Non-invasive fractional flow reserve estimation using deep learning on intermediate left anterior descending coronary artery lesion angiography images

This study aimed to design an end-to-end deep learning model for estimating the value of fractional flow reserve (FFR) using angiography images to classify left anterior descending (LAD) branch angiography images with average stenosis between 50 and 70% into two categories: FFR > 80 and FFR ≤ 80. In this study 3625 images were extracted from 41 patients' angiography films. Nine pre-trained convolutional neural networks (CNN), including DenseNet121, InceptionResNetV2, VGG16, VGG19, ResNet50V2, Xception, MobileNetV3Large, DenseNet201, and DenseNet169, were used to extract the features of images. DenseNet169 indicated higher performance compared to other networks. AUC, Accuracy, Sensitivity, Specificity, Precision, and F1-score of the proposed DenseNet169 network were 0.81, 0.81, 0.86, 0.75, 0.82, and 0.84, respectively. The deep learning-based method proposed in this study can non-invasively and consistently estimate FFR from angiographic images, offering significant clinical potential for diagnosing and treating coronary artery disease by combining anatomical and physiological parameters.

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

INTRODUCTION

The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures.

METHODS

In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025.

FINDINGS

Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2-6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p<0·0001) and independently associated with COVID-19 status (odds ratio [OR] 2·9 [95% CI 1·5-5·8]; padjusted=0·0023) after adjusting for relevant confounders. Compared with controls, patients were more likely to have MRI evidence of lung abnormalities (p=0·0001; parenchymal abnormalities), brain abnormalities (p<0·0001; more white matter hyperintensities and regional brain volume reduction), and kidney abnormalities (p=0·014; lower medullary T1 and loss of corticomedullary differentiation), whereas cardiac and liver MRI abnormalities were similar between patients and controls. Patients with multiorgan abnormalities were older (difference in mean age 7 years [95% CI 4-10]; mean age of 59·8 years [SD 11·7] with multiorgan abnormalities vs mean age of 52·8 years [11·9] without multiorgan abnormalities; p<0·0001), more likely to have three or more comorbidities (OR 2·47 [1·32-4·82]; padjusted=0·0059), and more likely to have a more severe acute infection (acute CRP >5mg/L, OR 3·55 [1·23-11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation.

INTERPRETATION

After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Integrated personal health record (PHR) security: requirements and mechanisms

BACKGROUND

Personal Health Records (PHRs) are designed to fulfill the goals of electronic health (eHealth) and empower the individual in the process of self-care. Integrated PHR can improve the quality of care, strengthen the patient-healthcare provider relationship, and reduce healthcare costs. Still, the process of PHR acceptance and use has been slow and mainly hindered by people's concerns about the security of their personal health information. Thus, the present study aimed to identify the Integrated PHR security requirements and mechanisms.

METHODS

In this applied study, PHR security requirements were identified with a literature review of (library sources, research articles, scientific documents, and reliable websites). The identified requirements were classified, and a questionnaire was developed accordingly. Thirty experts completed the questionnaire in a two-round Delphi technique, and the data were analyzed by descriptive statistics.

RESULTS

The PHR security requirements were identified and classified into seven dimensions confidentiality, availability, integrity, authentication, authorization, non-repudiation, and right of access, each dimension having certain mechanisms. On average, the experts reached an agreement about the mechanisms of confidentiality (94.67%), availability (96.67%), integrity (93.33%), authentication (100%), authorization (97.78%), non-repudiation (100%), and right of access (90%).

CONCLUSION

Integrated PHR security is a requirement for its acceptance and use. To design a useful and reliable integrated PHR, system designers, health policymakers, and healthcare organizations must identify and apply security requirements to guarantee the privacy and confidentiality of data.

Performance of machine learning techniques on prediction of esophageal varices grades among patients with cirrhosis

OBJECTIVES

All patients with cirrhosis should be periodically examined for esophageal varices (EV), however, a large percentage of patients undergoing screening, do not have EV or have only mild EV and do not have high-risk characteristics. Therefore, developing a non-invasive method to predict the occurrence of EV in patients with liver cirrhosis as a non-invasive method with high accuracy seems useful. In the present research, we compared the performance of several machine learning (ML) methods to predict EV on laboratory and clinical data to choose the best model.

METHODS

Four-hundred-and-ninety data from the Liver and Gastroenterology Research Center of Shahid Beheshti University of Medical Sciences in the period 2014-2021, were analyzed applying models including random forest (RF), artificial neural network (ANN), support vector machine (SVM), and logistic regression.

RESULTS

RF and SVM had the best results in general for all grades of EV. RF showed remarkably better results and the highest area under the curve (AUC). After that, SVM and ANN had the AUC of 98%, for grade 3, the SVM algorithm had the highest AUC after RF (89%).

CONCLUSIONS

The findings may help to better predict EV with high precision and accuracy and also can help reduce the burden of frequent visits to endoscopic centers. It can also help practitioners to manage cirrhosis by predicting EV with lower costs.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Identifying predictors of varices grading in patients with cirrhosis using ensemble learning

Objectives

The present study was conducted to improve the performance of predictive methods by introducing the most important factors which have the highest effects on the prediction of esophageal varices (EV) grades among patients with cirrhosis.

Methods

In the present study, the ensemble learning methods, including Catboost and XGB classifier, were used to choose the most potent predictors of EV grades solely based on routine laboratory and clinical data, a dataset of 490 patients with cirrhosis gathered. To increase the validity of the results, a five-fold cross-validation method was applied. The model was conducted using python language, Anaconda open-source platform. TRIPOD checklist for prediction model development was completed.

Results

The Catboost model predicted all the targets correctly with 100% precision. However, the XGB classifier had the best performance for predicting grades 0 and 1, and totally the accuracy was 91.02%. The most significant variables, according to the best performing model, which was CatBoost, were child score, white blood cell (WBC), vitalism K (K), and international normalized ratio (INR).

Conclusions

Using machine learning models, especially ensemble learning models, can remarkably increase the prediction performance. The models allow practitioners to predict EV risk at any clinical visit and decrease unneeded esophagogastroduodenoscopy (EGD) and consequently reduce morbidity, mortality, and cost of the long-term follow-ups for patients with cirrhosis.

