bluuebunny/crossref_metadata_2025 huggingface dataset:
Body-worn images: Point-of-view and the new aesthetics of policing
Authors: McKay Carolyn , Lee Murray
Published: September 2019

Police organisations across much of the Western world have eagerly embraced body-worn video camera technology, seen as a way to enhance public trust in police, provide transparency in policing activity, reduce conflict between police and citizens and provide a police perspective of incidents and events. Indeed, the cameras have become an everyday piece of police ‘kit’. Despite the growing ubiquity of the body-worn video camera, understandings of the nature and value of the audiovisual footage produced by police remain inchoate. Given body-worn video camera’s promise of veracity, this article is interested in the aesthetics of the camera images and the socio-cultural construction of the cameras as tellers of truth. We treat body-worn video cameras as image-making devices linked to techniques and technologies of power, which construct and frame police encounters in specific ways, and we suggest that the aesthetics and point-of-view nature of the image contribute greatly to the truth-value that the images acquire. This article begins by providing an historical context for the use of cameras and images in policing. We then introduce our framework of visual criminology and present theories of point-of-view as a construct in the diverse areas of gaming, pornography and the visual arts, as well as in television and cinema. The article deploys the cinematic use of point-of-view to unpack the affective impact and aesthetic of the police body-worn video camera footage. We suggest that viewers of the footage are placed in the position of the corporeally absent police officer whose experience has been recorded by a viewfinderless device. This generates a vacillating interplay between subjectivity and objectivity, given that the alleged faithful recording of the event by the body-worn video camera presents a singular perspective and incomplete document that may not necessarily capture the full context of the law enforcement event.
The Royal Navy Operating Department Practitioner: Perioperative care on land and sea
Authors: Long Glenn , Jones Gareth , Roper David , Eaton Yasmin , Howells Amy
Published: September 2019

Royal Navy Operating Department Practitioners are employed in a number of different roles, during peacetime, humanitarian aid operations and periods of war. In recent times, Royal Navy Operating Department Practitioners have deployed on active operations in addition to working in NHS hospitals at home in the United Kingdom. This article will explore the different avenues and experiences of Operating Department Practitioners who are currently serving in the Royal Navy. The reader will then also gain an insight into the different echelons of care provided by the Defence Medical Services to the United Kingdom Armed Forces and Allied Nations. The article will then consider the unique experiences available to Royal Navy Operating Department Practitioners in this multi-faceted role which offers the opportunity to explore work patterns in different environments.
Outcomes of open artificial urinary sphincter in women with stress urinary incontinence: long-term follow up
Authors: Tricard Thibault , Jochum Floriane , Bergerat Sébastien , Munier Pierre , Schroeder Alice , Saussine Christian
Published: September 2019

Background:

The aim of this study was to report the outcomes of artificial urinary sphincter (AUS) in women with stress urinary incontinence (SUI) resulting from intrinsic sphincter deficiency after a follow up of 10 years.

Methods:

The charts of female patients with moderate-to-severe SUI who underwent open AUS implantation between November 1994 and April 2007 were reviewed retrospectively. All patients were operated on by a single experienced surgeon through an open retropubic approach with systematic bladder incision. Primary endpoint was postoperative continence categorized as complete continence (no pads used), improved incontinence, or unchanged incontinence.

Results:

A total of 63 women (mean age: 58 years, range: 17–82) underwent open AUS implantation. There were seven (11.1%) intraoperative complications. At the last follow up, 26 (41.3%) initial AUSs remained in situ and 21 (33.3%) patients had at least one revision or reimplantation. Of these 47 patients (74.6%), 35 (74.5%) were fully continent, 3 (6.4%) had improved incontinence, and 9 (19.1%) had unchanged incontinence. A total of 20 patients (31.7%) experienced postoperative complications, but only 2 (3.2%) were Clavien ⩾3. After a median follow up of 14 ± 6 years, 20 (31.7%) explantations and 29 (46%) revisions occurred. The average time without explantation or revision was 11.6 and 9 years, respectively.

Conclusions:

In our experience, AUS is a good option for women with moderate to severe SUI, with good long-term outcomes.
A New Sexangularetin Derivative From Camellia hakodae
Authors: Tuyen Nguyen T. , Van Hieu Tran , Dien Pham G. , Ninh Tran , Hung Nguyen T. , Hoang Vu D.
Published: September 2019

A new flavonoid, sexangularetin 3- O-(2″- O-( E) -p-coumaroyl-β -d-glucopyranoside) (1), together with 9 known flavonoid compounds (2-10), was isolated from flowers of Camellia hakodae Ninh. Their structures were established based on physicochemical and spectroscopic analyses. The new compound displayed moderate to weak cytotoxic activities against HepG2 (IC50 192.0 μg/mL), Lu (IC50 90.2 μg/mL), and KB (IC50 72.7 μg/mL) cell lines, and inactivity against MCF7 (IC50 256.0 μg/mL).
Feline foamy virus seroprevalence and demographic risk factors in stray domestic cat populations in Colorado, Southern California and Florida, USA
Authors: Kechejian Sarah , Dannemiller Nick , Kraberger Simona , Ledesma Feliciano Carmen , Löchelt Martin , Carver Scott , VandeWoude Sue
Published: September 2019

Objectives

Our study aim was to document the seroprevalence and associated risk factors of feline foamy virus (FFV) infection in domestic cat populations presented to animal shelters located in Southern California, Colorado and Florida, USA.

