bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis on the Water Supply Chain Model under Revenue-Sharing Contract considering Marketing Effort, Water Purity
Authors: Huang Lijia , Tang Deshan
Published: April 2021

A two-tier water supply chain including a manufacturer and a retailer under revenue-sharing contract is constructed. And the contribution of the model is that marketing effort and water purity has been considered. First, four models including the centralized model (model B) and decentralized models (models BM, I, and II) are established and analyzed. Second, the Stackelberg game model is used to discuss the pricing strategy of water supply chain members in centralized and decentralized scenarios. The comparison results show that revenue-sharing contract is beneficial to improve the level of product greening, the profit of supply chain members, and the overall profit of the water supply chain compared with model BM. However, it leads to the decrease of retailers’ green marketing efforts and the wholesale price of water. In addition, revenue-sharing contract through bargaining makes bigger influence than revenue-sharing contract. Marketing can stimulate the increase of the green product’s market demand on one hand, and on the other hand, it generates the amount of marketing cost. In this study, the profit is that marketing produces cannot offset the cost that it brings. Thus, it will be important to take some measures to make up the loss that marketing generated.
Selecting and Characterizing Tyrosinase Inhibitors from Atractylodis macrocephalae Rhizoma Based on Spectrum-Activity Relationship and Molecular Docking
Authors: Liu Yong-Qin , Xu Chang-Yan , Liang Fang-Yu , Jin Pei-Chun , Qian Zhi-Yao , Luo Zhong-Sheng , Qin Rong-Gui
Published: April 2021

Atractylodis macrocephalae Rhizoma (AMR) is a famous classical Chinese traditional medicine (CTM), which has been used as a tonic for many diseases for thousands of years. In ancient China, it was used as a supplementary food for beauty in the palace. In preliminary studies, the function of whitening skin and the significant inhibiting effect on tyrosinase (TYR) which is the reactive enzyme in the composition of melanin of AMR were discovered, and the relevant research was rarely reported. In this study, high-performance liquid chromatography (HPLC) along with partial least squares regression analysis (PLS) was applied to survey the coherence between the chemical constituents and the inhibiting activity of 11 batches of AMR on TYR activity. The results of PLS showed that the chromatographic peaks 11 (atractylenolide III) and 15 could be important effective ingredients of the inhibition TYR activity as ascertained by spectrum-activity relationships. Furthermore, TYR inhibitory activity of atractylenolide III was validated by in vitro test by β-arbutin served as a positive control drug. The results of the in vitro test and the molecular docking showed that atractylenolide III has high TYR inhibitory activity and could link to the residues in TYR catalytic pocket. Therefore, bioassay, molecular docking, and spectrum-activity relationships are appropriate for linking the quality of samples with pharmaceutical-related active ingredients. And our studying would lay a theoretical foundation for applying the water extracts of AMR in whitening cosmetics.
Analysis and Research on Energy‐Saving Reconstruction of Building Heating System
Authors: Liu Yongqiang , Huang Zhanfang
Published: April 2021

A building heating system had high energy consumption and did not meet the requirements of environmental protection, so it was needed to be reformed. After recalculating the heat load, it was found that the heat source, pipe network specification, and radiator area of the original heating system were oversized. After comparing with a gas‐fired boiler, the heat source was transformed into the water source heat pump system. The water supply temperature of the water source heat pump was lower than that of the boiler. Generally, it seemed necessary to increase the radiator area. However, after calculation and verification, when the supply and return water temperature was 65/58°C, the system operated continuously and the original pipe network and radiator could still ensure the indoor temperature of 16°C. The total cost of transformation was 11.5 million Chinese Yuan. After analyzing the operation data of the new system, the water source heat pump system could save 82.6% energy compared with the original system and 29.6% cost compared with the central heating system. The transformation is successful, and the experience is worth popularizing.
Environmental Impact of the Presence, Distribution, and Use of Artificial Sweeteners as Emerging Sources of Pollution
Authors: Naik Ab Qayoom , Zafar Tabassum , Shrivastava Vinoy Kumar
Published: April 2021

Artificial sweeteners are posing a new threat to the environment. The water ecosystem is the primary recipient of these emerging contaminants. Once ingested, sufficient amount of these artificial sweeteners escape unchanged from the human body and are added to the environment. However, some are added in the form of their breakdown products through excretion. Artificial sweeteners are resistant to wastewater treatment processes and are therefore continuously introduced into the water environments. However, the environmental behavior, fate, and long-term ecotoxicological contributions of artificial sweeteners in our water resources still remain largely unknown. Some artificial sweeteners like saccharin are used as a food additive in animal feeds. It also forms the degradation product of the sulfonylurea herbicides. All artificial sweeteners enter into the wastewater treatment plants from the industries and households. From the effluents, they finally reside into the receiving environmental bodies including wastewaters, groundwaters, and surface waters. The global production of these sweeteners is several hundred tons annually and is continuously being added into the environment.
MicroRNA Biomarkers of High‐Grade Cervical Intraepithelial Neoplasia in Liquid Biopsy
Authors: Causin Rhafaela L. , da Silva Luciane S. , Evangelista Adriane F. , Leal Letícia F. , Souza Karen C. B. , Pessôa-Pereira Danielle , Matsushita Graziela M. , Reis Rui M. , Fregnani José H. T. G. , Marques Márcia M. C.
Published: April 2021

