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The majority of studies (n=18/20, 90%) found a reduction in a component of stigma, however most (90%) studies had a high risk of bias. CONCLUSIONS This review highlights the lack of quality evidence on effective stigma-reduction strategies for children with disabilities. Validation and consistent use of contextually relevant scales to measure stigma may advance this field of research. Studies that involve people with disabilities in the design and implementation of these strategies are needed. This article is protected by copyright. All rights reserved.AIM The aim of the present work was to investigate overexpression of the wysR gene in Streptomyces albulus var. wuyiensis strain CK-15 based on the ΔwysR3 mutant strain including the effect on morphological development, wuyiencin production and antibacterial activity. At the same time, we report a new rapid method for producing genetically engineered strains for industrial production of wuyiencin. METHODS AND RESULTS We developed a method to create a wysR overexpression strain based on the ΔwysR3 mutant strain by direct transformation. In this method, the desired gene fragment to be overexpressed was amplified by polymerase chain reaction (PCR) using Phusion High Fidelity DNA polymerase and fused with the linearized pSETC integrative plasmid by Gibson assembly. The resulting recombinant plasmid was transformed into ΔwysR3 mutant strain by the intergeneric conjugation method. The plasmid was then integrated into the chromosome and the resulting apramycin resistant overexpression strain was confirmed by PCR usis reserved.BACKGROUND & AIMS The liver Imaging Reporting and Data System (LI-RADS) is a comprehensive system for standardizing liver imaging in patients at high risk for hepatocellular carcinoma (HCC). We performed a meta-analysis to determine the diagnostic performance of the LR-5 category for HCC and the pooled proportions of HCCs in each LI-RADS category using CT/MRI LI-RADS v2017. AG-1478 nmr METHODS We searched multiple databases for original studies reporting on the diagnostic accuracy of CT/MRI LI-RADS v2017. Random-effects models were used to determine the summary estimates of the diagnostic performance of the LR-5 category and the pooled proportions of HCCs for each LI-RADS category. Risk of bias and concerns regarding applicability were evaluated with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS Fourteen studies (3 prospective studies and 11 retrospective studies) were included in the final analysis, consisting of 2056 patients, 2589 observations, and 1693 HCCs. The pooled per-observation sensitivity was 67% (95% confidence interval [CI], 62%-72%) with specificity of 92% (95% CI, 88%-95%) in the LR-5 category of CT/MRI LI-RADS v2017 for diagnosing HCC. The pooled proportions of HCCs were 0% (95% CI, 0%-0%) for LR-1, 4% (95% CI, 0%-8%) for LR-2, 34% (95% CI, 23%-44%) for LR-3, 67% (95% CI, 53%-81%) for LR-4, and 92% (95% CI, 87%-96%) for LR-5. The proportions of HCCs were significantly different among LI-RADS categories 1-5 (P = .034). CONCLUSIONS The LR-5 category of CT/MRI LI-RADS v2017 shows moderate sensitivity and high specificity for diagnosing HCC. Higher LI-RADS categories contained higher proportions of HCCs. © 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.OBJECTIVE To compare the risk of complications associated with benign hysterectomy according to surgical method. DESIGN Register-based prospective cohort study SETTING Danish Hysterectomy Database 2004 to 2015 POPULATION All Danish women with benign elective hysterectomy (N =51,141) METHODS Multivariate log-binomial regression to compute relative risks (RRs) stratified by calendar period, and adjusted for age, height, weight, smoking habits, use of alcohol, comorbidity, indications, uterine weight, and adhesions. Multiple imputation and 'intention to treat' analyses were performed. MAIN OUTCOME MEASURES Major (Grade III-V) and minor (Grade I-II) Clavien-Dindo modified complications within 30 days. RESULTS Overall, major complications occurred in 3,577 (7.0%) hysterectomies and minor complications in 4,788 (9.4%). The proportions of major and minor complications according to type of hysterectomy were 10.3% and 9.6% for abdominal (AH), 4.1% and 12.1% for laparoscopic (LH), 4.9% and 8.0% for vaginal (VH) for non-prolapse and 2.3% and 6.4% for prolapse. In multivariate analyses, compared to VH for non-prolapse, the risk of major complications was higher for AH [RR=1.82 (1.63-2.03)] but lower for both LH [RR=0.78 (0.68-0.90)] and VH for prolapse [RR=0.55 (0.41-0.75)] . For LH, the risk of major complications reduced from a RR=0.96 (0.75-1.22) in the time period 2004-2009 to a RR=0.72 (0.60-0.87) between 2010-2015. CONCLUSION Laparoscopic hysterectomy and VH for uterine prolapse are associated with fewer major complications, but AH is associated with more major complications, compared to VH performed in the absence of uterine prolapse. This article is protected by copyright. All rights reserved.Frailty, a state of decreased physiologic reserve and increased vulnerability to stressors, is known to negatively impact the prognosis of patients with cirrhosis.(1) Moderate-intensity exercise has been recommended by American College of Sports Medicine (ACSM) to promote physiologic adaptation in the general population,(2) however, its definition in end-stage liver disease (ESLD) has not been established. Cadence or per-minute steps has been proposed as a method to monitor exercise intensity and it can be obtained with personal activity trackers (PAT).(3) Although heart rate reserve (HRR) - percentage increase from resting to maximal heart rate (HR) - is recommended to identify moderate-intensity exercise,(2) it has not been evaluated in patients with ESLD, nor has it been compared with cadence. In this study, we aimed to test agreement between cadence, HRR, and a PAT-proprietary algorithm, and evaluate the optimal methods of measuring exercise intensity in ESLD patients as part of a home-based physical activity program (HB-PAP) randomized pilot trial.