bluuebunny/crossref_metadata_2025 huggingface dataset:
Variability of body build and physiological spinal curvatures of young people in an accelerated longitudinal study
Authors: Tuz Jacek , Maszczyk Adam , Zwierzchowska Anna
Published: March 2020

Objective : The human body is characterized by the variability of the characteristics of body build, which is expressed in the instability of spinal curvatures, which change during ontogeny. This phenomenon leads to a phylogenetic evolution of the human body build and posture. The aim of the study was to assess the dynamics of the variability of traits and indices of body build and posture and their mutual relations. It was assumed that over the 10-year observation period, a significant variability and relationships will be observed between the characteristics of body build and posture in young adults. Material and Methods: Between 2006 and 2016, 2,154 women and men aged 19.6±0.8 were examined (first-year students of the University of Economics in Katowice, Poland). Measurements of basic anthropometric measurements and angular values of lumbar lordosis and thoracic kyphosis were performed. The collected data were analysed statistically and the intergroup and intragroup differences were evaluated (ANOVA with repeated measures). The dynamics of variability (by building time series) and absolute and single-base increments were determined. Results : The body build of young men and women in the period of ontogenetic stabilization in the study group has changed statistically significantly over the decade. A prediction of the increases in body weight and hip circumference was recorded over a period of 10 years, especially in men. The characteristics of body posture have also undergone a significant progressive change. In women, thoracic kyphosis increased by 96.15%, whereas in men, lumbar lordosis decreased by 52.65%. Conclusions : Significant sexual differentiation was shown for such characteristics as body height, waist circumference and the angle of lumbar lordosis. The relationships between the characteristics of body build and posture were verified. There was a moderate relationship between the hip circumference and lumbar lordosis in women and a weak relationship between body height and the angle of thoracic kyphosis in men.The characteristics of human body build and posture during the period of ontogenetic stabilization show high non-linear variability, characterized by significant dimorphic differentiation.
Independent Risk Factors and The Long-term Outcomes for Postoperative Continuous Renal Replacement Treatment in Patients Who Underwent Emergency Surgery for Type A Acute Aortic Dissection
Authors: Wang Zhigang , Ge Min , Chen Tao , Chen Cheng , Zong Qiuyan , Lu Lichong , Wang Dongjin
Published: March 2020

Objective: The study objective was to investigate the incidence and risk factors of continuous renal replacement treatment (CRRT) in patients undergoing emergency surgery for type A acute aortic dissection (TA-AAD) and evaluate the perioperative and long-term outcomes. Methods: From January 2014 to December 2018, 712 consecutive patients were enrolled in the study. These patients were divided into two groups according to whether or not needed severe postoperative acute kidney injury (AKI) requiring CRRT: the CRRT group vs the control group. Univariate analysis and binary logistic regression analysis were used to analyze the risk factors of CRRT. Significant variables by univariate analysis were included in binary logistic regression analysis. To avoid the selection bias and confounders, baseline characteristics were matched for propensity scores. One-to-one pair matching was performed using nearest neighbor matching without replacement within 0.02 standard deviations of the logit of the propensity score as caliper width. Kaplan-Meier curves were generated to provide survival estimates at postoperative points in time. Differences between the 2 groups were determined by log-rank tests. Results: Before propensity score matching, univariate analysis showed that there significant differences in age, preoperative hypertension, pericardial effusion, preoperative serum creatinine (sCr), intraoperative need for combined coronary artery bypass grafting (CABG) or mitral valve or tricuspid valve surgery, cardiopulmonary bypass (CPB) time, extracorporeal circulation assistant time, aortic cross-clamp time, drainage volume 24 hours after surgery and ventilator time between two groups. All were higher in the CRRT group (p<0.05). These risk factors were included in binary logistic regression. It showed that preoperative sCr (OR=1.008, 95% CI:1.002-1.014, P=0.005) and CPB time (OR=1.022, 95% CI:1.003-1.042, P=0.026) were independent risk factors for CRRT patients undergoing surgery for TA-AAD. And there were significant differences regarding 30-day mortality (P<0.001) and long-term overall cumulative survival (P<0.001) with up to a 6-year follow-up. After propensity scoring, 29 pairs (58 patients) were successfully matched. Among these patients, the analysis showed that CPB time was still significantly longer in the CRRT group (P = 0.004), and the 30-day mortality rate was also higher in this group (44.8% vs 10.3%; P = 0.003).Conclusion: CRRT after TA-AAD is common and worsened short- and long- term mortality. The preoperative sCr and CPB time are independent risk factors for postoperative CRRT patients. Shorten the CPB time as much as possible is recommended to reduce the risk of CRRT after the operation.
High Sensitivity C-reactive Protein Concentrations, Lipid Status And Duration Of Type-1 Diabetes
Authors: BAKO HAUWA , Mu'azu Salisu Babura , Mohammed Alkali , Gwarzo Muhammmad Yalwa , Gezawa Ibrahim Danjummai , Bello Mohammad Ahmad
Published: March 2020

