bluuebunny/crossref_metadata_2025 huggingface dataset:
Original Paper Relationships Between Indices of Arm Anthropometry, Bioimpedance, and Laboratory in Maintenance Hemodialysis Patients
Authors: Wang Jenn-Yeu , Chen Shu- Chin , Hwang Betau
Published: August 2020

Background Maintenance hemodialysis patients often experience protein- calorie malnutrition. Our aim is to evaluate the independent prediction accuracy of bioelectrical impedance analysis derived variables by the measurements of upper arm anthropometry and clinical laboratory indexes for evaluation of nutritional status of hemodialysis patients. Furthermore, the relationship between measurements of upper arm anthropometry and clinical laboratory indexes and cross –sectional evaluation of the prevalence of malnutrition with the use of the norms and thresholds were done. Methods In a cross- sectional survey of 32 stable hemodialysis patients (aged 28 to 82 years) in hemodialysis unit of Taipei Municipal Zhongxiao Hospital, we evaluated measurements of upper arm anthropometry with measurements of single frequency bioelectrical impedance analysis and clinical laboratory indexes. Results The comparisons between measurements of upper arm anthropometry with measurements of single frequency bioelectrical impedance analysis and some of clinical laboratory indexes were statistically significant. This study further found that both mid-arm fat area and triceps skin-fold thickness were independent contributors to percent fat mass after adjustment for body mass index and gender in the multiple regression models. This study also demonstrated that mid-arm muscle circumference, or mid-arm muscle area, or corrected mid-arm muscle area independently predicted height normalized indices of fat-free mass respectively after adjustment for body mass index and gender in the multiple regression models. The prevalence of protein wasting measured by mid-arm muscle circumference (50%) appears to be equivalent to that measured by serum albumin concentration (50%). Conclusions Mid-arm muscle and fat variables by upper arm anthropometry correlated with nutritional variables of single frequency bioelectrical impedance analysis and clinical laboratory indexes. Mid-arm muscle and fat variables by upper arm anthropometry were independent predictors of body composition regarding height-normalized indices of fat-free mass and percent fat mass of hemodialysis patients even after adjustment of gender and BMI.
Definition, classification and morphometry of entrance of the bicipital groove and its associations with lesions of adjacent structures
Authors: Yuan Shiguo , Zou Yucong , Zheng Kai , Huang Xuecheng , Zhang Zhiwei , Gao Yanping , Li Yikai , Bai Xiaochun
Published: August 2020

Background

The definition of the entrance of the bicipital groove (EBG) is still unclear, and the relationships between the EBG and lesions of the long head of the biceps brachii tendon (LBT) and biceps pulley complex (BPC) have long been controversial. The purpose of this anatomic and imaging study was to define the EBG and to examine morphological parameters, classifications, and their relationships with lesions of the LBT and BPC.
Methods

One hundred thirteen unpaired intact dry humeri, 34 cadaveric shoulder specimens and 278 shoulder images were collected, measured, and classified based on morphological characteristics. Soft tissue and bony landmarks of the EBG were classified into different types. The relationships between the types and lesions of the LBT and BPC were analyzed through an anatomic and imaging study.
Results

Type II, type A and type i of the EBG and type b of the adjacent articular surface accounted for most of the dry humeri, cadavers, and images. Based on the EBG classification in the superoinferior image view, all of the subluxations and dislocations were classified as type B (61/120, 50.83%; χ2 = 16.55, P < 0.001), and most LBT and BPC lesions were type B (65/117, 55.56%; χ2 = 26.05, P < 0.001). LBTs were injured in (χ2=, P < 0.001) 83.56% of type B, 100% of type C, and 95.83% of type iii EBGs (χ2 = 135.69, 31.89, all P < 0.001). Similarly, BPCs were injured in 89.04% of type B and 93.10% of type C EBGs (χ2 = 153.14, P < 0.001), while BPCs were injured in 95.8% of type iii EBGs (χ2 = 33.79, P < 0.001).
Conclusions

The EBG is an anatomical concept worthy of clinical attention. Anatomical variations in the EBG correlated with lesions of the LBT and BPC. LBT and BPC lesions correlated with type B and C EBGs by imaging analysis.
Combining Targeted IASTM Applications and Neuromuscular Exercises can Correct forward Head Posture and Improve Functionality of Patients with Mechanical Neck Pain: A Randomized Control Study
Authors: Mylonas Konstantinos , Angelopoulos Pavlos , Billis Evdokia , Tsepis Elias , Fousekis Konstantinos
Published: August 2020

Backround: The purpose of this study was to evaluate the short- and long-term effects of the combined application of instrument-assisted soft tissue mobilization (IASTM) techniques, and neuromuscular exercises of the cervical and thoracic area on the improvement of the functionality of patients with mechanical neck pain and accompanying forward head posture (FHP).Methods: Twenty patients with neck pain and FHP were randomized and received eight treatment sessions of either targeted IASTM in combination with neuromuscular exercises (Group A), or classical massage and the same set of exercises (Group B). The cervical vertebral angle, cervical range of motion (ROM) and strength, and pain and disability were measured throughout the treatment period and in the two and four week post-treatment period.Results: The combined application of IASTM and neuromuscular exercise (Group A) contributed to a significant improvement in FHP and disability. Both interventions improved cervical ROM and strength in the short term. Pain was also improved for both groups in both short and long term.Conclusions: Combining IASTM and exercises for the cervical and thoracic area can induce positive postural adaptations and improve the neck pain patient's functional status.Trial registration: ISRCTN, ISRCTN54231174. Registered 19 March 2020 - Retrospectively registered, https://doi.org/10.1186/ISRCTN54231174
Insert Nails When Flexing the Knee in the Femoral Fracture External Fixation: A Technical Report
Authors: Wang Jinkui , Wang ZhongLiang , Qin JiaQiang , Nan Guoxin , Su Yuxi , He Bo , Cai Wenquan , Chen Kai , Gu Kai , Niang Xun , Yan Ge
Published: August 2020

