bluuebunny/crossref_metadata_2025 huggingface dataset:
A complex intervention for multimorbidity in primary care: A feasibility study
Authors: Birke Hanne , Jacobsen Ramune , Jønsson Alexandra BR , Guassora Ann Dorrit Kristiane , Walther Marie , Saxild Thomas , Laursen Jannie T , Vall-Lamora Maria Helena Dominquez , Frølich Anne
Published: July 2020

Aim:

To assess the feasibility of a patient-centered complex intervention for multimorbidity (CIM) based on general practice in collaboration with community health-care centers and outpatient clinics.

Methods:

Inclusion criteria were age ≥18 years, diagnoses of two or more of three chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), and chronic heart conditions), and a hospital contact during the previous year. The CIM included extended consultations and nurse care manager support in general practice and intensified cross-sectorial collaboration. Elements included a structured care plan based on patients’ care goals, coordination of services, and, if appropriate, shifting outpatient clinic visits to general practice, medication review, referral to rehabilitation, and home care. The acceptability dimension of feasibility was assessed with validated questionnaires, observations, and focus groups.

Results:

Forty-eight patients were included (mean age 72.2 (standard deviation (SD) 9.5, range 52–89); 23 (48%) were men. Thirty-seven patients had two diseases; most commonly COPD and cardiovascular disease (46%), followed by diabetes and cardiovascular disease (23%), and COPD and diabetes (15%). Eleven (23%) patients had all three conditions. Focus group interviews with patients with multimorbidity identified three main themes: (1) lack of care coordination existed across health-care sectors before the CIM, (2) extended consultations provided better care coordination, and (3) patients want to be involved in planning their treatment and care. In focus groups, health-care professionals discussed two main themes: (1) patient-centered care and (2) culture and organizational change. Completion rates for questionnaires were 98% (47/48).

Conclusions:

Patients and health-care professionals found the CIM acceptable.
How do emerging market SMEs utilize resources in the face of environmental uncertainty?
Authors: Temouri Yama , Shen Kathy , Pereira Vijay , Xie Xuanli
Published: July 2020

Using the resource-based view of the firm, this article examines how different resources are used by small- and medium-sized enterprises (SMEs) in response to environmental uncertainty in an emerging market context. A survey was conducted involving 212 owners, CEOs, or managing directors of SMEs in the United Arab Emirates (UAE) to explore the drivers of firm growth strategies. Our empirical results show that higher environmental uncertainty, in terms of market and regulatory uncertainty, drives SMEs to pursue a more exploratory instead of an exploitative growth strategy. Our results also show that SMEs pursuing more of an exploratory growth strategy focus predominantly on intangible resources such as human capital and social capital while firms pursuing more of an exploitative growth strategy focus more on financial resources. The results from our study provide valuable insights for how managers can structure, bundle, and leverage different resources for developing their strategies based on their level of perceived environmental uncertainty. The policy implications from our study are that support for SMEs should be multi-faceted depending on the combination of uncertainty faced and type of strategy chosen by SMEs.

JEL CLASSIFICATION: M10; M19; M13
Prediction of tool wear constants for diamond turn machining of CuBe
Authors: Sharma A. , Datta D. , Balasubramaniam R.
Published: July 2020

While several studies in diamond turning of homogeneous materials like Cu, Al, and Si are well published, there is a lack of understanding about tool wear in case of heterogeneous materials like CuBe. Severity of the tool wear can be understood from the magnitude of the wear coefficients, and the magnitude of these coefficients is influenced by the wear mechanism. Hence, this study is aimed to calculate the wear coefficients from a known tool wear model in diamond turn machining of CuBe. Molecular dynamics simulation (MDS) results show that stress and temperature are responsible for increasing rate of tool wear. From the experimental results, change in the tool cutting edge radius due to wear was obtained and the temperature and stress for various a/r were found out using MDS. With these data, the wear coefficients, A & B, from a wear model for diamond turning were calculated. This methodology of using MDS to obtain stress and temperature for various a/ r wherein, values of r are obtained from a single machining trial on actual material, will be useful for calculating the wear coefficients for the combination of single crystal diamond tool with various work piece materials and their activation energies.
Overview of collapsed buildings in Mexico City after the 19 September 2017 (Mw7.1) earthquake
Authors: Galvis Francisco A. , Miranda Eduardo , Heresi Pablo , Dávalos Héctor , Ruiz-García Jorge
Published: July 2020

An intraslab normal-faulting earthquake struck the central region of Mexico on 19 September 2017, leading to the collapse of 44 buildings in Mexico City. After the earthquake, the authors collected information in situ and through social media about the collapsed buildings, which was statistically processed to identify the causes of their collapse. This article presents the main collapse statistics, which revealed that 64% of the collapsed buildings had between 1 and 5 stories, 61% had a seismic-force-resisting system based on reinforced concrete columns with flat slabs, 57% experienced a soft-story mechanism, 91% were built before 1985, 43% were located at the corner blocks, and 10% exhibited pounding with neighboring buildings. The spatial distribution of the collapsed buildings and the recorded ground motion features suggest that short- and medium-period buildings having well-known vulnerabilities were particularly prone to collapse under amplified high-frequency seismic waves typical of intraslab normal-faulting earthquakes, such as the 2017 Puebla–Morelos earthquake.
Transverse testicular ectopia with Müllerian duct remnant in an incarcerated congenital inguinal hernia – a case report
Authors: Kotb Mostafa , Hassan Ahmed , Abouheba Mohamed
Published: July 2020

Background

Transverse testicular ectopia (TTE) is a rare anomaly characterized by both testes descending through a single inguinal canal. In this report, the diagnosis of TTE was discovered in the event of an incarcerated congenital inguinal hernia in a neonate.

