bluuebunny/crossref_metadata_2025 huggingface dataset:
Nadir CA-125 serum levels during neoadjuvant chemotherapy and no residual tumor at interval debulking surgery predict prognosis in advanced stage ovarian cancer
Authors: Nakamura Kazuto , Kitahara Yoshikazu , Nishimura Toshio , Yamashita Soichi , Kigure Keiko , Ito Ikuro , Kanuma Tatsuya
Published: August 2020

Background

Recent phase III randomized trials have suggested that neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) is a treatment option for patients with advanced epithelial ovarian cancer. This study aimed to use CA-125 and computed tomography (CT) scanning to generate a simple and clinically applicable model of predicting complete cytoreduction by interval debulking surgery (IDS) and the overall survival in patients who receive taxane/platinum-based chemotherapy as neoadjuvant chemotherapy (NACT).

Methods

Patients with stage IIIc or IV epithelial ovarian cancer who underwent taxane/platinum-based NACT followed by IDS in Gunma Prefectural Cancer Center, Takasaki General Medical Center, and Gunma University from April 2009 to March 2015 were included. Patients underwent a CT scan to confirm confirm tumors unresectable by standard surgery before NACT. CA-125 levels were measured pre-NACT, after each cycle of NACT, and before IDS. CT was also performed before IDS to evaluate tumor metastasis. Data were collected retrospectively and analyzed to determine the predictive factors of complete resection and overall survival.

Results

Among 63 patients who received NACT-IDS, 43 and 20 patients had stages IIIc and IV epithelial ovarian cancer at diagnosis, respectively. CT predictors of residual tumors after IDS such as extra-ovarian implants (P= 0.009) and omental cakes (P= 0.038) were not present. Univariate analysis revealed that the independent factors for overall survival were no residual tumor by IDS (P= 0.0016) and CA125 ≤ 20 U/ml before IDS (P= 0.0011).

Conclusions

Although this study had a small sample size, NACT-IDS used to completely remove macroscopic disease which significantly improved the prognosis of patients with preoperative CA-125 ≤ 20 U/ml. Results from this study provide useful information for future studies on the management of patients with advanced epithelial ovarian cancer.
Temporal trends in leisure-time sedentary behavior among adolescents aged 12-15 years from 26 countries in Asia, Africa, and the Americas
Authors: Felez-Nobrega Mireia , Raine Lauren B. , Haro Josep Maria , Wijndaele Katrien , Koyanagi Ai
Published: August 2020

Background

Multi-country studies examining trends in sedentary behaviors among adolescents have mainly focused on high-income or Western countries, and almost no data exists for the rest of the world. Thus, this study aims to examine temporal trends in adolescents’ leisure time sedentary behavior (LTSB) employing nationally representative datasets from 26 countries from five WHO-defined geographical regions.

Methods

Data from the Global School-based Student Health Survey 2003–2017 were analyzed in 17,734 adolescents [mean (SD) age: 13.7 (1.0) years; 49.0% boys]. LTSB was self-reported and included all types of sedentary behaviors, excluding time spent at school or doing homework. The prevalence and 95%CI of high LTSB (i.e., ≥3 h/day) was calculated for the overall sample and by sex for each survey. Crude linear trends in high LTSB were assessed by linear regression models. Interaction analyses were conducted to examine differing trends among boys and girls.

Results

Temporal variations in LTSB substantially diverged across countries, with results showing increasing (6/26 countries), decreasing (4/26) and stable trends. The sharpest increases in LTSB occurred in United Arab Emirates, Kuwait, and Thailand. Some countries did not show an increase in LTSB prevalence over time but had very high levels of LTSB (i.e., > 40%) across multiple years. Most countries showed no differences in LTSB trends between boys and girls.

Conclusions

Data from our study may serve as an important platform for policymakers, as well as local and national stakeholders, to establish country-specific and tailored strategies for reducing LTSB.
Correction to: Identification of miRNA-mRNA crosstalk in CD4+ T cells during HIV-1 infection by integrating transcriptome analyses
Authors: Liao Qibin , Wang Jin , Pei Zenglin , Xu Jianqing , Zhang Xiaoyan
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
Determinants of comprehensive knowledge of HIV/AIDS among reproductive age (15–49 years) women in Ethiopia: further analysis of 2016 Ethiopian demographic and health survey
Authors: Agegnehu Chilot Desta , Geremew Bisrat Misganaw , Sisay Malede Mequanent , Muchie Kindie Fentahun , Engida Zinash Teferu , Gudayu Temesgen Worku , Weldetsadik Daniel Sisay , Liyew Alemneh Mekuriaw
Published: August 2020

Background

The key cause of HIV transmission is failure to provide adequate information about HIV/AIDS which is a substantial public health issue in low and middle-income countries. While global health coverage continues, there is still little understanding of HIV/AIDS among women of reproductive age (15–49 years) in Ethiopia. Therefore, the purpose of this study was to identify the determinants of comprehensive knowledge of HIV/AIDS among women of reproductive age in Ethiopia.

Methods

A secondary data analysis was employed using the 2016 Ethiopian demographic and health survey data. Data were extracted about comprehensive knowledge of HIV/AIDS among women of reproductive age. We used multi-variable mixed-effect binary logistic regression to identify factors associated with comprehensive knowledge of HIV/AIDS among women of reproductive age. The adjusted odds ratio with 95% confidence interval was used to declare statistical significance.

