bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring artificial neural network combined with laser-induced auto-fluorescence technology for noninvasive in vivo upper gastrointestinal tract cancer early diagnosis
Authors: Chen Zheng Yi , Fu Sheng , Li Minghui , Zhang Wei , Ou Hui Bin
Published: December 2019

In this study, a laser-induced auto-fluorescence (LIAF) system combined with the artificial neural network (ANN) algorithm is developed for early detection of human upper gastrointestinal tract carcinoma in vivo, through investigating the LIAF spectrum characteristics of the normal mucosa layer and the changes concerning an abnormal surface. Of the 44 participating patients, 41 underwent biopsy at the abnormal surface area at endoscopy. The ANN is employed to differentiate the LIAF data obtained from the normal and carcinoma patients (according to biopsy pathology diagnosis). The LIAF spectrum between 500 and 700 nm is selected and normalized. One data point is selected every 10 nm. A feed-forward back-propagation network with 2 hidden layers is constructed and trained. To evaluate the performance of ANN, 10 normal and 10 carcinoma data sets are tested with the trained ANN. 100% of the carcinoma data are very close to −1 (desired), 80% of the normal surface is very close to 1 (desired), and 20% return values around −0.28. Previous works on this type of ANN suggested a threshold of −0.5. As a result, all normal data are successful and the carcinoma cases are accurately classified and diagnosed. In conclusion, the LIAF technology combined with ANN diagnosis is more accurate.
Begin Again and Continue With Life: A Qualitative Study on the Experiences of Cardiac Rehabilitation Patients
Authors: Jokar Fariba , Yousefi Hojatllah , Yousefy Alireza , Sadeghi Masoumeh
Published: December 2019

Background:

Cardiovascular diseases are a main cause of mortality worldwide. However, new diagnostic techniques and treatments have increased the rate of survival for patients with cardiovascular disease. Cardiac rehabilitation programs aim to maintain and enhance the quality of life of patients and improve the secondary prevention of coronary artery disease. Suboptimal participation in rehabilitation programs, early exit from these programs, and not achieving lasting changes are cardiac rehabilitation challenges that are associated with health issues, including the increased need for medication, repeated hospitalization, failure in the secondary prevention programs, and long waiting lists. Exploring the meaning of behavioral changes in the context of cardiac rehabilitation may facilitate the design of effective interventions that are critical to achieving the goals of cardiac rehabilitation programs.

Purpose:

This study explored the mechanisms that underlie behavioral changes within cardiac rehabilitation centers.

Methods:

We used a descriptive qualitative approach, which is widely acknowledged as the best approach for eliciting in-depth descriptions of behavioral changes in the context of cardiac rehabilitation centers. Using purposive sampling, 15 men and 8 women with coronary heart disease were referred to the two cardiac rehabilitation centers participating in this study. The inclusion criteria were participation in four cardiac rehabilitation sessions and ability and willingness to participate. The data were collected using semistructured in-depth interviews, and the inductive thematic analysis method was used for analysis.

Results:

“Trying to stay alive” and “begin again” arose as the two main themes related to behavioral change. These themes include the changes in cognition and values that lead to improvements in the process of behavioral change as a major outcome of cardiac rehabilitation.

Conclusions:

Using psychosocial interventions such as creating and strengthening hope and meaningful intrinsic motivation in the context of rehabilitation centers often helps deal with these challenges. “Trying to stay alive” may take place before referral to a cardiac rehabilitation center. Therefore, psychosocial nursing interventions such as motivational interviewing are designed to improve a process that may be already underway. Thus, stress and anxiety may be treated based on beliefs and emotions. The primary emphasis in cardiac rehabilitation should include changing the beliefs of the patient and motivating her or him to achieve sustainable behavioral change.
Loop Electrosurgical Excision Procedure Treats Cervical Intraepithelial Neoplasia 2/3 Among HIV− and HIV+ Women in Kenya
Authors: Mehta Naaman , Orang'o Omenge , Itsura Peter , Tonui Philip , Bussmann Hermann , Bogers JP , Liu Tao , Cu-Uvin Susan
Published: December 2019

Objective

The aim of the study was to compare loop electrosurgical excision procedure (LEEP) as treatment for cervical intraepithelial neoplasia (CIN) 2/3 in HIV− versus HIV+ women.

Materials and Methods

Seventy-five HIV− and 75 HIV+ women at 6 months or more after LEEP for CIN 2/3 were enrolled between September 2013 and November 2014 in this prospective cohort study at the cervical cancer screening clinic in Eldoret, Kenya. Visual inspection with acetic acid (VIA), followed by cervical cytology with conventional cytology, was performed on all women. Women with positive VIA or abnormal cervical cytology underwent colposcopy/biopsy. Lesion progression, persistence, and regression were assessed to quantify the efficacy of LEEP.

Results

Post–loop electrosurgical excision procedure screening test showed both a negative VIA and normal cervical cytology in 64 (85%) of HIV− and 57 (77%) HIV+ women (risk difference = 8.3%, CI = −4.2% to 21%, p = .20). Eleven (15%) HIV− and 17 (23%) HIV+ (p = .20) women had positive VIA, abnormal cervical cytology, or both and were referred for colposcopy/biopsy. Twenty-one (8 HIV−, 13 HIV+) women were biopsied. Of the 8 HIV− women, 4 (50%) had CIN lesions that regressed, 3 (38.0%) persisted, and 1 (12%) progressed to invasive cancer after LEEP. Of the 13 HIV+ women, 6 (46%) had CIN lesions that regressed, 7 (54%) had CIN lesions that persisted, and no HIV+ women had CIN lesions that progressed after LEEP. There was no difference in estimated efficacies of LEEP for HIV− and HIV+ women (92.7% versus 89.4%, risk difference = 3.3%, CI = −4.8% to 15.3%, p = .85).