Case presentation

We present a case of TTE accompanied by persistent Müllerian duct structures (PMDS) that had been discovered incidentally during inguinal exploration of a 26-day-old boy who presented with an incarcerated congenital inguinal hernia on the right side and left cryptochidism on the left side. The pathogenesis, approach and proposed management of TTE are discussed.

Conclusion

TTE is an extremely rare anomaly, especially in neonates, and should be suspected in patients presenting with inguinal hernia on one side and cryptorchidism on the other side.
Why do hospital prescribers continue antibiotics when it is safe to stop? Results of a choice experiment survey
Authors: Roope Laurence S. J. , Buchanan James , Morrell Liz , Pouwels Koen B. , Sivyer Katy , Mowbray Fiona , Abel Lucy , Cross Elizabeth L. A. , Yardley Lucy , Peto Tim , Walker A. Sarah , Llewelyn Martin J. , Wordsworth Sarah
Published: July 2020

Background

Deciding whether to discontinue antibiotics at early review is a cornerstone of hospital antimicrobial stewardship practice worldwide. In England, this approach is described in government guidance (‘Start Smart then Focus’). However, < 10% of hospital antibiotic prescriptions are discontinued at review, despite evidence that 20–30% could be discontinued safely. We aimed to quantify the relative importance of factors influencing prescriber decision-making at review.

Methods

We conducted an online choice experiment, a survey method to elicit preferences. Acute/general hospital prescribers in England were asked if they would continue or discontinue antibiotic treatment in 15 hypothetical scenarios. Scenarios were described according to six attributes, including patients’ presenting symptoms and whether discontinuation would conflict with local prescribing guidelines. Respondents’ choices were analysed using conditional logistic regression.

Results

One hundred respondents completed the survey. Respondents were more likely to continue antibiotics when discontinuation would ‘strongly conflict’ with local guidelines (average marginal effect (AME) on the probability of continuing + 0.194 (p < 0.001)), when presenting symptoms more clearly indicated antibiotics (AME of urinary tract infection symptoms + 0.173 (p < 0.001) versus unclear symptoms) and when patients had severe frailty/comorbidities (AME = + 0.101 (p < 0.001)). Respondents were less likely to continue antibiotics when under no external pressure to continue (AME = − 0.101 (p < 0.001)). Decisions were also influenced by the risks to patient health of continuing/discontinuing antibiotic treatment.

Conclusions

Guidelines that conflict with antibiotic discontinuation (e.g. pre-specify fixed durations) may discourage safe discontinuation at review. In contrast, guidelines conditional on patient factors/treatment response could help hospital prescribers discontinue antibiotics if diagnostic information suggesting they are no longer needed is available.
Age related differences in phylogenetic diversity, prevalence of Shiga toxins, Intimin, Hemolysin genes and select serogroups of Escherichia. coli from pastured meat goats detected in a longitudinal cohort study
Authors: Ndegwa Eunice , Alahmde Aber , Kim Chyer , Kaseloo Paul , O’Brien Dahlia
Published: July 2020

Background

Little is known on significance, diversity and characteristics of gut E. coli in goats despite their importance as food animals globally. We characterized the temporal dynamics in diversity of E. coli in fecal samples from a cohort of goat kids and adult meat goats on pasture over a one-year period. Isolates were characterized based on phylogenetic grouping, virulence genes; shiga toxins 1 and 2 (Stx1&Stx2) (STEC), intimin (eaeA), hemolysin (hly) and select important sero-groups (026, 045, 0103, 0126 and 0146) using molecular methods.

Results

A total of 516 E. coli isolates were screened. Prevalence of virulence genes and STEC was 65 and 56% respectively. Prevalence of virulence genes and STEC was significantly higher in goat kids less than six months (76% /66%) than adults (48% /28%). Isolates with virulence profiles of two or more genes were also higher in young goat kids (50%) than adults (20%). Entero-pathogenic E. coli (EPEC-eaeA gene only) were mostly from pre-weaned goat kids while hly gene only isolates were significantly higher in adults. The stx1, stx2 and hly genes peaked around weaning (60, 63 and 52%) respectively. Goats kids were mostly hosts to group D (59%) while adults older than one year had B1 (75%) isolates. Group D isolates were most abundant at weaning (64%) and diarrhea samples (74%). Group B2 isolates overall (6%) were mostly detected around weaning (63%) while A isolates were 4% overall. Twenty-four isolates belonged to sero-groups 026, 0103 and 0146 with 70% of the isolates detected around weaning. Nineteen of these isolates were STEC with most harboring the stx1/stx2/hly/eae (25%) profile. Most belonged to O26 sero-group (75%) and phylogroup D (75%).

