bluuebunny/crossref_metadata_2025 huggingface dataset:
Design and terrainability analysis of a novel mobile robot with variable-diameter wheels
Authors: Gao Feng , Zeng Wen , Jiang Hui , Xu Guoyan
Published: April 2020

Mobile robots are usually demanded to enter into unstructured terrain. Thus, terrainability of a robot is specially important in cluttered environments. A novel mobile robot with variable-diameter wheels is designed here. This robot can adjust its attitude by variable wheel diameters to improve its terrainability. For terrainability, stability and obstacle-surmounting capability of the robot are studied. Furthermore, variable wheel diameters’ effects on these performances were researched. For lateral and longitudinal stabilities, parametric relationships between the maximum slope that the robot can climb and stability requirements were obtained. To avoid stability failures, appropriate failure criterions were proposed. Stability of the robot can be enhanced by changing wheel diameters. The obstacle-surmounting performances of front and rear wheels were analyzed by building two quasi-static models. The results showed that increased wheel diameters enhanced the obstacle-surmounting height. The analytical calculations and the simulations were compared. The simulations verified the reliability of the theoretical calculations. Based on tip-over failure criterions, appropriate strategies can be used to enhance the stability. These analysis presented also can provide theoretical basis for performance optimization design of the robot.
Electrical control design of CNC equipment fault based on part quality
Authors: He Yi , Chen Xuezhen , Zhao Guobo , Li Ying
Published: April 2020

Aeronautical structure component has high value and complex shape, normally manufacturing by advanced five-axis CNC machine tools, but sometimes random failures also occur. Therefore, this research focuses on how to predict the failure, imply redundancy design technique and minimize part quality risk as much as possible. This article first analyses quality risk caused by device failure in manufacturing and introduces several axis movements during alarm occurring, then studies the influence of accuracy in movements and optimizes by the electrical and external power grid redundancy design. At last this article carries out engineering verification though practice application and reduces the quality risk from device failure in order to prepare quality insurance system in intelligent manufacturing.
Backstepping DTC control of PMSM with robust adaptive law
Authors: Zheng Xiaoming , Xue Lei , Wang Peng , Li Jia , Shen Zeyuan
Published: April 2020

The traditional direct torque control (DTC) of permanent magnet synchronous motor (PMSM) is characterized by the feature of inconstant switching frequency and large ripples of flux and torque which is due to the hysteresis controllers adopted in the system. Besides, the modification of motor parameters, especially the rise of stator temperature, and load torque disturbance further leads to the speed steady-state error and fluctuation. A novel DTC method of interior PMSM based on the adaptive backstepping control with load torque and stator resistance identification is proposed in this paper. In order to reduce the ripples of the traditional DTC, a speed backstepping controller is designed to replace PI speed controller, and torque and flux backstepping controllers are designed to replace torque and flux hysteresis controllers in this algorithm. Owing to the real-time and accurate estimation of the stator resistance and load torque, the control variables can be instantly and simultaneously modify to ensure the accurate and fast response of the speed. The effectiveness and correctness of the presented method are verified through multiple simulation experiments, and the results indicate that the dynamic and static performance of the PMSM can be significantly improved by using the method.
The Numerical Analysis to Gas-Liquid Separator used in On-orbit Refuelling Mission
Authors: Li Wen , Guo Lei , Liu Jintao , Li Yong , Chen Lei
Published: April 2020

In the process of on-orbit refuel, the gas-liquid separator needs to separate the pressurized gas from the propellant, and discharges the gas out of the tank in the process of the tank refilling by propellant. In this paper, the gas-liquid separator has been developed, which could effectively separate the gas-liquid under microgravity conditions. The numerical analysis result shown that the stability of gas-liquid separation was the key characteristics, which was closely related to the geometric parameters of the fluid domain.
The Associations of Ambient Fine Particulate Matter Exposure During Pregnancy With Blood Glucose Levels and Gestational Diabetes Mellitus Risk: A Prospective Cohort Study in Wuhan, China
Authors: Ye Beizhu , Zhong Chunrong , Li Qian , Xu Shangzhi , Zhang Yu , Zhang Xu , Chen Xi , Huang Li , Wang Huanzhuo , Zhang Zhen , Huang Jiao , Sun Guoqiang , Xiong Guoping , Yang Xuefeng , Hao Liping , Yang Nianhong , Wei Sheng
Published: April 2020

Investigators in previous studies have drawn inconsistent conclusions regarding the relationship between relatively low exposure to fine particulate matter (particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5)) and risk of gestational diabetes mellitus (GDM), while the association between high PM2.5 exposure and GDM risk has not been well studied. We investigated the association of high PM2.5 exposure during pregnancy with blood glucose levels and GDM risk in Chinese women. The present study was conducted from August 2013 to May 2016 among 3,967 pregnant women in the Tongji Maternal and Child Health Cohort in Wuhan, China. PM2.5 exposure during pregnancy for each participant was estimated by means of land-use regression models. An interquartile-range increase in PM2.5 exposure (33.84 μg/m3 for trimester 1 and 33.23 μg/m3 for trimester 2) was associated with 36% (95% confidence interval (CI): 1.15, 1.61) and 23% (95% CI: 1.01, 1.50) increased odds of GDM during trimester 1 and trimester 2, respectively. An interquartile-range increment of PM2.5 exposure during trimester 1 increased 1-hour and 2-hour blood glucose levels by 1.40% (95% CI: 0.42, 2.37) and 1.82% (95% CI: 0.98, 2.66), respectively. The same increment of PM2.5 exposure during trimester 2 increased fasting glucose level by 0.85% (95% CI: 0.41, 1.29). Our findings suggest that high PM2.5 exposure during pregnancy increases blood glucose levels and GDM risk in Chinese women.
Dynamic Reconfiguration, Fragmentation, and Integration of Whole-Brain Modular Structure across Depths of Unconsciousness
Authors: Standage Dominic , Areshenkoff Corson N , Nashed Joseph Y , Hutchison R Matthew , Hutchison Melina , Heinke Dietmar , Menon Ravi S , Everling Stefan , Gallivan Jason P
Published: April 2020

