bluuebunny/crossref_metadata_2025 huggingface dataset:
Myxoid Liposarcoma: Treatment Outcomes from Chemotherapy and Radiation Therapy
Authors: Chowdhry Varun , Goldberg Saveli , DeLaney Thomas F. , Cote Gregory M. , Chebib Ivan , Kim Jason , Lozano-Calderón Santiago A. , De Amorim Bernstein Karen
Published: November 2018

Introduction. Myxoid liposarcoma (MLS) is a subtype of liposarcoma characterized morphologically by lipomatous differentiation with a myxoid stroma. The purpose of this study was to review clinical and pathological information for patients treated for MLS at our institution to better understand neoadjuvant and adjuvant therapy. Materials and Methods. An institutional database of sarcomas was queried for patients who were treated for MLS at our institution between 1992 and 2013. Survival curves were constructed using Kaplan–Meier analysis, and univariate and multivariate statistics were performed using the Cox-proportional hazards model and using linear regression. Results. A total of 85 patients with myxoid liposarcoma were identified. The mean and median histologic response rate to treatment for patients who received preoperative radiation therapy was 77.6%. Five-year disease-free survival, distant metastasis-free survival, local recurrence-free survival, and overall survival were 78.6% (95% CI: 67.8–86.1), 84.7% (95% CI: 74.5–91.0), 95.6% (95% CI: 86.9–98.6), and 87.5% (95% CI: 77.2–93.3) respectively. On univariate analysis, there was a trend towards higher necrosis or treatment response rates in patients who received concurrent chemotherapy, 84.7% (95% CI: 75.9–93.4) and 69.5% (95% CI: 55.1–83.8), p=0.061. Tumor size was associated with inferior disease-free and overall survival. Hazard ratio for disease-free survival is 1.08 (per cm) (95% CI: 1.01–1.16), p=0.019. Conclusions. Myxoid liposarcoma exhibits histological response to chemotherapy and radiation therapy. Tumor size appears to be greatest predictor of long-term disease control and overall survival. We were not able to show that chemotherapy provides a clinical benefit with regard to local control, disease-free survival, or overall survival. However, it is important to note that the selected usage of chemotherapy in the highest risk patients confounds this analysis. Further investigation is needed to help better determine the optimal use of chemotherapy in this group of patients.
Time‐Varying Impedance Control of Port Hamiltonian System with a New Energy‐Storing Tank
Authors: Zheng Min , Yuan Tangqing , Huang Tao
Published: November 2018

In order to guarantee the passivity of a kind of conservative system, the port Hamiltonian framework combined with a new energy tank is proposed in this paper. A time‐varying impedance controller is designed based on this new framework. The time‐varying impedance control method is an extension of conventional impedance control and overcomes the singularity problem that existed in the traditional form of energy tank. The validity of the controller designed in this paper is shown by numerical examples. The simulation results show that the proposed controller can not only eliminate the singularity problem but can also improve the control performance.
Chemical, Mineralogical, and Refractory Characterization of Kaolin in the Regions of Huayacocotla‐Alumbres, Mexico
Authors: Romero-Guerrero L. M. , Moreno-Tovar R. , Arenas-Flores A. , Marmolejo Santillán Y. , Pérez-Moreno F.
Published: November 2018

In the present work, the chemical, mineralogical, refractory, and microstructural characterizations of kaolinites from the Huayacocotla‐Alumbres region, which is between Veracruz and Hidalgo border, by X‐ray diffraction (XRD), polarization optical microscopy (POM), scanning electron microscopy (SEM), refractoriness proof (pyrometric cone equivalent), and thermogravimetric analysis (TGA) were carried out. The analysis by POM showed that the kaolinization degree in this region is variable due to the presence of primary minerals, such as plagioclase, feldspar, and quartz. Additionally, hydrothermal alteration of the epithermal type was determined by oxidation of sulfides (pyrite and galena) and chlorite association. With the X‐ray diffraction technique, andalusite and kaolinite were identified as the majority phases in Huayacocotla and quartz was identified as the majority phase in Alumbres. The minority phases, such as dickite, kaolinite, and cristobalite, were observed in both zones. The SEM technique was useful in the determination of the morphology of kaolinite and impurities of Na, Mg, K, and Fe of the complex clay illite‐andalusite‐dickite group. Thermogravimetric analysis was useful to discover the decomposition temperature and reveal the significant difference between 400 and 800°C, which showcases the greatest mass loss due to dehydration and carbonates decomposition. The mullite phase was detected at approximately 1000°C in the kaolin samples. The refractoriness tests were important to determine the stability temperature of kaolin, which is between 1300 and 1600°C. This stability temperature makes it feasible to use the kaolin as a refractory material for both low and high temperatures. The variables that affect the kaolin stability temperature were determined by principal components with the XLSTAT free program.
RNA Sequencing Reveals the Suitability of Cardiac Death Livers for Transplantation
Authors: Chen Xinguo , Shen Zhongyang , Zhang Xuyi , Guo Jing , Hao Yuwen , Cao Li , Yue Yang , Wu Fengdong , Wang Yi , Wang Letian , Mao Sha , Zhang Qing
Published: November 2018

