bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of digital cholangioscopy assisted non-radiation endoscopic retrieval of common bile duct stones
Authors: Feng Yadong , Xu Wei , Liu Yang , Sun Xiaomei , Liang Yan , Bu Chibin , Li Yuanyuan , Zhang Youyu , Zhang Jiong , Shi Ruihua
Published: July 2020

Background Few studies have evaluated digital cholangioscopy (DCS) assisted non-radiation endoscopic retrograde cholangiopancreatography (NR-ERCP) for choledocholithiasis. Here, we evaluated the application of DCS assisted NR-ERCP for endoscopic retrieval of common bile duct (CBD) stones.Methods Patients who underwent ERCP for choledocholithiasis and without prior ERCP were included. Data related to technical success and outcomes of DCS-assisted NR-ERCP and conventional ERCP were retrieved and compared. Procedure and technical details of DCS assisted NR-ERCP were collated and reviewed.Results In total, 304 and 53 patients who underwent conventional and DCS-assisted ERCP were recruited. Relatively larger stones (p < 0.001) was present in DCS assisted NR-ERCP. No statistical difference was present in biliary access, lithotripsy, stone removal and total complications. A higher proportion of larger balloon for EPBD (p < 0.001) and more ERCP sessions for stone clearance (p < 0.001) were present in conventional ERCP. In DCS-assisted ERCP, technical success was achieved in 52 (98.1%) patients and DCS-guided laser lithotripsy was applied in 9 (17%) patients. DCS guided laser lithotripsy was superior to mechanical lithotripsy for stone clearance (p < 0.001) in large stones. Mean length of biliary exploration and whole NR-ERCP were 8.60 ± 1.96 (6–19) and 32.96 ± 16.29 (13–82) minutes, respectively. One delayed bile-leakage, one moderate pancreatitis, two mild pancreatitis and five cases of hyperamylasemia occurred. Technical details and complications were not statistically differed between patients with a dilated and a non-dilated CBD.Conclusions DCS-based NR-ERCP is technically feasible and safe for retrieval of CBD stones. It provides an alternative to conventional ERCP for endoscopic treatment of simple choledocholithiasis.
Plot-level wood-leaf separation of trees using terrestrial LiDAR data based on a segmentwise geometric feature classification method
Authors: Wan Peng , Zhang Wuming , Jin Shuangna , Wang Tiejun , Yang Shengmei , Yan Guangjian
Published: July 2020

Background: Detailed and accurate information about tree crown structures is crucial for researching tree physiology. Terrestrial laser scanning (TLS) is a promising technique for retrieving crown structure parameters but still faces bottlenecks in terms of data processing such as wood-leaf separation. Currently, most wood-leaf separation methods use pointwise and supervised classification strategies at the forest plot level, which is very time consuming for large-volume TLS datasets.Methods: In this study, we proposed a novel classification method to separate wood and leaf points based on connected component segmentation and segmentwise classification by geometric features. We tested the proposed method on both needleleaf and broadleaf forest plots and compared the results to those from a widely used pointwise classification method, CANUPO.Results: The results showed that the proposed segmentwise classification method is superior to CANUPO in terms of both classification accuracy and time efficiency, which were improved by 1.5 times and over 10 times, respectively.Conclusions: This study indicated that the segmentwise classification strategy is applicable to dense TLS data and can enhance the accuracy and efficiency of wood-leaf separation, which can in turn facilitate the retrieval of crown structure parameters.
Maternal High-fat Diet During Pregnancy Programs Platelet Hyperactivation in Male Mouse Offspring
Authors: Gaspar Renato Simões , Unsworth Amanda J , Bye Alex , Sage Tanya , Stewart Michelle , Wells Sara , Cox Roger D , Gibbins Jonathan M , Sellayah Dyan , Hughes Craig
Published: July 2020

Background: Maternal over-nutrition increases the risk of diabetes and cardiovascular events in offspring. While prominent effects on cardiovascular health are observed, the impact of this on platelet physiology has not been studied. Here, we sought to determine whether maternal high-fat diet (HF) ingestion can affect the platelet function in offspring.Methods: C57BL6/N mice dams were given a HF or control (C) diet for 8 weeks prior to and during pregnancy. Male offspring also received either C or HF diets for 26 weeks. Experimental groups were: C/C, dam and offspring fed chow; C/HF dam fed chow and offspring fed high-fat diet; HF/C and HF/HF. Various phenotypic (including body weight and % of body fat) and metabolic (glycaemia, triglyceridemia) tests were performed and blood collected for platelet studies. Results: Compared to C/C, HF/HF animals were obese, with fat accumulation, hyperglycaemia, insulin resistance and low respiratory exchange rate. HF/HF, but not C/HF mice also showed hypertriglyceredaemia and higher mean platelet volume. These platelets were hyperreactive, displaying higher fibrinogen binding after stimulation with different agonists. They also showed increased platelet adhesion and spreading on collagen. Maternal obesity led to an overall effect of increased platelet reactivity in offspring. Both maternal and offspring HF groups presented decreased levels of collagen receptor GPVI with increased oxidative stress. Western blotting experiments in stimulated platelets showed increased phosphorylation of PKC substrates, total tyrosine and AKT at Ser473, whilst response to nitric oxide donor PAPA-NONOate was unchanged compared to C/C.Conclusions: Maternal HF diet ingestion programmes platelet hyperactivation in male mouse offspring, whilst HF in both dams and offspring resulted in a 'double-hit' effect of increased serum triglyceride levels, large platelets and increased reactivity. This involved enhanced Tyr phosphorylation, ROS production and decreased GPVI expression. Since platelet function can be programmed by early developmental periods, it is possible to use this window of intervention to reduce the risk of thrombotic events.
Discriminant Models for the Prediction of Viral Shedding Time and Disease Progression in COVID-19
Authors: Li Wen Yang , Guo Yuhao , Zheng Xiaowei , Zhao Hongwen , Kang Jian , Wang Daqing , Wang Wei
Published: July 2020

