Measuring TB drug levels in the hair in adults and children to monitor drug exposure and outcomes

INTRODUCTION: Testing for anti-TB drugs in small hair samples may serve as a non-invasive tool to measure cumulative drug exposure and/or adherence, as these determine treatment success. We aimed to assess how well hair assays of TB drugs predict TB treatment outcomes.METHODS: A small thatch of hair, ~30 strands, was cut from the occipital region in adults and children from a prospective TB cohort in India. Isoniazid (INH), acetyl-INH and pyrazinamide (PZA) were extracted from the hair samples and quantified using liquid-chromatography-tandem mass spectrometry. The relationship between drug concentrations in hair and time to unfavourable outcomes was assessed using Cox-proportional hazards regression models.RESULTS: A two-fold increase in hair acetyl-INH concentrations in the 264 participants in our cohort with hair assays for TB drugs indicated a lower hazard of unfavourable TB treatment outcomes (aHR 0.67, 95%CI 0.44-1.02) and TB treatment failure (aHR 0.65, 95%CI 0.42-1.01). Higher summed concentrations (a summed measure of INH and acetyl-INH) indicated a lower hazard of treatment failure (aHR 0.69, 95%CI 0.45-1.05)CONCLUSION: Hair levels of INH and its metabolite may predict TB treatment outcomes, indicating the potential utility of this measure to assess and optimise TB treatment outcomes.

COVID-19 and extracorporeal membrane oxygenation: experiences as a patient, general practitioner, wife and mother

I contracted SARS‐CoV‐2 early in the first wave of the COVID‐19 pandemic in the UK and, following nine days of mechanical ventilation, was one of the first few patients to be accepted for venovenous extracorporeal membrane oxygenation. I remained in hospital for 150 days, 34 of which I spent with full extracorporeal respiratory support. I have no recollection of my time on extracorporeal membrane oxygenation, but liberation from it was not the end of my story; I had to overcome numerous physical and mental challenges during recovery and rehabilitation. I hope my story is read by others who are recovering from COVID‐19 or critical illness more generally, and that it provides hope that the challenges of rehabilitation can be overcome. This reflection is a personal view of my illness as a patient. In it, I focus upon the aspects of my care that I can remember, predominantly around the time I became unwell but also during the recovery and rehabilitation period, which remains ongoing despite my discharge from hospital and subsequent return to work as a general practitioner.

Perpendicular and in-plane hole asymmetry in a strained NiFe2O4film

Strained materials can exhibit drastically modified physical properties in comparison to their fully relaxed analogues. We report on the x-ray absorption spectra (XAS) and magnetic circular dichroism (XMCD) of a strained NiFe₂O₄inverse spinel film grown on a symmetry matched single crystal MgGa₂O₄substrate. The Ni XAS spectra exhibit a sizable difference in the white line intensity for measurements with the x-ray electric field parallel to the film plane (normal incidence) vs when the electric field is at an angle (off-normal). A considerable difference is also observed in the FeL_2,3XMCD spectrum. Modeling of the XAS and XMCD spectra indicate that the modified energy ordering of the cation 3dstates in the strained film leads to a preferential filling of 3dstates with out-of-plane character. In addition, the results point to the utility of x-ray spectroscopy in identifying orbital populations even with elliptically polarized x-rays.

Augmenting salt tolerance in rice by regulating uptake and tissue specific accumulation of Na+ - through Ca2+ -induced alteration of biochemical events

The protective effect of Ca²⁺ against NaCl toxicity was investigated in two rice varieties with contrasting for salt tolerance to understand the mechanistic details of the antagonism to address adverse effects of salinity on agriculture. The study primarily examined the influence of Ca²⁺ on expression/activity of the effectors and regulators involved in Na⁺ translocation. Calcium reduced uptake of Na⁺ concomitant with higher tissue K⁺ /Na⁺ in seedlings, comparatively more in salt-tolerant Nona Bokra than in salt-sensitive IR-64, together with a significant increase in root PM H⁺ ATPase in the former, but not in the latter. Increased antagonism in Nona Bokra could be the result of Ca²⁺ signalling-mediated phosphorylation of PM H⁺ ATPase in roots caused by a significant Ca²⁺ -dependent increase in expression of OsCIPK24, which did not occur in IR-64. Furthermore, significant Ca²⁺ -mediated NaCl-induced increase in transcription of 14-3-3 protein in Nona Bokra, but not in IR-64, might also lead to a greater protective effect of Ca²⁺ in the former, as 14-3-3 protein is essential for activating PM H⁺ ATPase. Thus, efficient functioning of PM H⁺ ATPase could be key in determining resistance of plants to salinity, implying that identification of the Ca²⁺ -dependent kinase phosphorylating the PM H⁺ ATPase threonine residue and manipulation of its expression, together with expression of 14-3-3 proteins could be an important strategy to improve salt tolerance of crops and their cultivation in salt-affected lands.