Methods

We used a glutathione S-transferase capture ELISA targeting the FFV Gag antigen to screen domestic cat serum collected from cats with unknown owners at eight different animal shelters from Colorado (n = 105, three shelters), Southern California (n = 172, three shelters) and Florida (n = 31, two shelters). χ2 statistics determined location effect on seroprevalence. Bayesian generalized linear models were used to explore age and sex as potential risk factors for infection.

Results

FFV seroprevalence was 64.0% across all locations. Seroprevalence by location was as follows: Southern California 75.0%, Colorado 52.4% and Florida 41.9%, with Southern California’s seroprevalence being significantly higher. Age had a significant effect on model fit for all locations, with adults having a higher probability of being infected. In Colorado, sex also had a significant effect on model fit, with males having a higher probability of being infected.

Conclusions and relevance

We have documented that FFV is extremely common in stray domestic cat populations across varied geographic and ecological niches throughout the USA. Adult cats are at a higher FFV infection risk than young cats. FFV has been associated with a higher risk of other retroviral infections and has been implicated in several chronic diseases of cats. Additional epidemiological and clinical studies are warranted to investigate the potential impacts of FFV on domestic cat health.
Reducing Alert Fatigue for Comfort Care and Palliative Care Hospital Patients
Authors: Patterson Emily S. , Hritz Christopher , Moffatt-Bruce Susan
Published: September 2019

Hospital nurses are inundated by numerous non-actionable and false telemetry alarms from bedside monitors, central nursing stations, and, in some cases, also from alarms escalated to hospital-provided cellphones after a short time period. There is widespread that patients electing to have DNR/comfort care status do not require telemetry monitoring, and an increasing awareness of the interference of these alarms with valuable end-of-life conversations and interactions with family members. In this project, we instituted policy changes, changes to the electronic health record, and educational interventions for physicians and nurses in order to reduce the proportion of DNR-CC patients with active telemetry monitoring. Overall, we learned that many bedside nurses prefer to turn down the volume or turn off the display inside rooms, which addresses the interference with family interactions but does not reduce the volume of unnecessary alarms and associated documentation requirements and inclusion of alarms in population-based analyses.
Evaluation of Mobile Tablet Computers for Use in the Veterans Health Administration
Authors: Herout Jennifer , Frisbee Kathleen L. , Wilck Nancy R. , Kabel Margo , Bentt Deyne , Evans Neil C. , Markowitz Gerald , Saleem Jason J.
Published: September 2019

The Veterans Health Administration (VHA) within the Department of Veterans Affairs (VA) was interested in determining how mobile tablets may be perceived by clinicians for use in clinical settings. Therefore, we conducted an evaluation to assess how performance might differ between two devices and to gather feedback on device use. We conducted a within-subject comparison with 32 clinicians involving a usability test and two questionnaires. Qualitative data was organized around eight themes: facilitators and barriers to tablet use, observations of physical use, device specific advantages and disadvantages, and the Patient Viewer mobile application. Clinicians envisioned many facilitators to tablet use, but also voiced some concerns. Participants rated one device significantly better than the other for questionnaire items related to ‘Access and Efficiency’, ‘Introduction into the Clinical Environment’, ‘Usability and Usefulness’, and ‘Desire to Use’. Results can be used by mobile health app developers, healthcare organizations considering device purchases, and researchers conducting studies on tablets to inform respective work.
Fuzzy Decision Trees in Medical Decision Making Support Systems
Authors: Barach P , Levashenko V , Zaitseva E
Published: September 2019

Fuzzy decision trees represent classification knowledge more naturally to the way of human thinking and are more robust in tolerating imprecise, conflict, and missing information. Decision Making Support Systems are used widely in clinical medicine because decisions play an important role in diagnostic processes. Decision trees are a very suitable candidate for induction of simple decision-making models with the possibility of automatic learning. The goal of this paper is to demonstrate a new approach for predictive data mining models in clinical medicine. This approach is based on induction of fuzzy decision trees. This approach allows us to build decision-making modesl with different properties (ordered, stability etc.). Three new types of fuzzy decision trees (non-ordered, ordered and stable) are considered in the paper. Induction of these fuzzy decision trees is based on cumulative information estimates. Results of experimental investigation are presented. Predictive data mining is becoming an essential instrument for researchers and clinical practitioners in medicine. Using new approaches based on fuzzy decision trees allows to increase the prediction accuracy. Decision trees are a very suitable candidate for induction using simple decision-making models with the possibility of automatic and AI learning.
Exploring Hospital Wayfinding Systems: Touchscreen Kiosks, Apps and Environmental Cues
Authors: Harper Christy , Jefferies Spencer , Crosser Andrea , Avera Angie , Duke Tyler , Klisans Daniela Vasquez
Published: September 2019

This research examined the usability and effectiveness of wayfinding in multiple large, complex, multi-building hospitals. The initial research explored three large hospitals’ touchscreen wayfinding interfaces. Errors and issues consistently observed were organized and developed into heuristics and design recommendations. In phase two, a promising mobile application was chosen and both a heuristic analysis and an onsite test of effectiveness were conducted by four researchers. Though the application met many requirements and solved many issues from phase one, it did not meet the expectation of real time navigation. For phase three we chose an app that provided real time navigation and conducted a usability test onsite. Results indicate that this problem is multi-faceted and wayfinding solutions must consider the other available aids in the environment. Incorporation of user centered design principles and requiring the evaluations of users in the development of wayfinding aids are needed. Beyond usability, the key learning is that the wayfinding systems cannot be created in a vacuum, rather the interfaces, the placement of the wayfinding system and the environment of the hospital must be considered. The wayfinding kiosk or app information should complement the environmental information such as color coding, landmarks, room and elevator labeling and signage.
Anesthesia Geriatric Evaluation (AGE): A Care-Ethical Perspective of a Multi-Disciplinary Approach for Tailored Preoperative Interventions
Authors: Pel E. L. , van Wijngaarden E. , van Dongen E. P. A. , Noordzij P. G.
Published: September 2019

