Search

Coronavirus disease 2019 (COVID-19) is a viral pulmonary infection that can progress to cytokine storm syndrome because of widespread dysregulated inflammatory response. Many patients at risk for severe COVID-19 manifestation have been identified as those with preexisting conditions of pulmonary origin, as well as conditions that impair appropriate immune response, such as obesity.The aim of this study is to describe the manifestation, clinical course, and inflammatory biomarker milieu of COVID-19 in patients with obesity.University Hospital Philadelphia, Pennsylvania.In this retrospective cohort study, 600 patients who were positive for COVID-19 were stratified by World Health Organization (WHO) obesity class and their presenting symptoms, disease biomarkers, demographics, and outcomes (intubation rate, intensive care unit [ICU] admission, length of stay [LOS], and mortality) were investigated.Age was inversely related to obesity class; patients of obesity class III presented 12.9 years younger than patients of normal weight (P.0001). Initial ferritin lab values were negatively correlated with increasing obesity class (P = .0192). Normal or near-normal lymphocyte profile was noted in patients with obesity compared with patients without obesity (P = .0017). Patients with obesity had an increased rate of ICU admission (P = .0215) and increased length of stay (P = .0004), but no differences in intubation rate (P = .3705) or mortality (P = .2486).Patients with obesity were more likely to present to the hospital at a younger age, with reduced levels of COVID-19 related biomarker disturbances, and increased LOS and ICU admission rates, although were not at increased risk for mortality.

BACKGROUND: Variation in the timing of menarche has been linked with adverse health outcomes in later life. There is evidence that exposure to hormonally active agents (or endocrine disrupting chemicals; EDCs) during childhood may play a role in accelerating or delaying menarche. The goal of this study was to generate hypotheses on the relationship between exposure to multiple EDCs and timing of menarche by applying a two-stage machine learning approach. METHODS: We used data from the National Health and Nutrition Examination Survey (NHANES) for years 2005–2008. Data were analyzed for 229 female participants 12–16 years of age who had blood and urine biomarker measures of 41 environmental exposures, all with >70% above limit of detection, in seven classes of chemicals. We modeled risk for earlier menarche (2.36 ng/mL: adjusted PR= 1.36, 95% CI: 1.02, 1.80). Combinations of lower MEHP with benzophenone-3, 2,4-DCP, and BPA had similar associations with earlier menarche, though slightly weaker in those smaller subgroups. For girls not having lower MEHP, exposure profiles included other biomarkers (BPA, enterodiol, monobenzyl phthalate, triclosan, and 1-hydroxypyrene); these showed largely null associations in the second-stage analysis. Adjustment for covariates did not materially change the estimates or CIs of these models. We observed weak or null effect estimates for some exposure biomarker profiles and relevant profiles consisted of no more than two EDCs, possibly due to small sample sizes in subgroups. CONCLUSION: A two-stage approach incorporating machine learning was able to identify interpretable combinations of biomarkers in relation to timing of menarche; these should be further explored in prospective studies. Machine learning methods can serve as a valuable tool to identify patterns within data and generate hypotheses that can be investigated within future, targeted analyses.

PURPOSE OF REVIEW: The goal of this article is to review the use of machine learning (ML) within studies of environmental exposures and children’s health, identify common themes across studies and provide recommendations to advance their use in research and practice. RECENT FINDINGS: We identified 42 articles reporting upon the use of ML within studies of environmental exposures and children’s health between 2017 and 2019. Common themes among the articles were analysis of mixture data, exposure prediction, disease prediction and forecasting, analysis of complex data and causal inference. SUMMARY: With increasing complexity of environmental health data, we anticipate greater use of ML to address challenges that cannot be handled by traditional analytics. In order for these methods to beneficially impact public health, the ML techniques we use need to be appropriate for our study questions, rigorously evaluated and reported in a way that can be critically assessed by the scientific community.

