bluuebunny/crossref_metadata_2025 huggingface dataset:
Mindfulness-based interventions to reduce burnout and stress in physicians: a study protocol for a systematic review and meta-analysis
Authors: Fendel Johannes Caspar , Bürkle Johannes Julian , Göritz Anja Simone
Published: November 2019

Introduction

Physicians often suffer from burnout and stress, not only affecting themselves, but also their patients and the healthcare system in general. An increasing number of studies suggest that mindfulness-based interventions improve physicians’ well-being as well as the quality of care they deliver. However, the evidence is scattered, and a systematic review and meta-analysis is lacking. To the best of our knowledge, this systematic review and meta-analysis will be the first to assess the effectiveness of mindfulness-based interventions in reducing burnout and stress among physicians. Further, it aims to uncover potential moderators of intervention effectiveness.

Methods and analysis

MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and the Cochrane Central Register of Controlled Trials will be screened without language or publication date restrictions. In addition, backward and forward citation searches of included studies and relevant reviews will be conducted. Studies examining the effect of interventions for physicians explicitly based on mindfulness will be included. Primary outcomes will be pre-post changes in burnout and stress if assessed with validated measures. Two reviewers independently search, select and extract data, and rate the methodological quality of the studies. Both controlled and uncontrolled studies will be included. Randomised controlled trails will be meta-analysed separately using between-group effect. In addition, non-randomised trials including non-controlled before-after studies will be meta-analysed using within-group effect. Potential moderators and sources of between-study heterogeneity will be tested using meta-regression and subgroup analyses. Futhermore, a narrative synthesis will be pursued. The Grading of Recommendations Assessment, Development and Evaluation system (GRADE) will be used to assess the quality of the cumulated evidence.

Ethics and dissemination

Ethical approval is not required. Results will be published in a peer-reviewed journal and presented at international conferences.

PROSPERO registration number

CRD42019133077
Research capacity in nursing: a concept analysis based on a scoping review
Authors: Chen Qirong , Sun Mei , Tang Siyuan , Castro Aimee R.
Published: November 2019

Objective

As the discipline of nursing has advanced, research capacity in nursing has become increasingly important to the discipline’s development. However, research capacity in nursing is still commonly used as a buzzword, without a consistent and clear definition. The purpose of this study is to clarify the concept of research capacity in nursing by identifying its conceptual components in the relevant nursing literature using the Pragmatic Utility method.

Design

A Pragmatic Utility concept analysis based on a scoping review.

Data sources

Academic literature retrieved from PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Scopus, Web of Science and ProQuest Dissertations and Theses (PQDT).

Eligibility criteria

Qualitative studies, quantitative studies, mixed method studies or literature reviews focusing on research capacity in nursing published in English between 2009 and 2019.

Results

Competence, motivation, infrastructure and collaboration for nursing research are the antecedents of research capacity in nursing. The attributes of research capacity in nursing are ‘non-individual level’, ‘context-embeddedness’ and ‘sustainability’. The direct outcome of research capacity in nursing is nursing research. The allied concepts identified are nursing research competency, nursing research capability and evidence-based practice capacity in nursing.

Conclusions

Research capacity in nursing is the ability to conduct nursing research activities in a sustainable manner in a specific context, and it is normally used at a non-individual level. Research capacity in nursing is critical for the development of the nursing discipline, and for positive nurse, patient and healthcare system outcomes. More studies are needed to further explore the allied concepts of research capacity in nursing, and to better understand relationships among these allied concepts.
Efficacy of Bifidobacterium longum, B. infantis and Lactobacillus acidophilus probiotics to prevent gut dysbiosis in preterm infants of 28+0–32+6 weeks of gestation: a randomised, placebo-controlled, double-blind, multicentre trial: the PRIMAL Clinical Study protocol
Authors: Marißen Janina , Haiß Annette , Meyer Claudius , Van Rossum Thea , Bünte Lisa Marie , Frommhold David , Gille Christian , Goedicke-Fritz Sybelle , Göpel Wolfgang , Hudalla Hannes , Pagel Julia , Pirr Sabine , Siller Bastian , Viemann Dorothee , Vens Maren , König Inke , Herting Egbert , Zemlin Michael , Gehring Stephan , Bork Peer , Henneke Philipp , Härtel Christoph
Published: November 2019

Introduction

The healthy ‘eubiosis’ microbiome in infancy is regarded as the microbiome derived from term, vaginally delivered, antibiotic free, breastfed infants at 4–6 months. Dysbiosis is regarded as a deviation from a healthy state with reduced microbial diversity and deficient capacity to control drug-resistant organisms. Preterm infants are highly sensitive to early gut dysbiosis. Latter has been associated with sepsis and necrotising enterocolitis, but may also contribute to long-term health problems. Probiotics hold promise to reduce the risk for adverse short-term outcomes but the evidence from clinical trials remains inconclusive and none has directly assessed the effects of probiotics on the microbiome at high resolution.

