bluuebunny/crossref_metadata_2025 huggingface dataset:
Guidelines for the management of hereditary colorectal cancer from the British Society of Gastroenterology (BSG)/Association of Coloproctology of Great Britain and Ireland (ACPGBI)/United Kingdom Cancer Genetics Group (UKCGG)
Authors: Monahan Kevin J , Bradshaw Nicola , Dolwani Sunil , Desouza Bianca , Dunlop Malcolm G , East James E , Ilyas Mohammad , Kaur Asha , Lalloo Fiona , Latchford Andrew , Rutter Matthew D , Tomlinson Ian , Thomas Huw J W , Hill James
Published: November 2019

Heritable factors account for approximately 35% of colorectal cancer (CRC) risk, and almost 30% of the population in the UK have a family history of CRC. The quantification of an individual’s lifetime risk of gastrointestinal cancer may incorporate clinical and molecular data, and depends on accurate phenotypic assessment and genetic diagnosis. In turn this may facilitate targeted risk-reducing interventions, including endoscopic surveillance, preventative surgery and chemoprophylaxis, which provide opportunities for cancer prevention. This guideline is an update from the 2010 British Society of Gastroenterology/Association of Coloproctology of Great Britain and Ireland (BSG/ACPGBI) guidelines for colorectal screening and surveillance in moderate and high-risk groups; however, this guideline is concerned specifically with people who have increased lifetime risk of CRC due to hereditary factors, including those with Lynch syndrome, polyposis or a family history of CRC. On this occasion we invited the UK Cancer Genetics Group (UKCGG), a subgroup within the British Society of Genetic Medicine (BSGM), as a partner to BSG and ACPGBI in the multidisciplinary guideline development process. We also invited external review through the Delphi process by members of the public as well as the steering committees of the European Hereditary Tumour Group (EHTG) and the European Society of Gastrointestinal Endoscopy (ESGE). A systematic review of 10 189 publications was undertaken to develop 67 evidence and expert opinion-based recommendations for the management of hereditary CRC risk. Ten research recommendations are also prioritised to inform clinical management of people at hereditary CRC risk.
Ethical concerns with online direct-to-consumer pharmaceutical companies
Authors: Curtis Henry , Milner Joseph
Published: November 2019

In recent years, online direct-to-consumer pharmaceutical companies have been created as an alternative method for individuals to get prescription medications. While these companies have noble aims to provide easier, more cost-effective access to medication, the fact that these companies both issue prescriptions (via entirely online medical reviews that can have no direct contact between physician and patient) as well as distribute and ship medications creates multiple ethical concerns. This paper aims to explore two in particular. First, this model creates conflicts of interest for the physicians hired by these companies to write prescriptions. Second, the lack of direct contact from physicians may be harmful to prospective patients. After analysing these issues, this paper argues that there ought to be further consideration for regulation and oversight for these companies.
Mechanical behavior of in vitro blood clots and the implications for acute ischemic stroke treatment
Authors: Johnson Sarah , Chueh Juyu , Gounis Matthew J , McCarthy Ray , McGarry J Patrick , McHugh Peter E , Gilvarry Michael
Published: November 2019

Background

Clot mechanical properties are influenced by composition and the arrangement of components within the clot. This work investigates the effects of platelet-driven contraction on blood clot microstructure and mechanical behavior, and provides insight into some implications for mechanical thrombectomy.

Methods

Platelet-contracted clot analogues (PCCs) and non-contracted clot analogues (NCCs) were prepared from blood mixtures of various hematocrits (%H), that is, the volume percentage of red blood cells (RBCs) in the mixture. Mechanical testing was performed to compare the behavior of the analogues with previously tested human thromboemboli. Scanning electron microscopy and histology investigated the clot microstructure and composition. The association between clot properties and their behavior during mechanical behavior was also investigated.

Results

Overall, PCCs were found to be stiffer than NCCs, across all hematocrits. PCCs with a low %H resisted complete ingestion via contact aspiration alone or complete retrieval with stent-retrievers. PCCs with a higher %H and all NCCs were fully retrievable, although the likelihood of fragmentation was increased in clots with a greater %H. Histologically, there was little difference in the RBC and fibrin content between PCCs and NCCs with the same %H. However, the microstructure of the two groups differed significantly.

Conclusion

A selection of repeatable clot analogues with a range of mechanical properties have been developed for in vitro modeling of acute ischemic stroke. Platelet contraction significantly affects clot volume and microstructure, and in turn clot stiffness. The significant difference in mechanical properties and microstructure, but without an appreciable difference in histology, implies that histological studies of explanted human clots alone may not prove to be predictive of the mechanical behavior of the clots in thrombectomy.
Association of pulse pressure with all-cause mortality in young adults
Authors: LI Jie , Huang Jia-Yi , Lo Kenneth , Zhang Bin , Huang Yu-Qing , Feng Ying Qing
Published: November 2019

Background

Pulse blood pressure was significantly associated with all-cause mortality in middle-aged and elderly populations, but less evidence was known in young adults.

Objective

To assess the association of pulse pressure (PP) with all-cause mortality in young adults.

Methods

This cohort from the 1999–2006 National Health and Nutrition Examination Survey included adults aged 18–40 years. All included participants were followed up until the date of death or 31 December 2015. PP was categorised into three groups: <50, 50~60, ≥60 mm Hg. Cox proportional hazards models and subgroup analysis were performed to estimate the adjusted HRs and 95% CIs for all-cause mortality.