Background: Low-grade inflammation, duration of diabetes, hyperglycemia, and dyslipidemia in the presence of other traditional risk factors have been implicated in the development of vascular, neurologic, musculoskeletal and dermatologic complications observed in type 1 diabetes irrespective of other confounding factors. The study was aimed at assessing the relationship between hs-CRP concentrations, lipid status and duration of type-1 diabetes.Methods: Thirty-four patients aged 15-26 years comprising 14 females and 20 males diagnosed with type 1 diabetes ≤10 years duration, who at first clinical assessment and thorough medical examination presented with any or a combination of the symptoms of ketoacidosis, polyuria, polydipsia, malnutrition, blurred vision, paresthesia, body swelling and frothy urine at the Accident and Emergency Unit of Rasheed Shekoni Specialist Hospital, Jigawa Nigeria were enrolled for the study in a cross-sectional pattern after granting informed consent or obtaining assent from parents or guardians. Blood samples for lipid profile, fasting plasma glucose (FPG) and High sensitivity C - reactive protein (hs-CRP) measurement were collected from all patients through venipuncture after 10 hours overnight fast for biochemical testing. Lipid profile and FPG were assayed using enzymatic methods, hs- CRP via Enzyme Linked immunosorbent Assay (ELISA) technique and Urinalysis with point of care urine test strips. Data obtained was analyzed and presented as Frequency, Percentages, Mean ± SD and Pearson’s correlation with statistical significance at p≤0.05.Results: Patients biochemical characteristics were Fasting Plasma Glucose (9.86 ± 4.44), Total Cholesterol (4.77 ± 2.07), High Density Lipoprotein- Cholesterol (1.35±0.54), Triglycerides (2.17 ± 1.06), Low Density Lipoprotein- Cholesterol (2.29 ±1.49), hs-CRP (6.99 ± 5.44). Correlation matrix showed significant relationship between Triglycerides and hs-CRP (r; 0.378**, p; 0.005), Low Density Lipoprotein-Cholesterol and hs-CRP (r; 0.457*, p; 0.007). hs- CRP concentrations in relation to duration of type-1 diabetes were 1-3 years (3.57±4.10), 3-6 years (6.66±4.39) and 6-10 years (10.06±8.69).Conclusions: Evaluation of hs-CRP concentrations irrespective of lipid status may serve as an inexpensive method of predicting the risk of development of diabetic complications in resource poor settings among patients with established type 1 diabetes as the duration progresses.
Factors associated with chronic kidney disease in HIV+ patients in Albert Luthuli Municipality of South Africa
Authors: BENGURA PEPUKAI , Ndlovu Principal , Managa Mulalo Annah
Published: March 2020

Background: Current research indicates that chronic kidney disease is a global problem which poses a major health threat to people of poor countries who have HIV/AIDS and are on antiretroviral treatment. In this study, the prevalence of chronic kidney disease and the factors associated with it were investigated among the HIV/AIDS patients in a rural community of South Africa. Methods: A cohort of HIV+ terminal ill patients was retrospectively followed from 2010 to 2017 until chronic kidney disease was diagnosed or until the end of the observation period at two hospitals (Carolina and Embhuleni). Patient information was obtained from the routine hospitals’ records, and the data were analysed using logistic regression and survival analysis (Kaplan-Meier hazard functions and ratios, and log-rank tests) methods. Results: Out of a random sample of 357 HIV/AIDS patients, 53 patients (14.85%) had chronic kidney disease. The factors associated with chronic kidney disease were: Gender (p-value<0.0024); Age (p-value<0.0420); Baseline creatinine (p-value<0.0116); Baseline alanine transaminase (p-value<0.0111); Treatment regimen 1 (p-value<0.0001); ART adherence (poor, fair, good) (p-value<0.0005); Hospital (p-value<0.0001); and Lost to follow-up (ye, no) (p-value<0.0069). Discussion: Whilst antiretroviral treatment is associated with some improvement in virology and immunology in HIV-infected patients, research is still needed for the assessment of the impact of ART and other risk factors on renal function in marginalised communities in Africa. Conclusion: The research findings on HIV+ patients in Albert Luthuli Municipality concurred with several previous research findings on risk factors to CKD. The expected action to alleviate the health threat due to CKD in South Africa is to educate the nation on prevention, early detection and on the management of the disease. The study established diverse baseline statistics against which future research may be based.
Efficacy of mesenchymal stem cell therapy for sepsis: A meta-analysis of preclinical studies
Authors: Sun Xueyi , Ding Xianfei , Liang Huoyan , Zhang Xiaojuan , liu Shaohua , Han Bing , Duan Xiaoguang , Sun Tongwen
Published: March 2020

Background: Multiple studies have reported that mesenchymal stem cell (MSC) therapy has beneficial effects in experimental models of sepsis. However, this finding remains inconclusive. This study was performed to systematically determine the connection between MSC therapy and mortality in sepsis animal models by pooling and analyzing data from newly published studies.Methods: A detailed search of related studies from 2009 to 2019 was conducted in four databases, including MEDLINE, EMBASE, Cochrane Library, and Web of Science. After browsing and filtering out articles that met the inclusion criteria for statistical analysis, the inverse variance method of the fixed effects model was used to calculate the pooled odds ratios (ORs) and their 95% confidence intervals (CIs).Results: Twenty-nine animal studies, including 1,266 animals, were identified. None of the studies were judged to have a low risk of bias. The meta-analysis demonstrated that MSC therapy was related to a significantly lower mortality rate (OR 0.29, 95% CI 0.22–0.38, P<0.001). Subgroup analyses performed based on the MSC injection dose (<1.0 × 106 cells, OR=0.33, 95% CI 0.20–0.56, P<0.001; 1.0 × 106 cells, OR=0.24, 95% CI 0.16–0.35, P<0.001) and injection time (<1 hour, OR=0.24, 95% CI 0.13–0.45, P<0.001; 1 hour, OR=0.28, 95% CI 0.17–0.46, P<0.001) demonstrated that treatment with MSCs significantly reduced the mortality rate of animals with sepsis.Conclusion: This up-to-date meta-analysis showed a connection between MSC therapy and lower mortality in sepsis animal models, supporting the potential therapeutic effect of MSC treatment in future clinical trials. The results in this study contradict a previous meta-analysis with regards to the ideal dose of MSC therapy. Thus, further research is required to support these findings.
A population pharmacokinetic model is beneficial in quantifying hair concentrations of ritonavir-boosted atazanavir: A study of HIV-infected Zimbabwean adolescents.
Authors: Ngara Bernard , Zvada Simbarashe , Chawana Tariro Dianah , Stray-Pedersen Babill , Nhachi Charles Fungai Brian , Rusakaniko Simbarashe
Published: March 2020

