bluuebunny/crossref_metadata_2025 huggingface dataset:
Lasting impact: a qualitative study of perspectives on surgery by adult recipients of free mission-based surgical care in Benin
Authors: Close Kristin L , Christie-de Jong Floor T.E.
Published: November 2019

Objectives

This study aimed to explore how adult patients who received free mission-based elective surgery experienced surgery and its outcomes, in order to provide recommendations for improved service delivery, measurement of impact and future quality initiatives for the humanitarian organisation Mercy Ships and other mission-based surgical platforms.

Setting

Data were collected in June 2017 in Cotonou, Benin, where the participants had previously received free mission-based elective surgery aboard theAfrica Mercy,a non-governmental hospital ship.

Participants

Sixteen patients (seven male, nine female, age range 22–71, mean age 43.25) who had previously received surgical care aboard theAfrica Mercyhospital ship between September 2016 and May 2017 participated in the study.

Methods

Using a qualitative design, 16 individual semistructured interviews were conducted with the assistance of two interpreters. Participants were recruited using purposive sampling from the Mercy Ships patient database. Interview data were coded and organised into themes and subthemes using thematic content analysis in an interpretivist approach.

Findings

Analysis of interview data revealed three main themes: barriers to surgery, experiences with Mercy Ships and changes in perspectives of surgery after their experiences. Key findings included barriers to local surgical provision such as cost, a noteworthy amount of fear and distrust of local surgical teams, exceptional positive experiences with the care at Mercy Ships, and impactful surgery, resulting in high levels of trust in foreign surgical teams.

Conclusions

While foreign surgical teams are meeting an immediate need for surgical care, the potential enduring legacy is one of trusting only foreigners for surgery. Patients are a critical component to a well-functioning surgical system, and mission-based surgical providers must formulate strategies to mitigate this legacy while strengthening the local surgical system.
Is neck circumference an appropriate tool to predict cardiovascular risk in clinical practice? A cross-sectional study in Chilean population
Authors: Caro Patricia , Guerra Ximena , Canals Andrea , Weisstaub Gerardo , Sandaña Carlos
Published: November 2019

Objectives

Neck circumference has emerged as a predictor of obesity and metabolic syndrome, but its clinical usefulness for different groups of population is not clearly defined. The aim is to evaluate the predictive capacity of neck circumference in order to detect cardiovascular risks (CVRs) on the Chilean population and to compare it with waist circumference performance.

Design

Cross-sectional study.

Setting

General Chilean population.

Participants

Data of 4607 adults aged 18 and over from the Chilean National Health Survey 2009–2010 were analysed.

Primary and secondary outcome measures

Anthropometrics measures included neck and waist circumference, height and weight. CVR was identified according to the Framingham tables adapted for the Chilean population. Receiver operating characteristics curves and logistic regression models were made to evaluate the performance of neck circumference to predict a moderate/high CVR, comparing it to waist circumference.

Results

Almost 10% of the sample had a moderate or high CVR. The probability of having a moderate/high cardiovascular risk increase with cervical obesity (OR 1.95, 95% CI 1.04 to 3.68) and central obesity (OR 4.5, 95% CI 2.47 to 8.22). The area under the curves were high for cervical obesity (AUC 81.4%, 95% CI 78.8% to 84.0%) and central obesity (AUC 82.2%, 95% CI 79.7% to 84.7%) and not statistically different (p=0.152).

Conclusions

Neck obesity has a high capacity to predict moderate/high CVR in the Chilean population. Its good performance appears as an opportunity to use it in clinical practice when waist circumference measurement is difficult to measure and eventually replace the waist circumference measurement as the technique is easier.
Ethnicity and risk of diagnosed dementia after stroke: a cohort study using the Clinical Practice Research Datalink
Authors: Shiekh Suhail Ismail , Forbes Harriet , Mathur Rohini , Smeeth Liam , Pearce Neil , Warren-Gash Charlotte
Published: November 2019

Introduction

The UK has over 1.2 million stroke survivors. Stroke is a major risk factor for dementia, and along with other risk factors such as hypertension and diabetes, is more common among Black, Asian and other ethnic minorities (BAME). We aimed to explore whether diagnosed dementia differed by ethnicity among adult stroke survivors.

Methodology

Using the UK Clinical Practice Research Datalink and linked hospital data, we conducted a cohort study among patients aged ≥40 years who had an incident stroke between 2005 and 2016. We fitted multivariable Cox proportional hazard models to estimate ethnic differences in the risk of poststroke dementia, adjusting for major clinical and social confounders.

Results

Our cohort comprised 45 474 stroke survivors (mean age 72.6 years, 49% female), of whom 95.7% were White, 2.0% South Asian, 1.2% Black and 1.1% of Mixed/Other ethnicity. Of these, 4624 (10.2%) were diagnosed with poststroke dementia over a median follow-up of 3.26 years. Compared with the White ethnic group, those of Black ethnicity were 42% more likely to be diagnosed with dementia (adjusted HR 1.42, 95% CI 1.05 to 1.93). There was no association between any other ethnic group and poststroke dementia diagnosis.

