bluuebunny/crossref_metadata_2025 huggingface dataset:
Disease burden metrics and the innovations of leading pharmaceutical companies: a global and regional comparative study
Authors: Jung Ye Lim , Hwang JeeNa , Yoo Hyoung Sun
Published: September 2020

Background

The recent innovation activities of global top-tier pharmaceutical companies in accordance with global and regional health concerns were investigated in order to identify their innovations contributing to population health.

Methods

“Innovation activity” was defined as the number of drugs for which R&D activities have been reported within the last three years. Such activities were measured by collecting the data on drug developments and classifying them by developer company, phase of development, therapeutic use, and the country in which the development conducted. Subsequently, we examined and compared the correlations between the global innovation activities of the top 20 pharmaceutical companies and the disease burden measured in disability-adjusted life years (DALYs) by income level and region. In addition, this study analyzed the association between country-specific innovations and DALYs in the corresponding countries.

Results

At a global level, the innovation activities were not associated with global DALYs. However, when analyzed by income level, the innovation activities were associated with DALYs in high income and upper middle income countries while it was not associated with DALYs in low middle income and low income countries. In terms of region, correlations were found between the innovation activities and DALYs in the European region, the Americas, and the Western Pacific region whereas such correlations were not found in the African, Eastern Mediterranean, and South-East Asian regions. Similar to the analyses by income level and region, correlations between country-specific innovations and DALYs were only found in high income or high GDP countries. In addition, an empirical analysis of several cases including Canada, Germany, South Korea, and the United Kingdom revealed that pharmaceutical innovation is more closely related to market size than disease burden.

Conclusions

This study identified that discrepancies between pharmaceutical innovation and public health needs, i.e., disease burden values, have persisted until recently. To alleviate this imbalance, both public and private sectors should not only fulfill their respective roles and responsibilities regarding these issues, but also make strategic and collaborative efforts such as Product Development Partnerships (PDPs) directed toward public health improvement.
Factors associated with duration of breastfeeding in Spain: a cohort study
Authors: Lechosa-Muñiz Carolina , Paz-Zulueta María , Sota Sonia Mateo , de Adana Herrero María Sáez , del Rio Elsa Cornejo , Llorca Javier , Cabero-Perez María J.
Published: September 2020

Background

Factors associated with duration of breastfeeding have been usually studied at specific times after birth. Little is known about how much time is added to breastfeeding by each associated factor.

Methods

A cohort of 969 mother-child dyads was followed-up for twelve months at the Marqués de Valdecilla University Hospital, Spain, in 2018. Data on mother characteristics, pregnancy, delivery and children characteristics were obtained from medical records. Length of breastfeeding was reported by the mothers and recorded in paediatric medical record at hospital discharge and 2, 4, 6, 9 and 12 months of life. Factors associated with duration of breastfeeding were analysed via multivariate Weibull regression parameterized as accelerated time of failure. Results are presented as time ratios.

Results

About four out of five children were breastfed at hospital discharge, although this proportion dropped to 65% in children born from smoker women, 70% in preterm children and 68% in neonates weighting less than 2500 g. Mother’s age was associated with longer breastfeeding, adding 2% more breastfeeding time per year (adjusted time ratio 1.02; 95% confidence interval 1.00, 1.04). Children born from mothers with university studies were breastfed 53% more time than those born from mothers with primary studies (adjusted time ratio 1.53; 95% confidence interval 1.21, 1.95); smoking in pregnancy decreased length of breastfeeding by 41% (adjusted time ratio 0.59; 95% confidence interval 0.46, 0.76). Other factors associated with longer breastfeeding were single pregnancy and newborn weight over 2500 g.

Conclusions

Analysing factors associated with duration of breastfeeding as time parameters allows us to quantify the amount of time gained or lost by each factor, which could make it easier to evaluate the relevance of programmes directed to promote facilitating breastfeeding factors.
A qualitative assessment of factors influencing implementation and sustainability of evidence-based tobacco use treatment in Vietnam health centers
Authors: VanDevanter Nancy , Vu Milkie , Nguyen Ann , Nguyen Trang , Van Minh Hoang , Nguyen Nam Truong , Shelley Donna R.
Published: September 2020

Background

Effective strategies are needed to increase implementation and sustainability of evidence-based tobacco dependence treatment (TDT) in public health systems in low- and middle-income countries (LMICs). Our two-arm cluster randomized controlled trial (VQuit) found that a multicomponent implementation strategy was effective in increasing provider adherence to TDT guidelines in commune health center (CHCs) in Vietnam. In this paper, we present findings from a post-implementation qualitative assessment of factors influencing effective implementation and program sustainability.

Methods

We conducted semi-structured qualitative interviews (n = 52) with 13 CHC medical directors (i.e., physicians), 25 CHC health care providers (e.g., nurses), and 14 village health workers (VHWs) in 13 study sites. Interviews were transcribed and translated into English. Two qualitative researchers used both deductive (guided by the Consolidated Framework for Implementation Research) and inductive approaches to analysis.

Results

Facilitators of effective implementing of TDT included training and point-of-service tools (e.g., desktop chart with prompts for offering brief counseling) that increased knowledge and self-efficacy, patient demand for TDT, and a referral system, available in arm 2, which reduced the provider burden by shifting more intensive cessation counseling to a trained VHW. The primary challenges to sustainability were competing priorities that are driven by the Ministry of Health and may result in fewer resources for TDT compared with other health programs. However, providers and VHWs suggested several options for adapting the intervention and implementation strategies to address challenges and increasing engagement of local government committees and other sectors to sustain gains.