Background: Frailty is considered to be an important risk factor for mortality in hospitalized patients. This study evaluates a preoperative frailty-screening tool called Anesthesia Geriatric Evaluation (AGE). Research into the concept of frailty, with a focus on multidisciplinary team meetings, may provide further insight for health care professionals in the understanding of frailty in everyday care situations. Methods: The research method chosen for this research is QUAGOL: Qualitative Analysis Guide of Leuven, which aims to reconstruct the story of the participants on a theoretical level and analyze the concepts found. Results: The following themes illustrate the analyzed concepts found: competence, resilience, sharing responsibility, broad frame of reference, obligation, and significance. Conclusion: AGE seems to create more awareness among health care professionals about frailty and tries to involve patients in their care process by making them aware of their abilities, motivation, and involving them in decisions to be made. This study shows that a shared decision-making process for surgical patients is often difficult to accomplish since AGE is still a paternalistic process of a multidisciplinary team with a medical perspective.
Biochemical alterations in diclofenac-treated rats: Effect of selenium on oxidative stress, inflammation, and hematological changes
Authors: Owumi Solomon E , Dim Uche J
Published: September 2019

We investigated the effect of selenium (Sel), a trace element in diclofenac sodium (DCF), nonsteroidal anti-inflammatory drugs-induced hepatic and renal toxicities in adult rats. Five experimental groups namely control, DCF (10 mg/kg), Sel (0.125 mg/kg), DCF + Sel (0.125 mg/kg), and DCF + Sel (0.25 mg/kg) consisting of 10 rats each were orally treated for 7 consecutive days. Following killing, biomarkers of hepatic and renal toxicities, antioxidant enzyme levels, myeloperoxidase activity, nitric oxide levels, reactive oxygen and nitrogen species (RONS), and lipid peroxidation (LPO) were analyzed spectrophotometrically. Further, the concentration of tumor necrosis factor alpha (TNF-α) was assessed using enzyme-linked immunosorbent assay, and hematological indices: white blood cells (WBC), lymphocytes, and neutrophils and eosinophil counts. Results indicated that DCF-induced increases in biomarkers of hepatic and renal toxicity were significantly ( p < 0.05) lessened in serum of rats co-exposed to DCF and Sel in a dose-dependent manner. DCF mediated decrease in antioxidant status, and increases in RONS, LPO, and TNF-α levels were reduced ( p < 0.05) in the liver and kidney of rats co-exposed to DCF and Sel. Additionally, Sel reduced hematological abnormalities associated with DCF treatment. Light microscopic examination showed that the severity of histopathological lesions induced by DCF was lessened in rats co-exposed to DCF and Sel. Taken together, Sel supplementation mitigated DCF-induced oxidative stress, inflammation, and hematological abnormalities in the liver and kidney of treated rats.
How I treat Waldenström macroglobulinemia
Authors: Dimopoulos Meletios A. , Kastritis Efstathios
Published: September 2019

In this How I Treat article on Waldenström macroglobulinemia, the authors present different case-based clinical scenarios and discuss available treatment options.
Employee stock ownership plan and stock price crash risk
Authors: Li Yan , Sun Bao , Yu Shangyao
Published: September 2019

This paper examines whether the announcement of an employee stock ownership plan (ESOP) affects stock price crash risk and the mechanism by which the ESOP may influence crash risk, using a sample of Chinese A-share firms from the period 2014 to 2017. We provide evidence that an ESOP announcement is significantly and negatively related to a firm’s stock price crash risk. An ESOP announcement sends positive signals to the market that insiders are optimistic about a firm’s future value, which helps enhance investor confidence, resist the pressure for a fire sale caused by negative information disclosure, and reduce stock price crash risk. Further research shows that larger-scale, lower-priced and non-leveraged ESOPs are more helpful in reducing crash risk. This paper sheds lights on the impact of ESOPs in a volatile market environment. It also contributes to firms’ implementation of ESOPs and the development of the legal system in capital markets.
An approach for evaluating early and long term mother-to-child transmission of HIV (MTCT) in low and middle income countries: a South African experience
Authors: Jackson Debra J. , Dinh Thu-Ha , Lombard Carl J. , Sherman Gayle G. , Goga Ameena E.
Published: September 2019

Background

Eliminating mother-to-child transmission of HIV is a global public health target. Robust, feasible methodologies to measure population level impact of programmes to prevent mother-to-child transmission of HIV (PMTCT) are needed in high HIV prevalence settings. We present a summary of the protocol of the South African PMTCT Evaluation (SAPMTCTE) with its revision over three repeated rounds of the survey, 2010–2014.

