bluuebunny/crossref_metadata_2025 huggingface dataset:
Dysregulation of lnc-SNHG1 and miR-216b-5p correlate with chemoresistance and indicate poor prognosis of serous epithelial ovarian cancer
Authors: Pei Mei Li , Zhao Zong Xia , Shuang Ting
Published: December 2020

Aim

This study aimed to explore whether the dysregulation of lnc-small nucleolar RNA host gene 1 (SNHG1) and miR-216b-5p correlated with chemoresistance and indicated poor prognosis of serous epithelial ovarian cancer (EOC).

Methods and results

The expression of lnc-SNHG1 was upregulated, while miR-216b-5p showed low expression in patients with chemoresistant EOC compared with patients with chemosensitive EOC. The multivariate Cox regression analysis showed that the expression of miR-216b-5p and FIGO stage were independent prognostic factors for the overall survival (OS) of patients with serous EOC. Kaplan–Meier curves revealed a significant association of the increased expression level of lnc-SNHG1 with shorter OS and disease-free survival (DFS). Patients with a low expression level of miR-216b-5p also had shorter OS and DFS. The biological functions were tested using CCK-8 assay, colony formation assay, wound healing assay, and cell apoptosis. The knockdown of SNHG1 and the overexpression of miR-216b-5p stimulated paclitaxel sensitivity in A2780/Taxol cells through inhibiting cell growth and migration and promoting apoptosis. The inhibition of miR-216b-5p could rescue the effect of lnc-SNHG1 inhibition on the sensitivity of A2780/Taxol cells to paclitaxel. Luciferase reporter assay, RNA Binding Protein Immunoprecipitation Assay (RIP), and quantitative reverse transcription–polymerase chain reaction (qRT-PCR) indicated that lnc-SNHG1 acted as a sponge of miR-216b-5p in A2780/Taxol cells.

Conclusions

This study showed that the overexpression of lnc-SNHG1 and decreased expression level of miR-216b-5p correlated with the chemoresistance of patients with serous EOC and indicated shorter OS and DFS. Lnc-SNHG1 functioned as a ceRNA with miR-216b-5p, which was critical in modulating the paclitaxel sensitivity of ovarian cancer cells.
Systematic evaluation of supervised machine learning for sample origin prediction using metagenomic sequencing data
Authors: Chen Julie Chih-yu , Tyler Andrea D.
Published: December 2020

Background

The advent of metagenomic sequencing provides microbial abundance patterns that can be leveraged for sample origin prediction. Supervised machine learning classification approaches have been reported to predict sample origin accurately when the origin has been previously sampled. Using metagenomic datasets provided by the 2019 CAMDA challenge, we evaluated the influence of variable technical, analytical and machine learning approaches for result interpretation and novel source prediction.

Results

Comparison between 16S rRNA amplicon and shotgun sequencing approaches as well as metagenomic analytical tools showed differences in normalized microbial abundance, especially for organisms present at low abundance. Shotgun sequence data analyzed using Kraken2 and Bracken, for taxonomic annotation, had higher detection sensitivity. As classification models are limited to labeling pre-trained origins, we took an alternative approach using Lasso-regularized multivariate regression to predict geographic coordinates for comparison. In both models, the prediction errors were much higher in Leave-1-city-out than in 10-fold cross validation, of which the former realistically forecasted the increased difficulty in accurately predicting samples from new origins. This challenge was further confirmed when applying the model to a set of samples obtained from new origins. Overall, the prediction performance of the regression and classification models, as measured by mean squared error, were comparable on mystery samples. Due to higher prediction error rates for samples from new origins, we provided an additional strategy based on prediction ambiguity to infer whether a sample is from a new origin. Lastly, we report increased prediction error when data from different sequencing protocols were included as training data.

Conclusions

Herein, we highlight the capacity of predicting sample origin accurately with pre-trained origins and the challenge of predicting new origins through both regression and classification models. Overall, this work provides a summary of the impact of sequencing technique, protocol, taxonomic analytical approaches, and machine learning approaches on the use of metagenomics for prediction of sample origin.
Measles-mumps-rubella vaccine at 6 months of age, immunology, and childhood morbidity in a high-income setting: study protocol for a randomized controlled trial
Authors: Vittrup Dorthe Maria , Laursen Anne Cathrine Lund , Malon Michelle , Soerensen Jesper Kiehn , Hjort Jakob , Buus Soren , Svensson Jannet , Stensballe Lone Graff
Published: December 2020

Background

Measles is a highly contagious and serious infection. Before the introduction of vaccination, measles caused yearly epidemics putting vulnerable children at risk of brain damage and death. Despite safe and cost-effective vaccines, measles remains a leading cause of death in children globally. Due to insufficient vaccine coverage and low levels of in utero transferred antibodies from vaccinated mothers, outbreaks of measles in Denmark and other high-income countries are observed at increasing frequency.

The current vaccine was introduced in Denmark in 1987 as a one-shot measles-mumps-rubella vaccine at 15 months, a timing chosen to avoid inhibition of the infant’s immune response by maternal antibodies. One generation later, the MMR vaccinated mothers have lower antibody levels compared to the naturally infected, and their infants are already susceptible at 6 months of age or earlier, thus increasing the risk of epidemics.

