bluuebunny/crossref_metadata_2025 huggingface dataset:
Snapshot of Social Work in China: Outcomes of Stakeholder Competition
Authors: Yi-Bing Xu , Quan-Cai Li , Meng Cui
Published: December 2020

Since its introduction from the West, social work has unprecedentedly developed in China in recent decades. Accordingly, existing definitions of social work became outdated quickly inevitably. Indigenisation offers a useful perspective for understanding the development of social work in the rapidly changing context of China. However, indigenisation is often regarded as a linear and unidirectional process of knowledge transfer and adoption from the West to third world countries, which easily results in local dynamics getting ignored. This article views indigenisation as the result of competition amongst different local stakeholders. By discussing social work in China presently and examining the performance of different stakeholders, we argue that Chinese social work differs from social work in the West to some extent, especially in terms of its professional value, which has been challenged. Finally, the article highlights the implications of China’s experience with social work for the international community.
Multidimensional inflammatory and immunological endotypes of idiopathic focal segmental glomerulosclerosis and their association with treatment outcomes
Authors: Roca Neus , Madrid Alvaro , Lopez Mercedes , Fraga Gloria , Jatem Elias , Gonzalez Jorge , Martinez Cristina , Segarra Alfons
Published: December 2020

Objectives

Idiopathic focal segmental glomerulosclerosis (FSGS) has been linked to immunological and inflammatory response dysregulations. The aim of this study was to find endotypes of FSGS patients using a cluster (CL) analysis based on inflammatory and immunological variables, and to analyse whether a certain endotype is associated with response to treatment with corticosteroids.

Methods

This prospective observational study included patients with idiopathic FSGS diagnosed by kidney biopsy. Serum levels of soluble interleukin (IL)-1 receptor, tumoural necrosis factor alpha, Interferon gamma (IFNγ), IL-6, IL-17, IL-12, IL-23, IL-13, IL-4, IL-5, IL-6, haemopexin (Hx), haptoglobin (Hgl), soluble urokinase-type plasminogen activator receptor (suPAR) and urinary CD80 (uCD80) were measured with enzyme-linked immunosorbent assay or nephelometry. T-helper lymphocyte populations and T-regulatory lymphocytes were analysed by flow cytometry. A factorial analysis followed by a k-means CL analysis was performed.

Results

A total of 79 FSGS patients were included. Three CLs were identified. CL1 (27.8%) included IL-12, IL-17, IL-23 and a T helper 17 (Th17) pattern. CL2 (20.2%) included IL-4, IL-5, IL-13, immunoglobulin E and Th2 pattern. CL3 (51.8%) included IL-6, Hx, Hgl, suPAR and uCD80. There were no differences in age, gender, kidney function, albumin or proteinuria among CLs. About 42/79 patients (53.1%) showed cortico-resistance. The prevalence of cortico-resistance was significantly lower in CL2 (4/16, 25%) than in CL1 (16/26, 72.7%) and CL3 (22/41, 53.7%) (P = 0.018), with no significant differences between CLs 1 and 3 (P = 0.14).

Conclusions

Patients with FSGS and indistinguishable clinical presentation at diagnosis were classified in three distinct CLs according to predominant Th17, Th2 and acute inflammatory responses that display differences in clinical response to treatment with corticosteroids.
Prenatal lead exposure and cord blood DNA methylation in PROGRESS: an epigenome-wide association study
Authors: Heiss Jonathan A , Téllez-Rojo Martha M , Estrada-Gutiérrez Guadalupe , Schnaas Lourdes , Amarasiriwardena Chitra , Baccarelli Andrea A , Wright Robert O , Just Allan C
Published: December 2020

The effects of prenatal lead exposure on child development include impaired growth and cognitive function. DNA methylation might be involved in the underlying mechanisms and previous epigenome-wide association studies reported associations between lead exposure during pregnancy and cord blood methylation levels. However, it is unclear during which developmental stage lead exposure is most harmful. Cord blood methylation levels were assayed in 420 children from a Mexican pre-birth cohort using the Illumina Infinium MethylationEPIC microarray. Lead concentrations were measured in umbilical cord blood as well as in blood samples from the mothers collected at 2nd and 3rd trimester and delivery using inductively coupled plasma-mass spectrometry. In addition, maternal bone lead levels were measured in tibia and patella using X-ray fluorescence. Comprehensive quality control and preprocessing of microarray data was followed by an unbiased restriction to methylation sites with substantial variance. Methylation levels at 202 111 cytosine-phosphate-guanine sites were regressed on each exposure adjusting for child sex, leukocyte composition, batch variables, gestational age, birthweight-for-gestational-age, maternal age, maternal education and mode of delivery. We find no association between prenatal lead exposure and cord blood methylation. This null result is strengthened by a sensitivity analysis showing that in the same dataset known biomarkers for birthweight-for-gestational-age can be recovered and the fact that phenotypic associations with lead exposure have been described in the same cohort.
Inferior ST-elevation myocardial infarction managed with a pharmacoinvasive strategy and conservative management of delayed atrioventricular block: classical case report
Authors: John Thadathilankal-Jess , Kyriakakis Charles , Zachariah Don , Doubell Anton
Published: December 2020

Background

The 2017 ESC guideline on patients with ST-segment elevation myocardial infarction (STEMI) provides guidance regarding the optimal management of these patients. Transient atrioventricular (AV) block is a relatively common complication of inferior STEMI and its management is also addressed in the guidelines.

