Use of bentonite-coated activated carbon for improving the sensitivity of RT-qPCR detection of norovirus from vegetables and fruits: The ISO 15216-1:2017 standard method extension.

Produce-related foodborne outbreaks are becoming increasingly prevalent worldwide. In plant tissues, various compounds, including polysaccharides, phenolic compounds, and chlorophyll, can inhibit RT-PCR detection of viruses. In this study, we developed a highly sensitive RT-qPCR in combination with the bentonite-coated activated carbon (BCAC) assay for detection of norovirus from fruits and vegetables, which could be completed within 7 h and was about 10-100 fold more sensitive than the standard procedures (ISO 15216-1:2017). The extraction efficiencies of three surrogate viruses (MS2, MNV-1, and TV) from five fresh produce (lettuce, cherry tomato, blueberry, strawberry, and spinach) were higher with BCAC treatment than those of control groups, ranging from 17.82% to 98.60%. The average detection limit of these viruses using the BCAC-RT-qPCR method was stable at an average of 102 PFU/g or GC/g. Finally, this BCAC-RT-qPCR method was applied for detection of human norovirus GII.4 spiked onto lettuce and cherry tomato. The viral extraction efficiencies were up to 53.43% and 95.56%, respectively, which is almost four and seven times better than those without BCAC. Therefore, the BCAC-RT-qPCR method can be used to detect low levels of foodborne viruses from produce.

PredictCBC-2.0: a contralateral breast cancer risk prediction model developed and validated in ~ 200,000 patients.

BACKGROUND: Prediction of contralateral breast cancer (CBC) risk is challenging due to moderate performances of the known risk factors. We aimed to improve our previous risk prediction model (PredictCBC) by updated follow-up and including additional risk factors. METHODS: We included data from 207,510 invasive breast cancer patients participating in 23 studies. In total, 8225 CBC events occurred over a median follow-up of 10.2 years. In addition to the previously included risk factors, PredictCBC-2.0 included CHEK2 c.1100delC, a 313 variant polygenic risk score (PRS-313), body mass index (BMI), and parity. Fine and Gray regression was used to fit the model. Calibration and a time-dependent area under the curve (AUC) at 5 and 10 years were assessed to determine the performance of the models. Decision curve analysis was performed to evaluate the net benefit of PredictCBC-2.0 and previous PredictCBC models. RESULTS: The discrimination of PredictCBC-2.0 at 10 years was higher than PredictCBC with an AUC of 0.65 (95% prediction intervals (PI) 0.56-0.74) versus 0.63 (95%PI 0.54-0.71). PredictCBC-2.0 was well calibrated with an observed/expected ratio at 10 years of 0.92 (95%PI 0.34-2.54). Decision curve analysis for contralateral preventive mastectomy (CPM) showed the potential clinical utility of PredictCBC-2.0 between thresholds of 4 and 12% 10-year CBC risk for BRCA1/2 mutation carriers and non-carriers. CONCLUSIONS: Additional genetic information beyond BRCA1/2 germline mutations improved CBC risk prediction and might help tailor clinical decision-making toward CPM or alternative preventive strategies. Identifying patients who benefit from CPM, especially in the general breast cancer population, remains challenging.

A new non-invasive procedure for refractory PPH after vaginal delivery and caesarean section.

Worldwide, the incidence of postpartum haemorrhage (PPH) is ∼6% and it is the leading cause of maternal mortality. The present study introduces a non-invasive procedure called bilateral cervix apex clamping (BCAC) as a new treatment for refractory PPH. A total of 13 vaginal deliveries and 5 caesarean section patients received the BCAC procedure to stop bleeding. During the procedure, the anterior and posterior walls of the cervical apex were clamped using toothless ovum forceps from the left and right side. The procedure was terminated when the bleeding had nearly stopped without clamping. The success rate of the procedure was 94.4% (17/18) overall, and 92.3% for vaginal delivery and 100% in caesarean section patients. Only one case of vaginal delivery did we resort to exploratory laparotomy and hysterectomy as amniotic fluid embolism occurred. The time spent on the procedure was 2-4 min for vaginal delivery cases and 5-7 min for caesarean section patients. The blood loss reduced significantly after the procedure, before the BCAC and after it was 875(450) ml versus 100(80)ml (p < .0001). There was a reduction in the need for UAE (uterine artery embolisation) from 13 in 22,817 deliveries (2013-2015) to 0 in 18,212 deliveries (2016-2017 (p < .001). But no change in the rate of hysterectomy (5/22817 versus 5/18212) (p = .76). BCAC is a simple, easy, safe, effective and non-invasive procedure that can decrease bleeding in patients with PPH.Impact statementWhat is already known on this subject? The BCAC clamping procedure was first described in Russia 80 years ago as the Genkel-Tikanadze method. But a PUBMED search did not identify and previous studies published on use of the technique.What do the results of this study add? The results of this study show that the BCAC clamping procedure can reduce bleeding significantly in refractory postpartum haemorrhage, when the uterine body is well contracted. The procedure can be performed after both in vaginal delivery and caesarean section. It can also reduce the necessity for UAE and balloon tamponade.What are the implications of these findings for clinical practice and/or further research? BCAC can be used after the failure of regular first line therapy for postpartum haemorrhage.

Bilateral cervix apex clamping procedure can be used as a new noninvasive second line therapy for postpartum hemorrhage.

In this study, we present a noninvasive procedure of bilateral cervix apex clamping (BCAC) procedure to control refractory postpartum hemorrhage (PPH) in vaginal delivery as a new second line therapy for refractory PPH. The procedure clamps the anterior and posterior walls of the cervical apex using toothless ovum forceps to arrest bleedingafter the failure of the first line therapy for PPH. 44 women were performed BCAC to control persistent bleeding in 13,359 vaginal deliveries from 1 January 2016 to 31 May 2018. In all of the BCAC, it can reduce bleeding significantly. The bleeding speed after BCAC was far less than that before it (2.64 ± 4.99 ml/min vs 20.23 ± 9.40 ml/min P < 0.001). The blood loss after BCAC was less than that before it (146.57 ± 170.83 vs 797.84 ± 200.73 ml P < 0.001). 41 (93.2%) BCACsucceeded and 3(6.8%) failed turned to intrauterine balloon tamponade, 2 succeeded and 1 failed turned to hysterectomy. In the successful group the bleeding speed after the BCAC was 1.38 ± 0.99 ml/min less than that 19.84 ± 6.27 ml/min in the failure group. (p < 0.001). The blood loss in the success group is also less than that in the failure ones after BCAC (107.29 ± 78.36mL vs 683.33 ± 202.07 ml P < 0.001) Even in the failure group, the bleeding speed also reduced after BCAC compared with that before BCAC (19.84 ± 6.27 vs 29.17 ± 7.12 ml/min p = 0.02). But the blood loss had no statistical difference (683.33 ± 202.07 vs 950 ± 132.29 ml p = 0.27) In all of the 13,359 vaginal deliveries, the incidence of PPH was 1.21% while the severe PPH was only 0.27%. The BCAC may reduce the incidence of severe PPH (0.27%) and also can reduce the necessity of IUBT (3/13,359 0.22‰), uterine artery embolization (UAE) (0/13,359) and even the exploratory laparotomy hysterectomy (1/13,359). Because it is effective, convenient, cheap and noninvasive, so we think it can be used as a new second line noninvasive treatment for PPH.