Methods

The Danish MMR trial is a double-blind randomized clinical trial recruiting between March 2019 and December 2021 with last patient last visit in February 2022. AltogetherN = 6500 infants aged 6 months will be randomly assigned to intramuscular vaccination with routine MMR (M-M-R VaxPro) or placebo (solvent only). According to the Danish Childhood vaccination program, all infants will receive a routine MMR vaccination at 15 months of age. At randomization, 1 month later, and 1 month after routine MMR vaccination at 15 months of age, a blood sample is drawn from app. 10% (N = 600) of the population. Additionally, hair, saliva, and urine are sampled at randomization. The co-primary study outcomes are immunogenicity 1 month after MMR vaccination at 6 months of age assessed as plaque-reduction neutralization test, and incidence of infectious disease hospitalizations from randomization to 12 months of age. Six weeks post randomization, all participants are interviewed regarding adverse events.

Trial registration

The trial is registered in the EU Clinical Trials Registry. EudraCT registration number:2016-001901-18. Registered on 14 February 2017.
Derived high reducing sugar and lignin colloid particles from corn stover
Authors: Liu Wei , Zhuo Shengnan , Si Mengying , Yuan Mengting , Shi Yan
Published: December 2020

Lignocellulosic biomass is considered as the largest potential candidate to develop alternative energy, such as biofuel, biomaterial. However, the efficient conversion of cellulose and practical utilization of lignin are great challenges for sustainable biorefinery. In this study, high reducing sugar yield and different size of lignin colloid particles (LCPs) were obtained via tetrahydrofuran–water (THF–H2O) pretreatment of corn stover (CS). THF–H2O as a co-solvent, could efficiently dissolve lignin and retain cellulose. After the pretreatment, 640.87 mg/g of reducing sugar was produced, that was 6.66-fold higher than that of the untreated CS. Meanwhile, the pretreatment liquor could form spherical LCPs with different sizes ranged from 202 to 732 nm through self-assembly. We studied the optimal pretreatment condition to simultaneously realize the high reducing sugar yield (588.4 mg/g) and excellent LCPs preparation with average size of 243 nm was under TH22 (THF–H2O pretreatment at 120 °C for 2 h). To further explore the formation of LCPs with different sizes. We studied the lignin structure changes of various conditions, concluded the size of LCPs was related to the lignin concentration and syringyl/guaiacyl (S/G) ratio. As the increase of the lignin concentration and S/G, the sizes of LCPs were increased. G-type lignin was easier to dissolve in the mild pretreatment supernatant, contributing to form smaller LCPs with a good dispersibility. In the severe condition, both of S and G-type lignin were dissolved due to the lignin depolymerization, formed the larger sphere particles. This work provides a novel perspective for the technical design of lignocellulosic biomass conversion.
Bilateral hypotropic dissociated vertical deviation: a case report
Authors: Shohadeh Nawar , Alhalabi Nawras
Published: December 2020

Background

Hypotropic dissociated vertical deviation (DVD) is a special form of strabismus characterized by a slow drift of the non-fixating eye when the other eye is fixating on a target. In contrast to hypertropic DVD, which is common, hypotropic DVD is exceedingly rare and seldom reported in previous literature. In this case, we report the clinical features of a rare case of a Syrian child with bilateral hypotropic DVD accompanied by manifest latent nystagmus and intermittent exotropia.

Case presentation

A 4-year-old Syrian Arab girl presented with intermittent exotropia of both eyes since the age of 7 months, without any prior treatment. The fixation was alternating. She had manifest latent nystagmus in both eyes and anomalous head posture. She had bilateral hypotropic DVD in both eyes which only appeared when covering each eye. The patient underwent bilateral lateral rectus recession with posterior fixation and bilateral inferior oblique recession. Three months after surgery, she was orthophoric in the primary gaze position with a normal head posture. No alteration of the appearance of the hypotropic DVD was observed after the surgery.

Conclusion

This is a rare case of hypotropic DVD showing bilateral hypotropic DVD with different characteristics from those previously reported cases (bilateral hypotropic DVD with intermittent exotropia, dissociated horizontal deviation, manifest latent nystagmus, and bilateral inferior oblique overaction). The hypotropic DVD only appeared when covering each eye, and thus there was no need for surgery. Moreover, the inferior oblique recession did not seem to negatively affect the appearance of the eyes.
Reinforcement learning-based hybrid spectrum resource allocation scheme for the high load of URLLC services
Authors: Huang Qian , Xie Xianzhong , Cheriet Mohamed
Published: December 2020

Ultra-reliable and low-latency communication (URLLC) in mobile networks is still one of the core solutions that require thorough research in 5G and beyond. With the vigorous development of various emerging URLLC technologies, resource shortages will soon occur even in mmWave cells with rich spectrum resources. As a result of the large radio resource space of mmWave, traditional real-time resource scheduling decisions can cause serious delays. Consequently, we investigate a delay minimization problem with the spectrum and power constraints in the mmWave hybrid access network. To reduce the delay caused by high load and radio resource shortage, a hybrid spectrum and power resource allocation scheme based on reinforcement learning (RL) is proposed. We compress the state space and the action space by temporarily dumping and decomposing the action. The multipath deep neural network and policy gradient method are used, respectively, as the approximater and update method of the parameterized policy. The experimental results reveal that the RL-based hybrid spectrum and the power resource allocation scheme eventually converged after a limited number of iterative learnings. Compared with other schemes, the RL-based scheme can effectively guarantee the URLLC delay constraint when the load does not exceed 130%.
Methods for testing the performance of long-distance wireless power transmission systems
Authors: Wang Xudong , Lu Changbo , Wang Changfu , Liu Panpan , Xu Wanli , Zhou Youjie , Wang Feng
Published: December 2020

