Publications by authors named "Gurpreet Singh"

386 Publications

Flexible Ag@LiNbO/PVDF Composite Film for Piezocatalytic Dye/Pharmaceutical Degradation and Bacterial Disinfection.

ACS Appl Mater Interfaces 2021 May 6. Epub 2021 May 6.

School of Engineering, Indian Institute of Technology Mandi, Mandi, Himachal Pradesh 175005, India.

A flexible poly(vinylidene difluoride) (PVDF) composite film embedding LiNbO ceramics decorated with silver nanoparticles (Ag NPs) has been synthesized using the solvent casting method. The polar β-phase, Ag NPs, and LiNbO phases were confirmed in the composite film using various characterization methods. The composite film showed promising degradation of cationic and anionic dyes using piezocatalysis under ultrasonication. Moreover, this composite film also effectively degraded two model pharmaceutical pollutants named tetracycline and ciprofloxacin using piezocatalysis under ultrasonication. In addition to this, this composite film piezocatalytically removed more than 99.999% of and 96.65% of bacteria within 180 min of sonication. The piezocatalytic performance of the PVDF composite film embedding Ag-loaded LiNbO in all three applications was superior to that obtained in the case of the PVDF film embedding LiNbO and the bare PVDF film. This demonstrates the pronounced effect of Ag NPs in the increase of piezocatalytic activity in the composite film.
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http://dx.doi.org/10.1021/acsami.1c01314DOI Listing
May 2021

Spectrum of PIK3CA/AKT mutations across molecular subtypes of triple-negative breast cancer.

Breast Cancer Res Treat 2021 May 5. Epub 2021 May 5.

Department of General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012, India.

Purpose: The heterogeneity of triple-negative breast cancer (TNBC) confers variable response to chemotherapy that results in poor outcome and relapse. Due to lack of targeted therapy, there is a need to provide molecular classification of TNBC and identify probable therapeutic targets.

Methods: We classified TNBC into surrogate molecular subtypes by immunohistochemistry and evaluated hotspot mutations (N = 80) in PIK3CA (exon 4, 9, and 20) and AKT1 (exon 2) in TNBC subtypes by Sanger sequencing.

Results: TNBCs were classified into Basal-like 1(BL1) (n = 20, 25%), Mesenchymal (n = 19, 23.75%), Luminal Androgen (LAR) (n = 12, 15%), Basal+Mesenchymal (Mixed type) (n = 10, 12.5%), and unclassified subtype (n = 19, 23.75%). PIK3CA mutations were observed in 16.25% (13/80) TNBC cases. PIK3CA mutations were more frequent in exon 20 (8.7%) than in exon 9 (5%) and exon 4 (2.5%). PIK3CA mutations were frequent in LAR subtype (33.3%) followed by unclassified type (31.5%), Mesenchymal (10.5%), and BL1 (5%) subtypes. Two hotspot mutations were found in AKT1 (T21I, E17K) in mixed and unclassified subtype.

Conclusions: This study highlights the heterogeneity within TNBCs. Higher frequencies of PIK3CA mutations were noted in LAR subtypes and unclassified type, comparable to their incidence reported in literature in ER-positive tumors. The mutation status can be used as potential biomarker for PI3K inhibitors in TNBC subgroups.
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http://dx.doi.org/10.1007/s10549-021-06242-3DOI Listing
May 2021

Ruptured Emphysematous Liver Abscess: An Unusual Presentation in Kochs.

Clin Pract 2021 Apr 2;11(2):200-204. Epub 2021 Apr 2.

Department of Surgery, Grant Govt Medical College & Sir J.J. Group of Hospitals, Mumbai 400008, India.

Gas forming liver abscess (GFLA) though rare is seen in diabetic patients. Rupture of such abscesses usually requires surgical intervention. These cases are associated with high morbidity and mortality due to sepsis. Tuberculous liver abscesses are more often silent in presentation. GFLA formed in the background of a tuberculous liver abscess is rare. We present a case of ruptured GFLA with underlying tuberculous pathology in a normoglycemic patient. The abscess was managed by image guided intervention. A brief case report along with review of literature is presented.
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http://dx.doi.org/10.3390/clinpract11020029DOI Listing
April 2021

Impact of sodium vanadium oxide (NaVO, NVO) material synthesis conditions on charge storage mechanism in Zn-ion aqueous batteries.

Phys Chem Chem Phys 2021 Apr 26;23(14):8607-8617. Epub 2021 Mar 26.

Institute for Electrochemically Stored Energy, State University of New York at Stony Brook, Stony Brook, New York 11794, USA.

The electrochemical charge storage of sodium vanadate (NaVO or NVO) cathodes in aqueous Zn-ion batteries has been hypothesized to be influenced by the inclusion of structural water for facilitating ion transfer in the material. Materials properties considered important (morphology, crystallite and particle size, surface area) are systematically studied herein through investigation of two NVO materials, NaVO·0.34HO [NVO(300)] and NaVO·0.05HO [NVO(500)], with different water content, acicular morphologies with different size and surface area achieved via post-synthesis heat treatment. The electrochemistry of the two materials was evaluated in aqueous Zn-ion cells with 2 M ZnSO electrolyte using cyclic voltammetry, galvanostatic cycling, and rate capability testing. The thinner NVO(300) nanobelts (0.13 μm) demonstrate greater specific capacities and higher effective diffusion coefficients relative to the thicker NVO(500) nanorods. Notably however, while cells containing NVO(500) deliver lower specific capacity, they demonstrate enhanced capacity retention with cycling. The structural changes accompanying oxidation and reduction are elucidated via ex situ X-ray diffraction, transmission electron microscopy, and operando V K-edge X-ray absorption spectroscopy (XAS), where NVO material properties are shown to influence the ion insertion. Operando XAS verified that electron transfer corresponds directly to change in vanadium oxidation state, affirming vanadium redox as the governing electrochemical process.
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http://dx.doi.org/10.1039/d1cp00516bDOI Listing
April 2021

High-Sensitivity Cardiac Troponin T for the Detection of Myocardial Injury and Risk Stratification in COVID-19.