Conclusion

Our findings offer insights into how a multicomponent implementation strategy influenced changes in the delivery of evidence-based TDT. In addition, the results illustrate the dynamic interplay between barriers and facilitators for sustaining TDT at the policy and community/practice level, particularly in the context of centralized public health systems like Vietnam’s. Sustaining gains in practice improvement and clinical outcomes will require strategies that include ongoing engagement with policymakers and other stakeholders at the national and local level, and planning for adaptations and subsequent resource allocations in order to meet the World Health Organization’s goals promoting access to effective treatment for all tobacco users.

Trial registration

NCT02564653, registered September 2015
Uniportal versus multiportal video-assisted thoracoscopic anatomical resection for NSCLC: a meta-analysis
Authors: Yan Yueren , Huang Qingyuan , Han Han , Zhang Yang , Chen Haiquan
Published: September 2020

Background

Uniportal video-assisted thoracoscopic surgery (U-VATS) has recently emerged as an alternative procedure for non-small cell lung cancer (NSCLC); however, whether U-VATS has advantages over multiportal VATS (M-VATS) remains unknown.

Methods

We performed a systematic review of two databases (Pubmed and Web of Science) to search comparative studies of U-VATS and M-VATS anatomical pulmonary resection for NSCLC. Operative time, blood loss, number of resected lymph nodes, drainage duration, length of postoperative stay, pain in postoperative day 1(POD1) and conversion rates were retrieved to estimate the comparison of outcomes. A subgroup analysis stratified by study type (propensity-matched analysis and randomized-controlled trial versus non-propensity matched analysis) was performed.

Result

A total of 20 studies with 4142 patients were included in this meta-analysis. U-VATS was performed on 1869 patients, whereas the other 2173 patients underwent M-VATS. This meta-analysis showed that there was no significant difference in operative time (U-VATS: 146.48 ± 55.07 min versus M-VATS: 171.70 ± 79.40 min, P = 0.81), blood loss (74.49 ± 109.03 mL versus 95.48 ± 133.67 mL, P = 0.18), resected lymph nodes (17.28 ± 9.46 versus 18.31 ± 10.17, P = 0.62), conversion rate (6.18% versus 4.34%, P = 0.14), drainage duration (3.90 ± 2.94 days versus 4.44 ± 3.12 days, p = 0.09), length of postoperative stay (6.16 ± 4.40 days versus 6.45 ± 4.80 days, P = 0.22), and pain in POD1 (3.94 ± 1.68 versus 3.59 ± 2.76, p = 0.07). Subgroup analysis showed the value of PSM and RCT group consistency with overall value.

Conclusion

This up-to-date meta-analysis shows that the perioperative outcomes of U-VATS and M-VATS anatomical pulmonary resection are equivalent. In addition, the differences in long-term outcomes of these two approaches are still unclear. Thoracic surgeons should pay more emphasize on providing high-quality and personalized surgical care for patients, to improve the survival ultimately.
Primary and secondary aortopathy associated with adult congenital heart disease - retrospective study
Authors: Schusterova Ingrid , Banovcinova Alžbeta , Vachalcova Marianna , Jakubova Marta , Artemiou Panagiotis
Published: September 2020

Background

Primary and secondary aortopathy are frequently encountered in patients with congenital heart disease. The aim of this study is to present our experience and the incidence of primary and secondary adult CHD-associated aortopathy.

Methods

The cohort is comprised of adult patients with congenital heart disease from the registry of the Eastern Slovakia Institute of Cardiovascular Diseases. Data from the last follow-up examinations are included in this study. In the primary and secondary aortopathy groups were 35 and 12 patients respectively. As a control group were selected 64 patients with non aortopathy associated congenital heart disease (atrial and ventricular septal defect).

Results

Patients with primary and secondary aortopathy had larger ascending aorta/aortic root diameters than the control group (36.28 (26–49) mm vs 30.25 (21–41) mm p = 0.000113, 33.82 27–49) mm vs 29.03 (19–38)mm p = 0.000366 and 42.1 (30–50) mm vs 30.25 (21–41) mm, p = 0.000106, 35.67 (27–48) mm vs 29.03 (19–38) mm, p = 0.000119 respectively). Moreover, patients with secondary aortopathy had statistically significant larger ascending aorta diameter compared to the patients with primary aortopathy (42.1 (30–50) mm vs 36.28 (26–49) mm p = 0.030). During the follow-up period, were performed only in 2 patients (one from each group) operations on the aortic root and the ascending aorta due to aortic root or ascending aorta dilatation.

Conclusion

More patients with secondary aortopathy had dilated ascending aorta/ aortic root, as well as larger aortic diameters compare to the patients with primary aortopathy. Routine follow-up of these patients with attention to aortic diameter is necessary.
Meta-analysis of association between CT-based features and tumor spread through air spaces in lung adenocarcinoma
Authors: Yin Qifan , Wang Huien , Cui Hongshang , Wang Wenhao , Yang Guang , Qie Peng , Xun Xuejiao , Han Shaohui , Liu Huining
Published: September 2020

Objective

Spread through air space (STAS) is a novel invasive pattern of lung adenocarcinoma and is also a risk factor for recurrence and worse prognosis of lung adenocarcinoma after sublobar resection. The aims of this study are to evaluate the association between computed tomography (CT)-based features and STAS for preoperative prediction of STAS in lung adenocarcinoma, eventually, which could help us choose appropriate surgical type.

