bluuebunny/crossref_metadata_2025 huggingface dataset:
ELONGATED HYPOCOTYL 5 mediates blue light-induced starch degradation in tomato
Authors: Dong Han , Hu Chaoyi , Liu Chaochao , Wang Jiachun , Zhou Yanhong , Yu Jingquan
Published: December 2020

Starch is the major storage carbohydrate in plants, and its metabolism in chloroplasts depends mainly on light. However, the mechanism through which photoreceptors regulate starch metabolism in chloroplasts is unclear. In this study, we found that the cryptochrome 1a (CRY1a)-mediated blue light signal is critical for regulating starch accumulation by inducing starch degradation through the transcription factor HY5 in chloroplasts in tomato. cry1a mutants and HY5-RNAi plants accumulated more starch and presented lower transcript levels of starch degradation-related genes in their leaves than wild-type plants. Blue light significantly induced the transcription of starch degradation-related genes in wild-type and CRY1a- or HY5-overexpressing plants but had little effect in cry1a and HY5-RNAi plants. Dual-luciferase assays, electrophoretic mobility shift assays, and chromatin immunoprecipitation–qPCR revealed that HY5 could activate the starch degradation-related genes PWD, BAM1, BAM3, BAM8, MEX1, and DPE1 by directly binding to their promoters. Silencing of HY5 and these starch degradation-related genes in CRY1a-overexpressing plants led to increased accumulation of starch and decreased accumulation of soluble sugars. The findings presented here not only deepen our understanding of how light controls starch degradation and sugar accumulation but also allow us to explore potential targets for improving crop quality.
Home sweet home: how mutualistic microbes modify root development to promote symbiosis
Authors: Ghahremani Mina , MacLean Allyson M
Published: December 2020

Post-embryonic organogenesis has uniquely equipped plants to become developmentally responsive to their environment, affording opportunities to remodel organism growth and architecture to an extent not possible in other higher order eukaryotes. It is this developmental plasticity that makes the field of plant–microbe interactions an exceptionally fascinating venue in which to study symbiosis. This review article describes the various ways in which mutualistic microbes alter the growth, development, and architecture of the roots of their plant hosts. We first summarize general knowledge of root development, and then examine how association of plants with beneficial microbes affects these processes. Working our way inwards from the epidermis to the pericycle, this review dissects the cell biology and molecular mechanisms underlying plant–microbe interactions in a tissue-specific manner. We examine the ways in which microbes gain entry into the root, and modify this specialized organ for symbiont accommodation, with a particular emphasis on the colonization of root cortical cells. We present significant advances in our understanding of root–microbe interactions, and conclude our discussion by identifying questions pertinent to root endosymbiosis that at present remain unresolved.
ALD1 accumulation in Arabidopsis epidermal plastids confers local and non-autonomous disease resistance
Authors: Jiang Shang-Chuan , Engle Nancy L , Banday Zeeshan Zahoor , Cecchini Nicolás M , Jung Ho Won , Tschaplinski Timothy J , Greenberg Jean T
Published: December 2020

The Arabidopsis plastid-localized ALD1 protein acts in the lysine catabolic pathway that produces infection-induced pipecolic acid (Pip), Pip derivatives, and basal non-Pip metabolite(s). ALD1 is indispensable for disease resistance associated with Pseudomonas syringae infections of naïve plants as well as those previously immunized by a local infection, a phenomenon called systemic acquired resistance (SAR). Pseudomonas syringae is known to associate with mesophyll as well as epidermal cells. To probe the importance of epidermal cells in conferring bacterial disease resistance, we studied plants in which ALD1 was only detectable in the epidermal cells of specific leaves. Local disease resistance and many features of SAR were restored when ALD1 preferentially accumulated in the epidermal plastids at immunization sites. Interestingly, SAR restoration occurred without appreciable accumulation of Pip or known Pip derivatives in secondary distal leaves. Our findings establish that ALD1 has a non-autonomous effect on pathogen growth and defense activation. We propose that ALD1 is sufficient in the epidermis of the immunized leaves to activate SAR, but basal ALD1 and possibly a non-Pip metabolite(s) are also needed at all infection sites to fully suppress bacterial growth. Thus, epidermal plastids that contain ALD1 play a key role in local and whole-plant immune signaling.
The POLLS—REVIEW
Authors: Newport Frank , Saad Lydia
Published: December 2020

Presidential job approval is arguably the most important time series in US polling history and likely the most well-understood public opinion measure in popular American culture. This article examines the history of the measure going back to its origination during the Roosevelt administration, the value of presidential job approval in assessing the timeline of US history, the life cycle of presidential approval within administrations, and the relationship between presidential approval and incumbent reelection. The evidence indicates increasingly rigid partisan politicization in presidential-approval ratings, suggesting less variation in approval in the future, fewer so-called rally events, and the possibility that job approval may become more of a measure of party loyalty than actual presidential performance assessment.
Relation of BMI and waist circumference with the risk of new-onset hyperuricemia in hypertensive patients
Authors: Li Q , Li R , Zhang S , Zhang Y , Liu M , Song Y , Liu C , Liu L , Wang X , Wang B , Xu X , Qin X
Published: December 2020

Background

We aimed to evaluate the relationship of body mass index (BMI) and waist circumference (WC) with the risk of new-onset hyperuricemia, and examine possible effect modifies in general hypertensive patients.

