bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrating health care in Australia: a qualitative evaluation
Authors: Trankle Steven A. , Usherwood Tim , Abbott Penny , Roberts Mary , Crampton Michael , Girgis Christian M. , Riskallah John , Chang Yashu , Saini Jaspreet , Reath Jennifer
Published: December 2019

Background

With aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses.

Methods

We aimed to investigate the WSICP’s effectiveness through a qualitative evaluation focused on the 10 WSICP strategies using a framework analysis. We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners (GPs) and primary care nurses, and program managers. Most participants (71%) were interviewed twice. We analysed data within a framework describing how strategies were implemented and used, the experiences around these, their perceived value, facilitators and barriers, and participant-identified suggestions for improvement.

Results

Care facilitators helped patients access services within the hospital and in primary care and connected general practices with hospital specialists and services. Rapid access and stabilisation clinics with their patient hotlines assisted patients and carers to self-manage chronic illness while connecting GPs to specialists through the GP support-line. Action plans from the hospital informed GPs and their shared care plans which could be accessed by other community health professionals and patients. HealthPathways provided GPs with local, evidence-based guidelines for managing patients. Difficulties persisted in effective widespread access to shared records and electronic communication across sectors.

Conclusions

The combined WSICP strategies improved patient and carer experience of healthcare and capacity of GPs to provide care in the community. Information sharing required longer-term investment and support, though benefits were evident by the end of our research.
The effect of an organic rumen-protected fat supplement on performance, metabolic status, and health of dairy cows
Authors: Manriquez Diego , Chen Liang , Melendez Pedro , Pinedo Pablo
Published: December 2019

Background

Negative energy balance during the transition period is a concern for both conventional and certified organic dairy systems. During early lactation, supplemental strategies are used to cope with nutrient deficiencies that are associated with impaired health, production, and reproduction. As organic certified dairies in the United States face restricted access to dietary supplements, the evaluation of products especially formulated for organic production is needed. Our objective was to assess the effect of supplementing 0.45 kg/d of an organic rumen-protected fat (RPF) on health, metabolic status, and productive and reproductive performance of organic certified Holstein cows from 1 to 150 days in milk (DIM). Two-hundred and two cows were enrolled in a randomized blocked controlled trial conducted from January to July 2017 in a certified organic dairy located in Northern Colorado (USA). Two groups were randomly assigned to be individually supplemented with organic RPF (ORG; n = 100) or control pellets (CON; n = 102) once per day, in addition to the total mixed ration (TMR). Outcomes of interest included milk yield (kg/d) and milk components, serum concentration of glucose, and non-esterified fatty acids (NEFA), resumption of cyclicity, time-to-first artificial insemination (AI), conception at first AI, and conception within 150 DIM, disease occurrence, culling, mortality.

Results

A significant effect for the inclusion of RPF was found in daily milk yield; RPF supplemented cows had greater milk yield (1.6 kg/d) compared to CON cows up to 150 DIM (P = 0.03). During grazing, multiparous (MP) ORG cows had greater milk yield compared to MP CON cows, whereas no effect was found in primiparous (PP) cows. Health outcomes, serum metabolite concentrations, and reproductive performance were not affected by the inclusion of RPF. Body condition loss was smaller in the ORG group up to 80 DIM; however, there was no effect on body condition during the grazing season and in the overall study period.

Conclusions

These results indicate that supplementation of RPF increased daily milk yield and prevented body condition loss during at 90 DIM. However, RPF supplementation did not affect health, serum metabolite concentration, milk components, and reproductive outcomes.
Threshold of the upper airway cross-section for hypopnea onset during sleep and its identification under waking condition
Authors: Lin Hongyi , Wang Cunting , Zhang Han , Xiong Huahui , Li Zheng , Huang Xiaoqing , Ji Changjin , Xian Junfang , Huang Yaqi
Published: December 2019

Background

There is currently no method that can predict whether or under what condition hypopnea, even obstructive sleep apnea (OSA), will occur during sleep for individuals based on credible parameters measured under waking condition. We propose a threshold concept based on the narrowest cross-sectional area of the upper airway (CSA-UA) and aim to prove our hypothesis on the threshold of the area for hypopnea onset (TAHO), which can be used as an indicator of hypopnea onset during sleep and measured while awake.

Methods

We performed magnetic resonance imaging for 20 OSA patients to observe CSA-UA changes during fluid accumulation in the neck caused by elevating their legs, and identified TAHO by capturing the sudden enlargement in CSA-UA. Correlation analyses between TAHO and the body mass index (BMI), and between the reduction in CSA-UA and the increase in the neck circumference (NC) with fluid accumulation were performed. Logistic regression analysis was performed for identifying OSA patients based on the behaviors of their CSA-UA changes during leg raising. Shape changes of airway cross-section were also investigated.

