bluuebunny/crossref_metadata_2025 huggingface dataset:
Which Chronic Low Back Pain Patients Respond Favorably to Yoga, Physical Therapy, and a Self-care Book? Responder Analyses from a Randomized Controlled Trial
Authors: Roseen Eric J , Gerlovin Hanna , Felson David T , Delitto Anthony , Sherman Karen J , Saper Robert B
Published: April 2020

Purpose

To identify baseline characteristics of adults with chronic low back pain (cLBP) that predict response (i.e., a clinically important improvement) and/or modify treatment effect across three nonpharmacologic interventions.

Design

Secondary analysis of a randomized controlled trial.

Setting

Academic safety net hospital and seven federally qualified community health centers.

Subjects

Adults with cLBP (N = 299).

Methods

We report patient characteristics that were predictors of response and/or modified treatment effect across three 12-week treatments: yoga, physical therapy [PT], and a self-care book. Using preselected characteristics, we used logistic regression to identify predictors of “response,” defined as a ≥30% improvement in the Roland Morris Disability Questionnaire. Then, using “response” as our outcome, we identified baseline characteristics that were treatment effect modifiers by testing for statistical interaction (P < 0.05) across two comparisons: 1) yoga-or-PT vs self-care and 2) yoga vs PT.

Results

Overall, 39% (116/299) of participants were responders, with more responders in the yoga-or-PT group (42%) than the self-care (23%) group. There was no difference in proportion responding to yoga (48%) vs PT (37%, odds ratio [OR] = 1.5, 95% confidence interval = 0.88 − 2.6). Predictors of response included having more than a high school education, a higher income, employment, few depressive symptoms, lower perceived stress, few work-related fear avoidance beliefs, high pain self-efficacy, and being a nonsmoker. Effect modifiers included use of pain medication and fear avoidance beliefs related to physical activity (both P = 0.02 for interaction). When comparing yoga or PT with self-care, a greater proportion were responders among those using pain meds (OR = 5.3), which differed from those not taking pain meds (OR = 0.94) at baseline. We also found greater treatment response among those with lower (OR = 7.0), but not high (OR = 1.3), fear avoidance beliefs around physical activity.

Conclusions

Our findings revealed important subgroups for whom referral to yoga or PT may improve cLBP outcomes.
Ultrasonographic Findings of the Ulnar Nerve Following Elbow Flexion in Patients with Cubital Tunnel Syndrome
Authors: Lee Goo Joo , Park Donghwi
Published: April 2020

Objective

To evaluate the ultrasonographic findings obtained following various degrees of elbow flexion in patients with cubital tunnel syndrome (CuTS).

Design

Retrospective, cross-sectional study.

Setting

General teaching hospital, rehabilitation unit.

Subjects

Electrophysiological and ultrasonographic assessments were performed on 11 elbows of healthy controls and 21 elbows of 17 patients with CuTS.

Methods

Dynamic movement of the ulnar nerve during elbow motion was measured. To measure ulnar nerve dynamic movement during elbow motion, the distance from the medial epicondyle (ME) to the nearest surface of the ulnar nerve toward the ME was measured at the cubital tunnel inlet at elbow extension (0°), elbow flexion to 60°, and elbow flexion to 90°.

Results

The distance between the ME and ulnar nerve was lower in CuTS patients than in healthy patients at all elbow flexion angles. This difference was statistically significant at 0° and 60° elbow flexion (P < 0.05). When calculating the cutoff value, the distance between the ME and ulnar nerve at full elbow extension for CuTS diagnosis was 0.53 cm (sensitivity = 71.4%, specificity = 90.7%). The distance ratio between the ME and ulnar nerve for diagnosis of ulnar neuropathy at the elbow was 24.4% (sensitivity = 76.2%, specificity = 100%).

Conclusion

Measurement of the distance between the ME and ulnar nerve in full elbow extension may facilitate the diagnosis of patients with CuTS. These findings may be important for CuTS diagnosis, as they were also observed in patients with mild-stage CuTS.
Assessment of radiographic sacroiliitis in anteroposterior lumbar vs conventional pelvic radiographs in axial spondyloarthritis
Authors: Rodriguez Valeria Rios , Llop Maria , Protopopov Mikhail , Sieper Joachim , Haibel Hildren , Proft Fabian , Rudwaleit Martin , Poddubnyy Denis
Published: April 2020

Objective

The aim was to investigate the reliability and validity of radiographic sacroiliitis assessment in anteroposterior (AP) lumbar radiographs compared with conventional pelvic radiographs in patients with axial spondyloarthritis (axSpA).

Methods

Patients from the German Spondyloarthritis Inception Cohort were selected based on the availability of pelvic and AP lumbar radiographs with visible SI joints at baseline and year 2. Two readers scored the images independently in a random order according to the modified New York criteria. The sacroiliitis sum score was calculated as the mean of both readers. Patients were classified as radiographic (r-)axSpA if radiographic sacroiliitis of grade ≥2 bilaterally or grade ≥3 unilaterally was present in the opinion of both readers and as non-radiographic (nr-)axSpA otherwise. The reliability and validity of sacroiliitis assessment in AP lumbar radiographs was assessed using intraclass correlation coefficients (ICCs), absolute agreement and κ statistics.

Results

A total of 226 sets of radiographs were scored from 113 patients included in the study. The ICC for the sacroiliitis sum score was 0.91 at both baseline and year 2. A total of 62 (54.9%) and 55 (48.7%) patients were classified as r-axSpA at baseline and 65 (57.5%) and 60 (53.1%) patients at year 2 based on evaluation of pelvic and AP lumbar radiographs, respectively. The absolute agreement between the methods on the classification was 84.9 and 85.0% at baseline and year 2, respectively, with the κ of 0.70 at both time points.