Methods

A total of 10 611 hypertensive patients with normal uric acid (UA) concentrations (<357 μmol/l) at baseline were included from the UA sub-study of the China Stroke Primary Prevention Trial. The primary outcome was new-onset hyperuricemia, defined as a UA concentration ≥417 μmol/l in men or ≥357 μmol/l in women at the exit visit.

Results

During a median follow-up duration of 4.4 years, 1663 (15.7%) participants developed new-onset hyperuricemia. When analyzed separately, increased BMI (≥25 kg/m2, quartile 3–4; OR, 1.46; 95% CI: 1.29–1.65), or increased WC (≥85 cm for females, quartile 3–4; OR, 1.24; 95% CI: 1.08–1.42; and ≥84 cm for males, quartile 3–4; OR, 1.30; 95% CI: 1.01–1.67) were each significantly associated with higher risk of new-onset hyperuricemia. When WC was forced into the model with BMI simultaneously, its significant association with new-onset hyperuricemia disappeared in females (<85 vs. ≥85 cm; OR, 0.96, 95% CI: 0.81–1.13) or males (≥84 vs. <84 cm; OR, 1.13; 95% CI: 0.84–1.52); however, BMI was still significantly related with new-onset hyperuricemia (≥25 vs. <25 kg/m2; OR, 1.48; 95% CI: 1.27–1.73). Moreover, the positive BMI & new-onset hyperuricemia association was more pronounced in participants with higher time-averaged on-treatment systolic blood pressure (median: <138.3 vs. ≥138.3 mmHg; P-interaction = 0.041).

Conclusions

Higher BMI, but not WC, is significantly and independently associated with an increased risk of new-onset hyperuricemia among hypertensive patients.
Institutional Investors and Hedge Fund Activism
Authors: Kedia Simi , Starks Laura T. , Wang Xianjue
Published: December 2020

Hedge fund activists have ambiguous relationships with the institutional shareholders in their target firms. While some support their activities, others counter their actions. Due to their relatively small holdings in target firms, activists typically need the cooperation of other institutional shareholders that are willing to influence the activists’ campaign success. We find the presence of “activism-friendly” institutions as owners is associated with an increased probability of being a target, higher long-term stock returns, and higher operating performance. Overall, we provide evidence suggesting the composition of a firm’s ownership has significant effects on hedge fund activists’ decisions and outcomes. (JEL: G13, G23, G34)

Received March 12, 2020; editorial decision July 13, 2020 by Editor Andrew Ellul. Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Hispanic Identity and Its Inclusion in the Race Discrimination Discourse in the United States
Authors: Fernández Cristina R. , Silva Debora , Mancias Pedro , Roldan Eneida O. , Sánchez John Paul
Published: December 2020

As protests against racism occur all over the United States and medical institutions face calls to incorporate antiracism and health equity curricula into professional training and patient care, the antiracism discourse has largely occurred through a Black/African American and White lens. Hispanics, an umbrella category created by the U.S. government to include all people of Spanish-speaking descent, are the largest minority group in the country. Hispanics are considered an ethnic rather than a racial group, although some Hispanics self-identify their race in terms of their ethnicity and/or country of origin while other Hispanics self-identify with any of the 5 racial categories used by the U.S. government (White, Black/African American, American Indian or Alaska Native, Asian, or Native Hawaiian or Other Pacific Islander). Expanding the antiracism discourse in medicine to include Hispanic perspectives and the diversity of histories and health outcomes among Hispanic groups is crucial to addressing inequities and disparities in health and medical training. A lack of inclusion of Hispanics has contributed to a growing shortage of Hispanic physicians and medical school faculty in the United States as well as discrimination against Hispanic physicians, trainees, and patients. To reverse this negative trend and advance a health care equity and antiracist agenda, the authors offer steps that medical schools, academic medical centers, and medical accreditation and licensing bodies must take to increase the representation of Hispanics and foster their engagement in this evolving antiracism discourse.
Art and Pediatric Orthopaedics: Monet and a Twist in Time
Authors: Rebello Gleeson , Joseph Benjamin
Published: December 2020

The work of art by Monet shows a young child sitting with the toes turned inwards. The cause is probably due to femoral anteversion.
Assessing the Impact of the Pediatric Orthopaedic Society of North America (POSNA) Visiting Scholar Program
Authors: Heffernan Michael J. , Song Bryant , Bovid Karen M. , Leonardi Claudia , Fornari Eric D.
Published: December 2020

Background:

The primary objective of the Pediatric Orthopaedic Society of North America (POSNA)-Children’s Orthopaedics in Underserved Regions (COUR) Visiting Scholar Program is to engage emerging leaders from low-income and middle-income countries (LMICs) in POSNA educational offerings. This study aims to outline the educational and leadership activities pursued by the alumni of the POSNA-COUR Visiting Scholars Program. We hypothesized that there may be a discrepancy between visiting scholar interest level and actual participation in key follow-up educational and leadership activities.

Methods:

A 32-question online survey developed by the POSNA-COUR committee was electronically delivered to the POSNA-COUR visiting scholarship recipients from 2007 to 2019. The survey inquired about scholars’ educational background, clinical practice, and academic interests. Respondents also reported educational, research, and leadership activities that occurred following program participation.