Long-distance wireless power transmission can reduce the dependence of unmanned systems on energy storage systems, which is especially advantageous for unmanned aerial vehicles. This approach is key for building an integrated and uninterrupted air-to-ground power supply network. This paper introduces the technical characteristics of long-distance wireless power transmission systems, reports the development of such systems at home and abroad, and proposes technical indices and methods for performance evaluation of these systems. A test was conducted using a testing device, and the key parameters of the system performance were obtained. This work provides a solid foundation for the performance evaluation studies of long-distance wireless power transmission systems.
Existence of local fractional integral equation via a measure of non-compactness with monotone property on Banach spaces
Authors: Nashine Hemant Kumar , Ibrahim Rabha W. , Agarwal Ravi P. , Can N. H.
Published: December 2020

In this paper, we discuss fixed point theorems for a new χ-set contraction condition in partially ordered Banach spaces, whose positive cone $\mathbb{K}$
K
is normal, and then proceed to prove some coupled fixed point theorems in partially ordered Banach spaces. We relax the conditions of a proper domain of an underlying operator for partially ordered Banach spaces. Furthermore, we discuss an application to the existence of a local fractional integral equation.
Prevalence and molecular characteristics of ESBL and AmpC β -lactamase producing Enterobacteriaceae strains isolated from UTIs in Egypt
Authors: Mohamed Ebtisam S. , Khairy Rasha M. M. , Abdelrahim Soha S.
Published: December 2020

Background

Infections caused by Enterobacteriaceae are mainly treated with the β-lactam antibiotics, nevertheless, the emergence of species with plasmid-borne β-lactamases has decreased the efficacy of these antibiotics. Therefore, continuing studies on the resistance pattern of different regions is important for assessment of proper antimicrobial therapy protocols. The study aimed to characterize extended-spectrum β-lactamase (ESBL) and AmpC β –lactamase (AmpC) producing Enterobacteriaceae isolated from community-acquired UTIs in Egypt.

Methods

Out of 705 urine samples, 440 Enterobacteriaceae isolates were investigated to detect ESBL and AmpC β -lactamases producers by phenotypic and molecular methods.

Results

Out of 440 Enterobacteriaceae isolates, 311 were identified as ESBL producers by phenotypic testing. ESBL genes were detected in 308 isolates. BlaCTX-M-type was the most prevalent 254 (81.6%), out of them blaCTXM-15 was the commonest (152, 48.8%) followed by blaCTX-M-1 (140, 45%), blaCTX-M-8 (72, 23.1%) and lastly blaCTX-M-2 (4, 1.3%).

blaTEM gene also was detected in a high rate (189, 60.7%). Two hundred and thirty-five (75.5%) of ESBL producers harbored blaCTX-M in combination with blaTEM and/or blaSHV genes. Multiple drug resistance in the ESBL-producers was significantly (P < 0.05) higher than in non–ESBL producers. Imipenem was the most effective drug against ESBL producers. Among 35 cefoxitin resistant isolates, 18 (51.4%) identified as carrying AmpC genes by multiplex PCR. Within AmpC β -lactamase genes, DHA gene was the predominant gene (15, 42.3%). CIT and MOX genes were also present, but in a low rate (5, 14.2% and 4, 11.4%) respectively. Co-existence of multiple AmpC genes was detected exclusively in K. pneumoniae isolates. E. coli isolates harbored DHA gene only. However, FOX gene was not detected in the study isolates. Seventeen of isolates carrying AmpC genes were also positive for ESBL genes.

Conclusion

The study shows that the prevalence of ESBL producing Enterobacteriaceae spread in south Egypt is alarming, however AmpC β -lactamase production is not so high.
Evaluation of the health and healthcare system burden due to antimicrobial-resistant Escherichia coli infections in humans: a systematic review and meta-analysis
Authors: MacKinnon M. C. , Sargeant J. M. , Pearl D. L. , Reid-Smith R. J. , Carson C. A. , Parmley E. J. , McEwen S. A.
Published: December 2020

Background

Assessment of the burden of disease due to antimicrobial-resistant Escherichia coli infections facilitates understanding the scale of the problem and potential impacts, and comparison to other diseases, which allows prioritization of research, surveillance, and funding. Using systematic review and meta-analysis methodology, the objectives were to evaluate whether humans with antimicrobial-resistant E. coli infections experience increases in measures of health or healthcare system burden when compared to susceptible E. coli infections.

Methods

Comprehensive literature searches were performed in four primary and seven grey literature databases. Analytic observational studies of human E. coli infections that assessed the impact of resistance to third/fourth/fifth-generation cephalosporins, resistance to quinolones, and/or multidrug resistance on mortality, treatment failure, length of hospital stay and/or healthcare costs were included. Two researchers independently performed screening, data extraction, and risk of bias assessment. When possible, random effect meta-analyses followed by assessment of the confidence in the cumulative evidence were performed for mortality and length of hospital stay outcomes, and narrative syntheses were performed for treatment failure and healthcare costs.

