullary Schwannoma: 2-Dimensional Operative Video
Authors: Strong Michael J , Yee Timothy J , Khalsa Siri Sahib S , Saadeh Yamaan S , Muhlestein Whitney E , North Robert Y , Szerlip Nicholas J
Published: April 2021

Schwannomas are typically benign tumors that arise from the sheaths of nerves in the peripheral nervous system. In the spine, schwannomas usually arise from spinal nerve roots and are therefore extramedullary in nature. Surgical resection-achieving a gross total resection, is the main treatment modality and is typically curative for patients with sporadic tumors.

In this video, we present the case of a 38-yr-old male with worsening left leg radiculopathy, found to have a lumbar schwannoma. Preoperative imaging demonstrated that the tumor was at the level of L4-L5. A laminectomy at this level was performed with gross total resection of the tumor. The key points of the video include use of intraoperative fluoroscopy to confirm surgical level and help plan surgical exposure, use of ultrasound for intradural tumor localization, and advocating for maximum safe resection using neurostimulation. The patient tolerated the surgery well without any complications. He was discharged home with no additional therapy needed.

Appropriate patient consent was obtained.
WARNER MUSIC UK LTD v TUNEIN INC
Authors:   Chancery Division
Published: April 2021

H1 Copyright – Infringement – Sound recordings – Internet radio services – Hyperlinks – Targeting – Communication to the public – Whether communication to the public in the UK – Consent – Whether the UK public was a new public – Freedom of information – Freedom of expression – Availability of a recording facility – Liability of users – Time shifting – Liability of station providers – Authorisation – Safe harbours
EVALUATION OF INTERNAL EXPOSURE TO RADIOACTIVE AEROSOL GENERATED FROM PLASMA MELTING SYSTEM USING THE BIDAS CODE
Authors: Kim S I , Lee H Y , Jung W C , Song J S
Published: April 2021

The radioactive aerosol generated by the Nuclear Power Plant (NPP) decommissioning process can be inhaled by workers and deposited inside the human body, resulting in internal exposure. Because internal exposure, unlike external exposure, is difficult to measure directly, it is all the more necessary to assess the dose workers receive as a result of internal exposure. Precise assessment of the internal exposure necessitates actual measurements in the work environment such as the workers’ respiration rate, kind of nuclide and amount of captured nuclide. However, in the event of difficulties in securing these measurements, the internal exposure dose can be estimated based upon the recommended values by the ICRP (International Commission on Radiological Protection) such as the intake fraction and particle size. In this study, 5 μm was selected as the particle size as recommended by the ICRP, and both heavy and light respiratory rates were used in the calculation. With respect to the nuclides contained in the radioactive aerosol and their concentrations, the data captured for the aerosol in the melting facility on the Kozloduy NPP premises in Bulgaria were applied to estimate workers’ internal exposure. As a result, each worker was found not to have received more than 20 mSv/yr, which is the maximum annual permissible dose for workers.
Brewers, Booze and Medicine: Industrial Funding of Alcoholic Liver Disease Research in 1980s Britain
Authors: Yokoe Ryosuke
Published: April 2021

This article investigates why Britain’s brewing industry chose to sponsor a particular set of studies on liver disease during the 1980s, expounding on the nature of private-sector funding in clinical research. Through previously unexplored internal records, the article underscores how the drinks industry participated in wider debates on alcohol and public health by seeking the aid of medical expertise. Partly to minimise its own responsibility for the rise of problem drinking, the industry financed studies that looked into factors other than alcohol that contributed to the development of cirrhosis. The identification of the disease’s inborn determinants relating to heredity and sex strengthened the notion that only a minority of drinkers were at risk of developing alcohol-related illnesses, undermining the call for policies that targeted all drinking. Although driven by self-interest, the industry nevertheless supported legitimate lines of inquiry that elucidated the complex, multifactorial causation of cirrhosis.
Family Structure, Risks, and Racial Stratification in Poverty
Authors: Williams Deadric T , Baker Regina S
Published: April 2021