Minimum Data Set of Personal Health Record (PHR) for Patients with Chronic Respiratory Diseases

Introduction: Chronic respiratory diseases are one of the four main groups of non-communicable diseases. People with these diseases need access to data to manage their disease and care plan. Personal health record (PHR) as a powerful health information technology tool can empower chronic patients to better manage their health status and become an active member of health care teams. This study is to determine the minimum data set (MDS) in personal health record for patients with chronic respiratory diseases.Materials and Method: This present applied research was done descriptively by Delphi method. First, the data sets of chronic respiratory diseases were extracted using a literature review. Then, using a researcher-made questionnaire and based on Delphi technique in two phases, it was evaluated by 5 pulmonologists.Results: The PHR data set for chronic respiratory diseases was classified into six categories, including physical examination and clinical observation, laboratory data, medications, specialized treatments, diagnostic procedures and vaccination. The 33 data element were identified as the main data elements with an agreement of more than 80% in the first phase of Delphi technique. Also, in the second phase, the four data elements proposed by the experts in the first phase were agreed upon above 80%.Conclusion: Given the role of PHR data in tracking the progress of chronic diseases, treating, and teamwork by physicians and other care providers, determining the minimum data set will be an effective step toward integrating and improving information management in these patients.

Application of ICT in effective crisis management: A systematic review

INTRODUCTION

Effective crisis management can reduce the costs and consequences of a crisis and has a significant impact on saving human lives in critical situations. Proper use of information and communication technologies (ICTs) can improve all crisis management phases and crisis communication cycles according to the needs of stakeholders. The purpose of this review article is to identify which ICTs have been used in effective crisis management and what managerial tasks they support.

METHOD

A systematic review was conducted based on PRISMA protocol. The investigated articles that have been published in English were all indexed in PubMed, Science Direct, IEEE, Web of Science, and Google Scholar databases from 2005 to 2019. The keywords searched were "Crisis Management," "Emergency Management," "Information and Communication Technology," and their synonyms.

RESULTS

A total of 1,703 articles were retrieved, and 81 articles that met the inclusion criteria were retained. In terms of content, there were 54 case studies/review articles, 38 proposals, and seven prototypes among which 18 case studies and proposals were the same. According to surveys, 18 ICT tools and technologies have been used in effective crisis management with the purpose of supporting managerial tasks such as situation assessment, decision-making, coordination/command and control, communication with the public, and supply of basic services in order to enable crisis management and logistics.

CONCLUSION

This study showed that proper use of ICT can help crisis managers optimize their performance that will consequently result in effective crisis management and the reduction of casualties. In the crisis management cycle, several tools and technologies have been used for various purposes, however; some crisis managers' tasks were still not taken into consideration sufficiently, and thus, some recommendations for further research in this field were provided.

Consequences for Norway from a hypothetical accident at the Sellafield reprocessing plant: Atmospheric transport of radionuclides

The potential consequences for Norway should a nuclear accident at the Sellafield nuclear site occur, have been of concern for Norwegian authorities for several decades. Meteorological data from a 33-year period and the dispersion model 'SNAP' were used to evaluate meteorological conditions for which atmospheric transport of radionuclides from Sellafield to Norway would lead to the most severe impacts. The worst-case meteorological scenario for Norway, was found on 25^th June 1989 for a low elevation (0-800 m) release and on 29^th June 2001 for a higher elevation (800-1600 m) release. In both cases the western part of Norway was most affected. In general, the probability for depositions (>10 Bq/m² of ¹³⁷Cs) increased about 40% during the autumn and winter compared to the spring and summer months. An influence of climate change on the depositions was analysed, but not verified. Results from a number of simulations were also compared to identify how factors such as radioactive particle characteristics and initial release conditions could affect the predicted radionuclide deposition. The impact on predicted total depositions as well as hot-spot depositions by varying particle density and size as well as release elevation in worst-case scenario simulations amounted to about 40%-50%.

Minimum Data Set for a Poisoning Registry: A Systematic Review

Poisoning, as a well-known medical condition, puts everyone at risk. As a data management tool, a registry plays an important role in monitoring the poisoned patients. Having a poisoning minimum data set is a major requirement for creating a poisoning registry. Therefore, the present systematic review was conducted in 2019 to identify the minimum data set for a poisoning registry. Searches were performed in four scientific databases, i.e., PubMed, Scopus, Web of Science, and Embase. The keywords used in the searches included minimum data set, "poison", and "registry". Two researchers independently evaluated the titles, abstracts, and texts of the papers. The data were collected from the related papers. Ultimately, the minimum data set was identified for the poisoning registry. Data elements extracted from the sources were classified into two general categories: administrative data and clinical data. Ninety-eight data elements in the administrative data category were subdivided into three sections: general data, admission data, and discharge data. One-hundred and thirty-one data elements in the clinical data category were subdivided into five sections: clinical observation data, clinical assessment data, past medical history data, diagnosis data, and treatment plan data. The minimum data set is a prerequisite for creating and using a poisoning registry and data system. It is suggested to evaluate and use the poisoning minimum data set in accordance with the national laws, needs, and standards based on the opinion of the local experts.

Functions and Outcomes of Personal Health Records for Patients with Chronic Diseases: A Systematic Review

INTRODUCTION

The personal health record (PHR) makes it possible for patients to access, manage, track, and share their health information. By engaging patients in chronic disease care, they will be active members in decision-making and healthcare management.

OBJECTIVES

This study aimed to identify the functions and outcomes of PHR for patients with four major groups of chronic diseases (cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases).

METHOD

A systematic review was conducted on studies published in PubMed, Scopus, Web of Science, and Embase. Searching and screening were performed using the keyword of "Personal Health Record" without time limitation, and ended in August 2018.

RESULTS

In total, 3742 studies were retrieved, 35 of which met the inclusion criteria. Out of these 35, 18 studies were conducted in the United States, 24 studies were related to patients with diabetes, and 32 studies focused on tethered PHRs. Moreover, in 25 studies, the function of viewing and reading medical records and personal health information was provided for three groups of chronic patients. Results showed that the use of PHRs helps the management and control of chronic diseases (10 studies).

CONCLUSION

It is recommended that integrated PHRs with comprehensive functions and features were designed in order to support patient independence and empowerment in self-management, decrease the number of referrals to health centers, and reduce the costs imposed on families and society.

Telemedicine Services in Chronic Obstructive Pulmonary Disease: A Systematic Review of Patients' Adherence

BACKGROUND

The current systematic review aimed to determine the effect of telemedicine services on adherence in patients with chronic obstructive pulmonary disease (COPD) and to describe the type of adherence and applied devices and modules.

MATERIALS AND METHODS

We reviewed PubMed, Scopus, Web of Science, and Embase databases to identify relevant studies from the time of inception of these databases to March 10, 2019, using three groups of keywords. The first group comprised words describing COPD, the second group included words describing types of telemedicine interventions, and the third group contained words describing adherence. The reference list of identified articles was also hand-searched to retrieve possibly relevant articles.

RESULTS

In total 21 articles were included, in which 13 reported a positive effect for telemedicine on patients' adherence. Adherence to treatment was classified under six categories. The highest frequency belongs to the adherence to performing exercises and participation in training sessions, using the system, using devices, measuring (like blood pressure, oxygen saturation, heart rate, weight, temperature, sputum volume) and reporting symptoms and the results of measurements, completing tasks, and medication.

