bluuebunny/crossref_metadata_2025 huggingface dataset:
Automatic Segmentation of Prostate Magnetic Resonance Imaging Using Generative Adversarial Networks
Authors: Wang Wei , Wang Mingang , Wu Xiaofen , Ding Xie , Cao Xuexiang , Wang Lei , Zhang Jingyi , Wang Peijun
Published: January 2020

Background: Automatic and detailed segmentation of the prostate using magnetic resonance imaging (MRI) plays an essential role in prostate imaging diagnosis. However, the complexity of the prostate gland hampers accurate segmentation from other tissues. Thus, we propose the automatic prostate segmentation method SegDGAN, which is based on a classic generative adversarial network (GAN) model. Methods: The proposed method comprises a fully convolutional generation network of densely connected blocks and a critic network with multi-scale feature extraction. In these computations, the objective function is optimized using mean absolute error and the Dice coefficient, leading to improved accuracy of segmentation results and correspondence with the ground truth. The common and similar medical image segmentation networks U-Net, fully convolution network, and SegAN were selected for qualitative and quantitative comparisons with SegDGAN using a 220-patient dataset and the publicly available dataset PROMISE12. The commonly used segmentation evaluation metrics Dice similarity coefficient (DSC), volumetric overlap error (VOE), average surface distance (ASD), and Hausdorff distance (HD) were also used to compare the accuracy of segmentation between these methods. Results: SegDGAN achieved the highest DSC value of 91.66%, the lowest VOE value of 23.47% and the lowest ASD values of 0.46 mm with the clinical dataset. In addition, the highest DCS value of 88.69%, the lowest VOE value of 23.47%, the lowest ASD value of 0.83 mm, and the lowest HD value of 11.40 mm was achieved with the PROMISE12 dataset. Conclusions: Our experimental results show that the SegDGAN model outperforms other segmentation methods Keywords: Automatic segmentation, Generative adversarial networks, Magnetic resonance imaging, Prostate
DNMT1 inhibits hepatocellular carcinoma cells by altering the epigenetic modification of Marveld1 gene
Authors: Zhang Song Yan , Luo Qian , Wang Peng , Zhao Hao Ran , Xu Hai Tao , Zhao Liang , Qu Zhao Wei , Sun Jian Min , Zhang Yu Bao , Zheng Biao
Published: January 2020

Objective to study the effect of DNA methyltransferase (DNMT1) on Marveld1 in hepatocellular Carcinoma (HCC), and explore its role in the molecular mechanism of HCC occurrence and development.Methods The expression level of Dnmt1 and Marveld1 genes was detected by RT-PCR in the intraoperative pathological specimens. The human hepatoma Bel7402 and SMMC7721 cell lines down-regulated by DNMT1 gene expression were constructed by SiRNA transfection. The methylation level of Marveld1 promoter region was detected after RT-PCR and West-blot verification. The expression of Marveld1 gene, cell proliferation, invasion and change of cell cycle were detected by RT-PCR and West-blot. The expressions of P53, CyclinD1, P21 and P16 protein were detected by West-blot method.Results The expression of DNMT1 gene in human hepatocarcinoma tissues was higher than that in adjacent tissues. The methylation level of the Marveld1 gene promoter region in human hepatoma cell line down-regulated by DNMT1 gene expression was decreased, the expression level of Marveld1 gene was increased, and the proliferation and invasion ability of cells were weakened. The cell cycle was showed as G1-S phase arrest; P53 and P16 protein expressions were up-regulated, and CyclinD1 and P21 protein expressions were down-regulated.Conclusions Dnmt1 gene is highly expressed in human hepatocarcinoma tissues. Down-regulation of DNMT1 gene expression can decrease the methylation level of Marveld1 promoter region, up-regulate Marveld1 gene and human P53 and P16 proteins expressions, and down-regulate CyclinD1 and P21 proteins expressions, inhibit the proliferation and invasion of human hepatoma cells and can cause cell cycle G1-S arrest.
Efficacy and safety of self-expanding metallic stent placement followed by neoadjuvant chemotherapy and scheduled surgery for treatment of obstructing left-sided colonic cancer
Authors: Han Jia Gang , Wang Zhen Jun , Zeng Wei Gen , Wang Yan Bin , Wei Guang Hui , Zhai Zhi Wei , Zhao Bao Cheng , Yi Bing Qiang
Published: January 2020

BACKGROUND: This study aimed to evaluate the safety and feasibility of self-expanding metallic stent (SEMS) followed by neoadjuvant chemotherapy prior to elective surgery for obstructing left-sided colon cancer.

METHODS: Eleven consecutive patients with obstructing left-sided colon cancer between May 2014 and November 2015 were included retrospectively. All patients received SEMS followed by neoadjuvant chemotherapy. The primary outcome measure was stoma and laparoscopic surgery.

RESULTS: Chemotherapy was with two cycles of CAPOX (54.5%) or three cycles mFOLFOX6 (45.5%). Median serum albumin and hemoglobin levels before surgery were significantly higher than before neoadjuvant chemotherapy (p = 0.01 and p = 0.008 respectively) and before SEMS (p = 0.01 and p = 0.003 respectively). Median bowel wall thickness proximal to the upper edge of tumor was significantly more before neoadjuvant chemotherapy than before stent (p = 0.003), and significantly less before surgery than before neoadjuvant chemotherapy (p = 0.003). No patient underwent stoma creation. Laparoscopic surgery was performed in nine (81.8%) patients. No local recurrence or metastases developed over median cancer-specific follow-up of 44 months (range, 37-55 months).