The effect of TB treatment on health-related quality of life for people with advanced HIV

BACKGROUND: Study A5274 was an open-label trial of people with HIV (PLHIV) with CD4 cell count <50 cells/µL who were randomized to empirical TB treatment vs. isoniazid preventive therapy (IPT) in addition to antiretroviral therapy (ART). We evaluated health-related quality of life (HRQoL) by study arm, changes over time, and association with sociodemographic and clinical factors.METHODS: Participants aged >13 years were enrolled from outpatient clinics in 10 countries. HRQoL was assessed at Weeks 0, 8, 24 and 96 with questions about daily activity, hospital or emergency room visits, and general health status. We used logistic regression to examine HRQoL by arm and association with sociodemographic and clinical factors.RESULTS: Among 850 participants (424 empiric arm, 426 IPT arm), HRQoL improved over time with no difference between arms. At baseline and Week 24, participants with WHO Stage 3 or 4 events, or those who had Grade 3 or 4 signs/symptoms, were significantly more likely to report poor HRQoL using the composite of four HRQoL measures.CONCLUSION: HRQoL improved substantially in both arms during the study period. These findings show that ART, TB screening, and IPT can not only reduce mortality, but also improve HRQoL in PLHIV with advanced disease.

Elliptic Flow of Electrons from Beauty-Hadron Decays in Pb-Pb Collisions at sqrt[s_{NN}]=5.02 TeV

The elliptic flow of electrons from beauty hadron decays at midrapidity (|y|<0.8) is measured in Pb-Pb collisions at sqrt[s_{NN}]=5.02  TeV with the ALICE detector at the LHC. The azimuthal distribution of the particles produced in the collisions can be parametrized with a Fourier expansion, in which the second harmonic coefficient represents the elliptic flow, v_{2}. The v_{2} coefficient of electrons from beauty hadron decays is measured for the first time in the transverse momentum (p_{T}) range 1.3-6  GeV/c in the centrality class 30%-50%. The measurement of electrons from beauty-hadron decays exploits their larger mean proper decay length cτ≈500  μm compared to that of charm hadrons and most of the other background sources. The v_{2} of electrons from beauty hadron decays at midrapidity is found to be positive with a significance of 3.75  σ. The results provide insights into the degree of thermalization of beauty quarks in the medium. A model assuming full thermalization of beauty quarks is strongly disfavored by the measurement at high p_{T}, but is in agreement with the results at low p_{T}. Transport models including substantial interactions of beauty quarks with an expanding strongly interacting medium describe the measurement within uncertainties.

Males Have Higher Rates of Peri-operative Mortality Following Surgery for Osteoporotic Vertebral Compression Fracture

In this study, we evaluated the association between sex and the incidence of postoperative mortality in the peri-operative period following surgical intervention for OVCF. We found no statistical association between surgical complications and patient sex. However, males exhibited higher rates of mortality and 30-day readmissions relative to females.

INTRODUCTION

Osteoporotic vertebral compression fractures (OVCF) contribute substantially to the financial burden of the US healthcare system. As the size of the elderly population grows, the number of fractures attributed to osteoporosis is expected to increase. Studies have shown that osteoporotic patients are at an increased risk for medical and surgical complications. The purpose of this study was to evaluate the association between sex and the incidence of postoperative mortality in the peri-operative period following surgical intervention for OVCF.

METHODS

A retrospective analysis of the American College of Surgeons National Surgery Quality Improvement Project (ACS-NSQIP) database from 2007 to 2014 identified 1979 patients. Patients were grouped as male or female. Mortality within 30 days of surgery due to any cause, incidence of surgical complications, and 30-day readmission rates following surgery were tabulated. A multivariate logistic regression analysis was conducted to calculate odds ratios (OR) with corresponding p values and 95% confidence intervals.

RESULTS

In total, 1979 patients met inclusion and exclusion criteria. Mortality within the 30 days following surgery for OVCF was statistically greater in men than in women (OR = 1.58; p = 0.050). The 30-day readmission rate was also statistically higher in men (OR = 1.41; p = 0.017). Neither minor (OR = 0.90; p = 0.560) nor major (OR = 1.14; p = 0.569) complications were statistically correlated with sex. On average, men underwent surgery for OVCF at a younger age than women.

