bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heterozygous, Polyploid, Giant Bacterium,Achromatium, Possesses an Identical Functional Inventory Worldwide across Drastically Different Ecosystems
Authors: Ionescu Danny , Zoccarato Luca , Zaduryan Artur , Schorn Sina , Bizic Mina , Pinnow Solvig , Cypionka Heribert , Grossart Hans-Peter 
Published: November 2020

AbstractAchromatium is large, hyperpolyploid and the only known heterozygous bacterium. Single cells contain approximately 300 different chromosomes with allelic diversity far exceeding that typically harbored by single bacteria genera. Surveying all publicly available sediment sequence archives, we show that Achromatium is common worldwide, spanning temperature, salinity, pH, and depth ranges normally resulting in bacterial speciation. Although saline and freshwater Achromatium spp. appear phylogenetically separated, the genus Achromatium contains a globally identical, complete functional inventory regardless of habitat. Achromatium spp. cells from differing ecosystems (e.g., from freshwater to saline) are, unexpectedly, equally functionally equipped but differ in gene expression patterns by transcribing only relevant genes. We suggest that environmental adaptation occurs by increasing the copy number of relevant genes across the cell’s hundreds of chromosomes, without losing irrelevant ones, thus maintaining the ability to survive in any ecosystem type. The functional versatility of Achromatium and its genomic features reveal alternative genetic and evolutionary mechanisms, expanding our understanding of the role and evolution of polyploidy in bacteria while challenging the bacterial species concept and drivers of bacterial speciation.
Congress of Neurological Surgeons Systematic Review and Evidence-Based Guideline on Neuroablative Procedures for Patients With Cancer Pain
Authors: Raslan Ahmed M , Ben-Haim Sharona , Falowski Steven M , Machado André G , Miller Jonathan , Pilitsis Julie G , Rosenberg William S , Rosenow Joshua M , Sweet Jennifer , Viswanathan Ashwin , Winfree Christopher J , Schwalb Jason M 
Published: November 2020

Abstract

BACKGROUND
Managing cancer pain once it is refractory to conventional treatment continues to challenge caregivers committed to serving those who are suffering from a malignancy. Although neuromodulation has a role in the treatment of cancer pain for some patients, these therapies may not be suitable for all patients. Therefore, neuroablative procedures, which were once a mainstay in treating intractable cancer pain, are again on the rise. This guideline serves as a systematic review of the literature of the outcomes following neuroablative procedures.

OBJECTIVE
To establish clinical practice guidelines for the use of neuroablative procedures to treat patients with cancer pain.

METHODS
A systematic review of neuroablative procedures used to treat patients with cancer pain from 1980 to April 2019 was performed using the United States National Library of Medicine PubMed database, EMBASE, and Cochrane CENTRAL. After inclusion criteria were established, full text articles that met the inclusion criteria were reviewed by 2 members of the task force and the quality of the evidence was graded.

RESULTS
In total, 14 646 relevant abstracts were identified by the literature search, from which 189 met initial screening criteria. After full text review, 58 of the 189 articles were included and subdivided into 4 different clinical scenarios. These include unilateral somatic nociceptive/neuropathic body cancer pain, craniofacial cancer pain, midline subdiaphragmatic visceral cancer pain, and disseminated cancer pain. Class II and III evidence was available for these 4 clinical scenarios. Level III recommendations were developed for the use of neuroablative procedures to treat patients with cancer pain.

CONCLUSION
Neuroablative procedures may be an option for treating patients with refractory cancer pain. Serious adverse events were reported in some studies, but were relatively uncommon. Improved imaging, refinements in technique and the availability of new lesioning modalities may minimize the risks of neuroablation even further.
The full guidelines can be accessed at https://www.cns.org/guidelines/browse-guidelines-detail/guidelines-on-neuroablative-procedures-patients-wi.
Perceptions of the Benefits and Risks of Antibiotics Among Adult Patients and Parents With High Antibiotic Utilization
Authors: Spicer Jennifer O , Roberts Rebecca M , Hicks Lauri A 
Published: November 2020

Abstract

Background
Inappropriate antibiotic use is common. Understanding how patients view antibiotic risks and/or benefits could inform development of patient education materials and clinician communication strategies. We explored current knowledge, attitudes, and behaviors related to antibiotics among populations with high antibiotic use.

