bluuebunny/crossref_metadata_2025 huggingface dataset:
Resident Rotations in Low- and Middle-Income Countries
Authors: Donnelley Claire A. , Won Nae , Roberts Heather J. , von Kaeppler Ericka P. , Albright Patrick D. , Woolley Pierre Marie , Haonga Billy , Shearer David W. , Sabharwal Sanjeev
Published: July 2020

Introduction:

Interest in clinical rotations in low- and middle-income countries (LMICs) has grown among high-income country (HIC) orthopaedic residents. This study addresses the following questions: (1) What motivates HIC surgical residents to rotate in LMICs? (2) What is the impact of rotations on HIC residents? (3) What are the LMIC partner perceptions of HIC collaboration?

Materials and Methods:

A search strategy of multiple databases returned 3,740 unique articles pertaining to HIC surgical resident motivations for participating in rotations in LMICs or the LMIC host perspective. Data extraction was dually performed using meta-ethnography, the qualitative equivalent of meta-analysis.

Results:

Twenty-one studies were included in the final analysis. HIC residents were primarily motivated to rotate in LMICs by altruistic intent, with greatest impact on professional development. LMIC partners mostly valued HIC sustained investment and educational opportunities for LMIC partners. From LMIC's perspective, potential harm from collaboration arose from system-level and individual-level discordance between HIC and LMIC expectations and priorities. HIC priorities included the following: (1) adequate operative time, (2) exposure to varied pathology, and (3) mentorship. LMIC priorities included the following: (1) avoiding competition with HIC residents for surgical cases, (2) that HIC groups not undermine LMIC internal authority, (3) that HIC initiatives address local LMIC needs, and (4) that LMIC partners be included as authors on HIC research initiatives. Both HIC and LMIC partners raised ethical concerns regarding collaboration and perceived HIC residents to be underprepared for their LMIC rotation.

Discussion:

This study synthesizes the available literature on HIC surgical resident motivations for and impact of rotating in LMICs and the LMIC host perception of collaboration. Three improvement categories emerged: that residents (1) receive site-specific preparation before departure, (2) remain in country long enough to develop site-specific skills, and (3) cultivate flexibility and cultural humility. Specific suggestions based on synthesized data are offered for each concept and can serve as a foundation for mutually beneficial international electives in LMICs for HIC orthopaedic trainees.
Coding Basics and Guidelines for Musculoskeletal Office Evaluation and Management
Authors: Hinckley Nathaniel , Davidson James , Henley M. Bradford , Davidson Jered R. , McIntyre Louis , Chhabra Anikar
Published: July 2020

» In documenting a patient encounter, the orthopaedic evaluation consists of 3 key components: “History,” “Physical Examination,” and “Medical Decision-Making.”

» The level of service coded must be supported by the complexity of the problem, the care provided, and the documentation of the encounter.

» Determining whether the patient is new or established is the first step in the evaluation and management (E/M) process and relies on same-practice/same-specialty rules.

» Careful attention must be paid to documentation and coding to allow for appropriate care of the patient and efficient use of the orthopaedist’s time. The available step-by-step guidelines include all necessary criteria to accomplish this.

» Continue to monitor for the U.S. Centers for Medicare & Medicaid Services (CMS) changes to stay up-to-date on changes in the guidelines.
Molecular epidemiological surveillance of Africa and Asia imported malaria in Wuhan, Central China: comparison of diagnostic tools during 2011–2018
Authors: Xie Yiting , Wu Kai , Cheng Weijia , Jiang Tingting , Yao Yi , Xu Mingxing , Yang Yan , Tan Huabing , Li Jian
Published: July 2020

Background: Malaria remains a serious public health problem globally. As the elimination of indigenous malaria continues in China, imported malaria has gradually become a major health hazard. Well-timed and accurate diagnoses could support the timely implementation of therapeutic schedules, reveal the prevalence of imported malaria and avoid transmission of the disease.Methods: Blood samples were collected in Wuhan, China, from August 2011 to December 2018. All patients accepted microscopy and rapid diagnosis test (RDT) examinations. Subsequently, each of the positive or suspected positive cases was tested for four human-infectious Plasmodium species by using 18S rRNA-based nested PCR and Taqman probe-based real-time PCR. The results of the microscopy and the two molecular diagnostic methods were analysed. Importation origins were traced by country, and the prevalence of Plasmodium species was analysed by year.Results: A total of 296 blood samples, including 288 that were microscopy and RDT positive, 7 RDT and P. falciparum positive, and 1 suspected case, were collected and reanalysed. After application of the two molecular methods and sequencing, 291 cases including 245 P. falciparum, 15 P. vivax, 20 P. ovale, 6 P. malariae and 5 mixed infections (3 P. falciparum + P. ovale, 2 P. vivax + P. ovale) were confirmed. These patients had returned from Africa (95.53%) and Asia (4.47%). Although the prevalence displayed a small-scale fluctuation, the overall trend of the imported cases increased yearly. Conclusions: These results emphasize the necessity of combined utilization of the four tools for malaria diagnosis in clinic and in field surveys of potential risk regions worldwide including Wuhan.
Mutation spectrum and biochemical features in infants with neonatal Dubin-Johnson syndrome
Authors: Kim Kwang Yeon , Kim Tae Hyeong , Seong Moon-Woo , Park Sung Sup , Moon Jin Soo , Ko Jae Sung
Published: July 2020