CONCLUSIONS

Male patients undergoing surgery for OVCF have higher rates of peri-operative mortality and 30-day readmissions following surgery. Sex was not found to be associated with postoperative complications.

LEVEL OF EVIDENCE

III.

Impact of grain germination on in vitro antioxidative properties, nutrients digestibility, and functional attributes of brown rice flour

Brown rice was germinated for different times (12, 24, 36, and 48 h) at different temperatures (25, 30, and 35 °C) with the aim to improve the in vitro digestibility and antioxidant potential of the flour made from it. Results showed that increase in germination time and temperature increased in vitro digestibility of starch and protein during germination of brown rice owing to depolymerisation of starch and protein molecules by enzymatic activity. After germination under varying conditions, antioxidant activity increased from 50.19 to 95.58%, total phenolic and flavonoid contents from 0.88 to 2.02 mg GAE/g and 34.06–62.94 mg QE/100g, respectively. Germination at elevated temperature (35 °C) for prolonged time (48 h) also increased the reducing power by 60.49% and metal chelating activity by 114.50% as a result of structural breakdown of bound phenolics. Increased activity of hydrolytic enzymes with progress in the germination time and temperature also results in continuous reduction in the pasting properties and lightness values (L), while increasing a* and b* values of the flour of germinated brown rice. Tailored germination, therefore, can be offered as a tool to increase nutrient digestibility and bioactive potential of brown rice as compared to non-germinated brown rice, thus, producing naturally modified flour with enhanced functionality.

Isolated brachial artery aneurysm: a rare presentation of paediatric Behçet's disease

Behçet's disease is a rare disease characterised by recurrent oral ulcers, with systemic manifestations including genital ulcers, ocular disease, skin lesions, gastrointestinal disease, neurologic disease, vascular disease and arthritis. Most clinical manifestations of Behçet's disease are believed to be due to vasculitis. The heterogeneous clinical spectrum is influenced by sex, ethnicity and country of residence. Vascular manifestation in the form of isolated large brachial artery aneurysm is rare in children. Treatment involves aneurysmorrhaphy to avoid rupture or ischaemic sequelae in addition to lifelong medical management to control vasculitis.

Unhealthy alcohol use independently associated with unfavorable TB treatment outcomes among Indian men

BACKGROUND: Approximately 10% of incident TB cases worldwide are attributable to alcohol. However, evidence associating alcohol with unfavorable TB treatment outcomes is weak.METHODS: We prospectively evaluated men (≥18 years) with pulmonary TB in India for up to 24 months to investigate the association between alcohol use and treatment outcomes. Unhealthy alcohol use was defined as a score of ≥4 on the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) scale at entry. Unfavorable TB treatment outcomes included failure, recurrence, and all-cause mortality, analyzed as composite and independent endpoints.RESULTS: Among 751 men, we identified unhealthy alcohol use in 302 (40%). Median age was 39 years (IQR 28-50); 415 (55%) were underweight (defined as a body mass index [BMI] <18.5 kg/m²); and 198 (26%) experienced an unfavorable outcome. Unhealthy alcohol use was an independent risk factor for the composite unfavorable outcome (adjusted incidence rate ratio [aIRR] 1.47, 95% CI 1.05-2.06; P = 0.03) and death (aIRR 1.90, 95% CI 1.08-3.34; P = 0.03), specifically. We found significant interaction between AUDIT-C and BMI; underweight men with unhealthy alcohol use had increased risk of unfavorable outcomes (aIRR 2.22, 95% CI 1.44-3.44; P < 0.001) compared to men with BMI ≥18.5 kg/m² and AUDIT-C <4.CONCLUSION: Unhealthy alcohol use was independently associated with unfavorable TB treatment outcomes, highlighting the need for integrating effective alcohol interventions into TB care.