Results

Literature searches identified 14,759 de-duplicated records and 76 articles were included. Based on 30-day and all-cause mortality meta-analyses, regardless of the type of resistance, there was a significant increase in the odds of dying with resistant E. coli infections compared to susceptible infections. A summary mean difference was not presented for total length of hospital stay meta-analyses due to substantial to considerable heterogeneity. Since small numbers of studies contributed to meta-analyses for bacterium-attributable mortality and post-infection length of hospital stay, the summary results should be considered with caution. Studies contributing results for treatment failure and healthcare costs had considerable variability in definitions and reporting.

Conclusions

Overall, resistant E. coli infections were associated with significant 30-day and all-cause mortality burden. More research and/or improved reporting are necessary to facilitate quantitative syntheses of bacterium-attributable mortality, length of hospital stay, and hospital costs.

Protocol Registration PROSPERO CRD42018111197.
CD44 as a tumor biomarker and therapeutic target
Authors: Xu Hanxiao , Niu Mengke , Yuan Xun , Wu Kongming , Liu Aiguo
Published: December 2020

CD44, a complex transmembrane glycoprotein, exists in multiple molecular forms, including the standard isoform CD44s and CD44 variant isoforms. CD44 participates in multiple physiological processes, and aberrant expression and dysregulation of CD44 contribute to tumor initiation and progression. CD44 represents a common biomarker of cancer stem cells, and promotes epithelial-mesenchymal transition. CD44 is involved in the regulation of diverse vital signaling pathways that modulate cancer proliferation, invasion, metastasis and therapy-resistance, and it is also modulated by a variety of molecules in cancer cells. In addition, CD44 can serve as an adverse prognostic marker among cancer population. The pleiotropic roles of CD44 in carcinoma potentially offering new molecular target for therapeutic intervention. Preclinical and clinical trials for evaluating the pharmacokinetics, efficacy and drug-related toxicity of CD44 monoclonal antibody have been carried out among tumors with CD44 expression. In this review, we focus on current data relevant to CD44, and outline CD44 structure, the regulation of CD44, functional properties of CD44 in carcinogenesis and cancer progression as well as the potential CD44-targeting therapy for cancer management.
The relationship between resilience and loneliness elucidated by a Danish version of the resilience scale for adults
Authors: Jakobsen Ida Skytte , Madsen Lykke Mie Riis , Mau Martin , Hjemdal Odin , Friborg Oddgeir
Published: December 2020

Background

Research on the relationship between resilience and loneliness is sparse. The construct of resilience has been conceptualized in multiple ways, including the measurement of resilience. The Resilience Scale for Adults (RSA) is a measure of protective factors. The present study examined whether resiliency moderates any negative relationship between loneliness and mental health and additionally examined the psychometric properties of the Danish translation of the RSA.

Methods

A Danish sample (N = 422) completed the UCLA Loneliness Scale, Hopkins Symptom Check List-25 (HSCL-25), the Sense of Coherence (SOC-13), and the RSA, Resilience Scale for Adults.

Results

The measure of loneliness correlated significantly and negatively with most facets of the RSA, except the subscales of family cohesion and structured style. The strongest correlation was the negative one between loneliness and SOC. The results indicated that people feeling lonely also experience their life as less meaningful.

Conclusion

The study supports the existing six-factor structure of the Resilience Scale for Adults (RSA) in a Danish sample. The results indicate that all facets of resiliency were negatively related to loneliness. Also, the facets of perception of self and family coherence could explain a substantial amount of the variance associated with symptoms of depression in relation to loneliness.
Common causes and characteristics of adverse drug reactions in older adults: a retrospective study
Authors: Woo Seong-Dae , Yoon Jiwon , Doo Go-Eun , Park Youjin , Lee Youngsoo , Lee So-Hee , Lee Young-Hee , Ye Young-Min
Published: December 2020

Background

Aging populations are often accompanied by comorbidity and polypharmacy, leading to increases in adverse drug reactions (ADRs). We sought to evaluate the causes and characteristics of ADRs in older Korean adults (≥65 years) in comparison to younger individuals (< 65 years).

Methods

Of 37,523 cases reported at a Korean pharmacovigilance center from 2011 to 2018, we reviewed 18,842 ADRs of certain or probable causality on the basis of WHO-UMC criteria. We estimated the number of ADRs per 1000 patients exposed to the major culprit drugs, and incidence rate ratios were obtained to assess high- and low-risk medications in older adults.

Results

In total, 4152 (22.0%) ADRs were reported for 3437 older adults (mean age, 74.6 years and 57.3% female). Tramadol (rate ratio, 1.32; 95% confidence interval [CI], 1.21–1.44; P < 0.001) and fentanyl (1.49, 1.16–1.92, P = 0.002) posed higher risks of ADRs in the older adults, whereas nonsteroidal anti-inflammatory drugs (NSAIDs) (0.35, 0.30–0.40, P < 0.001) and iodinated contrast media (ICM) (0.82, 0.76–0.89, P < 0.001) posed lower risks. Ratios of serious ADRs to NSAIDs (odds ratio, 2.16; 95% CI, 1.48–3.15; P < 0.001) and ICM (2.09, 1.36–3.21, P = 0.001) were higher in the older adults than in the younger patients. Analgesics primarily elicited cutaneous ADRs in the younger patients and gastrointestinal reactions in the older adults. ICM more commonly led to anaphylaxis in the older adults than the younger patients (3.0% vs. 1.6%, P = 0.019).