General anesthetics are routinely used to induce unconsciousness, and much is known about their effects on receptor function and single neuron activity. Much less is known about how these local effects are manifest at the whole-brain level nor how they influence network dynamics, especially past the point of induced unconsciousness. Using resting-state functional magnetic resonance imaging (fMRI) with nonhuman primates, we investigated the dose-dependent effects of anesthesia on whole-brain temporal modular structure, following loss of consciousness. We found that higher isoflurane dose was associated with an increase in both the number and isolation of whole-brain modules, as well as an increase in the uncoordinated movement of brain regions between those modules. Conversely, we found that higher dose was associated with a decrease in the cohesive movement of brain regions between modules, as well as a decrease in the proportion of modules in which brain regions participated. Moreover, higher dose was associated with a decrease in the overall integrity of networks derived from the temporal modules, with the exception of a single, sensory-motor network. Together, these findings suggest that anesthesia-induced unconsciousness results from the hierarchical fragmentation of dynamic whole-brain network structure, leading to the discoordination of temporal interactions between cortical modules.
Molecular Epidemiology of Mycobacterium tuberculosis To Describe the Transmission Dynamics Among Inuit Residing in Iqaluit Nunavut Using Whole-Genome Sequencing
Authors: Alvarez Gonzalo G , Zwerling Alice A , Duncan Carla , Pease Christopher , Van Dyk Deborah , Behr Marcel A , Lee Robyn S , Mulpuru Sunita , Pakhale Smita , Cameron D William , Aaron Shawn D , Patterson Michael , Allen Jean , Sullivan Kathryn , Jolly Anne , Sharma Meenu K , Jamieson Frances B
Published: April 2020

Background

In the last decade, tuberculosis (TB) incidence among Inuit in the Canadian Arctic has been rising. Our aim was to better understand the transmission dynamics of TB in this remote region of Canada using whole-genome sequencing.

Methods

Isolates from patients who had culture-positive pulmonary TB in Iqaluit, Nunavut, between 2009 and 2015 underwent whole-genome sequencing (WGS). The number of transmission events between cases within clusters was calculated using a threshold of a ≤3 single nucleotide polymorphism (SNP) difference between isolates and then combined with detailed epidemiological data using a reproducible novel algorithm. Social network analysis of epidemiological data was used to support the WGS data analysis.

Results

During the study period, 140 Mycobacterium tuberculosis isolates from 135 cases were sequenced. Four clusters were identified, all from Euro-American lineage. One cluster represented 62% of all cases that were sequenced over the entire study period. In this cluster, 2 large chains of transmission were associated with 3 superspreading events in a homeless shelter. One of the superspreading events was linked to a nonsanctioned gambling house that resulted in further transmission. Shelter to nonshelter transmission was also confirmed. An algorithm developed for the determination of transmission events demonstrated very good reproducibility (κ score .98, 95% confidence interval, .97–1.0).

Conclusions

Our study suggests that socioeconomic factors, namely residing in a homeless shelter and spending time in a gambling house, combined with the superspreading event effect may have been significant factors explaining the rise in cases in this predominantly Inuit Arctic community.
Advocacy for renal replacement therapy: the role of renal registries
Authors: Couchoud Cecile , Gharbi Mohamed Benghanem
Published: April 2020

The paper by Jardine et al. reporting results from the South African Renal Registry describes a 2-fold success. First, even in a limited-resource environment, survival of patients on renal replacement therapy (RRT) is favourable. Secondly, this information is available because a few years ago, South African nephrologists started a renal registry. These successes cannot conceal, however, that numerous patients are not offered RRT. Robust health information systems make it possible to define chronic kidney disease and end-stage kidney disease (ESKD) burdens, guide resource allocation, inform service planning and enable policy. Registries can highlight inequitable RRT access and help support advocacy in favour of additional resources for ESKD care.
Deleterious effects of viral pneumonia on cardiovascular system
Authors: Duan Jiahao , Wu Yeshun , Liu Cunming , Yang Chun , Yang Ling
Published: April 2020

Viral pneumonia has a significant effect on the cardiovascular system through various mechanisms; even though it is traditionally regarded as a pulmonary disease characterized by dyspnoea and hypoxaemia. Recent research works have shown that cardiovascular events outweigh all other causes of death in various influenza pandemics. Therefore, the exploration of the effects of viral pneumonia on cardiovascular system becomes increasingly essential. The objective of this review is three-fold: first, to summarize the knowledge about the epidemiological characteristics and clinical manifestations of viral infections that are the recent causes of global pandemics; second, to explore the cardiovascular response to these infections; and third, to attempt in identifying the possible coping strategies of the Wuhan epidemic and the future viral infection pandemics.
miR-145a Regulation of Pericyte Dysfunction in a Murine Model of Sepsis
Authors: Wu Yan , Li Pengfei , Goodwin Andrew J , Cook James A , Halushka Perry V , Zingarelli Basilia , Fan Hongkuan
Published: April 2020

Background

Sepsis is a life-threatening systemic disease with severe microvascular dysfunction. Pericytes preserve vascular homeostasis. To our knowledge, the potential roles of microRNAs in sepsis-induced pericyte dysfunction have not been explored.