CONCLUSION

This study demonstrated the effectiveness of telemedicine services on adherence to treatment plans in patients with COPD. The following factors contribute to the effectiveness of telemedicine services: patient support by healthcare professionals and easy access to them, uninterrupted execution of telemedicine programs, follow-up and supervision of providers, creating and maintaining motivation in patients, and provision of different self-management modules.

Immunization with recombinant PlpE of ovine Mannheimia haemolytica isolate provides protection against lethal challenge in mice

BACKGROUND

Mannheimia haemolytica primarily causes pneumonia leading to heavy morbidity and mortality in domestic livestock world-wide. Recently, outer membrane lipoproteins have emerged as targets for inducing protective immunity against the Pasteurella infection.

AIMS

This study aimed to evaluate recombinant outer membrane lipoprotein E (PlpE) from the ovine M. haemolytica isolate, as a potential vaccine candidate.

METHODS

Recombinant PlpE was constructed using pET26 (b) expression vector in Escherichia coli. Expressed recombinant PlpE was purified and injected subcutaneously to mice. The protection index of the vaccine was evaluated by challenge of mice intraperitoneally.

RESULTS

Anti-PlpE antibody responses in the immunized mice was significantly increased in comparison with the control group which in turn, provided effective protection when challenged with strain of virulent M. haemolytica.

CONCLUSION

Recombinant PlpE from ovine M. haemolytica isolate had the potential to be used as a vaccine candidate against M. haemolytica infection in sheep flocks.

Usability Evaluation of the Information System Used in Neuroscience Research Centres

Introduction: Information systems are tools for facilitating information management in research centres that improve quality by reducing errors and increasing speed and precision. Accordingly, their usability is of utmost importance. Usability problems can lead to user errors, may threaten patient safety, and negatively impact the quality of care. Aim: To evaluate the usability of the information system used in Neuroscience Research centres of hospitals affiliated with Shahid Beheshti University of Medical Sciences (SBUMS), Tehran, Iran. Materials and Methods: This was a descriptive study conducted in July 2020 at SBUMS. Before starting the study, ethical considerations such as obtaining informed consent, anonymity, confidentiality, and the participants’ freedom to withdraw from the study were taken into account. The data collection instrument was a questionnaire adapted from the Usefulness, Satisfaction, and Ease of Use (USE) and ISO Metrics questionnaires. Samples were information system used in Neuroscience Research Centres of hospitals affiliated with SBUMS. Therefore, from the centres affiliated with SBUMS, only two hospitals met this requirement, which were Educational hospitals affiliated with SBMUS. The content validity of the questionnaire was examined, and its reliability was checked by Cronbach’s alpha. Results: The information systems of the mentioned centres had a usefulness of 5.93, learnability of 5.79, memorability of 5.22, user satisfaction of 4.89, and ease of use of 4.76, based on a 7-point Likert scale. Overall, the usability of the designed systems had an acceptable and favourable state based on all the criteria. Conclusion: Of the examined criteria, usefulness and learnability achieved a higher score, indicating the good design of the system in terms of these dimensions. However, the ease of use had the lowest score, showing the poor user design of the information system in this dimension. To achieve an excellent level of information system usability in these centres, attention should be paid to all the dimensions of information system usability.

Designing a National Haemodialysis Registry Model for Iran

Introduction: The global prevalence of End-Stage Renal Disease (ESRD) requiring therapeutic dialysis is on the rise. Haemodialysis is the main therapeutic dialysis method. Evaluating its effectiveness and planning to promote the quality of care and epidemiological research necessitate the development of registries as the main management tool. Aim: To design a national haemodialysis registry model for Iran. Materials and Methods: This was an applied descriptive study. Based on a review of articles and information sources, and a comparative study of national hemodialysis registries in developed countries, a national haemodialysis registry model was designed for Iran. After confirming the reliability and validity of the questionnaire, the designed model was given to nephrologists in a two-stage Delphi technique, and their comments were applied to the final model. Results: The presented national haemodialysis registry model main components consist of: goals, structure, data sources, minimum dataset, standards, and processes, all of which received 100% expert consensus. Conclusion: This registry is a powerful database for the progress of treatment, understanding changes in the treatment and outcomes, examining the factors affecting prognosis and quality of life.

Development of a Knowledge-based Clinical Decision Support System for Multiple Sclerosis Diagnosis

The diagnosis of multiple sclerosis (MS) is difficult considering its complexity, variety in signs and symptoms, and its similarity to the signs and symptoms of other neurological diseases. The purpose of this study is to design and develop a clinical decision support system (CDSS) to help physicians diagnose MS with a relapsing-remitting phenotype. The CDSS software was developed in four stages: requirement analysis, system design, system development, and system evaluation. The Rational Rose and SQL Server were used to design the object-oriented conceptual model and develop the database. The C sharp programming language and the Visual Studio programming environment were used to develop the software. To evaluate the efficiency and applicability of the software, the data of 130 medical records of patients aged 20 to 40 between 2017 and 2019 were used along with the Nilsson standard questionnaire. SPSS Statistics was also used to analyze the data. For MS diagnosis, CDSS had a sensitivity, specificity and accuracy of 1, 0.97 and 0.99, respectively, and the area under the ROC curve was 0.98. The agreement rate of kappa coefficient (κ) between software diagnosis and physician's diagnosis was 0.98. The average score of software users was 98.33%, 96.65%, and 96.9% regarding the ease of learning, memorability, and satisfaction, respectively. Therefore, the applicability of the CDSS for MS diagnosis was confirmed by the neurologists. The evaluation findings show that CDSS can help physicians in the accurate and timely diagnosis of MS by using the rule-based method.

Mobile Health Technology for Hypertension Management: A Systematic Review

Hypertension is a chronic condition, and a major risk factor for other chronic conditions requires management. Considering the growth and extensive use of mobile health (mHealth) technologies and their capabilities, it is essential to examine the effects of these technologies on hypertension control and self-management. The present systematic review examined the effect of using mHealth technologies in controlling blood pressure and investigated the functionalities of mHealth technology on self-management aspects of patients with hypertension. A systematic search was conducted on PubMed, Web of Science, Embase, and Scopus databases. Clinical trials in English investigating the use of mHealth technologies for blood pressure control published from 2005 to 2018 were included in this study. The functionalities of these technologies were also investigated. These functionalities were divided into five categories of monitoring, alarms, feedbacks, education, and communication. The most frequently used technology for hypertension control was smartphones in the 15 articles examined. Moreover, the most frequent functionalities used for self-management of hypertension were communications and reminders, education, monitoring, and feedback, respectively. In the majority of the studies, these functionalities were employed in combination with mHealth technologies, a feature that affects hypertension control and self-management. The use of mHealth technologies, such as smartphones, positively affects hypertension self-management and reduces blood pressure. Functionalities such as communication and reminders, education, monitoring, and feedback are effective in hypertension self-management programs. The simultaneous use of these functionalities combined will be more effective in hypertension self-management programs.