Case summary

A 64-year-old gentleman with multiple cardiovascular risk factors presented to the emergency department with a history of ischaemic type chest pain and evidence of inferior ST-segment elevation on his electrocardiogram (ECG). First-degree AV block was noted on his initial ECG. He was given thrombolytic therapy as part of a pharmacoinvasive strategy of reperfusion. He, however, failed fibrinolytic therapy, and emergency angiography revealed critical disease of the right coronary artery which was successfully stented. Subsequent to reperfusion, he developed complete AV block without evidence of re-infarction, which was managed conservatively with successful resolution of the block after 7 days of expectant management with temporary transvenous pacing.

Discussion

We highlight some of the important management principles from the ESC guideline of STEMI including timing and the management of AV block in these patients. In addition, we highlight the role of a pharmacoinvasive strategy for reperfusion where timeous primary percutaneous coronary intervention cannot be performed. The usefulness of such a strategy within the COVID-19 era is also emphasized.
Genome-wide analysis identifies novel susceptibility loci for myocardial infarction
Authors: Hartiala Jaana A , Han Yi , Jia Qiong , Hilser James R , Huang Pin , Gukasyan Janet , Schwartzman William S , Cai Zhiheng , Biswas Subarna , Trégouët David-Alexandre , Smith Nicholas L ,   The INVENT Consortium,   The CHARGE Consortium Hemostasis Working Group,   The GENIUS-CHD Consortium, Seldin Marcus , Pan Calvin , Mehrabian Margarete , Lusis Aldons J , Bazeley Peter , Sun Yan V , Liu Chang , Quyyumi Arshed A , Scholz Markus , Thiery Joachim , Delgado Graciela E , Kleber Marcus E , März Winfried , Howe Laurence J , Asselbergs Folkert W , van Vugt Marion , Vlachojannis Georgios J , Patel Riyaz S , Lyytikäinen Leo-Pekka , Kähönen Mika , Lehtimäki Terho , Nieminen Tuomo V M , Kuukasjärvi Pekka , Laurikka Jari O , Chang Xuling , Heng Chew-Kiat , Jiang Rong , Kraus William E , Hauser Elizabeth R , Ferguson Jane F , Reilly Muredach P , Ito Kaoru , Koyama Satoshi , Kamatani Yoichiro , Komuro Issei ,   Biobank Japan, Stolze Lindsey K , Romanoski Casey E , Khan Mohammad Daud , Turner Adam W , Miller Clint L , Aherrahrou Redouane , Civelek Mete , Ma Lijiang , Björkegren Johan L M , Kumar S Ram , Tang W H Wilson , Hazen Stanley L , Allayee Hooman
Published: December 2020

Aims

While most patients with myocardial infarction (MI) have underlying coronary atherosclerosis, not all patients with coronary artery disease (CAD) develop MI. We sought to address the hypothesis that some of the genetic factors which establish atherosclerosis may be distinct from those that predispose to vulnerable plaques and thrombus formation.

Methods and results

We carried out a genome-wide association study for MI in the UK Biobank (n∼472 000), followed by a meta-analysis with summary statistics from the CARDIoGRAMplusC4D Consortium (n∼167 000). Multiple independent replication analyses and functional approaches were used to prioritize loci and evaluate positional candidate genes. Eight novel regions were identified for MI at the genome wide significance level, of which effect sizes at six loci were more robust for MI than for CAD without the presence of MI. Confirmatory evidence for association of a locus on chromosome 1p21.3 harbouring choline-like transporter 3 (SLC44A3) with MI in the context of CAD, but not with coronary atherosclerosis itself, was obtained in Biobank Japan (n∼165 000) and 16 independent angiography-based cohorts (n∼27 000). Follow-up analyses did not reveal association of the SLC44A3 locus with CAD risk factors, biomarkers of coagulation, other thrombotic diseases, or plasma levels of a broad array of metabolites, including choline, trimethylamine N-oxide, and betaine. However, aortic expression of SLC44A3 was increased in carriers of the MI risk allele at chromosome 1p21.3, increased in ischaemic (vs. non-diseased) coronary arteries, up-regulated in human aortic endothelial cells treated with interleukin-1β (vs. vehicle), and associated with smooth muscle cell migration in vitro.

Conclusions

A large-scale analysis comprising ∼831 000 subjects revealed novel genetic determinants of MI and implicated SLC44A3 in the pathophysiology of vulnerable plaques.
Lipoproteins in chronic kidney disease: from bench to bedside
Authors: Speer Thimoteus , Ridker Paul M , von Eckardstein Arnold , Schunk Stefan J , Fliser Danilo
Published: December 2020

