bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of direct water injection and injector configurations on performance and emission characteristics of a gasoline direct injection engine: A computational fluid dynamics analysis
Authors: Raut Ankit A , Mallikarjuna J M
Published: December 2019

In-cylinder water injection is a promising approach for reducing NOx and soot emissions from internal combustion engines. It allows one to use a higher compression ratio by reducing engine knock; hence, higher fuel economy and power output can be achieved. However, water injection can also affect engine combustion and emission characteristics if water injection and injector parameters are not properly set. Majority of the previous studies on the water injection are done through experiments. Therefore, subtle aspects of water injection such as in-cylinder interaction of water sprays, spatial distribution of water vapor, and effect on flame propagation are not clearly understood and rarely reported in literature due to experimental limitations. Thus, in the present article, a computational fluid dynamics investigation is carried out to analyze the effects of direct water injection under various injector configurations on water evaporation, combustion, performance, and emission characteristics of a gasoline direct injection engine. The emphasis is given to analyze in-cylinder water spray interactions, flame propagation, water spray droplet size distribution, and water vapor spatial distribution inside the engine cylinder. For the study, the water-to-fuel ratio is varied from 0 to 1. Various water injector configurations using nozzle hole diameters of 0.14, 0.179, and 0.205 mm, along with nozzle holes of 4, 5, 6, and 7, are considered for comparison in addition to the case of no_water. Computational fluid dynamics models used in this study are validated with the available data in literature. From the results, it is found that the emission and performance characteristics of the engine are highly dependent on water evaporation characteristics. Also, the water-to-fuel ratio of 0.6 with 6 number of nozzle holes and the nozzle diameter of 0.14 mm results in the highest indicated mean effective pressure and the lowest NOx, soot, and CO emissions compared to other cases considered.
Emerging Roles for Microglial Phagocytic Signaling in Epilepsy
Authors: Wyatt-Johnson Season K. , Brewster Amy L.
Published: December 2019

Microglia are the resident immune cells and professional phagocytes of the central nervous system. However, little is known about the contribution of their phagocytic signaling to the neuropathology and pathophysiology of epilepsy. Here, we summarize and discuss the implications of recent evidence supporting that aberrant microglia phagocytic activity and alterations in phagocytosis signaling molecules occur in association with microglia–neuronal contacts, neuronal/synaptic loss, and spontaneous recurrent seizures in human and preclinical models of epilepsy. This body of evidence provides strong support that the microglial contribution to epileptogenic networks goes beyond inflammation, and suggests that phagocytic signaling molecules may be novel therapeutic targets for epilepsy.
Focus on the Focus
Authors: Ewell Laura A.
Published: December 2019

[Box: see text]
Templating in shoulder arthroplasty – A comparison of 2D CT to 3D CT planning software: A systematic review
Authors: Olaiya Oluwatobi R , Nadeem Ibrahim , Horner Nolan S , Bedi Asheesh , Leroux Timothy , Alolabi Bashar , Khan Moin
Published: December 2019

Background

Computed tomography (CT) utilizing computer software technology to generate three-dimensional (3D) rendering of the glenoid has become the preferred method for preoperative planning. It remains largely unknown what benefits this software may have to the intraoperative placement of the components and patient outcomes.

Purpose

The purpose of this systematic review is to compare 2D CT to 3D CT planning in total shoulder arthroplasty.

Study design

Systematic review.

Methods

A systematic database search was conducted for relevant studies evaluating the role of 3D CT planning in total shoulder arthroplasty. The primary outcome was component placement variability, and the secondary outcomes were intra- and inter-observer reliability in the context of preoperative planning.

Results

Following title-abstract and full-text screening, six eligible studies were included in the review (n = 237). The variability in glenoid measurements between 3D CT and 2D CT planning ranged from no significant difference to a 5° difference in version and 1.7° difference in inclination (p<0.05). Posterior bone loss was underestimated in 52% of the 2D measured patients relative to 3D CT groups. Irrespective of 2D and 3D planning (39% and 43% of cases respectively), surgeons elected to implant larger components than those templated. There was no literature identified comparing differences in time, cost, functional outcomes, complications, or patient satisfaction.

Conclusion

The paucity of evidence exploring clinical parameters makes it difficult to comment on clinical outcomes using different methods of templating. More studies are required to identify how improved radiographic outcomes translate into improvements that are clinically meaningful to patients.
Radiographic Value of the Lisfranc Diastasis in a Standardized Population
Authors: Thomas James L. , Kopiec Adam , Mark Kunkel , Chandler L. Mae
Published: December 2019

Introduction. Injury to the Lisfranc’s joint, in particular to the second metatarsal–medial cuneiform (second MMC) joint, can be difficult to evaluate, especially in subtle Lisfranc injuries. The purpose of this study was to determine the value of the Lisfranc joint width (diastasis) of the adult foot in a standardized population thereby establishing a potential reference range when investigating this area for potential injury. Methods. The 2nd MMC joint in 50 men and 50 women was evaluated. Individuals with a history of foot/ankle pain, previous foot/ankle operation or fracture, or a history of systemic disease were excluded from the study. Bilateral weightbearing digital anterior-posterior and lateral radiographs were taken using a standardized method. Results. The mean 2nd MMC diastasis in 200 feet was 5.6 mm (95% CI 5.39-5.81). In the female population, the mean 2nd MMC diastasis was 5.8 mm (95% CI 5.51-6.09) as compared with 5.6 mm (95% CI 5.31-5.89) in males. The mean distance between the fifth metatarsal base and first cuneiform in the entire study population was 16.3 mm (95% CI 15.57-17.03). Conclusion. This study helps define baseline measurements of the Lisfranc joint for the general population, which can provide a standard measurement against which suspected foot injuries can be compared.