Methods

Three cross sectional surveys (2010, 2011–2012 and 2012–2013) were conducted in 580 primary health care immunisation service points randomly selected after stratified multistage probability proportional to size sampling. All infants aged 4–8 weeks receiving their six-week immunisation at a sampled facility on the day of the visit were eligible to participate. Trained research nurses conducted interviews and took infant dried blood spot (iDBS) samples for HIV enzyme immunoassay (EIA) and total nucleic acid polymerase chain reaction (PCR) testing. Interviews were conducted using mobile phones and iDBS were sent to the National Health Laboratory for testing. All findings were adjusted for study design, non-response, and weighted for number of South African live-birth in each study round. In 2012 a national closed cohort of these 4 to 8-week old infants testing EIA positive (HIV Exposed Infants) from the 2012–2013 cross-sectional survey was established to estimate longer-term PMTCT impact to 18 months. Follow-up analyses were to estimate weighted cumulative MTCT until 18 months, postnatal MTCT from 6 weeks until 18 months and a combined outcome of MTCT-or-death, using a competing risks model, with death as a competing risk. HIV-free survival was defined as a child surviving and HIV-negative up to 18 months or last visit seen. A weighted cumulative incidence analysis was conducted, adjusting for survey design effects.

Discussion

In the absence of robust high-quality routine medical recording systems, in the context of a generalised HIV epidemic, national surveys can be used to monitor PMTCT effectiveness; however, monitoring long-term outcomes nationally is difficult due to poor retention in care.
Infrastructural and human-resource factors associated with return of infant HIV test results to caregivers: secondary analysis of a nationally representative situational assessment, South Africa, 2010
Authors: Ngandu Nobubelo Kwanele , Maduna Vincent , Sherman Gayle , Noveve Nobuntu , Chirinda Witness , Ramokolo Vundli , Lombard Carl , Goga Ameena Ebrahim
Published: September 2019

Background

In June 2015, South Africa introduced early infant HIV diagnosis (EID) at birth and ten weeks postpartum. Guidelines recommended return of birth results within a week and ten weeks postpartum results within four weeks. Task shifting was also suggested to increase service coverage. This study aimed to understand factors affecting return of EID results to caregivers.

Methods

Secondary analysis of data gathered from 571 public-sector primary health care facilities (PHCs) during a nationally representative situational assessment, was conducted. The assessment was performed one to three months prior to facility involvement in the 2010 evaluation of the South African programme to prevent mother-to-child HIV transmission (SAPMTCTE). Self-reported infrastructural and human resource EID-related data were collected from managers and designated staff using a structured questionnaire. The main outcome variable was ‘EID turn-around-time (TAT) to caregiver’ (caregiver TAT), measured as reported number of weeks from infant blood draw to caregiver receipt of results. This was dichotomized as either short (≤3 weeks) or delayed (> 3 weeks) caregiver TAT. Logit-based risk difference analysis was used to assess factors associated with short caregiver TAT. Analysis included TAT to facility (facility TAT), defined as reported number of weeks from infant blood draw to facility receipt of results.

Results

Overall, 26.3% of the 571 PHCs reported short caregiver TAT. In adjusted analyses, short caregiver TAT was less achieved when facility TAT was > 7 days (versus ≤7 days) (adjusted risk difference (aRD): − 0.2 (95% confidence interval − 0.3-(− 0.1)),p = 0.006 for 8–14 days and − 0.3 (− 0.5-(− 0.1)), p = 0.006 for > 14 days), and in facilities with staff nurses (compared to those without) (aRD: − 9.4 (− 16.6-(− 2.2),p = 0.011).

Conclusion

Although short caregiver TAT for EID was only reported in approximately 26% of facilities, these facilities demonstrate that achieving EID TAT of ≤3 weeks is possible, making timely ART initiation within 3 weeks of diagnosis feasible within the public health sector. Our adjusted analyses underpin the need for quick return of results to facilities. They also raise questions around staff mentoring: we hypothesise that facilities with staff nurses were likely to have fewer professional nurses, and thus inadequate senior support.
Clinical, neuroimaging, biochemical, and genetic features in six Chinese patients with Adrenomyeloneuropathy
Authors: Li Jie , Wang Hongfen , He Zizi , Wang Xiangqing , Tang Jing , Huang Dehui
Published: September 2019

Background

Adrenoleukodystrophy is a rare neurogenetic disease, AMN is the most common adult phenotype, such patients in China have not gotten enough attention. This article aims to study the features of AMN in Chinese patients and expand the gene spectrum of Chinese X-linked adrenoleukodystrophy (X-ALD) patients.

Methods

We applied clinical analysis, radiology, plasma levels of very long chain fatty acids (VLCFA) and genetic analysis to test the 6 Chinese AMN patients.

Results

All 6 patients are men. Ages of neurological symptom onset are distributed between 21 and 38. Sexual dysfunction occurred in 5 of 6 patients. Three patients had positive family history. Five patients had Addison’s disease. Four patients were diagnosed as pure AMN, while the other two patients were with cerebral involvement. Four patients had abnormalities of nerve conduction studies. There were four patients with central conduction defects in somatosensory evoked potential tests. All 6 patients were found diffuse cord atrophy in spinal MRI. Brain MRI showed abnormal signals in 2 of the 6 tested patients, which indicated the clinical phenotypes. Plasma levels of VLCFA, as well as C24:0/C22:0 and C26:0/C22:0 ratios were elevated in 5 tested patients. Five different ABCD1 mutations were identified in 5 tested patients, one of which was a de novo mutation, and the other four have been reported previously.