New prevention strategies are needed to detect cervical intraepithelial neoplasia (CIN). The microRNA expression analysis has already been reported as molecular biomarkers in the early detection of cervical cancer (CC) through minimally invasive samples, such as liquid biopsy, obtained through collection using liquid‐based cytology (LBC). In this study, we aimed to identify molecular signatures of microRNAs in cervical precursor lesions from LBC cervical and the molecular pathways potentially associated with the CC progression. We analyzed 31 LBC cervical samples from women who underwent colposcopy. These samples were divided into two groups: the first group was composed of samples without precursor lesions of CC, considering the control group, referred to as healthy female subjects (HFS; n = 11). The second group corresponded to women diagnosed with cervical interepithelial neoplasia grade 3 (CIN 3; n = 20). We performed microRNA and gene expression profiling using the nCounter® miRNA Expression Assays (NanoString Technology) and PanCancer Pathways (NanoString Technology), respectively. A microRNA target prediction was performed by mirDIP, and molecular pathway interaction was constructed using Cytoscape. Bidirectional in silico analyses and Pearson’s correlation were performed for associated the relation between genes, and miRNAs differentially expressed related cervical cancer progression were performed. We found that the expression of nine microRNAs was significantly higher, two were downregulated (miR‐381‐3p and miR‐4531), and seven miRNAs were upregulated (miR‐205‐5p, miR‐130a‐3p, miR‐3136‐3p, miR‐128‐2‐5p, let‐7f‐5p, miR‐202‐3p, and miR‐323a‐5p) in CIN 3 (fold change ≥ 2 and p ≤ 0.05). The miRNA expression patterns were independent of hr‐HPV infection. We identified four miRNAs (miR‐205‐5p, miR‐130a‐3p, miR‐4531, and miR‐381‐3p) that could be used as biomarkers for CIN 3 in LBC samples through multiple logistic regression analyses. We found 16 genes differentially expressed between CIN 3 and HSF samples (fold change ≥ 2 and p ≤ 0.05). We found the correlation between miR‐130a‐3p and CCND1(R = −0.52; p = 0.0029), miR‐205‐5p and EGFR (R = 0.53; p = 0.0021), and miR‐4531 and SMAD2 (R = −0.54; p = 0.0016). In addition, we demonstrated the most significant pathways of the targets associated with cervical cancer progression (FDR‐corrected p < 0.001). This study demonstrated that miRNA biomarkers may distinguish healthy cervix and CIN 3 and regulate important molecular pathways of carcinogenesis.
WSN Routing Protocol Using a Multiobjective Greedy Approach
Authors: Nabavi Seyed Reza , Eraghi Nafiseh Osati , Torkestani Javad Akbari
Published: April 2021

Due to the widespread use of communication networks and the ease of transmitting and gathering information through these networks, wireless sensor networks (WSN) have become increasingly popular. Usability in any environment without the need for environmental monitoring and engineering of these networks has led to their increasing usage in various fields. Routing information from the sensor node to sink, so that node energy is consumed uniformly and network life is not reduced, is one of the most important challenges in wireless sensor networks. Most wireless networks have no infrastructure, and embedded sensor nodes have limited power. Thus, the early termination of the wireless node’s energy based on the transmission of messages over the network can disrupt the entire network process. In this paper, the object is designed to find the optimal path in WSN based on the multiobjective greedy approach to the near optimal path. The proposed model is presented in this method to transfer sensed data of the sensor network to the base station for the desired applications. In this method, the sensor nodes are identified as adjacent nodes based on their distance. The energy of all nodes initially is approximately equal, which decreases with the transfer of information between the nodes. In this way, when a node senses a message, it checks several factors for transmitting information to its adjacent nodes and selects the node with the largest amount of factors as the next hop. The simulation results show that the energy consumption in the network grids is almost symmetrically presented, and the network lifetime is reduced with a gentle slope that provides optimum energy consumption in the networks. Also, the packet transmission delay in the network reaches 450 milliseconds for the transmission of information between 15 nodes and 650 connections. Besides, network throughput increases by approximately 97%. It also shows better performance compared to other previous methods in terms of evaluation criteria.
Research Status and Challenges of Data‐Driven Construction Project Management in the Big Data Context
Authors: Huang Yao , Shi Qian , Zuo Jian , Pena-Mora Feniosky , Chen Jindao
Published: April 2021

The construction industry is facing a data tsunami, while emerging information technologies (IT) show great potential for the effective processing of these data or information. However, a comprehensive review for technological change, the resulting process, and organizational changes in the Big Data context, especially from the angle of whole lifecycle of construction project, is lacking. To fill the void, related works published in the databases of Web of Science, Science Direct, and American Society of Civil Engineers library are systematically reviewed. The general trend in emerging IT application in terms of construction project management (CPM) phases, technology and application, and research topics are revealed. Following this analysis, the particularized proposals in relation to each of the main topics within CPM is discussed. Furthermore, according to the advances and limitations of the current literature, corresponding future agendas such as the implementation of comprehensive data‐driven CPM scenario are proposed to bridge the gaps between theoretical research and practical demands.
Nursing and Midwifery Students’ Satisfaction with Their Clinical Rotation Experience: The Role of the Clinical Learning Environment
Authors: Adam Alhassan Basour , Druye Andrew Adjei , Kumi-Kyereme Akwasi , Osman Wahab , Alhassan Afizu
Published: April 2021