Background: The application of external femoral fixation techniques often causes complications of knee flexion dysfunction. We report on technical modifications in the complications of external femoral fixation leading to knee flexion disorders.Methods: We flexed the knee joint 90 degrees during the operation, and then placed the external fixation nail. A retrospective review was performed for all patients undergoing repair by this technique. Results: A total of 52 children with femoral shaft fractures were included, the flexion of the knee joint measured at the time of discharge was 80 degrees (70-90 degrees) on average; when the external fixation is removed, the knee flexion can reach an average of 95 degrees (90-115 degrees), no children have stiff knees.Conclusion: This technique is simple and easy to implement, and it is worthy of popularization and application in clinical practice.
Association Between Specific Indoor Air Pollutants and Pneumonia Episodes in Children Under Five in Abuja, Nigeria: A Case-control Study
Authors: Adaji Enemona Emmanuel , Clifford Michael , Gibson Jack , Breton Magdalena Opazo , Phalkey Revati
Published: August 2020

Background: Pneumonia causes most death in children under five globally. Indoor air pollution has been reported to increase the risk of children to pneumonia. ObjectiveTo investigate the association between specific indoor air pollutants and pneumonia episodes in children under five.MethodsUsing a case-control study design, we compared exposure of cases and controls to specific pollutants (PM2.5, CO, BC and PM1), using battery operated aerosol monitors. Data was analysed using Wilcoxon signed-rank test.ResultsThe mean PM2.5 was higher in controls compared to cases. PM2.5 highest mean recorded for controls was 177 µg/m3. There was a significant difference between cases and controls for 10 hours (p-value 0.0147), 15 hours (p-value 0.0111) and 20-24 hours (p-value 0.0296) for PM2.5. No significant difference in CO concentration between cases and controls, the highest CO mean concentration recorded being 2930 µg/m3. Similarly, PM1 was consistently higher in controls compared to cases. However, this difference was not significant from exposure to PM1 between cases and controls (P-value>0.05), with the highest PM1 mean concentration recorded being 91 µg/m3. There was a significant difference (p-value 0.0260) in exposure to Black Carbon between cases and controls. BC was higher in households of cases compared to controls, with the mean average of BC for cases 4350 µg/m3 and controls 4126 µg/m3. In this study, BC is positively associated with a pneumonia episode. We also report the importance of unmodifiable and behaviourally modifiable factors on pneumonia episode in children.Discussion: In conclusion, we show that children present during cooking, number of available windows and MUAC increased the likelihood of a pneumonia episode. We recommend household level behaviour changes and targeted IMCI including early effective detection and treatment of childhood pneumonia particularly in high pollution areas in Nigeria.
Estimating and forecasting the spread of COVID-19 in South Korea: A Bayesian SIHR-based dynamic model with non-pharmaceutical interventions
Authors: Choi Hyunho , Kang Dayun , Lee Unkyoung , Kim Jong-Hun , Choi Sungwha , Choi Jungsoon
Published: August 2020

Background: As of May 22, 2020, the total number of confirmed COVID-19 cases is over 5 million worldwide and more than 300 thousand people have lost their lives to the virus. South Korea also experienced a sharp increase in late February, but owing to non-pharmaceutical interventions, the number of confirmed cases has been decreasing since March. In this study, we aimed to investigate the transmission dynamics with these effects as well as forecast the spread of COVID-19 in South Korea, using a flexible statistical model.Methods: We analyzed the COVID-19 data obtained at the Korea Centers for Disease Control and Prevention from Feb 18 to April 30. Using a Bayesian susceptible-infectious-hospitalized-removed (SIHR) dynamic model, we estimated the dynamic transmission rate considering the non-pharmaceutical intervention effects and forecast the confirmed cases.Results: The estimated transmission rate without any control effects was 0.4605 with 95% credible interval (0.4468, 0.4745). During the days with effects between February 26 and March 6, the daily transmission rate decreased by about 89.48% of that of the previous day. With consistent control effects, it remained at 0.1549 with 95% credible interval (0.1497, 0.1602). Based on the estimated transmission rate, the forecast number of COVID-19 infections in South Korea showed an overall decreasing pattern.Conclusions: We considered and estimated the dynamic effects of the non-pharmaceutical interventions on COVID-19 using a Bayesian SIHR-based model. This study shows that non-pharmaceutical interventions including active testing, quarantine and isolation, personal preventive measures, and social distancing are crucial to curb the transmission. Our findings contribute to a better understanding of non-pharmaceutical interventions in COVID-19.
The Development and Validation of a Prognostic Nomogram and Nomogram Application Software Among Men Treated with Abiraterone Acetate and/or Enzalutamide for Metastatic Castration-resistant Prostate Cancer
Authors: Kawahara Takashi , Saigusa Yusuke , Yoneyama Shuko , Kato Masashi , Kojima Ippei , Yamada Hiroshi , Kamihira Osamu , Tabata Kenichi , Tsumura Hideyasu , Iwamura Masatsugu , Yao Masahiro , Uemura Hiroji , Miyoshi Yasuhide
Published: August 2020