Methods

We determined lung pericyte expression of miR-145a in cecal ligation and puncture (CLP)–induced sepsis. Mouse lung pericytes were isolated and transfected with a miR-145a mimic, followed by stimulation with lipopolysaccharide (LPS). We measured inflammatory cytokine levels. To assess the functions of miR-145a in vivo, we generated a pericyte-specific miR-145a–knockout mouse and determined sepsis-induced organ injury, lung and renal vascular leakage, and mouse survival rates. We used RNA sequencing and Western blotting to analyze the signaling pathways regulated by miR-145a.

Results

CLP led to decreased miR-145a expression in lung pericytes. The miR-145a mimic inhibited LPS-induced increases in cytokines. In CLP-induced sepsis, pericytes lacking miR-145a exhibited increased lung and kidney vascular leakage and reduced survival rates. We found that miR-145a could suppress LPS-induced NF-κB activation. In addition, we confirmed that the transcription factor Friend leukemia virus integration 1 (Fli-1) is a target of miR-145a and that Fli-1 activates NF-κB signaling.

Conclusion

Our results demonstrated that pericyte miR-145a mediates sepsis-associated microvascular dysfunction, potentially by means of Fli-1–mediated modulation of NF-κB signaling.
The bird’s-eye view: A data-driven approach to understanding patient journeys from claims data
Authors: Bobroske Katherine , Larish Christine , Cattrell Anita , Bjarnadóttir Margrét V , Huan Lawrence
Published: April 2020

Objective

In preference-sensitive conditions such as back pain, there can be high levels of variability in the trajectory of patient care. We sought to develop a methodology that extracts a realistic and comprehensive understanding of the patient journey using medical and pharmaceutical insurance claims data.

Materials and Methods

We processed a sample of 10 000 patient episodes (comprised of 113 215 back pain–related claims) into strings of characters, where each letter corresponds to a distinct encounter with the healthcare system. We customized the Levenshtein edit distance algorithm to evaluate the level of similarity between each pair of episodes based on both their content (types of events) and ordering (sequence of events). We then used clustering to extract the main variations of the patient journey.

Results

The algorithm resulted in 12 comprehensive and clinically distinct patterns (clusters) of patient journeys that represent the main ways patients are diagnosed and treated for back pain. We further characterized demographic and utilization metrics for each cluster and observed clear differentiation between the clusters in terms of both clinical content and patient characteristics.

Discussion

Despite being a complex and often noisy data source, administrative claims provide a unique longitudinal overview of patient care across multiple service providers and locations. This methodology leverages claims to capture a data-driven understanding of how patients traverse the healthcare system.

Conclusions

When tailored to various conditions and patient settings, this methodology can provide accurate overviews of patient journeys and facilitate a shift toward high-quality practice patterns.
Effects of mood and aging on keystroke dynamics metadata and their diurnal patterns in a large open-science sample: A BiAffect iOS study
Authors: Vesel Claudia , Rashidisabet Homa , Zulueta John , Stange Jonathan P , Duffecy Jennifer , Hussain Faraz , Piscitello Andrea , Bark John , Langenecker Scott A , Young Shannon , Mounts Erin , Omberg Larsson , Nelson Peter C , Moore Raeanne C , Koziol Dave , Bourne Keith , Bennett Casey C , Ajilore Olusola , Demos Alexander P , Leow Alex
Published: April 2020

Objective

Ubiquitous technologies can be leveraged to construct ecologically relevant metrics that complement traditional psychological assessments. This study aims to determine the feasibility of smartphone-derived real-world keyboard metadata to serve as digital biomarkers of mood.

Materials and Methods

BiAffect, a real-world observation study based on a freely available iPhone app, allowed the unobtrusive collection of typing metadata through a custom virtual keyboard that replaces the default keyboard. User demographics and self-reports for depression severity (Patient Health Questionnaire-8) were also collected. Using >14 million keypresses from 250 users who reported demographic information and a subset of 147 users who additionally completed at least 1 Patient Health Questionnaire, we employed hierarchical growth curve mixed-effects models to capture the effects of mood, demographics, and time of day on keyboard metadata.

Results

We analyzed 86 541 typing sessions associated with a total of 543 Patient Health Questionnaires. Results showed that more severe depression relates to more variable typing speed (P < .001), shorter session duration (P < .001), and lower accuracy (P < .05). Additionally, typing speed and variability exhibit a diurnal pattern, being fastest and least variable at midday. Older users exhibit slower and more variable typing, as well as more pronounced slowing in the evening. The effects of aging and time of day did not impact the relationship of mood to typing variables and were recapitulated in the 250-user group.

