bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Carbon Nanotubes on the Properties of Lightweight Concrete Prepared With Expanded Glass and Hydrophobic Silica Aerogel
Authors: adhikary suman kumar , Rudžionis Žymantas , Tučkutė Simona
Published: November 2020

This study aimed to study the effect of carbon nanotubes on the properties of expanded glass and silica aerogel based lightweight aggregate concrete. CNTs were dispersed in the polycarboxylate superplasticizer added water by ultrasonication energy for 3 minutes. Combinations of expanded glass (55%) and hydrophobic silica aerogel particles (45%) were used as lightweight aggregates. Study results show that the incorporation of MWCNTs significantly influences the mechanical and microstructural performance of aerogel based lightweight concrete. Almost 41% improvement in compressive strength was gained by the addition of carbon nanotubes. SEM image of lightweight concrete shows CNTs were almost dispersed homogeneously within the concrete structure. SEM image of the composite also shows the presence of the C-S-H structure surrounding the CNTs, that confirms the cites of nanotubes for higher growth of C-S-H. Besides, agglomeration of CNTs and the presence of Ettringites observed in the transition zone between the silica aerogel and cementitious materials. Moreover, flowability, water absorption, microscopy, XRD, and semi-adiabatic calorimetry results were analyzed in this study.
Liver Morbidity in Patients Negative for Overt HBV and HCV Undergoing Maintenance Hemodialysis: a Hospital-based Study
Authors: Alduraywish Abdulrahman , Kishk Rania , Omar Wafaa , Taher Ibrahim , Omar Hamdy , Louis Nageh , Ragheb Mostafa
Published: November 2020

Background: End-stage renal disease (ESRD) is an increasing health problem worldwide. Older age, diabetes and hypertension, acute kidney damage are among some of the factors that play a role in ESRD. This study aims at exploring liver morbidity (LM) among hemodialysis (HD) patients in an endemic country. Methods: The study included 142 patients aged 12 to 75 years; 53.5% were males. Data were retrieved from files and all participants were examined by abdominal ultrasonography and tested for liver functions and markers and viremia of HCV and HBV. Results: Three patterns of LM were found in 62 (43.7%); fatty in 30, fibrous in 19 and hepatitis in 13. The duration of renal impairment (p=0.02), duration of hemodialysis (p=0.011), and total dialysis sessions (p=0.007) were associated with LM. ALT and AST >40 IU/L levels were elevated in 9.9% and 9.2% of patients. All 14 patients with high ALT showed evidence of LM (p=0.017) compared to 4 of 13 patients with elevated AST (p<0.001). The ROC curve revealed ALT and AST cut-off points of 16.5 and 25.5 IU/L to discriminate LM. According to the new values, 58.5% and 40.1% of the studied participants had high ALT and AST. Conclusion: LM is common among EDKD patients undergoing hemodialysis despite the limited role of ALT and AST. The use of ultrasonography and the new lower levels of ALT and AST could improve the screening approach of LM.
A Novel Color Image Encryption Scheme Based on Cellular Neural Network and Chen's Chaotic System
Authors: Zhang Renxiu , Yu Longfei , Jiang Donghua , Ding Wei , Song Jian , He Kuncheng , Ding Qun
Published: November 2020

With the explosive development of communication technology, digital images are more widely stored and transmitted on the network as a medium of communication among people. At the same time, the security of the digital image has become the focus of people's attention, and it is also the hotspot and difficulty of current research. Therefore, a novel color image encryption scheme is proposed in this paper by combining the 6-dimensional cellular neural network (CNN) and Chen's hyperchaotic system. In the proposed scheme, the initial keys and switching function generated by the plaintext image are utilized to control the CNN to complete the scrambling operation. Then, using the Chen's hyperchaotic system to diffuse the scrambled image for realizing higher security. Finally, the simulation tests and security performance analyses on the proposed encryption scheme are carried out. Experimental results demonstrate that the proposed scheme has an excellent encryption effect compared with other advanced image cryptography systems.
Isotope separation of 176Lu a precursor to 177Lu medical isotope using broadband lasers
Authors: Mv Suryanarayana
Published: November 2020

A new photoionization scheme accessible by Rhodamine dye lasers is proposed for the isotopeseparation of 176Lu.
5d6s2 2D3/2 (0.0 cm-1) - 573.8130 nm -> 5d6s6p 4Fo3/2 (17427.28 cm-1) - 609.6007 nm -> 6s6p2 4P3/2 (33831.46 cm-1) ---> Autoionization State---> Lu+
Optimum conditions for the isotope separation have been derived and compared with thepreviously reported work. The enrichment of ~ 49% can be obtained with > 12 mg / hourproduction rates even when broadband lasers with bandwidth of 500 MHz employed for the twostep excitation. The simplified system requirements for the photoionization scheme with a highproduction rate is expected reduce the global shortage of 176Lu for medical applications.
In-Situ Stress Measurements and Stress Accumulation Level Analysis of Coal Mines in Northern Ordos Basin
Authors: Yang Donghui , Ning Zhangxuan , Li Yongming , Lv Zhaoheng , Qiao Yuandong
Published: November 2020