Results

After applying the exclusion criteria, 8356 participants (median age 26.63±7.01 years, 4598 women (55.03%)) were included, of which 265 (3.17%) have died during a median follow-up duration of 152.96±30.45 months. When treating PP as a continuous variable, multivariate Cox analysis showed that PP was an independent risk factor for all-cause mortality (HR 1.94, 95% CI 1.02 to 3.69; p=0.0422). When using PP<50 mm Hg as referent, from the 50~60 mm Hg to the ≥60 mm Hg group, the risks of all-cause mortality for participants with PP ranging 50–60 mm Hg or ≥60 mm Hg were 0.93 (95% CI 0.42 to 2.04) and 1.15 (95% CI 0.32 to 4.07) (P for tend was 0.959). Subgroup analysis showed that PP (HR 2.00, 95% CI 1.05 to 3.82; p=0.0360) was associated with all-cause mortality among non-hypertensive participants.

Conclusion

Among young adults, higher PP was significantly associated with an increased risk of all-cause mortality, particularly among those without hypertension.
Determinants of medical specialty competitiveness
Authors: Lefebvre Cedric , Hartman Nicholas , Tooze Janet , Manthey David
Published: November 2019

Background

Although the concept of medical specialty competitiveness may seem intuitive, there are very little existing empirical data on the determinants of specialty competitiveness in USA. An understanding of the determinants of specialty competitiveness may inform career choices among students and their advisors. Specialty competitiveness correlates with availability and appeal.

Methods

This narrative review examines 2019 National Resident Matching Program (NRMP) data and the existing literature to define the determinants of specialty competitiveness. A statistical analysis of key elements of the 2019 NRMP data was performed.

Results

Using US senior applicant fill rate as a measure of competitiveness, medical specialty competitiveness follows general principles of supply and demand. The demand, or appeal, of a specialty correlates with several factors, including salary, prestige and lifestyle. Salary correlates strongly with US senior fill rate (r=0.78, p=0.001). Relatively few positions are available for the most competitive specialties in the NRMP match. The negative correlation between US senior fill rate and position availability is also strong (r=−0.85; p<0.0001).

Conclusion

A ‘competitive specialty’ correlates strongly with high earnings potential and limited position availability. In an ideal world, a student’s pursuit of a medical specialty should be guided by interest, qualifications and ability to succeed in that field. However, students must contend with the realities of competition created by the residency matching system.
Routine Assessment of Patient Index Data 3 (RAPID3) alone is insufficient to monitor disease activity in rheumatoid arthritis in clinical practice
Authors: Boone Niels W , Sepriano Alexandre , van der Kuy Paul-Hugo , Janknegt Rob , Peeters Ralph , Landewé Robert B M
Published: November 2019

Objective

To test the longitudinal association between patient-reported outcome, Routine Assessment of Patient Index Data 3 (RAPID3) and the Disease Activity Score in 28 joints that includes the erythrocyte sedimentation rate (DAS28-ESR) in routine-care patients with rheumatoid arthritis (RA).

Methods

Patients with RA treated with disease-modifying antirheumatic drugs were included in this prospective observational cohort. The longitudinal association between RAPID3 (0–10) and DAS28-ESR and its individual components (swollen joint count (SJC), erythrocyte sedimentation rate (ESR) (mm/hour), tender joint count (TJC) and patient global assessment (PGA)) was tested using generalised estimating equations in patients with more than two consecutive visits with data on RAPID3 and DAS28-ESR. Interactions between RAPID3 and gender, pain, PGA and age at baseline were tested, and if significant (p<0.20) and clinically relevant, models were fit in the corresponding strata.

Results

In total, 330 patients were included (mean follow-up 10.7 (SD 9.7) months, female gender 67.9%). The longitudinal association between RAPID3 and DAS28-ESR was weak (β=0.29 (95% CI 0.24 to 0.35), n=207), meaning that one unit increase in RAPID3 corresponded to a 0.29 unit increase in Disease Activity Score in 28 joints (DAS28). RAPID3 was most strongly associated with subjective (TJC: β=0.89 (95% CI 0.61 to 1.17); PGA: β=0.94 (95% CI 0.84 to 1.04)) and not with objective components of DAS28 (SJC: β=0.29 (95% CI 0.17 to 0.41), n=172). The association between RAPID3 and ESR was poor but modified by gender, being only significant in men (β=0.37 (95% CI 0.08 to 0.67)).

Conclusions

These data suggest that RAPID3 does not sufficiently capture changes in objective inflammatory signs. Monitoring by RAPID3 alone is therefore insufficient to follow disease activity in patients wth RA in clinical practice.
Skull ontogeny of the pronghorn (Antilocapraamericana) in the comparative context of native North American ungulates
Authors: Moyano S.R. , Morales M.M. , Giannini N.P.
Published: November 2019

