bluuebunny/crossref_metadata_2025 huggingface dataset:
XPF Expression And Its Relationship With The Risk And Prognosis Of Colorectal Cancer
Authors: Hu Huixin , Jing Jingjing , Lu Xiaodong , Yuan Yuan , Xing Chengzhong
Published: October 2020

Background: XPF is a key factor contributing to DNA damage excision of nucleotide excision repair pathway. The relationship between XPF expression and the risk and prognosis of colorectal cancer (CRC) is unclear. Methods: In this experiment, a total of 824 cases of colorectal tissue were collected. XPF protein expression was detected by immunohistochemical staining. In order to explore the differential expression of XPF between CRC and non-cancer controls, and the correlation between XPF expression and CRC clinicopathological parameters, we conducted a non-parametric test. Univariate and multivariate Cox regression analyses were conducted to investigate the relationship between XPF expression and CRC prognosis. The Java based software GSEA as well as STRING, David, GO, KEGG were used to explore the function and regulation network of XPF. Results: The results demonstrated that the XPF expression in CRC was significantly up-regulated compared with non-tumor controls (P < 0.001) and adenoma tissues (P < 0.001). XPF protein was highly expressed in the dynamic sequence of anal diseases to adenoma tissues to CRC. Expression of XPF was related to tumor location (P=0.005) and with tumor growth pattern (P=0.009). The results of prognosis analysis suggested that in individuals with T1-2 invasive extent, XPF low expression may be significantly associated with better overall survival (HR = 7.978, 95% CI: 1.208-52.673, P = 0.031). XPF and its interacting genes played a vital role in different processes of nucleotide excision repair pathway. XPF expression was related with Ubiquitin like protein specific protease activity.Conclusions: XPF might be a promising biomarker for CRC risk, and also showed potential as a prognostic predictor in CRC patients.
Impaired Myeloid-derived Suppressor Cells Are Associated With Recurrent Implantation Failure: A Case-Control Study
Authors: Jiang Huanhuan , Zhu Mengting , Guo Peipei , Bi Kaihuan , Lu Zhimin , Li Caihua , Zhai Muxin , Wang Kangxia , Cao Yunxia
Published: October 2020

Background: Studies have reported that myeloid-derived suppressor cells (MDSCs) contribute to maintain pregnancy. The aim of this case-control study was to test whether there is a dysregulation of peripheral MDSCs in recurrent implantation failure (RIF).Methods: 26 RIF patients and 30 controls were recruited. Flow cytometry was applied to characterize polymorphonuclear (PMN)-MDSCs, monocytic-MDSCs (M-MDSCs), effector T cells (Teffs) and regulatory T cells (Tregs) in blood. ELISA was used to define MDSCs correlative cytokines and chemokines in serum from all patients.Results: Compared with controls, RIF patients showed significant reductions of blood PMN-MDSCs, M-MDSCs, Tregs and NO production by PMN-MDSCs, whereas the expression of ζ chain on CD4+T cell receptor (TCR) and CD8+TCR displayed a remarkable upregulation in RIF patients. Moreover, RIF patients presented a lower concentration of serum chemokine (C-C motif) ligand (CCL) 5 and transforming growth factor (TGF)-β than those from controls. Furthermore, the level of TCR ζ chain on CD4+ and CD8+ Teffs was negatively correlated not only with the percentage of PMN-MDSCs, but also with the amount of NO produced by PMN-MDSCs. The frequency of PMN-MDSCs had positive correlations with the concentration of CCL5 and TGF-β.Conclusions: This study indicated that the dysregulation of MDSCs might impair maternal-fetal immune balance thus resulting in RIF.
Identification and Validation of Potential Hub Genes Correlated With Ulcerative Colitis Through Integrated Bioinformatics Analysis
Authors: Li Ting , Hui Wenjia , Halike Halina , Gao Feng
Published: October 2020

Background: Ulcerative colitis (UC) is a chronic nonspecific intestinal inflammatory disorder associated with continuous, diffuse inflammatory alterations in the colonic mucosa of unknown etiology, Increasing evidence has showed aberrant expression of gene plays a vital function in the pathophysiological mechanisms of ulcerative colitis, Herein, we employed bioinformatics to investigate the core of the pathogenesis and provide potential markers for UC. Results: We downloaded the GSE36807, GSE65114, GSE59071 datasets from the Gene Expression Omnibus(GEO), then the differentially expressed genes (DEGs) were determined using adjusted P＜0. 05 and |log2FC>2 | between normal samples and UC samples. Intersection analysis among three datasets showed 12 DEGs were found to be significantly dysregulated in UC. Results indicated that the DEGs were primarily associated with functions like the humoral immune response, antimicrobial humoral response, and CXCR chemokine receptor binding, and they were primarily enriched in KEGG pathways, including the IL−17 signaling pathway, and Toll−like receptor signaling pathway . Cytoscape software calculated that CXCL8, DMBT1, REG3A, S100A8, DUOX2, and MMP1 were hub genes of UC. In addition, We collected samples of 8 UC tissues and 8 normal Colonic tissues to validate the selected genes by mRNA microarray.Conclusions: These results may provide potential biomarkers for UC, and our data and methodology provides new ideas that may be helpful in the understanding of the vital mechanisms underlying UC development.
Barriers to Diabetes Self-Management in New Zealand Patients with Type 2 Diabetes and Poor Glycaemic Control
Authors: Chepulis Lynne , Morison Brittany , Cassim Shemana , Norman Kimberley , Keenan Rawiri , Paul Ryan , Lawrenson Ross
Published: October 2020

