bluuebunny/crossref_metadata_2025 huggingface dataset:
Tele-transitions of Care (TTOC). A 12-month, Randomized Controlled Trial evaluating the use of Telehealth to achieve Triple Aim Objectives
Authors: Noel Kimberly , Messina Catherine , Hou Wei , Schoenfeld Elinor , Kelly Gerald
Published: January 2020

Background : Poor transitions of care leads to increased health costs, over-utilization of emergency room departments, increased re-hospitalizations and causes poor patient experiences and outcomes. This study evaluated Telehealth feasibility in improving transitions of care.
Methods : This is a 12-month randomized controlled trial, evaluating the use of telehealth (remote patient monitoring and video visits) versus standard transitions of care with the primary outcomes of hospital readmission and emergency department utilization and secondary outcomes of access to care, medication management and adherence and patient engagement. Electronic Medical Record data, Health Information Exchange data and phone survey data was collected. Multi-variable logistic regression models were created to evaluate the effect of Telehealth on hospital readmission, emergency department utilization, medication adherence. Chi-square tests or Fisher’s exact tests were used to compare the percentages of categorical variables between the Telehealth and control groups. T tests or Wilcoxon rank sum tests were used to compared means and medians between the two randomized groups.
Results : The study conducted between June 2017 and 2018, included 102 patients. Compared with the standard of care, Telehealth patients were more likely to have medicine reconciliation (p = 0.013) and were 7 times more likely to adhere to medication than the control group (p = 0.03). Telehealth patients exhibited enthusiasm (p = 0.0001), and confidence that Telehealth could improve their healthcare (p= 0.0001). Telehealth showed no statistical significance on emergency department utilization (p = 0.691) nor for readmissions (p = 0.31). 100% of Telehealth patients found the intervention to be valuable, 98% if given the opportunity, reported they would continue using telehealth to manage their healthcare needs, and 94% reported that the remote patient monitoring technology was useful.
Conclusions: Telehealth can improve transitions of care after hospital discharge improving patient engagement and adherence to medications. Although this study was unable to show the effect of Telehealth on reduced healthcare utilization, more research needs to be done in order to understand the true impact of Telehealth on preventing avoidable hospital readmission and emergency department visits.
Tooth Extraction as a Risk Factor for Maxillary Sinus Pneumatization: A Case-control Study
Authors: Ocak Hakan , Çolpak Halis Ali , Demetoğlu Umut , Soydan Damla , Kılıç Erdem , Canger Murat E , Alkan Alper
Published: January 2020

Purpose Maxillary sinus pneumatization following teeth extraction may require various treatment plans such as sinus lifting and alveolar grafting procedures to obtain sufficient alveolar bone height for implant surgery. The aim of this study was to identify sinus pneumatization and to help in determining the proper time for preprosthetic surgery following extraction of maxillary sinus related teeth. Methods We evaluated 75 teeth extraction related to maxillary sinus floor. The panoramic radiographs were evaluated before and after extraction of the posterior maxillary teeth. The radiographs were divided into 5 groups according to duration after extraction. Two reference points (the first point corresponds to the nasal spine while the second point corresponds to the most inferior point of the floor of the maxillary sinus wall) were determined on digital panoramic radiographs before and after teeth extraction and the distance between both aforementioned points was measured. Results The amount of pneumatization was found to be increased with time. The pneumatization within the first 6 months was limited. However, a sudden increase of pneumatization after 6th month, especially the highest between 18th and 24th months, was observed. The mean pneumatization amount was found to be highest in the 1st molar group. Conclusion According to the results of the present study, surgeons should not be waited any more than 6 months after tooth extraction for preprosthetic surgery in the posterior maxillary region as long as physiological healing of extraction socket is allowed.
Genomic-based identification of environmental and clinical Listeria monocytogenes strains associated with an abortion outbreak in beef heifers
Authors: Whitman Katherine , Bono James L. , Clawson Michael L. , Loy John D. , Bosilevac Joseph M. , Arthur Terrance M. , Ondrak Jeff D.
Published: January 2020

Background In a beef cattle facility an outbreak of abortions occurred over a 36-day period and included two aborted fetuses and 21 post-abortion clinical cases sampled. There are numerous etiologies, including clinical listeriosis. At the species level, Listeria monocytogenes is ubiquitous in cattle production environments, including soil, feed, and occasionally water sources, and is a common enteric resident of cattle and other mammals. There are four genetically distinct lineages of L. monocytogenes (I-IV), with most lineage III and IV isolates obtained from ruminants. Definitive diagnosis of L. monocytogenes as a causative agent in disease outbreaks relies upon case identification, appropriate sample collection, and laboratory confirmation. Furthermore, clearly establishing a relationship between a pathogen source and clinical disease is difficult.Results Of the two fetal and 21 clinical case submissions, 19 were positive for L. monocytogenes. Subsequent culture for L. monocytogenes from water and silage sources identified both as potential origins of infection. Using whole-genome sequencing and phylogenetic analyses, clinical, water and silage L. monocytogenes strains grouped into two of four lineages. All water and silage strains, plus 11 clinical strains placed in lineage III, with identical or nearly identical genomic sequences. The remaining eight clinical strains placed in lineage I, with seven having nearly identical sequences and one distinctly different.Conclusion Three genetically distinct strains within two lineages of L. monocytogenes caused the abortion outbreak. The etiology of abortion in 11 cases was directly linked to water and silage contamination from a lineage III L. monocytogenes strain. The source of infection for the remaining abortion cases with two different strains from lineage I is unknown. This is the first report of L. monocytogenes genomics being used as part of an outbreak investigation of cattle abortion.
Barriers of effective health insurance coverage for rural-to-urban migrant workers in China: A systematic review and policy gap analysis
Authors: Author) Shanquan Chen(Former Corresponding , Chen Yingyao , Feng Zhanchun , Chen Xi , Wang Zheng , Zhu Jianfeng , Jin Jun , Yao Qiang , Xiang Li , Yao Lan , Sun Ju , Zhao Lu , Fung Hong , Wong Eliza Lai-yi , Author) dong dong(New Corresponding
Published: January 2020