The pronghorn (Antilocapra americana (Ord, 1815)) is the single survivor of a largely extinct, isolated pecoran lineage (Antilocapridae) native to North America. We describe postnatal ontogeny of its skull in a comparative framework inclusive of representatives of other typical North American ungulate linages, all of which partially overlap in geographic distribution and share habitat with A. americana. To describe allometric growth, we took 23 linear cranial measurements in 30 specimens of A. americana and applied bi- and multi-variate statistics. The skull of A. americana generally grew with negative rates in width and height dimensions, and with positive rates in length, including an elongation of rostrum, particularly the nasals, and a relative narrowing of the braincase. We compared skull development in A. americana with development in two cervids (white-tailed deer (Odocoileus virginianus (Zimmermann, 1780)) and wapiti (Cervus canadensis Erxleben, 1777)) and two bovids (bighorn sheep (Ovis canadensis Shaw, 1804) and American bison (Bison bison (Linnaeus, 1758))). The multivariate ontogenetic trajectory of A. americana overlapped greatly with that of Odocoileus virginianus, and differed from the other species in varying degrees. These results indicated an essentially convergent pattern of skull growth with species showing important functional similarities, such as cervids of comparable size and feeding habits.
Two-soliton molecule bouncing in a dipolar Bose–Einstein condensates under the effect of gravity
Authors: Khamrakulov Kh. P.
Published: November 2019

The dynamics of a two-soliton molecule bouncing on the reflecting atomic mirror under the effect of gravity have been studied by analytical and numerical methods. The analytical description is based on the variational approximation. In numerical simulations, we observe the resonance oscillations of the two-soliton’s center-of-mass position and width, induced by modulated atomic mirror. Theoretical predictions are verified by numerical simulations of the nonlocal Gross–Pitaevskii equation (GPE) and qualitative agreement between them is found. Hamiltonian dynamic system for a dipolar Bose–Einstein condensates (BECs) has been studied.
Vortex statistics in two-dimensional turbulence based on IB-LBM
Authors: Li Jianghua , Xia Yuxian , Qiu Xiang , Qian Yuehong , Liu Yulu
Published: November 2019

In this paper, the two-dimensional (2D) turbulence perturbed by arrays of cylinders placed both horizontally and vertically is investigated by Immersed Boundary Lattice Boltzmann Method (IB-LBM). The energy spectrum reveals the coexistence of the inverse and direct cascades in 2D grid turbulence. By observing at the distribution of fluxes in space, the energy and enstrophy fluxes have explained the physical mechanism of the double cascades where the two Kolmogorov laws for structure functions are simultaneously observed. The results of vortex statistics by the conditional analysis, which are based on a new and accurate vortex identification criteria called Liutex, show that the algebraic number density [Formula: see text], where [Formula: see text] is vortex area. The time-evolving vortex number density distribution constructs a theoretical framework involving a three-part: [Formula: see text]; [Formula: see text]; [Formula: see text], which is satisfied with the prediction well. The relationship between the vortex circulation [Formula: see text] and vortex area [Formula: see text] is [Formula: see text] and the one between the kinetic energy of vortex [Formula: see text] and [Formula: see text] is [Formula: see text] in the range where [Formula: see text]. Moreover, it has been found that vortices contain about 30% of the total energy of the flow by studying the energy ratio of all vortices to the entire flow field. What is more, it is an interesting phenomenon is that there is only a range where [Formula: see text] in the energy spectrum for the coherent structure field which is obtained by using Liutex as the extraction of vortices. The probability density function (PDF) of the fluctuations of longitudinal velocity shows that an indication of small intermittency in the direct cascade and the absence of intermittency in the inverse cascade range. On the other hand, the scaling exponents [Formula: see text] of the structure function for the inverse cascade are consistent with Kr67 model, which shows the absence of intermittency. While the measured intermittency parameters are [Formula: see text] and [Formula: see text], which explains that there is a very weak intermittent correction in the direct cascade, and ESS has verified the existence of intermittency in our 2D turbulence.
Preparation, characterization, and study of the nonlinear optical properties of a new prepared nanoparticles copolymer
Authors: Hussain Mahmoud Sh. , Hassan Qusay M. A. , Sultan H. A. , Al-Asadi Ahmed S. , Chayed Hani T. , Emshary C. A.
Published: November 2019

The nonlinear optical properties of a nanoparticle polyaniline/polyacrylonitrile (PAn/PANr) copolymer newly prepared via experimental and theoretical findings are reported. Diffraction ring patterns result in the far field when a CW, visible, 473 nm, low power laser beam traverses the solution of PAn/PANr in the solvent ethanol. The diffraction ring patterns are usually used to estimate the nonlinear refractive index while the Z-scan is used to measure both nonlinear refractive index and its sign and nonlinear absorption coefficient. The experimentally observed ring patterns are numerically reproduced via the use of the Fresnel–Kirchhoff procedure. Good agreement between experimental findings and the numerical ones are obtained. The obtained diffraction ring patterns suffer modification in the vertical direction due to convection current as a result of local heating of the sample and the presence of gravity.
Conformally flat traveling plane wave solutions of Einstein equations
Authors: Haba Z.
Published: November 2019

We discuss conformally flat plane wave solutions of Einstein equations depending on the plane wave phase [Formula: see text], where [Formula: see text] is the conformal time. We show that ideal fluid Einstein equations and scalar fields with exponential self-interaction have solutions of the form of traveling fluid plane waves. We consider in more detail the source depending on [Formula: see text] with [Formula: see text] describing models of a massless scalar field, electromagnetic field and relativistic particles with space-time depending mass density. We obtain explicit conformally flat metrics solving Einstein equations with a source of the energy–momentum moving with a speed of light.
Cosmology from a running vacuum model driven by a scalar field
Authors: Santos J. R. L. , Moraes P. H. R. S.
Published: November 2019