Results

Four CSA-UA change patterns after fluid redistribution were identified. Six patients had similar CSA-UA variation behaviors observed in healthy subjects. From the other three change patterns involving 14 patients, a threshold value of CSA-UA 0.63 ± 0.21 cm2 was identified for normal breathing. Data showed a positive correlation between TAHO and BMI (r = 0.681, p = 0.0007), and a negative correlation between the reduction in CSA-UA and the increase in NC (r = − 0.513, p = 0.051) with fluid accumulation. A sigmoid function for the probability of being a OSA patient p = 1/[1 + exp. (4.836 + 3.850 t-8.4 h)] was obtained to effectively separate OSA patients from normal subjects. The upper airway narrowing occurred in anteroposterior, lateral, or both directions, suggesting different tendencies of upper airway collapse in patients. Three types of shape changes in the cross-section of the upper airway, which had different effects on airway resistance, were measured.

Conclusions

Our findings prove TAHO hypothesis. The threshold measured while awake for normal breathing can be used clinically as the indicator of hypopnea onset during sleep, and therefore to identify OSA patients under waking condition and design effective personalized treatments for OSA patients. Both shape and size changes in the cross-section of the upper airway affect airway resistance significantly. Shape change in the cross-section of the upper airway can provide key clinical information on the collapse patterns of the upper airway for individuals.
Prognostic value of HbA1c for in-hospital and short-term mortality in patients with acute coronary syndrome: a systematic review and meta-analysis
Authors: Pan Wenjun , Lu Haining , Lian Baotao , Liao Pengda , Guo Liheng , Zhang Minzhou
Published: December 2019

Background

HbA1c, the most commonly used indicator of chronic glucose metabolism, is closely associated with cardiovascular disease. However, the relationship between HbA1c and the mortality of acute coronary syndrome (ACS) patients has not been elucidated yet. Here, we aim to conduct a systematic review assessing the effect of HbA1c on in-hospital and short-term mortality in ACS patients.

Methods

Relevant studies reported before July 2019 were retrieved from databases including PubMed, Embase, and Central. Pooled relative risks (RRs) and the corresponding 95% confidence interval (CI) were calculated to evaluate the predictive value of HbA1c for the in-hospital mortality and short-term mortality.

Results

Data from 25 studies involving 304,253 ACS patients was included in systematic review. The pooled RR of in-hospital mortality was 1.246 (95% CI 1.113–1.396, p: 0.000, I2 = 48.6%, n = 14) after sensitivity analysis in studies reporting HbA1c as categorial valuable. The pooled RR was 1.042 (95% CI 0.904–1.202, p: 0.57, I2 = 82.7%, n = 4) in random-effects model for studies reporting it as continuous valuable. Subgroup analysis by diabetic status showed that elevated HbA1c is associated increased short-term mortality in ACS patients without diabetes mellitus (DM) history and without DM (RR: 2.31, 95% CI (1.81–2.94), p = 0.000, I2 = 0.0%, n = 5; RR: 2.56, 95% CI 1.38–4.74, p = 0.003, I2 = 0.0%, n = 2, respectively), which was not the case for patients with DM and patients from studies incorporating DM and non-DM individuals (RR: 1.16, 95% CI 0.79–1.69, p = 0.451, I2 = 31.9%, n = 3; RR: 1.10, 95% CI 0.51–2.38), p = 0.809, I2 = 47.4%, n = 4, respectively).

Conclusions

Higher HbA1c is a potential indicator for in-hospital death in ACS patients as well as a predictor for short-term mortality in ACS patients without known DM and without DM.
Effect of strontium-containing on the properties of Mg-doped wollastonite bioceramic scaffolds
Authors: Wang Su , Liu Linlin , Zhou Xin , Yang Danfeng , Shi Zhang’ao , Hao Yongqiang
Published: December 2019

Background

Bone scaffold is one of the most effective methods to treat bone defect. The ideal scaffold of bone tissue should not only provide space for bone tissue growth, but also have sufficient mechanical strength to support the bone defect area. Moreover, the scaffold should provide a customized size or shape for the patient’s bone defect.

Methods

In this study, strontium-containing Mg-doped wollastonite (Sr-CSM) bioceramic scaffolds with controllable pore size and pore structure were manufactured by direct ink writing 3D printing. Biological properties of Sr-CSM scaffolds were evaluated by apatite formation ability, in vitro proliferation ability of rabbit bone-marrow stem cells (rBMSCs), and alkaline phosphatase (ALP) activity using β-TCP and Mg-doped wollastonite (CSM) scaffolds as control. The compression strength of three scaffold specimens was probed after completely drying them while been submerged in Tris–HCl solution for 0, 2,4 and 6 weeks.

Results

The mechanical test results showed that strontium-containing Mg-doped wollastonite (Sr-CSM) scaffolds had acceptable initial compression strength (56 MPa) and maintained good mechanical stability during degradation in vitro. Biological experiments showed that Sr-CSM scaffolds had a better apatite formation ability. Cell experiments showed that Sr-CSM scaffold had a higher cell proliferation ability compared with β-TCP and CSM scaffold. The higher ALP activity of Sr-CSM scaffold indicates that it can better stimulate osteoblastic differentiation and bone mineralization.