Background: More than 90% of the Chinese population was covered by its three basic social health insurances.However, the Chinese rural-to-urban migrant workers (RUMWs), accounting for about one-fifth of China’s total population, seem to be put on a disadvantaged position under the current health insurance schemes. The purpose of this study is to identify the current barriers and to provide policy suggestions to the ineffective health insurance coverage of RUMWs in China.
Methods: A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The searched databases included PubMed, Embase, Medline, Web of Science, PsycINFO, Maternity and Infant Care Database MIDIRS, the Cochrane Library, WHO Library Database (WHOLIS), WHO Global Health Library, World Bank eLibrary, OpenGrey, CNKI, and Wanfang. In total, 70 articles were reviewed.
Results: (1) Chinese RUMWs have high work mobility and low job stability; (2) Barriers faced by RUMWs in obtaining effective health insurance coverage are primarily due to the reluctance of employers to provide insurance for all employees and the disadvantaged position held by RUMWs when negotiating with their employers; (3) Fissures among existing health insurance schemes leaves no room for RUMWs to meet their primary needs; and (4) Recent efforts in improving the portability and transferability of insurance across borders and schemes are not enough to solve the barriers.
Conclusion: It is argued that the Chinese central government must deal with the fragmentation of healthcare system in China and promote effective coverage by: (1) playing a more active role in coordinating different healthcare and social welfare schemes across the country, (2) increasing the health insurance portability, (3) making the healthcare policies more compatible with RUMW’s characteristics to meet their primary health needs, (4) strengthening supervision of employers, and (5) providing more vocational training and other support to increase RUMW’s job stability.
The efficacy of superior oblique posterior tenotomy in the treatment of A-pattern strabismus without ocular intorsion: A retrospective study
Authors: Wei Yan , Dong Ling-Yan , Zhao Pei-quan , Kang Xiao-li
Published: January 2020

Background: Superior oblique weakening is a common method to treat A-pattern strabismus. This study aims to evaluate the surgical results of the bilateral superior oblique posterior tenectomy procedure to treat A-pattern strabismus patients who had bilateral superior oblique overaction without objective ocular intorsion.
Methods: The records of 18 consecutive patients who underwent surgery of superior oblique posterior tenectomy close to its insertion with superior oblique overaction (SOOA)-associated A-pattern strabismus between September 1, 2015 and August 31, 2018 were retrospectively reviewed. Ocular alignment, objective torsion, A-pattern and ocular motility were assessed. Ocular alignment was measured in the primary position, 25° upgaze, and 25° downgaze using the prism bar cover test, and torsion was measured using fundus photographs.
Results: A total of 18 patients (mean age: 15 years; 6 female, 12 male) underwent bilateral superior oblique posterior tenectomy and simultaneous horizontal rectus muscle surgery were included. The mean preoperative A-pattern deviation was 15 PD and the mean postoperative A-pattern deviation was 2.25 PD with a mean reduction of 12.75 PD. The mean preoperative superior oblique overaction was 2.28 and the mean postoperative superior oblique overaction was 0.43 with a mean reduction of 1.85. There was no significant correlation between the ocular torsional, vertical alignment change and the superior oblique posterior tenectomy procedure.
Conclusions: Superior oblique posterior tenectomy surgery selectively improved the A-pattern and superior oblique overaction but not affect the primary position vertical deviation, as well as the ocular torsion. It is an effective procedure to treat the mild to moderate superior oblique overaction associated A pattern strabismus without ocular intorsion.
Using the anterior capsule of the hip joint to protect the tensor fascia lata muscle during direct anterior total hip arthroplasty: a randomized prospective trial
Authors: Zhao Gongyin , Zhu Ruixia , Jiang Shijie , Xu Nanwei , Bao Hongwei , Wang Yuji
Published: January 2020