Conclusion

To our knowledge this is the first study to highlight longitudinal age related differences in E. coli phylogenetic diversity, abundance of virulence genes and select important sero-groups in goats. Differences detected suggest a possible role of age and weaning stress in influencing E. coli diversity in the gut of goats. The findings are relevant to both animal and public health to advise on further studies on caprine E. coli isolates as animal and human pathogens.
Association of genotype III of dengue virus serotype 3 with disease outbreak in Eastern Sudan, 2019
Authors: Eldigail Mawahib H. , Abubaker Hazem A. , Khalid Fatima A. , Abdallah Tajeldin M. , Musa Hassan H. , Ahmed Mohamed E. , Adam Gamal K. , Elbashir Mustafa I. , Aradaib Imadeldin E.
Published: July 2020

Background

Dengue fever (DF) is an arthropod-borne disease caused by dengue virus (DENV). DENV is a member of the genus Flavivirus in the family Flaviviridae. Recently, DENV has been reported as an important emerging infectious viral pathogen in Sudan. Multiple outbreaks and sporadic cases of DF have been frequently reported in the eastern region of Sudan. The present study was conducted to confirm DENV outbreak in Kassala State, eastern Sudan, 2019, and to provide some information on the molecular characterization of the DENV isolate associated with the disease outbreak.

Methods

A hundred serum samples were collected during the outbreak from residents of Kassala State, Sudan, 2019. ELISA was used to detect DENV non structural protein NS1 (DENV-NS1) in acute phase sera sampled during the disease outbreak. RT-PCR assays were used to amplify a fragment of the capsid/pre-membrane region (CprM) of the viral polyprotein gene. The PCR products of the amplified CprM region of the viral polyprotein gene were purified and partial sequences were generated and used to confirm the specificity of DENV sequences and to identify the virus serotype. Phylogenetic tree was constructed to determine the genotype of DENV associated with the outbreak.

Results

Using DENV-NS1 ELISA assay, DENV infection was confirmed in 23% sampled sera. The detection of DENV RNA was made possible using group-specific RT-PCR assay. The virus was serotyped as DENV serotype 3 (DENV-3) using DENV serotype-specific RT-PCR assay. Phylogenetic analysis of the partial CprM sequences of the viral polyprotein gene indicates that the virus belonged to genotype III of DENV-3.

Conclusion

The scientific data presented in this investigation confirmed that genotype III of DENV-3 was associated with the disease outbreak in eastern Sudan, 2019. The study represents the first report on molecular characterization of DENV-3 in Sudan.
Pseudoscientific beliefs and psychopathological risks increase after COVID-19 social quarantine
Authors: Escolà-Gascón Álex , Marín Francesc-Xavier , Rusiñol Jordi , Gallifa Josep
Published: July 2020

Background

The health crisis caused by COVID-19 has led many countries to opt for social quarantine of the population. During this quarantine, communication systems have been characterized by disintermediation, the acceleration of digitization and an infodemic (excess and saturation of information). The following debate arises: Do the levels related to the psychotic phenotype and pseudoscientific beliefs related to the interpretation of information vary before and after social quarantine?

Objectives

This research aims to examine the psychological effects of social quarantine on the psychotic phenotype and pseudoscientific beliefs-experiences of the general nonclinical population. The following hypothesis was posed: social quarantine alters the levels of magical thinking, pseudoscientific beliefs and anomalous perceptions due to quarantine.

Methods

A pre- and posttest analysis design was applied based on the difference in means, and complementary Bayesian estimation was performed. A total of 174 Spanish subjects responded to different questionnaires that evaluated psychopathological risks based on psychotic phenotypes, pseudoscientific beliefs and experiences before and after quarantine.

Results

Significant differences were obtained for the variables positive psychotic symptoms, depressive symptoms, and certain perceptual alterations (e.g., cenesthetic perceptions), and a significant increase in pseudoscientific beliefs was also observed. The perceptual disturbances that increased the most after quarantine were those related to derealization and depersonalization. However, paranoid perceptions showed the highest increase, doubling the initial standard deviation. These high increases could be related to the delimitation of physical space during social quarantine and distrust towards information communicated by the government to the population. Is it possible that social alarmism generated by the excess of information and pseudoscientific information has increased paranoid perceptual alterations?

Conclusions

Measures taken after quarantine indicate that perceptual disturbances, subclinical psychotic symptoms and beliefs in the pseudoscience have increased. We discuss which elements of quarantine coincide with the social marginality theory and its clinical repercussions.
Detecting the colonization of ericoid mycorrhizal fungi in Vaccinium uliginosum using in situ polymerase chain reaction and green fluorescent protein
Authors: Yang Hongyi , Zhao Xingyu , Li Lili , Zhang Jie
Published: July 2020

Background

Ericoid mycorrhizal fungi (EMF) play important roles in mineral cycling and plant nutrient acquisition, and they increase plant survival in nutrient-poor environments. In this study, we detected the colonization of EMF using a green fluorescent protein (GFP) expression method and in situ PCR.

Results

Genetic transformants of Cryptosporiopsis ericae and Sordariomycetes sp. expressing GFP were obtained via Agrobacterium tumefaciens-mediated transformation. GFP transformants were able to infect Vaccinium uliginosum, and their fluorescence was visible in the hair roots. Both in situ PCR and the GFP-expressing method indicated that EMF could colonize the hair roots of V. uliginosum 2 weeks after inoculation.