The possibility that the vacuum energy density [Formula: see text] is, indeed, varying in time, has been investigated lately from the running vacuum models perspective. Motivated by such models, in this work, we relate the decaying vacuum energy [Formula: see text] with a scalar field [Formula: see text]. We derive the equations of motion from such a premise and implement the first-order formalism in order to obtain analytical solutions to the cosmological parameters. We show that these are in agreement with recent Planck observational data. We discuss the physical consequences of having [Formula: see text] related to [Formula: see text].
AN OPEN INNOVATION ECOSYSTEM FROM A STARTUP’S PERSPECTIVE
Authors: BERECZKI IZABELLA
Published: November 2019

Being embedded in an open innovation (OI) ecosystem can be the road to success for startups. In order to survive and become competitive, they must collaborate with external partners. Not only could large corporations be suitable partners, but innovation with small and medium enterprises (SMEs) can be constructive and fruitful as well. Furthermore, accelerators, incubators and other institutions can offer value to startups. Despite this fact, little attention has been paid to startups and SMEs embedded in OI ecosystems, especially from their point of view. The aim of this paper is to fulfil this research gap and deliver empirical data about the benefits and challenges of an OI ecosystem orchestrated by a startup and to investigate the potential role of an SME in these ecosystems. To answer the research questions, a case study approach was used.
Lupaş-type inequality and applications to Markov-type inequalities in weighted Sobolev spaces
Authors: Marcellán Francisco , Rodríguez José M.
Published: November 2019

Weighted Sobolev spaces play a main role in the study of Sobolev orthogonal polynomials. In particular, analytic properties of such polynomials have been extensively studied, mainly focused on their asymptotic behavior and the location of their zeros. On the other hand, the behavior of the Fourier–Sobolev projector allows to deal with very interesting approximation problems. The aim of this paper is twofold. First, we improve a well-known inequality by Lupaş by using connection formulas for Jacobi polynomials with different parameters. In the next step, we deduce Markov-type inequalities in weighted Sobolev spaces associated with generalized Laguerre and generalized Hermite weights.
Double points in families of map germs from ℝ2 to ℝ3
Authors: Moya-Pérez J. A. , Nuño-Ballesteros J. J.
Published: November 2019

We show that a 1-parameter family of real analytic map germs [Formula: see text] with isolated instability is topologically trivial if it is excellent and the family of double point curves [Formula: see text] in [Formula: see text] is topologically trivial. In particular, we deduce that [Formula: see text] is topologically trivial when the Milnor number [Formula: see text] is constant.
Layering and structural inheritance controls on fault zone structure in three dimensions: a case study from the northern Molasse Basin, Switzerland
Authors: Roche Vincent , Childs Conrad , Madritsch Herfried , Camanni Giovanni
Published: November 2019

Mechanical heterogeneity of a sedimentary sequence exerts a primary control on the geometry of fault zones and the proportion of offset accommodated by folding. The Wildensbuch Fault Zone in the Swiss Molasse Basin, with a maximum throw of 40 m, intersects a Mesozoic section containing a thick (120 m) clay-dominated unit (Opalinus Clay) over- and underlain by more competent limestone units. Interpretation of a 3D seismic reflection survey indicates that the fault zone formed by upward propagation of an east–west-trending basement structure, through the Mesozoic section, in response to NE–SW Miocene extension. This configuration formed an array of left-stepping normal fault segments above and below the Opalinus Clay. In cross-section a broad monoclinal fold is observed in the Opalinus Clay. Folding, however, is not ubiquitous and occurs in the Opalinus Clay where fault segments above and below are oblique to one another; where they are parallel the fault passes through the Opalinus Clay with little folding. These observations demonstrate that, even in strongly heterogeneous sequences, here a four-fold difference in both Young's modulus and cohesion between layers, the occurrence of folding may depend on the local relationship between fault geometry and applied stress field rather than rheological properties alone.
Seismic Damage Behavior of Aeolian Sand Concrete Columns with an Inner Square Steel Tube
Authors: Wang Yaohong , Zhang Zeping , Han Qing , Chu Qi , Ma Xiaoyan
Published: November 2019

In order to promote the application of aeolian sand in steel‐concrete composite structures, the aeolian sand concrete columns with an inner square steel tube is proposed in this paper. This kind of column is composed of aeolian sand concrete, reinforcing steel, and an inner square steel tube. The seismic damage behavior of the column was studied through cyclic loading test and damage analysis on seven specimens with different structural forms. The seismic damage indices of the specimens in this study include the failure mode, bearing capacity, ductility, stiffness, hysteresis behavior, and energy dissipation. Then, a damage model of this kind of column is proposed. The study results show that installing an inner square steel tube can significantly improve the seismic damage behavior of aeolian sand concrete columns. This mode of construction can be used to enhance the replacement percentage of aeolian sand. In addition, the damage model proposed in this paper agrees well with the experimental results and can be used to evaluate the damage degree of the aeolian sand concrete columns with an inner square steel tube.
Effects of PET Fibers on Pumpability, Shootability, and Mechanical Properties of Wet‐Mix Shotcrete
Authors: Cui Xiangfei , Liu Guoming , Wang Cheng-long , Qi Yudong
Published: November 2019

