bluuebunny/crossref_metadata_2025 huggingface dataset:
Automatic Planning for Nasopharyngeal Carcinoma Based on Progressive Optimization in RayStation Treatment Planning System
Authors: Yang Yiwei , Shao Kainan , Zhang Jie , Chen Ming , Chen Yuanyuan , Shan Guoping
Published: June 2020

Objective:

To evaluate and quantify the planning performance of automatic planning (AP) with manual planning (MP) for nasopharyngeal carcinoma in the RayStation treatment planning system (TPS).

Methods:

A progressive and effective design method for AP of nasopharyngeal carcinoma was realized through automated scripts in this study. A total of 30 patients with nasopharyngeal carcinoma with initial treatment was enrolled. The target coverage, conformity index (CI), homogeneity index (HI), organs at risk sparing, and the efficiency of design and execution were compared between automatic and manual volumetric modulated arc therapy (VMAT) plans.

Results:

The results of the 2 design methods met the clinical dose requirement. The differences in D95 between the 2 groups in PTV1 and PTV2 showed statistical significance, and the MPs are higher than APs, but the difference in absolute dose was only 0.21% and 0.16%. The results showed that the conformity index of planning target volumes (PTV1, PTV2, PTVnd and PGTVnx+rpn [PGTVnx and PGTVrpn]), homogeneity index of PGTVnx+rpn, and HI of PTVnd in APs are better than that in MPs. For organs at risk, the APs are lower than the MPs, and the difference was statistically significant ( P < .05). The manual operation time in APs was 83.21% less than that in MPs, and the computer processing time was 34.22% more.

Conclusion:

IronPython language designed by RayStation TPS has clinical application value in the design of automatic radiotherapy plan for nasopharyngeal carcinoma. The dose distribution of tumor target and organs at risk in the APs was similar or better than those in the MPs. The time of manual operation in the plan design showed a sharp reduction, thus significantly improving the work efficiency in clinical application.
Decontamination of Bacillus Spores with Formaldehyde Vapor Under Varied Environmental Conditions
Authors: Choi Young W. , Sunderman Michelle M. , McCauley Martha W. , Richter William R. , Willenberg Zachary J. , Wood Joseph , Serre Shannon , Mickelsen Leroy , Willison Stuart , Rupert Rich , Ortiz Jorge G. Muñiz , Casey Sara , Calfee M. Worth
Published: June 2020

Introduction:

This effort investigated formaldehyde vapor characteristics under various environmental conditions by the analyses of air samples collected over a time-course. This knowledge will help responders achieve desired formaldehyde exposure parameters for decontamination of affected spaces after a biological contamination incident.

Methods:

Prescribed masses of paraformaldehyde and formalin were sublimated or evaporated, respectively, to generate formaldehyde vapor. Adsorbent cartridges were used to collect air samples from the test chamber at predetermined times. A validated method was used to extract the cartridges and analyze for formaldehyde via liquid chromatography. In addition, material demand for the formaldehyde was evaluated by inclusion of arrays of Plexiglas panels in the test chamber to determine the effect of varied surface areas within the test chamber. Temperature was controlled with a circulating water bath connected to a radiator and fan inside the chamber. Relative humidity was controlled with humidity fixed-point salt solutions and water vapor generated from evaporated water.

Results:

Low temperature trials (approximately 10°C) resulted in decreased formaldehyde air concentrations throughout the 48-hour time-course when compared with formaldehyde concentrations in the ambient temperature trials (approximately 22°C). The addition of clear Plexiglas panels to increase the surface area of the test chamber interior resulted in appreciable decreases of formaldehyde air concentration when compared to an empty test chamber.

Conclusion:

This work has shown that environmental variables and surface-to-volume ratios in the decontaminated space may affect the availability of formaldehyde in the air and, therefore, may affect decontamination effectiveness.
When news is the crisis: Al Jazeera and Al Arabiya framing of the 2017 Gulf conflict
Authors: Ajaoud Soukaina , Elmasry Mohamad Hamas
Published: June 2020

The 2017 Gulf crisis raises important questions about what happens when news networks become part and parcel of a political conflict. This research employs content analysis to analyse how two flagship evening news programmes –  Al-Hasad ( The Harvest) on Al Jazeera and  Panorama on Al Arabiya – framed the early phase of the 2017 Gulf crisis. The study provides an elucidation of how, specifically, editorial positions were made manifest and, importantly, what framing mechanisms were employed. Results suggest that Al Jazeera’s  Al-Hasad took the position of a victim being attacked by an external oppressor, while Al Arabiya’s  Panorama framed Qatar as a sponsor of terrorism.
Maternal asthma and gestational diabetes mellitus: Exploration of potential associations
Authors: Jensen ME , Barrett HL , Peek MJ , Gibson PG , Murphy VE
Published: June 2020

Asthma and gestational diabetes mellitus are prevalent during pregnancy and associated with adverse perinatal outcomes. The risk of gestational diabetes mellitus is increased with asthma, and more severe asthma; yet, the underlying mechanisms are unknown. This review examines existing literature to explore possible links.

 Asthma and gestational diabetes mellitus are associated with obesity, excess gestational weight gain, altered adipokine levels and low vitamin D levels; yet, it’s unclear if these underpin the gestational diabetes mellitus–asthma association. Active antenatal asthma management reportedly mitigates asthma-associated gestational diabetes mellitus risk. However, mechanistic studies are lacking.