Chronic kidney disease (CKD) is associated with high cardiovascular risk. CKD patients exhibit a specific lipoprotein pattern termed ‘uraemic dyslipidaemia’, which is characterized by rather normal low-density lipoprotein cholesterol, low high-density lipoprotein cholesterol, and high triglyceride plasma levels. All three lipoprotein classes are involved in the pathogenesis of CKD-associated cardiovascular diseases (CVDs). Uraemia leads to several modifications of the structure of lipoproteins such as changes of the proteome and the lipidome, post-translational protein modifications (e.g. carbamylation) and accumulation of small-molecular substances within the lipoprotein moieties, which affect their functionality. Lipoproteins from CKD patients interfere with lipid transport and promote inflammation, oxidative stress, endothelial dysfunction as well as other features of atherogenesis, thus contributing to the development of CKD-associated CVD. While, lipid-modifying therapies play an important role in the management of CKD patients, their efficacy is modulated by kidney function. Novel therapeutic agents to prevent the adverse remodelling of lipoproteins in CKD and to improve their functional properties are highly desirable and partially under development.
Lessons for the global primary care response to COVID-19: a rapid review of evidence from past epidemics
Authors: Desborough Jane , Dykgraaf Sally Hall , Phillips Christine , Wright Michael , Maddox Raglan , Davis Stephanie , Kidd Michael
Published: December 2020

Background

COVID-19 is the fifth and most significant infectious disease epidemic this century. Primary health care providers, which include those working in primary care and public health roles, have critical responsibilities in the management of health emergencies.

Objective

To synthesize accounts of primary care lessons learnt from past epidemics and their relevance to COVID-19.

Methods

We conducted a review of lessons learnt from previous infectious disease epidemics for primary care, and their relevance to COVID-19. We searched PubMed/MEDLINE, PROQUEST and Google Scholar, hand-searched reference lists of included studies, and included research identified through professional contacts.

Results

Of 173 publications identified, 31 publications describing experiences of four epidemics in 11 countries were included. Synthesis of findings identified six key lessons: (i) improve collaboration, communication and integration between public health and primary care; (ii) strengthen the primary health care system; (iii) provide consistent, coordinated and reliable information emanating from a trusted source; (iv) define the role of primary care during pandemics; (v) protect the primary care workforce and the community and (vi) evaluate the effectiveness of interventions.

Conclusions

Evidence highlights distinct challenges to integrating and supporting primary care in response to infectious disease epidemics that have persisted over time, emerging again during COVID-19. These insights provide an opportunity for strengthening, and improved preparedness, that cannot be ignored in a world where the frequency, virility and global reach of infectious disease outbreaks are increasing. It is not too soon to plan for the next pandemic, which may already be on the horizon.
Amendments to the Argentine Trademark Law: Initial Impact
Authors: Quadrio Iris V , O’Donnell Carol A
Published: December 2020

This paper examines the principal changes to the Argentine Trademark Law in 2018. The aim of these amendments was to reduce bureaucracy and simplify administrative procedures in a vast diversity of areas besides intellectual property, such as corporate, finance, insurance and labor matters, among others. With respect to intellectual property, however, some of the changes seem to be substantive and not merely procedural. The purpose of this article is to analyze the changes to the Argentine Trademark Law and provide a practical reference guide in relation to trademark protection in Argentina. The authors discuss how the system for resolving oppositions has been simplified, reducing time and costs to obtain registrations. In addition, the authors provide a comparative review of some of the judicial decisions ruled on the merit of oppositions and those adopted by the National Institute of Industrial Property in 2020. Based on this comparative case law and the analysis of the amendments to the new law, the authors share their views on the implementation of the changes and their application in practice, which may serve as a starting point for those interested in registering their trademarks in Argentina. They conclude that the modifications to the Argentine Trademark Law are positive and aim to bring the Argentine system in line with international standards.
The role of government agencies and other actors in influencing access to medicines in three East African countries
Authors: Odoch Walter Denis , Dambisya Yoswa , Peacocke Elizabeth , Sandberg Kristin Ingstad , Hembre Berit Sofie Hustad
Published: December 2020

The WHO Model List of Essential Medicines (MLEM) has since 1977 helped prioritize and ensure availability of medicines especially in low- and middle-income countries. The MLEM consists mainly of generic medicines, though recent trends point towards listing expensive on-patent medicines and increasing global support for medicines against non-communicable diseases. However, the implications of such changes for national essential medicines list (NEML) updates for access to essential medicines has received relatively little attention. This study examined how government agencies and other actors in Kenya, Uganda and Tanzania participate in and influence the NEML update process and subsequent availability of prioritized medicines; and the alignment of these processes to WHO guidance. A mixed study design was used, with qualitative documentary review, key informant interviews and thematic data analysis. Results show that NEML updating processes were similar amongst the three countries and aligned to WHO guidelines, albeit conducted irregularly, with tendency to reprioritization during procurement stages, and were not always accompanied by revision of clinical guidelines. Variations were noted in the inclusion of medicines against cancer and hepatitis C, and the utilization of health technology assessment (HTA). For medicines against diseases with high global engagement, such as HIV/AIDS and TB, national stakeholders had more limited inputs in prioritization and funding. Furthermore, national actors were not influenced by the pharmaceutical industry during the NEML update process, nor were any conflicting agendas identified between health, trade and industrial policies. Hence, the study suggests that more attention should be paid to the combination of HTAs and NEMLs, particularly as countries work towards universal health coverage, in addition to heightened awareness of how global disease-specific initiatives may confound national implementation of the NEML. The study concludes with a call to strengthen country-level policy and procedural coherence around the process of prioritizing and ensuring availability of essential medicines.
Emergence and dissemination of three mild outbreaks ofNeisseria gonorrhoeaewith high-level resistance to azithromycin in Barcelona, 2016–18
Authors: Salmerón P , Moreno-Mingorance A , Trejo J , Amado R , Viñado B , Cornejo-Sanchez T , Alberny M , Barbera M J , Arando M , Pumarola T , Hoyos-Mallecot Y , Serra-Pladevall J , González-López J J
Published: December 2020

Background

Neisseria gonorrhoeae (NG) isolates with high-level azithromycin resistance (HL-AziR) have emerged worldwide in recent decades, threatening the sustainability of current dual-antimicrobial therapy.