Oncologic outcomes of patients with incidental prostate cancer who underwent RARC: a comparison between nerve sparing and non-nerve sparing approach

BACKGROUND

Incidental Prostate cancer (iPCa) is a relatively common finding during histopathological evaluation of radical cystectomy (RC) specimens. To reduce the high impact of RC on erectile function, several sexual-preserving techniques have been proposed. The aim of this study was to evaluate and compare the oncologic outcomes of patients with iPCa who underwent nerve spring and no-nerve sparing robot-assisted radical cystectomy (RARC).

METHODS

The clinicopathologic data of male patients who underwent RARC at our institution between 2006 and 2016 were retrospectively analysed. Patients with iPCa at definitive pathological examinations were stratified in two groups, according to the preservation of the neurovascular bundles (nerve sparing vs no nerve sparing). Significant PCa was defined as any Gleason score ≥ 3 + 4. Biochemical recurrence (BR) was defined as a sustained PSA level > 0.2 ng/mL on two or more consecutive appraisals. BR rate was assessed only in patients with incidental prostate cancer and at least 2 years of follow-up. Differences in categorical and continuous variables were analysed using the chi-squared test and the Mann-Withney U test, respectively. Biochemical recurrence curves were generated using the Kaplan-Meier method and compared with the Log-rank test.

RESULTS

Overall, 343 male patients underwent RARC for bladder cancer within the study period. Nerve-sparing surgery was performed in 143 patients (41%), of these 110 had at least 2 years of follow up after surgery. Patients who underwent nerve-sparing surgery were significantly younger (p < 0.001). Clinically significant PCa was found in 24% of patients. No significant differences regarding preoperative PSA value (p = 0.3), PCa pathological stage (p = 0.5), Gleason score (p = 0.3) and positive surgical margin rates (p = 0.3) were found between the two groups. After a median follow-up of 51 months only one patient, in the no-nerve-sparing group had developed a biochemical recurrence (p = 0.4).

CONCLUSIONS

In our series most of the iPca detected in RC specimens can be considered as insignificant with a low rate of BR (0.9%). Nerve-sparing RARC is a safe procedure which did not affect oncological outcomes of patients with iPCa.

EVALUATING SHORT-TERM EXPOSURE TO WI-FI SIGNALS ON STUDENTS' REACTION TIME, SHORT-TERM MEMORY AND REASONING ABILITY

This study investigated the effect of short-term exposure to Wi-Fi signals on the cognitive functions of the mind. After obtaining permission from the local Ethics Committee of Shiraz University of Medical Sciences and approval by the Iranian Registry of Clinical Trials (IRCT2017041233398N1), 45 male and female students from Shiraz University of Medical Sciences volunteered to participate in this study. They were exposed to Wi-Fi signals in two sham and exposure sessions, each for 2 hours. After completion, they took part in reaction time, short-term memory, and reasoning ability tests. After scoring, the data were analysed by SPSS software. In addition, the electric field strength and power density were calculated. The results showed no statistically significant differences between the mean scores of reaction time, short-term memory, and reasoning ability in sham and exposure. Also, the obtained values from the electric field strength and power density (E = 4.1 Vm-1, P = 0.446 Wm-2) were lower than that of threshold values by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Our results can greatly reduce concerns regarding the effects of short-term exposure to Wi-Fi waves on cognitive functions.

Cloning and Expression of Mannheimia haemolytica PlpE Gene in Escherichia coli and its Immunogenicity Assessment

Mannheimia haemolytica is responsible for considerable economic losses to cattle, sheep, and goat industries in many parts of the world. This bacterium isone of the causative agents of shipping fever in cattle. Current vaccines against M. haemolytica are moderately efficacious since they do not provide complete protection against the disease. Production of an economic vaccine for protecting farm animals against M. haemolytica has attracted the attention of many scientists. The outer membrane proteins (OMPs) play a major role in the pathogenesis and immunogenicity of M. haemolytica. Research on M. haemolytica OMPs has shown that antibodies to a particular OMP may be important in immune protection. In the current study, the gene for M. haemolytica OMP PlpE was cloned into the expression vector pET26-b, and then expressed in Escherichia coli BL21. The expression of the protein was carried out by the induction of cultured Escherichiacoli Bl21 cells with 1mM isopropyl-&amp;beta;-D-thiogalactopyranoside. The recombinant PlpE was purified using Ni-NTA agarose resin, and then subjected to sodium dodecyl sulfate polyacrylamide gel electrophoresis. The identity of the expressed protein was analyzed by western blotting. It was revealed that rPlpE was expressed and produced properly. To assess the immunogenicity of the recombinant protein, the purified rPlpE was used as an antigen for antibody production in goats. The observations suggested that the produced recombinant protein can be used as a antigen for developing diagnostic tests and or as a vaccine candidate.

Abstract P4-11-01: A simple intervention for long-term relief of chronic post mastectomy pain

Background: Post-mastectomy pain syndrome (PMPS) is a common and often debilitating condition. One common cause likely results from injury to the T4 and T5 sensory nerves during breast surgery, with resulting neuroma formation. It manifests as a pain syndrome diagnosed by “trigger points” that reproduce exquisite pain upon palpation. Pain specialists have found a combination of corticosteroids and local anaesthetic given through perineural infiltration, at other sites, effective in alleviating these neuromas or trigger points. Utilizing this principle, we initiated a quality improvement project to treat PMPS. This perineural injection led to remarkable, long-lasting relief of the first few patients, we therefore continued treating patients with clinical symptoms suggestive of a neuroma. We report on long-term pain relief after trigger point injections (TPI) for women with PMPS.

Methods: An observational cohort study of women with PMPS and clinical evidence of neuroma was undertaken. Patients were examined by breast surgeons at a single institution. We injected a 2mL mixture of equal parts 0.5% bupivacaine and 4 mg/mL dexamethasone into each trigger point. Demographics, type of breast and axillary surgery, duration of pain, history of surgical complications, adjuvant radiotherapy, number of injections required, location of trigger points and dates of injection were obtained from the electronic medical record. Patients were surveyed via telephone interview for long-term resolution of pain. Descriptive statistics are reported, univariate and bivariate analyses were conducted using Stata 12 (College Station, TX).

