Objective The study aimed at assessing trans-placental transmission of Chlamydia trachomatis (CT) and fetal survival at birth among CT infected mothers. Study Design This is a non-interventional prospective cohort study. Population /Study Setting The study was conducted among two thousand and fourteen pregnant women attending antenatal clinic at the Cape Coast Teaching Hospital. Methodology Cord blood from neonates born to one hundred and twelve (112) pregnant women whose cervical samples were positive for CT at first ANC visit were screened by Polymerase Chain Reaction (PCR) for CT infection. Transplacental transmission of CT was considered when CT DNA type-specific agreement was observed between the samples of maternal cervical specimen and the corresponding neonatal cord blood. A neonate who did not survive at birth at > 28weeks gestation or 1000g birthweight is considered stillbirth. Results There were one hundred and one (101) live births and eleven (11) stillbirths. Of the 101 live births, two (2) of the cord bloods were CT DNA positive whereas nine (9) of the eleven (11) stillbirths were cord blood positive for CT DNA. The two (2) neonates with cord blood positive for CT DNA developed early onset neonatal sepsis. There is therefore, a strong evidence that trans-placental CT infection is associated with stillbirth P< 0.001; OR, 38.5 ; 95% CI (6.91 – 412.3). Conclusion Antibiotic prophylaxis for pregnant women at risk for CT infection is recommended. Routine screening for all pregnant women should be considered for prenatal care in medium to long term planning.

From April 2018 to December 2019, we recruited 31 volunteers with mild cognitive impairment and 33 volunteers in the healthy control group from the residents of Wuxi City’s community. Relevant researches on resting state functional magnetic resonance and human plasma markers were done respectively; Studies have shown that there are differences in brain function between the MCI group and the healthy control group, which is similar to previous studies[1]; It is worth noting that most plasma markers and cerebrospinal fluid, apolipoprotein gene E have no significant difference, Most previous studies of the same kind have shown anomalies[2], and we speculate that this difference may be related to ethnic or regional differences[3, 4]. Next, we will expand the sample size to further verify this guess.

Objective To compare use of the copper intrauterine device (IUD) after immediate compared to delayed insertion following medical abortion (MA) at 17-20 gestational weeks (GW). Design Randomized controlled trial Setting One tertiary hospital and five community healthcare centres in South Africa Population Women admitted August 2018 to June 2019 for elective MA at 17-20 GW Methods Women were randomized to immediate (within 24 hours) or delayed (3 weeks post-abortion) insertion of the copper IUD. Follow-up was at 6 weeks, 3 and 6 months. Study outcomes were compared by intention-to-treat (ITT) and per-protocol analyses. Main outcomes Use of the original IUD, and use of any IUD at 6 weeks post-abortion (ITT) Results In the immediate (n=55) and delayed arms (n=57) respectively, 82% and 21% received the IUD as planned. By ITT, 56% in the immediate and 19% in the delayed arms were using the original IUD at six weeks (p<0.001), 76% in the immediate and 40% in the delayed arms were using any IUD (p<0.001). Loss-to-follow-up at 6 weeks was 2%. Complete expulsion or removal occurred in 14 (31%) in the immediate and 1 (7%) in the delayed arms (p=0.004). Conclusions Insertion of an IUD immediately after MA at 17-20 GW results in increased use after 6 weeks compared to delayed insertion. Expulsion rates are higher than interval insertion and immediate insertion at earlier gestation, but similar to immediate postpartum insertion. Key words Second trimester, medical abortion, IUD Clinical trials registration: clinicaltrials.gov/ (ID NCT03505047), Pan African Trials Registry (www.pactr.org), ID PACTR201804003324963