Background: Dubin-Johnson syndrome (DJS) is an autosomal recessive disorder presenting as isolated direct hyperbilirubinemia.DJS is rarely diagnosed in the neonatal period. The purpose of this study was to clarify the clinical features of neonatal DJS and to analyze the genetic mutation of adenosine triphosphate-binding cassette subfamily C member 2 (ABCC2).Methods: From 2013 to 2018, 135 infants with neonatal cholestasis at Seoul National University Hospital were enrolled. Genetic analysis was performed by neonatal cholestasis gene panel. To clarify the characteristics of neonatal DJS, the clinical and laboratory results of 6 DJS infants and 129 infants with neonatal cholestasis from other causes were compared.Results: A total of 8 different ABCC2 variants were identified among the 12 alleles of DJS. The most common variant was p.Arg768Trp (33.4%), followed by p.Arg100Ter (16.8%). Three novel variants were identified (p.Gly693Glu, p.Thr394Arg, and p.Asn718Ser). Aspartate transaminase (AST) and alanine transaminase (ALT) levels were significantly lower in infants with DJS than in infants with neonatal cholestasis from other causes. Direct bilirubin and total bilirubin were significantly higher in the infants with DJS.Conclusions: We found three novel variants in 6 Korean infants with DJS. When AST and ALT levels are normal in infants with neonatal cholestasis, genetic analysis of ABCC2 permits an accurate diagnosis.
Three-dimensional versus two-dimensional derived strain echocardiography for assessing right ventricular myocardial deformation in patients with chronic left ventricular heart failure: A proof-of-concept study
Authors: Gao Fei , Liu Chong , Guo Qiang , Jiang Shuang-quan , Wang Zhen-zhen , Liu Li , Li Hai-Ru , Du Guo-Qing , Tian Jia-wei
Published: July 2020

Background: A novel three-dimensional echocardiography (3DE)-derived strain analysis software specialized for right ventricular (RV) monitoring is emerging that could definitely evaluate RV free wall and interventricular septum longitudinal strain. The aim of this study was to compare the diagnostic performance in evaluating RV function between 3DE and two-dimensional echocardiography (2DE)-derived longitudinal strain. Methods: Echocardiographic examinations were performed in 82 patients with RV dysfunction associated with chronic left-sided heart failure and 40 control subjects. RV dysfunction was defined as a 3DE-derived RV ejection fraction (EF) <45%. Both 2DE and 3DE-derived strain analyses were performed in all the patients to measure the longitudinal strain of RV. Results: 3DE-derived peak systolic longitudinal strain of RV free wall (RV-fwLS) was significantly lower in patients with RV dysfunction compared to control subjects (-14.0±4.1 vs. -26.7±4.7%; p<0.001), and it correlated well with cardiac magnetic resonance-derived RVEF (r=0.74, p<0.001). On receiver operator characteristic analysis, a 3DE-derived RV-fwLS cutoff value of >-21.1% was most useful in identifying patients at higher risk of RV dysfunction (sensitivity: 90% and specificity: 85%), also higher than 2DE-derived strain parameters. Additionally, RV dysfunctional patients with pulmonary hypertension (PH) had significantly reduced 3DE-derived RV-fwLS value than the subgroup without PH (-13.1±3.8 vs. -15.0±4.2; p<0.05). Conclusion：Assessment of impaired RV systolic function by 3DE-derived longitudinal strain is better than 2DE in patients with chronic left-sided heart failure. 3DE-derived strain analysis specialized for RV should be considered as a complementary tool for assessing RV function.
Transcriptome Analysis Reveals the Long Intergenic Noncoding RNAs Contributed to Skeletal Muscle Differences between Yorkshire and Tibetan Pig
Authors: Huang Ziying , Li Qianqian , Li Mengxun , Li Changchun
Published: July 2020

Background

The difference between the skeletal muscle growth rates of Western and domestic breeds is remarkable, but the potential regulatory mechanism involved is still unclear. Numerous studies have pointed out that long intergenic noncoding RNA (lincRNA) plays a key role in skeletal muscle development. This study used published Yorkshire (LW) and Tibetan pig (TP) transcriptome data to explore the possible role of lincRNA in the difference in skeletal muscle development between the two breeds.

Results

Through differential expression analysis, 138 differentially expressed lincRNAs (DELs) were obtained between the two breeds, and their potential target genes (PTGs) were predicted. The results of Gene Ontology and pathway analysis revealed that PTGs are involved in multiple biological processes and pathways related to muscle development. The quantitative trait loci (QTLs) of DELs were predicted, and the results showed that most QTLs are related to muscle development. Finally, we constructed a co-expression network between muscle development related PTGs (MDRPTGs) and their corresponding DELs on the basis of their expression levels. The expression of DELs was significantly correlated with the corresponding MDRPTGs. Also, multiple MDRPTGs are involved in the key regulatory pathway of muscle fiber hypertrophy, which is the IGF-1-AKT-mTOR pathway.