CONCLUSION: SEMS followed by neoadjuvant chemotherapy prior to elective surgery appears to be safe and well tolerated in patients with obstructing left-sided colon cancer.
Familial autosomal recessive bestrophinopathy: identification of a novel variant in BEST1 gene and the specific metabolomic profile
Authors: Ye Panpan , Xu Jia , Luo Yueqiu , Su Zhitao , yao ke
Published: January 2020

Background
Autosomal recessive bestrophinopathy (ARB) is a retinal degenerative disorder caused by BEST1 mutations with autosomal recessive inheritance. We aim to map a comprehensive genomic and metabolomic profile of a consanguineous Chinese family with ARB.
Methods
Ophthalmic examinations were performed on the affected patients with ARB. The proband was screened for potential causative mutations in a panel with 256 known retinal disease genes by using target capture sequencing. The related mutation was further validated and segregated in the family members by Sanger sequencing. In silico prediction tools were used for pathogenicity assessment. A UHPLC-MS/MS metabolomic analysis was performed to explore the disease-associated metabolic feature.
Results
The affected patients from this family were characterized by low vision, the presence of subretinal fluid, macular edema, and hyperopia with coincidental angle closure. DNA sequencing identified a novel missense mutation in the BEST1 gene c.646G>A (p.Val216Ile) of the proband. Sanger sequencing further confirmed the mutation. The missense mutation was co-segregation across the pedigree and predicted to be deleterious by SIFT (0.017). The blood metabolic profiles were highly similar among all family members probably because of the same lifestyle, habitat and genomic background. However, ARB patients presented a significant deregulation of metabolites, such as citric acid, L-Threonic acid, and eicosapentaenoic acid.
Conclusions
We identified a novel disease-associated variant in the BEST1 gene as well as a disease-specific metabolic feature in familial ARB . Our findings helped improve the understanding of ARB mechanisms.
Clinical and functional patient characteristics predict medical needs in older patients at risk of functional decline
Authors: Scharf Anne-Carina , Gronewold Janine , Dahlmann Christian , Schlitzer Jeanina , Kribben Andreas , Gerken Guido , Frohnhofen Helmut , Dodel Richard , Hermann Dirk M
Published: January 2020

Background: The rising number of older multimorbid in-patients has implications for medical care. There is a growing need for the identification of factors predicting the needs of older patients in hospital environments. Our aim was to evaluate the use of clinical and functional patient characteristics for the prediction of medical needs in older hospitalized patients. Methods: 242 in-patients (57.4% male) aged 78.4±6.4 years, who were consecutively admitted to internal medicine departments of the University Hospital Essen between July 2015 and February 2017, were prospectively enrolled. Patients were assessed upon admission using the Identification of Seniors at Risk (ISAR) screening followed by comprehensive geriatric assessment (CGA). The CGA included standardized instruments for the assessment of activities of daily living (ADL), cognition, mobility, and signs of depression upon admission. In multivariable regressions we evaluated the association of clinical patient characteristics, the ISAR score and CGA results with length of hospital stay, number of nursing hours and receiving physiotherapy as indicators for medical needs. We identified clinical characteristics and risk factors associated with higher medical needs. Results: The 242 patients spent [median(Q1;Q3)]:9.0(4.0;16.0) days in the hospital, needed 2.0(1.5;2.7) hours of nursing each day, and 34.3% received physiotherapy. In multivariable regression analyses including clinical patient characteristics, ISAR and CGA domains, the factors age (β=-0.19, 95% confidence interval (CI)=-0.66;-0.13), number of admission diagnoses (β=0.28, 95%CI=0.16;0.41), ADL impairment (B=6.66, 95%CI=3.312;10.01), and signs of depression (B=6.69, 95%CI=1.43;11.94) independently predicted length of hospital stay. ADL impairment (B=1.14, 95%CI=0.67;1.61), cognition impairment (B=0.57, 95%CI=0.07;1.07) and ISAR score (β =0.26, 95%CI=0.01;0.28) independently predicted nursing hours. The number of admission diagnoses (risk ratio (RR)=1.06, 95%CI=1.04;1.08), ADL impairment (RR=3.54, 95%CI=2.29;5.47), cognition impairment (RR=1.77, 95%CI=1.20;2.62) and signs of depression (RR=1.99, 95%CI=1.39;2.85) predicted receiving physiotherapy. Conclusion: Among older in-patients at risk for functional decline, the number of comorbidities, reduced ADL, cognition impairment and signs of depression are important predictors of length of hospital stay, nursing hours, and receiving physiotherapy during hospital stay.
Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis
Authors: Nozaka Koji , Miyakoshi Naohisa , Kashiwagura Takeshi , Kasukawa Yuji , Saito Hidetomo , Kijima Hiroaki , Chida Shuichi , Tsuchie Hiroyuki , Shimada Yoichi
Published: January 2020