Conclusion

Radiographic sacroiliitis can be assessed in AP lumbar radiographs with a similar reliability to conventional pelvic radiographs.
Idiopathic multicentric Castleman disease with novel heterozygous Ile729Met mutation in exon 10 of familial Mediterranean fever gene
Authors: Endo Yushiro , Koga Tomohiro , Otaki Hiroki , Sasaki Daisuke , Sumiyoshi Remi , Furukawa Kaori , Tanaka Yoshimasa , Katsunori Yanagihara , Kawakami Atsushi
Published: April 2020

Objective

While the aetiology of idiopathic multicentric Castleman disease (iMCD) remains unclear, the involvement of autoinflammatory mechanisms has been suggested. Herein we report a Japanese patient with iMCD with a novel heterozygous Ile729Met mutation in exon 10 of the Mediterranean fever (MEFV) gene.

Methods

We performed genetic analysis via targeted next-generation sequencing analysis and Sanger sequencing and conducted molecular dynamics simulations to investigate the hydrophobic interactions around the 729th amino acid in human pyrin.

Results

In February 2011, a 59-year-old man was diagnosed with IgG4-related disease at our department based on the findings of cervical and hilar lymphadenopathies, typical lung lesions and cervical lymph node biopsy. The patient was followed up without treatment, as he was asymptomatic. However, he had been experiencing prolonged fatigue and fever with high levels of CRP since June 2017. Axillary lymph node biopsy findings led to the diagnosis of iMCD. He was successfully treated with an IL-6 inhibitor and has been in remission for 12 months. Genetic analyses for hereditary autoinflammatory disease–related genes were performed, revealing a novel heterozygous Ile729Met mutation in exon 10 of the MEFV gene. We identified that this novel mutation significantly altered the local interaction of the human pyrin B30.2 domain by molecular dynamics simulation analysis and experimentally had the potential for inflammasome activation with increased inflammatory cytokines.

Conclusion

The abnormal function of pyrin due to a mutation in the MEFV gene in this patient may have contributed to the development of MCD by inducing IL-6 production via inflammasome signalling.
The Usefulness of Zhukovsky Double Balloon in Obstetric Hemorrhage
Authors: Barinov Sergey V. , Medyannikova Irina V. , Borisova Anna V. , Tyrskaya Yulia I. , Savelieva Irina V. , Shamina Inna V. , Lazareva Oksana V. , Kadtsyna Tatyana V.
Published: April 2020

Objective:

To evaluate the effectiveness of the use of a modified Zhukovsky double (vaginal and uterine) balloon to improve the results of treatment in women with obstetric hemorrhage.

Methods:

We conducted an observational controlled study including 701 puerperas, which were divided into two groups: The main group consisted of 508 women, who underwent a combined management, that is, traditional (transfusion of fresh frozen plasma, erythrocyte mass, uterotonics, hemostatic agents), surgical hemostasis in cases of caesarean section, and insertion of a double Zhukovsky balloon; while the comparison group included 193 patients, who were managed traditionally. The main group and the comparison group were divided into subgroups according to the main etiology of obstetric hemorrhage: IA and IB—postpartum; IIA and IIB—placenta accreta; IIIA and IIIB—postpartum hysterectomy.

Results:

The most frequent causes of massive obstetric hemorrhage were atony of the uterus (39.2%), placenta previa (29.1%), and placental abruption (11.5%). Of the 508 balloon insertions, 345 (70.7%) were inserted for hemorrhage during cesarean section and 148 (29.3%) for obstetric hemorrhage after spontaneous delivery. Among the obstetric hemorrhage at caesarean section, lower segment bleeding prevailed (78.1%), caused mainly by placenta previa, placenta accreta, placental abruption, polyhydramnios, and uterine scar defects. Combined management, including surgical hemostasis and insertion of vaginal and uterine balloon of Zhukovsky, reduced blood loss by 1.5 times and the number of hysterectomies by 6.72 times compared to controls.

Conclusion:

The use of a modified Zhukovsky double balloon in the management of obstetric hemorrhage may reduce the number of hysterectomies and the amount of blood loss.
Antiphospholipid Antibody Syndrome: Pathogenesis, Diagnosis, and Management in Pregnancy
Authors: Khangura Raminder Kaur , Cooper Shontreal , Luo Guo-Yang
Published: April 2020

Antiphospholipid antibody syndrome is an autoimmune disorder that primarily affects reproductive age women and poses significant obstetric complications. Here we review the pathogenesis, diagnosis, obstetric complications, and management in women with antiphospholipid antibody syndrome.
Role of Ultrasonography in Pregnancies Complicated by Gestational Diabetes: A Review
Authors: Sinno Sara S. Hamze , Nassar Anwar H.
Published: April 2020

This review is to better clarify the role of ultrasonography during pregnancies complicated with gestational diabetes mellitus (GDM). It will focus on the effect of GDM on pregnancy, and the use of ultrasound modality to estimate fetal size and accordingly the mode of delivery. It will also shed light on how this technology can be used to improve our understanding of the pathophysiology of this diagnosis and hopefully improve the maternal-fetal outcome.
Maternal Thyroid-Stimulating Hormone Level and Thyroid Peroxidase Antibody Status in the First and Second Trimester of Pregnancy and Their Relationship with the Risk of Gestational Diabetes Mellitus
Authors: Deng Song-Qing , Chen Hai-Tian , Wang Dong-Yu , Liu Bin , Chen Han-Qing , Wang Zi-Lian
Published: April 2020

Objective:

To investigate thyroid-stimulating hormone (TSH) levels and thyroid peroxidase antibody (TPOAb) in early pregnancy and to estimate the risk of development of gestational diabetes mellitus (GDM).