BACKGROUND: Modelling of the London hepatitis C (HCV) epidemic in HIV-positive (HIV+) men who have sex with men (MSM) suggested early access to direct acting antiviral (DAA) treatment may reduce incidence. With high rates of linkage to care, micro-elimination of HCV within HIV+ MSM may be realistic, ahead of 2030 WHO targets. We examine trends in HCV incidence in the pre- and post-DAA eras for HIV+ MSM in London and Brighton. METHODS: A retrospective cohort study was conducted at 5 HIV clinics in London and Brighton between 2013 and 2018. Each site reported all acute HCV episodes (first and reinfections) during the study period. Treatment pathway and timing were collected. Incidence rates and reinfection proportion were calculated. RESULTS: 378 acute HCV infections were identified, comprising 292 first infections and 86 reinfections. Incidence rates of acute HCV in HIV+ MSM peaked at 14.57/1000 PYFU [95%CI 10.95-18.20] in the second half of 2015. Rates fell to 4.63/1000 HIV+ MSM PYFU [95%CI 2.60-6.67] by 2018.. Time from diagnosis to starting treatment reduced from 29.8 (2013) to 3.7 months (2018). CONCLUSIONS: We observed a 78% reduction in incidence of first HCV episode and 68% reduction of overall HCV incidence in HIV+ MSM since the epidemic peak of 2015 which coincides with wider access to DAAs in England. Further interventions to reduce transmission, including earlier access to treatment and for reinfection, are likely needed for micro-elimination to be achieved in this population.

HIV infection is one of the most serious and feared sexually transmitted infections and today it is pandemic. Worldwide, the main transmission route is through heterosexual and homosexual sexual intercourse and the presence of other STIs (e.g., Chlamydia trachomatis, Syphilis...) increases the risk of acquisition. Mother-to-child transmission is the second mode of spread, especially in Africa, but the exchange of needles among injective drug users remains a common route. Although the untreated infection leads to immunodeficiency syndrome, being associated with a poor prognosis, the introduction of antiretroviral therapy has today completely changed the life and survival of HIV-positive patients.

Here, we report the case of a young patient admitted to the emergency department because of abdominal pain. Computed tomography revealed a mass within her right heart. Through serial multimodality imaging testing, including computed tomography, three-dimensional (2D)- and three-dimensional echocardiography, as well as cardiac magnetic resonance, the diagnosis of cardiac involvement in the course of Echinococcus granulosus infection was hypothesized.

BACKGROUND/OBJECTIVE. Research suggests gestational exposure to particulate matter ≤ 2.5 μm (PM(2.5)) and extreme heat may independently increase risk of birth defects. We investigated whether duration of gestational extreme heat exposure modifies associations between PM(2.5) exposure and specific congenital heart defects (CHDs). We also explored nonlinear exposure-outcome relationships. METHODS. We identified CHD case children (n = 2,824) and non-malformed live-birth control children (n = 4,033) from pregnancies ending between 1999 and 2007 in the National Birth Defects Prevention Study, a U.S. population-based multicenter case-control study. We assigned mothers 6-week averages of PM(2.5) exposure during the cardiac critical period (postconceptional weeks 3–8) using the closest monitor within 50 kilometers of maternal residence. We assigned a count of extreme heat days (EHDs, days above the 90th percentile of daily maximum temperature for year, season, and weather station) during this period using the closest weather station. Using generalized additive models, we explored logit-nonlinear exposure-outcome relationships, concluding logistic models were reasonable. We estimated joint effects of PM(2.5) and EHDs on six CHDs using logistic regression models adjusted for mean dewpoint and maternal age, education, and race/ethnicity. We assessed multiplicative and additive effect modification. RESULTS. Conditional on the highest observed EHD count (15) and at least one critical period day during spring/summer, each 5 μg/m³ increase in average PM(2.5) exposure was significantly associated with perimembranous ventricular septal defects (VSDpm; OR: 1.54 [95% CI: 1.01, 2.41]). High EHD counts (8+) in the same population were positively, but non-significantly, associated with both overall septal defects and VSDpm. Null or inverse associations were observed for lower EHD counts. Multiplicative and additive effect modification estimates were consistently positive in all septal models. CONCLUSIONS. Results provide limited evidence that duration of extreme heat exposure modifies the PM(2.5)-septal defects relationship. Future research with enhanced exposure assessment and modeling techniques could clarify these relationships.