Conclusions

Therefore, Sr-CSM scaffolds not only have acceptable compression strength, but also have higher osteogenesis bioactivity, which can be used in bone tissue engineering scaffolds.
Complement C3 gene polymorphisms are associated with lipid levels, but not the risk of coronary artery disease: a case-control study
Authors: Cai Gaojun , Li Li , Chen Yifei , Huang Haomin , Yu Lei , Xu Lianhong
Published: December 2019

Background

Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. Previous studies have shown that complement component 3 (C3) is associated with atherosclerosis and cardiovascular risk factors.

Methods

We conducted this study to evaluate the associations between tagSNPs in the C3 gene locus and the CAD susceptibility and lipid levels in the Chinese population. A hospital-based case-control study, including 1017 subjects (580 CAD patients and 437 non-CAD controls), was conducted. TagSNPs in the C3 gene were searched and genotyped by using the polymerase chain reaction-ligase detection reaction method.

Results

The C3 levels were positively associated with the low-density lipoprotein cholesterol (LDL-C) levels (r = 0.269, P = 0.001). Compared with those in controls, the serum C3 levels in CAD patients were significantly higher (Control: 0.94 + 0.14 g/l; CAD: 1.10 + 0.19 g/l, P < 0.001). No significant differences in genotype or allele frequencies were observed between CAD patients and controls. The minor T allele of rs2287848 was associated with low apolipoprotein A1 (ApoA1) levels in controls (Bonferroni corrected P, Pc = 0.032). Linkage disequilibrium and haplotype analysis established two haplotype blocks (Block1: rs344555-rs2277984, Block 2: rs2287848-rs11672613) and six haplotypes. No significant associations between haplotypes and the risk of CAD were observed (all Pc > 0.05).

Conclusions

The results revealed that C3 gene polymorphisms were associated with the lipid levels, but not CAD susceptibility in the Chinese population.
Study on measurement method for apple root morphological parameters based on Labview
Authors: Liu Yu , Qian Ji , Yang Xin , Di Bao , Zhou Juan
Published: December 2019

Background

Traditional measurements of apple seedling roots often rely on manual measurements and existing root scanners on the market. Manual measurement requires a lot of labor and time, and subjective reasons may cause the uncertainty of data; root scanners have limited scanning size and expensive. In case of fruit roots, coverage and occlusion issues will occur, resulting in inaccurate results, but our research solved this problem.

Results

The background plate was selected according to the color of the seedling roots; the image of the roots of the collected apple seedlings was preprocessed with Vision Development Module by combining image and Labview. The root surface area, average root diameter, root length and root volume of apple seedlings were measured by combining root characteristic parameters algorithm. In order to verify the effectiveness of the proposed method, a set of measurement system for root morphology of apple seedlings was designed, and the measurement result was compared with the Canadian root system WinRHIZO 2016 (Canada). With application of SPSS v22.0 analysis, the significance P > 0.01 indicated that the difference was not significant. The relative error of surface area was less than 0.5%. The relative error of the average diameter and length of the root system was less than 0.1%, and the relative error of the root volume was less than 0.2%.

Conclusions

It not only proved that the root surface area, average root diameter, root length and root volume of apple seedlings could be accurately measured by the method described herein, which was handy in operation, but also reduced the cost by 80–90% compared with the conventional scanner.
TasselNetv2: in-field counting of wheat spikes with context-augmented local regression networks
Authors: Xiong Haipeng , Cao Zhiguo , Lu Hao , Madec Simon , Liu Liang , Shen Chunhua
Published: December 2019

Background

Grain yield of wheat is greatly associated with the population of wheat spikes, i.e., $$spike~number~\text {m}^{-2}$$spikenumberm-2. To obtain this index in a reliable and efficient way, it is necessary to count wheat spikes accurately and automatically. Currently computer vision technologies have shown great potential to automate this task effectively in a low-end manner. In particular, counting wheat spikes is a typical visual counting problem, which is substantially studied under the name of object counting in Computer Vision. TasselNet, which represents one of the state-of-the-art counting approaches, is a convolutional neural network-based local regression model, and currently benchmarks the best record on counting maize tassels. However, when applying TasselNet to wheat spikes, it cannot predict accurate counts when spikes partially present.

Results

In this paper, we make an important observation that the counting performance of local regression networks can be significantly improved via adding visual context to the local patches. Meanwhile, such context can be treated as part of the receptive field without increasing the model capacity. We thus propose a simple yet effective contextual extension of TasselNet—TasselNetv2. If implementing TasselNetv2 in a fully convolutional form, both training and inference can be greatly sped up by reducing redundant computations. In particular, we collected and labeled a large-scale wheat spikes counting (WSC) dataset, with 1764 high-resolution images and 675,322 manually-annotated instances. Extensive experiments show that, TasselNetv2 not only achieves state-of-the-art performance on the WSC dataset ($$91.01\%$$91.01% counting accuracy) but also is more than an order of magnitude faster than TasselNet (13.82 fps on $$912\times 1216$$912×1216 images). The generality of TasselNetv2 is further demonstrated by advancing the state of the art on both the Maize Tassels Counting and ShanghaiTech Crowd Counting datasets.