For non-directional drilling cores, the sample selection and test method for Kaiser effect (KE) in-situ stress measurement were proposed, and the magnitude and direction of its principal stresses were theoretically derived. Based on this method, the KE of 423 samples in Burtai and Baode coal mines in northern Ordos Basin (NOB) were tested. The results show that σH, σh and σv vary with depth and location, and their values increase with increasing of depths. Generally, horizontal stresses play a leading role. There are main stress regimes in NOB: σH > σh > σv (Burtai, <172m; Baode, <170m) and σH > σv > σh (Burtai, 170-800 m; Baode, 170-400 m), and the σv > σH > σh stress regime is mainly distributed in moderately deep to deep coal mines. For rock masses with a depth of 350m, k ((σH + σh) / 2σv) tends to 1, indicating that deep critical state will gradually emerge. The test results were compared with those of overcoring method (OC), elastic strain recovery (ASR) and micro-hydraulic fracturing (HF). The relative errors of σH, σh and σv are 14.90%, 19.67%, 15.47% (Burtai) and 10.74%, 22.76%, 19.97% (Baode), and they are all within a reasonable range required by the project, which verifies the reliability of KE method. The dominant orientation of σH (Burtai, NE-NNE; Baode, NEE) was obtained by using paleomagnetic technology, which is consistent with that (NE-NEE) of earthquake focal mechanisms in this area. Based on Byerlee-Anderson theory, the stress accumulation level of mine rock mass was discussed. Under dry rocks or hydrostatic pressure rocks, the friction coefficient of faults is both low, which is less than the lower limit (0.6) of strike-slip faults slip, indicating that the fracture stress with a low level around the study area is lower than the friction limit stress. The stress accumulation level in Baode mine is slightly larger than that in Burtai mine.
The Aiming Device for Cervical Distractor Pin Insertion: A Developmental and Experimental Study
Authors: Bunmaprasert Torphong , Luangkittikong Sittichai , Tosinthiti Mengghong , Nivescharoenpisan Supachoke , Raphitphan Raphi , Sugandhavesa Nantawit , Liawrungrueang Wongthawat , Riew K.Daniel
Published: November 2020

Background: Restoration of cervical lordosis after anterior discectomy and fusion is a desirable goal. Proper insertion of the vertebral distraction or Caspar pin can assist lordotic restoration by either putting the tips divergently or parallel to the index vertebral endplates. With inexperienced surgeons, the traditional free-hand technique for Caspar pin insertion may require multiple insertion attempts that may compromise the vertebral body and increase radiation exposure during pin localization. Our purpose is to evaluate the effectiveness of pin insertion aiming device for vertebral distraction pin insertion.Methods: A Smith-Robinson approach and anterior cervical discectomy were performed from C3 to C7 in 10 human cadaveric specimens. Caspar pins were inserted using a novel pin insertion aiming device at C3-4, C4-5, C5-6, and C6-7. The angles between the cervical endplate slope and Caspar pin alignment were measured with lateral cervical imaging.Results: The average Superior Endplate-to-Caspar Pin angle (SE-CP) and the average Inferior Endplate-to-Caspar Pin angle (IE-CP) were 6.2 ± 2.0° and 6.3 ± 2.2° respectively. For the proximal pins, the SE-CP and the IE-CP were 4.0 ± 1.1°and 5.2 ± 2.4° respectively. For the distal pins, the SE-CP and the IE-CP were 7.7 ± 1.4° and 6.2 ± 2.0° respectively. No cervical endplate violations occurred.Conclusion: The novel Caspar pin insertion aiming device can control the pin entry points and pin direction with the average SE-CP and average IE-CP of 6.2 ± 2.0° and 6.3 ± 2.2°, respectively. The study shows that the average different angles between the Caspar pin and cervical endplate are less than 7°.
Evaluation of Pleural Fluid Cytology for the Diagnosis of Malignant Pleural Effusion: A Retrospective Cohort Study
Authors: Pairman L , Beckert Lutz E.L. , Dagger Mark , Maze Michael J
Published: November 2020

BackgroundAs median survival time for patients with malignant pleural effusions (MPE) is nine months, rapid and accurate diagnosis is important. Cytological examination of pleural fluid has a good specificity but imperfect sensitivity. Published estimates of sensitivity vary substantially and predictors of false negative cytology are not well established. We aim to establish a local estimate of pleural fluid cytology sensitivity and identify risk factors for false negative cytology.MethodsWe conducted a retrospective cohort study of patients who had cytology testing of pleural fluid at Christchurch Hospital, New Zealand 21 July 2017 to 31 October 2019. Data on patient demographic, clinical and pleural fluid characteristics were collected. MPE was defined by positive pleural fluid cytology, tissue histology, or multi-disciplinary meeting consensus. We estimated sensitivity of the first pleural cytology assessment. We performed multivariate logistic regression to ascertain patient groups at greatest risk of false negative results. ResultsOf 156 patients with confirmed malignant pleural effusion included in our study, the initial pleural fluid cytology was diagnostic in 117, providing a sensitivity (95% confidence interval) of 75.0% (67.4-81.6%). The sensitivity was 79.0% (66.8-88.3%) for lung cancer, 91.3% (72.0-98.9%) for breast cancer and 33.3% (95% CI 11.8-61.6%) for mesothelioma. Cloudy appearance of pleural fluid (OR 0.17, 95% CI 0.04-0.84), but not pH, lactate dehydrogenase or polynuclear cell ratio, reduced the odds of false negative pleural cytology.ConclusionPleural fluid cytology was sensitive in diagnosing MPE due to primary lung and breast cancer, however it had low sensitivity in mesothelioma. Clinicians should be particularly alert to the high likelihood of false negative results when suspecting mesothelioma and consider early use of biopsy.
Molecular Characterization and Expression Analysis of Annexin B3 and B38 as Secretory Proteins in Echinococcus Granulosus
Authors: Song Hongyu , He Xue , Du Xiaodi , Hua Ruiqi , Xu Jing , He Ran , Xie Yue , Gu Xiaobin , Peng Xuerong , Yang Guangyou
Published: November 2020