Conclusions

Loop electrosurgical excision procedure for CIN 2/3 is effective treatment for HIV− and HIV+ women in low-resource settings. Future efforts should improve follow-up after treatment.
Time-Dependent Squamous Cell Carcinoma Antigen in Prediction of Relapse and Death of Patients With Cervical Cancer
Authors: Chang Chung , Chen Jiabin , Huang Chi-Hsiang , Lee Wen-Ying , Hsu Li-Chuan , Chiang An Jen
Published: December 2019

Objective

The aim of the study was to develop a methodology to identify the best use of a longitudinally measured biomarker in relevance to prognosis.

Materials and Methods

Data of squamous cell carcinoma antigen (SCC-Ag) from 770 patients with cervical squamous cell carcinoma (SCC) were used. The pretreatment, nadir, and time-dependent SCC-Ag values were analyzed in relevance to disease relapse and death with univariate and multivariate analysis side by side with a variety of available clinicopathologic factors. The predictive power of the significant variates was evaluated by C-index with 5-fold cross validation.

Results

The pretreatment, nadir, and time-dependent SCC-Ag were all significant risk factors for both relapse and death in the univariate analysis (p < .05), and the time-dependent SCC-Ag had the highest C-index in both events. The nadir and time-dependent SCC-Ag were both independently significant in response to relapse with International Federation of Gynecology and Obstetrics (FIGO) stage as the covariate, and the latter had a higher C-index (0.745). Only the time-dependent SCC-Ag was independently significant together with FIGO stage in response to death with the C-index at 0.844.

Conclusions

Increases in the serum level of SCC-Ag in cervical SCC patients suggest a higher risk of both relapse and death. The best use of serial SCC-Ag measurements is to include the time-dependent value in prognostic assessment with FIGO stage also accounted for. Cervical SCC patients should be followed up on their levels of SCC-Ag, and prognostic evaluation should be updated with recent measurements.
Diagnosing Anal Squamous Intraepithelial Lesions With and Without p16: An Interobserver Variability Study
Authors: Krishnamurti Uma , Mohammad Mohammad , Monsrud Ashley , Mosunjac Mario , Oprea Gabriela , Hanley Krisztina , Tadros Talaat , Flowers Lisa , Mosunjac Marina
Published: December 2019

Objective

Morphologic diagnosis and grading of anal squamous intraepithelial lesions (ASILs) are challenging. In this study, we investigated interobserver variability and p16 utility in accurately grading anal SIL.

Materials and Methods

Six pathologists evaluated the degree of SIL on hematoxylin and eosin slides from 146 anal biopsies, followed by the review of both p16 and hematoxylin and eosin slides in cases where p16 was previously performed. κ was calculated in the following 4 ways: (A) 4-tiered diagnosis (negative for SIL [NSIL], anal intraepithelial neoplasia [AIN 1, AIN 2, AIN 3]); (B) 3-tiered diagnosis (NSIL and AIN 1 [pooled], AIN 2, AIN 3); (A) 3-tiered diagnosis (NSIL, low-grade SIL, high-grade SIL [HSIL]); and (D) 2-tiered diagnosis (no HSIL, HSIL).

Results

There is only moderate agreement with a 4-tiered diagnosis with or without p16 (κ = 0.48–0.57). There is substantial agreement when AIN 2 and AIN 3 are pooled as HSIL in cases with or without p16 review (κ = 0.71–0.78). There is almost perfect agreement with a 2-tiered diagnosis of negative for HSIL and HSIL both in cases where p16 was used and where p16 was not required, with the best agreement for a 2-tiered diagnosis with concurrent p16 review.

Conclusions

This study highlights the importance of a judicious use of p16 for diagnosis. When there is no need for p16 by the Lower Anogenital Squamous Terminology guidelines, interobserver agreement was substantial to almost perfect with a 2-tiered diagnosis. However, when its use is indicated but it is not performed or reviewed, the agreement is much lower even with a 2-tiered diagnosis. Rational use of p16 will ensure diagnostic accuracy and the best possible patient care.
Association of Body Mass Index With Adherence to Cervical Cancer Screening Recommendations in Hispanic Women
Authors: Pérez Cynthia M. , González-Barrios Daisy , Ramos-Cartagena Jeslie M. , Ortiz Ana P.
Published: December 2019

Objective

Obese women have higher cervical cancer incidence and mortality than their counterparts, possibly related to nonadherence to screening recommendations. We assessed the association of body mass index with adherence to cervical cancer screening recommendations in Hispanic women living in Puerto Rico, a minority population with the highest incidence of cervical cancer in the United States.

Materials and Methods

We included 536 Hispanic women aged 21 to 64 years enrolled in a population-based study of human papillomavirus (HPV) infection. Demographic and clinical characteristics and risky behaviors were collected using structured interviews. Weight and height were measured to classify body mass index as underweight, normal, overweight, and obesity (class I, class II, class III). Adherence to cervical cancer screening recommendations was self-reported. Logistic regression models were fit to estimate the odds ratio with 95% CI after adjusting for covariates.

