bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Short Stature with An Increased Risk of End-Stage Renal Disease in Type 2 Diabetic Patients: A Nationwide Population-Based Cohort Study
Authors: Hong Yu Ah , Han Kyung-Do , Yun Jae-Seung , Koh Eun Sil , Ko Seung-Hyun , Chung Sungjin
Published: December 2019

Short stature has been associated with increased various disease and all-cause death, but no reliable data exist the association between height and end-stage renal disease (ESRD) in diabetic patients. We investigated the relationship between short stature, development of ESRD, and mortality in type 2 diabetes. This study analyzed clinical data using the National Health Insurance Database in Korea. Height was stratified by five groups according to age and sex. Risk of ESRD and all-cause mortality was analyzed with Cox proportional hazards models. During a 6.9-year follow-up period, 220,457 subjects (8.4%) died and 28,704 subjects (1.1%) started dialysis. Short stature significantly increased the incidence of ESRD and all-cause mortality in the overall cohort analysis. In multivariable analysis, hazard ratios (HR) for development of ESRD comparing the highest versus lowest quartiles of adult height were 0.86 (95% confidence interval (CI), 0.83–0.89). All-cause mortality also decreased with highest height compared to patients with lowest height after fully adjusting for confounding variables (HR 0.79, 95% CI, 0.78–0.81). Adult height had an inverse relationship with newly diagnosed ESRD and all-cause in both males and females. Short stature is strongly associated with an increased risk of ESRD and all-cause mortality in type 2 diabetes.
Effect of Olive-Pine Bottom Ash on Properties of Geopolymers Based on Metakaolin
Authors: Bonet-Martínez Eduardo , García-Cobo Pedro , Pérez-Villarejo Luis , Castro Eulogio , Eliche-Quesada Dolores
Published: December 2019

In this research, the feasibility of using bottom ashes generated by the combustion of biomass (olive pruning and pine pruning) as a source of aluminosilicates (OPBA) has been studied, replacing the metakaolin precursor (MK) in different proportions (0, 25, 50, 75 and 100 wt. % substitution) for the synthesis of geopolymers. As alkaline activator an 8 M NaOH solution and a Na2SiO3 have been used. The geopolymers were cured 24 hours in a climatic chamber at 60 ° C in a water-saturated atmosphere, subsequently demoulded and cured at room temperature for 28 days. The results indicated that the incorporation of OPBA waste, which have 19.7 wt. % of Ca, modifies the characteristics of the products formed after alkaline activation. In general terms, the incorporation of increasing amounts of calcium-rich ashes results in geopolymers with higher bulk density. The compressive strength increases with the addition of up to 50 wt. % of OPBA with respect to the control geopolymers, contributing the composition of the residue to the acquisition of a better behaviour mechanical. The results indicate the potential use of these OPBA waste as raw material to produce unconventional cements with 28-day curing strengths greater than 10 MPa, and thermal conductivities less than 0.35 W/mK.
Teaching Shared Value through University-business Contaminations
Authors: Scagnelli Simone , Corazza Laura
Published: December 2019

This paper presents and discusses the pedagogical implication of teaching Shared Value, presenting a case study about a contamination lab namely the case of the Shared Value Living Lab (SVLL) which took place at the University of Torino (UniTO) in Italy. The paper analyzes the pedagogical side of CSV (arguments, topics, learning methodologies, etc.) in the framework of recent theories and approaches of teaching sustainability in business school and in the cooperation between industry and academia, as well. Our research methodology relies on the analysis and comparison of one case study under an intrinsic as it enables researchers to find “interactivity” and connectedness between the individuals participating. The SVLL case is an interesting example of co-creation of social value between academia and its stakeholders. First, it represents an inclusive project linking society and business; second, SVLL acted as a hub putting in contact different interlocutors; third, SVLL training stimulated the acquisition of soft skill in students (interviews, managing relations, represents the project outside university, explaining the project to people, research curiosity) through contamination activities. With our study, we demonstrate the change in students participating in the SVLL may not only be cognitive but also affective, making students feel hopeful, empowered and liberated, and ready to contribute to a more profound change towards the vast array of pro-sustainability behaviors.
Teleconsultations between Patients and Healthcare Professionals in Primary Care in Catalonia: the Evaluation of Text Classification Algorithms Using Machine Learning
Authors: López Seguí Francesc , Ander Egg Aguilar Ricardo , de Maeztu Gabriel , García-Altés Anna , García Cuyàs Francesc , Walsh Sandra , Sagarra Castro Marta , Vidal-Alaball Josep
Published: December 2019

