bluuebunny/crossref_metadata_2025 huggingface dataset:
A Mass-Energy United Test of the Equivalence Principle
Authors: Zhan Mingsheng , Zhou Lin , He Chuan , Yan Sitong , Chen Xi , Gao Dongfeng , Duan Weitao , Ji Yuhang , Xu Rundong , Tang Biao , Zhou Chao , Barthwal Sachin , Wang Qi , Hou Zhuo , Xiong Zongyuan , Zhang Yuanzhong , Liu Min , Ni Wei-Tou , Wang Jin
Published: September 2020

The equivalence principle (EP) is one of the basic assumptions of general relativity. Almost all new theories[1] that attempt to unify gravity with the standard model[2] require the EP be broken. Experimental tests of EP provide opportunities for verification of different theoretical models and emergence of new physics. Traditional mass tests[3-9] of EP have achieved the precision of 10-15 level[3]. Tests with quantum properties including spin[10,11], superposition[12], quantum statistics[10] and internal state[4,13], have been performed, and entanglement[14] test was also proposed. Energy is another very important property and is related to mass by the mass-energy equivalence (MEE). However, mass-energy united tests of EP have never been carried out. Here, we achieve for the first time the united EP test covering energy interval from micro-eV to giga-eV by a mass and internal energy specified atom interferometer (AI). The AI was realized by taking advantage of the Four-Wave Double-diffraction Raman transition (4WDR) method[7] for specified internal energy states, and by extending 4WDR to include excited states. The Eötvös parameters of the four paired combinations (87Rb|F＝1>-85Rb|F＝2>, 87Rb|F＝2>-85Rb|F＝2>, 87Rb|F＝1>-85Rb|F＝3> and 87Rb|F＝2>-85Rb|F＝3>) were measured to be η1=(1.5±3.2)×10-10, η2=(-0.6 ±3.7)×10-10, η3=(-2.5±4.1)×10-10 and η4=(-2.7±3.6)×10-10, respectively. The violation parameters of mass and internal energy are constrained to η0 = (-0.8±1.4)×10-10 and β = (-0.6±6.9)×105. This work opens a door for united tests of EP and MEE in large energy range with quantum systems.
Chronic Liver Disease and COVID-19: A Perspective From Singapore
Authors: Kuang Jonathan , Lin Huiyu , Chew Wei Da , Ang Li Wei , Lye David , Young Barnaby , Yang Wei Lyn
Published: September 2020

Background: Chronic liver diseases including non-alcoholic fatty liver disease (NAFLD) are associated with COVID-19 progression. With no signs of the pandemic abating, thousands worldwide are at risk of a severe disease course. Objective: We aimed to describe the epidemiological features, clinical course, treatment and outcomes of our patients with COVID-19 and chronic liver disease.Methods: A retrospective descriptive study of COVID-19 patients with chronic liver disease admitted to the National Centre for Infectious Diseases in Singapore between 29th February and 2nd May 2020 was performed. Results: 16 patients had chronic liver disease – 9 had NAFLD. In the NAFLD group, peak ALT was higher (median: 84 U/L vs 38 U/L; P = 0.042) and more patients had hyperlipidaemia (88.9% vs 28.6%; p=0.035), but median Body Mass Index (BMI) was not significantly higher (24.3 kg/m2 vs 24.2 kg/m2). NAFLD patients had a poorer clinical course: more required anti-viral medications (66.7% vs 0%; p=0.011), and time to negative swab was longer (24 days vs 13 days; p=0.008). 3 patients had liver cirrhosis (all non-NAFLD). 1 decompensated but none required intensive care unit admission or died.Conclusion: Our results show that in COVID-19 patients with chronic liver disease, those with NAFLD experience a more severe clinical course. In Asians, NAFLD can have poorer prognostic implications, despite them having only mildly raised BMI. We advocate that patients with NAFLD and liver cirrhosis should be closely monitored for COVID-19 disease progression.
Variability of Total Daily Dose of Insulin in Type 1 Diabetic Pre-Menarchal vs Post-Menarchal Females
Authors: Sizemore Johnna M. , Stack Karolina , Bansal Sanjay K. , Sigman Garry , Joyce Cara
Published: September 2020

Study Objective Quantify the change of insulin requirements in pre- vs post-menarchal adolescent females with type 1 diabetes (T1DM) by measuring the total daily dose (TDD; units/kg/day) of insulin administered before vs after menarche in order to provide anticipatory guidance of insulin requirements in adolescent females as they progress through puberty to help reduce the long-term complications of poorly controlled T1DM. Design/Setting/Participants A retrospective chart review study was conducted which included 52 adolescent females with T1DM, after subjects who were diagnosed with T1DM after menarche, those on hormonal contraceptives, or those that had hypothyroidism, major medical comorbidities, or incomplete records were excluded. Subject demographics along with body mass index (BMI) percentile, HgbA1c (hemoglobin A1c), and TDD of insulin were collected 0-2 years pre-, 0-2 years post-, and 2-4 years post-menarche to assess differences in TDD of insulin in pre- and post-menarchal adolescent females with T1DM. Interventions None Main Outcome Measures TDD of insulin at 0-2 years pre-, 0-2 years post-, and 2-4 years post-menarche in adolescent females with T1DM. Results There was a statistically significant difference of TDD of insulin in pre- vs. post-menarchal adolescent females with T1DM after controlling for HgbA1c and BMI. Conclusions While poor glycemic control is often attributed to adolescent non-compliance of insulin administration, a physiologic process similar to polycystic ovarian syndrome may induce insulin resistance in post-pubertal adolescent females with T1DM.
Sensitivity of Prostate Cancer Foci using 1.5 T Multiparametric Magnetic Resonance Imaging
Authors: Ito Suguru , NAITO SEI , Narisawa Takafumi , Yagi Mayu , Kurota Yuta , Kanno Hidenori , Yamagishi Atsushi , Sakurai Toshihiko , Nishida Hayato , Yamanobe Takuya , Kato Tomoyuki , Tsuchiya Norihiko
Published: September 2020