Background The direct anterior approach for total hip arthroplasty (THA) has specific advantages, but injury to the tensor fasciae lata muscle (TFLM) remains a concern. This injury in part negates some of the advantages of the intermuscular approach, because injury of the muscle fibers of the TFLM can lead to less satisfactory clinical results. Thus, in this study, we propose an intraoperative method to protect the TFLM and demonstrate its feasibility.Methods Fifty-six patients undergoing THA by the direct anterior approach were divided randomly into two groups. In group A, the TFLM was protected by an autogenous tissue “pad” created from the anterior capsule of the joint that was rotated to protect the TFLM from direct contact with the retractors needed to expose the joint space. In group B, the operation was carried out in the typical fashion with no other protection of the TFLM except the attempt by the surgeons to consciously avoid compressive injury of the TFLM. We evaluated the magnitude of changes in the muscle cross-sectional area (MSCA) and fatty atrophy (FA) early and postoperatively between groups by magnetic resonance imaging. The differences in blood hemoglobin and serum levels of myoglobin, lactate dehydrogenase (LDH), and creatine phosphokinase (CPK) were compared at 8, 24, and 48 h, postoperatively. Postoperative drainage volume and pain evaluated by visual analogue scores (VAS) were compared between the two groups.Results LDH, CPK and myoglobin in group B were significantly higher than those in group A at 8, 24, and 48 hours after the surgery. (p<0.05) Compared to the group A, the decrease of hemoglobin in group B displayed significantly at 24 and 48 hours after surgery. (P<0.05) The significantly increased MSCA and FA of TFLM were demonstrated in group B. The PDV and VAS in group B were significantly higher compared with those in group A. (P<0.05)Conclusions Using the anterior capsule of the hip joint as an autogenous, protective capsular tissue pad to limit the trauma to the TFLM during a direct anterior approach to THA is an effective method to protect the TFLM and improve the clinical effect.
Genome-wide screen reveals novel mechanisms for sodium dodecyl sulfate toxicity in Saccharomyces cerevisiae
Authors: Cao Chunlei , Cao Zhengfeng , Yu Peibin , Zhao Yunying
Published: January 2020

Background: Sodium dodecyl sulfate (SDS) is one of the most widely used anionic alkyl sulfate surfactants. Toxicological information on SDS is accumulating, however, mechanisms of SDS toxicity regulation remain poorly understood. In this study, the relationship between the SDS-sensitive mutants and their intracellular ROS levels has been investigated. Results: Through a genome-scale screen, we have identified 108 yeast single-gene deletion mutants that are sensitive to 0.03% SDS. These genes were predominantly related to the cellular processes of metabolism, cell cycle and DNA processing, cellular transport, transport facilities and transport routes, transcription and the protein with binding function or cofactor requirement (structural or catalytic). Measurement of the intracellular ROS (reactive oxygen species) levels of these SDS-sensitive mutants showed that about 79% of SDS-sensitive mutants accumulated significantly higher intracellular ROS levels than the wild-type cells under SDS stress. Moreover, SDS could generate oxidative damage and up-regulate several antioxidant defenses genes, and some of the SDS-sensitive genes were involved in this process. Conclusion: This study provides insight on yeast genes involved in SDS tolerance and the elevated intracellular ROS caused by SDS stress. Our findings provide a basis to understand molecular mechanisms underlying the detoxification of SDS by yeast cells.
Economic costs incurred by the patients with Multiple Sclerosis at different levels of the disease: a cross-sectional study in northwest Iran
Authors: Imani Ali , Gharibi Farid , Khezri Ali , Joudyian Nasrin , Dalal Koustuv
Published: January 2020

Background Multiple sclerosis (MS) causes significant economic burden to the patients, families, health systems and society. This study aimed to estimate the economic costs incurred by patients with multiple sclerosis at different levels of the disease.Method This was a cross-sectional study, using the Expanded Disability Status Scale (EDSS) tool for assessing the disease level of 300 (=N) patients in East Azerbaijan province, Iran. To estimate the cost of MS, a questionnaire with its validity and reliability (CVR 92% and CVI 87%) and pilot test (Cronbach's alpha score 0.89) was used. The data were collected by interviewing patients and reviewing their clinical records. Linear regression and ANOVA were used to assess the relationship between disease levels and incurred costs.Results The results revealed that the mean annual cost for patients is 97,521,740 IRR (equivalent to 2,321.94 USD) and the mean score of EDSS in patients was 3.14. The annual cost incurred by patients with mild, moderate and severe levels of disease were 83,918,150 IRR (998.05 USD), 137,772,660 IRR (3,280.30 USD) and 119,962,670 IRR (2,856.25 USD) respectively. Also, there was a significant relationship between total cost and disease severity in such a way that any increase in EDSS degree is led to 8,139,260 IRR (193.79 USD) added cost for patients.Conclusion The study results could be helpful for Iranian health managers to solve problems which are facing patients and their families.
Meta-analysis of the diagnostic performance of circulating microRNAs for pancreatic cancer
Authors: Peng Cheng , Li Zhiqiang , Huang Lihua , Gao Wenzhe , Wang Jiale , Liu Yunfei , Li Xia , Yu Xiao
Published: January 2020

Background:
Pancreatic cancer (PC) is characterized by high malignancy and poor prognosis. Detection of circulating microRNAs (miRNAs) is one of the liquid biopsy approaches. Numerous researches have suggested that some differentially expressed miRNAs may be promising diagnostic markers for PC, but the results varied among studies. The present study aimed to summarize the diagnostic accuracy of circulating miRNAs, carbohydrate antigen 19-9 (CA19-9), and the combination of miRNAs and CA19-9.
Methods:
A literature search of online databases including Pubmed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI) and WanFang was conducted. Relative data were extracted from eligible included studies and a meta-analysis was performed.
Results:
A total of 46 studies involving 4,326 PC patients and 4,277 non-PC controls were included. The pooled sensitivity (SEN), specificity (SPE) and AUC of circulating miRNAs in differentiating PC from non-PC controls were 0.79 (0.77-0.81), 0.77 (0.75-0.79), and 0.85 (0.81-0.87), respectively. For CA19-9, the SEN, SPE and AUC were 0.78 (0.75-0.80), 0.90 (0.85-0.94) and 0.85 (0.82-0.88), respectively. The combination of miRNAs and CA19-9 greatly improved the SEN, SPE and AUC to 0.84 (0.80-0.87), 0.91 (0.89-0.93) and 0.94 (0.92-0.96), respectively. Circulating miRNAs also yielded an acceptable diagnostic accuracy for early-stage PC with SEN of 0.79 (0.76-0.82), SPE of 0.74 (0.68-0.79) and AUC of 0.81 (0.77-0.84).
Conclusions:
Circulating miRNAs exhibited a satisfactory diagnostic performance for PC, even early-stage PC. The combination of circulating miRNAs and the traditional marker CA19-9 can further improve the diagnostic accuracy, providing a novel strategy for PC diagnosis.
1,4NQ-BC enhances the lung inflammation by mediating the secretion of IL-33 which derived from macrophages
Authors: Wei Xuetao , Xiao Qianqian , Song Yiming , Chu Hongqian , Tang Mengmeng , Wang Siqi , Jiang Jianjun , Meng Qinghe , Hao Weidong
Published: January 2020