Level of Evidence: Level IV.
Socioeconomic Characteristics of Songbird Shop Owners in West Kalimantan, Indonesia
Authors: Miller Adam E. , Gary Demi , ansyah Juhardi , Sagita Novia , Muflihati  , Kartikawati  , Adirahmanta Sadtata N.
Published: December 2019

The songbird trade in Indonesia is a major driver of avian species loss. Songbird traders represent the link between trappers and consumers for this lucrative industry, though details on the dynamics of this relationship remain understudied. To understand why songbird shop owners entered the trade, if businesses were lucrative, and assess owner receptiveness to adopting alternative businesses, we investigated socioeconomic characteristics of 95 songbird shop owners via an interview-style survey across 13 regencies in West Kalimantan. Responses from shop owners showed a widespread lack of legal permitting for businesses and the sale of bird species. Indeed, the majority of respondents (63%) did not have the mandatory business permits, which suggests that nonwildlife regulatory laws could be leveraged to reduce the volume of the illegal songbird trade in West Kalimantan. Nearly half of all respondents (40%) noted that bird trading was not their sole income source, nor was it particularly lucrative. More than half (55%) of all bird traders interviewed expressed interest in switching to alternative businesses if given the resources and opportunity to do so. This study offers novel insights into motives of engaging in songbird trade in West Kalimantan. This study also supports the possibility of addressing the songbird trade via a combination of law enforcement and alternative business programs.
Customer learning trajectories when using a product for the first time
Authors: Monnot Elisa
Published: December 2019

Several studies in marketing research focus on learning costs in product usage linked to the acquisition of declarative and procedural knowledge in this context. Yet, the learning process itself and the ways customers actually learn to use products have received little attention. This research explores the dynamics of the customer’s learning experience and its heterogeneity in the case of the first use of a product, using Kolb’s experiential learning circle. The results of a qualitative study with filmed observations and interviews identify four customer learning paths, enriching this model. Based on these customer learning paths, the article proposes recommendations to improve business strategies in terms of customer training and product use assistance.
‘Kexue Wenhua’ in Chinese and ‘Scientific Culture’, ‘Science Culture’, ‘Culture of Science’ and ‘Science as Culture’ in English: The Meanings and the Structure
Authors: Zhang Yiming , Zhang Zengyi
Published: December 2019

The Chinese phrase kexue wenhua is a combined translation of science (equivalent to kexue) in a narrow sense and culture (equivalent to wenhua) in a narrow sense. In fact, kexue wenhua has multiple meanings (captured in four English phrases: ‘scientific culture’, ‘science culture’, ‘culture of science’ and ‘science as culture’), which confuse Chinese scholars greatly. This paper explores the diverse meanings of kexue wenhua. After tracing the sources of the four English phrases and studying some academic works of Western scholars, we have found that ‘scientific culture’ focuses on science's relationship with the scientific community, science education or science literacy; ‘science culture’ focuses on the establishment and application of the science culture index; the ‘culture of science’ focuses on its relationship with science communication; and ‘science as culture’ focuses on its research approaches and social significance. Based on this analysis, we propose a new four-layer structure for kexue wenhua, which comprises the cultural layers of material state, of system, of behaviour, and of mind. In this structure, material state is the basis, mind is the core, behaviour is the circulatory system, and the system is the framework.
The Process of Establishing a Special Class for the Gifted Young at the University of Science and Technology of China
Authors: He Haohua , Zhang Zhihui
Published: December 2019

The Special Class for the Gifted Young (SCGY) is an educational model created by the University of Science and Technology of China (USTC) during a special historical period. It aims at selecting and cultivating young talent in the natural sciences. Significantly, the establishment of the SCGY in 1978 marked the beginning of higher education reform in China after the ‘Cultural Revolution’ (1966–1976) and promoted the development of education. Currently, there are only a few general descriptions of how the SCGY was established. In research for this paper, we used many sources, including archives, personal diaries and interview records, to uncover the process leading to the establishment of the SCGY. We also investigated the reason why the SCGY was first established at USTC.
Insights from China for a Global Perspective on a Responsible Science–society Relationship
Authors: Dijkstra Anne M , Yin Lin
Published: December 2019

Ensuring that science meets the needs of society and does so responsibly is a key aim of current European policymaking. Under the label of ‘responsible research and innovation’, European Union projects, such as the NUCLEUS project, have been funded to both study and stimulate practices for the development of responsible science–society relationships. The NUCLEUS project aims to define a broader cultural, international and enriched perspective on what a responsible science–society relationship entails. In this paper, findings from a comparative case study in China are presented. Practices are analysed at the conceptual, governmental, institutional and individual levels. Our findings show that social responsibility is the key to the science–society relationship, and that science popularization is a means to enhance scientific literacy.
Science Communication in the Debate about ‘Poison’ in Traditional Chinese Medicine
Authors: Yue Liyuan , Liu Bing
Published: December 2019