Background. Organ transplantation is considered the best treatment for end-stage organ failure. However, the lack of available organs for transplantation and the increasing number of patients waiting for transplants are primary issues facing the transplant community. Thus, developing strategies to increase the number of donors, especially for liver transplantation, has become a priority. The use of organs acquired from donors who suffered cardiac related deaths has increased the pool of potential liver donors. However, donation after cardiac death (DCD) livers increases the risk of primary graft dysfunction. Methods. In the current study, we conducted transcriptome sequencing using livers from a DCD rat to assess the short-term feasibility and functional efficacy of DCD livers. RNA sequencing (RNAseq) data showed that the liver transcriptome varied greatly in rat livers subjected to 15 minutes of cardiac arrest. Results. The livers used in the current study had a significant loss of normal function before transplantation. Functional and network analyses consistently indicated that transcription and translation processes were inhibited after approximately 15 minutes of cardiac arrest. Moreover, the transcriptomic sequencing data provides significant insight for identifying functional genes and testing additional biological questions in DCD liver transplantation in future studies.
Physical Activity of Working-Age People in View of Their Income Status
Authors: Puciato Daniel , Rozpara Michał , Mynarski Władysław , Oleśniewicz Piotr , Markiewicz-Patkowska Julita , Dębska Małgorzata
Published: November 2018

Objective. The study examines relationships between physical activity levels and income status of working-age city residents. Methods. The study was carried out in the years 2014 and 2015 in Wrocław, Poland. The study sample comprised 4332 participants (2276 women; 2056 men) aged 18 to 64 years. Respondents’ habitual physical activity levels were measured with the International Physical Activity Questionnaire Short Form (IPAQ-SF), while their income status was assessed with author’s own Socio-Economic Status of Working-Age People Questionnaire (S-ESQ). Results. The results revealed positive correlations between the level of physical activity and income status of male and female working-age residents of Wrocław. The highest physical activity levels were noted among respondents with a steady income, as well as among respondents with the highest income and savings and with no debts. The odds for respondents’ above average physical activity levels were the greatest in women with the highest income and with savings and in debt-free men and women. Conclusion. Effective actions should be developed aimed at improvement of physical activity levels of people in an adverse financial situation.
Exact Analysis and Physical Realization of the 6‐Lobe Chua Corsage Memristor
Authors: Mannan Zubaer I. , Yang Changju , Adhikari Shyam P. , Kim Hyongsuk
Published: November 2018

A novel generic memristor, dubbed the 6-lobe Chua corsage memristor, is proposed with its nonlinear dynamical analysis and physical realization. The proposed corsage memristor contains four asymptotically stable equilibrium points on its complex and diversified dynamic routes which reveals a 4-state nonlinear memory device. The higher degree of versatility of its dynamic routes reveal that the proposed memristor has a variety of dynamic paths in response to different initial conditions and exhibits a highly nonlinear contiguous DC V‐I curve. The DC V‐I curve of the proposed memristor is endowed with an explicit analytical parametric representation. Moreover, the derived three formulas, exponential trajectories of state xn(t), time period tfn, and minimum pulse amplitude VA, are required to analyze the movement of the state trajectories on the piecewise linear (PWL) dynamic route map (DRM) of the corsage memristor. These formulas are universal, that is, applicable to any PWL DRM curves for any DC or pulse input and with any number of segments. Nonlinear dynamics and circuit and system theoretic approach are employed to explain the asymptotic quad-stable behavior of the proposed corsage memristor and to design a novel real memristor emulator using off-the-shelf circuit components.
Additive Manufacturing Enabled by Electrospinning for Tougher Bio‐Inspired Materials
Authors: Agarwal Komal , Zhou Yinning , Anwar Ali Hashina Parveen , Radchenko Ihor , Baji Avinash , Budiman Arief S.
Published: November 2018

Nature has taught us fascinating strategies to design materials such that they exhibit superior and novel properties. Shells of mantis club have protein fibres arranged in a 3D helicoidal architecture that give them remarkable strength and toughness, enabling them to absorb high‐impact energy. This complex architecture is now possible to replicate with the recent advances in additive manufacturing. In this paper, we used melt electrospinning to fabricate 3D polycaprolactone (PCL) fibrous design to mimic the natural helicoidal structures found in the shells of the mantis shrimp’s dactyl club. To improve the tensile deformation behavior of the structures, the surface of each layer of the samples were treated with carboxyl and amino groups. The toughness of the surface‐treated helicoidal sample was found to be two times higher than the surface‐treated unidirectional sample and five times higher than the helicoidal sample without surface treatment. Free amino groups (NH2) were introduced on the surface of the fibres and membrane via surface treatment to increase the interaction and adhesion among the different layers of membranes. We believe that this represents a preliminary feasibility in our attempt to mimic the 3D helicoidal architectures at small scales, and we still have room to improve further using even smaller fibre sizes of the modeled architectures. These lightweight synthetic analogue materials enabled by electrospinning as an additive manufacturing methodology would potentially display superior structural properties and functionalities such as high strength and extreme toughness.
Sleep Quality and Levodopa Intestinal Gel Infusion in Parkinson’s Disease: A Pilot Study
Authors: De Fabregues Oriol , Ferré Alex , Romero Odile , Quintana Manuel , Álvarez-Sabin José
Published: November 2018