Conclusions

This research represents the first attempt to detect ericoid mycorrhizal colonization using in situ PCR. A GFP-expressing method is an excellent system for detecting the colonization of EMF, but it is dependent on the successful transformation and expression of the gfp gene. In situ PCR and the GFP expression may be developed as new tools to study the interactions of EMF both with ericaceous plants and with the environment.
Deep learning-based detection of seedling development
Authors: Samiei Salma , Rasti Pejman , Ly Vu Joseph , Buitink Julia , Rousseau David
Published: July 2020

Background

Monitoring the timing of seedling emergence and early development via high-throughput phenotyping with computer vision is a challenging topic of high interest in plant science. While most studies focus on the measurements of leaf area index or detection of specific events such as emergence, little attention has been put on the identification of kinetics of events of early seedling development on a seed to seed basis.

Result

Imaging systems screened the whole seedling growth process from the top view. Precise annotation of emergence out of the soil, cotyledon opening, and appearance of first leaf was conducted. This annotated data set served to train deep neural networks. Various strategies to incorporate in neural networks, the prior knowledge of the order of the developmental stages were investigated. Best results were obtained with a deep neural network followed with a long short term memory cell, which achieves more than 90% accuracy of correct detection.

Conclusion

This work provides a full pipeline of image processing and machine learning to classify three stages of plant growth plus soil on the different accessions of two species of red clover and alfalfa but which could easily be extended to other crops and other stages of development.
Skin testing with bendamustine: what concentration should be used?
Authors: Malinauskiene Laura , Cerniauskas Kestutis , Linauskiene Kotryna , Griguola Linas , Chomiciene Anzelika , Blaziene Audra
Published: July 2020

We present a case of the patient, who developed hypersensitivity reaction during the treatment of chronic lymphocytic leukemia. Bendamustine was suspected as a culprit agent. The patient as well as 3 controls underwent skin testing with the concentrations of the bendamustine described in earlier studies. We doubted the testing recommendations as all the controls developed serious local reactions. The clinical meaning of the positive skin test reaction in the patient remained unclear and questioned the safeness of recommended testing concentrations as in certain situations wrong diagnosis could be made or even harm could be done. Future investigations are needed when allergy to bendamustine is suspected.
Nrf2 promotes esophageal squamous cell carcinoma (ESCC) resistance to radiotherapy through the CaMKIIα-associated activation of autophagy
Authors: Xia Di , Zhang Xiao-Ran , Ma Yan-Li , Zhao Zhi-Jun , Zhao Ren , Wang Yan-Yang
Published: July 2020

Background

NF-E2-related factor 2 (Nrf2) is involved in the radiation resistance of esophageal squamous cell carcinoma (ESCC), but the underlying molecular mechanism is unclear. The purpose of our study was to explore the role of Nrf2 in the radiation resistance of ESCC and the potential molecular mechanism.

Results

Nrf2 expression was introduced into Ec109 and KYSE-30 ESCC cells with lentivirus. CCK-8 and colony formation assays were used to evaluate the effect of Nrf2 on radioresistance in culture. The autophagy level was assessed by western blotting, flow cytometry, and confocal fluorescence microscopy. The effect of Nrf2 on the transcription of Ca2 +/calmodulin-dependent protein kinase II α (CaMKIIα) was studied by chromatin immunoprecipitation. We found that the overexpression of Nrf2 increased the radiation resistance of ESCC cells. Mechanistically, Nrf2 triggered the radiation resistance of ESCC cells by targeting CaMKIIα and subsequently activating autophagy. In addition, we found that Nrf2 directly regulated the transcription of CaMKIIα by binding to its promoter region. The effect of Nrf2 on radiation resistance was also explored in both a xenograft mouse model and ESCC patient samples. Consistent with the results of the in vitro study, high Nrf2 expression level resulted in in vivo radioresistance in an Ec109-derived xenograft mouse model. Furthermore, we also demonstrated that upregulations of both Nrf2 and CaMKIIα was closely related to lower survival rates of ESCC patients.

Conclusions

Our study reveals that Nrf2 promotes the radiation resistance of ESCC by targeting CaMKIIα and subsequently activating autophagy, which is characterized by the suppression of phosphorylated mTOR and p62, activation of Beclin 1, and transformation of LC3-I to LC3-II.
Barriers and facilitators of successful weight loss during participation in behavioural weight management programmes: a protocol for a systematic review
Authors: Thomson Meigan , Martin Anne , Logue Jennifer , Wells Valerie , Simpson Sharon A.
Published: July 2020

Background

Behavioural weight management programmes are effective in assisting people with overweight or obesity to lose excess body weight. Yet, many still struggle to attain their weight loss goals in such programmes. Little is understood about the factors which impact success in these programmes. Synthesising this data will allow for theory to be developed on how to improve success in such programmes. The main aim of this review will be to extract and synthesise the barriers and facilitators of successful weight loss during participation of behavioural weight loss programmes in adults living with overweight and obesity.