Methods and analysis

A randomised, double blind, placebo-controlled study has been designed to assess the safety and efficacy of the probiotic mix of Bifidobacterium longum and infantis and Lactobacillus acidophilus in the prevention of gut dysbiosis in preterm infants between 28+0 and 32+6 weeks of gestation. The study is conducted in 18 German neonatal intensive care units. Between April 2018 and March 2020, 654 preterm infants of 28+0–32+6 weeks of gestation will be randomised in the first 48 hours of life to 28 days of once daily treatment with either probiotics or placebo. The efficacy endpoint is the prevention of gut dysbiosis at day 30 of life. A compound definition of gut dysbosis is used: (1) colonisation with multidrug-resistant organisms or gram-negative bacteria with high epidemic potential or (2) a significant deviation of the gut microbiota composition as compared with healthy term infants. Dysbiosis is determined by (1) conventional microbiological culture and (2) phylogenetic microbiome analysis by high-throughput 16S rRNA and metagenome sequencing. Persistence of dysbiosis will be assessed at 12-month follow-up visits. Side effects and adverse events related to the intervention will be recorded. Key secondary endpoint(s) are putative consequences of dysbiosis. A subgroup of infants will be thoroughly phenotyped for immune parameters using chipcytometry.

Ethics and dissemination

Ethics approval was obtained in all participating sites. Results of the trial will be published in peer-review journals, at scientific meetings, on the website (www.primal-study.de) and via social media of parent organisations.

Trial registration number

DRKS00013197; Pre-results.
Existing comorbidities in people with osteoarthritis: a retrospective analysis of a population-based cohort in Alberta, Canada
Authors: Marshall Deborah A , Liu Xiaoxiao , Barnabe Cheryl , Yee Karen , Faris Peter D , Barber Claire , Mosher Dianne , Noseworthy Thomas , Werle Jason , Lix Lisa
Published: November 2019

Objectives

The purpose of this study is to estimate the prevalence of comorbidities among people with osteoarthritis (OA) using administrative health data.

Design

Retrospective cohort analysis.

Setting

All residents in the province of Alberta, Canada registered with the Alberta Health Care Insurance Plan population registry.

Participants

497 362 people with OA as defined by ‘having at least one OA-related hospitalization, or at least two OA-related physician visits or two ambulatory care visits within two years’.

Primary outcome measures

We selected eight comorbidities based on literature review, clinical consultation and the availability of validated case definitions to estimate their frequencies at the time of diagnosis of OA. Sex-stratified age-standardised prevalence rates per 1000 population of eight clinically relevant comorbidities were calculated using direct standardisation with 95% CIs. We applied χ2 tests of independence with a Bonferroni correction to compare the percentage of comorbid conditions in each age group.

Results

54.6% (n=2 71 794) of people meeting the OA case definition had at least one of the eight selected comorbidities. Females had a significantly higher rate of comorbidities compared with males (standardised rates ratio=1.26, 95% CI 1.25 to 1.28). Depression, chronic obstructive pulmonary disease (COPD) and hypertension were the most prevalent in both females and males after age-standardisation, with 40% of all cases having any combination of these comorbidities. We observed a significant difference in the percentage of comorbidities among age groups, illustrated by the youngest age group (<45 years) having the highest percentage of cases with depression (24.6%), compared with a frequency of 16.1% in those >65 years.

Conclusions

Our findings highlight the high frequency of comorbidity in people with OA, with depression having the highest age-standardised prevalence rate. Comorbidities differentially affect females, and vary by age. These factors should inform healthcare programme and delivery.
IDEAL Stage 2a experience with in-office, transperineal MRI/ultrasound software fusion targeted prostate biopsy
Authors: Tzeng Michael , Cricco-Lizza Eliza , Al Hussein Al Awamlh Bashir , Pantuck Morgan , Margolis Daniel J , Yu Miko , Hu Jim
Published: November 2019

Objective

Although the feasibility of transperineal biopsy under local anesthesia has been demonstrated, little is known regarding the application of MRI/ultrasound software fusion targeted biopsy for transperineal biopsy under local anesthesia. The objective of our study is to describe our initial experience with in-office transperineal MRI/ultrasound software fusion targeted biopsy (Idea, Development, Exploration, Assessment, Long-term Follow-up [IDEAL] Stage 2a).

Methods

Between October 2017 and July 2019, 33 men underwent in-office transperineal MRI-targeted biopsy using the Artemis (Eigen, Grass Valley, CA, USA) fixed-robotic arm system. The indication for biopsy was elevated prostate specific antigen (PSA) (n=14), prior negative biopsy (n=10), active surveillance (n=6), and surveillance after partial gland cryoablation (n=3). We prospectively captured patient demographic and clinical characteristics, biopsy outcomes, and complications. Complications were classified according to Common Terminology Criteria for Adverse Events (CTCAE) V.5.0.

Results

The median patient age was 67 years (IQR 61–71) and the median serum PSA level was 7.0 ng/mL (IQR 5.1–11.4). The median duration of in-office MRI-targeted transperineal biopsy was 26 min (IQR 23–28). Overall, transperineal MRI-targeted biopsy detected prostate cancer in 18 (54.6%) men, with 8 (24.2%) being clinically significant (Gleason Score ≥3+4, Grade Group ≥2). Clinically significant prostate cancer was detected in four (28.6%) biopsy naïve men, two (20.0%) men with a prior negative, one (16.7%) man on active surveillance and one (33.3%) man following partial gland ablation. Three (9.1%) men experienced complications: two hematuria and one urinary retention.