The beet armyworm, Spodoptera exigua, is a multifeeding insect pest, which has developed high resistance to chlorantraniliprole, a benzoylurea insecticide that targets on the ryanodine receptors (RyRs). However, few studies have been conducted on the highly resistant strain. Here, the resistant strain (SE-Sel) and sensitive strain (SE-Sus) were obtained by bidirectional screening for 6 generations. The potential oviposition and oviposition rate of the SE-Sel strain were dramatically lower than those of the SE-Sus strain, on the contrary the weights of prepupae and preadult were significantly increased. And the expression levels of vitellogenin (SeVg) and its receptor (SeVgR) in the SE-Sel strain were consistently lower than those in the SE-Sus strain. The RyRI4765M mutation and the upregulation of detoxification genes, such as SeABCOK, SeGST15, SeGSTZ2, SeCarEs1, CYP6AEW and SeCYP6AB10, contributed to the evolution of resistance to chlorantraniliprole. The RyRI4765M mutation could affect neuropeptide activation, and it conduced to the upregulated expression of the neuropeptide SeNPF and its receptor, SeNPFR, which could inhibit courtship behavior and reduce oviposition. And the neuropeptide SeNPF could influence the expression of juvenile hormone-binding protein and juvenile hormone diol kinase, and it led to the downregulated expression of SeVg. Therefore, these results indicate that the fitness cost accompanied by chlorantraniliprole resistance in S. exigua is related to the wicked evolution of RyR.

Pharmacometrics is an emerging science that interprets drug, disease and trial information in a mathematical fashion to inform and facilitate efficient drug development and/or regulatory decisions. Pharmacometric study is increasingly adopted in the regulatory review of new antimicrobial agents. We summarized and reviewed the 31 antimicrobial agents approved by the US Food and Drug Administration (FDA) and the 26 antimicrobial agents approved by European Medicines Agency (EMA) from January 2001 to May 2019. Regulatory concerns in pharmacometric review of antimicrobial agents were expounded with examples, including modeling and simulation methods, effects of internal/external factors on PK parameters, safety and efficacy evaluation in terms of exposure-response analysis, refinement of the wording of product labeling and package leaflet, and possible post-marketing clinical trial. Ongoing communication among regulators, academia, and industry regarding pharmacometrics is encouraged to streamline and facilitate the development of new antimicrobial agents. The industry can maximize its benefit in drug development through continued pharmacometric education/training.

Senior-Løken syndrome is a rare genetic disorder which presents with nephronophthisis and retinal degeneration, leading to end-stage renal disease and progressive blindness. The most frequent cause of juvenile nephronophthisis is mutation in the nephronophthisis type 1 (NPHP1) gene. NPHP1 encodes the protein nephrocystin-1, which functions at the transition zone (TZ) of primary cilia. Here we report a 9-year-old Senior-Løken syndrome patient with NPHP1 deletion, who presents with a decreased electroretinogram consistent with early retinal degeneration. The patient had undergone bilateral nephrectomy and a renal transplant. Immunohistochemistry and electron microscopy of the resected kidney showed disorganized cystic structures with loss of cilia in renal tubules. Phosphoinositides have been recently recognized as critical components of the ciliary membrane and immunostaining of kidney sections for phosphoinositide 5-phosphatases (INPP5E) showed loss of staining compared to a healthy control. The decreased expression of INPP5E specifically in the primary cilium, coupled with disorganized cilia morphology, suggests a novel role of NPHP1 that it is involved in regulating ciliary phosphoinositide in the ciliary membrane of renal tubular cells.

A document by Asami Fukuda. Click on the document to view its contents.

Population bottlenecks associated with founder events strongly impact the establishment and character of populations. Founding individuals bring along symbionts, which can affect the host establishment, dynamics and evolution. Thus, to understand introductions and invasions, we should identify the roles played by accompanying symbionts. In 1991, a parasitoid wasp and its associated hyperparasitoid were accidentally introduced from the main Åland islands to an isolated island in the archipelago, along with their host, the Glanville fritillary butterfly. The species have persisted as small populations since. A strain of the endosymbiotic bacterium Wolbachia has an intermediate prevalence across the main Åland parasitoid population. The infection increases susceptibility of the parasitoid to hyperparasitism. We investigated the establishment and dynamics of the parasitoid, along with pattern of prevalence of the symbiont using 324 specimens collected between 1992 and 2013, from five localities across Åland, including the source and introduced populations. Using 14 microsatellites and one mitochondrial marker, we suggest that occasional migration between the islands might have facilitated the persistence of all isolated populations, despite local population crashes. We also show local near-fixation of Wolbachia, where the hyperparasitoid is absent, and selection against infected host genotypes is relaxed.