Methods

A systematic search of MEDLINE, Embase, PsycINFO, The Cochrane Library and CINAHL will be performed from inception onwards. Studies will also be sought by contacting experts in the field, reference and website searching. Studies will be eligible if the participants are adults living with obesity (population) undertaking or recently completed behavioural weight loss programmes (intervention) with the primary focus of weight loss (outcome). The primary outcomes will be amount of weight lost and information on barriers and/or facilitators to success. The secondary outcomes will be reasons or factors related to attrition and adherence and behaviour change techniques used in programmes. Two reviewers will screen citations and full-text data. Reviewer 1 will screen all, and reviewer 2 will screen a random 50% of articles. Data extraction will be completed by reviewer 1, and 10% will be checked by the research team. Potential conflicts will be resolved through discussion. Data will be synthesised and described narratively to show the characteristics of each study, levels of success and barriers and facilitators during programme participation. A thematic approach will be taken, and themes will be coded against the levels of the socioecological model. Quantitative data will be extracted and categorised according to these themes and presented alongside the qualitative data.

Discussion

Our findings can be used to inform how weight loss programmes can be improved to facilitate success in those at risk of failure. Results will be published in a peer-reviewed journal.

Systematic review registration

(PROSPERO CRD42019148158 )
Anti-periodicity on high-order inertial Hopfield neural networks involving mixed delays
Authors: Yao Luogen , Cao Qian
Published: July 2020

This paper deals with a class of high-order inertial Hopfield neural networks involving mixed delays. Utilizing differential inequality techniques and the Lyapunov function method, we obtain a sufficient assertion to ensure the existence and global exponential stability of anti-periodic solutions of the proposed networks. Moreover, an example with a numerical simulation is furnished to illustrate the effectiveness and feasibility of the theoretical results.
DNA hypomethylation drives changes in MAGE-A gene expression resulting in alteration of proliferative status of cells
Authors: Colemon Ashley , Harris Taylor M. , Ramanathan Saumya
Published: July 2020

Melanoma Antigen Genes (MAGEs) are a family of genes that have piqued the interest of scientists for their unique expression pattern. A subset of MAGEs (Type I) are expressed in spermatogonial cells and in no other somatic tissue, and then re-expressed in many cancers. Type I MAGEs are often referred to as cancer-testis antigens due to this expression pattern, while Type II MAGEs are more ubiquitous in expression. This study determines the cause and consequence of the aberrant expression of the MAGE-A subfamily of cancer-testis antigens. We have discovered that MAGE-A genes are regulated by DNA methylation, as revealed by treatment with 5-azacytidine, an inhibitor of DNA methyltransferases. Furthermore, bioinformatics analysis of existing methylome sequencing data also corroborates our findings. The consequence of expressing certain MAGE-A genes is an increase in cell proliferation and colony formation and resistance to chemo-therapeutic agent 5-fluorouracil and DNA damaging agent sodium arsenite. Taken together, these data indicate that DNA methylation plays a crucial role in regulating the expression of MAGE-A genes which then act as drivers of cell proliferation, anchorage-independent growth and chemo-resistance that is critical for cancer-cell survival.
Classification of archaic rice grains excavated at the Mojiaoshan site within the Liangzhu site complex reveals an Indica and Japonica chloroplast complex
Authors: Tanaka Katsunori , Zhao Chunfang , Wang Ningyuan , Kubota Shinji , Kanehara Masaaki , Kamijo Nobuhiko , Ishikawa Ryuji , Tasaki Hiroyuki , Kanehara Minako , Liu Bin , Chen Minghui , Nakamura Shin-ichi , Udatsu Tetsuro , Wang Cailin
Published: July 2020

To understand rice types that were utilized during postdomestication and in the modern age and the potential of genetic research in aged rice materials, archaeogenetic analysis was conducted for two populations of archaic rice grains from the Mojiaoshan site during the Liangzhu Period in China (2940 to 2840 BC). Sequencing after the PCR amplification of three regions of the chloroplast genome and one region of the nuclear genome showed recovery rates that were comparable to those in previous studies except for one chloroplast genome region, suggesting that the materials used in this work were appropriate for recovering genetic information related to domestication traits by using advanced technology. Classification after sequencing in these regions proved the existence ofJaponicaandIndicachloroplasts in archaic grains from the west trench, which were subsequently classified into eight plastid groups (type I–VIII), and indicated that these rice grains derived from different maternal lineages were stored together in storage houses at the Mojiaohsan site. Among these plastid groups, type V exhibited the same sequences as two modernIndicaaccessions that are utilized in basic studies and rice breeding. It was inferred that part of the chloroplast genome of archaic rice has been preserved in modern genetic resources in these two modernIndicaaccessions, and the results indicated that rice related to their maternal ancestor was present at the Mojiaoshan site during the Liangzhu Period in China. The usefulness of archaeogenetic analysis can be demonstrated by our research data as well as previous studies, providing encouragement for the possibility that archaeogenetic analysis can be applied to older rice materials that were utilized in the rice-domesticated period.