Family structure remains a dominant explanation for understanding racial inequality in poverty. Yet, empirical studies show family structure does not fully account for this association. We present racial stratification as an alternative perspective emphasizing the social construction of race and how race contributes to the unequal distribution of resources. To illustrate the link between racial stratification and poverty, we rely on risk research and conceptualize risk in terms of prevalences (the percentage of people with risks) and penalties (the probability of poverty associated with risks). We assess whether family structure and risks intersect by racialized groups, and if so, whether the penalties for risks among Black and Latinx mothers, relative to white mothers, converge (i.e., smaller gap in penalties) or diverge (i.e., larger gap in penalties). Using panel data, our results revealed Black mothers had higher risk prevalence than both Latinx and white mothers. Moreover, a dramatic divergence in the penalties for risks emerged between racialized groups whereby Black and Latinx mothers experience greater disadvantage from risks than white mothers, regardless of family structure. We conclude family structure is not only an oversimplified explanation but also contributes to obscuring structural and systemic sources of racial inequality in poverty.
Airway Microbiology in Children with Cystic Fibrosis: A Prospective Cohort Study from Northern India
Authors: Bashir Gulnaz , Bhat Javeed Iqbal , Mohammad Sozia , Fomda Bashir Ahmad , Bali Nargis K , Altaf Insha
Published: April 2021

Objective

The objective of this study is to find the organism profile and antimicrobial susceptibility patterns in children with cystic fibrosis (CF).

Design

Prospective cohort study.

Setting

Hospital-based study.

Intervention

Sputum cultures/throat swabs were collected from the study population. Relevant details like anthropometry, systemic examination findings and investigations were entered in a pre-designed format. Sputum culture was subjected to microbiological analysis at the hospital microbiology laboratory.

Main outcome measure

Prevalence of positive sputum/cough swab culture in CF patients, their organism profile and antibiotic sensitivity.

Results

A total of 63 patients were enrolled in the study. A total of 136 organisms were grown in our study population. Thirteen different organisms were isolated, which included five gram-positive bacteria, six gram-negative bacteria, eight Candida spp. and one filamentous. Antibiotic sensitivity profile of the Pseudomonas aeruginosa showed excellent sensitivity to all the aminoglycosides, piperacillin-tazobacteum and polymixin, similarly methicillin-sensitive Staphylococcus aureus, methicillin-resistant S. aureus and Enterococcus spp. were uniformly sensitive to vancomycin, linezolid and teicoplanin. Fungal isolates showed 100% sensitivity to all the antifungals tested including azoles and amphotericin B.

Conclusion

We observed 61% of culture positivity for different organisms in our study. Staphylococcus aureus and P. aeruginosa were the most frequently isolated organisms. Pseudomonas aeruginosa isolates were largely sensitive to aminoglycosides, carbapenems and polymixin. We found an unusually higher incidence of enterococcal infection in our study cohort with few vancomycin-resistant isolates.
Surgical Site Infection Following Neuromuscular Posterior Spinal Fusion Fell 72% After Adopting the 2013 Best Practice Guidelines
Authors: Stephan Stephen R. , Illingworth Kenneth D. , Gupta Kavish , Andras Lindsay M. , Skaggs David L.
Published: April 2021

Study Design.

Retrospective cohort study.

Objective.

The purpose of this study is to investigate the incidence of surgical site infection in neuromuscular scoliosis (NMS) patients at a tertiary children's hospital before and after the implementation of strategies mentioned in the 2013 Best Practice Guideline.

Summary of Background Data.

Patients with NMS are at high risk for surgical site infection following spine surgery. In 2013, a Best Practice Guideline for surgical site infection prevention in high-risk pediatric spine surgery patients reported strategies to decrease incidence. To date, no studies have looked at the efficacy of these strategies.

Methods.

A retrospective review of surgical site infection in NMS patients was performed. NMS patients undergoing primary posterior spinal fusion from January 2008 to December 2012 (Group 1) and January 2014 to December 2018 (Group 2) were included, with 2013 excluded as a transition year. The primary outcome was incidence of surgical site infection within 1 year of surgery, as defined by the Centers for Disease Control and National Healthcare Safety Network. All patients had at least 1 year of documented follow-up.

Results.

One hundred ninety eight patients were included, 62 in Group 1 and 136 in Group 2. Age, BMI, sex, fusion to pelvis, preoperative Cobb angle, incontinence, drain use, blood loss, surgical time, and other perioperative values were similar (P > 0.05). Deep surgical site infection occurred in 10 (16.1%) patients in Group 1 and six (4.4%) patients in Group 2 (P = 0.005). Thirteen (59.1%) identified organisms were gram-negative, with 11 (84.6%) isolated from Group 1 (P = 0.047). Polymicrobial infections accounted for six (37.5%) infections overall.

Conclusion.