Background. The clinical learning environment and clinical rotation experience of students are integral to nursing curriculum and are a crucial component of nursing education which helps transform theoretical knowledge to clinical practical skills. Objective. This study was aimed at assessing the role of the clinical learning environment on undergraduate nursing and midwifery students’ satisfaction with their clinical rotation experience. Method. The study employed a quantitative cross-sectional survey design. Data was collected from a sample of 240 undergraduate nursing and midwifery students of the University for Development Studies, Tamale, Ghana, using a structured questionnaire. Ethical approval was obtained from the University of Cape Coast Ethics Review Board. Descriptive analysis was displayed as frequencies and percentages. Inferentially, Fisher’s exact test, linear regression, and Spearman’s correlation tests were used to test for and quantify associations between independent and dependent variables atp≤0.05. Results. The level of students’ satisfaction with both clinical rotation experience and the clinical learning environment was high (65.6% and 63.5%, respectively). A statistically significant association of the students’ satisfaction with their clinical rotation experience was found. There was a statistically significant relationship between the clinical learning environment (χ2 (9, N = 224) = 80.665,p<0.001), pedagogical atmosphere in the clinical area (rs = 0.379,p<0.001), the leadership style of the ward manager (rs = 0.340,p<0.001), the premises of nursing in the ward environment (rs = 0.501,p<0.001), and the students’ satisfaction with their clinical rotation experience. Conclusion. These findings provide nurse educators and clinicians with meaningful understanding about areas to prioritise when planning clinical learning opportunities in such a way that skills learning and practice of nursing skills are successful and satisfactory for undergraduate student nurses and midwives.
Effect of a Traction Exercise Neck Brace on Cervical Spondylopathy Radiculopathy: A Clinical Study and Finite Element Analysis
Authors: Xiao Liang-Xing , Liu Chang-Shun , Zhong Shi-Zhen , Huang Wen-Hua
Published: April 2021

Traction of cervical spine is an effective method for the treatment of cervical spondylotic radiculopathy (CSR). In this study, a cervical tractor named traction exercise neck brace (TENB) was used to evaluate its effect on the patients with CSR. Forty CSR volunteers were recruited and randomly divided into two groups. One group was subjected to cervical muscle exercise with TENB under static traction condition. Another group was subjected to (JOBT) as controls. Symptoms of CSR were evaluated by the visual analogue scale (VAS) and neck disability index (NDI). Imaging characteristics were assessed by curvature of the cervical spine and size of the intervertebral foramen. A finite element (FE) analysis model of cervical spine was established by 3D reconstruction to simulate the TENB traction, which evaluates the biomechanical performance. Results showed that TENB significantly reduced scores of VAS and NDI in subjects, and this improved effect on symptoms of pain and radiculopathy is better than that of JOBT. TENB also improved the cervical curvature and enlarged intervertebral foramen at the C4–C6 level. Moreover, FE analysis found that simulated TENB traction increased the spacing of intervertebral foramen, intervertebral disc, and zygapophyseal and uncovertebral joints and changed the stress distribution on the facet joints and nucleus pulposus. This study demonstrates that TENB relieves the symptoms of CSR by adjusting structure of cervical vertebra and restoring its biomechanical performance, which may be a promising instrument in the treatment of CSR.
Fecal 16S rRNA Gene Sequencing Analysis of Changes in the Gut Microbiota of Rats with Low‐Dose Aspirin‐Related Intestinal Injury
Authors: Chi Tianyu , Zhao Quchuan , Wang Peili
Published: April 2021

Background. The incidence of small intestinal injury caused by low‐dose aspirin (LDA) is high, but the pathogenesis and intervention measures of it have not been elucidated. Recent studies have found gut microbiota to be closely associated with onset and development of NSAID‐induced intestinal injury. However, studies of the changes in the gut microbiota of rats with LDA‐related intestinal injury have been lacking recently. In this study, we investigated fecal 16S rRNA gene sequencing analysis of changes in the gut microbiota of rats with LDA‐related intestinal injury. Methods. Sprague‐Dawley (SD) rat models of small intestinal injury were established by intragastric administration of LDA. The small intestinal tissues and the fecal samples were harvested. The fecal samples were then analyzed using high‐throughput sequencing of 16S rRNA V3‐V4 amplicons. The gut microbiota composition and diversity were analyzed and compared using principal coordinate analysis (PCoA), nonmetric multidimensional scaling (NMDS) analysis, the unweighted pair‐group method with arithmetic mean (UPGMA) clustering analysis, multivariate statistical analysis (ANOSIM, MetaStats, and LEfSe), and spatial statistics. Results. The LDA rat model was successfully established. Decreased Firmicutes and increased Bacteroidetes abundances in rats with LDA‐induced small intestinal injury were revealed. MetaStats analysis between the before administration of LDA (CG) and after administration of LDA (APC) groups showed that the intestinal floras exhibiting significant differences (P < 0.05, q < 0.1) were Firmicutes, Bacteroides, Cyanobacteria, Melainabacteria, Coriobacteriia, Bacteroidia, Bacteroidales, Eubacteriaceae, and Streptococcaceae. In addition, the bacterial taxa showing significant differences between the control (NS) and APC groups were Firmicutes, Bacteroides, Verrucomicrobiaceae and Peptococcaceae. Conclusions. The alterations in the gut microbiota composition and diversity of rats with LDA‐related intestinal injury were found in the present study. The change of gut microbiota in LDA‐related intestinal injury will lay the foundation for further research on the function and signaling pathways of the intestinal flora and promote the use of intestinal flora as drug targets to treat LDA‐induced small intestinal injury.
The Pharmacological Activity of the Wenjing Decoction in Recurrent Spontaneous Abortion
Authors: Cao Linhui , Chen Hui , Huang Yanxia , Chen Liudan , Kang Mengru , Liang Junxiong
Published: April 2021