Background: The detection of prostate cancer (CaP) has increasingly being carried out by multiparametric magnetic resonance imaging (mpMRI). Despite many previous studies, the sensitivity for clinically significant CaP (csCaP) was high, information on mpMRI false-negative lesions is limited. Therefore, the aim of this study was to evaluate the use and limitations of mpMRI in CaP.Methods: A total of 228 CaP foci in 100 patients who underwent 1.5 T mpMRI and radical prostatectomy between December 2015 and June 2017 were retrospectively analyzed. The sensitivities of CaP foci, csCaP, and index tumors (ITs) were measured. Clinically significant CaP was defined into two categories based on the Gleason score (GS): csCaP/GS ≥3 + 4 (GS ≥3 + 4 or diameter >10 mm) and csCaP/GS ≥4 + 3 (GS ≥4 + 3 or diameter >10 mm). In addition, the characteristics of false-negative lesions were identified. The Prostate Imaging Reporting and Data System version 2 was used to determine an mpMRI positive lesion, defined as a lesion having a score of ≥3.Results: The sensitivity of all legions, csCaP/GS ≥3 + 4, csCaP/GS ≥4 + 3, and ITs were 61.4%, 75.8%, 83.0%, and 91%, respectively. There were 91 lesions that were mpMRI false, 40% of which were csCaP/GS ≥3 + 4. There were three lesions with a GS of ≥8 and ≥10 mm in the false-negative results.Conclusions: mpMRI can highly detect ITs and csCaP/GS ≥4 + 3; however, a few large and high-GS CaPs constitute undetectable lesions in 1.5 T mpMRI.
Corded and hyalinized endometrioid carcinoma: a rare case and review of the literature
Authors: Li Yan , Lang Yuejiao , Yuan Kaitao , Tuo Ying , Xiang Pei , Zheng Donghua , Liu Dawei
Published: September 2020

Background

Corded and hyalinized endometrioid carcinoma(CHEC) is a rare morphological variation of endometrioid carcinoma(EC) in the endometrium. Reports of CHEC were very limited. We represent the clinical and pathological findings of this rare endometrioid carcinoma in a 26-year-old woman and reviews the literatures updated on CHEC.
Case presentation:

A 26-year-old woman presented with abnormal vaginal bleeding for 3 months and the initial cervical biopsy revealed a mullerian mixed tumor in another clinic. Abdominopelvic computed tomography revealed a mass in the uterine cavity and cervix, suggesting a malignant tumor. Histologically, the tumor showed a biphasic pattern characterized by an appearance of 2 components, the conventional endometrioid carcinoma component and sex cord-like component with hyalinization. In the areas of sex cord-like elements, the epithelioid and spindle cells were usually seen around the glands, and mostly arranged in cords or trabeculaes, sometimes embedded within a richly hyalinized collagenous or sometimes myxoid matrix. Tumor cells in the sex cord-like region show a different immunohistochemical expression pattern from conventional adenocarcinoma. Cytokeratin(CK) and vimentin are positive in both components, and vimentin shows more diffuse positivity while CK is more restricted and focally expressed in tumor cells in the sex cord-like region. Complete loss of expression of E-cadherin and epithelial membrane antigen(EMA) was seen in tumor cells in the sex cord-like region whereas it was well preserved in the area of conventional adenocarcinoma. Nuclear expression of β-catenin was noted in tumor cells in the sex cord-like region. P53 was focally positive in both components. Based on histological and immunochemical examinations, the patient was diagnosed with CHEC.
Conclusions

CHEC is not uncommonly mistaken for a wide variety of diseases. It’s of great significance to raise the awareness of CHEC to avoid over-treatment caused by over-diagnosis, especially in young patients and in curettage. We report one case of CHEC in a 26-year-old woman which was misdiagnosed as a mullerian mixed tumor in the initial curettage specimen. The clinicopathologic, light microscopic, immunohistochemical features of this tumor are described and the differential diagnosis is discussed.
Efficacy and Safety of Oral Micronized Progesterone That Converts to Allopregnanolone as an Adjunctive Treatment in Refractory Status Epilepticus: A Prospective Interventional Phase IIa Study
Authors: Sithinamsuwan Pasiri , Santimaleeworagun Wichai , Saelim Weerayuth , Samchai Sippanont , Ruttanajirundorn Puntawat , Senngam Marisa , Onsombat Wisithipong , Suphanklang Juthathip
Published: September 2020