Results

We found that having primary (AOR = 1.75, 95% CI 1.56–1.97),secondary (AOR = 2.74, 95% CI 2.33–3.22), and higher (AOR = 4.07, 95% CI 3.32–4.99) educational statuses, being in highest wealth quintiles; richer (AOR = 1.20, 95% CI 1.01–1.43) and richest (AOR = 1.51, 95% CI 1.22–1.87), knowing the place for HIV test (AOR = 2.13, 95% CI 1.88–2.42), use of traditional contraceptive method (AOR = 1.93,95% CI 1.12–3.35), female household head (AOR = 1.18, 95% CI 1.07–1.31), watching television (AOR = 1.22, 95% CI 1.06–1.41) and own mobile phone (AOR = 1.18, 95% CI 1.05–1.33) were positively associated with comprehensive knowledge of HIV/AIDS among women of reproductive age in Ethiopia.

Conclusion

Women with higher education and higher wealth quintiles, knowing the place of HIV test, watching television, a traditional contraceptive method use, having a mobile phone and being in female headed household were positively associated with comprehensive knowledge of HIV/AIDS among women of reproductive age in Ethiopia. Programs working on HIV/AIDS should target women based on the identified factors so as to scale up their comprehensive knowledge towards HIV/AIDS. In this context, the media should actively contribute to raising awareness of HIV/AIDS.
Biomarkers in critical care nutrition
Authors: Stoppe Christian , Wendt Sebastian , Mehta Nilesh M. , Compher Charlene , Preiser Jean-Charles , Heyland Daren K. , Kristof Arnold S.
Published: August 2020

The goal of nutrition support is to provide the substrates required to match the bioenergetic needs of the patient and promote the net synthesis of macromolecules required for the preservation of lean mass, organ function, and immunity. Contemporary observational studies have exposed the pervasive undernutrition of critically ill patients and its association with adverse clinical outcomes. The intuitive hypothesis is that optimization of nutrition delivery should improve ICU clinical outcomes. It is therefore surprising that multiple large randomized controlled trials have failed to demonstrate the clinical benefit of restoring or maximizing nutrient intake. This may be in part due to the absence of biological markers that identify patients who are most likely to benefit from nutrition interventions and that monitor the effects of nutrition support. Here, we discuss the need for practical risk stratification tools in critical care nutrition, a proposed rationale for targeted biomarker development, and potential approaches that can be adopted for biomarker identification and validation in the field.
Unspecific post-mortem findings despite multiorgan viral spread in COVID-19 patients
Authors: Remmelink Myriam , De Mendonça Ricardo , D’Haene Nicky , De Clercq Sarah , Verocq Camille , Lebrun Laetitia , Lavis Philomène , Racu Marie-Lucie , Trépant Anne-Laure , Maris Calliope , Rorive Sandrine , Goffard Jean-Christophe , De Witte Olivier , Peluso Lorenzo , Vincent Jean-Louis , Decaestecker Christine , Taccone Fabio Silvio , Salmon Isabelle
Published: August 2020

Background

Post-mortem studies can provide important information for understanding new diseases and small autopsy case series have already reported different findings in COVID-19 patients.

Methods

We evaluated whether some specific post-mortem features are observed in these patients and if these changes are related to the presence of the virus in different organs. Complete macroscopic and microscopic autopsies were performed on different organs in 17 COVID-19 non-survivors. Presence of SARS-CoV-2 was evaluated with immunohistochemistry (IHC) in lung samples and with real-time reverse-transcription polymerase chain reaction (RT-PCR) test in the lung and other organs.

Results

Pulmonary findings revealed early-stage diffuse alveolar damage (DAD) in 15 out of 17 patients and microthrombi in small lung arteries in 11 patients. Late-stage DAD, atypical pneumocytes, and/or acute pneumonia were also observed. Four lung infarcts, two acute myocardial infarctions, and one ischemic enteritis were observed. There was no evidence of myocarditis, hepatitis, or encephalitis. Kidney evaluation revealed the presence of hemosiderin in tubules or pigmented casts in most patients. Spongiosis and vascular congestion were the most frequently encountered brain lesions. No specific SARS-CoV-2 lesions were observed in any organ. IHC revealed positive cells with a heterogeneous distribution in the lungs of 11 of the 17 (65%) patients; RT-PCR yielded a wide distribution of SARS-CoV-2 in different tissues, with 8 patients showing viral presence in all tested organs (i.e., lung, heart, spleen, liver, colon, kidney, and brain).

Conclusions

In conclusion, autopsies revealed a great heterogeneity of COVID-19-associated organ injury and the remarkable absence of any specific viral lesions, even when RT-PCR identified the presence of the virus in many organs.
MDM2 inhibition in combination with endocrine therapy and CDK4/6 inhibition for the treatment of ER-positive breast cancer
Authors: Portman Neil , Milioli Heloisa H. , Alexandrou Sarah , Coulson Rhiannon , Yong Aliza , Fernandez Kristine J. , Chia Kee Ming , Halilovic Ensar , Segara Davendra , Parker Andrew , Haupt Sue , Haupt Ygal , Tilley Wayne D. , Swarbrick Alex , Caldon C. Elizabeth , Lim Elgene
Published: August 2020

Background

Resistance to endocrine therapy is a major clinical challenge in the management of oestrogen receptor (ER)-positive breast cancer. In this setting, p53 is frequently wildtype and its activity may be suppressed via upregulation of its key regulator MDM2. This underlies our rationale to evaluate MDM2 inhibition as a therapeutic strategy in treatment-resistant ER-positive breast cancer.