Background: the primary care service in Catalonia has operated an asynchronous teleconsulting service between GPs and patients since 2015 (eConsulta), which has generated some 500,000 messages. New developments in big data analysis tools, particularly those involving natural language, can be used to accurately and systematically evaluate the impact of the service. Objective: the study was intended to examine the predictive potential of eConsulta messages through different combinations of vector representation of text and machine learning algorithms and to evaluate their performance. Methodology: 20 machine learning algorithms (based on 5 types of algorithms and 4 text representation techniques)were trained using a sample of 3,559 messages (169,102 words) corresponding to 2,268 teleconsultations (1.57 messages per teleconsultation) in order to predict the three variables of interest (avoiding the need for a face-to-face visit, increased demand and type of use of the teleconsultation). The performance of the various combinations was measured in terms of precision, sensitivity, F-value and the ROC curve. Results: the best-trained algorithms are generally effective, proving themselves to be more robust when approximating the two binary variables "avoiding the need of a face-to-face visit" and "increased demand" (precision = 0.98 and 0.97, respectively) rather than the variable "type of query"(precision = 0.48). Conclusion: to the best of our knowledge, this study is the first to investigate a machine learning strategy for text classification using primary care teleconsultation datasets. The study illustrates the possible capacities of text analysis using artificial intelligence. The development of a robust text classification tool could be feasible by validating it with more data, making it potentially more useful for decision support for health professionals.
Adoption of ICT-based Information Sources and Market Participation among Smallholder Livestock Farmers in South Africa
Authors: Nwafor Christopher Ugochukwu , Ogundeji Abiodun, A. , van der Westhuizen Carlu
Published: December 2019

The study explored the contribution of ICT-based information sources to market participation among smallholder livestock farmers. Use of ICTs is considered paramount for providing smallholder farmers with required market information, in order to reduce market asymmetries. A Double Hurdle regression was utilized to analyze data collected from 150 smallholder livestock farmers in the study area. The results show that while use of ICT-based market information sources significantly influenced market participation, the effect of using ICT-based information sources on intensity of market participation was not significant. Other variables shown to influence both market participation and the intensity of market participation were age, additional income and membership of farmer cooperatives. This suggests the need to also consider other associated factors in the application of interventions which utilize ICT-based information sources in achieving planned market interventions.
An Information Ontology for the Process Algebra Model of Non-Relativistic Quantum Mechanics
Authors: Sulis William
Published: December 2019

The Process Algebra model has been shown to provide an alternative mathematical framework for non-relativistic quantum mechanics (NRQM). It reproduces the wave functions of non-relativistic quantum mechanics to a high degree of accuracy. It posits a fundamental level of finite, discrete events upon which the usual entities of NRQM supervene. It has been suggested that the Process Algebra model provides a true completion of NRQM, free of divergences and paradoxes, with causally local information propagation, contextuality and realism. Arguments in support of these claims have been mathematical. Missing has been an ontology of this fundamental level from which the formalism naturally emerges. In this paper it is argued that information and information flow provides this ontology. Higher level constructs such as energy, momentum, mass, spacetime, are all emergent from this fundamental level.
Testing Joints between Walls Made of AAC Masonry Units
Authors: Jasiński Radosław , Galman Iwona
Published: December 2019

Joints between walls are very important for structural analysis of each masonry building at the global and local level. This issue was often neglected in case of traditional joints and relatively squat walls. Nowadays the issue of wall joints is becoming particularly important due to the continuous strive for simplifying structures, introducing new technologies and materials. Eurocode 6 and other standards (USA, Canadian, Chinese, and Japanese) recommend inspecting joints between walls, but no detail procedures have been specified. This paper presents our own tests on joints between walls made of autoclaved aerated concrete (AAC) masonry units. Tests included reference models composed of two wall panels joined perpendicularly with a masonry bond (6 models), traditional steel and modified connectors (12 models). A shape and size of test models and structure of a test stand were determined on the basis of the analysis of the current knowledge, pilot studies and numerical analyses of FEM. The analysis referred to the morphology and failure mechanism of models. Load-displacement relationships for different types of joints were compared and obtained results were referred to results for reference models. A mechanism of cracking and failure was found to vary, and clear differences in behaviour and load capacity of each type of joints were observed. Individual working phases of joints were determined and defined, and the empirical approach was suggested to determine forces and displacement of wall joints.
Efficiency through a Lean Healthcare Implementation in a Public Hospital
Authors: Rosas-Hernandez Luisa , Tlapa Diego , Baez-Lopez Yolanda , Limon-Romero Jorge , Perez-Sanchez Armando
Published: December 2019

Hospitals face challenges to improve efficiency in order to meet an increasing demand for high quality of care and low costs. Industry-based methods such as lean healthcare (LH) are implemented to improve healthcare systems. This study presents a LH implementation following the DMAIC approach (Define-Measure-Analysis-Improve-Control) in a Mexican public hospital, and contributes to the literature by analyzing the relation of waste reduction and sustainability. We focused on improving the medical supply chain from a temporary warehouse (TW) to the operating room (OR). Therefore, we analyzed the value stream including main surgical procedures and their related medical supplies, and identified different causes of inefficiency, which were evaluated and controlled. As a result, five types of waste were reduced through different tools including: value stream map, Kanban, 5’s, among others. Over-processing requests were reduced 15.3%; similarly, defective identification numbers were reduced up to 46.5%, redundant processing was improved by 94.8%, unnecessary inventories were reduced near to 2.8% of the TW inventory, and transportation waste was reduced up to 16.7%. As a consequence, the lead-time for the main supplies was reduced 33 days. Results indicate that LH and DMAIC are effective to reduce waste and highly conducive to improve healthcare process sustainability.
Control Points Selection based on Maximum External Reliability for Designing Geodetic Networks
Authors: Matsuoka Marcelo Tomio , Rofatto Vinicius Francisco , Klein Ivandro , Roberto Veronez Mauricio , Da Silveira Luiz Gonzaga , Neto João Batista Silva , Alves Ana Cristina Ramos
Published: December 2019