Background Black carbon (BC) is a product of incomplete combustion of fossil fuels and vegetation. The compelling evidence has demonstrated that it has a close relationship with several respiratory and cardiovascular diseases. BC provides the reactive sites and surfaces to absorb various chemicals, such as polycyclic aromatic hydrocarbons (PAH). Naphthoquinone is a typical PAHs which was found in particulate matter (PM) and 1,4NQ-BC owned high oxidative potential and cytotoxicity. IL-33 is an alarmin which increases innate immunity through Th2 responses. It was reported that IL-33 was a potent inducer of pro-inflammatory cytokines, like IL-6. In our previous study, it was revealed that 1,4NQ-BC instilled intratracheally to mice could trigger zthe lung inflammation and stimulate the secretion of IL-33 in lung tissue.Results We found that IL-33 could induce inflammation in lung itself. When the macrophages were eliminated, the secretion of IL-33 was reduced and the pathological damage in the lung was relieved after exposure to 1,4NQ-BC. Both MAPK and PI3k/Akt signal pathways were involved in the process of IL-33 secretion and the lung inflammation induced by 1,4NQ-BC.Conclusions The findings herein support the notion that after exposure to 1,4NQ-BC, the increased secretion of IL-33 was mainly derived from macrophage through both MAPK and PI3k/Akt signal pathways.
Investigating Current Directions in Cross-Industry Innovation Research – a Systematic Literature Review
Authors: Mahnken Torben Andreas
Published: January 2020

Background: The companies’ operative environment is covered by a constant change through digitization, industry 4.0, artificial intelligence and megatrends, which pose enormous challenges. In order to master these challenges, the development of knowledge from foreign industries is a possible solution. This phenomenon is called cross-industry innovation. The aim of this study is to identify major directions in cross-industry innovation research. An essential part of science is to build on and enhance already published knowledge. In order to identify this knowledge and to offer a comprehensible and reproducible process, a systematic approach is required. For this study, a systematic literature review will be applied. During the review of the relevant literature, an understanding of the broad and deep nature of the literature emerges and it is possible to identify research gaps, which is often based on qualitative analyses. We will develop a new approach for analyzing literature based on semantic similarity analysis. Methods: In order to achieve the research objectives a systematic literature review is applied and slightly modified. First, we will apply a systematic literature review protocol to establish reproducible results. Second, we develop a new approach for analyzing literature using a combination of semantic similarity analysis and a cluster analysis. Conclusion: This review will aid in determining the directions of cross-industry innovation. Overall, six directions of cross-industry innovation research can be identified. Furthermore, this study offers a new approach for analyzing literature based on quantitative analysis like semantic similarity analysis.
Low-temperature plasma radiofrequency ablation of Sphenopalatine ganglion in Cluster headache: a case report
Authors: Wang Xiaoping , Yang Liqiang , Guo Yuna , Ni Jiaxiang , Tang Yuanzhang
Published: January 2020

Background： Herpes zoster is a common disease mainly affect sensory nerves, but in this report sphenopalatine ganglion (SPG), mainly a parasympathetic ganglion was infected by the vesicular-zoster virus, with the performance of cluster headache. Case presentation: The patient underwent headache on left side orbit, supraorbital and temporal regions after infection of herpes zoster for 8 months, with lacrimation, conjunctival injection and nasal discharge. Pulsed radiofrequency of the SPG under ultrasound guidance was performed, we applied 2 cycles of PRF at 42℃for 120 seconds each time. Partial response lasted 1 month and the pain had recover to its baseline level. Low-temperature plasma radiofrequency ablation (coblation) technology is a relatively new technology that has shown promise in treating neuropathic pain. Then a CT-guided coblation of SPG was performed, used three of intensity for coblation (lasting for 30s, repeat twice) and six of intensity for coagulation (lasting for 30s, once). After coblation, the patient reported completed pain relief and autonomic symptoms disappeared without any side effects. The patient was satisfied with the effect on post-operative telephone follow-up performed on day 7, month 1 and month 3, pain VAS score remained on 0/10. Conclusions: Our report demonstrates that coblation technology is succeseful treatment for cluster headache in this case, but this finding still needs additional studies for confirmation. Key words: cluster headache, coblation, herpes zoster
The Bipedicle Advancement Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Study of 18 Cases.
Authors: Ma Yanming , Meng Xiangjun , Su Yun , Yan Zuofa , Shao Quansheng , Chen Yiqing
Published: January 2020