Methods

We used the MDM2 inhibitor NVP-CGM097 to treat in vitro and in vivo models alone and in combination with fulvestrant or palbociclib. We perform cell viability, cell cycle, apoptosis and senescence assays to evaluate anti-tumour effects in p53 wildtype and p53 mutant ER-positive cell lines (MCF-7, ZR75-1, T-47D) and MCF-7 lines resistant to endocrine therapy and to CDK4/6 inhibition. We further assess the drug effects in patient-derived xenograft (PDX) models of endocrine-sensitive and endocrine-resistant ER-positive breast cancer.

Results

We demonstrate that MDM2 inhibition results in cell cycle arrest and increased apoptosis in p53-wildtype in vitro and in vivo breast cancer models, leading to potent anti-tumour activity. We find that endocrine therapy or CDK4/6 inhibition synergises with MDM2 inhibition but does not further enhance apoptosis. Instead, combination treatments result in profound regulation of cell cycle-related transcriptional programmes, with synergy achieved through increased antagonism of cell cycle progression. Combination therapy pushes cell lines resistant to fulvestrant or palbociclib to become senescent and significantly reduces tumour growth in a fulvestrant-resistant patient-derived xenograft model.

Conclusions

We conclude that MDM2 inhibitors in combination with ER degraders or CDK4/6 inhibitors represent a rational strategy for treating advanced, endocrine-resistant ER-positive breast cancer, operating through synergistic activation of cell cycle co-regulatory programmes.
Strain-level epidemiology of microbial communities and the human microbiome
Authors: Yan Yan , Nguyen Long H. , Franzosa Eric A. , Huttenhower Curtis
Published: August 2020

The biological importance and varied metabolic capabilities of specific microbial strains have long been established in the scientific community. Strains have, in the past, been largely defined and characterized based on microbial isolates. However, the emergence of new technologies and techniques has enabled assessments of their ecology and phenotypes within microbial communities and the human microbiome. While it is now more obvious how pathogenic strain variants are detrimental to human health, the consequences of subtle genetic variation in the microbiome have only recently been exposed. Here, we review the operational definitions of strains (e.g., genetic and structural variants) as they can now be identified from microbial communities using different high-throughput, often culture-independent techniques. We summarize the distribution and diversity of strains across the human body and their emerging links to health maintenance, disease risk and progression, and biochemical responses to perturbations, such as diet or drugs. We list methods for identifying, quantifying, and tracking strains, utilizing high-throughput sequencing along with other molecular and “culturomics” technologies. Finally, we discuss implications of population studies in bridging experimental gaps and leading to a better understanding of the health effects of strains in the human microbiome.
Computational homogenization of transient chemo-mechanical processes based on a variational minimization principle
Authors: Polukhov Elten , Keip Marc-André
Published: August 2020

We present a variational framework for the computational homogenization of chemo-mechanical processes of soft porous materials. The multiscale variational framework is based on a minimization principle with deformation map and solvent flux acting as independent variables. At the microscopic scale we assume the existence of periodic representative volume elements (RVEs) that are linked to the macroscopic scale via first-order scale transition. In this context, the macroscopic problem is considered to be homogeneous in nature and is thus solved at a single macroscopic material point. The microscopic problem is however assumed to be heterogeneous in nature and thus calls for spatial discretization of the underlying RVE. Here, we employ Raviart–Thomas finite elements and thus arrive at a conforming finite-element formulation of the problem. We present a sequence of numerical examples to demonstrate the capabilities of the multiscale formulation and to discuss a number of fundamental effects.
Culturally and developmentally adapting group interpersonal therapy for adolescents with depression in rural Nepal
Authors: Rose-Clarke Kelly , Pradhan Indira , Shrestha Pragya , B.K. Prakash , Magar Jananee , Luitel Nagendra P. , Devakumar Delan , Rafaeli Alexandra Klein , Clougherty Kathleen , Kohrt Brandon A. , Jordans Mark J. D. , Verdeli Helen
Published: August 2020

Background

Evidence-based interventions are needed to reduce depression among adolescents in low- and middle-income countries (LMICs). One approach could be cultural adaptation of psychological therapies developed in high-income countries. We aimed to adapt the World Health Organization’s Group Interpersonal Therapy (IPT) Manual for adolescents with depression in rural Nepal.

Methods

We used a participatory, multi-stage adaptation process involving: translation and clinical review of the WHO Manual; desk reviews of adaptations of IPT in LMICs, and literature on child and adolescent mental health interventions and interpersonal problems in Nepal; a qualitative study to understand experiences of adolescent depression and preferences for a community-based psychological intervention including 25 interviews with adolescent boys and girls aged 13–18 with depression, four focus group discussions with adolescents, four with parents/caregivers and two with teachers, six interviews with community health workers and one with a representative from a local non-governmental organisation (total of 126 participants); training of IPT trainers and facilitators and practice IPT groups; and consultation with a youth mental health advisory board. We used the Ecological Validity Framework to guide the adaptation process.