The incidence of surgical site infection in NMS patients decreased significantly (16.1% vs. 4.4%) after the implementation of the strategies mentioned in the 2013 Best Practice Guideline. Further studies are required to continue to decrease the incidence in this high-risk population.

Level of Evidence: 3
Stratifying Deterioration Risk by Acuity at Admission Offers Triage Insights for Coronavirus Disease 2019 Patients
Authors: Beals Joseph , Barnes Jaime J. , Durand Daniel J. , Rimar Joan M. , Donohue Thomas J. , Hoq S. Mahfuz , Belk Kathy W. , Amin Alpesh N. , Rothman Michael J.
Published: April 2021

Objectives:

Triaging patients at admission to determine subsequent deterioration risk can be difficult. This is especially true of coronavirus disease 2019 patients, some of whom experience significant physiologic deterioration due to dysregulated immune response following admission. A well-established acuity measure, the Rothman Index, is evaluated for stratification of patients at admission into high or low risk of subsequent deterioration.

Design:

Multicenter retrospective study.

Setting:

One academic medical center in Connecticut, and three community hospitals in Connecticut and Maryland.

Patients:

Three thousand four hundred ninety-nine coronavirus disease 2019 and 14,658 noncoronavirus disease 2019 adult patients admitted to a medical service between January 1, 2020, and September 15, 2020.

Interventions:

None.

Measurements and Main Results:

Performance of the Rothman Index at admission to predict in-hospital mortality or ICU utilization for both general medical and coronavirus disease 2019 populations was evaluated using the area under the curve. Precision and recall for mortality prediction were calculated, high- and low-risk thresholds were determined, and patients meeting threshold criteria were characterized. The Rothman Index at admission has good to excellent discriminatory performance for in-hospital mortality in the coronavirus disease 2019 (area under the curve, 0.81–0.84) and noncoronavirus disease 2019 (area under the curve, 0.90–0.92) populations. We show that for a given admission acuity, the risk of deterioration for coronavirus disease 2019 patients is significantly higher than for noncoronavirus disease 2019 patients. At admission, Rothman Index–based thresholds segregate the majority of patients into either high- or low-risk groups; high-risk groups have mortality rates of 34–45% (coronavirus disease 2019) and 17–25% (noncoronavirus disease 2019), whereas low-risk groups have mortality rates of 2–5% (coronavirus disease 2019) and 0.2–0.4% (noncoronavirus disease 2019). Similarly large differences in ICU utilization are also found.

Conclusions:

Acuity level at admission may support rapid and effective risk triage. Notably, in-hospital mortality risk associated with a given acuity at admission is significantly higher for coronavirus disease 2019 patients than for noncoronavirus disease 2019 patients. This insight may help physicians more effectively triage coronavirus disease 2019 patients, guiding level of care decisions and resource allocation.
Circ_GRN Promotes the Proliferation, Migration, and Inflammation of Vascular Smooth Muscle Cells in Atherosclerosis Through miR-214-3p/FOXO1 Axis
Authors: Li Xiaohua , Li Li , Dong Xiaochun , Ding Junrong , Ma Hua , Han Wei
Published: April 2021

Dysfunction of vascular smooth muscle cells (VSMCs) assumes a fundamental part in the pathogenesis of atherosclerosis (AS). Circular RNA granulin precursor (circ_GRN) was identified to promote the proliferation and invasion of human VSMCs (HVSMCs) in an in vitro AS model. However, the underlying mechanisms remain unclear. Levels of circ_GRN, microRNA (miR)-214-3p, and forkhead box protein O1 (FOXO1) were detected using quantitative real-time polymerase chain reaction and Western blot assays. The proliferation, migration, and inflammatory response of HVSMCs were evaluated by using flow cytometry, colony formation, Cell Counting Kit-8, Western blot, transwell assays, and enzyme-linked immunosorbent assay, respectively. The binding interaction between miR-214-3p and circ_GRN or FOXO1 was detected by dual-luciferase reporter assay. In this study, we found that circ_GRN was elevated in the serum of AS and oxidized low-density lipoprotein (ox-LDL)-induced HVSMCs. The in vitro AS model was established by exposing HVSMCs to ox-LDL, and we found circ_GRN knockdown reversed ox-LDL-evoked cell proliferation, migration, and inflammation. In a mechanical study, miR-214-3p directly bound to circ_GRN or FOXO1, and circ_GRN could regulate FOXO1 expression by competitively binding to miR-214-3p. Importantly, we demonstrated that miR-214-3p inhibition attenuated the protective effects of circ_GRN knockdown on ox-LDL-induced HVSMCs; besides that, miR-214-3p overexpression abolished ox-LDL-triggered HVSMC proliferation, migration, and inflammation, which were counteracted by FOXO1 upregulation. In conclusion, circ_GRN promoted the proliferation, migration, and inflammation of HVSMCs through miR-214-3p/FOXO1 axis in ox-LDL-induced AS model in vitro, suggesting the potential involvement in an AS process, which provided a potential candidate for future clinic intervention in AS.
Current practice of anesthetic equipment disinfection in the University of Gondar Comprehensive Specialized Hospital, 2020: a cross sectional study
Authors: Ahmed Seid A. , Fentie Demeke Y.
Published: April 2021