Background. Sleep problems in patients with advanced Parkinson’s disease (PD) have a deleterious impact on quality of life. Objective. To assess the effect of levodopa-carbidopa intestinal gel (LCIG) infusion on sleep quality in advanced PD patients. Methods. Seven patients participated in a prospective pilot study. Before and after 6 months of LCIG infusion, an overnight polysomnography was performed and the Epworth Sleepiness Scale, fatigue scale, Pittsburgh Sleep Quality Index, Beck Depression Inventory, and the Hamilton Anxiety Rating Scale were administered. Results. PSG showed low sleep efficiency. REM sleep without atony was found in 5 patients. After 6 months of LCIG infusion, the percentage of REM sleep decreased as well as the number of arousals especially due to reduction of spontaneous arousals and periodic leg movements during REM sleep, but differences were not statistically significant. Also, scores of all study questionnaires showed a tendency to improve. Conclusion. The results show a trend toward an improvement of sleep quality after 6 months of LCIG infusion, although differences as compared to pretreatment values were not statistically significant. The sleep architecture was not modified by LCIG. Further studies with larger study samples are needed to confirm these preliminary findings.
A Comparative Study on Efficacy and Safety of Propofol versus Dexmedetomidine in Sleep Apnea Patients undergoing Drug-Induced Sleep Endoscopy: A CONSORT-Prospective, Randomized, Controlled Clinical Trial
Authors: Zhao L. L. , Liu H. , Zhang Y. Y. , Wei J. Q. , Han Y. , Han L. , Yang J. P.
Published: November 2018

The aim of this study is to compare the efficacy and safety of propofol with dexmedetomidine in patients with obstructive sleep apnea hypopnea syndrome (SAHS) undergoing drug-induced sleep endoscopy (DISE). The 88 patients diagnosed with SAHS in the Affiliated Hospital of Xuzhou Medical University were randomly allocated into 2 groups (n = 44). Patients in the group dexmedetomidine (group D) received continuous intravenous infusion of dexmedetomidine 1 μg/kg over 15 minutes before the endoscopy, and propofol 2 mg/kg was intravenously administrated in the group propofol (group P). Cardiopulmonary parameters of patients were recorded. The time to fall asleep, duration of endoscopic examination, the wakeup time of patients, the number of mask ventilations for patients, the satisfaction of patients and endoscopic performers, and false positive cases of SAHS of patients were compared between the two groups. Compared with group D, mean arterial pressure (MAP) and blood oxygen saturation (SPO2) of patients in the P group were lower at the time point of T1 (P < 0.05), the duration of endoscopic examination and wakeup time of patients were obviously prolonged, the incidence of mask ventilation for patients and false positive cases of SAHS of patients was observably higher, and the satisfaction of endoscopic performers was markedly lower, but the time to fall asleep was significantly shortened (P < 0.05). Dexmedetomidine served as a novel sleep induced drug and can provide satisfactory conditions and be safely and effectively applied for endoscopy in patients with SAHS, without adverse hemodynamic effects.
Bridge Responses Induced by Adjacent Subway Station Construction Using Shallow Tunneling Method
Authors: Su Jie , Fang Qian , Zhang Dingli , Niu Xiaokai , Liu Xiang , Jie Yunming
Published: November 2018

This paper presents a case of subway station construction under an existing prestressed concrete bridge with a three‐span continuous beam located at the intersection of the 3rd Ring Road, Beijing. The Huayuan Subway Station of line 6, constructed crossing between #7 and the #8 piers of the bridge by the shallow tunneling method, is approximately perpendicular to the existing Huayuan Bridge. The minimum horizontal distance between the pile foundation and the subway station is only 0.08 m. The “Pile‐Beam‐Arc” construction sequence was used to ensure the safety of both the subway station and the bridge. Moreover, a series of reinforcement measures were adopted to safeguard the project, including deep grouting reinforcement surrounding the pile foundation from ground surface, temporary inverted arch in the middle of No. 5 drift, and the lateral steel support. Even though some cracks were observed on the bridge deck surface by the on‐site deformation monitoring, the results were still within the proposed control standard. To prevent the further development of the cracks, jacking protection measure and bonded steel constructed under the box girder were performed. The related measures proposed in this research can provide useful references for future similar projects.
Uncontrolled Diabetes Mellitus Has No Major Influence on the Platelet Transcriptome
Authors: Nührenberg Thomas G. , Cederqvist Marco , Marini Federico , Stratz Christian , Grüning Björn A. , Trenk Dietmar , Binder Harald , Gilsbach Ralf , Neumann Franz-Josef , Hein Lutz
Published: November 2018

Background. Diabetes mellitus (DM) has been associated with increased platelet reactivity as well as increased levels of platelet RNAs in plasma. Here, we sought to evaluate whether the platelet transcriptome is altered in the presence of uncontrolled DM. Methods. Next-generation sequencing (NGS) was performed on platelet RNA for 5 patients with uncontrolled DM (HbA1c 9.0%) and 5 control patients (HbA1c 5.5%) with otherwise similar clinical characteristics. RNA was isolated from leucocyte-depleted platelet-rich plasma. Libraries of platelet RNAs were created separately for long RNAs after ribosomal depletion and for small RNAs from total RNA, followed by next-generation sequencing. Results. Platelets in both groups demonstrated RNA expression profiles characterized by absence of leukocyte-specific transcripts, high expression of well-known platelet transcripts, and in total 6,343 consistently detectable transcripts. Extensive statistical bioinformatic analysis yielded 12 genes with consistently differential expression at a lenient FDR < 0.1, thereof 8 protein-coding genes and 2 genes with known expression in platelets (MACF1 and ITGB3BP). Three of the four differentially expressed noncoding genes were YRNAs (RNY1, RNY3, and RNY4) which were all downregulated in DM. 23 miRNAs were differentially expressed between the two groups. Of the 13 miRNAs with decreased expression in the diabetic group, 8 belonged to the DLK1–DIO3 gene region on chromosome 14q32.2. Conclusions. In this study, uncontrolled DM had a remote impact on different components of the platelet transcriptome. Increased expression of MACF1, together with supporting predicted mRNA-miRNA interactions as well as reduced expression of RNYs in platelets, may reflect subclinical platelet activation in uncontrolled DM.
Twin Pregnancy in Brazil: A Profile Analysis Exploring Population Information from the National Birth E-Registry on Live Births
Authors: Santana Danielly S. , Souza Renato T. , Surita Fernanda G. , Argenton Juliana L. , Silva Cleide M. , Cecatti Jose G.
Published: November 2018