Graphical abstract
18F-fluciclovine (Axumin) PET/CT detecting occult bone metastasis
Authors: Nepal Pankaj , Rodrigue Paul , Olsavsky Thomas
Published: July 2020

Background

18F-fluciclovine (Axumin) positron emission tomography (PET) is a novel agent for detection of biochemical recurrence of the prostate cancer. In this article, we present an interesting case of prostate cancer recurrence with bone metastasis not visualized with conventional CT, but detected with Axumin PET/CT. This case report will help reader to understand shortcomings of conventional modalities (CT/MRI/bone scan) in evaluation of biochemical recurrence of prostate cancer.

Case presentation

We report a case of 73-year-old male previously diagnosed with adenocarcinoma of prostate, status post-radiation treatment with excellent response to therapy. He presented with progressively increasing right groin pain and rising PSA level indicating biochemical recurrence. A bony metastasis to right inferior pubic ramus was diagnosed with Axumin PET/CT, not detected with conventional CT. He underwent local radiation treatment with excellent response to therapy.

Conclusion

18F-fluciclovine (Axumin) PET/CT is the most sensitive tool in detection of biochemical recurrence of prostate cancer. CT and MRI may not detect early cases of tumor recurrence which affects disease prognosis and patient management.
Arterial stiffness can occur early in mild-to-moderate chronic obstructive pulmonary disease
Authors: Mansour Waleed , El-Shabrawy Mohamed , Khalil Wael A. , Eldamanhory Ahmad S. , Embarak Sameh
Published: July 2020

Background

Chronic obstructive pulmonary disease (COPD) is a well-known respiratory system disorder impacting patient’s morbidity and mortality. Many COPD patients die from cardiovascular diseases. Criteria of arterial stiffness might be the early clue for cardiovascular affection in COPD patients. This study aimed to evaluate the occurrence of arterial stiffness as an early subclinical change in stable mild to moderate COPD patients.

Results

This cross-sectional study included 80 mild-to-moderate COPD patients and another 80 healthy controls. The carotid-femoral pulse wave velocity (cf-PWV) and the heart rate adjusted augmentation index (AIx75) were statistically significantly higher (13.8 ± 2.6 and 23.9 ± 10.8, respectively) among studied mild-to-moderate COPD patients when compared to healthy controls (10.7 ± 1.1 and 18.1 ± 8.9, respectively) (p < 0.001). FEV1 (forced expiratory volume in 1 s) % of predicted correlated negatively with both AIx75 (r = − 0.84, p < 0.001) and cf-PWV (r = − 0.85, p < 0.001), while BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index correlated positively with both AIx75 (r = 0.58, p < 0.001) and cf-PWV (r = 0.52, p < 0.001) in patients with mild-to-moderate COPD.

Conclusions

Pulse wave velocity and augmentation index correlated with FEV1% of predicted and BODE index in patients with mild-to-moderate COPD.
Generative Adversarial Domain Adaptation for Nucleus Quantification in Images of Tissue Immunohistochemically Stained for Ki-67
Authors: Zhang Xuhong , Cornish Toby C. , Yang Lin , Bennett Tellen D. , Ghosh Debashis , Xing Fuyong
Published: July 2020

PURPOSE

We focus on the problem of scarcity of annotated training data for nucleus recognition in Ki-67 immunohistochemistry (IHC)–stained pancreatic neuroendocrine tumor (NET) images. We hypothesize that deep learning–based domain adaptation is helpful for nucleus recognition when image annotations are unavailable in target data sets.

METHODS

We considered 2 different institutional pancreatic NET data sets: one (ie, source) containing 38 cases with 114 annotated images and the other (ie, target) containing 72 cases with 20 annotated images. The gold standards were manually annotated by 1 pathologist. We developed a novel deep learning–based domain adaptation framework to count different types of nuclei (ie, immunopositive tumor, immunonegative tumor, nontumor nuclei). We compared the proposed method with several recent fully supervised deep learning models, such as fully convolutional network-8s (FCN-8s), U-Net, fully convolutional regression network (FCRN) A, FCRNB, and fully residual convolutional network (FRCN). We also evaluated the proposed method by learning with a mixture of converted source images and real target annotations.

RESULTS

Our method achieved an F1 score of 81.3% and 62.3% for nucleus detection and classification in the target data set, respectively. Our method outperformed FCN-8s (53.6% and 43.6% for nucleus detection and classification, respectively), U-Net (61.1% and 47.6%), FCRNA (63.4% and 55.8%), and FCRNB (68.2% and 60.6%) in terms of F1 score and was competitive with FRCN (81.7% and 70.7%). In addition, learning with a mixture of converted source images and only a small set of real target labels could further boost the performance.

CONCLUSION

This study demonstrates that deep learning–based domain adaptation is helpful for nucleus recognition in Ki-67 IHC stained images when target data annotations are not available. It would improve the applicability of deep learning models designed for downstream supervised learning tasks on different data sets.
Bortezomib, Melphalan, and Dexamethasone for Light-Chain Amyloidosis
Authors: Kastritis Efstathios , Leleu Xavier , Arnulf Bertrand , Zamagni Elena , Cibeira María Teresa , Kwok Fiona , Mollee Peter , Hájek Roman , Moreau Philippe , Jaccard Arnaud , Schönland Stefan O. , Filshie Robin , Nicolas-Virelizier Emmanuelle , Augustson Bradley , Mateos María-Victoria , Wechalekar Ashutosh , Hachulla Eric , Milani Paolo , Dimopoulos Meletios A. , Fermand Jean-Paul , Foli Andrea , Gavriatopoulou Maria , Klersy Catherine , Palumbo Antonio , Sonneveld Pieter , Johnsen Hans Erik , Merlini Giampaolo , Palladini Giovanni
Published: July 2020

PURPOSE

Oral melphalan and dexamethasone (MDex) were considered a standard of care in light-chain (AL) amyloidosis. In the past decade, bortezomib has been increasingly used in combination with alkylating agents and dexamethasone. We prospectively compared the efficacy and safety of MDex and MDex with the addition of bortezomib (BMDex).