Online Education Status at Dental Colleges During COVID-19 Pandemic in Nepal

Background The COVID-19 pandemic has caused lockdown situation impeding all educational institutions including dental colleges. The circumstance demanded online classes as the alternative strategy for continuation of education. Objective To assess current practice and perception about online education among faculties of dental colleges in Nepal. Method A cross-sectional study was conducted among 208 faculties of all dental colleges in Nepal. Data collection was done through structured online questionnaire comprising demographic information, practice and perception of the respondents towards online education. Descriptive statistics surveyed the frequency distribution and Chisquare test assessed the difference in perception among the faculties of different universities. Result The response rate was 74.3%. Faculties commonly used PowerPoint presentation (96.6%) on Zoom platform (83.3%) using laptop (94.7%) with Wi-Fi connection (91.8%). Majority of faculties had good or satisfactory access to internet (94.8%). The faculties believed that the online class environment was interactive (95.2%); but it was not effective (86.5%) as live classroom. Majority of the faculties (79.4%) felt tracking of students' presence was difficult. There was no significant difference on perception towards online class among the faculties of Kathmandu University, Tribhuvan University and BP Koirala Institute Health Sciences at p < 0.05. Conclusion The COVID-19 pandemic has paved the way for e-learning in dental education in Nepal. Faculties agree to complete the theory syllabus and conduct sessional exams as an alternative during the lockdown period. However, they show strong reservations in carrying out practical/clinical simulations and university exams online. Training on e-learning and institutional strategy for online education is recommended.

Ultrasound-guided percutaneous biopsy of thoracic lesions: high diagnostic yield and low complication rate

AIM

To investigate the use of ultrasound (US)-guided biopsy of thoracic lesions aiming to determine diagnostic success and complication rates and to identify factors that may affect sample adequacy and safety.

MATERIAL AND METHODS

This was a retrospective study of consecutive percutaneous US-guided biopsy over 10-year period, including 147 procedures in 146 patients (66 ± 7 years, 83 men, 63 women) with lesions located in the lung (67/147), chest wall (54/147), mediastinum (14/147) and pleura (12/147). Overall diagnostic success, yield for benign and malignant diagnoses and diagnostic success according to lesion location, biopsy type (fine-need aspiration [FNA] or core-needle biopsy [CNB]) and number of specimens were calculated. Presence of complications and effect of age, lesion location, biopsy type, and number of specimens were measured.

RESULTS

The overall diagnostic success rate was 90.5% and was similar for malignant (90.6%) and benign (87.5%) diagnoses. Specimen adequacy was similar for FNA and CNB (91.2% and 88.9%, p=0.66); number of specimens did not affect yield. Diagnostic success was highest for mediastinal and chest wall lesions (92.9% and 94.4%) and lowest for pleural lesions (75%), albeit not statistically significant (p=0.45). Complications occurred in 4/147(2.7%) cases, exclusively in lung lesions, and were not associated with any covariates analysed.

CONCLUSIONS

US-guided biopsy is an effective and safe technique for diagnosis of thoracic lesions, with high diagnostic yield and low complication rate. In the presence of an adequate acoustic window, US guidance can be valuable for diagnosis of peripheral lung and mediastinal lesions. Radiologists performing thoracic biopsy should be encouraged to implement or expand the use of US guidance in their practice.

Clinical profile and outcomes of De novo posttransplant thrombotic microangiopathy

Thrombotic microangiopathy (TMA) after kidney transplant is rather uncommon but an important reversible cause of graft loss. This retrospective study of biopsy-proven posttransplant TMA was done to identify the important etiological factors, clinical features, and outcomes of post transplant TMA in a tertiary care referral hospital in northern India. This retrospective study was conducted among all renal transplant recipients who presented with graft dysfunction between 1989 and 2015. All the cases were looked for their etiology, clinical course, treatment modalities, and renal outcomes. The study was conducted in accord with prevailing ethical principles and reviewed by our own institutional review board. Seventeen patients out of 2000 (0.008%) transplants done during the study period had posttransplant TMA, out of which all the patients had de novo TMA, and the median time of presentation after transplantation was four months. Systemic TMA was noted in only four patients. Biopsy revealed associated rejection in five patients and associated calcineurin inhibitor (CNI) toxicity in 12 patients. Patients with TMA due to CNI toxicity were managed with CNI reduction or switching to alternate CNI or mammalian target of rapamycin inhibitors. In addition, antithymocyte globulin and plasma exchange were used in rejection-associated TMA. While four out of 12 patients (33%) in CNI-related TMA developed end-stage renal disease (ESRD), all patients in rejection-associated TMA developed ESRD. The overall one-year graft survival was 47%, whereas five- and 10-year survival was 35%. There was no significant difference in graft survival between localized and systemic TMAs (P = 0.4). Posttransplant TMA should be suspected even if there are no systemic features of hemolysis and early graft biopsy and prompt action is needed. The occurrence of TMA in the setting of rejection is associated with grave prognosis.