Background. Recurrent spontaneous abortion (RSA) is intractable infertility and can be ameliorated with the use of traditional Chinese medicine preparation, the Wenjing decoction. This study aimed to identify the therapeutic mechanism of Wenjing decoction on specific target proteins involved in RSA. Methods. Wenjing decoction contains Wuzhuyu, Danggui, Chuanxiong, Guizhi, Shengjiang, Banxia, Gancao, Ejiao, Mudanpi, Chishao, Dangshen, and Maidong. Using TCMSP and BATMAN databases, we queried for active ingredients and predicted their target proteins by BATMAN. Using the edgeR package, we analyzed the differentially expressed genes (DEGs) in the GSE121950 database between control samples and RSA (n = 3). The interaction between DEGs and the predicted target proteins was identified by the Venn diagram. Using the Cytoscape software and clusterProfiler package, enrichment analysis was conducted for the intersected target proteins. Additionally, the protein-protein interaction (PPI) network and pharmacological network were generated using the Cytoscape software. Results. In total, 31, 2, 7, 7, 5, 13, 93, 11, 29, and 21 active ingredients were identified from Wuzhuyu, Danggui, Chuanxiong, Guizhi, Shengjiang, Banxia, Gancao, Mudanpi, Chishao, and Dangshen, respectively. Additionally, 100 intersected target proteins were revealed by the Venn diagram. Moreover, 98 functional terms and 24 pathways (including C-type lectin receptor signaling pathway, chemokine signaling pathway, leukocyte transendothelial migration, fluid shear stress, and atherosclerosis, and AGE-RAGE signaling pathway in diabetic complications) were enriched. In the PPI network, 10 proteins involved in these five pathways were identified, namely, TNF-α (tumor necrosis factor-α), IL-10 (interleukin-10), TLR4 (Toll-like receptor 4), JUN (Jun proto-oncogene), IL-1B (interleukin-1-beta), CYBB (cytochrome b558 heavy chain gene), PTGS2 (prostaglandin-endoperoxide synthase 2), APOE (apolipoprotein E), SPI1 (salmonella pathogenicity island 1), and MPO (myeloperoxidase) which showed higher degrees. Conclusion. The abovementioned genes and pathways might be involved in the pharmacological activity of Wenjing decoction in RSA.
Chemical Composition and Larvicidal Activity of Lavandula angustifolia Subsp. angustifolia and Lavandula dentata Spp. dentata Essential Oils against Culex pipiens Larvae, Vector of West Nile Virus
Authors: El-Akhal Fouad , Ramzi Amal , Farah Abdellah , Ez Zoubi Yassine , Benboubker Moussa , Taghzouti Khalid , El Ouali Lalami Abdelhakim
Published: April 2021

The Culex pipiens mosquito (Diptera: Culicidae) is highly suspected to be the vector responsible for the spread of several parasitic and viral diseases. The use of synthetic insecticides is generally the preferred method of controlling these mosquitoes’ proliferation. However, it has led to resistance problems in target mosquitoes and environmental damage. Hence, diverse plant extracts could be considered as an alternative and potential source as mosquito control agents. In this study, essential oils of Lavandula angustifolia subsp. angustifolia and Lavandula dentata spp. dentata that are growing in Morocco were examined for their insecticidal effects on Culex pipiens larvae. The bioassay was performed according to a methodology inspired by the standard protocol of the World Health Organization. The mortality rate was determined after 24 hours of exposure, and probit regression analysis was used to calculate LC50 and LC90. The chemical analysis revealed that the principal compounds of L. angustifolia subsp. essential oils include linalool, linalyl acetate, geraniol, lavandulyl acetate, camphor, β-caryophyllene, terpinen-4-ol, β-myrcene, and 1,8-cineole, while the essential oil of L. dentata spp. was mainly composed of 1,8-cineole, camphor, α-pinene, trans-pinocarveol, linalool, and borneol. These volatile compounds have shown a toxic effect against Culex pipiens larvae, with lethal concentrations LC50 and LC90 being, respectively, 140 µg/ml and 450 µg/ml, for the L. angustifolia subsp. essential oil. Meanwhile, they were estimated at 2670 µg/ml and 7400 µg/ml, respectively, for the L. dentata spp. essential oil. These results suggest using essential oils of two species of Lavandula to control the Culex pipiens mosquito. It could be useful for the study of new natural larvicidal compounds.
Estimation of Extreme Cable Forces of Cable‐Stayed Bridges Based on Monitoring Data and Random Vehicle Models
Authors: Ren Yuan , Zhu Zhiyuan , Fan Ziyuan , Huang Qiao
Published: April 2021