Results

Nearly one third (29.7%) of women were overweight and 43.5% were obese (class I: 22.6%, class II: 11.0%, class III: 9.9%). Overall adherence to cervical cancer screening within the past 3 years was 78.5%, being lowest among women with class III obesity (60.4%). After multivariable adjustment, only women with class III obesity had significantly higher odds (odds ratio = 2.5, 95% CI: 1.2–5.1) of reporting nonadherence to cervical cancer screening compared with normal weight women.

Conclusions

Adherence to cervical cancer screening in this population was below the Healthy People 2020 target of 93%, especially for women with morbid obesity. These findings highlight the importance of adequate interventions to decrease cervical cancer screening disparities in these women.
Specimen Fragmentation and Loop Electrosurgical Excision Procedure and Cold Knife Cone Biopsy Outcomes
Authors: Grubman Jessica , Meinhardt Summer S. , Nambiar Anjali , Lea Jayanthi S.
Published: December 2019

Objective

Surgical technique for loop electrosurgical excision procedure (LEEP) and cold knife cone (CKC) emphasizes a uniform specimen, but sequelae of specimen fragmentation are not established. We evaluated outcomes between fragmented and unfragmented excisional biopsy specimens.

Materials and Methods

Loop electrosurgical excision procedure and CKCs from January 2010 to October 2013 were reviewed. Intraepithelial lesion grade, fragmentation, margin, and Endocervical curettage status were analyzed. Adenocarcinoma in situ and cancer were excluded. Repeat procedures during the study period were included in follow-up. Loop electrosurgical excision procedures with top hat with no separate fragments were analyzed independently versus those with fragmented LEEP and/or top hat. Indeterminate margin was defined as inconclusive or unevaluable margin, or intraepithelial lesion in unidentifiable margin or fragment. Outcomes involved residual or recurrent disease and repeat procedures for intraepithelial lesion. χ2 was used for statistical analysis.

Results

Fragmented specimens were more likely to have any positive margin (p = .01), multiple positive margins (p < .001), and indeterminate margin (p < .001) than unfragmented specimens. There was no significant difference in rates of positive, insufficient, or high-grade Endocervical curettage (p = .74, 0.54, 0.92). Patients with fragmented specimens were more likely to have high-grade lesion recurrence in the following 3 years (p = .04) versus patients with index unfragmented specimens, though not compared with those with unfragmented LEEP + top-hat cases. Overall rates of repeat LEEP/CKC or hysterectomy for dysplasia were not different (p = .56).

Conclusions

Fragmentation of LEEP and CKC specimens is associated with higher rates of positive margins, recurrent high-grade intraepithelial lesions, and indeterminate margins. These may cause diagnostic uncertainty, require closer follow-up, and increase cost with more visits and studies.
Genetic Epidemiology of Hearing Loss in the 22 Arab Countries: A Systematic Review
Authors: Sidenna Mariem , Fadl Tasnim , Zayed Hatem
Published: December 2019

Background:

Hearing loss (HL) is a heterogeneous condition that causes partial or complete hearing impairment. Hundreds of variants in more than 60 genes have been reported to be associated with Hereditary HL (HHL). The HHL prevalence is thought to be high in the Arab population; however, the genetic epidemiology of HHL among Arab populations is understudied. This study aimed to systematically analyze the genetic epidemiology of HHL in Arab countries.

Methods:

We searched four literature databases (PubMed, Scopus, Science Direct, and Web of Science) from the time of inception until January 2019 using broad search terms to capture all the reported epidemiological and genetic data related to Arab patients with HHL.

Findings:

A total of 2,600 citations were obtained; 96 studies met our inclusion criteria. Our search strategy yielded 121,276 individuals who were tested for HL over 52 years (1966–2018), of whom 8,099 were clinically diagnosed with HL and belonged to 16 Arab countries. A total of 5,394 patients and 61 families with HHL were genotyped, of whom 336 patients and 6 families carried 104 variants in 44 genes and were from 17/22 Arab countries. Of these variants, 72 (in 41 genes) were distinctive to Arab patients. Arab patients manifested distinctive clinical phenotypes. The incidence of HHL in the captured studies ranged from 1.20 to 18 per 1,000 births per year, and the prevalence was the highest in Iraq (76.3%) and the lowest in Jordan (1.5%).

Interpretation:

This is the first systematic review to capture the prevalence and spectrum of variants associated with HHL in an Arab population. There appears to be a distinctive clinical picture for Arab patients with HHL, and the range and distribution of variants among Arab patients differ from those noted in other affected ethnic groups.
Single High‐dose Vitamin D3 Supplementation in Pediatric Patients With Inflammatory Bowel Disease and Hypovitaminosis D
Authors: Lee Rose , Maltz Ross M. , Crandall Wallace V. , Plogsted Steven W. , Shaikhkhalil Ala K. , Bowden Sasigarn A. , Mezoff Ethan A.
Published: December 2019

Objectives:

The primary aim was to determine the effectiveness of a single high‐dose of oral vitamin D3 (stoss therapy) in children with inflammatory bowel disease (IBD) and hypovitaminosis D. Our secondary aim was to examine the safety of stoss therapy.

Methods:

We conducted a randomized, prospective study of 44 patients, ages 6 to 21 years, with IBD and 25‐hydroxyvitamin D (25‐OHD) concentrations <30 ng/mL. Patients were randomized to receive 50,000 IU of vitamin D3 once weekly for 6 weeks (standard of care, SOC group) or 300,000 IU once (stoss group). Serum 25‐OHD levels were obtained at baseline, 4 and 12 weeks. Safety monitoring labs were performed at week 4.