Unicornuate uterus with pregnancy in the non-communicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment.

Understanding the impact of historical and demographic processes on genetic variation is essential for devising conservation strategies and predicting responses to climate change. Recolonizations after Pleistocene glaciations and population's positions within species ranges are expected to leave distinct genetic signatures. However, the general applicability of these patterns and relative importance of historical and demographic factors remains unknown. Here, we analysed the distribution of genetic variation in 91 native species of North American plants by coupling microsatellite data and Species Distribution Modelling. We tested the contributions of historical climatic shifts and the central-marginal hypothesis on genetic diversity and structure. Decreased diversity was found with increased distance from potential glacial refugia, coinciding with the expected make-up of postglacially colonised localities. At the range periphery, lower genetic diversity, higher inbreeding levels and genetic differentiation were reported, following the assumptions of the central-marginal hypothesis. History and demography were found to have approximately equal importance in shaping genetic variation.

This paper describes an in-depth methodical approach to the development of efficient high frequency (HF) antennas for usage in radio frequency identification (RFID) systems operating at 13.56MHz. It presents brief theory relevant to RFID communication and sets up a framework within which features and requirements of antennas are linked to key design parameters such as antenna form-factor and size; RF power level, materials and communication protocol. Tuning circuits necessary to adjust the resonance and power matching characteristics of antennas for good transponder interrogation and response recovery are discussed. To validate the approaches outlined, a complete step-wise antenna design and measurement described. Common practical problems that are often encountered in such design processes are also commented on.

The following provides excerpts from the reviews of the manuscript along with responses to them from the authors of the paper (italicized).Referee #1 (Report openly available here after publication of the article)Detailed Report

Background Patients with end-stage renal disease have an increased risk of cardiac events. Although preemptive renal transplantation decreases mortality that is associated with dialysis, coronary artery disease remains as the primary cause of mortality even after transplantation. In this context, diabetic patients are more prone to adverse cardiac events. We aimed to compare the incidence of coronary artery disease and long-term survival rates in preemptive and non-preemptive diabetic renal transplantation recipients. Methods Diabetic patients with end-stage renal disease who underwent coronary angiography before renal transplantation were included retrospectively. These patients were divided into two groups as preemptive and non-preemptive according to transplantation strategy. Angiographic findings, particularly the severity of coronary artery disease, were compared between the two groups. Long-term all-cause mortality rates were also compared. Results A total of 164 patients were included in the study. Of these patients, 125 (78%) were male, and the median age was 54 (Q1-Q3=45-59). The extent of coronary artery disease, revascularization rates SYNTAX and Gemini scores were similar between the two groups (all p>0.05). During 4,8 years of follow-up was there was no statistical difference in all-cause mortality rates (HR=0.59,[0.20–0.71],p[log-rank]=0,33). Multivariate Cox regression analysis revealed that only age and hyperlipidemia were predictive of all-cause mortality (HR=1.03 [1.001-1.07], p=0.04 and HR=2.75 [1.20-6.28], p=0.01 respectively) Conclusion The prevalence, severity and revascularization rates of coronary artery disease were similar between the preemptive and non-preemptive diabetic renal transplant recipients. Also, there was no statistical difference in all-cause mortality rates during long-term follow-up. Keywords Kidney, coronary, diabetes, transplantation, preemptive What’s known? : Although preemptive kidney transplantation is advantageous since dialysis is not applied, cardiovascular diseases are the most important cause of morbidity. What’s new: Comparison of patients with and without preemptive transplantation in the diabetic patient group in terms of coronary artery disease and survival has not been performed