Results:

Fifty-seven percent (44/77) of the previous scholars participated in the survey. Sixty-eight percent reported that >75% of their practice was comprised of pediatric patients. The COUR scholarship afforded 15 scholars the opportunity to attend their first educational conference in North America. The majority (86%) of respondents consulted POSNA members on care-related issues, 52% organized a POSNA member’s visit to their country, and 13% have become members of POSNA. Scholars shared their knowledge with colleagues through lectures (73%), demonstration of surgical skills (63%), mentorship (59%), hosting local courses (43%), and research (14%). There was a significant discrepancy between interest and actual participation in research (98% vs. 16%, P<0.0001), hosting a regional course (98% vs. 43%, P<0.0001), and becoming a member of POSNA (96% vs. 13%, P<0.0001).

Conclusions:

The POSNA-COUR Visiting Scholar Program is effective at providing beneficial educational opportunities to orthopaedic surgeons from LMICs. There is, however, a significant discrepancy between reported scholar interest and actual engagement in leadership endeavors including: research, organization of regional courses, and POSNA membership. The impact of the POSNA-COUR visiting scholar program can be enhanced through collaboration with scholarship alumni in these key areas.

Level of Evidence:

Level IV—case series.
Supracondylar Humerus Fractures in Older Children: Success of Closed Reduction and Percutaneous Pinning
Authors: Bekmez Senol , Camp Mark W. , Ling Rebecca , El-Amiri Nisrine , Howard Andrew W.
Published: December 2020

Background:

The incidence of supracondylar humerus (SCH) fracture declines and fracture types change as children grow. Optimal treatment method is unclear in older children. The aim of the study was to determine if fracture type and configuration of distal humerus fractures changes as patients approach skeletal maturity, and to assess the success of closed reduction and percutaneous pin (CRPP) in extra-articular SCH fractures in this transitional age group.

Methods:

Inclusion criteria for this retrospective review were (1) distal humerus fractures with extension types 2 and 3, flexion type, T-type; (2) surgically managed, and (3) modified Sauvegrain score ≥1. Reviewed parameters included fracture type and configuration, grade of skeletal maturity, fixation technique, and loss of reduction. Primary analysis was to determine the distribution of fracture type and configuration with age or grade of skeletal maturity. Secondary analysis was used to determine the factors affecting treatment success of CRPP in extra-articular fractures.

Results:

A total of 142 patients were included (58 males and 84 females). Fracture types revealed significant changes with increased age (P=0.031) and skeletal maturity grade (P<0.005). Skeletal maturity was a better predictor of changing fracture type than chronological age. T-type fractures were only seen in patients with modified Sauvegrain score ≥6 and flexion-type fractures were only seen in patients with modified Sauvegrain score ≤4. Loss of reduction rate after CRPP was 5%. The success of CRPP was not affected by age, sex, modified Sauvegrain score, fracture type, direction of displacement, coronal fracture pattern, number of pins or medial pin use. Fracture obliquity in the sagittal plane (P=0.05), suboptimal pin spread (P<0.01), and lack of bicolumnar fixation (P<0.01) were found as statistically significant factors associated with failed CRPP.

Conclusion:

The distribution of fracture type changed with increased age and skeletal maturity. CRPP of extra-articular fractures in older children is a reliable option regardless of the stage of skeletal maturity. Determinants of a good outcome include optimal pinning technique with adequate pin spread at the fracture site and bicolumnar fixation.

Level of Evidence:

Level IV—retrospective case series.
Fascial Epicondylar Augmentation in Cases of Cubital Tunnel Syndrome With Ulnar Nerve Instability
Authors: Kapickis Martins , Beinarovica Iveta
Published: December 2020

Cubital tunnel syndrome (CubTS) is one of the most common compression-traction neuropathy in the upper extremity. The gold standard is simple in situ decompression with revision of potential compression sites through skin incision as small as rationally possible. Properly conducted conservative treatment is more effective in CubTS as opposed to carpal tunnel syndrome. At the same time, optimal management of CubTS remains controversial. Nevertheless, there is a subclass of patients with symptoms of CubTS that have ulnar nerve instability (UNI) with subluxation of the nerve over the medial epicondyle where conservative treatment would not be successful. UNI can be diagnosed by ultrasound preoperatively, but there are situations where the ulnar nerve becomes unstable with elbow flexion already on the operating table. Currently the most popular surgical reconstruction for clinically relevant UNI is anterior transposition of the nerve. With the proposed technique the nerve stays in orthotopic position, and the segmental vascularity is preserved, innervation to the flexor carpi ulnaris muscle is not jeopardized and ulnar nerve glide-floss exercises are possible as opposed to the standard subcutaneous transposition technique. No subfascial transposition, slings or blocking flaps are used for nerve stabilization which we consider contradiction to the surgery of nerve release.
Surgeon Preference for Keratoplasty Techniques and Barriers to Performing Deep Anterior Lamellar Keratoplasty
Authors: Thanitcul Chanon , Mathews Priya , Woreta Fasika A. , Akpek Esen K. , Varadaraj Varshini , Srikumaran Divya
Published: December 2020

Purpose:

To identify barriers and facilitators to adopting deep anterior lamellar keratoplasty (DALK) for nonendothelial corneal pathology.

Methods:

An anonymous survey consisting of 22 multiple choice and free text questions was designed to gather information on demographic factors of surgeons and DALK surgical practices. The survey was emailed to members of the kera-net, a global online corneal surgeon/surgery platform.