Background Many patients have skin defects after digital mucous cyst (DMC) excision, and this study aimed to assess the clinical outcomes of using a bipedicle advancement flap to cover such defects.Methods From January 2016 to January 2018, DMCs on 18 fingers of 15 patients (4 males and 11 females, with a mean age of 64 years) were treated with cyst and osteophyte excision and a bipedicle advancement flap to cover the resultant defect in this retrospective study. Postoperative flap survival, healing and infection were evaluated. The pre- and postoperative ranges of motion (ROMs) of the distal interphalangeal (DIP) or thumb interphalangeal (IP) joints were recorded. The patients were followed up for 12-36 months (mean, 20 months).Results All the flaps survived, the incisions healed well without infection, and no cyst recurrence occurred. The postoperative ROM of the affected fingers was restored to the preoperative ROM by two months after surgery. No difference was found between the preoperative and postoperative ROMs.Conclusions The bipedicle advancement flap is a simple and effective technique for covering skin defects following DMC excision.
Effects of arthroscopic capsular and inferior glenohumeral ligament release on function and stability for patients with frozen shoulder
Authors: Zhang Yao , Cao Shichao , Liu Mingsheng , Fei Wenyong , Wang Jingcheng
Published: January 2020

Background The inferior glenohumeral ligament (IGHL) plays an important role in maintaining shoulder joint stability. However, no systematic studies on shoulder stability and function of patients with FS after IGHL release exist. This study assessed the functional and clinical outcomes of IGHL release for FS.Methods Forty-seven patients underwent arthroscopic capsule and IGHL release with the same postoperative rehabilitation procedure. Five functional parameters were measured postoperatively at 4, 8, 12 and 28 weeks: the apprehension test result, American Shoulder and Elbow Surgeons Score (ASES), Constant score, visual analog scale (VAS) score and active range of motion (ROM).Results All patients improved in the aforementioned evaluations. At 28 weeks, the ASES, Constant score and VAS score improved from 31.30±6.41 to 92.43±3.89, 30.15±6.85 to 90.71±4.27 and 6.73±0.72 to 0.60±0.74, respectively (p<0.05). Forward flexion (FF) and abduction (ABD) improved from 73.85±14.94 to 166.70±7.23 and from 69.65±12.74 to 165.03±6.36, respectively (p<0.05). External rotation (ER) and internal rotation (IR) also significantly improved. In total, 95% of the patients were able to perform full elevation, and 97.5% of the patients could place the dorsum of their hands between their shoulder blades. All patients had negative apprehension tests, and no dislocations occurred. No other serious postoperative complications were observed.Conclusions Arthroscopic capsule and IGHL release was effective and could improve the active ROM and relieve pain in patients with FS. This surgical procedure did not cause instability or dislocations in the shoulder joint.
Lesion distribution characteristics of deep infiltrating endometriosis with ovarian endometrioma: An observational clinical study
Authors: Kwok Hungling , Jiang Hongye , Li Tian , Yang Huan , Fei Hui , Cheng Li , Yao Shuzhong , Chen Shu-Qin
Published: January 2020

Purpose: To investigate the characteristics of deep infiltrating endometriosis (DIE) lesion distribution when associated with ovarian endometrioma (OEM). Methods:The present study analyzed retrospective data obtained by the First Affiliated Hospital of Sun Yat-sen University, between June 2008 to June 2016. A total of 304 patients underwent laparoscopic surgery for complete removal of endometriosis by one experienced surgeon, and histological confirmation of OEM associated with DIE was conducted for each patient. Clinical data were recorded for each patient from medical, operative and pathological reports. Patients were then divided into two groups according to unilateral or bilateral OEM. Patients with unilateral OEM were subsequently divided into two subgroups according to OEM location (left- or right-hand side) and the diameter of the OEM (≤50 and >50 mm). The distribution characteristics of DIE lesions were then compared between the groups. Results:DIE lesions were widely distributed, 30 anatomical sites were involved. Patients with associated unilateral OEM (n=184 patients) had a significantly increased number of DIE lesions when compared with patients with bilateral OEM (n=120 patients; 2.76±1.52 vs. 2.33±1.34; P=0.006). Compared with bilateral OEM with DIE, there was a higher rate of intestinal (39.1% vs. 18.3%; P<0.01) and vaginal (17.4% vs. 6.7%; P<0.01) infiltration by DIE lesions in unilateral OEM with DIE. The mean number of DIE lesions was not significantly correlated with the location or size of the OEM (2.83±1.56 vs. 2.74±1.53; P=0.678; and 2.65±1.42 vs. 2.80±1.43; P=0.518, respectively). There was no significant difference between the groups with OEM ≤50 mm and >50 mm. Conclusion:Lesion distribution characteristics in women diagnosed with histologically proven OEM associated with DIE were frequently multifocal and severe.
Diagnostic and prognostic value of plasma adrenomedullin compared to other biomarkers using Sepsis-3 definitions for sepsis and septic shock
Authors: Yonaha Tetsu , Maruta Toyoaki , Otao Go , Igarashi Koji , Nagata Sayaka , Yano Takeshi , Taniguchi Masahiko , Kitamura Kazuo , Tsuneyoshi Isao
Published: January 2020