Methods
We conducted 12 focus groups with adult patients and parents across the United States by telephone in March 2017. Purposive sampling was used to identify participants with high antibiotic use. We transcribed the discussions verbatim and performed thematic analysis.

Results
We identified 4 major themes. First, participants expressed uncertainty regarding which clinical syndromes required antibiotics, and emotion often influenced their desire for antibiotics. Second, they had a limited understanding of antibiotic risks. Antibiotic resistance was viewed as the primary risk but was seen as a “distant, future” issue, whereas immediate adverse events, such as side effects, were minimized; however, patients expressed concern when told about the risk of serious adverse events. Third, they prioritized antibiotic benefits over risks in their decision-making, both due to an inaccurate estimation of antibiotic risks and/or benefits and a tendency to prioritize instant gratification. Fourth, most participants were willing to defer to their clinicians’ decisions about antibiotics, especially if their clinician provided symptomatic treatment and anticipatory guidance.

Conclusions
Patients have a limited understanding of antibiotic risks, potentially explaining why they are willing to try antibiotics even if it is unclear antibiotics will help. Educating patients on the potential antibiotic risks versus benefits, rather than just antibiotic resistance, may have a bigger impact on their decision-making.
Ethical challenges in the treatment of non-refugee migrants with tuberculosis in Canada
Authors: Silva Diego S , Cook Victoria J , Johnston James C , Gardy Jennifer 
Published: November 2020

Abstract
While attention to the ethical issues that migrants face in accessing tuberculosis care has increased in the last few years, most of the attention has focused on challenges that refugees face when emigrating. Less attention has been given to ethical challenges that arise in the context of providing tuberculosis treatment and care to non-refugee migrants in high-income countries (HIC), particularly those that do not face immediate danger or violence. In this paper, we analyze some of the ethical challenges associated with treating migrants with tuberculosis in the Canadian context. In particular, we will discuss (i) inter- and intra-jurisdictional issues that challenge quotidian public health governance structures, and (ii) the ethical imperative for the Canadian government and its provinces to clearly differentiate access to healthcare from a person’s immigration status to help overcome power imbalances that may exist between public health workers and their clients. The arguments presented herein could potentially apply to other HIC with some form of universal health coverage.
Randomized clinical trials of cardiovascular disease in obstructive sleep apnea: understanding and overcoming bias
Authors: Pack Allan I , Magalang Ulysses J , Singh Bhajan , Kuna Samuel T , Keenan Brendan T , Maislin Greg 
Published: November 2020

AbstractThree recent randomized control trials (RCTs) found that treatment of obstructive sleep apnea (OSA) with continuous positive airway pressure (CPAP) did not reduce rates of future cardiovascular events. This article discusses the biases in these RCTs that may explain their negative results, and how to overcome these biases in future studies.First, sample selection bias affected each RCT. The subjects recruited were not patients typically presenting for treatment of OSA. In particular, subjects with excessive sleepiness were excluded due to ethical concerns. As recent data indicate that the excessively sleepy OSA subtype has increased cardiovascular risk, subjects most likely to benefit from treatment were excluded. Second, RCTs had low adherence to therapy. Reported adherence is lower than found clinically, suggesting it is in part related to selection bias. Each RCT showed a CPAP benefit consistent with epidemiological studies when restricting to adherent patients, but was underpowered.Future studies need to include sleepy individuals and maximize adherence. Since it is unethical and impractical to randomize very sleepy subjects to no therapy, alternative designs are required. Observational designs using propensity scores, which are accepted by FDA for studies of medical devices, provide an opportunity. The design needs to ensure covariate balance, including measures assessing healthy user and healthy adherer biases, between regular users of CPAP and non-users. Sensitivity analyses can evaluate the robustness of results to unmeasured confounding, thereby improving confidence in conclusions. Thus, these designs can robustly assess the cardiovascular benefit of CPAP in real-world patients, overcoming biases in RCTs.
4-Hydroxyhalcone effects on cisplatin-induced genotoxicity model
Authors: Nazari Aref , Mirian Mina , Aghaei Mahmoud , Aliomrani Mehdi 
Published: November 2020

Abstract

Background
The genotoxicity of cisplatin (CP) as a platinum-based antineoplastic agent due to its oxidative stress induction was well known. In this research, we examined 4-hydroxychalcone (4-HCH) as a natural food that presents flavonoid effects on reactive oxygen species (ROS) production and CP-induced in vivo genotoxicity.