Background:

Anesthetic equipments undeniably occupy prime importance in clinical practice. However, their importance falls into question if they are not appropriately prepared and handled.

Objectives:

The objective of this audit was to assess the current practice of anesthetic equipment disinfection in comprehensive specialized hospital.

Methods:

An observational study was conducted. A total of 70 patients were operated during the study period and data was analyzed using Microsoft Excel as well as descriptive statistics was used.

Results:

Around 94.2% of anesthetists followed only the first step of disinfecting laryngoscope blade and 74.2% of anesthetists stored both the laryngoscope blade and handle appropriately but the rest of the steps were performed poorly and none of the anesthetists applied alcohol for both blade and handle disinfection. All anesthetists immersed the endotracheal tube or laryngeal mask airway in high level disinfection solution and then rinse them with water. However, none of the anesthetists were applied around 6 of the process of disinfecting these equipments. Regarding face mask, only 4 (5.7%) of the anesthetists washed the anesthetic face mask with soap and 2 (2.8%) stored it safely for further use but none of them used alcohol to disinfect this equipment.

Conclusions:

Even if all of the anesthetic equipments disinfection process needs improvement, special attention should be given to laryngoscope disinfection protocol since this equipment is being used frequently between patients as well as changing the high level disinfectant solution every 24 hours because more than this hour the solution cannot be used as disinfectant and finally we recommend that all anesthetists should follow the standards of anesthetic equipment disinfection process.
Reducing Disparities Using Telehealth Approaches for Postdelivery Preeclampsia Care
Authors: KERN-GOLDBERGER ADINA , HIRSHBERG ADI
Published: April 2021

The management of hypertensive disease of pregnancy presents an ongoing challenge after patients are discharged from delivery hospitalizations. Preeclampsia and other forms of postpartum hypertension increase the risk for severe maternal morbidity and mortality in the postpartum period, and both hypertension and its associated adverse events disproportionately affect black women. With its ability to transcend barriers to health care access, telemedicine can facilitate high-quality postpartum care delivery for preeclampsia management and thereby reduce racial disparities in obstetric care and outcomes. Here we discuss racial disparities in preeclampsia and the challenge of providing equitable postpartum preeclampsia care. We then describe the utility of novel telemedicine platforms and their application to combat these disparities in preeclampsia care.
McCannel Suture Technique Resolves Persistent Dysphotopsia Following Laser Peripheral Iridotomy in Phakic Eyes
Authors: Nicholas Matthew P. , Vaz Tara , Idrees Sana , Shareef Shakeel
Published: April 2021

A 57-year-old woman presented with photophobia and complaint of a persistent white light in the inferior field of her left eye for 18 months following laser peripheral iridotomy both eyes. In primary gaze, the upper lid margin was noted to bisect the iridotomy at 2 o’clock left eye (OS). She relates that the light moves with her eyelid OS only and resolves by lifting the lid. A 54-year-old male presented with complaint of seeing 2 horizontal lines in his field of vision immediately following laser iridotomy OS that have persisted for a duration of 7 years. He notes they are constant and resolve by lifting up the eyelid. In primary position, the left upper lid margin was noted to bisect the iridotomy at 12 o’clock OS. Given the presence of nonresolving symptomatic dysphotopsia, each patient underwent surgical repair of the iridotomy using a McCannel suture technique with complete resolution of their symptoms. Dysphotopsias are an uncommon complication that can occur following laser peripheral iridotomy. If they persist and conservative measures are ineffective, iris suture repair can provide a definitive intervention in resolving them. Laser iridotomies located in the far periphery pose a surgical challenge with respect to accessibility. A McCannel suture technique provides a feasible approach in suturing them with minimal iris manipulation. Furthermore, it is prudent to assess the upper lid position in primary gaze before creating an iridotomy in order to avoid interference with the lid margin tear film meniscus that can lead to the formation of symptomatic dysphotopsia.
Rescue of Failed XEN-45 Gel Implant by Nd:YAG Shock Wave to Anterior Chamber Tip to Dislodge Hidden Intraluminal Occlusion
Authors: Fellman Ronald L. , Grover Davinder S. , Smith Oluwatosin U. , Kornmann Helen L.
Published: April 2021