Background Sepsis-3, the recent sepsis definitions, was modified based on a scoring system focused on organ failure; however, it would remain a time-consuming process to detect septic patients using these definitions. Adrenomedullin (AM) is a biomarker for diagnosing sepsis and septic shock, monitoring treatment efficacy, and prognosis. We conducted a study to assess the accuracy of AM for diagnosing and prognosing sepsis and septic shock based on the Sepsis-3 definitions.Methods This is a prospective observational single-center study. Patients admitted to the intensive care unit (ICU) were retrospectively categorized as non-sepsis, sepsis, or septic shock by Sepsis-3 definitions. Total AM (tAM) and mature AM (mAM) were measured upon ICU admission. Receiver operating characteristics (ROC) analyses were performed by calculating the area under the curve (AUC) for diagnosis and prognosis of sepsis and septic shock.ResultsA total of 98 patients were enrolled in the final analysis. Among these, 42, 22, and 34 patients were assigned to non-sepsis, sepsis, and septic shock, respectively. tAM and mAM levels significantly increased according to the severity of sepsis. The AUCs of tAM/mAM for diagnosing sepsis and septic shock were 0.879/0.848 and 0.858/0.830, respectively, whereas those of procalcitonin (PCT)/presepsin (PSEP) were 0.822/0.682 and 0.811/0.661, respectively. The AUCs of tAM/mAM on Day 1 and 3 for predicting 28-day mortality of septic patients were 0.669/0.5741 and 0.931/0.892, respectively, whereas those of sequential organ failure assessment (SOFA) score/lactate were 0.669/0.824 and 0.922/0.794, respectively.Conclusions Both tAM and mAM are reliable, early biomarkers to diagnose sepsis and septic shock according to the Sepsis-3 definitions, and are comparable to PCT. Furthermore, AM level on Day 3 is a reliable biomarker to predict 28-day mortality due to sepsis, which is comparable to that of the SOFA score and lactate level.
Age-related differences in the impact of coagulopathy in patients with isolated traumatic brain injury: an observational cohort study
Authors: Takayama Wataru , Endo Akira , Koguchi Hazuki , Murata Kiyoshi , Otomo Yasuhiro
Published: January 2020

Background Although age and trauma-induced coagulopathy (TIC) are well-known predictors of poor outcome after traumatic brain injury (TBI), the interaction effect of these two predictors remains unclear.Objectives We assessed age-related differences in the impact of TIC on the outcome following isolated TBI.Methods We conducted a retrospective observational study in two tertiary emergency critical care medical centers in Japan from 2013 to 2018. A total of 1036 patients with isolated TBI [head abbreviated injury scale (AIS) ≥3, and other AIS <3] were selected, and divided into the non-elderly (n = 501, 16-64 years) and elderly group (n = 535, age ≥65 years). We further evaluated the impact of coagulopathy (international normalized ratio ≥1.2, and/or platelet count <120 × 10 9 /L, and/or fibrinogen ≤150 mg/dL) on TBI outcomes [Glasgow Outcome Scale-Extended (GOS-E) scores, in-hospital mortality, and ventilation-free days (VFD)] in both groups using univariate and multivariate models. Further, we conducted an age-based assessment of the impact of coagulopathy on GOS-E using a generalized additive model.Results The multivariate model showed a significant association of age and coagulopathy with lower GOS-E scores, in-hospital mortality, and shorter VFD in the non-elderly group; however, significant impact of coagulopathy was not observed for all the outcomes in the elderly group. There was a decrease in the correlation degree between coagulopathy and GOS-E scores decreased with age over 65 years old.Conclusions There was a low impact of coagulopathy on functional and survival outcomes in geriatric patients with isolated TBI.
Enhanced Awareness Indicated by Detection Ratio of Dementia with Community-based Active Survey
Authors: Lu Yun-Ru , Jeng Ya-Chung , Lee Wen-Yuan , Hsu Wei-Chih , Yen Amy Ming-Fang , Pan Shin-Liang , Chen Yen-Ching , Chen Sam Li-Sheng , Chen Hsiu-Hsi , Liou Horng-Huei , Wu Tzy-Haw
Published: January 2020

Background: Little is known about how early awareness is enhanced via a community-based active detection of dementia in comparison with the passive detected dementia through routine clinical practice. Methods: To assess the extent of the awareness, the adjusted detection ratio, the ratio of prevalence to incidence was developed by a Bayesian regression model based on a sample of 183 participants from community-based active survey and 1,921,308 subjects from clinical practice. Results: Given 2.91% prevalence estimated from passive detection and 6.59% prevalence on active survey, and 1.83 % incidence for those aged 65 years or older, the detection ratios were higher in active survey than passive detection for those aged 65-79 years (4.23, 95% CI: 2.68-6.69) versus (1.45, 95% CI: 1.43-1.47). Similar findings were also observed for those aged 80 years Conclusions: Active community-based detection was approximately three times that of passive detection due to the enhanced awareness of early detection of dementia. Keywords: Dementia; Early detection; Prevalence; Incidence
Characterization of two in vivo challenge models to measure functional activity of monoclonal antibodies to Plasmodium falciparum circumsporozoite protein
Authors: Raghunandan Rama , Mayer Bryan T , Flores-Garcia Yevel , Gerber Monica W , Gottardo Raphael , Jhun Hugo , Herrera Sonia M , Perez-Ramos Daniel W , Locke Emily , King C Richter , Zavala Fidel
Published: January 2020