Conclusions

In summary, multiple lincRNAs that may cause differences in skeletal muscle development between the two breeds were identified, and their possible regulatory roles were explored. The findings of this study may provide a valuable reference for further research on the role of lincRNA in skeletal muscle development.
[18F]FEPPA Pet Imaging for Monitoring CD68 Positive Microglia/Macrophage Neuroinflammation in Nonhuman Primates
Authors: Zammit Matthew , Tao Yunlong , Olsen Miles , Metzger Jeanette , Vermilyea Scott , Bjornson Kathryn , Slesarev Maxim , Block Walter , Fuchs Kerri , Phillips Sean , Bondarenko Viktorya , Zhang Su-Chun , Emborg Marina , Christian Brad
Published: July 2020

Purpose: The aim of this study was to examine whether the translocator protein 18-kDa (TSPO) PET ligand [18F]FEPPA has the sensitivity for detecting changes in CD68 positive microglial/macrophage activation in hemiparkinsonian rhesus macaques treated with allogeneic grafts of induced pluripotent stem cell-derived midbrain dopaminergic neurons (iPSC-mDA).Methods: In vivo positron emission tomography (PET) imaging with [18F]FEPPA was used in conjunction with postmortem CD68 immunostaining to evaluate neuroinflammation in the brains of hemiparkinsonian rhesus macaques (n = 6) that received allogeneic iPSC-mDA grafts in the putamen ipsilateral to MPTP administration. Results: Based on assessment of radiotracer uptake and confirmed by visual inspection of the imaging data, nonhuman primates with allogeneic grafts showed increased [18F]FEPPA binding at the graft sites relative to the contralateral putamen. From PET asymmetry analysis of the images, the mean asymmetry index of the monkeys was AI = -0.085 ± 0.018. Evaluation and scoring of CD68 immunoreactivity by an investigator blind to the treatment identified significantly more neuroinflammation in the grafted areas of the putamen compared to the contralateral putamen (p = 0.0004). [18F]FEPPA PET AI showed a positive correlation with CD68 immunoreactivity AI ratings in the monkeys (Spearman’s ρ = 0.94; p = 0.005). Conclusion: These findings reveal that [18F]FEPPA PET is an effective marker for detecting increased CD68 positive microglial/macrophage activation and demonstrate sufficient sensitivity to detect changes in neuroinflammation in vivo following allogeneic cell engraftment.
Cost-utility Analysis of Extensile Lateral Approach Versus Sinus Tarsi Approach in Sanders type II/III Calcaneus Fractures
Authors: Li Zihua , Wu Xinbo , Zhou Haichao , Xu Shaochen , Xiao Fajiao , Huang Hui , Yang Yunfeng
Published: July 2020

Background. Extensile lateral approach had been recognized as the gold standard technique for displaced intra-articular calcaneus fractures (DIACFs) while sinus tarsi approach had been increasingly valued by surgeons and comparative clinical outcome was shown in both techniques. Appropriate decisions could be made by the clinicians with the help of cost-utility analysis (CUA) about optimal healthcare for type II/III calcaneus fracture.Method. A single-center, retrospective study was conducted in which basic characteristics, clinical outcomes and health care costs of 109 patients had been obtained and analyzed. Changes in health-related quality of life (HRQoL) scores, validated by EuroQol five-dimensional-three levels (EQ-5D-3L), were used to enumerate quality-adjusted life-years (QALYs). Cost-effectiveness was determined by the incremental cost per QALY.Results. 109 patients were enrolled in our study including 62 in the ELA group and 47 in the STA group. There were no significant differences between these two groups in mean total cost, laboratory and radiographic evaluation expense, surgery, anesthesia and antibiotic expense. The expense of internal fixation materials ($3289.0 ± 543.9) versus ($2630.6 ± 763.7) and analgesia ($145.8 ± 85.6) versus ($102.9 ± 62.7) in ELA group were significantly higher than in the STA group (P＜.001, P=.008, respectively). Visual Analogue Scale (VAS) scores showed significant difference at postoperative 3 and 5 days (P＜.001). American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and the Bohlers’ and Gissane angle showed no significant differences between the two groups before and after the operation. The cost-effectiveness ratios of ELA and STA were $8766.8±2835.2/QALY and $7914.9 ± 1822.0/QALY respectively and incremental cost-effectiveness ratio (ICERs) of ELA over STA was $32110.00/QALY, but both showed no significant difference.Conclusion. Both ELA and STA techniques are effective operative procedures for the patients with calcaneus fracture. Moreover, STA seems to be more reasonable for its merits including less postoperative pain, and less expense of analgesia as well as internal fixation materials.
Exploring Determinants of Hand Hygiene among Hospital nurses: a qualitative study
Authors: Ghaffari Mohtasham , Rakhshanderou Sakineh , Safari-Moradabadi Ali , Barkati Hassan
Published: July 2020

Background: The present research is a qualitative one aiming to determine factors affecting hand-hygiene behavior of the nursing staff in Shariati Hospital of Tehran, Iran.Methods: This was a qualitative study performed using content analysis approach. Considering the aim of the study, 16 in-depth semi-structured interviews were held with the nursing staff of Shariati Hospital of Tehran University of Medical Sciences. A convenient sampling was performed and continued until data saturation and until no new codes and categories were obtained. Data were analyzed through a qualitative content analysis based on the Graham and landsman method. Directed qualitative content analysis was done in order to analyze the data. Results: The results of this study revealed 3 main themes in the Theory of Planned Behavior (TPB) (attitude, subjective norms and perceived behavioral control) and 8 main themes in the outside the framework (environment, perceptions, life style, morality, education, organizational culture, salience and personality). Conclusion: Due to the other factors also found in this study, an integration of theories and models for designing of interventions is recommended to increase adherence to hand hygiene behavior.
Clinicopathological study of mixed cryoglobulinemic glomerulonephritis secondary to Hepatitis B virus infection
Authors: LI CHAO , LI HANG , SU WEI , WEN YU-BING , YE WEI , YE WEN-LING , CAI JIAN-FANG , QIN XU-ZHEN , LI XUE-MEI , LI XUE-WANG
Published: July 2020