Results: We identified 89 trigger points on 61 breasts in 53 patients with PMPS. Patient age ranged from 30-92 years. Mean number of surgeries prior to injection was 2.2 (range 1-8). In this cohort, we found mastectomy was the most frequent surgical procedure preceding the development of a neuroma (41 breasts), followed by reduction mammoplasty with or without concurrent partial mastectomy (16 breasts), and least frequently lumpectomy alone (4 breasts). The time from the onset of neuropathic pain to the first trigger point injection varied from as early as 1 week post-operatively to 132 months (mean 22.2 months). Effectiveness of the TPI was assessed by physical examination immediately (1-3 minutes) after the injection, then with telephone interview (at &gt;/=3 months post TPI). All 53 patients had long-term follow-up data (≥3 months). Long-term relief was achieved in 84 of 89 trigger points (94.4%) or 54 of 61 breasts (88.5%). Trigger point injections were well tolerated by all patients and no complications were reported.

Discussion: Perineural infiltration with bupivacaine and dexamethasone is a safe, simple, and effective treatment option for PMPS with an associated trigger point. Our data suggest this significant problem can easily be resolved in an outpatient setting. All breast specialists should inquire about the presence of symptoms consistent with PMPS and understand the value of intervention to eliminate neuropathic pain. This technique should be added to the armamentarium of all surgeons who perform breast surgery.

Citation Format: Keane HJ, Khoury AL, Hosseini A, Varghese FP, Mukhtar R, Eder SE, Wong J, Esserman LJ. A simple intervention for long-term relief of chronic post mastectomy pain [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-11-01.

Notifiable Diseases Surveillance System with a Data Architecture Approach: a Systematic Review

Introduction:

The wide range of notifiable diseases and the need for immediate reporting complicate the management of these diseases. Developing a surveillance system using precise architectural principles could ease the management of these diseases.

Aim:

The present study reviews the data architecture of notifiable diseases surveillance systems to provide a basis for developing such systems.

Methods:

A systematic review was conducted on the literature focused on data architecture of notifiable diseases surveillance systems. The searches for relevant English language articles were conducted based on the paper keywords, as well as the words Mesh and EMTREE.

Results:

The findings were categorized into five groups, including organizations involved in the generation and monitoring of notifiable diseases’ data. The databases in the present study were relational and used a centralized architecture for information sharing. The minimum dataset was determined in two information categories. The data standards were categorized into three main groups. The key approaches for data quality control included checking the completeness, timeliness, accuracy, consistency, adequacy, and validity of the data.

Conclusion:

Developing a notifiable diseases surveillance based on data architecture principles could lay the foundation for better management of such diseases through eliminating the obstacles experienced during data generation, data processing, and data sharing.

Logarithmic Upturn in Low-Temperature Electronic Transport as a Signature of d-Wave Order in Cuprate Superconductors

In cuprate superconductors, high magnetic fields have been used extensively to suppress superconductivity and expose the underlying normal state. Early measurements revealed insulatinglike behavior in underdoped material versus temperature T, in which resistivity increases on cooling with a puzzling log(1/T) form. We instead use microwave measurements of flux-flow resistivity in YBa_{2}Cu_{3}O_{6+y} and Tl_{2}Ba_{2}CuO_{6+δ} to study charge transport deep inside the superconducting phase, in the low-temperature and low-field regime. Here, the transition from metallic low-temperature resistivity (dρ/dT>0) to a log(1/T) upturn persists throughout the superconducting doping range, including a regime at high carrier dopings in which the field-revealed normal-state resistivity is Fermi-liquid-like. The log(1/T) form is thus likely a signature of d-wave superconducting order, and the field-revealed normal state's log(1/T) resistivity may indicate the free-flux-flow regime of a phase-disordered d-wave superconductor.

Intelligent Computer Systems for Multiple Sclerosis Diagnosis: a Systematic Review of Reasoning Techniques and Methods

OBJECTIVE

Intelligent computer systems are used in diagnosing Multiple Sclerosis and help physicians in the accurate and timely diagnosis of the disease. This study focuses on a review of different reasoning techniques and methods used in intelligent systems to diagnose MS and analyze the application and efficiency of different reasoning methods in order to find the most efficient and applicable methods and techniques for MS diagnosis.

METHODS

A complete research was carried out on articles in various electronic databases based on Mesh vocabulary. 85 articles out of 614 articles published in English between 2000 to 2018 were analyzed, 30 of which have been selected based on inclusion criteria such as system scope and domain, full description of reasoning method and system evaluation.

RESULTS

Results indicate that different reasoning methods are used unintelligent systems of MS diagnosis. In 27% of the studies, the rule-based method was used, in 20% the fuzzy logic method, in 18%the artificial neural network method, and in 35% other reasoning methods were used. The average sensitivity, specificity and accuracy of reasoning methods were0.91, 0.77, and 0.86, respectively.

CONCLUSIONS

Rule-based, fuzzy-logic and artificial neural network methods have had more applications in intelligent systems for the diagnosis of MS, respectively. The highest rate of sensitivity and accuracy indexes is associated to the neural network reasoning method at 0.97 and 0.99, respectively .In the fuzzy logic method, the Kappa rate has been reported as one, which shows full conformity between software diagnosis and the physician's decision .In some articles, in order to remove the limitations of the methods and enhance their efficiency, combinations of different methods are used.

Developing a Dashboard Software for the ICUs and Studying its Impact on Reducing the Ventilator-Associated Pneumonia

Objective:

Ventilator-Associated Pneumonia (VAP), a lung infection developing in patients on a ventilator in Intensive Care Units (ICU), is the second most common nosocomial infection and a leading cause of morbidity and mortality in ICUs. To reduce the incidence rate of VAP complication, many healthcare organizations have already developed certain strategies and guidelines. However, there are still high rates of VAP infections mainly due to: conflicting guidelines from different sources, implementing the guidelines at different times and conditions, different ICU caregivers at different shifts, and of course the human mistakes.

Methods:

The present study aimed to develop a dashboard to help reducing VAP incidences in ICUs. To achieve the objective of the research, first, the VAP prevention guidelines were compiled. The object-oriented analysis approach was adopted for designing of the dashboard software. To assess the impact of the developed dashboard on the reduction of VAP events, a pilot hospital was selected and a pilot project was prepared. For the dashboard usability assessment based on user satisfaction, a questionnaire was developed as the survey tool.

Conclusion:

The dashboard was developed and put into operation in a pilot ICU. The results from the t-test (with a probable error of 0.05 percent) indicated a meaningful difference between the number of VAP patients before and after the dashboard implementation with p-value ˂ 0.02. Also, the developed software was evaluated from a usability point of view based on user satisfaction, with health professionals and caregivers of the pilot ICU as the users of the software. The total score was equivalent to 95 percent, falling within the acceptable range of 75-100 percent.