Clin Chem 2021 Apr 16. Epub 2021 Apr 16.

Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

Methods: We conducted a multicenter, retrospective, observational, US-based study of COVID-19 patients undergoing hs-cTnT. Outcomes included short-term mortality (in-hospital and 30-days post-discharge) and a composite of major adverse events including respiratory failure requiring mechanical ventilation, cardiac arrest, and shock within the index presentation and/or mortality during the index hospitalization or within 30-days post-discharge.

Results: Among 367 COVID-19 patients undergoing hs-cTnT, myocardial injury was identified in 46%. They had a higher risk for mortality (20% vs. 12%, P<0.0001; unadjusted HR 4.44, 95% CI 2.13-9.25, P<0.001) and major adverse events (35% vs. 11%, P<0.0001; unadjusted OR 4.29, 95% CI 2.50-7.40, P<0.0001). Myocardial injury was associated with major adverse events (adjusted OR 3.84, 95% CI 2.00-7.36, P<0.0001) but not mortality. Baseline (adjusted OR 1.003, 95% CI 1.00-1.007, P=0.047) and maximum (adjusted OR 1.005, 95% CI 1.001-1.009, P=0.0012) hs-cTnT were independent predictors of major adverse events. Most (95%) increases were due to myocardial injury, with 5% (n = 8) classified as type 1 or 2 myocardial infarction. A single hs-cTnT <6 ng/L identified 26% of patients without mortality, with a 94.9% (95% CI 87.5-98.6) negative predictive value and 93.1% sensitivity (95% CI 83.3-98.1) for major adverse events in those presenting to the ED.

Conclusions: Myocardial injury is frequent and prognostic in COVID-19. While most hs-cTnT increases are modest and due to myocardial injury, they have important prognostic implications. A single hs-cTnT <6 ng/L at presentation may facilitate the identification of patients with a favorable prognosis.
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http://dx.doi.org/10.1093/clinchem/hvab062DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083261PMC
April 2021

Prognostic implications of cardiac damage classification based on computed tomography in severe aortic stenosis.

Eur Heart J Cardiovasc Imaging 2021 Apr 14. Epub 2021 Apr 14.

Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300 RC Leiden, The Netherlands.

Aims: An echocardiographic staging system of severe aortic stenosis (AS) based on additional extra-valvular cardiac damage has been associated with prognosis after transcatheter aortic valve implantation (TAVI). Multidetector row computed tomography (MDCT) is key in the evaluation of AS patients undergoing TAVI and can potentially detect extra-valvular cardiac damage. This study aimed at evaluating the prognostic implications of an MDCT staging system of severe AS in patients undergoing TAVI.

Methods And Results: A total of 405 patients (80 ± 7 years, 52% men) who underwent full-beat MDCT prior to TAVI were included. The extent of cardiac damage was assessed by MDCT and classified in five categories; Stage 0 (no cardiac damage), Stage 1 (left ventricular damage), Stage 2 (left atrium and mitral valve damage), Stage 3 (right atrial damage), and Stage 4 (right ventricular damage). Twenty-seven (7%) patients were stratified as Stage 0, 96 (24%) as Stage 1, 152 (38%) as Stage 2, 78 (19%) as Stage 3, and 52 (13%) as Stage 4. During a median follow-up of 3.7 (IQR 1.7-5.5) years, 150 (37%) died. On multivariable Cox regression analysis, cardiac damage Stage 3 (HR vs. Stage 0: 4.496, P = 0.039) and Stage 4 (HR vs. Stage 0: 5.565, P = 0.020) were independently associated with all-cause mortality.

Conclusion: The MDCT-based staging system of cardiac damage in severe AS effectively identifies the patients who are at higher risk of death after TAVI.
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http://dx.doi.org/10.1093/ehjci/jeab071DOI Listing
April 2021

An insight into the medicinal attributes of berberine derivatives: A review.

Bioorg Med Chem 2021 May 2;38:116143. Epub 2021 Apr 2.

Department of Pharmaceutical Chemistry, ISF College of Pharmacy, GT Road, Ghal Kalan, Moga-142001, Punjab, India. Electronic address:

In the last few decades, traditional natural products have been the center of attention for the scientific community and exploration of their therapeutic abilities is proceeding perpetually. Berberine, with remarkable therapeutic diversity, is a plant derived isoquinoline alkaloid which is widely used as a traditional medicine in China. Berberine has been tackled as a fascinating pharmacophore to make great contributions to the discovery and development of new therapeutic agents against variegated diseases. Despite its tremendous therapeutic potential, clinical utility of this alkaloid was significantly compromised due to undesirable pharmacokinetic properties. To overcome this limitation, several structural modifications were performed on this scaffold to improve its therapeutic efficacy. The collective efforts of the community have achieved the tremendous advancements, bringing berberine to clinical use and discovering new therapeutic opportunities by structural modifications on the berberine scaffold. In this review, recent advancements in the medicinal chemistry of berberine and its derivatives in the last few years (2016-2020) have been compiled to represent inclusive data associated with various biological activities of this alkaloid. The comprehensive structure-activity relationship studies along with molecular modelling and mechanistic studies have also been summarized. This article would be highly helpful for the scientific community to get better insight into medicinal research of berberine and become a compelling guide for the rational design of berberine based compounds.
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http://dx.doi.org/10.1016/j.bmc.2021.116143DOI Listing
May 2021

Tetrahydropiperic acid (THPA) conjugated cationic hybrid dipeptides as antimicrobial agents.

J Antibiot (Tokyo) 2021 Mar 25. Epub 2021 Mar 25.

Medicinal Chemistry Division, Council of Scientific & Industrial Research-Indian Institute of Integrative Medicine(CSIR-IIIM), Jammu-180001, India.