Methods:

The levels of TSH, free thyroxine, free triiodothyronine, and TPOAb were retrospectively evaluated in 2333 pregnant women. All women recruited were divided into groups of TSH high (H), TSH low (L), TSH (H) TPOAb positive (+), TSH (H)TPOAb negative (−), TSH normal (N)TPOAb (+), TSH (L)TPOAb (+), TSH (L)TPOAb (−), and estimated the risk of GDM.

Results:

TSH level (X
2 = 13.0024, P = 0.0015) and TSH combined TPOAb (X
2 = 20.0038, P = 0.0012) were correlated to development of GDM. The level of TSH in 95 women was increased, and in 216 women were decreased. Of the 2333 pregnant women, 546 patients were diagnosed with GDM, with a prevalence of 23.40%. The prevalence of GDM was 35.78% and 28.70% for the TSH high (H) and TSH low (L) pregnant women, respectively. The increased TSH (P = 0.0013, odds ratio: 2.09, confidence interval:1.34–3.28) was correlated to increase GDM incidence. TSH (H) TPOAb (+) (n = 29), TSH (H) TPOAb (−) (n = 58), TSH normal (N) TPOAb (+) (n = 265), TSH (L) TPOAb (+) (n = 30), TSH (L) TPOAb (−) (n = 154) were in this study. The prevalence of GDM was 51.72%, 29.31%, 23.02%, 26.67%, and 29.87% for the TSH (H) TPOAb (+), TSH (H) TPOAb (−), TSH (N) TPOAb (+), TSH (L) TPOAb (+), and TSH (L) TPOAb (−) pregnant women, respectively. Only the TSH (H) TPOAb (+) pregnant women had a significant higher incidence of GDM (P = 0.0018, odds ratio: 3.63, confidence interval: 1.62–8.16). Trimester specific results showed that only second trimester had higher GDM risk either analyze TSH or the combination of TSH and TPOAb.

Conclusion:

Elevated TSH level and TPOAb positive in the second trimester of pregnancy were correlated to an increased risk of GDM.
Updates in Long-term Maternal and Fetal Adverse Effects of Gestational Diabetes Mellitus
Authors: Shou Chong , Wei Yu-Mei , Wang Chen , Yang Hui-Xia
Published: April 2020

Gestational diabetes mellitus (GDM) is associated with long-term maternal and fetal adverse outcomes. Recent evidences suggest GDM increases long-term maternal cardiovascular disease, chronic kidney disease, and cancer risks. Maternal hyperglycemia is associated with offspring obesity, overweight, insulin resistance, and neurocognitive development. It remains unclear whether treating mild GDM would reduce long-term maternal and fetal adverse effects.
A Cohort Analysis of Patients with Stage I Twin-to-Twin Transfusion Syndrome from a Major Referral Hospital in Northern China
Authors: Yang Jing , Yuan Peng-Bo , Wei Yuan , Li Hong-Tian , Wang Xue-Ju , Li Lu-Yao , Jiang Yuan-Hui , Wang Jing , Gong Xiao-Li , Zhao Yang-Yu
Published: April 2020

Objective:

To describe the outcomes of Stage I twin-to-twin transfusion syndrome among patients treated with expectant management (EM), amnioreduction (AR), or fetoscopic laser occlusion of chorioangiopagous vessels (FLOC).

Methods:

A cohort of 89 cases was studied. Based on the initial management strategy, patients were classified into three groups: the EM, AR, and FLOC. We assessed perinatal survival to 28 days of age and categorized pregnancy outcomes as good (twin live birth at ≥30.0 weeks), mixed (single fetal demise or delivery between 26.0 and 29.9 weeks), or poor (double fetal demise or delivery at <26.0 weeks).

Results:

26 (29.2%) patients underwent EM, 35 (39.3%) underwent AR, and 28 (31.5%) underwent FLOC therapy. Of those managed expectantly, 19.2% experienced spontaneous abortion, 50% progressed in stage, and 30.8% remained stable or regressed. After adjusting for potential confounders including maternal age, nulliparity, placenta location, and recipient maximum vertical pocket, and so on, FLOC therapy and AR were associated with significantly [odds ratio (OR) = 0.09] and borderline significantly (OR = 0.20) reduced risks of poor pregnancy outcomes and of no survivors to 28 days of age after birth (OR = 0.04 and OR = 0.20, respectively) compared with EM.

Conclusion:

About 70% of those treated with EM progressed in stage or experienced fetal loss. Compared to EM, intervention may decrease the risk of poor pregnancy outcomes and improve the perinatal survival rate.
Frontier Progress in the Establishment of Trophoblast Stem Cell and the Identification of New Cell Subtypes at the Maternal-Fetal Interface
Authors: Zhou Xiao-Bo , Zhou Chan , Sun Yang , Liu Dong , Kong Shuang-Bo , Lu Jin-Hua , Qi Hong-Bo , Wang Hai-Bin
Published: April 2020

Proper development of the human placenta is of vital importance for a successful pregnancy, and a series of pregnancy complications are considered originating from dysfunctional placentas. Like other organ system development, placentation requires large numbers of co-regulators, while the underlying molecular mechanisms orchestrating the placental formation and function are poorly understood. Although we have made many signs of progress in understanding the placental architectures and developments using mouse models, the species-specific differences impede our progress due to the lack of appropriate model systems. In the past few years, major progress has been made by the establishment of novel in-vitro self-renewing stem cell models, as well as identifying the full picture of the cellular organization of the maternal and fetal interface. Providing the tools for the investigation of placentation and reproductive-related regulation mechanism. In this review, we focus on the detailed progress of the human trophoblast stem cells culturing system, and the cellular and molecular terrain at the maternal-fetal interface, respectively, thus providing new insights into placental development.
Application of Modified Cesarean Hysterectomy for Patients with Placenta Previa Complicated with Placenta Percreta
Authors: Zhao Yin , Zou Li , Gao Hui , Wu Di , Zhu Jian-Wen , Liu Xiao-Xia , Zhang Wen , Luo Li-Bo
Published: April 2020

Objective:

To evaluate the efficacy and safety of a modified cesarean hysterectomy (MCH) procedure in controlling hemorrhage in patients with placenta previa complicated with placenta percreta.