Dietary energy level affects adipose depot mass but does not impair in vitro subcutaneous adipose tissue response to short-term insulin and tumor necrosis factor-α challenge in nonlactating, nonpregnant Holstein cows

We assessed effects of overfeeding energy to nonlactating and nonpregnant Holstein cows during a length of time similar to a typical dry period on body lipid storage and the abundance of genes related to insulin signaling, inflammation, and ubiquitination in subcutaneous adipose tissue (SAT) in vitro challenged with insulin and recombinant bovine tumor necrosis factor-α. Fourteen cows were randomly assigned to either a high-energy (OVE; net energy for lactation = 1.60 Mcal/kg of dry matter; n = 7) or control (CON; net energy for lactation = 1.30 Mcal/kg of dry matter; n = 7) diet for 6 wk. Immediately after slaughter, liver, kidneys, and mammary gland were separated and weighed. The adipose tissue mass in the omental, mesenteric, and perirenal depots was dissected and weighed. Subcutaneous adipose tissue was collected from the tail-head region and was used as follows: control, bovine insulin (INS) at 1 µmol/L, tumor necrosis factor-α at 5 ng/mL (TNF), and their combination. Despite a lack of difference in final body condition score, OVE cows had greater energy intake and were heavier than CON cows. Furthermore, overfeeding led to greater mass of mesenteric and perirenal adipose, liver, and mammary gland. Overall, SAT incubated with INS had an upregulation of insulin receptor (INSR), interleukin-10 (IL10), small ubiquitin-like modifier 3 (SUMO3), and ubiquitin conjugating enzyme E2I (UBC9), whereas TNF upregulated peroxisome proliferator-activated receptor gamma (PPARG), diacylglycerol O-acyltransferase 2 (DGAT2), interleukin-6 (IL6), nuclear factor kappa B subunit 1 (NFKB1), small ubiquitin-like modifier 2 (SUMO2), and UBC9. Regardless of in vitro treatment, feeding OVE upregulated PPARG, fatty acid synthase (FASN), and insulin induced gene 1 (INSIG1). Abundance of PPARG was greater in SAT of OVE cows cultured individually with INS and TNF. The interaction between diet and in vitro treatment revealed that sterol regulatory element binding transcription factor 1 (SREBF1) had greater abundance in SAT from the CON group in response to culture with INS, whereas SAT from OVE cows had greater SREBF1 abundance in response to culture with TNF. The mRNA abundance of IL6 and NFKB1 was greater in response to TNF treatment and overall in CON cows. Furthermore, SAT from these cows had greater IL10 abundance when cultured with INS and TNF. Overall, data highlighted that overfeeding energy increases adipose tissue mass in part by stimulating transcription of key genes associated with insulin signaling, adipogenesis, and lipogenesis. Because SAT thickness or mass was not measured, the lack of effect of overfeeding on body condition score limits its use to predict overall body lipid storage. An overt inflammatory response in SAT after a 6-wk period of over-consumption of energy could not be discerned.

National information system for rare diseases with an approach to data architecture: A systematic review

The study aims to systematically review literature on the rare diseases information system to identify architecture of this system from a data perspective. The search for relevant English language articles, based on keywords in title, abstract, Mesh and Emtree terms, was done in Pubmed and Embase (from 1980 to June 2017), Scopus, Science Direct and Cochran (from 1980 to July 2017). Articles were selected if they addressed data architecture of information systems with a focus on rare disease, and if at least one of their objectives dealt with design, implementation, and development of rare diseases information systems. Thirty-five studies met the inclusion criteria. The findings were categorized into six groups. This first group addressed organizations acting as data generators, data users, and data governors. The second group was related to data sources and databases. Datasets and data elements formed the third group of findings, including common datasets, specific datasets, and complementary datasets. The fourth group of findings was in relation to data standards. Data sharing and interactions among relevant bodies included the fifth group of the findings. The last group of findings was pertinent to procedures and criteria used for checking the quality of data, as cross review checking was a main procedure assessing the accuracy, consistency, and completeness of data. Design and development of an integrated information system for rare diseases considering data architecture principles in practice could help eliminating issues with management of rare diseases through facilitating sharing information and experiences.

Lactation-related changes in tissue expression of PEDF in dairy cows

Pigment epithelium-derived factor (PEDF) is evolving as metabolic regulatory protein. Albeit mostly considered in only pathological conditions related to excess energy intake resulting in obesity and insulin resistance, PEDF is likely to be involved in other physiological processes such as the homeorhetic adaptation of metabolism to lactation. We aimed to characterize the expression of PEDF and its association to the concomitant mobilization of body reserves during lactation in nonobese subjects. This mobilization is particularly distinct in dairy cows, and we therefore assessed the mRNA expression of PEDF and its putative receptors in different tissues in 2 trials with dairy cows fed with or without conjugated linoleic acids (CLAs). Conjugated linoleic acids depress milk fat synthesis and may thus reduce the drain of energy via milk. In pluriparous cows, the serum PEDF concentrations and the mRNA abundance in subcutaneous adipose tissue (scAT), as well as the hepatic and scAT mRNA abundance of the putative receptors, adipose triglyceride lipase, and laminin receptor 1, changed over time of sampling (day -21 until day 252 relative to calving). Conjugated linoleic acid treatment was associated with reduced PEDF concentrations in serum and lower PEDF mRNA abundance in scAT on day 21 postpartum. Comparing different tissues from primiparous cows, PEDF mRNA was highest in the liver, followed by scAT, visceral adipose tissue (AT), and mammary gland, and lowest in the muscle. Significant changes in PEDF expression with time of sampling were limited to AT in primiparous and pluriparous cows. Our data support a regulatory role for PEDF. The similarities between the time course of the serum concentrations of PEDF and its mRNA abundance in scAT may point to a regulatory role for AT rather than the liver for PEDF in dairy cows.

Treatment of third-degree burn wounds in animal specimens: acellular dermis or partial-thickness skin graft

Several dermal products have been introduced to substitute dermal tissues. In this study we review the effects of these products on repairing third-degree burn wounds and managing complications in animal specimens. Using an interventional approach, rats were randomly assigned to four groups (G1 to G4). Two wounds were created on the back of each rat. An open wound was left on the back of rats in G1; in G2, wounds were covered with a thick rat derived-ADM product and overlying thin skin graft; on G3 rats, similar third degree ulcers were made with one ulcer covered with harvested thin skin graft. In G4, ulcers were covered with a thin rat derived-ADM product and thin graft. Factors such as take rate, histopathological score, wound contracture and graft contracture were compared on the 7th, 15th, 21st and 30th day. Mean graft take rate on the 30th day in the thick ADM, thin ADM and graft group showed a significant difference (p=0.015). Histopathological score on the 30th day in the thin ADM, thick ADM and graft group showed no considerable difference. Mean graft take rate was significantly better in the thin ADM and graft group than in the thick ADM group. Wound contracture was significantly more severe in the thick ADM and control group than in the thin ADM and graft group.