Conclusions

Keystroke dynamics, unobtrusively collected in the real world, are significantly associated with mood despite diurnal patterns and effects of age, and thus could serve as a foundation for constructing digital biomarkers.
Role of Breast Imaging Radiologists as Advocates for Screening Mammography
Authors: Omofoye Toma S , Parikh Jay R
Published: April 2020

The objective of this article is to outline opportunities for breast imaging radiologists to advocate for screening mammography. Despite breast cancer being the second most common cancer in women and screening mammography’s ability to reduce mortality from this disease, there remains suboptimal utilization in the community. The different guidelines for screening presented by respected organizations has created confusion for patients and referring clinicians and the eventual underutilization of screening mammography. As experts in the value of early detection, breast radiologists are well suited to take on the role of screening advocates. Using specific action steps and examples, we create a template for a radiologist to utilize in the promotion of screening among the breast imaging team, clinicians, administrators, and the community at large. By deliberately filling the role of screening mammography advocate, one can satisfy the mandate for radiologists to bring increased value to the health care team while contributing to community health and patient satisfaction.
Don’t Stress Me Now: Assessing the Regulatory Impact of Face-to-Face and Online Feedback Prosociality on Stress During an Important Life Event
Authors: Rodríguez-Hidalgo C T , Tan E S H , Verlegh P W J , Beyens I , Kühne R
Published: April 2020

This study investigates the interplay between online and face-to-face (FtF) feedback on stress during an important life event. We present data on a two-month, six-wave longitudinal study of 468 Chilean adolescents across three important stages of a competitive national university selection test (Prueba de Selección Universitaria [PSU]) to assess longitudinal and reciprocal relationships. Random intercept cross-lagged panel models (RI-CLPM) showed that online feedback had a small effect in decreasing stress during the three short-termed waves, before and after the three main events of the test: test taking, test scores, and final selection. No intrapersonal effects were found for FtF feedback on stress, and vice versa. At the interpersonal level, only feedback variables were related. Results suggest that prosocial replies on social media may slightly help to downregulate stress from important life events at the intrapersonal level, an effect which appears to be short-lived (e.g., only a few days), rather than long-lived (e.g., three weeks).
Decoupled drought responses of fine-root versus leaf acquisitive traits among six Prunus hybrids
Authors: Zhou Shuang-Xi , Walker Rob R , Edwards Everard
Published: April 2020

Aims

Predicting drought consequences on forests and fruit crop plantings requires improved understanding of drought responses of both leaf and fine-root resource acquisitive traits (specific leaf area—SLA, specific root surface area—SRA and specific root length—SRL). We hypothesize their responses are coordinated towards integrated plant resource conservation under severe drought.

Methods

We tested the hypothesis with a greenhouse-based drought experiment on saplings of six Prunus hybrids with a priori known contrasting drought sensitivity. Saplings were subjected to either control (100% field capacity) or severe drought stress treatment (33% evapotranspiration of hybrid-specific control plants). Sample collections were carried out at 30 and at 60 days after the start of treatments, for both control and stressed saplings.

Important Findings

No hybrid showed concurrent significant decrease of SLA and SRA (or SRL) under severe drought. The fine-root traits of the six hybrids showed two major drought-response scenarios, in particular: (i) increased root tissue density (RTD) and decreased average root diameter without significant change of SRL and (ii) increased RTD and decreased SRL without significant change of average root diameter. Drought responses of leaf gas exchange, SRA, SRL and RTD were closely correlated along a gradient towards resource conservation from control to drought-stressed plants in all hybrids, which was orthogonal to another gradient characterized by a hybrid-dependent decrease of SLA. These findings highlight (i) the multi-dimensionality of root-trait drought responses, (ii) the decoupling between leaf economics and leaf hydraulics and (iii) the covariation of leaf and root hydraulics in terms of trait drought responses. The study contributes to identifying the origin of the multi-dimensionality of root-trait drought response at intraspecific scale, and highlights differential drought–response combinations of leaf and fine-root traits among hybrids to survive under severe soil drought stress.
A rare case of ileocolic intussusception due to severe endometriosis
Authors: Benigno Luca , Lisarelli Loriana , Sortino Rosita , Neuweiler Joerg , Steffen Thomas
Published: April 2020

Intestinal intussusception is a rare cause of intestinal obstruction; intestinal intussusception associated with endometriosis is very rare. The varied clinical presentations make the diagnosis demanding. In this article, we report the case of a young female patient with an intestinal obstruction due to intussusception. The successive histologic examination of the resected sample showed advanced endometriosis. This is a very rare entity with only a few similar cases reported in the literature.
Minimally invasive approach to esophageal lipoma
Authors: Bernardi Daniele , Ferrari Davide , Siboni Stefano , Porta Matteo , Bruni Barbara , Bonavina Luigi
Published: April 2020