Co-occurrence of Aicardi-Goutières syndrome type 6 and dyschromatosis symmetrica hereditaria due to compound heterozygous pathogenic variants in ADAR1: a case series from India

Aicardi-Goutières syndrome type 6 (AGS6) and dyschromatosis symmetrica hereditaria (DSH) are allelic disorders caused respectively by biallelic and heterozygous pathogenic variants in ADAR1. We report three unrelated children presenting with features of both AGS6 and DSH, two of whom had compound heterozygous pathogenic variants in ADAR1. We also describe the novel genetic variants in our cases and review the literature on association of ADAR1-related AGS6 and DSH with these phenotypes.

Qualitative and quantitative analyses of impact of COVID-19 on sustainable development goals (SDGs) in Indian subcontinent with a focus on air quality

Coronavirus disease 2019 (COVID-19) is spreading all over the world in a short time. It originated from Wuhan City of China in the late 2019. Proper vaccines have still been in progress; the spread of the virus is contracted by lockdown and social distancing protocols. These lockdowns resulted in significant benefits, improving the quality of air and reducing the level of environmental pollution. In this context, the study proposes to identify the air quality in the region and its relation with COVID-19-affected people in metropolitan cities of India during COVID-19 lockdowns using a geographical information system (GIS), where over 90% of commercial and industrial sites and 100% school and colleges were closed. The study outcomes highlight the areas encountering high levels of pollution under the pre-lockdown scenario and have seen a higher number of cases. The relation is most evident for PM_2.5, which is responsible for respiratory disorders and is the place of attack of SARS-CoV-2. This approach provides comparable outcomes with other decision-making tools. Our primary precedence should be to develop communities to enable people to remain healthy and stay. Healthy societies are crucial not only for people's health, but also for sustainable development. Centered on GIS is concealed; moreover, it is very flexible to use by policymakers.

The long noncoding RNA MALAT1 suppresses miR-211 to confer protection from ultraviolet-mediated DNA damage in vitiligo epidermis by upregulating sirtuin 1

BACKGROUND

The absence of melanocytes poses a challenge for long-term tissue homeostasis in vitiligo. Surprisingly, while individuals with Fitzpatrick phototypes I-II (low melanin content) have a higher incidence of melanoma and nonmelanoma skin cancer, people with vitiligo are at a decreased risk for the same.

OBJECTIVES

To understand the molecular mechanisms that protect vitiligo skin from ultraviolet (UV)-induced DNA damage by (i) characterizing differentially expressed microRNAs in lesional vs. nonlesional epidermis and (ii) identifying their upstream regulators and downstream gene targets.

METHODS

Genome-wide microRNA profiling of nonlesional and lesional epidermis was performed on five individuals with stable nonsegmental vitiligo using next-generation RNA sequencing. The relevance of the upstream regulator and downstream target gene of the most differentially expressed microRNA was studied.

RESULTS

Our study found sirtuin1 (SIRT1), an NAD-dependent deacetylase, to be a direct target of miR-211 - the most significantly downregulated microRNA in lesional epidermis. Inhibition of SIRT1 with EX-527 downregulated keratin 10 and involucrin, suggesting that SIRT1 promotes keratinocyte differentiation. Overexpression of miR-211 mimic led to a significant increase in γ-H2AX positivity and cyclobutane pyrimidine dimer (CPD) formation, hallmarks of UVB-mediated DNA damage. These effects could be ameliorated by the addition of resveratrol, a SIRT1 activator. Furthermore, a long noncoding RNA, MALAT1, was identified as a negative upstream regulator of miR-211. Overexpression of MALAT1 resulted in increased expression of SIRT1 and a concomitant removal of UVB-induced CPDs in primary keratinocytes.

CONCLUSIONS

These findings establish a novel MALAT1-miR-211-SIRT1 signalling axis that potentially confers protection to the 'amelanotic' keratinocytes in vitiligo.

Of "Cotton Balls" and "Owl's eyes"

Report of a 3-month old girl child who died due to multi-systemic infection of cytomegalovirus (CMV) involving the lungs, liver and kidneys along with pneumocystis jiroveci pneumonia (PJP). The mother of the child tested positive for CMV IgG and HIV with a very low CD4 count (160/ μl). Co-infection of cytomegalovirus and pneumocystis jiroveci always occurs in the setting of immunocompromise. Congenital CMV infection is transmitted through the placenta, especially during the first trimester and causes severe multi-systemic disease whereas perinatal infection is acquired during childbirth/ breastfeeding where the babies have maternal protective antibodies leading to much milder or asymptomatic infection. PJP is more common in infancy and presents as hypoxic pneumonia. CMV causes cyto-nucleomegaly and classic "owl's eye" inclusions on histology while PJP presents with characteristic fluffy "cotton ball" alveolar exudates.