At the end of 2017, research revealed that herbal remedies containing aristolochic acid may cause liver cancer. This triggered a wide debate on ‘poison’ in traditional Chinese medicine. The popular TV show A Bite of China 3 also put the safety issue of traditional Chinese medicines as tonic food in the spotlight of public opinion. In fact, there are many misunderstandings about poison in descriptions of food safety and medicine safety on the internet and WeChat. From the perspective of science communication, our understanding of poison and its uses should transcend the monism of Western science.
Leadership and work engagement: Exploring explanatory mechanisms
Authors: Decuypere Anouk , Schaufeli Wilmar
Published: December 2019

Construct proliferation in the leadership field raises questions concerning parsimony and whether we should focus on joint mechanisms of leadership styles, rather than the differences between them. In this theoretical research article, we propose that positive leadership styles translate into similar leader behaviors on the work floor that influence employee work engagement through a number of shared pathways. We take a deductive approach and review several established theories as well as relevant up-to-date empirical work from a bird’s-eye view to generate a general framework. We introduce a model with three processes (one direct process and two indirect processes) and five pathways (practical, motivational, affective, cognitive, and behavioral). With regard to the indirect processes, we propose that work characteristics (material pathway) and psychological need satisfaction (intrapersonal motivational pathway) mediate the relationship between positive leadership styles and engagement. Regarding the direct interpersonal process, we propose that leaders directly influence employee engagement through three pathways: emotional contagion (affective interpersonal pathway), social exchange (cognitive interpersonal pathway), and role modeling (behavioral interpersonal pathway). Our parsimonious research model furthers the integration of different theoretical viewpoints as well as underscores joint mechanisms with regard to the effect of positive leadership styles. Practically speaking, this article also provides insight into which processes leaders can work on to stimulate employee work engagement through progressive policies and work practices.
Integrative analysis of spontaneous CLL regression highlights genetic and microenvironmental interdependency in CLL
Authors: Kwok Marwan , Oldreive Ceri , Rawstron Andy C. , Goel Anshita , Papatzikas Grigorios , Jones Rhiannon E. , Drennan Samantha , Agathanggelou Angelo , Sharma-Oates Archana , Evans Paul , Smith Edward , Dalal Surita , Mao Jingwen , Hollows Robert , Gordon Naheema , Hamada Mayumi , Davies Nicholas J. , Parry Helen , Beggs Andrew D. , Munir Talha , Moreton Paul , Paneesha Shankara , Pratt Guy , Taylor A. Malcolm R. , Forconi Francesco , Baird Duncan M. , Cazier Jean-Baptiste , Moss Paul , Hillmen Peter , Stankovic Tatjana
Published: December 2019

Spontaneous regression is a recognized phenomenon in chronic lymphocytic leukemia (CLL) but its biological basis remains unknown. We undertook a detailed investigation of the biological and clinical features of 20 spontaneous CLL regression cases incorporating phenotypic, functional, transcriptomic, and genomic studies at sequential time points. All spontaneously regressed tumors were IGHV-mutated with no restricted IGHV usage or B-cell receptor (BCR) stereotypy. They exhibited shortened telomeres similar to nonregressing CLL, indicating prior proliferation. They also displayed low Ki-67, CD49d, cell-surface immunoglobulin M (IgM) expression and IgM-signaling response but high CXCR4 expression, indicating low proliferative activity associated with poor migration to proliferation centers, with these features becoming increasingly marked during regression. Spontaneously regressed CLL displayed a transcriptome profile characterized by downregulation of metabolic processes as well as MYC and its downstream targets compared with nonregressing CLL. Moreover, spontaneous regression was associated with reversal of T-cell exhaustion features including reduced programmed cell death 1 expression and increased T-cell proliferation. Interestingly, archetypal CLL genomic aberrations including HIST1H1B and TP53 mutations and del(13q14) were found in some spontaneously regressing tumors, but genetic composition remained stable during regression. Conversely, a single case of CLL relapse following spontaneous regression was associated with increased BCR signaling, CLL proliferation, and clonal evolution. These observations indicate that spontaneously regressing CLL appear to undergo a period of proliferation before entering a more quiescent state, and that a complex interaction between genomic alterations and the microenvironment determines disease course. Together, the findings provide novel insight into the biological processes underpinning spontaneous CLL regression, with implications for CLL treatment.
Prevalence of fluoroquinolone resistance and mutations in the gyrA, parC and parE genes of Riemerella anatipestifer isolated from ducks in China
Authors: Zhu Dekang , Zheng Mingyu , Xu Jinge , Wang Mingshu , Jia Renyong , Chen Shun , Liu Mafeng , Zhao Xinxin , Yang Qiao , Wu Ying , Zhang Shaqiu , Huang Juan , Liu Yunya , Zhang Ling , Yu Yanling , Pan Leichang , Chen Xiaoyue , Cheng Anchun
Published: December 2019

Background

Riemerella anatipestifer is one of the most serious infectious disease-causing pathogens in the duck industry. Drug administration is an important method for prevention and treatment of infection in duck production, leading to widespread drug resistance in R. anatipestifer.