METHODS

This was a phase III, multicenter, randomized, open-label trial. Patients were stratified according to cardiac stage. Patients with advanced cardiac stage (stage IIIb) amyloidosis were not eligible. The primary end point was hematologic response rate at 3 months. This trial is registered with ClinicalTrials.gov identifier NCT01277016 .

RESULTS

A total of 109 patients, 53 in the BMDex and 56 in the MDex group, received ≥ 1 dose of therapy (from January 2011 to February 2016). Hematologic response rate at 3 months was higher in the BMDex arm (79% v 52%; P = .002). Higher rates of very good partial or complete response rates (64% v 39%; hazard ratio [HR], 2.47; 95% CI, 1.30 to 4.71) and improved overall survival, with a 2-fold decrease in mortality rate (HR, 0.50; 95% CI, 0.27 to 0.90), were observed in the BMDex arm. Grade 3 and 4 adverse events (the most common being cytopenia, peripheral neuropathy, and heart failure) were more common in the BMDex arm, occurring in 20% versus 10% of cycles performed.

CONCLUSION

BMDex improved hematologic response rate and overall survival. To our knowledge, this is the first time a controlled study has demonstrated a survival advantage in AL amyloidosis. BMDex should be considered a new standard of care for AL amyloidosis.
Optimizing Behavioral Sleep Strategies
Authors: Ong Jason C. , Gamaldo Charlene
Published: July 2020

Patients are increasingly looking to optimize sleep as a health and wellness strategy. Sleep health is often individualized based on three elements that correspond to overall physical and mental well-being: (1) sleep quality, which refers to the continuity and depth of sleep as well as a feeling of restoration upon awakening; (2) sleep quantity, which refers to the duration of sleep that is appropriate for a given age group; and (3) timing of the sleep window, which refers to the positioning of sleep that is aligned with an individual’s circadian rhythm for sleep or an ideal circadian zone. In the past, prescribing hypnotic medications was considered the primary approach for improving sleep. However, there has been a recent paradigm shift to favor behavioral approaches, particularly in the case of insomnia where cognitive-behavioral therapy has been shown to have a more favorable benefit-to-harm profile than medications. The clinical vignette is presented here as a springboard for discussion regarding the latest evidence and efficacy for sleep behavior techniques and consumer monitoring devices developed to improve sleep health and awareness for clinicians to consider when educating their patients on maximizing sleep health behaviors.
Parasomnias Occurring in Non–Rapid Eye Movement Sleep
Authors: Silber Michael H.
Published: July 2020

PURPOSE OF REVIEW

This article discusses the clinical manifestations, diagnosis and differential diagnosis, pathophysiology, and management of parasomnias occurring in non–rapid eye movement (REM) sleep.

RECENT FINDINGS

Disorders of arousal are characterized by dissociated sleep, with wake and sleep phenomena intermingling, and local sleep, in which different areas of the brain exist simultaneously in different states of wakefulness or sleep. The frequency of arousals from slow-wave sleep with delta or mixed-frequency activity has a high sensitivity but relatively low specificity for the diagnosis of arousal parasomnias.

Disorders of arousal (sleepwalking, sleep terrors, and confusional arousals) are characterized by incomplete awakenings from slow-wave sleep, limited recall of imagery, and partial or complete amnesia. They occur most frequently in childhood. Management includes correction of precipitating factors, attention to safety, behavioral techniques, and medications. Sleep-related eating disorder is a variant of arousal disorders and may be associated with the use of short-acting hypnotics and restless legs syndrome. Complex nocturnal visual hallucinations can occur with visual loss, dementia with Lewy bodies, use of β-adrenergic receptor antagonists, and anxiety. Exploding head syndrome occurs at wake-sleep transition or on waking during the night, is usually benign, and requires treatment only if significant sleep disruption occurs.
Insomnia
Authors: Perez Maria Nichole , Salas Rachel Marie E.
Published: July 2020

PURPOSE OF REVIEW

This article provides updated information regarding the diagnosis and treatment of chronic insomnia disorder. In addition to discussing the latest recommendations regarding pharmacotherapeutic options for insomnia, this article also discusses the increased use of nonpharmacologic treatment approaches, including cognitive-behavioral therapy intervention, integrative medicine, mindfulness and meditation, and other therapeutic options in clinical practice.