Background:With widespread medication choices for metastatic castration-resistant prostate cancer (mCRPC) is now available, on the other hand biomarker to predict the efficacy of each mCRPC treatment has not been established.Objective:This study developed prognostic nomogram to predict prognosis in CRPC patients who received abiraterone acetate (ABI) and/or enzalutamide (ENZ).Design, Setting, and Participants:A total of 568 mCRPC patients received ABI and/or ENZ from 2012 to 2017 were enrolled in this study. We developed prognostic nomogram based on the risk factors by Cox proportional hazards regression model.Outcome Measurements and Statistical Analysis:The nomogram was also assessed for discriminatory ability with the concordance index (C-index). We repeated 5-fold cross-validation 2000 times to estimate the C-index and reported the means of the estimated C-index for the training and validation sets. And we also developed nomogram application software (app) based on this nomogram.Results and Limitations:The median overall survival (OS) was 24.7 months. A multivariable analysis showed that the time to CRPC, pre-chemotherapy, baseline PSA, baseline ALP, and baseline LDH were independent risk factors for the OS (HR: 0.521, 1.681, 1.439, 1.827, 12,123, p:0.001, 0.001, <0.001, 0.019, <0.001)). C-index was 0.72 in training cohort and 0.71 in validation cohort.Conclusion:We developed nomograms to predict the OS for Japanese mCRPC patients who received ABI and/or ENZ. The advent of mCRPC prognosis prediction app will facilitate greater accessibility for clinical use.Patient SummaryThis study developed and validated a nomogram for predicting the prognosis of mCRPC patients who receive ABI/ENZ treatment using clinical information. This study also developed mobile app to facilitate clinical usage.
Operando Unraveling Photothermal-Promoted Dynamic Active Sites Generation in Spinel NiFe2O4 for Oxygen Evolution
Authors: Gao Likun , Cui Xun , Wang Zewei , Sewell Christopher , Li Zili , Liang Shuang , Zhang Mingyue , Li Jian , Hu Yingjie , Lin Zhiqun
Published: August 2020

The ability to develop highly active and low-cost electrocatalysts represents an important endeavor toward accelerating sluggish water-oxidation kinetics. Herein, we report, for the first time, the implementation and unravelling of photothermal effect of spinel nanoparticles (NPs) on promoting dynamic active sites generation to markedly enhance their oxygen evolution reaction (OER) activity via an integrated operando Raman and density functional theory (DFT) study. Specifically, NiFe2O4 (NFO) NPs are first synthesized by capitalizing on amphiphilic star-like diblock copolymers as nanoreactors. Upon the NIR light irradiation, the photothermal heating of the NFO-based electrode progressively raises the temperature, accompanied by a marked decrease of overpotential. Accordingly, only an overpotential of 309 mV is required to yield a high current density of 100 mA cm-2, greatly lower than recently-reported earth-abundant electrocatalysts. More importantly, photothermal effect of NFO NPs not only significantly reduces the activation energy necessitated for water splitting, but also facilitates surface reconstruction into high-active oxyhydroxides at lower potential (1.36 V) under OER conditions, as revealed by operando Raman spectra-electrochemistry. Moreover, the DFT calculation corroborates that these reconstructed (Ni,Fe)oxyhydroxides are electrocatalytically active sites as the kinetics barrier is largely reduced over pure NFO without surface reconstruction. Given the diversity of materials (metal oxides, sulfides, phosphides, etc.) possessing the photo-to-thermal conversion, this effect may thus provide a unique and robust platform to boost highly-active surface species in nanomaterials for fundamental understanding of enhanced performance that may underpin future advances in electrocatalysis, photocatalysis, solar energy conversion and renewable energy production.
Phenotypic and Molecular Characterization of Carbapenem-Resistant Enterobacteriaceae from Clinical Bacterial Isolates: A Multicenter Retrospective Chart Review Study in western of Saudi Arabia
Authors: Taha Rbab , Alamri Abdulfattah W , Mufti Areej H , thaqafi Abdulhakim Al , Fatani Asif Jiman Fatani , El-Hossary Dalia , Ossenkopp John , AlhajHussein Baraa , Kaaki Mai M , Jawi Noha , Hassanien Ashraf , Alsaedi Asim
Published: August 2020

The authors have requested that this preprint be removed from Research Square.
A Patient Satisfaction Survey Investigating Pre- and Post-Operative Information Provision in Lower Limb Surgery
Authors: Renna Maxwell Stanley , Metcalfe Andrew , Ellard David , Davies David
Published: August 2020