Esophageal lipoma is a rare neoplasm with heterogeneous and sometimes life-threatening clinical presentation. We report the case of two patients, a 77-year-old man and a 69-year-old woman presenting with heartburn and dysphagia, and with recurrent vomiting and asphyxia, respectively. Upper gastrointestinal endoscopy and computed tomography were highly suggestive of the diagnosis of esophageal lipoma and identified an intramural and an intraluminal pedunculated mass originating, respectively, from the distal and the cervical esophagus. The first patient was treated by laparoscopic transhiatal enucleation and the second by transoral endoscopic resection under general anesthesia. Both had an uneventful postoperative course and were discharged home on postoperative day 2. Minimally invasive excision of esophageal lipoma is feasible and effective. It may be life-saving in patients with pedunculated tumors who suffer from intermittent regurgitation of a bulky polypoid mass in the mouth causing asphyxia.
Emerging crosstalk between two signaling pathways coordinates K+ and Na+ homeostasis in the halophyte Hordeum brevisubulatum
Authors: Zhang Haiwen , Feng Hao , Zhang Junwen , Ge Rongchao , Zhang Liyuan , Wang Yunxiao , Li Legong , Wei Jianhua , Li Ruifen
Published: April 2020

K+/Na+ homeostasis is the primary core response for plant to tolerate salinity. Halophytes have evolved novel regulatory mechanisms to maintain a suitable K+/Na+ ratio during long-term adaptation. The wild halophyte Hordeum brevisubulatum can adopt efficient strategies to achieve synergistic levels of K+ and Na+ under high salt stress. However, little is known about its molecular mechanism. Our previous study indicated that HbCIPK2 contributed to prevention of Na+ accumulation and K+ reduction. Here, we further identified the HbCIPK2-interacting proteins including upstream Ca2+ sensors, HbCBL1, HbCBL4, and HbCBL10, and downstream phosphorylated targets, the voltage-gated K+ channel HbVGKC1 and SOS1-like transporter HbSOS1L. HbCBL1 combined with HbCIPK2 could activate HbVGKC1 to absorb K+, while the HbCBL4/10–HbCIPK2 complex modulated HbSOS1L to exclude Na+. This discovery suggested that crosstalk between the sodium response and the potassium uptake signaling pathways indeed exists for HbCIPK2 as the signal hub, and paved the way for understanding the novel mechanism of K+/Na+ homeostasis which has evolved in the halophytic grass.
L’évaluation médicale des enfants prépubères qu’on soupçonne d’être victimes d’une agression sexuelle
Authors: Smith Tanya , Chauvin-Kimoff Laurel , Baird Burke , Ornstein Amy
Published: April 2020

L’agression sexuelle sur les mineurs est un problème important et relativement courant. Les enfants victimes d’une agression sexuelle peuvent se présenter au cabinet d’un médecin, à un centre de soins d’urgence ou au département d’urgence d’un hôpital en vue d’une évaluation médicale. Cette évaluation peut rassurer à la fois l’enfant et la personne qui l’a à sa charge, établir les soins à apporter et offrir une interprétation précise des constatations au système de justice et aux services de protection de l’enfance. Étant donné le potentiel de conséquences médicolégales, une évaluation approfondie exige à la fois des connaissances à jour et des compétences cliniques. Le présent document de principes propose une approche fondée sur des données probantes et respectueuse des traumatismes lors de l’évaluation médicale des enfants prépubères victimes d’une agression sexuelle présumée ou confirmée.
Demedicalizing the Ethics of PrEP as HIV Prevention: The Social Effects on MSM
Authors: Montess Michael
Published: April 2020

In order to demedicalize the ethics of pre-exposure prophylaxis (PrEP) as HIV prevention, I consider the social effects on men who have sex with men (MSM). The Centers for Disease Control and Prevention (CDC) considers MSM to be the highest risk group for contracting HIV in the USA. The ethics of using PrEP as HIV prevention among MSM, however, has both a medical dimension and a social dimension. While the medical dimension of the ethics of PrEP includes concerns about side effects, drug resistance and distribution, the social dimension of the ethics of PrEP includes concerns about stigmatization, sexual and romantic relationships and sexual freedom. The medical concerns of the ethics of PrEP may take precedence over the social concerns, but there is a growing body of literature that already addresses the medical concerns. Much less attention has been given to the social concerns of the ethics of PrEP, and in this article, I aim to fill this gap in the literature. Therefore, I focus on the often-overlooked social dimension of the ethics of PrEP to help understand the connection between the risks, relationships and communities of MSM using PrEP as HIV prevention.
Affective brain patterns as multivariate neural correlates of cardiovascular disease risk
Authors: Gianaros Peter J , Kraynak Thomas E , Kuan Dora C-H , Gross James J , McRae Kateri , Hariri Ahmad R , Manuck Stephen B , Rasero Javier , Verstynen Timothy D
Published: April 2020

This study tested whether brain activity patterns evoked by affective stimuli relate to individual differences in an indicator of pre-clinical atherosclerosis: carotid artery intima-media thickness (CA-IMT). Adults (aged 30–54 years) completed functional magnetic resonance imaging (fMRI) tasks that involved viewing three sets of affective stimuli. Two sets included facial expressions of emotion, and one set included neutral and unpleasant images from the International Affective Picture System (IAPS). Cross-validated, multivariate and machine learning models showed that individual differences in CA-IMT were partially predicted by brain activity patterns evoked by unpleasant IAPS images, even after accounting for age, sex and known cardiovascular disease risk factors. CA-IMT was also predicted by brain activity patterns evoked by angry and fearful faces from one of the two stimulus sets of facial expressions, but this predictive association did not persist after accounting for known cardiovascular risk factors. The reliability (internal consistency) of brain activity patterns evoked by affective stimuli may have constrained their prediction of CA-IMT. Distributed brain activity patterns could comprise affective neural correlates of pre-clinical atherosclerosis; however, the interpretation of such correlates may depend on their psychometric properties, as well as the influence of other cardiovascular risk factors and specific affective cues.
Accuracy of Bilistick (a Point-of-Care Device) to Detect Neonatal Hyperbilirubinemia
Authors: Kamineni Bhargavi , Tanniru Anusha , Vardhelli Venkateshwarlu , Sharma Deepak , Pawale Dinesh , Kulkarni Dattatray , Muppidi Pranitha Reddy , Deshabhotla Saikiran , Murki Srinivas
Published: April 2020