Methods:

A retrospective analysis was conducted on 23 patients with placenta previa complicated with placenta percreta from January 2016 to December 2018 in the Union Hospital. The patients’ age ranged from 24 to 41 years, and had gestational durations of 32–38 weeks. Nine of them underwent MCH and 14 underwent conventional cesarean hysterectomy (CCH). In the MCH group, the bladder was not mobilized, deliberately. The uterus was excised horizontally above the tourniquet level. Placental tissue around the cervical os was cleaned thoroughly, and hemostatic suturing was performed under direct vision. In the CCH group, the uterus was removed gradually after programmed hemostasis and dissection of adhesions of the vesicouterine peritoneal fold and mobilization of the bladder.

Results:

There were no significant differences in general conditions between the two groups. The blood loss was significantly less in the MCH group (P < 0.05). The operation time was also decreased dramatically and hospital stay (in days) was shorter than in the CCH group (P < 0.05). There were no bladder or ureter injuries in the MCH group, compared with three cases in the CCH group. There were no statistically significant differences in neonatal birth weight, Apgar score, or intensive care unit admittance rates between the two groups (P > 0.05).

Conclusion:

This MCH procedure reduced blood loss, avoided bladder injury, and had no long-term complications. It is a safe, rapid, and effective way to control fetal hemorrhage during surgery for women with placenta previa complicated with placenta percreta.
Diagnostic Value of Magnetic Resonance Imaging in Fetal Lateral Ventriculomegaly and the Relationship Between the Degree of Isolated Lateral Ventriculomegaly and Neonatal Prognosis
Authors: Zhao Xiao-Min , Li Xing , Li Wen , Li Shan-Shan , Chang Ying
Published: April 2020

Objective:

To assess the value of magnetic resonance imaging (MRI) in fetal lateral ventriculomegaly diagnosed with ultrasound, and to study the relationship between the degree of isolated lateral ventriculomegaly and neonatal prognosis.

Methods:

The pregnancy information and outcomes of 97 cases of fetal ventriculomegaly were retrospectively reviewed in the Tianjin Central Hospital of Gynecology Obstetrics from January 2016 to December 2017. The maternal age was 18–42 years, and the fetal gestational age at diagnosis was 19+4 to 37+3 weeks. MRI and ultrasound were used to compared the diagnosis of fetal lateral ventriculomegaly and evaluated the development of the nervous system after birth.

Results:

Among 97 pregnancy cases, associated central nervous system malformations were observed in 36 cases on ultrasound or ultrasound + MRI. Central nervous system malformations were diagnosed with ultrasound in 15 cases (15/36, 41.7%) and with ultrasound + MRI in 25 cases (25/36, 69.4%). Pearson χ
2 test was used to compare the detection rates between the groups, and the difference was statistically significant (P < 0.05). We followed up 61 cases of isolated lateral ventriculomegaly for 1–3 years after birth. According to the width of the lateral ventricle of the fetus in middle pregnancy, the subjects were grouped as follows: mild 33 cases (lateral ventricle width 10.0–12.0 mm), moderate 23 cases (lateral ventricle width 12.1–15.0 mm), and severe 5 cases (lateral ventricle width >15.0 mm). The rate of normal growth and development in the mild group was 90.9% (30/33), that in the moderate group was 69.6% (16/23), and that in the severe group was 40.0% (2/5), and the difference between groups was statistically significant (P < 0.05).

Conclusion:

Ultrasound combined with MRI can detect more central nervous system malformations, and the degree of isolated lateral ventriculomegaly is closely related to fetal prognosis.
Sex Hormone-binding Globulin, Cardiometabolic Biomarkers, and Gestational Diabetes: A Longitudinal Study and Meta-analysis
Authors: Li Meng-Ying , Rawal Shristi , Hinkle Stefanie N. , Zhu Ye-Yi , Tekola-Ayele Fasil , Tsai Michael Y. , Liu Si-Min , Zhang Cui-Lin
Published: April 2020

Objective:

This study investigated the prospective associations of circulating levels of sex hormone-binding globulin (SHBG) levels with cardiometabolic biomarkers and risk of gestational diabetes (GDM) during pregnancy. It also examines the longitudinal trajectory of SHBG in women with and without GDM.

Methods:

We conducted a nested case-control study of 107 incident GDM cases and 214 matched controls within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort. The cohort enrolled non-obese and obese women aged 18–40 years with a singleton pregnancy between 8 and 13 weeks of gestation from 2009 to 2013. GDM was ascertained via medical records review. Blood samples were drawn four times at gestational weeks 10–14, 15–26, 23–31, and 33–39. The prospective associations between SHBG levels and cardiometabolic biomarkers were examined using the Spearman partial correlation among the controls. The longitudinal trajectories of SHBG levels were examined among the cases and the controls. Meta-analysis of prospective studies were performed to examine the association between SHBG levels and GDM risk.