BackgroundPlanned lower limb surgery is common, with over 90,000 hip replacements, 95,000 knee replacements and 15,000 anterior cruciate ligament reconstructions performed in the UK each year. Patient satisfaction an important element of healthcare provision that is usually measured by functional outcomes but influenced by many other factors. Few studies have assessed patients’ views on the information given to them pertaining surgery and patients are infrequently consulted when designing leaflets and information packs which can lead to confusion during the recovery period and poor long-term outcomes. We aimed to assess if patients were satisfied with the information they received around their operations and identify potential improvements.MethodsSet in a major trauma centre in the West Midlands, a multiple choice and free-text answer survey was administered to patients who used the orthopaedic service over the course of one month. Surveys were designed in Qualtrics and administered face-to-face on paper. Thematic content analysis was performed. ResultsEighty patients completed the survey, of which 88.8% of patients were satisfied with the information they received. Discussions with surgeons were the most useful resource and 53% of patients requested more internet resources. Post-operative patients were statistically more likely to be dissatisfied with information provision. Over 20% of patients requested more information on post-op pain and recovery timelines. ConclusionsAlthough patients were satisfied in general, areas for change were identified. Suggested improvements take the form of webpages, a mobile platform or forum for asking healthcare professionals questions. Extra resources could contain educational videos, patient experiences and an interactive recovery timeline. These suggestions may enable NHS Trusts to “get into the digital age”, however, more research on patient satisfaction around information provision and the impact it has on recovery and decision making is needed.
Survival Analysis of Elderly Patients Over 65 Years Old With Stage Ii/iii Gastric Cancer Treated With Adjuvant Chemotherapy After Laparoscopic D2 Gastrectomy: a Retrospective Cohort Study
Authors: Liang Yanrui , Zhao Liying , Chen Hao , Lin Tian , Chen Tao , Zhao Mingli , Hu Yanfeng , Yu Jiang , Liu Hao , Li Guoxin
Published: August 2020

Background: The benefits of adjuvant chemotherapy for elderly patients (age >65) with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. To evaluate the effectiveness and complications of adjuvant chemotherapy in elderly patients (>65 years of age) after laparoscopic D2 gastrectomy.Methods: This was a retrospective cohort study of elderly patients (>65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy between 2004 and 2018. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), circulating tumor cells (CTCs), chemotherapy duration, and toxicity were examined. Results: There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were ten (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1-/3-/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P=0.018). For stage III patients, the 1-/3-/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P=0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR=0.568, 95%CI: 0.357-0.903, P=0.017) and DFS (HR=0.511, 95%CI: 0.322-0.811, P=0.004) in stage III patients. CTC >0 had no significant impact on the benefits of adjuvant chemotherapy on OS and DFS.Conclusions: This study suggested that adjuvant chemotherapy significantly improves OS and DFS for elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.
ITGA5 Is a Prognostic Biomarker and Correlated with Immune Infiltration In Gastrointestinal Cancers
Authors: Zhu Hai , Wang Gang , Zhu Haixing , Xu Aman
Published: August 2020

Background: Integrin Subunit Alpha 5 (ITGA5) belongs to the integrin alpha chain family, is vital for promoting cancer cell invasion, metastasis. However, the correlation between ITGA5 expression and immune infiltration in gastrointestinal (GI) tumors remain unclear.Methods: The expression levels of ITGA5 were detected by Oncomine and Tumor Immune Estimation Resource (TIMER). The association between ITGA5 and prognosis of patients was identified by Kaplan–Meier plotter, Gene Expression Profiling Interactive Analysis 2(GEPIA2) and PrognoScan. We evaluated the correlation between ITGA5 expression and immune infiltrating level via TIMER. Besides, TIMER and immunohistochemistry (IHC) staining were used to explore correlations between ITGA5 expression and markers of immune infiltrates cells. Furthermore, we constructed protein-protein interaction (PPI) network and performed functional enrichment by GeneMANIA and Metascape.Results: ITGA5 was generally overexpressed and correlated with worse prognosis in multiple types of GI tumors. In addition, ITGA5 expression levels was significantly associated with tumor purity and immune infiltration levels of different immune cells in GI tumors. Interestingly, Immune markers for monocytes, tumor - associated macrophages (TAMs), macrophages 2 (M2) cells and T-helper 2 (Th2) cells were found to be significantly and positively correlated with ITGA5 expression levels in colon and gastric cancer. Results from IHC staining further proved that markers of Th2 and M2 cell were significantly increased in gastric cancer patients with high ITGA5 expression levels. Lastly, interaction network and function enrichment analysis revealed ITGA5 were mainly involved in “integrin mediated signaling pathway”, “leukocyte migration”, “cell-substrate adhesion”.Conclutions: our study demonstrated that ITGA5 may act as an essential regulator of tumor immune cell infiltration and a valuable prognostic biomarker in GI tumors. Additional work is needed to fully elucidate the underlying mechanisms behind these observations.
The Mechanism of Jinqi Jiangtang Tablet in Treatment of Type 2 Diabetes Mellitus Based on Network Pharmacology
Authors: Yang Mingjun , Song Boni , Bing Zhitong , Liu Juxiang , Li Rui , Zhang Jingyun , Yuan Lingyan , Yang Lijuan
Published: August 2020