The present work describes the synthesis of hybrid dipeptides H-Lys-Gpn-PEA, C1; H-Lys-βAPEA, C2, and THPA conjugated dipeptides, THPA-Lys-Gpn-PEA, C3, and THPA-Lys-βA-PEA, C4. All the peptides were evaluated against both Gram-negative and Gram-positive bacterial strains. Among all, peptide C4 exhibited the most potent activity with MIC 1.56 μM against P. aeruginosa (MTCC 424) and S. aureus (MTCC 737). Further, time-kill kinetics, fluorescence assays, and scanning electron microscopy (SEM) studies were performed in order to understand the mechanism of action and efficacy of peptide C4, The fluorescence assays and SEM images demonstrated the bacterial killing through membrane disruption. The peptide C4 exhibited very low hemolytic activity with negligible cytotoxicity against normal human breast cell line FR2.
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http://dx.doi.org/10.1038/s41429-021-00419-0DOI Listing
March 2021

Impact of Chronic Obstructive Pulmonary Disease in Heart Failure With Preserved Ejection Fraction.

Am J Cardiol 2021 Mar 21. Epub 2021 Mar 21.

University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Hospital of University of Pennsylvania, Philadelphia, Pennsylvania; Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania. Electronic address:

COPD often coexists with HFpEF, but its impact on cardiovascular structure and function in HFpEF is incompletely understood. We aimed to compare cardiovascular phenotypes in patients with Chronic Obstructive Pulmonary Disease (COPD), Heart Failure with Preserved Ejection Fraction (HFpEF), or both. We studied 159 subjects with COPD alone (n = 48), HFpEF alone (n = 79) and HFpEF + COPD (n = 32). We used MRI and arterial tonometry to assess cardiac structure and function, thoracic aortic stiffness, and measures of body composition. Relative to participants with COPD only, those with HFpEF with or without COPD exhibited a greater prevalence of female sex and obesity, whereas those with HFpEF + COPD were more often African-American. Compared to the other groups, participants with HFpEF and COPD demonstrated a more concentric LV geometry (LV wall-cavity ratio 1.2, 95%CI: 1.1-1.3; p = 0.003), a greater LV mass (67.4, 95%CI: 60.7-74.2; p = 0.03, and LV extracellular volume (49.4, 95%CI: 40.9-57.9; p = 0.002). Patients with comorbid HFpEF + COPD also exhibited greater thoracic aortic stiffness assessed by pulse-wave velocity (11.3, 95% CI: 8.7-14.0 m/s; p = 0.004) and pulsatile load imposed by the ascending aorta as measured by aortic characteristic impedance (139 dsc; 95%CI=111-166; p = 0.005). Participants with HFpEF, with or without COPD, exhibited greater abdominal and pericardial fat, without difference in thoracic skeletal muscle size. In conclusion, individuals with co-morbid HFpEF and COPD have a greater degree of systemic large artery stiffening, LV remodeling, and LV fibrosis than those with either condition alone.
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http://dx.doi.org/10.1016/j.amjcard.2021.03.009DOI Listing
March 2021

Triple-negative breast cancer and factors affecting disease-free survival-Experience from a tertiary care center in India.

Breast J 2021 Mar 21. Epub 2021 Mar 21.

Department of Surgery, Post Graduate Institute of Medical Education & Research (P.G.I.M.E.R.), Chandigarh, India.

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http://dx.doi.org/10.1111/tbj.14227DOI Listing
March 2021

Altered bowel habit and rectal bleeding in pregnancy: the importance of recognising undiagnosed inflammatory bowel disease.

Intern Med J 2021 Mar;51(3):424-427

Department of Gastroenterology, Northern Hospital, Melbourne, Victoria, Australia.

Worsening of disease activity during pregnancy in patients with known inflammatory bowel disease, especially ulcerative colitis (UC), is well recognised, but the diagnosis of new-onset or previously undiagnosed UC in pregnancy has been inadequately studied to date. Recognition of gastrointestinal symptoms in pregnancy as potentially indicating UC is of paramount importance, as this allows appropriate investigation and instigation of therapies to optimise maternal and foetal outcomes. Here, we report three cases of women with gastrointestinal symptoms in pregnancy with disparate outcomes.
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http://dx.doi.org/10.1111/imj.15231DOI Listing
March 2021

Potential therapeutic applications of phytoconstituents as immunomodulators: Pre-clinical and clinical evidences.

Phytother Res 2021 Mar 18. Epub 2021 Mar 18.

Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research-Raebareli (NIPER-R), Lucknow, India.

Autoimmune and infectious diseases are the major public health issues and have gained great attention in the last few years for the search of new agents with therapeutic benefits on the host immune functions. In recent years, natural products (NPs) have been studied broadly for their multi-targeted activities under pathological conditions. Interestingly, several attempts have been made to outline the immunomodulatory properties of NPs. Research on in-vitro and in-vivo models have shown the immunomodulatory activity of NPs, is due to their antiinflammatory property, induction of phagocytosis and immune cells stimulation activity. Moreover, studies on humans have suggested that phytomedicines reduce inflammation and could provide appropriate benefits either in single form or complex combinations with other agents preventing disease progression, subsequently enhancing the efficacy of treatment to combat multiple malignancies. However, the exact mechanism of immunomodulation is far from clear, warranting more detailed investigations on their effectiveness. Nevertheless, the reduction of inflammatory cascades is considered as a prime protective mechanism in a number of inflammation regulated autoimmune diseases. Altogether, this review will discuss the biological activities of plant-derived secondary metabolites, such as polyphenols, alkaloids, saponins, polysaccharides and so forth, against various diseases and their potential use as an immunomodulatory agent under pathological conditions.
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http://dx.doi.org/10.1002/ptr.7068DOI Listing
March 2021

Predicting Response to Neoadjuvant Chemotherapy in Locally Advanced Breast Cancer After the Second Cycle of Chemotherapy Using Shear-Wave Elastography-A Preliminary Evaluation.