Background

COVID-19 infection can cause life-threatening respiratory disease. This study aimed to fully characterize the clinical features associated with postponed viral shedding and disease progression, then develop and validate two prognostic discriminant models.
Methods

This study included 125 hospitalized patients with COVID-19. 44 parameters were recorded, including age, gender, underlying comorbidities, epidemic features, laboratory indexes, imaging characteristics and therapeutic regimen, et al. F-test and χ2 test were used for feature selection. All models were developed with 4-fold cross-validation, and the final performances of each model were compared by the Area Under Receiving Operating Curve (AUROC). After optimizing the parameters via L2 regularization, prognostic discriminant models were built to predict postponed viral shedding and disease progression of COVID-19 infection. The test set was then used to detect the predictive values via assessing models sensitivity and specificity.
Results

69 patients had a postponed viral shedding time (> 14 days), and 28 of 125 patients progressed into severe cases. Eleven and six demographic, clinical features and therapeutic regimen were significantly associated with postponed viral shedding and disease progressing, respectively (p < 0.05). The optimal discriminant models are: y1 (postponed viral shedding) = -0.244 + 0.2829x1 (the interval from the onset of symptoms to antiviral treatment) + 0.2306x4 (age) + 0.234x28 (Urea) − 0.2847x34 (Dual-antiviral therapy) + 0.3084x38 (Treatment with antibiotics) + 0.3025x21 (Treatment with Methylprednisolone); y2 (disease progression) = -0.348–0.099x2 (interval from Jan 1st, 2020 to individualized onset of symptoms) + 0.0945x4 (age) + 0.1176x5 (imaging characteristics) + 0.0398x8 (short- term exposure to Wuhan) − 0.1646x19 (lymphocyte counts) + 0.0914x20 (neutrophil counts) + 0.1254x21 (neutrphil/lymphocyte ratio) + 0.1397x22 (C-Reactive Protein) + 0.0814x23 (Procalcitonin) + 0.1294x24 (Lactic dehydrogenase) + 0.1099x29 (Creatine kinase). The output ≥ 0 predicted postponed viral shedding or disease progressing to severe/critical state. These two models yielded the maximum AUROC, and faired best in terms of prognostic performance (sensitivity of 73.3%, 75%, and specificity of 78.6%, 75% for prediction of postponed viral shedding and disease severity, respectively).
Conclusion

The two discriminant models could effectively predict the postponed viral shedding and disease severity, and be used as early-warning tools for COVID-19.
Characteristics of Klebsiella Pneumoniae ST4 Coharboring qnrB1, aac-Ib-cr, CTX-M-15 and SHV 11 in a Tunisian Hospital
Authors: Yaiche MARIEM Nasri , Rafraf Ikbel Denden , guo qinglan , Mastouri Maha , Aouni Mahjoub , Wang Minggui
Published: July 2020

Background: Multiresistant Klebsiella pneumoniae are predominant cause of hospital acquired infection. This work describes the molecular epidemiology of these isolates in Tunisian Hospital.Methods: Between October 2010 and June 2013, 50 non-duplicated clinical K.pneumoniae were selected on the basis of nalidixic acid (NA) resistance and were characterized. Isolates were identified using APi 20E system. Susceptibility testing was determined using the disc diffusion method and the microdilution technique to determine the MIC of ciprofloxacin.PMQR and ESBL genes were detected by PCR and positive results were confirmed by direct sequencing of PCR products. Multilocus sequence typing (MLST) was performed to determine the genetic relationship among isolates. Conjugation and transformation were done to know if PMQR and ESBL were carried with one or two plasmids.Results: A total of 20 PMQR harboring K.pneumoniae representing 40% of all NA resistant isolates were characterized. Among PMQR positive K.pneumoniae 13 were resistant to amoxicilline, amoxicilline/clavulanic acid, ticarcilline, piperacilline, cefaloridine, cefotaxime (CTX) and ceftazidime. The rate of resistance to gentamicine, tobramicine and amikacine were 85%, 95% and 25% respectively.Out of 20 K.pneumoniae (60%) were qnr positive (1 qnrA6 and 11 qnrB1) and (60%) were aac-Ib-cr positive. 33.3% coharbored the aac-Ib-cr and qnrB1 determinants. Out of all PMQR positive strains, 65% harbored ctx-M-15 gene. It was associated to shv11 in three cases and tem1 in two cases. The predominant types were ST4 (35%) and ST15 (20%). ST 101(15%) and ST 147 (10%) come in second order. one case of each ST14,ST86,ST336 and ST307 were also observed. qnrB1, aac-Ib-cr, Ctx-m-15 can be carried with more than one plasmid in the same bacteria.Conclusion: The co-existing of different genes conferring resistance among the same and different family of antibiotics is a big threat to patient because it limits the therapeutic process. This phenomonen is a problem of concern that needs to improve the resistance surveillance of multi gene carrying K pneumoniae.
A phase II study of amrubicin as palliative chemotherapy for previously treated malignant pleural mesothelioma
Authors: Watanabe Kageaki , Okuma Yusuke , Kawai Shoko , Nagamata Makoto , Hosomi Yukio
Published: July 2020