BackgroundAdolescents experience higher levels of non-adherence to HIV treatment. Drug concentration in hair promises to be reliable for assessing exposure to antiretroviral (ARV) drugs. Pharmacokinetic modelling can explore utility of drug in hair. We aimed at developing and validating a pharmacokinetic model based on atazanavir/ritonavir (ATV/r) in hair and identify factors associated with variabilities in hair accumulation.MethodsWe based the study on secondary data analysis whereby data from a previous study on Zimbabwean adolescents which collected hair samples at enrolment and three months follow-up was used in model development. We performed model development in NONMEM (version 7.3) ADVAN 13. ResultsThere is 16% / 18% of the respective ATV/r in hair as a ratio of steady-state trough plasma concentrations. At follow-up, we estimated an increase of 30% /42% of respective ATV/r in hair. We associated a unit increase in adherence score with 2% increase in hair concentration both ATV/r. Thinner participants had 54% higher while overweight had 21% lower atazanavir in hair compared to normal weight participants. Adolescents receiving care from fellow siblings had atazanavir in hair at least 54% less compared to other forms of care. ConclusionThe determinants of increased ATV/r concentrations in hair found in our analysis are monitoring at follow up event, body mass index, and caregiver status. Measuring drug concentration in hair is feasibly accomplished and could be more accurate for monitoring ARV drugs exposure.
True first-pass effect in basilar artery occlusions: first-pass complete reperfusion improves clinical outcome in stroke thrombectomy patients
Authors: Abdullayev Nuran , Maus Volker , Behme Daniel , Barnikol Utako B , Kutschke Seraphine , Stockero Andrea , Goertz Lukas , Celik Erkan , Borggrefe Jan , Schlamann Marc , Liebig Thomas , Kabbasch Christoph , Mpotsaris Anastasios
Published: March 2020

Background Complete reperfusion (mTICI 3) in anterior circulation ischemic stroke patients after a single mechanical thrombectomy (MT) pass has been identified as a predictor of favorable outcome (modified Rankin Score 0-2) and defined as true first-pass effect recently. This effect has not yet been demonstrated in posterior circulation ischemic stroke. We hypothesized a true first-pass effect for the subgroup of acute basilar artery occlusions (BAO). Methods Consecutive patients with acute thromboembolic occlusions in the posterior circulation, treated between 2010 and 2017, were screened and all BAO patients with complete angiographic reperfusion and known symptom onset included for unmatched and matched analysis after adjustment for multiple confounding factors (demographics, time intervals, stroke severity, posterior circulation Alberta Stroke Program early computed tomography Score and comorbidity. The primary objective was outcome at 90 days between matched cohorts of single pass vs. multi pass complete reperfusion patients. Results 90 MTs in BAO were analyzed, yielding 56 patients with known symptom onset, in whom we achieved complete reperfusion (mTICI 3), depending on whether complete reperfusion was achieved after a single pass (n=28) or multiple passes (n=28). Multivariable analysis of 56 non-matched patients revealed a significant association between first-pass complete reperfusion and favorable outcome (p<0.01). In matched cohorts (n=7 vs. n=7), favorable outcome was only seen if complete reperfusion was achieved after a single pass (86% vs. 0%). Conclusion Single pass complete reperfusion in acute basilar artery occlusion is an independent predictor of favorable outcome. Achieving complete reperfusion after multiple passes might impair favorable patient recovery.
Adjunctive therapies for the nonsurgical treatment of peri-implant diseases: systemic review and meta-analysis
Authors: xiao yuhan , Qin Yichun , Yu Haiyang
Published: March 2020