Ultrasound Q 2021 Mar;37(1):16-22

Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Abstract: The primary objective of the study was to determine whether shear wave elastography can be used to predict the response of neoadjuvant chemotherapy (NACT) in women having invasive breast cancer. A prospective study involving 28 patients having invasive breast cancer and undergoing NACT followed by surgery was done after institutional review board approval. All the patients underwent 2-dimensional B-mode ultrasound and 2-dimensional shear wave elastography before the start of chemotherapy and after 2 cycles of completion of chemotherapy, and mean stiffness was recorded. The patients were segregated to responders and nonresponders based on residual cancer burden scoring. Difference in mean elasticity was compared between the 2 groups. The results showed that the mean stiffness after 2 cycles was significantly different between the responders and nonresponders and so was the change in the mean stiffness after 2 cycles of NACT. Using a cutoff value of 45.5 kPa (20.53%), change in mean elasticity after 2 cycles of NACT, sensitivity of 76.9%, and specificity of 80% with negative predictive value of 80.1 was attained. Responders show greater change in mean stiffness after 2 cycles of NACT as compared with nonresponders on shear wave elastography; thus, it can be used to predict response to NACT after 2 cycles.
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http://dx.doi.org/10.1097/RUQ.0000000000000552DOI Listing
March 2021

Self-Expandable Transcatheter Aortic Valve Frame Infolding: An Increasingly Recognized Complication.

Eur J Case Rep Intern Med 2020 14;7(12):002100. Epub 2020 Dec 14.

Department of Cardiovascular Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.

Transcatheter aortic valve replacement (TAVR) with either a balloon-expandable or a self-expandable transcatheter heart valve (THV) is an approved therapy for patients with symptomatic severe aortic stenosis and high or intermediate surgical risk. Here we present a case of severe valve frame infolding of a CoreValve Evolut PRO self-expandable THV (Medtronic Inc.), which was restored to optimal geometry with balloon post-dilation.

Learning Points: Clinicians should be aware of the rare complication of frame infolding during deployment of a self-expanding transcatheter valve.Multimodality cardiac imaging is important to optimize transcatheter valve deployment.
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http://dx.doi.org/10.12890/2020_002100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7875597PMC
December 2020

High-Temperature Properties and Applications of Si-Based Polymer-Derived Ceramics: A Review.

Materials (Basel) 2021 Jan 29;14(3). Epub 2021 Jan 29.

Department of Mechanical and Nuclear Engineering, Kansas State University, Manhattan, KS 66506, USA.

Ceramics derived from organic polymer precursors, which have exceptional mechanical and chemical properties that are stable up to temperatures slightly below 2000 °C, are referred to as polymer-derived ceramics (PDCs). These molecularly designed amorphous ceramics have the same high mechanical and chemical properties as conventional powder-based ceramics, but they also demonstrate improved oxidation resistance and creep resistance and low pyrolysis temperature. Since the early 1970s, PDCs have attracted widespread attention due to their unique microstructures, and the benefits of polymeric precursors for advanced manufacturing techniques. Depending on various doping elements, molecular configurations, and microstructures, PDCs may also be beneficial for electrochemical applications at elevated temperatures that exceed the applicability of other materials. However, the microstructural evolution, or the conversion, segregation, and decomposition of amorphous nanodomain structures, decreases the reliability of PDC products at temperatures above 1400 °C. This review investigates structure-related properties of PDC products at elevated temperatures close to or higher than 1000 °C, including manufacturing production, and challenges of high-temperature PDCs. Analysis and future outlook of high-temperature structural and electrical applications, such as fibers, ceramic matrix composites (CMCs), microelectromechanical systems (MEMSs), and sensors, within high-temperature regimes are also discussed.
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http://dx.doi.org/10.3390/ma14030614DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7866281PMC
January 2021

SARS-CoV-2 setting-specific transmission rates: a systematic review and meta-analysis.

Clin Infect Dis 2021 Feb 9. Epub 2021 Feb 9.

MRC Centre for Global Infectious Disease Analysis & WHO Collaborating Centre for Infectious Disease Modelling, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London, London, UK.

Background: Understanding the drivers of SARS-CoV-2 transmission is crucial for control policies but evidence of transmission rates in different settings remains limited.

Methods: We conducted a systematic review to estimate secondary attack rates (SAR) and observed reproduction numbers (Robs) in different settings exploring differences by age, symptom status, and duration of exposure. To account for additional study heterogeneity, we employed a Beta-Binomial model to pool SARs across studies and a Negative-binomial model to estimate Robs.

Results: Households showed the highest transmission rates, with a pooled SAR of 21.1% (95%CI:17.4%-24.8%). SARs were significantly higher where the duration of household exposure exceeded 5 days compared with exposure of ≤5 days. SARs related to contacts at social events with family and friends were higher than those for low-risk casual contacts (5.9% vs. 1.2%). Estimates of SAR and Robs for asymptomatic index cases were approximately a seventh, and for pre-symptomatic two thirds of those for symptomatic index cases. We found some evidence for reduced transmission potential both from and to individuals under 20 years of age in the household context, which is more limited when examining all settings.

Conclusions: Our results suggest that exposure in settings with familiar contacts increases SARS-CoV-2 transmission potential. Additionally, the differences observed in transmissibility by index case symptom status and duration of exposure have important implications for control strategies such as contact tracing, testing and rapid isolation of cases. There was limited data to explore transmission patterns in workplaces, schools, and care-homes, highlighting the need for further research in such settings.
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http://dx.doi.org/10.1093/cid/ciab100DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7929012PMC
February 2021

End-to-End, Pixel-Wise Vessel-Specific Coronary and Aortic Calcium Detection and Scoring Using Deep Learning.

Diagnostics (Basel) 2021 Feb 2;11(2). Epub 2021 Feb 2.

Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, NY 10021, USA.