Purpose of review Increasingly, there is a need for examining exposure disease associations in large, diverse datasets to understand the complex determinants of pediatric disease and disability. Recognizing that children's health research consortia will be important sources of big data, it is crucial for the pediatric research community to be knowledgeable about the challenges and opportunities that they will face. The present review will provide examples of existing children's health consortia, highlight recent pooled analyses conducted by children's health research consortia, address common challenges of pooled analyses, and provide recommendations to advance collective research efforts in pediatric research. Recent findings Formal consortia and other collective-science initiatives are increasingly being created to share individual data from a set of relevant epidemiological studies to address a common research topic under the concept that the joint effort of many individual groups can accomplish far more than working alone. There are practical challenges to the participation of investigators within consortia that need to be addressed in order for them to work. Summary Researchers who access consortia with data centers will be able to go far beyond their initial hypotheses and potentially accomplish research that was previously thought infeasible or too costly.

Infectious proctitis may mimic inflammatory bowel disease, particularly when limited to the rectum. The present case report includes findings from a 50-year-old man, soldier, referring to our Inflammatory Bowel Disease Unit with a diagnosis of rectal Crohn's disease, refractory to conventional treatments. Mild anemia, hypergammaglobulinemia and HIV-antibodies seronegativity were detected. Entero-MRI and stool examinations were negative. Ileocolonoscopy detected few rectal ulcers with irregular edges. Endosonography showed marked thickening of the rectal wall and enlarged perirectal lymphnodes. Nodal and rectal fine needle aspirate did not show atypia (PAN CK-). Rectal biopsies showed flogistic granular tissue (PAN CK-): Warthin-Starry stain was negative. Previous Treponema pallidum infection was detected. Clinical history revealed habits at risk for sexually transmitted infection. Rectal swabs for RT-PCR for Chlamydia trachomatis, Neisseria gonorrhoeae, and Herpes Simplex Virus 1-2 lead to a diagnosis of lymphogranuloma venereum. Doxycycline 100 mg and Azitromicyn 500 mg t.i.d. were given for 21 days, followed by negativity for RT-PCR for Chlamydia trachomatis at rectal swabs. Complete disappearance of symptoms and mucosal healing occurred. Due to the increased frequency of infectious diseases, sexually transmitted infection (including lymphogranuloma venereum) should be considered as possible differential diagnosis when assessing patients with inflammatory bowel disease limited to the rectum.

Little is known about how children use Individuals with Disabilities Education Act services across early intervention (EI), early childhood special education (ECSE), and school-age special education (SE). We applied sequence analysis to a data linkage across five public record systems among New York City children born in 1998, who had records from birth through third grade. Five predominant patterns of service use were identified: 1) Multiple therapies across EI/ECSE/SE (13%); 2) EI without transition to Department of Education schools or services (24%); 3) EI and intermittent ECSE/SE (16%); 4) older entry into EI and both speech & occupational therapy throughout ECSE/SE (9%); and 5) limited EI use and mostly speech therapy in ECSE/SE (38%). Each pattern had distinct demographics, service use characteristics, and academic outcomes.