Discussion

There was good evidence that those of Black ethnicity had higher risk of diagnosed dementia poststroke. Further understanding of the mechanisms of this relationship could help target interventions at communities most at risk of dementia poststroke.
Responding to Simkulet’s objections to the two tragedies argument
Authors: Friberg-Fernros Henrik
Published: November 2019

The two tragedies argument (2TA) has been raised as a response to the argument against abortion from spontaneous abortion (or miscarriages). According to this argument against the antiabortion position (AAP), miscarriages should be of great concern for proponents of this position since they result in a greater amount of deaths of human beings than induced abortions do. According to critics of AAP, this fact undermines its plausibility, since proponents of the AAP either must try to prevent miscarriages to the same extent as they try to prevent abortions or abandon their opposition to at least some abortions—which are not acceptable options for proponents of APP. The claim of 2TA is that one can differentiate between induced abortion and miscarriages due to the fact that the former involves the act of killing of another human being. This fact adds a tragedy to the tragedy that both abortions and miscarriages result in – the death of a human being – and contributes to justifying the choice of proponents of AAP to prioritise the prevention of abortions rather than miscarriages. In this response, I defend 2TA against criticism that claims that this argument is: (1) inconsistent with the AAP and (2) trivialises the death of the fetus. My claim is that the first line of criticism rests on a misunderstanding of the premises of 2TA while the second line of criticism rests on a disanalogous thought experiment. I therefore conclude that these objections fail.
Carbon footprint impact of the choice of inhalers for asthma and COPD
Authors: Janson Christer , Henderson Richard , Löfdahl Magnus , Hedberg Martin , Sharma Raj , Wilkinson Alexander J K
Published: November 2019

In the 1990s, metered dose inhalers (MDIs) containing chlorofluorocarbons were replaced with dry-powder inhalers (DPIs) and MDIs containing hydrofluorocarbons (HFCs). While HFCs are not ozone depleting, they are potent greenhouse gases. Annual carbon footprint (CO2e), per patient were 17 kg for Relvar-Ellipta/Ventolin-Accuhaler; and 439 kg for Seretide-Evohaler/Ventolin-Evohaler. In 2017, 70% of all inhalers sold in England were MDI, versus 13% in Sweden. Applying the Swedish DPI and MDI distribution to England would result in an annual reduction of 550 kt CO2e. The lower carbon footprint of DPIs should be considered alongside other factors when choosing inhalation devices.
Treating yourself with compassion
Authors: Escalona Ebony
Published: November 2019

Many of those working in the veterinary world rightly see compassion as one of their greatest strengths. As Ebony Escalona explains, it is a power than can valuably be used to boost your own wellbeing as well as that of others.
Andrew John Brown
Authors: Boag Amanda , Brainard Ben
Published: November 2019

An inspirational clinician and educator who touched the lives of not only his patients and clients, but also a generation of students and vets in the USA and the UK.
Dipole moments and quenching of fluorescence of a new coumarin dye
Authors: Patil Omnath , Ingalagondi P.K. , Gounhalli Shivaraj , Hanagodimath S.M.
Published: November 2019

The absorption and fluorescence emission spectra of a newly synthesized laser grade coumarin dye, 1-((4-methoxyphenoxy) methyl)-3H-benzo[f]chromen-3-one (4-MPMBC), have been recorded in various solvents having different polarities. The spectrum peak was found to shift toward a higher wavelength with an increase in the solvent polarity. The dipole moments of the ground state (μg) and excited state (μe) were estimated using the Lippert, Bakshiev, and Kawski–Chamma–Viallet equations. The μe values were found to be greater than the μg values in all solvents, indicating that the dye is more polar in the excited state than in the ground state. The absorption maximum and emission maximum energies, ground- and excited-state dipole moments, and HOMO–LUMO energy gaps were estimated using Gaussian 16W. These have been compared with the experimental results. The estimated chemical hardness of the dye molecule indicates the soft nature in all of the solvents. The reactive centers such as nucleophilic and electrophilic sites were identified along with contour action using electrostatic potential three-dimensional map density functional theory analysis. The fluorescence quenching has been studied in solvents of varying polarities using aniline as a quencher. The quenching process was found to follow the Stern–Volmer equation and was studied by considering the role of diffusion. In all solvents, the probability of quenching per encounter (p) was found to be less than unity. The activation energy for diffusion and activation energy for quenching were estimated using the values of p.
Global identification and analysis of microRNAs involved in salt stress responses in two alfalfa (Medicago sativa ‘Millennium’) lines
Authors: Ma Jin , Wang Yichun , Li Jiayun
Published: November 2019

Alfalfa is an important economic crop; a mutant (M) strain was identified during planting and production. M plants consistently had better relative water content and relative electrical conductivity under higher salt conditions compared with the wild type (WT) plants, suggesting that M plants have higher tolerance for salt. To understand the microRNAs (miRNAs) involved in salt stress response in alfalfa, 128 miRNAs were identified from the WT and M alfalfa plants under normal and saline conditions. Of the 128 miRNAs, 29 and 23 differentially expressed miRNAs were identified in the M vs. WT control (M-CK vs. WT-CK) and salt-stressed M vs. WT (M-salt vs. WT-salt) comparison, respectively. These miRNAs responded to salt stress and showed different expression patterns after salt treatment. Their potential target genes were predicted and further analysed by GO classification and KEGG pathway analysis, where the majority of target genes were associated with plant growth and development, and exhibited significant changes in WT and M plants. In addition, compared with the WT plants, miR172-CNGC, miR319-CAX2, miR408-NHX and miR2590-CHX14/15 showed significant upregulation in M alfalfa plants, suggesting that M plants have higher ion transport levels. The differential expression profiles of miRNAs and putative target genes were further validated by quantitative real-time polymerase chain reaction. It is speculated that these miRNAs are involved in the increased salt tolerance of the M alfalfa plants.
Thermodynamics and phase transition in rotational Kiselev black hole
Authors: Xu Zhaoyi , Liao Yi , Wang Jiancheng
Published: November 2019