Birth records as SINASC (Brazilian Live Birth Information System) are highlighted in uncommon conditions such as twin pregnancy whose prevalence rarely exceeds 2 to 3% of the total number of births. The objective of this study was to assess the prevalence of twin pregnancies in Brazil and their maternal and perinatal characteristics using data from the national birth e-Registry. All births in Brazil from 2011 to 2014 were assessed. Prevalence of twin pregnancies per region was assessed and correlated with the Human Development Index (HDI). Sociodemographic and obstetric factors and main perinatal outcomes were assessed for the first and second twin, in comparison to singletons, and the second twin compared to the first twin, with PR and 95%CI. A multiple logistic regression analysis was conducted to identify factors independently associated with a low 5-minute Apgar score in twin pregnancies. Twin pregnancy occurred in 1.13% in Brazil, with a higher prevalence in regions with a higher HDI. It was associated with a complete higher level of education (22.9% versus 16.3% for singles) and maternal age > 35 years (17.5% versus 11.4% for singles). Preterm birth <32 weeks (prevalence ratio-PR 12.13 [11.93 – 12.33]), low birth weight (PR 17.8 [17.6-18.0] for the first and PR 20.1 [19.8-20.3] for the second twin), and low Apgar score (PR 2.9 [2.8-3.0] for the first and PR 2.7 [2.6-2.8] for the second twin) were the most important perinatal outcomes associated with twin pregnancies. A 5-minute Apgar score < 7 among twins was associated with inadequate prenatal care, extreme preterm birth, vaginal delivery, intrapartum cesarean, and combined delivery. Twin pregnancy in Brazil is associated with worse perinatal outcomes, especially for the second twin.
The Unbalanced Radial Force of In‐Wheel Switched Reluctance Motors Effect on Vehicle Performance under Stability Condition
Authors: Wang Yanyang , Yang Funing , Shang Fuxing , Xiong Qing
Published: November 2018

This paper studies the unbalanced radial force of in‐wheel switched reluctance motors effect on vehicle performance under stability condition. First, the IWM‐EV vehicle model which highlights the new factors of the rotor, stator, SRM vertical force, and airgap deflection was adopted. And the vehicle comparison models were established to make a contrastive study about IWM‐EV new structure effects. Then, Routh’s stability criterion method was adopted to judge the vehicle system’s stability condition. It includes two parts: characteristic polynomial of the vehicle system which is served to calculate the IWM‐EV system Routh array and Routh’s stability criterion which is used to judge the vehicle system’s stability condition. The effect of the new structure on vehicle performance was further discussed under stability condition. It mainly includes two aspects: vehicle vibration mode analysis which is used to study vehicle vibration characteristics and amplitude‐frequency analysis which is served to research transfer response characteristics of the vehicle system. The result shows that the new structure of IWM‐EV has a negative effect on vehicle stability performance. The SRM vertical force will change vehicle stability characteristic. In some severe cases, it will even destroy IWM‐EV’s stability.
Investigation of Objective Parameters of Vehicle Door Closing Transient Sound Quality Based on Complex Analytic Wavelet Method
Authors: Xie Xiaoping , Zeng Fandong , Shen Guangjian
Published: November 2018

In view of the deficiency of psychoacoustic objective parameters in prediction of nonstationary vehicle sound quality, we propose an innovative method to extract the transient acoustic time‐frequency characteristic parameters as objective parameters to evaluate the quality of vehicle door closing sound based on complex analytic wavelet. The signal is decomposed by empirical mode decomposition (EMD) and the decomposed intrinsic mode function (IMF) components are analyzed by the spectrum analysis. On the basis of human auditory frequency range, some IMF components are eliminated and the main frequency bands of the effective IMF components are extracted as the analytical frequency bands of the complex analytic wavelet. The center frequencies of the complex analytic wavelet analysis are extracted according to the critical bands, thereby determining wavelet parameters (band width, center frequency, scale factor, etc.,). To highlight the influence of high‐frequency components and balance the data discrepancy, we extract the energy ratio coefficient as the objective parameter after weighting the time‐frequency components. By comparing with the extracted objective parameters of traditional psychoacoustics, the correlation between the subjective evaluation results and the energy ratio coefficients is analyzed. The results demonstrate that the energy ratio coefficients extracted based on the complex analytic wavelet transform have a greater correlation with subjective evaluation results than the traditional psychoacoustic objective parameters. In addition, the frequency components of 1720 Hz∼3150 Hz have a strong negative correlation with the vehicle door closing sound quality.
Hypospermia Improvement in Dogs Fed on a Nutraceutical Diet
Authors: Ciribé Francesco , Panzarella Riccardo , Pisu Maria Carmela , Di Cerbo Alessandro , Guidetti Gianandrea , Canello Sergio
Published: November 2018