Geodetic networks are essential for most geodetic, geodynamics and civil projects, such as monitoring the position and deformation of man-made structures, monitoring the crustal deformation of the Earth, establishing and maintaining a geospatial reference frame, mapping, civil engineering projects and so on. Before the installation of geodetic marks and gathering of survey data, geodetic networks need to be designed according to the pre-established quality criteria. In this study, we present a method for designing geodetic networks based on the concept of reliability. We highlight that the method discards the use of the observation vector of Gauss-Markov model. In fact, the only needs are the geometrical network configuration and the uncertainties of the observations. The aim of the proposed method is to find the optimum configuration of the geodetic control points so that the maximum influence of an outlier on the coordinates of the network is minimum. Here, the concept of Minimal Detectable Bias defines the size of the outlier and its propagation on the parameters is used to describe the external reliability. The proposed method is demonstrated by practical application of one simulated levelling network. We highlight that the method can be applied not only for geodetic network problems, but also in any branch of modern science.
Determination of Key Factors Affecting Transient Seaport Selection for Landlocked Countries in African Continent
Authors: Badi Ibrahim , Pamucar Dragan
Published: December 2019

Abstract: Many countries around the world suffer from the lack of a sea port directly linked to the rest of the world. Such countries are called "landlocked countries". This leads to Weak competitiveness of their products in the global market, as well as to the high cost of the imports. Africa has the largest share of these countries, with 16 of the 43 landlocked countries around the world. The aim of this paper is to propose a general framework for criteria that can be used to choose between ports in transit countries that can be used for import or export. These criteria are related to the assessment of the sea ports in terms of infrastructure and tariffs. It is also related to transport infrastructure from the transit country to the landlocked country and the level of safety. The study identified nine criteria that could be used to compare between ports in transit countries. Using Full Consistency Method (FUCOM) to evaluate those criteria showed that the number of navigation lines is the most important criteria followed by the port service level.
Deep Cerebellar Transcranial Direct Current Stimulation of the Dentate Nucleus to Facilitate Standing Balance in Chronic Stroke Survivors
Authors: Rezaee Zeynab , Kaura Surbhi , Solanki Dhaval , Dash Adyasha , Srivastava M V Padma , Lahiri Uttama , Dutta Anirban
Published: December 2019

Objective: Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. We hypothesized that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and the lower-limb representations in the cerebellum can improve standing balance functional reach in chronic (> 6 months’ post-stroke) stroke survivors. Materials and Methods: Magnetic resonance imaging(MRI) based subject-specific electric field was computed across 10 stroke survivors and one healthy MRI template to find an optimal bipolar bilateral ctDCS montage to target dentate nuclei and lower-limb representations (lobules VII-IX). Then, in a repeated-measure crossover study on 5 stroke survivors, we compared 15minutes of 2mA ctDCS based on the effects on successful functional reach(%) during standing balance task. Three-way ANOVA investigated the factors of interest– brain regions, montages, stroke participants, and their interactions.Results: “One-size-fits-all” ctDCS montage for the clinical study was found to be bipolar PO9h – PO10h for dentate nuclei and bipolar Exx7–Exx8 for lobules VII-IX with contalesional anode. Bipolar PO9h–PO10h ctDCS performed significantly (alpha=0.05) better in facilitating successful functional reach (%) when compared to bipolar Exx7–Exx8 ctDCS. Furthermore, a linear relationship between successful functional reach (%) and electric field strength was found where bipolar PO9h–PO10h montage resulted in a significantly (alpha=0.05) higher electric field strength when compared to bipolar Exx7–Exx8 montage for the same 2mA current. Conclusion: We presented a rational neuroimaging based approach to optimize deep ctDCS of the dentate nuclei and lower limb representations in the cerebellum for post-stroke balance rehabilitation.
Debt And Equity-Based Financing, Size And Islamic Banks Profitability: Empirical Evidence From Indonesia
Authors: Wahyudi Rofiul , Mujibatun Siti , Riduwan Riduwan
Published: December 2019

Islamic Banking as a financial institution functions to collect and distribute funds to the public. To carry out these functions, the capital structure scheme uses debt and equity based financing. In addition, the implementation is also influenced by the size which ultimately affect the performance of Islamic banking. This study aims to examine debt and equity-based financing, size and Islamic banks profitability: empirical evidence from Indonesia. The research method used is model estimation test of Moderated Regression Analysis (MRA) to see size as moderation variable. Banks profitability is represented by ROA and ROE. This study uses Islamic bank panel data from financial reports published during the sample period covering 2008-2017. The empirical findings show that debt and equity-based financing affect banks profitability. Furthemore, bank size does not moderate the debt and equity-based financing relationship to Islamic banks profitability.
Candida parapsilosis Flexor Tenosynovitis in an Immunocompetent Patient
Authors: Colombo Joshua R.
Published: December 2019