Conclusion

This research described the clinical, neuroimaging, biochemical, and genetic sides of Chinese AMN patients. A de novo mutation in the ABCD1 gene sequence was identified. Emotional trauma may trigger or aggravate the development of cerebral demyelination in AMN patients. Regular evaluation of brain MRI is important for AMN patients, especially for ‘pure AMN’ patients. When encountering patients with ‘myeloneuropathy-only’, neurologists should not ignore the tests of VLCFA or/and the ABCD1 gene.
Maternal pre-pregnancy body mass index, smoking in pregnancy, and alcohol intake in pregnancy in relation to pubertal timing in the children
Authors: Brix Nis , Ernst Andreas , Lauridsen Lea Lykke Braskhøj , Parner Erik Thorlund , Arah Onyebuchi A. , Olsen Jørn , Henriksen Tine Brink , Ramlau-Hansen Cecilia Høst
Published: September 2019

Background

Earlier pubertal timing has been observed in many countries. We aimed to explore if prenatal exposure to maternal obesity, smoking, and alcohol intake was associated with timing of puberty by use of a novel marker of pubertal timing: ‘the height difference in standard deviations’ (HD:SDS).

Methods

HD:SDS is the difference between pubertal height in standard deviations and adult height in standard deviations, and it correlates well with age at peak height velocity. Pubertal height was measured by health care professionals at approximately 13 years in boys and 11 years in girls, and the children’s adult height was predicted from parental height reported by the mothers during pregnancy. Information on HD:SDS was available for 42,849 of 56,641 eligible boys and girls from the Danish National Birth Cohort born 2000–2003. In a subsample, HD:SDS was validated against age at the following self-reported pubertal milestones: Tanner stages, menarche, first ejaculation, voice break, acne, and axillary hair. Prenatal exposures were reported by mothers during pregnancy.

Results

HD:SDS correlated moderately with the pubertal milestones considered (correlation coefficients: − 0.20 to − 0.53). With normal weight (body mass index (BMI): 18.5–24.9 kg/m2) as the reference, maternal pre-pregnancy obesity (BMI: 30.0+ kg/m2) was associated with earlier pubertal timing: 0.23 (95% confidence interval (CI): 0.18, 0.28) higher HD:SDS in boys and 0.19 (95% CI, 0.14, 0.24) higher HD:SDS in girls. Maternal smoking was not associated with pubertal timing. Compared to alcohol abstainers, maternal intake of > 3 units of alcohol weekly was associated with later puberty in boys only: 0.14 (95% CI, 0.05, 0.24) lower HD:SDS.

Conclusion

As correlations between HD:SDS and the considered pubertal milestones were comparable to those reported in the literature between age a peak height velocity and the considered pubertal milestones, the validity of HD:SDS seems acceptable. Maternal pre-pregnancy obesity was associated with earlier pubertal timing in both sexes, and maternal alcohol intake during pregnancy was associated with later pubertal timing in boys. Maternal smoking has been linked to earlier timing of puberty, but this was not replicated in our setting using HD:SDS as a marker of pubertal timing.
Development and validation of a prediction model for knee joint line orientation after high tibial osteotomy
Authors: Park Jae-Young , Chang Chong Bum , Kang Dong-Wan , Oh Sohee , Kang Seung-Baik , Lee Myung Chul
Published: September 2019

Background

Maintenance of optimal knee joint line orientation (KJLO) is important after high tibial osteotomy (HTO). No tools, however, are currently available that could predict the value of postoperative KJLO before surgery. First, this study sought to determine the effects of various preoperative anatomical alignment parameters to postoperative KJLO. Based upon these analyses, we aimed to devise an equation that predicts the value of postoperative KJLO.

Methods

A total of 14 radiographic parameters were measured in preoperative and postoperative full-limb standing anteroposterior radiographs on 50 patients who underwent open-wedge HTO. The parameters were analysed using multivariable linear regression to predict KJLO after HTO. External validation of the equation was done with 20 patients who underwent HTO at another institution.

Results

After HTO, KJLO increased from − 0.8° to 2.9° (P < 0.001). Based on the multivariable linear regression analysis, an equation was derived that can estimate postoperative KJLO after HTO; postoperative KJLO(°) = 1.029 + 0.560 × preoperative KJLO(°) + 0.310 × preoperative tibia plateau inclination(°) + 0.463 × aimed correction angle(°). The adjusted coefficients of determination value for this equation was 0.721. The equation also showed good calibration and predictability in external validation with predicted squared correlation coefficient of 0.867.

Conclusions

This study analysed the effects of preoperative anatomical alignment parameters on the postoperative KJLO. An equation which predicts postoperative KJLO with preoperative anatomical alignment factors was devised and validated. This equation would help in selecting optimal patients for HTO and in selecting the optimal target correction angle in HTO.
A cross-sectional and 6-year follow-up study of associations between leisure time physical activity and vertebral fracture in adults
Authors: Mikkilä Saija , Calogiuri Giovanna , Emaus Nina , Morseth Bente
Published: September 2019

Introduction

Vertebral fractures are common osteoporotic fractures, affecting 2–46% of the population, causing morbidity and increased risk of mortality. Physical activity has beneficial effects for bone health, including increased bone mineral density and reduced hip fractures. However, evidence concerning prevention of vertebral fractures is scarce. Therefore, the aim of this study was to investigate the association between leisure time physical activity and vertebral fracture risk.