Background: Cystic Echinococcosis is a parasitic zoonotic disease, which poses a threat to public health and animal husbandry, and causes significant economic losses. Annexin is a kind of phospholipid binding protein with calcium ion binding activity, which has many functions.Methods: Two annexin protein family genes (EgAnxB3 and EgAnxB38) were cloned and molecular characterized using bioinformatic analysis. The immunoreactivity of rEgAnxB3 and rEgAnxB38 was investigated using western blotting. The distribution and transcript levels of EgAnxB3 and EgAnxB38 in different developmental stages of Echinococcus granulosus were analyzed by immunofluorescence localization and quantitative real-time reverse transcription PCR, and their secretory characteristics were analyzed preliminary. The phospholipid-binding activities of rEgAnxB3 and rEgAnxB38 were also tested.Results: EgAnxB3 and EgAnxB38 are conserved and contain calcium binding sites. Both rEgAnxB3 and rEgAnxB38 could be specifically recognized by the serum samples from E. granulosus-infected sheep, which have strong immunoreactivity. EgAnxB3 and EgAnxB38 were distributed in all stages of E. granulosus and had high transcript levels in the 28-day strobilated worms. They were found in liver tissues near the cysts. In addition, rEgAnxB3 had Ca2+-dependent phospholipid-binding properties.Conclusions: EgAnxB3 and EgAnxB38 contained calcium-binding sites, and rEgAnxB3 had Ca2+-dependent phospholipid-binding properties. rEgAnxB3 and rEgAnxB38 had strong immunoreactivity. EgAnxB3 and EgAnxB38 were transcribed in PSCs and worms. They were expressed in all stages of E. granulosus, and distributed in the liver tissues near the hydatid cyst, indicating that EgAnxB3 and EgAnxB38 are secreted proteins that play an crucial role in the development of E. granulosus.
The Effects of EMMPRIN/CD147 on Late Function and Histopathological Lesions of the Renal Graft
Authors: Nalewajska Magdalena , Opara-Bajerowicz Martyna , Safranow Krzysztof , Pawlik Andrzej , Ciechanowski Kazimierz , Kwiatkowski Sebastian , Kwiatkowska Ewa
Published: November 2020

Background/Aims:Chronic kidney disease is associated with renal fibrosis, develops with the participation of fibroblasts and myofibroblasts from epithelial-to-mesenchymal transition (EMT). In cancer research, the key role of the glycoprotein EMMPRIN/CD147 in EMT has been proven. We evaluates how CD147/EMMPRIN affects long-term renal graft function and renal biopsy specimen lesions. Patients and methods:49 renal graft recipients who had a renal biopsy within the last 18 months were retrospectively reviewed. The mean period after kidney transplantation (Tx) was 70 months. At their most recent appointments, their concentrations of CD147/EMMPRIN were evaluated. Renal function at their most recent appointment was assessed, and so was the occurrence of delayed graft function (DGF) and estimated glomerular filtration rate (EGFR) at 1 year and the subsequent years of the follow-up period. Renal biopsy specimen lesions, mainly those related to renal fibrosis and tubular atrophy, were evaluated.Results: EMMPRIN concentration correlated positively with eGFR at the most recent appointment and with eGFR at 1 and 2 years after Tx, with p<0.05, R-0.69, R-0.39 and R-0.40, respectively. CD147/EMMPRIN levels correlated positively with urine protein concentrations, with p<0.05 and R=0.73. A positive correlation was found with the severity of renal biopsy specimen lesions such as CI, CT, CG, MM and AH ( p<0.05, R=0.39, R=0.29, R=0.41, R=0.32 and R=0.40, respectively). Patients with a history of DGF had higher CD147/EMMPRIN concentrations (<0.05).Conclusions:EMMPRIN/CD147 is a glycoprotein that is linked to poorer long-term renal graft function. Also, its high concentration is associated with exacerbated IF/TA lesions and proteinuria.
Lumbar Posterior Muscle and Local Kyphosis in Patients with Degenerative Thoracolumbar Kyphosis: A Case-Control Study
Authors: Xu Shuai , Guo Chen , Liang Yan , Zhu Zhenqi , Liu Haiying
Published: November 2020

Purpose: To explore the relationship between thoracolumbar kyphosis (TLK), body mass index (BMI) and the content of lumbar posterior muscles in patients with degenerative thoracolumbar kyphosis (DTLK) combined with lumbar stenosis syndrome (LSS).Methods: 126 patients with DTLK and LSS (DTLK group) and 87 patients with simple LSS (control group) were retrospectively included with well-matched demographics. TLK and lumbar lordosis (LL) were obtained on the X-ray of the whole spine. Lumbar crossing indentation value (LCIV) was introduced to evaluate the content of the lumbar muscles, with was measured from T12-L1 to L4-L5 at T2-MRI axial imaging. Three subgroups of normal weight, overweight and obesity were respectively divided into in both groups according to BMI. Three subgroups of increased LL, normal LL normal and decreased LL were also divided into in DTLK group.Results: The mean LCIV (mLCIV) of the DTLK group was less than control group and LCIV showed an increasing trend in DTLK group from T12-L1 to L4-L5. Different from control group, there were no significances in gender and BMI distribution of mLCIV in DTLK group (P>0.05). LCIV in increased LL subgroup was larger than that of normal LL and less LL subgroup (P<0.01). There were no relationship between TLK and BMI in both groups. BMI was positively correlated with mLCIV in control group(P=0.004). TLK and LCIV were negatively correlated (P<0.001) in DTLK group with LCIV=13.75-0.48×TLK.Conclusion: LCIV in DTLK group was less than control group with no gender- and BMI-difference. LCIV and TLK were mutually predictable in DTLK with LCIV=13.75-0.48×TLK.
Clinical Outcomes in Soft Tissue Repair Surgery With and Without Femoral Derotation Osteotomy for Patellar Dislocation: A Retrospective Study
Authors: Fan Chongyi , Yang Guangmin , Niu Yingzhen , Xu Yirong , Li Ming , Feng Xunkai , Wang Fei
Published: November 2020