Background: We aimed to study the efficacy and safety of allopregnanolone which convert from oral micronized progesterone as an adjunctive treatment for Thai patients with refractory status epilepticus.Methods: Adults 18–80 years old who diagnosed with either convulsive or non-convulsive refractory status epilepticus receiving standard AED treatment, intravenous midazolam, for longer than 60 minutes were included. The intervention group received Utrogestran® (micronized progesterone, 200 mg/capsule) via enteric feeding every 8 h for five days. Treatments for RSE were continuing along the clinical trial period. Serum allopregnanolone levels were measured by radioimmunoassay (DetectX® Allopregnanolone Immunoassay Kit; Arbor Assays, Michigan, United States). Control patients were randomly selected from our hospital RSE cohort during 2015–2019. Continuous data were presented as the mean and standard deviation. Discrete data were assessed by number and percentage. The changes in laboratories were analyzed by paired t-test. The difference between groups were compared by independent sample t-test. The Mann-Whitney U test, Chi-square test or Fisher’s exact test were used for non-parametric parameters. A p-value < 0.05 indicated statistical significance. All analyses were performed using SPSS version 26 software (IBM Corp., Armonk, NY).Results: The average duration of refractory status epilepticus after treatment with midazolam plus progesterone (intervention group) and without progesterone until status epilepticus termination was 25.5 and 58.4 hours, (p = 0.004), indicated that allopregnanolone significantly shortens the refractory status epilepticus duration in vivo.Conclusions: Allopregnanolone, produced from oral micronized progesterone, demonstrates efficacy and safety in treating refractory status epilepticus as an adjunctive treatment.Trial registration: This trial was registered in Thai Clinical Trials Registry (TCTR) database. The trial registration number was “TCTR20200717002”, 16 July 2020, retrospectively registered.
Long-Term Efficacy and Safety of Intravenous Injection of Clonal Mesenchymal Stem Cells Derived From Bone Marrow in Five Adults With Moderate to Severe Atopic Dermatitis
Authors: Shin Hyun-Tae , Lee Si Hyub , Yoon Hee Seong , Heo Ji Hye , Lee Seon Bok , Byun Ji Won , Shin Jeonghyun , Cho Yun-Kyoung , Chung Eunkyung , Jeon Myung-Shin , Song Sun U. , Choi Gwang Seong
Published: September 2020

Atopic dermatitis is a chronic and relapsing inflammatory skin disease that is treated with immunosuppressants. However, long-term use of immunosuppressants may cause toxicity and severe side effects. To confirm the long-term efficacy and safety of clonal mesenchymal stem cell therapy, we performed investigator-initiated clinical trials and long-term observation in five adult patients with moderate to severe atopic dermatitis that was refractory to conventional treatments. The clinical response assessment values such as eczema area and severity index (EASI) improved significantly at 16 weeks, and 80% (4/5) of the patients achieved EASI-50 after one or two treatment cycles. Patients were observed for long-term efficacy and safety for an average of 38 weeks (range: 16–86 weeks) and showed no serious side effects. Among the cytokines tested, CCL-17, IL-13 and IL-22 significantly decreased at the endpoint of the five participants, two patients who maintained good clinical response over 84 weeks showed increased IL-17 cytokine levels in the blood.
Functional drug–target–disease network analysis of gene–phenotype connectivity for curcumin in cancer
Authors: Zhao Yuanyuan , Tao Jiahao , Chen Zhuangzhong , Li Suihui , Liu Zeyu , Lin Lizhu , Zhai Linzhu
Published: September 2020

Background

The anti-tumor properties of curcumin have been elucidated in many cancer types. However, a systematic functional and biological analysis related to its target proteins has yet to be documented fully. The aim of this study was to explore the underlying mechanisms of curcumin and broaden the perspective of targeted therapies.
Methods

Direct protein targets (DPTs) of curcumin were searched in the DrugBank database. Using the STRING database, the interaction between curcumin and DPTs and indirect protein targets (IPTs) was documented. The protein–protein interaction (PPI) network of curcumin-mediated proteins was visualized using Cytoscape. The Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was performed for all curcumin-mediated proteins. Furthermore, the cancer targets were searched in the Comparative Toxicogenomics Database (CTD). The overlapping targets were studied using Kaplan–Meier analysis to evaluate cancer survival. Further genomic analysis of overlapping genes was conducted using the cBioPortal database. Lastly, CKK-8, qPCR, and WB analysis were used to validate the predicted results on HCC cells.
Results

A total of 5 DPTs and 199 IPTs were found. These protein targets were found in 121 molecular pathways analyzed via KEGG enrichment. Based on the anti-tumor properties of curcumin, two pathways were selected, including pathways in cancer (36 genes) and hepatocellular carcinoma (HCC) pathway (22 genes). Overlapping with 505 HCC-related gene sets identified in CTD, five genes (TP53、 RB1、 TGFB1、 GSTP1、 and GSTM1) were finally identified. High mRNA levels of TP53, RB1, and GSTM1 indicated a prolonged OS in HCC, while elevated mRNA levels of TGFB1 were correlated with poor prognosis. The viability of HepG2 cells and Hep3B cells can both be significantly reduced by curcumin at concentrations of 20 or 30 µM after 48 or 72 h of culture. At a concentration of 20 µM curcumin, the expression of TGFB1 and GSTP1 in Hep3B cells was reduced significantly in qPCR analysis, and reduced TGFB1 protein expression was also found in Hep3B cells.
Conclusions

The current results provided evidence that curcumin has the potential to become an alternative chemotherapy or chemoprevention for HCC.
Adapted Diving Mask Bench Tests as an Autonomous Respiratory Support in Healthy Volunteer
Authors: Arias-Arcos Beatriz , Collado-Escudero Carlos , Candelario-Cáceres Ariela , Buendia-García Maria Jesus , Abad-Gurumeta Alfredo , Mendiguren-Santiago Jose María , Larrainzar-Garijo Ricardo
Published: September 2020