Objectives

This study aimed to characterize the first 16 NG isolates with HL-AziR in Barcelona between 2016 and 2018.

Methods

WGS was used to identify the mechanisms of antimicrobial resistance, to establish the MLST ST, NG multiantigen sequence typing (NG-MAST) ST and NG sequence typing for antimicrobial resistance (NG-STAR) ST and to identify the clonal relatedness of the isolates with other closely related NG previously described in other countries based on a whole-genome SNP analysis approach. The sociodemographic characteristics of the patients included in the study were collected by comprehensive review of their medical records.

Results

Twelve out of 16 HL-AziR isolates belonged to the MLST ST7823/NG-MAST ST5309 genotype and 4 to MLST ST9363/NG-MAST ST3935. All presented the A2059G mutation in all four alleles of the 23S rRNA gene. MLST ST7823/NG-MAST ST5309 isolates were only identified in men who have sex with women and MLST ST9363/NG-MAST ST3935 were found in MSM. Phylogenomic analysis revealed the presence of three transmission clusters of three different NG strains independently associated with sexual behaviour.

Conclusions

Our findings support the first appearance of three mild outbreaks of NG with HL-AziR in Spain. These results highlight the continuous capacity of NG to develop antimicrobial resistance and spread among sexual networks. The enhanced resolution of WGS provides valuable information for outbreak investigation, complementing the implementation of public health measures focused on the prevention and dissemination of MDR NG.
High rate of virological failure and HIV drug resistance in semi-rural Gabon and implications for dolutegravir-based regimen efficacy
Authors: Engone-Ondo Jéordy D , Mouinga-Ondémé Augustin , Lékana-Douki Sonia E , Diané Abdoulaye , Mamimandjiami Antony I , Banga Octavie , Ndong-Atome Guy-Roger , Aghokeng Avelin F
Published: December 2020

Background

The projected UNAIDS goal of ending AIDS by 2030 requires significant global efforts to improve current and future ART strategies. In this study, we assessed viral load (VL) suppression and acquired drug resistance, as well as future efficacy of dolutegravir-based combinations for patients living in semi-rural regions of Gabon.

Methods

Eligible study participants were adults receiving ART and recruited between 2018 and 2019 in Franceville, Gabon. VL testing was conducted to assess VL suppression and HIV drug resistance (HIVDR) testing was performed to identify resistance mutations and assess their impact on ongoing and future ART regimens.

Results

We recruited 219 participants overall. The median time on ART was 27 months and 216/219 participants were on first-line ART. VL suppression (VL < 1000 copies/mL) was 57.1% (95% CI 50.5–63.8) overall; 59.4% (51.4–67.5) and 52.2% (40.3–64.2) for women and men, respectively. The overall prevalence of HIVDR was 21.9% among the study population and 67.2% among those who failed ART. Presence of both NRTI and NNRTI mutations was found in 84.6% of sequences with drug resistance mutations, and full activity of a dolutegravir-based first-line regimen including tenofovir disoproxil fumarate/lamivudine/dolutegravir was expected only for 5/39 patients with a resistant virus.

Conclusions

This study shows a very low rate of VL suppression in a semi-rural context in Africa. Moreover, the high burden of HIVDR has affected both current and newly recommended ART strategies. Better management of ART in resource-limited settings is still a challenging ambition.
Alternative vanHAX promoters and increased vanA-plasmid copy number resurrect silenced glycopeptide resistance in Enterococcus faecium
Authors: Wagner Theresa Maria , Janice Jessin , Sivertsen Audun , Sjögren Ingegerd , Sundsfjord Arnfinn , Hegstad Kristin
Published: December 2020

Background

Vancomycin variable enterococci (VVE) are van-positive isolates with a susceptible phenotype that can convert to a resistant phenotype during vancomycin selection.

Objectives

To describe a vancomycin-susceptible vanA-PCR positive ST203 VVE Enterococcus faecium isolate (VVESwe-S) from a liver transplantation patient in Sweden which reverted to resistant (VVESwe-R) during in vitro vancomycin exposure.

Methods

WGS analysis revealed the genetic differences between the isolates. Expression of the van-operon was investigated by qPCR. Fitness and stability of the revertant were investigated by growth measurements, competition and serial transfer.