Conclusion

For early detection of ADRs in older adults, better understanding of differences in the causes and characteristics thereof in comparison to the general population is needed.
Nano drug delivery systems in upper gastrointestinal cancer therapy
Authors: Salapa Julia , Bushman Allison , Lowe Kevin , Irudayaraj Joseph
Published: December 2020

Upper gastrointestinal (GI) carcinomas are characterized as one of the deadliest cancer types with the highest recurrence rates. Their treatment is challenging due to late diagnosis, early metastasis formation, resistance to systemic therapy and complicated surgeries performed in poorly accessible locations. Current cancer medication face deficiencies such as high toxicity and systemic side-effects due to the non-specific distribution of the drug agent. Nanomedicine has the potential to offer sophisticated therapeutic possibilities through adjusted delivery systems. This review aims to provide an overview of novel approaches and perspectives on nanoparticle (NP) drug delivery systems for gastrointestinal carcinomas. Present regimen for the treatment of upper GI carcinomas are described prior to detailing various NP drug delivery formulations and their current and potential role in GI cancer theranostics with a specific emphasis on targeted nanodelivery systems. To date, only a handful of NP systems have met the standard of care requirements for GI carcinoma patients. However, an increasing number of studies provide evidence supporting NP-based diagnostic and therapeutic tools. Future development and strategic use of NP-based drug formulations will be a hallmark in the treatment of various cancers. This article seeks to highlight the exciting potential of novel NPs for targeted cancer therapy in GI carcinomas and thus provide motivation for further research in this field.
Cerebellar hemorrhage in patients treated with edoxaban for portal vein thrombosis after hepatobiliary surgery: a report of two cases
Authors: Iida Hiroya , Miyake Toru , Tani Masaji , Tanaka Takuya , Kawakami Kayo , Ikuno Yoshihiro , Mandai Ryoichi , Shimizu Tomoharu
Published: December 2020

Background

The standard therapeutic agent administered for portal vein thrombosis (PVT) in patients with or without cirrhosis is warfarin or low-molecular weight heparin. However, therapy with edoxaban appears to be one of the most promising treatments for patients who require anticoagulation therapy. We encountered two cases of cerebellar hemorrhage in patients treated with edoxaban for PVT after hepatobiliary surgery during the past 2 years.

Case presentation

Case 1A 67-year-old male underwent cholecystectomy and choledocholithotomy with choledochoduodenostomy to treat choledocholithiasis after cholangitis. Enhanced computed tomography (CT) on the 1st postoperative day (POD) revealed thrombosis in the left and anterior segment of the portal vein branches. We administered antithrombin III concentrate with heparin for 5 days; thereafter, we switched to 60 mg edoxaban. A sudden decrease in the patient’s level of consciousness was observed due to cerebellar hemorrhage on POD 27. Cerebellar hemorrhage was successfully treated with craniotomy hematoma evacuation and ventricular drainage; however, the patient died from aggravation of hepatic failure due to PVT and intra-abdominal infection.Case 2A 67-year-old male received laparoscopic microwave coagulation therapy for two hepatic nodules suggestive of hepatocellular carcinoma in the left lobe of the liver due to alcoholic hepatitis. Enhanced CT on POD 5 revealed a thrombosis in the 4th segment branch of the portal vein, and the patient was treated with 60 mg edoxaban. Cerebellar hemorrhage with ventricular perforation occurred on POD 15. Cerebellar hemorrhage was successfully treated by craniotomy hematoma evacuation with ventricular drainage. Prolonged consciousness disorder persisted, and the patient was transferred to another medical facility for rehabilitation 49 days after brain surgery.

Conclusions

Although edoxaban is recently described to be one of the options for patients with PVT who require anticoagulation therapy instead of heparin or warfarin, it should be used with caution, given its propensity to induce severe hemorrhagic adverse events in cases such as those described above. The monitoring of hepatic dysfunction and decision for continuation of drug may be required during edoxaban use for PVT, especially after hepatobiliary surgery.
Multicenter retrospective study of transcatheter arterial embolisation for life-threatening haemorrhage in patients with uncorrected bleeding diathesis
Authors: Spiliopoulos Stavros , Katsanos Konstantinos , Paraskevopoulos Ioannis , Mariappan Martin , Festas Georgios , Kitrou Panagiotis , Papageorgiou Christos , Reppas Lazaros , Palialexis Konstantinos , Karnabatidis Dimitrios , Brountzos Elias
Published: December 2020

Background

We retrospectively investigated outcomes of emergency TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding diathesis.

Materials and methods

This multicenter, retrospective, study, was designed to investigate the safety and efficacy of percutaneous TAE for the management of life-threatening haemorrhage in patients with uncorrected bleeding disorder at the time of embolization. All consecutive patients with uncorrected coagulation who underwent TAE for the treatment of haemorrhage, between January 1st and December 31th 2019 in three European centers were included. Inclusion criteria were thrombocytopenia (platelet count < 50,000/mL) and/or International Normalized Ratio (INR) ≥2.0, and/or activated partial thromboplastin time (aPTT) > 45 s, and/or a pre-existing underlying blood-clotting disorder such as factor VIII, Von Willebrand disease, hepatic cirrhosis with abnormal liver function tests. Primary outcome measures were technical success, rebleeding rate and clinical success. Secondary outcome measures included patients’ 30-day survival rate, and procedure-related complications.