 Existing research suggests asthma management during pregnancy influences gestational diabetes mellitus risk; this may have important implications for future antenatal strategies to improve maternal-fetal outcomes by addressing both conditions. Addressing shared risk factors, as part of antenatal care, may also improve outcomes. Finally, mechanistic studies, to establish the underlying pathophysiology linking asthma and gestational diabetes mellitus, could uncover new treatment approaches to optimise maternal and child health outcomes.
Self-Esteem, Social Esteem, and Pride
Authors: Salice Alessandro
Published: June 2020

This article explores self-esteem as an episodic self-conscious emotion. Episodic self-esteem is first distinguished from trait self-esteem, which is described as an enduring state related to the subject’s sense of self-worth. Episodic self-esteem is further compared with pride by claiming that the two attitudes differ in crucial respects. Importantly, episodic self-esteem—but not pride—is a function of social esteem: in episodic self-esteem, the subject evaluates herself in the same way in which others evaluate her. Furthermore, social esteem elicits episodic self-esteem if the values at the basis of the others’ evaluation are shared by the subject. Such sharing of values suggests that only the evaluations of those others that the subject frames as her in-group members are relevant to episodic self-esteem.
School Nurses on the Front Lines of Healthcare: Serious Infections in Students and Their Common Presenting Complaints
Authors: McNickle Lauren , Olympia Robert P.
Published: June 2020

School nurses occasionally deal with students presenting with serious infections associated with common chief complaints. Although rare, the implications of missing the signs and symptoms of these infections are potentially life-threatening and devastating, with both immediate and long-term complications. Rapid recognition and stabilization, with immediate transfer to the closest emergency department via emergency medical services for antibiotic administration, is the key to reducing morbidity and mortality associated with these serious infections. We discuss three students presenting with febrile illnesses associated with chest pain, headache, and back pain, focusing on the initial assessment and management of these students and their common presenting complaints.
Protease-Activated Receptor-2 Decreased Zonula Occlidens-1 and Claudin-1 Expression and Induced Epithelial Barrier Dysfunction in Allergic Rhinitis
Authors: Wang, MS Jun , Kang, MS Xue , Huang, MS Zhi-Qun , Shen, MS Li , Luo, MD Qing , Li, MS Meng-Yue , Luo, MS Li-Ping , Tu, MS Jun-Hao , Han, MS Mei , Ye Jing
Published: June 2020

Background

Protease-activated receptor-2 (PAR-2)-modulated tight junctions (TJs) have been suggested to be involved in the pathogenesis of chronic inflammatory diseases. However, immunopathogenesis remains to be investigated among patients with allergic rhinitis (AR).

Objective

This study sought to investigate the role of PAR-2 in the modulation of epithelial barrier function and the expression of TJs in the nasal mucosa of AR patients.

Methods

The expression of TJs and PAR-2 of the nasal mucosa in AR patients and control subjects by immunohistochemistry, quantitative real-time polymerase chain reaction (qRT-PCR), and western blotting. In vitro, Primary human nasal epithelial cells (pHNECs) of AR patients were stimulated by Der p1 to analyze the correlation between PAR-2 and TJs expression. Der p1-induced pHNECs were treated with the PAR-2 agonist SLIGRL-NH2 and antagonist FSLLRY-NH2. Fluorescein isothiocyanate–dextran 4 kDa detection was employed as an indicator of epithelial permeability.

Results

Lower expression levels of TJs in the nasal epithelium of AR patients were observed in comparison with that in control subjects. The PAR-2 level was markedly increased following treatment with 1,000 ng/mL of Der p1 for 24 hours in a cellular model of AR. The expression of PAR-2 was increased in Der p1-induced pHNECs of AR patients and correlated inversely with zonula occlidens (ZO)-1 and claudin-1. Treatment with Der p1 further downregulated TJs expression and promoted an increased epithelial permeability in Der p1-induced pHNECs.

Conclusions

PAR-2 could downregulate the expression of ZO-1 and claudin-1, which is involved in epithelial barrier dysfunction in AR.
Sinus Development and Pneumatization in a Primary Ciliary Dyskinesia Cohort
Authors: Pappa Andrew K. , Sullivan Kelli M. , Lopez Erin M. , Adams Katherine N. , Zanation Adam M. , Ebert Charles S. , Thorp Brian D. , Senior Brent A. , Leigh Margaret W. , Knowles Mike R. , Kimple Adam J.
Published: June 2020

Background

Primary ciliary dyskinesia (PCD) is a genetically diverse disease which causes impaired mucociliary clearance, and results in pulmonary, otologic, and rhinologic disease in affected patients. Genetic mutations in multiple genes impair the ability of patients to clear mucous from the lungs, middle ear, and sinonasal cavity and lead to chronic pulmonary and sinonasal symptoms.

Methods

We identified 17 PCD patients who had available CT scans. Volumes for bilateral maxillary, sphenoid, and frontal sinuses were calculated. A control population of patients who had preoperative CT scans for endoscopic endonasal resection of skull base pathology without sinonasal cavity involvement was also identified.

Results

The mean age of PCD was 33 and ranged from 13 to 54 years. Patients were age- and gender-matched to a control group that underwent resection of anterior skull-base tumors and had a mean age of 35 that ranged between 17–53 years old. The volumes for all thee sinus cavities were significantly smaller (p < 0.007) compared to the control population. The average Lund-Mackay score was 10.6 in the PCD cohort (range 6–16) in comparison to an average of 0.7 in the control cohort (range 0–2).