Introduction

Early diagnosis and appropriate management of neonatal jaundice is crucial in avoiding severe hyperbilirubinemia and brain injury. A low-cost, minimally invasive, point-of-care (PoC) tool for total bilirubin (TB) estimation which can be useful across all ranges of bilirubin values and all settings is the need of the hour.

Objective

To assess the accuracy of Bilistick system, a PoC device, for measurement of TB in comparison with estimation by spectrophotometry.

Design/methods

In this cross-sectional clinical study, in infants who required TB estimation, blood samples in 25-µl sample transfer pipettes were collected at the same time from venous blood obtained for laboratory bilirubin estimation. The accuracy of Bilistick in estimating TB within ±2 mg/dl of bilirubin estimation by spectrophotometry was the primary outcome.

Results

Among the enrolled infants, 198 infants were eligible for study analysis with the mean gestation of 36 ± 2.3 weeks and the mean birth weight of 2368 ± 623 g. The median age at enrollment was 68.5 h (interquartile range: 48–92). Bilistick was accurate only in 54.5% infants in measuring TB within ±2 mg/dl difference of TB measured by spectrophotometry. There was a moderate degree of correlation between the two methods (r = 0.457; 95% CI: 0.339–0.561, p value < 0.001). Bland–Altman analysis showed a mean difference of 0.5 mg/dl (SD ± 4.4) with limits of agreement between −8.2 and +9.1 mg/dl.

Conclusion

Bilistick as a PoC device is not accurate to estimate TB within the clinically acceptable difference (±2 mg/dl) of TB estimation by spectrophotometry and needs further improvement to make it more accurate.
Tracking echovirus eleven outbreaks in Guangdong, China: a metatranscriptomic, phylogenetic, and epidemiological study
Authors: Lu Jing , Kang Min , Zeng Hanri , Zhong Yuwen , Fang Ling , Zheng Xiaoling , Liu Leng , Yi Lina , Lin Huifang , Peng Jingju , Li Caixia , Zhang Yingtao , Sun Limei , Luo Shuhua , Xiao Jianpeng , Munnink Bas B Oude , Koopmans Marion P G , Wu Jie , Zhang Yong , Zhang Yonghui , Song Tie , Li Hui , Zheng Huanying
Published: April 2020

In April 2019, a suspect cluster of enterovirus cases was reported in a neonatology department in Guangdong, China, resulting in five deaths. We aimed to investigate the pathogen profiles in fatal cases, the circulation and transmission pattern of the viruses by combining metatranscriptomic, phylogenetic, and epidemiological analyses. Metatranscriptomic sequencing was used to characterize the enteroviruses. Clinical and environmental surveillance in the local population was performed to understand the prevalence and genetic diversity of the viruses in the local population. The possible source(s), evolution, transmission, and recombination of the viruses were investigated by incorporating genomes from the current outbreak, from local retrospective surveillance, and from public databases. Metatranscriptomic analysis identified Echovirus 11 (E11) in three fatal cases. Seroprevalence of neutralization antibody to E11 was 35 to 44 per cent in 3–15 age groups of general population, and the viruses were associated with various clinical symptoms. From the viral phylogeny, nosocomial transmissions were identified and all E11 2019 outbreak strains were closely related with E11 strains circulating in local population 2017–19. Frequent recombination occurred among the 2019 Guangdong E11 outbreak strains and various genotypes in enterovirus B species. This study provides an example of combining advanced genetic technology and epidemiological surveillance in pathogen diagnosis, source(s), and transmission tracing during an infectious disease outbreak. The result highlights the hidden E11 circulation and the risk of viral transmission and infection in the young age population in China. Frequent recombination between Guangdong-like strains and other enterovirus genotypes also implies the prevalence of these emerging E11 strains.
Recognizing and managing upper extremity compartment syndrome
Authors: Miranda-Klein Jacqueline , Howell Christopher M. , Davis-Cheshire Michael
Published: April 2020

Compartment syndrome is an acute limb-threatening condition typically treated with emergency fasciotomy. Although limbs often are saved, ischemia can cause irreversible neurologic damage to the extremity. Patients with upper extremity compartment syndrome may lose fine motor function, which can result in long-term impairment of perceived quality of life. This article reviews the anatomy, physiology, presentation, diagnosis, and treatment of upper extremity compartment syndrome, including rehabilitation, which can reduce complications that occur even in patients who were promptly and properly treated.
Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement From Society for Neuroscience in Anesthesiology & Critical Care (SNACC)
Authors: Sharma Deepak , Rasmussen Mads , Han Ruquan , Whalin Matthew K. , Davis Melinda , Kofke W. Andrew , Venkatraghvan Lakshmikumar , Raychev Radoslav , Fraser Justin F.
Published: April 2020