Background: Despite the fact that there is an increasingly effective armoury of medications to treat diabetes many patients continue to have substantially elevated blood glucose levels. The purpose of this study was to explore what the barriers to diabetes management are in a cohort of people with diabetes and poor glycaemic control.Methods: Qualitative semi-structured interviews were carried out with 10 people with diabetes who had known diabetes and a recent HbA1c of > 11.3% (100 mmol/mol) to explore their experiences of barriers to diabetes self-management and glycaemic control. Results: Barriers to diabetes management were based around two key themes: biopsychosocial factors and disease awareness / information delivery. Specifically, financial concerns, social stigma, medication side effects and cognitive impairment due to hyperglycaemia were commonly reported as barriers to medication use. Other barriers included a lack of knowledge about their own disease, poor relationships with health care professionals and a lack of relevant resources to support diet and weight loss.Conclusion: people with diabetes with poor glycaemic control experience many of the same barriers as those reported elsewhere, but also experience issues specifically related to their severe hyperglycaemia. Management of diabetes could be improved via the increased use of patient education and availability of locally relevant resources.
Probiotics Mediated Gut Microbiota Diversity Shifts Are Associated With Reduction in Histopathology and Shedding of Lawsonia Intracellularis
Authors: Muwonge Adrian , Karuppannan Anbu K. , Opriessnig Tanja
Published: October 2020

Background: Clinical intervention during bacterial infections in farm animals such as pigs commonly consists of antimicrobial use. With the rise of antimicrobial resistance and the attempts to reduce the use of antibiotics in food animals, effective alternatives are urgently needed to reduce or even remove pathogens and disease risk. Improving clinical outcomes and overall pig health by using probiotics appears attractive. However, reliable data sets on the efficacy of probiotics are scarce. The obligate intracellular bacterium Lawsonia intracellularis is widespread in pigs and associated with severe enteropathy, mainly in the ileum, commonly resulting in substantial reduction in weight gain. The impact of three in-feed probiotics and a commercial live L. intracellularis vaccine were compared in a pig challenge model. Probiotic treatment was associated with reduced L. intracellularis fecal shedding and reduced gut lesions. Here, the bacterial microbiota of the ileum of these pigs was characterized with 16S rRNA gene sequencing and was subsequently analyzed with bioinformatics tools. Results: The greatest microbial richness was observed in the probiotic treated group T03-LAW, which accounted for 87% of richness observed in the study. Treatment had a significant impact on both the microbiota structure and taxonomic profile in the ileum, explaining between 26-36% of the structural variation, with the strongest association in the T03-LAW group. Overall, the largest changes were observed for the pigs treated with in-feed Bacillus pumilus; the microbiota of these pigs had the greatest diversity and highest richness. We also observed depleted and enriched core microbiota amongst the groups; however, there was no correlation with clinical characteristics. The results suggest that an increased diversity of the ileal microbiota is associated with a reduction in shedding i.e. a unit increase in Shannon diversity index resulted in 2.8 log reduction in shedding.Conclusions: Probiotic supplementation of a base feed ration increased ileum microbiota diversity leading to a mitigation of the effects of a pathogenic L. intracellularis challenge. An even and diverse microbiota community benefits pigs infected with L. intracellularis, however, investigations are needed to determine if this is also true for other pathogens. The study unambiguously demonstrates the usefulness of probiotic supplementation in reducing the impact of enteric pathogens and pathogen shedding rates in food animals without the use of antimicrobials.
Comparisons among rainbow trout, Oncorhynchus mykiss, populations of maternal transcript profile associated with egg viability
Authors: Weber Gregory M. , Birkett Jill , Martin Kyle , II Doug Dixon , Gao Guangtu , Leeds Timothy D. , Vallejo Roger L. , Ma Hao
Published: October 2020

Background: Transcription is arrested in the late stage oocyte and therefore the maternal transcriptome stored in the oocyte provides nearly all the mRNA required for oocyte maturation, fertilization, and early cleavage of the embryo. The transcriptome of the unfertilized egg, therefore, has potential to provide markers for predictors of egg quality and diagnosing problems with embryo production encountered by fish hatcheries. Although levels of specific transcripts have been shown to associate with measures of egg quality, these differentially expressed genes (DEGs) have not been consistent among studies. The present study compares differences in select transcripts among unfertilized rainbow trout eggs of different quality based on eyeing rate, among two year classes of the same population (A1, A2) and a population from a different hatchery (B). The study compared 65 transcripts previously reported to be differentially expressed with egg quality in rainbow trout. Results: There were 32 transcripts identified as DEGs among the three groups by regression analysis. Group A1 had the most DEGs, 26; A2 had 15, 14 of which were shared with A1; and B had 12, 7 of which overlapped with A1 or A2. Six transcripts were found in all three groups, dcaf11, impa2, mrpl39_like, senp7, tfip11 and uchl1. Conclusions: Our results confirmed maternal transcripts found to be differentially expressed between low- and high-quality eggs in one population of rainbow trout can often be found to overlap with DEGs in other populations. The transcripts differentially expressed with egg quality remain consistent among year classes of the same population. Greater similarity in dysregulated transcripts within year classes of the same population than among populations suggests patterns of transcriptome dysregulation may provide insight into causes of decreased viability within a hatchery population. Although many DEGs were identified, for each of the genes there is considerable variability in transcript abundance among eggs of similar quality and low correlations between transcript abundance and eyeing rate, making it highly improbable to predict the quality of a single batch of eggs based on transcript abundance of just a few genes.
Multicenter Randomized Controlled Trial Comparing Digital and Traditional Chest Drain in a VATS Pulmonary Lobectomy Cohort: Interim Analysis
Authors: Mendogni Paolo , Tosi Davide , Marulli Giuseppe , Comacchio Giovanni Maria , Pieropan Sara , Rossi Veronica , Brascia Debora , Andriolo Luigi Gaetano , Imbriglio Giovanna , Bonitta Gianluca , Lopez Camillo , Rea Federico , Nosotti Mario
Published: October 2020