Conclusions

This paper describes TasselNetv2 for counting wheat spikes, which simultaneously addresses two important use cases in plant counting: improving the counting accuracy without increasing model capacity, and improving efficiency without sacrificing accuracy. It is promising to be deployed in a real-time system with high-throughput demand. In particular, TasselNetv2 can achieve sufficiently accurate results when training from scratch with small networks, and adopting larger pre-trained networks can further boost accuracy. In practice, one can trade off the performance and efficiency according to certain application scenarios. Code and models are made available at: https://tinyurl.com/TasselNetv2.
The combination of microfracture with induction of Wnt / β- Catenin pathway, leads to enhanced cartilage regeneration
Authors: Schizas Nikitas P. , Savvidou Olga , Diamantopoulou Kalliopi , Papadakis Stamatios , Papagelopoulos Panayiotis J. , Triantafyllopoulos Ioannis K.
Published: December 2019

Introduction

Microfracture does not lead to complete healing of full-thickness cartilage defects. The aim of this study was to evaluate the effect of modifying Wnt/β-catenin signaling following microfracture, on the restoration of a full-thickness cartilage defect in a rabbit model. The modification of the canonical Wnt pathway was achieved through per os administration of lithium carbonate, which is an intracellular inhibitor of glycogen synthase kinase 3-β (Gsk3-β) and therefore induces Wnt/β-catenin signaling.

Materials and methods

Full-thickness cartilage defects of 4 mm in diameter were created in the patellar groove of the right femurs of 18 male New Zealand white rabbits. The rabbits were divided into three groups of six (n = 6) based on post-surgery treatment differences, as follows: microfracture only (group 1), microfracture plus lithium carbonate 7 mM in the drinking water for 1 week (group 2), microfracture plus lithium carbonate 7 mM in the drinking water for 4 weeks (group 3). All animals were sacrificed 9 weeks after surgery. The outcome was assessed histologically, by using the International Cartilage Repair Society (ICRS) visual histological scale. Immunohistochemistry for type II collagen was also conducted.

Results

Statistical analysis of the histological ICRS scores showed that group 3 was significantly superior to group 1 in four out of six ICRS categories, while group 2 was superior to 1 in only two out of six.

Conclusion

The combination of microfracture and systematic administration of lithium carbonate 7 mM for 4 weeks shows statistically significant superiority in four out of six ICRS categories compared with microfracture only for the treatment of full-thickness cartilage defects in a rabbit experimental model.
Knowledge, attitude and practice of surgical staff towards preoperative surgical antibiotic prophylaxis at an academic tertiary hospital in Sudan
Authors: Ahmed Ali Mohammed , Nasr Sara , Ahmed Almegdad Mohamed , Elkhidir Osama
Published: December 2019

Background

Surgical site infections (SSIs) are among the most common serious complications after surgery and associated with preventable morbidity, mortality, and increased health care costs. The use of surgical antimicrobial prophylaxis (SAP) is an effective measure that helps to protect against SSIs. This study aims to evaluate the knowledge, attitude, and practice of surgical staff towards preoperative antibiotic prophylaxis in surgery department at an academic tertiary hospital in Sudan.

Methodology

An observational descriptive study was conducted among doctors in the surgery department at an academic tertiary hospital in Sudan in order to assess their knowledge, attitude, and practice (KAP) towards surgical antibiotic prophylaxis (SAP). A four-section multiple-choice questionnaire was designed and hand-delivered to registered doctors in the surgery department at an academic tertiary hospital in Sudan. The WHO guidelines were used to evaluate the answers of the participants.

Results

Out of 56 doctors requested to participate in this study, only 49 responded and their response rate was 87.5%. Six (12.5%) surgeons had good knowledge about appropriate SAP. However, 16.3 and 24.5% of the respondents were aware of appropriate SAP in the case of Ig E-mediated reaction to penicillin and risk of Gram-negative infections, respectively. The surgeon’s attitude score about the need for local and national guidelines for SAP was 98 and 100%, respectively. Accordance of the physician’s practice with ASHP guidelines regarding timing of the first dosage of SAP was 35.4% while correct administration of an intraoperative dose was 42.9% in agreement with the guideline. 53.1% knows when to stop SAP after surgery correctly.

