Network Analysis of Demographics, Dietary Intake, and Comorbidity Interactions

The aim of this study was to elucidate the complex interrelationships among dietary intake, demographics, and the risk of comorbidities. We applied a Gaussian graphical model to calculate the dietary scores of the participants. The network structure of dietary intake, demographics, and comorbidities was estimated in a mixed graphical model. The centrality indices of the nodes (strength (S), closeness (C), and betweenness (B)) were measured to identify the central node. Multinomial logistic regression was used to examine the association between the factors and comorbidities. Among 7423 participants, the strongest pairwise interactions were found between sex and smoking (1.56), sex and employment (0.66), sex and marital status (0.58), marital status and income (0.65), and age and employment (0.58). Among the factors in the network, sex played a central role (S = 4.63, C = 0.014, B = 41), followed by age (S = 2.81, C = 0.013, B = 18), smoking (S = 2.72, C = 0.013, B = 0), and employment (S = 2.17, C = 0.014, B = 22). While the odds of hypertension and diseases were significantly higher among females than males, an inverse association was observed between high cholesterol and moderate chronic kidney disease. Among these factors, dietary intake was not a strongly interacting factor in the network, whereas age was consistently associated with the comorbidities of hypertension, high cholesterol, diabetes, and chronic kidney disease.

Genomic Epidemiology Reveals the Reduction of the Introduction and Spread of SARS-CoV-2 After Implementing Control Strategies in South Korea, 2020

Genomic epidemiology is a core component in investigating the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this study, the efficacy of control strategies in South Korea was evaluated using genomic epidemiology based on viral genome sequences of 2,065 SARS-CoV-2 cases identified in South Korea from January 2020 to December 2020. Phylogenetic analysis revealed that the majority of viruses introduced from inbound travelers did not further spread throughout South Korea; however, four distinct subgroups (KR.1–4, belonging to B.1.497, B.1, K.1 and B.41) of viruses caused local epidemics. After the introduction of enhanced social distancing, the viral population size and daily case numbers decreased, and KR.2–4 subgroups were extinguished from South Korea. Nevertheless, there was a subsequent increase in KR.1 subgroups after the downgrading of social distancing level. These results indicate that the international traveler quarantine system implemented in South Korea along with social distancing measures efficiently reduced the introduction and spread of SARS-CoV-2, but it was not completely controlled. An improvement of control strategies will be required to better control SARS-CoV-2, its variants, and future pandemic viruses.

Keefektifan Model Pembelajaran Problem Based Learning dan Problem Solving Terhadap Kemampuan Berpikir Kritis Matematika Siswa Kelas V

Penelitian ini digunakan guna melihat efektivitas model pembelajaran Problem Based Learning dan Problem-solving ditinjau dari kemampuan berpikir kritis siswa kelas 5 SD. Subjek dari penelitian ini ialah siswa kelas 5 di Sekolah Dasar Negeri Pakis 1 dengan jumlah siswa di kelas parallel A dan B 41 siswa, 20 di kelas 5A dan 20 di kelas 5B. teknik yang digunakan untuk mengumpulkan data ialah observasi dan tes. Penelitian ini dilakukan dengan menggunakan instrumen RPP Problem Based Learning dan Problem-solving serta menggunakan instrumen kemampuan berpikir kritis siswa. Analisis data yang digunakan dalam penelitian ini ialah analisis deskripsi kuantitatif sebagai uji prasyarat, uji T dan uji N-Gain. Hasil pengujian hipotesis, dengan uji t-sig (2-tailed) di peroleh 0,000 < 0,05 dengan thitung 6.942 maka H0 ditolak dapat di artikan bahwa terdapat perbedaan yang segnifikan terhadap kemampuan berpikir kritis matematika. Hal tersebut juga dikuatkan dengan meningkatnya kemampuan berpikir kritis siswa kelas 5A yang diberikan perlakuan menggunakan model pembelajaran Problem Based Learning dengan rata-rata skor awal yang di peroleh 69,60 meningkat menjadi 87,35 sedangkan di kelas 5B yang diberikan perlakuan menggunakan model pembelajaran Problem-solving perolehan skor awal 65,75 hanya meningkat menjadi 79,20. Hal tersebut menunjukkan bahwa model Problem Based Learning lebih efektif dibandingkan dengan model Problem-solving dilihat dari kemampuan berpikir kritis matematika.