Background: Type 2 Diabetes Mellitus(T2DM) is an endocrine disease that caused mainly by insulin resistance (IR) and β cell dysfunction. The incidence of T2DM is quite high in the worldwide. To explore the molecular mechanism of Jinqi Jiangtang Tablet(JJT) in treating of T2DM based on Network Pharmacology. Methods: The active compounds, targets of three Traditional Chinese medicines in JJT were obtained by the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform（TCMSP） database and Uniprot database; The targets of T2DM were screened through the Drugbank database; The compound-target network was constructed via the Cytoscape 3.7.2 software and used the built-in Network analyzer to analyze and select the key active compounds; The overlapping targets of drug and disease targets were gained by the VENNY online tool and the targets were built by STRING website to select the key genes; Gene Ontology(GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway were performed on the potential targets using DAVID6.8 online tool to study the mechanism of overlapping targets. Via Systems Dock platform to validate the interaction between compound and targets Results: Twenty-five active compounds of JJT were screened, 101 drug targets, 142 disease targets and twenty-one overlapping targets. GO enrichment analysis showed that the biological processes (BP)mainly included the blood circulation ,etc. Cell composition(CC) mainly affected the integral component of plasma membrane, etc. Molecular functions(MF) mainly involved alpha-adrenergic receptor activity, etc. KEGG pathway analysis showed that there were twelve pathways related to T2DM, among which PPAR signaling pathway was related to T2DM mostly. RXRA is one of key targets of JJT and berberine performed well. Conclusions: This study revealed the mechanism of JJT in treatment of T2DM preliminarily and supplied a further foundation for studying its mechanism.
Factors Associated with Adult Mental Health Treatment Among Youth with and without Adverse Childhood Experiences from the 1997 National Longitudinal Survey of Youth
Authors: Benevides Teal W. , Heboyan Vahe , Tiwari Ashwini , Douglas Megan
Published: August 2020

Background: Evidence suggests that childhood is an important critical period for adult mental health outcomes. Most studies evaluating childhood factors use cross-sectional data, limiting our understanding of life course factors contributing to mental health. The purpose of this study was to evaluate the contribution of life course factors on adult mental health treatment from a longitudinal cohort of U.S. respondents. Methods: We used data from the National Longitudinal Survey of Youth-1997 (N=8,984) through the 2011 data collection year, in which n=7,009 adult respondents reported on the number of mental health visits between 2009-2011. We used zero-inflated negative binomial regression to evaluate the impact of childhood, adolescent, and adult factors on mental health visits. Results: Respondents with more than three adverse childhood experiences (ACE) reported in adolescence were significantly more likely to utilize mental health treatment as an adult (Incidence Rate Ratio[IRR]=1.30). No other childhood or adolescent factors contributed to adult mental health utilization. Adult factors associated with greater mental health visits included: having any health insurance (IRR=1.40), being unemployed (IRR=1.56) or employed part-time (IRR=1.31). African-American respondents had significantly fewer mental health visits than white respondents (IRR=0.79). Non-significant factors included: gender, ethnicity, parent-reported childhood emotional problem, family receipt of governmental assistance as an adolescent, living in a high-poverty household as an adult, and living in a state with high unemployment. Conclusions: Critical periods of development, combined with cumulative risk and protective factors, contribute to adult mental health seeking. Adolescence is a critical period for trauma and later need for mental health treatment. Other factors, such as full-time employment, appear to be associated with reduced likelihood of the need for mental health treatment. Future evaluation of community and population-based approaches, including policy interventions, is needed to understand risk and protective factors contributing to mental health across the life course.
Scutellarin Ameliorated Carbon Tetrachloride-Induced Chronic Liver Injury in Mice
Authors: Miao Zhimin , Zhao Yingying , Li Chunyan , Chen Lingmin , Zhou Jianeng , Lai Yong , Lan Hai
Published: August 2020

Background: Erigeron breviscapus (Vant.) Hand. -Mazz. is an edible and traditional medical herb and its extract scutellarin (SCU) is a widely used flavonoid showing anti-oxidant and anti-inflammatory activities. The purpose of this study was to evaluate the hepatoprotective effect of SCU on carbon tetrachloride (CCl4)-induced chronic liver injury in mice and reveal the underlying mechanisms. Methods: Chronic liver injury in mice was induced by intraperitoneal injection of 1 ml/kg CCl4 every three days. SCU (15 mg/kg, 30 mg/kg and 60 mg/kg) was administered through gavage every day. Bifendate (120 mg/kg) serves as a positive drug to validate the effectiveness of SCU.Results: The hepatoprotective effect of SCU was confirmed by liver function analysis, histological analysis and TUNEL assay. Administration of SCU recovered the activities of superoxide dismutase (SOD) and reduced the production of malondialdehyde (MDA). Additionally, treatment with SCU significantly decreased the mRNA levels of pro-inflammatory cytokines including IL-6, IL-1β and TNF-α. Moreover, SCU treatment suppressed the activation of NF-κB by decreasing the degradation of IκBα and inhibited the expression of CYP2E1. The 16S rRNA sequencing demonstrated that intake of SCU significantly remodeled gut microbiota, especially enriching the following: Lactobacillus, Coprobacillus, Akkermansia, Bifidobacterium, Parabacteroides. Conclusion: Our findings showed that SCU effectively ameliorated CCl4-induced chronic liver injury. This hepatoprotective effects might be attributed to inhibition of CCl4-induced NF-κB and CYP2E1 activation and enrichment of beneficial microbial community.
Radical Hysterectomy Versus Simple Hysterectomy and Brachytherapy for Patients with Stage II Endometrial Cancer
Authors: Wang Ming , Ran Ran , Wu Yumei
Published: August 2020