Hypotonic polyuria: at the cross-roads of copeptin

The aetiology of hypotonic polyuria, after excluding solute diuresis, is one of primary polydipsia, central, or nephrogenic diabetes insipidus. Theoretically, these disorders should be relatively easily distinguished based on history and the results of an indirect water deprivation test. Practically, however, there is a significant overlap in diagnostic evaluation, potentially leading to an erroneous diagnosis and deleterious management plan. The ability to measure a stimulated copeptin level, either with hypertonic saline or arginine infusion, has led to greater diagnostic accuracy.

nSARS-Cov-2, pulmonary edema and thrombosis: possible molecular insights using miRNA-gene circuits in regulatory networks

Background

Given the worldwide spread of the novel Severe Acute Respiratory Syndrome Coronavirus 2 (nSARS-CoV-2) infection pandemic situation, research to repurpose drugs, identify novel drug targets, vaccine candidates have created a new race to curb the disease. While the molecular signature of nSARS-CoV-2 is still under investigation, growing literature shows similarity among nSARS-CoV-2, pulmonary edema, and thromboembolic disorders due to common symptomatic features. A network medicine approach is used to to explore the molecular complexity of the disease and to uncover common molecular trajectories of edema and thrombosis with nSARS-CoV-2.

Results and conclusion

A comprehensive nSARS-CoV-2 responsive miRNA: Transcription Factor (TF): gene co-regulatory network was built using host-responsive miRNAs and it’s associated tripartite, Feed-Forward Loops (FFLs) regulatory circuits were identified. These regulatory circuits regulate signaling pathways like virus endocytosis, viral replication, inflammatory response, pulmonary vascularization, cell cycle control, virus spike protein stabilization, antigen presentation, etc. A unique miRNA-gene regulatory circuit containing a consortium of four hub FFL motifs is proposed to regulate the virus-endocytosis and antigen-presentation signaling pathways. These regulatory circuits also suggest potential correlations/similarity in the molecular mechanisms during nSARS-CoV-2 infection, pulmonary diseases and thromboembolic disorders and thus could pave way for repurposing of drugs. Some important miRNAs and genes have also been proposed as potential candidate markers. A detailed molecular snapshot of TGF signaling as the common pathway, that could play an important role in controlling common pathophysiologies among diseases, is also put forth.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s41544-020-00057-y.

The reporting of reproducibility of cardiac imaging biomarkers

Introduction

There is inconsistency in the reporting of reproducibility of imaging biomarkers in published literature.

Purpose

To assess the reporting of reproducibility of imaging biomarkers described in original articles across the top 3 multi-modality cardiovascular imaging journals.

Methods

We reviewed all published articles in 2018 in the 3 leading cardiovascular imaging journals: JACC cardiovascular Imaging (A), Circulation. Cardiovascular Imaging (B), and EHJ Cardiovascular Imaging (C). Articles were excluded if they were not original research or reproducibility reporting was not required: case reports, editorials, research supports, meta- analysis, reviews, miscellaneous.

The remaining articles were assessed for the following reproducibility reporting parameters:

1) Discuss reproducibility; 2) Assess reproducibility in current study; 3) Reproducibility tools used: Intra-class correlation coefficient (ICC), coefficient of variance (COV), Bland Altman analysis (BA), etc and 5) Proportion of total population used in reproducibility analysis

Results

Among 951 articles published (Journal A/B/C 521/ 171/ 259), 692 were excluded due to above reasons. 259 articles were assessed for reproducibility data (Figure 1a). 122 of the 259 (47%) articles discussed reproducibility, including 26/122 (21%) referring to previous reproducibility data. Remaining 96/122 (79%) articles demonstrated reproducibility in the current manuscript- there was no difference in the frequency of articles discussing reproducibility across three journals (A 35/85 (41%); B 25/52 (48%); C 62/122 (51%), p=0.39).

Modality differences between reporting of reproducibility were as follows: (Echo 66/122 (54%); CT 14/38 (37%); CMR 27/55 (49%); Nuclear 9/26 (35%) and others 6/18 (33%), p=0.04)

Measures used to demonstrate reproducibility were as follows: (1.) ICC 64/96 (67%); 2.) BA 28/96 (29%); 3.) COV 16/96 (17%); 4.) Agreement 18/96 (19%); 5.) Correlation (Pearson's r) 3/96 (3%) p&lt;0.001) (Figure 1b).