BackgroundCryoglobulinemic glomerulonephritis (CryoGn) caused by hepatitis B virus (HBV) infection was rarely reported. Our study aimed to investigate the clinical features, renal pathology findings, and prognosis in patients with HBV related CryoGn. Methods This was a retrospective study including seven Chinese patients with HBV related CryoGn in a tertiary referral hospital from April 2016 to March 2019. The clinical and pathological data were collected and analyzed.Results Age at renal biopsy was 47±12 years, with female/male ration 3/4. Urine protein was 5.6(3.0, 6.6) g/d and five cases presented with nephrotic syndrome. The baseline eGFR was 23.5 (20.2, 46.3) ml/min per 1.73m2. The extrarenal manifestations included purpura (n=6), arthralgia (n=1), peripheral neuropathy (n=1), and cardiomyopathy (n=1). Six cases had type II cryoglobulinemia with IgMκ, the other one had type III. The median cryocrit was 4.0 (1.0, 15.0) %. Renal pathologic findings on light microscopy: endocapillary proliferative glomerulonephritis (Gn) (n=3), membranoproliferative Gn (n=3), and mesangial proliferative Gn (n=1). On immunofluorescence microscopy, the predominant type of immunoglobulin deposits was IgM(n=5). HBsAg and HBcAg deposits were found in one case. Ultrastructural studies showed granular subendothelial and mesangial electron-dense deposits in all patients and microtubules in one case. All patients received antiviral medications. They were given corticosteroid alone (n=2) or combined with cyclophosphamide (n=4) or mycophenolate mofetil (n=1). Two patients received plasmapheresis. The median follow-up time was 18 (6, 37) months. Four patients got remission, two patients died of pneumonia, and one progressed to end-stage renal disease (ESRD). At endpoint of follow-up, 24hUP was 2.1 (0.8-5.2) g/d, and eGFR was 55.3 (20.7, 111.8) ml/min per 1.73m2. The median cryocrit decreased to 1.0 (0, 5.75) %.ConclusionsThe etiology of mixed CryoGn should be screened for HBV infection. Endocapillary proliferative Gn and membranoproliferative Gn were the common pathologic patterns. Diagnosis and treatment in early-stage benefit patients’ renal outcomes. Immunosuppressive therapy should be considered for severe renal disease, based on efficient antiviral therapy.
Idiographic analyses of motivation and related processes in participants with schizophrenia following a therapeutic intervention for negative symptoms
Authors: Thonon Bénédicte , Aubel Evelyne Van , Lafit Ginette , Libera Clara Della , Laroi Frank
Published: July 2020

Background : Motivational negative symptoms hinder quality of life and daily functioning of individuals with schizophrenia spectrum disorders. A recently developed intervention, Switch, has shown promising effects on negative symptoms and functional outcomes. Switch targets multiple cognitive, emotional and behavioural processes associated with motivation and goal directed behaviours. We aimed to investigate its effects on motivation and associated processes in a naturalistic setting, and to explore the dynamics between the processes. Methods : We used a single case approach ( n = 3), with a pre-post and follow-up assessment design, which also included ambulatory assessments (experience sampling method, ESM; and step count). We computed autoregressive lag 1 models to evaluate the effects of the intervention on daily motivation levels and related processes, descriptive pie-charts, and vector autoregressive modelling to reveal the dynamics of the processes over time. Results : The intervention was beneficial for each participant according to traditional evaluations of motivational negative symptoms, apathy, daily functioning and quality of life. The effects on the ESM variables revealed distinct outcomes for each individual. The dynamics between the various processes differed between participants, and fluctuated within participants (when comparing baseline, intervention phase, and follow-up). Conclusions : This study used an innovative approach to look at the effectiveness of an intervention. The intervention seems to lead to meaningful improvements in motivational negative symptoms and functional outcomes. The mechanisms of change need to be further investigated.
Blinding in electric current stimulation in subacute neglect patients with current densities of 0.8 A/m²: A cross-over pilot study
Authors: Gorsler Anna , Grittner Ulrike , Külzow Nadine , Rackoll Torsten
Published: July 2020

Objective Neglect after stroke is a disabling disorder and its rehabilitation is a major challenge. Transcranial direct current stimulation (tDCS) seems to be a promising adjuvant technique to improve standard care neglect therapy. Since electric fields are influenced by age-related factors higher current densities are probably needed for effective treatment in aged stroke patients. The validation of treatment efficacy requires sham-controlled experiments but increased current densities might comprise blinding. Therefore, we conducted a pilot study to test sham adequacy when using current density of 0.8 A/m2. Whether especially neglect patients who mainly suffer from perceptual and attentional deficits are able to differentiate beyond chance active from sham tDCS was investigated in a cross-over design (active/sham stimulation, randomized order) in 12 early subacute patients with left-sided hemineglect. Stimulation was performed simultaneous to standard care neglect therapy with 0.8 A/m². Progress of neglect symptomatology was also monitored during inpatient rehabilitation.Results Higher odds of correct guessing an active tDCS condition compared to wrongly judge an active tDCS condition as sham stimulation (Odds ratio 10.00, 95%CI: 0.65 - 154.40, p = 0.099) were observed. Therefore, blinding success remains debatable in neglect studies with current densities of 0.8 A/m² and still warrants further investigation.
Reactional Ultrasonic Systems And Microwave Irradiation For Pretreatment Of Agro-Industrial Waste To Increase Enzymatic Activity
Authors: Czapela Fabiane Fernanda , Kubeneck Simone , Preczeski Karina Paula , Dalastra Caroline , Scapini Thamarys , Bonatto Charline , Stefanski Fábio Spitza , Camargo Aline Frumi , Zanivan Jessica , Mossi Altemir José , Fongaro Gislaine , Treichel Helen
Published: July 2020