Methods

For a total of 162 isolates of R. anatipestifer, the MICs were determined for a quinolone antimicrobial agent, namely, nalidixic acid, and three fluoroquinolones, namely, ciprofloxacin, enrofloxacin and ofloxacin. The gyrA, parC, and parE gene fragments were amplified by PCR to identify the mutation sites in these strains. Site-directed mutants with mutations that were detected at a high frequency in vivo were constructed (hereafter referred to as site-directed in vivo mutants), and the MICs of these four drugs for these strains were determined.

Results

In total, 100, 97.8, 99.3 and 97.8% of the 137 R. anatipestifer strains isolated between 2013 and 2018 showed resistance to nalidixic acid, ciprofloxacin, enrofloxacin, and ofloxacin, respectively. The high-frequency mutation sites were detected in a total of 162 R. anatipestifer strains, such as Ser83Ile and Ser83Arg, which are two types of substitution mutations of amino acid 83 in GyrA; Val799Ala and Ile811Val in ParC; and Val357Ile, His358Tyr, and Arg541Lys in ParE. MIC analysis results for the site-directed in vivo mutants showed that the strains with only the Ser83Ile mutation in GyrA exhibited an 8–16-fold increase in MIC values, and all mutants showed resistance to ampicillin and ceftiofur.

Conclusions

The resistance of R. anatipestifer to quinolone agents is a serious problem. Amino acid 83 in GyrA is the major target mutation site for the fluoroquinolone resistance mechanism of R. anatipestifer.
QTL identification for seed weight and size based on a high-density SLAF-seq genetic map in peanut (Arachis hypogaea L.)
Authors: Zhang Shengzhong , Hu Xiaohui , Miao Huarong , Chu Ye , Cui Fenggao , Yang Weiqiang , Wang Chunming , Shen Yi , Xu Tingting , Zhao Libo , Zhang Jiancheng , Chen Jing
Published: December 2019

Background

The cultivated peanut is an important oil and cash crop grown worldwide. To meet the growing demand for peanut production each year, genetic studies and enhanced selection efficiency are essential, including linkage mapping, genome-wide association study, bulked-segregant analysis and marker-assisted selection. Specific locus amplified fragment sequencing (SLAF-seq) is a powerful tool for high density genetic map (HDGM) construction and quantitative trait loci (QTLs) mapping. In this study, a HDGM was constructed using SLAF-seq leading to identification of QTL for seed weight and size in peanut.

Results

A recombinant inbred line (RIL) population was advanced from a cross between a cultivar ‘Huayu36’ and a germplasm line ‘6–13’ with contrasting seed weight, size and shape. Based on the cultivated peanut genome, a HDGM was constructed with 3866 loci consisting of SLAF-seq and simple sequence repeat (SSR) markers distributed on 20 linkage groups (LGs) covering a total map distance of 1266.87 cM. Phenotypic data of four seed related traits were obtained in four environments, which mostly displayed normal distribution with varied levels of correlation. A total of 27 QTLs for 100 seed weight (100SW), seed length (SL), seed width (SW) and length to width ratio (L/W) were identified on 8 chromosomes, with LOD values of 3.16–31.55 and explaining phenotypic variance (PVE) from 0.74 to 83.23%. Two stable QTL regions were identified on chromosomes 2 and 16, and gene content within these regions provided valuable information for further functional analysis of yield component traits.

Conclusions

This study represents a new HDGM based on the cultivated peanut genome using SLAF-seq and SSRs. QTL mapping of four seed related traits revealed two stable QTL regions on chromosomes 2 and 16, which not only facilitate fine mapping and cloning these genes, but also provide opportunity for molecular breeding of new peanut cultivars with improved seed weight and size.
Emergent airway management outside of the operating room – a retrospective review of patient characteristics, complications and ICU stay
Authors: Yoon Uzung , Mojica Jeffrey , Wiltshire Matthew , Segna Kara , Block Michael , Pantoja Anthony , Torjman Marc , Wolo Elizabeth
Published: December 2019

Background

Emergent airway management outside of the operating room is a high-risk procedure. Limited data exists about the indication and physiologic state of the patient at the time of intubation, the location in which it occurs, or patient outcomes afterward.

Methods

We retrospectively collected data on all emergent airway management interventions performed outside of the operating room over a 6-month period. Documentation included intubation performance, and intubation related complications and mortality. Additional information including demographics, ASA-classification, comorbidities, hospital-stay, ICU-stay, and 30-day in-hospital mortality was obtained.