Results

We made adaptations to optimise treatment delivery and emphasise developmental and cultural aspects of depression. Key adaptations were: integrating therapy into secondary schools for delivery by school nurses and lay community members; adding components to promote parental engagement including a pre-group session with the adolescent and parent to mobilise parental support; using locally acceptable terms for mental illness such as udas-chinta (sadness and worry) and man ko samasya (heart-mind problem); framing the intervention as a training programme to de-stigmatise treatment; and including activities to strengthen relationships between group members. We did not adapt the therapeutic goals of IPT and conserved IPT-specific strategies and techniques, making edits only to the way these were described in the Manual.

Conclusions

Group IPT can be adapted for adolescents in Nepal and delivered through the education system. A randomised controlled trial is needed to assess the impact and costs of the intervention in this setting. Future research in LMICs to adapt IPT for adolescents could use this adapted intervention as a starting point.
Development of a highly sensitive method for detection of FLT3D835Y
Authors: Guo Yao , Sun Honghua , Zhang Dengyang , Zhao Yuming , Shi Mingxia , Yang Ming , Xing Shu , Fu Xueqi , Bin Ting , Lu Bo , Wu Shunjie , Xu Xiaojun , Xu Xuesong , Chen Yun , Zhao Zhizhuang Joe
Published: August 2020

Background

Acute myeloid leukemia (AML) is a malignant hematological neoplasm of myeloid progenitor cells. Mutations of FLT3 in its tyrosine kinase domain (FLT3-TKD) are found in ~ 8% of patients with AML, with D835Y as the most common substitution. This mutation activates survival signals that drives the disease and is resistant to the first generation FLT3 inhibitors. Development of a highly sensitive method to detect FLT3D835Y is important to direct therapeutic options, predict prognosis, and monitor minimal residual disease in patients with AML.

Methods and results

In the present study, we developed a highly sensitive FLT3D835Y detection method by using the restriction fragment nested allele-specific PCR technique. The method consists of three steps: 1) initial amplification of DNA samples with PCR primers surrounding the FLT3D835Y mutation site, 2) digestion of the PCR products with restriction enzyme EcoRV that only cleaves the wild type allele, and 3) detection of FLT3D835Y by allele-specific PCR with nested primers. We were able to detect FLT3D835Y with a sensitivity of 0.001% by using purified plasmid DNAs and blood cell DNAs containing known proportions of FLT3D835Y. We analyzed blood cell DNA samples from 64 patients with AML and found six FLT3D835Y-positive cases, two of which could not be detected by conventional DNA sequencing methods. Importantly, the method was able to detect FLT3D835Y in a sample collected from a relapsed patient while the patient was in complete remission with negative MRD determined by flow cytometry. Therefore, our RFN-AS-PCR detected MRD after treatment that was missed by flow cytometry and Sanger DNA sequencing, by conventional methods.

Conclusions

We have developed a simple and highly sensitive method that will allow for detection of FLT3D835Y at a very low level. This method may have major clinical implications for treatment of AML.
Laparoscopic sleeve gastrectomy performed in a morbidly obese patient with gastrointestinal stromal tumor: a case report and literature review
Authors: Hashimoto Kenkichi , Sakaguchi Yoshihisa , Nambara Sho , Kudou Kensuke , Kusumoto Eiji , Yoshinaga Keiji , Kusumoto Tetsuya , Ikejiri Koji
Published: August 2020

Background

Gastrointestinal stromal tumor (GIST) is the most frequent submucosal tumor, and with advancements of diagnostic modalities, the incidence of GIST cases diagnosed have increased. Similarly, prevalence of morbid obesity has also rapidly increased over the past decade. Notably, the incidence of GIST in obese patients was reported to be more frequent as compared to the general population. Despite local resection being the first choice for GIST treatment, extensive surgery should also be considered depending on the tumor size and location. Laparoscopic sleeve gastrectomy (LSG), the most popular bariatric procedure, could also be a concomitant treatment option for both morbid obesity and GIST when the tumor is contained within LSG the excision range. There are, however, few reports about LSG planned for GIST preoperatively.

Case presentation

A morbidly obese 46-year-old Japanese male (body weight of 105.4 kg, body mass index (BMI) of 36.6 kg/m2) was diagnosed with an intramural GIST in the gastric fundus. Because of his extreme visceral fat dominated obesity (visceral fat area of 386 cm2), in addition to the size and location of the tumor, we determined that it would be difficult to perform local resection. We planned LSG as a concomitant treatment for both GIST and morbid obesity. After the preoperative examination and 6 months of weight control, the patient lost enough weight to undergo LSG safely. Keeping enough distance away from the tumor, which we observed with an endoscope, we performed LSG to successfully resect the tumor. The patient was discharged uneventfully. Weight loss was successful as his BMI was 21.0 kg/m2 at 3 months post-surgery.