PurposeThe scenario of global health crisis due to SARS-CoV-2 pandemia combined with the shortage of resources in many countries has justified numerous studies to design easily replicable and economic respiratory support devices. We have developed an adapted diving mask (ADM) to be used as an autonomous and safe respiratory support. The objective was to prove a minimum positive end expiratory pressure (PEEP) with the ADM without any adverse events.MethodsBench tests was done in 22 healthy volunteers with our ADM prototype. Expiratory-inspiratory flow and pressure were registered apart from blood and transcutaneous hypercapnia.ResultsThere were no statistically significant differences in the baseline analysis results and after therapy, except in pO2. Mean PEEP measured was 8.2 ± 4.2 cmH2O with a peak measured pressure of 20 cm H2O.ConclussionsThe ADM has shown good tolerance and a therapeutic manteining PEEP with no evidence of any deletereous effect or hypercapnia with its continuous use.
The Effect of Entrepreneurial Orientation on Business Performance: A Comparative Study of Necessity and Opportunity Entrepreneurs by Gender
Authors: Ndikubwimana Jean Bosco , Mukasekuru Alice , Ndizeye Idrissa , Mutesi Josephine , Byukusenge Eugenie
Published: September 2020

Entrepreneurship is known, contribute to the economic growth locally as well as globally. To make entrepreneurship play its economic role, entrepreneurs are oriented by different factors and perform differently in their business. This lead the researchers to investigate the entrepreneurial orientation considering necessity and opportunity factors among women and men business owners and their owned businesses in Huye District. This was done to find out the effect of such orientation on their business performance and to examine the significance of cross-gender differences with regard to the variables under study. For achieving the above objectives; structured questionnaire and documentary review techniques were used to collect data. From total population of 1787 business owners identified from 11 sectors in Huye District, researchers sampled 327 respondents. Random and convenience sampling techniques were used. The results showed that both males and females are more opportunity oriented than necessity oriented. Study shows that business owned by males perform better than business owned by females regarding both financial and non-financial performance aspects. It was also found out that there are no significant differences in both levels of entrepreneurial orientation and business performance across gender. Correlation analysis revealed a significant relationship between entrepreneurial orientation of women and men business owners and their business performance. Based on these findings, it recommends that the Government of Rwanda (GoR) should focus training and sensitization for women to increase their involvement in business and improve the performance of existing women business owners. Improving entrepreneurship program by MINEDUC should also be given consideration especially at primary and secondary levels/educations to prepare potential entrepreneurs.
Analysis of Radiographic Spinopelvic Parameters in Patients With Degenerative Lumbar Kyphoscoliosis
Authors: Rile Ge , Yang Peng , Liu Xin , Wen Bingtao , Guo Zhaoqing , Chen zhongqiang
Published: September 2020

Purpose: To analyze the relationships between coronal and sagittal spinopelvic parameters in degenerative lumbar kyphoscoliosis (DLKS).Methods: We enrolled 75 patients with DLKS for a radiographic study between January 2016 and September 2018. Correlations between coronal and sagittal spinopelvic radiographic parameters were analyzed. Then patients were divided into two groups: sagittal balanced group (SVA<= 5cm, 30 patients) and sagittal imbalanced group (SVA> 5cm, 45 patients), and relevant parameters were compared.Results: The Cobb angle and lumbar lordosis of the DLKS patients were 24.87 ± 11.59° and 17.26 ± 12.24°, respectively. The average age was 68 years old (range: 42-82), and the sex ratio was 2.6:1 (female:54 patients; male: 21 patients). 50 patients (66.7%) located convexity of the curve at left side, while 25 patients (33.3%) at right side. The Cobb angle correlated with LL-TK (r = -0.228, p = 0.049), LL (r = -0.255, p = 0.027) and SS (r = -0.232, p = 0.045). There were significant differences in PI-LL (t = -3.484, P = 0.001), LL-TK (t = 2.354, P = 0.023), PI (t = -3201, P = 0.002) and PT (t = -2.521, P = 0.014) between sagittal balanced and imbalanced group. Conclusions: In degenerative lumbar kyphoscoliosis, there are some correlations between coronal and sagittal spinopelvic parameters. Moreover, PI-LL, LL-TK, PI, PT were significantly different between sagittal balanced and imbalanced DLKS patients.
The clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome: a systematic review and meta-analysis
Authors: Li Yan , Liang Xiying , Zhang Wenjiao , Qiao Xuan , Wang Zhilu
Published: September 2020

Background

Optimal stent deployment is closely related to the prognosis of patients with coronary artery disease, but the effect of post-dilation on clinical and angiographic outcomes in patients with acute coronary syndrome is still controversial. This meta-analysis aims to analyze the clinical and angiographic outcomes of post-dilation after percutaneous coronary intervention in patients with acute coronary syndrome.
Methods

PubMed, Embase, The Cochrane Library, Web of Science, CNKI and WANGFANG date-bases were searched from inception to August 30, 2020. Eligible studies from acute coronary syndrome patients treated with post-dilation were included. The primary clinical outcome was major adverse cardiovascular events (MACE), the secondary clinical outcomes were comprised of all-cause death, stent thrombosis, myocardial infarction, and target vessel revascularization, the angiographic outcomes were no reflow and slow reflow.
Results