Background: The purpose of our study was to report the clinical outcomes of isolated soft tissue repair or combined femoral derotation osteotomy (DFO) in patients with patellar dislocation with increased femoral anteversion angle (FAA).Methods: A total of 63 patients with patellar dislocation were retrospectively reviewed in this study. 33 patients received isolated soft tissue repair (group 1) and 30 patients were a combination with a femoral deroration osteotomy (group 2). CT were used to assess the correction of the femoral anteversion angle, the tibia tuberosity-trochlear groove (TT-TG) distance, patellar tilt (PTA), and the congruence angle (CA) following the two surgical programs. Subjective scores, such as Kujala, International Knee Documentation Committee (IKDC), Lysholm ,Tegner, and visual analogue scale (VAS) scores, were used to evaluate knee function.Results: In group 2, the mean of the FAA was corrected to15.76 ±2.02° postoperatively compared with 29.16± 2.87° preoperatively (P < 0.001). The TT-TG distance was decreased from 19.03 ±2.52 mm before surgery to 17.80 ±2.24 mm after surgery (< 0.001). Besides, Postoperative PTA and CA were corrected in both groups (P < 0.001). Kujala, IKDC, Lysholm and VAS scores of between groups were significantly improved after operation (P < 0.001). Furthermore, Compared with the isolated soft tissue repair surgery, the combined surgery achieve better postoperative outcomes in Kujala, (IKDC), Lysholm and VAS scores (P < 0.001). Conclusion: Although DFO can be used in combination with DFO to achieve better results, it should also be tailored to the individual and reduce patient suffering.
Things in the Air: Tagging Wearable IoT Informationon Drone Videos
Authors: Van Lan-Da , Zhang Ling-Yan , Chang Chun-Hao , Tong Kit-Lun , Wu Kun-Ru , Tseng Yu-Chee
Published: November 2020

Drones have been applied to a wide range of security and surveillance applications recently. With drones, Internet of Things are extending to3D space. An interesting question is: Can we conduct person identification(PID) in a drone view? Traditional PID technologies such as RFID and fingerprint/iris/face recognition have their limitations or require close contactto specific devices. Hence, these traditional technologies can not be easily deployed to drones due to dynamic change of view angle and height. In this work,we demonstrate how to retrieve IoT data from users’ and correctly tag themon the human objects captured by a drone camera to identify and track groundhuman objects. First, we retrieve human objects from videos and conduct coordination transformation to handle the change of drone positions. Second,a fusion algorithm is applied to measure the correlation of video data andinertial data based on the extracted human motion features. Finally, we cancouple human objects with their wearable IoT devices, achieving our goal oftagging wearable device data such as personal profiles) on human objects ina drone view. Our experimental evaluation shows a recognition rate of 98.9%.To the best of our knowledge, this is the first work integrating videos fromdrone cameras and IoT data from inertial sensors.
Albumin Platelet Product: A Novel Score for Liver Fibrosis Stage and Prognosis.
Authors: Fujita Koji , Yamasaki Kazumi , Morishita Asahiro , Shi Tingting , Tani Joji , Nishiyama Noriko , Kobara Hideki , Himoto Takashi , Yatsuhashi Hiroshi , Masaki Tsutomu
Published: November 2020

Fibrosis-4 index, a conventional biomarker for liver fibrosis stage, is confounded by age and hepatitis activity grade . The current retrospective multicenter study aimed to formulate the novel indices of liver fibrosis by mathematically combining items of peripheral blood examination and to evaluate ability of prognosis prediction. After a novel index was established in a training cohort, the index was tested in a validation cohort. Briefly, a total of 426 patients were enrolled in a training cohort. Albumin and platelet most strongly correlated to fibrosis stage among blood examination. Albumin platelet product (APP) = Albumin × platelet / 1000 could differentiate the four stages of liver fibrosis (p < 0.05). APP indicated fibrosis stage independent from hepatitis activity grade. A cut-off value = 4.349 diagnosed cirrhosis with area under ROC more than 0.8. Multivariate analysis revealed that smaller APP independently contributed to HCC prevalence and overall mortality. The results were validated in another 707 patients with HCV infection. In conclusion, APP was not confounded by age or hepatitis activity grade contrary to Fibrosis-4 index. APP is as simple as physicians can calculate it by pen calculation. The product serves physicians in managing patients with chronic liver disease.
The Rural Tax: Out-of-Pocket Costs for Patient Travel in British Columbia
Authors: Kornelsen Jude , Khowaja Asif , Av-gay Gal , Sullivan Eva , Parajulee Anshu , Dunnebacke Marjorie , Egan Dorothy , Balas Mickey , Williamson Peggy
Published: November 2020