Invasive fungal flexor tenosynovitis caused by Candida species is a rare diagnosis, with only a very small number of case reports in the literature to date. We present only the fifth case reported in the literature of flexor tenosynovitis caused by Candida species. Only one other case reported Candida parapsilosis as the causative organism. Fungal flexor tenosynovitis typically presents in a subacute or chronic fashion. This is the only reported case of fungal flexor tenosynovitis caused by Candida to present acutely. Clinicians should consider fungal etiologies in invasive hand infections in both immunocompetent and immunosuppressed patients.
Detection of Nutrients and Major Ions at Al Muthanna Storage Site Soil
Authors: Et al. Al Sharaa
Published: December 2019

In the early 90s military operations and United Nations Special Commission “UNSCOM” teams have been destroyed the past Iraqi chemical program. Both operations led an extensive number of scattered remnants of contaminated areas. The quantities of hazardous materials, incomplete destructed materials, and toxic chemicals were sealed in two bunkers. Deficiency of appropriate destruction technology led to spreading the contamination around the storage site. This paper aims to introduce the environmental detection of the contamination in the storage site area using geospatial analysis technique. The environmental contamination level of nutrients and major ions such as sulphate (SO4), potassium (K), sodium (Na), magnesium (Mg), calcium (Ca), chlorine (Cl), phosphate (PO4) and nitrate (NO3) were detected and analyzed. The grid soil samples on the site and surrounding areas have been investigated, analyzed, and compared to the background points. The storage area grid was divided into 30 major sectors and all samples were evaluated from acquires 10 samples from each sector. The detection results have indicated that SO4 level was exceeded the permitted level by 25 times, K level also exceeded the permitted level but by 460, Na ions were 85 times greater the permitted level. Mg level was 180 times higher than that of permitted content. Activity level of Ca in the soil samples of the study area has also exhibited variability with nine times over the permitted level near the bunkers. However, very high contamination spot activity of Cl was found in destruction zone about which 44 times over the background level was found while PO4 level exceeded the permitted level by 35 times over the permitted level and there was no activity detected for the nitrate in the storage area site.
Orthogonal Symmetric Higher bi-Derivations on Semiprime Г-Rings
Authors: Et al. Salih
Published: December 2019

Let M is a Г-ring. In this paper the concept of orthogonal symmetric higher bi-derivations on semiprime Г-ring is presented and studied and the relations of two symmetric higher bi-derivations on Г-ring are introduced.
Prevalencia de recesión gingival y factores asociados a la higiene bucal en estudiantes del postgrado de la Universidad Científica del Sur
Authors: Rivera-Valerio R. , De los Ríos–Argumedo M.
Published: December 2019

OBJETIVO: Determinar la prevalencia de la recesión gingival y los factores asociados a la higiene bucal en estudiantes del postgrado de la UCSUR. Lima 2014. METODOLOGÍA: Se realizó un estudio observacional, descriptivo y transversal en una muestra de 77 alumnos. Los datos se obtuvieron mediante un cuestionario, se tomaron de 3 fotografías intraorales: anterior y laterales (derecha e izquierda), usando separadores y una cámara profesional Canon T3 con lente Sigma de 105 mm y ring flash; se examinaron los cepillos dentales con un uso no menor a un mes, estos fueron observados, fotografiados y clasificados. RESULTADOS: Se utilizó el modelo de análisis de regresión logística múltiple para explicar el comportamiento de la recesión gingival con respecto al género, tipo de cerdas, frecuencia de cepillado, técnica de Bass, presión excesiva, ortodoncia previa, deterioro de cerdas y edad, encontrándose valores para la edad (p=0.02) con un OR=8.292 y el deterioro de las cerdas (p=0.045) con un OR=0.150, que si aportaron significativamente al modelo. Sin embargo, el resto de variables resultaron no tener un aporte, ni ser un factor de riesgo significativo. CONCLUSIONES: La prevalencia de la recesión gingival fue elevada en los alumnos evaluados de Postgrado de la UCSUR, asimismo se encontró asociación entre recesión gingival con el grupo etario igual o mayor a 30 años, con el deterioro de cerdas, con la excesiva presión al cepillado y el tipo de pieza dentaria.
Contenidos
Authors: Científica del Sur Estomatología
Published: December 2019

Contenidos
Ateromas como hallazgo incidental en tomografía computarizada de haz cónico (TCHC): reporte de un caso
Authors: Chávez Lazo Yris Elisa
Published: December 2019