Conclusions

Overall sinus volumes were smaller in patients with PCD compared to our control population. Future studies will be aimed at understanding defects in sinus development as a function of specific genetic mutations in PCD patients. Ultimately, a better understanding of the underlying pathophysiology of PCD will allow us to identify the optimal treatment practices for this unique patient group.
Guidelines Without Lines, Communities Without Borders: The Marketplace of Ideas and Digital Manifest Destiny in Social Media Platform Policies
Authors: Maddox Jessica , Malson Jennifer
Published: June 2020

When faced with conflicts, social media platforms harken back to their front-facing, user-friendly documents. These documents, often called community standards, or something similar, lay out the practices allowed on their sites. It is well documented in legal scholarship how technology companies incorporate particular First Amendment jurisprudence into these community standards documents, and this work aims to empirically examine this claim. Specifically, we were interested in how the backbone of American free expression—the marketplace of ideas metaphor—was incorporated into these governing documents. We conducted a textual analysis of five US-based social media platforms (Facebook, Twitter, YouTube, Instagram, and Tumblr) to analyze how the marketplace of ideas metaphor may be invoked. We found these documents do rely heavily on the metaphor for presenting governing strategies. They also rely heavily on an oft-referenced ambiguous moderation line and the idea of a singular, global, borderless community, both of which bolster the marketplace metaphor. Given this, US-based social media platforms are holding the rest of the world to US-based ideas of free expression, thus engaging in digital manifest destiny.
Probing the Effects of Transformational Leadership on Employees’ Job Satisfaction With Interaction of Organizational Learning Culture
Authors: Khan Saif-Ur-Rehman , Anjam Mahwish , Abu Faiz Mohammad , Khan Faisal , Khan Hashim
Published: June 2020

The purpose of this study is to explore how various dimensions of leadership style are being used to measure organizational effectiveness. Job satisfaction is one of the essential indicators used to measure organizational effectiveness. Literature suggests that the manager’s transformational leadership style highly influences the employees’ job satisfaction. This study focuses on identifying the role of a transformational leader in developing job satisfaction in employees of the banking industry, using the organizations’ learning culture as the moderating variable. For this purpose, a total of 180 respondents were surveyed from UAE’s banking sector. In this study descriptive statistics, Pearson’s correlation coefficient, and multiple regression analysis were employed for the data analyses. The results confirmed that the five dimensions of transformational leaders and overall transformational leadership style significantly affect the employee’s job satisfaction, whereas the moderating effect of the organizational learning culture on any of the said relationships was found insignificant. This study used self-reported data based on a cross-sectional survey in the banking sector only. The research emphasizes the implication of the leaders’ personal traits to be a significant determinant of an employee’s satisfaction. In addition, managers in the banking sector in UAE realized that organization learning culture (OLC) has not had any significant impact on employees’ job satisfaction. As there is not sufficient literature on the moderating role of organizational learning culture, this study is a valuable contribution to the existing body of knowledge.
Mobile Banking Adoption: Examining the Role of Personality Traits
Authors: Agyei James , Sun Shaorong , Abrokwah Eugene , Penney Emmanuel Kofi , Ofori-Boafo Richmond
Published: June 2020

A number of studies have been conducted on the salient factors that influence consumers’ intention to adopt mobile banking services. However, none of these studies has explored the impact of personality traits on consumers’ intention to adopt mobile banking services. This study investigates the impact of personality traits on users’ intention to adopt mobile banking. Data gathered from 482 mobile banking users in Ghana via a convenience sampling technique using a questionnaire survey were analyzed using structural equation modeling. The results show that agreeableness, conscientiousness, and openness to new experience significantly impact users’ intention to adopt mobile banking through perceptions of usefulness and ease of use, with agreeableness showing the strongest total effect, followed by conscientiousness. The results also reveal that perceived usefulness and perceived ease of use are salient predictors of users’ intention to adopt mobile banking. The study underscores the need for service providers to focus on designing effective marketing strategies that recognize different user personality traits so as to improve adoption.
Stasis and Change in Public School District Racial/Ethnic Segregation, 1993–2015
Authors: Richards Meredith P. , Stroub Kori James , Kennedy Camila Cigarroa
Published: June 2020

Scholars have often suggested that racial integration is inherently unstable—a transition point in the racial transformation of neighborhoods and schools. While much empirical attention has been paid to documenting changes in segregation in public school districts, in this study we provide initial evidence focusing on the stability of segregation patterns. We calculate annual measures of district racial/ethnic segregation from the National Center for Education Statistics Common Core of Data from 1993 to 2015. Our findings suggest that despite relatively high and stable levels of segregation nationally, stability is the rule, rather than the exception, for the majority of public school districts. Using a taxonomy of severity and stability derived from previous scholarship, we find that most districts are “stably integrated,” with a minority “stably segregated” or exhibiting meaningful change. Our findings suggest that further attention to the characteristics and practices of “stably integrated” districts may be warranted.
How I treat renal anemia
Authors: Fishbane Steven , Coyne Daniel W.
Published: June 2020