Purpose:

The purpose of this study was to inform ophthalmic surgeons in a timely manner of the hidden problem of clear intraluminal cellular debris as a cause for XEN-45 failure and to describe low energy neodymium-doped yttrium aluminum garnet (Nd:YAG) laser revision with periluminal anterior chamber tip shockwave treatment to improve flow to the bleb.

Patients and Methods:

Six patients with visibly patent stent lumen post XEN-45 surgery. These eyes developed rising intraocular pressure (IOP) with a history of excellent prior bleb formation and were treated successfully with Nd:YAG laser shockwave therapy to disperse assumed intraluminal cellular debris. The laser was aimed just anterior and axial to the intracameral tip of the gel stent through a gonioscopy lens.

Results:

Six patients with an average age of 75 years (60 to 90 y), preoperative IOP of 30 mm Hg (16 to 52 mm Hg) on an average of 2 antiglaucoma medications (0 to 4) underwent periluminal anterior chamber tip shock wave at an average of 12 months (1 to 38 mo) from XEN-45 surgery. The IOP was immediately reduced to an average of 15 mm Hg (8 to 23 mm Hg) and last IOP averaged 15 mm Hg (10 to 23 mm Hg) on 1.5 medications (0 to 4) at 4 months post periluminal anterior chamber tip shock wave.

Conclusion:

Nd:YAG laser revision of hidden blockage of a XEN-45 gel implant with periluminal anterior chamber tip shockwave treatment can disperse invisible intraluminal cellular debris and improve flow in a failing XEN-45 microstent, especially when distal fibrosis is not excessive.
Pathway Linking Different Types of Childhood Trauma to Somatic Symptoms in a Subclinical Sample of Female College Students
Authors: Heshmati Rasoul , Azmoodeh Shahin , Caltabiano Marie L.
Published: April 2021

Research has shown that women are more prone to childhood trauma and this state is associated with somatic symptoms. Also, people who have been exposed to traumatic experiences use experiential avoidance to reduce negative emotions. However, the mediating role of experiential avoidance in the relationship between childhood trauma and somatic symptoms is not clear, so, the present study investigated whether the relationships among different types of childhood trauma and somatic symptoms could be explained by experiential avoidance in female college students. In a cross-sectional study, 251 Iranian female college students with somatic symptoms were recruited from the University of Tabriz. Participants completed self-report scales, including the Persian version of Child Abuse Self-Reported Scale, Acceptance and Action Questionnaire-II (AAQ-II), and the Patient-health questionnaire (PHQ-15). A path analysis was used to empirically explore the relationships. Structural equation modeling analyses confirmed a partial mediation model. Study participants who had a higher level of emotional trauma reported higher levels of somatic symptoms. Emotional and neglect trauma showed significant positive relations with experiential avoidance. Bootstrapping results showed that experiential avoidance partially mediated the relationship between emotional trauma and somatic symptoms. Moreover, the association between neglect and somatic symptoms was fully mediated by experiential avoidance. These findings suggest that experiential avoidance might be one mechanism explaining how adverse emotional and neglect experiences influence somatic symptoms. Interventions addressing experiential avoidance through methods such as emotion-focused therapy and mindfulness are discussed as potential future directions for treating somatic symptoms in females who experienced emotional and neglect trauma.
Deep-Learning-Based Diagnosis of Bedside Chest X-ray in Intensive Care and Emergency Medicine
Authors: Niehues Stefan M. , Adams Lisa C. , Gaudin Robert A. , Erxleben Christoph , Keller Sarah , Makowski Marcus R. , Vahldiek Janis L. , Bressem Keno K.
Published: April 2021

Objectives

Validation of deep learning models should separately consider bedside chest radiographs (CXRs) as they are the most challenging to interpret, while at the same time the resulting diagnoses are important for managing critically ill patients. Therefore, we aimed to develop and evaluate deep learning models for the identification of clinically relevant abnormalities in bedside CXRs, using reference standards established by computed tomography (CT) and multiple radiologists.