BACKGROUND: To compare the survival outcome between radical hysterectomy and simple hysterectomy with implants radiation in patients with stage II endometrial cancer.METHODS: This is a retrospective cohort study. We identified 1349 patients diagnosed with stage II endometrial cancer from Jan 1, 1988 to Dec 31 2015 in the Surveillance, Epidemiology, and End Results. Patients were divided into two groups based on the primary treatment (simple hysterectomy combined with brachytherapy or radical hysterectomy). The primary outcome was the rate of overall survival and cause-specific survival of two groups.RESULTS: A total of 1349 patients were enrolled in the study, 117(7.35%) patients received radical hysterectomy and 460 patients who received simple hysterectomy and vaginal brachytherapy were selected as control. All patients received external beam radiation therapy after the surgery. Overall, the median follow-up duration was 82.77±1.44months (95%CI: 79.94-85.61months). There was no difference in the baseline information between two groups, including ages, ethnicity, and rates of histologic subtypes. The 5-year mortality was 62.31% among women who underwent radical hysterectomy which was lower than 78.48% among those who underwent simple hysterectomy and vaginal brachytherapy (HR, 2.22; 95% CI, 1.52 to 3.24; P <0.001 by the log-rank test). Women who underwent radical hysterectomy also had shorter 5-year cause-specific survival (74.60 vs.85.38%; HR, 1.91; 95% CI, 1.13 to 3.23; P =0.01 by the log-rank test) than those who underwent simple hysterectomy and vaginal brachytherapy. However, the negative outcomes were further validated in patients with high-risk endometrial cancer, not in patients with grade 1-2 low-risk EC both on cause-specific survival and overall survival. Grade 3 low-risk endometrial cancer was only found with lower overall survival not cause-specific survival.CONCLUSIONS: This study revealed that in patients’ stage II high-risk endometrial cancer, radical hysterectomy radiation was associated with shorter overall survival and cause-specific survival than simple hysterectomy and vaginal brachytherapy.
Clinical features and inpatient trajectories of older inpatients with COVID-19: a retrospective observational study.
Authors: Osuafor Christopher N , Davidson Catriona , Mackett Alistair J , Goujon Marie , Poel Lelane Van Der , Taylor Vince , Preller Jacobus , Goudie Robert J B , Keevil Victoria L
Published: August 2020

Background: A comprehensive description of the clinical characteristics, inpatient trajectory and relationship with frailty of older inpatients admitted with COVID-19 is essential in the management of older adults during the COVID-19 pandemic. The aim of this study was to describe the clinical features and inpatient trajectory of older inpatients with confirmed COVID -19.Methods: This was a retrospective observational study of hospitalised older adults. Subjects include unscheduled medical admissions of older inpatients to a University Hospital with laboratory and clinically confirmed COVID-19. The primary outcome was death during the inpatient stay or within 14 days of discharge after a maximum follow up time of 45 days. The characteristics of the cohort were described in detail as a whole and by frailty status.Results: 214 patients were included in this study with a mean length of stay of 11 days (Range 6 to 18 days), of whom 140 (65.4%) patients were discharged and 74 (34.6%) patients died in hospital. 142 (66.4%) patients were frail with median Clinical Frailty Scale (CFS) score of 6. Frail patients were more likely to present with atypical symptoms including new or worsening confusion compared to non-frail patients (20.8% vs 45.1%, p<0.001) and were more likely to die in hospital or within 14 days of discharge (66% vs 16%, p=0.001). Older age, being male, presenting with high illness acuity and high frailty were all independently associated with higher risk of death and a dose response association between higher frailty and higher mortality was observed.Conclusions: Older adult inpatients with COVID-19 infection are likely to present with atypical symptoms, experience delirium and have a high mortality, especially if they are also living with frailty. Clinicians should have a low threshold for testing for COVID-19 in older and frail patients presenting to hospital as an emergency during periods when there is community transmission of COVID-19 and, when diagnosed, this should prompt early advanced care planning with the patient and family.
Anesthetic management during cochlear implant surgery on a child with congenital long QT syndrome
Authors: YAMAN Ferda , Baydogan Nurdan , İncesulu Armağan , Bilir Ayten
Published: August 2020

Background

Long QT syndrome (LQTS) is an inherited disorder of the heart’s electrical activity that may also be associated with malignant arrhythmia and cause sudden death. In addition to this inherited condition, several commonly used anesthetic drugs can prolong the QT interval. The clinical symptoms of LQTS are heart palpitations, syncope, anoxic seizures secondary to ventricular arrhythmia, and torsades de pointes.
Case:

We present here a 17-month-old male patient with bilateral sensorineural hearing loss who underwent general anesthesia for a cochlear implant. The surgical team was advised about the possible risks of using local anesthesia without adrenaline. A defibrillator, which was checked for pediatric use, was made available in the operating room. After the vascular access was opened, the patient was provided with induction propofol, remifentanil, and rocuronium, and anesthesia was maintained using an intravenous anesthetic. No cardiac arrhythmia was observed in the patient, whose muscle relaxant effect was reversed using sugammadex.
Discussion