Results:

Thirty‐nine of 44 enrolled patients (19 stoss, 20 SOC) completed the study. Baseline vitamin D levels were not significantly different between the groups. Stoss therapy resulted in a substantial rise in 25‐OHD levels at week 4, equivalent to the weekly regimen (53.6 ± 17.3 vs 54.6 ± 17.5 ng/mL). At week 12, serum 25‐OHD levels decreased in both groups, significantly lower in the stoss group, but remained close to 30 ng/mL (29.8 ± 7.1 vs 40.4 ± 11.9 ng/mL, P = 0.04). A significant interaction with treatment group over time was observed (P = 0.0003). At the week‐4 time point, all patients who received stoss therapy had normal serum calcium and PTH levels. Eighty percentage of patients preferred stoss therapy to the weekly regimen.

Conclusions:

Stoss therapy was safe and effective in raising 25‐OHD in children with IBD commensurate to that of the weekly regimen.
Knowledge deficits and barriers to performing soft-tissue coverage procedures: An analysis of participants in an orthopaedic surgical skills training course in Mexico
Authors: Albright Patrick D. , Mackechnie Madeline C. , Jackson J. Hunter , Chopra Aman , Holler Jordan T. , Flores Biard Antonio , Padilla Rojas Luis G. , Morshed Saam , Miclau Theodore , Shearer David W. , Terry Michael J.
Published: December 2019

Background:

An increasing number of traumatic injuries in low- and low-middle-income countries (LICs/LMICs) have coexisting injuries requiring soft-tissue coverage (flaps). Yet, there is a lack of subspecialty care and flap training in Latin America. This study assesses the effectiveness of a surgical skills training course in improving rotational and free flap knowledge and identifies barriers to performing these types of flaps.

Methods:

Participants attending a surgical skills training course in Guadalajara, Mexico completed a pre/postcourse flaps knowledge survey consisting of 15 questions from the plastic surgery in-training examination and also completed a 7-point Likert survey regarding perceived barriers to performing flaps at their institution.

Results:

Of the course participants, 17 (44.7%) completed the precourse knowledge survey, 24 (63.2%) completed the postcourse survey, and 37 (97.4%) completed the barriers survey. Scores improved from pre- to postcourse knowledge surveys (39.6% to 53.6%, P = .005). Plastic surgery subsection scores also improved (39.0% to 60.4%, P = .003). Twenty-five percent of attendees received prior flap training and had plastic surgeons available to perform flaps. Few participants (38.9%) reported flap procedures being commonly completed at their hospitals. Participants stating that flaps were uncommon in their hospital reported more institutional barriers and less access to dermatomes. These participants also reported lack of operating room and surgical personnel availability.

Conclusion:

A surgical skills training course may be useful in improving knowledge of soft-tissue coverage procedures. There are also modifiable physician and institutional barriers that can improve the ability to perform rotational and free flaps as identified by the course participants.
For Human Papillomavirus Self-Sampling, Stated Willingness Does Not Correspond With Subsequent Uptake by Rural Malawian Women
Authors: Hood Robert B. , Turner Abigail Norris , Huber-Krum Sarah , Lancaster Kathryn E. , Mwapasa Victor , Poindexter Tiara , Nampandeni Patrick , Esber Allahna , Norris Alison H.
Published: December 2019

Background

Human papilloma virus (HPV), the causative agent for cervical cancer, can be tested for using self-collected vaginal samples. Self-collection is promising for HPV screening in hard-to-reach populations. To assess the relationship between willingness to self-collect and subsequent uptake of self-collection, we conducted a longitudinal study of reproductive-age women in rural Malawi.

Methods

At baseline, we asked women if they would be willing to self-collect a vaginal sample for HPV testing. At follow-up (12–18 months later), we offered the same women the opportunity to self-collect a sample for HPV testing. We examined unadjusted and adjusted associations between baseline willingness to self-collect a sample for HPV testing and uptake of self-collection at follow-up using log-binomial models.

Results

Among 122 women who, at baseline, indicated willingness to self-collect, n = 65 (53%) agreed to self-collect a sample at follow-up. Of 64 women who stated unwillingness at baseline to self-collect, n = 30 (47%) self-collected a sample for testing at follow-up. We observed no association between women's willingness at baseline and their observed self-collection decision at follow-up (unadjusted prevalence ratio, 1.14; 95% confidence interval, 0.83–1.55). The association remained null after adjustment for age, awareness of cervical cancer, and perceived behavioral control.

Conclusions

Our results suggest that evaluation of acceptability of self-collection should go beyond simply asking women if they would be willing to self-collect a vaginal sample. Given that half of this study's participants agreed to self-collect a sample when the opportunity was offered, regardless of their previously stated preferences, self-collection should be offered to everyone.
Medicaid for the Plastic and Reconstructive Surgeon
Authors: Firouzbakht Peter K. , Shaum Katherine M. , Israel Jacqueline S. , Rao Venkat K.
Published: December 2019