Results:

A total of 100 surgeons completed the survey, most of whom practice in the United States (73%). Most surgeons (89%) reported performing DALK. Surgeons who did not learn DALK during fellowship (34%) tended to be in practice for higher numbers of years (P< 0.001). Surgeons in private practice are more likely to perform DALK versus those in other settings (92.7% vs. 80.8%,P= 0.087). Surgeons performing more corneal surgeries (at least 100 per year) are more likely to perform DALK than those who perform fewer than 100 per year (52% vs. 14%,P= 0.01). Surgeons who perform Descemet membrane endothelial keratoplasty are more likely to perform DALK than those who do not (81.7% vs. 18.3%,P= 0.014). There was also a positive correlation between PK and DALK surgical volumes (Spearman rank correlation coefficient = 0.57,P< 0.001). The main reasons for surgeon preference for DALK over PK were a desire to preserve the endothelium, intraoperative safety, and decreased complications. Longer surgical time and low patient volume were cited as barriers to adoption of DALK.

Conclusions:

Alterations in DALK technique that reduce surgical time and providing more learning opportunities for DALK might improve adoption.
Nursing Contributions to Ending the Global Adolescent and Young Adult HIV Pandemic
Authors: Guilamo-Ramos Vincent , Flores Dalmacio Dennis , Randolph Schenita D. , Andjembe Etogho Elvine Belinda
Published: December 2020

The welfare of adolescents and young adults (AYA) is pivotal for a sustainable future. However, despite worldwide efforts, alarming disparities in HIV morbidity and mortality persist: AYA are disproportionately affected. Specific world regions and key populations particularly warrant increased efforts to improve prevention and treatment via the global 95-95-95 strategy. Although the idiosyncrasies of AYA represent a challenge to a global response, for the past four decades, nurses have initiated and contributed to advances in HIV policy, practice, and research with AYA. Their unique position within the health care system renders success of these initiatives contingent on the collective capacity to leverage the well-established potential of nursing care. In this article, we (a) characterize the global epidemiology of HIV among AYA; (b) discuss important youth-focused HIV nursing achievements and identify nurses' unique competencies compatible with adolescent and young adult needs; and (c) examine the implications for future youth-tailored HIV nursing science and practice.
Increased Efficacy of Whole Lung Lavage Treatment in Alveolar Proteinosis Using a New Modified Lavage Technique
Authors: Grutters L. Agnes , Smith Elseline C. , Casteleijn Cees W. , van Dongen Eric P. , Ruven Henk J. , van der Vis Joanne J. , Veltkamp Marcel
Published: December 2020

Background:

Autoimmune pulmonary alveolar proteinosis is an ultra-rare pulmonary disease. Whole lung lavage (WLL) is considered the gold standard therapy. We report a protocol for a new modified lavage technique (nMLT) in which controlled repetitive manual hyperinflation (MH) and intermittent chest percussion are used to enhance WLL efficacy.

Methods:

We included all subjects with autoimmune pulmonary alveolar proteinosis treated with nMLT between 2013 and 2018. nMLT consisted of repetitive MH with intermittent chest percussion every third wash. We reported: instilled volume, protein concentration, and optical density using spectrophotometry. Pulmonary function (FVC %predicted and DLCO %predicted) at start of nMLT was recorded. Data are displayed as mean (±SD), median [interquartile range], or number (%). Comparisons within individuals were made using Students t test.

Results:

We included 11 subjects (64% male) in whom a total of 67 nMLTs were performed. One nMLT consisted of 15 [12-18] washes. Protein removal was 9.80 [7.52-12.66] g per nMLT. After the first, second, and third cycle of 3 washes, 56% [49% to 61%], 81% [77% to 84%], and 91% [88% to 94%] of the final protein yield was removed, respectively. Optical density was measured 116 times and increased from 1.13 (±0.52) to 1.31 (±0.52) after MH (P<0.001).

Conclusion:

Efficacy of WLL seems to be enhanced by applying MH every 3 washes. Our technique of WLL with nMLT could be used to increase the amount of protein recruited while instilling the lung with the smallest volume of fluid as possible.
Gastrointestinal Bleeding Rates in Left Ventricular Assist Device Population Reduced with Octreotide Utilization
Authors: Wilson Tyler J. , Baran David A. , Herre John M. , Cameron Chad M. , Yehya Amin , Ingemi Amanda I.
Published: December 2020

Patients with continuous-flow left ventricular assist devices have a high risk of gastrointestinal bleeding (GIB) and recurrent bleeding. Studies have shown octreotide can reduce the risk of GIB. This retrospective, case-crossover study, evaluated the efficacy of octreotide for the prevention of recurrent GIB in patients with left ventricular assist devices between August 2008 and October 2018. A total of 32 patients received octreotide and were included in the study. Hospital admission for GIB was evaluated before and after the initiation of octreotide. Each case served as his/her own control. Most patients were on a reduced aspirin dose (56.2%) and had a reduced international normalized ratio goal (59.4%) before starting monthly octreotide. The most common dose of long-acting octreotide was 30 mg every 28 days. Overall, octreotide decreased the frequency of GIB (4.3 vs. 0.9 events/year, p < 0.001). Nineteen (59.4%) patients did not have a subsequent gastrointestinal bleed. Of the 13 patients who rebled after initiation of octreotide, the frequency of events decreased by 2.6 bleeds per patient per year (4.8 vs. 2.2; p = 0.043). In high-risk patients who have failed conventional therapy, octreotide can be useful for the prevention of recurrent GIB.
Mixed Endometrioid Adenocarcinoma and Müllerian Adenosarcoma of the Uterus and Ovary
Authors: El Hallani Soufiane , Arora Rupali , Lin Douglas I. , Måsbäc Anna , Mateoiu Claudia , McCluggage W. Glenn , Nucci Marisa R. , Otis Christopher N. , Parkash Vinita , Parra-Herran Carlos , Longacre Teri A.
Published: December 2020