Background Treatment options for malignant pleural mesothelioma (MPM) are limited. Anthracyclines are considered key drugs for treating MPM. However, their use is limited by severe cardiac toxicities. Amrubicin (AMR) is a next-generation anthracycline that is commonly used to treat lung cancer. We conducted a phase II trial of this drug in patients with previously treated MPM.Methods Eligible patients with MPM having adequate organ function and a performance status of 0–2 were enrolled after disease progression following pemetrexed/platinum therapy. Patients received 35 mg/m2 AMR on days 1–3 every 3 weeks until tumor progression or the appearance of unacceptable toxicities. The primary endpoint was the objective response rate (ORR). Median progression-free survival (PFS), overall survival (OS), number of treatment cycles, and adverse events (AEs) were evaluated as secondary endpoints.Results This trial was discontinued because of low accrual. From September 2013 to July 2018, five patients with MPM were enrolled. Stable disease (SD) was observed in three patients (60%), and progressive disease was noted in two patients (40%). The median PFS was 2.4 (range, 1.2–11.2) months, and the median OS was 9.1 (range, 6.2–22.0) months. The median number of treatment cycles was three (range, 2–11). Grade 1/2 toxicities were observed in all patients. Grade 3/4 neutropenia was observed in four patients (80%), but there were no cases of febrile neutropenia.Conclusion Despite the absence of the responders, the observation of SD in three patients suggests that AMR could have potential for treating MPM.Trial registration number and date of registrationUMIN000010739, May 16, 2013, retrospectively registered
Efficacy and safety of novel treatments in chemotherapy-naïve castration-resistant prostate cancer
Authors: Min ZhiChao
Published: July 2020

Background

Currently, novel treatment methods for chemotherapy-naïve castration-resistant prostate cancer (CRPC) patients have been applied in clinical practice. Since the optimum regimen remains inconclusive, this study compares the efficacy and safety of these treatments by network meta-analysis.

Methods

The PubMed and ClinicalTrials.gov database and review articles before January 30, 2020 were searched and date were extracted. A total of 29908 patients with CRPC from 23 randomized controlled trials were included. Relative hazard ratios (HR) had been used to assess the effects on overall survival (OS), progression-free survival (PFS) or radiographic PFS (rPFS), and adverse events (AEs). We then pooled the data and used Bayesian and frequentist random-effects model to identify the best treatment strategy.

Results

Compared with the placebo, both Bayesian and frequentist random-effects network meta-analyses found that only enzalutamide and abiraterone had a significant effect in OS. Similar results were observed in PFS/rPFS. Bicalutamide, tasquinimod and orteronel could also improve rPFS. Enzalutamide only could improve rPFS more effectively than abiraterone with no significant differences in OS/PFS/AEs. In any subgroups of patients with age <75, ≥75 or ECOG score = 0,1 or Gleason score ≤7, ≥8, enzalutamide could improve the OS significantly. Nevertheless, the significant benefit of abiraterone was only found in patients with age <75 and ECOG score = 0.

Conclusions

Our network analysis suggested that both enzalutamide and abiraterone are optimal treatment for chemotherapy-naïve CRPC patients with age <75 and ECOG score = 0 for great improvement on OS and PFS. In addition, enzalutamide is also an optimum therapy for chemotherapy-naïve CRPC patients with age ≥75 and ECOG score = 1.
SARS-CoV-2 Viral Load is Associated with Increased Disease Severity and Mortality
Authors: Fajnzylber Jesse , Regan James , Coxen Kendyll , Corry Heather , Wong Colline , Rosenthal Alexandra , Worrall Daniel , Giguel Francoise , Piechocka-Trocha Alicja , Atyeo Caroline , Fischinger Stephanie , Chan Andrew , Flaherty Keith , Hall Kathryn , Dougan Michael , Ryan Edward , Gillespie Elizabeth , Chishti Rida , Li Yijia , Jilg Nikolaus , Hanidziar Dusan , Baron Rebecca , Baden Lindsey , Tsibris Athe , Armstrong Katrina , Alter Galit , Kuritzkes Daniel , Walker Bruce , Yu Xu , Li Jonathan
Published: July 2020

The relationship between SARS-CoV-2 viral load and risk of disease progression remains largely undefined in coronavirus disease 2019 (COVID-19). We quantified SARS-CoV-2 viral load from participants with a diverse range of COVID-19 severity, including those requiring hospitalization, outpatients with mild disease, and individuals with resolved infection. SARS-CoV-2 plasma RNA was detected in 27% of hospitalized participants and 13% of outpatients diagnosed with COVID-19. Amongst the participants hospitalized with COVID-19, higher prevalence of detectable SARS-CoV-2 plasma viral load was associated with worse respiratory disease severity, lower absolute lymphocyte counts, and increased markers of inflammation, including C-reactive protein and IL-6. SARS-CoV-2 viral loads, especially plasma viremia, were associated with increased risk of mortality. SARS-CoV-2 viral load may aid in the risk stratification of patients with COVID-19 and its role in disease pathogenesis should be further explored.
Kaempferide Improves Glycolipid Metabolism Disorder by Activating PPARγ in High-Fat-Diet-Fed Mice
Authors: Zeng Qingfu , Tang Heng , Tang Ting , Pu Peng
Published: July 2020