Conclusion

Our findings demonstrate the feasibility of the fixed-robotic arm fusion platform for in-office transperineal MRI-targeted biopsy and a low rate of adverse events. However, larger prostate size precludes MRI/ultrasound software fusion and pubic arch interference hindered the transperineal MRI-targeted approach in 9.1% of men. Pubic arch interference was overcome by a free-hand approach with software fusion guidance.
Late time dynamics of f(R,T,RμνTμν) gravity
Authors: Abchouyeh Maryam Aghaei , Mirza Behrouz , Shahidi Parisa , Oboudiat Fatemeh
Published: November 2019

Dynamical behavior and future singularities of [Formula: see text] gravitational theory are investigated. This gravitational model is a more complete form of the [Formula: see text] gravity which can offer new dynamics for the universe. We investigate this gravitational theory for the case [Formula: see text] using the method of autonomous dynamical systems and by assuming an interaction between matter and dark energy. The fixed points are identified and the results are consistent with standard cosmology and show that for small [Formula: see text], the radiation-dominated era is an unstable fixed point of the theory and the universe will continue its procedure toward matter era which is a saddle point of the theory and allows the evolution to dark energy-dominated universe. Finally, the dark energy-dominated epoch is a stable fixed point and will be the late time attractor for the universe. We also consider future singularities for the two [Formula: see text] and [Formula: see text] cases and for [Formula: see text] and [Formula: see text]. Our results show that for the case of [Formula: see text], the future singularities of the universe will happen in the same condition as do for the Einstein–Hilbert FRW universe. However, a new type of singularity is obtained for [Formula: see text] that is captured by [Formula: see text] [Formula: see text] [Formula: see text] and [Formula: see text].
Pruning High-Similarity Clusters to Optimize Data Diversity when Building Ensemble Classifiers
Authors: Fletcher Sam , Verma Brijesh
Published: November 2019

Diversity is a key component for building a successful ensemble classifier. One approach to diversifying the base classifiers in an ensemble classifier is to diversify the data they are trained on. While sampling approaches such as bagging have been used for this task in the past, we argue that since they maintain the global distribution, they do not create diversity. Instead, we make a principled argument for the use of [Formula: see text]-means clustering to create diversity. Expanding on previous work, we observe that when creating multiple clusterings with multiple [Formula: see text] values, there is a risk of different clusterings discovering the same clusters, which would in turn train the same base classifiers. This would bias the ensemble voting process. We propose a new approach that uses the Jaccard Index to detect and remove similar clusters before training the base classifiers, not only saving computation time, but also reducing classification error by removing repeated votes. We empirically demonstrate the effectiveness of the proposed approach compared to the state of the art on 19 UCI benchmark datasets.
Synthesis of cobalt porphyrin/Ti5NbO14 nanocomposite used as an ascorbic acid electrochemical detection material
Authors: Wu Shining , Liu Lin , Fan Zichun , Ma Juanjuan , Wang Haoran , tong Zhiwei
Published: November 2019

A novel layered nanocomposite CoTMPyP/Ti5[Formula: see text] was synthesized via exfoliation/restacking where cobalt porphyrin (CoTMPyP) was intercalated into exfoliated titanoniobate (Ti5[Formula: see text] nanosheets. The CoTMPyP/Ti5[Formula: see text] was characterized by X-ray powder diffraction (XRD), scanning electron microscopy (SEM), transmission electron microscopy (TEM), energy-dispersive spectroscopy (EDS), Fourier transform infrared (FTIR), and ultraviolet-visible absorption spectrscopy (UV–Vis). The morphology and structure analyses indicated that CoTMPyP/Ti5[Formula: see text] was synthesized successfully. The CoTMPyP was speculated to have been implanted with an angle of [Formula: see text] into the gallery of the Ti5[Formula: see text]. Electrochemical methods, including differential pulse voltammetry (DPV) and cyclic voltammetry (CV) were used to investigate the catalytic properties of CoTMPyP/Ti5[Formula: see text]. The cyclic voltammograms indicated that the CoTMPyP/Ti5[Formula: see text] exhibited excellent electrocatalysis of ascorbic acid (AA) in neutral phosphate buffered solution. The cyclic voltammograms further demonstrated an excellent diffusion-controlled electrochemical redox process. On the basis of the DPV analysis, the detection limit of AA was calculated to be [Formula: see text][Formula: see text]moL[Formula: see text][Formula: see text] within the concentration range from [Formula: see text] to [Formula: see text][Formula: see text]moL [Formula: see text].
Special Issue for Early Career Researchers: editorial
Authors: Stewart Heather A. , Kirkbride Martin P.
Published: November 2019

Thematic collection:
This article is part of the ‘Early Career Researchers’ available at:
https://www.lyellcollection.org/cc/SJG-early-career-research
Security-aware Routing and Scheduling for Control Applications on Ethernet TSN Networks
Authors: Mahfouzi Rouhollah , Aminifar Amir , Samii Soheil , Eles Petru , Peng Zebo
Published: November 2019

Today, it is common knowledge in the cyber-physical systems domain that the tight interaction between the cyber and physical elements provides the possibility of substantially improving the performance of these systems that is otherwise impossible. On the downside, however, this tight interaction with cyber elements makes it easier for an adversary to compromise the safety of the system. This becomes particularly important, since such systems typically are composed of several critical physical components, e.g., adaptive cruise control or engine control that allow deep intervention in the driving of a vehicle. As a result, it is important to ensure not only the reliability of such systems, e.g., in terms of schedulability and stability of control plants, but also resilience to adversarial attacks.