Los ateromas son lesiones focales que se desarrollan cuando las sustancias grasas, plauqetas, residuos celulares yl el calcio se depositan en el revestimiento de las arterias, siendo la causa principal de los infartos de miocardio y accidentes cerebro vasculares.
Capillary Pressure Effects on Estimating the Enhanced-Oil-Recovery Potential During Low-Salinity and Smart Waterflooding
Authors: Andersen Pål Østebø
Published: December 2019

Many experimental studies have investigated smart water and low-salinity waterflooding and observed significant incremental oil recovery after changes in the injected-brine composition. The common approach to model such enhanced-oil-recovery (EOR) mechanisms is by shifting the input relative permeability curves, particularly including a reduction of the residual oil saturation. Cores that originally display oil-wetness can retain much oil at the outlet of the flooded core because of the capillary pressure being zero at a high oil saturation. This end effect is difficult to overcome in highly permeable cores at typical laboratory rates. Injecting a brine that changes the wetting state to less-oil-wet conditions (represented by zero capillary pressure at a lower oil saturation) will lead to a release of oil previously trapped at the outlet. Although this is chemically induced incremental oil, it represents a reduction of remaining oil saturation, not necessarily of residual oil saturation.

This paper illustrates the mentioned issues of interpreting the difference in remaining and residual oil saturation during chemical EOR and hence the evaluation of potential smart water effects. We present a mathematical model representing coreflooding that accounts for wettability changes caused by changes in the injected composition. For purpose of illustration, this is performed in terms of adsorption of a wettability-alteration (WA) component coupled to the shifting of relative permeability curves and capillary pressure curves. The model is parameterized in accordance with experimental data by matching brine-dependent saturation functions to experiments where wettability alteration takes place dynamically because of the changing of one chemical component. It is seen that several effects can give an apparent smart water effect without having any real reduction of the residual oil saturation, including changes in the mobility ratio, where the oil already flowing is pushed more efficiently, and the magnitude of capillary end effects can be reduced because of increased water-wetness or because of a reduction in water relative permeability giving a greater viscous drag on the oil.
Identification of two novel COL10A1 heterozygous mutations in two Chinese pedigrees with Schmid-type metaphyseal chondrodysplasia
Authors: Kong Lingchi , Shi Li , Wang Wenbo , Zuo Rongtai , Wang Mengwei , Kang Qinglin
Published: December 2019

Background: Schmid-type metaphyseal chondrodysplasia (MCDS) is an autosomal dominant disorder caused by COL10A1 mutations, which is characterized by short stature, waddling gait, coxa vara and bowing of the long bones. However, descriptions of the expressivity of MCDS are rare.
Methods: Two probands and available family members affected with MCDS were subjected to clinical and radiological examination. Genomic DNA of all affected individuals was subjected to whole-exome sequencing, and candidate mutations were verified by Sanger sequencing in all available family members and in 250 healthy donors. A spatial model of the type X collagen (α1) C-terminal noncollagenous (NC1) domain was further constructed.
Results: We found that the phenotype of affected family members exhibited incomplete dominance. Mutation analysis indicated that there were two novel heterozygous missense mutations, [c.1765T>A (p.Phe589Ile)] and [c.1846A>G (p.Lys616Glu)] in the COL10A1 gene in family 1 and 2, respectively. The two novel substitution sites were highly conserved and the mutations were predicted to be deleterious by in silico analysis. Furthermore, protein modeling revealed that the two substitutions were located in the NC1 domain of collagen X (α1), which potentially impacted the trimerization of collagen X (α1) and combination with molecules in the pericellular matrix.
Conclusion: Two novel mutations were identified in the present study, which will facilitate diagnosis of MCDS and further expand the spectrum of the COL10A1 mutations associated with MCDS patients. In addition, our research revealed the phenomenon of incomplete dominance in MCDS.
Purification of the recombinant green fluorescent protein from tobacco plants using alcohol/salt aqueous two-phase system and hydrophobic interaction chromatography
Authors: Dong Jie , Ding Xiangzhen , Wang Sheng
Published: December 2019

Background: The green fluorescent protein (GFP) has been regarded as a valuable tool and widely applied as a biomarker in medical applications and diagnostics. A cost-efficient upstream expression system and an inexpensive downstream purification process will meet the demands of the GFP protein with high-purity. Results: The recombinant GFP was transiently expressed in an active form in agoinoculated Nicotiana benthamiana leaves by using Tobacco mosaic virus (TMV) RNA-based overexpression vector (TRBO). The yield of recombinant GFP was up to ~60% of total soluble proteins (TSP). Purification of recombinant GFP from the clarified lysate of N. benthaniana leaves was achieved by using an alcohol/salt aqueous two-phase system (ATPS) and following with a further hydrophobic interaction chromatography (HIC). The purification process takes only ~4 h and can recover 34.1 % of the protein. The purity of purified GFP was more than 95% and there were no changes in its spectroscopic characteristics. Conclusions: The strategy described here combines the advantages of both the economy and efficiency of plant virus-based expression platform and the simplicity and rapidity of environmentally friendly alcohol/salt ATPS. It has a considerable potential for the development of a cost-efficient alternative for production of recombinant GFP.
Low adaptive potential for tolerance to ethynylestradiol, but also low toxicity, in a grayling population (Thymallus thymallus)
Authors: Cunha Lucas Marques da , Maitre Diane , Wedekind Claus
Published: December 2019