In this paper, we investigate the thermodynamic properties of rotational Kiselev black holes (KBH). Specifically, we use the first-order approximation of the event horizon (EH) to calculate thermodynamic properties for general equations of state [Formula: see text]. These thermodynamic properties include areas, entropies, horizon radii, surface gravities, surface temperatures, Komar energies and irreducible masses at the Cauchy horizon (CH) and EH. We study the products of these thermodynamic quantities, we find that these products are determined by the equation of state [Formula: see text] and strength parameter [Formula: see text]. In the case of the quintessence matter [Formula: see text], radiation [Formula: see text] and dust [Formula: see text], we discuss their properties in detail. We also generalize the Smarr mass formula and Christodoulou–Ruffini mass formula to rotational KBH. Finally, we study the phase transition and thermodynamic geometry for rotational KBH with radiation [Formula: see text]. Through analysis, we find that this phase transition is a second-order phase transition. Furthermore, we also obtain the scalar curvature in the thermodynamic geometry framework, indicating that the radiation matter may change the phase transition condition and properties for Kerr black hole.
Consistency analysis of a CPT-even and CPT-odd Lorentz-violating effective field theory in the electrodynamics at Planck scale by an influence of a background isotropic field
Authors: Sampaio T. A. M. , Passos E.
Published: November 2019

Based on the motivation that some quantum gravity theories predicts the Lorentz Invariance Violation (LIV) around Planck-scale energy levels, this paper proposes a new formalism that addresses the possible effects of LIV in electrodynamics. This formalism is capable of changing the usual electrodynamics through high derivative arbitrary mass dimension terms that includes a constant background field controlling the intensity of LIV in the models, producing modifications in the dispersion relations in a manner that is similar to the Myers–Pospelov approach. With this framework, it was possible to generate a CPT-even and CPT-odd generalized modifications of the electrodynamics in order to study the stability and causality of these theories considering the isotropic case for the background field. An additional analysis of unitarity at tree level was considered by studying the saturated propagators. After this analysis, we conclude that, while CPT-even modifications always preserve the stability, causality and unitarity in the boundaries of the effective field theory and therefore may be good candidates for field theories with interactions, the CPT-odd one violates causality and unitarity. This feature is a consequence of the vacuum birefringence characteristics that are present in CPT-odd theories for the photon sector.
Magnetohydrodynamic three-dimensional boundary layer flow and heat transfer of water-driven copper and alumina nanoparticles induced by convective conditions
Authors: Gupta Sumit , Kumar Devendra , Singh Jagdev
Published: November 2019

This work examines the magnetohydrodynamic (MHD) three-dimensional (3D) flow comprising Cu and Al2O3 water-based nanofluids. The effects of heat and mass transfer with the effects of nanoparticles are carried out in the existence of thermal radiation and convective heat and mass transfer boundary conditions. By applying the proper similarity transformations the partial differential equations describing velocity, temperature and nanoparticle volume fraction (NVF) are transformed to a system of nonlinear ordinary differential equations (NODE). An optimal homotopy analysis technique is applied to evaluate the analytical solutions. The influences of pertinent parameters on the velocity, temperature and NVF are displayed in graphical and tabular forms. Calculations of Nusselt number, skin friction coefficients and the local Sherwood number are evaluated via tables. An excellent comparison has also been made with the previously-published literature.
Structures and Interactions of Quantum Particles Based on the Energy Circulation Theory
Authors: Nagao Shigeto
Published: November 2019

Although the quark model is widely accepted, it is unknown what the origin of the electric charge of a quark is and why the charge magnitudes are fractional and different among the [Formula: see text] and [Formula: see text] quarks. Here we propose a novel scheme for quantum particles independent of quantum chromodynamics and quarks. We previously reported the energy circulation theory, in which the fundamental force works between antiparallel energy movements based on momentums, and forms an energy circulation. The electric charge is the momentum in the hidden dimension of an energy circulation in hidden–space dimensions. In this paper, we examine the interactions between energy circulations precisely covering the whole range of distance, and derive formulas for strong and weak nuclear interactions. The strong force is an inter-circulation interaction by the fundamental force. The weak interaction is an orthogonal separation of an energy circulation in space–space dimensions to two halves. A quantum particle consists of one or plural energy circulations in a unit space of radius of the lowest-frequency hidden dimension. We propose the respective compositions of energy circulations for major particles so that they as much conform to reported decays, spin and rest-mass values. This new model of particles provides potential solutions to unexplained issues from the Standard Model as follows: The new model presents the theoretical origin of the electric charge and its elementary charge. Because elementary components of hadrons are energy circulations instead of quarks, it is not required to introduce a fractional electric charge. A composition of elementary energy circulations for a quantum particle shows its electric charge and mass (rest energy) by the addition of those of elements. Furthermore, the model successfully exhibits strong and weak nuclear interactions as well as the electric force.
The Code-Theoretic Axiom: The Third Ontology
Authors: Irwin Klee
Published: November 2019