Background Peri-implant diseases are caused by biofilms around the implant and may lead to implant failure. Non-surgical mechanical debridement with different adjunctive therapies has being applied in the treatment of peri-implant diseases. This systematic review aims to figure out whether one adjunctive therapy is superior to any other. Methods Two independent authors screened the literature via the MEDLINE and Cochrane Library. Only clinical randomized controlled trials (RCTs) that compared the efficacy of adjunctive therapies in the treatment of experimental peri-implant mucositis with non-surgical mechanical debridement (MD) were included in this review. The studies selected were published before February 2020. Comparisons of clinical outcomes were estimated using meta-analysis Results: A total of thirty-one RCTs met the inclusion criteria. The following adjunctive interventions were compared in the included studies: modifying the prosthesis; air abrasive; Er:YAG laser; diode laser; photodynamic therapy; local antibiotics; system antibiotics; probiotics; enamel matrix derivative. Follow-up ranged from 3 months to 1 years. Statistically significant difference was observed between MD with photodynamic therapy and MD alone at 3 months follow-up (P < 0.01). There is no statistical difference between MD with chlorhexidine and MD alone at 3 months follow-up (P = 0.61), so is MD with probiotics and MD alone (P = 0.47), and so is systemic antibiotics and MD alone (P = 0.96). Conclusion.At present, we do not know which non-surgical intervention is superior to any other, and for the interventions having similar degrees of effectiveness we do not know which one has less side effects, is simpler and cheaper to use. It is necessary to conduct well-designed RCTs with longer follow-ups to assess the accurate effectiveness of therapies.
Comparison of the clinical outcomes of percutaneous vertebroplasty vs. kyphoplasty for the treatment of osteoporotic Kümmell’s disease:a prospective cohort study
Authors: Chang Jian-Zhong , Bei Ming-Jian , Shu Dong-Ping , Sun Cheng-Jun , Chen Ji-Bin , Xiao Ya-Ping
Published: March 2020

Background Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) are widely used in the treatment of Kümmell's disease. The purpose of this article is to investigate the clinical efficacy of PVP and PKP for Kümmell's disease. Methods The clinical data that 56 cases of OVCF treated with either PVP (28 cases) or PKP (28 cases) and met the selection criteria from December 2015 to December 2017 were prospectively analyzed. Gender, age, course of disease, injury segment, BMD, VAS, ODI, imaging measurement indexes before surgery between the two groups showed no significant difference (all P>0.05). The bone cement leakage rate, bone cement injection amount, operation time, VAS, ODI, the rate of vertebral compression, correction rate of kyphosis and refracture rate of adjacent vertebra in 2 years were compared between the two groups to calculate clinical efficacy. Results The two groups were followed up for 24-48 months. There was no significant difference in the follow-up time, amount of bone cement injected, incidence of bone cement leakage and refracture rate of adjacent vertebra between the two groups (all P > 0.05). The operation time, intraoperative blood loss and fluoroscopy times of the PVP group were significantly lower than those of the PKP group (all P = 0.000). VAS score and ODI of the two groups were significantly lower at 1 d, 1 year and 2 years after surgery than before surgery (all P <0.05), but there was not statistically significant difference between the two groups at each time point after surgery (all P> 0.05). The rate of vertebral compression and kyphosis correction in the two groups were significantly corrected (P <0.05, respectively) and decreased significantly with time (all P <0.05), But there was not significant difference between the two groups at any time point (all P> 0.05). Conclusion Both PVP and PKP can achieve similar effects in the treatment of Kümmell's disease. Because the cost, operation time, blood loss, radiation exposure and surgical procedure of PVP are less than those of PKP, PVP has more clinical priority value.
A novel technique of treating anterior cruciate ligament injury: combining the ACL reconstruction and repair.
Authors: Yang Yuan , Zhu Weimin , Lai Yuxiao , Chen Kang , Feng Wenzhe
Published: March 2020

If the ACL stump is strong enough and of good quality, we combine the ACL reconstruction and repair together. The main aim of this technique is to retain the autologous ACL stump to protect the proprioception and accelerate the revascularization and may even promote the healing of the bone to tendon. It is assumed that this will be better for the knee biomechanics in contrast to the simple reconstruction. This technique may also save the graft. That means we can only harvest one tendon gracilis or semitendinosus to satisfy the need of the knee stability.
Contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners in Bao'an District, Shenzhen, China
Authors: Yan Rui-lin , Deng Bao-Qing , Wen Gui-Chun , Huang Li-Cheng , Li Li-Mei , Huang Zhi-Ming
Published: March 2020

Background Untreated male partners are critical source of maternal re-infection. Contact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal re-infection. This study aimed to analyze the current situation and related factors of contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners.Method Data of syphilis-seropositive pregnant women and their male partners attending clinics for syphilis-screening were obtained from the Shenzhen Program for Prevention of Congenital Syphilis. Contact tracing rate of syphilis-seropositive pregnant women and syphilis prevalence among male partners were counted, and related factors were also analyzed using a random-effects logistic regression model.Result Of the 1299 syphilis-seropositive pregnant women, 74.1% (963/1299) had their male partners receiving syphilis-screening and 19.1% (184/963) of male partners were syphilis-infected. For pregnant women, being divorced (adjusted odds ratio [AOR] =0.39; 95%CI: 0.17-0.88), seeking for emergency services at their first antenatal clinics visit (AOR=0.59; 95%CI: 0.44-0.79), reporting willingness to notify partner (AOR=7.75; 95%CI: 4.73-12.70), and having a history of drug abuse (AOR=0.35; 95%CI: 0.13-0.93) were independently associated with successful contact tracing. For male partners, of minority nationality (AOR=4.15; 95%CI: 1.66-10.34), age of first sex>20(AOR=0.57; 95%CI: 0.37-0.87), reporting multi-partner (AOR = 1.60; 95%CI: 1.04-2.46), having a history of drug abuse (AOR=4.07; 95%CI: 1.31-12.64) were independently associated with syphilis-infection. In addition, pregnant women with TRUST titer ≥1:8 (AOR=2.81; 95%CI: 1.87-4.21), having a history of adverse pregnancy outcomes (AOR=1.70; 95%CI: 1.14-2.53), reporting multi-partners (AOR=0.43; 95%CI: 0.29-0.64) and reporting the current partner as the source of syphilis (AOR=5.05; 95%CI: 2.82-9.03) were independently associated with partners' syphilis-infection.Conclusion Contact tracing is feasible and effective in identifying syphilis-infected partners among syphilis-seropositive pregnant women. Contact tracing is associated with many factors such as women's marital status, services at their first antenatal clinics visit and willingness of partner notification. Partners' ethnicity, age of first sex, multi-partners and history of drug abuse as well as women's levels of TRUST titer were associated with partners' syphilis-infection.
Application of Dose-Volume Histogram Prediction in Biologically Related Models for Nasopharyngeal Carcinomas Treatment Planning
Authors: Cao Wufei , Zhuang Yongdong , Chen Lixin , Liu Xiaowei
Published: March 2020