Male dog infertility may represent a serious concern in the canine breeding market. The aim of this clinical evaluation was to test the efficacy of a commercially available nutraceutical diet, enriched with Lepidium meyenii, Tribulus terrestris, L-carnitine, zinc, omega-3 (N-3) fatty acids, beta-carotene, vitamin E, and folic acid, in 28 male dogs suffering from infertility associated with hypospermia. All dogs received the diet over a period of 100 days. At the end of the evaluation period, no adverse effects, including head and tail anomalies percentage onset, were reported. Interestingly, motility percentage, semen volume and concentration, and total number of sperms per ejaculation significantly increased. Further investigations on a wider cohort of dogs might be useful to better correlate the presence of oxytetracycline in pet’s diet and the onset of infertility and clearly assess the action mechanism of an oxytetracycline-free nutraceutical diet.
Genetic Heterogeneity ofAlicyclobacillusStrains Revealed by RFLP Analysis ofvdcRegion andrpoBGene
Authors: Dekowska Agnieszka , Niezgoda Jolanta , Sokołowska Barbara
Published: November 2018

PCR-RFLP targeting of the 16S rDNA andrpoBgenes, as well as thevdcregion, was applied to identify and differentiate between the spoilage and non-spoilageAlicyclobacillusspecies. Eight reference strains and 75 strains isolated from spoiled juices, juice concentrates, drinks, its intermediates, and fresh apples were subject to study. Hin6I restriction patterns of the 16S rDNA gene enabled distinguishing between all the species analyzed, while therpoBgene andvdcgene cluster analysis also revealed that there were two major types among theA. acidoterrestrisisolates, one similar to the reference strainA. acidoterrestrisDSM 2498, and the other similar to the reference strainA. acidoterrestrisATCC 49025. Heterogeneity was also observed among theA. acidocaldariusisolates. RFLP analysis of the 16S rDNA andrpoBgenes, as well asvdcregion, can be used successfully in the identification and research of intraspecies heterogeneity of theAlicyclobacillusspecies.
Small or Non-Small Cell Lung Cancer Based Therapy for Treatment of Large Cell Neuroendocrine Cancer of The Lung? University of Cincinnati Experience
Authors: Eldessouki Ihab , Gaber Ola , Namad Tariq , Wang Jiang , Morris John C. , Abdel Karim Nagla
Published: November 2018

Large cell neuroendocrine cancer (LCNEC) of the lung exhibits morphological and immunohistochemical characteristics of both neuroendocrine and large cell carcinomas. No defined optimal therapy has been described for this subset of patients and the question of whether these patients should be treated with non-small cell lung cancer (NSCLC) treatment protocols, according to the National Comprehensive Cancer Network (NCCN) guidelines, or with small cell lung cancer (SCLC) due to histological and clinical similarities is still uncertain. We conducted a retrospective review of patients identified with diagnosis of LCNEC of the lung at the University of Cincinnati Cancer Center from the year 2002 to 2012 to determine which treatment approach resulted in improved outcomes in this rare category of disease. Patients who received chemotherapy whether NSCLC (group A) or SCLC (group B) protocols did not show significant changes in OS (P=0.911). Meanwhile, patients who underwent surgery (group C) had better OS compared to groups A and B (P= 0.027 and 0.024, respectively). This analysis reveals that outcomes for SCLC or NSCLC treatment strategies in LCNEC patients did not result in survival advantages and future research should be addressing it as a separate entity.
The Motoric Types of Delirium and Estimated Blood Loss during Perioperative Period in Orthopedic Elderly Patients
Authors: Hong Narei , Park Jae-Yong
Published: November 2018

Background. Delirium is a common and serious syndrome in elderly patients. The hypoactive type of delirium is known to have different characteristics, but further studies are needed to define the specificities of these characteristics. Our study aims at finding specific risk factors, especially estimated blood loss during operations of hyper- and hypoactive delirium in orthopedic elderly patients.Methods. One hundred and seventy-five elderly patients were evaluated using the Confusion Assessment Method (CAM) and the4thedition text revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). Trained psychiatrists interviewed the subjects directly at pre- and postoperative time points. We reviewed medical records after the patients were discharged.Results. Thirty-nine patients (22.3%) were diagnosed with multiple types of delirium, which included 17 hyperactive types (65.9%), 13 hypoactive types (33.3%), and 9 mixed types (23.1%). Although the mean estimated blood loss in patients with either hyper- or hypoactive symptoms was larger than in patients lacking these symptoms, the odds ratio was only significant in patients with hyperactive symptoms. In addition, age, preoperative daily function, and preoperative hyponatremia were found to be risk factors for hyperactive but not hypoactive symptoms.Conclusion. Patients with hypoactive symptoms had different risk factors than patients with hyperactive symptoms of delirium. The estimated blood loss, well-known risk factors for delirium, might be risk factors for only hyperactive delirium. The acute precipitating factors seemed to show stronger correlation with the hyperactive type of delirium than with the hypoactive type.
IgG4-Related Diseases in the Gastrointestinal Tract: Clinical Presentation, Diagnosis and Treatment Challenges
Authors: Backhus Johanna , Seufferlein Thomas , Perkhofer Lukas , Hermann Patrick C. , Kleger Alexander
Published: November 2018

Background: IgG4-related diseases are a rare but an important entity. Due to the variable clinical presentation, this multiorgan disease was attributed to single-organ systems for many years. Also, it often remains a challenge to differentiate between IgG4-related diseases and malignancies. The pathogenesis seems to be a mixture of Th1- and Th2- immune responses, whereas the role of the non-pathogenic IgG4 antibodies is still unclear. Histopathological characteristics are a lymphoplasmacellular infiltrate with IgG4+ plasma cells, a storiform fibrosis and an obliterative phlebitis. This can lead to the functional destruction of every organ affected. In most cases, glucocorticoid treatment leads to remission and is used as maintenance therapy as well. Immune modulatory therapies are employed in case of steroid resistance. However, a majority of patients achieve remission without any therapy. Summary: In this study, we review the current state-of-the-art regarding pathophysiology, diagnostics, organ manifestation and therapeutic approaches. Key Messages: While the diagnosis of IgG4-related diseases is still challenging, there have been significant improvements in diagnostic as well as in therapeutic approaches. This is partially due to a better understanding of the pathophysiology of the disease but also due to improved imaging modalities and novel, more targeted therapies.
Breast Cancer Recurrence Risk Assessment: Is Non-Invasive Monitoring an Option?
Authors: Schunkert Elisa M. , Zhao Wanzhou  , Zänker Kurt
Published: November 2018