Anemia is a frequent complication of kidney disease. When severe, it causes symptoms that can be debilitating. The course of anemia tends to track the decline in kidney function, with prevalence increasing in more advanced disease. Although the most common cause is relative erythropoietin deficiency, other factors such as reduced iron availability contribute to the pathobiology. In this review, we use cases to explore the surprising complexity of decision-making in management of renal anemia.
Chemical inhibition of PAPD5/7 rescues telomerase function and hematopoiesis in dyskeratosis congenita
Authors: Shukla Siddharth , Jeong Ho-Chang , Sturgeon Christopher M. , Parker Roy , Batista Luis Francisco Zirnberger
Published: June 2020

Dyskeratosis congenita (DC) is a pediatric bone marrow failure syndrome caused by germline mutations in telomere biology genes. Mutations in DKC1 (the most commonly mutated gene in DC), the 3′ region of TERC, and poly(A)-specific ribonuclease (PARN) cause reduced levels of the telomerase RNA component (TERC) by reducing its stability and accelerating TERC degradation. We have previously shown that depleting wild-type DKC1 levels by RNA interference or expression of the disease-associated A353V mutation in the DKC1 gene leads to decay of TERC, modulated by 3′-end oligoadenylation by noncanonical poly(A) polymerase 5 (PAPD5) followed by 3′ to 5′ degradation by EXOSC10. Furthermore, the constitutive genetic silencing of PAPD5 is sufficient to rescue TERC levels, restore telomerase function, and elongate telomeres in DKC1_A353V mutant human embryonic stem cells (hESCs). Here, we tested a novel PAPD5/7 inhibitor (RG7834), which was originally discovered in screens against hepatitis B viral loads in hepatic cells. We found that treatment with RG7834 rescues TERC levels, restores correct telomerase localization in DKC1 and PARN-depleted cells, and is sufficient to elongate telomeres in DKC1_A353V hESCs. Finally, treatment with RG7834 significantly improved definitive hematopoietic potential from DKC1_A353V hESCs, indicating that the chemical inhibition of PAPD5 is a potential therapy for patients with DC and reduced TERC levels.
The neuro-pathophysiology of temporomandibular disorders-related pain: a systematic review of structural and functional MRI studies
Authors: Yin Yuanyuan , He Shushu , Xu Jingchen , You Wanfang , Li Qian , Long Jingyi , Luo Lekai , Kemp Graham J. , Sweeney John A. , Li Fei , Chen Song , Gong Qiyong
Published: June 2020

Chronic pain surrounding the temporomandibular joints and masticatory muscles is often the primary chief complaint of patients with temporomandibular disorders (TMD) seeking treatment. Yet, the neuro-pathophysiological basis underlying it remains to be clarified. Neuroimaging techniques have provided a deeper understanding of what happens to brain structure and function in TMD patients with chronic pain. Therefore, we performed a systematic review of magnetic resonance imaging (MRI) studies investigating structural and functional brain alterations in TMD patients to further unravel the neurobiological underpinnings of TMD-related pain. Online databases (PubMed, EMBASE, and Web of Science) were searched up to August 3, 2019, as complemented by a hand search in reference lists. A total of 622 papers were initially identified after duplicates removed and 25 studies met inclusion criteria for this review. Notably, the variations of MRI techniques used and study design among included studies preclude a meta-analysis and we discussed the findings qualitatively according to the specific neural system or network the brain regions were involved in. Brain changes were found in pathways responsible for abnormal pain perception, including the classic trigemino-thalamo-cortical system and the lateral and medial pain systems. Dysfunction and maladaptive changes were also identified in the default mode network, the top-down antinociceptive periaqueductal gray-raphe magnus pathway, as well as the motor system. TMD patients displayed altered brain activations in response to both innocuous and painful stimuli compared with healthy controls. Additionally, evidence indicates that splint therapy can alleviate TMD-related symptoms by inducing functional brain changes. In summary, MRI research provides important novel insights into the altered neural manifestations underlying chronic pain in TMD.
Correction to: Relationship of living arrangement with the decline in functional capacity in elderly people by gender: a longitudinal observational study
Authors: Imamura Haruhiko , Uchiyama Eiko , Akiyama Miki , Kaneko Ikuyo , Takebayashi Toru , Nishiwaki Yuji
Published: June 2020

An amendment to this paper has been published and can be accessed via the original article.
Conjunctival structure of glaucomatous eyes treated with anti-glaucoma eye drops: a cross-sectional study using anterior segment optical coherence tomography
Authors: Gozawa Makoto , Takamura Yoshihiro , Iwasaki Kentaro , Arimura Shogo , Inatani Masaru
Published: June 2020

Background

To determine the effect of various factors to the preservation rate of the conjunctival layer borderlines of glaucomatous eyes treated with anti-glaucoma eye drops.

Methods

Anterior segment optical coherence tomography (AS-OCT) images of the bulbar conjunctiva of 328 eyes were analyzed with and without anti-glaucoma eye drops to quantify the preservation rates of the conjunctival layer borderlines.

Results

More anti-glaucoma eye drops and a longer duration of administration were associated with lower preservation rates of the borderlines between both the conjunctival stroma/Tenon’s capsule (P < 0.001 and P < 0.001, respectively) and Tenon’s capsule/sclera (P < 0.001 and P < 0.001, respectively). Prostaglandin analogs and fixed combinations of β-blockers/prostaglandin analogs were prognostic factors for lower preservation rates of the borderlines between both the conjunctival stroma/Tenon’s capsule (P < 0.001 and P = 0.009, respectively) and Tenon’s capsule/sclera (P < 0.001 and P = 0.008, respectively).