Background: Kaempferide (Ka, 3,5,7-trihydroxy-4′-methoxyflavone), an active ingredient of Tagetes erecta L has been demonstrated to possess many pharmacological effects, including antioxidant, anti-inflammation, anticancer and antihypertension in previous study. However, there is no evidence of Ka on metabolic disorder in former studies. This study investigated the effects of Ka on glycolipid metabolism and explored the underlying mechanisms of action in vivo and vitro. Methods: High-fat diet (HFD) was used to induce the model of glycolipid metabolism disorder in mice.The hypolipidemic and hypoglycemic effect was detected by several indicators, like blood sample analysis blood glucose, serum insulin, HOMA index and intraperitoneal glucose tolerance tests (IPGTT). The signaling pathways of lipid metabolism (PPARγ/LXRα/ABCA1) and glucose metabolism (PPARγ/PI3K/AKT) were evaluated using Real-Time PCR and Western blot. The primary culture of hepatocytes was prepared to confirm the target of Ka by co-culturing with PPARγ agonist or inhibitor.Results: Administration of Ka at a dose of 10mg/kg for 16 weeks effectively attenuated obesity, hyperlipidemia, hyperglycemia and insulin resistance in HFD mice. Further studies revealed the hypolipidemic and hypoglycemic effects of Ka depended on the activation of PPARγ/LXRα/ABCA1 pathway and PPARγ/PI3K/AKT pathway, respectively. The primary hepatocyte test, co-cultured with PPARγ agonists or inhibitors, further confirmed the above signaling pathway and key protein. Conclusion: Ka played an important role in improving glycolipid metabolism disorder, which were causally associated with weight loss. The underlying mechanisms might are associated with the activation of PPARγ and its downstream signaling pathway. Our study helped to understand the pharmacological actions of Ka, and provides theoretical basis for Ka in the effective treatment of obesity, diabetes and other metabolic diseases.
High prevalence of pre-existing HBV polymerase mutations in pregnant women do not limit the telbivudine treatment efficacy
Authors: Wang Jing , Liu Jinfeng , Yu Qiang , Jin Li , Yao Naijuan , Yang Yuan , Yan Taotao , Hu Chunhua , He Yingli , Zhao Yingren , Chen Tianyan , Zheng Jie
Published: July 2020

Background: HBV resistant mutants in treatment-naïve patients may lead to antiviral treatment failure. It’s not clear if HBV resistant mutants present in the pregnant women before the antiviral treatment and the influence of the pre-existing resistant mutants on the short-term Telbivudine (TBV) therapy during the late pregnancy.Method: We enrolled 73 pregnant women with high HBV DNA load and TBV treatment during the pregnancy from 2012 to 2015 in this retrospective study. All subjects were followed at least 52 weeks postpartum. The UDPS was used to detect the HBV mutations before and after the TBV treatment.Results: Before TBV treatment, the complexity of HBV quasispecies of all subjects was 0.40± 0.09. At primary drug resistance mutation sites, 41.1% (30/73) and 53.4% (39/73) subjects had rtM204I/V and rtN236T/A detected, respectively; 9.6% (7/73) patients had more than 20% frequency mutation of rtM204I/V, which was also similar with high frequency of rtN236T/A mutation (41.1% vs. 53.4%, P = 0.136; frequencies > 20%: 9.6% vs. 5.5%, P = 0.347). After TBV treatment, 71.2% (52/73) subjects still had HBV DNA load ≥ 103IU/mL at delivery. Among them, 75.0% patietns with rtM204I positive had HBV DNA load ≥ 103IU/mL at delivery, which was comparable with the subjects without rtM204I (75.0% vs. 70.8%, P = 0.710). No changes were found in the frequencies and the complexity of HBV quasispecies of rtM204I mutation after the TVB treatment.Conclusion: The prevalence of pre-existing drug resistant mutations among the pregnant women was high using UPDS. However, the pre-existing HBV mutation had limited influence on the efficacy of short-term TBV treatment, and TBV treatment during late pregnancy seemed not to increase the risk of emerging HBV resistant mutants.
Prognostic risk model for advanced renal cell carcinoma (RCC) with immune-related genes
Authors: Cao Peng , Zhang Jian-Dong , Sun Ze-Jia , Zheng Xiang , Yu Bao-Zhong , Cao Hao-Yuan , Zhang Fei-Long , Gao Zi-Hao , Wang Wei
Published: July 2020

Background Renal cell carcinoma (RCC) is a common tumor of the urinary system. Nowadays, Immunotherapy is a hot topic in the treatment of solid tumors, especially for those tumors with pre-activated immune state. Methods In this study, we downloaded genomic and clinical data of RCC samples from The Cancer Genome Atlas (TCGA) database. Four immune-related genetic signatures were used to predict the prognosis of RCC by Cox regression analysis. We selected the most relevant genes from each signature to construct a prognostic risk model to predict prognosis via Kaplan-Meier (KM) survival analysis. And subgroups of the TCGA samples and external data from International Cancer Genome Consortium (ICGC) database were used to verify predictive stability of the model. We performed landscape analysis to assess the difference of gene mutant based on the data from TCGA. Finally, we explored the correlation between the selected genes and the level of tumor immune infiltration via Tumor Immune Estimation Resource (TIMER) platform. Results We found that the four prognostic risk models constructed by the signatures all could divide the RCC samples into high- and low-risk groups with significantly different prognosis, especially in advanced RCC. And the prognostic risk model was constructed by 8 candidate genes (HLA-B, HLA-A, HLA-DRA, IDO1, TAGAP, CIITA, PRF1 and CD8B) which divided the advanced RCC samples from TCGA database into high-risk and low-risk groups. And there was a significant difference in overall survival (OS) between the two groups. The validity of the model was verified by independent data from ICGC database. And the classification efficiency of the model was stable for the samples from different subgroups. landscape analysis showed that mutation ratios of some genes were different between two risk groups. In addition, the expression levels of the selected genes were significantly correlated with the infiltration degree of immune cells in the advanced RCC. Conclusions Sum up, eight immune-related genes were screened in our study to construct prognostic risk model with great predictive value for the prognosis of advanced RCC, and the genes were associated with infiltrating immune cells in tumors which have potential to conduct personalized treatment for advanced RCC.
Mapping The Quality of EFL Mixed Methods Research: What Does The Research Synthesis Indicate?
Authors: Farsani Mohammad Amini , Mohammadi Vali
Published: July 2020

The authors have requested that this preprint be removed from Research Square.
Sole Adjuvant Intraoperative Breast Radiotherapy in Taiwan: A Single-Center Experience
Authors: Yang Hsin-Yi , Tu Chi-Wen , Hsu Yu-Chen
Published: July 2020