Background: Advanced to end-stage ankle osteoarthritis in highly active older individuals has traditionally been treated using tibiotalar arthrodesis. With tibiotalar arthrodesis, high levels of pain-free function are possible; however, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy, a type of joint preservation surgery, has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator on ankle osteoarthritis.
Methods: A total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed. Subsequently, angled osteotomy and correction of the distal tibia were performed. After ankle conditions improved, stabilization of the ankle joint was performed. An external fixator was used in all patients. In addition, joint distraction of about 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.
Results: The anteroposterior mortise angle during weight-bearing, lateral mortise angle during weight-bearing, and talar tilt angle and anterior translation of the talus on ankle stress radiography significantly improved (P < 0.05). In addition, signal changes on magnetic resonance imaging improved in all patients. Visual analogue scale and American Orthopedic Foot & Ankle Society scores also improved significantly (P < 0.05). No severe complications were observed.
Conclusion: DTO with joint distraction may be useful for older patients with a high physical activity level as a joint-preserving surgery for medial ankle osteoarthritis.
Level of evidence: Level IV, retrospective case series
Key words : distal tibial osteotomy, medial ankle arthritis, joint distraction, circular external fixator
Twenty-five Years On: Revisiting Bosnia and Herzegovina after Implementation of a Family Medicine Development Program.
Authors: Hodgetts Geoffrey , Brown Glenn , Batić-Mujanović Olivera , Gavran Larisa , Jatić Zaim , Račić Maja , Tešanović Gordana , Zahilić Amra , Martin Mary Imelda , Birtwhistle Richard
Published: January 2020

Background: The wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990’s resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen-years, the Queen’s University Family Medicine Development Program in Bosnia and Herzegovina (B-H) played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were supported by new laws and regulations to insure sustainability. This study revisited B-H 8-years after the end of the program to explore the impact of initiatives through understanding the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, , Health Centre Directors and Association Leaders.

Methods: Qualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes analyzed using an interpretative phenomenological approach to identify major themes and subthemes.

Results: Overall, 118 participants were interviewed. Three major themes and 9 subthemes were identified including (1) The Development of Family Medicine Education, (subthemes: establishment of departments of family medicine, undergraduate medical curriculum change), (2) Family Medicine as a Discipline (Family Medicine specialization, academic development, and Family Medicine Associations), and (3) Health Care System Issues (continuity of care, comprehensiveness of care, practice organization and health human resources).

Conclusions: Despite the impact of years of war and the challenges of a complex and unstable postwar environment, initiatives introduced by the Queen’s Program succeeded in establishing sustainable changes, allowing Family Medicine in BH to continue to adapt without abandoning its strong foundations. Despite the success of the program, the undervaluing of Primary Care from a human resource and health finance perspective presents ongoing threats to the system.
Preoperative predictive factor analysis of ovarian malignant involvement in premenopausal patients with clinical stage I endometrioid endometrial carcinoma
Authors: Chen Qin , Feng Yan , Wang Wenwen , Lv Weiguo , Li Baohua
Published: January 2020

Background Earlier literature suggests that ovarian preservation in young premenopausal clinical stage I endometrioid endometrial carcinoma patients does not negatively impact prognosis and is a more suitable choice for management of the disease. The main purpose of this study was to clarify the incidence of ovarian malignant involvement in premenopausal clinical stage I endometrioid endometrial carcinoma and further identify potential preoperative predictive factors of ovarian malignant involvement. Methods Premenopausal patients (≤50 years) with clinical stage I endometrioid endometrial carcinoma subjected to total hysterectomy and bilateral salpingo-oophorectomy with or without pelvic and/or para-aortic lymph node dissection at Women’s Hospital, Zhejiang University School of Medicine between 2002 and 2016 were enrolled for study. Patients were excluded in cases of gross extra pelvic disease on examination or imaging and family history of colon or gastrointestinal carcinoma. The included patient population was examined for incidence of ovarian malignant involvement and potential preoperative clinical predictive factors.Results A total of 511 premenopausal (age≤50 years) patients diagnosed with clinical stage I endometrioid endometrial carcinoma were enrolled for the study. Ovarian malignant involvements were detected in 23 of the patients (4.5%). Kaplan-Meier analysis showed poorer prognoses of patients with ovarian malignant involvement than those without ovarian involvement. Univariate and multivariate logistic analysis validated preoperative imaging of myometrial invasion depth, the gross appearance of the ovaries, and preoperative serum carbohydrate antigen 125 (CA125) level as independent risk predictors of postoperative ovarian malignant involvement. Receiver operating characteristic (ROC) curves was individually generated for preoperative myometrial invasion depth, the gross appearance of the ovaries, and serum CA125 level as well as a combination of the three factors. The area under curve (AUC) was 0.858 (95% confidence interval [CI], 0.757–0.960) for the combined three factors.Conclusions The incidence of ovarian malignant involvement in premenopausal patients with clinical stage I endometrioid endometrial carcinoma was relatively minimal. Preoperative imaging of myometrial invasion depth, the gross appearance of the ovaries, and serum CA125 level were independent risk predictors of ovarian malignant involvement. These findings may facilitate preoperative counseling of patients and informed clinical decision-making on ovarian preservation in these patients.
Agrobacterium tumefaciens mediated transformation of the aquatic carnivorous plant Utricularia gibba﻿
Authors: Oropeza-Aburto Araceli , Cervantes-Perez Sergio Alan , Herrera-Estrella Luis Rafael
Published: January 2020

