bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic significance of preinjury anticoagulation in patients with traumatic brain injury: A systematic review and meta-analysis
Authors: Lim Xin Tian , Ang Eshen , Lee Zong Xuan , Hajibandeh Shahin , Hajibandeh Shahab 
Published: October 2020

BACKGROUND
Traumatic brain injury (TBI) is a leading cause of injury-related deaths and neurological disability globally. Considering the widespread anticoagulant use among the aging population, we aimed to perform a systematic review and meta-analysis to evaluate the prognostic significance of preinjury anticoagulation in TBI patients.

METHODS
This systematic review was conducted according to a predefined protocol (International Prospective Register of Systematic Reviews CRD42020192323). In compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-Analysis of Observational Studies in Epidemiology standards, a structured electronic database search was undertaken to identify all observational studies comparing preinjury anticoagulation with no preinjury anticoagulation in TBI patients. The primary outcome measure was overall mortality. The secondary outcome measures comprised in-hospital mortality, length of hospital stay, length of intensive care unit stay, need for neurosurgical procedure, and number of patients discharged home. All outcome data were analyzed using random effects modeling.

RESULTS
Twelve comparative studies enrolling a total of 4,417 patients were included. Preinjury anticoagulation was associated with higher risk of overall mortality (odds ratio [OR], 2.39; 95% confidence interval [CI], 1.63–3.50, p < 0.00001), in-hospital mortality (OR, 2.47; 95% CI, 1.56–3.93, p = 0.0001), and longer length of intensive care unit stay (mean difference, 1.06; 95% CI, 0.54–1.57; p < 0.0001) compared with no preinjury anticoagulation. No statistical difference was observed in length of hospital stay (mean difference, −2.15; 95% CI, −5.36 to 1.05, p = 0.19), need for neurosurgical procedure (OR, 1.30; 95% CI, 0.70–2.44; p = 0.41), and discharged home (OR, 0.76; 95% CI, 0.55–1.04; p = 0.09) between the two groups.

CONCLUSION
Preinjury anticoagulation is a powerful prognosticator of mortality in TBI patients. This highlights the need for dedicated triage and trauma team activation protocols considering earlier intervention and more aggressive imaging in all anticoagulated patients. Future studies should focus on strategies that can potentially reduce the risk of mortality in this population. The prognostic significance of direct oral anticoagulants versus warfarin remains unanswered.

LEVEL OF EVIDENCE
Systematic review and meta-analysis of observational studies, level III.
Ethinyl estradiol sulfate acts without fluid resuscitation through estrogen receptors to rapidly protect the cardiovascular system from severe hemorrhage
Authors: Hubbard William J. , Yang Shaolong , Chaudry Irshad H. 
Published: October 2020

BACKGROUND
Our in vivo rodent and pig model evidenced that estrogen and its derivative, ethinyl estradiol sulfate (EES), promote survival following hemorrhagic shock. To determine its mechanism, we first confirmed EES binding to estrogen receptor (ER) and improving/restoring cellular signaling, countering the assumption that EES, an ethinyl estradiol metabolite, is inactive. In addition, we examined if EES acts rapidly, consistent with nongenomic signaling. We selected the biomarkers of cardiovascular performance, reduction of apoptosis and proinflammatory responses, and elaboration of nitric oxide (NO) to validate efficacy.

METHODS
A rat trauma-hemorrhage model, consisting of a midline laparotomy and controlled bleeding (60% blood loss) without fluid resuscitation, was used. At 30 minutes after hemorrhage, heart performance was monitored, and Western blots were used to quantify biochemical analytes. The specificity of EES for ER was profiled with ER antagonists. Binding studies by Sekisui XenoTech (Kansas City, KS) determined an LD50 value for EES binding the rat ER.

RESULTS
The EES IC50 value was 1.52 × 10−8 Mol/L, consistent with pharmacologic efficacy. Ethinyl estradiol sulfate raised mean arterial pressure and ±derivative of pressure over time (dP/dT) significantly (but did not fully restore) within a 30-minute window. Levels of apoptosis and activation of NF-κB were dramatically reduced, as was elaboration of nitric oxide (NO) by inducible nitric oxide synthase. Phospho-endothelial nitric oxide synthase (eNOS) was restored to physiological levels. The restoration of cellular signaling occurs before restoration of cardiac contractility.