LQTS patients have developed arrhythmia and sudden cardiac arrest from administration of sevoflurane and neostigmine during anesthesia. The application of intravenous anesthetics was preferred to maintain anesthesia for this patient and was safely applied. In addition, a defibrillator was available for immediate use during the perioperative period.
Conclusion

Anesthesia can be safe by using intravenous rocuronium and sugammadex and local anesthetic without adrenaline.
Investigation of the Mechanisms of Neuroprotection Mediated by Lobelia Species via Computational Network Pharmacology and Molecular Modeling
Authors: Zheng Qinfang , Fang Liangzi , Huang Xiaolong , Wang Ye , Zhang Shuihan
Published: August 2020

BackgroundSeveral species of the medicinally valuable genus Lobelia (Campanulaceae) exhibit neuroprotection. While the neuroprotective mechanisms of some components (e.g. lobeline, lobelanine, and lobelanidine) belonging to the L. nicotianaefolia or L. inflata are extensively characterized, there remains the need to study and elucidate the mechanism of action of other species and their active components. In this work, we have studied the neuroprotective mechanism of the pharmacokinetically favorable active compounds of 17 Lobelia species.MethodsNetwork pharmacology approach and molecular modeling were employed. We have conducted drug-likeness evaluation, oral bioavailability prediction followed by the Gene Ontology (GO) terms and pathways enrichment analysis, protein-protein and protein-compound interaction network construction and analysis, and molecular docking studies. Five neurodegenerative diseases viz. Alzheimer’s disease, Parkinson’s disease, Huntington’s disease, epilepsy, and Amyotrophic lateral sclerosis along with the common neuroprotection mechanism-associated genes were evaluated.ResultsWe revealed the neuroprotective mechanism of the active ingredients of Lobelia species. Our study strongly indicates that 12 unique active ingredients viz. luteolin, kaempferol, acacetin, chryseriol, norlobelanine, lobelanine, 2-[(2R,6S)-6-[(2R)-2-hydroxy-2-phenylethyl]-1-methylpiperidin-2-yl]-1-phenylethanone, hydroxygenkwanin, lobelanidine, quercetin, and diosmetin regulates 31 targets within multiple signaling pathways. The nitric oxide synthase, brain (NOS1), androgen receptor (ANDR), sodium- and chloride-dependent GABA transporter 1 (SC6A1), apoptosis regulator Bcl-2 (BCL2), RAC-alpha serine/threonine-protein kinase (AKT1), cellular tumor antigen p53, apoptosis regulator BAX, and tumor necrosis factor (TNFA) were identified as the majorly regulated genes. A majority of these target proteins act via several cancer-related pathways proven to have cross-talks with the pathogenesis of neurodegenerative diseases.ConclusionsThis study explains how the active ingredients of the Lobelia species exhibit their neuroprotective actions and provide a reference basis to investigate their pharmacological effects in detail.
Knowledge of Resident Doctors Regarding Palliative Care: A Systematic Review
Authors: Oliveira Arlene Sousa Barcelos , Hernandes Janete Capel , Castro Viviane Cruvinel Di , Santana Cristina Celia Almeida Pereira , Montagnini Marcos Luis , Porto Celmo Celeno
Published: August 2020

Background: Palliative care aims to improve life quality of patients and their families, preventing and relieving people's suffering in coping life-threatening diseases. Many challenges are linked to palliative care, such as the lack of specific disciplines in doctors training; the scarcity of services and specialized programs in palliative care in public and private health systems and the lack of training for resident doctors. Objective: To identify knowledge of resident doctors regarding palliative care. Method: A systematic review according to PRISMA (2009), with searches carried out in Cochrane Library, MEDLINE / PubMed, Scopus, Web of Science databases and gray literature of Brazilian Digital Library of Theses and Dissertations (BDTD), with the acceptance of articles in English, Portuguese and Spanish, without delimitation of publication date, geographic location and type of study. Only studies with resident doctors were included. Results: During the search, 931 articles were found. Of these, 363 were discarded because they were duplicated and 568 were discarded after reading titles and abstracts, leaving 24 articles for complete reading, which after reading and consensus of the three researchers, only 07 of these articles were included in the comparative synthesis. Three intervention studies, two cross-sectional and two qualitative studies were found. In the observed data, all the analyzed studies had a sample of less than 100 subjects, with a total of 442 subjects, of which 137 (30.99%) were women and 111 (25.12%) men, with average age ranging from 26.6 to 32.1. Conclusions: The studies analyzed in this review indicate that the knowledge of resident doctors was limited and insufficient related to palliative care, what indicates the need of greater investments in training, through teaching-learning methods based on rotation, simulation and others, thus improving not only knowledge, but also the practice in palliative care. PROSPERO record: CRD42020159428
Oral beta-lactam step down in bacteremic E. coli urinary tract infections
Authors: Saad Stephan , Mina Neil , Lee Colin , Afra Kevin
Published: August 2020