Background Utricularia genus belongs to Lentibulariaceae family and has the highest number of species including terrestrials, epiphytes and aquatics plants. The development of specialized structures that evolved for carnivory is a feature of this genus that has been of great interest to biologist since the early studies of Darwin. Utricularia gibba is an aquatic carnivorous plant with sophisticated bladders traps that have one of the most complex suction mechanisms for trapping a prey. However, the molecular characterization of trap developmental and the biophysical processes involved in prey trapping are still largely unknown due to the lack of simple and reproducible gene transfer system for carnivorous plants.Results Here, we report the establishment of a simple, fast and effective protocol for the genetic transformation of U. gibba based on the T-DNA of Agrobacterium tumefaciens . An in vitro selection system using Phosphinotricin as selective agent was established for U. gibba. We report the tissue specific expression of the 35S promoter and the promoter of a trap specific ribonuclease gene. Plant transformation was confirmed by PCR and Real Time PCR in U. gibba plants.Conclusions We conclude that the genetic transformation protocol we developed is an effective method to study developmental biology and functional genomics of carnivory and propose U. gibba as model to study the developmental processes involved in trap formation.
A Randomized Clinical Trial on Combination Use of Sirolimus and Tacrolimus in Renal Transplant: A De novo Immunosuppression Approach
Authors: Hematian Farzaneh , Dalili Nooshin , Ahmadpoor Pedram , Moradi Omid , Pour-reza-gholi Fatemeh , Samadian Shiva , Samadian Fariba , Nafar Mohsen , Firoozan Ahmad , Ziaie Shadi
Published: January 2020

Background: With the introduction of new immunosuppressive agents like Sirolimus (SRL), we could increase long term allograft survival and decrease the use of other agents like calcineurin inhibitors. SRL in combination with other immunosuppressive medications like calcineurin inhibitors can lead to increase graft function and produce better long-term outcomes. Methods : We enrolled 40 kidney transplantation recipients in trial and followed them up for a duration of 6 months in Shahid Labbafinejad Medical Center. These patients were assigned to receive Tacrolimus (TAC) in combination with Mycophenolic acid or SRL, along with glucocorticoids. All kidney transplant recipients were followed up for serum creatinine and glomerular filtration rate and also complications during therapy. Results : There were no significant differences between the two treated groups regarding serum creatinine level ( p -values = 0.075). However, glomerular filtration rate was significantly increased in SRL group than the other one ( p -values = 0.023). There was no difference between the number of biopsies performed in the two treated groups. In biopsies that were done, in TAC/Mycophenolic acid group, acute antibody mediated rejection in four patients and in SRL/TAC group, acute cellular rejection in two patients were reported. Total cholesterol level was significantly increased in patients who received SRL ( p -values = 0.002). Other side effects were not significantly different in two arms. Conclusions : Our study demonstrated that SRL in the immunosuppressive regimen of kidney transplant recipients in de novo approach lead to better renal function. The long-term outcomes of de novo SRL utilization in kidney allograft recipients should further be assessed. Trial registration: The trial was retrospectively registered in the Iranian Registry on Clinical Trials ( www.irct.ir , registration code: IRCT20160412027346N6), by the date of 04/30/2019. ( https://www.irct.ir/trial/22416 ) Key words : Kidney transplantation, Immunosuppressive Agents, Mammalian target of rapamycin, Calcineurin Inhibitors, Graft Rejection, Sirolimus, Tacrolimus.
Incidence of injuries and illness and related risk factors in mountain biking events: A systematic review protocol
Authors: Buchholtz Kim , Lambert Mike , Burgess Theresa
Published: January 2020

Background Cycling is a popular sport and method of transportation globally but is a significant contributor to sports injury admissions in hospital emergency units. Mountain biking events present additional challenges with remote venues, and isolated courses. Most mountain biking events will provide on-site medical care for both injury and illness occurring during races. These data are essential to understand the true incidence of injury and illness in mountain biking events as national health data may not represent these events specifically. Methods This review will follow the preferred reporting items for systematic reviews and meta-analysis (PRISMA) statement. Search engines PubMed, Scopus, CINAHL (EBSCOhost), PEDro and the Cochrane Library will be systematically searched. Gray literature searches of Google Scholar and manual searching of reference lists and congress abstracts from cycling specific congresses will be conducted. Journal articles documenting illness and injury in adults participating in mountain bike cross-country marathon events will be included. A narrative analysis of the types, severity and area of injuries; and illness type and severity will be performed. A quantitative analysis will be performed should there be sufficient studies reported in the same format. Discussion This protocol outlines a systematic review on injury and illness in mountain biking events. Data from hospital records may not adequately represent the burden of injury and illness at events held in remote venues, especially if those treated on site do not require further hospital based treatment. This review will assist with the development of further research in this area, and in preparation of clinicians working in these types of events. Systematic review registration: This protocol has been registered with PROSPERO International prospective register of systematic reviews (No: CRD42019134584).
Short-term recovery of heart rate variability and its relationship with blood pressure after different intensity treadmill exercise
Authors: Wu Liang , Shi Ping , Shao Jiang , Li Anan , Yu Hongliu , Liu Yang
Published: January 2020