Conclusions

Numerous anti-glaucoma eye drops and their long-term administration are associated with the disruption of the bulbar conjunctival borderlines detected by AS-OCT.
Validity, reliability and feasibility of a new observation rating tool and a post encounter rating tool for the assessment of clinical reasoning skills of medical students during their internal medicine clerkship: a pilot study
Authors: Haring Catharina M. , Klaarwater Claudia C. R. , Bouwmans Geert A. , Cools Bernadette M. , van Gurp Petra J. M. , van der Meer Jos W. M. , Postma Cornelis T.
Published: June 2020

Background

Systematic assessment of clinical reasoning skills of medical students in clinical practice is very difficult. This is partly caused by the lack of understanding of the fundamental mechanisms underlying the process of clinical reasoning.

Methods

We previously developed an observation tool to assess the clinical reasoning skills of medical students during clinical practice. This observation tool consists of an 11-item observation rating form (ORT). In the present study we verified the validity, reliability and feasibility of this tool and of an already existing post-encounter rating tool (PERT) in clinical practice among medical students during the internal medicine clerkship.

Results

Six raters each assessed the same 15 student-patient encounters. The internal consistency (Cronbach’s alfa) for the (ORT) was 0.87 (0.71–0.84) and the 5-item (PERT) was 0.81 (0.71–0.87). The intraclass-correlation coefficient for single measurements was poor for both the ORT; 0.32 (p < 0.001) as well as the PERT; 0.36 (p < 0.001). The Generalizability study (G-study) and decision study (D-study) showed that 6 raters are required to achieve a G-coefficient of > 0.7 for the ORT and 7 raters for the PERT. The largest sources of variance are the interaction between raters and students. There was a consistent correlation between the ORT and PERT of 0.53 (p = 0.04).

Conclusions

The ORT and PERT are both feasible, valid and reliable instruments to assess students’ clinical reasoning skills in clinical practice.
T2 and T17 cytokines alter the cargo and function of airway epithelium-derived extracellular vesicles
Authors: Ax Elisabeth , Jevnikar Zala , Cvjetkovic Aleksander , Malmhäll Carina , Olsson Henric , Rådinger Madeleine , Lässer Cecilia
Published: June 2020

Background

Asthma is a common and heterogeneous disease that includes subgroups characterized by type 2 (T2) or type 17 (T17) immune responses for which there is a need to identify the underlying mechanisms and biomarkers in order to develop specific therapies. These subgroups can be defined by airway epithelium gene signatures and the airway epithelium has also been implicated to play a significant role in asthma pathology. Extracellular vesicles (EVs) carry functional biomolecules and participate in cell-to-cell communication in both health and disease, properties that are likely to be involved in airway diseases such as asthma. The aim of this study was to identify stimulus-specific proteins and functionality of bronchial epithelium-derived EVs following stimulation with T2 or T17 cytokines.

Methods

EVs from cytokine-stimulated (T2: IL-4 + IL-13 or T17: IL-17A + TNFα) human bronchial epithelial cells cultured at air-liquid interface (HBEC-ALI) were isolated by density cushion centrifugation and size exclusion chromatography and characterized with Western blotting and electron microscopy. Transcriptomic (cells) and proteomic (EVs) profiling was also performed.

Results

Our data shows that EVs are secreted and can be isolated from the apical side of HBEC-ALI and that cytokine stimulation increases EV release. Genes upregulated in cells stimulated with T2 or T17 cytokines were increased also on protein level in the EVs. Proteins found in T17-derived EVs were suggested to be involved in pathways related to neutrophil movement which was supported by assessing neutrophil chemotaxis ex vivo.

Conclusions

Together, the results suggest that epithelial EVs are involved in airway inflammation and that the EV proteome may be used for discovery of disease-specific mechanisms and signatures which may enable a precision medicine approach to the treatment of asthma.
Non-optimal effectiveness of convalescent plasma transfusion and hydroxychloroquine in treating COVID-19: a case report
Authors: Xu Tian-min , Lin Bin , Chen Cong , Liu Long-gen , Xue Yuan
Published: June 2020

Background

Convalescent plasma (CP) transfusion was reported to be effective in treating critically ill patients with COVID-19, and hydroxychloroquine could potently inhibit SARS-CoV-2 in vitro. Herein, we reported a case receiving combination therapy with CP transfusion and hydroxychloroquine for the first time.

Case presentation

Laboratory findings showed high lactic acid level (2.1 mmol/L) and C-reactive protein (CRP, 48.8 mg/L), and low white blood cell count (1.96 × 109/L) in a 65-year-old Chinese man, who was diagnosed with severe COVID-19. CP was intravenously given twice, and hydroxychloroquine was orally administrated for a week (0.2 g, three times a day). The lactic acid and C-reactive protein levels remained high (2.1 mmol/L and 73.23 mg/L, respectively), while the arterial oxyhemoglobin saturation decreased to 86% with a low oxygenation index (OI, 76 mmHg) on day 4 after CP transfusion. His temperature returned to normal and the OI ascended above 300 on day 11. Moreover, the RNA test remained positive in throat swab, and computed tomography revealed severe pulmonary lesions on day 11 after admission.