For long‐span cable‐stayed bridges, cables serve as one of the most important components to guarantee structural integrity. Forces of stay cables indicate not only the performance of cables themselves but also the overall condition of bridges. In order to help stakeholders to make maintenance decisions, an extreme cable force estimation method was proposed based on cable force measurements and traffic data from the weighing system. First, raw monitoring data were preprocessed based on a median filtering to obtain usable cable force signals. The multiresolution wavelet method was used to extract traffic‐induced force component from mixed signals. Then, a Monte Carlo‐based random vehicle model was developed using traffic data from the weighing system. Based on field temperature measurements and simulation of traffic‐induced effects, extreme cable forces with respect to vehicle loads and temperature effects were predicted by extreme value theory. The Generalized Pareto Distribution (GPD) was adopted to establish the probability distribution models of the daily maximum cable force. Then, the extreme value within a return period of 100 years was determined and compared with the design loading demand. Finally, the effectiveness of the proposed method was validated through a cable‐stayed bridge in China. As a result, the low‐frequency varying component of cable force response had positive correlation with environmental temperatures, and the extreme value of the predicted cable force under prospective traffic volumes was within limit interval value according to the design code. The conclusions can be utilized by bridge owners to make maintenance decisions.
Development of an Implementation Framework for Overcoming Underdiagnoses of Familial Hypercholesterolemia in the USA
Authors: Miller Dana M. , Gaviglio Amy , Zierhut Heather A.
Published: April 2021

Familial hypercholesterolemia (FH) is a genetic condition which causes elevated low-density lipoprotein cholesterol from birth. With a prevalence of 1 in 250 and the availability of effective treatments, the diagnostic rate of <1 to 10% is unacceptably low. Screening for FH is supported by multiple organizations, but it has not been broadly adopted and implemented across the USA. To investigate the implementation of FH screening, key informants were recruited from across the USA for their expertise in FH-related literature, guidelines, public health, and/or advocacy to complete ­semistructured interviews guided by implementation science (RE-AIM framework). Sixteen semistructured interviews were analyzed with directed content and thematic analyses, yielding specific barriers and recommendations to improve FH screening. Barriers to FH screening included patient recruitment and participation, equitable access to healthcare, provider discomfort with screening and treating FH, provider burden, lack of public health and legislative support, FH awareness, guideline complexity, facilitation of genetic testing and cascade screening, and lack of coordination between stakeholders. Awareness, engagement, communication, and collaboration between stakeholders is integral to successful FH screening. Individualized plans will be required at national, regional, and institutional levels. FH screening implementation can be achieved through practice facilitation, streamlined screening approaches, electric medical record tools, and consensus guidelines to increase screening adoption and consistent delivery. Reliable funding and established lines of communication between stakeholders can maintain efforts as FH screening progresses.
Prediction of Cytokine Storm and Mortality in Patients with COVID-19 Admitted to ICU: Do Markers Tell the Story?
Authors: Nadeem Rashid , Elhoufi Ashraf Mahmoud , Iqbal Naheed Elahi , Obaida Zainab Abdulameer , Elgohary Doaa Mohamed , Singh Mukesh Kumar , Zoraey Shymaa Farouk , Abdalla Rami M. , Eltayeb Sara Yousif , Danthi Crystal Sharon , Azaza Nouha , Ahmed Waleed Mohamed , Hafeez Muzammil , AlSada Maryam , Mir Fatima Farid
Published: April 2021

Introduction: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2020. Markers of disease activity like ferritin, C-reactive protein (CRP), and D-dimers are frequently monitored to detect the best opportunity for intensive treatment. Methods: All patients of >18 years of age were included. The primary variables of interest, ferritin, CRP, and D-dimers, for each patient throughout hospitalization were recorded. Primary clinical outcomes of length of stay in ICU and survival were recorded. Demographics: age, gender, BMI, and nationality. Ferritin, CRP, and D-dimers were recorded daily if available for the whole ICU stay, and all other variables were recorded on admission day to ICU. Results: The sample includes 235 records. More than 95% of patients have all markers on the day of admission to ICU were ferritin (median 1,278; IQR 1,424), D-dimer 1.21 (3.4), and CRP 129.5 (121). Daily average levels of markers were different from their admission day level: ferritin 1,395 (1,331), D-dimer 3.11 (5.52), and CRP 107 (75.8). Multiple logistic regression analysis determined that average CRP during the stay was the only predictor of survival. Discussion: Data on markers utilization to detect the acute phase of inflammation help clinicians focus on the opportunity window for intensive treatment. Conclusion: Average CRP during the stay in ICU is higher than CRP on admission. Average CRP is the only factor that predicts survival.
Successful Treatment of Late Isolated Bone Metastasis in a Patient with Bilateral Retinoblastoma Using an Unconventional Method
Authors: Boddu Deepthi , Thankamony Priyakumari , Prakasam Reshma , Sugath Subin , Kumar Aswin , Nair Sindhu
Published: April 2021