Background: A significant concern for rural patients is the cost of travel outside of their community for specialist and diagnostic care. Often, these costs are downloaded to patients and their families. Methods: Online retrospective provincial survey seeking to estimate the out-of-pocket (OOP) costs and associated experiences of rural patients traveling to access health care in British Columbia. Respondents were surveyed across five categories: Distance Traveled and Transportation Costs, Accommodation Costs, Co-Traveler Costs, Lost Wages, and Patient Stress. Results: On average, costs for respondents were $777 and $674 for transport and accommodation, respectively. Patient perspectives obtained from this survey expressed a number of related issues, including the physical and psychosocial impacts of travel as well as delayed or diminished care seeking. Conclusions: These key findings highlight the existing inequities between rural and urban patient access to health care. This study can directly inform policy related efforts towards mitigating the rural-urban gap in access to health care.
Comprehensive Analysis and Expression Profiling of PIN, AUX/LAX, and ABCB Auxin Transporter Gene Families in Solanum tuberosum under Phytohormone Stimuli and Abiotic Stresses
Authors: Yang Chenghui , Wang Dongdong , Zhang Chao , Ye Minghui , Kong Nana , Ma Haoli , Chen Qin
Published: November 2020

Background:Auxin is the only plant hormone that exhibits transport polarity that is mediated by three classes of proteins, AUX/LAX influx carriers, the PIN and ABCB efflux carriers. Extensive studies have been conducted to examine the biological functions of auxin transporter genes using model plants systems and in several plant species. Despite this, information regarding the comprehensive analysis of auxin transporter genes in potato species and information regarding the expression patterns of these genes in response to external stresses remains scarce.Results: Here, we conducted a genome-wide annotation of the StLAX, StPIN, and StABCB auxin transporter gene families to examine genomic distributions, gene structures, phylogenic relationships and co-expression analysis. From these analyses, 5 StLAXs, 10 StPINs, and 22 StABCBs were identified in the potato genome and mapped to 12 chromosomes. Constructing co-expression networks revealed 18 gene modules and potato auxin transporter genes distributed in ten of them correlating to the development of various tissues. Tissue-specific expression analysis indicated that genes from the StLAX family were expressed at significantly higher levels compared to those of the other two gene families, suggesting that the StLAXs may be more important for these designated developmental stages in potato. Quantitative real-time PCR analysis indicated responsiveness of StLAXs, StPINs, and StABCBs to auxin and PATIs, implying their possible roles in mediating intercellular auxin homoeostasis and redistribution. Additionally, the differential expression levels of the StLAX, StPIN, and StABCB genes under ABA and abiotic stresses were indicative of their specific adaptive mechanisms regulating tolerance to various environmental stimuli. Promoter cis-regulatory element analyses were used to explore a large number of auxin-responsive and stress-related cis-elements within the promoters of the StLAX, StPIN, and StABCB genes that could account for their responsiveness to diverse stresses.Conclusions: In summary, we have provided comprehensive information on StLAX, StPIN, and StABCB auxin transporter gene families in potato. We are confident that our results provide a foundation for a better understanding of auxin transport in potato, as we have demonstrated the biological significance of these family genes in hormone signalling and adaption to environmental stresses.
A Roadmap to Inform the Implementation of Evidence-Based Collaborative Care Interventions in Communities: Insights From the Michigan Mental Health Integration Partnership
Authors: Rusch Amy , DeCamp Lindsay , Liebrecht Celeste , Choi Seo Youn , Dalack Gregory W , Kilbourne Amy M , Smith Shawna N
Published: November 2020

BackgroundIn spite of increasing calls for further spread of evidence-based collaborative care interventions (EBIs) in community-based settings, practitioner-driven efforts are often stymied by a lack of experience in addressing barriers to community-based implementation, especially for those not familiar with implementation science. The Michigan Mental Health Integration Partnership (MIP) is a statewide initiative that funds projects that support implementation and uptake of EBIs in community-based settings. MIP also provides an in situ implementation laboratory for understanding barriers to the uptake of EBIs across a variety of settings. We report findings from a Statewide qualitative study of practitioners involved in MIP projects to garner their perspectives of best practices in the implementation of EBIs. MethodsTwenty-eight semi-structured interviews of practitioners and researchers from six MIP Projects were conducted with individuals implementing various MIP EBI projects across Michigan, including stakeholders from project teams, implementation sites, and the State of Michigan, to identify common barriers, challenges, and implementation strategies deployed by the project teams, with the purpose of informing a set of implementation steps and milestones. ResultsStakeholders identified a number of barriers to and strategies for success, including the need for tailoring program deployment and implementation to specific site needs, development of web-based tools for facilitating program implementation, and the importance of upper level administration buy-in. Findings informed our resultant community-based Implementation Roadmap, which identifies critical steps across three implementation phases--pre-implementation, implementation, and sustainability—for implementation practitioners to use in their EBI implementation efforts. ConclusionImplementation practitioners interested in community-based EBI implementation often lack access to operationalized implementation “steps” or “best practices” that can facilitate successful uptake and evaluation. Our community-informed MIP Implementation Roadmap, offering generalized steps for reaching successful implementation, uses experiences from a diverse set of MIP teams to guide practitioners through the practices necessary for scaling up EBIs in community-based settings over pre-implementation, implementation and sustainability phases.
The Role of α-Smooth Muscle Actin in Confirming the Microinvasion of Laryngeal Squamous Cell Carcinoma
Authors: Bai Yuping , Yue Changli , Lu Zhichun , Liu Honggang
Published: November 2020