A total of 11 studies enrolling 5663 patients met inclusion criteria. Our pooled analysis demonstrated that the post-dilation did not have significant impact on MACE (OR = 0.76, 95% CI 0.50–1.17; P = 0.21), stent thrombosis (OR = 0.71, 95% CI 0.40–1.26; P = 0.24), myocardial infarction (OR = 0.14, 95% CI 0.51–3.83; P = 0.51), and target vessel revascularization of clinical outcomes (OR = 0.61, 95% CI 0.21–1.80; P = 0.37) between post-dilation and non-post-dilation groups, but increased the risk of all-cause death (OR = 1.49, 95% CI 1.05–2.19; P = 0.03). There were no significant difference in no reflow (OR = 1.19, 95% CI 0.54–2.65; P = 0.66) and slow reflow (OR = 1.12, 95% CI 0.93–1.35; P = 0.24) of angiographic outcomes between two groups.
Conclusions

The post-dilation can increase the risk of all-cause death, without affecting the risks of MACE, stent thrombosis, myocardial infarction, target vessel revascularization, no reflow and slow reflow. However, more randomized controlled trials are required for investigating the benefits of post-dilation for patients with acute coronary syndrome (Registered by PROSPERO, CRD42020160748).
Health-Related Quality of Life of Military Policemen in Salvador, Brazil: Cross-Sectional Study.
Authors: Barreto Carla Requião , Carvalho Fernando Martins , Lins-Kusterer Liliane
Published: September 2020

Background: Brazil is a violent society and police officers play a fundamental role in this scenario. Police work is a stressful occupation. Dealing with routine violence, police officers must have high standards of physical and mental health. Patrolling the streets involves several risks and stressful situations that may hamper military policemen's quality of life. This study aimed to identify factors associated with health-related quality of life in military policemen. Methods: A cross-sectional design study investigated a random sample of 329 male military police officers, engaged in patrolling the streets of Salvador, Bahia, Brazil. A structured questionnaire was applied to the policemen during their working hours. Information was collected about age, education, marital status, housing, car ownership, police rank, working day, alcohol consumption, smoking, frequency of vigorous physical activity and weight and height, in order to calculate body mass index. Health-related quality of life was evaluated through the 36-Item Short Form Survey Questionnaire (SF-36). Work ability was assessed through the Work Ability Index questionnaire. Poor work ability was defined by a Work Ability Index 7-27 points. Multivariable linear regression models were used to measure the impact of police officer characteristics on variation in the Physical Component and Mental Component Summary scores.Results: Normalised scores were below 50.0 for seven out of the eight SF-36 domains and for the two component summaries. The SF-36 Physical Component Summary was associated with poor work ability, while the Mental Component Summary was associated with poor work ability, excessive alcohol consumption, and younger age. Poor work ability affected 10.3% of the workforce. Decreases of 7.363 units (%) in the Physical Component Summary mean and of 12.862 units (%) in the Mental Component Summary mean were estimated for policemen with poor work ability.Conclusions: The military police officers investigated presented poor health-related quality of life, associated with younger age, excessive alcohol consumption, and poor work ability, which may hamper the performance of their professional activities.
The outcomes of Ilizarov treatment in aseptic nonunions of the tibia stratified by treatment strategies and surgical techniques
Authors: Szelerski Łukasz , Kozłowska Andżelika Pajchert , Żarek Sławomir , Górski Radosław , Małdyk Paweł , Morasiewicz Piotr
Published: September 2020

INTRODUCTIONNonunions of the tibia, particularly those located in the distal third of the bone, are relatively common in clinical practice. There is no gold standard for the treatment of nonunions of the tibia. The purpose of our study was to assess the results of treatment with the Ilizarov method in patients with aseptic nonunions of the tibia, depending on the employed treatment strategies and surgical techniques.MATERIALS AND METHODSA total of 75patients with Ilizarov treatment of aseptic nonunions of the tibia were evaluated in the study. The patients’s mean age at the beginning of treatment was 46years.The mean follow-up period was 10years and 11months.The evaluated patients underwent either closed technique or open technique. The operators used one of two treatment strategies: neutral fixation without compression or continued compression.The following were assessed: rates of union, ASAMI bone scores, ASAMI functional scores, treatment time, complications, duration of hospital stay.RESULTS: Bone union was achieved in all of the75evaluated patients. The results of most analyses showed no significant differences in the assessed variables, except for the ASAMI functional scores, which were higher in the group of patients who underwent closed surgery (Me=6.00vs.Me=4.00).DISCUSSIONWe observed better ASAMI functional score outcomes in the patients who underwent closed fixation than in the open fixation group.The different surgical techniques and treatment strategies had no effect on the number of complications, rates of bone union,length of hospital stay,duration of Ilizarov treatment,or ASAMI bone scores.For managing nonunions of the tibia we recommend the technique of closed fixation without continued compression.The Ilizarov method in the treatment of nonunions of the tibia gives good outcomes.Level of EvidenceDiagnostic Level IV
Association Between Serum High-Density Lipoprotein Cholesterol Concentration and Mortality in Critically Ill Patients: A Retrospective Cohort Study
Authors: Guo Xu , Xu Zhiyu , Qu Hengxing , Woods Ryan Charles , Njobvu Eunice , Zhou Zhongyi , Xie Xiaohong , Tian Jia
Published: September 2020