Background: The presence of a novel pollutant can induce rapid evolution if there is additive genetic variance for the tolerance to the stressor. Continuous selection over some generations can then reduce the toxicity of the pollutant but also deplete the additive genetic variance for the tolerance and thereby slow down adaptation. One common pollutant that has been ecologically relevant for some time is 17alpha-ethynylestradiol (EE2), a synthetic compound of oral contraceptives since their market launch in the 1960s. EE2 is typically found in higher concentrations in rivers than in lakes. Recent experimental work revealed significant genetic variance for the tolerance to EE2 in two lake-spawning salmonid species but no such variance in river-spawning brown trout. We used another river-spawning salmonid, the European grayling Thymallus thymallus, to study the toxicity of an ecologically relevant concentration of EE2. We also used a full-factorial in vitro breeding design and singly rearing of 1,555 embryos and larvae of 40 sib groups to test whether there is additive genetic variance for the tolerance to this pollutant. Results: We found that exposure to EE2 reduced larval growth after hatching, but contrary to what has been found in the other salmonids, there were no significant effects of EE2 on embryo growth and survival. We found additive genetic variance for embryo viability, i.e. heritability for fitness. However, there was no significant additive variance for the tolerance to EE2. Conclusions: Our findings support the hypothesis that continuous selection has reduced the toxicity of EE2 and depleted genetic variance for tolerance to this synthetic stressor.
Absorbable suture can be effectively and safely used to close the mesenteric defect in a Gastric bypass Sprague-Dawley Rat Model
Authors: Yao Libin , Dolo Ponnie Robertlee , Shao Yong , Li Chao , Widjaja Jason , Hong Jian , Zhu Xiaocheng
Published: December 2019

Background: To observe if closing the mesenteric defect with absorbable sutures creates a safe adhesion compared to non-absorbable suture after Roux-en-Y gastric bypass. Methods: Rats were randomly assigned to 5 experimental groups according to the different suture materials used in closing the mesenteric defects (Peterson’s space) after Roux-en-Y gastric bypass. Group A (control group), Group B (non-absorbable suture, Prolene suture), Group C (biological glue), Group D (non-absorbable suture, polyester suture) and Group E (absorbable suture). All rats were followed up for 8 weeks postoperatively and underwent laparotomy to observe the degree of adhesion and closure of the mesenteric defect. Results: No significant difference was found in the decrease in food intake and body weight among all groups. No internal hernia (IH) occurred in any group. The mesenteric defects of Group A remained completely visible without any closure or adhesion. Multiple gaps were found between the Prolene suture and the mesentery along the suture line in Group B. The mesenteric defects of Group C were complete closed with multiple adhesions of the small intestine and the greater omentum. The mesenteric defects in both Group D and Group E closed completely. The average adhesion scores in Group A and Group B were 0 and 0.33±0.52 respectively. The average adhesion score in group C (3.83±0.41) was higher than the other groups (p ＜ 0.05). The average adhesion scores in Group D and E were similar (3.17±0.41 and 3.00±0.00 respectively). Conclusion: Absorbable suture created a safe adhesion score between the mesentery which was not inferior to non-absorbable sutures.
An immune-centric exploration of BRCA1 and BRCA2 germline mutation related breast and ovarian cancers
Authors: Przybytkowski Ewa , Davis Thomas , Hosny Abdelrahman , Eismann Julia , Matulonis Ursula A. , Wulf Gerburg M. , Nabavi Sheida
Published: December 2019

Background: BRCA1/2 germline mutation related cancers are candidates for new immune therapeutic interventions. This study was a hypothesis generating exploration of genomic data collected at diagnosis for 19 patients. The prominent tumor mutation burden (TMB) in hereditary breast and ovarian cancers in this cohort was not correlated with high global immune activity in their microenvironments. More information is needed about the relationship between genomic instability, phenotypes and immune microenvironments of these hereditary tumors in order to find appropriate markers of immune activity and the most effective anticancer immune strategies. Methods: Mining and statistical analyses of the original DNA and RNA sequencing data and The Cancer Genome Atlas data were performed. To interpret the data, we have used published literature and web available resources such as Gene Ontology, The Cancer immunome Atlas and the Cancer Research Institute iAtlas. Results: We found that BRCA1/2 germline related breast and ovarian cancers do not represent a unique phenotypic identity, but theyexpress a range of phenotypes similar to sporadic cancers. All breast and ovarian BRCA1/2 related tumors are characterized by high homologous recombination deficiency (HRD) and low aneuploidy. Interestingly, all sporadic high grade serous ovarian cancers (HGSOC) and most of the subtypes of triple negative breast cancers (TNBC) also express a high degree of HRD. Conclusions: TMB is not associated with the magnitude of the immune response in hereditary BRCA1/2 related breast and ovarian cancers or in sporadic TNBC and sporadic HGSOC. Hereditary tumors express phenotypes as heterogenous as sporadic tumors with various degree of “BRCAness” and various characteristics of the immune microenvironments. The subtyping criteria developed for sporadic tumors can be applied for the classification of hereditary tumors and possibly also characterization of their immune microenvironment. A high HRD score may be a good candidate biomarker for response to platinum, and potentially PARP-inhibition. Trial registration: Phase I Study of the Oral PI3kinase Inhibitor BKM120 or BYL719 and the Oral PARP Inhibitor Olaparib in Patients With Recurrent TNBC or HGSOC(NCT01623349). The design and the outcome of the clinical trial is not in the scope of this hypothesis generating study.
Explaining the successes and failures of tuberculosis treatment programs; a tale of two regions in rural Eastern Uganda
Authors: Izudi Jonathan , Tamwesigire Imelda K , Bajunirwe Francis
Published: December 2019