Conclusion

We successfully performed LSG in a morbidly obese patient with a large GIST. This is the largest GIST concomitantly resected with LSG reported within current literature.
A qualitative study using hybrid simulation to explore the impacts of human factors e-learning on behaviour change
Authors: Carter Harry , Hanks Sally , Gale Thomas
Published: August 2020

Background

There is an international drive to increase human factors training in undergraduate medical curricula through various educational platforms. E-learning can be effective at teaching technical skills but there is limited research exploring the benefits of e-learning in human factors training. This study aimed to utilise hybrid simulation to investigate the impact of a human factors focused e-learning package for intravenous cannulation on safety behaviours.

Methods

Video-reflexive ethnography (VRE) techniques and interviews were used to explore human factor-related behaviour change in hybrid simulation scenarios, before and after e-learning modular training. Ten final-year medical students were recruited for the study. Content analysis of VRE data from hybrid simulation scenarios identified which behaviours had changed; thematic analysis of semi-structured interviews uncovered why.

Results

Results demonstrate improvement in safety behaviours in the domains of physical-, cognitive- and macro-ergonomics, suggesting safer cannulation practice following training. Online videos with interactive activities were reported as the major pedagogical driver for change. The impact of the e-learning was identified across four themes: environment, person, policy-related tasks, and preparedness for practise. Reported intention to change practise and altered behaviour in the workplace supports the conclusion that this training prepares students for practise by facilitating them to incorporate human factors principles in their clinical work.

Conclusion

E-learning is a valuable and effective method for supporting medical student learning about human factors. Hybrid simulation and VRE combine well together to evaluate behaviour change following educational interventions.
COVID-19 related deaths in an urban academic medical center in Brooklyn – a descriptive case series
Authors: McCracken James Andrew , Nakeshbandi Mohamed , Arace Jeffrey , Riley Wayne J. , Sharma Roopali
Published: August 2020

Background

Available studies are lacking in analysis of baseline demographics and hospital presentation of patients at risk of expiring due to coronavirus disease 2019 (COVID-19), particularly Black American patients. We conducted a retrospective chart review to determine similarities in demographics and hospital presentation among patients who expired due to COVID-19 at an academic medical center in Brooklyn, New York.

Study design and methods

This is a retrospective observational study of 200 patients who expired due to complications of COVID-19. Patients were included in this study if they had laboratory-confirmed SARS-CoV-2 infection and expired during their admission. Data were collected on patients who expired between March 17 and April 16, 2020.

Results

A vast majority of patients were Black Americans (89%) with no history of international travel who had more than one comorbidity (81%), with the most common comorbidities being hypertension (84·5%), diabetes mellitus (57·5%), and obesity (41·5%). Fifty-five percent of our patient population had three or more comorbidities. Among patients with available data, C-reactive protein, lactate dehydrogenase, and ferritin values were elevated above normal limits at admission. Dyspnea was the most common presenting symptom (92·5%). Most (90·5%) presented within the first week of symptoms, with a median time of symptoms prior to expiration being 8·42 days (IQR 5·57–12·72).

Interpretation

Socioeconomic status and healthcare inequalities have greatly affected the Black population of Brooklyn, New York, and these disparities become even more apparent in COVID-19 infection. Patients presenting with numerous comorbidities and elevated inflammatory markers represent a population at high risk of in-hospital mortality.
Rivastigmine patch (Exelon patch) compared to melatonin patch in prevention of postoperative delirium in the elderly
Authors: Hussien Rania Maher , Shoukry Aktham Adel
Published: August 2020

Background

Postoperative delirium (PD) is an acute, transient disorder of consciousness, attention, perception, and cognition. Many theories, such as decreased cholinergic neurotransmission and surgery-induced disturbances in melatonin secretion, were proposed as a potential cause for developing PD especially in the elderly.

Previous studies concluded that perioperative rivastigmine significantly reduced the prevalence and severity of PD. Other studies concluded that oral perioperative melatonin was associated with a lower risk of PD. However, the effect of melatonin in patch form was not studied and the effect of perioperative rivastigmine and melatonin patch was not compared.

Our aim was to compare rivastigmine patch to melatonin patch regarding the incidence and severity of PD in elderly patients undergoing major orthopaedic surgery.

Methods

In this double blinded randomized study, 180 elderly patients, ASA I–III, aged 60–85 years undergoing major orthopaedic surgery were divided into two equal groups; group R patients received a rivastigmine patch (4.6 mg) and group M patients received a melatonin patch (7 mg). Both patches were administered 24 h preoperative, on the day of operation and for the following 3 postoperative days. All patients received regional anaesthesia and basic monitoring in the form of NIBP, SPO2, and ECG. Patients were examined for PD using the Confusion Assessment Method (CAM) and level of sedation using the Ramsay Sedation Score (RSS) on the first, second, third, and 7th postoperative day, and for those who develop PD, a CAM-S score was done to assess the severity of PD. Drug-related side effects were recorded. Statistical analyses were performed using a standard SPSS software.

Results

CAM score was positive in a total of 39 patients. Rivastigmine patch significantly decreased the incidence of PD when compared to melatonin patch (P value 0.047). However, CAM-S indicated that the severity of PD was comparable. Patients were more sedated in the melatonin group. There were no melatonin- nor rivastigmine-related perioperative complications. Intraoperative SBP, DBP, and HR were slightly less in melatonin group, although statistically non-significant.

Conclusions

Rivastigmine patch is superior to melatonin patch in decreasing the incidence of PD in elderly patients undergoing major orthopaedic surgery; however, both drugs were comparable in decreasing its severity.