Mullerian adenosarcoma is a biphasic neoplasm composed of benign or atypical Müllerian epithelium and a malignant mesenchymal component that is usually, but not always, of low grade. Focal architectural or cytologic atypia of the epithelial component resembling atypical hyperplasia may uncommonly be present and foci of adenocarcinoma have been rarely reported. Whether the coexistence of these 2 tumor components is a result of independent primaries (collision tumor), adenocarcinoma arising from the epithelial component of the adenosarcoma, an unusual form of carcinosarcoma or some other mechanism is uncertain. To establish the diagnostic criteria and clinical significance of the coexistence of adenocarcinoma in close association with Müllerian adenosarcoma, we conducted a multi-institutional study of these rare tumors. Twenty-six patients were identified with “mixed” adenosarcoma and adenocarcinoma; they ranged in age from 43 to 87 years (median: 66 y). Tumors occurred in the uterine corpus (n=22), ovary (n=2), and the pelvis (n=2). All but 6 had International Federation of Gynecology and Obstetrics (FIGO) stage I disease. All extrauterine tumors were associated with endometriosis. The tumor size ranged from 2 to 25 cm (median: 7.9 cm). The sarcomatous component was of low grade in 18 and high grade in 8 (the majority demonstrating rhabdomyoblastic differentiation); 9 had stromal overgrowth. Twenty-five carcinomas were endometrioid in type (23 FIGO grade 1; 3 FIGO grade 2) and 1 carcinoma was dedifferentiated with FIGO grade 1 endometrioid adenocarcinoma component; 33% of the uterine neoplasms were associated with adjacent endometrial hyperplasia. Next-generation sequencing in 2 tumors identified similar molecular abnormalities in the sarcomatous and carcinomatous components supporting a clonal relationship. Of 10 patients with available follow-up (median: 18 mo), 8 had no evidence of disease and 2 died of recurrent sarcoma at 7 and 8 months. Endometrioid adenocarcinomas that arise in close spatial association with Müllerian adenosarcoma appear to be clonally related to the sarcoma. Unlike carcinosarcomas, these tumors are usually early stage at presentation. The prognosis appears to be driven by the sarcomatous component. These tumors should be distinguished from carcinosarcomas, dedifferentiated endometrial carcinomas, and corded and hyalinized endometrioid carcinomas.
Computed Tomography-based Lung Residual Volume and Mortality of Patients With Coronavirus Disease-19 (COVID-19)
Authors: Timaran-Montenegro David Ernesto , Torres-Ramírez Christian Alexander , Morales-Jaramillo Leonardo Mauricio , Mateo-Camacho Yohana Sarahi , Tapia-Rangel Edgar Alonso , Fuentes-Badillo Karla Daniela , Hernández-Rojas Ana Milena , Morales-Domínguez Valeria , Saenz-Castillo Pedro Fernando , Parra-Guerrero Lina Marcela , Jacome-Portilla Katherine Isamara , Obrando-Bravo Daniel Ernesto , Contla-Trejo Giovanni Saul , Falla-Trujillo Manuel Gerardo , Punzo-Alcaraz Gerardo Rafael , Feria-Arroyo Gustavo Adolfo , Chávez-Sastre Alberto Joshua , Govea-Palma Jovani , Carrillo-Álvarez Santiago , Orozco-Vázquez Julita del Socorro
Published: December 2020

Rationale and Objectives:

To assess the effect of computed tomography (CT)-based residual lung volume (RLV) on mortality of patients with coronavirus disease 2019 (COVID-19).

Materials and Methods:

A single-center, retrospective study of a prospectively maintained database was performed. In total, 138 patients with COVID-19 were enrolled. Baseline chest CT scan was performed in all patients. CT-based automated and semi-automated lung segmentation was performed using the Alma Medical workstation to calculate normal lung volume, lung opacities volume, total lung volume, and RLV. The primary end point of the study was mortality. Univariate and multivariate analyses were performed to determine independent predictors of mortality.

Results:

Overall, 84 men (61%) and 54 women (39%) with a mean age of 47.3 years (±14.3 y) were included in the study. Overall mortality rate was 21% (29 patients) at a median time of 7 days (interquartile range, 4 to 11 d). Univariate analysis demonstrated that age, hypertension, and diabetes were associated with death (P<0.01). Similarly, patients who died had lower normal lung volume and RLV than patients who survived (P<0.01). Multivariate analysis demonstrated that low RLV was the only independent predictor of death (odds ratio, 1.042; 95% confidence interval, 10.2-10.65). Furthermore, receiver operating characteristic curve analysis demonstrated that a RLV ≤64% significantly increased the risk of death (odds ratio, 4.8; 95% confidence interval, 1.9-11.7).