Background This research aims to explore the association between serum high-density lipoprotein cholesterol (HDL-C) and mortality in patients who are critically ill. MethodsThis was a retrospective cohort study. Data were extracted from an online database named ‘Multiparameter Intelligent Monitoring in Intensive Care III (MIMIC III)’. 3384 patients were included, 967 septic patients and 1380 patients with acute kidney injury (AKI) were screened from all the patients included. The association between HDL-C and hospital mortality in all patients, septic patients and AKI patients was evaluated using HDL-C as a design variable.Results Serum HDL-C (42.4±18.0 VS 45.0±15.2, P<0.001) concentration was significantly lower for non-survivors than survivors. An arc-shaped relationship between HDL-C and mortality was found for the whole group of patients and the AKI subgroup of patients with inflection point at around 30mg/dL; for septic patients, this relationship became ‘U’-shaped with inflection points at around 30mg/dL and 60mg/dL, respectively. Low HDL-C was associated with increased hospital and ICU mortality, longer ICU length of stay (LOS) and hospital LOS compared with medium HDL-C level for all included patients (p<0.01, all) while the differences between high HDL-C and medium HDL-C group were statistically nonsignificant. Similar patterns were found among AKI subgroup of patients. For the sepsis subgroup, low HDL-C group also showed higher hospital and ICU mortality rate (p<0.001, p=0.002, respectively); however, low HDL-C group did not show longer ICU LOS or hospital LOS. Multivariate logistic regression models showed only low HDL-C(<30mg/dL) were associated with increased hospital mortality in all three models(model 1 OR: 1.44, 95% CI 1.05 to 1.97, p=0.022 ; model 2 OR: 1.51, 95% CI 1.01 to 2.27, p=0.044; model 3 OR: 1.69, 95% CI 1.15 to 2.49, p=0.007). In all three models, age, mechanical ventilation use, Sequential Organ Failure Assessment (SOFA) score and Elixhauser comorbidity score were positively associated with mortality.Conclusions Low HDL-C is associated with increased mortality in patients who are critically ill.
Potential Mechanism of Guizhi Decoction in Hypertension Treatment Based on Network Pharmacology and Dahl Salt-Sensitive Rat Model
Authors: Chen Ji-ye , Zhang Yong-jian , Wang Yong-cheng , Zhou Guo-feng , Li Xiao
Published: September 2020

Background

Guizhi decoction (GZD), a classical Chinese herbal formula, has been widely used to treat hypertension, but its underlying mechanisms remain elusive. The present study aimed to explore its therapeutic effects and potential mechanisms in the treatment of hypertension using network pharmacology and experimental validation.
Methods

The active ingredients and corresponding targets were collected from Traditional Chinese Medicine Systems Pharmacology database and Analysis Platform (TCMSP). The targets related to hypertension were identified from multiple databases, and multiple networks were constructed to identify key compounds, hub targets, and main biological processes and pathways of GZD against hypertension. The Surflex-Dock software was used to validate the binding affinity between key targets and their corresponding active compounds. The Dahl salt-sensitive rat model was used to evaluate the therapeutic effects of GZD on hypertension.
Results

A total of 112 active ingredients, 222 targets of GZD and 341 hypertension- related targets were obtained. Furthermore, 56 overlapping targets were identified, five of which were determined as the hub targets to perform experimental verification, including interleukin 6 (IL-6), C-C motif chemokine 2 (CCL2), IL-1β, matrix metalloproteinase 2(MMP-2), and MMP9. Pathway enrichment
Co-expression Network Identification and Clinical Prognostic Evaluation of Hub Genes in Head and Neck Squamous Cell Carcinoma
Authors: Feng Jialian , Han Baoai , Yu Chaosheng , Shen Congxiang , Wen Zhong
Published: September 2020

Background: According to statistics, even with active treatment, the recurrence rate of HNSCC is at 40%-50%. Head and neck cancer remains a challenge for otolaryngologists. Therefore, the identification of new biomarkers is an urgent need for the diagnosis, treatment, and prognosis of malignant tumors of the head and neck. Methods: In this study, transcriptome data from The Cancer Genome Atlas (TCGA) database and the Gene Expression Omnibus (GEO) database were used to identify differentially expressed genes (DEGs). Weighted gene co-expression network analysis (WGCNA) was performed to identify gene modules and hub genes related to head and neck squamous cell carcinoma (HNSCC). Protei-Protei interaction(PPI) network and Cytoscape software were used to analyze the protein interaction network. HNSCC clinical data from the TCGA and Gene Expression Profile Interactive Analysis 2 databases were used to analyze the survival rate of hub genes, and the correlation between hub genes and tumor stage was further analyzed.Results: A total of 2836 and 570 DEGs were identified from the TCGA expression data and GEO gene chip datasets, respectively. We found that the green module had the highest correlation with HNSCC. A total of 15 hub genes were also identified. In the Human Protein Atlas database, we found that thioredoxin reductase 1 (TXNRD1) was overexpressed in HNSCC tumors compared with normal tissues at the transcriptional level. Survival analysis also suggested that TXNRD1 was a poor prognostic factor for HNSCC.Conclusion: Our results indicate that TXNRD1 is very likely to be identified as a potential biomarker and target for HNSCC. However, further research is required to fully reveal its role in HNSCC pathogenesis as well as its value as a prognostic biomarker.
High Nuclear Expression of Yes-Associated Protein 1 (YAP1) Correlates with Metastasis in Patients with Breast Cancer
Authors: Cha Yoon Jin , Bae Soong June , Kim Dooreh , Ahn Sung Gwe , Jeong Joon , Koo Ja Seung , Yoo Tae-Kyung , Park Woo-Chan , Lee Ahwon , Yoon Chang Ik
Published: September 2020