Trial registration

Clinical trails.gov, NCT04189666. December 6, 2019, prospectively registered
A sequential inversion with outer iterations for the velocity and the intrinsic attenuation using an efficient wavefield inversion
Authors: Song Chao , Alkhalifah Tariq , Li Yuanyuan
Published: August 2020

Full-waveform inversion (FWI) has become a popular method to retrieve high-resolution subsurface model parameters. It is a highly nonlinear optimization problem based on minimizing the misfit between the observed and predicted data. For intrinsically attenuating media, wave propagation experiences significant loss of energy. Thus, for better data fitting, it is sometimes crucial to consider attenuation in FWI. Viscoacoustic FWI aims at achieving a joint inversion of the velocity and attenuation models. However, multiparameter FWI imposes additional challenges including expanding the null space and facing parameter trade-off issues. Theoretically, an ideal way to mitigate the trade-off issue in multiparameter FWI is to apply the inverse Hessian operator to the parameter gradients. However, it is often not practical to calculate the full Hessian and its matrix inverse because this will be extremely expensive. To improve the computational efficiency and mitigate the trade-off issue, we have used an efficient wavefield inversion (EWI) method to invert for the velocity and the intrinsic attenuation. This approach is implemented in the frequency domain, and the velocity, in this case, is complex-valued in the viscoacoustic EWI. We evaluate a sequential update strategy for the velocity and the intrinsic attenuation, and we repeat the separate optimizations, which we refer to as outer iterations, until the convergence is achieved. Because viscoacoustic EWI is able to recover an accurate velocity model, the velocity update leakage to the [Formula: see text] model is largely reduced. We determine the effectiveness of this approach using synthetic data generated for the viscoacoustic Marmousi and Overthrust models. To further demonstrate the validity of our approach, we generate data in the time domain using a viscoelastic wave equation solver and obtain reasonable inversion results in the frequency domain using the viscoacoustic approximation.
Estimation of in situ hydrocarbon saturation of porous rocks from borehole measurements of spontaneous potential
Authors: Bautista-Anguiano Joshua , Torres-Verdín Carlos
Published: August 2020

It has been previously shown that Nernst’s equation is not reliable for the interpretation of spontaneous potential (SP) measurements acquired in hydrocarbon-bearing rocks. We have examined whether the difference between borehole SP measurements and Nernst-equation predictions could be used to estimate in situ hydrocarbon saturation of porous rocks. For this purpose, a new petrophysical model and a mechanistic finite-difference algorithm for simulating SP borehole measurements in the presence of mud-filtrate invasion are used to establish the limits of detectability of hydrocarbon saturation using only SP logs. We find that the optimal conditions for the detection of hydrocarbon saturation from SP borehole measurements are when (1) capillary forces dominate the process of mud-filtrate invasion, (2) the matrix-pore interface region, known as the electrical double layer, has a relevant impact in the diffusion of counterions, and (3) the electrolyte concentration of drilling mud is greater than that of formation water. We also determine why high values of the endpoint of the water relative permeability favor the detection of hydrocarbon-saturated rocks with the SP log. Using measurements acquired in three key wells within a mature and active hydrocarbon field, three blind tests find that our petrophysical model together with the mechanistic SP simulation algorithm enable the estimation of hydrocarbon saturation from SP borehole measurements without the need for resistivity logs or porosity calculations. The estimation is reliable when the volumetric concentration of shale is negligible, the pore network structure is constant throughout the reservoir, and radial invasion profiles are similar to those observed in the calibration key wells.
Magnetic resonance tomography constrained by ground-penetrating radar for improved hydrogeophysical characterization
Authors: Jiang Chuandong , Igel Jan , Dlugosch Raphael , Müller-Petke Mike , Günther Thomas , Helms Julian , Lang Jörg , Winsemann Jutta
Published: August 2020

Geophysical methods can characterize aquifer systems noninvasively and are particularly helpful to image the complex depositional architecture of the subsurface. Among these, ground-penetrating radar (GPR) is an effective tool for detailed investigations of shallow subsurface geometry, but it provides only limited information on hydraulic properties. Magnetic resonance tomography (MRT) provides parameters such as water content (porosity) and relaxation time/hydraulic conductivity, but it suffers from resolution limits. Furthermore, it requires knowledge of subsurface electrical resistivity, which can be obtained by electrical resistivity tomography (ERT) also suffering from resolution limits. To overcome the limitations in resolution, we have incorporated GPR reflectors as structural information into the ERT and MRT data inversion. We test the methodology on a synthetic example and find improved imaging properties compared to standard inversion, particularly at greater depths, where the resolution is limited. We apply the methodology to a test site that is characterized by a complex depositional architecture. The Quaternary deposits consist of interbedded meltwater deposits (aquifers) and till (aquitards), overlain by aeolian deposits. To image the subsurface depositional architecture in three dimensions, a [Formula: see text] area was surveyed by GPR. The use of GPR constraints clearly improves the resolution and zonation of the subsurface image, which is validated by drill-core analyses. We develop a workflow to combine GPR, MRT, and ERT, leading the way to high-resolution hydrogeologic models that can be used for groundwater studies.
Cross-profile seismic data acquisition, imaging, and modeling of iron-oxide deposits: A case study from Blötberget, south-central Sweden
Authors: Maries Georgiana , Malehmir Alireza , Marsden Paul
Published: August 2020