Results

336 intubations were performed in 275 patients during the six-month period. The majority of intubations (n = 196, 58%) occurred in an ICU setting, and the rest 140 (42%) occurred on a normal floor or in a remote location. The mean admission ASA status was 3.6 ± 0.5, age 60 ± 16 years, and BMI 30 ± 9 kg/m2. Chest X-rays performed immediately after intubation showed main stem intubation in 3.3% (n = 9). Two immediate (within 20 min after intubation) intubation related cardiac arrest/mortality events were identified. The 30-day in-hospital mortality was 31.6% (n = 87), the overall in-hospital mortality was 37.1% (n = 102), the mean hospital stay was 22 ± 20 days, and the mean ICU-stay was 14 days (13.9 ± 0.9, CI 12.1–15.8) with a 7.3% ICU-readmission rate.

Conclusion

Patients requiring emergent airway management are a high-risk patient population with multiple comorbidities and high ASA scores on admission. Only a small number of intubation-related complications were reported but ICU length of stay was high.
A comparison of methods to estimate the survivor average causal effect in the presence of missing data: a simulation study
Authors: McGuinness Myra B. , Kasza Jessica , Karahalios Amalia , Guymer Robyn H. , Finger Robert P. , Simpson Julie A.
Published: December 2019

Background

Attrition due to death and non-attendance are common sources of bias in studies of age-related diseases. A simulation study is presented to compare two methods for estimating the survivor average causal effect (SACE) of a binary exposure (sex-specific dietary iron intake) on a binary outcome (age-related macular degeneration, AMD) in this setting.

Methods

A dataset of 10,000 participants was simulated 1200 times under each scenario with outcome data missing dependent on measured and unmeasured covariates and survival. Scenarios differed by the magnitude and direction of effect of an unmeasured confounder on both survival and the outcome, and whether participants who died following a protective exposure would also die if they had not received the exposure (validity of the monotonicity assumption). The performance of a marginal structural model (MSM, weighting for exposure, survival and missing data) was compared to a sensitivity approach for estimating the SACE. As an illustrative example, the SACE of iron intake on AMD was estimated using data from 39,918 participants of the Melbourne Collaborative Cohort Study.

Results

The MSM approach tended to underestimate the true magnitude of effect when the unmeasured confounder had opposing directions of effect on survival and the outcome. Overestimation was observed when the unmeasured confounder had the same direction of effect on survival and the outcome. Violation of the monotonicity assumption did not increase bias. The estimates were similar between the MSM approach and the sensitivity approach assessed at the sensitivity parameter of 1 (assuming no survival bias). In the illustrative example, high iron intake was found to be protective of AMD (adjusted OR 0.57, 95% CI 0.40–0.82) using complete case analysis via traditional logistic regression. The adjusted SACE odds ratio did not differ substantially from the complete case estimate, ranging from 0.54 to 0.58 for each of the SACE methods.

Conclusions

On average, MSMs with weighting for exposure, missing data and survival produced biased estimates of the SACE in the presence of an unmeasured survival-outcome confounder. The direction and magnitude of effect of unmeasured survival-outcome confounders should be considered when assessing exposure-outcome associations in the presence of attrition due to death.
Patient involvement in assessing consultation quality: validation of patient enablement instrument (PEI) in Lithuanian general practice
Authors: Skarbalienė Aelita , Jurgutis Arnoldas , Strandberg Eva Lena , Pawlikowska Teresa
Published: December 2019

Background

The Patient Enablement Instrument (PEI) was designed to encapsulate consultation outcome from the perspective that increasing their understanding and coping ability would underpin a positive consultation outcome for patients. The objective of the study was the validation of the PEI in Lithuanian general practice and comparison of Lithuanian patients’ enablement with previous studies in Europe to see if factors associated with patient enablement in Lithuania were reflective of those in the previous studies.

Methods

The Patient Enablement Instrument was translated into Lithuanian and included in the questionnaire along with the questions about a person’s health, reasons for visiting the doctor and feeling about the consultation. Practices from 4 different municipalities that are situated in different geographical regions which have both town and rural areas were sampled randomly. Patients scheduled consecutively aged 18 years or more were the subjects of the study. The data analyses focused on internal reliability and concept validity.

Results

The overall mean patient enablement score was 6.43. Enablement scores declined with increasing patient age, and female patients were more enabled. Patients with biomedical problems had the highest enablement results, while patients with complex problems had the lower results. Enablement was positively related to receiving a prescription and knowing a doctor, and negatively related to wish having consultation with another doctor.

Conclusions

This study substantiates the rationality of using PEI in assessing primary care consultations in Lithuania. The correlations of enablement largely reflect the situation in Western and Central Europe: longer consultation and access to the same physician increases patient enablement.
Different imaging patterns of PCNSL and IVL: a case report
Authors: Jeon Seung-Ho , Kang Mi-Kyoung , Lee Seung Jae , Shin Byoung-Soo , Kang Hyun Goo
Published: December 2019

Background

Primary central nervous system lymphoma (PCNSL) is a rare, malignant, non-Hodgkin’s lymphoma of the brain, leptomeninges, and rarely the spinal cord. PCNSL has characteristic magnetic resonance imaging (MRI) findings, and effective treatment strategies are available. It is characterized predominately by neurological symptoms, which are caused by tumor infiltration into the nervous system as well as ischemia. Chemotherapy is an effective treatment, if started prior to the ischemic damage.