Background. Optimally performing tuberculosis (TB) programs are characterized by treatment success rate (TSR) of at least 90%. In rural eastern Uganda, and elsewhere in sub Saharan Africa, TSR varies considerably across district TB programs and the reasons for the differences are unclear. This study explored factors associated with the low and high TSR across four districts in rural eastern Uganda. Methods. We interviewed District TB and Leprosy Supervisors, Laboratory focal persons, and health facility TB focal persons from four districts in Eastern Uganda as key informants. Interviews were audio recorded, transcribed verbatim, and imported into ATLAs.ti where thematic content analysis was performed and results were summarized into themes. Results . The emerging themes were categorized as either facilitators of or barriers to treatment success. The emerging facilitators prevailing in the districts with high rates of treatment success were using data to make decisions and design interventions, continuous quality improvement, capacity building, and prioritization of better management of people with TB. The barriers common in districts with low rates of treatment success included lack of motivated and dedicated TB focal persons, scarce or no funding for implementing TB activities , and a poor implementation of community-based directly observed therapy short course. Conclusion. This study shows that several factors are associated with the differing rates of treatment success in rural eastern Uganda. These factors should be the focus for TB control programs in Uganda and similar settings in order to improve rates of treatment success.
Age is a predictor for the recurrence of syncope in vasovagal syncope patients with a positive head-up tilt test
Authors: Guo Yongjuan , Chen Xiaomin , Zeng Tianze , Wang Lin , Cen Lvwei
Published: December 2019

BACKROUND Valid predictors of the recurrence of syncope in vasovagal syncope(VVS) patients with a positive head-up tilt test (HUTT) are currently lacking. The goal of this study was to identify the predictive performance of age for the recurrence of syncope in VVS patients with a positive HUTT.METHODS in total, 175 VVS patients with a positive HUTT were followed for 6 to 32 months, and ≥1 syncope episodes during follow-up was considered the recurrence of syncope. The study population was divided into 2 groups, namely, a recurrence of syncope group (44 patients) and a no recurrence of syncope group (131 patients). The baseline clinical data, hemodynamic parameters and classification of the vasovagal syncope on the HUTT were analyzed. Logistics regression was used to analyze the effect size and confidence interval of age. A receiver operating characteristic(ROC) analysis was used to assess the predictive performance and investigate the predictive value of age by the area under the curve (AUC).RESULTS The age of recurrence of syncope group 60.0 (47.8, 66.0) years was older than that of no recurrence of syncope group 53.0 (43.0, 62.0) years, and there was a significant difference between the two groups (P < 0.05). The trend of syncope recurrence changed with age and the logistics regression model adjusted by sex showed that the elder was an increased risk of syncope recurrence in VVS with positive HUTT [OR value: 1.03, 95% confidence interval(CI) 1.008 to 1.061 p < 0.05].Age was a valid predictor for the recurrence of syncope in VVS patients with a positive HUTT (AUC: 0.688; 95%CI 0.598 to 0.777 p < 0.05). The cut-off value was 53.5 years, and the sensitivity and specificity were 72.7% and 52.7%, respectively. CONCLUSIONS Age may be a valid predictor for recurrence of syncope in VVS patients with positive HUTT. The rate of recurrence of syncope increased with increasing age, especially in old female.
CD45dimCD34+CD38-CD133+ cells have the potential as leukemic stem cells in acute myeloid leukemia .
Authors: Heo Sook-Kyoung , Noh Eui-Kyu , Ju Lan Jeong , Sung Jun Young , Jeong Yoo Kyung , Cheon Jaekyung , Koh SuJin , Min Young Joo , Choi Yunsuk , Jo Jae-Cheol
Published: December 2019