Background: The usefulness of digital chest drain is still discussed. We are carrying out a study to determine if the use of a digital system compared with a traditional system reduces the duration of chest drainage. To evaluate safety, benefit, or futility of this trial we planned the current interim analysis.Methods: An interim analysis on preliminary data from ongoing investigator-initiated, multicenter, interventional, prospective randomized trial. Original protocol number: (NCT03536130). The interim main endpoint was overall complications; secondary endpoints were the concordance between the two primary endpoints of the RCT (chest tube duration and length of hospital stay). We planned the interim analysis when half of the patients have been randomised and completed the study. Data were described using mean and standard deviation or absolute frequencies and percentage. T-test for unpaired samples, Chi-square test, Poisson regression and absolute standardized mean difference (ASMD) were used. P-value <0.05 was considered significant. Results: From April 2017 to November 2018, out of 317 patients were enrolled by 3 centers, 231 fulfilled inclusion criteria and were randomized. Twenty-two of them dropped out after randomization. Finally, 209 patients were analyzed: among them 94 used the digital device and 115 the traditional one. The overall postoperative complications were 35 (16.8%) including prolonged air leak (1.9%). Mean chest tube duration was 3.6 days (SD=1.8), with no differences between two groups (p=0.203). The overall difference between hospital stay and chest tube duration was 1.4 days (SD=1.4). Air leak at first postoperative day detected by digital and traditional devices predicted increasing in tube duration of 1.6 day (CI 95% 0.8-2.5, p<0.001) and 2.0 days (CI 95% 1.0-3.1, p<0.001), respectively. Conclusions: This interim analysis supported the authors’ will to continue with the enrollment and to analyze data once the estimated sample size will be reached.Trial registration: Trial registration number NCT03536130, Registered 24 May 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/results?cond=&term=NCT03536130&cntry=&state=&city=& dist=
Treatment of Intrathoracic Anastomotic Leak After Esophagectomy with the Sump Drainage Tube
Authors: Yin Qifan , Zhou Shaohui , Song Yongbin Song , Xun Xuejiao Xun , Liu Nana Liu , Liu Lijun
Published: October 2020

Background: Intrathoracic esophagogastric anastomotic leak is one of the deadliest complications after esophagectomy. In recent years, we have implemented new method for the treatment of intrathoracic esophagogastric anastomotic leak with the nasogastric placement of sump drainage tube through fistula into abscess cavity. The aim of this study is to compare the efficacy of the new method and conventional therapies for intrathoracic anastomotic leak after esophagectomy. Method: Esophagectomy and esophagogastric anastomotic procedures were performed in 875 patients at our institution from January 2008 to December 2019. Of these patients, 43(4.9%) patients developed intrathoracic anastomotic leaks postoperatively were enrolled into our study and their clinical data were retrospectively assessed. 20 (47%) patients from January 2008 to December 2012 received conventional treatments (group 1) known as the traditional ‘‘three-tube method’’, and 23 (53%) patients from January 2013 to December 2019 received new treatments (group 2), consisted of conventional therapies and the nasogastric placement of sump drainage tube through fistula into abscess cavity. Results: The presence of intrathoracic anastomotic leak was proven by contrast esophagography in 43 patients (4.9%). Among them, The average duration of chest tube was 47 days in group 1 and 28 days in group 2. The average length of leak treatment was 52 days in group 1 and 35 days in group 2. The average length of postoperative hospital stay was 56 days in group 1 and 39 days in group 2,respectively. 7(35%) patients among 20 patients died from intrathoracic anastomotic leak in group 1;and 3(13%) patients among 23 patients died from intrathoracic anastomotic leak in group 2. Compared with the conventional treatments (group 1), The average duration of chest tube was significantly decreased in the new treatments (group 2) (P < 0.01), as well as the length of leak treatment (P < 0.05) and the length of postoperative hospital stay (P < 0.01). However, there was no significant difference in the mortality rate (P=0.148 > 0.05).Conclusion: In conclusion, Our results showed this method of the nasogastric placement of sump drainage tube through fistula appears to be an safe, effective, technically feasible treatment option for intrathoracic esophagogastric anastomotic leak. The efficacy and feasibility could be further investigated with a well-designed and large-scale RCT research.
Perioperative outcomes of combined heart surgery and lung tumor resection: A systematic review and meta-analysis
Authors: Cheng Shizhao , Jiang Yiyao , Li Xin , Lu Xike , Zhang Xun , Sun Daqiang
Published: October 2020