Pretreatment of keratinous residues using an ultrasonic reaction system provides greater enzymatic production in less time. This is a promising technology for measuring enzyme activity and microwave processes. In the present work, an ultrasonic probe reaction system was used to evaluate the potential of swine hair pretreatment. The pretreated material was submerged with non-pretreated residues for 9 days to obtain the enzyme. Enzyme activity was measured in the extracts obtained using the ultrasonic probe, ultrasonic bath, and microwave. We also used the enzymatic concentration technique with NaCl and acetone. Homemade enzymatic extracts were evaluated for their ability to degrade swine hair and chicken feathers by comparing them with the activities commercial enzymes. Macrobeads gave greater energy dissipation in less time, providing greater enzyme activity (50.8 U/mL over 3 days). In terms of waste degradation, non-pretreated swine hair was more promising. The ultrasonic probe reaction system had the potential to evaluate increased enzyme activity (38.4% relative activity) and the enzyme concentration increased activity by 53.5%. The homemade enzymatic extract showed promise for degradation of keratinous residues.
The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China
Authors: Shi Jianwei , Jin Hua , Shi Leiyu , Chen Chen , Ge Xuhua , Lu Yuan , Zhang Hanzhi , Wang Zhaoxin , Yu Dehua
Published: July 2020

Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs should strengthen first contact (utilization), first contact (accessibility) and coordination (referral system) aspects of primary care performance. However, all CHCs should improve coordination (information system).
Alpha-1 antitrypsin deficient individuals have circulating extracellular vesicles with profibrogenic cargo
Authors: Khodayari Nazli , Oshins Regina , Holliday Shannon , Clark Virginia , Xiao Qiang , Marek George , Mehrad Borna , Brantly Mark
Published: July 2020

Alpha-1 antitrypsin deficiency (AATD)-mediated liver disease is a toxic “gain-of-function” inflammation in the liver associated with intracellular retention of mutant alpha-1 antitrypsin. The clinical presentation of the disease includes fibrosis, cirrhosis and liver failure. However, the pathogenic mechanism of AATD-mediated liver disease is not well understood. Here, we investigated the role of plasma extracellular vesicles (EVs) in progression of AATD-mediated liver disease. EVs were isolated from plasma of AATD individuals with liver disease and healthy controls. Their cytokines and miRNA content were examined by multiplex assay and small RNA sequencing. We have found that AATD individuals have a distinct population of EVs with pathological cytokine and miRNA contents. Human hepatic stellate cells (HSCs) were then treated with EVs isolated from control or AATD plasma samples. When HSCs were cultured with AATD plasma derived-EVs, the expression of genes related to the development of fibrosis were significantly amplified compared to those treated with healthy control plasma EVs. In conclusion, AATD individuals have a distinct population of EVs with abnormal cytokine and miRNA contents and the capacity to activate HSCs and mediate fibrosis. Better understanding of the components which cause liver inflammation and fibrogenesis, leading to further liver injury, has the potential to lead to the development of new treatments or preventive strategies to prevent AATD-mediated liver disease.
From a PMT-based to a SiPM-based PET system: a study to define matched acquisition/reconstruction parameters and NEMA performance of the Biograph Vision 450
Authors: Carlier Thomas , Ferrer Ludovic , Conti Maurizio , Bodet-Milin Caroline , Rousseau Caroline , Bercier Yanic , Bendriem Bernard , Kraeber-Bodéré Francoise
Published: July 2020

Background The purpose of this work was to propose an approach based on noise measurement to adapt present clinical acquisition and reconstruction parameters adapted to a PMT-based system (Biograph mCT) to a SiPM-based system (Biograph Vision 450) sharing identical geometrical properties. The NEMA performance (NEMA) of the recently released Biograph Vision 450 PET/CT (Vision) was also derived. Methods All measurements were conducted on Vision and Biograph mCT with TrueV (mCT). A full NEMA-based performance was derived for Vision only. The adaptation of acquisition and reconstruction parameters from mCT to Vision was done using the NEMA image quality phantom. The noise level reached using mCT was set as the reference value for six different numbers of net true coincidences. The noise level computed using Vision was matched to the reference noise level (within 0.01%) using a different reconstruction set-up to determine the potential reduction of counts numbers for the same noise level. Results Vision sensitivity was 9.1 kcps/MBq for a timing resolution of 213 ps at 5.3 kBq/mL. The NEMA-based CR for the 10mm sphere was better than 75% regardless the reconstruction set-up studied. The mCT reference noise properties could be achieved using Vision with a scan time reduction (STR) of 1.34 with four iterations and a 440×440 matrix size (or STR=1.89 with a 220×220 matrix size) together with a 3D CR improvement of 53% for the 10mm sphere (24% using 220×220). Conclusion The Vision exhibited improved NEMA performances compared to mCT. Using the proposed approach, the time acquisition could be divided by almost two, while keeping the same noise properties as that of mCT with a marked improvement of contrast recovery.
Clinical practice guidelines and experts’ consensuses of traditional Chinese herbal medicine for novel coronavirus (COVID-19): protocol of a systematic review
Authors: Li Yuxi , Li Juan , Zhong Dongling , Zhang Yue , Zhang Yonggang , Guo Yan , Clarke Mike , Jin Rongjiang
Published: July 2020