Purpose: In this study, we employed a gated recurrent unit (GRU)-based recurrent neural network (RNN) to predict the dose-volume histogram (DVH) and investigated the feasibility and usefulness of this method in biologically related models for nasopharyngeal carcinomas treatment planning.Methods and Materials: One hundred NPC patients were selected from a database containing clinical VMAT plans in recent two years; of these, the data from 80 patients were used to train the GRU-RNN, and the data of the other 20 patients were used for testing. For the prescribed doses of all the plans in 30 or 31 fractions, 70 Gy were delivered to PTV70 (the gross tumour volume with circumferential margin), 60 Gy were delivered to PTV60, 54 Gy were delivered to PTV54 and 66 Gy were delivered to PTV66 (lymph node gross tumour volume with circumferential margin). For each NPC patient, the DVHs of different organs at risk (OARs) were predicted by the trained GRU-based RNN using the information given by individual conformal beams. Based on the predictive DVHs, the equivalent uniform dose (EUD) were calculated, and directly applied as dose constrains in Treatment Planning optimization. The regenerated VMAT experimental plans (EPs) were evaluated by comparing them with the clinical plans (CPs).Results: For the 20 test patients, the regenerated EPs guided by the GRU-RNN predictive model achieved very good consistency relative to the CPs. The EPs showed better dose sparing for many OARs and significant differences were found in the maximum/mean doses to the brain stem, brain stem PRV, spinal cord, lenses, temporal lobes and parotids with P-values <0.05, respectively. On average, compared with the CPs, the maximum/mean doses to these OARs were altered by -3.44 Gy, -1.94 Gy, -1.88 Gy, 0.44 Gy, 1.98 Gy and -1.82 Gy, respectively.Conclusion: The GRU-RNN based DVH prediction method is capable of accurately and completely predicting the whole DVH for EUD calculation. The regenerated plans guided by the predictive EUD sparing were not inferior to the manual plans, indicating the great potential for improved planning and quality control in clinical applications.
Normative Values for Potential Necrotizing Enterocolitis Biomarkers Across Gestational Ages
Authors: Shores Darla , Fundora Jennifer , Go Mitzi , Shakeel Fauzia , Brooks Sandra , Alaish Samuel M. , Yang Jun , Sodhi Chhinder P. , Hackam David J. , Everett Allen
Published: March 2020

Background: Necrotizing enterocolitis (NEC) is associated with significant morbidity and mortality. Serum biomarkers to aid diagnosis, such as intestinal fatty acid binding protein (IFABP) and calprotectin, are actively being investigated; however, the normative values of these markers among healthy premature and term infants remains unknown.Aims: We sought to identify normative values for the serum concentrations of IFABP and calprotectin across gestational (GA) and post-menstrual age.Methods: We collected serum from infants (24-40 weeks GA) in the first week of life and at multiple time points in a sub-cohort of premature infants (24-29 weeks GA), excluding sepsis or known intestinal disease. IFABP and calprotectin were measured using ELISA. Groups were compared with descriptive statistics and mixed effects linear regression.Results: 112 infants had specimens in the first week of life, and 19 premature infants had longitudinal specimens. IFABP concentration in the first week of life was low and did not differ across gestational ages. Longitudinally, IFABP increased 4% per day (P<0.001). Calprotectin concentration in the first week of life was more variable. An inverse relationship between day of life and calprotectin level was found in the longitudinal cohort (P <0.001).Conclusions: Serum IFABP and calprotectin fluctuate over time. Infants had low levels of IFABP during the first week of life, independent of gestational age, and levels increased longitudinally in premature infants. Calprotectin levels generally declined over time. Normative data for infants is necessary to establish meaningful cut-off levels for clinical use.
Competing Risk Nomograms Predicting Cause-specific Mortality and Competing Mortality in Patients with Lung Adenosquamous Carcinoma
Authors: Wu Xiao , Yu Wenfeng , Petersen RH , Sheng Hongxu , Wang Yiqing , Lv Wang , Hu Jian
Published: March 2020