Background. New strategies are needed to reduce the incidence of malaria, and promising approaches include the development of vaccines and monoclonal antibodies (mAbs) that target the circumsporozoite protein (CSP). To select the best candidates and speed development, it is essential to standardize preclinical assays to measure the potency of such interventions in animal models. Method. Two assay configurations were studied using transgenic P. berghei expressing P. falciparum full-length circumsporozoite protein. The assays measured 1) reduction in parasite infection of the liver (liver burden) following an intravenous (i.v) administration of sporozoites and 2) protection from parasitemia following mosquito bite challenge. Two human CSP mAbs, AB311 and AB317, were compared for their ability to inhibit infection. Multiple independent experiments were conducted to define assay variability and resultant impact on the ability to discriminate differences in mAb functional activity.Results. Overall, the assays produced highly consistent results in that all individual experiments showed greater functional activity for AB317 compared to AB311 as calculated by the dose required for 50 % inhibition (ID50) as well as the serum concentration required for 50% inhibition (IC50). The data were then used to model experimental designs with adequate statistical power to rigorously screen, compare, and rank order novel anti-CSP mAbs. Conclusion. Our results indicate that in vivo assays described here can provide reliable information for comparing the functional activity of mAbs. Our results also provide guidance regarding selection of the appropriate experimental design, dose selection, and group sizes.
Distinct assembly mechanisms underlie similar biogeographical patterns of rare and abundant bacteria in Tibetan Plateau grassland soils
Authors: Ji Mukan , Kong Weidong , Stegen James , Yue Linyan , Wang Fei , Dong Xiaobin , Cowan Don A , Ferrari Belinda C
Published: January 2020

Background: Bacteria in low abundance represent the majority of Earth’s biodiversity and perform vital ecological functions, but little is known about their biogeography nor the ecological processes that drive their community assembly in terrestrial ecosystems. Here, we investigated the community compositions and phylogenies of rare (relative abundance < 0.1%) and abundant (> 1%) soil bacteria along a transect containing three alpine grassland types (meadow, steppe, and desert) on the Tibetan Plateau. Results: Our results revealed similar biogeographical patterns of rare and abundant bacteria, with their community compositions and phylogenies shifting gradually along the transect. The similar patterns, however, were driven by contrasting community assembly processes, with rare subcommunity being more heavily influenced by stochasticity (72%) than abundant (57%). The composition of abundant subcommunity (80%) was better explained by local (including soil and vegetation factors), geospatial and climatic factors than that of rare subcommunity (41%), while the phylogeny of the rare one (36%) was better explained than that of the abundant one (29%). Variation partitioning analysis indicated that pure local factors consistently explained a higher proportion of the community composition than geospatial factors in both rare (12.3% and 8.7%, respectively) and abundant bacteria (18.3% and 14.1%, respectively). In contrast, the phylogeny of rare subcommunity was explained by local and geospatial factors equally (11.5% and 11.9%, respectively), while that of abundant subcommunity was more explained by geospatial (22.1%) than local factors (11.3%). Furthermore, our results revealed a tighter connection between the community phylogeny and composition in rare than in abundant bacteria. Conclusions: Our results revealed consistent biogeographical patterns of rare and abundant bacteria in grassland soils, but their assembly processes were distinct. We further demonstrated that rare subcommunity was less predictable than the abundant subcommunity by environmental and geospatial factors. Rare and abundant bacteria responded differentially to factors, which was attributed to the distinct life strategies. Our study provides novel insights into the assembly processes and biographical patterns of rare and abundant bacteria in terrestrial ecosystems.
Three-Dimensional Morphological Analysis of the Femoral Neck Torsion Angle - An Anatomical Study.
Authors: Zhang Ru-yi , Su Xiu-yun , Zhao Jing-xin , Li Jian-tao , Zhang Li-cheng , Tang Pei-fu
Published: January 2020

Background: The femoral neck torsion angle (FNTA) is a very important but often neglected parameter in assessments of the anatomical morphology of the femoral neck, and it is often confused with the femoral neck anteversion angle (FNAA) in the current literature. Currently, naked eye or two-dimensional literature (2D) visualization method was used in the literature that the measurement method reported, and the measurement parameters and details are not clearly defined. The objection of this research was to establish a three-dimensional (3D) method to measure the FNTA, and to analyse the anatomical and clinical significance of the results. Methods: Computed tomography (CT) data of 200 patients who received a lower extremity CT angiography examination were selected for the three-dimensional CT (3D CT) reconstruction of bilateral femurs by using Mimics software. The 3D axis of the femoral neck was built, and the FNTAs of the isthmus and the basilar part were measured using the “inertia axes” method. SPSS software was used for statistical analyses. Results: The difference in FNTA was statistically significant between the isthmus and the basilar part (isthmus 30.58 ± 8.90° vs. basilar part 23.79 ± 3.98°; p < 0.01). Significant differences in the FNTA were observed between the sexes (males 31.99 ± 9.25° vs. females 27.49 ± 7.19°; p < 0.01). The increase in FNTA from the basilar part to the isthmus was 6.79 ± 8.06°, and the increase observed in men (7.87 ± 8.57°) was larger than that in women (4.44 ± 6.23°, p < 0.01). However, no significant differences in the values were observed between sides. According to the correlation analysis, height exerted the greatest effect on the FNTA (r = 0.255, p＜0.001), and the stepwise linear regression analysis produced the following final regression model: Y = -27.685 + 35.134 × HEIGHT (p < 0.001, R2 = 0.095). Conclusions: This study provides a new and reliable 3D method for measuring the FNTA. The method and results provide a methodological foundation and theoretical support for the research and development of internal fixation devices and configurations of the space for an implant designed to treat a femoral neck fracture. And, the optimal opening point of the femoral medullary cavity is recommended to be located at the posterior position of the top of the femoral neck cross-section during hip replacement.
Daptomycin for the treatment of gram-positive periprosthetic hip infections: Can daptomycin prevent the implant removal?
Authors: Oe Kenichi , Sawada Masahiro , Kawamura Hiroshi , Ueda Narumi , Nakamura Tomohisa , Iida Hirokazu , Saito Takanori
Published: January 2020