Introduction: Intraoperative radiotherapy (IORT) is more convenient than standard whole-breast external beam radiotherapy (EBRT) as a sole adjuvant radiotherapy for breast cancer. The impact of age on breast cancer course and treatment strategy is still under investigation, and the peak age for breast cancer in Taiwan is much younger than that in Western countries. We aimed to review the oncological outcomes of sole IORT compared with standard EBRT in a country with younger breast cancer patients.Patients and methods: We reviewed patients with invasive breast cancer who received breast-conserving surgery (BCS) from September 2014 to December 2016. The clinicopathologic characteristics and oncological outcomes of eligible patients who received EBRT or IORT as sole adjuvant radiotherapy after BCS were collected and reviewed.Results: A total of 170 patients were enrolled with a mean follow-up time of 3.53 ± 0.82 years. The risk of locoregional recurrence was 2.44% for EBRT versus 10.64% for IORT (p = 0.024). IORT was a significant risk factor of locoregional recurrence (p = 0.005). The hazard ratios (HRs) for locoregional recurrence in the IORT group compared with the EBRT group were significantly higher in non-suitable risk group patients (HR = 7.02, p = 0.009) and in patients under 50 years old (HR = 10.42, p = 0.011).Conclusions: Locoregional recurrence was significantly higher in patients who received IORT than in those who underwent EBRT. IORT should not be used alone in patients under 50 years old who do not belong to a suitable group.
Maternal Health Among Venezuelan Women Migrants at the Border of Brazil.
Authors: Bahamondes Luis Guillermo , Laporte Montas , Margatho Deborah , de Amorin Helder , Brasil Cinthia , Charles Charles Mpoca , Becerra Alejandra , Hidalgo Maria Margarethe
Published: July 2020

Background: Meeting the Sexual and reproductive health and rights (SRHR) for populations living in fragile and humanitarian settings is critical, essential as well as a basic human right. Compounded with the inherent vulnerabilities of women in crises, there are substantial complications that directly associated with increasing the risks of poor SRHR outcomes for displaced populations. The current forced displacement of the Venezuelans migrants is one of the largest in the Latin America’s history. Our research aimed to assess sexual and reproductive health and rights (SRHR) situation among Venezuelan women in Roraima State, Brazil. Methods: A study with face-to-face interviews was conducted. Data collection covered various issues pertaining to SRHR services, access and use among Venezuelan migrant’s women aged 18-49 years old. We used to data collection the Minimum Initial Service Package readiness assessment tools from the Inter-Agency Working Group on Reproductive Health. Results: We present results of interviews with 405 women were conducted between 24 and 30 November 2019. The most common observed findings in our research as reported by women were unmet family planning needs. A significant proportion of women who needed family planning reported that they were unable to access family planning. This was attributed to either inability to access them and unavailability at the health care centres. Further, 25.0% of pregnant women or postpartum women did not receive antenatal or postnatal care. Conclusion: Meeting the essential SRHR needs among Venezuelan’s migrant women in Roraima, State, Brazil appears to be limited and challenging. Given the high and growing numbers of this migrant population in Brazil, the Brazilian health system must be adaptable to meet the needs of this population. Efforts among not only health governmental sectors, but also academic, non-governmental and international organisations need to be encouraged as well as coordinated for a comprehensive SRHR response. Given the current high risks associated with the Covid-19 pandemic. Meeting the SRH needs migrant populations has become more critical than ever given the current COVID-19 pandemic.
Nanoparticle encapsulation of HDACi with HA targeting in endometrial cancer models
Authors: Edwards Kadie , Yao Seydou , Pisano Simone , Feltraccao Veronica , Brusehafer Katja , Samanta Sumanta , Oommen Oommen P , Gazze Salvatore Andrea , Paravati Roberta , Maddison Holly , Li Chao , Gonzalez Deyarina , Conlan R. Steven , Francis Lewis W
Published: July 2020

Bespoke nanoparticle systems can enhance drug delivery, preventing systemic exposure by modifying release kinetics and increasing tumour penetration. Flexible nano vector systems have led to selective tumour targeting through surface modifications and the addition of target moieties over expressed in the cancer microenvironment. As such nanomedicines are enabling drug re-purposing and renewed applications in solid tumour cancers. Here we present the nanoscale encapsulation of Vorinostat within a F127 Pluronic polymer particle modified to incorporate a Hyaluronic Acid moiety, targeting increased CD44 expression in endometrial cancer cells. Encapsulation within a stable micellar structure stabilized SAHA activity, demonstrating increased cytotoxic efficacy in 2-D and 3-D cultures. In addition, nano delivery enhanced spheroid penetration, suppression in cell growth, P21 associated cell cycle arrest and overcome EMT associated phenotype formation observed in the free drug treated type II Hec50 cells. Together, this study clearly demonstrates that HDAC nanoparticle encapsulation and HA targeting may offer a solution to overcoming the toxicity and side effects issues observed in clinical trials. Given the demonstrated involvement of epigenetic processes in oncology, this study is an important demonstration of this class of anti-cancerous agents for the treatment of endometrial cancers.
Metastasis of missed cholangiocarcinoma in the left lobethrough abdominal wall laparoscopic port-site and umbilicus after laparoscopic cholecystectomy: case report and literature review
Authors: Huang Lesheng , Li Hongyi , Chen Jun , Jiang Jinghua , Zhang Wanchun , Liu Tianzhu
Published: July 2020