Objective: The coexistence of concomitant lesions of the heart and lungs needed surgical intervention is increasing. Simultaneous cardiac surgery with pulmonary resection can solve the lesions at the same time, thus avoiding the second operation. However, concern exists regarding the potentially increased mortality and complication rate of simultaneous surgery and the adequacy of lung exposure during heart surgery. Therefore, we performed a meta-analysis to evaluate the perioperative mortality and complication rate of combined heart surgery and lung tumor resection.Methods: A comprehensive literature search was performed in July 2020. PubMed, Embase and Web of Science databases were searched to collect studies reported the perioperative outcomes of combined heart surgery and lung tumor resection. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Pooled proportion and its 95% confidence intervals (95% CI) was performed by R version 3.6.1 using the meta package.Results: A total of 536 patients from 29 studies were included in this analysis. Overall, the results of this meta-analysis showed that the pooled proportion of operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57) for patients underwent combined cardiothoracic surgery. Subgroup analysis by lung pathology revealed that, for lung cancer patients, the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95, 1.00), and the pooled proportion of systematic lymph node dissection or sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery procedures found that the pooled proportion of postoperative complications of coronary artery bypass grafting (CABG) patients using off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled proportion of on-pump method was 0.61 (95% CI: 0.38, 0.82).Conclusion: This study presented that combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analysis revealed most lung cancer patients underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG could potentially reduce the complication rate compared with on-pump CABG. While further researches are still needed.
Giant Intrapericardial Bronchogenic Cyst Associated with Congestive Heart Failure and Atrial Fibrillation: A Case Report
Authors: Maldonado Javier , Molina German , T Francisco M- Rincón , Buitrago Lina M. Acosta , Rivera Carlos J- Perez
Published: October 2020

Background: Large intracardiac bronchogenic cysts are rare mediastinal masses, however they must always be considered in the differential diagnosis of heart failure. Case Presentation: We present a 60-year-old female patient with de novo atrial fibrillation and heart failure, resulting from an incidental large intrapericardial mass. The patient underwent successful surgical resection, with pathological findings confirming a bronchogenic cyst.Conclusions: Large bronchogenic cysts located intrapericardially are very rare, however they should be included in the differential diagnosis of patients presenting with atrial fibrillation and heart failure.
Automatic Identification of Upper Extremity Rehabilitation Exercise Type and Dose Using Body-Worn Sensors and Machine Learning: A Pilot Study
Authors: Balestra Noah , Sharma Gaurav , Riek Linda M. , Busza Ania
Published: October 2020

Background: Prior studies suggest that participation in rehabilitation exercises improves motor function post-stroke; however, studies on optimal exercise dose and timing have been limited by the technical challenge of quantifying exercise activities over multiple days. Objective: In this exploratory study, we assessed the feasibility of using body-worn sensors to track rehabilitation exercises in the inpatient setting and investigated which recording parameters and data analysis strategies are sufficient for accurately identifying and counting exercise repetitions. Methods: MC10 BioStampRC® sensors were used to measure accelerometry and gyroscopy data from arms of healthy controls (n=13) and patients with upper extremity (UE) weakness due to recent stroke (n=13) while the subjects performed three pre-selected UE exercises. Sensor data was then labeled by exercise type, and this labeled data set was used to train a machine learning classification algorithm for identifying exercise type. The machine-learning algorithm and a peak-finding algorithm were used to count exercise repetitions in non-labeled data sets. Results: We achieved a repetition counting accuracy of 95.6 ± 2.4 % overall, and 95.0 ± 2.3 % in patients with UE weakness due to stroke. Accuracy was decreased when using fewer sensors or using accelerometry data alone. Conclusions: Our exploratory study suggests that body-worn sensor systems are technically feasible, well-tolerated in subjects with recent stroke, and may ultimately be useful for developing a system to measure total exercise “dose” in post-stroke patients during clinical rehabilitation or clinical trials.
Augmented Feedback for Manual Wheelchair Propulsion Technique Training in a Virtual Reality Simulator
Authors: Yan Hui , Archambault Philippe S.
Published: October 2020

Background: Motor learning of appropriate manual wheelchair propulsion is critical, as incorrect technique elevates risk for upper extremity pain. Virtual reality simulators allow users to practice this complex task in a safe and realistic environment. Additionally, augmented feedback may be provided in order to optimize learning. The purpose of this study was to investigate the effects of providing augmented feedback with various delivery schedules on motor learning and transfer of this skill to over-ground propulsion.Methods: Thirty healthy young adults were randomly assigned to three groups. During a virtual reality propulsion training session, the high-frequency feedback group received augmented feedback throughout all propulsion training; the faded feedback group received this information in a faded schedule; and the control group underwent training with no augmented feedback. Propulsion assessments were performed at baseline and 48 hours after practice in both virtual and real environments to measure retention and transfer, respectively.Results: Compared to the control group, both feedback groups exhibited significant improvements in contact angle and push frequency in both environments after training. Small, non-significant differences were also found between the high-frequency and faded feedback groups.Conclusion: Virtual reality training is an effective learning intervention for acquisition, retention, and transfer of appropriate manual wheelchair propulsion technique when such training includes augmented feedback about propulsion biomechanics.
Impact of Goal-directed Hemodynamic Management on the Incidence of Acute Kidney Injury in Patients Undergoing Partial Nephrectomy: A Pilot Randomized Controlled Trial
Authors: Wu Qiong-Fang , Kong Hao , Xu Zhen-Zhen , Li Huai-Jin , Mu Dong-Liang , Wang Dong-Xin
Published: October 2020