Methods

The data were retrieved from the 2001 and 2007–2008 surveys of the Tromsø Study, a longitudinal population study in Norway. A total of 1904 participants (1030 women and 874 men, age 38–87 yr and 40–87 yr respectively) were included in the cross-sectional analysis (2007–2008). Prospective follow-up data (2001 to 2007) on physical activity were available for 1131 participants (636 women and 495 men, age 32–69 yr and 33–69 yr respectively). Physical activity was assessed by a questionnaire and vertebral fracture by lateral vertebral fracture assessment from dual-energy x-ray absorptiometry scans. Logistic regression was used to examine associations between physical activity and vertebral fracture.

Results

After controlling for confounders (age, height, weight, smoking, osteoporosis, osteoporosis medication, left hip total bone mineral density, and use of hormones in women only), no cross-sectional associations between physical activity levels and vertebral fracture were observed, OR 1.13 (95% CI: 0.59–2.13), for moderately active women and 1.44 (0.61–3.42) for highly active women, compared with sedentary women. In men, the respective ORs were 1.74 (95% CI: 0.91–3.35) and 1.64 (0.78–3.41). In the prospective analyses, OR for vertebral fracture in women with reduced physical activity was 0.81 (95% CI: 0.18–3.62), 1.24 (95% CI: 0.29–5.26) for increased physical activity and 1.54 (95% CI: 0.43–5.50) for active unchanged physical activity pattern, compared with sedentary unchanged physical activity. In men, the respective ORs were 2.05 (95% CI: 0.57–7.42), 2.23 (95% CI: 0.63–7.87), and 1.81 (95% CI: 0.54–6.02). Subanalyses of women and men ≥50 yr showed similar results.

Conclusions

Our findings suggest that physical activity does not play a major role in preventing vertebral fractures in Norwegian adults. Future studies may benefit from data on incident vertebral fracture, and objectively measured physical activity.
Improved long-term cardiovascular outcomes after intensive versus standard screening of diabetic complications: an observational study
Authors: Morieri Mario Luca , Longato Enrico , Mazzucato Marta , Di Camillo Barbara , Cocchiglia Arianna , Gubian Lorenzo , Sparacino Giovanni , Avogaro Angelo , Fadini Gian Paolo , Vigili de Kreutzenberg Saula
Published: September 2019

Background

Complication screening is recommended for patients with type 2 diabetes (T2D), but the optimal screening intensity and schedules are unknown. In this study, we evaluated whether intensive versus standard complication screening affects long-term cardiovascular outcomes.

Methods

In this observational study, we included 368 T2D patients referred for intensive screening provided as a 1-day session of clinical–instrumental evaluation of diabetic complications, followed by dedicated counseling. From a total of 4906 patients, we selected control T2D patients who underwent standard complication screening at different visits, by 2:1 propensity score matching. The primary endpoint was the 4p-MACE, defined as cardiovascular mortality, or non-fatal myocardial infarction, stroke, or heart failure. The Cox proportional regression analyses was used to compare outcome occurrence in the two groups, adjusted for residual confounders.

Results

357 patients from the intensive screening group (out of 368) were matched with 683 patients in the standard screening group. Clinical characteristics were well balanced between the two groups, except for a slightly higher prevalence of microangiopathy in the intensive group (56% vs 50%; standardized mean difference 0.11, p = 0.1). Median follow-up was 5.6 years. The adjusted incidence of 4p-MACE was significantly lower in the intensive versus standard screening group (HR 0.70; 95% CI 0.52–0.95; p = 0.02). All components of the primary endpoint had nominally lower rates in the intensive versus standard screening group, which was particularly significant for heart failure (HR 0.43; 95% CI 0.22–0.83; p = 0.01).

Conclusion

Among T2D patients attending a specialist outpatient clinic, intensive complication screening is followed by better long-term cardiovascular outcomes. No significant effect was noted for cardiovascular and all-cause mortality and the benefit was mainly driven by a reduced rate of hospitalization for heart failure.
Improvement of Fab expression by screening combinatorial synonymous signal sequence libraries
Authors: Kulmala Antti , Huovinen Tuomas , Lamminmäki Urpo
Published: September 2019

Background

Antibody fragments can be expressed in Escherichia coli, where they are commonly directed to the periplasm via Sec pathway to enable disulphide bridge formations and correct folding. In order to transport antibody fragments to the periplasmic space via Sec pathway, they are equipped with N-terminal signal sequence. Periplasmic expression has many benefits but it’s also subjected to many hurdles like inefficient translocation across the inner membrane and insufficient capacity of the translocation system. One solution to overcome these hurdles is a modulation of codon usage of signal sequence which has proved to be an efficient way of tuning the translocation process. Modulation of codon usage of signal sequences has been successfully employed also in improving the expression levels of antibody fragments, but unfortunately the effect of codon usage on the expression has not been thoroughly analyzed.

Results

In the present study we established three synonymous PelB signal sequence libraries by modulating codon usage of light chain and heavy chain PelB signal sequences of a Fab fragment. Each region (n-region, hydrophobic region and c-region) of the PelB signal sequence in the both chains of the Fab fragment in a bicistronic expression vector was mutated separately. We then screened for clones with improved expression profile. The best source for improved clones was the n-region library but in general, improved clones were obtained from all of the three libraries. After screening, we analyzed the effects of codon usage and mRNA secondary structures of chosen clones on the expression levels of the Fab fragment. When it comes to codon usage based factors, it was discovered that especially codon usage of fifth leucine position of the light chain PelB affects the expression levels of Fab fragment. In addition, we observed that mRNA secondary structures in the translation initiation regions of the light and heavy chain have an effect on expression levels as well.