Medicaid is a complex federally and state funded health insurance program in the United States that insures an estimated 76 million individuals, approximately 20 percent of the U.S. population. Many physicians may not receive formal training or education to help understand the complexities of Medicaid. Plastic surgeons, residents, and advanced practice practitioners benefit from a basic understanding of Medicaid, eligibility requirements, reimbursement methods, and upcoming healthcare trends. Medicaid is implemented by states with certain federal guidelines. Eligibility varies from state to state (in many states it’s linked to the federal poverty level), and is based on financial and nonfinancial criteria. The passage of the Affordable Care Act in 2010 permitted states to increase the federal poverty level eligibility cutoff to expand coverage for low-income adults. The aim of this review is to provide a brief history of Medicaid, explain the basics of eligibility and changes invoked by the Affordable Care Act, and describe how federal insurance programs relate to plastic surgery, both at academic institutions and in community practice environments.
A Report on the Representation of Women in Academic Plastic Surgery Leadership
Authors: Chen Wendy , Baron Marissa , Bourne Debra A. , Kim Justine S. , Washington Kia M , De La Cruz Carolyn
Published: December 2019

Background:

The year 2017 marked the first year women comprised a majority of U.S. medical school matriculants. While more women are pursuing surgical training, within plastic surgery, there is a steady attrition of women advancing in leadership roles. The authors report the current status of women in academic plastic surgery, from trainees to chairwomen and national leadership positions.

Methods:

The Electronic Residency Applications Service, San Francisco Match, National Resident Matching Program, Association of American Medical Colleges, American Council of Academic Plastic Surgeons, Plastic Surgery Education Network, and professional websites for journals and national societies were accessed for demographic information from 2007 to 2017.

Results:

The number of female integrated pathway applicants remained stable (30 percent), with an increased proportion of female residents from 30 percent to 40 percent. There was an increase in female faculty members from 14.6 percent to 22.0 percent, an increase of less than 1 percent per year. Twelve percent of program directors and 8.7 percent of department heads were women. Nationally, major professional societies and administrative boards demonstrated a proportion of female members ranging from 19 percent to 55 percent (average, 27.7 percent). The proportion of female committee leaders ranged from 0 percent to 50 percent (average, 21.5 percent). Only six societies have had female presidents. No major journal had had a female editor-in-chief. The proportion of female editorial board members ranged from 1 percent to 33 percent (average, 16.1 percent).

Conclusions:

The authors’ study shows a leak in the pipeline at all levels, from trainees to faculty to leadership on the national stage. This report serves as a starting point for investigating reasons for the underrepresentation of talented women in plastic surgery leadership.
Anger Expression and the Risk of Cardiovascular Disease Among Urban and Rural Japanese Residents: The Circulatory Risk in Communities Study
Authors: Tezuka Kazuhide , Kubota Yasuhiko , Ohira Tetsuya , Shimizu Yuji , Yamagishi Kazumasa , Umesawa Mitsumasa , Sankai Tomoko , Imano Hironori , Okada Takeo , Kiyama Masahiko , Iso Hiroyasu
Published: December 2019

Objective

It has been suggested that urbanization, which has been expanding rapidly for the past several decades, increases the risk of cardiovascular disease (CVD) associated with psychological factors such as anger, but the evidence is limited. We examined the hypothesis that urbanicity modifies the association of anger expression with the risk of CVD.

Methods

A prospective study was conducted in 5936 residents of urban and rural communities aged 40 to 79 years who had completed an annual health checkup including a questionnaire on anger expression between 1995 and 1998. Associations of anger expression with the risk of CVDs were examined using Cox proportional hazards models, after adjusting for classical cardiovascular risk factors.

Results

During a median follow-up of 16.6 years, we identified 312 incident CVDs. The means (SDs) of anger expression were 24.7 (5.8) among urban residents and 24.6 (5.7) among rural participants (p = .87). Among urban residents, anger expression was positively associated with the risk of total CVD: the multivariable hazard ratio (95% confidence interval) was 1.27 (1.05–1.54). In contrast, no association was found among rural residents: the corresponding ratio (interval) was 0.96 (0.85–1.09), with a significant interaction between urban and rural residency with anger expression for incident CVD (p = .047). Similar associations were observed with the risk of CVD subtypes, including ischemic stroke and ischemic CVD.

Conclusions

We found a positive association between anger expression and the risk of CVD among urban residents but not rural residents, suggesting that urbanicity enhances the anger-CVD association.
American Urogynecologic Society Systematic Review: The Impact of Weight Loss Intervention on Lower Urinary Tract Symptoms and Urinary Incontinence in Overweight and Obese Women
Authors: Yazdany Tajnoos , Jakus-Waldman Sharon , Jeppson Peter C. , Schimpf Megan O. , Yurteri-Kaplan Ladin A. , Ferzandi Tanaz R. , Weber-LeBrun Emily , Knoepp Leise , Mamik Mamta , Viswanathan Meera , Ward Renée M.
Published: December 2019

Objective

Obesity can contribute to urinary symptoms such as urgency, frequency, and incontinence. In addition to classic treatments, weight loss interventions offer a unique clinical opportunity to improve these symptoms.

Study Design

The American Urogynecologic Society Systematic Review Group conducted a review of articles on the impact of surgical and behavioral weight loss (BWL) interventions on urinary symptoms in overweight and obese women. The certainty of the evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation criteria.

Results

The review group identified 43 publications from 39 studies, including 10 reports that used data from 5 randomized trials. Overall, there is high-certainty evidence that BWL, such as diet and exercise, decreases the prevalence of stress urinary incontinence 15% to 18% and overall urinary incontinence (UI) by 12% to 17% at 1 to 2.9 years. The certainty of evidence on the long-term impact of these interventions was lower. The certainty of the evidence was moderate to low regarding the benefit of BWL on urgency UI and overactive bladder symptoms. No randomized trials evaluated the impact of surgical weight loss on urinary symptoms, and the certainty of evidence of other study types was very low.