Conclusion

These findings suggested that the effectiveness of combination therapy with CP and hydroxychloroquine may be non-optimal, and specific therapy needs to be explored.
Audit and feedback to improve laboratory test and transfusion ordering in critical care: a systematic review
Authors: Foster Madison , Presseau Justin , McCleary Nicola , Carroll Kelly , McIntyre Lauralyn , Hutton Brian , Brehaut Jamie
Published: June 2020

Background

Laboratory tests and transfusions are sometimes ordered inappropriately, particularly in the critical care setting, which sees frequent use of both. Audit and Feedback (A&F) is a potentially useful intervention for modifying healthcare provider behaviors, but its application to the complex, team-based environment of critical care is not well understood. We conducted a systematic review of the literature on A&F interventions for improving test or transfusion ordering in the critical care setting.

Methods

Five databases, two registries, and the bibliographies of relevant articles were searched. We included critical care studies that assessed the use of A&F targeting healthcare provider behaviors, alone or in combination with other interventions to improve test and transfusion ordering, as compared to historical practice, no intervention, or another healthcare behaviour change intervention. Studies were included only if they reported laboratory test or transfusion orders, or the appropriateness of orders, as outcomes. There were no restrictions based on study design, date of publication, or follow-up time. Intervention characteristics and absolute differences in outcomes were summarized. The quality of individual studies was assessed using a modified version of the Effective Practice and Organisation of Care Cochrane Review Group’s criteria.

Results

We identified 16 studies, including 13 uncontrolled before-after studies, one randomized controlled trial, one controlled before-after study, and one controlled clinical trial (quasi-experimental). These studies described 17 interventions, mostly (88%) multifaceted interventions with an A&F component. Feedback was most often provided in a written format only (41%), more than once (53%), and most often only provided data aggregated to the group-level (41%). Most studies saw a change in the hypothesized direction, but not all studies provided statistical analyses to formally test improvement. Overall study quality was low, with studies often lacking a concurrent control group.

Conclusions

Our review summarizes characteristics of A&F interventions implemented in the critical care context, points to some mechanisms by which A&F might be made more effective in this setting, and provides an overview of how the appropriateness of orders was reported. Our findings suggest that A&F can be effective in the context of critical care; however, further research is required to characterize approaches that optimize the effectiveness in this setting alongside more rigorous evaluation methods.

Trial registration

PROSPEROCRD42016051941.
Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis
Authors: Fang Likui , Yu Guocan , Huang Jinpeng , Zhao Wuchen , Ye Bo
Published: June 2020

Background

The risk factors of postoperative outcomes after pericardiectomy in tuberculous constrictive pericarditis have still been unclear. This study aimed to investigate the predictors of postoperative complication and prolonged intensive care unit (ICU) stay in the patients with tuberculous constrictive pericarditis undergoing pericardiectomy.

Methods

A total of 88 patients with tuberculous constrictive pericarditis undergoing pericardiectomy were retrospectively enrolled. Logistic regression and Cox regression analysis were performed to identify the predictors of postoperative complication and prolonged ICU stay, respectively.

Results

All patients underwent complete pericardiectomy and 35 (39.8%) had postoperative complication with no mortality within 30 days after surgery and no in-hospital deaths. Postoperative complication prolonged postoperative ICU stay (P < 0.001), duration of chest drainage (P < 0.001) and postoperative hospital stay (P < 0.001). Preoperative NYHA functional class (P = 0.004, OR 4.051, 95%CI 1.558–10.533) and preoperative central venous pressure (CVP) (P = 0.031, OR 1.151, 95%CI 1.013–1.309) were independent risk factors of postoperative complication. Postoperative complication (P < 0.001, HR 4.132, 95%CI 2.217–7.692) was the independent risk factor for prolonged ICU stay.

Conclusion

Complete pericardiectomy was associated with high risk of postoperative complication in tuberculous constrictive pericarditis. Poor preoperative NYHA functional class and high preoperative CVP were shown to predict postoperative complication which was the predictor of prolonged ICU stay.
Selective inhibition of neuronal Cav3.3 T-type calcium channels by TAT-based channel peptide
Authors: Cmarko Leos , Weiss Norbert
Published: June 2020

Low-voltage-activated Cav3 calcium channels (T-type) play an essential role in the functioning of the nervous system where they support oscillatory activities that relie on several channel molecular determinants that shape their unique gating properties. In a previous study, we documented the important role of the carboxy proximal region in the functioning of Cav3.3 channels. Here, we explore the ability of a TAT-based cell penetrating peptide containing this carboxy proximal region (TAT-C3P) to modulate the activity of Cav3 channels. We show that chronic application of TAT-C3P on tsA-201 cells expressing Cav3 channels selectively inhibits Cav3.3 channels without affecting Cav3.1 and Cav3.2 channels. Therefore, the TAT-C3P peptide described in this study represents a new tool to address the specific physiological role of Cav3.3 channels, and to potentially enhance our understanding of Cav3.3 in disease.
Enhanced Integrated Gradients: improving interpretability of deep learning models using splicing codes as a case study
Authors: Jha Anupama , K. Aicher Joseph , R. Gazzara Matthew , Singh Deependra , Barash Yoseph
Published: June 2020