Background : Heart rate variability (HRV) provides an opportunity to capture the tiny but early signs that may predict the future cardiovascular risk in healthy individuals and further, helps understand how well the cardiovascular autonomic system works. Aims of this study were to elucidate short-term recovery of HRV and its relationship with blood pressure recovery after different intensity treadmill exercise. Methods : Fifteen healthy participants performed four different conditions (REST; speed 6km/h; speed 8km/h; speed 10km/h), systolic and diastolic blood pressure per 30s (SBP, DBP) and 5-mins consecutive heart beats intervals were measured after each trial. Autonomic nervous regulation was evaluated using HRV time-frequency domain indices and heart rate asymmetry (HRA) indices. Each index was calculated using 5 mins electrocardiogram (ECG) series and consecutive 30-s windows in 5 mins. Results : the vagally related indices (RMSSD, pNN50 and HF) decreased and the indices representing overall variability (SDNN, LF) had different trends as intensity increasing. The sympathetic-vagal balance parameter LF/HF increased, too. HRV indices had strong correlations with DBP but weak with SBP. Meanwhile, heart rate asymmetry vanished after each trial. Conclusions : The findings suggested a vagal withdrawal as soon as the end of treadmill exercise. It could be concluded that sympathetic modulation was stronger as intensity increasing. During recovery period, DBP was mediated by vagal activation and sympathetic withdrawal. The diminished asymmetry in Poincaré plot was the result of sympathetic acceleration and vagal reduction.
Wounds at risk of tetanus: unexpected prevalence of immunization in a patient cohort
Authors: Piccini Gaia Bavestrello , Cavenaile Jean-Christophe , Bressan Maria Antonietta
Published: January 2020

BackgroundTetanus is an acute and potentially fatal disease caused by Clostridium Tetani, an extremely resilient pathogen. The bacterium can contaminate traumatic wounds which account for approximately 5.4% of all visits to the Emergency Department. According to several surveillance programs, the incidence of clinical tetanus in Italy is ten-fold higher than in other industrialised countries. In 2010, Italy accounted for 57 of the 74 confirmed cases reported in the European Union.Methods The study analysed data from 1094 patients who presented to the Emergency Department of the Fondazione IRRCS Policlinico San Matteo between April 2016 and November 2017 with wounds potentially at risk for infection with Clostridium Tetani.Results Data showed that, in conformity with the literature, the elderly (> 60 years old) constitute a high-risk category, with 219 unprotected individuals out of 238. Also, among patients aged more than 60 years old, there was a statistically significant difference between female and male patients. From the comparative analysis of the data however, it was surprisingly found that even younger patients are lacking protective immunity.Conclusions When considering other medical systems, both European and non-European ones, and analysing their guidelines for the prevention of tetanus infection, the necessity of adopting a well-defined algorithm becomes evident. This, also in order to avoid the excessive administration of prophylaxis, as well as to allow to put in place the necessary preventive measures for each patient. This study highlights the need for a better patient and clinician awareness, and an improvement in record keeping and management of the documentation related to the vaccinations. The analysed data also suggests the need for conducting awareness campaigns on the topic of vaccines and vaccine preventable infections. Patients should be made aware of the importance of keeping track of their own immunization status, and of remembering the date of the last administration of the vaccine or, of carrying around their vaccination card.
Episodes Of Violence Suffered By Migrants Transiting Through Libya: A Cross Sectional Study
Authors: reques laura , Aranda-Fernandez E , Rolland C , Grippon A , Reboul C , Godard N , Luhmann N
Published: January 2020

Introduction The Central Mediterranean Route (CMR), passing through Libya, is one of the most dangerous for migrants from Africa. Episodes of violence have been documented but have not been accurately quantified. The objective of the study was to estimate the prevalence of episodes of violence suffered in Libya by migrants consulting Médecins du Monde (MdM) programs in France.Methodology Monocentric cross-sectional study. The inclusion criteria included all migrants over the age of 18 who had passed through Libya, who arrived in Europe from 2017 and consulted at the MdM health centre in Paris. The presence of psycho-traumatic events was considered as exclusion criteria. The study was implemented from February to May 2019. An ad-hoc questionnaire was created. The proportion, frequency and factors associated to physical, deprivation and sexual violence were estimated, as well as access to health care and need for psychosocial support.Results 98 people were recruited and 72 were interviewed (17 refused to participate and 9 were excluded). 76.4% were men, the average age was 31.9 years, 76.4% had a low level of education, 66.7% came from Ivory Coast and 59.7% had left their country for security reasons. The median length of stay in Libya was 180 days. The overall proportion of persons having suffered violence was 96.4% for men and 88.2% for women. The prevalence of physical, deprivation and sexual violence was 94.2%, 81.7% and 18.% for men and 80.0%, 86.7% and 53.3% for women, respectively. No statistical differences by other variables were found. Access to health care in Libya was non-existent. 63.9% of participants were oriented for psychosocial support.Conclusions The vast majority of migrants report having been victims of violence during their transit in Libya. Women are at particular risk of sexual violence. Mental health support for these populations is urgent.
Tryptophan-like fluorescence as a fingerprint of urban river water intrusion into storm drainage system
Authors: Yin Hailong , Wang Yue , Yang Yang , Huang Jingshui , Xu Zuxin
Published: January 2020