In this article, we propose a security-aware methodology for routing and scheduling for control applications in Ethernet networks. The goal is to maximize the resilience of control applications within these networked control systems to malicious interference while guaranteeing the stability of all control plants, despite the stringent resource constraints in such cyber-physical systems. Our experimental evaluations demonstrate that careful optimization of available resources can significantly improve the resilience of these networked control systems to attacks.
Respirometric In-Situ Methods for Real-Time Monitoring of Corrosion Rates: Part I. Atmospheric Corrosion
Authors: Strebl Michael , Bruns Mark , Virtanen Sannakaisa
Published: November 2019

A novel respirometric approach to monitor atmospheric corrosion kinetics is presented. Simultaneous real-time monitoring of the H2 evolution reaction (HER) and the O2 reduction reaction (ORR) is possible with a combination of optical O2 sensor measurements with gravimetric volume sensitive techniques or pressure sensor based techniques in closed chambers. The respirometric method is a universal, non-destructive tool applicable to any metal or alloy. It shows a high sensitivity for low corrosion rates and has a high time-resolution. Different examples of relevant engineering metals and alloys will be provided. Mass loss validation measurements carried out at the end of exposure show a good correlation with the total recorded cathodic charge. For metals with different oxidation states the average valency in the corrosion products can be calculated from the cathodic charge together with mass loss. The versatility of the novel monitoring technique is further demonstrated by studying the influence of wet-dry cycling, temperature steps or changes in the gas composition in-situ. The rate of HER, ORR and total corrosion rate during these changing exposure conditions can be tracked directly on the same sample. Overall the new method contributes to bridging the gap between lab tests, accelerated testing and field exposure.
Can Lipoic Acid Attenuate Cardiovascular Disturbances Induced by Ethanol and Disulfiram Administration Separately or Jointly in Rats?
Authors: Bilska-Wilkosz Anna , Kotańska Magdalena , Górny Magdalena , Filipek Barbara , Iciek Małgorzata
Published: November 2019

The exogenous lipoic acid (LA) is successfully used as a drug in the treatment of many diseases. It is assumed that after administration, LA is transported to the intracellular compartments and reduced to dihydrolipoic acid (DHLA) which is catalyzed by NAD(P)H-dependent enzymes. The purpose of this study was to investigate whether LA can attenuate cardiovascular disturbances induced by ethanol (EtOH) and disulfiram (DSF) administration separately or jointly in rats. For this purpose, we measured systolic and diastolic blood pressure, recorded electrocardiogram (ECG), and estimated mortality of rats. We also studied the activity of aldehyde dehydrogenase (ALDH) in the rat liver. It was shown for the first time that LA partially attenuated the cardiac arrhythmia (extrasystoles and atrioventricular blocks) induced by EtOH and reduced the EtOH-induced mortality of animals, which suggests that LA may have a potential for use in cardiac disturbance in conditions of acute EtOH intoxication. The administration of EtOH, LA, and DSF separately or jointly affected the ALDH activity in the rat liver since a significant decrease in the activity of the enzyme was observed in all treatment groups. The results indicating that LA is an inhibitor of ALDH activity are very surprising.
High Prevalence of Overweight/Obesity in Urban Sri Lanka: Findings from the Colombo Urban Study
Authors: Somasundaram Noel , Ranathunga Ishara , Gunawardana Kavinga , Ahamed Muneer , Ediriweera Dileepa , Antonypillai C. N. , Kalupahana Nishan
Published: November 2019

Background. South Asian countries face a double burden of malnutrition characterized by high prevalence of underweight, overweight, and obesity. Understanding the distribution of this public health problem is important to tailor targeted interventions for communities. The objective of the current study was to find out the prevalence of obesity in urban Sri Lanka and to identify sociodemographic factors associated with it. Methods. Adult males and females residing in an urban government division of the Colombo District in Sri Lanka were included in this study (Colombo Urban Study). Stratified simple random sampling was used to select a sample of 463 from the total population. Sociodemographic data using an interviewer-administered questionnaire, anthropometric measurements, and serum samples were obtained for investigations. Results. When the global BMI cutoffs were applied, the community prevalences of underweight, normal weight, overweight, and obesity were 7.7%, 39.6%, 37.0%, and 15.8%, respectively. When the Asian BMI cutoffs were applied, the respective prevalences were 7.7%, 26.8%, 34.3%, and 31.2%. The community prevalence for abdominal obesity was 58.1% when using Asian cutoffs. Females had a higher prevalence of both obesity and abdominal obesity. There was an ethnic difference in obesity rates with Moors having the highest rates (65.5%) followed by Sinhalese (52.3%) and Tamils (40.2%). The highest obesity prevalence was observed in the most educated group. Multiple regression analysis showed that high BMI was associated with female gender and family history of hypertension. Serum LDL negatively associated with BMI while the strength of this relationship was impacted by serum HBA1c levels. Finally, serum triglyceride level showed positive association with BMI, and the effect was more marked in Moors compared to Sinhalese. Conclusion. Two-thirds of adults in the studied urban population were overweight or obese. This highlights the urgent need for interventions to curb this epidemic. The gender, ethnic differences in obesity, its associations with educational status, and the interactions with metabolic comorbidities indicate that these interventions may need to be targeted towards different groups in the population.
Session-Based Webshell Detection Using Machine Learning in Web Logs
Authors: Wu Yixin , Sun Yuqiang , Huang Cheng , Jia Peng , Liu Luping
Published: November 2019