Background: Metastatic breast cancer (MBC) represents a life-threatening disease with a median survival time of 18–24 months that often can only be treated palliatively. The majority of women suffering from MBC are those who had been previously diagnosed with locally advanced disease and subsequently experienced cancer recurrence in the form of metastasis. However, according to guidelines, no systemic follow-up for monitoring purposes is recommended for these women. The purpose of this article is to review current methods of recurrent risk assessment as well as non-invasive monitoring options for women at risk for distant disease relapse and metastasis formation. Methods: We used PubMed and national guidelines, such as the National Comprehensive Cancer Network (NCCN), to find recently published studies on breast cancer recurrence risk assessment and systemic monitoring of breast cancer patients through non-invasive means. Results: The options for recurrence risk assessment of locally invasive breast cancer has improved due to diverse genetic tests, such as Oncotype DX, MammaPrint, the PAM50 (now known as the “Prosigna Test”) assay, EndoPredict (EP), and the Breast Cancer Index (BCI), which evaluate a women’s risk of relapse according to certain cancer-gene expression patterns. Different promising non-invasive urinary protein-based biomarkers with metastasis surveillance potential that have been identified are MMP-2, MMP-9, NGAL, and ADAM12. In particular, ααCTX, ββCTX, and NTX could help to monitor bone metastasis. Conclusion: In times of improved recurrence risk assessment of women with breast cancer, non-invasive biomarkers are urgently needed as potential monitoring options for women who have an increased risk of recurrence. Urine as a bioliquid of choice provides several advantages – it is non-invasive, can be obtained easily and frequently, and is economical. Promising biomarkers that could help to follow up women with increased recurrence risk have been identified. In order for them to be implemented in clinical usage and national guideline recommendations, further validation in larger independent cohorts will be needed.
Prescription Drug Shortages: Impact on Neonatal Intensive Care
Authors: Ziesenitz Victoria C. , Fox Erin , Zocchi Mark , Samiee-Zafarghandy Samira , van den Anker Johannes N. , Mazer-Amirshahi Maryann
Published: November 2018

Background: Prescription drug shortages have increased significantly during the past two decades and also impact drugs used in critical care and pediatrics. Objectives: To analyze drug shortages affecting medications used in neonatal intensive care units (NICUs). Methods: Drug shortage data for the top 100 NICU drugs were retrieved from the University of Utah Drug Information Service from 2001 to 2016. Data were analyzed focusing on drug class, formulation, reason for shortage, and shortage duration. Results: Seventy-four of the top 100 NICU drugs were impacted by 227 shortages (10.3% of total shortages). Twenty-eight (12.3%) shortages were unresolved as of December 2016. Resolved shortages had a median duration of 8.8 months (interquartile range 3.6–21.3), and generic drugs were involved in 175 (87.9%). An alternative agent was available for 171 (85.8%) drugs but 120 (70.2%) of alternatives were also affected by shortages. Parenteral drugs were involved in 172 (86.4%) shortages, with longer durations than nonparenteral drugs (9.9 vs. 6.4 months, p = 0.022). The most common shortage reason was manufacturing problems (32.2%). Conclusions: Drug shortages affected many agents used in NICUs, which can have quality and safety implications for patient care, especially in extremely low birth weight infants. Neonatologists must be aware of current shortages and implement mitigation strategies to optimize patient care.
Increasing Silicone Oil Viscosity Increases Resistance to Volume Displacement in an in vitro Retinal Detachment Model
Authors: Rubowitz Alexander , Asalee Leena , Zaretski Uri
Published: November 2018

Purpose: To determine whether higher-viscosity silicone oils offer greater resistance to volume displacement in an in vitro eye model of retinal detachment and could subsequently be expected to generate stronger retinal tamponades in cases of recurrent or complex retinal detachments. Methods: We used an eye model that included a membrane representing the retina. Silicone oils with different viscosities were injected, and oil displacement and resistance were measured. Results: Membrane movement and volume changes in an eye model were proportional to the viscosity of the oil: the lower the viscosity, the faster volume changes and displacement occurred. Conclusions: Our results show that the volume change rate has a linear relationship with oil viscosity. Our findings suggest that in this eye model, silicone oil tamponades the retina against the retinal pigment epithelium mainly through volume displacement and that silicone oil viscosity may play an important role in preventing retinal displacement and in providing tamponade.
Mutation Analysis of the ATP7B Gene in Seven Chinese Families with Wilson’s Disease
Authors: Xiao Heng , Deng Sheng , Deng Xiong , Gu Shaojuan , Yang Zhijian , Yin Hang , Deng Hao
Published: November 2018