Abstract P5-22-22: Breast tumor location in BRCA mutation carriers and implications for prevention

Introduction:

Close to 65% of BRCA mutation carriers do not choose prophylactic mastectomy, despite their high breast cancer risk. Breast reduction mammoplasty is a surgical technique shown to reduce breast cancer risk and can be modified to target specific areas of the breast. We wondered if a majority of tumors in BRCA mutation carriers would be confined to one quadrant, allowing for the use of targeted cosmetic mammoplasty as a novel method of risk reduction.

Methods:

We reviewed imaging reports on 103 consecutive patients with BRCA mutations and invasive breast cancer, and categorized tumor location by quadrant. Tumors spanning &gt;1 quadrant were classified as being in both. Bilateral cancers were counted separately. Categorical variables were compared with the chi-squaredtest.

Results:

Mean age at breast cancer diagnosis was 44 years with mean tumor size of 2.2 cm (0.1-7cm). 92% of tumors were invasive ductal carcinoma, 46% were hormone receptor positive, 10% Her2 positive, and 44% triple negative. 70% of the tumors were unicentric. Tumors were significantly more likely to be in the upper outer quadrant whether or not multicentric tumors were included in the analysis (p&lt;0.00001). Her2 positive tumors were more likely to be multicentric than other subtypes (p=0.021).

Conclusions:

More than half of breast cancers in BRCA mutation carriers form in the upper outer quadrant, suggesting that removing this quadrant through breast reduction mammoplasty could significantly reduce breast cancer risk. For women who are not ready for prophylactic mastectomy, this data supports an intermediate risk reduction step instead of only offering surveillance.

Citation Format: Hosseini A, Esserman LJ, Wallace AM, Au A, Mukhtar RA. Breast tumor location in BRCA mutation carriers and implications for prevention [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-22-22.

Abstract P5-12-04: The impact of bariatric surgery on mammographic breast density

Background:

Bariatric surgery decreases breast cancer risk, but its impact on mammographic findings is not well understood. Obesity and breast density both increase breast cancer risk, but paradoxically are inversely related. We investigated how mammographic density changes after bariatric surgery, and whether or not that change is related to amount of weight loss.

Methods:

We reviewed records for 349 prospectively collected patients who underwent bariatric surgery between 2013-2015, and identified 45 women with pre- and post-operative screening mammograms within 1.5 years of surgery. We recorded body mass index (BMI), Breast Imaging-Reporting and Data System density, and calculated excess BMI loss. Data were analyzed in Stata 14.2.

Results:

Average age was 54 years, mean pre-operative BMI was 44 (range 36-72), and mean percentage excess BMI lost was 73% at 1.3 years. One third had a change in mammographic breast density, which increased 93% of the time (p&lt;0.001). Amount of weight loss was not associated with density change; in fact, weight loss was lower in those with a density change than in those without a density change (68% versus 75% excess BMI lost).

Conclusions:

The majority of women with a mammographic change had an increase in breast density, despite bariatric surgery being associated with reduced breast cancer risk. Interestingly, the amount of weight loss was not associated with change in breast density. These findings suggest the metabolic effects of bariatric surgery have an effect on breast cancer risk independent of BMI reduction. Future work will include studying mammographic changes associated with non-surgical weight loss.

Citation Format: Hosseini A, Khoury AL, Carter J, Wong JM, Alvarado MD, Ewing C, Esserman LJ, Mukhtar RA. The impact of bariatric surgery on mammographic breast density [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-12-04.

Effect of time of eCG administration on the fate of ovarian follicle in Holstein heifers

The objective of this study was to investigate the effect of equine chorionic gonadotropin (eCG) on ovarian follicles at three stages of development (emergence, dominance and early static phases) during the first follicular wave (FFW) in Holstein heifers. Heifers (n=20) were randomly assigned into four experimental groups (n=5 in each group). Heifers received eCG (500 IU; Folligon^®; Intervet, Holland; i.m) a) on the day of follicle emergence (day of ovulation; group 1), b) on the dominant phase (dominant follicle (DF): the first day in which follicle was observed at ≥10 mm; group 2, and c) on the early static phase (group 3) of the FFW. Control group heifers did not receive any treatment. Daily ultrasonography was conducted to monitor ovarian structure throughout estrous cycle. All treatment group heifers, regardless of the stage of follicle development, displayed follicle growth after eCG injection. Administration of eCG, in group 1, hastened DF detection and induced co-dominant follicles; whereas, in groups 2 and 3, it delayed DF regression, and increased cycle length compared to control. In all treatment group heifers, DF was present 84 h after eCG injection. Maximum diameter of corpus luteum was larger in eCG treated groups compared to control (P<0.05). In conclusion, depending on the time of eCG administration throughout the FFW (emergence, dominant and early static phases), co-dominancy, maintenance of DF, enhancement of follicle and corpus luteum growth and increase in estrous cycle length could be observed in Holstein heifers.

Enrichment of magnetic particles using temperature and magnetic field gradients induced by benchtop fabricated micro-electromagnets

The active transport of analytes inside biosensing systems is important for reducing the response time and enhancing the limit-of-detection of these systems. Due to the ease of functionalization with bio-recognition agents and manipulation with magnetic fields, magnetic particles are widely used for active and directed transport of biological analytes. On-chip active electromagnets are ideally suited for manipulating magnetic particles in an automated and miniaturized fashion inside biosensing systems. Unfortunately, the magnetic force exerted by these devices decays rapidly as we move away from the device edges, and increasing the generated force to the levels necessary for particle manipulation requires a parallel increase in the applied current and the resultant Joule heating. In this paper, we designed a study to understand the combined role of thermal and magnetic forces on the movement of magnetic particles in order to extend the interaction distance of on-chip magnetic devices beyond the device edges. For this purpose, we used a rapid prototyping method to create an active/passive on-chip electromagnet with a micro/nano-structured active layer and a patterned ferromagnetic passive layer. We demonstrated that the measured terminal velocities of particles positioned near the electromagnet edge (∼5.5 μm) closely reflect the values obtained by multi-physics modelling. Interestingly, we observed a two orders of magnitude deviation between the experimental and modelling results for the terminal velocities of particles far from the electromagnet edge (∼55.5 μm). Heat modelling of the system using experimentally-measured thermal gradients indicates that this discrepancy is related to the enhanced fluid movement caused by thermal forces. This study enables the rational design of thermo-magnetic systems for thermally driving and magnetically capturing particles that are positioned at distances tens to hundreds of microns away from the edges of on-chip magnetic devices.