Results:

SHBG levels at gestational weeks 10–14 were significantly inversely associated with fasting insulin (r = −0.17, P = 0.01) and insulin resistance as measured by HOMA-IR (r = −0.17, P = 0.01) at gestational week 15–26. SHBG at gestational weeks 10–14 and 15–26 was lower in cases than controls (mean ± standard deviation: (204.0 ± 97.6) vs. (220.9 ± 102.5) nmol/L, P = 0.16 and (305.6 ± 124.3) vs. (322.7 ± 105.1) nmol/L, P = 0.14, respectively), yet the differences were not significant. In the meta-analysis, SHBG was 41.5 nmol/L (95% confidence interval: 23.9, 59.1, P < 0.01) significantly lower among women with GDM than without, and each 50 nmol/L increase in SHBG was significantly associated with an odds ratio of 0.85 (95% confidence interval: 0.76–0.95, P = 0.01) for GDM.

Conclusion:

Lower SHBG levels in early pregnancy were prospectively associated with higher high insulin levels and insulin resistance in mid-pregnancy and subsequent risk of GDM, independent of adiposity. SHBG may serve as a marker for the identification of high-risk pregnancies during early pregnancy.
Risk Assessment and Prevention of Spontaneous Preterm Birth
Authors: Li Chao
Published: April 2020

Preterm parturition is the consequence of pathological signals that activate the common pathway of parturition and considered as a syndrome. Many risk factors for spontaneous preterm birth (sPTB) have been identified. Two significant risk factors for sPTB are history of prior sPTB and short cervical length at midtrimester. 17 hydroxyprogesterone caproate, vaginal progesterone, cerclage, and pessary have all been studied for prevention of sPTB. Difference in patient populations likely contributes to the conflicting study results. Further studies are needed to establish strategies in prevention of sPTB in singleton as well as multiple pregnancies.
Efficacy of Nonsteroidal Anti-inflammatory Drugs for Treatment of Uncomplicated Lower Urinary Tract Infections in Women: A Meta-analysis
Authors: Zhang Yu , Wu Jian-Guo , Zhou Hong-Ji , Huang Wen-Xiang , Jia Bei
Published: April 2020

Urinary tract infections (UTIs) are among the most frequent causes for antibiotic prescription and; therefore, alternative treatment options for UTIs can potentially reduce antibiotic usage and development of resistance. To evaluate the efficacy of nonsteroidal anti-inflammatory drugs (NSAIDS) for the treatment of uncomplicated lower UTIs in women, this study implemented a meta-analytic approach to evaluate the results of available randomized clinical studies from online databases. A total of four trials involving 1144 patients with uncomplicated lower UTIs were included in the final evaluation. Results showed that symptom resolution at Day 3–4 in the NSAIDs group was significantly lower than that in the antibiotics group [pooled odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.23–0.74, P < 0.05]. However, there was no significant difference between the NSAIDs and antibiotics groups in symptom resolution at Day 7 (pooled OR = 0.43, 95% CI: 0.17–1.06, P = 0.07), secondary antibiotic treatment rate at Day 28–30 (pooled OR = 1.15, 95% CI: 0.16–7.98, P = 0.89) and adverse events rate (pooled OR = 1.09, 95% CI: 0.61–1.96, P = 0.77). Therefore, this meta-analysis suggests that, although inferior to antibiotics in fast symptom resolution, symptomatic treatment with NSAIDs can be considered as an alternative treatment option for uncomplicated lower UTIs in women. However, given the low number of randomized controlled trials that met inclusion criteria in this meta-analysis, efficacy of NSAIDs for treatment of uncomplicated lower UTIs should be further evaluated in more comprehensive clinical studies.
Annulare With Tuberculosis and Cutis Laxa: A Rare Case Report
Authors: Wang Yi-Fei , Geng Yi , Xu Xiu-Lian
Published: April 2020

Introduction:

Granuloma annulare (GA) is a benign, noninfectious granulomatous disorder of unknown etiology, characterized by an annular arrangement of erythematous small nodules and plaques, classically localized on dorsal surfaces of the hands and feet. GA shows palisading granulomas with a central zone of necrobiotic collagen and mucin deposition surrounded by a palisade of histiocytes.

Here, we reported a 24-year-old man with GA combined with tuberculosis and cutis laxa.

Case presentation:

A 24-year-old man was presented with skin annular lesions on the trunk and extremities without subjective symptoms for three years. The annular lesions first arose in the trunk that slowly progressed to most parts of the body and cutis laxa-like lesions appeared on the left inguinal region with inguinal hernia two years ago. At the same time, the patient was diagnosed with pulmonary tuberculosis due to the hemoptysis for two years and the sputum culture for tuberculosis bacillus was positive. He was treated with triple anti-tuberculosis drugs regularly. Partial remission of the skin lesions was noted since then. Pathological examination showed similar histological changes in the interstitial pattern of GA.

Discussion:

Tuberculosis was a possible etiologic factor in GA because of the coincidental occurrence, granulomatous histologic features, and positive tuberculin skin tests. In fact, some cases of GA with chronic pulmonary tuberculosis responding to a specific anti-tuberculosis therapy were reported. It is worth noting that tuberculids, generalized exanthems in the skin of tuberculous patients possibly resulting from hypersensitivity reactions to the tubercle bacillus, may mimic GA. Furthermore, our patient also showed extremely characteristic slack skin in posterior lumbar and groin, which was deemed to be related to reduction and destruction of elastic fibers.