Inappropriate dry-weather misconnections into storm drainage system is a demanding environmental problem worldwide. Especially river water intrusion into storm drains may cause the overloading of storm pipes and unexpected serious dry-weather discharge. In this study, we evaluated the possibility of quantifying proportional source contribution in a storm drainage system with dry-weather misconnections from domestic sewage and river water inflow, using rapid and low-cost fluorescence spectroscopy methods. For this purpose, samples of both misconnection sources and outflows of storm drainage system were collected and analyzed in a downtown catchment of Shanghai, China. Results showed that fluorescent peak intensity of tryptophan-like T1 in domestic sewage (802±126 a.u.) was significantly higher than that in urban river water (57±12 a.u.), while fluorescent peak intensities of tryptophan-like T2 in urban river water (998±187 a.u.) was much higher than that in domestic sewage (241±72 a.u.) due to increased phytoplankton or algal activity in the polluted water. However, only Peak T2 passed the conservative behavior test in the incubation experiments, which could be used as a fingerprint for quantitatively identifying the misconnections of urban river water intrusion. We further developed a Bayesian fluorescence mass balance model (FMBM) to infer the percentage of dry-weather misconnections into the storm drainage system as a function of fluorescence intensities of Peak T2 in the samples of sources and outflows. It was found that the maximum posteriori probability estimate of the percentage of river water intrusion into the storm drains was up to 20.8% in this site, which was validated by the results of on-site investigation. Our findings implied that in-situ fluorescent sensors and Bayesian FMBM for the fingerprint fluorescence peak could be applied to fast track urban river water intrusion into storm drainage system from both qualitative and quantitative perspective with low costs.
Emission Inventory and Spatial Distribution of Particulate Matter from Dust Sources in Zhengzhou City, China
Authors: Yang Huan , Song Xuan , Song Jiarui , Zhang Qi , Cui Jian , Yin Shasha
Published: January 2020

Background: With the rapid development of society and economy, Zhengzhou city, a new first-tier city in central China, is facing high levels of particulate matter (PM) pollution. Dust source has been generally recognized as one of the major source of PM emission that cannot be ignored. In this study, we aimed to establish an emission inventory of PM from dust source and characterize its spatial pattern in Zhengzhou, China. Methods: A GIS＆RS based approach was proposed to establish the emission inventory of total suspended particles (TSP), particulate matter 10 (PM 10 ) and particulate matter 2.5 (PM 2.5 ) from dust source. Bare ground, construction sites and paved roads in 2016 was recognized with high resolution remote sensing data.Technical Guidelines for Emissions Inventory of Particulate Matter Emitted from Dust Source recommended by the Ministry of Ecological Environment (MEP) was used to estimate PM emission, and a spatial grid of 3km×3km resolution was established to display the distribution of PM emission from different dust sources. Results: The total emission of TSP, PM 10 and PM 2.5 in Zhengzhou was 237.5 kt·a -1 , 103.7 kt·a -1 and 22.4 kt·a -1 , respectively in 2016. Compared to other cities in China, the PM emission in Zhengzhou was at a relatively high level. Construction dust source was the main emission source in Zhengzhou, the TSP, PM 10 and PM 2.5 emission of which account for 76.42%, 89.68% and 88.39%, respectively of the total emissions, followed by road dust source and soil dust source. Spatially, total TSP, PM 10 , PM 2.5 emission were larger in main urban areas including Jinshui, Zhongyuan, Erqi, Jingkai and other urban districts. Zhongmou, Xingyang and Xinzheng, which bordering with the main urban area, were also the area with high PM emission, while Dengfeng, Gongyi and other remote areas had relatively small emission of PM. Conclusions: The GIS＆RS based approach has good applicability for identifying the emission characteristics in urban area, and it is urgent for Zhengzhou city to take specific measures for the prevention and control of atmospheric pollution under the severe situation of high- level PM emission.
Quantitative analysis of the effect of fraction of inspired oxygen on peripheral oxygen saturation in healthy volunteers
Authors: Bang Ji-Yeon , Cho Changhun , Lee Eun-Kyung , Choi Byung-Moon , Noh Gyu-Jeong
Published: January 2020