KARAKTERISASI RESERVOIR UNTUK MENENTUKAN PERSEBARAN BATUPASIR PEMBAWA HIDROKARBON MENGGUNAKAN INVERSI SIMULTAN

Dalam exploitasi hidrokarbon, salah satu tantangan yang paling penting adalah pemetaan persebaran batuan reservoir dan fluida pengisinya. Salah satu metode yang digunakan adalah inversi simultan. Inversi simultan merupakan salah satu teknik inversi seismik yang mengekstraksi data AVO untuk memperoleh nilai impedansi seismik dari data seismik Pre-Stack hingga memperoleh nilai impedansi P dan S serta densitas. Salah satu metode lanjutan yang paling umum dipakai adalah metode Lambda-Mu-Rho (LMR) untuk membatu identifikasi litologi dan fluida resorvoir. Penelitian dilakukan dengan menggunakan data dari Lapangan Nova Scotia, dengan target pada batupasir Formasi Missisauga. Data yang digunakan adalah data sumur L-30 dan B-41 dan data seismik 3D PSTM. Sumur B-41 berada di struktur lebih tinggi dari sumur L-30 namun tidak menghasilkan hidrokarbon. Log Vs dibuat sintetik menggunakan metode Fluid Replacement Modeling dan LMR diturunkan dengan transformasi log Vp, Vs dan densitas. Hasil pemetaan zona target pada kedalaman 2095-2250 ms yaitu dengan menggunakan range cut-off Lambda-Rho 17-22 Gpa*g/cc dan Mu-Rho 20-28 Gpa*g/cc maka didapat peta persebaran batuan reservoir dan hidrokarbon. Hasil interpretasi dari peta sebaran menunjukkan sumur B-41 adalah dry hole karena lapisan batupasir mempunyai nilai Mu-Rho rendah yang diakibatkan lapisan tipis dan perselingan dengan batulempung.

40 Weeks of Gestation is as High-Risk Gestation as 41 Weeks in Low-Risk Pregnancies

Introduction: Postdate pregnancy is associated with a higher frequency of obstetrical complications and perinatal morbidity. The incidence of meconium-stained amniotic fluid is 30% at 40 weeks which is very high. This study aimed to find out the need for fetal surveillance and delivery in our population, keeping in view that 40 weeks of gestation is as high risk as 41 weeks gestation in low-risk pregnancies.Material and Methods: The study was conducted at Obstetrics & Gynecology Department, Unit-II, Holy Family Hospital, and Rawalpindi from 16 February to 15 August 2019 after ethical clearance. Postdate pregnant women from 40 to 41 weeks who meet study criteria were enrolled in the study. We divided participants into two groups. Group A (40 to 40+6 weeks of gestation) while group B had Group B (41 to 41+6 weeks of gestation). Results: A total of 236 postdate mothers presented of which 148(62%) were in group A while 88 (38%) were in group B. Mean gestational age in our study was 40.88 ± 0.71 weeks. overall vaginal delivery, cesarean delivery, and meconium stained liquor were found in 75.84%, 24.16%, and 35.17% patients respectively. 82 (34.7%) participants presented with meconium-stained liquor meconium-stained liquor with women in group B has a higher frequency of meconium-stained liquor, 45 (30.41%) in group A and 37 (42.04%) in group B, P-value 0.069. rate of vaginal delivery was 71.62% in group A and 82.95% in group B which was statistically significant. P-value 0.049Conclusion: High percentage of meconium-stained liquor was observed in the study population. Frequency of vaginal delivery increases if postdate women waited till 41 weeks. 30% of women at gestation age 40 to 40+6 have meconium-stained liquor which shows almost 1/3 of pregnant ladies are exposed to the compromised fetal status which is a considerable risk. This increases further as the gestation age advances. Appropriate interventions should be taken at 40 weeks in low-risk pregnancies to avoid perinatal risk.