Two 2D reflection seismic profiles were acquired in Blötberget, south-central Sweden, for deep targeting and delineation of sheet-like iron-oxide deposits, known to dip toward the southeast and extend down to at least 0.8 km depth from core drilling observations. The two perpendicular profiles recorded shots at every receiver station along the main and cross profiles. To obtain more information on the lateral extent of the mineralized horizons, data from the two profiles, including the cross-profile records, were binned together in a 3D grid and further processed as a 3D data set. Processing results suggest that more information is retrieved when 3D processing is used and the mineralization lateral extent can be inferred for at least 0.3 km. The seismic response of the mineralization was further studied through forward reflection traveltime modeling, using a 3D ray-tracing approach; thus, the 3D geometry of several planar reflectors was validated. Additionally, 2D elastic finite-difference modeling work showed that the observed reflection pattern in the seismic data may originate from several mineralized horizons, suggesting potential resources in the footwall of the known deposits and large-scale geologic structures. The results encourage the use of seismic methods for direct delineation of mineral deposits even from 2D profiles and prompted a 3D survey in the area.
Velocity model estimation of karstic fault reservoirs using full-waveform inversion accelerated on graphics processing unit
Authors: Wang Ziying , Huang Jianping , Li Zhenchun , Fu Li-Yun , Luo Wenqiang , Mu Xinru
Published: August 2020

The karstic fault reservoir is a type of hydrocarbon-enriched carbonate reservoir. It is a combination of small-scale caves, vugs, and fractures developing near deep-seated faults, which makes it difficult to delineate using traditional seismic imaging methods. Recent research on geologic characteristics of paleokarst reservoirs facilitates hydrocarbon exploration and exploitation in western China. To interpret karstic fault systems and reservoirs, the seismic image is an effective tool. A high-quality velocity model is essential for high-resolution migration. These seismic results contain crucial information to interpret reservoirs. Full-waveform inversion (FWI) is a powerful method to obtain high-precision velocity models because it makes use of the kinematic and dynamic information in the seismic full wavefield. To image such complicated and irregular fractured-cavity reservoirs accurately, we have applied a multiscale FWI method accelerated on graphics processing unit devices to fault-controlled paleokarst reservoir models. According to the model test results, FWI shows high performance in delineating the boundaries of fault-controlled karstic reservoirs. The proposed method also has the potential to characterize inner structures. Based on the high-precision velocity model provided by FWI, the seismic image obtained by reverse time migration is also improved. These seismic results will show the location, width, and shape of the fault-karst structure, which gives detailed information for fault-controlled paleokarst reservoir interpretation.
Soil erosion and conservation in northern Europe
Authors: Fullen Michael A.
Published: August 2020

Soil conservation policies are suggested at national, regional and local levels, including adoption and modification of several Australian, European and North American policies. The Australian Landcare system and programmes of the US Natural Resources Conservation Service (NRCS) are particularly informative. Several European initiatives are promising models, including the strategies of the Danish Land Development Service (Hedeselskabet) and the Icelandic Soil Conservation Service (Landsgraedsla Rikisins). The Erosienormeringsprojekt of South Limburg (The Netherlands) is a coordinated and integrated soil conservation project and seems a particularly useful model for future soil conservation in northern Europe. Several best management practices for soil conservation are identified. These include the promotion of soil conservation by a properly funded and relatively well known soil conservation service and full mapping, monitoring and costing of erosion risk by national soil survey organizations. A participatory approach to soil conservation should be adopted, involving farmers and interested members of the public, and there should be a ‘cost share’ partnership between government and farmers in funding conservation work on farms. Rational land-use policies need to be developed, such as the promotion of ‘set-aside’ on erodible soils, grass strips on arable slopes and buffer strips in riparian zones. Education programmes are necessary to actively inform the public on the importance of soil as a resource. These schemes should particularly encourage ‘land literacy’ among participants. It is imperative that the broader societal benefits of effective soil conservation are recognized, such as its potential contribution to habitat creation, biodiversity and carbon sequestration.
Prevalence and Subtype Distribution of High-Risk Human Papillomavirus Among Women Presenting for Cervical Cancer Screening at Karanda Mission Hospital
Authors: Thistle Paul , Parpia Rabea , Pain Debanjan , Lee Hang , Manasa Justen , Schnipper Lowell E.
Published: August 2020

PURPOSE

High-risk human papillomaviruses (hrHPV) are the primary cause of cervical cancer. Human papillomavirus (HPV) vaccination is expected to prevent cervical cancers caused by the HPV types included in vaccines and possibly by cross-protection from other types. This study sought to determine the hrHPV type distribution in women at a rural Zimbabwe hospital.

METHODS

We implemented a cross-sectional study at the Karanda Mission Hospital. Using the Visual Inspection with Acetic Acid Cervicography technique, clinicians collected cervical swabs from 400 women presenting for screening for cervical cancer. Samples were initially analyzed by Cepheid GeneXpert; candidate hrHPV genotypes were further characterized using the Anyplex II HPV28 Detection Kit.