Results

The VVESwe-R isolate gained high-level vancomycin (MIC >256 mg/L) and teicoplanin resistance (MIC = 8 mg/L). VVESwe-S has a 5′-truncated vanR activator sequence and the VVESwe-R has in addition acquired a 44 bp deletion upstream of vanHAX in a region containing alternative putative constitutive promoters. In VVESwe-R the vanHAX-operon is constitutively expressed at a level comparable to the non-induced prototype E. faecium BM4147 strain. The vanHAX operon of VVESwe is located on an Inc18-like plasmid, which has a 3–4-fold higher copy number in VVESwe-R compared with VVESwe-S. Resistance has a low fitness cost and the vancomycin MIC of VVESwe-R decreased during in vitro serial culture without selection. The reduction in MIC was associated with a decreased vanA-plasmid copy number.

Conclusions

Our data support a mechanism by which vancomycin-susceptible VVE strains may revert to a resistant phenotype through the use of an alternative, constitutive, vanR-activator-independent promoter and a vanA-plasmid copy number increase.
The influence of art censorship on New York collectors in the Gilded Age
Authors: Werbel Amy
Published: December 2020

With ample funds to furnish enormous homes and contribute to new public art museums, New York collectors in the mid-nineteenth century made a variety of choices regarding nudity and sexual themes in the works they purchased. After a surge in art censorship cases, beginning in 1883, collectors increasingly were confronted with polemical rhetoric urging them to refrain from purchasing art representing nude figures. While some collectors clearly adhered to this moralizing advice, including William H. Vanderbilt, James Lenox and Morris K. Jesup, others – most famously Henry O. and Louisine Havemeyer – were spurred on by their advocacy for civil liberties and cosmopolitan sophistication to purchase more nudes. Understanding both the intended and unintended consequences of art censorship campaigns in the Gilded Age is instructive for the likely outcome of analogous debates about appropriate subject matter on display in our own time.
Johann Daniel Major (1634–1693) and the experimental museum
Authors: Keller Vera
Published: December 2020

In the late seventeenth century, Johann Daniel Major, professor of medicine at Kiel University, claimed to have founded a new discipline, the ‘tactica conclavium’ – that is, the study of arranging a collection. At times, scholars have characterized Major’s museology as a form of disordered polyhistorism. This essay emphasizes that the goal of the ‘tactica conclavium’ was experimental use. It situates Major’s interventions as an early example of a ‘political–gallant’ model of learning that would become an increasingly dominant ideal by the turn of the eighteenth century and would shape academic research infrastructures. Recasting collected objects as materials for experiments meant re-envisioning everything about the collection, from its contents to the cabinetry and architecture, the cataloguing and the aesthetics of display.
Discrepancies in Parent Perceptions of Child Vulnerability in Youth With Spina Bifida
Authors: Kritikos Tessa K , Driscoll Colleen F Bechtel , Holmbeck Grayson N
Published: December 2020

Objective 

This study aimed to describe informant discrepancies between mother and father reports of child vulnerability in youth with spina bifida (SB) and examine variables that were associated with these discrepancies.

Methods 

Ninety-two parent dyads, with a child with SB (ages 8–15 years), were recruited as a part of a longitudinal study. Mothers and fathers completed questionnaires assessing parental perception of child vulnerability (PPCV), as well as medical and demographic information, behavioral aspects of the couple relationship, parenting stress, mental health of the parent, and child behavioral adjustment. The degree to which there was a parenting alliance was assessed with observational data. Mother–father discrepancies were calculated at the item level.

Results 

Findings revealed that greater father mental health symptoms, parenting stress, and child behavior problems were associated with “father high and mother low” discrepancies in PPCV. There were also lower scores on observed parenting alliance when there were higher rates of “father high and mother low” discrepancies in PPCV.

Conclusions 

For families of youth with SB, discrepancies in PPCV where fathers perceive high vulnerability and mothers perceive low vulnerability may be a “red flag” for the presence of other parental and child adjustment difficulties. Findings are discussed in terms of the Attribution Bias Context Model and underscore the importance of including fathers in research on families who have children with chronic health conditions.
A Surge in Pediatric Coronavirus Disease 2019 Cases: The Experience of Texas Children’s Hospital From March to June 2020
Authors: Foster Catherine E , Marquez Lucila , Davis Andrea L , Tocco Elizabeth , Koy Tjin H , Dunn James , Revell Paula A , Arrington Amy S , Campbell Judith R
Published: December 2020

Background

An understanding of the clinical characteristics of children with coronavirus disease 2019 in diverse communities is needed to optimize the response of healthcare providers during this pandemic.

Methods

We performed a retrospective review of all children presenting to the Texas Children’s Hospital system with testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from March 10, 2020, through June 28, 2020. Demographics were recorded for all patients undergoing testing and clinical characteristics and outcomes were recorded for children with positive tests.

Results

Of 16 554 unique patients ≤ 21 years of age who were tested for SARS-CoV-2, 1215 (7.3%) patients tested positive. Infants under 1 year of age and patients aged 18–21 years had the highest percent of positive tests at 9.9% (230/2329) and 10.7% (79/739), respectively. Hispanic children accounted for 66% (802/1215) of positive tests, though they only represented 42.1% (6972/16 554) of all children tested for SARS-CoV-2. Of the 1215 children with a positive test, 55.7% had fever, 40.9% had cough, 39.8% had congestion or rhinorrhea, 21.9% had gastrointestinal complaints, and 15.9% were asymptomatic. Only 97 (8%) patients were hospitalized (of which 68% were Hispanic). Most of the hospitalized patients had underlying medical conditions (62/97, 63.9%), including obesity. Thirty-one hospitalized patients (31/97, 32%) required respiratory support and 9 patients (9/97, 9.3%) received SARS-CoV-2 antiviral therapy. Two patients died.