Background: The incidence of acute kidney injury (AKI) remains high after partial nephrectomy. Ischemia-reperfusion injury produced by renal hilum clamping during surgery might have contributed to the development of AKI. In this study we tested the hypothesis that goal-directed fluid and blood pressure management could reduce AKI in patients following partial nephrectomy. Methods: This was a pilot randomized controlled trial. Adult patients who were scheduled to undergo partial nephrectomy were randomized into two groups. In the intervention group, goal-directed hemodynamic management was performed from renal hilum clamping until end of surgery; the target was to maintain stroke volume variation < 6%, cardiac index 3.0 - 4.0 L/min/m2 and mean arterial pressure > 95mmHg with crystalloid fluids and infusion of dobutamine and/or norepinephrine. In the control group, hemodynamic management was performed according to routine practice. The primary outcome was the incidence of AKI within the first 3 postoperative days. Results: From June 2016 to January 2017, 144 patients were enrolled and randomized (intervention group, n = 72, control group, n = 72). AKI developed in 12.5% of patients in the intervention group and in 20.8% of patients in the control group; the relative reduction of AKI was 39.9% in the intervention group but the difference was not statistically significant (relative risk 0.60, 95% confidence interval [CI] 0.28-1.28; P = 0.180). No significant differences were found regarding AKI classification, change of estimated glomerular filtration rate over time, incidence of postoperative 30-day complications, postoperative length of hospital stay, as well as 30-day and 6-month mortality between the two groups.Conclusion: For patients undergoing partial nephrectomy, goal-directed circulatory management during surgery reduced postoperative AKI by about 40%, although not significantly so. The trial was underpowered. Large sample size randomized trials are needed to confirm our results.Trial registration: Clinicaltrials.gov identifier: NCT02803372. Date of registration: June 6, 2016.
High-dose CytoSorb hemoadsorption is associated with improved survival in patients with septic shock: A retrospective cohort study
Authors: Schultz Philipp , Schwier Elke , Eickmeyer Claas , Henzler Dietrich , Koehler Thomas
Published: October 2020

Background: Septic shock and SIRS are life-threatening diseases with persistent high mortality. Hemoadsorption with CytoSorb® offers a possible therapeutic approach, but the optimal timing, dosing and indications are still unclear.Methods: Observational data from 70 patients with septic shock or SIRS, treated in a university hospital with hemoadsorption by CytoSorb® in addition to renal replacement therapy were analyzed retrospectively. Physiologic parameters and clinical outcomes were extracted from the electronic charts. The predicted mortality was calculated based on APACHE II and SOFA scores and compared with the actual 28-day survival. The total amount of blood purified was correlated with outcome.Results: The main origins of septic shock were abdominal (n=29) or pulmonary (n=22). The mean age was 70.6±13.3 years. Hemoadsorption was applied for 85.6±53.8h with 3.2±1.7 cycles lasting 26.75±11.1h each. The severity was characterized by a mean APACHE II score of 30.2±6.3 and SOFA score of 13.8±3.5, which calculated to a predicted mortality of 73.3% and 62.1%, respectively. The observed mortality was significantly lower (35/70 patients (50%), p<0.05). Interleukin-6 levels at baseline were high (survivors: 7964±11242pg/ml; nonsurvivors: 8.755±15.800pg/ml, p=0.27) and decreased rapidly within 4-24h. Survival was independently associated with lower IL-6 levels and norepinephrine dosage after 24h. An increase in IL-6 after 48h was predictive of poor outcome.The treatment duration and amount of blood purified was higher in survivors than in non-survivors (8.47±4.42 vs. 6.07±3.57l/kg BW, p=0.017). We identified 3 clusters of <6l/kg, 6-13l/kg and ≥13l/kg BW with a linear dose-response relation between blood purification volume and survival. Although the predicted mortality was comparable among the clusters (p=ns), survival was best in the highest volume cluster (16.7%; p=0.045).Conclusions: The application of CytoSorb® seems to be safe and effective in various conditions of septic shock and SIRS, although the optimal duration and dosing remain unclear. In a cohort of severely ill patients the observed mortality rate was lower than predicted and decreased linearly with blood purification volumes exceeding 6l/kg BW. These results suggest that hemoadsorption with CytoSorb® improves survival in septic shock or SIRS, provided that the applied dose is high enough.
Evaluation of Early Postoperative Intravenous Opioid Rescue as a Novel Quality Measure in Patients who Receive Thoracic Epidural Analgesia: A Retrospective Cohort Analysis and Prospective Performance Improvement Intervention
Authors: Levy Nadav , Santer Peter , Zucco Liana , Nabel Sarah , Korsunsky Galina , Ramachandran Satya Krishna
Published: October 2020