Though survival in bilateral retinoblastoma (RB) has improved due to advancement in diagnostics and treatment modalities, children require long-term follow-ups for recurrence and second malignancies. We report a case of bilateral RB in a 7-month-old baby who was treated with chemotherapy, transpupillary thermotherapy, and periocular carboplatin for both eyes following which there was complete regression of tumour. Six and a half years after treatment, the child presented with metastatic recurrence of tumour in the left ulna. He was treated successfully with chemotherapy, extracorporeal radiation and reimplantation therapy. A less aggressive treatment approach for isolated bone relapse may be considered in selected cases.
What Are the Results and the Prognostic Factors of Motor Cortex Stimulation in Patients with Facial Pain? A Systematic Review of the Literature
Authors: Rapisarda Alessandro , Ioannoni Eleonora , Izzo Alessandro , Montano Nicola
Published: April 2021

Introduction: Facial pain (FP) is a type of neuropathic pain which recognizes both central and peripheral causes. It can be difficult to treat because it can often become resistant to pharmacological treatments. Motor Cortex Stimulation (MCS) has been used in selected cases, but the correct indications of MCS in FP have not been fully established. Here we systematically reviewed the literature regarding MCS in FP analysing the results of this technique and studying the possible role of different factors in the prognosis of these patients. Methods: A literature search was performed through different databases (PubMed, Scopus, and Embase) according to PRISMA guidelines using the following terms in any possible combination: “facial pain” or “trigeminal” or “anaesthesia dolorosa” and “motor cortex stimulation.” Results: 111 articles were reviewed, and 12 studies were included in the present analysis for a total of 108 patients. Overall, at latest follow-up (FU), 70.83% of patients responded to MCS. The preoperative VAS significantly decreased at the latest FU (8.83 ± 1.17 and 4.31 ± 2.05, respectively; p < 0.0001). Younger age (p = 0.0478) and a peripheral FP syndrome (p = 0.0006) positively affected the definitive implantation rate on univariate analysis. Younger age emerged as a factor strongly associated to a higher probability to go to a definitive MCS implant on multivariate analysis (p = 0.0415). Conclusion: Our results evidenced the effectiveness of MCS in treating FP. Moreover, the younger age emerged as a positive prognostic factor for definitive implantation. Further studies with longer FU are needed to better evaluate the long-term results of MCS.
Right Ventricular Dysfunction and Adverse Outcomes after Renal Transplantation
Authors: Joseph Megan S. , Tinney Francis , Naik Abhijit , Parasuraman Raviprasenna , Samaniego-Picota Milagros , Bhave Nicole M.
Published: April 2021

Introduction: Pulmonary hypertension is common among patients with end-stage renal disease, although data regarding the impact of right ventricular (RV) failure on postoperative outcomes remain limited. We hypothesized that echocardiographic findings of RV dilation and dysfunction are associated with adverse clinical outcomes after renal transplant. Methods: A retrospective review of adult renal transplant recipients at a single institution from January 2008 to June 2010 was conducted. Patients with transthoracic echocardiograms (TTEs) within 1 year leading up to transplant were included. The primary end point was a composite of delayed graft function, graft failure, and all-cause mortality. Results: Eighty patients were included. Mean follow-up time was 9.4 ± 0.8 years. Eight patients (100%) with qualitative RV dysfunction met the primary end point, while 39/65 patients (60.0%) without RV dysfunction met the end point (p = 0.026). Qualitative RV dilation was associated with a significantly shorter time to all-cause graft failure (p = 0.03) and death (p = 0.048). RV systolic pressure was not measurable in 45/80 patients (56%) and was not associated with outcomes in the remaining patients. Conclusion: RV dilation and dysfunction are associated with adverse outcomes after renal transplant. TTE assessment of RV size and function should be a standard part of the pre-kidney transplant cardiovascular risk assessment.
Reticulated Hyperpigmentation as a Sign of Lichen Planopilaris
Authors: Goldman Chloe , Williams Natalie M. , Tosti Antonella , Romanelli Paolo , Morrison Brian
Published: April 2021

Introduction: Reticulated hyperpigmentation is a relatively uncommon dermatologic pattern. It is used to describe brown-colored skin lesions that manifest in a lacy or net-like distribution. When a clinician encounters a patient with reticulated hyperpigmentation, its location is often the most helpful feature in establishing a differential diagnosis. As this pattern is rarely observed on the scalp, this site is currently not included in the diagnostic approach. Case Presentation: In this report, we present a case of lichen planopilaris (LPP) in a black man who presented with reticulated hyperpigmentation over the scalp. Conclusion: We suggest that it may be warranted to add LPP to the differential diagnosis of reticulated hyperpigmentation, especially when arising on the scalp of darker skinned individuals.
Enhanced Recovery after Surgery: Benefits for the Fetal Surgery Patient
Authors: Patino Mario , Tran Thien-Duy , Shittu Teniola , Owens-Stuberfield Margaret , Meador Marcie , Sanz Cortes Magdalena , Shamshirsaz Alireza A. , Espinoza Jimmy , Nassr Ahmed A. , Hassanpour Ali , Aina Titilopemi , Sutton Caitlin , Mann David , Whitehead William E. , Belfort Michael A. , Olutoye Olutoyin A.
Published: April 2021