Background The international organization for standardization (ISO) 80601-2-61 dictates that the accuracy of a pulse oximeter should be assessed by a controlled desaturation study. We aimed to characterize the relationship between the fraction of inspired oxygen (FiO 2 ) and peripheral oxygen saturation (SpO 2 ) using a turnover model by retrospectively analyzing the data obtained from previous controlled desaturation studies. We also measured the changes in biomarkers expected to be related to hypoxia (i.e., lactate, carboxyhemoglobin (COHb), and methemoglobin (MetHb)) in response to short-term exposure to hypoxia.Methods Volunteers were exposed to various levels of induced hypoxia over 70−100% arterial oxygen saturation (SaO 2 ). The study period consisted of two rounds of hypoxia and the volunteers were maintained in room air between each round. FiO 2 and SpO 2 were recorded continuously during the study period. A population pharmacodynamic analysis was performed with the NONMEM VII level 4 (ICON Development Solutions, Ellicott City, MD, USA). Lactate, COHb, and MetHb were measured using a CO-oximeter.Results In total, 2899 SpO 2 data points obtained from 20 volunteers were used to determine the pharmacodynamic characteristics. The pharmacodynamic parameters were as follows: k out = 0.942 1/min, Imax = 0.802, IC 50 = 85.3%, γ = 27.3. The changes in SpO 2 due to decreases in FiO 2 well explained by the turnover model with inhibitory function as a sigmoidal model. As SpO 2 decreased, lactate and COHb increased as a whole, and COHb showed the best correlation (Pearson’s correlation, R 2 =0.3263, P < 0.0001).Conclusion The potency of FiO 2 required to reduce SpO 2 from 100% to 70% was 14.7%. Carboxyhemoglobin has the potential to be a useful biomarker for acute hypoxia.
A comparative assessment of Rapid Diagnosis Test (RDT) versus microscopy for malaria diagnosis in health care facilities
Authors: Metoh Theresia Njuabe , Fru Chi Tchampo , FonGah Philip , Zhou Xiaonong
Published: January 2020

Background: Management of malaria requires prompt diagnosis of malaria by microscopy, Rapid Diagnostic Tests (RDTs), or other available tools. The objective of this study was to determine the best approach on malaria diagnosis in detection of malaria parasite in the Northwest region, of Cameroon among different population groups. Materials and method: The cross sectional study was conducted on 60 febrile patients who were directed to the laboratory department for blood screening at the Bamenda Regional Hospital after showing signs and symptoms of malaria infection. Blood sample were collected aseptically and dispensed into an EDTA container where RDTs and microscopic examination were performed to assess the presence of malaria parasites. Results from the rapid diagnostic kits were analyzed and compared to those obtained by general microscopy. Results : Of the 60 samples enrolled 37 (61.7%) were found to be positive with blood films examination while in rapid diagnostic test 27 (45%) were positive. Based on frequency of infection by age 20-35 years had 13 (35.1%) as the most vulnerable group, followed by 0 -5 year with 11 (29.7%), 6-19 had 6 (16.2%) while age group of 36-59 had 5 (16.0%) and lastly the age group of 60 and above had least value of 2 (5.4%). The prevalence of malaria obtained through microscopy (62%) was significantly higher than in RDT (45%). Considering microscopy as the gold standard, RDT exhibited high specificity (100%) and sensitivity (73%) with positive predictive and negative predictive values of 100% and 70%, respectively. The sensitivity of RDT increased significantly with increase in P. falciparum parasitaemia which was the plasmodium specie detected in all positive cases. Conclusion: The study, therefore, highlights that the routine microscopy test demonstrated a superior sensitivity compared to RDT method of malaria diagnosis, however, RDT could be a useful tool in individuals suspected to show high degree of disease spectrum for quick intervention in order to avert danger associated with delayed diagnosis.
Expression of VEGF-C and its association with clinicopathological features among patients with gastric cancer undergoing gastric surgery at Tongji medical hospital, China.
Authors: MAWALLA BRIAN , Luo Xiaoxiao , Xianglin Yuan
Published: January 2020

Objectives:
Gastric cancer shows epidemiological variability according to geographic locations, these differences have been demonstrated both regionally and within countries. There is no baseline protocol regarding using VEGF-C as tumor marker in local setting therefore it was necessary to conduct this study, the current study conducted to analyze the correlation exists between VEGF-C and clinicopathological parameters in patients with gastric cancer undergoing a surgical procedure at Tongji medical hospital.
Results:
161samples analyzed were from Chinese patients who had undergone either palliative or curative surgical procedure between October 2015 and September 2017 at Tongji medical hospital. I mmunohistochemistry was method was used to analyses presence of VEGF-C in tissues. Among 161 gastric cancer patients, 101 (62.7%) gastric samples showed strong VEGF-C expression and 60 (37.3%) gastric samples showed weak VEGF-C expression. Using multivariate logistic regression analysis, tumor grade, invasion of lymph nodes and TNM staging were statistically significantly found to associate with strong expression of VEGF-C. VEGF-C strong expression was significantly seen more in adenocarcinoma of gastric cancer, and Therefore, VEGF-C may be used as a biological marker for assessing the biological characteristics of gastric.
Does the position of cage affect the clinical outcome of lateral interbody fusion in lumbar spinal stenosis?
Authors: Qiao Guangxi , Feng Min , Liu Jian , Wang Xiaodong , Ge Miao , Yang Bin , Yue Bin
Published: January 2020