Background: Yes-associated protein 1 (YAP1) is a transcription factor regulated by the Hippo pathway and functions as an oncogene in various solid tumors under dysregulated Hippo pathway. However, the role of YAP1 in breast cancer is controversial. Here, we investigated the impact of different levels of nuclear YAP1 expression on the clinical characteristics and survival outcome of patients with breast cancer.Patients and Methods: Retrospectively obtained 469 breast tumor samples at the Gangnam Severance Hospital were examined for YAP1 expression by immunohistochemistry, and the clinical data were analyzed. External validation was performed using a retrospective cohort and tissues in 489 patients from Severance Hospital.Results: High nuclear YAP1 expression was associated with hormone receptor negativity and aggressive tumor behavior, including lymph node metastasis, high Ki67 labeling index and inferior distant metastasis-free survival (DMFS), and also confirmed in external validation cohort. In patients with triple-negative breast cancer (TNBC), high nuclear YAP1 expression was an independent significant determinant of poor DMFS (HR 1.947, 95% CIs 1.003-3.779, P=0.049).Conclusion: Our findings suggest that nuclear YAP1 expression is a biomarker of adverse prognosis and a potential therapeutic target in patients with breast cancer, especially in TNBC.
Common Causes of Chest Pain in the Emergency Department of Orotta National Referral Hospital, Asmara, Eritrea
Authors: Berhe Selam , Amanuel Naemi
Published: September 2020

BackgroundChest pain is one of the common causes of visits to the emergency department. However, there is scarcity of studies on the causes and prevalence of this common symptom in Eritrea. This retrospective descriptive study was done to determine the prevalence, causes, clinical features, demographics, diagnostic modality and outcome of all patients with the chief complaint of chest pain who presented to the ED of Orotta national referral hospital in Eritrea and the association of demographic characters, diagnostic modality, and clinical features with final diagnosis and outcome.MethodsAfter securing approval by Ministry of Health ethical and research committee, Clinical Service Division and from Orotta National Referral Hospital in Asmara Eritrea, Records of patients 15 years and older presenting with the complaint of chest pain from 1st January 2018 through 31st December 2018 were assessed. A sample of patients who presented with chest pain and did ECG were also included. All data were collected in Microsoft excel software, cleaned and then analyzed using Statistical Package of Social Sciences (SPSS) software version 20.Results855 patients presented with chest pain to the emergency department, out of which 798 patient files were retrieved. Respiratory disease was the most common cause 441(51.6%), with pneumonia the most common diagnosis 415 (94.1%) followed by cardiac cause at 234( 27.4%).Out of the study population 253 study sample were taken with inclusion criteria of those who did an ECG. In these study samples the most common cause was cardiovascular 149(58.9%) out of which the most common illness was ST elevation myocardial infarction 60(23.7%). Out of 253 patients who did electrocardiogram 230(90.9%) were discharged and 23(9.1%) died. 6(26%) of those who died were smokers and 13(56.5%) of those who died were above 69 years old.ConclusionThe main cause of chest pain was found to be respiratory disease, followed by cardiovascular disease in the population study, which was reversed in the sample study (those who did ECG). Age and Smoking were found to affect the prognosis. There were highest mortality rates in STEMI and pulmonary embolism.
The Incidence, Risk Factors and Outcomes of Acute Kidney Injury in Critically Ill Patients Undergoing Emergency Surgery: A Prospective Observational Study
Authors: Hu Linhui , Gao Lu , Zhang Danqing , Hou Yating , Deng Yujun , Fang Heng , Zhang Huidan , He LinLing , Liang Yufan , Xu Jing , Chen Chunbo
Published: September 2020

BackgroundPostoperative acute kidney injury (AKI) is associated with higher morbidity, mortality, and economic burden. However, there is a lack of evaluation of postoperative AKI in highly heterogeneous critically ill patients undergoing emergency surgery. To explore the incidence, risk factors, and prognosis, to clarify the epidemiological status, and to improve the early identification and diagnosis of postoperative AKI, this study was taken.MethodsA prospective observational study was conducted in the general intensive care units of Guangdong Provincial People's Hospital from January 2014 to March 2018. Preoperative variables, intraoperative variables, postoperative variables, and postoperative prognosis data were collected. The diagnosis and staging of postoperative AKI were based on the Kidney Disease: Improving Global Outcomes criteria. They were divided into two groups according to whether postoperative AKI occurred: AKI group and non-AKI group. The baseline characteristics, postoperative AKI incidence, AKI stage, and in-hospital prognosis in all enrolled patients were analyzed prospectively. Multivariate logistic forward stepwise (odds ratio, OR) regression was used to determine the independent risk factors of postoperative AKI. Results were presented using the OR with 95% confidence intervals (CIs).ResultsA total of 383 critically ill patients undergoing emergency surgery, 151 (39.4%) patients among them developed postoperative AKI. Postoperative reoperation, postoperative Acute Physiology and Chronic Health Evaluation (APACHE II) score, postoperative serum lactic acid (LAC), postoperative serum creatinine (sCr) were independent risk factors for postoperative AKI in critically ill patients undergoing emergency surgery, with the adjusted OR (ORadj) of 1.854 ( 95% CI, 1.091 - 3.152), 1.059 ( 95% CI, 1.018 - 1.102), 1. 239 (95% CI, 1.047 - 1.467), and 3.934 (95% CI, 2.426 - 6.382), respectively. Duration of mechanical ventilation, renal replacement therapy, ICU and hospital mortality, ICU and hospital length of stay, total ICU and hospital costs were higher in the AKI group than in the non-AKI group.ConclusionsThe independent risk factors which included postoperative reoperation, postoperative APACHE II score, postoperative LAC, and postoperative sCr could improve the early diagnosis and prevention of postoperative AKI and identify the higher risk of adverse outcomes in critically ill patients undergoing emergency surgery.
A Nano-Platform for in situ Investigations of Ovarian Follicles
Authors: Feugang Jean M. , Ishak Ghassan , Eggert Matthew , Arnold Robert , Willard Scott , Ryan Peter , Gastal Eduardo
Published: September 2020