Effects of Chlamydia trachomatis infection on sperm chromatin condensation and DNA integrity

The present study was performed to investigate the relation of Chlamydia trachomatis infection to sperm chromatin/DNA integrity in a population of infertile men (male partner of infertile couples) from Iran. Blood, semen and first-void urine samples were obtained from 250 infertile men. Data were analysed with regard to the results of (i) serological analysis for specific antibodies to C. trachomatis in serum; (ii) the presence of C. trachomatis and DNA in first-void urine; and (iii) in the semen sample of the male partner, in addition to sperm analysis, four different tests (aniline blue, chromomycin A3, acridine orange and TUNEL) were used to detect sperm chromatin and DNA abnormalities. The main conclusions of the results were: (i) no evidence of C. trachomatis infection in semen samples was found; (ii) sperm DNA fragmentation and chromatin studies were not correlated with C. trachomatis diagnosis; (iii) the percentage of DNA fragmentation is positively correlated with the percentage of immotile sperm but negatively with semen volume, normal morphology; and (iv) in sperm chromatin evaluations, only the percentage of chromatin protamination was related to male age.

Extended C-band tunable multi-channel InP-based coherent receiver PICs

Fully integrated monolithic, multi-channel InP-based coherent receiver PICs and transceiver modules with extended C-band tunability are described. These PICs operate at 33 and 44 Gbaud per channel under dual polarization (DP) 16-QAM modulation. Fourteen-channel monolithic InP receiver PICs show integration and data rate scaling capability to operate at 44 Gbaud under DP 16-QAM modulation for combined 4.9 Tb/s total capacity. Six channel simultaneous operation of a commercial transceiver module at 33 Gbaud is demonstrated for a variety of modulation formats including DP 16-QAM for >1.2Tbit/s aggregate data capacity.

Optimal ratios of essential amino acids stimulate β-casein synthesis via activation of the mammalian target of rapamycin signaling pathway in MAC-T cells and bovine mammary tissue explants

Amino acids are the building blocks of proteins and serve as key molecular components upstream of the signaling pathways that regulate protein synthesis. The objective of this study was to systematically investigate the effect of essential AA ratios on milk protein synthesis in vitro and to elucidate some of the underlying mechanisms. Triplicate cultures of MAC-T cells and bovine mammary tissue explants (MTE) were incubated with the optimal AA ratio (OPAA; Lys:Met, 2.9:1; Thr:Phe, 1.05:1; Lys:Thr, 1.8:1; Lys:His, 2.38:1; and Lys:Val, 1.23:1) in the presence of rapamycin (control), OPAA, a Lys:Thr ratio of 2.1:1, a Lys:Thr ratio of 1.3:1, a Lys:His ratio of 3.05:1, or a Lys:Val ratio of 1.62:1 for 12 h; the other AA concentrations were equal to OPAA. In some experiments, the cells were cultured with OPAA with or without rapamycin (100 ng/mL) or with mammalian target of rapamycin (mTOR) small interference RNA, and the MTE were exposed to OPAA with rapamycin for β-casein expression. Among the treatments, the expression of β-casein was greatest in the MTE cultured with OPAA. In MAC-T cells, the OPAA upregulated the mRNA expression of SLC1A5 and SLC7A5 but downregulated the expression of IRS1, AKT3, EEF1A1, and EEF2 compared with the control. The OPAA had no effect on the mTOR phosphorylation status but increased the phosphorylation of S6K1 and RPS6. When the MTE were treated with rapamycin in the presence of OPAA, the expression of β-casein was markedly decreased. The phosphorylation of RPS6 and 4EBP1 also was reduced in MAC-T cells. A similar negative effect on the expression of RPS6KB1 and EIF4EBP1 was detected when the cells were cultured with either rapamycin or mTOR small interference RNA. The optimal AA ratio stimulated β-casein expression partly by enhancing the transport of AA into the cells, cross-talk with insulin signaling and a subsequent enhancement of mTOR signaling, or translation elongation in both MAC-T cells and bovine MTE.

Modelling dispersal of radioactive contaminants in Arctic waters as a result of potential recovery operations on the dumped submarine K-27

Of the wide variety of dumped objects containing radioactive materials in the Arctic seas, the submarine K-27 constitutes a major risk due to the large amount of highly enriched uranium onboard and its location in shallow waters. As the matter of potential operations involving raising of the submarine have entered the public arena, a priori assessment of the contamination in the Arctic marine environment that could result after a possible accident during such operations is a matter of some interest. The dispersion of contaminants within the Arctic has been assessed using a large scale hydrodynamic model for a series of plausible accident scenarios and locations under different oceanographic regimes. Results indicate that, depending primarily on the nature of a release (i.e. instantaneous or continuous), large areas of the Arctic marine environment will exhibit contamination to varying degrees.

Precision surgery and avoiding over-treatment

Over-diagnosis and over-treatment are consequences of greater awareness about breast cancer, more intensive screening, and the resultant identification of more cases of breast cancer that are low or ultralow risk. This area represents an important opportunity to optimize the delivery of appropriate targeted therapy for breast cancer patients. Despite the evolution of breast cancer care over the last few decades and our ability to tailor treatment to biology, a one-size fits all approach is still prevalent in the local and regional management of and screening for breast cancer, failing to reflect the unique biology and tumor characteristics of each patient. In this review, we explore how we can use new tools to better define tumor biology and also how we can change current clinical practices based on already available data. Every surgeon should be knowledgeable about how to craft personalized breast cancer care in the areas of systemic therapy, adjuvant radiation therapy, management of ductal carcinoma in situ (DCIS), precision surgery, and breast cancer screening.

Impacts on the marine environment in the case of a hypothetical accident involving the recovery of the dumped Russian submarine K-27, based on dispersion of 137Cs

There is increasing concern regarding the issue of dumped nuclear waste in the Arctic Seas and in particular dumped objects with Spent Nuclear Fuel (SNF). Amongst dumped objects in the Arctic, the dumped Russian submarine K-27 has received great attention as it contains two reactors with highly enriched fuel and lies at a depth of about 30 m under water. To address these concerns a health and environmental impact assessment has been undertaken. Marine dispersion of potentially released radionuclides as a consequence of different hypothetical accident scenarios was modelled using the model NAOSIM. The outputs from the dispersion modelling have been used as inputs to food-chain transfer and environmental dosimetry models. The annual effective doses for subsistence fishing communities of the Barents-Kara seas region do not exceed 0.6 mSv for hypothetical accidents located at Stepovogo fjord or the Barents Sea. For high rate consumers of fish in Norway, following a potential accident at the Gremikha Bay, annual effects doses would be at around 0.15 mSv. Accumulated doses (over 90 days) for various organisms and for all release scenarios considered were never in excess of 150 μGy. The levels of ¹³⁷Cs derived for marine organism in areas close to Norway were not values that would likely cause concern from a regulatory perspective although for subsistence fishing communities close to the considered accident locations, it is not inconceivable that some restrictions on fishing etc. would need to be introduced.