Case presentation

A 62-year-old male patient with PCNSL presented with altered mental status. The initial brain MRI revealed high signal intensity on the T2-weighted images (T2WIs) of the putamen area of the right basal ganglia, and the clinical symptoms improved after steroid administration. However, the symptoms were later deteriorated, we considered the possibility of autoimmune encephalitis and, consequently, conducted an immunomodulatory therapy. In a follow-up brain MRI, enlargement lesions of T2WI in basal ganglia and pons were simultaneously enhanced. Subsequently, the patient’s mental status deteriorated to a semi-coma and PCNSL was diagnosed after a surgical biopsy. Chemotherapy was started immediately; however, the patient died.

Conclusions

Effective treatments are available for PCNSL and intravascular lymphoma; thus, their prognosis is generally good if they are diagnosed early. Herein, we report the case of a patient suspected with autoimmune encephalitis after brain MRI and treated with immunomodulation therapy. However, PCNSL was confirmed by a surgical biopsy. It is, therefore recommended to consider lymphoma in patients with neurological symptoms that are difficult to localize and rapidly progressive enhancing lesions showing a mass effect on brain MRI.
Tumor suppressor HIC1 is synergistically compromised by cancer-associated fibroblasts and tumor cells through the IL-6/pSTAT3 axis in breast cancer
Authors: Sun Xueqing , Qu Qing , Lao Yimin , Zhang Mi , Yin Xiaoling , Zhu Huiqin , Wang Ying , Yang Jie , Yi Jing , Hao Mingang
Published: December 2019

Abstracts

Background

Interleukin-6 (IL-6) is commonly highly secreted in the breast cancer (BrCA) microenvironment and implicated in disease development. In this study, we aimed to determine the role of the IL-6/pSTAT3/HIC1 axis in the breast cancer microenvironment, including in cancer-associated fibroblasts (CAFs) and breast cancer cells.

Methods

Stromal fibroblasts from the breast cancer tissue were isolated, and the supernatants of the fibroblasts were analyzed. Recombinant human IL-6 (rhIL-6) was applied to simulate the effect of CAF-derived IL-6 to study the mechanism of HIC1 (tumor suppressor hypermethylated in cancer 1) downregulation. IL-6 was knocked down in the high IL-6-expressing BrCA cell line MDA-MB-231, which enabled the investigation of the IL-6/pSTAT3/HIC1 axis in the autocrine pathway.

Results

Increased IL-6 was found in the supernatant of isolated CAFs, which suppressed HIC1 expression in cancer cells and promoted BrCA cell proliferation. After stimulating the BrCA cell line SK-BR-3 (where IL-6R is highly expressed) with rhIL-6, signal transducers and activators of transcription 3 (STAT3) was found to be phosphorylated and HIC1 decreased, and a STAT3 inhibitor completely rescued HIC1 expression. Moreover, HIC1 was restored upon knocking down IL-6 expression in MDA-MB-231 cells, accompanied by a decrease in STAT3 activity.

Conclusions

These findings indicate that IL-6 downregulates the tumor suppressor HIC1 and promotes BrCA development in the tumor microenvironment through paracrine or autocrine signaling.
Comparing biological information contained in mRNA and non-coding RNAs for classification of lung cancer patients
Authors: Smolander Johannes , Stupnikov Alexey , Glazko Galina , Dehmer Matthias , Emmert-Streib Frank
Published: December 2019

Background

Deciphering the meaning of the human DNA is an outstanding goal which would revolutionize medicine and our way for treating diseases. In recent years, non-coding RNAs have attracted much attention and shown to be functional in part. Yet the importance of these RNAs especially for higher biological functions remains under investigation.

Methods

In this paper, we analyze RNA-seq data, including non-coding and protein coding RNAs, from lung adenocarcinoma patients, a histologic subtype of non-small-cell lung cancer, with deep learning neural networks and other state-of-the-art classification methods. The purpose of our paper is three-fold. First, we compare the classification performance of different versions of deep belief networks with SVMs, decision trees and random forests. Second, we compare the classification capabilities of protein coding and non-coding RNAs. Third, we study the influence of feature selection on the classification performance.

Results

As a result, we find that deep belief networks perform at least competitively to other state-of-the-art classifiers. Second, data from non-coding RNAs perform better than coding RNAs across a number of different classification methods. This demonstrates the equivalence of predictive information as captured by non-coding RNAs compared to protein coding RNAs, conventionally used in computational diagnostics tasks. Third, we find that feature selection has in general a negative effect on the classification performance which means that unfiltered data with all features give the best classification results.

Conclusions

Our study is the first to use ncRNAs beyond miRNAs for the computational classification of cancer and for performing a direct comparison of the classification capabilities of protein coding RNAs and non-coding RNAs.
The treatment of a hypertrophic bleb after XEN gel implantation with the “Drainage Channel with sutures” method: a case report
Authors: Yavuzer Kamil , Meşen Ali
Published: December 2019

Background

The placement of a XEN gel stent is an ab-interno, minimally invasive glaucoma surgery which provides a subconjunctival drainage pathway and decreases intraocular pressure (IOP).