CONCLUSION
Ethinyl estradiol sulfate is a potent drug for improving heart performance, which also dramatically reduces damage by apoptosis, proinflammatory activity, and NO production, validating that EES can blunt multiple harmful outcomes arising from hypoxia and hypovolemia. The actions are dependent on receptor engagement, where specificity is confirmed by ER antagonists. The constraint of a 30-minute sampling window affirms that the responses are nongenomic and very likely restricted to cell-surface receptor engagement. The rapidity of these responses makes EES promising for intervention in the “golden hour.”
Characteristics and clinical features of SARS-CoV-2 infections among ambulatory and hospitalized children and adolescents in an integrated health care system in Tennessee
Authors: Howard Leigh M. , Garguilo Kathryn , Gillon Jessica , Seegmiller Adam C. , Schmitz Jonathan E. , Webber Steven A. , Halasa Natasha B. , Banerjee Ritu 
Published: October 2020

AbstractBackgroundLittle is known regarding the full spectrum of illness among children with SARS-CoV-2 infection across ambulatory and inpatient settings.MethodsActive surveillance was performed for SARS-CoV-2 by polymerase chain reaction among asymptomatic and symptomatic individuals in a quaternary care academic hospital laboratory in Tennessee from March 12-July 17, 2020. For symptomatic patients ≤18 years of age, we performed phone follow-up and medical record review to obtain sociodemographic and clinical data on days 2, 7, and 30 after diagnosis and on day 30 for asymptomatic patients ≤18 years. Daily and 7-day average test positivity frequencies were calculated for children and adults beginning April 26, 2020.ResultsSARS-CoV-2 was detected in 531/10327 (5.1%) specimens from patients ≤18 years, including 46/5752 (0.8%) asymptomatic and 485/4575 (10.6%) specimens from 459 unique symptomatic children. Cough (51%), fever (42%), and headache (41%) were the most common symptoms associated with SARS-CoV-2 infection. SARS-CoV-2-related hospitalization was uncommon (18/459 children; 4%); no children with SARS-CoV-2 infection during the study period required intensive care unit admission. Symptom resolution occurred by follow-up day 2 in 192/459 (42%), by day 7 in 332/459 (72%), and by day 30 in 373/396 (94%). The number of cases and percent positivity rose in late June and July in all ages.ConclusionsIn an integrated healthcare network, most pediatric SARS-CoV-2 infections were mild, brief, and rarely required hospital admission, despite increasing cases as community response measures were relaxed.Key pointsIn an integrated healthcare network in the Southeastern United States, symptomatic SARS-CoV-2 infection in children was generally mild, resolved rapidly, and rarely required hospitalization. Cases increased in children and adults as community mitigation measures became less restrictive.
What Specimen Urologists Should Be Most Concerned About ? A Systematic Review and Meta-Analysis
Authors: Roshandel M. Reza , Nateqi Masoud , Lak Ramin , Aavani Pooya , Motlagh Reza Sari , Badr Tannaz Aghaei , Sfakianos John , Kaplan Steven A. , Shariat Shahrokh F. , Tewari Ashutosh K. 
Published: October 2020

AbstractObjectiveInvestigating the infectivity of body fluid can be useful for preventative measures in the community and ensuring safety in the operating rooms and on the laboratory practices.MethodsWe performed a literature search of clinical trials, cohorts, and case series using PubMed/MEDLINE, Google Scholar, and Cochrane library, and downloadable database of CDC. We excluded case reports and searched all-language articles for review and repeated until the final drafting. The search protocol was registered in the PROSPERO database.ResultsThirty studies with urinary sampling for viral shedding were included. A total number of 1,271 patients were enrolled initially, among which 569 patients had undergone urinary testing. Nine studies observed urinary viral shedding in urine from 41 patients. The total incidence of urinary SARS-CoV-2 shedding was 8%, compared to 21.3% and 39.5 % for blood and stool, respectively. The summarized risk ratio (RR) estimates for urine positive rates compared to the pharyngeal rate was 0.08. The pertaining RR urine compared to blood and stool positive rates were 0.20 and 0.33 respectively.ConclusionsOur review concludes that not only the SARS-CoV-2 can be excreted in the urine in eight percent of patients but also its incidence may have associations with the severity of the systemic disease, ICU admission, and fatality rates. Moreover, the findings in our review suggest that a larger population size may reveal more positive urinary cases possibly by minimizing biases. However, it is important to notice that it is the naso-pharyngeal specimens, stool, and serum that show more possibilities to became positive, respectively.Take-home bullet points❖The urinary shedding incidence was 8%, compared to 21.3% and 39.5 % for blood and stool, respectively.❖Urinary shedding may have associations with the severity of the systemic disease, ICU admission, and fatality rates.❖Repeat urinary testing is warranted throughout the disease phases, especially in clinically suspected cases with an initially negative results.❖Technical errors in handling samples, as well as different rRT-PCR methods can be responsible for diversity found in results, in part.
Prevalence and Determinants of Premarital Sexual Practice Among Youths in Ethiopia: Further analysis of the Ethiopian Demographic and Health Survey
Authors: Getie Kegnie Shitu , Kassie Ayenew , Woldie Maereg 
Published: October 2020