Background: Wilson’s disease (WD) is an autosomal recessive disease, which is characterized by an excessive copper accumulation in the liver and brain, leading to subsequent hepatic and/or neurological disorders. The causative gene for WD has been identified as the ATPase Cu2+ transporting beta polypeptide gene (ATP7B), which encodes a protein called copper-transporting ATPase 2. ATP7B mutations may lead to reduced biliary excretion of excess copper and disrupted copper homeostasis, resulting in various clinical symptoms of WD. Methods: Direct sequencing of the ATP7B gene was performed in 7 Han Chinese families with WD, and haplotype analysis was conducted in families having the same mutation. Results: Nine ATP7B gene mutations were identified, including 7 missense mutations (p.Asp765Gly, p.Arg778Leu, p.Thr888Pro, p.Pro992Leu, p.Asp1047Val, p.Ile1148Thr and p.Ala1295Val), 1 duplication mutation (c.525dupA), and 1 nonsense mutation (p.Gly837*). Combined with our previous data, haplotype analysis revealed that the founder effect accounted for 48% of alleles in Han Chinese, constituted by high allele frequency mutations p.Arg778Leu, p.Pro992Leu and p.Ala1295Val. Conclusion: This study revealed genetic defects of 7 Han Chinese families with WD, and has implications for their genetic counseling and clinical management.
Ten-Year Evaluation of the TOYOTA Prehospital Stroke Scale for Tissue Plasminogen Activator Intravenous Therapy in the Real World
Authors: Suzuki Junichiro , Nakai Noriyoshi , Kondo Naohide , Tsuji Hirotake , Inagaki Ryosuke , Furukawa Soma , Iwata Mai , Nishida Suguru , Ito Yasuhiro
Published: November 2018

Background: Emergency medical services are an important part of acute stroke management. We devised a prehospital stroke scale, the TOYOTA prehospital stroke scale for tissue plasminogen activator (t-PA) intravenous therapy (TOPSPIN) for triaging patients with ischemic stroke and especial indications for intravenous t-PA therapy in December 2006; this scale comprises 5 items including consciousness, atrial fibrillation, language disorder, disturbance of the upper extremities, and disturbance of the lower extremities. The aim of this study was to analyze the results of 10 years of TOPSPIN implementation and to distinguish ischemic stroke from hemorrhagic stroke in the real world. Methods: We prospectively enrolled consecutive patients who were transferred to our hospital and evaluated by Toyota city ambulance services using the TOPSPIN from December 2006 to January 2017. We examined definite diagnosis at the time of hospital discharge (ischemic stroke, hemorrhagic stroke, or stroke mimic), positive-predictive value of the stroke, the rate of the recanalization therapy, and clinical differentiation among patients with hemorrhagic stroke, ischemic stroke, and stroke mimics. Results: A total of 1,482 consecutive patients were enrolled; 1,134 (76.5%) were patients with stroke (628 ischemic-type, 34 transient ischemic attack-type, and 472 hemorrhagic-type) and 348 (23.5%) without stroke (80 with seizure, 42 with syncope, 27 with hypoglycemia, and 199 other). Among 628 patients with ischemic stroke, 130 (20.7%) received intravenous recombinant t-PA treatment, endovascular therapy, or both. The presence of atrial fibrillation, older age, lower blood pressure, and lower total TOPSPIN score was more commonly associated with ischemic stroke than with hemorrhagic stroke. In multivariable logistic regression analysis, the presence of atrial fibrillation was independently associated with ischemic stroke (OR 2.33; 95% CI 1.61–3.40). Conclusions: The TOPSPIN is a simple prehospital stroke scale that includes an assessment of atrial fibrillation. Detection of atrial fibrillation in the prehospital stage may point to a higher probability of ischemic stroke.
Proteome and Transcriptome Reveal Involvement of Heat Shock Proteins and Indoleacetic Acid Metabolism Process in Lentinula Edodes Thermotolerance
Authors: Wang Gang-Zheng , Ma Chao-Jun , Luo Yi , Zhou Sha-Sha , Zhou Yan , Ma Xiao-Long , Cai Ying-Li , Yu Jing-Jing , Bian Yin-Bing , Gong Yu-Hua
Published: November 2018

Background/Aims: Heat stress could cause huge losses for Lentinula edodes in China and other Asian cultivation areas. Yet our understanding of mechanism how to defend to heat stress is incomplete. Methods: Using heat-tolerant and heat-sensitive strains of L. edodes, we reported a combined proteome and transcriptome analysis of L. edodes response to 40 °C heat stress for 24 h. Meanwhile, the effect of LeDnaJ on the thermotolerance and IAA (indoleacetic acid) biosynthesis in L. edodes was analyzed via the over-expression method. Results: The proteome results revealed that HSPs (heat shock proteins) such as Hsp40 (DnaJ), Hsp70, Hsp90 and key enzymes involved in tryptophan and IAA metabolism process LeTrpE, LeTrpD, LeTam-1, LeYUCCA were more highly expressed in S606 than in YS3357, demonstrating that HSPs and tryptophan as well as IAA metabolism pathway should play an important role in thermotolerance. Over-expression of LeDnaJ gene in S606 strains showed better tolerance to heat stress. It was also documented that intracellular IAA accumulation of S606 (8-fold up) was more than YS3357 (2-fold up), and exogenous IAA enhanced L. edodes tolerance to heat stress. Conclusion: Our data support the interest of LeTrpE, LeDnaJ, tryptophan and IAA could play a pivotal role in enhancing organism thermotolerance.
Ghrelin Stimulates Hepatocyte Proliferation via Regulating Cell Cycle Through GSK3β/Β-Catenin Signaling Pathway
Authors: Wang Qin , Zheng Ming , Yin Yue , Zhang Weizhen
Published: November 2018