Attackers upload webshell into a web server to achieve the purpose of stealing data, launching a DDoS attack, modifying files with malicious intentions, etc. Once these objects are accomplished, it will bring huge losses to website managers. With the gradual development of encryption and confusion technology, the most common detection approach using taint analysis and feature matching might become less useful. Instead of applying source file codes, POST contents, or all received traffic, this paper demonstrated an intelligent and efficient framework that employs precise sessions derived from the web logs to detect webshell communication. Features were extracted from the raw sequence data in web logs while a statistical method based on time interval was proposed to identify sessions specifically. Besides, the paper leveraged long short-term memory and hidden Markov model to constitute the framework, respectively. Finally, the framework was evaluated with real data. The experiment shows that the LSTM-based model can achieve a higher accuracy rate of 95.97% with a recall rate of 96.15%, which has a much better performance than the HMM-based model. Moreover, the experiment demonstrated the high efficiency of the proposed approach in terms of the quick detection without source code, especially when it only considers detecting for a period of time, as it takes 98.5% less time than the cited related approach to get the result. As long as the webshell behavior is detected, we can pinpoint the anomaly session and utilize the statistical method to find the webshell file accurately.
Pioglitazone Protects Compression-Mediated Apoptosis in Nucleus Pulposus Mesenchymal Stem Cells by Suppressing Oxidative Stress
Authors: Hu Yiqiang , Huang Liang , Shen Min , Liu Yunlu , Liu Guohui , Wu Yongchao , Ding Fan , Ma Kaige , Wang Wentian , Zhang Yanbin , Shao Zengwu , Cai Xianyi , Xiong Liming
Published: November 2019

Excessive compression, the main cause of intervertebral disc (IVD) degeneration, affected endogenous repair of the intervertebral disc. Pioglitazone (PGZ) is the agonist of peroxisome proliferator-activated receptor γ, which has been widely used in the treatment of diabetes mellitus. The present study aim at investigating whether pioglitazone has protective effects on compression-mediated cell apoptosis in nucleus pulposus mesenchymal stem cells (NP-MSCs) and further exploring the possible underlying mechanism. Our results indicated that the isolated cells satisfied the criteria of MSC stated by the International Society for Cellular Therapy. Besides, our research revealed that pioglitazone could protect cell viability, cell proliferation of NP-MSCs and alleviated the toxic effects caused by compression. The actin stress fibers was suppressed obviously under compression, and pioglitazone alleviated the adverse outcomes. Pioglitazone exerted protective effects on compression-induced NP-MSCs apoptosis according to annexin V/PI double-staining and TUNEL assays. Pioglitazone suppressed compression-induced NP-MSCs oxidative stress, including decreasing compression-induced overproduction of reactive oxygen species (ROS) and malondialdehyde (MDA), and alleviated compression-induced mitochondrial membrane potential (MMP) decrease. Ultrastructure collapse of the mitochondria exhibited a notable improvement by pioglitazone in compression-induced NP-MSCs according to transmission electron microscopy (TEM). Furthermore, the molecular results showed that pioglitazone significantly decreased the expression of apoptosis-associated proteins, including cyto.cytochrome c, Bax, cleaved caspase-9, and cleaved caspase-3, and promoted Bcl-2 expression. These results indicated that pioglitazone alleviated compression-induced NP-MSCs apoptosis by suppressing oxidative stress and the mitochondrial apoptosis pathway, which may be a valuable candidate for the treatment of IVD degeneration.
Solving Linear Second-Order Singularly Perturbed Differential Difference Equations via Initial Value Method
Authors: Melesse Wondwosen Gebeyaw , Tiruneh Awoke Andargie , Derese Getachew Adamu
Published: November 2019

In this paper, an initial value method for solving a class of linear second-order singularly perturbed differential difference equation containing mixed shifts is proposed. In doing so, first, the given problem is modified in to an equivalent singularly perturbed problem by approximating the term containing the delay and advance parameters using Taylor series expansion. From the modified problem, two explicit initial value problems which are independent of the perturbation parameter are produced; namely, the reduced problem and the boundary layer correction problem. These problems are then solved analytically and/or numerically, and those solutions are combined to give an approximate solution to the original problem. An error estimate for this method is derived using maximum norm. Several test problems are considered to illustrate the theoretical results. It is observed that the present method approximates the exact solution very well.
The Effect of Iron Deficiency Anemia Early in the Third Trimester on Small for Gestational Age and Birth Weight: A Retrospective Cohort Study on Iron Deficiency Anemia and Fetal Weight
Authors: Col Madendag Ilknur , Eraslan Sahin Mefkure , Madendag Yusuf , Sahin Erdem , Demir Mustafa Bertan , Acmaz Banu , Acmaz Gokhan , Muderris Iptisam Ipek
Published: November 2019