Method and materials
Cytotoxicity of CP and 4-HCH was measured on human embryonic kidney 293 cells with MTT assay. Then, intracellular ROS content at IC50 concentration of CP was measured with 2′,7′-dichlorofluorescein diacetate (DCFDA) dye. Finally, 4-HCH was administered intraperitoneally at 10 and 40 mg/kg/BW doses as a pre and post-treatment schedule in a mice model of CP genotoxicity (7 mg/kg). Acridine-orange-stained bone marrow cells were quantified for micronucleus presence examination.

Results
The calculated IC50 of CP and 4-HCH were reported around 19.4 and 133.6 μM, respectively, on HEK293 cells. Also, it was observed that 4-HCH at 0.2, 2 and 10 μM concentrations did not show obvious cytotoxicity. The fluorimetry confirmed that pre-treatment with 10 μM and co-treatment with 2 μM of 4-HCH could attenuate the CP-induced ROS production (P &lt; 0.05 and P &lt; 0.01, respectively). Also, the lowest micronucleated cells were seen in 10 mg/kg 4-HCH-treated group after CP exposure (39 ± 7.9, P &lt; 0.0001).

Discussion
Our results demonstrated the antigenotoxic action of 4-HCH in CP-treated mice bone marrow cells for the first time in both concentrations of 10 and 40 mg/kg especially in the form of co-treatment. Further studies required clinical application of this compound in a combination of CP to attenuate the normal cells’ genotoxicity side effects.
A High Psychological and Somatic Symptom Profile and Family Health Factors Predict New or Persistent Pain During Early Adolescence
Authors: Voepel-Lewis Terri , Seng Julia S. , Chen Bingxin , Scott Eric L. 
Published: November 2020

Objectives:
Persistent or recurrent pain is common among adolescents and is associated with poor functioning. The purpose of this study was to determine whether preteens who present with pain, and higher, co-occurring psychological and somatic symptoms (PSS) are at higher risk for persistent pain than other children.

Materials and Methods:
We conducted a secondary analysis of the longitudinal Adolescent Brain and Cognitive Development database (version 2.0.1) that includes 11,863 children aged 9 to 12 years. We differentiated children into baseline Pain/PSS profiles using the Child Behavior Checklist assessments of pain, cognitive-fogginess, somatic symptoms, depression, and anxiety and the Sleep Disorder Survey-Children somnolence subscale. We examined whether Pain/PSS profile predicted 1-year new/persistent pain when controlled for child characteristics and intergenerational mental health factors.

Results:
Four profiles were differentiated: No Pain/Low PSS, No Pain/High PSS, Pain/Low PSS, Pain/High PSS. Trauma exposure and family symptoms were associated with increased odds of being in the higher PSS groups. Baseline symptom profile predicted 14% of the variance in new/persistent pain at 1-year. Compared with the No Pain/Low PSS group, an increased odds of 1-year new or persistent pain was found in children with No Pain/High PSS (adjusted odds ratio [OR]: 1.44; [95% confidence interval: 1.14, 1.82]), Pain/Low PSS (adjusted OR: 4.69 [4.01, 5.48]) and Pain/High PSS (adjusted OR: 5.48 [4.35, 6.91]).

Discussion:
Preteen children with higher comorbid Pain/PSS symptomology were at higher risk for new or persistent pain at 1 year when controlled for important child and family characteristics. Findings support the importance of considering co-occurring symptoms when evaluating children with pain.
Hemoglobin Concentration May Influence the Incidence of Postoperative Transient Neurological Events in Patients With Moyamoya After Extracranial-intracranial Arterial Bypass: A Retrospective Single Center Experience
Authors: Mendez Nicholas V. , Chen Catherine , Richardson Angela M. , Morcos Jacques J. , Deepika Krishnaprasad 
Published: November 2020

Background:
Moyamoya is a rare condition characterized by cerebral angiographic findings of intracranial carotid artery stenosis with abnormal net-like vessels in the brain, and often presents as transient ischemic attacks or intracranial hemorrhage. Revascularization in the form of extracranial-intracranial (EC-IC) artery bypass has demonstrated efficacy in preventing ischemic attacks and intracranial hemorrhage, although it is associated with a relatively high rate of perioperative ischemic and hemorrhagic stroke. This retrospective analysis aims to evaluate the possible association between postoperative hemoglobin (Hgb) concentration and early postoperative transient neurological events (TNEs) experienced at our center.