Background: The World Health Organization declared on 11 March 2020 that the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) has escalated from epidemic into pandemic. As the initial outbreak area, China has taken multiple active measures to deal with the epidemic. Updated versions of diagnosis and treatment guideline for novel coronavirus (COVID-19) patients have been issued, and traditional Chinese herbal medicine has been recommended as a treatment. The objective of this study will be to summarize the recommendations in current clinical practice guidelines about the use of traditional Chinese herbal medicine for COVID-19 patients. We will also evaluate and report on the methodological and reporting quality of these guidelines.Methods: In this systematic review, we will search for guidelines, expert consensuses and policy documents published since December 2019 in electronic databases (e.g. PubMed, EMBASE, and Chinese databases) and on websites of governments or organizations (e.g. The National Guideline Clearinghouse [NGC], Guidelines International Network [GIN], National Institute for Health and Clinical Excellence (NICE), Scottish Intercollegiate Guidelines Network [SIGN] and WHO]). Eligible documents will be independently selected, and relevant data will be independently extracted by two reviewers. We will also independently evaluate the methodological quality and reporting quality of the included guidelines, using the Appraisal of Guidelines for REsearch & Evaluation (AGREE) II tool and Reporting Items for Practice Guidelines in healthcare (RIGHT) statement, respectively. Any discrepancies will be discussed and resolved through discussion among the reviewers. We will use the extracted information to summarize their recommendations for traditional Chinese herbal formulae and Chinese patent medicine for COVID-19 patients, and to summarize the strength and quality of these recommendations with reference to the results of AGREE II and RIGHT tools.Discussion: This review will summarize the recommendations in current clinical practice guidelines and provide insight into the implementation strategies for traditional Chinese herbal medicine in COVID-19 patients. Systematic review registration: PROSPERO registration number: CRD42020179205
A clinical trial of Nicergoline to prevent temporary threshold shift
Authors: KLAMKAM PANA , Pagcharoenpol Rongrat , Treesaranuwattana Treewit , Silpsrikul Pichayen , Jaruchinda Pariyanan , Wasuwat Piyalarp
Published: July 2020

Background: In Thailand, military personnel attending the annual firing practice are at risk for noise-induced hearing loss (NIHL). Nowadays, hearing protection devices have been approved to prevent NIHL. Furthermore, N-acetyl-cysteine, Vitamin B12 or Magnesium were proved to be effective against temporary threshold shift (TTS). However, limited research regarding the effectiveness of nicergoline on preventing TTS has been reported. Methods: A randomized controlled trial was conducted. Two hundred twenty-four participants were evaluated for general physical status, hearing threshold levels and blood chemistry. After the inform consent form was explained and signed, the participants were divided into 2 groups. Nicergoline 30 mg twice daily intake was prescribed to the study group (n=119) for 3 weeks. The placebo was prescribed to the control group (n=105) for 3 weeks, as well. At the end of the second week, they had to attend the firing practice. All participants had to wear the silicone ear plugs. In addition, the audiometry was measured within 48 hours after the end of the firing practice. Moreover, aural symptoms (tinnitus and aural fullness) and the side effects of the medication were recorded. Results: TTS was detected in both groups 14 ears – 10 ears from the control group and 4 ears from the study group (p=0.075). The post-firing practice audiometry showed that the average hearing threshold levels of the study group significantly improved than that of the control group across all frequencies (p<0.05). Moreover, the audiometry from the control group worsened at 250 and 6K Hz (p<0.05). The duration of tinnitus and aural fullness in the study group occurred over a shorter period than that in the control group. Conclusion: The TTS was found in both groups without statistical significant differences. The effectiveness of nicergoline from the study demonstrated tinnitus reduction after the firing practice. Furthermore, the hearing threshold significantly improved in the study group.
A robust eleven-genes prognostic model can predict overall survival in bladder cancer patients based on five cohorts
Authors: Lin Jiaxing , Yang Jieping , Xu Xiao , Wang Yutao , Yu Meng , Zhu Yuyan
Published: July 2020