Methods

Systematic research was conducted to search for studies published before September 1, 2019. The association between CT-based features of radiological tumor size>2 cm、pure solid nodule、 part-solid nodule or Percentage of solid component (PSC)>50% and STAS was evaluated. According to rigorous inclusion and exclusion criteria. Eight studies including 2385 patients published between 2015 and 2018 were finally enrolled in our meta-analysis.

Results

Our results clearly depicted that there is no significant relationship between radiological tumor size>2 cm and STAS with the combined OR of 1.47(95% CI:0.86–2.51). Meta-analysis of 3 studies showed that pure solid nodule in CT image were more likely to spread through air spaces with pooled OR of 3.10(95%CI2.17–4.43). Meta-analysis of 5 studies revealed the part-solid nodule in CT image may be more likely to appear STAS in adenocarcinoma (ADC) (combined OR:3.10,95%CI:2.17–4.43). PSC>50% in CT image was a significant independent predictor in the diagnosis of STAS in ADC from our meta-analysis with combined OR of 2.95(95%CI:1.88–4.63).

Conclusion

In conclusion, The CT-based features of pure solid nodule、part-solid nodule、PSC>50% are promising imaging biomarkers for predicting STAS in ADC and may substantially influence the choice of surgical type. In future, more studies with well-designed and large-scale are needed to confirm the conclusion.
Natural history of Krabbe disease – a nationwide study in Germany using clinical and MRI data
Authors: Krieg Sarah Isabel , Krägeloh-Mann Ingeborg , Groeschel Samuel , Beck-Wödl Stefanie , Husain Ralf A. , Schöls Ludger , Kehrer Christiane
Published: September 2020

Background

Krabbe disease or globoid cell leukodystrophy is a severe neurodegenerative disorder caused by a defect in the GALC gene leading to a deficiency of the enzyme ß-galactocerebrosidase. The aim of this work was to describe the natural disease course covering the whole spectrum of the disease.

Methods

Natural history data were collected with a standardized questionnaire, supplemented by medical record data. We defined different forms of the disease according to Abdelhalim et al. (2014). Developmental and disease trajectories were described based on the acquisition and loss of milestones as well as the time of first clearly identifiable symptoms and needs such as spasticity, seizures and tube feeding. MRI was assessed using the scoring system by Loes et al. (1999) and in addition a pattern recognition approach, based on Abdelhalim et al. (2014).

Results

Thirty-eight patients were identified, from 27 of these patients 40 MRIs were available; 30 (79%) had an infantile onset, showing first symptoms in their first year of life, almost all (27 out of 30) starting in the first six months. A later onset after the first year of life was observed in 8 patients (21%, range 18 months to 60 years). Irritability, abnormalities in movement pattern as well as general developmental regression were the first symptoms in the infantile group; disease course was severe with rapid progression, e.g. loss of visual fixation, need for tube feeding and then an early death. Gait disorders were the first symptoms in all patients of the later onset groups; progression was variable. The different forms of the disease were characterized by different MRI patterns (infantile: diffuse white matter involvement and cerebellar structures specifically affected, later onset: parieto-occipital white matter and splenium affected, adult: motor tracts specifically affected).

Conclusion

This is the first description of the natural history of Krabbe disease in a larger European cohort using developmental, clinical and MRI data. We would like to highlight the very different clinical and MRI characteristics of the later onset forms. These data are important for counselling affected patients and families and may serve as a basis for future treatment trials.
Hidden scars: the impact of violence and the COVID-19 pandemic on children’s mental health
Authors: Maalla M’jid Najat
Published: September 2020

More than 1 billion children are exposed to violence every year. The devastating immediate and long-term impact of violence on the mental health of children is well established. Despite commitments made by the international community to end violence against children and support their mental health, there has been a serious lack of investment and capacity to provide quality, rights-based, culturally appropriate mental health care globally. The arrival of the COVID-19 pandemic has magnified these challenges. This article outlines how the risk of children experiencing violence has increased and how the pandemic has weakened the capacity of child protection and mental health services to respond. The article argues for child protection, mental health and other core services to be prioritized during and after the pandemic. A failure to do so will undermine the international community’s ability to achieve the Sustainable Development Goals by 2030 and to fulfil its obligations under the UN Convention on the Rights of the Child.
Machine intelligence for nerve conduit design and production
Authors: Stewart Caleb E. , Kan Chin Fung Kelvin , Stewart Brody R. , Sanicola Henry W. , Jung Jangwook P. , Sulaiman Olawale A. R. , Wang Dadong
Published: September 2020

Nerve guidance conduits (NGCs) have emerged from recent advances within tissue engineering as a promising alternative to autografts for peripheral nerve repair. NGCs are tubular structures with engineered biomaterials, which guide axonal regeneration from the injured proximal nerve to the distal stump. NGC design can synergistically combine multiple properties to enhance proliferation of stem and neuronal cells, improve nerve migration, attenuate inflammation and reduce scar tissue formation. The aim of most laboratories fabricating NGCs is the development of an automated process that incorporates patient-specific features and complex tissue blueprints (e.g. neurovascular conduit) that serve as the basis for more complicated muscular and skin grafts. One of the major limitations for tissue engineering is lack of guidance for generating tissue blueprints and the absence of streamlined manufacturing processes. With the rapid expansion of machine intelligence, high dimensional image analysis, and computational scaffold design, optimized tissue templates for 3D bioprinting (3DBP) are feasible. In this review, we examine the translational challenges to peripheral nerve regeneration and where machine intelligence can innovate bottlenecks in neural tissue engineering.
Cytogenomic characterization of three murine malignant mesothelioma tumor cell lines
Authors: Wahlbuhl Eva , Liehr Thomas , Rincic Martina , Azawi Shaymaa
Published: September 2020