Background: Management of periprosthetic hip infections (PHIs) generally consists of implant removal and thorough debridement, accompanied by appropriate antibiotic therapy. Daptomycin (DAP) is a novel antibiotic, which allowed for implant retention in several patients after treating their infected joints. However, there is no consensus about implant retention or removal during treatment of PHIs. The aim of this study was to examine the effect of DAP, and to determine a surgical treatment strategy. Methods: This study retrospectively evaluated 20 patients between August 2014 and December 2018, divided into implant retention (n = 9) and implant removal groups (n = 11). Infection control and risk of recurrent infection were evaluated. Infection control was defined as not requiring implant removal after the final treatment. Results: Infection control rates in implant retention and implant removal groups were 67% and 90%, respectively. All late chronic infections resulted in failure cases within the implant retention group. In the implant retention group, mean preoperative risk scores for successful cases were significantly higher than those for failure cases (P < 0.05). Conclusions: Patients with low-risk did not require implant removal, suggesting that DAP may be a breakthrough alternative to traditional PHI management.
Development of the “POP” scoring system for predicting obstetric and gynecological diseases in the emergency department: A retrospective cohort study
Authors: OKADA ASAMI , Okada Yohei , Fujita Hiroyuki , Iiduka Ryoji
Published: January 2020

Background: Obstetric and gynecological (OBGY) diseases are among the most important differential diagnoses for young women with acute abdominal pain. However, there are few established clinical prediction rules for screening OBGY diseases in the emergency department (ED). This study aimed to develop a prediction model for diagnosing OBGY diseases in the ED.Methods: This single-center retrospective cohort study included female patients with acute abdominal pain who presented to our emergency department. We developed a logistic regression model for predicting OBGY diseases and assessed its diagnostic ability. This study included young female patients aged between 16 and 49 years old, who had abdominal pain and were examined at the ED from April 2017 to March 2018. Trauma patients and patients referred from another hospital or from the OBGY department of our hospital were excluded.Results: Of 27,991 patients, 740 were included. Sixty-five patients were diagnosed with OBGY diseases (8.8%). The "POP" scoring system [past history of OBGY diseases +1, no other symptoms +1, and peritoneal irritation signs +1] was developed. Cut-off values set between 0 and 1 points, sensitivity at 97%, specificity at 39%, and negative likelihood ratio (LR-) of 0.08 were considered for rule-out, while cut-off values set between 2 and 3 points, sensitivity at 23%, specificity at 99%, and positive likelihood ratio (LR+) of 17.29 were suitable for rule-in.Conclusions: Our "POP" scoring system can be useful for screening of OBGY diseases in the ED.
The growing impact of older patients in the Emergence Department: a 5-year retrospective analysis in Brazil
Authors: Gomes João Carlos Pereira , Dias Roger Daglius , Barros Jacson Venancio , Velasco Irineu Tadeu , Filho Wilson Jacob
Published: January 2020

Background: The average age of the global population is rising at an increasing rate. There is a disproportional increase in Emergency Department (ED) visits by older people worldwide. In the Brazilian health system, complex and severely ill patients and those requiring specialized urgent procedures are referred to tertiary level care. As far as we know, no other study in Latin America has analyzed the impact of demographic changes in tertiary ED attendance.Methods: Aim: To describe the sociodemographic characteristics and outcomes of tertiary Brazilian ED users. Design: Observational cross-sectional analytic study. Setting: Emergency Department, tertiary university hospital, São Paulo, Brazil. Participants: patients aged 18 years or older attending a tertiary ED (2009-2013). The primary outcomes were hospitalization and mortality; the secondary outcome was ICU admission. Age was categorized as ‘young adults’ (18-39y), ‘adults’ (40-59y), ‘young-older adults’ (60-79y), and ‘old-older adults’ (80-109y). Other variables included sex, reason for attendance, time of ED visit, mode of presentation, type of hospitalization, main procedure, length of hospital stay (LOS) and length of ICU stay (ICU-LOS). We calculated descriptive statistics, built generalized linear mixed models for each outcome and estimated Odds Ratios (95% CI) for the independent categorical variables. The significance level was 5% with Bonferroni correction.Results: Older age-groups represented 26.6% of 333,028 ED visits, 40.7% of admissions, 42.7% of ICU admissions and 58% of all deaths. Old-older patients accounted for 5.1% of ED visits, 9.5% of admissions and 10.1% of ICU admissions. Hospitalization, ICU admission and mortality rates increased with older age in both sexes. LOS and ICU-LOS were similar across age-groups. The proportions of visits and admissions attributed to young adults decreased annually, while those of people aged 60 or over increased. The ORs for hospitalization, ICU admission and mortality associated with the old-older group were 3.49 (95% CI = 3.15-3.87), 1.27 (1.15-1.39) and 5.93 (5.29-6.66) respectively, with young adults as the reference.Conclusions: In tertiary ED, age is an important risk factor for hospitalization and mortality, but not for ICU admission. Old-older people are at the greatest risk and demand further subgroup stratification.