Conclusions

There is high-certainty evidence that BWL results in modest improvements in stress and overall UI in overweight and obese women at 1 to 2.9 years after the intervention. Robust studies with low risk of bias are needed to assess whether these benefits are maintained over the long term and are associated with adverse events and to assess the impact of surgical weight loss interventions on urinary outcomes in overweight and obese women.
The Multistate Research Experience Reexamined
Authors: Gilbride Judith A.
Published: December 2019

This report is an update of a multistate research project focused on nutrition and aging published in 2004. The project originated in the northeast of the United States, with approval by the US Department of Agriculture in 5-year cycles over the past 15 years. Following an approved plan, research scientists work to understand and improve the nutritional health of older adults. The multidisciplinary team conducts an annual review of their progress, adjusts goals and experiments based on their analysis, and seeks new approaches and interventions for the ongoing collaboration.
Exploring Relationships of Eating and Physical Activity Behaviors With Sleep Behaviors Among Adult Weight Loss Participants
Authors: Richards Amy L. , Specker Bonny L.
Published: December 2019

Little is known about the possible effects of regular physical activity and sleep on emotional eating, uncontrolled eating, and cognitive restraint. Participants were 162 adults aged 19 to 75 years enrolled in a weight-loss program. This cross-sectional study investigated baseline data to evaluate associations among self-reported physical activity, perceived stress, and sleep on eating behaviors. Stress, gender, working 40 or more hours a week, and lack of sleep were associated with greater emotional eating while getting the recommended amount of physical activity was associated with lower emotional eating. Increasing physical activity to recommended levels, reducing stress, having adequate sleep, and increasing cognitive restraint as one ages may result in better weight management.
Lessons Learned
Authors: Buys David R. , Francis Sarah L. , Marra Melissa Ventura , Locher Julie L. , Lofgren Ingrid E.
Published: December 2019

Aging adults are the fastest-growing population in the United States, but they are underrepresented in health care research. Evidence-based decisions for aging adults need to be made using research done with this population. However, recruiting aging adults into research has many challenges. This article presents multiple cases of recruiting aging adults into nutrition research studies in 3 different US geographic locations. The challenges, successes, and lessons learned are presented. The lessons learned can provide guidance to others already doing research with aging adults and those clinical and community dietitians who want to start doing research with aging adults.
Francisella opportunistica sp. nov., isolated from human blood and cerebrospinal fluid
Authors: Dietrich Elizabeth A. , Kingry Luke C. , Kugeler Kiersten J. , Levy Craig , Yaglom Hayley , Young John W. , Mead Paul S. , Petersen Jeannine M.
Published: December 2019

Two isolates of a Gram-negative, non-spore-forming coccobacillus cultured from the blood and cerebrospinal fluid of immunocompromised patients in the United States were described previously. Biochemical and phylogenetic analyses revealed that they belong to a novel species within the

Francisella

genus. Here we describe a third isolate of this species, recovered from blood of a febrile patient with renal failure, and formally name the

Francisella

species. Whole genome comparisons indicated the three isolates display greater than 99.9 % average nucleotide identity (ANI) to each other and are most closely related to the tick endosymbiont

F. persica

, with only 88.6–88.8 % ANI to the type strain of

F. persica

. Based on biochemical, metabolic and genomic comparisons, we propose that these three isolates should be recognized as Francisella opportunistica sp. nov, with the type strain of the species, PA05-1188T, available through the Deutsche Sammlung von Mikroorganismen und Zellkulturen (DSM 107100) and the American Type Culture Collection (ATCC BAA-2974).
Genomic analysis of carbapenemase-producing Enterobacteriaceae in Queensland reveals widespread transmission of bla
IMP-4 on an IncHI2 plasmid
Authors: Roberts Leah W. , Catchpoole Elizabeth , Jennison Amy V. , Bergh Haakon , Hume Anna , Heney Claire , George Narelle , Paterson David L. , Schembri Mark A. , Beatson Scott A. , Harris Patrick N. A.
Published: December 2019

Carbapenemase-producing

Enterobacteriaceae

(CPE) are an increasingly common cause of healthcare-associated infections and may occasionally be identified in patients without extensive healthcare exposure. bla
IMP-4 is the most frequently detected carbapenemase gene in

Enterobacteriaceae

within Australia, but little is known about the mechanisms behind its persistence. Here we used whole genome sequencing (WGS) to investigate the molecular epidemiology of bla
IMP-4 in Queensland, Australia. In total, 107 CPE were collected between 2014 and 2017 and sent for WGS on an Illumina NextSeq500. Resistance genes and plasmid types were detected using a combination of read mapping and nucleotide comparison of de novo assemblies. Six isolates were additionally sequenced using Oxford Nanopore MinION to generate long-reads and fully characterize the context of the bla
IMP-4 gene. Of 107 CPE, 93 carried the bla
IMP-4 gene; 74/107 also carried an IncHI2 plasmid, suggesting carriage of the bla
IMP-4 gene on an IncHI2 plasmid. Comparison of these isolates to a previously characterized IncHI2 plasmid pMS7884A (isolated from an

Enterobacter hormaechei

strain in Brisbane) suggested that all isolates carried a similar plasmid. Five of six representative isolates sequenced using Nanopore long-read technology carried IncHI2 plasmids harbouring the bla
IMP-4 gene. While the vast majority of isolates represented ﻿