Background

Malignant mesothelioma (MM) is a rare aggressive cancer primary located in pleura and lung. MMs can be divided into biphasic, epithelioid and sarcomatoid subtypes. In majority of cases MMs are induced by asbestos fiber exposure. As latency period after asbestos exposure ranges between ~ 10 and 60 years MMs are mainly observed in elder people. Human MM, being a rare tumor type, lacks detailed cytogenetic data, while molecular genetic studies have been undertaken more frequently. However, murine MM cell lines are also regularly applied to get more insight into MM biology and to test new therapy strategies.

Results

Here the murine MM cell lines AB1, AB22 and AC29 were studied by molecular cytogenetics and molecular karyotyping. Interestingly, yet there were no genetic or genomic studies undertaken for these already in 1992 established cell lines. The obtained data on genomic imbalances in these murine cell lines was translated into the human genome as previously reported based on human and murine genomic browsers.

Conclusions

It turned out that all three cell lines showed high similarities in copy number variants as observed typically in human MM. Also, all three cell lines were most similar to human epithelioid MMs, and should be used as models therefore.
The threat of reduced efficacy of anthelmintics against gastrointestinal nematodes in sheep from an area considered anthelmintic resistance-free
Authors: Bosco Antonio , Kießler Jan , Amadesi Alessandra , Varady Marian , Hinney Barbara , Ianniello Davide , Maurelli Maria Paola , Cringoli Giuseppe , Rinaldi Laura
Published: September 2020

Background

The worldwide increased difficulty to combat gastrointestinal nematode (GIN) infection in sheep, due to progressing anthelmintic resistance (AR), calls for an enhanced and standardized implementation of early detection of AR. This study provides a snapshot of the current AR status against benzimidazoles and macrocyclic lactones in southern Italy, generated with standardized techniques.

Methods

On 10 sheep farms, the efficacy of albendazole (ALB) and either eprinomectin (EPR) or ivermectin (IVM) was evaluated based on the faecal egg count reduction test (FECRT) performed with the Mini-FLOTAC. For each tested drug, 40 sheep were rectally sampled at D0 and sampled again 14 days after the treatment (D14). The FECRT was calculated from individual samples and pooled samples which consist of 5 individual samples. Efficacy was classified as ‘reduced, ‘suspected’ and ‘normal’. Coprocultures were set for D0 and D14 faecal samples of each group. From farms with FECR < 95%, an in vitro egg hatch test (EHT) and a follow-up FECRT using fenbendazole (FBZ) were conducted.

Results

Based on the FECR, high efficacy (from 95.7% to 100%) was observed for ALB and IVM in eight farms (Farms 3–10). On Farm 1 and Farm 2, the efficacy for the macrocyclic lactones was classified as ‘normal’, but ‘reduced’ efficacy was observed for ALB on Farm 1 (FECR = 75%) and ‘suspected’ efficacy on Farm 2 (FECR = 93.3%) with the predominant GIN genus Trichostrongylus followed by Haemonchus at D14. The FEC results of pooled samples strongly correlated with those of individual samples, for FEC at D0 (rs = 0.984; P < 0.0001) and at D14 (rs = 0.913; P < 0.0001). The classifications of efficacy in Farm 1 (FECR = 86.0%) and Farm 2 (FECR = 93.0%) in the follow-up FECRT with FBZ coincide with the main FECRT trial. The in vitro EHT confirmed AR in both farms (Farm 1: 89%; Farm 2: 74%).

Conclusions

In regions like southern Italy, where the negative impacts from AR have played a minor role, efficient monitoring of AR is important in order to evaluate potential risks and being able to promptly respond with countermeasures.
A polyclonal allelic expression assay for detecting regulatory effects of transcript variants
Authors: Brandt Margot , Gokden Alper , Ziosi Marcello , Lappalainen Tuuli
Published: September 2020

We present an assay to experimentally test the regulatory effects of genetic variants within transcripts using CRISPR/Cas9 followed by targeted sequencing. We applied the assay to 32 premature stop-gained variants across the genome and in two Mendelian disease genes, 33 putative causal variants of eQTLs, and 62 control variants in HEK293T cells, replicating a subset of variants in HeLa cells. We detected significant effects in the expected direction (in 60% of variants), demonstrating the ability of the assay to capture regulatory effects of eQTL variants and nonsense-mediated decay triggered by premature stop-gained variants. The results suggest a utility for validating transcript-level effects of genetic variants.
The multi-biomarker disease activity test for assessing response to treatment strategies using methotrexate with or without prednisone in the CAMERA-II trial
Authors: Jurgens M. S. , Safy-Khan M. , de Hair M. J. H. , Bijlsma J. W. J. , Welsing P. M. J. , Tekstra J. , Lafeber F. P. J. G. , Sasso E. H. , Jacobs J. W. G. ,   on behalf of the Society for Rheumatology research Utrecht
Published: September 2020

Objectives

The CAMERA-II trial compared two tight-control, treat-to-target strategies, initiating methotrexate with prednisone (MTX+pred) or MTX with placebo (MTX+plac), in early RA-patients. The multi-biomarker disease activity (MBDA) blood test objectively measures RA disease activity with a score of 1–100. In CAMERA-II, response profiles of the MBDA score, its individual biomarkers, and DAS28 were assessed.