Conclusions

A relatively high percentage of Hispanic children tested positive for SARS-CoV-2 and were hospitalized. Most of the children with detection of SARS-CoV-2 had uncomplicated illness courses; some children were critically ill; and 2 patients died.
New X-ray detections of known Wolf–Rayet stars
Authors: Nazé Yaël , Gosset Eric , Marechal Quentin
Published: December 2020

Using XMM–Newton, we undertook a dedicated project to search for X-ray bright wind–wind collisions in 18 WR+OB systems. We complemented these observations with Swift and Chandra data sets, allowing for the study of two additional systems. We also improved the ephemerides, for these systems displaying photometric changes, using TESS, Kepler, and ASAS-SN data. Five systems displayed a very faint X-ray emission (log [LX/LBOL] < −8) and three a faint one (log [LX/LBOL] ∼ −7), incompatible with typical colliding wind emission: not all WR (Wolf–Rayet) binaries are thus X-ray bright. In a few other systems, X-rays from the O-star companion cannot be excluded as being the true source of X-rays (or a large contributor). In two additional cases, the emission appears faint but the observations were taken with the WR wind obscuring the line of sight, which could hide a colliding wind emission. Clear evidence of colliding winds was however found in the remaining six systems (WR 19, 21, 31, 97, 105, and 127). In WR 19, a large absorption and larger emission at periastron are even detected, in line with expectations of adiabatic collisions.
A simple, heuristic derivation of the Balescu-Lenard kinetic equation for stellar systems
Authors: Hamilton Chris
Published: December 2020

The unshielded nature of gravity means that stellar systems are inherently inhomogeneous. As a result, stars do not move in straight lines. This obvious fact severely complicates the kinetic theory of stellar systems because position and velocity turn out to be poor coordinates with which to describe stellar orbits – instead, one must use angle-action variables. Moreover, the slow relaxation of star clusters and galaxies can be enhanced or suppressed by collective interactions (‘polarisation’ effects) involving many stars simultaneously. These collective effects are also present in plasmas; in that case they are accounted for by the Balescu-Lenard (BL) equation, which is a kinetic equation in velocity space. Recently, several authors have shown how to account for both inhomogeneity and collective effects in the kinetic theory of stellar systems by deriving an angle-action generalisation of the BL equation. Unfortunately their derivations are long and complicated, involving multiple coordinate transforms, contour integrals in the complex plane, and so on. On the other hand, Rostoker’s superposition principle allows one to pretend that a long-range interacting N-body system, such as a plasma or star cluster, consists merely of uncorrelated particles that are ‘dressed’ by polarisation clouds. In this paper we use Rostoker’s principle to provide a simple, intuitive derivation of the BL equation for stellar systems which is much shorter than others in the literature. It also allows us to straightforwardly connect the BL picture of self-gravitating kinetics to the classical ‘two-body relaxation’ theory of uncorrelated flybys pioneered by Chandrasekhar.
Multiple positron emission tomography tracers for use in the classification of gliomas according to the 2016 World Health Organization criteria
Authors: Miyake Keisuke , Suzuki Kenta , Ogawa Tomoya , Ogawa Daisuke , Hatakeyama Tetsuhiro , Shinomiya Aya , Kudomi Nobuyuki , Yamamoto Yuka , Nishiyama Yoshihiro , Tamiya Takashi
Published: December 2020

Background

The molecular diagnosis of gliomas such as isocitrate dehydrogenase (IDH) status (wild-type [wt] or mutation [mut]) is especially important in the 2016 World Health Organization (WHO) classification. Positron emission tomography (PET) has afforded molecular and metabolic diagnostic imaging. The present study aimed to define the interrelationship between the 2016 WHO classification of gliomas and the integrated data from PET images using multiple tracers, including 18F-fluorodeoxyglucose (18F-FDG), 11C-methionine (11C-MET), 18F-fluorothymidine (18F-FLT), and 18F-fluoromisonidazole (18F-FMISO).

Methods

This retrospective, single-center study comprised 113 patients with newly diagnosed glioma based on the 2016 WHO criteria. Patients were divided into 4 glioma subtypes (Mut, Codel, Wt, and glioblastoma multiforme [GBM]). Tumor standardized uptake value (SUV) divided by mean normal cortical SUV (tumor–normal tissue ratio [TNR]) was calculated for 18F-FDG, 11C-MET, and 18F-FLT. Tumor–blood SUV ratio (TBR) was calculated for 18F-FMISO. To assess the diagnostic accuracy of PET tracers in distinguishing glioma subtypes, a comparative analysis of TNRs and TBR as well as the metabolic tumor volume (MTV) were calculated by Scheffe's multiple comparison procedure for each PET tracer following the Kruskal–Wallis test.

Results

The differences in mean 18F-FLT TNR and 18F-FMISO TBR were significant between GBM and other glioma subtypes (P < .001). Regarding the comparison between Gd-T1WI volumes and 18F-FLT MTVs or 18F-FMISO MTVs, we identified significant differences between Wt and Mut or Codel (P < .01).