AbstractIntroductionPremarital sexual practice becomes a common phenomenon among youths in Ethiopia. It is usually associated with an unwanted pregnancy, abortion, and sexually transmitted diseases including HIV/AIDS.ObjectiveThis study aimed to assess the prevalence and determinants of premarital sexual practice among Ethiopian youths.Methods and MaterialsA Community-based cross-sectional study was conducted in all regions of Ethiopia from January 18 to June 27, 2016. All participants from the age of 15-24 (7, 389) were included for the analysis of the present study. Bivariable and multivariable binary logistic regression analytical models were fitted to identify factors associated with the premarital sexual practice. A 95% CI and p-value < 0.05 were used to declare statistical significance.ResultThe prevalence of premarital sexual practice was 10.8% (95% CI, 10 % – 11.5%). Being in the age group of 20 - 24 (AOR = 3.6, 95% CI (2.8, 4.6)), male sex (AOR = 1.7, 95% CI (1.3, 2.2)), employed (AOR = 1.4, 95% CI (1.03, 1.8)), from pastorals region (AOR= 1.4, 95% CI (1.3,2.4)), having mobile phone (AOR=1.7, 95% CI, (1.3, 2.3)), ever use of internet (AOR = 1.8, 95% CI (1.3, 2.5)), ever drinking alcohol AOR = 2.4, 95% CI (1.7, 2.5)), ever chewed khat (AOR = 2.4, 95% CI (1.6, 3.5), and ever tested for HIV (AOR = 1.3, 95% CI (1.1,1.6)) were a statistically significant factors associated with premarital sexual practice at p value less than 0.05.ConclusionFor every 10 youths at least one of them had sexual intercourse before they got married. Being in the age group of 20 - 24, male sex, employed, from a pastoral region, having a mobile phone, ever use of the internet, alcohol drinking, khat chewing, and ever tested for HIV were significant factors associated with the premarital sexual practice. Thus, national sexual education and reproductive health behavior change interventions should give due attention for those groups. Indeed, adequate education should be given about premarital sexual intercourse when youths come for HIV test.
Explaining the Effective Reproduction Number of COVID-19 through Mobility and Enterprise Statistics: Evidence from the First Wave in Japan
Authors: Kajitani Yoshio , Hatayama Michinori 
Published: October 2020

AbstractThis study uses mobility statistics combined with business census data for the eight Japanese prefectures with the highest COVID-19 infection rates to study the effect of mobility reductions on the effective reproduction number (i.e., the average number of secondary cases caused by one infected person). Mobility statistics are a relatively new data source created by compiling smartphone location data. Based on data for the first wave of infections in Japan, we found that reductions targeting the hospitality industry were more effective than restrictions on general business activities. Specifically, we found that to hold back the pandemic (that is, to reduce the effective reproduction number to one or less for all days), a 20-35% reduction in weekly mobility is required, depending on the region. A lesser goal, 80% of days with one or less observed transmission, can be achieved with a 6-30% reduction in weekly mobility. These are the results if other potential causes of spread are ignored; more careful observations and expanded data sets are needed.
A rapid and cost-effective multiplex ARMS-PCR method for the simultaneous genotyping of the circulating SARS-CoV-2 phylogenetic clades
Authors: Islam Md. Tanvir , Alam A. S. M. Rubayet Ul , Sakib Najmuj , Hasan Md. Shazid , Chakrovarty Tanay , Tawyabur Md. , Islam Ovinu Kibria , Al-Emran Hassan M. , Jahid Iqbal Kabir , Hossain M. Anwar 
Published: October 2020