Results

In total, 134 patients underwent TAE for bleeding control. A subgroup of 17 patients with 18 procedures [11 female, mean age 70.5 ± 15 years] which represent 12.7% of the total number of patients, presented with pathological coagulation parameters at the time of TAE (haemophilia n = 3, thrombocytopenia n = 1, cirrhosis n = 5, anticoagulants n = 7, secondary to bleeding n = 1) and were analyzed. Technical success was 100%, as in all procedures the bleeding site was detected and successfully embolised. Clinical success was 100%, as none of the patients died of bleeding during hospitalization, nor was surgically treated for bleeding relapse. Only one rebleeding case was noted (5.9%) that was successfully treated with a second TAE. No procedure-related complications were noted. According to Kaplan-Meier analysis the estimated 30-day survival rate was 84.2%.

Conclusion

TAE in selected patients with uncorrected bleeding diathesis should be considered as a suitable individualized management approach. Emergency TAE for life threatening haemorrhage in patients with coagulation cascade disorders should be used as an aid in realistic clinical decision making.
A trip of peptides to the brain
Authors: Matsui Toshiro , Yoshino Atsuko , Tanaka Mitsuru
Published: December 2020

Dietary di/tripeptides elicit preventive effects against lifestyle-related diseases such as hypertension, and hypercholesterolemia, etc. Although there have been evidential reports that the intake of protein hydrolysate improved impaired memory in human, limited studies on bioavailability, in particular, beyond the blood-brain barrier (BBB) of candidates in hydrolysate may prevent their extensive physiological studies. Thus, this review discusses the updated studies on BBB transport of peptides showing improved cognitive decline. Furthermore, their accumulation in the brain cerebral parenchyma is also introduced.

Graphical abstract
Development of nitazoxanide-loaded colon-targeted formulation for intestinal parasitic infections: centre composite design-based optimization and characterization
Authors: Bharti Charu , Nagaich Upendra , Pandey Jaya , Jain Suman , Jain Neha
Published: December 2020

Background

The current investigation is focused on the development and characterization of Eudragit S100 coated nitazoxanide-loaded microbeads as colon-targeted system utilizing central composite design (CCD) and desirability function. The study initiated with the selection of a BCS class II drug nitazoxanide and its preformulation screening with excipients, selection of polymer and identification of concentration for CCD, selection of optimized formulation based on desirability function, and in vitro release studies in simulated gastric and colonic media and stability studies. A two-factor, three-level CCD was employed with two independent variables, i.e. X1 (chitosan % w/v) and X2 (sodium tripolyphosphate % w/v), and three dependent variables, i.e. Y1 (particle size in micrometres), Y2 (percentage yield) and Y3 (percent entrapment efficiency), were chosen. Additionally, surface morphology, mucoadhesion and in vitro drug release studies were also conducted.

Result

Chitosan concentration showing maximum entrapment and optimum particle size was selected to formulate chitosan beads. The polynomial equation and model graphs obtained from the Design-Expert were utilized to examine the effect of independent variables on responses. The effect of formulation composition was found to be significant (p ˂ 0.05). Based on the desirability function, the optimized formulation was found to have 910.14 μm ± 1.03 particle size, 91.84% ± 0.64 percentage yield and 84.75% ± 0.38 entrapment efficiency with a desirability of 0.961. Furthermore, the formulations were characterized for in vitro drug release in simulated colonic media (2% rat caecal content) and have shown a sustained release of ∼ 92% up to 24 h as compared to in vitro release in simulated gastric fluid.

Conclusion

The possibility of formulation in enhancing percentage yield and entrapment efficiency of nitazoxanide and the utilization of CCD helps to effectively integrate nitazoxanide microbeads into a potential pharmaceutical dosage form for sustained release.
Emerging challenges in meeting physiotherapy needs during COVID-19 through telerehabilitation
Authors: Aderonmu Joseph Ayotunde
Published: December 2020

Background

Physiotherapy plays a significant role in rehabilitation. However, the emergence of the coronavirus disease 2019 (COVID-19) has posed a big challenge to its practice, especially regarding the level of contact with patients. There is a dire need for the exploration of rehabilitation options, other than in-person contacts, to limit the spread of the virus. This article explores telerehabilitation, its outcomes, and the challenges involved in the continuum of care of patients by physiotherapists in the face of the pandemic.

Body

Telerehabilitation is a vital tool which utilizes technology to link practitioners to patients. With its previous history of favorable outcomes for the rehabilitation of certain conditions, telerehabilitation has been widely recommended. However, issues exist on how well it can bridge the gap of physical touch in physiotherapy, its effectiveness in terms of outcomes and satisfaction across various conditions and large population sizes, and finally, its cost and effects, especially in developing countries.