Background: The fetoscopic approach to the prenatal closure of a neural tube defect (NTD) may offer similar advantages to the newborn compared to prenatal open closure of a NTD, with a reduction in maternal risks. Enhanced recovery after surgery (ERAS) protocols have been applied to different surgical procedures with documented advantages. We modified the perioperative care of patients undergoing in utero repair of myelomeningocele with the goal of enhancing the recovery. A retrospective study comparing traditional management to the ERAS protocol was conducted. Aims: Primary aim was to evaluate the length of stay (LOS). Secondary outcomes included pain scores, time to oral intake, opioid-induced side effects, and respiratory complications. Methods: Thirty patients who underwent a mid-gestation fetoscopic closure of a NTD were included. Data analyzed include demographics, comorbidities, LOS, anatomical location of the NTD, magnesium sulfate doses and duration of administration, oxygen requirements, duration of the postoperative epidural infusion, duration of surgery and anesthesia, incidence of postoperative nausea and vomiting, respiratory complications, time to oral intake, pain scores, and sedation scores. Differences between the treatment groups were compared using the independent sample t-test or Mann-Whitney Ʋ test. Results: Of the 30 patients, 10 patients were managed according to the ERAS protocol and 20 patients according to the traditional management (1:2 ratio). The mean gestational age at the time of intervention for the traditional and ERAS groups was 24.9 ± 0.5 weeks and 24.8 ± 0.5 weeks, respectively. Compared to the traditional group, the LOS was reduced in the ERAS group to 112.5 ± 12.6 h (4.7 ± 0.5 days) from 179.7 ± 87.9 h (7.5 ± 3.7 days) (p = 0.012). The time to oral intake was also shorter 502.6 ± 473.4 min versus 1015.6 ± 698.2 min; p = 0.049. Oxygen requirements were prolonged in the traditional group (1843.7 ± 1262.6 min vs. 1051.7 ± 1078.1 min p = 0.052). The total duration of magnesium sulfate was longer for patients in the traditional group (2125.6 ± 727.1 min vs. 1429.5 ± 553.8 min; p = 0.006). No statistically significant difference in pain scores was observed between the groups. Conclusions: Establishing an ERAS protocol for fetoscopic in utero repair of NTDs approach is feasible with the advantages of decreased postoperative LOS, reduced oxygen requirements, lower duration of magnesium sulfate infusion, and facilitation of earlier oral intake without compromising the pain scores.
Efficacy of Lutetium-Peptide Receptor Radionuclide Therapy in Inducing Prolonged Tumour Regression in Small-Bowel Neuroendocrine Tumours: A Case of Favourable Response to Retreatment after Initial Objective Response
Authors: Rinzivillo Maria , Prosperi Daniela , Bartolomei Mirco , Panareo Stefano , Iannicelli Elsa , Magi Ludovica , Panzuto Francesco
Published: April 2021

Introduction: The efficacy of 177Lu-Dotatate was shown in the NETTER-1 trial, an international, open-label, multicentre phase III clinical trial that evaluated the safety and efficacy of 177Lu-Dotatate in patients with well-differentiated, advanced midgut neuroendocrine tumours (NETs) with evidence of disease progression. Recently, retreatment with peptide receptor radionuclide therapy (PRRT) has been proposed as a valid therapeutic option in patients without other effective options who had responded to initial PRRT; however, data on this therapeutic option are still inadequate. Case Report: In this report, we present the case of a patient who achieved a delayed complete radiological response after initial 177Lu-Dotatate treatment and who had a complete tumour response with PRRT retreatment 5 years later. Conclusions: This case report shows that, although rare, a complete, prolonged tumour response may occur in patients with advanced small-bowel NETs receiving PRRT. Retreatment with PRRT may be a valid option in cases of subsequent disease recurrence.
Biomarker-Based Risk Prediction With the ABC-AF Scores in Patients With Atrial Fibrillation Not Receiving Oral Anticoagulation
Authors: Benz Alexander P. , Hijazi Ziad , Lindbäck Johan , Connolly Stuart J. , Eikelboom John W. , Oldgren Jonas , Siegbahn Agneta , Wallentin Lars
Published: April 2021

Background:

The novel ABC (Age, Biomarkers, Clinical History) scores outperform traditional risk scores for stroke, major bleeding, and death in patients with atrial fibrillation (AF) receiving oral anticoagulation. To refine their utility, the ABC-AF scores needed to be validated in patients not receiving oral anticoagulation.

Methods:

We measured plasma levels of the ABC biomarkers (N-terminal pro-B-type natriuretic peptide, cardiac troponin-T, and growth-differentiation factor 15) to apply the previously developed ABC-AF scores in patients with AF receiving aspirin (n=3195) or aspirin and clopidogrel (n=1110) in 2 large clinical trials. Calibration was assessed by comparing estimated with observed 1-year risks. Cox regression models were used for recalibration. Discrimination was evaluated separately for the aspirin-only and the overall cohort (n=4305).

Results:

The ABC-AF-stroke score yielded a c-index of 0.70 (95% CI, 0.67–0.73) in both cohorts. The ABC-AF-bleeding score had a c-index of 0.76 (95% CI, 0.71–0.81) in the aspirin-only cohort and 0.73 (95% CI, 0.69–0.77) overall. Both scores were superior to risk scores recommended by current guidelines. The ABC-AF-death score yielded a c-index of 0.78 (95% CI, 0.76–0.80) overall. Calibrated in patients receiving oral anticoagulation, the ABC-AF-stroke score underestimated and the ABC-AF-bleeding score overestimated the risk of events in both cohorts. These scores were recalibrated for prediction of absolute event rates in the absence of oral anticoagulation.