The proportion of the total population used for reproducibility analysis ranged from 0.8% to 100%, median 18.6% IQR (7.8%- 56.3%). Regression revealed proportion of total population used, was inversely related to population size (r=−0.32, p 0.002). Modality differences were as follows: (Echo 12.0% (5.7%- 36.1%); CT 17.1% (7.8%- 100%); CMR 25.0% (16.1%- 97.1%); Nuclear 68.9% (29.6% - 100%) and others 56.1% (32.6%- 62.3%), p=0.03).

Conclusions

Approximately half original research manuscripts published across 3 major multi-modality imaging journals discussed or demonstrated reproducibility. No differences across journals were identified. There are differences between modalities with respect to reporting reproducibility. The most common tool used to report reproducibility was ICC. There is marked heterogeneity in the proportion of the total population used to demonstrate reproducibility, this is partly determined by the size of population being examined.

Figure 1. A Snapshot of reproducibility reporting

Funding Acknowledgement

Type of funding source: None

Brain Imaging of Patients with COVID-19: Findings at an Academic Institution during the Height of the Outbreak in New York City

BACKGROUND AND PURPOSE

A large spectrum of neurologic disease has been reported in patients with coronavirus disease 2019 (COVID-19) infection. Our aim was to investigate the yield of neuroimaging in patients with COVID-19 undergoing CT or MR imaging of the brain and to describe associated imaging findings.

MATERIALS AND METHODS

We performed a retrospective cohort study involving 2054 patients with laboratory-confirmed COVID-19 presenting to 2 hospitals in New York City between March 4 and May 9, 2020, of whom 278 (14%) underwent either CT or MR imaging of the brain. All images initially received a formal interpretation from a neuroradiologist within the institution and were subsequently reviewed by 2 neuroradiologists in consensus, with disputes resolved by a third neuroradiologist.

RESULTS

The median age of these patients was 64 years (interquartile range, 50-75 years), and 43% were women. Among imaged patients, 58 (21%) demonstrated acute or subacute neuroimaging findings, the most common including cerebral infarctions (11%), parenchymal hematomas (3.6%), and posterior reversible encephalopathy syndrome (1.1%). Among the 51 patients with MR imaging examinations, 26 (51%) demonstrated acute or subacute findings; notable findings included 6 cases of cranial nerve abnormalities (including 4 patients with olfactory bulb abnormalities) and 3 patients with a microhemorrhage pattern compatible with critical illness-associated microbleeds.

CONCLUSIONS

Our experience confirms the wide range of neurologic imaging findings in patients with COVID-19 and suggests the need for further studies to optimize management for these patients.

Pulmonary Capillaritis: The Breakdown of the Histologic Features

Introduction/Objective

Capillary inflammation (capillaritis) is rarely the primary pathologic cause of pulmonary hemorrhage. It may coexist with vasculitis. The aim of this study is to investigate the specificity of five histologic features of pulmonary capillaritis previously described by Mark and Ramirez (discussed below). They are usually treated with corticosteroids and cyclophosphamide or azathioprine.

Methods

A retrospective review of patients with a pathologic diagnosis of capillaritis in open lung biopsies was done. The diagnosis was confirmed by two expert pulmonary pathologists. The slides were reviewed and compared to a control group, who also underwent open lung biopsies for clinical suggestion of pulmonary hemorrhage and no pathologic diagnosis of capillaritis. Cases with malignant neoplasms, large and medium size vasculitis syndromes, and diffuse alveolar damage (DAD) were excluded. The five pathologic features of capillaritis were evaluated and scored as negative (0), focal (1+) and moderate to diffuse (2+) in both groups.

Results

Five cases of pulmonary capillaritis and five cases in control group were identified. The etiology of pulmonary capillaritis in the five identified cases included autoimmune diseases, pulmonary hypertension, non-specific interstitial pneumonia, and idiopathic capillaritis. The average score for the morphologic features of capillaritis versus the control group were as follows: Interstitial erythrocytes and/or hemosiderin (2+ vs 2+), fibrinoid necrosis of capillary walls (2+vs 0), intraalveolar septal capillary occlusion by fibrin thrombi (1+ vs 0), neutrophils and nuclear dust in the interstitium, in the fibrin, and in the adjacent alveolar spaces (2+ vs 1+), and fibrin clots attached to interalveolar septa in a sessile manner (2+ vs 1+).