A logical physical ontology is code theory, wherein reality is neither deterministic nor random. In light of Conway and Kochen’s free will theorem [The free will theorem, Found. Phys. 36(10) (2006) 1441–1473] and strong free will theorem [The strong free will theorem, Not. Am. Math. Soc. 56(2) (2009) 226–232], we discuss the plausibility of a third axiomatic option — geometric language; the code-theoretic axiom. We suggest that freewill choices at the syntactically-free steps of a geometric language of spacetime form the code-theoretic substrate upon which particle and gravitational physics emerge.
Archean crustal evolution of the Bundelkhand Craton: evidence from granitoid magmatism
Authors: Singh Vinod K. , Verma Sanjeet K. , Singh Pradip K. , Slabunov A. I. , Mishra Sumit , Chaudhary Neeraj
Published: November 2019

This study presents petrological and geochemical data on Neoarchean granitoids from the northern and central parts of the Bundelkhand Craton to discuss its crustal evolution and tectonic history. The study deals with two granitoid suites, i.e. tonalites–trondhjemites–granodiorites (TTG) and sanukitoids. TTGs are characterized by high SiO
2
, Na
2
O and mostly low to moderate Mg#. They display enrichment in light rare earth elements, low to moderately fractionated heavy rare earth elements (HREE) and low Sr/Y ratios, suggesting their high-HREE character or low-pressure origin from melting of a mafic protolith. The sanukitoid samples show relatively low SiO
2
, high K
2
O (2.1–4.6 wt%), Pb, Sr and Ba, and moderate to low Mg#, Cr, Ni. These granitoids probably generated from partial melting of hydrous mafic rocks followed by interaction with a mantle peridotite. Geochemical characteristics, tectonic discrimination using ratios like (Ce/Pb)
PM
, (La/Nb)
PM
and (Th/Nb)
PM
and regional rock association suggest that the Neoarchean TTGs and sanukitoids were emplaced in a subduction setting. Combining the existing knowledge base, a schematic model for generation and evolution of crust from Paleoarchean to Neoarchean has been proposed for the Bundelkhand Craton.
Back under a SQL Umbrella
Authors: Colyer Adrian
Published: November 2019

Procella is the latest in a long line of data processing systems at Google. What’s unique about it is that it’s a single store handling reporting, embedded statistics, time series, and ad-hoc analysis workloads under one roof. It’s SQL on top, cloud-native underneath, and it’s serving billions of queries per day over tens of petabytes of data. There’s one big data use case that Procella isn’t handling today though, and that’s machine learning. But in ’Declarative recursive computation on an RDBMS... or, why you should use a database for distributed machine learning,’ Jankov et al. make the case for the database being the ideal place to handle the most demanding of distributed machine learning workloads.
The difference between a clinical technician and clinical practitioner is in the scope of practice: the need for a bioscience understanding in paramedicine
Authors: Rathner Joseph A. , Kettle Christine
Published: November 2019

“Only teach me what I need to know!” This commonly heard refrain is often spoken by allied health students while studying preclinical sciences (physiology, anatomy, pharmacology). Here we use a clinical scenario undertaken by second-year Bachelor of Paramedic Practice students of acute coronary syndrome to demonstrate the difference in clinical decision making when using a clinical reasoning approach to treatment rather than relying exclusively on a practice guidelines approach. We hope to demonstrate that understanding basic bioscience concepts, such as the Frank-Starling mechanism and the anatomy and physiology of the autonomic nervous system, are key to providing good clinical care in response to ambiguous patient symptoms. Students who understand these concepts underlying their patient care guideline will make better clinical decisions and better provide quality of care than students who follow the guideline exclusively. We aim this as a practical demonstration of the value of detailed understanding of human bioscience in allied health education. As health care providers transition from “technician” to “practitioner,” the key distinguishing feature of the role is the ability to practice independently, using “best judgment” rather than clinical guidelines (alone). Evidence suggests that complex case management requires detailed bioscience understanding.
A Network Pharmacology Approach for Uncovering the Osteogenic Mechanisms of Psoralea corylifolia Linn
Authors: Ge Luna , Cheng Kai , Han Jinxiang
Published: November 2019