Conclusion:

Overall mortality of patients with COVID-19 may reach 21%. Univariate and multivariate analyses demonstrated that reduced RLV was the principal independent predictor of death. Furthermore, RLV ≤64% is associated with a 4-fold increase on the risk of death.
Airflow and air velocity measurements while playing wind instruments, with respect to risk assessment of a SARS-CoV-2 infection
Authors: Spahn Claudia , Hipp Anna , Schubert Bernd , Axt Marcus Rudolf , Stratmann Markus , Schmölder Christian , Richter Bernhard
Published: December 2020

Due to airborne transmission of infection with the coronavirus, the question arose as to how high the risk of spreading infectious particles can be while playing a wind instrument.

To contribute to this question and to help clarify the possible risks, we analyzed 14 wind instruments, first qualitative by making airflows visible while playing and second quantitative by measuring air velocities at three distances (1m, 1.5m and 2m) in direction of the instrument’s bell.

Measurements took place with wind instrumentalists of the Bamberg Symphony in their concert hall.

Our findings highlight that while playing all wind instruments no airflow escaping from the instruments – from the bell with brass instruments, from the mouthpiece, keyholes and bell with woodwinds – was measured beyond a distance of 1.5m from the instruments’ bell, regardless of volume, pitch or what was played. With that, air velocity while playing corresponded to the usual value of hall-like rooms, of 0.1 m/s. For air-jet woodwinds, alto flute and piccolo, significant air movements were seen close to their mouthpieces, which escaped directly into the room without passing through the instrument and therefore generating directed air movements.
Source-level EEG and graph theory reveal widespread functional network alterations in focal epilepsy
Authors: Hatlestad-Hall Christoffer , Bruña Ricardo , Syvertsen Marte Roa , Erichsen Aksel , Andersson Vebjørn , Vecchio Fabrizio , Miraglia Francesca , Rossini Paolo M. , Renvall Hanna , Taubøll Erik , Maestú Fernando , Haraldsen Ira H.
Published: December 2020

Objective

The hypersynchronous neuronal activity associated with epilepsy causes widespread functional network disruptions extending beyond the epileptogenic zone. This altered functional network topology is considered a mediator from which non-seizure symptoms arise, such as cognitive impairment. The aim of the present study was to demonstrate the presence of functional network alterations in focal epilepsy patients with good seizure control and high quality of life.

Methods

We compared twenty-two focal epilepsy patients and sixteen healthy controls on graph metrics derived from functional connectivity (phase-locking value) of source reconstructed resting-state EEG. Graph metrics were calculated over a predefined range of network densities in five frequency bands.

Results

In terms of global network topology alterations, we observed a significantly increased small world index in epilepsy patients relative to the healthy controls. On the local level, two left-hemisphere regions displayed a shift towards greater alpha band “hubness”.

Conclusions

Subtle widespread functional network alterations are evident in focal epilepsy, even in a cohort characterised by successful anti-seizure medication therapy and high quality of life. These findings suggest a possible clinical relevance of functional network analysis in epilepsy.

Significance

Focal epilepsy is accompanied by global and local functional network aberrancies which might be implied in the sustenance of non-seizure symptoms.

Highlights

Focal epilepsies are associated with widespread interictal functional network alterations, extending beyond the epilepsy focus.

Global and local graph theoretical analyses of source-space EEG functional connectivity networks capture these network changes, and might thus be of clinical relevance.

Group-level differences in network metrics are relatively stable across network analysis parameters.
Screening and identification of key biomarkers in clear cell renal cell carcinoma based on bioinformatics analysis
Authors: Vastrad Basavaraj , Vastrad Chanabasayya , Kotturshetti Iranna
Published: December 2020

Clear cell renal cell carcinoma (ccRCC) is one of the most common types of malignancy of the urinary system. The pathogenesis and effective diagnosis of ccRCC have become popular topics for research in the previous decade. In the current study, an integrated bioinformatics analysis was performed to identify core genes associated in ccRCC. An expression dataset (GSE105261) was downloaded from the Gene Expression Omnibus database, and included 26 ccRCC and 9 normal kideny samples. Assessment of the microarray dataset led to the recognition of differentially expressed genes (DEGs), which was subsequently used for pathway and gene ontology (GO) enrichment analysis. This data was utilized in the construction of the protein-protein interaction network and module analysis was conducted using Human Integrated Protein-Protein Interaction rEference (HIPPIE) and Cytoscape software. In addation, target gene - miRNA regulatory network and target gene - TF regulatory network were constructed and analysed. Finally, hub genes were validated by survival analysis, expression analysis, stage analysis, mutation analysis, immune histochemical analysis, receiver operating characteristic (ROC) curve analysis, RT-PCR and immune infiltration analysis. The results of these analyses led to the identification of a total of 930 DEGs, including 469 up regulated and 461 down regulated genes. The pathwayes and GO found to be enriched in the DEGs (up and down regulated genes) were dTMP de novo biosynthesis, glycolysis, 4-hydroxyproline degradation, fatty acid beta-oxidation (peroxisome), cytokine, defense response, renal system development and organic acid metabolic process. Hub genes were identified from PPI network according to the node degree, betweenness centrality, stress centrality, closeness centrality and clustering coefficient. Similarly, targate genes were identified from target gene - miRNA regulatory network and target gene - TF regulatory network according to the node degree. Furthermore, survival analysis, expression analysis, stage analysis, mutation analysis, immune histochemical analysis, ROC curve analysis, RT-PCR and immune infiltration analysis revealed that CANX, SHMT2, IFI16, P4HB, CALU, CDH1, ERBB2, NEDD4L, TFAP2A and SORT1 may be associated in the tumorigenesis, advancement or prognosis of ccRCC. In conclusion, the 10 hub genes diagonised in the current study may help researchers in exemplify the molecular mechanisms linked with the tumorigenesis and advancement of ccRCC, and may be powerful and favorable candidate biomarkers for the prognosis, diagnosis and treatment of ccRCC.
Clinical characteristics of COVID-19 patients in Latvia under low incidence in Spring 2020
Authors: Viksna Ludmila , Kolesova Oksana , Kolesovs Aleksandrs , Vanaga Ieva , Arutjunana Seda , Laivacuma Sniedze , Storozenko Jelena , Tolmane Ieva , Berzina Ilze , Rozentale Baiba
Published: December 2020