Polyethylene terephthalate (PET) fiber from waste plastic bottles is an environmentally friendly fiber that can improve the mechanical properties of wet‐mix shotcrete. The main objective of this paper is to investigate the effects of PET fiber parameters on pumpability, shootability, and mechanical properties of wet‐mix shotcrete. For this purpose, the orthogonal test based on three factors and three levels was conducted. The width, length, and content of PET fiber were selected as the experimental variables. The tests of wet‐mix shotcrete reinforced by PET fibers were carried out, along with properties tests such as slump, pressure drop, build‐up thickness, compressive strength, and splitting strength. The results showed the change trend of shotcrete performances with increasing PET fiber parameters (width, length, and content). According to the orthogonal test, PET fiber parameters were determined (1 mm width, 20 mm length, and 5 kg/m3 content). Furthermore, relationships between slump and pumpability and shootability were explored, as well as the relationships between pumpability, shootability, and mechanical properties. It was found that pressure drop and compressive strength had the strongest negative linear relationship among all fitting relationships. We hoped that this study could contribute the useful information for the application of wet‐mix shotcrete mixed with PET fibers.
Assessment of Anxiety, Depression, Stress, and Associated Psychological Morbidities among Patients Receiving Ayurvedic Treatment for Different Health Issues: First Study from Sri Lanka
Authors: Gunathilaka Hiruni Jayagrahi , Vitharana Pemasiri , Udayanga Lahiru , Gunathilaka Nayana
Published: November 2019

Background. Good mental condition is a vital part of health. Physical impairments would potentially have psychiatric manifestations during the course of a disease that could cause patients to experience a wide range of psychological conditions. This study was conducted to determine prevalence of anxiety, depression, stress, and psychological morbidities among the patients who received warded treatments at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Sri Lanka. Methods. A total of 148 patients admitted to the hospital were selected for the study on a random systematic basis under four systemic groups (gastrointestinal, integumentary, musculoskeletal, and nervous system) depending on the chief complaint. The presence of depressive, anxiety, and stress symptoms was assessed by the Depression Anxiety Stress Scale 21 item version (DASS 21). The General Linear Model (GLM) was used for statistical analysis. Results. Over 50% of the participants in all four patient groups belonged to age group of 35 to 65 years, encompassing the fraction of population that actively contribute to the workforce in the society. Stress, anxiety, and depression values of patients belonging to different complications varied significantly, as indicated by GLM (p<0.05). Patients diagnosed with integumentary system-related issues denoted the highest stress levels (27.7 ± 2.54), while the mean stress values among the other systemic groups were not significantly different among each other. The highest anxiety levels were indicated by patients with nervous system-related issues (18.6 ± 1.51), while the lowest anxiety levels were indicated by patients with integumentary disorders (6.0 ± 2.73). The highest depression level was identified from patients suffering from integumentary system-related disorders (31.7 ± 3.42), followed by nervous system (23.2 ± 1.78), gastrointestinal (19.5 ± 3.77), and musculoskeletal (16.8 ± 1.57) disorders. Conclusion. Overall, high distress levels were observed among the majority of the patients. Furthermore, integumentary issues may lead to significant psychological impacts. As most of the patients seek for Ayurveda treatments when their diseased condition becomes chronic, it is vital to focus on a biopsychosocial approach to patient assessment and patient care, in actual practice.
Evaluation of Some Mechanical Properties of a Maxillofacial Silicon Elastomer Reinforced with Polyester Powder
Authors: Haider Yagthan Mohammed , Abdullah Zainab Salih , Jani Ghasak H. , Mokhtar Norehan
Published: November 2019

Maxillofacial silicone elastomers are used to replace and reconstruct missing facial parts for patients with trauma or a certain disease. Although commonly favorable silicone elastomers are not ideal in properties, many studies have been carried out to improve their mechanical properties and to come out with ideal maxillofacial prosthetic materials, so as to render patients with the best maxillofacial prostheses. The aim of the current study is to evaluate the effect of addition of different concentrations of polyester powder on hardness, tear strength, surface roughness, and tensile strength of maxillofacial A-2186 RTV silicone elastomers. Polyester powder was added to the silicone elastomer in the concentrations of 1%, 3% and 5% by using an electronic digital balance, compared with the control group of 0% polyester filler. The shore A hardness test was done according to ASTM D 2240 standards. The tear test was done according to ASTM D624 type C standards. The tensile test was done according to ISO specification number 37:2011. The surface roughness test was performed according to ISO 7619-1 2010 specifications. The data collected were then analyzed using one-way analysis of variance (ANOVA) and post hoc and Fisher’s LSD tests. All three groups showed a highly significant increase in tear strength, tensile strength, hardness, and roughness, compared to the control group. Reinforcement of A-2186 Platinum RTV Silicone Elastomer with 5% polyester significantly improved the mechanical properties tested in this study.
Research on Novel Bearing Fault Diagnosis Method Based on Improved Krill Herd Algorithm and Kernel Extreme Learning Machine
Authors: Wang Zhijian , Zheng Likang , Wang Junyuan , Du Wenhua
Published: November 2019