Background and Aim. Psoralea corylifolia Linn (PCL) is an herb that is commonly used for alleviating osteoporosis and vitiligo. Although accumulating evidence has demonstrated the antiosteoporotic effect of PCL, the identities of the osteogenic compounds in PCL and their functional targets remain elusive. To investigate the osteogenic ingredients in PCL and their functional mechanisms, network pharmacology analysis was performed on the targets of PCL and osteogenesis. Methods. The active components of PCL were screened by literature review. The potential protein targets of the active PCL components were predicted with the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform (TCMSP), Search Tool for Interactions of Chemicals (STITCH), SwissTargetPrediction, and PubChem. The target networks related to PCL and osteogenic differentiation were constructed by using Cytoscape. MC3T3-E1 cells were used to verify the targets. Results. Twenty-three active components of PCL and 162 potential target proteins were identified. Further analysis reduced the number of potential target proteins to 71. Of the 23 components, bavachalcone, psoralen, bavachinin, neobavaisoflavone, methoxsalen, psoradin, bakuchiol, and angelicin may be the main active components of PCL that promote bone formation. PPARγ and aryl hydrocarbon receptor (AhR) were verified as targets of PCL in MC3T3-E1 cells, and the western blot and immunofluorescence staining results showed that compared to the control, PCL reduced the expression of these targets. Conclusions. The active components of PCL and the mechanisms by which they promoted osteogenic differentiation were successfully identified using network pharmacology.
The Manufacture of GMP-Grade Bone Marrow Stromal Cells with Validated In Vivo Bone-Forming Potential in an Orthopedic Clinical Center in Brazil
Authors: Dias Rhayra B. , Guimarães João A. M. , Cury Marco B. , Rocha Leonardo R. , da Costa Elaine S. , Nogueira Liebert P. , Hochman-Mendez Camila , Fortuna-Costa Anneliese , Silva Anna Karoline F. , Cunha Karin S. , de Souza Sergio A. L. , Duarte Maria Eugênia L. , Sartore Rafaela C. , Bonfim Danielle C.
Published: November 2019

In vitro-expanded bone marrow stromal cells (BMSCs) have long been proposed for the treatment of complex bone-related injuries because of their inherent potential to differentiate into multiple skeletal cell types, modulate inflammatory responses, and support angiogenesis. Although a wide variety of methods have been used to expand BMSCs on a large scale by using good manufacturing practice (GMP), little attention has been paid to whether the expansion procedures indeed allow the maintenance of critical cell characteristics and potency, which are crucial for therapeutic effectiveness. Here, we described standard procedures adopted in our facility for the manufacture of clinical-grade BMSC products with a preserved capacity to generate bone in vivo in compliance with the Brazilian regulatory guidelines for cells intended for use in humans. Bone marrow samples were obtained from trabecular bone. After cell isolation in standard monolayer flasks, BMSC expansion was subsequently performed in two cycles, in 2- and 10-layer cell factories, respectively. The average cell yield per cell factory at passage 1 was of 21.93±12.81×106 cells, while at passage 2, it was of 83.05±114.72×106 cells. All final cellular products were free from contamination with aerobic/anaerobic pathogens, mycoplasma, and bacterial endotoxins. The expanded BMSCs expressed CD73, CD90, CD105, and CD146 and were able to differentiate into osteogenic, chondrogenic, and adipogenic lineages in vitro. Most importantly, nine out of 10 of the cell products formed bone when transplanted in vivo. These validated procedures will serve as the basis for in-house BMSC manufacturing for use in clinical applications in our center.
Thalamic Abscess in a Newly Diagnosed Diabetic Patient
Authors: Swanson Kenneth A. , Citronberg Robert J.
Published: November 2019

Brain abscesses are commonly located in the cerebral cortex and cerebellum; however, solitary thalamic lesions are rare. Recent cases report dental pathology as a common source, potentially compounded by immunocompromise. Here, we report a newly diagnosed diabetic male with poor dentition presenting with evidence of meningitis wherein thalamic abscess was discovered.
Research on Impact Performance of Hydraulic Rock Drill with Floating Characteristics of Double Damping System
Authors: Li Yelin , Bin Zeng , Tu Yi
Published: November 2019

As a technological innovation of high‐power hydraulic rock drill, double damping system has a very important effect on impact performance. The double damping system is a floating mechanism. The characteristics of the floating mechanism have an important influence on the impact energy, frequency, and power of the hydraulic rock drill. Based on orifice throttling theory, the static equilibrium position of a damping piston was calculated, and the characteristic parameters of the double damping system were summarized as damping flow (Qd) and feed force (Fd). According to the characterization parameters of the double damping system, an experimental scheme of the floating characteristics of the double damping system was designed, and the combined experimental data of Qd and Fd were obtained. The 40 groups of experimental data were extracted, and the relationship between the combination (Qd, Fd) and impact energy and frequency and power were analyzed. The combination (Qd, Fd) with maximum and minimum power was selected to analyze the motion law of an impact piston. The maximum drilling power was obtained at the combination (Qd = 8 L·min−1, Fd = 16.25 kN). The influence factors of the double damping system on impact performance were summarized, and the characteristics of the double damping system under optimal impact performance were obtained.
Epidemiological and Clinical Features of Dengue Infection in Adults in the 2017 Outbreak in Vietnam
Authors: Huy Bui Vu , Hoa Le Nguyen Minh , Thuy Dang Thi , Van Kinh Nguyen , Ngan Ta Thi Dieu , Duyet Le Van , Hung Nguyen Thanh , Minh Ngo Ngoc Quang , Truong Nguyen Thanh , Chau Nguyen Van Vinh
Published: November 2019