Background: Despite the growing array of assisted reproductive techniques, there is still a lack of rapid, non-cytotoxic, and minimally invasive in situ approaches for further enhancements through cell targeting. Here we synthesized clinically relevant liposome nanoparticles for real-time cellular targeting and drug (doxorubicin) delivery, using pigs and mares as animal models. In Experiment 1, fluorescently labeled and doxorubicin-loaded (without fluorescent probe) liposomes were injected in cultured pig ovarian follicles to assess plasma membrane binding and intracellular doxorubicin delivery. In Experiment 2, fluorescent liposomes were in vivo injected into small and large ovarian follicles of living mares to assess their binding capability to follicular cells. Twenty-four hours post-injection, all cultured pig follicles were collected while mare samples (i.e., follicle wall fragments, granulosa cells and follicular fluids) were harvested through follicle wall biopsy (FWB), and follicle aspiration and flushing techniques using transvaginal ultrasound-guided approach.Results: All injected follicles were healthy and samples were subjected to fluorescence imaging before and after fixation. Findings revealed successful intrafollicular migration and binding of liposomes to all follicle cell layers (granulosa, theca interna, and theca externa) regardless of the follicle size. The intracellular delivery of doxorubicin was confirmed with the staining of nuclei of follicle cells. Conclusions: This study demonstrates the promising combination of the FWB technique and nanotechnology tools for real-time monitoring of intrafollicular treatment, follicular health and oocyte development, which in turn has the potential to help understand the mechanisms of ovulatory dysfunction and to select high-quatity oocytes for assisted reproduction techniques.
Biomechanical Effects of Position-Loading During Cervical Rotatory Manipulation: A Finite Element Analysis
Authors: Wang Huihao , Zhan Hongsheng , Wang Kuan , Deng Zhen , Li Xiaofei , Yu Zhongxiang
Published: September 2020

Background: Cervical rotatory manipulation(CRM) is one of the most common treatments for neck pain in China. This study utilized a finite element method (FEM) to model the biomechanical effects of positioning during CRM in a normal sitting position. Methods: Passive head kinematics data, including angular displacement in six directions, were recorded. These data were then imported and a finite element model constructed, then validated. Relative angular displacements, and stress on the intervertebral discs and articular surfaces were calculated in a standard symmetry model (SSM) and compared with a pathological model (PM).Results: The results indicate that the intervertebral disc pressure (IDP) at the C2-C3, C3-C4 and C4-C5 discs subjected to CRM with position-loading were lower than the pressures experienced without position-loading. Furthermore, IDP on the target C5-C6 segment during CRM with position-loading in the PM was lower than that without position-loading, the former being close to the IDP of the C5-C6 segment during CRM without position-loading in the SSM. The left articular surface contact pressure of the target C5-C6 segment subjected to CRM towards the right without position-loading in the PM was slightly lower than that of the right articular surface experiencing leftward manipulation and lower than that predicted by the SSM. However, contact pressure of the C5-T1 segment in leftward CRM with position-loading in the PM and C6-T1 in rightward CRM with position-loading in the PM were significantly higher than the standard threshold, especially for contact pressure on the articular surfaces of C5-C6 in leftward CRM with position-loading in the PM. Conclusions: CRM should be considered a promising strategy to mitigate neck pain in patients.
Implementation, Spread and Impact of the Patient Oriented Discharge Summary (Pods) Across Ontario Hospitals: A Mixed Methods Evaluation
Authors: Hahn-Goldberg Shoshana , Huynh Tai , Chaput Audrey , Krahn Murray , Rac Valeria , Tomlinson George , Matelski John , Abrams Howard , Bell Chaim , Madho Craig , Ferguson Christine , Turcotte Ann , Free Connie , Hogan Sheila , Nicholas Bonnie , Oldershaw Betty , Okrainec Karen
Published: September 2020

BACKGROUNDTraditional discharge processes lack a patient-centred focus. This project studied the implementation and effectiveness of an individualized discharge tool across Ontario hospitals. The Patient Oriented Discharge Summary (PODS) is an individualized discharge tool with guidelines that was co-designed with patients and families to enable a patient-centred process. METHODSTwenty one acute-care and rehabilitation hospitals in Ontario, Canada engaged in a supported community of practice and worked over a period of 18 months to implement PODS. An effectiveness-implementation hybrid design using a triangulation approach was used with hospital-collected data, patient and provider surveys, and interviews of project teams. Key outcomes included: reach within and spread outside target populations, change in patient-centred processes, patient and provider experience, understanding of discharge instructions, and healthcare utilization. Statistical methods included linear mixed effects models and generalized estimating equations. RESULTSOf 65,221 discharges across hospitals, 41,884 patients (64%) received a PODS. There was variation in reach and implementation pattern between sites, though none of the between site covariates was significantly associated with implementation success. Both high participation in the community of practice and scoring highly on quality of PODS were associated with higher implementation success. PODS improved family involvement during discharge teaching (7% increase, p=0.026), use of teach-back (11% increase, p<0.001) and discussion of help needed (6% increase, p=0.041). Although unscheduled healthcare utilization decreased with PODS implementation, it was not statistically significant.CONCLUSIONSThis project highlighted the system-wide adaptability and ease of implementing PODS across multiple patient groups and hospital settings. PODS demonstrated an improvement in patient-centred discharge processes linked to quality standards and health outcomes. A community of practice and high quality content may be needed for successful implementation.