RECENT FINDINGS

Insomnia is one of the most common sleep disorders in patients with other neurologic disorders. The definition and criteria for insomnia were updated with the release of the International Classification of Sleep Disorders, Third Edition. The American Academy of Sleep Medicine has updated clinical practice guidelines for the pharmacologic treatment of chronic insomnia in adults. New diagnostic and therapeutic options (eg, pharmacologic and behavioral therapies, at-home devices) have emerged to optimize and personalize the evaluation and management of sleep disorders such as insomnia. Although some of these devices and treatment options are still in the early stages of development, several are currently in clinical trials or will soon be available.

This article emphasizes complexities related to the evaluation and management of patients with chronic insomnia disorder and describes alternative therapeutic options for patients with this common sleep disorder.
Central Disorders of Hypersomnolence
Authors: Trotti Lynn Marie
Published: July 2020

PURPOSE OF REVIEW

This article discusses the central disorders of hypersomnolence, a group of disorders resulting in pathologic daytime sleepiness, particularly narcolepsy type 1 and narcolepsy type 2, idiopathic hypersomnia, and Kleine-Levin syndrome. Disease features, diagnostic testing, epidemiology, pathophysiology, and treatment are reviewed.

RECENT FINDINGS

Increasing evidence implicates autoimmunity in narcolepsy type 1, including a strong association with human leukocyte antigen–DQB1*06:02, association with a polymorphism in the T-cell receptor alpha locus in genome-wide association, and the identification of autoreactive T cells in patients with this type of narcolepsy. In contrast, the cause or causes of narcolepsy type 2 and idiopathic hypersomnia are unknown. Multiple treatment options exist, including two medications approved for the treatment of narcolepsy by the US Food and Drug Administration (FDA) in 2019. These include solriamfetol, a dopamine- and norepinephrine-reuptake inhibitor, and pitolisant, an H3-inverse agonist/antagonist that increases histaminergic neurotransmission.

The central disorders of hypersomnolence all cause severe sleepiness but can be differentiated based on ancillary symptoms, diagnostic testing, and pathophysiology. It is important that these disorders are identified because multiple treatments are available to improve functioning and quality of life.
Circadian Rhythm Sleep-Wake Disorders
Authors: Zee Phyllis C. , Abbott Sabra M.
Published: July 2020

PURPOSE OF REVIEW

This article provides an overview of circadian physiology and discusses common presentations and treatment strategies for the circadian rhythm sleep-wake disorders.

RECENT FINDINGS

Circadian rhythms are present throughout the body, and appreciation for the role that circadian dysregulation plays in overall health is increasing, with mounting associations between circadian disruption and cardiometabolic disease risk.

It is important to recognize the ubiquitous role that circadian rhythms play throughout the brain and body. An understanding of circadian neurophysiology will provide insight into the means by which patients with a variety of neuropathologies at the level of the retina, optic nerve, or hypothalamus may also be at risk for circadian dysfunction.
Obstructive Sleep Apnea
Authors: Kirsch Douglas B.
Published: July 2020

PURPOSE OF REVIEW

Obstructive sleep apnea (OSA) is often overlooked by clinicians; however, undiagnosed OSA can lead to negative outcomes for patients, including patients with underlying neurologic conditions. Clinicians should be aware of what questions to ask, what diagnostic tests to use, and what treatments to consider in patients with OSA.

RECENT FINDINGS

OSA influences many neurologic conditions, including stroke, epilepsy, headache, and neuromuscular conditions. Treatment of OSA is effective, especially with patient-tailored options, the correct education, and support.

OSA is a serious medical condition with impacts on patients’ health, safety, and quality of life. Clinicians should identify patients at high risk for OSA and arrange for appropriate diagnosis and treatment, which, in turn, may lead to the improvement of or reduction in risk for neurologic and other health conditions.
Imaging of COVID-19 pneumonia in children
Authors: Palabiyik Figen , Kokurcan Suna Ors , Hatipoglu Nevin , Cebeci Sinem Oral , Inci Ercan
Published: July 2020

Objective:

Literature related to the imaging of COVID-19 pneumonia, its findings and contribution to diagnosis and its differences from adults are limited in pediatric patients. The aim of this study was to evaluate chest X-ray and chest CT findings in children with COVID-19 pneumonia.

Methods:

Chest X-ray findings of 59 pediatric patients and chest CT findings of 22 patients with a confirmed diagnosis of COVID-19 pneumonia were evaluated retrospectively.

Results:

COVID-19 pneumonia was most commonly observed unilaterally and in lower zones of lungs in chest X-ray examinations. Bilateral and multifocal involvement (55%) was the most observed involvement in the CT examinations, as well as, single lesion and single lobe (27%) involvement were also detected. Pure ground-glass appearance was observed in 41%, ground-glass appearance and consolidation together was in 36%. While peripheral and central co-distribution of the lesions (55%) were frequently observed, the involvement of the lower lobes (69%) was significant. In four cases,the coexistence of multiple rounded multifocal ground-glass appearance and rounded consolidation were observed.

Conclusion:

COVID-19 pneumonia imaging findings may differ in the pediatric population from adults. In diagnosis, chest X-ray should be preferred, CT should be requested if there is a pathologic finding on radiography that merits further evaluation and if clinically indicated.

Advances in knowledge:

Radiological findings of COVID-19 observed in children may differ from adults. Chest X-ray should often be sufficient in children avoiding additional irradiation, chest CT needs only be done in cases of clinical necessity.