Conventional scoring and identification methods for coronary artery calcium (CAC) and aortic calcium (AC) result in information loss from the original image and can be time-consuming. In this study, we sought to demonstrate an end-to-end deep learning model as an alternative to the conventional methods. Scans of 377 patients with no history of coronary artery disease (CAD) were obtained and annotated. A deep learning model was trained, tested and validated in a 60:20:20 split. Within the cohort, mean age was 64.2 ± 9.8 years, and 33% were female. Left anterior descending, right coronary artery, left circumflex, triple vessel, and aortic calcifications were present in 74.87%, 55.82%, 57.41%, 46.03%, and 85.41% of patients respectively. An overall Dice score of 0.952 (interquartile range 0.921, 0.981) was achieved. Stratified by subgroups, there was no difference between male (0.948, interquartile range 0.920, 0.981) and female (0.965, interquartile range 0.933, 0.980) patients ( = 0.350), or, between age <65 (0.950, interquartile range 0.913, 0.981) and age ≥65 (0.957, interquartile range 0.930, 0.9778) ( = 0.742). There was good correlation and agreement for CAC prediction (rho = 0.876, < 0.001), with a mean difference of 11.2% ( = 0.100). AC correlated well (rho = 0.947, < 0.001), with a mean difference of 9% ( = 0.070). Automated segmentation took approximately 4 s per patient. Taken together, the deep-end learning model was able to robustly identify vessel-specific CAC and AC with high accuracy, and predict Agatston scores that correlated well with manual annotation, facilitating application into areas of research and clinical importance.
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http://dx.doi.org/10.3390/diagnostics11020215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7913112PMC
February 2021

Secondary prevention of stroke by a primary health care approach: An open-label cluster randomised trial.

J Clin Neurosci 2021 Feb 28;84:53-59. Epub 2020 Dec 28.

Achuta Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.

Background And Aim: Increasing stroke burden in developing countries necessitates measures to strengthen health systems. We aimed to evaluate whether a Community Health Worker (CHW) based educational intervention will improve risk factor control among stroke survivors and enhance behavior change communication.

Method: An open-label, cluster-randomized trial was conducted in rural area of Thiruvananthapuram district, Kerala from December 2017 to December 2018. A CHW-based educational intervention in addition to standard of care was provided in intervention arm and compared to standard clinical care in the control arm with follow-up at three and six months. The primary outcome measures were risk factor control and quality of behavior change communication provided by CHWs.

Results: Of the 234 Stroke/TIA survivors enrolled, the mean age (SD) was 59.43 (11.07) years. At 6-month follow up, all patients with smokeless tobacco consumption had quit in the intervention arm (5 at baseline and 0 at six months) and no relapse in smoking was found (as compared to control arm wherein 9 at baseline and one at 6 months). The control of hypertension and diabetes was not significant at 3 months and 6 months in both intervention and control groups. Home visits as well as health education on risk factors by CHWs in the intervention arm were significantly higher.

Conclusion: Community health worker-based intervention is feasible in resource constrained settings for secondary stroke prevention. Training of CHW on risk factor control and lifestyle modifications for stroke survivors enhances quality of health education provided by health services.
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http://dx.doi.org/10.1016/j.jocn.2020.12.006DOI Listing
February 2021

Impact of an antimicrobial stewardship and monitoring of infection control bundle in a surgical intensive care unit of a tertiary-care hospital in India.

J Glob Antimicrob Resist 2021 Mar 18;24:260-265. Epub 2021 Jan 18.

Department of General Surgery, PGIMER, Chandigarh, India.

Objectives: Antimicrobial stewardship (AMS) in resource-limited settings lacks models that can be readily adapted to their settings. Here we discuss the impact of a combined strategy of AMS and monitoring of infection control practices in a tertiary-care centre of a developing country.

Methods: This study was undertaken in the surgical unit of a tertiary-care hospital over an 8-month period. In the first 2 months (baseline phase), prospective audit and feedback alone was undertaken, while in the next 6 months (intervention phase) this was supplemented with strategies such as antimicrobial timeout, correction of doses and bundle approach for prevention of hospital-acquired infections.

Results: A total of 337 patients were included (94 in the baseline phase and 243 in the intervention phase). There was a decrease in days of therapy per 1000 patient-days (1000PD) (1112.3 days vs. 1048.6 days), length of therapy per 1000PD (956 days vs. 936.3 days) and defined daily doses (DDD) per 1000PD for most antimicrobials. A decrease in double cover for Gram-negative infections (9.6% vs. 2.9%) but an increase in double anaerobic cover (4.2% vs. 7.4%) was observed. There was a decrease in the incidence of ventilator-associated pneumonia per 1000 ventilator-days in the intervention phase (46.4 vs. 35.4), whereas central line-associated bloodstream infections per 1000 central line-days remained the same (14.7 vs. 14.8).

Conclusion: This study shows that implementation of routine AMS activities with monitoring of infection control practices can help decrease overall antimicrobial use. With furtherance of measures to control infection, antimicrobial use may be further curtailed.
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http://dx.doi.org/10.1016/j.jgar.2021.01.003DOI Listing
March 2021

Ag-nanoparticles-loaded BaCaTiZrO for multicatalytic dye degradation.

Nanotechnology 2021 Jan 19;32(14):145716. Epub 2021 Jan 19.