SummaryTracing the globally circulating SARS-CoV-2 mutants is essential for the outbreak alerts and far-reaching epidemiological surveillance. The available technique to identify the phylogenetic clades through high-throughput sequencing is costly, time-consuming, and labor-intensive that hinders the viral genotyping in low-income countries. Here, we propose a rapid, simple and cost-effective amplification-refractory mutation system (ARMS)-based multiplex reverse-transcriptase PCR assay to identify six distinct phylogenetic clades: S, L, V, G, GH, and GR. This approach is applied on 24 COVID-19 positive samples as confirmed by CDC approved real-time PCR assay for SARS-CoV-2. Our multiplex PCR is designed in a mutually exclusive way to identify V-S and G-GH-GR clade variants separately. The pentaplex assay included all five variants and the quadruplex comprised of the triplex variants alongside either V or S clade mutations that created two separate subsets. The procedure was optimized in the primer concentration (0.2-0.6 µM) and annealing temperature (56-60°C) of PCR using 3-5 ng/µl cDNA template synthesized upon random- and oligo(dT)-primer based reverse transcription. The different primer concentration for the triplex and quadruplex adjusted to different strengths ensured an even amplification with a maximum resolution of all targeted amplicons. The targeted Sanger sequencing further confirmed the presence of the clade-featured mutations with another set of our designed primers. This multiplex ARMS-PCR assay is sample, cost-effective, and convenient that can successfully discriminate the circulating phylogenetic clades of SARS-CoV-2.
Value CMR: Towards a Comprehensive, Rapid, Cost-Effective Cardiovascular Magnetic Resonance Imaging
Authors: Ibrahim El-Sayed H. , Frank Luba , Baruah Dhiraj , Rubenstein Jason C. , Arpinar V. Emre , Nencka Andrew S. , Koch Kevin M. , Muftuler L Tugan , Unal Orhan , Stojanovska Jadranka , Charlson John , Gore Elizabeth M. , Bergom Carmen 
Published: October 2020

AbstractCMR is considered the gold standard for measuring heart function, including cardiac volumes and mass. Further, in a single CMR exam, information about cardiac function, structure, tissue composition, and blood flow could be obtained. Nevertheless, CMR is underutilized due to long scanning times, the need for multiple breath-holds, use of a contrast agent, and relatively higher cost compared to echocardiography.In this study, we propose a rapid CMR exam based on recent developments in imaging sequences. The proposed exam is both rapid and provides comprehensive cardiovascular information without the need for a contrast agent or multiple breath-holds. The developed exam includes advanced sequences for evaluating global and regional cardiac functions, myocardial tissue characterization, and flow hemodynamics in the heart, valves, and large vessels. Time-consuming conventional sequences have been replaced by advanced sequences, which resulted in reducing scan time from > 1 hour with conventional CMR exam to <20 minutes with the proposed rapid CMR exam. Specifically, conventional two-dimensional (2D) cine and phase-contrast (PC) sequences have been replaced by optimized three-dimensional (3D)-cine and four-dimensional (4D)-flow sequences, respectively. Compared to 2D cine imaging that requires 12-16 separate breath-holds, the implemented 3D-cine sequence allows for whole heart coverage in 1-2 breath-holds; thus, reducing scan time by 80-90%. Similarly, compared to 2D PC flow imaging that requires multiple breath-holds and the presence of an experienced cardiac operator for precise prescription of the imaging planes, the implemented 4D-flow sequence allows for whole-chest coverage in ∼10-minute, free-breathing acquisition without the need for a navigator echo, which makes scan time independent of the patient’s breathing pattern. Furthermore, conventional myocardial tagging has been replaced by the fast strain-encoding (SENC) sequence, which reduces scan time from one slice per breath-hold to only one slice per heartbeat (∼1 second). Finally, T1 and T2 mapping sequences are included in this proposed exam, which allow for myocardial tissue characterization without the need for contrast. The proposed rapid exam has been tested on volunteers and measurements showed good agreement with those from conventional sequences despite the significant reduction in scan time.In conclusion, we propose a rapid, contrast-free, and comprehensive cardiovascular exam that does not require repeated breath-holds or a cardiac experienced operator to run the exam, which would result in improving cost effectiveness of CMR and increasing its adoption in clinical practice.
Discovering early imaging biomarkers of osteoradionecrosis in oropharyngeal cancer by characterization of temporal changes in computed tomography mandibular radiomic features
Authors: Barua Souptik , Elhalawani Hesham , Volpe Stefania , Feghali Karine Al , Yang Pei , Ng Sweet Ping , Elgohari Baher , Granberry Robin C. , Mackin Dennis S. , Gunn G. Brandon , Hutcheson Katherine A. , Chambers Mark S. , Court Laurence E. , Mohamed Abdallah , Fuller Clifton D. , Lai Stephen Y. , Rao Arvind 
Published: October 2020