Introduction: Laparoscopic cholecystectomy (LC) has been widely used by surgeons. However, a serious but rare condition may be happened, which is the missed diagnosis of intraperitoneal malignant tumor. If the malignancy exists, the changes of the abdominal environment or the laparoscopic operation might brought the cancer cells to the abdominal cavity or the abdominal wall. The missed laparoscopic malignant tumors are prone to metastasis, especially at the laparoscopic port-site. More extreme condition will be located in the navel, which is known as Sister Mary Joseph’s nodule(SMJN).Case presentation: A 63-year-old female who had undergone cholecystectomy and choledocholithotomy ten months ago was hospitalized for upper abdominal pain. Laboratory examination indicated that the most of tumor markers were increased. CT scan revealed that there was a diffused irregular and progressively enhanced mass around the left lobe bile duct, multiple enlarged lymph nodes in the abdominal cavity and multiple nodular lesions were found under the costal margin of the right upper abdominal wall, right lower abdominal wall and the umbilicus. Biopsy of the nodules under the original surgical scar showed an infiltrative or metastatic middle differentiated adenocarcinoma. So the diagnosis was left lobe cholangiocarcinoma of the liver, multiple lymph nodes metastasis in the abdominal cavity and multiple implant metastasis in abdominal wall laparoscopic port-site and umbilical.Conclusion: In laparoscopic cholecystectomy, surgeons should not only focus on the local lesions, like gallstone in biliary system, but also look around other the tissues and organs to avoid missing the abdominal malignant tumor or other lesions. When atypical symptoms or abnormalities have been found pre-operation, all abdominal organs should be evaluated in detail to avoid missed diagnosis of potential malignant tumors. On the other hand, when there is a nodule in the umbilicus, all the organs and tissues in abdomen should be examined to find the potential malignant tumor. Finally, multiple cholelithiasis in the left lobe of the liver should be regarded as a high risk factor for cholangiocarcinoma.
Bilateral Primary Breast Cancer: A Case Report and Literature Review
Authors: Fan Shuyao , Gu Xidong , Liang Zhehao , Mao Yuping , Zhou Changyu , Gu Shicheng , Xie Xiaohong
Published: July 2020

BackgroundInvasive micropapillary carcinoma (IMPC) and secretory carcinoma of the breast (SCB) are relatively rare types of breast cancer. IMPC is usually associated with high incidence of lymphovascular invasion, lymph node metastasis and poor prognosis. While SCB usually carries a relatively favorable prognosis, cases of axillary and distant metastases have been reported. Clinicians generally adopt systemic treatments based on the histopathological findings of the patients to improve the prognosis, but there is currently no consensus on the optimal treatment for these two types of cancer.Case presentationWe treated a 50‐year‐old woman with lung cancer history who presented with a single lump in each breast. Following bilateral breast-conserving surgery, the diagnosis of SCB of the left breast and IMPC of the right breast was confirmed with immunohistochemistry. It is worth noting that the pathological results of left lung adenocarcinoma centered on micropapillary-type was same as the invasive micropapillary component of right breast.ConclusionsWe reported this case of bilateral primary relatively-rare-form breast cancer for its extremely rare occurrence and there are less than 20 cases of SCB reported worldwide till now. It is also significative to distinguish this primary tumor of right breast from metastatic cancer. Our histopathologic diagnosis and synthetical therapy scheme will provide material for SCB and IMPC. To facilitate the diagnosis and prognosis of such relatively rare tumors, more cases will need to be reported.
Correlation Between Toxicity and Dosimetric Parameters in Patients Treated with Adjuvant Intensity-Modulated Radiation Therapy for Breast Cancer: The Results of a Prospective Study.
Authors: Pasquier David , Bataille Benoit , Tinier Florence Le , Bennadji Raoudha , Langin Hélène , Escande Alexandre , Tresch Emmanuelle , Darloy Franck , Carlier Damien , Crop Frederik , Lartigau Eric
Published: July 2020

Background. In the treatment of breast cancer, intensity-modulated radiation therapy (IMRT) reportedly reduces the high-dose irradiation of at-risk organs and decreases the frequency of adverse events (AEs). Comparisons with conventional radiotherapy have shown that IMRT is associated with lower frequencies of acute and late-onset AEs. Here, we extended a prospective, observational, single-center study of the safety of IMRT to a second investigating center. Methods. Patients scheduled for adjuvant IMRT after partial or total mastectomy were given a dose of 50 Gy (25 fractions of 2 Gy over five weeks), with a simultaneous integrated boost in patients having undergone conservative surgery. Results. 300 patients were included in the study, and 288 were analyzed. The median follow-up period was 2.1 years. Most AEs were mild. The most common AEs were skin-related - mainly radiodermatitis (in 266 patients (92.4%)) and hyperpigmentation (in 178 (61.8%)). Smoking (odds ratio) [95%CI] = 2.10 [1.14–3.87]; p = 0.017), no prior chemotherapy (0.52 [0.27–0.98]; p = 0.044), and D98% for subclavicular skin (1.030 [1.001–1.061]; p = 0.045) were associated with grade ≥ 2 acute AEs. In a univariate analysis, the mean dose, (p < 0.0001), D2% (p < 0.0001), D50% (p = 0.037), D95% (p = 0.0005), D98% (p = 0.0007), V30Gy (p < 0.0001), and V45Gy (p = 0.0001) were significantly associated with grade ≥ 1 acute esophageal AEs. In a multivariate analysis, D95% for the skin (p < 0.001), D98% for the subclavicular skin and low D95% for the internal mammary lymph nodes were associated with grade ≥ 1 medium-term AEs. Conclusions. The safety profile of adjuvant IMRT after partial or total mastectomy is influenced by dosimetric parameters. Trial registration: ClinicalTrials.gov NCT02281149
Trends and outcomes of blunt renal trauma management: A nationwide cohort study in Japan
Authors: Nakao Shunichiro , Katayama Yusuke , Hirayama Atsushi , Hirose Tomoya , Ishida Kenichiro , Umemura Yutaka , Tachino Jotaro , Kiguchi Takeyuki , Matsuyama Tasuku , Kiyohara Kosuke , Kitamura Tetsuhisa , Nakagawa Yuko , Shimazu Takeshi
Published: July 2020