Conclusions

In conclusion, the established synonymous signal sequence libraries are good sources for discovering Fab fragments with improved expression profile and obtaining new codon usage related information.
Role of the dynamic tumor microenvironment in controversies regarding immune checkpoint inhibitors for the treatment of non-small cell lung cancer (NSCLC) with EGFR mutations
Authors: Lin Anqi , Wei Ting , Meng Hui , Luo Peng , Zhang Jian
Published: September 2019

Immunotherapy has been incorporated into the first- and second-line treatment strategies for non-small cell lung cancer (NSCLC), profoundly ushering in a new treatment landscape. However, both adaptive signaling and oncogenic (epidermal growth factor receptor (EGFR)-driven) signaling may induce PD-L1 upregulation in NSCLC. Nevertheless, the superiority of immune checkpoint inhibitors (ICIs) in advanced EGFR-mutant NSCLC is only moderate. ICIs appear to be well tolerated, but clinical activity for some advanced EGFR-mutant NSCLC patients has only been observed in a small proportion of trials. Hence, there are still several open questions about PD-L1 axis inhibitors in patients with NSCLC whose tumors harbor EGFR mutations, such as the effect of EGFR tyrosine kinase inhibitors (TKIs) or EGFR mutations in the tumor microenvironment (TME). Finding the answers to these questions requires ongoing trials and preclinical studies to identify the mechanisms explaining this possible increased susceptibility and to identify prognostic molecular and clinical markers that may predict benefits with PD-1 axis inhibition in this specific NSCLC subpopulation. The presence of multiple mechanisms, including dynamic immune TME profiles, changes in PD-L1 expression and low tumor mutational burdens, may explain the conflicting data regarding the correlation between PD-L1 axis inhibitors and EGFR mutation status. We conducted a review of this currently controversial topic in an attempt to aid in the decision-making process.
Long-term statin persistence is poor among high-risk patients with dyslipidemia: a real-world administrative claims analysis
Authors: Toth Peter P. , Granowitz Craig , Hull Michael , Anderson Amy , Philip Sephy
Published: September 2019

Background

A decade ago, statin persistence was < 50% after 1 year, and recent short-term analyses have revealed very little progress in improving statin persistence, even in patients with a prior cardiovascular (CV) event. Data on longer-term statin persistence are lacking. We measured long-term statin persistence in patients with high CV risk.

Methods

This retrospective administrative claims analysis of the Optum Research Database included patients aged ≥ 45 years with diabetes and/or atherosclerotic CV disease (ASCVD) who had a statin prescription filled in 2010. It included an elevated triglycerides (TG) cohort of patients with index date in 2010 and TG ≥ 150 mg/dL (n = 23,181) and a propensity-matched comparator cohort with TG < 150 mg/dL and high-density lipoprotein cholesterol > 40 mg/dL (n = 23,181). Both cohorts were followed for ≥ 6 months up to March 2016.

Results

The probability of remaining on a prescription fill for index statin therapy was 47% after 1 year and 19% after 5 years in both cohorts. Statin persistence was worse among women than men, and among younger versus older patients (P < 0.001 for all comparisons). After 5 years, the probability of remaining on a prescription fill for index statin was < 25% across all subgroups assessed including patients with and without baseline revascularization, heart failure, peripheral artery disease and renal disease. Similar results were observed in a subcohort analysis of patients with TG 200–499 mg/dL.

Conclusions

Long-term statin persistence after 5 years is alarmingly low (< 25%) and is a public health concern.
Segmental aneuploidy in human blastocysts: a qualitative and quantitative overview
Authors: Escribà María-José , Vendrell Xavier , Peinado Vanessa
Published: September 2019

Background

Microarray-based and next generation sequencing (NGS) technologies have revealed that segmental aneuploidy is frequently present in human oocytes, cleavage-stage embryos and blastocysts. However, very little research has analyzed the type, size, chromosomal distribution and topography of the chromosomal segments at the different stages of development.

Methods

This is a retrospective study of 822 PGT-A (preimplantation genetic test for aneuploidies) performed on trophectoderm samples from 3565 blastocysts biopsied between January 2016 and April 2017. The cycles in question had been initiated for varying clinical indications. Samples were analyzed by next generation sequencing-based technology. Segmental aneuploidies were evaluated when fragment size was > 5 Mb. Blastocysts presenting a single segmental aneuploidy (SSA), without any additional whole-chromosome gain/loss, were statistically analyzed for incidence, type, size and chromosomal emplacement. Segment sizes relative to the whole chromosome or arm (chromosome- and arm-ratios) were also studied.

Results

8.4% (299/3565) of blastocysts exhibited segmental aneuploidy for one or more chromosomes, some of which were associated with whole-chromosome aneuploidy while others were not. Nearly half of them (4.5%: 159/3565 of blastocysts) exhibited pure-SSA, meaning that a single chromosome was affected by a SSA. Segments were more frequent in medium-sized metacentric or submetacentric chromosomes and particularly in q-chrmosome arms, variables that were related to trophectoderm quality. SSA size was related to a greater extent to chromosome number and the arm affected than it was to SSA type. In absolute values (Mb), SSA size was larger in large chromosomes. However, the SSA:chromosome ratio was constant across all chromosomes and never exceeded 50% of the chromosome.