OBJECTİVE In this study, we aim to investigate the thoughts and attitudes of individuals towards the future COVID-19 vaccine. METHODS This descriptive study was carried out on the web between 10/06/2020 - 10/07/2020. The sample constitutes all individuals above 18 years of age using social media and smartphone. The e-survey form was shared by the researchers via the web for a month, and those who completed the survey were included in the study and formed the sample of the research. RESULTS 759 were participated. 49.7% of the participants stated to be vaccinated; 38.4% of them stated to be vaccinated their children against COVID-19; if the vaccine for COVID-19 is developed. The request for the COVID 19 vaccine had relationship with gender, occupation, health insurance, anxiety level, having children, willing to get vaccinated for their children. “Afraid of the side effects of vaccine”, “don’t think it can be reliable as it will be a new vaccine” and “COVID-19 infection is a biological weapon and the vaccine will serve those who produce this virus” were the most common reasons for rejection of vaccine. CONCLUSION In our study afraid of the side effects of vaccine and not thinking it can be reliable as it will be a new vaccine is the most reasons of indecision and rejection about COVID 19 vaccine. In order for the future COVID 19 vaccination campaign to not fail, media, politicians, healthcare professionals should closely follow the vaccination development processes, inform the public transparently and consider public’s concerns.

Objective: To determine the current state of urgent neurologic in-hospital consultations, this study investigated urgent neurologic in-hospital consultations in a large tertiary hospital in China over a 4-year period. Methods: We conducted a retrospective study of urgent neurologic in-hospital consultations in a large tertiary hospital for 4 consecutive years (Jan. 1, 2014 to Dec. 31, 2017). The clinical data of patients who received urgent neurologic in-hospital consultations were obtained from the electronic medical record system and analyzed. Results: A total of 1437 cases (age range: 9–103 years old; average age: 60.3; males: 54.6%) were included in the study; 57.5% of the consultations were in line with urgent consultation criteria. The departments applying for urgent consultation involved 29Twenty-nine clinical departments were involved in the urgent consultations. consciousness disorder (36.0%), tics/stiffness (13.6%), limb weakness (8%), and mental disorders (5.6%). Urgent consultation diseases were divided into three categories: neurological diseases (77.8%), non-neurological non-neurological diseases (10.4%), and undiagnosed diseases (11.8%). The common neurological disorders included urgent cerebrovascular disease (33.6%), epilepsy/status epilepticus (15.8%), and metabolic or infective toxic encephalopathy (14.9%). Conclusions: Most urgent neurologic consultation is in line with consultations followed the guidelines for urgent neurologic consultation criteria. Non-neurologic. Non-neurological physicians in clinics should enrich their knowledge of frequently occurring urgent and critical neurological diseases.

Here, we report a case of PNH with gastroduodenal lesions likely caused by transient mucosal ischemia due to thrombosis. When patients with PNH present with abdominal symptoms, thrombosis-induced gastrointestinal injury should be considered. Recognition of gastric patchy redness on esophagogastroduodenoscopy may help make the diagnosis of this potentially serious complication.

Abstract Background The benefits of hospital clinical pharmacy services are well established, though staff numbers required for its delivery have not been well described, leading to variation in pharmacy staffing between hospitals. The need to identify a consistent, objective method of determining staffing levels was recognised at a UK University Hospital and a Clinical Pharmacy Workforce Calculator (CPWC) was developed. Objective To report on the validation of the CPWC across acute hospital settings in Great Britain. Method Using the World Health Organisation’s Workload Indicators of Staffing Need (WISN) methodology, a two-round Delphi consensus study with an Expert Panel of UK hospital pharmacy managers was undertaken to develop the Activity Standard for pharmaceutical care and to identify the time unavailable for clinical work inherent in employing staff. Consenting Panel members then tested the CPWC by calculating the staff resource required for three staffing scenarios to determine whether it could be reliably used by different operators. Results Thirty-six participants consented to participate, and data was returned from 22 participants (61%) of whom 20 (56%) supplied analysable data. Consensus was achieved on the tasks required for pharmaceutical care delivery, the mean time each takes, the frequency of completion and the unavailable time in the employment of each grade of staff identified. The CPWC uses this data in an algorithm to calculate staffing requirements. Eleven participants (55%) tested the CPWC and analysis of their responses showed that 31 of 33 (94%) calculations were accurately completed using the CPWC. Conclusion This study has defined the WISN Activity Standard for pharmaceutical care delivery to hospital inpatients and validated the CPWC for acute medical and surgical hospital settings. The CPWC offers hospital pharmacy managers a useful tool to negotiate adequate staffing to deliver pharmaceutical care and its development methodology could be applied widely in pharmacy practice internationally.