Background Previous research shows that environmental and social factors contribute to the development of attention-deficit/hyperactivity disorder (ADHD). Objective To determine the relationship between early-life exposure to common ambient air pollutants (benzene, toluene, ethylbenzene, and xylene, also known as BTEX), household material hardship (a measure of socio-economic status), and ADHD-suggestive behaviours in kindergarten-age children. Methods Pollutant exposure estimated from the 2002 National Air Toxics Assessment at each child's residential ZIP code at enrolment was linked to the Early Childhood Longitudinal Study Birth Cohort (n = 4650). Material hardship was assigned as a composite score of access to food, health care, and housing. Kindergarten teachers rated children's behaviours and activity in the classroom using a five-point Likert scale. Children with summary scores in the bottom decile were classified as displaying ADHD-suggestive behaviours. Logistic regression models were constructed to estimate the association between both BTEX exposure and material hardship on ADHD-suggestive behaviours. Results The odds of displaying ADHD-suggestive behaviours were greater in children with combined high-level exposure to BTEX and in those experiencing material hardship (odds ratio 1.54, 95% confidence interval [CI] 1.12, 2.11, and OR 2.12, 95% CI 1.25, 3.59, respectively), adjusting for covariates. These associations were stronger when restricting the study population to urban areas. There was no evidence of interaction between early life BTEX exposure and material hardship, although the effects of BTEX exposure were slightly greater in magnitude among those with higher material hardship scores. Conclusions Children exposed to air toxics, material hardship, or both early in life are more likely to display signs of ADHD-suggestive behaviours as assessed by their kindergarten teachers. The associations between exposures to air pollution and to socio-economic hardship were observed in all children but were particularly strong in those living in urban areas.

Background Early intervention (EI) and special education (SE) are beneficial for children with developmental disabilities and/or delays and their families, yet there are disparities in service use. We sought to identify the birth characteristics that predict EI/SE service use patterns. Methods We conducted a retrospective cohort study using linked administrative data from five sources for all children born in 1998 to New York City resident mothers. Multinomial regression was used to identify birth characteristics that predicted predominant patterns of service use. Results Children with service use patterns characterized by late or limited/no EI use were more likely to be first-born children and have Black or Latina mothers. Children born with a gestational age ≤31 weeks were more likely to enter services early. Early term gestational age was associated with patterns of service use common to children with pervasive developmental delay, and maternal obesity was associated with the initiation of speech therapy at the time of entry into school. Conclusions Maternal racial disparities existed for patterns of EI/SE service use. Specific birth characteristics, such as parity and gestational age, may be useful to better identify children who are at risk for suboptimal EI use.

BACKGROUND: Congenital limb deficiencies (CLDs) are a relatively common group of birth defects whose etiology is mostly unknown. Recent studies suggest maternal air pollution exposure as a potential risk factor. AIM: To investigate the relationship between ambient air pollution exposure during early pregnancy and offspring CLDs. METHODS: The study population was identified from the National Birth Defects Prevention Study, a population-based multi-center case-control study, and consisted of 615 CLD cases and 5,701 controls with due dates during 1997 through 2006. Daily averages and/or maxima of six criteria air pollutants (particulate matter < 2.5 μm [PM(2.5)], particulate matter < 10 μm [PM(10)], nitrogen dioxide [NO(2)], sulfur dioxide [SO(2)], carbon monoxide [CO], and ozone [O(3)]) were averaged over gestational weeks 2–8, as well as for individual weeks during this period, using data from EPA air monitors nearest to the maternal address. Logistic regression was used to estimate odds ratios (aORs) and 95% confidence intervals (CIs) adjusted for maternal age, race/ethnicity, education, and study center. We estimated aORs for any CLD and CLD subtypes (i.e., transverse, longitudinal, and preaxial). Potential confounding by co-pollutant was assessed by adjusting for one additional air pollutant. Using the single pollutant model, we further investigated effect measure modification by body mass index, cigarette smoking, and folic acid use. Sensitivity analyses were conducted restricting to those with a residence closer to an air monitor. RESULTS: We observed near-null aORs for CLDs per interquartile range (IQR) increase in PM(10), PM(2.5), and O(3). However, weekly averages of the daily average NO(2) and SO(2), and daily max NO(2), SO(2), and CO concentrations were associated with increased odds of CLDs. The crude ORs ranged from 1.03 to 1.12 per IQR increase in these air pollution concentrations, and consistently elevated aORs were observed for CO. Stronger associations were observed for SO(2) and O(3) in subtype analysis (preaxial). In co-pollutant adjusted models, associations with CO remained elevated (aORs: 1.02–1.30); but aORs for SO(2) and NO(2) became near-null. The aORs for CO remained elevated among mothers who lived within 20 km of an air monitor. The aORs varied by maternal BMI, smoking status, and folic acid use. CONCLUSION: We observed modest associations between CLDs and air pollution exposures during pregnancy, including CO, SO(2), and NO(2), though replication through further epidemiologic research is warranted.