BackgroundThe diagnosis of microinvasive laryngeal squamous cell carcinoma (mLSCC) is not always straightforward and sometimes can be very challenge in daily clinical practice, particularly in the circumstances with differentials such as SIL with inverted growth pattern and PEH. The focus of the diagnosis is the confirmation of microinvasion. Cancer-associated fibroblasts (CAFs), as the major element of tumor microenvironment, are believed to participate actively in the invasion of tumor cells. In this study, we sought to evaluate the diagnostic role of α-SMA labelling CAFs in mLSCC, with comparison of laryngeal squamous intraepithelial lesion (SIL) and benign pseudoepitheliomatous hyperplasia (PEH).MethodsA total of 81 laryngeal biopsy specimens were retrieved, including 41 cases of mLSCC with depth of invasion no more than 3 mm, 20 laryngeal SIL, and 20 PEH. All tissues were stained for immunohistochemistry, using antibody against the α-SMA antigen. We observed the presence of α-SMA positive fibroblasts in mLSCC, compared the results with that of laryngeal SIL and benign PEH by Chi-square statistics test, and investigated the correlation between tumor histological characteristics and the presence of CAFs in mLSCC.ResultsImmunoreactivity of α-SMA was detected in twenty-nine mLSCC (29/41, 70.7%), while no reactivity was observed in laryngeal SIL (0/20, 0%), and few in PEH (2/20, 10%). The α-SMA expression pattern in stromal fibroblasts of mLSCC were significantly different from those of SIL (χ2￼ = 26.966, p=0.000) and PEH (χ2￼ = 19.838, p=0.000). This support that, α-SMA as an immunolabeling of CAFs plays a reliable role in confirming the microinvasion of LSCC. In addition , we finds that there is dense lymphoplasmacytic infiltration in the stroma of a few mLSCC (7/41, 17.1% ) cases rather than tumor-related desmoplastic hyperplasia. And it seems that there is a negative correlation between dense lymphoplasmacytic infiltration and the presence of CAFs in LSCC.ConclusionsOur study highlights practical role of utilizing α-SMA in the diagnosis of microinvasive laryngeal squamous cell carcinoma, with emphasis on variable histomorphologic features of mLSCCs.
Screening for Familial Hypercholesterolemia in Small Towns: Experience from 11 Brazilian Cities at the HipercolBrasil Program
Authors: Jannes Cinthia Elim , Silvino Júnea Paolucci.Paiva , Silva Pãmela Rodrigues de Souza , Lima Isabella Ramos , Tada Mauricio Teruo , Oliveira Théo Gremen Mimary , Santos Raul Dias , Krieger Jose Eduardo , Pereira Alexandre da Costa
Published: November 2020

Background: Familial hypercholesterolemia is an autosomal dominant disease clinically characterized by elevated serum levels of low density lipoprotein-cholesterol (LDL-C) and associated with the occurrence of early atherosclerotic cardiovascular disease. In Brazil, HipercolBrasil, currently the largest screening program underway, exists since 2012 and has already identified more than 2000 individuals with causal genetic variants for FH. The standard approach of HipercolBrasil is based on cascade-screening of refereed index cases, hypercholesterolemic individuals with a clinical suspicion of FH. Methodology: to assess a new methodology for identifying new individuals with genetic alterations for FH we performed a comprehensive city-wide screening in 11 small Brazilian cities (up to 60 thousand inhabitants). The selection of cities occurred in 3 ways: 1) cities with suspicious founder effect (4 cities); 2) Cities in a region with high rates of dyslipidemic individuals as described by the National Health System database (DATASUS) (2 cities); and 3) Cities geographically close to other cities with a high incidence of individuals with FH (5 cities). Results: One-hundred and five (105) index cases and 409 first-degree relatives were enrolled. The yield of such approach was significantly better than the general HipercolBrasil positivity rate in molecular screening. We identified 36 IC with a pathogenic or likely-pathogenic variants for FH and 240 affected first-degree relatives. Conclusion: our data suggest that once detected, specific geographical regions warrant a target approach for the identification of clusters of FH individuals.
Analysis of PET Parameters Predicting Response to Radiotherapy for Myeloid Sarcoma
Authors: Choi Kyu Hye , Song Jin Ho , Kwak Yoo-Kang , Park Eun Young , Lee Jong Hoon , Jang HongSeok
Published: November 2020

Background: Positron-emission tomography (PET)-CT has recently been used for diagnostic imaging and radiotherapy for myeloid sarcoma, but there is little research on predicting the response of radiotherapy. The aim of this study was to analyze the association between PET-CT variables and the response to radiotherapy in patients with myeloid sarcoma.Methods: This study was conducted in myeloid sarcoma patients who received radiotherapy and PET-CT before and after radiotherapy. The response to radiotherapy was evaluated based on the European Organization for Research and Treatment of Cancer PET response criteria, and binary regression analysis was performed to assess the factors predicting reductions in the SUVmax.Results: Twenty-seven sites in 12 patients were included in the study. The 27 irradiated sites included 14 soft tissues, 11 bones, and two organs. Complete metabolic responses were seen in 24 patients after radiotherapy, a partial metabolic response in one, and progressive metabolic disease in two patients. The prescribed dose of more than 3000 cGy10 was significantly greater in the treatment control group (P = 0.024). In binary logistic regression analysis predicting reductions in the SUVmax of more than 70% after radiotherapy, the pretreatment SUVmax (≥ 7.5) and further chemotherapy after radiotherapy showed significant differences in univariate and multivariate analyses.Conclusions: Good metabolic responses (complete or partial) to radiotherapy were achieved in 92.6% of the myeloid sarcoma patients. Radiation doses < 3000 cGy10 and increased SUVmax were related to treatment failure and high SUVmax before radiotherapy was a factor influencing SUVmax reduction. Further large-scale studies are needed.
Knowledge-based Planning using Pseudo-structures for Volumetric Modulated arc Therapy (VMAT) of Postoperative Uterine Cervical Cancer: A Multi-Institutional Study
Authors: Kamima Tatsuya , Ueda Yoshihiro , Fukunaga Jun-ichi , Tamura Mikoto , Shimizu Yumiko , Muraki Yuta , Yoshioka Yasuo , Kitamura Nozomi , Nitta Yuya , Otsuka Masakazu , Monzen Hajime
Published: November 2020

