First evidence for a latitudinal body mass effect in extant Crocodylia and the relationships of their reproductive characters

Relationships between distribution patterns and body size have been documented in many endothermic taxa. However, the evidence for these trends in ectotherms generally is equivocal, and there have been no studies of effects in crocodylians specifically. Here, we examine the relationship between latitudinal distribution and body mass in 20 extant species of crocodylians, as well as the relationships between seven important reproductive variables. Using phylogenetically independent contrasts to inform generalized linear models, we provide the first evidence of a latitudinal effect on adult female body mass in crocodylians. In addition, we explore the relationships between reproductive variables including egg mass, hatchling mass and clutch size. We report no correlation between egg mass and clutch size, upholding previously reported within-species trends. We also find no evidence of a correlation between measures of latitudinal range and incubation temperature, contrasting with the trends found in turtles.

The pathway to diagnosis and treatment for surgically managed lung cancer patients

BACKGROUND

Most lung cancer is diagnosed at an advanced stage, resulting in poor survival. This study examined diagnostic pathways for patients with operable lung cancer to identify factors contributing to early diagnosis.

METHODS

Surgically treated lung cancer patients (aged ≥40, within 6 months of diagnosis), approached via the population-based Cancer Registry, with their primary care physicians (PCPs) and specialists completed cross-sectional surveys assessing symptoms, diagnostic route (symptomatic or 'investigation' of other problem), tests, key event dates and treatment. Time intervals to diagnosis and treatment were determined, and quantile regression examined differences between the two diagnostic routes. Cox proportional hazard regression analyses examined associations between survival and diagnostic route adjusting for stage, sex and age.

RESULTS

One hundred and ninety-two patients (36% response rate), 107 PCPs and 55 specialists participated. Fifty-eight per cent of patients had a symptomatic diagnostic route reporting an average of 1.6 symptoms, most commonly cough, fatigue or haemoptysis. Symptomatic patients had longer median primary care interval than 'investigation' patients (12 versus 9 days, P < 0.05) and were more likely to report their PCP first-ordered imaging tests. Secondary care interval was shorter for symptomatic (median = 43 days) than investigation (median = 62 days, P < 0.05) patients. However, 56% of all patients waited longer than national recommendations (6 weeks). While survival estimates were better for investigation than symptomatic patients, these differences were not significant.

CONCLUSION

Many operable lung cancer patients are diagnosed incidentally, highlighting the difficulty of symptom-based approaches to diagnosing early stage disease. Longer than recommended secondary care interval suggests the need for improvements in care pathways.

From protocol to product: ventral midbrain dopaminergic neuron differentiation for the treatment of Parkinson's disease

Current cell therapy product limitations include the need for in-depth product understanding to ensure product potency, safety and purity. New technologies require development and validation to address issues of production scale-up to meet clinical need; assays are required for process control, validation and release. Prior to clinical realization, an understanding of production processes is required to implement process changes that are essential for process control. Identification of key parameters forms the basis of process tolerances, allowing for validated, adaptive manufacturing processes. This enables greater process control and yield while withstanding regulatory scrutiny. This report summaries key milestones in specifically for ventral midbrain dopaminergic neuroprogenitor differentiation and key translational considerations and recommendations to enable successful, robust and reproducible current cell therapy product-manufacturing.

Thermal damage thresholds for multiple-pulse porcine skin laser exposures at 1070 nm

As solid-state laser technology continues to mature, high-energy lasers operating in the near-infrared (NIR) band have seen increased utilization in manufacturing, medical, and military applications. Formulations of maximum permissible exposure limits establish guidelines for the safe use of these systems for a given set of laser parameters, based on past experimental and analytical studies of exposure thresholds causing injury to the skin and eyes. The purpose of our study is to characterize the skin response to multiple-pulsed laser exposures at the NIR wavelength of 1070 nm, at a constant beam diameter of 1 cm, using anesthetized Yucatan mini-pig subjects. Our study explores three constant total laser-on times of 0.01, 0.1, and 10 s as single- and multiple-pulse sequences. Exposures consisting of 10, 30, and 100 pulses have identical individual pulse durations but different duty cycles in order to include variable degrees of thermal additivity. A plurality of three observers quantifies skin damage with the minimally visible lesion metric, judged at the 1- and 24-h intervals postexposure. Calculation of the median effective dose (ED₅₀) provides injury thresholds for all exposure conditions, based on varying laser power across subjects. The results of this study will provide a quantitative basis for the incorporation of multiple-pulsed laser exposure into standards and augment data contained in the existing ED₅₀ database.