Conclusion

Although the participants in this study showed a positive attitude towards antibiotic prophylaxis guidelines, their knowledge and strict adherence to a protocolized practice per WHO checklist should be improved in order to reduce the incidence of preventable surgical site infections.
Criteria for site selection in industry-sponsored clinical trials: a survey among decision-makers in biopharmaceutical companies and clinical research organizations
Authors: Dombernowsky Tilde , Haedersdal Merete , Lassen Ulrik , Thomsen Simon Francis
Published: December 2019

Background

Knowledge of what the pharmaceutical industry emphasizes when assessing trial sites during site selection is sparse. A better understanding of this issue can improve the collaboration on clinical trials and increase knowledge of how to attract and retain industry-sponsored trials. Accordingly, we investigated which site-related qualities multinational biopharmaceutical companies and clinical research organizations (CROs) find most important during site selection.

Methods

An online survey among decision-makers for trial site selection in the Nordic countries employed at multinational biopharmaceutical companies and CROs was conducted. The respondents’ experiences with and perceptions of site selection were addressed to evaluate the relative importance of site-related qualities. We included up to four respondents per company, representing different geographic regions. Descriptive statistics were used to summarize findings.

Results

Of 49 eligible companies, 20 biopharmaceutical companies and 23 CROs participated. In total, 83 responses were analyzed (estimated response rate 78%). A relative importance of site-related qualities was identified: For example, 88% (binomial 95% confidence interval [CI] ±7%) preferred reaching enrollment goals at trial sites in their region 10% quicker rather than cutting the costs at all sites by 20%. Likewise, 42% (CI ±11%) of the respondents preferred that trial sites were best at having the first patients ready for inclusion right after site initiation visit compared to having good data entry, documentation, and reporting practice (25% [CI ±9%]), easily reachable site personnel and backup (23% [CI ±9%]), fast contractual procedure times (6% [CI ±5%]), a key opinion leader associated with the site (3% [CI ±4%]), and updated equipment and facilities (1% [CI ±2%]). In total, 75% [CI ±9%] agreed that their company would be interested in cooperating with an inexperienced trial site if the site had access to a large patient population and 52% [CI ±11%] had experienced that their company selected an inexperienced trial site in favor of an experienced site due to a higher level of interest and commitment.

Conclusions

This study indicates that recruitment-related factors are pivotal to the pharmaceutical industry when assessing trial sites during site selection. Data quality-related factors seem highly valued especially in early phase trials whereas costs and investigator’s publication track record are less important. Experience in conducting clinical trials is not imperative. However, this applies primarily to late phase trials.
Budgeting of non-commercial clinical trials: development of a budget tool by a public funding agency
Authors: Nevens Hilde , Harrison Jillian , Vrijens France , Verleye Leen , Stocquart Nelle , Marynen Elisabeth , Hulstaert Frank
Published: December 2019

Background

Investigator-led multicentre randomised trials are essential to generate evidence on the optimal use of medical interventions. These non-commercial trials are often hampered by underfunding, which may lead to difficulties in gathering a team with the necessary expertise, a delayed trial start, slow recruitment and even early trial discontinuation. As a new public funder of pragmatic clinical trials, the KCE Trials programme was committed to correctly pay all trial activities in order to assure timely delivery of high-quality trial results. As no appropriate trial budget tool was readily publicly available that took into account the costs for the sponsor as well as the costs for participating sites, we developed a tool to make the budgeting of a clinical trial efficient, transparent and fair across applicants.

Methods

All trial-related activities of the sponsor and sites were categorised, and cost drivers were identified. All elements were included in a spreadsheet tool allowing the sponsor team to calculate in detail the various activities of a clinical trial and to appreciate the budget impact of specific cost drivers, e.g. a delay in recruitment. Hourly fees by role were adapted from published data. Fixed amounts per activity were developed when appropriate.

Results

This publicly available tool has already been used for 17 trials funded since the start of the KCE Trials programme in 2016, and it continues to be used and improved. This budget tool is used together with additional risk-reducing measures such as a multistep selection process with advance payments, a recruitment feasibility check by sponsor and funder, a close monitoring of study progress and a milestone-based payment schedule with the last payment made when the manuscript is submitted.

Conclusions

The budget tool helps the KCE Trials programme to answer relevant research questions in a timely way, within budget and with high quality, a necessary condition to achieve impact of this programme for patients, clinical practice and healthcare payers.
Landiolol, an ultra-short acting beta-1 blocker, for preventing postoperative lung cancer recurrence: study protocol for a phase III, multicenter randomized trial with two parallel groups of patients
Authors: Yamamoto Haruko , Hamasaki Toshimitsu , Onda Kaori , Nojiri Takashi , Aragaki Masato , Horie Nao , Sato Norihiro , Hida Yasuhiro
Published: December 2019

Background

Recurrence of cancer after curative surgery is a major problem after most cancer treatments. Increased sympathetic activity during the perioperative period could promote cancer cell invasion to blood vessels and angiogenesis, resulting in cancer metastasis. Recent studies showed that use of beta blockers can be associated with the prolonged survival of patients with cancer. The objective of this study is to evaluate the preventive effects of landiolol hydrochloride, which is an ultra-short-acting beta-1-selective blocker that has been developed in Japan, on reducing recurrence of cancer after curative surgery for patients with lung cancer.