Conclusion

Combined administration of 4 PET tracers might aid in the preoperative differential diagnosis of gliomas according to the 2016 WHO criteria.
The mutational landscape of spinal chordomas and their sensitive detection using circulating tumor DNA
Authors: Mattox Austin K , Yang Beibei , Douville Christopher , Lo Sheng-fu , Sciubba Daniel , Wolinsky Jean Paul , Gokaslan Ziya L , Robison Jamie , Blair Cherie , Jiao Yuchen , Bettegowda Chetan
Published: December 2020

Background

Chordomas are the most common primary spinal column malignancy in the United States. The aim of this study was to determine whether chordomas may be detected by evaluating mutations in circulating tumor DNA (ctDNA).

Methods

Thirty-two patients with a biopsy-confirmed diagnosis of chordoma had blood drawn pre-operatively and/or at follow-up appointments. Mutations in the primary tumor were identified by whole exome sequencing and liquid biopsy by ddPCR and/or RACE-Seq was used to detect one or more of these mutations in plasma ctDNA at concurrent or later time points.

Results

At the time of initial blood draw, 87.1% of patients were ctDNA positive (P <.001). Follow-up blood draws in twenty of the patients suggest that ctDNA levels may reflect the clinical status of the disease. Patients with positive ctDNA levels were more likely to have greater mutant allele frequencies in their primary tumors (P = .004) and undergo radiotherapy (P = .02), and the presence of ctDNA may correlate with response to systemic chemotherapy and/or disease recurrence.

Conclusions

Detection of ctDNA mutations may allow for the detection and monitoring of disease progression for chordomas.
Decompression of a Dorsal Arachnoid Web of the Spine: 2-Dimensional Operative Video
Authors: Andrews John P , Chan Andrew K , Mummaneni Praveen V
Published: December 2020

Arachnoid webs of the spine are a relatively rare entity with unique radiological findings, most notably the scalpel-sign on sagittal magnetic resonance imaging (MRI).
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To date there have been no videographic descriptions of the surgical treatment for this clinical entity. We present the case of a patient with progressive myelopathy and MRI showing a cervical and thoracic syrinx with a sharp transition point at the level of the T5 vertebral body. On computed tomography myelogram, there was preserved cerebrospinal fluid (CSF) in the ventral subarachnoid space—this space is often interrupted in ventral cord herniation, and preserved in dorsal arachnoid webs.
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A laminectomy with intradural excision of arachnoid web was offered and the patient consented for the procedure. Preoperatively, a fiducial screw was placed at T5. A T4-6 laminectomy was performed. A clearly compressive arachnoid web was encountered on exposure. Bands were dissected under an operating microscope, restoring normal CSF flow. Ventral dural defect was ruled out by passing a delicot beneath the cord and withdrawing it on the contralateral side. The patient did well and has shown improvement in myelopathic symptoms at 1- and 3-mo follow-up. Arachnoid webs of the spine can be treated effectively with a prudent, stepwise approach, and careful microsurgical technique. The neurosurgeon should consult closely with their neuroradiology colleagues to rule out other entities prior to the operation, such as ventral cord herniations, which can mimic dorsal arachnoid webs radiologically and clinically. We have received informed consent of the patient to submit this video.
Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis
Authors: Chen Kuo-Tai , Choi Kyung-Chul , Song Myung-Soo , Jabri Hussam , Lokanath Yadhu K , Kim Jin-Sung
Published: December 2020

BACKGROUND

Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis.

OBJECTIVE

To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment.

METHODS

Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented.

RESULTS

A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P < .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P < .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy.

CONCLUSION

Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.
Combined Petrosal Approach for Resection of a Large Trigeminal Schwannoma With Meckel's Cave Involvement—Part I: Anatomic Rationale and Analysis: 2-Dimensional Operative Video
Authors: Tayebi Meybodi Ali , Liu James K
Published: December 2020

Resection of large trigeminal schwannomas involving both posterior and middle cranial fossae is challenging. The depth of the surgical target in the superomedial corner of the cerebellopontine angle and the petrous apex makes for a difficult lesion to favorably access, expose, and safely resect. Judicious planning of a skull base approach is therefore the most crucial step in successful management of these formidable tumors. When properly chosen, planned, and executed, the combined petrosal approach sets the stage for an optimal exposure of such tumors that involve both posterior and middle cranial fossae. The present video is the first of a 2-part video presentation that explains the anatomic rationale of selecting a combined petrosal approach (anterior petrosectomy and retrolabyrinthine petrosectomy) for the resection of a large trigeminal schwannoma involving the posterior and middle cranial fossae with an extension into Meckel's cave in a 54-yr-old female presenting with 5-yr history of increasing headaches, left-sided face numbness, and disequilibrium. The benefits, risks, and alternatives of the surgical procedure were discussed in detail with the patient and she consented to proceed with surgery. Part I also discusses the important nuances of positioning the patient, as well as planning and execution of the skin incision, including pericranial flap harvesting.