Background: In this study, we explored the prevalence of intravenous opioid rescue analgesia in the post-anesthesia care unit (PACU-OpResc) as a single marker of thoracic epidural analgesia (TEA) failure and evaluated the resource implications and quality improvement applications of this measure. Methods: We performed a retrospective analysis of all TEA placements during 2016-2018 at a single academic medical center in Boston, Massachusetts. The study exposure was the need for intravenous opioid rescue analgesia in the PACU (PACU-OpResc). Primary outcome was PACU length of stay (LOS). Secondary outcomes included delayed PACU discharge and intraoperative hypotension. The analyses were adjusted for confounding variables including patient comorbidities, surgical complexity, intraoperative intravenous opioids, chronic opioid use and local anesthetic bolus through TEA catheter. Post analysis chart review was conducted to determine the positive predictive value (PPV) of PACU-OpResc for inadequate TEA. As a first Plan-Do-Study-Act cycle, we then introduced a checkbox for documentation of a sensory level check (SLC) after TEA placement. Post implementation data was collected for 7 months. Results: PACU-OpResc was required by 211 (22.1%) patients who received preoperative TEA, was associated with longer PACU LOS (incidence rate ratio 1.20, 95% CI:1.07–1.34, p=0.001) and delayed discharge due to inadequate pain control (odds ratio 5.15, 95% CI 3.51–7.57, p<0.001). PACU-OpResc had a PPV of 76.3% and 60.4% for re-evaluation and manipulation of the TEA catheter in PACU, respectively. Following implementation of a checkbox, average monthly compliance with documented SLCs after TEA placement was noted to be 39.7%. During this time, a reduction of 8.2% in the rate of PACU-OpResc was observed.Conclusions: This study demonstrates that PACU-OpResc can be used as a quality assurance measure or surrogate for TEA efficiency, to track performance and monitor innovation efforts aimed at improving analgesia, such as our intervention to facilitate SLCs and reduced PACU-OpResc.
Home Range Characteristics and Diel Patterns in Space Use of Mutton Snapper, Lutjanus Analis, in St. Thomas, Us Virgin Islands
Authors: Heidmann Sarah L. , Jossart Jonathan , Nemeth Richard S.
Published: October 2020

Background: The movement ecology of mutton snapper Lutjanus analis is poorly understood despite their ecological and economic importance in the Caribbean. Passive acoustic telemetry was used to determine home ranges of six adult L. analis, including diel patterns, in Brewers Bay, St. Thomas, US Virgin Islands. Understanding long-term space use, including site fidelity and habitat usage, is necessary to implement effective and appropriate management actions for a species with extensive space and resource needs.Results: Individual L. analis were tracked over an average period of 316 days (range 125 - 509 days) and showed high site fidelity to relatively small home ranges (mean ± SD: 0.103 ± 0.028 km2, range 0.019 - 0.190 km2) and core use areas with low overlap among individuals. Most home ranges had a habitat composition dominated by seagrass and to a lesser degree, coral reef and/or pavement. Nighttime activity spaces were distinct from but contained within daytime areas.Conclusions: Mutton snapper showed strong site fidelity to home ranges in Brewers Bay. Two individuals that were absent from the array for more than a few hours were detected at separate arrays at spawning aggregation sites. This study expands upon knowledge of mutton snapper home range characteristics, highlights the importance of maintaining adjacent high-quality habitat types in any spatial management plan, and encourages the adoption of other types of management strategies, particularly for transient-aggregating species.
Impact of Therapeutic Hypothermia During Cardiopulmonary Resuscitation on Neurologic Outcome: A Systematic Review and Meta-analysis
Authors: Annoni Filippo , PELUSO Lorenzo , FIORE Marco , NORDBERG Per , SVENSSON Leif , ABELLA Benjamin , CALABRO' Lorenzo , SCOLLETTA Sabino , VINCENT Jean-Louis , CRETEUR Jacques , TACCONE Fabio Silvio
Published: October 2020

Background: Therapeutic cooling initiated during cardiopulmonary resuscitation (intra arrest therapeutic hypothermia, IATH) provided diverging effect on neurological outcome of out-of-hospital cardiac arrest (OHCA) patients depending on the initial cardiac rhythm and the cooling methods used. Methods: We performed a systematic search of PubMed, EMBASE and the CENTRAL databases using established Medical Subject Headings (MeSH) terms for IATH and OHCA. Only studies comparing IATH to standard in-hospital targeted temperature management (TTM – control group) were selected. We used the revised Cochrane RoB-2 and the Newcastle-Ottawa scale tool to assess risk of bias of each study. Primary outcome was favorable neurological outcome (FO); secondary outcomes included return of spontaneous circulation (ROSC) rate and overall survival to hospital discharge. Two authors independently assessed the validity of included human studies and extracted data regarding characteristics of the studied cohorts and main outcomes. Results: Out of 20950 studies, 8 studies (n=3493 patients, including 4 randomized trials, RCTs) were included in the final analysis. When compared to controls, the use of IATH was not associated with improved favorable neurological outcome (OR 0.96 [95% CIs 0.68-1.37]; p= 0.84), increased ROSC rate (OR 1.11 [95% CIs 0.83-1.49]; p= 0.46) or survival to hospital discharge (OR 0.91 [95% CIs 0.73-1.14]; p= 0.43). Significant heterogeneity among studies was observed only for the analysis of ROSC rate (I2=69%). Trans-nasal evaporative cooling and cold fluids were explored in two RCTs each and no significant differences were observed on neurological outcome. However, trans-nasal evaporative cooling was associated with a higher probability of favorable neurological outcome when compared to controls in patients with an initial shockable rhythm (OR 1.62 [95% CI 1.00-2.64]; p=0.05]. Conclusions: In this meta-analysis, IATH was not associated with improved neurological outcome when compared to standard in-hospital TTM. However, there are considerable outcome differences depending on the methods used and the studied population that need to be explored in future trials. Clinical Trial Registration: PROSPERO (CRD42019130322)
A microplanning strategy to improve door-to-door health service delivery: The case of Seasonal Malaria Chemoprevention in Sub-Saharan African villages
Authors: Ouedraogo Andre Lin , Zhang Julie , Tinto Halidou , Valéa Innocent , Wenger Edward A.
Published: October 2020