The pandemic of coronavirus disease 2019 (COVID-19) has unique implications for the anesthetic management of endovascular therapy for acute ischemic stroke. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert recommendations using available evidence for the safe and effective anesthetic management of endovascular therapy for acute ischemic stroke during the COVID-19 pandemic. The goal of this consensus statement is to provide recommendations for anesthetic management considering the following (and they are): (1) optimal neurological outcomes for patients; (2) minimizing the risk for health care professionals, and (3) facilitating judicious use of resources while accounting for existing variability in care. It provides a framework for selecting the optimal anesthetic technique (general anesthesia or monitored anesthesia care) for a given patient and offers suggestions for best practices for anesthesia care during the pandemic. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.
Rheumatologic Medication Use During Pregnancy
Authors: Peterson Emily A. , Lynton Jessica , Bernard Allison , Santillan Mark K. , Bettendorf Brittany
Published: April 2020

Chronic rheumatic diseases often occur in women of reproductive age, and the effect rheumatic disease has on pregnancy varies depending on the condition. Medical management of rheumatic diseases during pregnancy may prevent joint or organ damage and minimize the adverse effects of the disease itself on pregnancy outcomes. Each patient requires individual assessment to control disease activity while minimizing or avoiding medications with potential maternal or fetal toxicity. An open discussion with shared decision making between patients, obstetricians, rheumatologists, and pharmacists is imperative to create an individualized treatment plan that meets patients' goals. This article will review the current literature for use of disease modifying antirheumatic drugs and biologics during pregnancy and lactation, providing health care professionals with the most up-to-date information available.
Fetal Sex Results of Noninvasive Prenatal Testing and Differences With Ultrasonography
Authors: Dhamankar Rupin , DiNonno Wendy , Martin Kimberly A. , Demko Zachary P. , Gomez-Lobo Veronica
Published: April 2020

OBJECTIVE:

To assess the causes of reported discordance between noninvasive prenatal testing (NIPT) and ultrasound or other clinical information.

METHODS:

In this retrospective, observational study, all cases in which single-nucleotide polymorphism (SNP)–based NIPT reported normal sex chromosomes and the laboratory was notified by the patient or health care provider of discordance between NIPT and observed or expected fetal sex from clinical information were reviewed. When discordances were unresolved after internal and external laboratory clerical data review or repeat ultrasound imaging, additional clinical records, genetic testing results and pregnancy outcomes were reviewed.

RESULTS:

Of the 1,301,117 eligible NIPT cases, fetal sex discordances were reported in 91 (0.007%; 1:14,300; 95% CI 1:11,600–1:17,800); partial or complete outcome information was available for 83 of 91 cases. In 30 of 83 (36%) cases, karyotyping was performed, and sufficient clinical information was provided to establish the diagnosis of disorders of sexual development. The disorders of sexual development were classified into three categories: 46,XY disorders of sexual development (n=19), 46,XX disorders of sexual development (n=4), and sex chromosome disorders of sexual development (n=7). In 28 of 83 (34%) cases, the cause of the apparent discrepancy was attributable to human error, predominantly phlebotomy labeling or ultrasound misassignment. In 25 of 83 cases, a diagnosis was not possible; the outcome reported was either abnormal (18/83, 22%) or no abnormalities were reported (7/83, 8%). When normal sex chromosomes were predicted by SNP-based NIPT and clinical information was discordant, disorders of sexual development were common. Internal laboratory clerical data review and re-imaging confirmed the NIPT fetal sex reports in 34% cases, providing reassurance that no further evaluation was necessary.

CONCLUSION:

Identification of apparent fetal sex discordances with NIPT results, and reporting this suspicion to the laboratory, provides an opportunity for further evaluation to identify the cause of apparent discordances and the involvement of a multi-disciplinary team, as necessary to prepare for postnatal care. We propose a protocol for evaluation of these cases.

FUNDING SOURCE:

This study was funded by Natera, Inc.
Internal Iliac Artery Balloon Occlusion for Placenta Previa and Suspected Placenta Accreta
Authors: Chen Meng , Liu Xinghui , You Yong , Wang Xiaodong , Li Tao , Luo Hong , Qu Haibo , Xu Lian
Published: April 2020

OBJECTIVE:

To investigate the effect of intraoperative balloon occlusion of the internal iliac arteries in women with placenta previa and antenatally diagnosed placenta accreta.

METHODS:

In this single-center, randomized controlled trial, women with placenta previa and antenatally suspected placenta accreta were randomly assigned to either the balloon occlusion group or to the control group. The perioperative management approach was similar for both groups, other than preoperative balloon catheter placement and intraoperative occlusion of bilateral internal iliac arteries. The primary outcome was the number of packed red blood cell (RBC) units transfused. With a two-sided α of 0.05 and a power of 0.8, a sample size of 48 women per group was calculated to detect a mean reduction of 2 units packed RBCs transfused with an expected SD of 3.5.

RESULTS:

From August 2017 to July 2018, we randomized 50 eligible women to the balloon group and 50 to the control group. Demographic, obstetric, and placental imaging characteristics were similar between groups. The number of packed RBC units transfused was not significantly different between groups (5.3±5.3 in the occlusion group vs 4.7±5.4 in the control group, P=.54). Hospitalization costs and incidence of postoperative fever were significantly higher in the balloon group. No significant differences were found in other outcomes.