Background: Bladder cancer is the tenth most common cancer globally, but existing biomarkers and prognostic models are limited. Method: In this study, we used four bladder cancer cohorts from The Cancer Genome Atlas and Gene Expression Omnibus databases to perform univariate Cox regression analysis to identify common prognostic genes. We used the least absolute shrinkage and selection operator regression to construct a prognostic Cox model. Kaplan-Meier analysis, receiver operating characteristic curve, and univariate / multivariate Cox analysis were used to evaluate the prognostic model for the four cohorts. Finally, a co-expression network, CIBERSORT, and ESTIMATE algorithm were used to explore the mechanism related to the model. Results: A total of 11 genes were identified from the four cohorts to construct the prognostic model, including eight risk genes (SERPINE2, PRR11, DSEL, DNM1, COMP, ELOVL4, RTKN, and MAPK12) and three protective genes (FABP6, C16orf74, and TNK1). The 11-genes model could stratify the risk of patients in all five cohorts, and the prognosis was worse in the group with a high-risk score. The area under the curve values of the five cohorts in the first year are all greater than 0.65. Furthermore, this model's predictive ability is stronger than that of age, gender, grade, and T stage. Through the weighted co-expression network analysis, the gene module related to the model was found, and the key genes in this module were mainly enriched in the tumor microenvironment. B cell memory showed low infiltration in high-risk patients. Furthermore, in the case of low B cell memory infiltration and high-risk score, the prognosis of the patients was the worst. Conclusion: The proposed eleven-genes model is a promising biomarker for estimating overall survival in bladder cancer. This model can be used to stratify the risk of bladder cancer patients, which is beneficial to the realization of individualized treatment.
WITHDRAWN: Analysis of the effectiveness of wound closure techniques among surgeons and emergency physicians in Mecca Hospitals: Retrospective Cohort Study.
Authors: Felemban Jeehad Mansour , Binyaseen Kenan , Almalki Waleed , Altowairqi Fahad , Sakhakhini Amer , Alharbi Ziyad
Published: July 2020

Objective: Wound suturing is a procedure performed at many medical specialties. This study aims to analyze the effectiveness of wound closure techniques by recognizing the common suturing techniques and materials used in different types of wounds among surgeons and emergency physicians in Mecca hospitals and assessing their awareness about the factors contributing to scars formation and improper wound healing.Result: Choosing the simple interrupted technique exceeded 50% among all other types of studied wounds. The other most common techniques among participants were the subcuticular and vertical mattress, respectively, also using stapler was limited to some wound types. This study showed a high level of awareness among participants with significant p-values (P<0.05) of Strongly agree and Agree regarding the essential factors affecting wound healing and scars formation. The result gives an insight into the most common suture techniques and materials used in wound closure. There are wide variations in selecting these techniques and materials among the participants. Also, it showed that there is good awareness among participants about factors that lead to scar formation.
The prognostic link between metabolic syndrome and the different breast cancer molecular subtypes: a case control study.
Authors: Chen Yi zuo , Zhou Yu ying , Chen En dong , Hu Di shuang , Shao Xuan , Cai Ye Feng , You Jie
Published: July 2020

Background Metabolic syndrome (MetS) is an important factor related to the poor prognosis of breast cancer (BC). Molecular heterogeneity in the tumor may affect the consequence of BC. The main purpose of this study was to assess the prognostic link between MetS and the different BC molecular subtypes.

Methods A total of 960 patients with BC were recruited from January 2010 to June 2014. The relationship between MetS and disease prognosis was assessed by using univariate and multivariate analyses.

Results At recruitment, MetS was diagnosed in 199 patients (20.7%). The mean follow-up period was 68.5 months (range, 2–103 months). MetS remained significantly associated with 64% increased risk of recurrence (Hazard Ratio (HR)=1.64; 95% confidence interval (CI) 1.19–2.27, P<0.01) and twofold increased risk of mortality (HR=2.02, 95% CI 1.29–3.16, P<0.01) according to multivariate analysis. By reviewing BC molecular subtypes, the significant associations remained in the subsets of Luminal A (HR=3.1, 95% CI 1.28–4.57, P=0.01), Luminal B (Her2-negative) (HR=3.3, 95% CI 1.31–8.33, P=0.01), and Her-2-positive (non-Luminal) (HR=2.2, 95% CI 1.10–4.39, P=0.03).

Conclusions MetS was significantly related to unfavorable prognosis in operable BC, especially in the subgroup of Luminal A. More studies are needed to definitively determine which factors influence the association of MetS with Luminal A subtype.
The stem cell transcription factor SOX2 is essential for astrocyte maturation and controls animal hyperactive behavior
Authors: Zhang Sheng , Lan Zhaohui , Wang Yan , Kim Bokyung , Guo Fuzheng
Published: July 2020

Children with SOX2-deficiency develop anophthalmia/microphthalmia and display neurological impairment. Here we report an essential role for astroglial SOX2 in brain anomalies and neurological defects. Sox2-deficiency inhibited postnatal astrocyte maturation without affecting astroglial proliferation and population expansion. Mechanistically, we found that SOX2 directly bound to a cohort of astrocytic signature genes such as those involving in glutamate transport and that Sox2-deficiency remarkably reduced glutamate transporter expression and compromised astrocyte function of glutamate uptake. Behaviorally, astroglial Sox2-deficient mice developed hyperactivity in locomotion while their motor skills, social capability, and learning abilities were unaffected. We found that astroglial Sox2-deficiency results in elevated glutamatergic synapse formation and elevated excitability of striatal medium spiny neurons, which has been shown to trigger hyperactive locomotion. Our study provides new insights into the biological mechanisms underlying brain defects in children with SOX2 mutations and unveils a novel connection between astrocyte SOX2 and brain development and behavior.
Therapeutic activity of sarpogrelate, and dopamine D2 receptor agonists on cardiovascular and renal systems in alloxan-induced diabetic rats
Authors: Fouad Mohamed , Latif Hekma A. Abd El , Galal May , Yamani Mohammed El , Hassaneen Sherifa , Masoaad Raneem
Published: July 2020