(4). This article is protected by copyright. All rights reserved.OBJECTIVE To identify variables that influence pain reduction following peripheral nerve field stimulation (PNFS) in order to identify a potential responder profile. METHODS Exploratory univariate and multivariate (random forest) analyses were performed separately on 2 randomized controlled trials and a registry; all included patients with chronic back pain, mainly failed back surgery syndrome. An international expert panel judged the clinical relevance of variables to identify responders by consensus. RESULTS Variables identified that may help predict PNFS success in patients with back pain include patient and pain characteristics (age, time since onset of pain and spinal surgery, pain medication history, position and size of pain area, pain severity, mixed nociceptive/neuropathic pain, health-related quality of life, depression, functional disability, and leg pain status), implant procedure variables (the number and position of leads, paresthesia coverage, and amount of pain relief during the trial), and programming (number of programs, cathodes, and anodes; pulse rate; pulse width; and percentage of device usage). CONCLUSIONS While these analyses are exploratory and restricted to a limited sample size, they suggest variables that may play a role in predicting a therapeutic response. These results, however, are informative only and should be cautiously interpreted. Future research to validate the variables in a clinical study is needed. © 2020 World Institute of Pain.BACKGROUND Acute kidney injury (AKI) is common in hospitalized and critically ill children. Apart from primary kidney disease, etiologies of AKI are usually related to systemic disease and nephrotoxic insult. This study examines an incidence, characteristics and mortality risks of AKI in critically ill children without primary renal disease and previously known chronic kidney disease (CKD). METHODS A retrospective cohort study of patients aged 1-18 years diagnosed AKI (excluding severe glomerulonephritis and previously known CKD) in pediatric intensive care unit (PICU) between 2013 and 2016, was conducted. AKI was defined according to the Kidney Disease Improving Global Outcomes (KDIGO) classifications. Cox proportional hazards regression analysis was employed to assess the effects of the risk factors on death. RESULTS 253 (18.4%) out of 1,377 PICU patients developed AKI and only 169 (12.3%) who did not have previously known renal disease were included. Of these 169 AKI patients, mean age was 8.1 ± 4.7 years, 88 (52.1%) patients were male, and 60 (35.5%) patients had AKI stage 3. The most common etiologies of AKI were sepsis (76.9%) and shock (64.5%). 53 (31.4%) of those patients died during admission. The risk factors of death were the need for mechanical ventilation (adjusted HR, 17.82; 95% CI, 2.41-132.06) and AKI stage 3 (adjusted HR, 2.32; 95% CI, 1.07-5.00). CONCLUSIONS AKI in critically ill children without previously known renal disease was approximately two-third of the overall incidence. The risk factors of in-hospital death were the use of mechanical ventilation, and AKI stage 3. This article is protected by copyright. All rights reserved.BACKGROUND & AIMS Total bilirubin is a predictor of survival in primary biliary cholangitis, with the main elevated component being direct bilirubin. The purpose of this post hoc analysis was to assess the efficacy and safety of obeticholic acid across quartiles of varying baseline levels of direct bilirubin in the phase 3, randomized, placebo-controlled Primary Biliary Cholangitis Obeticholic Acid International Study of Efficacy. METHODS This analysis assessed patients on the basis of their baseline direct bilirubin level (divided by quartile). Biochemistry and safety outcomes were evaluated within each quartile over time. RESULTS In the quartile with the highest baseline direct bilirubin (>5.47 µmol/L), there was a significant reduction in both direct and total bilirubin at Month 12 compared with placebo. Least squares mean (standard error) change from baseline in direct bilirubin at Month 12 was 4.17 (1.42) µmol/L for placebo, -3.48 (1.63) µmol/L for obeticholic acid 5-10 mg and -3.66 (1.51) µmol/L for obeticholic acid 10 mg (P  less then  .0001, obeticholic acid vs placebo); the corresponding values for total bilirubin at Month 12 were 4.38 (1.55) µmol/L for placebo, -4.53 (1.83) µmol/L for obeticholic acid 5-10 mg and -5.06 (1.64) µmol/L for obeticholic acid 10 mg (P  less then  .0001, obeticholic acid vs placebo). CONCLUSIONS Obeticholic acid treatment was associated with significant reductions in total and direct bilirubin, particularly in patients with high baseline direct bilirubin. Because raised direct bilirubin levels, even within the normal range, are predictive of survival in primary biliary cholangitis, these results suggest substantial benefits of obeticholic acid in at-risk patients. © 2020 The Authors. Liver International published by John Wiley & Sons Ltd.Testate (shell-building) amoebae, such as the Arcellinida (Amoebozoa), are useful bioindicators for climate change. Though past work has relied on morphological analyses to characterize Arcellinida diversity, genetic analyses revealed the presence of multiple cryptic species underlying morphospecies. Here, we design and deploy Arcellinida-specific primers for the SSU-rDNA gene to assess the community composition on the molecular level in two sample sets from a New England fen 1) 36 cm horizontal transects and vertical cores; and 2) 26 m horizontal transects fractioned into four size classes (2-10 µm, 10-35 µm, 35-100 µm, 100-300 µm). Analyses of these data show 1) a considerable genetic diversity within Arcellinida, much of which comes from morphospecies lacking sequences on GenBank; 2) communities characterized by DNA (i.e. active + quiescent) are distinct from those characterized by RNA (i.e. active, indicator of biomass); 3) active communities on the surface tend to be more similar to one another than to core communities, despite considerable heterogeneity; and 4) analyses of communities fractioned by size find some lineages (OTUs) that are abundant in disjunct size categories, suggesting possible life history stages.