Methods

We evaluated 92 patients from CAMERA-II of whom clinical data and serum for MBDA testing at baseline and ≥ 1 time-point from months 1, 2, 3, 4, 5, 6, 9, or 12 were available. Changes (∆) from baseline for DAS28 and MBDA score and comparisons of ∆DAS28 and ∆MBDA score over time within the MTX+pred versus the MTX+plac strategy were tested for significance with t tests. Changes in biomarker concentration from baseline to months 1–5 were tested with Wilcoxon signed rank test and tested for difference between treatment arms by Mann-Whitney U test.

Results

MBDA and DAS28 showed similar response profiles, with gradual improvement over the first 6 months in the MTX+plac group, and in the MTX+pred group faster improvement during month 1, followed by gradual improvement. The 12 MBDA biomarkers could be grouped into 4 categories of response profiles, with significant responses for 4 biomarkers during the MTX+plac strategy and 9 biomarkers during the MTX+pred strategy.

Conclusions

MBDA tracked treatment response in CAMERA-II similarly to DAS28. More individual MBDA biomarkers tracked treatment response to MTX+pred than to MTX+plac. Four response profiles could be observed.

Trial registration

CAMERA-II International Standard Randomised Controlled Trial Number: ISRCTN 70365169. Registered on 29 March 2006, retrospectively registered.
Access to oral rehydration solution and zinc supplementation for treatment of childhood diarrhoeal diseases in Sudan
Authors: Mohamed Sagad Omer Obeid , Alawad Mansour Osman Alhaj , Ahmed Asaad Ahmed Mohammed , Mahmoud Ahmed Abdallah Ali
Published: September 2020

Objectives

The decline in diarrhoeal disease-related mortality globally has been attributed to the use of oral rehydration solution (ORS) and zinc supplementation. However, data on ORS and zinc supplementation in Sudan are scarce. We aimed to investigate the access to ORS and zinc treatments and the associated factors, through the analysis of the latest available data from Sudan-Multiple Indicator Cluster Survey (MICS)-2014 obtained from the United Nations Children’s Fund (UNICEF).

Results

A total of 14,081 children were included in this analysis. During the 2 weeks preceding the survey, 29.3% of these children had a diarrhoeal disease. Only 18.9% and 14.8% of these children had received ORS and zinc supplements, respectively. Whereas children from the higher wealth index groups were more likely to receive ORS treatment (fourth group: AOR = 1.301; 95% CI 1.006–1.682), children from rural areas were less likely to receive ORS treatment (AOR = 0.666; 95% CI 0.552–0.803) and zinc supplements (AOR = 0.603; 95% CI 0.500–0.728). The results indicate the existence of unequal access to treatment of childhood diarrhoeal diseases among children under 5 years in Sudan.
A mixed-type intraductal papillary mucinous neoplasm of the pancreas with a histologic combination of gastric and pancreatobiliary subtypes in a 70-year-old woman: a case report
Authors: Ismail Sawsan , Darwisho Rama , Ali Mohammed , Haidar Maen , Houreih Mohammad Adib , Alshehabi Zuheir
Published: September 2020

Background

Intraductal papillary mucinous neoplasms are rare papillary pancreatic neoplasms arising from major pancreatic ducts, characterized by duct dilation and mucin secretion. They comprise approximately 1% of all exocrine neoplasms and are classified according to their anatomical sites into main duct-type, branch duct-type, and mixed-type intraductal papillary mucinous neoplasms. Histological examination plays a crucial role in distinguishing and classifying intraductal papillary mucinous neoplasms into gastric, intestinal, pancreatobiliary, and oncocytic subtypes.

Case presentation

We present the case of a 70-year-old Syrian woman who was admitted to our hospital due to an intermittent epigastric pain accompanied by diarrhea and weight loss with a recent diagnosis of diabetes mellitus. Following clinical, laboratory, and radiological examination, distal pancreatectomy involving the body and the tail of the pancreas was performed. Interestingly, histological examination of the resected specimens revealed the diagnosis of a mixed-type intraductal papillary mucinous neoplasm with a unique combination of gastric and pancreatobiliary subtypes.

Conclusion

To the best of our knowledge, the combination of multiple histological subtypes of intraductal papillary mucinous neoplasms has been recorded in a few studies with reference to the challenging histological detection. Herein, we report a rare case with a significant histological combination, highlighting the difficulties in differential diagnosis due to the absence of ancillary techniques, with a brief review on diagnostic methods, histological characteristics and surgical recommendations.
The feasibility of [18F]EF5-PET/CT to image hypoxia in ovarian tumors: a clinical study
Authors: Laasik Maren , Hynninen Johanna , Forsback Sarita , Noponen Tommi , Seppänen Marko , Hietanen Sakari
Published: September 2020

Rationale

Evaluation of the feasibility of [18F]EF5-PET/CT scan in identifying hypoxic lesions in ovarian tumors in prospective clinical setting.

Methods

Fifteen patients with a suspected malignant ovarian tumor were scanned with [18F]EF5 and [18F]FDG-PET/CT preoperatively. The distribution of [18F]EF5-uptake, total intraabdominal metabolic tumor volume (TMTV), and hypoxic subvolume (HSV) were assessed.