Conclusion:

Generalized interstitial GA with tuberculosis and cutis laxa is vary rare, which is worth being aware of the possibility of such a occurrence.
National Guidelines on Diagnosis and Treatment of Gonorrhea in China (2020)#
Authors: Wang Qian-Qiu , Zhang Rui-Li , Liu Quan-Zhong , Xu Jin-Hua , Su Xiao-Hong , Yin Yue-Ping , Qi Shu-Zhen , Xu Dong-Mei , Zhou Ping-Yu , Li Yu-Ye , Li Xiao-Fang , Wu Min-Zhi , Zou Xian-Biao , Yang Li-Gang , Chen Xiang-Sheng , Gong Xiang-Dong , Liang Guo-Jun , Jiang Juan , Cheng Hao , Ge Feng-Qin
Published: April 2020

Gonorrhea is one of the main sexually transmitted diseases in China. It mainly affects the genitourinary tract, and its clinical manifestations vary from asymptomatic to complicated types. The diagnosis of gonorrhea should be based on the patient's epidemiological history, clinical manifestations, and laboratory examination results. Treatment should be prompt and standardized and should involve the recommended treatment regimens. Patients should be appropriately followed up after treatment. The antimicrobial resistance of gonococcal isolates has become a severe problem of clinical concern. In order to provide technical guidance of the diagnosis and treatment of gonorrhea for health care workers, the authors developed the guidelines based on the version of 2014, which will be of important in the standardizing medical care of gonorrhea, and further facilitating control and prevention of the disease.
Clinical Manifestations of Adult Langerhans Cell Histiocytosis with Multisystem Involvement Successfully Treated Using Chemotherapy
Authors: Lin Nai-Yu , Tang Xu-Hua , Han Jian-De
Published: April 2020

Introduction:

Langerhans cell histiocytosis (LCH), the most common histiocytic disorder, characterized by the abnormal over production of histiocytes that tend to infiltrate single or multiple organ systems leading to significant tissue damage.

Here we report a case of an adult patient who was diagnosed with LCH presenting as multisystem involvement.

Case presentation:

We describe a 23-year-old man suffering from central diabetes insipidus, "hemorrhoids", progressive hearing loss and a surge in weight. Physical examination revealed lesion involvement of the skin and mucous membranes, including the perianal area, gingiva, and external auditory canal. He was diagnosed as LCH, who achieved remission following a chemotherapy regimen.

Discussion:

LCH is common in children, but it is not surprising to see it in adults. The clinical manifestations of LCH are highly variable and may involve multiple organs and systems. While, skin involvement is the most obvious symptom, and dermatologists should be familiar with it. Chemotherapy is the first-line treatment for multisystem or multifocal single system adult LCH.

Conclusion:

Characteristic features of LCH involving the perianal area was described in this case which helped the dermatologist to make quick judgments. We also emphasize that a global concept should be established confronting with a patient with multiple complaints.
Chinese Expert Proposal on the Diagnosis and Management of Pemphigus Vulgaris (2020)#
Authors: Zuo Ya-Gang , Li Li , Chen Jin-Bo , Chen Liu-Qing , Feng Su-Ying , Li Wei , Luo Xiao-Qun , Pan Meng , Wang Gang , Xiao Ting , Yang Bao-Qi , Zeng Kang , Zhang Gui-Ying , Jin Hong-Zhong
Published: April 2020

Pemphigus vulgaris (PV) is a life-threatening autoimmune bullous disease that causes blisters and erosions on the skin and mucous membranes to standardize the diagnosis and treatment of PV, Chinese experts in this field were invited to make recommendations which are presented in this article. Pemphigus vulgaris can be divided into cutaneous mucous type, cutaneous type and mucous mucous dominant type according to the different clinical manifestations. The pathological manifestations of PV are acantholysis above the basal layer. The diagnosis of PV and the assessment of the severity of the disease are made in accordance with the clinical manifestations, histopathological features, immunofluorescence assay results, and detection of pathogenic serum antibodies. The first-line treatment of PV comprises systemic glucocorticoids. Early combination with immunosuppressive agents or rituximab is recommended for moderate and severe PV. Intravenous immunoglobulin administration is recommended for patients being treated with rituximab. Plasma exchange and stem cell transplantation can be performed if necessary. During the course of therapy, the disease activity should be closely monitored, and actions should be taken to prevent adverse reactions.
Bringing accountability to the peak of the pandemic using linear response theory
Authors: Prakash Meher K.
Published: April 2020

The peak of the daily new infections in COVID-19 remained qualitative in description and elusive in arrival. Because of the lack of clarity in what to expect from the peak, apart from the hope that one day the peak will be reached, there has been no metric to describe the success of the implemented strategies. We propose a way of predicting the number of infections that can be expected after a lockdown, assuming they come from the asymptomatic cases prior to the lockdown and using linear response theory. These predictions for several western countries faithfully follow the observed infections for several weeks after the lockdown, suggesting universalities in the recovery pattern of several countries. At the same time, the gap between the quantitative predictions of the recovery patterns for New York and Milan and the observations is striking. These gaps which arise even while emulating the recovery patterns of other western countries raise the possibility of an audit of the success of the implemented strategies, and the potential newer sources of infection.
Approaching Patient-Clinician Relationships Issues Involving Artificial Intelligence Using Ethics of Care and Nursing Ethics
Authors: Hossain Soaad Q.
Published: April 2020

With the rise of artificial intelligence (AI) and its application within industries, there is no doubt that someday AI will be one of the key players in medical diagnoses, assessments and treatments. With the involvement of AI in health care and medicine comes concerns pertaining to its application, more specifically its impact on both patients and medical professionals. To further expand on the discussion, using ethics of care, literature and a systematic review, we will address the impact of allowing AI to guide clinicians with medical procedures and decisions. We will then argue that the impact of allowing AI to guide clinicians with medical procedures and decisions can hinder patient-clinician relationships, concluding with a discussion on the future of patient care and how ethics of care can be used to investigate issues within AI in medicine.
Night Shift Work Increases the Risk of Asthma
Authors: Maidstone RJ , Turner J , Vetter C , Dashti HS , Saxena R , Scheer FAJL , Shea SA , Kyle SD , Lawlor DA , Loudon ASI , Blaikley JF , Rutter MK , Ray DW , Durrington HJ
Published: April 2020