Methods

The present study is a phase III, multicenter, randomized trial with two parallel groups of patients with lung cancer, comparing surgery alone and surgery with landiolol administration for three days during the perioperative period. A total of 400 patients will be enrolled from 12 Japanese institutions. The primary endpoint is two-year relapse-free survival and overall survival after curative surgery for lung cancer. The secondary endpoints are additional treatment after recurrence of cancer, safety events, and the incidence of postoperative complications.

Discussion

The principal question addressed in this trial is whether landiolol can reduce recurrence of cancer after curative surgery for lung cancer.

Trial registration

Japan Registry of Clinical Trials, jRCT2011180004. Registered 17 January 2019.
Contralateral migration of Kirschner wire from right acromioclavicular joint to left side of neck: a case report
Authors: Ko How-Yun , Lee Ka-Wo
Published: December 2019

Background

Kirschner wire migration is one of the most common complications after internal fixation of fracture or dislocation in the shoulder region. However, cases of contralateral wire migration are rare. We present a case of contralateral loosened Kirschner wire migration from the right acromioclavicular joint to the left side of the neck without damage to any important structures or great vessels.

Case presentation

We report a case of a loosened Kirschner wire migrating from the right acromioclavicular joint to the left side of the neck in a 34-year-old Taiwanese man following a route of transversal, descendant, and then ascendant directions. The Kirschner wire was removed by exploratory neck dissection under C-arm fluoroscopy assistance without complication.

Conclusion

Wire migration may occur after surgical treatment with or without clinical complaint. Several hypotheses for the mechanism of wire migration have been postulated, including muscular activity, respiratory motion, gravity, and motion of upper extremity. Therefore, the importance of follow-up should be communicated to the patient. Once wire loosening or migration is noted, the implant should be removed immediately under intraoperative C-arm fluoroscopy or ultrasound assistance.
Speech enhancement methods based on binaural cue coding
Authors: Wang Xianyun , Bao Changchun
Published: December 2019

According to the encoding and decoding mechanism of binaural cue coding (BCC), in this paper, the speech and noise are considered as left channel signal and right channel signal of the BCC framework, respectively. Subsequently, the speech signal is estimated from noisy speech when the inter-channel level difference (ICLD) and inter-channel correlation (ICC) between speech and noise are given. In this paper, exact inter-channel cues and the pre-enhanced inter-channel cues are used for speech restoration. The exact inter-channel cues are extracted from clean speech and noise, and the pre-enhanced inter-channel cues are extracted from the pre-enhanced speech and estimated noise. After that, they are combined one by one to form a codebook. Once the pre-enhanced cues are extracted from noisy speech, the exact cues are estimated by a mapping between the pre-enhanced cues and a prior codebook. Next, the estimated exact cues are used to obtain a time-frequency (T-F) mask for enhancing noisy speech based on the decoding of BCC. In addition, in order to further improve accuracy of the T-F mask based on the inter-channel cues, the deep neural network (DNN)-based method is proposed to learn the mapping relationship between input features of noisy speech and the T-F masks. Experimental results show that the codebook-driven method can achieve better performance than conventional methods, and the DNN-based method performs better than the codebook-driven method.
View synthesis based on spatio-temporal continuity
Authors: Yao Li , Lu Qiurui , Li Xiaomin
Published: December 2019

Free viewpoint video is generated on the basis of a video plus depth (V+D) virtual point rendering framework. Because of the limited bandwidth of video transmission, depth-image-based rendering (DIBR) has become a common method. Most DIBR methods not only have holes and ghost artifacts but also have problems with time continuity, leading to frequent flickers. In this paper, we make full use of time domain information in video sequences and adjacent frames to extract the static background image of the whole scene. Furthermore, we propose a weighted-fusion hole-filling method based on static background to fill holes and maintain time continuity. Experimental results show that the proposed method can improve the quality of virtual view images and strengthen spatio-temporal continuity.
Factors associated with alexithymia among the Lebanese population: results of a cross-sectional study
Authors: Obeid Sahar , Akel Marwan , Haddad Chadia , Fares Kassandra , Sacre Hala , Salameh Pascale , Hallit Souheil
Published: December 2019

Background

To our knowledge, no research project on alexithymia has been conducted in Lebanon. The objective of this study was to assess risk factors associated with alexithymia in a representative sample of the Lebanese population.

Methods

This is a cross-sectional study, conducted between November 2017 and March 2018, which enrolled 789 participants from al districts of Lebanon. The Toronto Alexithymia Scale (TAS-20) was used to measure alexithymia, the Alcohol Use Disorders Identification Test to assess alcohol use, drinking patterns, and alcohol-related issues, the Rosenberg self-esteem scale to evaluate self-worth, the Hamilton depression rating scale and Hamilton Anxiety Scale to screen for depression and anxiety respectively, the Three-Dimensional Work Fatigue Inventory to measure physical, mental and emotional work fatigue respectively, the Columbia–Suicide Severity Rating Scale to evaluate suicidal ideation and behavior, the Perceived Stress Scale to measure stress, the Liebowitz Social Anxiety Scale to help identify a social anxiety disorder and the Quick Emotional Intelligence Self-Assessment to measure emotional intelligence.