Aim. The aim of the present study was to evaluate the relationship between iron deficiency anemia and small for gestational age (SGA) in early third trimester pregnancies. Methods. A total of 4800 pregnant women who met the inclusion criteria were analyzed retrospectively. We included pregnant women who had iron deficiency anemia between 26+0 and 30+0 weeks of gestation and delivered singletons between 37+0 and 41+6 weeks of gestation. Patients were divided into four groups according to anemia level: (1) hemoglobin (Hb) < 7 mg/dl (n = 80), (2) Hb 7–9.9 mg/dl (n = 320), (3) Hb 10–10.9 mg/dl (n = 1300), and (4) Hb > 11 mg/dl (n = 3100, control group). The primary outcome of this study was the presence of SGA. Results. The demographic and obstetric characteristics were similar among all the groups. Maternal age, BMI <30 kg/m2, nulliparity rates, and previous cesarean delivery rates were similar among groups. Ethnicity was significantly different in the severe and moderate anemia groups (<0.001). Mean fetal weight was 2900 ± 80 g in the severe anemia group, 3050 ± 100 g in the moderate anemia group, 3350 ± 310 g in the mild anemia group, and 3400 ± 310 g in the control group. Fetal weight was significantly lower in the severe and moderate anemia groups compared to the mild anemia and control groups (<0.001). The SGA rate was 18.7% in the severe anemia group, 12.1% in the moderate anemia group, 5.3% in the mild anemia group, and 4.9% in the control group. SGA was significantly higher in the severe and moderate anemia groups compared to the mild anemia and control groups (<0.001). Conclusion. The results of this study indicated that early third trimester severe and moderate iron deficiency anemia was associated with SGA. Iron deficiency anemia in pregnant women may lead to low birth weight.
Impact of Poor Preoperative Glycemic Control on Outcomes among Patients with Cervical Cancer Undergoing a Radical Hysterectomy
Authors: Liang Si-Hua , Shen Yu-Chong , Wu Jie-Ying , Wang Li-Juan , Wu Miao-Fang , Li Jing
Published: November 2019

Background: The impact of preoperative glycemic control on the survival outcomes of patients undergoing a radical hysterectomy (RH) for cervical cancer has not been investigated. Patients and Methods: We reviewed patients who underwent a type III RH for cervical cancer between January 2004 and June 2011 in our institution. Results: A total of 431 patients were included and 83 (19.3%) were diagnosed with diabetes mellitus (DM). Poorly controlled DM (preoperative hemoglobin A1c [HbA1c] ≥7.0%) was observed in 49 (59.0%) diabetic patients. Compared to patients without DM and diabetic patients with good glycemic control (preoperative HbA1c <7.0%), diabetic patients with poor glycemic control had significantly higher risks of tumor recurrence, cervical cancer-specific death, and overall death. In multivariate analysis, DM with poor glycemic control independently predicted recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). We excluded patients without DM and performed a sensitivity analysis. When HbA1c levels were treated as a dichotomous variable, preoperative HbA1c ≥7.0% was independently associated with RFS, CSS, and OS. When HbA1c level was treated as a continuous variable, it remained an independent predictor of RFS, CSS, and OS. Conclusion: DM with poor glycemic control prior to RH was significantly associated with an increased risk of recurrence and mortality in cervical cancer patients. These results underscore the importance of intensive glycemic control and close follow-up for diabetic patients.
Percutaneous Intramyocardial Septal Radiofrequency Ablation for Interventricular Septal Reduction: An Ovine Model with 1-Year Outcomes
Authors: Liu Fang , Fu Jianli , Hsi David , Sun Chao , He Guangbin , Hu Rui , Zhang Jun , Liu Liwen
Published: November 2019

Background: Percutaneous intramyocardial (PIM) septal radiofrequency ablation (SRA) is a novel treatment approach for hypertrophic obstructive cardiomyopathy patients, but there has been lack of a large animal model to study PIM-SRA. We aimed to validate the long-term safety and efficacy of PIM-SRA and to observe pathological changes of the ablated interventricular septum (IVS) in a healthy sheep model. Methods and Results: Twelve sheep were randomized to the PIM-SRA group (n = 6) and the sham group (n = 6). In the PIM-SRA group, a radiofrequency (RF) electrode was inserted into the IVS with a maximum power of 80 W for 5 min. In the sham group, the RF electrode tip was positioned in the IVS segment but without RF power delivery. Septal hypokinesis was seen in all PIM-SRA group animals immediately after the procedure; the systolic wall thickening rate and motion amplitude of the ablated region decreased (p < 0.01), and the diastolic IVS thickness also decreased significantly over time (p < 0.01). ECG showed that all the sheep had normal sinus rhythm during the follow-up. Pathological examinations revealed scar tissue in the ablated region as expected. Conclusions: PIM-SRA produced precisely ablated myocardial tissue, reduced the IVS thickness significantly, preserved the global LV function, and avoided the incidence of conduction system damage in the long term. PIM-SRA was found to be a safe and effective minimally invasive septal reduction therapy.
Long-Term Weight Loss and Metabolic Syndrome Remission after Bariatric Surgery: The Effect of Sex, Age, Metabolic Parameters and Surgical Technique – A 4-Year Follow-Up Study
Authors: Guerreiro Vanessa , Neves João Sérgio , Salazar Daniela , Ferreira Maria João , Oliveira Sofia Castro , Souteiro Pedro , Pedro Jorge , Magalhães Daniela , Varela Ana , Belo Sandra , Freitas Paula , Carvalho Davide ,   AMTCO Group
Published: November 2019