Case presentation

A 75-year-old male patient who had undergone XEN45 gel implantation after phacoemulsification and intraocular lens implantation appealed to the clinic. A filtration bleb was seen that extended through the nasal 180 degrees of the eye which caused ectropion of the lower eyelid. The value of the IOP was 12 mm Hg (mmHg). By the “Drainage Channel with Sutures” method this complication was effectively treated. As with every new method, there is a lack of knowledge about long-term outcomes in terms of effectiveness, technique and complications.

Conclusion

The “Drainage Channel with Sutures” method has not been described in the literature yet. By this minimal invasive method, hypertrophic bleb complication of XEN gel implant has been successfully treated.
Integrating HIV, syphilis, malaria and anaemia point-of-care testing (POCT) for antenatal care at dispensaries in western Kenya: discrete-event simulation modelling of operational impact
Authors: Young N. , Taetgmeyer M. , Zulaika G. , Aol G. , Desai M. , Ter Kuile F. , Langley I.
Published: December 2019

Background

Despite WHO advocating for an integrated approach to antenatal care (ANC), testing coverage for conditions other than HIV remains low and women are referred to distant laboratories for testing. Using point-of-care tests (POCTs) at peripheral dispensaries could improve access to testing and timely treatment. However, the effect of providing additional services on nurse workload and client wait times are unknown. We use discrete-event simulation (DES) modelling to understand the effect of providing four point-of-care tests for ANC on nurse utilization and wait times for women seeking maternal and child health (MCH) services.

Methods

We collected detailed time-motion data over 20 days from one high volume dispensary in western Kenya during the 8-month implementation period (2014–2015) of the intervention. We constructed a simulation model using empirical arrival distributions, activity durations and client pathways of women seeking MCH services. We removed the intervention from the model to obtain wait times, length-of-stay and nurse utilization rates for the baseline scenario where only HIV testing was offered for ANC. Additionally, we modelled a scenario where nurse consultations were set to have minimum durations for sufficient delivery of all WHO-recommended services.

Results

A total of 183 women visited the dispensary for MCH services and 14 of these women received point-of-care testing (POCT). The mean difference in total waiting time was 2 min (95%CI: < 1–4 min,p = 0.026) for MCH women when integrated POCT was given, and 9 min (95%CI: 4–14 min,p < 0.001) when integrated POCT with adequate ANC consult times was given compared to the baseline scenario. Mean length-of-stay increased by 2 min (95%CI: < 1–4 min,p = 0.015) with integrated POCT and by 16 min (95%CI: 10–21 min,p < 0.001) with integrated POCT and adequate consult times compared to the baseline scenario. The two nurses’ overall daily utilization in the scenario with sufficient minimum consult durations were 72 and 75%.

Conclusion

The intervention had a modest overall impact on wait times and length-of-stay for women seeking MCH services while ensuring pregnant women received essential diagnostic testing. Nurse utilization rates fluctuated among days: nurses experienced spikes in workload on some days but were under-utilized on the majority of days. Overall, our model suggests there was sufficient time to deliver all WHO’s required ANC activities and offer integrated testing for ANC first and re-visits with the current number of healthcare staff. Further investigations on improving healthcare worker, availability, performance and quality of care are needed. Delivering four point-of-care tests together for ANC at dispensary level would be a low burden strategy to improve ANC.
A community-based pragmatic, controlled trial for preventing and reducing oral diseases among 1–6-year-old children visiting Anganwadi centers, under the Integrated Child Development Scheme, India
Authors: Goyal Ashima , Grover Ashoo , Gauba Krishan , Gupta Arpit , Mehta Nishant , Dutta Sourabh , Pandey R. M. , Joshi Ashish , Thakur J. S. , Mohanty Utkal , Dhaliwal R. S.
Published: December 2019

Background

Early childhood caries (ECC) has reached epidemic proportions affecting millions of children worldwide. Its prevention becomes imperative owing to the significant morbidity and financial implications involved with its treatment. The Integrated Child Development Scheme (ICDS), launched in India to provide mid-day meals, pre-school education and primary healthcare to children, can be utilised to counsel and deliver oral health education to mothers. The purpose of the study is to compare the effect of an oral health care package (OHCP) with usual care on the change in dental disease status among 1 to 3-year-old children at Anganwadi centres (AWC) in periurban areas of Chandigarh and rural areas of Cuttack, Orissa over a follow-up period of three years.

Methods

Two geographically distant ICDS blocks would be selected at each of the two study sites and would be randomly allocated to intervention and control group. Closely located AWCs under each of the selected blocks shall constitute the study setting. OHCP would be delivered to the mothers of the 1–6-year-old children enrolled in the AWCs of the experimental group whereas mothers under control group would receive usual care advice available at the AWCs.

Discussion

ECC prevention had conventionally focused upon testing effectiveness of programs targeting behaviour change among the caregivers and children, but surprisingly minimal efforts have been made to seek translation of these efforts into reduction of ECC at the community level. The present study has two components; testing effect of altering maternal and child behavioral aspects on ECC incidence through cohort follow up of 1–3-year-old children for three consecutive years and cross-sectional follow up of all available 1–6-year old children at the selected AWCs at regular intervals to look for change in prevalence of ECC at community level. In other regions of the world surveys of ECC prevalence before and after the intensive educational programs have shown a significant reduction in ECC prevalence. A similar decline can be anticipated through this program.