BaCaTiZrO (BCZTO) ferroelectric ceramic loaded with Ag nanoparticles (NPs) was explored for its photo/piezocatalytic performance. The presence of Ag loading on BCZTO ceramic was confirmed using electron microscopes. X-ray photoelectron spectroscopy revealed the metallic chemical state of Ag NPs loaded on the surface of BCZTO ceramic. The absorbance spectrum of the Ag-loaded BCZTO sample showed a visible light absorption hump due to the phenomenon of surface plasmonic resonance. During the photocatalysis process, the [Formula: see text]99% of rhodamine B (RB) dye was degraded in aqueous solution using the Ag-loaded BCZTO sample, showing its promising photocatalysis activity. During the piezocatalysis process, the [Formula: see text]95% of RB dye was degraded using the Ag-loaded BCZTO sample, showing its promising piezocatalytic activity. The ·OH radical species were found responsible for the photocatalytic and piezocatalytic performance. The photo/piezocatalytic performance was found to be consistent over five cycles, indicating promising reusability of the Ag-loaded BCZTO sample.
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http://dx.doi.org/10.1088/1361-6528/abd5e6DOI Listing
January 2021

Ag nanoparticles loadedBa0.85Ca0.15Ti0.9Zr0.1O3for multicatalytic dye degradation.

Nanotechnology 2020 Dec 22. Epub 2020 Dec 22.

School of Engineering, Indian Institute of Technology - Bombay, Mandi 175001, Mandi, INDIA.

Ba0.85Ca0.15Ti0.9Zr0.1O3(BCZTO) ferroelectric ceramic loaded with Ag nanoparticles (NPs) was explored for their photo/piezocatalytic performance. The presence of Ag loading on BCZTO ceramic was confirmed using the electron microscopes. X-ray photoelectron spectroscopy revealed the metallic chemical state of Ag NPs loaded on the surface of BCZTO ceramic. The absorbance spectrum of the Ag loaded BCZTO sample showed visible light absorption hump due to the phenomenon of surface plasmonic resonance (SPR). During the photocatalysis process, the ~99% of rhodamine B (RB) dye was degraded in aqueous solution using Ag loaded BCZTO sample showing its promising photocatalysis activity. During piezocatalysis process, the ~95% of RB dye was degraded using Ag loaded BCZTO sample showing its promising piezocatalytic activity. The •OH radical species were found responsible behind the photocatalytic and piezocatalytic performance. The photo/piezocatalytic performance was found to be consistent over five cycles indicating promising reusability of Ag loaded BCZTO sample.
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http://dx.doi.org/10.1088/1361-6528/abd5e6DOI Listing
December 2020

Comparison of two radiation boost schedules in postlumpectomy patients with breast cancer.

J Cancer Res Ther 2020 Oct-Dec;16(6):1344-1349

Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Background: We have been practicing hypofractionation, 40 Gy in 16 fractions over 3 weeks for whole breast irradiation (WBI) for the past five decades with or without boost at our center. In this study, we compared two boost schedules of 10 Gy/5#/1 week with 16 Gy/8#/1.5 weeks in postlumpectomy patients with breast cancer after WBI.

Materials And Methods: From June 2012 to June 2016, the study included 87 breast cancer patients postbreast conservation surgery. The institutional ethics committee approved the study, which was registered with ClinicalTrials.gov (ClinicalTrials.gov identifier no. CT02142907). All patients were treated with WBI of 40 Gy/16#/3 weeks. WBI was followed by tumor bed boost of 10 Gy/5#/1 week in 44 patients and 16 Gy/8#/1.5 weeks in 43 patients, either with electron beam therapy or 3D CRT with photons. The primary endpoint of the study was the comparison of local control between two schedules. Secondary endpoints were acute and late radiation toxicities, cosmetic score analysis, disease-free survival (DFS), and overall survival (OS). The assessment of acute and late skin toxicity was made as per RTOG scores and LENT-SOMA scale. The cosmetic assessment was made with Harvard/NSABP/RTOG Breast Cosmesis Grading Scale.

Results: Median follow-up was 55 months (range 18-78 months). Local recurrence was seen in 1 (2.3%) patient in the 16 Gy boost only. Acute Grade 2 skin toxicity was 33% in 16 Gy boost arm compared to 23% in 10 Gy boost arm. Late skin toxicities were also high in patients with 16 Gy boost. Grade ≥2 induration was seen in 4.5% and 14% of patients with 10 Gy and 16 Gy boost, respectively. None of the patients with 10 Gy boost had Grade 2 edema as compared to 5% with 16 Gy. Pigmentation was observed in 9% and 23% patients with 10 Gy and 16 Gy boost, respectively. Grade 1 fibrosis was 2% versus 12% in patients with 10 Gy and 16 Gy boost, respectively. The cosmetic score was good/excellent in 91% and 84% of patients with 10 Gy and 16 Gy boost, respectively. Distant metastasis occurred in 2 (4%) and 3 (7%) patients in 10 Gy and 16 Gy boost, respectively. DFS and OS at 5 years were comparable between the two boost schedules.

Conclusion: Local control was comparable with 10 Gy and 16 Gy boost. Acute and late skin toxicities were higher with 16 Gy boost dose. The cosmetic score was better with 10 Gy boost. DFS and OS was comparable with the two boost schedules. Hence, a boost of 10 Gy/5# after WBI may be adequate in patients with breast cancer.
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http://dx.doi.org/10.4103/jcrt.JCRT_549_19DOI Listing
December 2020

Mammographic breast density and breast cancer risk: Evaluation using volumetric breast density software.

J Cancer Res Ther 2020 Oct-Dec;16(6):1258-1264

General Surgery, Postgraduate Institute of Medical Education Research, Chandigarh, India.

Purpose: The study aimed to assess breast density as a risk factor for breast malignancy using automated volumetric breast density software and to study the relationship of breast density with tumor histopathological characteristics.

Materials And Methods: One hundred and thirty-four women with unilateral core biopsy-proven breast cancer were taken in the "case group." Two hundred and one women with normal bilateral screening mammograms were enrolled in the "control group." The cases and controls were further divided into pre- and post-menopausal subgroups. The mammograms of the contralateral breast of the cases and bilateral breasts of the controls were evaluated by automated volumetric breast density software and classified into four density grades. The tumor histopathological characteristics in the various density grades were also evaluated.