E. hormaechei

, several other species were also found to carry the IncHI2 plasmid, including

Klebsiella

species,

Escherichia coli

and

Citrobacter

species. Several clonal groups of

E. hormaechei

were also identified, suggesting that persistence of bla
IMP-4 is driven by both presence on a common plasmid and clonal spread of certain

E. hormaechei

lineages.
Integrative analysis of the plasma proteome and polygenic risk of cardiometabolic diseases
Authors: Ritchie Scott C. , Lambert Samuel A. , Arnold Matthew , Teo Shu Mei , Lim Sol , Scepanovic Petar , Marten Jonathan , Zahid Sohail , Chaffin Mark , Liu Yingying , Abraham Gad , Ouwehand Willem H. , Roberts David J. , Watkins Nicholas A. , Drew Brian G. , Calkin Anna C. , Di Angelantonio Emanuele , Soranzo Nicole , Burgess Stephen , Chapman Michael , Kathiresan Sekar , Khera Amit V. , Danesh John , Butterworth Adam S. , Inouye Michael
Published: December 2019

Summary Paragraph

Common human diseases are frequently polygenic in architecture, comprising a large number of risk alleles with small effects spread across the genome1–3. Polygenic scores (PGSs) aggregate these alleles into a metric which represents an individual’s genetic predisposition to a specific disease. PGSs have shown promise for early risk prediction4–7, and there is potential to use PGSs to understand disease biology in parallel8. Here, we investigate the role plasma protein levels play in cardiometabolic disease risk in a cohort of 3,087 healthy individuals using PGSs. We found PGSs for coronary artery disease (CAD), type 2 diabetes (T2D), chronic kidney disease (CKD), and ischaemic stroke (IS) were associated with levels of 49 plasma proteins. These associations were polygenic in architecture, largely independent of cis protein QTLs, and robust to environmental variation. Over a median 7.7 years follow-up, 28 of these plasma proteins were associated with future myocardial infarction (MI) or T2D events, 16 of which were causal mediators between polygenic risk and incident disease. These protein mediators of polygenic disease risk included targets of approved therapies which may have repurposing potential. Our results demonstrate that PGSs can identify proteins with causal roles in disease, and may have utility in drug development.
Mechanical model of muscle contraction 2. Kinematic and dynamic aspects of a myosin II head during the working stroke
Authors: Louvet S.
Published: December 2019

The condition of a myosin II head during which force and movement are generated is commonly referred to as Working Stroke (WS). During the WS, the myosin head is mechanically modelled by 3 two by two articulated segments, the motor domain (S1a) strongly fixed to an actin molecule, the lever (S1b) on which a motor moment is exerted, and the rod (S2) pulling the myosin filament (Mfil). When the half-sarcomere (hs) is shortened or lengthened by a few nanometers, it is assumed that the lever of a myosin head in WS state moves in a fixed plane including the longitudinal axis of the actin filament (Afil). As a result, the 5 rigid segments, i.e. Afil, S1a, S1b, S2 and Mfil, follow deterministic and configurable trajectories. The orientation of S1b in the fixed plane is characterized by the angle θ. After deriving the geometric equations singularizing the WS state, we obtain an analytical relationship between the hs shortening velocity (u) and the angular velocity of the lever. The principles of classical mechanics applied to the 3 solids, S1a, S1b and S2, lead to a relationship between the motor moment exerted on the lever (MB) and the tangential force dragging the actin filament (TA). We distinguish θupand θdown, the two boundaries framing the angle θ during the WS, relating toupanddownconformations. With the usual data assigned to the cross-bridge elements, a linearization procedure of the relationships between u and, on the one hand, and between MBand TA, on the other hand, is performed. This algorithmic optimization leads to theoretical values of θupand θdownequal to +28° (−28°) and −42° (+42°) respectively with a variability of ±5° in a hs on the right (left), data in accordance with the commonly accepted experimental values for vertebrate muscle fibers.
The stronger downregulation ofin vitroandin vivoinnate antiviral responses by a very virulent strain of infectious bursal disease virus (IBDV), compared to a classical strain, is mediated, in part, by the VP4 protein
Authors: Dulwich KL , Asfor AS , Gray AG , Giotis ES , Skinner MA , Broadbent AJ
Published: December 2019

IBDV is economically important to the poultry industry. Very virulent (vv) strains cause higher mortality rates than other strains for reasons that remain poorly understood. In order to provide more information on IBDV disease outcome, groups of chickens (n=18) were inoculated with the vv strain, UK661, or the classical strain, F52/70. Birds infected with UK661 had a lower survival rate (50%) compared to F52/70 (80%). There was no difference in peak viral replication in the bursa of Fabricius (BF), but the expression of chicken IFNβ, MX1 and IL-8 was significantly lower in the BF of birds infected with UK661 compared to F52/70 (p<0.05) as quantified by RTqPCR, and this trend was also observed in DT40 cells infected with UK661 or F52/70 (p<0.05). The induction of expression of type I IFN in DF-1 cells stimulated with polyI:C (measured by an IFN-β luciferase reporter assay) was significantly reduced in cells expressing ectopic VP4 from UK661 (p<0.05), but was higher in cells expressing ectopic VP4 from F52/70. Cells infected with a chimeric recombinant IBDV carrying the UK661-VP4 gene in the background of PBG98, an attenuated vaccine strain that induces high levels of innate responses (PBG98-VP4UK661) also showed a reduced level of IFNα and IL-8 compared to cells infected with a chimeric virus carrying the F52/70-VP4 gene (PBG98-VP4F52/70), and birds infected with PBG98-VP4UK661also had a reduced expression of IFNα in the BF compared to birds infected with PBG98-VP4F52/70. Taken together, these data demonstrate that UK661 induced the expression of lower levels of anti-viral type I IFN and proinflammatory genes than the classical strainin vitroandin vivoand this was, in part, due to strain-dependent differences in the VP4 protein.
Highly parallelized microfluidic droplet cultivation and prioritization on antibiotic producers from complex natural microbial communities
Authors: Mahler Lisa , Niehs Sarah , Martin Karin , Weber Thomas , Scherlach Kirstin , Agler-Rosenbaum Miriam , Hertweck Christian , Roth Martin
Published: December 2019