Despite the success and fast adaptation of deep learning models in biomedical domains, their lack of interpretability remains an issue. Here, we introduce Enhanced Integrated Gradients (EIG), a method to identify significant features associated with a specific prediction task. Using RNA splicing prediction as well as digit classification as case studies, we demonstrate that EIG improves upon the original Integrated Gradients method and produces sets of informative features. We then apply EIG to identify A1CF as a key regulator of liver-specific alternative splicing, supporting this finding with subsequent analysis of relevant A1CF functional (RNA-seq) and binding data (PAR-CLIP).
Characterization of exosome-like vesicles derived from Taenia pisiformis cysticercus and their immunoregulatory role on macrophages
Authors: Wang Li-Qun , Liu Ting-Li , Liang Pan-Hong , Zhang Shao-Hua , Li Tao-Shan , Li Yan-Ping , Liu Guang-Xue , Mao Li , Luo Xue-Nong
Published: June 2020

Background

Taenia pisiformis is one of the most common intestinal parasites in canines, and leads to serious economic losses in the rabbit breeding industry. Exosome-like vesicles from parasites play crucial roles in host-parasite interactions by transferring cargo from parasites to host cells and by modulating host immunological response through inducing production of host-derived cytokines. Nevertheless, the mechanism by which exosome-like vesicles from T. pisiformis cysticercus regulate the macrophage immune response remains unknown.

Methods

Using ultracentrifugation, we isolated exosome-like vesicles from excretory/secretory products (ESP) of T. pisiformis cysticercus. The morphology and size of purified vesicles were confirmed by transmission electron microscopy (TEM) and nanoparticle tracking analysis (NTA). The components of proteins and miRNAs within these vesicles were identified by proteomic analysis and high-throughput small RNA sequencing. The biological function of targets of exosomal miRNAs was predicted by Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. Moreover, the expression of Th1- and Th2-type immune response associated cytokines in RAW264.7 macrophages were evaluated by qPCR and ELISA. We found that exosome-like vesicles were typical cup-shaped vesicles with diameters from 30 to 150 nm. A total of 87 proteins were identified by proteomic analysis, including proteins prominently associated with exosome-like vesicles biogenesis and vesicle trafficking. 41 known miRNAs and 18 novel miRNAs were identified in the exosome-like vesicles. Eleven selected miRNAs, including 7 known miRNAs (miR-71-5p, miR-10a-5p, miR-let-7-5p, miR-745-3p, miR-219-5p, miR-124-3p and miR-4989-3p) and 4 novel miRNAs (novel-mir-3, novel-mir-7, novel-mir-8 and novel-mir-11) were validated to exist in metacestiodes and exosome-like vesicles of T. pisiformis cysticercus by qPCR. The functions of most targets of exosomal miRNAs were mainly associated with signal transduction and the immune system. Additionally, T. pisiformis cysticercus-derived vesicles induced the production of IL-4, IL-6, IL-10, IL-13 and Arg-1, but downregulated the expression of IL-12, IFN-γ and iNOS in RAW264.7 macrophages.

Conclusions

We demonstrated that proteins and miRNAs enclosed within exosome-like vesicles from T. pisiformis cysticercus have immunomodulatory functions. Furthermore, exosome-like vesicles were shown to induce the macrophage Th2-type immune response in vitro. Our study suggests that exosome-like vesicles play an important role in the interaction between cysticerci and their hosts.
Diverse proteins aggregate in mild cognitive impairment and Alzheimer’s disease brain
Authors: Kepchia Devin , Huang Ling , Dargusch Richard , Rissman Robert A. , Shokhirev Maxim N. , Fischer Wolfgang , Schubert David
Published: June 2020

Background

All cells accumulate insoluble protein aggregates throughout their lifespan. While many studies have characterized the canonical disease-associated protein aggregates, such as those associated with amyloid plaques, additional, undefined proteins aggregate in the brain and may be directly associated with disease and lifespan.

Methods

A proteomics approach was used to identify a large subset of insoluble proteins in the mild cognitively impaired (MCI) and Alzheimer’s disease (AD) human brain. Cortical samples from control, MCI, and AD patients were separated into detergent-soluble and detergent-insoluble fractions, and high-resolution LC/MS/MS technology was used to determine which proteins became more insoluble in the disease state. Bioinformatics analyses were used to determine if the alteration of protein aggregation between AD and control patients was associated with any specific biological process. Western blots were used to validate the proteomics data and to assess the levels of secondary protein modifications in MCI and AD.

Results

There was a stage-dependent increase in detergent-insoluble proteins, with more extreme changes occurring in the AD cohort. Glycolysis was the most significantly overrepresented gene ontology biological process associated with the alteration of protein aggregation between AD and control patients. It was further shown that many low molecular weight proteins that were enriched in the AD brain were also highly aggregated, migrating on SDS-PAGE far above their predicted molecular masses. Glucose-6-phosphate isomerase, ubiquitin carboxyl-terminal hydrolase isoenzyme L1 (UCHL1/PARK5), and the DNA damage repair enzyme KU70 were among the top insoluble proteins identified by proteomics and validated by Western blot to be increased in the insoluble fractions of both MCI and AD brain samples.