Materials and Methods

In this retrospective study, a dataset consisting of 18,361 bedside CXRs of patients treated at a level 1 medical center between January 2009 and March 2019 was used. All included CXRs occurred within 24 hours before or after a chest CT. A deep learning algorithm was developed to identify 8 findings on bedside CXRs (cardiac congestion, pleural effusion, air-space opacification, pneumothorax, central venous catheter, thoracic drain, gastric tube, and tracheal tube/cannula). For the training dataset, 17,275 combined labels were extracted from the CXR and CT reports by a deep learning natural language processing (NLP) tool. In case of a disagreement between CXR and CT, human-in-the-loop annotations were used. The test dataset consisted of 583 images, evaluated by 4 radiologists. Performance was assessed by area under the receiver operating characteristic curve analysis, sensitivity, specificity, and positive predictive value.

Results

Areas under the receiver operating characteristic curve for cardiac congestion, pleural effusion, air-space opacification, pneumothorax, central venous catheter, thoracic drain, gastric tube, and tracheal tube/cannula were 0.90 (95% confidence interval [CI], 0.87–0.93; 3 radiologists on the receiver operating characteristic [ROC] curve), 0.95 (95% CI, 0.93–0.96; 3 radiologists on the ROC curve), 0.85 (95% CI, 0.82–0.89; 1 radiologist on the ROC curve), 0.92 (95% CI, 0.89–0.95; 1 radiologist on the ROC curve), 0.99 (95% CI, 0.98–0.99), 0.99 (95% CI, 0.98–0.99), 0.98 (95% CI, 0.97–0.99), and 0.99 (95% CI, 0.98–1.00), respectively.

Conclusions

A deep learning model used specifically for bedside CXRs showed similar performance to expert radiologists. It could therefore be used to detect clinically relevant findings during after-hours and help emergency and intensive care physicians to focus on patient care.
Ultra-High b-Value Diffusion-Weighted Imaging-Based Abbreviated Protocols for Breast Cancer Detection
Authors: Ohlmeyer Sabine , Laun Frederik Bernd , Bickelhaupt Sebastian , Palm Theresa , Janka Rolf , Weiland Elisabeth , Uder Michael , Wenkel Evelyn
Published: April 2021

Objectives

Contrast-enhanced (CE) magnetic resonance imaging (MRI) is the most effective imaging modality for breast cancer detection. A contrast agent–free examination technique would be desirable for breast MRI screening. The purpose of this study was to evaluate the capability to detect and characterize suspicious breast lesions with an abbreviated, non–contrast-enhanced MRI protocol featuring ultra-high b-value diffusion-weighted imaging (DWI) compared with CE images.

Materials and Methods

The institutional review board–approved prospective study included 127 female subjects with different clinical indications for breast MRI. Magnetic resonance imaging examinations included DWI sequences with b-values of 1500 s/mm2 (b1500) and 2500 s/mm2 (b2500), native T1- and T2-weighted images, and CE sequences at 1.5 T and 3 T scanners. Two reading rounds were performed, including either the b1500 or the b2500 DWI in consecutive assessment steps: (A) maximum intensity projections (MIPs) of DWI, (B) DWI and apparent diffusion coefficient maps, (C) as (B) but with additional native T1- and T2-weighted images, and (D) as (C) but with additional CE images (full-length protocol). Two readers independently determined the presence of a suspicious lesion. Histological confirmation was obtained for conspicuous lesions, whereas the full MRI data set was obtained for inconspicuous and clearly benign lesions. Statistical analysis included calculation of diagnostic accuracy and interrater agreement via the intraclass correlation coefficient.

Results

The cohort comprised 116 cases with BI-RADS 1 findings and 138 cases with BI-RADS ≥2 findings, including 38 histologically confirmed malignancies. For (A), breasts without pathological findings could be recognized with high diagnostic accuracy (negative predictive value, ≥97.0%; sensitivity, ≥92.1% for both readers), but with a limited specificity (≥58.3%; positive predictive value, ≥28.6%). Within the native readings, approach (C) with b2500 performed best (negative predictive value, 99.5%; sensitivity, 97.4%; specificity, 88.4%). The intraclass correlation coefficient was between 0.683 (MIP b1500) and 0.996 (full protocol).