Results: In premenopausal women, the odds of having breast cancer was significantly higher for Grade 3 breasts (odds ratio [OR] 3.03; 95% confidence interval [CI]: [1.19-7.71]) versus Grade 1 and 2 breasts. Grade 4 premenopausal breasts also had greater odds (OR 3.09; 95% CI [0.89-10.78]) of developing breast cancer. No such relationship was established for postmenopausal women. No significant difference was seen in the histopathology of breast cancer among various breast density groups.

Conclusion: Increased breast density can be considered as an inherent, independent risk factor for breast cancer in premenopausal women.
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http://dx.doi.org/10.4103/jcrt.JCRT_568_18DOI Listing
February 2021

Molecular Subtyping of Triple Negative Breast Cancer by Surrogate Immunohistochemistry Markers.

Appl Immunohistochem Mol Morphol 2021 Apr;29(4):251-257

General Surgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

Triple negative breast cancer (TNBC) is a heterogeneous disease and an attempt was made to classify TNBCs into surrogate molecular subtypes using immunohistochemical markers. Tissue microarrays were constructed for 245 cases of TNBCs. For classification of TNBCs immunohistochemistry was done on tissue microarrays for cytokeratin 5/6, 4/14 (CK5/6, CK4/14), epidermal growth factor receptor (EGFR), vimentin, E-cadherin, claudin 3 and 7, androgen receptor (AR) and aldehyde dehydrogenase1A. The TNBCs were classified into basal-like 1 (BL1) type (CK5/6+, CK4/14+, EGFR- n=32; 13.1%), basal-like 2 (BL2) type (EGFR+, n=4; 1.6%), mesenchymal type (Vimentin+, E-cadherin ̅, claudin 3-and 7-, n=70; 28.6%), luminal androgen type (AR+, n=41; 16.7%), mixed type (n=37; 15.1%), and unclassified type (n=61; 24.9%). Luminal androgen receptor subtype showed apocrine features, and was associated with older age group, lower proliferation index and high frequency of lymph node metastasis. Basal subtype was cellular with rich stromal lymphocytic infiltrate. Mesenchymal stem like subtype was associated with younger age group with metaplastic and mesenchymal features. Mesenchymal stem like and unclassified subtype had shorter overall survival with median of 68.2 and 69.2 months, respectively, and the BL2 had median disease-free survival of 35.4 months. On immunohistochemistry TNBC is a heterogeneous entity composed of 6 major subtypes. Immunohistochemical subtyping of TNBC can provide information on prognostication and selection of appropriate targeted therapy for these patients.
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http://dx.doi.org/10.1097/PAI.0000000000000897DOI Listing
April 2021

Assessment of PD-L1 expression and tumor-infiltrating lymphocytes (TILs) across molecular subtypes of triple-negative breast cancer.

Breast J 2020 12 14;26(12):2424-2427. Epub 2020 Dec 14.

Departments of Histopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.

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http://dx.doi.org/10.1111/tbj.14110DOI Listing
December 2020

Polymer-based prolonged-release nanoformulation of duloxetine: fabrication, characterization and neuropharmacological assessments.

Drug Dev Ind Pharm 2021 Jan 9;47(1):12-21. Epub 2020 Dec 9.

Department of Pharmaceutics, University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh, India.

Objective: The poly D, L-Lactic-co-glycolic acid (PLGA) and Polycaprolactone (PCL) have been widely applied for developing the prolonged-release formulation. The current study explores the application of these polymers for developing prolonged-release nanosphere of Duloxetine (DLX). Developing a prolonged release parenteral nanosphere formulation of DLX would be overcoming pitfalls like acid-labile degradation, first-pass metabolism and erratic bioavailability along with long-term therapeutic benefit in the treatment of depression.

Methods: DLX-loaded PLGA and PCL nanospheres were prepared by using the emulsion solvent evaporation technique. The developed formulation was compared with DLX oral solution concerning brain estimation. The prepared nanospheres were subjected to the morphology of the drug particles, polydispersity Index (PDI), distribution size, zeta potential, entrapment efficiency and percentage yield to generate a proof of concept.

Results: DLX-loaded polymeric nanosphere exhibited the uniform size from 89.48 nm to 100.9 nm. The entrapment efficiency was in the range of 74.93 to 77.49, respectively, of PLGA and PCL formulation. The FSEM image affirmed smooth spherical morphology. A good PDI and negative zeta potential value (-31.3 mV for F1 and -30.7 mV for F2) supported the stability of the nanosphere. The brain concentration of the drug was three times enhanced supporting the effectiveness of the nanosphere during pharmacodynamic and pharmacokinetic studies.

Conclusion: The intramuscular DLX-loaded nanospheres signify improved brain availability relative to DLX solution. This can be a blueprint for the effective and targeted brain delivery of CNS drugs.
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http://dx.doi.org/10.1080/03639045.2020.1851240DOI Listing
January 2021

Antimicrobial activities and mechanism of action of Cymbopogon khasianus (Munro ex Hackel) Bor essential oil.

BMC Complement Med Ther 2020 Nov 5;20(1):331. Epub 2020 Nov 5.

Microbial Biotechnology Division, Indian Institute of Integrative Medicine, Canal Road, Jammu, 180001, India.

Background: Due to concerns regarding the safety of the chemical control measures, the trend is shifting globally towards the use of natural compounds as antimicrobial agent especially, plant essential oils.

Results: This study presented the antibacterial potential of Cymbopogon khasianus essential oil (CKEO) against human pathogens: Pseudomonas aeruginosa, Salmonella typhimurium, Escherichia coli, Klebsiella pneumoniae, Bacillus subtilis, Staphylococcus aureus and Candida albicans with MIC ranging from 20 to 100 μg/mL. CKEO, in comparison to its major constituent, geraniol, showed better MICs against tested pathogens. In combination studies, the effective concentrations of CKEO and streptomycin were reduced from 20 to 5 μg/mL and 11 to 0.7 ng/mL against E. coli. This suggests their synergistic action. However, CKEO showed partial synergy with ciprofloxacin. To understand the efficacy of CKEO, time-kill kinetics was performed. CKEO took the half time to show the bactericidal effect in comparison to streptomycin at their 2x MICs (double the MIC), while their combination took only 30 min for this. Fluorescence and surface electron microscopic and protein estimation studies suggested the multi-target action of CKEO-streptomycin combination against E. coli. Further, CKEO alone/in combination exhibited less than 10% haemolytic activity at its MIC.