Conclusions

Diverse proteins became more detergent-insoluble in the brains of both MCI and AD patients compared to age-matched controls, suggesting that multiple proteins aggregate in these diseases, likely posing a direct toxic insult to neurons. Furthermore, detergent-insoluble proteins included those with important biological activities for critical cellular processes such as energetics, proteolysis, and DNA damage repair. Thus, reduced protein solubility likely promotes aggregation and limits functionality, reducing the efficiency of multiple aspects of cell physiology. Pharmaceutical interventions that increase autophagy may provide a useful therapeutic treatment to combat protein aggregation.
Evaluating the association between feed efficiency and the fecal microbiota of early-life Duroc pigs using 16S rRNA sequencing
Authors: Si Jinglei , Feng Lingli , Gao Jiuyu , Huang Ye , Zhang Guangjie , Mo Jiayuan , Zhu Siran , Qi Wenjing , Liang Jing , Lan Ganqiu
Published: June 2020

Improving the predication efficiency of porcine production performance at early stage will contribute to reducing the breeding and production costs. The intestinal microbiota had received plenty of attention in recent years due to their influence on host health and performance. The purpose of this study was to investigate the relationship between the fecal microbiota at early growth period and porcine feed efficiency (FE) under a commercial feeding environment. Ninety-one pigs were reordered according to the residual feed intake (RFI) values between day 90 on test and day 160 off test, 9 lowest RFI pigs and 9 highest RFI pigs were selected as the LRFI group and the HRFI group, respectively. Fecal samples from pigs in the early grower phase (day 80) were performed for microbial diversity, composition, and predicted functionality by using 16S rRNA sequencing. The results showed that no significant differences in microbial alpha diversity were observed between two RFI groups, whereas, some RFI-associated compositional differences were revealed. In particular, the microbiota of the LRFI group (more feed-efficient) had significantly higher levels of some members of Clostridiales and Bacteroidales (e.g., g_1_68 and g_norank_f_p_2534_18B5), which may promoted FE through protecting gut barrier function, compared with those of the HRFI pigs. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways analysis found that the LRFI pigs were likely have microbiota with higher levels of amino acid metabolism. Moreover, redundancy analysis (RDA) showed that litter size, parity, and date of birth had significant effects on the bacterial community structure. These results improved our knowledge of the porcine early-life fecal microbiota and its potential link underlying RFI, which would be useful for future development of microbial biomarkers for predicting and improving porcine FE as well as investigation of targets for dietary strategies.
Predictive precoding based on the Grassmannian manifold for UAV-enabled cache-assisted B5G communication systems
Authors: Zhou Wen , Li Xutao , Wu Haiqing , Xu Yihan , Zhou Qingfeng , Rao Yanyi
Published: June 2020

The unmanned aerial vehicle (UAV) can extend the network coverage and improve the system throughput for 5th generation (5G) communication systems; hence, it receives a lot of attention recently. This paper considers the problem of channel predictive precoding for UAV-enabled cache-assisted B5G multi-input multi-output (MIMO) systems. A novel channel precoder predictor is proposed, in which the prediction is conducted on a non-linear vector space—Grassmannian manifold. The predictor at the receiver utilizes the current and previous channel matrices to solve the precoder at the next time and then feeds it back to the transmitter for precoding. More specifically, two sub-matrices are extracted from the channel right singular matrices and modeled as two points on the Grassmannian manifold. Then, the geodesic between the two points is conducted. Unlike the conventional method in which the tangent vector at the previous point is parallel transported along the geodesic, we predict the next point by use of the geodesic equation directly. We analyze the computational complexity of the proposed method and demonstrate the superiority of the proposed method by comparing with the conventional one. Besides, we adopt a general Ricean channel model in the UAV MIMO system, where both the Kronecker model and Jake’s model are incorporated. The effects of various channel model parameters on the system performance in terms of the chordal error of channel predictor and the optimum step are thoroughly investigated.
ANN-assisted robust GPS/INS information fusion to bridge GPS outage
Authors: Aslinezhad Mehdi , Malekijavan Alireza , Abbasi Pouya
Published: June 2020

Inertial navigation is an edge computing-based method for determining the position and orientation of a moving vehicle that operates according to Newton’s laws of motion on which all the computations are performed at the edge level without need to other far resources. One of the most crucial struggles in Global Positioning System (GPS) and Inertial Navigation System (INS) fusion algorithms is that the accuracy of the algorithm is reduced during GPS interruptions. In this paper, a low-cost method for GPS/INS fusion and error compensation of the GPS/INS fusion algorithm during GPS interruption is proposed. To further enhance the reliability and performance of the GPS/INS fusion algorithm, a Robust Kalman Filter (RKF) is used to compensate the influence of gross error from INS observations. When GPS data is interrupted, Kalman filter observations will not be updated, and the accuracy of the position will continuously decrease over time. To bridge GPS data interruption, an artificial neural network-based fusion method is proposed to provide missing position information. A well-trained neural network is used to predict and compensate the interrupted position signal error. Finally, to evaluate the effectiveness of the proposed method, an outdoor test using a custom-designed hardware, GPS, and INS sensors is employed. The results indicate that the accuracy of the positioning has improved by 67% in each axis during an interruption. The proposed algorithm can enhance the accuracy of the GPS/INS integrated system in the required navigation performance.
On a hybrid inclusion problem via hybrid boundary value conditions
Authors: Etemad S. , Pourrazi S. , Rezapour Sh.
Published: June 2020

In this manuscript, the existence of solutions for a novel category of the fractional differential equation of hybrid type with hybrid boundary value conditions is studied. Also, we review the existence result for its related hybrid inclusion problem with hybrid conditions. In the end of the paper, two illustrative examples are given to demonstrate the consistency to our key results.