Pulmonary Vein Thrombosis (PVT) is a rare and insidious condition with only few case series and case reports described in literature. PVT effects on pulmonary circulation is similar to mitral stenosis and its haemodynamic consequences depend on the number of veins involved, the obstruction severity and the pulmonary vessels compliance. Here we present a case in which a multimodality approach with Transesophageal Echocardiography (TEE) and Computed Tomography (CT) imaging helped to guide therapeutic decisions. Specifically, a post-processing reconstruction of TEE projection directly from CT imaging was performed.

Introduction: Coronary artery fistula (CAF) is a rare cardiac anomaly that typically presents as a continuous murmur in an otherwise asymptomatic patient. Occasionally, it can result in congestive heart failure or bacterial endocarditis. Objective: To better delineate the course of coronary artery fistula using an intracoronary injection of SonoVue contrast agent, whilst performing transthoracic echocardiography. Method and results: A referred 46-year-old male, with a history of exertional dyspnea for almost three months, was admitted to the hospital with progressive dyspnea, and assessed under suspicion of CAF. CAF was seen with a coronary angiogram, but the exact entry point in the left ventricle or left atrial wall could not be determined. CT angiography also failed to establish the drainage site , so CAG (coronary angiography) was repeated with the SonoVue contrast agent injected into LM (Left main) while using a Siemens echocardiography machine. Multiple views were obtained during the injection and revealed unusual flow in the left ventricle just below the PML (posterior mitral leaflet) and passing through the fistula to LV. Conclusion: Contrast-Enhanced Echocardiography by direct intracoronary injection of SonoVue contrast agent, is safe and can aid in the delineation of fistula drainage.

Creseis acicula is a pteropod species, widely distributed in the world’s ocean. The latest report of its bloom was in the Mediterranean Sea in 1990. On June 12, 2020, an unprecedented bloom of C. acicula was observed in Daya Bay, China, that lasted for over a month and caused economic losses. The maximum abundance of C. acicula was up to 5595 ind. m-3, 1000 times the local record high, and 10 times the highest number recorded elsewhere. Higher abundance (≥ 1000 ind. m-3) was found in the warm water of ≥ 30℃ along the southwest shore of Daya Bay. The initiation of the bloom matched a sharp increase of temperature and chlorophyll a and an abrupt decrease of salinity attributed to heavy rainfall that lasted for more than 20 days. Considering rising occurrences of extreme weather due to global change, possibilities of recurrent C. acicula blooms worldwide certainly deserve attention.

Both PU and PC increased maize yield, water use efficiency (WUE), and partial factor productivity from applied N (PFPN), relative to CK. PC increased maize yield more than PU, and had higher soil organic carbon (SOC) content than PU, which was mainly due to the decline in SOC stocks in the 250–2000, 53–250, and <53 μm soil aggregates. The soil bacterial community structure was driven by SOC, C: N ratio, total nitrogen (TN), pH, microaggregates, clay and silt in CK, and by larger macroaggregates and mean weight diameter in PC and PU. Both PC and PU significantly changed soil bacterial community beta diversity, and decreased both positive and negative links of the co-occurrence network, relative to CK. Better soil nutrient conditions in PC explained the small number of positive and negative links between soil bacteria. Our results suggest PM improves maize yield, water and nitrogen use efficiency, and soil aggregate stability while alleviating bacterial competition. However, the reduction of SOC and pH caused by PM still needs our attention. PC alleviates the decline of soil fertility and soil acidification and has higher yield relative to PU. Therefore, we proposed PC is a potential agricultural measure that can replace PU on the Loess Plateau.