Conclusion

In this small study, we can conclude that fibrinous necrosis is the most specific finding for pulmonary capillaritis while interstitial erythrocytes and/or hemosiderin is least specific. Therefore, in the presence of fibrinous necrosis; in addition to other supporting features; a pathologist is more inclined to communicate a diagnosis of pulmonary capillaritis to the clinicians.

Measurement of the Low-Energy Antideuteron Inelastic Cross Section

In this Letter, we report the first measurement of the inelastic cross section for antideuteron-nucleus interactions at low particle momenta, covering a range of 0.3≤p<4  GeV/c. The measurement is carried out using p-Pb collisions at a center-of-mass energy per nucleon-nucleon pair of sqrt[s_{NN}]=5.02  TeV, recorded with the ALICE detector at the CERN LHC and utilizing the detector material as an absorber for antideuterons and antiprotons. The extracted raw primary antiparticle-to-particle ratios are compared to the results from detailed ALICE simulations based on the geant4 toolkit for the propagation of (anti)particles through the detector material. The analysis of the raw primary (anti)proton spectra serves as a benchmark for this study, since their hadronic interaction cross sections are well constrained experimentally. The first measurement of the inelastic cross section for antideuteron-nucleus interactions averaged over the ALICE detector material with atomic mass numbers ⟨A⟩=17.4 and 31.8 is obtained. The measured inelastic cross section points to a possible excess with respect to the Glauber model parametrization used in geant4 in the lowest momentum interval of 0.3≤p<0.47  GeV/c up to a factor 2.1. This result is relevant for the understanding of antimatter propagation and the contributions to antinuclei production from cosmic ray interactions within the interstellar medium. In addition, the momentum range covered by this measurement is of particular importance to evaluate signal predictions for indirect dark-matter searches.

Haemorrhage control beyond Advanced Trauma Life Support (ATLS) protocol in life threatening maxillofacial trauma - experience from a level Ⅰ trauma centre

Maxillofacial injuries are usually not life-threatening and do not get priority over other associated injuries. However, some maxillofacial injuries with active oral or nasal bleeding need immediate management due to threatened airway and blood loss. In the case of major active vascular bleeding, measures such as local pressure, anterior nasal packing, posterior nasal packing, and balloon tamponade are ineffective. In these cases, angiography and transcatheter arterial embolisation (TAE) are used to treat life-threatening haemorrhage caused by maxillofacial trauma. We analysed the medical records of 39 patients with severe maxillofacial trauma and life-threatening haemorrhage that was a result of intractable oral or nasal bleeding. These patients were considered for TAE from January 2010 to December 2019. A total of 1668 patients was admitted, out of which 39 (2.3%) had severe maxillofacial injuries with life-threatening oral or nasal bleeding and underwent TAE. Out of a total of 39 patients, 38 were male and one female. Ages ranged from 16 to 65 years. Road traffic injury was the most common cause of injury (79.5%), Lefort I and II were the most common facial fractures, and traumatic brain injury was the most common associated injury. Embolisation and bleeding control were done successfully in all 39 patients with no procedure-related complications. A total of 17 deaths during the study period were due to severe traumatic brain injuries or haemorrhagic shock.

GW190521: A Binary Black Hole Merger with a Total Mass of 150 M_{⊙}

On May 21, 2019 at 03:02:29 UTC Advanced LIGO and Advanced Virgo observed a short duration gravitational-wave signal, GW190521, with a three-detector network signal-to-noise ratio of 14.7, and an estimated false-alarm rate of 1 in 4900 yr using a search sensitive to generic transients. If GW190521 is from a quasicircular binary inspiral, then the detected signal is consistent with the merger of two black holes with masses of 85_{-14}^{+21}  M_{⊙} and 66_{-18}^{+17}  M_{⊙} (90% credible intervals). We infer that the primary black hole mass lies within the gap produced by (pulsational) pair-instability supernova processes, with only a 0.32% probability of being below 65  M_{⊙}. We calculate the mass of the remnant to be 142_{-16}^{+28}  M_{⊙}, which can be considered an intermediate mass black hole (IMBH). The luminosity distance of the source is 5.3_{-2.6}^{+2.4}  Gpc, corresponding to a redshift of 0.82_{-0.34}^{+0.28}. The inferred rate of mergers similar to GW190521 is 0.13_{-0.11}^{+0.30}  Gpc^{-3} yr^{-1}.