In this paper, a novel bearing intelligent fault diagnosis method based on a novel krill herd algorithm (NKH) and kernel extreme learning machine (KELM) is proposed. Firstly, multiscale dispersion entropy (MDE) is used to extract fault features of bearings to obtain a set of fault feature vectors composed of dispersion entropy. Then, it is imported into the kernel extreme learning machine for fault diagnosis. But considering the kernel function parameters σ and the error penalty factor C will affect the classification accuracy of the kernel extreme learning machine, this paper uses the novel krill herd algorithm (NKH) for their optimization. The opposite populations are added to the NKH in the initialization of population to improve its speed and prevent local optimum, and during the period of looking for the optimal solution, the impulse operator is introduced to ensure it has enough impulse to rush out of the local optimal once into the local optimum. Finally, in order to verify the effectiveness of the proposed method, it was applied to the bearing fault experiment of Case Western Reserve University and XJTU‐SY bearing data set. The results show that the proposed method not only has good fault diagnosis performance and generalization but also has fast convergence speed and does not easily fall into the local optimum. Therefore, this paper provides a method for fault diagnosis under different loads. Meanwhile, the new method (NKH‐KELM) is compared and analyzed with other mainstream intelligent bearing fault diagnosis methods to verify the effectiveness and accuracy of the proposed method.
Gastroblastoma in Adulthood—A Rarity among Rare Cancers—A Case Report and Review of the Literature
Authors: Centonze Giovanni , Mangogna Alessandro , Salviato Tiziana , Belmonte Beatrice , Cattaneo Laura , Monica Melissa Anna Teresa , Garzone Giovanna , Brambilla Cecilia , Pellegrinelli Alessio , Melotti Flavia , Testi Adele , Monti Valentina , Kankava Ketevani , Gasparini Patrizia , Dagrada Gianpaolo , Mazzaferro Vincenzo , Cotsoglou Christian , Collini Paola , Pruneri Giancarlo , Milione Massimo
Published: November 2019

Gastroblastoma (GB) is a rare gastric epithelial-mesenchymal neoplasm, first described by Miettinen et al. So far, all reported cases described the tumor in children or young adults, and similarities with other childhood blastomas have been postulated. We report a case of GB in a 43-year-old patient with long follow up and no recurrence up to 100 months after surgery. So far, this is the second case of GB occurring in the adult age >40-year-old. Hence, GB should be considered in the differential diagnosis of microscopically comparable conditions in adults carrying a worse prognosis and different clinical approach.
Correlation Analysis between Serum Vitamin D Levels and Lower Extremity Macrovascular Complications in Individuals with Type 2 Diabetes Mellitus
Authors: Yang Mengxue , Liu Jun , Zhou Xue , Ding Heyuan , Xu Jie , Yang Bo , Sun Bowen , Xiao Dandan , Yu Jie , Gong Qihai
Published: November 2019

The correlation between serum 25-hydroxy vitamin D (25(OH)D) levels and lower extremity atherosclerotic disease and the predictive value of 25(OH)D for early-stage lower extremity atherosclerotic disease in patients with type 2 diabetes mellitus (T2DM) were explored. In total, 620 subjects (590 T2DM patients and 30 healthy subjects) completed a questionnaire. All subjects were divided into four groups according to serum 25(OH)D concentration quartile: Q1 (<12.18 ng/ml), Q2 (12.18~20.65 ng/ml), Q3 (20.65~31.97 ng/ml), and Q4 (>31.97 ng/ml). Participants were also divided into four groups based on the degree of lower extremity arteriostenosis: A1 (T2DM), A2 (T2DM with mild lower extremity vascular lesions (LEVL)), A3 (T2DM with moderate LEVL), and A4 (T2DM with severe LEVL). The incidence of lower extremity artery plaque was significantly higher in groups Q1 and Q2 than in group Q4 (both P<0.05). The concentration of 25(OH)D was significantly lower in group A4 than in groups A1 and A2. Pearson correlation analysis revealed that the degree of lower extremity vascular stenosis was positively correlated with age, smoking, and HbA1c, CRP, and LDL-C levels and negatively correlated with 25(OH)D concentrations. Logistic regression analysis demonstrated that 25(OH)D concentrations exerted a protective effect against LEVL in T2DM patients. Serum 25(OH)D concentrations may be correlated with the incidence of macrovascular disease in T2DM patients. A low serum 25(OH)D concentration is an independent risk factor for lower extremity vascular pathological changes and acts as a prognostic index for lower extremity atherosclerotic disease.
Discharge against Medical Advice (DAMA) from an Emergency Department of a Tertiary Care Hospital in Saudi Arabia
Authors: El-Metwally Ashraf , Suliman Alwallan Nesreen , Amin Alnajjar Ali , Zahid Nida , Alahmary Khalid , Toivola Paivi
Published: November 2019