Results

The results showed that 395 (50.4%) were not alexithymic, 226 (28.8%) were possible alexithymic, whereas 163 (20.8%) were alexithymic according to established clinical cutoffs. Stress (Beta = 0.456), emotional exhaustion (Beta = 0.249), the AUDIT score (Beta = 0.225) and anxiety (Beta = 0.096) were associated with higher alexithymia, whereas low emotional work fatigue (Beta = −0.114) and being married (Beta = −1.933) were associated with lower alexithymia.

People in distress (Beta = 7.33) was associated with higher alexithymia scores, whereas people with high wellbeing (Beta = −2.18), an intermediate (Beta = −2.90) and a high (Beta = −2.71) family monthly income were associated with lower alexithymia compared to a low one.

Conclusion

Alexithymia appears to be influenced by many factors, including stress, anxiety, and burnout. To reduce its prevalence, it is important that health professionals educate the public about these factors. Further studies on a larger scale are needed to confirm our findings.
Regulation of microglial TMEM119 and P2RY12 immunoreactivity in multiple sclerosis white and grey matter lesions is dependent on their inflammatory environment
Authors: van Wageningen Thecla A. , Vlaar Eva , Kooij Gijs , Jongenelen Cornelis A. M. , Geurts Jeroen J. G. , van Dam Anne-Marie
Published: December 2019

Multiple Sclerosis (MS) is the most common cause of acquired neurological disability in young adults, pathologically characterized by leukocyte infiltration of the central nervous system, demyelination of the white and grey matter, and subsequent axonal loss. Microglia are proposed to play a role in MS lesion formation, however previous literature has not been able to distinguish infiltrated macrophages from microglia. Therefore, in this study we utilize the microglia-specific, homeostatic markers TMEM119 and P2RY12 to characterize their immunoreactivity in MS grey matter lesions in comparison to white matter lesions. Furthermore, we assessed the immunological status of the white and grey matter lesions, as well as the responsivity of human white and grey matter derived microglia to inflammatory mediators. We are the first to show that white and grey matter lesions in post-mortem human material differ in their immunoreactivity for the homeostatic microglia-specific markers TMEM119 and P2RY12. In particular, whereas immunoreactivity for TMEM119 and P2RY12 is decreased in the center of WMLs, immunoreactivity for both markers is not altered in GMLs. Based on data from post-mortem human microglia cultures, treated with IL-4 or IFNγ+LPS and on  counts of CD3+ or CD20+ lymphocytes in lesions, we show that downregulation of TMEM119 and P2RY12  immunoreactivity in MS lesions corresponds with the presence of lymphocytes and lymphocyte-derived cytokines within the parenchyma but not in  the meninges. Furthermore, the presence of TMEM119+ and partly P2RY12+ microglia in pre-active lesions as well as in  the rim of active white and grey matter lesions, in addition to TMEM119+ and P2RY12+ rod-like microglia in subpial grey matter lesions suggest that blocking the entrance of lymphocytes into the CNS of MS patients may not interfere with all possible effects of TMEM119+ and P2RY12+ microglia in both white and grey matter MS lesions.
Molecular signature of different lesion types in the brain white matter of patients with progressive multiple sclerosis
Authors: Elkjaer Maria L. , Frisch Tobias , Reynolds Richard , Kacprowski Tim , Burton Mark , Kruse Torben A. , Thomassen Mads , Baumbach Jan , Illes Zsolt
Published: December 2019

To identify pathogenetic markers and potential drivers of different lesion types in the white matter (WM) of patients with progressive multiple sclerosis (PMS), we sequenced RNA from 73 different WM areas. Compared to 25 WM controls, 6713 out of 18,609 genes were significantly differentially expressed in MS tissues (FDR < 0.05). A computational systems medicine analysis was performed to describe the MS lesion endophenotypes. The cellular source of specific molecules was examined by RNAscope, immunohistochemistry, and immunofluorescence. To examine common lesion specific mechanisms, we performed de novo network enrichment based on shared differentially expressed genes (DEGs), and found TGFβ-R2 as a central hub. RNAscope revealed astrocytes as the cellular source of TGFβ-R2 in remyelinating lesions. Since lesion-specific unique DEGs were more common than shared signatures, we examined lesion-specific pathways and de novo networks enriched with unique DEGs. Such network analysis indicated classic inflammatory responses in active lesions; catabolic and heat shock protein responses in inactive lesions; neuronal/axonal specific processes in chronic active lesions. In remyelinating lesions, de novo analyses identified axonal transport responses and adaptive immune markers, which was also supported by the most heterogeneous immunoglobulin gene expression. The signature of the normal-appearing white matter (NAWM) was more similar to control WM than to lesions: only 465 DEGs differentiated NAWM from controls, and 16 were unique. The upregulated marker CD26/DPP4 was expressed by microglia in the NAWM but by mononuclear cells in active lesions, which may indicate a special subset of microglia before the lesion develops, but also emphasizes that omics related to MS lesions should be interpreted in the context of different lesions types. While chronic active lesions were the most distinct from control WM based on the highest number of unique DEGs (n = 2213), remyelinating lesions had the highest gene expression levels, and the most different molecular map from chronic active lesions. This may suggest that these two lesion types represent two ends of the spectrum of lesion evolution in PMS. The profound changes in chronic active lesions, the predominance of synaptic/neural/axonal signatures coupled with minor inflammation may indicate end-stage irreversible molecular events responsible for this less treatable phase.
Role of serial lactate measurement to predict 28-day mortality in patients undergoing emergency laparotomy for perforation peritonitis: prospective observational study
Authors: Jobin S. P. , Maitra Souvik , Baidya Dalim Kumar , Subramaniam Rajeshwari , Prasad Ganga , Seenu Vathulru
Published: December 2019