Conclusions

A native abbreviated breast MRI protocol with advanced high b-value DWI might allow nearly equivalent diagnostic accuracy as CE breast MRI and seems to be well suited for lesion detection purposes.
The weird eusociality of polyembryonic parasites
Authors: Whyte Brian A.
Published: April 2021

Some parasitoid wasps possess soldier castes during their parasitic larval stage, but are often neglected from our evolutionary theories explaining caste systems in animal societies. This is primarily due to the polyembryonic origin of their societies. However, recent discoveries of polyembryonic trematodes (i.e. flatworms) possessing soldier castes require us to reconsider this reasoning. I argue we can benefit from including these polyembryonic parasites in eusocial discussions, for polyembryony and parasitism are taxonomically vast and influence the evolution of social behaviours and caste systems in various circumstances. Despite their polyembryony, their social evolution can be explained by theories of eusociality designed for parent–offspring groups, which are the subjects of most social evolution research. Including polyembryonic parasites in these theories follows the trend of major evolutionary transitions theory expanding social evolution research into all levels of biological organization. In addition, these continued discoveries of caste systems in parasites suggest social evolution may be more relevant to parasitology than currently acknowledged.
Non-uniform mixing of hepatic venous flow and inferior vena cava flow in the Fontan conduit
Authors: Rijnberg Friso M. , van der Woude Séline F. S. , van Assen Hans C. , Juffermans Joe F. , Hazekamp Mark G. , Jongbloed Monique R. M. , Kenjeres Sasa , Lamb Hildo J. , Westenberg Jos J. M. , Wentzel Jolanda J. , Roest Arno A. W.
Published: April 2021

Fontan patients require a balanced hepatic blood flow distribution (HFD) to prevent pulmonary arteriovenous malformations. Currently, HFD is quantified by tracking Fontan conduit flow, assuming hepatic venous (HV) flow to be uniformly distributed within the Fontan conduit. However, this assumption may be unvalid leading to inaccuracies in HFD quantification with potential clinical impact. The aim of this study was to (i) assess the mixing of HV flow and inferior vena caval (IVC) flow within the Fontan conduit and (ii) quantify HFD by directly tracking HV flow and quantitatively comparing results with the conventional approach. Patient-specific, time-resolved computational fluid dynamic models of 15 total cavopulmonary connections were generated, including the HV and subhepatic IVC. Mixing of HV and IVC flow, on a scale between 0 (no mixing) and 1 (perfect mixing), was assessed at the caudal and cranial Fontan conduit. HFD was quantified by tracking particles from the caudal (HFD
caudal conduit
) and cranial (HFD
cranial conduit
) conduit and from the hepatic veins (HFD
HV
). HV flow was non-uniformly distributed at both the caudal (mean mixing 0.66 ± 0.13) and cranial (mean 0.79 ± 0.11) level within the Fontan conduit. On a cohort level, differences in HFD between methods were significant but small; HFD
HV
(51.0 ± 20.6%) versus HFD
caudal conduit
(48.2 ± 21.9%,
p
= 0.033) or HFD
cranial conduit
(48.0 ± 21.9%,
p
= 0.044). However, individual absolute differences of 8.2–14.9% in HFD were observed in 4/15 patients. HV flow is non-uniformly distributed within the Fontan conduit. Substantial individual inaccuracies in HFD quantification were observed in a subset of patients with potential clinical impact.
Flashing spots on the dorsal trunk of hardyhead silverside fish
Authors: Iwasaka Masakazu
Published: April 2021

A large number of living creatures are able to use ambient light effectively in biological signalling.
Atherinomorus lacunosus
, a teleost fish has alignments of circular spots on its dorsal trunk. The spot consists of iridophores, whose diameters are approximately 7–10 µm. The iridophore contains guanine crystals with diameters of 1–3 µm. Here, it is found that more than one spot with a diameter of approximately 0.1 mm causes a rhythmic flashing of light when viewed under white light. The typical light flash has a pulse width of approximately one second. When a pulsed train of flashes appears, the flash repeats at a typical frequency of 0.5–1 Hz. The observed phenomenon is one example of the evidence for the existence of rapid colour changing teleost fish.
General soliton and (semi-)rational solutions of the partial reverse space y-non-local Mel’nikov equation with non-zero boundary conditions
Authors: Fu Heming , Lu Wanshi , Guo Jiawei , Wu Chengfa
Published: April 2021