Conclusions

SSA frequency is chromosome- and topographically dependent, and its incidence is not related to clinical or embryological factors, but rather to trophectoderm quality. SSA might be originated by chromosome instability in response to chromothripsis, bias introduced by the biopsy and/or iatrogenic effects.

Trial registration

Retrospectively registered.
Preactivation of Notch1 in remote ischemic preconditioning reduces cerebral ischemia-reperfusion injury through crosstalk with the NF-κB pathway
Authors: Liang Weidong , Lin Chunshui , Yuan Liuqing , Chen Li , Guo Peipei , Li Ping , Wang Wei , Zhang Xin
Published: September 2019

Background

Remote ischemic preconditioning (RIPC) initiates endogenous protective pathways in the brain from a distance and represents a new, promising paradigm in neuroprotection against cerebral ischemia-reperfusion (I/R) injury. However, the underlying mechanism of RIPC-mediated cerebral ischemia tolerance is complicated and not well understood. We reported previously that preactivation of Notch1 mediated the neuroprotective effects of cerebral ischemic preconditioning in rats subjected to cerebral I/R injury. The present study seeks to further explore the role of crosstalk between the Notch1 and NF-κB signaling pathways in the process of RIPC-induced neuroprotection.

Methods

Middle cerebral artery occlusion and reperfusion (MCAO/R) in adult male rats and oxygen-glucose deprivation and reoxygenation (OGD/R) in primary hippocampal neurons were used as models of I/R injury in vivo and in vitro, respectively. RIPC was induced by a 3-day procedure with 4 cycles of 5 min of left hind limb ischemia followed by 5 min of reperfusion each day before MCAO/R. Intracerebroventricular DAPT injection and sh-Notch1 lentivirus interference were used to inhibit the Notch1 signaling pathway in vivo and in vitro, respectively. After 24 h of reperfusion, neurological deficit scores, infarct volume, neuronal apoptosis, and cell viability were assessed. The protein expression levels of NICD, Hes1, Phospho-IKKα/β (p-IKK α/β), Phospho-NF-κB p65 (p-NF-κB p65), Bcl-2, and Bax were assessed by Western blotting.

Results

RIPC significantly improved neurological scores and reduced infarct volume and neuronal apoptosis in rats subjected to I/R injury. OGD preconditioning significantly reduced neuronal apoptosis and improved cell viability after I/R injury on days 3 and 7 after OGD/R. However, the neuroprotective effect was reversed by DAPT in vivo and attenuated by Notch1-RNAi in vitro. RIPC significantly upregulated the expression of proteins related to the Notch1 and NF-κB pathways. NF-κB signaling pathway activity was suppressed by a Notch1 signaling pathway inhibitor and Notch1-RNAi.

Conclusions

The neuroprotective effect of RIPC against cerebral I/R injury was associated with preactivation of the Notch1 and NF-κB pathways in neurons. The NF-κB pathway is a downstream target of the Notch1 pathway in RIPC and helps protect focal cerebral I/R injury.
Diagnostic extended usefulness of RMI: comparison of four risk of malignancy index in preoperative differentiation of borderline ovarian tumors and benign ovarian tumors
Authors: Zhang Shuang , Yu Shan , Hou Wenying , Li Xiaoying , Ning Chunping , Wu Yingnan , Zhang Feng , Jiao Yu Fei , Lee Leo Tsz On , Sun Litao
Published: September 2019

Background

This study aimed to examine the performance of the four risk of malignancy index (RMI) in discriminating borderline ovarian tumors (BOTs) and benign ovarian masses in daily clinical practice.

Methods

A total of 162 women with BOTs and 379 women with benign ovarian tumors diagnosed at the Second Affiliated Hospital of Harbin Medical University from January 2012 to December 2016 were enrolled in this retrospective study. Also, we classified these patients into serous borderline ovarian tumor (SBOT) and mucinous borderline ovarian tumor (MBOT) subgroup. Preoperative ultrasound findings, cancer antigen 125 (CA125) and menopausal status were reviewed. The area under the curve (AUC) of receiver operator characteristic curves (ROC) and performance indices of RMI I, RMI II, RMI III and RMI IV were calculated and compared for discrimination between benign ovarian tumors and BOTs.

Results

RMI I had the highest AUC (0.825, 95% CI: 0.790–0.856) among the four RMIs in BOTs group. Similar results were found in SBOT (0.839, 95% CI: 0.804–0.871) and MBOT (0.791, 95% CI: 0.749–0.829) subgroups. RMI I had the highest specificity among the BOTs group (87.6, 95% CI: 83.9–90.7%), SBOT (87.6, 95% CI: 83.9–90.7%) and MBOT group (87.6, 95% CI: 83.9–90.7%). RMI II scored the highest overall in terms of sensitivity among the BOTs group (69.75, 95% CI: 62.1–76.7%), SBOT (74.34, 95% CI: 65.3–82.1%) and MBOT (59.18, 95% CI: 44.2–73.0%) group.

Conclusion

Compared to other RMIs, RMI I was the best-performed method for differentiation of BOTs from benign ovarian tumors. At the same time, RMI I also performed best in the discrimination SBOT from benign ovarian tumors.
External iliac vein compression and lower-extremity swelling caused by an iliopectineal ganglion: a case report
Authors: Fukui Kiyokazu , Kaneuji Ayumi , Kawahara Norio
Published: September 2019

Background

A hip joint ganglion is a rare cause of lower-extremity swelling.

Case presentation

We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis.

Conclusions

Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.