Methods:
Consecutive patients undergoing EC-IC bypass between January 1, 2017 and August 31, 2019 were identified, resulting in a study population of 24 patients with 34 individual cases for different cerebral hemispheres. Postoperative Hgb level was evaluated upon arrival to the intensive care unit (ICU) and the primary outcome was the occurrence of TNEs within 24-hours after surgery.

Results:
The incidence of TNEs within 24 hours postoperatively was 12% (n=4). Statistically significant differences were demonstrated between patients who did and did not experience TNEs in the postoperative period: total Hgb value (mean 9.4 vs. 11.3 g/dL, respectively; P=0.012) and percentage of patients with Hgb <10 g/dL (75% vs. 20%, respectively; P=0.048). Patients with a postoperative Hgb value <10 g/dL upon arrival to the ICU were significantly more likely to experience TNEs (odds ratio, 12; 95% confidence interval, 1.053-136.794; P=0.045).

Conclusions:
This study reports a possible association between postoperative Hgb level and the occurrence of TNEs within the first 24 hours after surgery in patients undergoing EC-IC for moyamoya.
Potential benefits, mechanisms, and uncertainties of convalescent plasma therapy for COVID-19
Authors: Dai Weiqian , Gu Haihui , Hao Sha 
Published: November 2020

Abstract
The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in China led to a public health emergency of international concern, putting all health organizations on high alert in the beginning of 2020. Corona virus disease 2019 (COVID-19) is highly infectious and has resulted in thousands of deaths which exceeded that of the SARS coronavirus (SARS-CoV) outbreak back in 2002 and 2003 in China. Besides, the number of diagnosed patients, patients who are suspected to have contracted the disease, and deaths are increasing worldwide. Unfortunately, effective drugs and vaccines to combat SARS-CoV-2 are still lacking. Convalescent plasma, a seemingly successful treatment for COVID-19 patients, proved to be of huge value in terms of saving severely ill patients. This review introduces the reported effects, potential mechanisms, and future uncertainties of convalescent plasma therapy in the treatment of COVID-19 patients, in the hopes that it will provide useful information for relevant physicians and researchers.
SUSPENDED SCATTERING PARTICLES IN MOTION MAY INFLUENCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY VESSEL DENSITY METRICS IN EYES WITH DIABETIC MACULAR EDEMA
Authors: Maltsev Dmitrii S. , Kulikov Alexei N. , Kazak Alina A. , Freund K. Bailey 
Published: November 2020

Purpose:
To study the effect of the suspended scattering particles in motion (SSPiM) on optical coherence tomography angiography (OCTA) vessel density metrics in eyes with diabetic macular edema (DME).

Methods:
Thirty-four eyes with DME from 27 patients (16 men and 11 women; 61.4 ± 9.6 years) with DME were included in this retrospective cohort study. Among these eyes, 19 (55.9%) showed the SSPiM artifact on OCTA. All participants received 3-mm and 6-mm optical coherence tomography angiography (OCTA) imaging. Perfusion density and skeletonized vessel density were calculated for the superficial capillary plexus (SCP) and the deep capillary plexus (DCP), and these were compared between eyes with and without SSPiM. Additionally, foveal vessel density in a 300-µm-wide region around the foveal avascular zone (FVD) was evaluated on 3-mm OCTA scans. The main outcome measures were vessel density in the SCP and the DCP.

Results:
Among the 3-mm OCTA images, there was no statistically significant difference in SCP vessel density in eyes with and without SSPiM (P = 0.98). Vessel density in the DCP (P = 0.001 and P = 0.028 for perfusion and skeletonized vessel density, respectively) and FVD (P = 0.03) on 3-mm OCTA scans were significantly higher in DME eyes with SSPiM than in those without SSPiM. There were no statistically significant differences in vessel density in SCP and DCP between eyes with and without SSPiM based on 6-mm OCTA scans.