CONCLUSION:

Intraoperative balloon occlusion of the internal iliac arteries did not reduce the number of packed RBC units transfused in women with placenta previa and antenatally suspected placenta accreta.

CLINICAL TRIAL REGISTRATION:

Chinese Clinical Trial Registry, ChiCTR-IOR-17012244.
Double-Balloon Device for 6 Compared With 12 Hours for Cervical Ripening
Authors: Bleicher Inna , Dikopoltsev Elena , Kadour-Ferro Einav , Sammour Rami , Gonen Ron , Sagi Shlomi , Eshel Aya , Nussam Liraz , Vitner Dana
Published: April 2020

OBJECTIVE:

To evaluate whether removal of a double-balloon device for cervical ripening for 6 compared with 12 hours in women with an unfavorable cervix will result in a shorter time to delivery, similar cervical ripening, and without affecting cesarean delivery rate.

METHODS:

In a prospective randomized trial, cervical ripening was performed using a double-balloon device. Women were randomized to removal of the device after 6 compared with 12 hours. Primary outcome was time to delivery. Secondary outcomes included mode of delivery, Bishop score, and maternal and neonatal adverse outcomes. A sample size of 100 nulliparous and 100 parous women was required assuming a 95% CI, power of 80%, and mean decrease of 6 hours to delivery between the groups.

RESULTS:

From March 2017 through February 2019, 688 women were screened, 243 were found eligible, and 197 were randomized as follows: nulliparous cohort (n=101): removal after 6 hours (n=48) compared with removal after 12 hours (n=53); parous cohort (n=96): removal after 6 hours (n=49) compared with removal after 12 hours (n=47). Insertion-to-delivery interval was significantly shorter in the 6-hour group for both nulliparous (25.6±12.8 hours vs 31.4±15.2 hours, P<.04; mean difference 5.8, 95% CI 0.2–11.3), and parous cohorts (18.0±6.8 hours vs 22.6±8.2 hours, P=.003; mean difference 4.7, 95% CI 1.6–7.7). Bishop score change and cesarean delivery rate were similar between groups regardless of parity. The 12-hour group in the combined cohort was associated with higher rates of maternal intrapartum fever (2% vs 10%, P=.02; odds ratio 5.3, 95% CI 1.1–24.8).

CONCLUSION:

Insertion-to-delivery interval is shorter after 6 compared with 12 hours for both nulliparous and parous women. Cervical ripening with a double-balloon device may be achieved in 6 hours. The longer time was associated with a higher rate of intrapartum fever. Six hours should be considered as standard placement time for double-balloon catheters.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03045939.
Role of Prenatal Ultrasonography and Amniocentesis in the Diagnosis of Congenital Zika Syndrome
Authors: Viens Laura J. , Fleck-Derderian Shannon , Baez-Santiago Madelyn A. , Oduyebo Titilope , Broussard Cheryl S. , Khan Sumaiya , Jones Abbey M. , Meaney-Delman Dana
Published: April 2020

OBJECTIVE:

To examine the relationship between prenatal diagnostics (ultrasound examination and amniotic fluid Zika virus testing) and postnatal congenital Zika syndrome abnormalities.

DATA SOURCES:

Systematic searches were performed in 27 databases, including ClinicalTrials.gov, from inception to July 1, 2019, for articles with the keywords “Zika,” “prenatal,” “ultrasound,” and “amniocentesis.”

METHODS OF STUDY SELECTION:

A total of 3,049 unique records were identified. Two reviewers independently assessed titles, abstracts, and full texts for relevance; 84 articles met the inclusion criteria. These articles describe 402 mother–fetus or mother–neonate dyads; 385 were included in the review of prenatal ultrasound examination, and 56 in the review of amniocentesis (39 in both).

TABULATION, INTEGRATION, AND RESULTS:

Among 195 fetuses with congenital Zika syndrome findings on prenatal ultrasound examination, postnatal congenital Zika syndrome abnormalities were reported for 153 (78%; 95% CI 7–84%). High proportions of microcephaly (76%; 95% CI 69–82%) and brain abnormalities (78%; 95% CI 69–86%) were confirmed postnatally. Among 190 fetuses without congenital Zika syndrome findings on prenatal ultrasound examination, 17% (95% CI 12–24%) had congenital Zika syndrome abnormalities identified postnatally. Structural congenital Zika syndrome abnormalities were identified postnatally in approximately equal proportions among dyads with and without Zika virus RNA detected in an amniotic fluid specimen (68% and 67%; 95% CI 52–82% and 95% CI 38–88%). In six pregnancies, Zika virus RNA was detected in amniotic fluid but not in a subsequent amniocentesis specimen.

CONCLUSION:

Prenatal ultrasound examination frequently detects structural findings associated with Zika virus infection; however, not all abnormalities are detected, and some may represent transient findings. As with other congenital infections, prenatal detection may vary with timing of infection, timing of ultrasound examination, technical expertise, and severity of abnormalities. The detection of Zika virus RNA in amniotic fluid in the included studies did not predict the risk for congenital Zika syndrome abnormalities in these cases, and clearance of Zika virus RNA from amniotic fluid appears possible after maternal infection. Diagnostic testing for Zika virus infection remains a shared decision between patients and clinicians, and more data are needed to define clinical predictors that will inform these decisions.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42018080959.