Conclusion

Telerehabilitation is a necessary adaptation to ensure continued physiotherapy service delivery during the pandemic. However, more quality studies are recommended to evaluate its effectiveness and outcomes. Also, measures to ensure that developing countries are catered for in meeting the rising demands for physiotherapy services using telerehabilitation should be carried out.
Neuromuscular and Clinical Recovery in Thoracic Surgical Patients Reversed With Neostigmine or Sugammadex
Authors: Murphy Glenn S. , Avram Michael J. , Greenberg Steven B. , Bilimoria Sara , Benson Jessica , Maher Colleen E. , Teister Kevin J. , Szokol Joseph W.
Published: December 2020

BACKGROUND:

Patients undergoing thoracoscopic procedures may be at high-risk for incomplete neuromuscular recovery and associated complications. The aim of this clinical investigation was to assess the incidence of postoperative residual neuromuscular blockade in adult thoracic surgical patients administered neostigmine or sugammadex when optimal dosing and reversal strategies for these agents were used. The effect of choice of reversal agent on hypoxemic events and signs and symptoms of muscle weakness were also determined. Additionally, operative conditions in each group were graded by surgeons performing the procedures.

METHODS:

Two hundred patients undergoing thoracoscopic surgical procedures were enrolled in this nonrandomized controlled trial. One hundred consecutive patients maintained at moderate levels of neuromuscular blockade were reversed with neostigmine (neostigmine group) followed by 100 consecutive patients given sugammadex to antagonize deeper levels of neuromuscular blockade (sugammadex group). Anesthetic and neuromuscular management were standardized. Surgeons rated operative conditions at the conclusion of the procedure on a 4-point scale (grade 1 = excellent to grade 4 = poor). Train-of-four ratios were measured immediately before extubation and at PACU admission (primary outcomes). Postoperatively, patients were assessed for adverse respiratory events and 11 signs and 16 symptoms of muscle weakness.

RESULTS:

The 2 groups were similar in intraoperative management characteristics. The percentage of patients with residual neuromuscular blockade, defined as a normalized train-of-four ratio <0.9, was significantly greater in the neostigmine group than the sugammadex group at both tracheal extubation (80% vs 6%, respectively, P < .0001) and PACU admission (61% vs 1%, respectively, P < .0001). Patients in the neostigmine group had less optimal operative conditions (median score 2 [good] versus 1 [excellent] in the sugammadex group; P < .0001), and more symptoms of muscle weakness were present in these subjects (median number [interquartile range] 4 [1–8] vs 1 [0–2] in the sugammadex group, P < .0001). No differences between groups in adverse airway events were observed.

CONCLUSIONS:

Despite the application of strategies documented to reduce the risk of residual neuromuscular blockade, a high percentage of thoracoscopic patients whose neuromuscular blockade was reversed with neostigmine were admitted to the PACU with clinical evidence of residual paralysis. In contrast, muscle weakness was rarely observed in patients whose neuromuscular blockade was antagonized with sugammadex.
Gamer's Health Guide: Optimizing Performance, Recognizing Hazards, and Promoting Wellness in Esports
Authors: Emara Ahmed K. , Ng Mitchell K. , Cruickshank Jason A. , Kampert Matthew W. , Piuzzi Nicolas S. , Schaffer Jonathan L. , King Dominic
Published: December 2020

Electronic sports (esports), or competitive video gaming, is a rapidly growing industry and phenomenon. While around 90% of American children play video games recreationally, the average professional esports athlete spends 5.5 to 10 h gaming daily. These times and efforts parallel those of traditional sports activities where individuals can participate at the casual to the professional level with the respective time commitments. Given the rapid growth in esports, greater emphasis has been placed on identification, management, and prevention of common health hazards that are associated with esports participation while also focusing on the importance of health promotion for this group of athletes. This review outlines a three-point framework for sports medicine providers, trainers, and coaches to provide a holistic approach for the care of the esports athlete. This esports framework includes awareness and management of common musculoskeletal and health hazards, opportunities for health promotion, and recommendations for performance optimization.
Seed characteristics of Amygdalus arabica in Adıyaman region of Turkey
Authors: Yilmaz Mustafa , Kalkan Mehmet , Demirbağ Hakan
Published: December 2020

Mountain almond (Amygdalus arabica) is a shrub with naturally distributing in Turkey, Iran, Iraq, Syria, Jordan and Saudi Arabia. A. arabica also known as bitter almond and can reach up to 2.5 m. The natural distribution of mountain almond is generally in the Southeast Region of Turkey. The present study carried out to determine the morphological and physiological characteristics of the seed of mountain almond. The seeds were collected from three different populations of A. arabica in Adıyaman. For different each populations seed weight, height, width, thickness, and 1000-seed weight were measured in the laboratory. Morphological characteristics of A. arabica seeds varied according to their populations. Seed germination tests were conducted at 20 °C, after prechilling for 0, 3, 6, and 9 weeks at 4 °C. Prechilling treatments of 3 weeks were insufficient, but 6 and 9 weeks of prechilling were found to eliminate seed dormancy and led to the highest germination percentage. The average germination percentage after 0, 3, 6, and 9 weeks of prechilling were 3.1%, 49.6%, 80.4%, and 81.1%, respectively. The average mean germination time was approximately between 8 and 10 days.
Kolb’s Learning Style Inventory 4.0 and its association with traditional and problem based learning teaching methodologies in medical students
Authors: Hydrie Muhammad Zafar Iqbal , Naqvi Syed Muhammad Zulfiqar Hyder , Alam Shams Nadeem , Jafry Syed Imtiaz Ahmed
Published: December 2020

Objectives: To assess learning styles and the association of various teaching methodologies of medical students.