Background. The discharge against medical advice (DAMA) in the Emergency Department (ED) is an issue of great concern because it may result in adverse consequences at a later stage. The reported worldwide prevalence of DAMA ranges from 0.07 to 20% for emergency admissions. The outcomes of DAMA can have significantly damaging effects, causing possible relapses of disease, readmission, and increases in medical costs for the patient. Therefore, it is imperative to identify the predictors of DAMA in ED. Methods. It was a cross-sectional study. The medical records used were those of all the patients (n = 11513) admitted to the Emergency Department (ED) of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, between 2017 and 2018. A thorough analysis was performed using IBM SPSS Statistics version 22. Descriptive statistics were reported for quantitative and categorical variables and assessed by independent t-test/chi-square/ANOVA (analysis of variance), where appropriate. Unadjusted and adjusted odds ratios with their 95% CI (confidence interval) were reported by performing logistic regression. A p value of ≤0.05 was considered statistically significant throughout the study. Results. The prevalence of DAMA in our study was 1%. In a multivariable analysis, after adjusting for the other covariates, we observed a significant interaction between age and gender. It was observed that the odds of DAMA for ≤40-year-old males were 3.12 times higher than those of a ≤40-year-old female (p value < 0.1). To further investigate this interaction, men and women were modeled separately in multivariable models using the same covariates. We found that, for men, the effect of age (≤40 years) was significant (OR = 3.94, 95% CI 1.31–11.80, p=0.014), while, for women, the effect of age (≤40 years) was not as pronounced (OR = 1.27, 95% CI = 0.66–2.42, p=0.27). Conclusions. Our study concluded that DAMA was more likely among younger male patients (≤40 years of age). Most of the patients with DAMA were presented to the urgent care of the Emergency Department. We recommend that patients be given some financial support to bear the expenses of the hospital stay from the healthcare facility or from the state. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.
MicroRNA-205-5p Targets HMGB1 to Suppress Inflammatory Responses during Lung Injury after Hip Fracture
Authors: Yu Xiaojie , Chen Xiaobin , Sun Tiansheng
Published: November 2019

Hip fracture is the most common type of injury in elderly people and is associated with a high incidence of complications and risk of mortality. In these patients, subsequent pulmonary infection can contribute to the development of an acute lung injury, a consequence of the systemic inflammatory response induced by hip fracture. Although the crucial role of microRNAs (miRNAs) in inflammatory responses has been established, the functions of miRNAs in the inflammatory responses associated with lung injury after hip fracture remain poorly understood. In this study, we explored the potential role of miR-205-5p in lung injury after hip fracture in an in vivo hip fracture model and in vitro cultures of human pulmonary alveolar epithelial cells (HPAEpiC). An analysis of clinical serum samples revealed increased levels of miR-205-5p and high mobility group box 1 (HMGB1) after hip fracture. A bioinformatics analysis and dual-luciferase reporter assay identified HMGB1 as a potential target of miR-205-5p. The overexpression of miR-205-5p clearly reduced the expression of HMGB1 and inhibited NF-κB signaling, apoptosis, and proinflammatory cytokine production while enabling continued cell proliferation. Our results demonstrate that the upregulation of miR-205-5p suppresses inflammatory responses and promotes cell viability and proliferation by selectively targeting HMGB1 in the context of lung injury after hip fracture. Therefore, miR-205-5p may be an alternative target of therapeutic strategies for lung injury after hip fracture.
Toxic Acetaminophen Exposure Induces Distal Lung ER Stress, Proinflammatory Signaling, and Emphysematous Changes in the Adult Murine Lung
Authors: Sandoval Jeryl , Orlicky David J. , Allawzi Ayed , Butler Brittany , Ju Cynthia , Phan Caroline T. , Toston Roy , De Dios Robyn , Nguyen Leanna , McKenna Sarah , Nozik-Grayck Eva , Wright Clyde J.
Published: November 2019

Clinical studies have demonstrated a strong association between both acute toxic exposure and the repetitive, chronic exposure to acetaminophen (APAP) with pulmonary dysfunction. However, the mechanisms underlying this association are unknown. Preclinical reports have demonstrated that significant bronchiolar injury occurs with toxic APAP exposure, but very little information exists on how the distal lung is affected. However, cells in the alveolar space, including the pulmonary epithelium and resident macrophages, express the APAP-metabolizing enzyme CYP2E1 and are a potential source of toxic metabolites and subsequent distal lung injury. Thus, we hypothesized that distal lung injury would occur in a murine model of toxic APAP exposure. Following exposure of APAP (280 mg/kg, IP), adult male mice were found to have significant proximal lung histopathology as well as distal lung inflammation and emphysematous changes. Toxic APAP exposure was associated with increased CYP2E1 expression in the distal lung and accumulation of APAP-protein adducts. This injury was associated with distal lung activation of oxidant stress, endoplasmic reticulum stress, and inflammatory stress response pathways. Our findings confirm that following toxic APAP exposure, distal lung CYP2E1 expression is associated with APAP metabolism, tissue injury, and oxidant, inflammatory, and endoplasmic reticulum signaling. This previously unrecognized injury may help improve our understanding of the relationship between APAP and pulmonary-related morbidity.
Establishing a Differential Marker Profile for Pregnancy Complications Near Delivery
Authors: Sharabi-Nov Adi , Kumar Kristina , Fabjan Vodušek Vesna , Premru Sršen Tanja , Tul Nataša , Fabjan Teja , Meiri Hamutal , Nicolaides Kypros H. , Osredkar Joško
Published: November 2019