Conclusions:

The biomarker-based ABC-AF scores showed better discrimination than traditional risk scores and were recalibrated for precise risk estimation in patients not receiving oral anticoagulation. They can now provide improved decision support on treatment of an individual patient with AF.
Recommendations for the application and follow-up of quality controls in medical laboratories
Authors: Giannoli Jean-Marc , Cohen Richard , Vialle Jean-Michel , Vassault Anne , Siest Jean-Pascal , Scherrer Florian , Portugal Henri , Paris Mickaël , Kuentz Mathieu , Galinier Jean-Louis , Essemilaire Luc , Colard Nathalie , Cartier Régine , Bouilloux Jean-Pierre , Avellan Thierry , Albarede Stéphanie
Published: April 2021

This is a translation of the paper “Recommendations for the application and follow-up of quality controls in medical biology laboratories” published in French in the journal Annales de Biologie Clinique (Recommandations pour la mise en place et le suivi des contrôles de qualité dans les laboratoires de biologie médicale. Ann Biol Clin (Paris). 2019;77:577-97.). The recommendations proposed in this document are the result of work conducted jointly by the Network of Accredited Medical Laboratories (LABAC), the French Society of Medical Biology (SFBC) and the Federation of Associations for External Quality Assessment (FAEEQ). The different steps of the implementation of quality controls, based on a risk analysis, are described. The changes of reagent or internal quality control (IQC) materials batches, the action to be taken in case of non-conform IQC results, the choice of external quality assessment (EQA) scheme and interpretation of their results as well as the new issue of analyses performed on several automatic systems available in the same laboratory are discussed. Finally, the concept of measurement uncertainty, the robustness of the methods as well as the specificities of near-patient testing and rapid tests are described. These recommendations cannot apply for all cases we can find in medical laboratories. The implementation of an objective alternative strategy, supported with documented evidence, might be equally considered.
Comparison of hyaluronic acid in patients with rheumatoid arthritis, systemic sclerosis and systemic lupus erythematosus
Authors: Cylwik Bogdan , Gruszewska Ewa , Gindzienska-Sieskiewicz Ewa , Kowal-Bielecka Otylia , Chrostek Lech
Published: April 2021

The aim of the present study was to determine and compare the concentration of hyaluronic acid (HA) in rheumatoid arthritis (RA), systemic sclerosis (SSc) and systemic lupus erythematosus (SLE), and its correlation with parameters of disease activity and duration. The hypothesis was that HA should be increased in rheumatic diseases. We also expected that HA could be a marker of disease activity and inflammation in some of these diseases.
The study group comprised 149 patients with RA, SSc and SLE hospitalized in the Department of Rheumatology and Internal Diseases, Medical University of Bialystok (Bialystok, Poland) and 30 healthy controls. The concentrations of HA, C-reactive protein (CRP) and rheumatoid factor (RF) were measured using Architect ci8200; haemoglobin, platelets on Sysmex XS-800i; and erythrocyte sedimentation rate (ESR) on Sediplus S 2000 analysers. Statistical analysis was performed using Statistica 13.3 PL.
Hyaluronic acid was increased in RA, SLE and SSc when compared to controls (P < 0.001, P = 0.011, and P = 0.015, respectively). There were no differences in HA between rheumatic diseases (P = 0.840). Hyaluronic acid positively correlated with SLE activity (P = 0.025). In RA, HA positively correlated with ESR (P = 0.028) and CRP (P = 0.009). However, HA was not found to correlate with the duration of rheumatic diseases.
Hyaluronic acid concentration undergoes changes in rheumatic diseases with no difference between RA, SLE and SSc. In RA, HA concentration can be a marker of inflammation, while in SLE patients an indicator of disease activity.
Decision support system through automatic algorithms and electronic request in diagnosis of anaemia for primary care patients
Authors: Rodriguez-Borja Enrique , Díaz-Gimenez Macarena , Carratala Calvo Arturo , Vinyals-Bellido Inmaculada , Corchon-Peyrallo Africa , Hervas-Romero Ausias , Pozo-Giraldez Adela
Published: April 2021

An appropriate management of anaemia laboratory tests is crucial for a correct diagnosis and treatment. A non-sequential “shotgun” approach (where every anaemia related test is ordered) causes workload and cost increases and could be potentially harmful. We have implemented a Decision Support System through our laboratory information system (LIMS) based on reflexive algorithms and automatic generation of interpretative reports specifically in diagnosis of anaemia for primary care patients.
When a request contained an “Anaemia Suspicion Study” profile, more than twenty automatic reflexive rules were activated in our LIMS based upon laboratory results. These rules normally involved the addition of reflexive tests. A final report was automatically generated for each interpretation which was always reviewed for their validity by two staff pathologists. We measured the impact of this system in the ordering of most common anaemia related tests and if a proper treatment was established based on the interpretive report.
From all the studies performed, only 12% were positive being “iron deficiency” and “anaemia of chronic disease” the most frequent causes, 62% and 17%, respectively. Proper treatment was established in 88% of these anaemic patients. Total iron, transferrin, ferritin, folate and vitamin B12 demand decreased substantially after implementation representing a cost reduction of 40% only for these five tests.
Our system has easily improved patient outcomes, advising on individual clinical cases. We have also noticeably reduced the number of over-requested tests and laboratory costs.