Towards Identifying the Target of Autoimmunity in Aplastic Anemia

Acquired aplastic anemia (AA) is an autoimmune bone marrow aplasia caused by T cell-mediated destruction of hematopoietic stem and progenitor cells. The antigenic target in AA remains unknown. Recently, we and others identified frequent somatic loss of function of several human leukocyte antigen (HLA) class I alleles in hematopoietic cells that survive the AA immune attack, suggesting these alleles ("risk alleles") present autoantigen in the affected patients. We hypothesize that risk alleles share structural features and peptide-binding characteristics that may inform our understanding of the immune mechanism of AA. To identify additional AA HLA class I risk alleles, we have partnered with two multi-institutional consortia, the North American Pediatric Aplastic Anemia Consortium (NAPAAC) and the Center for International Blood and Marrow Transplant Research (CIBMTR), to evaluate 507 AA patients for somatic HLA loss. Using a combination of targeted massively parallel sequencing of HLA class I genes and single nucleotide polymorphism array genotyping, we identified HLA loss in 19% of the NAPAAC cohort (30 of 156 unselected AA patients) and 13% of the CIBMTR cohort (46 of 351 patients selected to maximize discovery of less common risk alleles). Copy number-neutral loss of heterozygosity of chromosome arm 6p (6p CN-LOH) was the most common cause of HLA loss, occurring in 50 patients (10% of total cohort, 12% NAAPAC and 9% CIBMTR). Somatic mutations were present in 45 patients (9% of total cohort, 12% of NAPAAC and 7% CIBMTR). Patients with HLA loss had a median of 1 mutant clone per patient (range 1-7). Of the somatic mutations, 80% were predicted to disrupt expression of the affected allele (through loss of start, nonsense, or frameshift mutations). The other 20% were missense mutations affecting residues in the peptide binding groove (6 mutations) and the α3 domain (9 mutations) of the HLA class I protein. A total of 19 distinct AA HLA risk alleles were identified, of which 13 were newly identified in this study. Several risk alleles (HLA-B*14:02, HLA-B*40:02, HLA-A*02:01) were enriched in AA patients compared to ethnicity matched controls. Among the 507 patients in the study, at least one risk allele was present in 436/493 (88%) of AA patients and in 34/39 (87%) of the 6p CN-LOH events. Mutations clustered in several groups of alleles (supertypes) known to bind overlapping peptide repertoires, with alleles in B27 and B44 supertypes being most commonly affected. There were no mutations in A01, A01A03, A01A24, A24, B58, B62, or in any of the HLA-C alleles analyzed. Using several metrics to estimate the strength of the autoimmune selection on a given allele, including the frequency of somatic loss and similarity to other HLA risk alleles, we developed an AA HLA risk allele pathogenicity index ranging from very high (B*14:02 and B*40:02) and high pathogenicity (A*33:03, B*08:01, B*13:02, B*14:01, B*27:03, B*27:05, B*38:02, B*41:02 and B*49:01) to those unlikely to be pathogenic. Interestingly, even within high risk supertypes such as B44, there was a wide variation in predicted pathogenicity, ranging from high (for B*40:02 and B*41:02) to low pathogenicity (for B*44:02 and B*44:03), suggesting differences in autopeptide binding. Our study provides a comprehensive analysis of AA HLA risk alleles in a large diverse cohort of AA patients. Our results suggest that HLA risk alleles have shared autoantigen binding specificities that define their pathogenicity in AA, which can be used to identify candidate AA autoantigens. HLA risk allele pathogenicity may have future clinical utility as an adjunctive diagnostic test, as well as for prognostic assessment and haploidentical donor selection. Disclosures Lee: AstraZeneca: Research Funding; Kadmon: Research Funding; Takeda: Research Funding; Novartis: Research Funding; Amgen: Research Funding; Syndax: Research Funding; Pfizer: Consultancy, Research Funding; Incyte: Consultancy, Research Funding. Monos:Omixon: Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees, Patents & Royalties.

Strong Correlation between HLA and Clinical Course of Subacute Thyroiditis—A Report of the Three Siblings

Subacute thyroiditis (SAT) is a thyroid inflammatory disease with susceptibility associated with the presence of human leukocyte antigen (HLA)-B*35, -B*18:01, -DRB1*01 and -C*04:01. Previous viral infection is considered as a triggering factor in genetically predisposed individuals. The influence of HLA on the SAT course was previously suggested. We aim to present the three siblings—female twins and their brother—with very close onset but different clinical courses of SAT, which appeared to be HLA-dependent. The HLA profile in the reported three siblings is strongly correlated with both SAT and Graves’ disease (GD), however the coexistence of particular sets of high risk and protective alleles seems to be crucial for the GD development and the SAT course. The co-occurrence of HLA-DRB1*15:01 and/or -B*07:02, possibly together with the lack of HLA-A*01:01 and -B*41:01 seems to be key factors protecting against the development of GD with high TRAb levels, as well as against the recurrent SAT course and steroid dependence.

Standardization of lateral pelvic radiograph is necessary to predict spinopelvic mobility accurately

Aims Patients with abnormal spinopelvic mobility are at increased risk for instability. Measuring the change in sacral slope (ΔSS) can help determine spinopelvic mobility preoperatively. Sacral slope (SS) should decrease at least 10° to demonstrate adequate posterior pelvic tilt. There is potential for different ΔSS measurements in the same patient based on sitting posture. The purpose of this study was to determine the effect of sitting posture on the ΔSS in patients undergoing total hip arthroplasty (THA). Methods In total, 51 patients undergoing THA were reviewed to quantify the variability in preoperative spinopelvic mobility when measuring two different sitting positions using SS for planning. Results A total of 32 patients had standardized relaxed sitting radiographs, while 35 patients had standardized flexed sitting images. Of the 32 patients with relaxed sitting views, the mean ΔSS was 20.7° (SD 8.9°). No patients exhibited an increase in SS during relaxed sitting (i.e. anterior pelvic tilt or so-called reverse accommodation). Of the 35 patients with flexed sitting radiographs, the mean ΔSS was only 2.1° (SD 9.7°) with 16/35 (45.71%) showing anterior pelvic tilt, or so-called reverse accommodation, unexpectedly increasing the sitting SS compared to the standing SS. Overall, 18 patients had both relaxed sitting and flexed sitting radiographs. In patients with both types of sitting radiographs, the mean relaxed sit to stand ΔSS was 18.06° (SD 6.07°), while only a 3.00° (SD 10.53°) ΔSS was noted when flexed sitting. There was a mean ΔSS difference of 15.06° (SD 7.67°) noted in the same patient cohort depending on sitting posture (p < 0.001). Conclusion A 15° mean difference was noted depending on the sitting posture of the patient. Since decisions on component position can be made on preoperative lateral sit-stand radiographs, postural standardization is crucial. If using ΔSS for preoperative planning, the relaxed sitting radiograph is preferred. Cite this article: Bone Joint J 2020;102-B(7 Supple B):41–46.