Results

[18F]EF5-PET/CT suggested hypoxia in 47% (7/15) patients. The median HSV was 87 cm3 (31% of TMTV). The [18F]EF5-uptake was detected in primary tumors and in four patients also in intra-abdominal metastases. The [18F]EF5-uptake in cancer tissue was low compared to physiological excretory pathways, complicating the interpretation of PET/CT images.

Conclusions

[18F]EF5-PET/CT is not feasible in ovarian cancer imaging in clinical setting due to physiological intra-abdominal [18F]EF5-accumulation. However, it may be useful when used complementarily to FDG-PET/CT.
A new method based on stacked auto-encoders to identify abnormal weather radar echo images
Authors: Yang Ling , Wang Yun , Wang Zhongke , Qi Yang , Li Yong , Yang Zhipeng , Chen Wenle
Published: September 2020

It is not denied that real-time monitoring of radar products is an important part in actual meteorological operations. But the weather radar often brings out abnormal radar echoes due to various factors, such as climate and hardware failure. So it is of great practical significance and research value to realize automatic identification of radar anomaly products. However, the traditional algorithms to identify anomalies of weather radar echo images are not the most accurate and efficient. In order to improve the efficiency of the anomaly identification, a novel method combining the theory of classical image processing and deep learning was proposed. The proposed method mainly includes three parts: coordinate transformation, integral projection, and classification using deep learning. Furthermore, extensive experiments have been done to validate the performance of the new algorithm. The results show that the recognition rate of the proposed method can reach up to more than 95%, which can successfully achieve the goal of screening abnormal radar echo images; also, the computation speed of it is fairly satisfactory.
Defense against adversarial attacks in traffic sign images identification based on 5G
Authors: Wu Fei , Xiao Limin , Yang Wenxue , Zhu Jinbin
Published: September 2020

In the past decade, artificial intelligence and Internet of things (IoT) technology have been rapid development, gradually began to integrate with each other, especially in coming 5G era. Admittedly, image recognition is the key technology due to a huge number of video cameras integrated in intelligent IoT equipment, such as driverless cars. However, the rapidly growing body of research in adversarial machine learning has demonstrated that the deep learning architectures are vulnerable to adversarial examples. Thus, the raises questions about the security of intelligent Internet of thing (IoT) and trust sensitive areas. This emphasizes the urgent need for practical defense technology that can be deployed to real-time combat attacks at any time. Well-crafted small perturbations lead to the misclassification of legitimate images by neural networks, but not the human visual system. It is worth noting that many attack strategies are designed to disrupt image pixels in a visually imperceptible manner. Therefore, we propose a new defense method and take full advantage of 5G high-speed bandwidth and mobile edge computing (MEC) effectively. We use singular value decomposition (SVD) which is the optimal approximation of matrix in the sense of square loss to eliminate the perturbation. We have conducted extensive and large-scale experiments with German Traffic Sign Recognition Benchmark (GTSRB) datasets and the results show that adversarial attacks, such as Carlini-Wagner’sl2, Deepfool, and I-FSGM, can be better eliminated by the method and provide lower latency.
Standard reference values of the postural control in healthy female adults aged between 31 and 40 years in Germany: an observational study
Authors: Ohlendorf Daniela , Pflaum Julia , Wischnewski Christina , Schamberger Sebastian , Erbe Christina , Wanke Eileen M. , Holzgreve Fabian , Groneberg David A.
Published: September 2020

Background

To detect deviations from a normal postural control, standard values can be helpful for comparison purposes. Since the postural control is influenced by gender and age, the aim of the present study was the collection of standard values for women between 31 and 40 years of age.

Methods

For the study, 106 female, subjectively healthy, German subjects aged between 31 and 40 years (35 ± 2.98 years) were measured using a pressure measuring platform.

Results

Their average BMI was 21.60 ± 4.65 kg/m2. The load distribution between left and right foot was almost evenly balanced with a median 51.46% load on the left [tolerance interval (TR) 37.02%/65.90%; confidence interval (CI) 50.06/52.85%] and 48.54% [TR 43.10/62.97%; CI 47.14/49.93%] on the right foot. The median forefoot load was 33.84% [TR 20.68/54.73%; CI 31.67/37.33%] and the rearfoot load was measured at 66.16% [TR 45.27/79.33%; CI 62.67/68.33%]. The median/mean body sway in the sagittal plane was measured 12 mm [TR 5.45/23.44 mm; CI 11.00/14.00 mm] and 8.17 mm in the frontal plane [TR 3.33/19.08 mm; CI 7.67/9.33 mm]. The median of the ellipse area is 0.72 cm2 [TR 0.15/3.69 cm2; CI 0.54/0.89°]. The ellipse width has a median of 0.66 cm [TR 0.30/1.77 cm; CI 0.61/0.78 cm] and the height of 0.33 cm [TR 0.13/0.71 cm; CI 0.30/0.37 cm]. The ellipse angle (sway, left forefoot to right rearfoot) has a mean of − 19.34° [TR − 59.21/− 0.44°; CI − 22.52/− 16.16°] and the ellipse angle sway from right forefoot to left rearfoot has a mean of 12.75° [TR 0.09/59.09°; CI 9.00/16.33°].