Background

COVID-19 is a new infectious disease with severe disease course and high mortality in some groups. Blood tests on admission to the hospital can be useful for stratification of patients and timely correction. Our study investigated the clinical features of COVID-19 patients in Latvia and differences in blood tests in groups with different disease severity.

Methods

The retrospective study included 100 patients hospitalized in Riga East Clinical University Hospital in Spring 2020. The severity of the disease course was classified by the presence of pneumonia and its combination with respiratory failure. We have assessed blood cells’ count, hemoglobin, hematocrit, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), alanine aminotransferase, lactate dehydrogenase (LDH), troponin T, electrolytes, creatinine, glomerular filtration rate (GFR), D-dimer, prothrombin time, prothrombin index, oxygen saturation, and temperature on admission to the hospital.

Results

Patients were from 18 to 99 (57±18 years, 57% males). Comorbidities were found in 74% of patients. The mild, moderate, and severe groups included 35, 44, and 16 patients, respectively. In the severe group, the mortality rate was 50%. The progression to severe COVID-19 was associated positively with temperature, ESR, CRP, creatinine, LDH, and troponin T and negatively associated with oxygen saturation, eosinophils, and GFR on admission to the hospital.

Conclusions

COVID-19 severity associates with lower renal function and a higher level of inflammation and tissue damage. Eosinophils, CRP, ESR, LDH, troponin T, creatinine, and GFR are blood indicators for monitoring patients’ condition.
Effective design of barrier enclosure to contain aerosol emissions from COVID-19 patients
Authors: Daniel Dan , Lin Marcus , Luhung Irvan , Lui Tony , Sadovoy Anton , Koh Xueqi , Sng Anqi , Tran Tuan , Schuster Stephan C. , Loh Xian Jun , Thet Oo Schwe , Tan Chee Keat
Published: December 2020

Facing shortages of personal protective equipment, some clinicians have advocated the use of barrier enclosures (typically mounted over the head, with and without suction) to contain aerosol emissions from coronavirus disease 2019 (COVID-19) patients. There is however little evidence for its usefulness. To test the effectiveness of such a device, we built a manikin that can expire micron-sized aerosols at flow rates close to physiological conditions. We then placed the manikin inside the enclosure and used a laser sheet to visualize the aerosol leaking out. We show that with sufficient suction, it is possible to effectively contain aerosol from the manikin even at high flow rates (up to 60 L min−1) of oxygen, reducing aerosol exposure outside the enclosure by 99%. In contrast, a passive barrier without suction only reduces aerosol exposure by 60%.
Real-world clinical performance of commercial SARS-CoV-2 rapid antigen tests in suspected COVID-19: A systematic meta-analysis of available data as per November 20, 2020
Authors: Hayer Johannes , Kasapic Dusanka , Zemmrich Claudia
Published: December 2020

Background

Immunochromatographic rapid antigen tests (RATs) emerged onto the COVID-19 pandemic testing landscape to aid in the rapid diagnosis of people with suspected SARS-CoV-2 infection. RATs are particularly useful where RT-PCR is not immediately available and symptoms suggestive of a high viral load and infectiousness are assumed. Several lateral flow immunoassays have been authorized for use under EUA and/or the CE mark, presenting varying overall clinical performance data generated by the manufacturer or by independent investigators. To compare the real-world clinical performance of commercially available rapid chromatographic immunoassays intended for the qualitative detection of SARS-CoV-2, we performed a systematic meta-analysis of published data.

Methods

We searched the MEDLINE®, Embase, BIOSIS and Derwent Drug File (ProQuest)for manufacturer-independent prospective clinical performance studies comparing SARS-CoV-2 RATs and RT-PCR assays. Only studies on lateral flow assays not needing a separate reader for retrieving the result were included, if data were available on viral load, patients’ symptom status, sample type, and PCR assay used. For better data comparability, recalculation of the studies’ single performance data confidence intervals using the exact Clopper–Pearson method was applied.

Results

We could include 19 studies (ten peer-reviewed) presenting detailed clinical performance data on 11,209 samples with 2449 RT-PCR-positives out of study prevalence rates between 1.9–100 % and between 50– 100% symptomatic samples. Four studies directly compared two to three different RATs and 15 studies compared one RAT to RT-PCR. Overall specificity ranged, with one test outlier, between 92.4% (87.4– 95.9) and 100% (99.7–100), and overall clinical sensitivity varied between 28.9% (16.4–44.3) and 98.3% (91.1–99.7), depending on assay, population characteristics, viral load, and symptom status. Sensitivity in high-viral-load samples (cycle threshold ≤25) showed a considerable heterogeneity among the assays ranging from 66.7% to 100%.