Introduction: Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities. However, the literature reports inconsistent results regarding weight loss (WL) and the resolution of comorbidities associated with obesity. Objective: We aim to evaluate long-term differences in WL between different surgical techniques and the impact of each surgical technique on metabolic parameters (type 2 diabetes mellitus [T2DM], dyslipidemia,hypertension, and metabolic syndrome). We also aim to evaluate the effect of baseline clinical characteristics in WL and in the evolution of metabolic syndrome (MetS) components. Our hypothesis is that different types of surgery have different effects on WL and the prevalence of comorbidities over time. Methods: We retrospectively evaluated WL and metabolic parameter remission (T2DM, dyslipidemia, hypertension, and MetS) during 4 years in 1,837 morbidly obese patients (females, 85%; age, 42.5 ± 10.6 years; BMI, 44.0 ± 5.8) who underwent bariatric surgery (Roux-en-Y gastric bypass [RYGB], laparoscopic sleeve gastrectomy [LSG], and laparoscopic adjustable gastric band [LAGB]). Results: The mean percentage of WL for RYGB, LSG, and LAGB was, respectively, 32.9 ± 8.7, 29.8 ± 9.8, and 16.2 ± 9.6 at 12 months and 30.6 ± 9.1, 22.7 ± 10.0, and 15.8 ± 10.8 at 48 months (p < 0.001), even after adjustment for baseline weight, BMI, age, and sex (p < 0.001). Women had more WL during the first 36 months (p = 0.013 and 0.007 at 12 and 36 months, respectively) and older patients had less WL compared to younger ones (p <0.001), except at 48 months. Patients with T2DM had less WL than those without diabetes after adjustment (sex, age, and surgical technique) during the same period. Patients with hypertension had less WL at 12 months (p = 0.009) and MetS at 24 months (p = 0.020) compared to those without these comorbidities. There was no significant difference regarding the presence of dyslipidemia in WL. The RYGB group showed better results for MetS resolution. Conclusion:During the 4-year follow-up, RYGB was the surgical procedure that caused the highest WL and MetS resolution.
EEMCO Guidance for the in vivo Assessment of Biomechanical Properties of the Human Skin and Its Annexes: Revisiting Instrumentation and Test Modes
Authors: Monteiro Rodrigues Luis , Fluhr Joachim W. ,   the EEMCO Group
Published: November 2019

Biomechanics of the skin is an important subject in skin research. It has been studied for many decades involving various technologies and methods to characterize and quantify mechanical properties of the skin under different in vivo conditions. The present EEMCO paper reviews the current rel­evant information, providing practical orientation to researchers dedicated to in vivo assessment of biomechanics of skin and its annexes. We discuss the available non-invasive instruments, including their principles and variables. A correspondence between the descriptors nomenclature proposed by Agache and the designation for the suction-based standard instruments is proposed. The addressed properties include skin softness/stiffness, firmness, elasticity, elastic and viscoelastic properties, extensibility, resilience, anisotropy, acoustical shock wave hardness, friction (in relation to topographic properties), thickness, fiber/stress mechanics (bending, cyclic, tensile, fatigue, or torsion), and hardness. We provide the relation of these properties to biomechanical descriptors and in some cases to SI units. Practical guidance for the proper use of these instruments, limitations, and possible interpretations are provided, while discussing the meaning of descriptive or “phenomenological” variables. For studies intended to quantify the effect of an intervention with regard to mechanical properties, we recommend a minimum of 30–40 participants, based on normal distribution of the data sets. Some important limitations are recognized, including the lack of standardization of procedures and calibration of instruments, which compromises the relevance and real nature of the descriptors/parameters obtained with these devices. The present work highlights an approach to a better practice and a science-supported biomechanical assessment of human skin, hair, and nails.
Longitudinal Changes of Subpubic Arch Angle throughout Pregnancy
Authors: Martelli Federica , Youssef Aly , Capogna Maria Vittoria , Bruno Antonella , Bruno Valentina , Dodaro Maria Gaia , Ticconi Carlo , Ghi Tullio , Piccione Emilio , Pietropolli Adalgisa
Published: November 2019

Objective: The objective of this study is to assess whether the subpubic arch angle (SPA) changes throughout pregnancy. Materials and Methods: We recruited a group of nulliparous women in the first trimester of pregnancy. Each woman was assessed 3 times throughout pregnancy, once per each trimester, by measuring SPA using a recently described highly reproducible three-dimensional transperineal ultrasound (linear reconstruction with contrast enhancement technique; OmniView-volume contrast imaging). Repeated measures analysis of variance was used to study SPA changes during pregnancy. Results: Overall, 97 women were included in the final analysis. SPA increased progressively and significantly (F = 27.824, p < 0.001) from the first to the second trimester (121.8 ± 8.7 vs. 123.5 ± 8.4°, p = 0.01) and from the second to the third trimester (123.5 ± 8.4 vs. 125.3 ± 8.1°, p = 0.01). Conclusion: SPA width increases progressively but slightly during pregnancy. Although this finding is interesting, the extremely small difference detected is unlikely to be clinically significant.
Cinacalcet Treatment Significantly Improves All-Cause and Cardiovascular Survival in Dialysis Patients: Results from a Meta-Analysis
Authors: Zu Yuan , Lu Xiangxue , Song Jinghong , Yu Ling , Li Han , Wang Shixiang
Published: November 2019