Background: Literature is scarce regarding oral step down to beta-lactams in bacteremic urinary tract infections. Oral fluoroquinolones are an accepted and common step down for bacteremic urinary tract infections; however, their use is associated with mounting safety concerns. We compared clinical cure in patients with E. coli bacteremic urinary tract infections who were stepped down to oral beta-lactams compared to oral fluoroquinolones.Methods: This multicentre retrospective cohort study included patients with first positive concurrent urine and blood cultures from January 2016 to December 2016. Patients were included if they received empiric intravenous beta-lactam therapy with step down to either oral beta-lactam or fluoroquinolone for treatment completion. The primary outcome was clinical cure. Secondary outcomes were length of hospitalization, all-cause mortality and C. difficile infection. Multivariate analysis and propensity score were used to control for confounding.Results: A total of 207 patients were identified with bacteremic E.coli urinary tract infections. Clinical cure was achieved in 72/77 (94%) in the oral beta-lactam group versus 127/130 (98%) in the oral fluoroquinolone group (absolute difference − 4.2%, 95% confidence interval [CI] -10.3–1.9%, p = 0.13). The adjusted odds ratio (OR) for clinical cure with oral beta-lactams was 0.31 (95% CI 0.05–1.90, p = 0.21); propensity score adjusted analysis showed a similar result. There was no statistically significant difference in secondary outcomes.Conclusions: Oral beta-lactams appear to be a safe and effective step down option in bacteremic E. coli urinary tract infections compared to oral fluoroquinolones.
Clinical Efficacy of Unicompartmental Knee Arthroplasty in the Treatment of Spontaneous Osteonecrosis of the Knee
Authors: Li Hao , Liu Ting ting , Zhang Min
Published: August 2020

BackgroundThis retrospective study aimed to evaluate the short-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of spontaneous osteonecrosis of the knee (SONK).MethodsThe patients who were diagnosed as SONK and received UKA in our hospital from January 2012 to January 2018 were retrospectively analyzed. The patients were diagnosed and staged by X-ray and MRI techniques before surgery. The range of motion (ROM), femorotibial angle (FTA), and visual analog scale (VAS) score of patients' knee joints were assessed before and after surgery. Clinical outcomes were evaluated by the hospital for special surgery (HSS) knee score.ResultsA total of 18 patients with spontaneous osteonecrosis (4 males and 14 females; mean age: 62.5 years) met the inclusion criteria participated in this study. According to the Mont grades, 12 cases (66.7%) were in stage III, and 6 cases (33.3%) were in stage IV. The average follow-up was 19.6 months. At the last follow-up, it was found that the hospital for HSS score was increased from 61.22 ± 2.90 to 91.0 ± 2.89 (P < 0.05); VAS score was decreased from 6.44 ± 1.04 to 1.94 ± 0.99 (P < 0.05); FTA was improved from 178.42 ± 0.84 to 176.17 ± 0.87 (P < 0.05); ROM (120.17 ± 5.88) was not significantly different from that before surgery (119.61 ± 5.56, P = 0.601).ConclusionThe encouraging results of this study indicate that UKA has an excellent short-term clinical effect in the treatment of SONK.
Identification of repurposable cytoprotective drugs in Vanishing White Matter Disease patient-derived cells
Authors: Ng Neville , Cabral-da-Silva Mauricio Castro , Maksour Simon , Berg Tracey , Engel Martin , Silva Dina M. , Do-Ha Dzung , Lum Jeremy S. , Muñoz Sonia Sanz , Suarez-Bosche Nadia , Stevens Claire H. , Ooi Lezanne
Published: August 2020

Background
Vanishing white matter disease (VWMD) is a rare leukodystrophy caused by mutations of the guanine exchange factor eIF2B that typically presents with juvenile onset. There are few treatments and no cures for the disease. Recent progress in the field has established mitochondrial dysfunction and endoplasmic reticulum (ER) stress to be strongly implicated in observed glial cell pathology. Drug repurposing offers a rapid approach toward translation of therapeutics with already-licensed drugs.
Objective
The aim of this study was to use fibroblasts and induced pluripotent stem cell (iPSC)-derived astrocytes from patients bearing the EIF2B5R113H/A403V or EIF2B2G200V/E213G VWMD mutations to identify potentially repurposable FDA-approved drugs based on in vitro assays.
Methods
Cell viability in the presence or absence of stress was assessed by resazurin reduction activity assay, mitochondrial membrane potential by TMRE fluorescence, and oxidative stress by H2DCFDA oxidation. Relative eIF2B phosphorylation, GADD34 and CHOP were quantified by fluorescent western blot.
Results
Dysregulated GADD34 and CHOP were identified in patient fibroblasts and iPSC-derived astrocytes under induced stress conditions. A drug screen from a 2,400 FDA-approved drug library with EIF2B5R113H/A403V VWMD patient fibroblasts identified 113 anti-inflammatory drugs as a major class of hits with cytoprotective effects. A panel of potential candidate drugs, including berberine, deflazacort, ursodiol, zileuton, guanabenz and Anavex 2–73, and preclinical ISRIB, increased cell survival of EIF2B5R113H/A403V or EIF2B2G200V/E213G VWMD astrocytes, and were further investigated for their effect on the integrated stress response and mitochondrial stress. Ursodiol demonstrated capacity to ameliorate oxidative stress and loss of mitochondrial membrane potential in VWMD patient iPSC-derived astrocytes in the presence or absence of stress conditions.
Conclusion
Patient-derived cells can be used to identify cellular phenotypes and for large-scale drug screening. Anti-inflammatory compounds, such as berberine, deflazacort, ursodiol and zileuton are potentially repurposable drug candidates for VWMD that should be further investigated for translation in vivo.