Conclusion: These results indicate that CKEO is a potentially safe alternative for the treatment of various pathogenic bacterial strains. It could be used for a variety of applications including human health, food storage, aquaculture, etc.
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http://dx.doi.org/10.1186/s12906-020-03112-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643435PMC
November 2020

Benefits of phone consultation for endoscopy-related clinics in the COVID-19 pandemic.

J Gastroenterol Hepatol 2021 Apr 22;36(4):1064-1080. Epub 2020 Nov 22.

Department of Gastroenterology and Hepatology, Austin Health, Heidelberg, Victoria, Australia.

Background And Aim: During COVID-19 outbreak, restrictions to in-person consultations were introduced with a rise in telehealth. An indirect benefit of telehealth could be better attendance. This study aimed to assess "failure-to-attend" (FTA) rate and satisfaction for two endoscopy-related compulsory telehealth clinics during the COVID-19 outbreak.

Methods: Consecutive patients booked for endoscopy-related telehealth clinics at a tertiary hospital were prospectively assessed. In-person clinic control data were assessed retrospectively. Sample size was calculated to detect an anticipated increase in attendance of 8%. Secondary outcomes included FTA differences between clinics and evaluation of patients and doctors satisfaction. Satisfaction was assessed based on six Likert scale questions used in previous telehealth research and asked to both patients and doctors (6Q_score). This study was exempt from IRB review after institutional IRB review.

Results: There were 691 patients booked for appointments in our endoscopy clinics during the study periods (373 in 2020). FTA rates were lowered by half during the compulsory telehealth clinics (12.6% to 6.4%, P < 0.01). The patient 6Q_score was higher for the advanced endoscopy clinic (84.6% vs 73.8%, P < 0.01), while the doctor 6Q_score was similar between both advanced clinics and post endoscopy clinics (91.1% vs 92.5% respectively, P = 0.80). An in-person follow-up consultation was suggested for 3.5% of the appointments, while the necessity of physical examination was flagged in 5.1%.

Conclusions: The use of phone consultations in endoscopy-related clinics during the COVID-19 outbreak has improved FTA rates while demonstrating high satisfaction rates. The need for in-person follow-up consultations and physical examination were low.
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http://dx.doi.org/10.1111/jgh.15292DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7675268PMC
April 2021

Surface Characterization and Tribological Performance Analysis of Electric Discharge Machined Duplex Stainless Steel.

Micromachines (Basel) 2020 Oct 7;11(10). Epub 2020 Oct 7.

Mechanical Engineering Department, Beant College of Engineering and Technology, Gurdaspur 143521, India.

The present article focused on the surface characterization of electric discharge machined duplex stainless steel (DSS-2205) alloy with three variants of electrode material (Graphite, Copper-Tungsten and Tungsten electrodes). Experimentation was executed as per Taguchi L18 orthogonal array to inspect the influence of electric discharge machining (EDM) parameters on the material removal rate and surface roughness. The results revealed that the discharge current (contribution: 45.10%), dielectric medium (contribution: 18.24%) majorly affects the material removal rate, whereas electrode material (contribution: 38.72%), pulse-on-time (contribution: 26.11%) were the significant parameters affecting the surface roughness. The machined surface at high spark energy in EDM oil portrayed porosity, oxides formation, and intermetallic compounds. Moreover, a pin-on-disc wear analysis was executed and the machined surface exhibits 70% superior wear resistance compared to the un-machined sample. The surface thus produced also exhibited improved surface wettability responses. The outcomes depict that EDMed DSS alloy can be considered in the different biomedical and industrial applications.
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http://dx.doi.org/10.3390/mi11100926DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599910PMC
October 2020

Comparing a novel machine learning method to the Friedewald formula and Martin-Hopkins equation for low-density lipoprotein estimation.

PLoS One 2020 30;15(9):e0239934. Epub 2020 Sep 30.

Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine, New York, New York, United States of America.

Background: Low-density lipoprotein cholesterol (LDL-C) is a target for cardiovascular prevention. Contemporary equations for LDL-C estimation have limited accuracy in certain scenarios (high triglycerides [TG], very low LDL-C).

Objectives: We derived a novel method for LDL-C estimation from the standard lipid profile using a machine learning (ML) approach utilizing random forests (the Weill Cornell model). We compared its correlation to direct LDL-C with the Friedewald and Martin-Hopkins equations for LDL-C estimation.

Methods: The study cohort comprised a convenience sample of standard lipid profile measurements (with the directly measured components of total cholesterol [TC], high-density lipoprotein cholesterol [HDL-C], and TG) as well as chemical-based direct LDL-C performed on the same day at the New York-Presbyterian Hospital/Weill Cornell Medicine (NYP-WCM). Subsequently, an ML algorithm was used to construct a model for LDL-C estimation. Results are reported on the held-out test set, with correlation coefficients and absolute residuals used to assess model performance.

Results: Between 2005 and 2019, there were 17,500 lipid profiles performed on 10,936 unique individuals (4,456 females; 40.8%) aged 1 to 103. Correlation coefficients between estimated and measured LDL-C values were 0.982 for the Weill Cornell model, compared to 0.950 for Friedewald and 0.962 for the Martin-Hopkins method. The Weill Cornell model was consistently better across subgroups stratified by LDL-C and TG values, including TG >500 and LDL-C <70.

Conclusions: An ML model was found to have a better correlation with direct LDL-C than either the Friedewald formula or Martin-Hopkins equation, including in the setting of elevated TG and very low LDL-C.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239934PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7526877PMC
December 2020