Objective: To assess the long-term effects including all-cause mortality, cardiovascular mortality, and fracture incidence, of cinacalcet on secondary hyperparathyroidism (SHPT) in patients on dialysis. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched from their inception to October 2018. Randomized controlled trials (RCTs) and cohort design prospective observational studies assessing cinacalcet for the treatment of SHPT in dialysis patients were included. Data extraction was independently completed by 2 authors who determined the methodological quality of the studies and extracted data in duplicate. Study-specific risk estimates were tested by using a fixed effects model. Results: A total of 14 articles with 38,219 participants were included, of which 10 RCTs with 7,471 participants and 4 prospective observational studies with 30,748 participants fulfilled the eligibility criteria. Compared with no cinacalcet, cinacalcet administration reduced all-cause mortality (relative risk [RR] 0.91, 95% CI 0.89–0.94, p < 0.001) and cardiovascular mortality (RR 0.92, 95% CI 0.89–0.95, p < 0.001), but it did not significantly reduce the incidence of fractures (RR 0.93, 95% CI 0.87–1.00, p = 0.05). Conclusions: The results of this meta-analysis indicated that the treatment of SHPT with cinacalcet may in fact reduce all-cause mortality and cardiovascular mortality among patients receiving maintenance dialysis.
Efficacy of the Spiration Valve System in Patients with Severe Heterogeneous Emphysema: A Systematic Review and Meta-Analysis
Authors: Majid Adnan , Labarca Gonzalo , Uribe Juan Pablo , Kheir Fayez , Pacheco Cecilia , Folch Erik , Jantz Michael A. , Mehta Hiren J. , Patel Neal M. , Herth Felix J.F. , Fernandez-Bussy Sebastian
Published: November 2019

Background: Spiration Valve System (SVS) is an alternative for patients with severe heterogeneous emphysema; however, data about efficacy from randomized controlled trials (RCT) are unclear. Objectives: To explore both efficacy and safety of SVS in patients with severe emphysema and hyperinflation. Methods: We included PubMed, EMBASE, Coch­rane database. All searches were performed until August 2019. Only RCTs were included for analysis. Risk of bias was assessed using Cochrane risk of bias tool. A meta-analysis evaluated change in forced expiratory volume in 1 s (FEV1), 6-min walking test (6MWT), residual volume, modified medical research council (mMRC) and Saint George respiratory questionnaire (SGRQ), all-cause mortality, risk of pneumothorax, and risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Quality of the evidence was rated using GRADE approach. Results: Four RCTs including 629 subjects were included. SVS showed an overall change of 0.03 L (–0.07 to 0.13, I2 = 90%) in the in FEV1 (L) and a 2.03% (–2.50 to 6.57, I2 = 96%) in the predicted FEV1 (%) compared to baseline; however, studies without collateral ventilation (CV) showed an improvement of 0.12 L (95% CI 0.09–0.015, I2 = 0%), This subgroup also reported better results in SGRQ –12.27 points (95% CI –15.84 to –8.70, I2 = 0%) and mMRC –0.54 (95% CI –0.74 to –0.33, I2 = 0%). We found no benefit in 6MWT mean difference = 4.56 m (95% CI –21.88 to 31.00, I2 = 73%). Relative risk of mortality was 2.54 (95% CI 0.81–7.96, I2 = 0%), for pneumothorax 3.3 (95% CI 0.61–18.12, I2 = 0%) and AECOPD 1.68 (95% CI 1.04–2.70, I2 = 0%). Conclusion: In patients with severe heterogeneous emphysema and hyperinflation without CV, SVS is an alternative that showed an improvement in pulmonary function, quality of life, and dyspnea score with an acceptable risk profile.
Regulation of the Sox3 Gene in an X0/X0 Mammal without Sry, the Amami Spiny Rat, Tokudaia osimensis
Authors: Washio Kohei , Mizushima Shusei , Jogahara Takamichi , Kuroiwa Asato
Published: November 2019

Two species of spiny rats, Tokudaia osimensis and Tokudaia tokunoshimensis, show an X0/X0 sex chromosome constitution due to the lack of a Y chromosome. The Sry gene has been completely lost from the genome of these species. We hypothesized that Sox3, which is thought to be originally a homologue of Sry, could function in sex determination in these animals in the absence of Sry. Sox3 was localized in a region of the X chromosome in T. osimensis homologous to mouse. A similar testis- and ovary-specific pattern of expression was observed in mouse and T. osimensis. Although the sequence of the Sox3 gene and its promoter are highly conserved, a 13-bp deletion was specifically found in the promoter region of the 2 spiny rat species. Reporter gene assays were performed to examine the effect of the 13-bp deletion in the promoter region on Sox3 regulation. Although an approximately 60% decrease in activity was observed using the Tokudaia promoters with the 13-bp deletion, the activity was recovered using a mutated promoter in which the deletion was filled with mouse sequence. To evaluate whether SOX3 could regulate Sox9 expression, a reporter gene assay was carried out using testis-specific enhancer of Sox9 core (TESCO). Co-transfection with a combination of mouse SF1 and mouse SOX3 or T. osimensis SOX3 resulted in a greater than 2-fold increase in activity of mouse and T. osimensis TESCO. These results support the idea that the function of SOX3 as a transcription factor, as has been reported in mice and humans, is conserved in T. osimensis. Therefore, we conclude that the Sox3 gene has no function in sex determination in Sry-lacking Tokudaia species.