Background: The aim of this study was to investigate the performance of the RapidPlan knowledge-based treatment planning system using models including registered pseudo-structures, and to determine how many structures are required for automatic optimization of volumetric modulated arc therapy (VMAT) for postoperative uterine cervical cancer. Methods: Pseudo-structures were retrospectively contoured for patients who had completed treatment at one of five institutions. For 22 patients, RPs were generated with a single optimization for models with two (RP_2), four (RP_4), or five (RP_5) registered structures, and the dosimetric parameters of these models were compared with a clinical plan with several optimizations. The total times for pseudo-structure creation and optimization were also measured.Results: Most dosimetric parameters showed no major differences between each RP. In particular, the rectum Dmax, V50Gy, and V40Gy with RP_2, RP_4, and RP_5 were not significantly different, and were lower than those of the clinical plan. In addition, the average proportions of plans achieving acceptable criteria for all dosimetric parameters were 98%, 99%, 98%, and 98% for the clinical plan, RP_2, RP_4, and RP_5, respectively. The average times for the creation and optimization of pseudo-structures were 105, 17, 21, and 29 minutes, for the clinical plan, RP_2, RP_4, and RP_5, respectively. Conclusions: The RapidPlan model with two registered pseudo-structures could generate clinically acceptable plans while saving time. This modeling approach using pseudo-structures could possibility be used for the VMAT planning process.
Mother-to-infant transmission of the carcinogenic colibactin-producing bacteria
Authors: Watanabe Kenji , Tsunematsu Yuta , Hosomi Koji , Kunisawa Jun , Sato Michio , Shibuya Noriko , Saito Emiko , Murakami Haruka , Yoshikawa Yuko , Iwashita Yuji , Miyoshi Noriyuki , Mutoh Michihiro , Ishikawa Hideki , Sugimura Haruhiko , Miyachi Motohiko , Wakabayashi Keiji
Published: November 2020

While colibactin-producing Escherichia coli is linked to colorectal oncogenesis, its infection route remains poorly characterized. Here, analysis of fecal samples of infants over the first month of birth for the presence of a colibactin biosynthetic gene revealed that the bacterium may be transmitted from mother to infant through intimate contacts, such as natural childbirth and breastfeeding. This finding suggests the possibility of developing early preventive measures against colorectal cancer.
Difference in Gender Perception Regarding Smokeless Tobacco; A Cross Sectional Survey from Karachi Pakistan
Authors: Iqbal NOUSHEEN , Sheikh Muhammad Dawood Amir , Riaz Urooj , Irfan Muhammad , Awan Safia , Khan Muhammad Waqas , Bana Sohail , Khan Javaid
Published: November 2020

BackgroundSmokeless tobacco (SLT) consumption is high in south Asia where it is a leading cause of head and neck cancer. However, limited data available on the perception of SLT consumption among males and females. Methods A cross-sectional survey was conducted from October to December 2018 in five major hospitals of Karachi Pakistan. All male and female, using SLT were first identified through random convenient sampling and then interviewed, 500 participants were approached and 455 were consented to participate in the study. ResultsOut of 455, 286(61.9%) were male, the mean age was 36.8±13.4 years. Among them 97(34%) males and 3(1.8%) females were also using cigarettes. Major reason for starting SLT among women was the norm of family 56(33%) followed by emotional stress relief 53(31%), while among male 69 (24%) started for emotional stress relief followed by the curiosity of trying something new in 59 (20.6%).Both male 205(71.7%) and female 130(76.9%) think it is less harmful then smoking while 44% (127) male and 63(37%) female think its bed for health. Only 100(35%) of men and 71(42%) of women believed that SLT use could cause cancer. Conclusion Smokeless tobacco is considered as less harmful among males and females. Social acceptability was also found to be common. Awareness regarding the harmful effect of SLT is required among both males and females.
Legume and Sesame Oral Food Challenge Outcomes
Authors: Pozin Jacob J. , Devonshire Ashley L. , Tom Kevin , Makhija Melanie , Singh Anne Marie
Published: November 2020