Shift work causes misalignment between our internal clock and daily behavioural cycles and is associated with metabolic disorders and cancer. Here, we describe the relationship between shift work and prevalent asthma in >280,000 UK Biobank participants. Compared to day workers, ‘permanent’ night shift workers had a higher likelihood of moderate/severe asthma (odds ratio (OR) 1.36 (1.03-1.8)) and all asthma (OR 1.23 (1.03-1.46) after adjustment for known major confounders). The public health implications of this finding are far-reaching due to the high prevalence and co-occurrence of both asthma and shift work.
Strict Lower Bound on the COVID-19 Fatality Rate in Overwhelmed Healthcare Systems
Authors: Bassett Bruce A.
Published: April 2020

The Infection Fatality Rate (IFR) for COVID-19 is a poorly known, yet crucial, aspect of the disease. Counting only current deaths in a region and assuming everyone in that region is infected provides an absolute lower bound on the IFR. Using this estimator for New York City, Lombardy and Madrid yields strong bounds on the average IFR in overwhelmed health systems. Their combined 35, 152 deaths implies an IFR ≥ 0.14% averaged over 25.1 million people. This is the best-case scenario and conclusively demonstrates that COVID-19 is more deadly than influenza. The actual value of the average COVID-19 IFR is likely to be higher than this bound.
Early detection of superspreaders by mass group pool testing can mitigate COVID-19 pandemic
Authors: Gongalsky M.B.
Published: April 2020

Background

Most of epidemiological models applied for COVID-19 do not consider heterogeneity in infectiousness and impact of superspreaders, despite the broad viral loading distributions amongst COVID-19 positive people (1 – 106 per mL). Also, mass group testing is not used regardless to existing shortage of tests. I propose new strategy for early detection of superspreaders with reasonable number of RT-PCR tests, which can dramatically mitigate development COVID-19 pandemic and even turn it endemic.

Methods

I used stochastic social-epidemiological SEIAR model, where S-suspected, E-exposed, I-infectious, A-admitted (confirmed COVID-19 positive, who are admitted to hospital or completely isolated), R-recovered. The model was applied to real COVID-19 dynamics in London, Moscow and New York City.

Findings

Viral loading data measured by RT-PCR were fitted by broad log-normal distribution, which governed high importance of superspreaders. The proposed full scale model of a metropolis shows that top 10% spreaders (100+ higher viral loading than median infector) transmit 45% of new cases. Rapid isolation of superspreaders leads to 4-8 fold mitigation of pandemic depending on applied quarantine strength and amount of currently infected people. High viral loading allows efficient group “matrix” pool testing of population focused on detection of the superspreaders requiring remarkably small amount of tests.

Interpretation

The model and new testing strategy may prevent thousand or millions COVID-19 deaths requiring just about 5000 daily RT-PCR test for big 12 million city such as Moscow. Though applied to COVID-19 pandemic the results are universal and can be used for other infectious heterogenous epidemics.

Funding

No funding
A poor-man’s approach to the effective reproduction number: the COVID-19 case
Authors: Menéndez José
Published: April 2020

It is shown that estimates of the effective reproduction number Rt for COVID-19 using standard packages such as EpiEstim can be reproduced very accurately using the expression Rt = c(t)/c(t − τ), where c(t) is the incidence at time t and τ the mean value of the series interval.
Identification of Differentially Expressed Gene Modules in Heterogeneous Diseases
Authors: Zolotareva Olga , Khakabimamaghani Sahand , Isaeva Olga I. , Chervontseva Zoe , Savchik Alexey , Ester Martin
Published: April 2020

Motivation

Identification of differentially expressed genes is necessary for unraveling disease pathogenesis. This task is complicated by the fact that many diseases are heterogeneous at the molecular level and samples representing distinct disease subtypes may demonstrate different patterns of dysregulation. Biclustering methods are capable of identifying genes that follow a similar expression pattern only in a subset of samples and hence can consider disease heterogeneity. However, identifying biologically significant and reproducible sets of genes and samples remains challenging for the existing tools. Many recent studies have shown that the integration of gene expression and protein interaction data improves the robustness of prediction and classification and advances biomarker discovery.

Results

Here we present DESMOND, a new method for identification of Differentially ExpreSsed gene MOdules iN Diseases. DESMOND performs network-constrained biclustering on gene expression data and identifies gene modules — connected sets of genes up- or down-regulated in subsets of samples. We applied DESMOND on expression profiles of samples from two large breast cancer cohorts and have shown that the capability of DESMOND to incorporate protein interactions allows identifying the biologically meaningful gene and sample subsets and improves the reproducibility of the results.

Availability

https://github.com/ozolotareva/DESMOND

Contact

ozolotareva@techfak.uni-bielefeld.de

Supplementary information

Supplementary data are available atBioinformaticsonline.
Endocrine signaling mediates asymmetric motor deficits after unilateral brain injury
Authors: Lukoyanov Nikolay , Watanabe Hiroyuki , Carvalho Liliana S. , Nosova Olga , Sarkisyan Daniil , Zhang Mengliang , Andersen Marlene Storm , Lukoyanova Elena A. , Galatenko Vladimir , Tonevitsky Alex , Bazov Igor , Iakovleva Tatiana , Schouenborg Jens , Bakalkin Georgy
Published: April 2020