Background: Leukemia stem cells (LSCs) in play an important role in the initiation, relapse, and progression of acute myeloid leukemia (AML), and in the development of chemotherapeutic drug resistance in AML. Studies regarding the detection of LSCs and the development of novel therapies for targeting them are extensive. The identification of LSCs and targeting therapies for them has been continuously under investigation. Methods: We examined the levels of CD45 dim CD34 + CD38 - CD133 + cells in bone marrow samples from patients with hematological malignancies and healthy controls, using four-color flow cytometry. Results: Interestingly, the CD45 dim CD34 + CD38 - CD133 + cells were highly expressed in the bone marrow of patients with AML compared to that in healthy controls (HC). Moreover, the proportions of CD45 dim CD34 + CD38 - CD133 + cells were also examined in diverse hematological malignancies, including AML, CML, DLBCL, MM, MDS, HL, ALL, and CLL. LSCs were prominently detected in the BMCs isolated from patients with AML and CML, but rarely in BMCs isolated from patients with DLBCL, MM, MDS, ALL, CLL, and HL. Additionally, the high CD45 dim CD34 + CD38 - CD133 + cell counts in AML patients served as a significantly poor risk factor for overall and event free survival. Conclusions: Therefore, our results suggest that CD45 dim CD34 + CD38 - CD133 + cells in AML might potentially serve as LSCs. In addition, this cell population might represent a novel therapeutic target in AML.
Brain Natriuretic Peptide to Predict Successful Liberation from Mechanical Ventilation in Critically Ill Patients: a Systematic Review and Meta-Analysis.
Authors: Deschamps Jean , Andersen Sarah K. , Webber Jordan , Featherstone Robin , Sebastianski Meghan , Vandermeer Ben , Senaratne Janek , Bagshaw Sean M.
Published: December 2019

Background Predicting successful liberation from mechanical ventilation (MV) in critically ill patients is challenging. Brain natriuretic peptide (BNP) has been proposed to help guide decision-making for readiness to liberate from MV following a spontaneous breathing trial (SBT).Methods We performed a systematic review and meta-analysis of randomized and prospective observational studies that measured BNP levels at the time of SBT in patients receiving MV. The primary endpoint was successful liberation from MV (absence of re-intubation or non-invasive ventilation at 48h). Statistical analyses include bi-variate and Moses-Littenberg models, and DerSimonian-Laird pooling of areas under ROC curve (AUROC).Results A total of 731 articles were screened. After pre-specified inclusion criteria, 18 adult and 2 pediatric studies were included. The measure of the relative variation of BNP during SBT (ΔBNP%) after exclusion of SBT failure by clinical criteria in adults yielded a sensitivity and specificity of 0.889 [0.831-0.929] and 0.828 [0.730-0.896] respectively, with a pooled AUROC of 0.92 [0.88-0.97] for successful liberation from MV. The pooled AUROC for any method of analysis for absolute variation of BNP (ΔBNP), pre-SBT BNP and post-SBT BNP were 0.89 [0.83-0.95], 0.77 [0.63-0.91], and 0.85 [0.80-0.90], respectively.Conclusion The ΔBNP during a SBT is an accurate incremental tool after SBT success by clinical indices to predict successful liberation from MV in adults. There is insufficient data to support its use as an alternate test to clinical indices of SBT or the use of ΔBNP, BNP-pre and BNP-post as an alternate or incremental test, or in pediatric patients.
Thrombocytopenia in critically ill patients with sepsis or septic shock: a systematic review and meta-analysis
Authors: Li Yuting , Li Hongxiang , Guo Jianxing , Zhang Dong
Published: December 2019

Background Thrombocytopenia is a common feature of sepsis or septic shock, but few meta-analyses have specifically evaluated prognostic importance of thrombocytopenia in patients with sepsis or septic shock. The objective of this meta-analysis was to evaluate the prognosis of thrombocytopenia in critically ill patients with sepsis or septic shock.Methods We searched the PubMed, Cochrane, and Embase databases for studies from inception to the 30th of November 2019. Prospective or retrospective cohort studies comparing thrombocytopenia to no thrombocytopenia in critically ill patients with sepsis or septic shock were included. All authors reported our primary outcome of short-term mortality(defined as ICU or 48-hour mortality) with clinically relevant secondary outcomes(ICU length of stay, rate of AKI, rate of mechanical ventilation). Results were expressed as odds ratio (OR) and mean difference (MD) with accompanying 95% confidence interval (CI).Results Seven studies including 4243 patients were included. The results of this meta-analysis showed that the short-term mortality of thrombocytopenia group was higher than that of the no thrombocytopenia group (odds ratio [OR]=2.01;95% CI, 1.73-2.33; P<0.00001; I2=78%).In addition, compared with no thrombocytopenia group, thrombocytopenia group showed higher rate of AKI(odds ratio [OR]=1.31;95% CI, 1.03-1.66; P=0.03 I2=65%) and longer ICU length of stay(Mean difference=1.31;95% CI, 0.66-1.96; P<0.0001; I2=50%). There was no statistically significant difference in the rate of mechanical ventilation between 2 groups (odds ratio [OR]=1.24;95% CI, 0.82-1.88; P=0.30; I2=0%).Conclusions Thrombocytopenia was associated with increased short-term mortality, ICU length of stay and rate of AKI in critically ill patients with sepsis or septic shock. The analysis of secondary outcomes showed no significant difference in the rate of mechanical ventilation between the two groups. Further randomized controlled studies of thrombocytopenia are still required.