Using porous iron composite (PIC) material to immobilize rhenium as an analogue for technetium

Technetium (⁹⁹Tc), a uranium-235 (²³⁵U) and plutonium-239 (²³⁹Pu) fission product, is a primary risk driver in low level radioactive liquid waste at U.S. Department of Energy sites. Previous studies have shown success in using Zero Valent Iron (ZVI) to chemically reduce and immobilize redox sensitive groundwater contaminants. Batch and column experiments were performed to assess the ability of a novel porous iron composite material (PIC) to immobilize Tc(VII) in comparison with two commercial Fe oxide sorbents and reagent grade ZVI in the presence and absence of NO₃^-, a competing oxidized species that is often found in high concentrations in liquid nuclear waste. Perrhenate (ReO₄^-) was used as a non-radioactive chemical analogue for pertechnetate (TcO₄^-) under both oxic and anoxic test conditions. The PIC powder was the most effective at immobilizing Re(VII) under all batch test conditions. The presence of nitrate (NO₃^-) slowed the removal of ReO₄^- from solution, presumably through chemical reduction and precipitation. Even so, the PIC and ZVI were effective at removing both Re(VII) and NO₃^- completely from solution. Nitrate was reduced to NH₃ with very little nitrite (NO₂^-) buildup during equilibration. Significant Re immobilization was observed in the column tests containing PIC sorbent, even though inlet solutions were in equilibrium with O₂. The presence of NO₃^- hastened Re breakthrough, while NO₃^- reduction to NH₃ was observed. The results suggest that PIC and ZVI would be the most effective at the removal of TcO₄^- from contaminated groundwater sites.

The Respiratory Signature: A Novel Concept to Leverage Continuous Positive Airway Pressure Therapy as an Early Warning System for Exacerbations of Common Diseases such as Heart Failure

ABSTRACT

Each night millions of patients use continuous positive airway pressure (CPAP) to treat obstructive sleep apnea (OSA). To facilitate monitoring of treatment success, modern CPAP machines routinely record and analyze the respiratory signal in near real-time and submit some of these data to the manufacturer's centralized cloud server. Some of the conditions frequently associated with OSA such as heart failure or chronic obstructive pulmonary disease result in characteristic changes of the respiratory signal ("signatures"), especially during exacerbations. Thus, this infrastructure could be leveraged to detect changes in patients' health status facilitating early interventions. To illustrate this concept, we present and discuss the case of a patient with OSA who showed abrupt changes in his breathing pattern (increase in periodic breathing and machine-detected obstructive apneas) from 10 days prior until 8 days after a hospitalization for acute heart failure exacerbation.

Quantifying statistical uncertainty in metrics of sleep disordered breathing

BACKGROUND

The apnea-hypopnea index (AHI) (or one of its derivatives) is the primary clinical metric for characterizing sleep disordered breathing-the value of which with respect to a threshold determines severity of diagnosis and eligibility for treatment reimbursement. The index value, however, is taken as a perfect point estimate, with no measure of statistical uncertainty. Thus, current practice does not robustly account for variability in diagnosis/eligibility due to chance. In this paper, we quantify the statistical uncertainty associated with respiratory event indices for sleep disordered breathing and the effect of uncertainty on treatment eligibility.

METHODS

We develop an empirical estimate of uncertainty using a non-parametric bootstrap on the interevent times, as well as a theoretical Poisson estimate reflecting the current formulation of the AHI. We then apply these methods to estimate AHI uncertainty for 2049 subjects (954/1095 M/F, age: mean 69 ± 9.1) from the Multi-Ethnic Study of Atherosclerosis (MESA).