Background
There is a paucity of information for predicting patient outcomes other than the American Association for the Surgery of Trauma (AAST) renal injury scale. The aim of this study was to evaluate the association between the patient characteristics and outcomes of patients with blunt renal trauma using a nationwide database in Japan.
Methods
We performed a retrospective analysis of the Japan Trauma Data Bank (JTDB) from 2004 to 2018. We identified patients with blunt renal trauma by AIS codes converted to AAST grades. We evaluated trends in patient characteristics and management, and assessed factors associated with mortality and nephrectomy using a multivariable logistic regression analysis.
Results
We identified 3,550 patients with blunt renal trauma. Their median age was 43 years and 74.2% were male. Nephrectomy was performed in 3.8% and the overall mortality rate was 9.5%. We found increasing trends in age and emergency abdominal angiography, and decreasing trends in nephrectomy and mortality over the 15-year period. The following factors were associated with mortality: age ≥ 65 years (adjusted OR 3.36), pedestrian accident (adjusted OR 1.94), fall from height (adjusted OR 1.91), shock on arrival (adjusted OR 4.02), concomitant injuries to head/neck (adjusted OR 3.14), pelvis/lower-extremity (adjusted OR 1.59), liver (adjusted OR 1.68), spleen (adjusted OR 1.45), and gastrointestinal tract (adjusted OR 1.90), AAST grade III-V (adjusted ORs 1.42, 2.16 and 5.55), and emergency abdominal angiography (adjusted OR 0.70). The following factors were associated with nephrectomy: shock on arrival (adjusted OR 1.98), concomitant injuries to thorax (adjusted OR 0.46) and spleen (adjusted OR 2.07), AAST grade III, IV and V (adjusted ORs 18.40, 113.89, and 468.17) and emergency abdominal angiography (adjusted OR 0.28).
Conclusions
We demonstrated that the AAST grade and emergency angiography were associated with mortality and nephrectomy in blunt renal trauma in the Japanese population.
Trial registration:
Not applicable
Qishentaohong Granule as Adjuvant Therapy for Improving Cardiac Function and Quality of Life in Patients with Chronic Heart Failure: a Randomized Controlled Trial
Authors: Li Xing-xing , Fan Zong-Jing , Cui Jie , Lin Quan , Lin Qian , Yan Rong-Kun , Wu Yang , Li Yan
Published: July 2020

Background: Qishentaohong Granule (QSG) is a traditional Chinese medicine (TCM) prescription for the treatment of chronic heart failure (CHF). The objective is to confirm the improvement of QSG on cardiac function and quality of life (QOL) in patients with CHF.Methods: This is a single-center, prospective, randomized controlled clinical trial. Seventy-six patients (forty-four male and twenty-six female) from 27 to 84 years old with diagnosed CHF New York Heart Association (NYHA) classⅡ or Ⅲ in stage C were enrolled and randomly assigned in a 1:1 ratio to receive the QSG (9 g, twice daily) or trimetazidine (TMZ) (10 mg, thrice daily) in addition to their standard medications for the treatment of CHF. The study period was 4 weeks. The primary outcomes (cardiac function and QOL) and secondary outcomes were measured at the baseline and end of the trial.Results: Thirty-five patients completed the study in each group. At the 4-week follow-up, the efective rate in NYHA classification in the QSG group was better than that in the TMZ group (74.29% vs. 54.29%, P < 0.05). Chronic heart failure integrated traditional Chinese and Western medicine survival scale (CHFQLS) scores were improved by 13.82 ± 6.04 vs. 7.49 ± 2.28 in the QSG and TMZ groups respectively (P < 0.05). Subgroup analysis of the CHFQLS results showed that physiological function, role limitation and vitality were significantly higher in the QSG group (15.76 ± 7.85 vs. 7.40 ± 3.36, P < 0.05; 16.00 ± 8.35 vs. 10.53 ± 4.64, P < 0.05; 15.31 ± 8.09 vs. 7.89 ± 4.60, P < 0.05). Treatment with QSG also demonstrated superior performance in comparison to the TMZ with respect to 6-minute walking test (6MWT), TCM syndrome, shortness of breath, fatigue, gasp, general edema and the N-terminal pro-B-type natriuretic peptide (NT-proBNP) level. No significant adverse reactions (ARs) and adverse cardiac events (ACEs) occurred during treatment in either group.Conclusion: In addition to conventional treatments, QSG as an adjuvant therapy significantly improved cardiac function and QOL in patients with CHF class Ⅱ or Ⅲ in stage C.Trial registration: This trial is registered with ChiCTR, No. ChiCTR-TRC-12002857. Registered March 21, 2019. (retrospectively registered)
One More “Living Fossil”: Mesozoic Lineage Differentiation, Morphological Stasis and Weak Phylogeographic Structure in Eurasia in the Bosminopsis Deitersi Group (Crustacea: Cladocera: Bosminidae)
Authors: Garibian Petr G. , Karabanov Dmitry P. , Neretina Anna N. , Taylor Derek J. , Kotov Alexey
Published: July 2020