In questo studio, l’obiettivo perseguito è stato quello di indagare l’ipotesi secondo cui attraverso l’incremento della eccitabilità della corteccia prefrontale si potesse ottenere un’influenza inibitoria sull’attività del sistema nervoso autonomo e una regolazione dei sistemi fisiologici di risposta allo stress mediante l’utilizzo della stimolazione transcranica a corrente diretta (tDCS). I partecipanti erano 30 soggetti destrimani maschi sani che venivano assegnati con modalità random ad un gruppo che riceveva la tDCS (n=15) o ad uno di controllo (sham, n=15). La stimolazione interessava la corteccia prefrontale dorsolaterale di sinistra (DLPFC) e veniva effettuata prima e durante l’esposizione ad un test di stress psicosociale (Trier Social Stress Test, TSST). Sono stati analizzati, durante la fase di esposizione all’evento stressante e nelle 24 ore precedenti e successive la seduta di laboratorio, i seguenti parametri: per il sistema nervoso autonomo, la frequenza cardiaca (HR) e la sua variabilità (HRV); per l’asse ipotalamo-ipofisi-corticosurrene (HPA), i livelli di cortisolo salivare. Le misure del cortisolo e della variabilità della frequenza cardiaca sono associate con l’attività della corteccia prefrontale e dell’amigdala, e per di più esiste una relazione inversa tra cortisolo e HRV, a confermare l’idea che l’appropriata regolazione dell’asse HPA e dell’output autonomico dipendano dall’influenza inibitoria della corteccia prefrontale sull’amigdala. Con una singola sessione di tDCS anodale a livello della corteccia prefrontale dorsolaterale sinistra (L-DLPFC) i risultati sono stati: riduzione della frequenza cardiaca; maggiore prevalenza della branca parasimpatica prima del TSST; moderazione dell’accelerazione della frequenza cardiaca indotta da stress e dell’attivazione simpatica/withdrawal vagale; nessun effetto sul rilascio di cortisolo indotto da stress; prevenzione sugli effetti dell’evento stressante sulla risposta al risveglio del cortisolo (CAR); riduzione dei livelli di ansia di stato percepita alla fine della sessione di laboratorio. Tali esiti potrebbero essere indicativi dell’importante ruolo dell’area cerebrale indagata sui processi di coping attuati in situazioni stressanti. In this study, the pursued aim was to investigate the hypothesis according to the impact of increasing prefrontal cortex excitability would enhance an inhibitory influence of autonomic nervous system activity and a regulation of physiological systems of stress response using transcranial direct current stimulation (tDCS). Thirty right-handed healthy male participants were randomly assigned to a group that receives either active (n=15) or sham (n=15) tDCS over the left dorsolateral prefrontal cortex, before and during the exposure to the psychosocial stress test, TSST. During the exposure phase to the stressful event and during the 24 hours before and after the laboratory session, the following parameters were assessed: for the autonomic nervous system, those relating to the heart rate (HR) and its variability (HRV); for the hypothalamic-pituitary-adrenal axis (HPA), those related to cortisol levels (salivary cortisol). Cortisol measurements and heart rate variability are associated with the activity of the prefrontal cortex and the amygdala, and moreover there is an inverse relationship between cortisol and HRV suggesting that the appropriate regulation of the HPA axis partly depends on the parasympathetic influences and on the inhibitory influence of the prefrontal cortex over the amygdala. With a single session of anodal tDCS over the L-DLPFC, the active subject’s results obtained were been: reduction of heart rate; higher prevalence of the parasympathetic branch before the TSST; moderation of stress-induced heart rate acceleration and sympathetic activation/vagal withdrawal; no effect on stress-induced cortisol release; prevention of the stressful event’s effects on the cortisol awakening response (CAR); reduction of the perceived levels of state anxiety at the end of the laboratory session. These results might be indicative of the important role of the examined brain area on coping processes performed in stressful situations.