Following respiratory viral infections, there is a brief window in which a host has less susceptibility to other respiratory viruses. This is essential, as it may take up to 1 year to develop a vaccine. Most people get SARS-CoV-2 from their infected relatives at home, particularly during the first two weeks after exposure. Self-quarantine does not necessarily reduce the level of exposure for the relatives interacting with infected patients. The new infection may happen at least 10-14 days after the first infection. We propose to induce other viral respiratory infections such as non-fatal, mild, and self-limited Rhinoviruses or Coronavirus, which cause the common cold, prior to exposure to COVID-19. This would be beneficial for surrounding community members of infected individuals. In conclusion, theoretically we may protect immediate relatives of an infected person for at least two weeks, during active screening, by inducing temporary-immunity through the administration of non-fatal respiratory viruses.

Background: NeurologicalEarly prediction model for seizures in influenza complications of influenza are associated with high morbidity and mortality in children. The prognosis could be improved if early treatments are undertaken. Objective: To establish and validate an early prediction model to discriminate among neurological complications such as seizures, acute influenza virus-associated encephalitis (IAE), and acute necrotizing encephalopathy (ANE) in children with influenza. Methods: This was a retrospective single-center case-control study conducted at the Guangzhou Women and Children’s Medical Center in Guangzhou (GWCMC), China, from November 2012 to January 2020. The random forest model was used to screen the characteristics and construct an early prediction model for convulsions, IAE, and ANE. Results: Of the 433 patients (294 male, 139 female; median age 2.8 (1.7,4.8) years), 278 (64.2%) had seizures, 106 (24.5%) had IAE, and 49 (11.3%) had ANE; 348 patients were in the training set and 85 in the validation set. When 10 variables were included, the cross-validation error was minimal; convulsions, procalcitonin, urea, γ-glutamyltransferase, aspartate aminotransferase, albumin/globulin ratio, α-hydroxybutyric dehydrogenase, alanine aminotransferase, alkaline phosphatase, and C-reactive protein were included. The likelihood of having only seizures decreased with increasing procalcitonin, urea, γ-glutamyltransferase, α-hydroxybutyric dehydrogenase, alanine aminotransferase, and aspartate aminotransferase, and with decreasing albumin/globulin ratio and alkaline phosphatase. The prediction model gave a prediction accuracy of 84.2%. Conclusion: This model can distinguish the seizures from IAE and from ANE. This could allow for the early management of children with influenza in order to prevent morbidity and mortality. The biochemical/hematologic markers lacked specificity.

Acute upper respiratory infections (URIs) represent a major source of annual emergency department (EDs) visits in the United States. However, the definitive etiology of symptoms is generally not determined as testing has historically been prioritized for influenza virus and recently, respiratory syncytial virus (RSV). To elucidate the prevalence, rates of co-infections, and etiologic composition of URIs from symptomatic adult ED patients, we evaluated specimens from four geographically diverse EDs in the United States from 2013-2014 utilizing a multiplex molecular diagnostic assay. 1941 ED patients who had signs and/or symptoms of an acute URI and were considered ‘high-risk’ for influenza related complications according to CDC criteria, were consecutively enrolled and tested for influenza; influenza prevalence was 9.4% (183/1941). Among them, 799 nasopharyngeal swab specimens with sufficient residual volumes were subsequently tested for additional respiratory pathogens. The overall positivity rate was 30.1% (241/799), of which 6.6% (16/241) were co-infected. Non-influenza pathogens from most to least common were: rhinovirus/enterovirus, coronavirus, human metapneumovirus and RSV, respectively. The ratio of co-infection to mono-infection was highest amongst those with adenovirus, versus mon-infections (2.0). Broad differences in disease prevalence and pathogen distributions were observed across geographic regions; the site with the highest detection rate (for both mono and co-infections) demonstrated the greatest pathogen diversity. Adult ED patients at high-risk for influenza complications were infected with a variety of respiratory pathogens and geographic variations in the disease prevalence and co-pathogen type were observed. Further research is required to evaluate the clinical relevance of these findings.