Conclusion

The right-to-left ratio is balanced. The forefoot-to-rearfoot ratio is approximately 1:2. Also, the body sway can be classified with 12 and 8 mm as normal. The direction of fluctuation is either approx. 19° from the left forefoot to the right rearfoot or approx. 13° the opposite. Body weight, height, and BMI were comparable to the German average of women in a similar age group, so that the measured standard values are representative and might serve as baseline for the normal function of the balance system in order to support the diagnosis of possible dysfunctions in postural control.
Early clinical course after hematopoietic stem cell transplantation in children with juvenile metachromatic leukodystrophy
Authors: Beschle Judith , Döring Michaela , Kehrer Christiane , Raabe Christa , Bayha Ute , Strölin Manuel , Böhringer Judith , Bevot Andrea , Kaiser Nadja , Bender Benjamin , Grimm Alexander , Lang Peter , Müller Ingo , Krägeloh-Mann Ingeborg , Groeschel Samuel
Published: September 2020

Background

Long-term outcomes of hematopoietic stem cell transplantation (HSCT) in children with juvenile metachromatic leukodystrophy (MLD) have been investigated systematically, while short-term effects of HSCT on the course of the disease remain to be elucidated.

Results

In this study, the clinical course was evaluated over the first 24 months following HSCT, conducted at our center in 12 children with juvenile MLD (mean follow-up 6.75 years, range 3–13.5) and compared with 35 non-transplanted children with juvenile MLD. Motor function (GMFM-88 and GMFC-MLD), cognitive function (FSIQ), peripheral neuropathy (tibial nerve conduction velocity), and cerebral changes (MLD-MR severity score) were tested prospectively.

Seven children remained neurologically stable over a long period, five exhibited rapid disease progression over the first 12 to 18 months after transplantation. In the latter, time from first gross motor symptoms to loss of independent walking was significantly shorter compared with non-transplanted patients at the same stage of disease (p < 0.02). Positive prognostic factors were good motor function (GMFM = 100%, GMFC-MLD = 0) and a low MR severity score (≤ 17) at the time of HSCT.

Conclusions

Our results show that if disease progression occurs, this happens early on after HSCT and proceeds faster than in non-transplanted children with juvenile MLD, indicating that HSCT may trigger disease progression.
Synergy in fertility forecasting: improving forecast accuracy through model averaging
Authors: Shang Han Lin , Booth Heather
Published: September 2020

Accuracy in fertility forecasting has proved challenging and warrants renewed attention. One way to improve accuracy is to combine the strengths of a set of existing models through model averaging. The model-averaged forecast is derived using empirical model weights that optimise forecast accuracy at each forecast horizon based on historical data. We apply model averaging to fertility forecasting for the first time, using data for 17 countries and six models. Four model-averaging methods are compared: frequentist, Bayesian, model confidence set, and equal weights. We compute individual-model and model-averaged point and interval forecasts at horizons of one to 20 years. We demonstrate gains in average accuracy of 4–23% for point forecasts and 3–24% for interval forecasts, with greater gains from the frequentist and equal weights approaches at longer horizons. Data for England and Wales are used to illustrate model averaging in forecasting age-specific fertility to 2036. The advantages and further potential of model averaging for fertility forecasting are discussed. As the accuracy of model-averaged forecasts depends on the accuracy of the individual models, there is ongoing need to develop better models of fertility for use in forecasting and model averaging. We conclude that model averaging holds considerable promise for the improvement of fertility forecasting in a systematic way using existing models and warrants further investigation.
Effects of some entomopathogenic fungi on the aphid species, Aphis gossypii Glover (Hemiptera: Aphididae)
Authors: Bayındır Erol Alime , Abdelaziz Ouidad , Birgücü Ali Kemal , Senoussi Mohamed Morad , Oufroukh Ammar , Karaca İsmail
Published: September 2020

Background

Effects of the entomopathogenic fungi Beauveria bassiana, Verticillium alfalfae, and Trichoderma viride; secondary metabolites of MS1 (B. bassiana) and MS2 (V. alfalfae); and Dimethoate active substances on the aphid species, Aphis gossypii Glover (Hemiptera: Aphididae), were tested.

Main body of the abstract

Fungus isolates were prepared as 107 conidia ml−1 of spore suspensions and applied on the 2nd instar nymphs of A. gossypii. After the applications, evaluations were made on the 1st, 3rd, 5th, and 7th days by counting the live individuals. Obtained data were 100 and 93% mortality rate at MS1 (B. bassiana) and MS2 (V. alfalfae), and secondary metabolites were recorded in the 3rd day count results. On the 5th day counts, the highest mortality rates after secondary metabolites were statistically at the same group with B. bassiana, T. viride, and dimethoate. On the 7th day, counting results of all experiment groups were analyzed statistically and were found effective.

Short conclusion

Obtained results showed that the fungal secondary metabolites might be useful when utilized as a biocontrol agent against the aphids.
Psychiatric presentation of patients with acute SARS-CoV-2 infection: a retrospective review of 50 consecutive patients seen by a consultation-liaison psychiatry team
Authors: Iqbal Yousaf , Al Abdulla Majid Ali , Albrahim Sultan , Latoo Javed , Kumar Rajeev , Haddad Peter M.
Published: September 2020

Background

Reports of psychiatric morbidity associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection tend to be limited by geography and patients’ clinical status. Representative samples are needed to inform service planning and research.

Aims

To describe the psychiatric morbidity associated with SARS-CoV-2 infection (confirmed by real-time polymerase chain reaction) in referrals to a consultation-liaison psychiatry service in Qatar.