Background and Purpose- Although obesity is an established risk factor for cardiovascular disease and stroke, studies have shown evidence of an obesity paradox-a protective effect of obesity in patients who already have these disease states. Data on the obesity paradox in intracerebral hemorrhage is limited. Methods- Clinical data for adult intracerebral hemorrhage patients were extracted from the National Inpatient Sample between 2007 and 2014. Multivariable logistic regression analyzed the association of body habitus with in-hospital mortality, discharge disposition, length of stay, tracheostomy or gastrostomy placement, and ventriculoperitoneal shunt placement. Results- There were 99 212 patients who were eligible. Patients with both obesity (OR=0.69; 95% CI=0.62-0.76; P0.001) and morbid obesity (OR=0.85; 95% CI=0.74-0.97; P=0.02) were associated with decreased odds of in-hospital mortality. Morbid obesity was significantly associated with increased odds of a tracheostomy or gastrostomy placement (OR=1.42; 1.20-1.69; P0.001) and decreased odds of a routine discharge disposition (OR=0.84; 0.74-0.97; P=0.014). Conclusions- Obesity and morbid obesity appear to protect against mortality in intracerebral hemorrhage.

PURPOSE: Studies suggest exposure to ambient particulate matter less than 2.5 μg/m(3) in aerodynamic diameter (PM(2.5)) may be associated with preterm birth (PTB), but few have evaluated how this is modified by ambient temperature. We investigated the relationship between PM(2.5) exposure during pregnancy and PTB in infants without birth defects (1999–2006) and enrolled in the National Birth Defects Prevention Study and how it is modified by concurrent temperature. METHODS: PTB was defined as spontaneous or iatrogenic delivery before 37 weeks. Exposure was assigned using inverse distance weighting with up to four monitors within 50 kilometers of maternal residence. To account for state-level variations, a Bayesian two-level hierarchal model was developed. RESULTS: PTB was associated with PM(2.5) during the third and fourth months of pregnancy (range: (odds ratio (95% confidence interval) = 1.00 (0.35, 2.15) to 1.49 (0.82, 2.68) and 1.31 (0.56, 2.91) to 1.62 (0.7, 3.32), respectively); no week of exposure conveyed greater risk. Temperature may modify this relationship; higher local average temperatures during pregnancy yielded stronger positive relationships between PM(2.5) and PTB compared to nonstratified results. CONCLUSIONS: Results add to literature on associations between PM(2.5) and PTB, underscoring the importance of considering co-exposures when estimating effects of PM(2.5) exposure during pregnancy.

Background: Congenital limb deficiencies (CLDs) are a relatively common group of birth defects whose etiology is mostly unknown. Recent studies suggest maternal air pollution exposure as a potential risk factor. Aim: To investigate the relationship between ambient air pollution exposure during early pregnancy and offspring CLDs. Methods: The study population was identified from the National Birth Defects Prevention Study, a population-based multi-center case-control study, and consisted of 615 CLD cases and 5,701 controls with due dates during 1997 through 2006. Daily averages and/or maxima of six criteria air pollutants (particulate matter