Background/Aims: Obesity is associated with a reduction in ghrelin, a 28 aa gastric hormone. Whether reduced ghrelin contributes to the impaired proliferation of hepatocytes associated with obesity-related steatosis remains largely unknown. Here we examined the effects of ghrelin on the proliferation of hepatocytes derived from lean and obese mice. Methods: AML 12 cells or hepatocytes isolated from mice fed normal chow diet (NCD) or high fat diet (HFD) were used. Effects of ghrelin on hepatocyte proliferation were detected with CCK8 assay and EdU staining. Cell cycle was analyzed by flow cytometry. Levels of proliferation markers was examined by Western blot. Results: Growth hormone secretagogue receptor 1a (GHS-R1a) mRNA and protein were present in hepatocytes. Levels of GHS-R1a were increased upon ghrelin treatment. Ghrelin significantly increased hepatocyte proliferation measured by Cell Counting Kit-8(CCK8) assay and EdU staining in a dose- and time-dependent manner. Proportion of cells in S phase was markedly increased upon treatment with ghrelin. Ghrelin significantly increased levels of proliferating cell nuclear antigen (PCNA) and cyclin D1, while reducing p27 in hepatocytes from mice fed NCD or HFD. Deletion of GHS-R1a completely abolished the effects of ghrelin in cultured hepatocytes. Ghrelin stimulated the phosphorylation of glycogen synthase kinase 3 beta (GSK3β), leading to subsequent increase of nuclear β-catenin in hepatocytes derived from lean and obese mice. This effect was dependent on the GHS-R1a. Conclusion: Ghrelin activates GHS-R1a to stimulate hepatocyte proliferation via GSK3/β-catenin signaling pathway.
Salusin-α Inhibits Proliferation and Migration of Vascular Smooth Muscle Cell via Akt/mTOR Signaling
Authors: Gao Shoucui , Xu Liran , Zhang Yali , Yu Qingqing , Li Jiayan , Guan Hua , Wang Xiaojing , Cheng Daxin , Liu Yi , Bai Liang , Wang Rong , Fan Jianglin , Zhao Sihai  , Liu Enqi
Published: November 2018

Background/Aims: The proliferation and migration of vascular smooth muscle cells (VSMCs) are key steps in the progression of atherosclerosis. The aim of the present study was to investigate the potential roles of salusin-α in the functions of VSMCs during the development of atherosclerosis. Methods: In vivo, the effects of salusin-α on atherogenesis were examined in rabbits fed a cholesterol diet. The aortas were en face stained with Sudan IV to evaluate the gross atherosclerotic lesion size. The cellular components of atherosclerotic plaques were analyzed by immunohistochemical methods. In vitro, Cell Counting Kit-8 and wound-healing assays were used to assess the effects of salusin-α on VSMC proliferation and migration. In addition, western blotting was used to evaluate the total and phosphorylated levels of Akt (also known as protein kinase B) and mammalian target of rapamycin (mTOR) in VSMCs. Results: Salusin-α infusion significantly reduced the aortic lesion areas of atherosclerosis, with a 39% reduction in the aortic arch, a 71% reduction in the thoracic aorta, and a 71% reduction in the abdominal aorta; plasma lipid levels were unaffected. Immunohistochemical staining showed that salusin-α decreased both macrophage- and VSMC-positively stained areas in atherosclerotic lesions by 54% and 69%, cell proliferative activity in the intima and media of arteriosclerotic lesions, and matrix metalloproteinase 2 (MMP-2) and MMP-9 expression in plaques. Studies using cultured VSMCs showed that salusin-α decreased VSMC migration and proliferation via reduced phosphorylation of Akt and mTOR. Conclusion: Our data indicate that salusin-α suppresses the development of atherosclerosis by inhibiting VSMC proliferation and migration through the Akt/mTOR pathway.
The Landscape of Non-Coding RNA in an Adult Pig Model of Intrauterine Growth Restriction
Authors: Shen Linyuan , Zhang Shunhua , Li Qiang , Fu Yuhua , Tang Guoqing , Jiang Yanzhi , Li Mingzhou , Wang Jinyong , Li Xuewei , Che Lianqiang , Zhu Li
Published: November 2018

Background/Aims: Intrauterine growth restriction (IUGR) is a risk factor for adult metabolic syndrome, but how this disease is regulated by lncRNAs and circRNAs remains elusive. Methods: Here, we employed adult IUGR and normal pigs as models to evaluate the expression of various global lncRNAs and circRNAs in pig livers using RNA-seq. Results: In total, we obtained 1,162 million raw reads of approximately 104.54 Gb high quality data. After a strict five-step filtering process, 3,368 lncRNAs were identified, including 300 differentially expressed lncRNAs (p < 0.05) in the IUGR group relative to the control group. The cis-regulatory analysis identified target genes that were enriched in specific GO terms and pathways (p < 0.05), including amino acid metabolism, oxidoreductase activity, PPAR signaling pathway, and insulin signaling pathway. These are closely related to the observed phenotypes of increased gluconeogenesis and impaired mitochondrial oxidative phosphorylation in adulthood of the IUGR group. Additionally, we also identified 403 circRNAs, of which 44 were differentially expressed (p < 0.05). Interestingly, our results identified ATF4-miR214-circRNA7964 and TCF7-miR22-3p-circRNA16347 as two competing endogenous networks, which were closely associated with the observed increase in hepatic gluconeogenesis in the IUGR group. Conclusion: Together, this study reveals a multitude of candidate lncRNAs and circRNAs involved in the development of IUGR pigs, which could facilitate further researches on the molecular mechanisms of metabolic syndrome.