Method

Retrospective review of 50 consecutive referrals.

Results

Most patients were male. Median age was 39.5 years. Thirty-one patients were symptomatic (upper respiratory tract symptoms or pneumonia) for coronavirus disease 2019 (COVID-19) and 19 were asymptomatic (no characteristic physical symptoms of COVID-19 infection). Seventeen patients (34%) had a past psychiatric history including eight with bipolar I disorder or psychosis, all of whom relapsed. Thirty patients (60%) had physical comorbidity. The principal psychiatric diagnoses made by the consultation-liaison team were delirium (n = 13), psychosis (n = 9), acute stress reaction (n = 8), anxiety disorder (n = 8), depression (n = 8) and mania (n = 8). Delirium was confined to the COVID-19 symptomatic group (the exception being one asymptomatic patient with concurrent physical illness). The other psychiatric diagnoses spanned the symptomatic and asymptomatic patients with COVID. One patient with COVID-19 pneumonia experienced an ischaemic stroke. Approximately half the patients with mania and psychosis had no past psychiatric history. Three patients self-harmed. The commonest psychiatric symptoms were sleep disturbance (70%), anxiety (64%), agitation (50%), depressed mood (42%) and irritability (36%).

Conclusions

A wide range of psychiatric morbidity is associated with SARS-CoV-2 infection and is seen in symptomatic and asymptomatic individuals. Cases of psychosis and mania represented relapses in people with schizophrenia and bipolar disorder and also new onset cases.
Mortality risk factors among National Football League players: An analysis using player career data
Authors: Ehrlich Justin , Kmush Brittany , Walia Bhavneet , Sanders Shane
Published: September 2020

In general, National Football League (NFL) players tend to live longer than the general population. However, little information exists about the long-term mortality risk in this population. Frequent, yet mild, head trauma may be associated with early mortality in this group of elite athletes. Therefore, career playing statistics can be used as a proxy for frequent head trauma. Using data from Pro Football Reference, we analyzed the association between age-at-death, position, and NFL seasons-played among 6,408 NFL players that were deceased as of July 1, 2018. The linear regression model allowing for a healthy worker effect demonstrated the best fit statistics (F-statistic = 9.95, p-value = 0.0016). The overall association of age-at-death and seasons-played is positive beginning at the 10.75 and 10.64 seasons-played point in our two models that feature seasons-played and seasons-played squared as explanatory variables. Previous research that does not account for this survivorship bias/healthy worker effect may not adequately describe mortality risk among NFL players.
O mapeamento da área de risco à jusante do lago Igapó em Londrina – PR - Brasil, no caso de rompimento hipotético da barragem
Authors: Prado Alves Junior Agostinho , Osvaldo Osvaldo Coelho Pereira Neto
Published: September 2020

O Lago Igapó é uma área de lazer localizada na cidade de Londrina no Estado do Paraná – Brasil, sendo uma das mais belas áreas de lazer da cidade. Nos cinco últimos anos o grande volume de águas das fortes chuvas ocasionaram a saturação do nível de água da barragem do lago. Dessa forma, este trabalho buscou produzir através de software de Sistema de Informação Geográfica (SIG), mapas de declividade e mapas de classificação com potencial área de risco. Dessa forma, os mapas temáticos desenvolvidos fornecerão um cenário conforme a classificação das áreas de risco caso ocorra o rompimento da barragem do Lago Igapó. A base cartográfica escolhida permitiu selecionar a curva de nível 525 metros por esta cota contornar o Lago por quase toda sua extensão até ao limite de crescimento da área urbana da cidade de Londrina. Mesmo verificando que a água diminui na cota de 525 metros ao longo do trajeto do Lago, o impacto na cota de 525 será mantido. No entanto, o impacto será maior nas cotas menores, principalmente nas cotas abaixo de 515 metros. Dessa forma, as classes de uso do solo, permitirá identificar as áreas vulneráveis, identificando os locais que podem ser classificados como área de baixo e alto risco.
Interaction between stress hormones and phagocytic cells and its effect on the health status of dairy cows: A review
Authors: Alhussien Mohanned Naif , Dang Ajay Kumar
Published: September 2020

Dairy cows are exposed to various stressors during their production cycle that makes them more susceptible to various diseases. Phagocytes (neutrophils and macrophages) are important soldiers of the innate immune system. Neutrophils are the first responders to an inflammatory response and stress and kill pathogens by generating reactive oxygen species and by the release of various antimicrobial peptides, enzymes, neutrophil extracellular trap formation, etc. Macrophages, the other phagocytes, are also the cleanup crew for the innate immune system that removes debris, pathogens, and dead neutrophils later on after an inflammatory response. The neuroendocrine system along with phagocytes exhibits an immunomodulatory potential during stressful conditions. Neuroendocrine system directly affects the activity of phagocytes by communicating bidirectionally through shared receptors and messenger molecules such as hormones, neurotransmitters, or cytokines. Different immune cells may show variable responses to each hormone. Short time exposure to stress can be beneficial, but repeated or extended exposure to stress may be detrimental to the overall health and well-being of an animal. Although some stresses associated with farming practices in dairy cows are unavoidable, better understanding of the interactions occurring between various stress hormones and phagocytic cells can help to reduce stress, improve productivity and animal welfare. This review highlights the role played by various stress hormones in modulating phagocytic cell performance of dairy cattle under inflammatory conditions.