Purpose: Studies suggest exposure to ambient particulate matter less than 2.5 μg/m3 in aerodynamic diameter (PM2.5) may be associated with preterm birth (PTB), but few have evaluated how this is modified by ambient temperature. We investigated the relationship between PM2.5 exposure during pregnancy and PTB in infants without birth defects (1999–2006) and enrolled in the National Birth Defects Prevention Study and how it is modified by concurrent temperature. Methods: PTB was defined as spontaneous or iatrogenic delivery before 37 weeks. Exposure was assigned using inverse distance weighting with up to four monitors within 50 kilometers of maternal residence. To account for state-level variations, a Bayesian two-level hierarchal model was developed. Results: PTB was associated with PM2.5 during the third and fourth months of pregnancy (range: (odds ratio (95% confidence interval) = 1.00 (0.35, 2.15) to 1.49 (0.82, 2.68) and 1.31 (0.56, 2.91) to 1.62 (0.7, 3.32), respectively); no week of exposure conveyed greater risk. Temperature may modify this relationship; higher local average temperatures during pregnancy yielded stronger positive relationships between PM2.5 and PTB compared to nonstratified results. Conclusions: Results add to literature on associations between PM2.5 and PTB, underscoring the importance of considering co-exposures when estimating effects of PM2.5 exposure during pregnancy.

The genuineness of fruit juices and purees is regulated by guidelines of European Fruit Juice Association. Nevertheless, the addition of peach puree to apricot puree is considered the most common adulteration, very difficult to discover. In this study, the composition in free and conjugated polyphenols of apricot and peach purees was performed by target and untarget approaches with Q-Exactive(™) quadrupole-Orbitrap mass spectrometer. Apricot purees showed a higher polyphenol content than those of peaches. Between target coumpounds, chlorogenic acid, rutin, catechin and smaller quantities of hyperoside and kaempferol-3-rutinoside were found in both purees. Apricot puree was also found to contain epicatechin and procianidin B2, absent in peach puree. Peach puree was found to contain small amounts of kaempferol-3-glucoside, absent in apricot. In order to identify untarget polyphenols, data obtained by ultra-high pressure liquid chromatography tandem mass spectrometry analysis were processed with Thermo Scientific automated label-free differential expression software (sieve(™) 2.1 software). Three hydroxycinnamic acid conjugates and a procyanidin were identified and confirmed by tandem mass spectrometry spectra. Some compounds of interest found from differential analysis had a putative identification, while others remained unidentified. The high-resolution mass spectrometry approach using Q-Exactive(™) quadrupole-Orbitrap mass spectrometer could be an important and powerful tool for determination of new biomarkers in fruits and vegetables. Copyright © 2016 John Wiley & Sons, Ltd.

The objective of this research was to determine if prenatal exposure to two common urban air pollutants, diesel and perchloroethylene, affects children's 3rd grade standardized test scores in mathematics and English language arts (ELA). Exposure estimates consisted of annual average ambient concentrations of diesel particulate matter and perchloroethylene obtained from the Environmental Protection Agency's 1996 National Air Toxics Assessment for the residential census tract at birth. Outcome data consisted of linked birth and educational records for 201,559 singleton, non-anomalous children born between 1994 and 1998 who attended New York City public schools. Quantile regression models were used to estimate the effects of these exposures on multiple points within the continuous distribution of standardized test scores. Modified Poisson regression models were used to calculate risk ratios (RR) and 95% confidence intervals (CI) of failing to meet curricula standards, an indicator derived from test scores. Models were adjusted for a number of maternal, neighborhood and childhood factors. Results showed that math scores were approximately 6% of a standard deviation lower for children exposed to the highest levels of both pollutants as compared to children with low levels of both pollutants. Children exposed to high levels of both pollutants also had the largest risk of failing to meet math test standards when compared to children with low levels of exposure to the pollutants (RR 1.10 95%CI 1.07,1.12 RR high perchloroethylene only 1.03 95%CI 1.00,1.06; RR high diesel PM only 1.02 95%CI 0.99,1.06). There was no association observed between exposure to the pollutants and failing to meet ELA standards. This study provides preliminary evidence of associations between prenatal exposure to urban air pollutants and lower academic outcomes. Additionally, these findings suggest that individual pollutants may additively impact health and point to the need to study the collective effects of air pollutant mixtures. Key Words: air toxics, academic outcomes, urban health, tetrachloroethylene, air pollutant mixtures