RESULTS AND CONCLUSIONS

The mean 95% empirical confidence interval width was 11.500 ± 6.208 events per hour and the mean 95% theoretical Poisson confidence interval width was 5.998 ± 2.897 events per hour, suggesting that uncertainty is likely a major confounding factor within the current diagnostic framework. Of the 278 subjects in the symptomatic population (ESS>10), 27% (76/278) had uncertain diagnoses given the 95% empirical confidence interval. Of the 2049 subjects in the full population, 43% (880/2049) had uncertain diagnoses given the 95% empirical confidence interval. The inclusion of subjects with uncertain diagnoses increases the number of eligible patients by 21.3% for the symptomatic population and by 84.8% for the full population. The exclusion of subjects with uncertain diagnoses given the 95% empirical confidence interval decreases the number of eligible patients by 12.4% for the symptomatic population and by 34.8% for full population. Additional analyses suggest that it is practically infeasible to gain diagnostic statistical significance through additional testing for a broad range of borderline cases. Overall, these results suggest that AHI uncertainty is a vital additional piece of information that would greatly benefit clinical practice, and that the inclusion of uncertainty in epidemiological analysis might help improve the ability for researchers to robustly link AHI with co-morbidities and long-term outcomes.

Prevalence and Characteristics of Restless Legs Syndrome in Korean Adults: A Study in Two Independent Samples of the General Population

BACKGROUND

Restless legs syndrome (RLS) is a common sleep disorder, although it has a low prevalence in Asian populations. However, the reported RLS prevalence in -Korean adults is mostly 4.5-12.1%, which is higher than that reported in other Asian populations. This study aimed to diagnose RLS and exclude mimicking conditions in 2 independent samples of Korean adults, and to compare its prevalence to that from previous studies performed in Asian countries.

METHODS

Study populations included a (1) nationwide stratified random sample (n = 2,824; age 19-79 years) and (2) community-based cohort (n = 2,685; age 47-79 years). We applied the Cambridge-Hopkins diagnostic questionnaire to diagnose RLS and differentiate it from RLS mimics. Sleep-related symptoms, mood, and medical conditions were compared between the RLS and non-RLS groups. Prior studies of the RLS prevalence in Asia were systematically reviewed and compared to our findings.

RESULTS

The adjusted RLS prevalence was 0.4 and 1.3% in populations 1 and 2, respectively. In both populations, subjects with RLS had more depression. The prevalence of RLS mimics was 5.1 and 2.6%, in populations 1 and 2, respectively. The RLS prevalence in Asia was higher when RLS was defined by the presence of essential clinical features and lower when a differential diagnosis was additionally implemented.

CONCLUSIONS

The RLS prevalence in Korean adults considering RLS mimics is comparable to that in adults from other Asian countries (< 2%). The reported RLS prevalence varies depending on the diagnostic method employed.

Suprathreshold laser injuries in excised porcine skin for millisecond exposures at 1070 nm

Skin injury response to near-infrared (NIR) laser radiation between the minimum visible lesion threshold and ablation onset is not well understood. This study utilizes a 1070-nm diode-pumped Yb-fiber laser to explore the response of excised porcine skin to high-energy exposures in the suprathreshold injury region without inducing ablation. Concurrent high-speed videography is employed to determine a dichotomous response for three progressive damage categories: observable surface distortion, surface bubble formation due to contained intracutaneous water vaporization, and surface bubble rupture during exposure. Median effective dose (ED50) values are calculated in these categories for 3- and 100-ms pulses with beam diameters (1  /  e2) of 3 mm (28, 35, and 49  J  /  cm2) and 7 mm (96, 141, and 212  J  /  cm2), respectively. Double-pulse cases are secondarily investigated. Experimental data are compared with the maximum permissible exposure limits and ablation onset simulated by a one-dimensional multiphysics model. Logistic regression analysis predicted injury events with ∼90  %   of accuracy. The distinction of skin response into progressive damage categories expands the current understanding of high-energy laser safety while underlining the unique biophysical effects during induced water phase change in tissue. These results prove to be useful in the diagnosis and treatment of NIR laser injuries.

Science-based assessment of source materials for cell-based medicines: report of a stakeholders workshop

Human pluripotent stem cells (hPSCs) have the potential to transform medicine. However, hurdles remain to ensure safety for such cellular products. Science-based understanding of the requirements for source materials is required as are appropriate materials. Leaders in hPSC biology, clinical translation, biomanufacturing and regulatory issues were brought together to define requirements for source materials for the production of hPSC-derived therapies and to identify other key issues for the safety of cell therapy products. While the focus of this meeting was on hPSC-derived cell therapies, many of the issues are generic to all cell-based medicines. The intent of this report is to summarize the key issues discussed and record the consensus reached on each of these by the expert delegates.