Trial registration

This trial has been prospectively registered at Clinical Trials Registry, India (CTRI/2019/02/017556, 08 February 2019).
Age, maturation and serum lipid parameters: findings from the German Health Survey for Children and Adolescents
Authors: Schienkiewitz Anja , Truthmann Julia , Ernert Andrea , Wiegand Susanna , Schwab Karl Otfried , Scheidt-Nave Christa
Published: December 2019

Background

Recommendations on preventive lipid screening among children and adolescents remain controversial. The aim of the study was to assess age and puberty-related changes in serum lipids, including total cholesterol (TC), and high-density (HDL-C) andnon-high-densitylipoprotein cholesterol (Non-HDL-C).

Methods

Using cross-sectional data from the National Health Interview and Examination Survey for Children and Adolescents in Germany (KiGGS 2003–2006;N = 13,676; 1–17 years), changes in distributions of serum lipids were visualized according to sex, age and maturation. Youth aged 10–17 years were classified as prepubescent, early/mid-puberty, and mature/advanced puberty. Multiple linear regressions were used to quantify the impact of pubertal stage on serum lipid levels, adjusted for potential confounding factors.

Results

Among children 1–9 years mean serum lipid measures increased with age, with higher mean TC and Non-HDL-C among girls than boys. Among children 10–17 years, advanced pubertal stage was independently related to lower lipid measures. Adjusted mean TC, HDL-C and Non-HDL-C was 19.4, 5.9 and 13.6 mg/dL lower among mature/advanced puberty compared to prepubescent boys and 11.0, 4.0 and 7.0 mg/dL lower in mature/advanced puberty compared to prepubescent girls.

Conclusions

Lipid concentrations undergo considerable and sex-specific changes during physical growth and sexual maturation and significantly differ between pubertal stages. Screening recommendations need to consider the fluctuations of serum lipids during growth and sexual maturation.
Household composition and child health in Botswana
Authors: Ntshebe Oleosi , Channon Andrew Amos , Hosegood Victoria
Published: December 2019

Background

There is a general lack of research on children’s household experiences and child health outcomes in low- and middle-income countries (LMICs). This study examines the relationship between household composition, stunting and diarrhoea prevalence among children younger than 5 years of age in Botswana.

Methods

The analysis uses data from the 2007 Botswana Family Health Survey (BFHS) and multilevel logistic regression models.

Results

The findings indicate that stunting varies by whom the child lives with. Stunting is higher among children living with no parents compared to those living with both parents. Stunting is also high among children living with unrelated household members. Similarly, children in households with a mother-only and with a grandparent present, have a higher level of stunting compared to those living with both parents. Conversely, living with an aunt and living with other relatives, protects against stunting. The findings on diarrhoea prevalence show that children living in mother-only households and those living with no parents are less likely to have diarrhoea than those living with both parents. Also, across all households, those who are more affluent have lower rates of child stunting and diarrhoea than those which are more deprived. Finally, the findings show a clustering effect at the household level for both stunting and diarrhoea prevalence.

Conclusions

These findings suggest that policies and programs aimed at reducing stunting and diarrhoea may work best if they target households and other adults co-residing in homes with children besides biological parents. Further, children who live in poorer households deserve special attention.
Factors that influence implementation at scale of a community-based health promotion intervention for older adults
Authors: Sims-Gould Joanie , McKay Heather A. , Hoy Christa L. , Nettlefold Lindsay , Gray Samantha M. , Lau Erica Y. , Bauman Adrian
Published: December 2019

Background

Despite the many known benefits of physical activity (PA), relatively few older adults are active on a regular basis. Older adult PA interventions delivered in controlled settings showed promising results. However, to achieve population level health impact, programs must be effectively scaled-up, and few interventions have achieved this. To effectively scale-up it is essential to identify contextual factors that facilitate or impede implementation at scale. Our aim is to describe factors that influence implementation at scale of a health promotion intervention for older adults (Choose to Move). This implementation evaluation complements our previously published study that assessed the impact of Choose to Move on older adult health indicators.

Methods

To describe factors that influenced implementation our evaluation targeted five distinct levels across a socioecological continuum. Four members of our project team conducted semi-structured interviews by telephone with 1) leaders of delivery partner organizations (n = 13) 2) recreation managers (n = 6), recreation coordinators (n = 27), activity coaches (n = 36) and participants (n = 42) [August 2015 – April 2017]. Interviews were audio-recorded and professionally transcribed and data were analyzed using framework analysis.

Results

Partners agreed on the timeliness and need for scaled-up evidence-based health promotion programs for older adults. Choose to Move aligned with organizational priorities, visions and strategic directions and was deemed easy to deliver, flexible and adaptable. Partners also noted the critical role played by our project team as the support unit. However, partners noted availability of financial resources as a potential barrier to sustainability.

Conclusions

Even relatively simple evidence-based interventions can be challenging to scale-up and sustain. To ensure successful implementation it is essential to align with multilevel socioecological perspectives and assess the vast array of contextual factors that are at the core of better understanding successful implementation.