Background Adenosquamous carcinoma (ASC) is an uncommon histological subtype of lung cancer. The purpose of this study was to assess the cumulative incidence of lung cancer-specific mortality (LC-SM) and other cause-specific mortality (OCSM) for lung ASC patients, and construct the corresponding competing risk nomograms. Methods Data on 2,705 patients with first primary lung ASC histologically diagnosed during 2004 and 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Cumulative incidence function (CIF) was utilized to calculate the 3-year and 5-year probabilities of LC-SM and OCSM, and a competing risk model was built. Based on the model, we developed the competing risk nomograms, and the corresponding concordance indexes ( C -index) and calibration curves were derived to assess the model performance. Results The 3-year and 5-year cumulative mortalities were 49.6% and 55.8% for LC-SM, and 8.2% and 11.8% for OCSM, respectively. In multivariate analysis, increasing age, male sex, no surgery, and advanced T, N and M stage were related to a significantly higher likelihood of LC-SM, in contrast with increasing age and surgery served as predictors for an elevated risk of OCSM. The nomogram showed a good calibration, and the 5-year C-indexes for predicting probabilities of LC-SM and OCSM in the validation cohort were 0.79 and 0.63, respectively. Conclusions The competing risk nomogram displayed an excellent discrimination and calibration, especially for predicting LC-SM. With the aid of this individualized predictive tool, it is more expedient for clinicians to devise appropriate treatment protocols and follow-up schedules.
Achieving objective response in treatment of non-resectable neuroendocrine tumors does not predict longer time to progression compared to achieving stable disease
Authors: Thiis-Evensen Espen , Poole Amalie Christine , Nguyen Hong-Thien Thi , Sponheim Jon
Published: March 2020

Background: There are several treatment modalities for unresectable neuroendocrine tumors. Traditionally, the aim of these treatments has been to reduce the tumor load; referred to as objective response (OR). Less emphasis has been put on inducing the tumors to stop growing without a reduction in total tumor load; termed as stable disease (SD). We wanted to investigate whether achieving OR compared to obtaining SD predicted a longer time to progression (TTP) in patients with neuroendocrine tumors (WHO Grade 1 and 2) treated with peptide receptor radionuclide therapy, chemotherapy or molecular targeted therapy. Methods : Patients treated with either peptide receptor radionuclide therapy (PRRT) with 177 Lutetium-DOTA-octreotate, the chemotherapy combination streptozotocin/5-fluorouracil or everolimus were retrospectively assessed to evaluate the effect of the treatments on disease progression. We analyzed the TTP for patients for each treatment modality and compared the TTP between those who achieved OR and those who achieved SD. Results: Altogether 56 patients treated with PRRT, 32 treated with streptozotocin/5-fluorouracil and 52 treated with everolimus were included in the analyses. The median TTP for those treated with PRRT and achieving OR was 31 months, the TTP for those achieving SD was 43 months (p=0,2). For patients treated with streptozotocin/5-fluorouracil the results were: OR: 18 months, SD: 23 months (p=0,9) and for those treated with everolimus; OR: 9 months, SD: 20 months (p=0,5), respectively. We found no differences between patients achieving OR compared to SD regarding age, sex, stage, primary tumor location, Ki-67% or ongoing treatment with somatostatinanalogues. Conclusions: We found no treatment benefit with regard to TTP for our patients that experienced OR compared to those who achieved SD, but a trend toward longer TTP among patients with SD.
Assessment of the predictive role of oestrogen and progesterone receptor status in breast cancer patients treated with neoadjuvant chemotherapy: A retrospective analysis for 689 patients
Authors: Ye Ying , Chen Rui , Fu Yong , Peng Yang , Qu Fanli , Tang Zhenrong , Zong Beige , Wang Yihua , Luo Feng , Liu S
Published: March 2020

Background : To explore the predictive indicators in hormone receptor (HR)-positive breast cancer (BC) patients receiving neoadjuvant chemotherapy (NACT) and to evaluate the value of quantitative oestrogen receptor (ER) and progesterone receptor (PR) in predicting tumour response. Methods : Six hundred eighty-nine BC patients with HR-positive status who were treated with anthracycline, epirubicin and taxane NACT treatment were retrospectively analysed. Clinical and pathological features of the patients were used to evaluate the response to NACT. Results : Patients with larger tumour sizes ( OR 1.657 CI 1.186-2.313 p=0.003 ), those who were in a premenopausal status ( OR 1.458 CI 1.039-2.045 p=0.029 ) and those with higher Ki67 levels ( OR 1.735 CI 1.231-2.444 p=0.002 ) exhibited a better therapy response. Among the patients in the postmenopausal subgroup, a lower pretreatment ER or PR expression were associated with a reduction in tumour size, and the cut-off values for ER and PR were 87.5% and 65%, respectively ( p=0.006 and p=0.05 ). Decreased expression of ER and PR was also observed after NACT treatment ( p=0.028 and p<0.001, respectively ) but played only a predictive role in the Her-2-negative subgroup; the cut-off values for decreased ER and PR were 17.5% and 26.5%, respectively ( p=0.044 and p<0.001 ). Conclusions : Semiquantified pretreatment HR expression can be used to predict the response of NACT in postmenopausal BC patients. Decreased ER and PR expression is also associated with a reduction in tumour size in Her-2-negative subtypes treated with NACT.
Loss of survival advantage for deficient mismatch repair in patients with advanced colorectal cancer may be caused by changes in prognostic value of CD8+T cell expression
Authors: Wang Bingyan , Li Fei , Guo Limei , Lu Siyi , Ma Junren , Ma Yanpeng , Meng Yan , Wang Junwei , Zhou Xin , Fu Wei
Published: March 2020