Methods: A cross-sectional study was carried out amongst 523 medical students of Baqai Medical College, Baqai Medical University, Karachi, from July 2019 to October 2019. All students from first to final year, who attended the undergraduate MBBS program were included. The study instrument was a questionnaire containing students’ demographic details, David Kolb’s Learning Style Inventory 4.0 and traditional and PBL teaching methodologies were asked. The association of various learning styles and preferred teaching methodologies with year of study was also assessed by using Pearson’s chi-square test.

Results: Out of 523 students, 518 returned the completed questionnaire. A majority of the students had either imagining or experiencing learning style. No change in learning style was observed between years of study. A significant association between the teaching methodologies and year of study was found in the imagining (p=0.033) and experiencing (p=0.044) learning style groups.

Conclusion: Students from different years of study at medical school did not have significantly different learning styles though the student’s preferences to teaching methodologies seem to change over time in the respective learning style groups. Longitudinal studies are necessary to identify the factors influencing such change and explore the association between learning styles over time on teaching methodologies in medical education.

doi: https://doi.org/10.12669/pjms.37.1.2275

How to cite this:Hydrie MZI, Naqvi SMZH, Alam SN, Jafry SIA. Kolb’s Learning Style Inventory 4.0 and its association with traditional and problem based learning teaching methodologies in medical students. Pak J Med Sci. 2021;37(1):146-150.  doi: https://doi.org/10.12669/pjms.37.1.2275

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Medical Students’ perceptions and attitudes toward Medical Leadership and Management
Authors: Alzahrani Sami Hamdan , Baig Mukhtiar , Omer Anoud R. , Algethami Mohammed R.
Published: December 2020

Objectives: To find out medical students’ perceptions and attitudes toward medical leadership and management (MLM).
Methods: A total of 336 medical students from the 2nd to 6th academic years from King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA), were included in this cross-sectional study. This study was conducted in January-February 2020. The students were asked about their perceptions, attitudes, and interests in the leadership of medical care and clinicians. A four-part questionnaire was used for collecting data. SPSS-21 was used for analysis.
Results: The participants included 172 (51.2%) males and 164 (48.8%) females. In total, 105 (31.3%) participants agreed that they had been very well educated about their perception, behavior, and interest in the field of medical leadership and clinic management, and 175 (52.1%) students agreed that clinicians should influence management decisions in a healthcare setting. Overall, 167 (49.7%) students agreed that management/leadership skills are important for clinicians. In total, 145 students (43.2%) desired to have more leadership training in medical school, and 129 (38.4%) students agreed to seek additional leadership/management training in their postgraduate research studies. When asked about their self-perception of good leadership skills, the students indicated that good leadership skills included integrity (47.9%), conflict resolution (46.7%), organization (44.4%), confidence (41.9%), communication (40.5%), self-reflection (40.2%), time management (33.6%), the ability to motivate others (36.9%), and the ability to keep calm under stress (33.3%).
Conclusion: Many students were well aware of the MLM concepts. However, students agreed that management/leadership skills are important for clinicians, and there should be more leadership training in medical schools.
doi: https://doi.org/10.12669/pjms.37.1.2406
How to cite this:Alzahrani SH, Baig M, Omer AR, Algethami MR. Medical Students’ Perceptions and Attitudes Toward Medical Leadership and Management. Pak J Med Sci. 2021;37(1):223-228. doi: https://doi.org/10.12669/pjms.37.1.2406
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon
Authors: Şimşir Adnan , Kızılay Fuat , Aliyev Bayram , Kalemci Serdar
Published: December 2020

Objective: In this study, we aimed to make a comprehensive comparison of the first hundred robot-assisted radical prostatectomy (RARP) and open retropubic radical prostatectomy (RRP) cases of a single surgeon in a high-volume center.

Methods: Preoperative, perioperative and postoperative data were collected retrospectively. Perioperative, oncological data and functional results in the first year were compared between the two groups. There were 204 RARPs between January 1, 2014 and December 31, 2019, and 755 RRPs between April 1, 2007 and December 31, 2019.

Results: While the operation time was in favor of the open group (117 vs 188 min, p<0.001), the estimated blood loss (328 vs 150 ml, p<0.001), blood transfusion rate (12 vs 2, p=0.021), and re-operation rate (6 vs 0, p=0.001) were in favor of the robotic group. Mean length of hospital stay (5.4 vs 3.1, p<0.001), urine leak rate (11 vs 2, p=0.033), complication rate (37 vs 16, p=0.018), and the 12th month continence rate (67 vs 85, p=0.002) were better in the robotic group.

Conclusions: RARP may provide better perioperative outcomes and lower complication rates after the surgeon factor is eliminated in the early period. Since our case group includes the initial 100 patients, studies with larger patient groups with longer follow-up are needed to adapt these early results to general outcomes.\

doi: https://doi.org/10.12669/pjms.37.1.2719

How to cite this:Simsir A, Kizilay F, Aliyev B, Kalemci S. Comparison of robotic and open radical prostatectomy: Initial experience of a single surgeon. Pak J Med Sci. 2021;37(1):167-174. doi: https://doi.org/10.12669/pjms.37.1.2719

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.