Background

Serial lactate measurement is found to predict mortality in septic shock. Majority of patients with perforation peritonitis for emergency laparotomy are in sepsis and mortality rate is substantial. However, lactate dynamics has not been studied in this patient population.

Methods

After institutional ethics clearance and informed written consent, 113 patients with suspected or proven perforation peritonitis presenting for emergency laparotomy were recruited in this prospective observational trial. Baseline Mannheim peritonitis index (MPI), SOFA and APACHE II score were calculated. Lactate values were obtained at baseline, immediate and 24-h postoperative period. Primary outcome was 28-day mortality.

Results

Mortality was 15.04% at 28 days. Age, SOFA, qSOFA, APACHE, preoperative lactate, MPI and site of perforation were significantly different between survivors and non-survivors. Arterial lactate values at preoperative (cut off 2.75 mmol/L), immediate postoperative (cut off 2.8 mmol/L) and 24 h-postoperative period (cut off 2.45 mmol/L) independently predicted mortality at day 28. Combination of MPI and 24-h lactate value was best predictor of mortality with AUC 0.99.

Conclusion

Preoperative, immediate postoperative and 24-h postoperative lactate value independently predict 28-day mortality in perforation peritonitis patients undergoing emergency laparotomy. Combination of MPI and 24-h lactate value is the most accurate predictor of mortality.

Trial registration

Clinical Trial Registry of India - CTRI/2018/01/011103
Emergency laparoscopic cholecystectomy for intraabdominal hemorrhage in a patient with a left ventricular assist device: a case report
Authors: Takagi Akihiko , Nagai Erina , Toda Takeo , Kosaka Hayato , Ishimatsu Hisato , Kyoden Yusuke , Akimoto Takehide , Kanemoto Hideyuki , Oba Noriyuki
Published: December 2019

Background

Continuous-flow left ventricular assist devices (LVADs), called “second generation LVADs,” have significantly improved the survival and quality of life outcomes. Accordingly, non-cardiac surgery in a patient with LVADs has required for conditions not directly related to their LVADs. And the management of bleeding in non-cardiac site remains one of long-term critical topics. Laparoscopic approach is useful in a patient with LVADs; however, there have been only few clinical reports. This report describes the first case of laparoscopic cholecystectomy (LC) for intraabdominal hemorrhage from the gallbladder serosa in a patient with LVADs.

Case presentation

A 56-year-old man with an LVAD had undergone LVAD (Jarvik 2000™; Jarvik Heart, Inc., New York, NY, USA) implantation at 53 years of age. He was in shock, and contrast-enhanced computed tomography revealed abdominal hemorrhage from the gallbladder serosa. Emergency laparoscopic cholecystectomy was performed. We could avoid injury of the LVADs driveline, which was located across the upper abdominal midline, near the right hypochondriac region, by laparoscopic approach. LVADs (Jarvik 2000) did not disturb the operating field because of its smaller size. There were no intra- and postoperative complications.

Conclusions

Laparoscopic approach is useful and safe in a patient with LVADs for abdominal surgery. We could perform LC for intraabdominal hemorrhage from gallbladder serosa safety.
The potential for an outbreak of glanders in Nepal
Authors: Adhikari Niran , Acharya Krishna Prasad , Wilson Richard Trevor
Published: December 2019

Confirmation of glanders has not been possible in suspected cases submitted by field veterinarians, mainly due to the lack of diagnostic tools in Nepal. In view, however, of the re-emergence of glanders in India and the unrestricted migration of equines from there in to Nepal, an outbreak of Glanders in the short term is a distinct possibility. Such an event would affect the rural, marginalized community, and brick kiln industries. Therefore, due attention on the national epidemiological study and strengthened animal quarantine system with holding yards and laboratory backups are highly requested. Besides, the government’s timely action on disease prevalence, monitoring, and disease reporting is utmost important besides widespread public awareness to prevent the entry and control the disease.