Background: Patients with stage II deficient mismatch repair (dMMR) show a better prognosis than patients with colorectal cancer with proficient mismatch repair (pMMR). However, this beneficial effect is decreased in advanced stages of the disease. This study was conducted to investigate the prognostic value of dMMR and alterations in the tumour microenvironment. Methods: This was a matched retrospective cohort study. Thirty-two patients with stage III&IV dMMR matched with 32 patients with stage I&II dMMR and 64 patients with pMMR were evaluated. Immunohistochemistry analysis was performed for the 64 patients with dMMR to explore the expression and prognostic effect of CD3, CD4, CD8, and PD-L1. Results: Patients with stage III-IV dMMR showed no advantage in overall survival (OS) and disease-free survival (DFS) compared to patients with pMMR (P = 0.244, P = 0.667). No expression differences in CD3, CD4, CD8, and PD-L1 at the centre of the tumour (CT) or invasive margin (IM) were found between patients with stage I&II and stage III&IV dMMR. High CD3 expression at the CT and high CD3 an CD4 expression at the IM improved both OS and DFS. High CD8 expression showed opposite prognostic value in patients with stage I&II and III&IV dMMR. A similar tendency was observed for PD-L1 expression. Conclusion: Patients with stage III-IV dMMR showed no prognostic advantage over patients with pMMR. Expression of CD3, CD4, CD8, and PD-L1 was similar between stage I&II and III&IV dMMR CRC. High CD3 expression at the CT and high CD3 and CD4 expression at the IM can significantly improve patient prognosis. The opposite prognostic tendency of CD8 and PD-L1 for patients with stage I&II and III&IV dMMR may be relevant to CD8+T cell exhaustion and functional changes at inhibitory immune checkpoints. Keywords: colorectal cancer, deficient mismatch repair, tumour-infiltrating lymphocyte, PD-L1, prognosis
Comparison of non-schistosomal colorectal cancer and schistosomal colorectal cancer
Authors: Wang Weixia , Lu Kui , Wang Limei , Jing Hongyan , Pan Weiyu , Huang Sinian , Xu Yanchao , Bu Dacheng , Cheng Meihong , Liu Jing , Liu Jican , Shen Weidong , Zhang Yingyi , Yao Junxia , Zhu Ting
Published: March 2020

Aim The purpose of this study was to compare clinicopathological features of patients with non-schistosomal and schistosomal colorectal cancer to explore the prognostic role of schistosoma infection in colorectal cancer(CRC). Methods 354 cases of CRC were retrospectively analyzed in a tissue microarray format. Survival curves were constructed by using the Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression models were performed to identify associations with outcome variables. Results Patients with schistosomiasis (CRC-S) were significantly older ( P <0.001) and were mostly in stage III and IV tumors ( P <0.001) than patients without schistosomiasis (CRC-NS). However, there were no significant difference between CRC-S and CRC-NS patients in other clinicopathological features. Overall, CRC-S patients were associated with adverse overall survival upon K-M analysis ( P =0.0239). By univariate and multivariate analysis, CRC-S patients were significantly correlated with OS ( P =0.041), but it was not an independent prognostic factor. In addition, age( P =0.013), gender ( P =0.008), tumor differentiation ( P =0.018) and invasive depth ( P =0.013) were all independent predictors. When patients were stratified according to clinical stage and lymph node metastasis state, the prognostic role was not consistent. In patients with stage III-IV tumors and with lymph node metastasis, schistosomiasis, gender and invasive depth were independent predictors, but not in patients with stage I-II tumors and in patients without lymph node metastasis. Conclusion Schistosomiasis is an unfavorable factor for OS and could be considered to refine risk stratification and provide better risk-oriented treatment for CRC patients with different clinical stage or lymph node metastasis state.
The perceptions of medical specialists on the influence of Electronic Medical Record use on the quality of hospital care.
Authors: poelgeest rube van , Schrijvers Guus , Boonstra Albert , Roes Kit
Published: March 2020

Background: Numerous publications show that Electronic Medical Record (EMR) systems may provide an important contribution to increasing the quality and effectiveness of care. There are indications that particularly the medical specialist plays an important role in the implementation of EMR systems in hospitals. Our goal in this study is to answer the question: which positive or negative factors influence, in the perception of medical specialists, the relation between the EMR use and the quality of medical care?Methods: To answer this question, a qualitative study was conducted in the period August until October 2018. Semi-structured interviews of around 90 minutes were held with twelve medical specialists of twelve different Dutch hospitals. For the analysis of the answers, we used the classification of factors that can influence the implementation of EMR systems based on a previously published taxonomy.Results: The participating interviewees were experienced medical specialists. Their experience within the hospitals concerned varies between 5 and 27 years. There is a spread across different types of hospitals and specialisms. When the answers received are categorised using a previously published taxonomy, the medical specialist considered technical factors the most significant barriers for EMR use to have a positive effect on quality of care, followed by the suboptimal change processes surrounding implementation. The categories ‘social’ and ‘psychological’ and ‘time’ come in at a shared third place. On the positive side, they also identified potential technical facilitators, particularly in the assured availability of information to all health professionals involved in the care of a patient. They see promise in using EMRs for medical decision support to improve quality of care, but consider these capabilities currently lacking.Conclusions: In comparison with the paper record, the interviewed medical specialists consider the digitalised record a great leap forward. Every involved health professional can access the patient data if desired at any time they need it. However, in practice, real quality improvement lags behind as long as, for instance, no one uses decision support no one uses decision support, good integrated analytic tools are missing, and the organisation of care is not adapted to these new possibilities.
Discriminative Validity of the Core Outcome Set Functional Independence in a Population of Older Adults
Authors: Dockx Yvonne , Molenaar Esther , Barten Di-Janne , Veenhof Cindy
Published: March 2020