Background Malaria incidence has plateaued in Sub-Saharan Africa despite Seasonal Malaria Chemoprevention’s (SMC) introduction. Community health workers (CHW) use a door-to-door delivery strategy to treat children with SMC drugs, but for SMC to be as effective as in clinical trials, coverage must be high over successive seasons. Methods We developed and used a microplanning model that `utilizes raster to estimate population size, generates optimal households visit itinerary, and quantifies SMC coverage based on CHWs’ time investment for treatment and walking. CHWs’ performance under current SMC deployment mode was assessed using CHWs’ tracking data and compared to microplanning in villages with varying demographics and geographies. Results Estimates showed that microplanning significantly reduces CHWs’ walking distance by 25%, increases the number of visited households by 36% (p < 0.001) and increases SMC coverage by 21% from 37.3% under current SMC deployment mode up to 58.3% under microplanning (p < 0.001). Optimal visit itinerary alone increased SMC coverage up to 100% in small villages whereas in larger or hard-to-reach villages, filling the gap additionally needed an optimization of the CHW ratio.Conclusion We estimate that for a pair of CHWs, the daily optimal number of visited children (assuming 8.5mn spent per child) and walking distance should not exceed 45 and 5km respectively. Our work contributes to extend SMC coverage by 21-63% and may have broader applicability for other community health programs.
The impact of government subsidy programs on equity in health financing
Authors: Mohammadzadeh Yousef , Dizaj Jafar Yahyavi , Mosadeghrad Ali Mohammad , Kazemi Ali , Yusefzadeh Hasan
Published: October 2020

Background: Iran government launched the targeted subsidy plan (TSP) in December 2011 to reduce inequality and poverty. In addition, Health Transformation Plan (HTP) was implemented in ministry of health to reduce people out of pocket payment. This study aimed to examine the impact of these two government subsidy programs on equity in health financing. Method: In this longitudinal study, data on 413,201 households were collected using household surveys during 11 years (2007-2017). The Fairness in Financial Contribution (FFCI) index and Catastrophic Health Expenditures (CHE) index were calculated.Also Logistic regression model was performed by the applied software of Stata V.14 to examine the effects of TSP and HTP policies and other socioeconomic characteristics of households on their exposure to CHE.Results: The FFC index was 0.829 and 0.830 respectively in 2007 and 2017. The trend analysis did not show significant changes in FFC index between 2007 and 2017. TSP and HTP implementation die not reduce households’ exposure to CHE significantly. Crowded households with more elder people, belonging to low income deciles, without houses, living in rural areas and deprived provinces, are more likely to be at risk of CHE. Health insurance coverage did not protect households from CHE. High educated and employed households were exposed to less CHE.Conclusion: The government subsidy programs have not been effective in improving FFC and reducing CHE indices. None of them has been able to realize the goal of the 6th National Development Plan of reducing CHE to 1%. The government should devise support packages for target household (households with more elderly people, lower incomes, without private house, crowded, rural and inhabited in deprived provinces), so they can protect households against CHE. Modifying and improving the quality of insurance coverage is strongly recommended due to its inefficiency.
Physical and Psychological Characteristics of Nitrous Oxide Abusers During the COVID-19 Pandemic: An Observational Study.
Authors: Wang Shanshan , Wu Gang , Wang Tingling , Yu Anna , Wang Yajing , Liu Suzhi
Published: October 2020

Background The coronavirus disease 2019 (COVID-19) was classified as a global pandemic by the World Health Organization. In addition to health effects, it has also brought about psychological problems due to its economic and social impact. Psychological effects have led to drug and alcohol abuse. To inform physician decisions, there is a need to characterize the physical and psychological characteristics of nitrous oxide abusers during the COVID-19 Pandemic. Methods: We enrolled six nitrous oxide abusers who sought treatment at Taizhou Hospital of Zhejiang province between May 2020 and June 2020. Clinical data including socio-demographic, physical examination, laboratory examination, electromyography, neuroimaging, and psychological assessment were collected. Results: The enrolled patients had a mean age of 22±4.3. Clinical presentations included varying degrees of limb numbness and an ataxic gait. Under laboratory examination, it was revealed that all the patients did not have pernicious anemia, 4 patients had decreased vitamin B12 while 3 patients exhibited elevated homocysteine levels. MR of the spinal cord revealed that 4 patients had abnormal signals in the cervical spinal cord. These signals were of high symmetry with splayed or inverted V sign after T2WI. Peripheral nerve damage was observed in 5 patients who were subjected to an electromyogram (EMG) test. The Symptom Checklist 90 (SCL-90) psychological evaluation indicated that all patients had severe anxiety, depression and psychosis. The psychological status of nitrous oxide abusers was significantly different from that of health controls. After treatment by vitamin B12, the patients’ physical symptoms improved, and they were discharged from the hospital. For the evaluation of mental and psychological outcomes post-discharge, patients were asked to go to the psychological department for check-up and follow-up.Conclusion: The enrolled 6 patients caused by abuse of nitrous oxide presented with symptoms of subacute combined with spinal degeneration. They had more serious psychological problems related to the COVID-19 pandemic. These problems require immediate attention and interventional approaches. The national government and other departments should take active measures to control abuse of nitrous oxide. Trial registration: Not applicable.
Investigating primary health care practitioners’ barriers and enablers to referral of COPD patients to Pulmonary Rehabilitation: an exploratory sequential mixed methods study using the Theoretical Domains Framework
Authors: Watson Jane Suzanne , Jordan Rachel Elizabeth , Adab Peymane , Vlaev Ivo , Enocson Alexandra , Greenfield Sheila
Published: October 2020