 Of note, the patient consented to the publication of images obtained from her.
Formation of Chromitite Seams and Associated Anorthosites in Layered Intrusion by Reactive Volatile-rich Fluid Infiltration
Authors: Marsh Jennifer S , Pasecznyk Michael J , Boudreau Alan E
Published: December 2020

Drilling related to development of the platinum-group element deposit of the J-M Reef of the Stillwater Complex returned samples of a rare chromitite seam between anorthosite and norite in a discordant anorthositic body. Plagioclase core An concentrations are marginally higher and modestly reversely zoned on the norite side (average Ancore = 83·8; average Ancore – Anrim = –1·1) as compared with the anorthosite side (average Ancore 82·5; average Ancore – Anrim = +1·0). The anorthosites are also characterized by a slightly smaller average plagioclase grain size than plagioclase in the norite (1·41 mm and 1·54 mm, respectively). The chromite can contain single and polyphase inclusions of orthopyroxene, plagioclase, amphibole, biotite and Cl-rich apatite. These and other compositional and textural features, as well as inference from other discordant anorthositic bodies in the Banded series, are all consistent with a chromatographic model of chromite precipitation at a reaction front as a norite protolith reacts with a Cl-rich aqueous fluid saturated in plagioclase alone. Chromitite seam formation is modeled using an infiltration metasomatic model, in which a fluid becomes progressively undersaturated in pyroxene as it rises into the hotter part of the crystal pile. As this pyroxene-undersaturated fluid moves through a noritic protolith, it dissolves the Cr-bearing orthopyroxene to produce an anorthosite. Chromite precipitates at the reaction front between the anorthosite and the norite owing to liberation of Mg and Cr from pyroxene. Continuous redissolution and reprecipitation of chromite occurs as the pyroxene dissolution front moves in the direction of fluid flow, collecting the Cr lost from the anorthosite. Owing to Cr dissolved mainly as a neutral divalent cation complex, CrCl(OH)0, in the solution, but incorporated as a trivalent cation in chromite, the required redox reaction can involve concurrent precipitation of sulfide with chromite. This mechanism differs from some recent models in that the anorthosites are themselves replacement bodies and are not original precipitates from a magma nor formed by loss of mafic material by partial melting. The results show the need for experimental mineral solubility data at T and P conditions appropriate to upper crustal mafic–ultramafic intrusions.
Cross-regional variations of Covid-19 mortality in Italy: an ecological study
Authors: Oliva Cristina , Di Maddaloni Francesco , Marcellusi Andrea , Favato Giampiero
Published: December 2020

Background

Disparities in cross-regional coronavirus disease 2019 (Covid-19) mortality remain poorly understood. The association between pre-epidemic health and epidemic mortality can inform a policy response to future outbreaks.

Method

We conducted an ecological study of the association between the cumulative deaths attributed to Covid-19 epidemic in the 20 Italian regions and nine determinants of population health derived from a systematic review of the literature. We used a multiple least square regression to predict the cross-regional variation in mortality observed from the onset of the epidemic to 23 September 2020.

Results

Four independent variables best explained the cross-regional differences in the number of deaths attributed to Covid-19: the force of infection, population density, number of elderly living in assisted facilities and the standard rate of diabetes. The semi-partial correlation coefficients suggest that the force of infection and the number of elderly residents in nursing homes were the dominant predictors of the number of deaths attributed to Covid-19. Statistical controls and validation confirmed the generalizability of the predictive model.

Conclusions

Our findings indicate that a significant reduction of social contacts in main metropolitan areas and the timely isolation of elderly and diabetic residents could significantly reduce the death toll of the next wave of Covid-19 infection in Italy.
Ventricular arrhythmia predicts poor outcome in polymyositis/dermatomyositis with myocardial involvement
Authors: Huang Yongfa , Liu Huazhen , Wu Chanyuan , Fang Ligang , Fang Quan , Wang Qian , Fei Yunyun , Guo Xiaoxiao , Zhang Shuyang
Published: December 2020

Objective

Myocardial involvement (MCI) is known to increase morbidity and mortality in polymyositis (PM) and dermatomyositis (DM). This study aims to investigate whether complicating with ventricular arrhythmia (VA) predicts poor outcomes in patients with PM/DM-related myocardial involvement (PM/DM-MCI).

Methods

We reviewed all PM/DM-MCI patients admitted to Peking Union Medical College Hospital from October 1997 to April 2019. VA and the other possible risk factors for the composite endpoint, including death from any cause and rehospitalization for cardiac causes, were analyzed.

Results

A total of 75 PM/DM-MCI patients (44 PM and 31 DM) were enrolled, of which 27 (36%) met the composite endpoint during a median follow-up of 24 months. Independent prognostic factors for the composite endpoint include VA [HR 4.215, 95% CI (1.737, 10.230)], NT-proBNP > 3415 pg/ml [HR 2.606, 95% CI (1.203, 5.646)], interstitial lung disease [HR 2.688, 95% CI (1.209, 5.978)], and anti-cardiac remodelling therapy [HR 0.302, 95% CI (0.115, 0.792)]. The 3-year event-free survival rate of patients without VA was significantly higher than that of patients with VA (63.3% vs 40.7%, P = 0.034). Skin lesions [OR 0.163, 95% CI (0.051, 0.523)] and positive antimitochondrial antibody [OR 3.484, 95% CI (1.192, 10.183)] were independent predictors of VA.

Conclusion

VA provides prognostic insights for PM/DM-MCI patients and predicts poor outcome. Polymyositis and positive antimitochondrial antibody are closely associated with the presence of VA in PM/DM-MCI.