Background In line with current healthcare policy, clinicians are challenged to support older adults to maintain a certain level of Functional Independence (FI). FI is defined as functioning physically safely and independent from another person, within one’s own context”. A Core Outcome Set was developed to measure FI. The purpose of this study was to assess discriminative validity of the Core Outcome Set FI in a population of Dutch older adults (> 65 years) with different levels of FI. Secondary objective was to assess to what extent the underlying domains ‘coping’, ‘empowerment’ and ‘health literacy’ contribute to the Core Outcome Set FI in addition to the domain ‘physical capacity’ in a population of Dutch older adults.Methods A population of 200 community-dwelling older adults and older adults recruited in residential care facilities were evaluated by the Core Outcome Set FI. The Core Outcome Set FI contains measurements on the four domains of FI: physical capacity, coping, empowerment and health literacy. Because no gold standard for FI exists, a proxy indicator was used as reference variable: group membership based on help needed in (instrumental) activities of daily living ((i)ADL) and living situation (three groups). Ordinal logistic regression was used with main outcome prediction accuracy of the Core Outcome Set FI on the proxy indicator for FI.Results The model based on the Core Outcome Set FI had an overall prediction accuracy of 68%. For older adults living at home and depending on help in (i)ADL, prediction accuracy was 58%. Only physical capacity measured with Short Physical Performance Battery was significantly associated with group membership. Adding health literacy with coping or empowerment to a model with physical capacity improved the model significantly (p<0.01).Conclusions Although the overall discriminative validity of the Core Outcome Set FI is moderate, determining the level of Functional Independence in community-dwelling older adults who receive help from others is still a challenge. Context-related factors, like the presence of a spouse, also may be a determining factor in this population. It is recommended to include context-related factors in further research on determining FI in subgroups of older people.
Effect of Decontamination Procedures on Marginal and Internal Adaptation in Saliva Contaminated Resin Composite Restorations
Authors: Pappa Eftychia , Masouras Konstantinos , Margaritis Vasileios , Kakaboura Afrodite
Published: March 2020

Background: The aim of this study was to evaluate the effect of natural saliva contamination of dentin, on marginal and internal adaptation of resin-composite restorations performed with an etch-and-rinse adhesive and determine the efficiency of various decontamination techniques. Methods: A hundred and twenty human molars and premolars were randomly distributed into six groups (n=20). Enamel was removed and standardized dentin cavities (diameter: 3 mm, depth: 2 mm) were filled with a two-step etch-and-rinse adhesive and resin-composite under six different surface treatments: (1) adhesive application following manufacturers’ instructions (control); (2) dentin etching, 5-s saliva, 5-s air-dry, adhesive; (3) dentin etching, 5-s saliva, 10-s water-rinse, 5-s air-dry, adhesive; (4) adhesive application/light-cure, 5-s saliva, 5-s air-dry; (5) adhesive application/light-cure, 5-s saliva, 10-s water-rinse, 5-s air-dry; (6) adhesive application/light-cure, 5-s saliva, 10-s water-rinse, 5-s air-dry, adhesive reapplication. Wall adaptation was evaluated at the upper surface and at two consecutive depth levels of 0.5mm each, by measuring the length of the debonded margins relative to the cavity periphery (%DM) and the width of the maximum marginal gap (MG). Results: Statistically significant differences occurred among groups, presenting inferior adaptation after contamination took place. Group (1) at the upper surface presented the most satisfactory adaptation, whereas, groups (4) and (5) had the significantly poorest adaptation in all surfaces. Groups (2), (3), and (6) revealed no statistically significant differences in comparison to group (1). Conclusion: Saliva contamination resulted in deterioration of marginal and internal adaptation when it occurred after the adhesive application. Reapplication of the adhesive restored DM and MG values.
Clinical and molecular spectrum of 46, XY disorders of sex development that harbour MAMLD1 variations: Case series and review of literature
Authors: Lele Li , Fan Lijun , Gao Fenqi , Wu Di , Gong Chunxiu
Published: March 2020

Background Mastermind-like domain-containing 1 (MAMLD1) has previously been identified as a causative gene for "46, XY Disorders of Sex Development (DSD)". Recently, there has been some controversy regarding the causative role of MAMLD1 variations in DSDs. Here we describe a clinical series and review the reported cases to evaluate the role of MAMLD1 variants in children with 46, XY DSD. Cases of 46, XY DSD harbouring MAMLD1 variants from unrelated families were recruited from the Beijing Children’s Hospital in China (N = 10)or identified through a literature search (N = 26). The clinical manifestations and genetic variants of all the patients were evaluated.Results Hypospadias was the most prevalent phenotype among our 10 cases (8 out of 10 cases) and in all the previously reported ones. Central precocious puberty and isolated micropeniswere observedfor the first time. Among the 10 cases, nine variants were identified, including three nonsense (p.A356X, p.G152X, and p.G124X) and six missense (p.P334S, p.S662A, p.A421P,p.T992I, p.P542S, and p.A927L) variants. In silico analysis showed that the variants p.P334S, p.P542S, p.S662A, and p.A927Lmight lead to drastic changes in the interaction force of the amino acid chain and the flexibility of the spatial structure, and such changes may affect protein function.Conclusion Patients with 46, XY DSD harbouring MAMLD1variants manifest a broad spectrum of phenotypes and mostly present with hypospadias. The six novel variants reported here enrich the mutation database and contribute to our understanding of the pathogenesis of 46, XY DSD.