Purpose. The clinical features and laboratory results of dengue-infected adult patients admitted to the hospital during the 2017 outbreak were analyzed in this study. Method. This is a cross-sectional study. 2922 patients aged 18 years or more with dengue fever in National Hospital for Tropical Diseases (NHTD) in the North and Hospital for Tropical Disease (HTD) in the South of Vietnam were recruited in this study. Result. Patients were admitted in the hospital around the year and concentrated from August to December, in 53/63 (84.0%) provinces in Vietnam, and patients in all ages were affected. The number of patients with dengue fever was 1675 (57.3%), dengue with warning signs 914 (31.3%), and severe dengue 333 (11.4%), respectively. Among patients with severe dengue, severe plasma leakage and dengue shock account for 238 (8.1%), severe organ impairment 73 (2.5%), and severe bleeding 22 (0.75%). The rate of mortality was 0.8%, and the outcome of dengue patients is worse in the elderly and people with underlying diseases. Conclusion. The 2017 dengue outbreak occurred in a larger scale than in the previous years in terms of time, location, and number of patients. More elderly patients were infected by dengue in this outbreak, and this may contribute to the mortality rate. Clinical manifestations of dengue patients in Southern Vietnam are more typical than the northern, but the rate of severe dengue is not different. The mortality risk and underlying conditions associated with dengue-infected elderly patients are worthy of further investigations in the future.
Integrated Longitudinal and Lateral Control System Design and Case Study on an Electric Vehicle
Authors: Zhao Jin , Fu Haolong , Liu Dongjie , Wang Guangwei , El Kamel Abdelkader
Published: November 2019

This paper presents the design of an integrated longitudinal and lateral controller for autonomous vehicle and field tests with an electric vehicle. First, the longitudinal design was studied which includes the spacing policy as the upper level controller and throttle and brake control as the lower level controller. A safety spacing policy was proposed considering both the vehicle states and the vehicle capability. A coordinated throttle and brake controller was also designed to ensure the vehicle pursuing the desired acceleration. Second, a multimodel lateral controller was proposed which can perform the lane tracking and lane changing manoeuvres. Then, an integrated control structure was proposed to manage both the longitudinal and lateral controller. Finally, simulation and visualization works were carried out to validate the proposed solutions. An electric vehicle experiment platform was also built, and field tests showed encouraging results.
Identification of Circular RNAs Regulating Isletβ-Cell Autophagy in Type 2 Diabetes Mellitus
Authors: Bai Chao , Yang Wenwen , Lu Yao , Wei Wei , Li Zongbao , Zhang Li
Published: November 2019

This study is to identify the circular RNA (circRNA) expression profile that is functionally related to pancreatic isletβ-cell autophagy and their potential regulation mechanisms in type 2 diabetes mellitus (T2DM). T2DM rat model was constructed by administration of high-fat and high-sugar diet.β-cells were isolated from islets by flow cytometry. CircRNA expression profile inβ-cells was detected by circRNA microarrays, and the differentially expressed circRNAs were identified and validated by qRT-PCR. MicroRNA (miRNA) target prediction software and multiple bioinformatic approaches were used to construct a map of circRNA-miRNA interactions for the differentially expressed circRNAs. A total of 825 differentially expressed circular transcripts were identified in T2DM rats compared with control rats, among which 388 were upregulated and 437 were downregulated. Ten circRNAs were identified to have significant differences by qRT-PCR. GO analysis enriched terms such as organelle membrane and protein binding and the top enriched pathways for the circRNAs included MAPK signaling pathway. The differentially expressed circRNAs might involve in MAPK signaling pathway, apoptosis, and Ras signaling pathway. We speculate that these circRNAs, especially rno_circRNA_008565, can regulate the autophagy of isletβ-cells via interactions with miRNA. Dysregulation of several circRNAs may play a role in T2DM development, and rno_circRNA_008565 may be a potential regulator ofβ-cell autophagy.
Autophagy in Immune-Related Renal Disease
Authors: Ye Xin , Zhou Xu-jie , Zhang Hong
Published: November 2019

Autophagy is an important biology process, central to the maintenance of biology process in both physiological and pathological situations. It is regarded as a “double-edged sword”—exerting both protective and/or detrimental effects. These two-way effects are observed in immune cells as well as renal resident cells, including podocytes, mesangial cells, tubular epithelial cells, and endothelial cells of the glomerular capillaries. Mounting evidence suggests that autophagy is implicated in the pathological process of various immune-related renal diseases (IRRDs) as well as the kidney that underwent transplantation. Here, we provide an overview of the pathological role of autophagy in IRRDs, including lupus nephritis, IgA nephropathy, membrane nephropathy, ANCA-associated nephritis, and diabetic nephropathy. The understanding of the pathogenesis and regulatory mechanisms of autophagy in these renal diseases may lead to the identification of new diagnostic targets and refined therapeutic modulation.
A Three-Gene Expression Signature Identifies a Cluster of Patients with Short Survival in Chronic Lymphocytic Leukemia
Authors: Mosquera Orgueira Adrián , Antelo Rodríguez Beatriz , Díaz Arias José Ángel , Díaz Varela Nicolás , Bello López José Luis
Published: November 2019