SDNET2018: An annotated image dataset for non-contact concrete crack detection using deep convolutional neural networks

SDNET2018 is an annotated image dataset for training, validation, and benchmarking of artificial intelligence based crack detection algorithms for concrete. SDNET2018 contains over 56,000 images of cracked and non-cracked concrete bridge decks, walls, and pavements. The dataset includes cracks as narrow as 0.06 mm and as wide as 25 mm. The dataset also includes images with a variety of obstructions, including shadows, surface roughness, scaling, edges, holes, and background debris. SDNET2018 will be useful for the continued development of concrete crack detection algorithms based on deep convolutional neural networks (DCNNs), which are a subject of continued research in the field of structural health monitoring. The authors present benchmark results for crack detection using SDNET2018 and a crack detection algorithm based on the AlexNet DCNN architecture. SDNET2018 is freely available at https://doi.org/10.15142/T3TD19.

Brain age from the electroencephalogram of sleep

The human electroencephalogram (EEG) of sleep undergoes profound changes with age. These changes can be conceptualized as "brain age (BA)," which can be compared to chronological age to reflect the degree of deviation from normal aging. Here, we develop an interpretable machine learning model to predict BA based on 2 large sleep EEG data sets: the Massachusetts General Hospital (MGH) sleep lab data set (N = 2532; ages 18-80); and the Sleep Heart Health Study (SHHS, N = 1974; ages 40-80). The model obtains a mean absolute deviation of 7.6 years between BA and chronological age (CA) in healthy participants in the MGH data set. As validation, a subset of SHHS containing longitudinal EEGs 5.2 years apart shows an average of 5.4 years increase in BA. Participants with significant neurological or psychiatric disease exhibit a mean excess BA, or "brain age index" (BAI = BA-CA) of 4 years relative to healthy controls. Participants with hypertension and diabetes have a mean excess BA of 3.5 years. The findings raise the prospect of using the sleep EEG as a potential biomarker for healthy brain aging.

Obstructive sleep apnea, low transferrin saturation levels, and male-pattern baldness

BACKGROUND

There are limited data on the association between obstructive sleep apnea (OSA), which is characterized by intermittent hypoxia, and male-pattern baldness (MPB). Low blood iron levels are reportedly associated with hypoxia and hair loss. This study explored a possible link among OSA, iron status, and MPB.

METHODS

Polysomnography (PSG) and hair assessments were conducted in a cross-sectional study including 932 men aged 46-76 years. OSA was defined as an apnea-hypopnea index ≥5 by PSG evaluation and MPB as scales from IV to VII according to the Norwood-Hamilton scale classification. Serum transferrin saturation (TSA) levels were assessed.

RESULTS

A total of 224 men (24%) were identified as MPB cases and 495 men (53%) as having OSA. After considering potential risk factors, OSA and other sleep-related variables were not associated with MPB. In joint analysis of OSA and family history of hair loss, men with these two factors showed a sevenfold higher multivariate odds ratio (95% confidence interval: 3.70, 12.56) for MPB than those without both of them (P < 0.05 for the interaction between OSA and family history of hair loss). TSA levels were significantly associated with MPB and OSA. OSA cases without MPB as well as MPB cases showed lower TSA levels than those with neither OSA nor MPB (P < 0.05).

CONCLUSIONS

These findings suggest that OSA may be a risk factor for MPB in men who have a family history of hair loss and that low serum TSA levels associated with hypoxia may be involved in a pathway linking OSA and MPB.

Lifestyle-dependent brain change: a longitudinal cohort MRI study

We investigated both independent and interconnected effects of 3 lifestyle factors on brain volume, measuring yearly changes using large-scale longitudinal magnetic resonance imaging, in middle-aged to older adults. We measured brain volumes in a cohort (n = 984, 49-79 years) from the Korean Genome and Epidemiology Study group, using baseline and follow-up estimates after 4 years. In our analysis, the accelerated brain atrophy in normal aging was observed across regions (e.g., brain tissue: -0.098 ± 0.01 mL/y, p < 0.001). An independent lifestyle-specific trend of brain atrophy across time was also evident in men, where smoking (p = 0.012) and physical activity (p = 0.014) showed the strongest association with the atrophy rate. Linear regression analysis of the interconnected effect revealed that brain atrophy is mitigated by intense physical activity in smoking males. Lifestyle factors did not show any significant effect on brain volume in women. These results provide important information regarding lifestyle factors that affect brain aging in mid-to-late adulthood. Our findings may aid in the identification of preventive measures against dementia.