A paradigm in neurology is that brain injury-induced motor deficits (e.g. hemiparesis and hemiplegia) arise due to aberrant activity of descending neural pathways. We discovered that a unilateral injury of the hindlimb sensorimotor cortex of rats with completely transected thoracic spinal cord produces hindlimb postural asymmetry with contralateral flexion, and asymmetric changes in nociceptive hindlimb withdrawal reflexes and gene expression patterns in lumbar spinal cord. The injury-induced postural effects were abolished by prior hypophysectomy and were mimicked by transfusion of serum from animals with unilateral brain injury. Antagonists of the opioid and vasopressin receptors blocked formation of hindlimb postural asymmetry suggesting that these neurohormones mediate effects of brain injury on lateralized motor responses. Our data indicate that descending neural control of spinal circuits is complemented by a previously unknown humoral signaling from injured brain to the contra- and ipsilesional hindlimbs, and suggest the existence of a body side-specific neuroendocrine regulation in bilaterally symmetric animals.
The First Month Spread of COVID-19 in Madagascar
Authors: Narison Stephan
Published: April 2020

Using the officially published data and aware of the unclear source and inaccurate number of samples, we present a first and (for the moment) unique attempt to study the spread of the pandemic COVID-19 in Madagascar. The approach has been tested by predicting the number of contaminated persons until 20 days after fitting the inputs data collected within 15 days using standard least χ2-fit method. Encouraged by this first test, we add the new data collected within 30 days and give prevision until 33 days. The present data show an approximate linear increase of about (4-5) infected persons per day while the analysis signals an eventual near future stronger growth. These results may also be interpreted as the lowest values of the real cases due to the insufficient number of samples (about 2200 for 20 millions of population). A comparison with some other approaches is done. Some social, economical and political impacts of COVID-19 and confinement for Madagascar and Worldwide are shortly discussed.
Intention to participate in a COVID-19 vaccine clinical trial and to get vaccinated against COVID-19 in France during the pandemic
Authors: Detoc Maëlle , Bruel Sébastien , Frappe Paul , Botelho-Nevers Elisabeth , Gagneux-Brunon Amandine
Published: April 2020

Background

The world is facing the COVID-19 pandemic. Development of vaccine is challenging.

Aim

To determine the proportion of people who intend to get vaccinated against COVID-19 in France or to participate in a vaccine clinical trial.

Methods

We conducted an anonymous on-line survey from the 26th of March to the 20th of April 2020. Primary endpoints were the intention to get vaccinated against COVID-19 if a vaccine was available or participate in a vaccine clinical trial.

Results

Three thousand two hundred and fifty nine individuals answered the survey; women accounted for 67.4 % of the responders, 670 (20.6 %) were under 30 years of age, 1,502 (46.1 %) between 30-49 years, 803 (24.6 %) between 50-64 years, 271 (8.3%) between 65-80 years, 13 (0.4%) over 80 years of age. According to their statements, 2.512 participants (77.6%, 95 % CI 76.2-79 %) will certainly or probably agree to get vaccinated against COVID-19. Older age, male gender, fear about COVID-19, being healthcare workers and individual perceived risk were associated with COVID-19 vaccine acceptance Vaccine hesitancy was associated with a decrease in COVID-19 vaccine acceptance. One thousand and five hundred and fifty responders (47.6 % 95 % CI 45.9-49.3 %) will certainly or probably agree to participate in a COVID-19 vaccine clinical trial.

Conclusions and Relevance

Nearly 75 % and 48 % of the survey responders were likely to accept vaccination or participation in a clinical trial against COVID-19. Vaccine hesitancy will be the major barrier to COVID-19 vaccine uptake.
Seed biopriming with P- and K-solubilizingEnterobacter hormaecheisp. improves the early vegetative growth and the P and K uptake of okra (Abelmoschus esculentus) seedling
Authors: Roslan Muhamad Aidilfitri Mohamad , Zulkifli Nurzulaikha Nadiah , Sobri Zulfazli M. , Zuan Ali Tan Kee , Cheak Sim Choon , Rahman Nor Aini Abdul
Published: April 2020

Limited information is available that seed biopriming by plant growth-promoting bacteria such as those amongEnterobacterspp. play a prominent role to enhance vegetative growth of plants. Contrary toEnterobacter cloacae,Enterobacter hormaecheiis a less-studied counterpart despite its vast potential in plant growth-promotion mainly through the inorganic phosphorus (P) and potassium (K) solubilization abilities. To this end, 18 locally isolated bacterial pure cultures screened and three strains showed high P- and K-solubilizing capabilities. Light microscopy, biochemical tests and 16S rRNA gene sequencing revealed that strains 15a1 and 40a were closely related toEnterobacter hormaecheiwhile strain 38 was closely related toEnterobacter cloacae(Accession number:MN294583;MN294585;MN294584). AllEnterobacterspp. shared common plant growth-promoting traits, namely N2fixators, indole-3-acetic acid producers and siderophore producers. Gibberellic acid was only produced by strain 38 and 40a, while exopolysaccharide formation was solely detected on agar containing colonies of strain 38. Underin vitrogermination assay of okra (Abelmoschus esculentus) seeds,Enterobacterspp. significantly improved overall germination parameters and vigor index (19.6%) of seedlings. The efficacy of root colonization ofEnterobacterspp. on the pre-treated seedling root tips was confirmed using Scanning Electron Microscopy (SEM). The pot experiment of bioprimed seeds of okra seedling showed significant improvement of the plant growth (> 28%) which corresponded to the increase of P and K uptakes (> 89%) as compared to the uninoculated control plants. The leaf surface area and the SPAD chlorophyll index of bioprimed plants were increased up to 29% and 9% respectively. This report revealed that the under-explored species of P- and K-solubilizingEnterobacter hormaecheisp. with multiple plant beneficial traits hold as a good potential sustainable approach for enhancement of soil fertility and P and K uptakes of plants.