Chronic lymphocytic leukemia (CLL) is a lymphoproliferative disorder characterized by its heterogeneous clinical evolution. Despite the discovery of the most frequent cytogenomic drivers of disease during the last decade, new efforts are needed in order to improve prognostication. In this study, we used gene expression data of CLL samples in order to discover novel transcriptomic patterns associated with patient survival. We observed that a 3-gene expression signature composed of SCGB2A1, KLF4, and PPP1R14B differentiate a group of circa 5% of cases with short survival. This effect was independent of the main cytogenetic markers of adverse prognosis. Finally, this finding was reproduced in an independent retrospective cohort. We believe that this small gene expression pattern will be useful for CLL prognostication and its association with CLL response to novel drugs should be explored in the future.
Hepatoprotective Effects of Morinda citrifolia Leaf Extract on Ovariectomized Rats Fed with Thermoxidized Palm Oil Diet: Evidence at Histological and Ultrastructural Level
Authors: Chong C. L. G. , Hussan F. , Othman F.
Published: November 2019

Morinda citrifolia (Rubiaceae) or Noni was previously reported to have leaf with broad therapeutic property whereas the fruit was rarely described as medicinal. Ironically, extensive research and review has been done on the fruit and little was known about the therapeutic activity of the leaf as a medicinal food. The aim of this study was to investigate the therapeutic effects of Morinda citrifolia (MC) ethanolic leaf extract on the hepatic structure and function in postmenopausal rats fed with thermoxidized palm oil (TPO) diet. Thirty eight female Sprague Dawley rats were divided into five groups: sham (Sham), ovariectomized (OVX), ovariectomized and treated with simvastatin 10 mg/kg (OVX+ST), ovariectomized and supplemented with low dose MC 500 mg/kg (OVX+MCLD), and ovariectomized and supplemented with high dose MC 1000 mg/kg (OVX+MCHD). All the ovariectomized groups were fed with TPO diet whereas the Sham group was fed with normal diet. Consumption of TPO diet in postmenopausal rats resulted in obesity, significantly elevated (P<0.05) liver oxidative stress marker; malondialdehyde (MDA), diffuse microvesicular steatosis, and defective mitochondria. Treatment with MC leaf extract prevented hepatic steatosis by significantly increasing (P<0.05) the liver antioxidant enzyme SOD and GPx, significantly increasing (P<0.05) ALP, decreasing liver lipids infiltration, preventing mitochondrial damage, and overall maintaining the normal liver histology and ultrastructure. In conclusion, we provided detailed histological and ultrastructural evidence showing hepatoprotective effects of MC leaf extract through its antioxidant mechanism.
Tumor-Associated Fibroblasts Promote HER2-Targeted Therapy Resistance through FGFR2 Activation
Authors: Fernández-Nogueira Patricia , Mancino Mario , Fuster Gemma , López-Plana Anna , Jauregui Patricia , Almendro Vanesa , Enreig Estel , Menéndez Silvia , Rojo Federico , Noguera-Castells Aleix , Bill Anke , Gaither L. Alex , Serrano Laia , Recalde-Percaz Leire , Moragas Núria , Alonso Raul , Ametller Elisabet , Rovira Ana , Lluch Ana , Albanell Joan , Gascon Pere , Bragado Paloma
Published: November 2019

Purpose:

Despite the therapeutic success of existing HER2-targeted therapies, tumors invariably relapse. This study aimed at identifying new mechanisms responsible for HER2-targeted therapy resistance.

Experimental Design:

We have used a platform of HER2-targeted therapy–resistant cell lines and primary cultures of healthy and tumor-associated fibroblasts (TAF) to identify new potential targets related to tumor escape from anti-HER2 therapies.

Results:

We have shown that TAFs promote resistance to HER2-targeted therapies. TAFs produce and secrete high levels of FGF5, which induces FGFR2 activation in the surrounding breast cancer cells. FGFR2 transactivates HER2 via c-Src, leading to resistance to HER2-targeted therapies. In vivo, coinoculating nonresistant cell lines with TAFs results in more aggressive and resistant tumors. Resistant cells activate fibroblasts and secrete FGFR ligands, creating a positive feedback loop that fuels resistance. FGFR2 inhibition not only inhibits HER2 activation, but also induces apoptosis in cells resistant to HER2-targeted therapies. In vivo, inhibitors of FGFR2 reverse resistance and resensitize resistant cells to HER2-targeted therapies. In HER2 patients' samples, α-SMA, FGF5, and FGFR2 contribute to poor outcome and correlate with c-Src activation. Importantly, expression of FGF5 and phospho-HER2 correlated with a reduced pathologic complete response rate in patients with HER2-positive breast cancer treated with neoadjuvant trastuzumab, which highlights the significant role of TAFs/FGF5 in HER2 breast cancer progression and resistance.

Conclusions:

We have identified the TAF/FGF5/FGFR2/c-Src/HER2 axis as an escape pathway responsible for HER2-targeted therapy resistance in breast cancer, which can be reversed by FGFR inhibitors.
Combined Vaccination with NY-ESO-1 Protein, Poly-ICLC, and Montanide Improves Humoral and Cellular Immune Responses in Patients with High-Risk Melanoma
Authors: Pavlick Anna , Blazquez Ana B. , Meseck Marcia , Lattanzi Michael , Ott Patrick A. , Marron Thomas U. , Holman Rose Marie , Mandeli John , Salazar Andres M. , McClain Christopher B. , Gimenez Gustavo , Balan Sreekumar , Gnjatic Sacha , Sabado Rachel Lubong , Bhardwaj Nina
Published: November 2019