Conclusion:
The presence of SSPiM may lead to an overestimation of DCP vessel density in eyes with DME when 3-mm OCTA scans are used for analysis.
Coronavirus Surveillance in a Pediatric Population in Jordan From 2010 to 2013
Authors: Haddadin Zaid , Chappell James , McHenry Rendie , Pulido Claudia Guevara , Rahman Herdi , Gu Wenying , Rankin Danielle A. , Talj Rana , Howard Leigh M. , Williams John V. , Faouri Samir , Shehabi Asem , Khuri-Bulos Najwa , Halasa Natasha B. 
Published: November 2020

Background:
Human coronaviruses (HCoVs) are a significant cause of acute respiratory illness (ARI) in children; however, the role of HCoVs in ARI among hospitalized children in the Middle East is not well defined.

Methods:
Children under 2 years admitted with fever and/or respiratory symptoms were enrolled from 2010 to 2013 in Amman, Jordan. Nasal/throat swabs were collected and stored for testing. Demographic and clinical characteristics were collected through parent/guardian interviews and medical chart abstractions. Prior stored specimens were tested for HCoVs (HKU1, OC43, 229E and NL63) by qRT-PCR.

Results:
Of the 3168 children enrolled, 6.7% were HCoVs-positive. Among HCoV-positive children, the median age was 3.8 (1.9–8.4) months, 59% were male, 14% were premature, 11% had underlying medical conditions and 76% had viral-codetection. The most common presenting symptoms were cough, fever, wheezing and shortness of breath. HCoVs were detected year-round, peaking in winter-spring months. Overall, 56%, 22%, 13% and 6% were OC43, NL63, HKU1 and 229E, respectively. There was no difference in disease severity between the species, except higher intensive care unit admission frequency in NL63-positive subjects.

Conclusions:
HCoVs were detected in around 7% of children enrolled in our study. Despite HCoV detection in children with ARI with highest peaks in respiratory seasons, the actual burden and pathogenic role of HCoVs in ARI merits further evaluation given the high frequency of viral codetection.
Postbaccalaureate Premedicine Programs: A Path to Diversity in Physician Assistant Education
Authors: Gillum J. Barton 
Published: November 2020

Abstract
The importance of diversity in the physician assistant (PA) profession is well understood. Some of the benefits of diversity include improved patient care and patient satisfaction. In recent times, efforts at increasing diversity in PA education have involved implementing a holistic admissions process and targeted recruitment of applicants who are underrepresented in medicine. Historically, postbaccalaureate programs have been an effective tool for increasing enrollment of both underrepresented and disadvantaged matriculants in medical school. A larger than expected proportion of these students go on to work with underserved patient populations. The authors suggest that similar postbaccalaureate programs could help underrepresented and disadvantaged students be successful in PA education.
Predictors of Attrition Among Accelerated and Traditional Physician Assistant Students
Authors: Wolf Corri , Ahmed Anoma Zehra , Schmidt Gordon , Winter Sara 
Published: November 2020

Purpose
Students can be admitted to a physician assistant program via an accelerated bachelor of science/master of science (BS/MS) track or by a postbaccalaureate track. The purpose of this study was to identify predictors of student attrition based on differences in modes of admission.

Methods
Student admissions and retention data were collected for 277 students in the physician assistant program at the New York Institute of Technology from the graduation years 2016 to 2020. A t-test was used to analyze differences among admissions methods for the following variables: age, cumulative grade point average (GPA), science GPA, and patient contact hours.

Results
A total of 10.4% (n = 29) of students from the total enrollment left the program for academic reasons. These students had a significantly lower cumulative GPA (3.54 vs. 3.71) and science GPA (3.45 vs. 3.68), and fewer patient contact hours (951 vs. 1720) at admission (p < .05). Furthermore, 44 students entered via the BS/MS track, and 41% (n = 18) were dismissed for academic reasons. This group of 18 BS/MS students comprised 62% of all students dismissed for academic reasons over the past 5 years. When considering only BS/MS students, those who left for academic reasons had a significantly lower science GPA (3.37 vs. 3.62, p < .05) than those who successfully completed the program.

Conclusions
Having dual tracks of entry resulted in varying degrees of academic preparation and, for our institution, a disproportionate number of students from the accelerated track being dismissed despite meeting published admissions criteria.