Conclusion

Only two RATs offered sufficient manufacturer-independent, real-world performance data supporting use for the detection of current SARS-CoV-2 infection in symptomatic or high-viral-load patient populations. Reliable positive predictive values require testing of symptomatic patients or asymptomatic individuals only in case of a high pre-test probability. If RATs are used for screening of asymptomatic cases in low-prevalence scenarios, a lower positive predictive value of the result has to be considered.
Environmental scan of provincial and territorial planning for COVID-19 vaccination programs
Authors: MacDonald Shannon E. , Sell Hannah , Wilson Sarah , Meyer Samantha B. , Gagneur Arnaud , Assi Ali , Sadarangani Manish ,   And members of the COVImm study team
Published: December 2020

Background

Public health departments in Canada are currently facing the challenging task of planning and implementing COVID-19 vaccination programs.

Objective

To collect and synthesize information regarding COVID-19 vaccination programs in each of the provinces and territories (P/Ts).

Methods

Provincial/territorial public health leaders were interviewed via teleconference between August-October 2020 to collect information on the following topics, drawn from scientific literature and media: unique factors for COVID-19 vaccination, adoption of National Advisory Committee on Immunization (NACI) recommendations, priority groups for early vaccination, and vaccine safety and effectiveness monitoring. Data were grouped according to common responses and descriptive analysis was performed.

Results

Eighteen interviews occurred with 25 participants from 11 of 13 P/Ts. Factors unique to COVID-19 vaccination included prioritizing groups for early vaccination (n=7), public perception of vaccines (n=6), and differing eligibility criteria (n=5). Almost all P/Ts (n=10) reported reliance on NACI recommendations. Long-term care residents (n=10) and health care workers (n=10) were most frequently prioritized for early vaccination, followed by people with chronic medical conditions (n=9) and seniors (n=8). Most P/Ts (n=9) are planning routine adverse event monitoring to assess vaccine safety. Evaluation of effectiveness was anticipated to occur within public health departments (n=3), by researchers (n=3), or based on national guidance (n=4).

Conclusion

Plans for COVID-19 vaccination programs in the P/Ts exhibit some similarities and are largely consistent with NACI guidelines, with some discrepancies. Further research is needed to evaluate the success of COVID-19 vaccination programs once implemented.
The main factors influencing COVID-19 spread and deaths in Mexico: A comparison between Phases I and II
Authors: Benita Francisco , Gasca-Sanchez Francisco
Published: December 2020

This article investigates the geographical spread of confirmed COVID-19 cases and deaths across municipalities in Mexico. It focuses on the spread dynamics and containment of the virus between Phase I (from March 23 to May 31, 2020) and Phase II (from June 1 to August 22, 2020) of the social distancing measures. It also examines municipal-level factors associated with cumulative COVID-19 cases and deaths to understand the spatial determinants of the pandemic. The analysis of the geographic pattern of the pandemic via spatial scan statistics revealed a fast spread among municipalities. During Phase I, clusters of infections and deaths were mainly located at the country’s center, whereas in Phase II, these clusters dispersed to the rest of the country. The regression results from the zero-inflated negative binomial regression analysis suggested that income inequality, the prevalence of obesity and diabetes, and concentration of fine particulate matter (PM 2.5) are strongly positively associated with confirmed cases and deaths regardless of lockdown.
“There’s No Place Like Home for The Holidays:” Travel and SARS-CoV-2 Test Positivity Following Thanksgiving Weekend
Authors: Mehta Shruti H. , Clipman Steven J. , Wesolowski Amy , Solomon Sunil S.
Published: December 2020

In the US, public health officials discouraged travel and social gatherings for Thanksgiving. Data suggests that many individuals did travel over the holidays, albeit in smaller numbers than previous years. Using an online panel survey of individuals across ten US states, we found that many individuals reported spending Thanksgiving outside of their home (25.9%) or at home with at least one non-household member (27.3%). Among those who were tested, those who had Thanksgiving outside their home were significantly more likely to self-report a positive PCR test for SARS-CoV-2 infection in the prior two weeks compared to those who had Thanksgiving at home with non-household members or with household members only (41.7% vs. 21.4% and 13.8%, respectively; p<0.001). Persons who had Thanksgiving outside their home and tested positive for SARS-CoV-2 participated in a median 35 (IQR: 21 - 53). non-essential activities compared to those who had Thanksgiving at home and tested positive (median 3 activities, IQR 0-13). Notably, planned travel over the December holidays was most common among those who tested positive for SARS-CoV-2 in the prior 2 weeks (66.5%) compared with 25.4% of those who tested negative in the prior 2 weeks and 11.0% among those who were not tested. While public health authorities should continue promoting messages to dissuade travel and social gatherings over the holidays, as supported by these data, it is equally important to promote messaging on how to get together in a “low-risk” manner for those who travel and plan gatherings. In particular, it is critical that those who do travel or visit with others outside their household do so cautiously and avoid or significantly minimize all other activities where they may potentially acquire and transmit infection in the weeks prior to and after their visit.