RESULTS

Twenty-one percent of the 400 women were positive for a high-risk genotype when using the GeneXpert analyzer; 17% were positive when using the multiplex analysis. Almost two thirds of the hrHPV women had a single DNA type identified, whereas one third had multiple genotypes, ranging from 2 to 5. hrHPV was observed more frequently in HIV-positive than in HIV-negative women (27% v 15%). Of the 113 isolates obtained, 77% were hrHPV genotypes not included in the bivalent or quadrivalent vaccines, and 47% represented DNA types not covered in the nonavalent vaccine. Forty-seven percent of the women with hrHPV harbored a single genotype that was not covered by the nonavalent vaccine.

CONCLUSION

A large fraction of hrHPV isolates from women participating in a cervical cancer screening program in northern Zimbabwe are DNA types not covered by the bivalent, quadrivalent, or nonavalent vaccines. These findings suggest the importance of characterizing the hrHPV DNA types isolated from cervical neoplasia in this population and determining whether cross-immunization against these genotypes develops after administration of the vaccines in current use.
Bone Marrow Metabolism Is Impaired in Insulin Resistance and Improves After Exercise Training
Authors: Ojala Ronja , Motiani Kumail K , Ivaska Kaisa K , Arponen Milja , Eskelinen Jari-Joonas , Virtanen Kirsi A , Löyttyniemi Eliisa , Heiskanen Marja A , U-Din Mueez , Nuutila Pirjo , Kalliokoski Kari K , Hannukainen Jarna C
Published: August 2020

Context

Exercise training improves bone mineral density, but little is known about the effects of training on bone marrow (BM) metabolism. BM insulin sensitivity has been suggested to play an important role in bone health and whole-body insulin sensitivity.

Objective

To study the effects of exercise training on BM metabolism.

Design

Randomized controlled trial.

Setting

Clinical research center.

Participants

Sedentary healthy (n = 28, 40–55 years, all males) and insulin resistant (IR) subjects (n = 26, 43–55 years, males/females 16/10)

Intervention

Two weeks of sprint interval training or moderate-intensity continuous training

Main outcome measures

We measured femoral, lumbar, and thoracic BM insulin-stimulated glucose uptake (GU) and fasting free fatty acid uptake (FFAU) using positron-emission tomography and bone turnover markers from plasma.

Results

At baseline, GU was highest in lumbar, followed by thoracic, and lowest in femoral BM (all Ps < 0.0001). FFAU was higher in lumbar and thoracic than femoral BM (both Ps < 0.0001). BM FFAU and femoral BM GU were higher in healthy compared to IR men and in females compared to males (all Ps < 0.05). Training increased femoral BM GU similarly in all groups and decreased lumbar BM FFAU in males (all Ps < 0.05). Osteocalcin and PINP were lower in IR than healthy men and correlated positively with femoral BM GU and glycemic status (all Ps < 0.05).

Conclusions

BM metabolism differs regarding anatomical location. Short-term training improves BM GU and FFAU in healthy and IR subjects. Bone turnover rate is decreased in insulin resistance and associates positively with BM metabolism and glycemic control.

Clinical Trial Registration Number

NCT01344928.
Markers of Iron Flux during Testosterone-Mediated Erythropoiesis in Older Men with Unexplained or Iron-Deficiency Anemia
Authors: Artz Andrew S , Stephens-Shields Alisa J , Bhasin Shalender , Ellenberg Susan S , Cohen Harvey J , Snyder Peter J
Published: August 2020

Context

Testosterone treatment of hypogonadal men improves their hemoglobin, but the mechanism is not understood.

Objective

To investigate possible mechanisms by which testosterone stimulates erythropoiesis in hypogonadal older men with unexplained or iron-deficiency anemia.

Design

The Anemia Trial of The Testosterone Trials, a placebo-controlled study in older, hypogonadal men.

Setting

Twelve academic medical centers.

Participants

A total of 95 hypogonadal men (testosterone < 275 ng/mL) ≥65 years with anemia (hemoglobin < 12.7 g/dL). They were classified as having unexplained (n = 58) or iron deficiency anemia (n = 37).

Intervention

Testosterone or placebo gel for 1 year.

Main Outcome Measures

Markers of iron metabolism during the first 3 months of treatment.

Results

Testosterone replacement significantly (P < 0.001) increased hemoglobin in the 58 men who had unexplained anemia (adjusted mean difference 0.58 g/dL; 95% confidence interval, 0.31-0.85). Testosterone replacement tended to increase hemoglobin in the 37 men who had iron deficiency (0.38 g/dL; −0.19, 0.95), but the response was more variable and not statistically significant (P = 0.19). In men with unexplained anemia, testosterone replacement suppressed hepcidin (−8.2 ng/mL; −13.7, −2.7; P = 0.004) and ferritin (−19.6 µg/L; −32.8, −6.3; P = 0.004), but in men with iron deficiency, testosterone replacement did not. The decrease in hepcidin was moderately correlated with the increase in hemoglobin in the men with unexplained anemia (correlation coefficient −0.35, P = 0.01) but not in those with iron deficiency anemia (correlation coefficient −0.07, P = 0.73).

Conclusions

Testosterone replacement of older hypogonadal men with unexplained anemia stimulates erythropoiesis associated with increased iron mobilization. This effect appears to be attenuated by iron deficiency.