To investigate the overwhelming part of the bacterial diversity still evading standard cultivation for its potential use in antibiotic synthesis, we have compiled a microscale-cultivation and screening system. We devised a strategy based on droplet-microfluidics taking advantage of the inherent miniaturization and high throughput. Single cells of natural samples were confined in 9 x 106 aqueous droplets and subjected to long-term incubation under controlled conditions. Subsequent a high-throughput screening for antimicrobial natural products was implemented, employing a whole cell reporting system using the viability of reporter strains as a probe for antimicrobial activity. Due to the described microscale cultivation a novel subset of bacterial strains was made available for the following screening for antimicrobials. We demonstrate the merits of the in-droplet cultivation by comparing the cultivation outcome in microfluidic droplets and on conventional agar plates for a bacterial community derived from soil by 16S rRNA gene amplicon sequencing. In-droplet cultivation resulted in a significantly higher bacterial diversity without the common overrepresentation of Firmicutes. Natural strains able to inhibit either a Gram-positive or a Gram-negative reporter strain were isolated from the microscale system and further cultivated. Thereby a variety of rare isolates was obtained. The natural products with antimicrobial activity were elucidated for the most promising candidate. Our method combines a new cultivation approach with a high-throughput search for antibiotic producers to increase the chances of finding new lead substances.
Dissection of demethylation and toxicity induced gene expression changes after decitabine treatment
Authors: Turchinovich A , Surowy HM , Tonevitsky AG , Burwinkel B
Published: December 2019

The DNA methyltransferase inhibitor decitabine (DAC) is a widely used drug for both fundamental epigenetics studies and anti-cancer therapy. Besides DNA demethylation, DAC also induces cell toxicity associated with DNA damage. The dual-mode of DAC action on cells provides a significant hurdle to study genes which expression is regulated by CpG methylation. In this work, we performed the analysis of global DNA methylation levels in cultured cancer cells after treatment with increasing doses of DAC and have found the U-shaped curve of the de-methylation efficacy induced by the drug. Specifically, high doses of DAC induced significantly lower DNA hypomethylation as compared to hundred-fold less concentrated doses. At the same time, the impact of DAC on cell viability was dose-dependent. These findings allowed dissecting the demethylation and the cell toxicity impact of DAC on gene expression in subsequent mRNA-seq experiments. Surprisingly, the number of genes that were upregulated due to DNA hypomethylation was comparable to the number of genes induced by DAC toxicity. Furthermore, we show that high DAC concentrations induce downregulation of housekeeping genes which are most widely used for RT-qPCR normalization (including GAPDH, actin and tubulin). The latter suggests that genes unaffected by DAC treatment would manifest themselves as upregulated when their expression is normalized on a downregulated housekeeping reference. Finally, we show that expression of most human oncogenes and tumor-suppressor genes remains unaffected after DAC treatment, and only a few of them were upregulated due to DNA hypomethylation. Our work stresses the importance of closely studying the correlation of the degree of DNA demethylation induced by varying doses of DAC with changes in gene expression levels to avoid erroneous conclusions regarding epigenetic silencing of a gene.
A broad mutational target explains an evolutionary trend
Authors: Besnard Fabrice , Picao-Osorio Joao , Dubois Clément , Félix Marie-Anne
Published: December 2019

An evolutionary trend, the rapid evolution of a trait in a group of organisms, can in some cases be explained by the mutational variance, the propensity of a phenotype to change under spontaneous mutation. However, the causes of high mutational variance are still elusive. For some morphological traits, fast evolution was shown to depend on the high mutation rate of one or few underlying loci with short tandem repeats. Here, we investigate the case of the fastest evolving cell fate among vulva precursor cells inCaenorhabditisnematodes, that of the cell called ‘P3.p’. For this, we combine mutation accumulation lines, whole-genome sequencing, genetic linkage analysis of the phenotype in recombinant lines, and candidate testing through mutant and CRISPR genome editing to identify causal mutations and the corresponding loci underlying the high mutational variance of P3.p. We identify and validate molecular lesions responsible for changes in this cell’s phenotype during a mutation accumulation experiment. We find that these loci do not present any characteristics of a high mutation rate, are scattered across the genome and belong to distinct biological pathways. Our data instead indicate that a broad mutational target size is the cause of the high mutational variance and of the corresponding evolutionary trend.
Whisper 2: indel-sensitive short read mapping
Authors: Deorowicz Sebastian , Gudyś Adam
Published: December 2019

Whisper 2 is a short-read-mapping software providing superior quality of indel variant calling. Its running times place it among the fastest existing tools.

Availability and Implementation

https://github.com/refresh-bio/whisper

Contact

sebastian.deorowicz@polsl.pl

Supplementary information

Supplementary data are available at publisher’s Web site.