Epidemiologic studies suggest that maternal ambient air pollution exposure during critical periods of pregnancy is associated with adverse effects on fetal development. In this work, we introduce new methodology for identifying critical periods of development during post-conception gestational weeks 2-8 where elevated exposure to particulate matter less than 2.5 µm (PM2.5 ) adversely impacts development of the heart. Past studies have focused on highly aggregated temporal levels of exposure during the pregnancy and have failed to account for anatomical similarities between the considered congenital heart defects. We introduce a multinomial probit model in the Bayesian setting that allows for joint identification of susceptible daily periods during pregnancy for 12 types of congenital heart defects with respect to maternal PM2.5 exposure. We apply the model to a dataset of mothers from the National Birth Defect Prevention Study where daily PM2.5 exposures from post-conception gestational weeks 2-8 are assigned using predictions from the downscaler pollution model. This approach is compared with two aggregated exposure models that define exposure as the average value over post-conception gestational weeks 2-8 and the average over individual weeks, respectively. Results suggest an association between increased PM2.5 exposure on post-conception gestational day 53 with the development of pulmonary valve stenosis and exposures during days 50 and 51 with tetralogy of Fallot. Significant associations are masked when using the aggregated exposure models. Simulation study results suggest that the findings are robust to multiple sources of error. The general form of the model allows for different exposures and health outcomes to be considered in future applications. Copyright © 2016 John Wiley & Sons, Ltd.

Highlights • Ocrelizumab is not associated to increased severity in MS patients with COVID-19. • B-cell depleting treatment could impact on virus-specific antibody production. • B-cell depleting therapies can reduce IL-6 production, thus modulating inflammation., Background Recently SARS-CoV-2 has spread worldwide causing a pandemic. Little is known about disease severity in immunocompromised hosts and people receiving disease modifying therapies (DMTs). In the last decades DMTs have been widely employed, and ocrelizumab represents one of the newest therapies for the relapsing remitting and progressive forms of multiple sclerosis (MS). Objectives to describe SARS-CoV-2 related pneumonia in two MS patients under ocrelizumab treatment. Methods Case series. Results Patients showed a mild clinical course of SARS-CoV-2 related pneumonia without complications or sequelae. Conclusion Ocrelizumab treatment is not necessarily associated to increased severity in MS patients with SARS-CoV-2 infection.

Background Obesity is a risk factor for pancreatic cancer which may be treated with Roux-en-Y gastric bypass and represents an increasing morbidity. Post-RYGB anatomy poses considerable challenges for reconstruction after pancreaticoduodenectomy (PD), a growing problem encountered by surgeons. We characterize specific strategies used for post-PD reconstruction in the RYGB patient. Methods PubMed search was performed using MeSH terms “Gastric Bypass” and “Pancreaticoduodenectomy” between 2000 and 2018. Articles reporting cases of pancreaticoduodenectomy in post-RYGB patients were included and systematically reviewed for this study. Results Three case reports and five case series (25 patients) addressed PD after RYGB; we report one additional case. The typical post-gastric bypass PD patient is a woman in the sixth decade of life, presenting most commonly with pain (69.2%) and/or jaundice (53.8%), median 5 years after RYGB. Five post-PD reconstructive options are reported. Among these, the gastric remnant was resected in 18 cases (69.2%), with reconstruction of biliopancreatic drainage most commonly achieved using the distal jejunal segment of the pre-existing biliopancreatic limb (73.1%). Similarly, in the eight cases where the gastric remnant was spared (30.8%), drainage was most commonly performed using the distal jejunal segment of the biliopancreatic limb (50%). Among the 17 cases reporting follow-up data, median was 27 months. Conclusion Reconstruction options after PD in the post-RYGB patient focus on resection or preservation gastric remnant, as well as creation of new biliopancreatic limb. Insufficient data exists to make recommendations regarding the optimal reconstruction option, yet surgeons must prepare for the possible clinical challenge. PD reconstruction post-RYGB requires evaluation through prospective studies.