Background: Legume and sesame are emerging food allergens. The utility of specific IgE testing (sIgE) to predict clinical reactivity to these allergens is not well described.Objective: To describe clinical outcomes and sIgE in sesame and legume OFCs. Methods: We performed a retrospective review of 74 legume and sesame oral food challenges (OFC) performed between 2007-2017 at the Ann & Robert H. Lurie Children’s Hospital of Chicago. Clinical data, OFC outcome, and sIgE to legume and sesame were collected. Receiver operating characteristic curves (ROC) and logistic regression models predicting OFC outcome were generated. Results: Twenty-eight patients (median age 6.15 years) passed legume OFC (84.85%), and twenty-five patients (median age 5.91 years) passed sesame OFC (60.98%). The median sIgE to legume was 1.41 kUa/L, and 2.34 kUa/L, to sesame. For patients who failed legume OFC, 67% had cutaneous, 16.5% had gastrointestinal, and 16.5% had anaphylaxis. Of these reactions, 80% were controlled with Benadryl alone and 20% required epinephrine. For patients who failed sesame OFC, 53% had cutaneous, 12% had gastrointestinal, and 35% had anaphylaxis. Of these reactions, 6% required epinephrine, 31% were controlled with Benadryl alone, and 63% required additional epinephrine or steroids. Conclusion: Most OFC to legumes were passed and reactions to failed legume OFCs were more likely to be non-severe. Failing an OFC to sesame was almost twice as likely compared to failing a legume OFC, and reactions to failed sesame OFC were often more severe. Sesame sIgE did not correlate with OFC outcome.
A Global SWOT Analysis of Advanced Practice Nursing: Policy, Regulation, and Practice
Authors: Ladd Elissa , Miller MInna , Wheeler Kathy , Wainaina Samuel , Aguirre Francisca , McGrath Heather , Lee Susanna , Nashwan Abdulqadir , Neary Anna , Core Katherine
Published: November 2020

Background: The advanced practice nursing role has been characterized as task sharing between physicians and nurses, and commonly is a part of national or health system schemes to expand healthcare access and/or to improve efficiencies. However, lack of regulatory uniformity can lead to inconsistent qualifications, competencies, and a limitation of expansion of healthcare services, based on regulated scope of practice. Methods: The SWOT analysis technique (strengths, weaknesses, opportunities, threats) was used to assess the current state of advanced practice nursing worldwide, with specific focus on regulation, education, licensure, and practice. Data were collected broadly from peer reviewed, governmental and regulatory sources, as well as grey literature. Results: Key regulatory elements that frame advanced practice nursing vary significantly by country and region and remain dynamic. However, practice and educational models are outpacing regulatory standards in all six WHO regions. Overall, advanced practice nursing is expanding at an accelerated pace in order to meet population and health system needs, despite weaknesses of the regulatory system, or threats from systems that are not ready to accept innovative strategies. Conclusion: Advanced practice nursing is an innovative role that is progressing broadly in response to the global drivers of an aging population, workforce shortages, the increasing prevalence of non-communicable disease, and the need to develop system-based efficiencies for cost containment. The role is developing organically, driven by local needs, but still lags in terms of the formal regulatory legitimization in many countries. Notably, it is being buoyed by the global movement toward universal health coverage.
Elucidating the Gut Microbiome of Colorectal Cancer: 40 Fecal Bacteria as Non-invasive Biomarkers
Authors: Yuan Biao , Ma SiPing , Meng Qingkai , Du Tao , Zhu Yueyan , Yu Jing , Liang Qinsi , Wang Peicheng , Sun Zikui , Song Chun
Published: November 2020

Background: Colorectal adenocarcinoma (CRC) ranks one of the 5 most lethal malignant tumors both in China and worldwide. Emerging evidences have revealed the importance of gut microbiome on CRC, thus microbial community could be termed as a potential screen for early diagnosis. Importantly, compared with the whole microbial community analysis, few numbers of bacteria genus as non-invasive biomarkers with high sensitivity and specificity causing less cost would benefit more in clinical. Methods: Here we analyzed the gut microbiome from 226 CRC patients and 156 healthy people by 16s rRNA sequencing. We analyzed the microbiome diversity between CRC patients and healthy controls. We used ExtraTrees classifier to screening the biomarkers and took SVM (Support Vector Machine) model to test the specificity and sensitivity of our biomarkers. Results: Compared with the healthy gut, the microbial composition are divergent in CRC, especially the increase of some bacteria related to CRC and the decrease of some healthy bacteria. 40 bacteria genus exhibiting high weight for the healthy and CRC microbiome classification were screened as biomarkers for CRC. In addition, the combination of 40 biomarkers and FOBT showed an outstanding sensitivity and specificity for discrimination CRC patients from healthy controls. Conclusion: The method could be used as a non-invasive method for CRC early diagnosis.
A Case Report of Phelan-McDermid Syndrome: Successful Treatment with Growth Hormone Therapy
Authors: Xie RuiJin , Li TianXiao , SUN CHENYU , CE CHENG , Hua Xu , Zhao JinLin , Liu YueYing
Published: November 2020

Background: Phelan-McDermid syndrome (PMS), also known as 22q13.3 deletion syndrome, is a rare neurodevelopmental syndrome resulting from a deletion of the distal long arm of chromosome 22. Case presentation: We report a case of a 21 months old Chinese girl presenting with global developmental delay, absence of speech, unable to understand a few words or walk independently, insomnia, and autism-like behaviors. Second-generation sequencing and copy number variation analysis showed a heterozygous loss of SHANK3 gene in the 22q13 region, consistent with a diagnosis of PMS. After treatment with recombinant human growth hormone (rhGH), this patient had an improvement in motor skills and social behaviors. No side effects from rhGH therapy were reported. Conclusions: This is the first report of using rhGH to treat a Chinese girl diagnosed with PMS. We speculate rhGH could be a reasonable alternative choice for PMS treatment with similar clinical outcomes in comparison to insulin-like growth factor-1(IGF-1). However, further clinical trials are needed to confirm this hypothesis.