General soliton and (semi-)rational solutions to the y-non-local Mel’nikov equation with non-zero boundary conditions are derived by the Kadomtsev–Petviashvili (KP) hierarchy reduction method. The solutions are expressed in
N
×
N
Gram-type determinants with an arbitrary positive integer
N
. A possible new feature of our results compared to previous studies of non-local equations using the KP reduction method is that there are two families of constraints among the parameters appearing in the solutions, which display significant discrepancies. For even
N
, one of them only generates pairs of solitons or lumps while the other one can give rise to odd numbers of solitons or lumps; the interactions between lumps and solitons are always inelastic for one family whereas the other family may lead to semi-rational solutions with elastic collisions between lumps and solitons. These differences are illustrated by a thorough study of the solution dynamics for
N
= 1, 2, 3. Besides, regularities of solutions are discussed under proper choices of parameters.
Polar bears are inefficient predators of seabird eggs
Authors: Jagielski Patrick M. , Dey Cody J. , Gilchrist H. Grant , Richardson Evan S. , Love Oliver P. , Semeniuk Christina A. D.
Published: April 2021

Climate-mediated sea-ice loss is disrupting the foraging ecology of polar bears (Ursus maritimus) across much of their range. As a result, there have been increased reports of polar bears foraging on seabird eggs across parts of their range. Given that polar bears have evolved to hunt seals on ice, they may not be efficient predators of seabird eggs. We investigated polar bears' foraging performance on common eider (Somateria mollissima) eggs on Mitivik Island, Nunavut, Canada to test whether bear decision-making heuristics are consistent with expectations of optimal foraging theory. Using aerial-drones, we recorded multiple foraging bouts over 11 days, and found that as clutches were depleted to completion, bears did not exhibit foraging behaviours matched to resource density. As the season progressed, bears visited fewer nests overall, but marginally increased their visitation to nests that were already empty. Bears did not display different movement modes related to nest density, but became less selective in their choice of clutches to consume. Lastly, bears that capitalized on visual cues of flushing eider hens significantly increased the number of clutches they consumed; however, they did not use this strategy consistently or universally. The foraging behaviours exhibited by polar bears in this study suggest they are inefficient predators of seabird eggs, particularly in the context of matching behaviours to resource density.
Drug repositioning candidates identified using in-silico quasi-quantum molecular simulation demonstrate reduced COVID-19 mortality in 1.5M patient records
Authors: Alamgir Joy , Yajima Masanao , Ergas Rosa , Chen Xinci , Hill Nicholas , Munir Naved , Saeed Mohsan , Gersing Ken , Haendel Melissa , Chute Christopher G , Abid M. Ruhul
Published: April 2021

Background

Drug repositioning is a key component of COVID-19 pandemic response, through identification of existing drugs that can effectively disrupt COVID-19 disease processes, contributing valuable insights into disease pathways. Traditional non in silico drug repositioning approaches take substantial time and cost to discover effect and, crucially, to validate repositioned effects.

Methods

Using a novel in-silico quasi-quantum molecular simulation platform that analyzes energies and electron densities of both target proteins and candidate interruption compounds on High Performance Computing (HPC), we identified a list of FDA-approved compounds with potential to interrupt specific SARS-CoV-2 proteins. Subsequently we used 1.5M patient records from the National COVID Cohort Collaborative to create matched cohorts to refine our in-silico hits to those candidates that show statistically significant clinical effect.

Results

We identified four drugs, Metformin, Triamcinolone, Amoxicillin and Hydrochlorothiazide, that were associated with reduced mortality by 27%, 26%, 26%, and 23%, respectively, in COVID-19 patients.

Conclusions

Together, these findings provide support to our hypothesis that in-silico simulation of active compounds against SARS-CoV-2 proteins followed by statistical analysis of electronic health data results in effective therapeutics identification.
Rapid screening for variants of concern in routine SARS-CoV-2 PCR diagnostics
Authors: Naaber Paul , Lahesaare Andrio , Truu Laura , Soojärv Andres , Adamson Ainika , Beljaev Kaido , Aamisepp Rainar , Ratnik Kaspar
Published: April 2021

The emerging spread of variants of concern (VOC) of SARS-CoV-2 has been noted in several countries worldwide during last months. VOCs associated with increased transmissibility and morality. Sequencing is the gold standard for investigation of variants, however it is expensive and time-consuming. S-dropout routine monitoring in combination with VOC screening by RT-PCR is a useful tool for VOC surveillance.