Background: Water fleas (Crustacea: Cladocera) of the Family Bosminidae have been studied since the founding of paleolimnology and freshwater ecology. However, one species, Bosminopsis deitersi, stands out for its exceptional multicontinental range and broad ecological requirements. Results: Here we use an integrated morphological and multilocus genetic approach to to address the species problem in B. deitersi. We analyzed 32 populations of B. deitersi s. lat. Two nuclear and two mitochondrial loci were used to carry out the bGMYC, mPTP and STACEY algorithms for species delimitation. Detailed morphological study was also carried out across continents. The evidence indicated a widely distributed cryptic species in the Old World (Bosminopsis zernowi) that is genetically divergent from B. deitersi s.str. We revised the taxonomy and redescribed the species in this complex. Our sampling indicated that B. zernowi had weak genetic differentiation across its range. A molecular clock and biogeographic analysis with fossil calibrations suggested a Mesozoic origin for the Bosminopsis deitersi group. Conclusions: Our evidence rejects the single species hypothesis for B. deitersi and is consistent with an ancient species group (potentially Mesozoic) that shows marked morphological conservation. The family Bosminidae, then, has examples of both rapid morphological evolution (Holocene Bosmina), and morphological stasis (Bosminopsis).
Kinematic analysis of scissor-like elements using dual quaternions
Authors: Grijalva Juan Gabriel Guerrero , Pieri Edson Roberto De
Published: July 2020

This paper presents a standard approach, based on dual quaternions (DQ), to deal with the kinematic analysis of scissor-like elements (SLE). Kinematic relations of homogeneous SLE are simplified by using DQ exponentiation. The steps to identify kinematic singularities are detailed by an algorithm. A second algorithm is introduced to deal with the computation and plotting of reachable and dexterous workspace. In this approach, not just points and vectors, but lines and planes are represented by DQ. The motion of points, lines and planes can be appreciated in practical examples based on domotics.
Pathogens Isolated in Respiratory Tract Samples of Recently Hospitalized Patients: Implications for Primary Care Physicians
Authors: Henig Oryan , Benaim Anat Reiner , Neuberger Ami
Published: July 2020

Background.

Little is known about the etiology of community-acquired lower respiratory tract infections (CA-LRTI), and treatment is largely empirical. We aimed to provide clinicians with microbiologic data of the more severe cases, i.e. those that result in hospital admission.
Methods.

A retrospective observational cohort study was conducted at a tertiary care hospital in Haifa, Israel. Consecutive respiratory tract samples obtained from admitted patients older than 12 years between 2014 and 2020 were included. Pathogen distribution and drug susceptibility were described, and factors associated with 14 day mortality rates were analyzed using a multivariable logistic regression with a stepwise model reduction.
Results.

A total of 1,395; 2,212; and 2,760 samples were included in the community-acquired, healthcare-associated and hospital-acquired LRTI groups, respectively. Gram negative bacteria were the most common bacteria isolated. Streptococcus pneumoniae was over represented in patients admitted to the intensive care unit (ICU) with CA-LRTI and healthcare-associated LRTI (accounting for 20% and 10.1% of patients admitted to the ICU versus 12.6% and 6.4% of patients in the entire cohort, p < 0.001). Streptococcus pneumoniae was susceptible to penicillin in around 50% of cases; to erythromycin in 65% of cases; and to fluoroquinolones and 3rd generation cephalosporins in more than 95% of cases. Twenty-five percent of other typical community-acquired pathogens (Hemophillus influenza, Moraxella spp., and Bordatella spp.) were resistant to ampicillin. Susceptibility of Gram negative bacteria to penicillins with and without a β-lactamase inhibitor and to second generation cephalosporins was lower than 50%. In the multivariable analysis, factors that were associated with increased mortality in the entire cohort were: age, admission to an ICU or surgical department, healthcare-associated or hospital-acquired infections, and infections with gram negative bacteria, Staphylococcus aureus, and Stenotrophomonas or Acinetobacter baummannii.
Conclusions.

Our data shows that gram negative bacteria are common causative agents among elderly patients with multiple comorbidities. Streptococcus pneumoniae and other typical community acquired pathogens are proportionally more common in younger patients, although most absolute cases occur in elderly patients. The susceptibility pattern of these community pathogens suggests that for high-risk patients the choice of effective oral antibiotic agents in the community is limited.
Neonate Bloodstream Infections (BSI) in China: Emerging Threat of Multidrug-resistant (MDR) pathogens
Authors: zou hua , Zhou Ligang , Shen Yan , Li Chunli , Li Qiuhong
Published: July 2020

Background: Bloodstream Infections (BSIs) continue to be associated with significant morbidity and mortality worldwide, which multidrug-resistant (MDR) pathogens present an ever-growing burden in the hospital and community settings. Data on antimicrobial resistance and prevalence of BSIs pathogens among hospitalized neonates in China are few and not clearly defined. Methods: we retrospectively collected clinical and bacteria data about patients with BSI from 2013 to 2017 in Chongqing Health Center for Women and Children. The patients were divided into the early- and late-onset BSI groups according to if BSI occurred within or beyond 72 hours after admission.Results: 210 BSIs occurred from January 1st, 2014 to December 31th, 2019. Of all included 210 patients, there were 99(47.14%), 105 (50.00%), and 6 (2.86%) infected with gram-positive bacteria, gram-negative bacteria, and fungi, respectively. For early-onset BSI, the predominated pathogen was E. coli, accounting for 59.6% with 29.72% producing of extended-spectrum beta-lactamases (ESBLs). CNS (40.3%), K. pneumoniae (23.8%), and E. coli (20.9%) constitute the main causes of late-onset BSIs. Notably, 75.0% of K. pneumoniae produced ESBLs and 81.3% were MDR, which were higher than early-onset BSIs. Late onset BSIs and antibiotic exposure were significantly associated with MDR infection. Conclusion: Gram-negative bacteria gradually became the main pathogenic bacteria, among which E. coli and K. pneumoniae accounted for the largest proportion. The phenomenon of multi-drug resistance of bacteria is serious, and the first-line drug can't meet the practical needs. Late onset sepsis and antibiotic exposure were significantly associated with MDR infection.