Objective: The aim of this work was to define a differential marker profile for pregnancy complications near delivery. Methods: We enrolled pregnant women who were referred to the outpatient pregnancy clinic of the University Medical Center, Ljubljana, Slovenia, due to symptoms of pregnancy complications and women with a history of pregnancy complications attending the high-risk hospital clinic for close surveillance. They were evaluated for prior risk and were tested for biophysical and biochemical markers at the time of enrolment. Biochemical markers included the pro- and anti-angiogenic markers, along with additional previously reported markers of potential value, all tested by various formats of immuno-diagnostics. Biophysical markers included blood pressure, sonographic markers, and EndoPAT. Statistical differences were determined with Kruskal-Wallis and Mann-Whitney tests for continuous parameters, and Pearson χ2 for categorical values. p < 0.05 was considered significant. Results: The cohort included 125 pregnant patients, 31 developed preeclampsia (PE) alone (13 were <34 weeks’ gestation), 16 had intrauterine growth restriction (IUGR) alone (12 were <34 weeks), 42 had both IUGR and PE (22 were <34 weeks), and 15 had an iatrogenic preterm delivery (PTD; 6 were <34 weeks). Twenty-one were unaffected and delivered a healthy baby at term. Mean arterial blood pressure and proteinuria were significantly higher in PE and PE+IUGR but not in pure IUGR or PTD. In PE, IUGR, and PE+IUGR, the levels of soluble fms-like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng) were significantly higher, while placental growth factor (PlGF) was very low compared to unaffected controls and PTD. PE, IUGR, and PE+IUGR also had a high anti-angiogenic ratio (sFlt-1/PlGF) and a low proangiogenic ratio of PlGF/(sFlt-1+Eng). Levels of inhibin A were significantly higher in pure PE across subgroups but had many extreme values, which made it a poor differentiator. Higher uterine artery Doppler pulsatility indexes were detected in PE, IUGR, and PE+IUGR, with similar resistance indexes and peaks of systolic velocity. A significantly different marker level between PE and IUGR was found using arterial stiffness that was 10 times higher in PE; concurrently with an increase of the reactive hyperemia index, both were accompanied by a slight increase in placental protein 13. Higher tumor necrosis factor alpha (TNFα) differentially identified iatrogenic very early PTD (<34 weeks). Conclusion: Arterial stiffness can serve as a major marker to differentiate PE (with/without IUGR) from pure IUGR near delivery. TNFα can differentiate iatrogenic early PTD from other complications of pregnancy and term IUGR.
Precision Medicine and Vaccination of Older Adults: From Reactive to Proactive (A Mini-Review)
Authors: Doherty T. Mark , Di Pasquale Alberta , Michel Jean-Pierre , Del Giudice Giuseppe
Published: November 2019

As populations age globally, the health of older adults is looming larger on the agendas of public health bodies. In particular, the priority is to ensure that older adults remain healthy, independent, and engaged in their communities. In other words, ensuring that increasing life spans are matched by increasing “health spans,” meaning years spent in good health. Chronic conditions such as cancer or respiratory and cardiovascular diseases account for the bulk of the disease burden in older adults, and the consensus is that these can best be tackled by effective primary prevention. However, given the diverse nature of older populations, whose prior health experiences can be complicated by multi-morbidity and poly-pharmacy, effective primary prevention can be challenging. One approach that is gaining momentum is what is called “precision” or P4 medicine. The acronym stands for “predictive, personalized, preventive, participatory” medicine, and is based on the premise that preventing disease is better than treating it. However, effective prevention requires the ability to predict disease risk for a given patient, the tailoring of treatment to their circumstances, and their consent for or participation in the offered treatment. A P4 approach may seem counter-intuitive, given that vaccination is generally considered a public health intervention. However, in this article, we discuss the application of P4 medicine as a complement to planning the vaccination of older individuals, with a special focus on the important role that vaccine-preventable infections play in the burden of non-communicable disease.
Optimal Starting Age and Baseline Level for Repeat Tests: Economic Concerns of PSA Screening for Chinese Men – 10-Year Experience of a Single Center
Authors: Liu Yang , Xiao Gang , Zhou Jia-Wei , Yang Jian-Kun , Lu Li , Bian Jun , Zhong Lin , Wei Qing-Zhu , Zhou Qi-Zhao , Xue Kang-Yi , Guo Wen-Bing , Xia Ming , Zhou Jun-Hao , Bao Ji-Ming , Yang Cheng , Liu Cun-Dong , Chen Ming-Kun
Published: November 2019

Objective: To investigate the optimal age for the baseline serum prostate-specific antigen (PSA) test and for repeat screening and its economic burden in a single center in China. Materials and Methods: 35,533 men with PSA screening were retrospectively enrolled in this study. Follow-ups were conducted in 1,586 men with PSA >4 ng/mL, and receiver-operating characteristic (ROC) curves were employed to investigate the optimal cutoffs. Results: ROC analysis indicated that the optimal age for initial PSA screening was 57.5 years (AUC = 0.84), 62.5 years (AUC = 0.902), 60.5 years (AUC = 0.909), and 61.5 years (AUC = 0.890) for individuals with PSA >4 and >10 ng/mL, a diagnosis of prostate cancer (PCa), and clinically significant PCa defined as the focus events, respectively. For Chinese men aged 50–59, 60–69, and >70 years, the initial PSA levels of 1.305 ng/mL (AUC = 0.699), 1.975 ng/mL (AUC = 0.711), and 2.740 ng/mL (AUC = 0.720) might have a PSA velocity >0.75 ng/mL per year during the follow-up. In addition, the total cost amounts to CNY 13,609,260 in these cases, but only 60 of the 35,533 (0.17%) men gained benefit from PSA screening. Conclusion: In our opinion, the optimal starting age for initial PSA testing was 57.5 years. The necessity for repeat screening should be based on the first PSA level depending on age. A cost-­benefit analysis should be included in population-based screening.