AbstractOsteoradionecrosis (ORN) is a major side-effect of radiation therapy in oropharyngeal cancer (OPC) patients. In this study, we demonstrate that early prediction of ORN is possible by analyzing the temporal evolution of mandibular subvolumes receiving radiation. For our analysis, we use computed tomography (CT) scans from 21 OPC patients treated with Intensity Modulated Radiation Therapy (IMRT) with subsequent radiographically-proven ≥ grade II ORN, at three different time points: pre-IMRT, 2-months, and 6-months post-IMRT. For each patient, radiomic features were extracted from a mandibular subvolume that developed ORN and a control subvolume that received the same dose but did not develop ORN. We used a Multivariate Functional Principal Component Analysis (MFPCA) approach to characterize the temporal trajectories of these features. The proposed MFPCA model performs the best at classifying ORN vs Control subvolumes with an area under curve (AUC) = 0.74 (95% confidence interval (C.I.): 0.61-0.90), significantly outperforming existing approaches such as a pre-IMRT features model or a delta model based on changes at intermediate time points, i.e. at 2- and 6-month follow-up. This suggests that temporal trajectories of radiomics features derived from sequential pre- and post-RT CT scans can provide markers that are correlates of RT-induced mandibular injury, and consequently aid in earlier management of ORN.
Successive epidemic waves of cholera in South Sudan, 2014 - 2017
Authors: Jones Forrest K , Wamala Joseph F , Rumunu John , Mawien Pinyi Nyimol , Tut Kol Mathew , Wohl Shirlee , Deng Lul , Pezzoli Lorenzo , Omar Linda Haj , Lessler Justin , Quilici Marie-Laure , Luquero Francisco J , Azman Andrew S 
Published: October 2020

AbstractBackgroundBetween 2014 and 2017, successive cholera epidemics occurred in South Sudan within the context of civil war, population displacement, flooding, and drought. Understanding the determinants of cholera spread in complex settings like this can provide valuable insights for mitigating future cholera risk.MethodsWe analyzed cholera linelist and molecular data to describe the spatio-temporal progression of the epidemics. We explored the role of rainfall, population movement and vaccination campaigns in shaping the explaining incidence and the spatial distribution of reported cases.FindingsSouth Sudan experienced three distinct cholera epidemic waves of cholera ranging from 6-18 months with more than 28,000 cases reported and more than 2 million cholera vaccine doses delivered to curb transmission. The 2014 and 2015 epidemics remained spatially limited while the 2016/17 epidemic exploded along the Nile river. Initial cases of each epidemic were reported in or around Juba soon after the start of the rainy season, but we found no evidence that rainfall modulated transmission during each epidemic. All isolates analyzed had similar genotypic and phenotypic characteristics, closely related to sequences from Uganda and Democratic Republic of Congo. The direction of large-scale population movements between counties with cholera outbreaks was consistent with the spatial distribution of outbreaks. As of September 2020, zero cholera cases have been confirmed within South Sudan since 2017.InterpretationThe three epidemic waves were caused byV. choleraeof the same clonal origin despite the periods of no reported cases between waves. While the complex emergency likely shaped some of the observed spatial and temporal patterns of reported cases, the full scope of transmission determinants remains unclear. Timely and well targeted use of cholera vaccine can avert cases and deaths, however, most of the vaccine campaigns occurred after the epidemic peak highlighting the challenges of delivering vaccines quickly in response to an outbreak in settings like South Sudan. These analyses provide a multi-faceted template for examining cholera dynamics through epidemiological, microbiological, climatic, and behavioral lenses.FundingTheBill and Melinda Gates Foundation