Given its ability to induce both humoral and cellular immune responses, NY-ESO-1 has been considered a suitable antigen for a cancer vaccine. Despite promising results from early-phase clinical studies in patients with melanoma, NY-ESO-1 vaccine immunotherapy has not been widely investigated in larger trials; consequently, many questions remain as to the optimal vaccine formulation, predictive biomarkers, and sequencing and timing of vaccines in melanoma treatment. We conducted an adjuvant phase I/II clinical trial in high-risk resected melanoma to optimize the delivery of poly-ICLC, a TLR-3/MDA-5 agonist, as a component of vaccine formulation. A phase I dose-escalation part was undertaken to identify the MTD of poly-ICLC administered in combination with NY-ESO-1 and montanide. This was followed by a randomized phase II part investigating the MTD of poly-ICLC with NY-ESO-1 with or without montanide. The vaccine regimens were generally well tolerated, with no treatment-related grade 3/4 adverse events. Both regimens induced integrated NY-ESO-1–specific CD4+ T-cell and humoral responses. CD8+ T-cell responses were mainly detected in patients receiving montanide. T-cell avidity toward NY-ESO-1 peptides was higher in patients vaccinated with montanide. In conclusion, NY-ESO-1 protein in combination with poly-ICLC is safe, well tolerated, and capable of inducing integrated antibody and CD4+ T-cell responses in most patients. Combination with montanide enhances antigen-specific T-cell avidity and CD8+ T-cell cross-priming in a fraction of patients, indicating that montanide contributes to the induction of specific CD8+ T-cell responses to NY-ESO-1.
The Pectoralis Major Island Flap: Short Scar Modified Muscle-Sparing Harvesting Technique Improves Aesthetic Outcome in Reconstructive Head and Neck Surgery
Authors: Rauchenwald Tina , Dejaco Daniel , Morandi Evi M. , Djedovic Gabriel , Wolfram Dolores , Riechelmann Herbert , Pierer Gerhard
Published: November 2019

Background: Pectoralis major flap reconstruction is often associated with large unappealing scars in head-neck surgery. We recently established an alternative harvesting technique that improves aesthetic outcome. Objectives: The objective of this study was to demonstrate a modified surgical technique that harvests the pectoralis major muscle as an island flap and focuses on minimizing incision lines and applying a muscle-sparing approach. Methods: A retrospective analysis covering the period 2008–2018 was conducted. Patients who underwent pectoralis major island flap reconstruction for fistula prophylaxis after salvage laryngectomy at the Medical University of Innsbruck were included. Flap harvesting was performed subcutaneously using two small incision lines, thereby sparing the clavicular and upper sternocostal aspects of the pectoralis muscle. Results: Twenty-three patients with squamous cell carcinoma of the larynx (n = 19) or pharynx (n = 4) underwent salvage laryngectomy and consecutive reconstruction using a pectoralis major island flap and our muscle-sparing technique. Mean overall operation time was 147 ± 48.6 min. The majority (70%) of patients had an uneventful course of recovery and showed satisfying aesthetic results and low donor site morbidity as compared to traditional harvesting techniques. Six (26%) patients had major complications that required surgical revision. Three (13%) cases were complicated with fistulas. Conclusion: The pectoralis major island flap is shown to be reliable in otolaryngeal surgery. This surgical technique minimizes scarring and preserves thoracic wall architecture by taking a less invasive approach, thereby improving aesthetic outcome and reducing overall patient morbidity.
Current Concepts of Pharmacotherapy in Crohn’s Disease
Authors: Einwächter Henrik
Published: November 2019

Background: The incidence of Crohn’s disease (CD) is rising, and still many patients have to undergo repeated surgery due to failure of pharmacologic therapy. Results: While the introduction of anti-TNF agents started biologic therapy for CD and revolutionized the management of patients, the number of patients who do not respond to this treatment or lose their initial response to this treatment is still substantial. Therefore, the recent introduction of new therapeutic options with anti-integrins and new anti-cytokines was an important step to provide more effective treatment for our patients. Yet, next to new drugs also new treatment strategies have been proposed. Conclusion: In this article, we will review these new aspects of pharmacologic therapy for CD ­patients.
Capacidade Turística e Desempenho
Authors: Castro Junior Deosir Flávio Lobo de , Ferreira Camila Arlinda Laurentino , Miura Márcio Nakayama , Mondo Tiago Savi
Published: November 2019

Esta pesquisa teve como objetivo analisar a relação da capacidade dinâmica turística e o desempenho nos meios de hospedagem da região de Urubici-SC. O estudo caracteriza-se como uma abordagem quantitativa. Para a análise dos dados, utilizou-se análise fatorial exploratória, análise fatorial confirmatória e modelagem de equações estruturais. Para a coleta dos dados, utilizou-se de questionário estruturado aplicado em 52 meios de hospedagem. Como principais resultados, identificou-se que a aplicação das variáveis conhecimento sobre os atrativos turísticos, atenção aos novos acontecimentos turísticos da região e conhecimento sobre a história local relaciona-se ao melhor desempenho na hotelaria, portanto estão relacionadas com a utilização das capacidades turísticas pelos empreendimentos hoteleiros, que auxilia na vantagem competitiva, em meio a um ambiente dinâmico. Do mesmo modo, alcança satisfação dos clientes e resultados em bom desempenho organizacional.