BackgroundPulmonary rehabilitation is a highly effective, globally recommended intervention for patients with Chronic Obstructive Pulmonary Disease (COPD). Understanding why referral rates remain persistently low is important and enables the development of targeted interventions in order to improve future uptake. MethodsWe undertook an exploratory sequential mixed methods study to investigate the referral practices of Primary Health Care Practitioners (PHCPs) in the United Kingdom (UK). In phase 1 semi structured interviews were undertaken. Content analysis was used to map arising themes to the Theoretical Domains Framework (TDF) and the development of a 54-item TDF based questionnaire.In Phase 2 we distributed the questionnaire through relevant conferences and organisation memberships, to obtain views from a larger, more generalisable PHCP population. We used descriptive analyses to identify the most important barriers and enablers, and key TDF domains. Mixing of data occurred at 2 time points; instrument design and interpretation. Results19 PHCP took part in interviews and 233 responded to the survey. Integrated results revealed that PHCPs with a post qualifying respiratory qualification (154/241; 63.9%) referred more frequently (91/154; 59.1%) than those without (28/87; 32.2%).There were more barriers than enablers for referral in all 13 mapped TDF domains. Key barriers included: infrequent engagement from PR provider to referrer, concern around patient’s physical ability and access to PR (particularly for those in work), assumed poor patient motivation, no clear practice referrer and few referral opportunities. These mapped to the following domains: belief about capabilities, social influences, environment, optimism, skills and social and professional role.Enablers to referral were observed within the knowledge, social influences memory and environment domains. Many PHCPs believed in the physical and psychological value of PR, and helpful enablers were out-of-practice support from respiratory interested colleagues, dedicated referral time (annual review) and on-screen referral prompts. ConclusionsReferral to PR is a complex process. Barriers outweighed enablers. Aligning these findings to behaviour change techniques will identify practice-based interventions to overcome current barriers and strengthen enablers, thereby increasing referral of COPD patients to PR as recommended by international COPD guidelines
Differences in Expression of Genes Related to Steroidgenesis in Abdominal Subcutaneous Adipose Tissue of Pregnant Women with and without PCOS
Authors: Emami Neda , Moini Ashraf , Yaghmaei Parichehreh , Akbarinejad Vahid , Shahhoseini Maryam , Alizadeh AliReza
Published: October 2020

Background: It was hypothesized that steroid-related gene expressions in the adipose tissue (AT) of women are different between women with and without polycystic ovary syndrome (PCOS). However, little information exists regarding pregnant women suffering from PCOS when interrelationships among maternal PCOS, patient’s quality of life and offspring’s health is a consideration issue in health and diseases. Our objectives were to compare the mRNA expression levels of key steroid-converting enzymes in subcutaneous AT of PCOS vs. non-PCOS pregnant women.Methods: The subjects were 48 pregnant women (12 PCOS and 36 non–PCOS women) undergoing cesarean section, from whom abdominal subcutaneous AT samples were retrieved. Expressions of fifteen genes related to steriodogenesis were investigated using quantitative real-time PCR. Results: No significant differences were found with respect to age, BMI (before pregnancy and at delivery day), gestational period and parity among non-PCOS and PCOS pregnant women. Most of the sex steroid-converting genes except 17β-Hydroxysteroid dehydrogenases2 (17BHSD2), were highly expressed on the day of delivery in subcutaneous AT. PCOS patients showed significantly higher mRNA levels of steroidgenic acute regulator (STAR; P<0.001), cytochrome P450 monooxygenase (CYP11A1; P<0.05), 17α-hydroxylase (CYP17A1; P<0.05), and 11β-Hydroxysteroid dehydrogenase (11BHSD1-2; P<0.05). The expression of steroid 21-hydroxylase (CYP21) in non-PCOS women was 4-fold higher than for PCOS women (P < 0.001). There were no significant differences between relative expression of aromatase cytochrome P450 (CYP19A1), 3β-hydroxysteroid dehydrogenase1-2 (3BHSD1-2), and 17BHSD family (1, 3, 5, 7, and 12) between the two groups.Conclusion: The expression levels of genes related to sex steroids metabolism were similar in age-matched and BMI- matched non-PCOS and PCOS pregnant women at delivery day. However, the alterations in gene expressions involved in glucocorticoids and mineralocorticoid metabolism was shown which warrants further studies regards functional activity. More attention should be given to AT of PCOS mothers that was previously ignored.