Background: Lateral interbody fusion (LLIF) decompress the neural elements indirectly by increasing the height of disc, instead of resecting the disc or osteophytes herniated to the canal. When performing LLIF, the position of interbody cage is quite important for the outcome of decompression. This study aims to identify the ideal cage position in LLIF and to investigate if the posterior instrumentation would affect the indirect decompression. Methods: This is a retrospective study. Patients underwent 2-stage surgeries: stage I was LLIF and stage II was percutaneous pedicle screws fixation after 1 week. Anterior disc height (ADH), posterior disc height (PDH), left and right foraminal height (FH) and segmental angle (SA) were measured on lateral CT reconstructions. The cross-sectional area of the thecal sac (CSA) was determined by the outlined area of the thecal sac on a T2-weighted axial MRI. The patients were subgroups according to the cage position: the anterior (cage located at the anterior 1/3 of disc space) and posterior groups (cage located at the posterior 2/3 of disc space). P-values <0.05 were considered significant. Results: This study included 46 patients and 71 surgical levels. After stage I LLIF, significant increase in ADH, PDH, bilateral FH was found in both 2 subgroups, as well as the CSA (all p<0.01). SA increased 2.84±3.2° in anterior group after stage I LLIF and increased 0.81±3.1° in posterior group (p=0.013). After stage II surgery, SA was similar between anterior and posterior group (p=0.20). CSA showed no difference between the 2 groups. Conclusion: The anteriorly placed cage may provide better improvement of anterior disc height and segmental angle after stand-alone LLIF surgery. After the second stage posterior instrumentation, the cage position would not affect the segmental angle or foraminal height.
Clinical features, treatment, and survival outcome of primary pulmonary NUT midline carcinoma
Authors: Xie Xiaohong , Wang Liqiang , Qin Yinyin , Lin Xinqing , Xie Zhanhong , Liu Ming , Zhang Jiexia , Ouyang Ming , Liu Jun , Gu Yingying , Li Shiyue , Zhou Chengzhi
Published: January 2020

Objective: NUT midline carcinoma (NMC), a rare type of squamous cell carcinoma, is genetically characterised by NUT midline carcinoma family member 1 (NUTM1) gene rearrangement. NMC can arise from the lungs; however, there is no standard for the management of primary pulmonary NMC. This study aimed to confirm the clinical features and report the treatments, especially with immune checkpoint inhibitors (ICIs), and outcomes of patients with primary pulmonary NMC. Methods: A retrospective review of patients with primary pulmonary NMC was performed in the First Affiliated Hospital of Guangzhou Medical University between January 2015 and December 2018. Clinical manifestations as well as radiographic and pathological findings were recorded. Whole-exome sequencing (WES), a predictor for ICI response, was used to determine the tumour mutational burden (TMB). Treatments, especially by immune checkpoint blockade, and patient survival were analysed. Results: Seven patients with primary pulmonary mass (four men and three women) with a mean age of 42 years (range, 23–74) who were diagnosed with NMC according to NUT immunohistochemistry staining were included for analysis. One patient had a rare fusion of CHRM5-NUTM1 by tumour sequencing. A wide range of TMB (1.75–73.81 mutations/Mbp) was observed. The initial treatments included chemotherapy (5/7, 71.4%), surgery (1/7, 14.3%), and radiotherapy (1/7, 14.3%). Five patients (5/7, 71.4%) received ICIs ( programmed cell death protein 1 [ PD1]/ programmed cell death ligand 1 [ PDL1] monoclonal antibody) as second- or higher-line treatments. The median overall survival (OS) was 4.1 months (range, 1.5–26.7 months). Conclusions: Patients with primary pulmonary NMC have a poor prognosis and chemotherapy is often preferred. Checkpoint immunotherapy is a good option as the second- or higher-line treatment. TMB seems to be not associated with OS.
Sporadic and Familial Variants in NF1: An Explanation of the Wide Variability in Neurocognitive Phenotype?
Authors: Biotteau Maelle , Déjean Sébastien , Lelong Sandrine , Iannuzzi Stéphanie , Faure-Marie Nathalie , Castelnau Pierre , Rivier François , Lauwers-Cancès Valérie , Baudou Eloïse , Chaix Yves
Published: January 2020

Background: Cognitive impairment is the most common neurological manifestation in NF1 and occurs in 30–70% of NF1 cases. The onset and severity of each specific cognitive deficit varies greatly from child to child, with no apparent external causes. The wide variability of phenotype is the most complex aspect in terms of management and care. Despite multiple research, the mechanism underlying the high heterogeneity in NF1 has not yet been elucidated. While many studies have focused on the effects of specific and precise genetic mutations on the NF1 phenotype, little has been done on the impact of NF1 transmission (sporadic vs. familial cases). Method: We used a complete neuropsychological evaluation designed to assess five large cognitive areas: general cognitive functions (WISC-IV and EVIP); reading skills (“L’Alouette”, ODEDYS-2 and Lobrot French reading tests); phonological process (ODEDYS-2 test); visual perceptual skills (JLO, Thurstone and Corsi block tests) and attention (CPT-II), as well as psychosocial adjustments (CBCL) to explore the impact of NF1 transmission on cognitive disease manifestation in 96 children affected by NF1 (55 sporadic cases (29♀,26♂); 41 familial cases (24♀,17♂)). Results: Familial and Sporadic form of NF1 only differ in IQ expression. The families' SES impacts IQ performance but not differently between sporadic and familial variants. However, SES is lower in familial variants than in the sporadic variant of NF1. No other cognitive differences emerge between sporadic and familial NF1. Conclusions: Inheritance in NF1 failed to explain the phenotype variability in its entirety. IQ differences between groups seems in part linked to the environment where the child grows up. Children with NF1, and especially those that have early diagnoses (most often in inherited cases), must obtain careful monitoring from their early childhood, at home to strengthen investment in education and in school to early detect emerging academic problems and to quickly place them into care.