Background Dopamine D2 agonists are notable medications in the treatment of Parkinsonism, hyperprolactinemia, and hyperglycemia. An affiliation showed between the enlistment of myocardial injury ailment and long haul treatment with dopamine D2 agonist drugs identified with the partial initiation of 5-HT 2a receptors.Methods The investigation aims to represent the activity of sarpogrelate, a particular 5-HT (2A) receptor blocker, in diminishing myocardial injury prompted by extended haul utilization of D2 agonist drugs in diabetic rodents. Both bromocriptine and cabergoline managed independently and combined with sarpogelate for about a month to diabetic nephropathy rats.Results Bromocriptine and cabergoline created a significant reduction in BGL, BP, and kidney hypertrophy index in diabetic nephropathy rats. Administration of bromocriptine, cabergoline, alone, or in combination with sarbogrelate fundamentally diminished blood concentrations of ALP, AST, urea, and creatinine. Bromocriptine and cabergoline alone showed noteworthy ascending of LDH-1, Troponin I, and TNFα1 levels in the serum (p < 0.05). Paradoxically, utilizing bromocriptine and cabergoline with sarpogrelate treatment altogether diminished the degree of the myocardial biomarkers in the serum. A mix of bromocriptine or cabergoline with sarpogrelate diminished the level of the myocardial infarct size in the heart assessed utilizing the TTC staining method.Conclusions The examination exhibited that both bromocriptine and cabergoline could be utilized securely in blend with sarpogrelate for a long duration of treatment for diseases like hypertension and diabetes.
Relationship Between Integrin β1 (ITGB1), β3 (ITGB3) and Intracerebral Hemorrhage (ICH)
Authors: Ma Hai-Yang , Xu Yan , Qiao Chun-You , Peng Yi , Ding Qi , Wang Li-Zhong , Yan Jun-Fei , Hou Yuan , Di Fei
Published: July 2020

Background: Intracerebral hemorrhage (ICH) is fatal and detrimental to quality of life. Clinically, options for monitoring are often limited, potentially missing subtle neurological changes especially in low-grade patients. This study explored the relationship between expression of integrin β1 (ITGB1), β3 (ITGB3) in intracerebral hemorrhage (ICH) to analyze their functional and clinical relevance. Methods: The expression of ITGB1 and ITGB3 in ICH was accomplished by immunohistochemical (IHC) staining and western blotting (WB) analysis, respectively. Results: Furthermore, the results demonstrated that TGB1 was expressed in ICH tissues, but ITGB3 was not expressed in ICH tissues.Conclusions: In summary, the clinical progression of ICH was related to the expression of ITGB1. ITGB1 may be a potential biomarker and contribute to the treatment of ICH.
Targeted Protein Liposomes-Mediated AChE Gene Therapy for Effective Liver Cancer Treatment
Authors: Wang Kai , Shang Fusheng , Chen Dagui , Jiao Jianpeng , Cao Tieliu , Wang Xiaowei , He Shengli , Liang Xiaofei
Published: July 2020

The development of highly efficient non-viral gene vector systems has very important application value in the field of cancer therapy. The high protein content of proteolipids allows for high biocompatibility, low immunogenicity, and surface modification of proteins to confer more targeted drug/gene function. For the first time, this study selected transferrin, which has hepatocellular carcinoma cell targeting function, with a liposome backbone material to construct transferrin liposome (Tf-PL), and load acetylcholinesterase (AChE) therapeutic gene for in vitro and in vivo functions evaluation. The results showed that the Tf-PL transfection efficiency was higher than that of commercial Lipo 2000, low cytotoxicity and targeted ability to liver cancer SMMC-7721 cells. After tail vein injection, Tf-PL/AChE can effectively target to liver cancer, significantly inhibiting the growth of liver cancer xenografts in nude mice, prolonging the survival time of tumor-bearing nude mice, and also does not cause significant systemic toxicities. Our study provides a strategy for proteolipids targeting the transferrin receptor to carry therapeutic gene therapy for tumors. This method has strong tumor affinity and can provide an effective vector selection for precise tumor therapy.
Patterns of Informal Family Care During Acute Hospitalization of Older Adults from Different Ethno-Cultural Groups in Israel.
Authors: Shulyaev Ksenya , Gur-Yaish Nurit , Shadmi Efrat , Zisberg Anna
Published: July 2020

Introduction Informal caregiving during hospitalization of older adults is significantly related to hospital processes and patient outcomes. Studies in the home settings demonstrate that ethno-cultural background is related to various aspects of informal caregiving; however, this association in the hospital setting was insufficiently researched.Objectives Our study looked for differences between ethno-cultural groups in the amount and kind of informal support they provided for older adults during hospitalization.Methods This study is a secondary data analysis of two cohort studies conducted in Israeli hospitals. Hospitalized older adults were divided into three groups: Israeli-born and veteran immigrant Jews, Arabs, and Jewish immigrants from the Former Soviet Union (FSU).Results Informal caregivers of “FSU immigrants” stayed less hours during the day in both cohorts, were less present during the night in study 1, and provided less supervision of medical care in study 2, in comparison to the two other groups. Findings from study 1 also suggested that informal caregivers of “Arab” older adults were more likely to stay during the night in comparison to the two other groups.Conclusion Ethno cultural groups differ in terms of the patterns of caregiving older adults during hospitalization. Health care professionals should be aware of these patterns and the cultural norms that are related to caregiving practices for better cooperation between informal and formal caregivers of older adults.