bluuebunny/crossref_metadata_2025 huggingface dataset:
Pre-post implementation survey of a multicomponent intervention to improve informed consent for caesarean section in Southern Malawi
Authors: Zethof Siem , Bakker Wouter , Nansongole Felix , Kilowe Kelvin , van Roosmalen Jos , van den Akker Thomas
Published: January 2020

Objective

Surgical informed consent is essential prior to caesarean section, but potentially compromised by insufficient communication. We assessed the association between a multicomponent intervention and women’s recollection of information pertaining to informed consent for caesarean section in a low-resource setting, thereby contributing to respectful maternity care.

Design

Pre-post implementation survey, conducted from January to June 2018, surveying women prior to discharge.

Setting

Rural 150-bed mission hospital in Southern Malawi.

Participants

A total of 160 postoperative women were included: 80 preimplementation and 80 postimplementation.

Intervention

Based on observed deficiencies and input from local stakeholders, a multicomponent intervention was developed, consisting of a standardised checklist, wall poster with a six-step guide and on-the-job communication training for health workers.

Primary and secondary outcome measures

Individual components of informed consent were: indication, explanation of procedure, common complications, implications for future pregnancies and verbal enquiry of consent, which were compared preintervention and postintervention using χ2test. Generalised linear models were used to analyse incompleteness scores and recollection of the informed consent process.

Results

The proportion of women who recollected being informed about procedure-related risks increased from 25/80 to 47/80 (OR 3.13 (95% CI 1.64 to 6.00)). Recollection of an explanation of the procedure changed from 44/80 to 55/80 (OR 1.80 (0.94 to 3.44)), implications for future pregnancy from 25/80 to 47/80 (1.69 (0.89 to 3.20)) and of consent enquiry from 67/80 to 73/80 (OR 2.02 (0.73 to 5.37)). After controlling for other variables, incompleteness scores postintervention were 26% lower (Exp(β)=0.74; 95% CI 0.57 to 0.96). Recollection of common complications increased with 0.25 complications (β=0.25; 95% CI 0.01 to 0.49). Recollection of the correct indication did not differ significantly.

Conclusion

Recollection of informed consent for caesarean section changed significantly in the postintervention group. Obtaining informed consent for caesarean section is one of the essential components of respectful maternity care.
Emergency medicine registrar training in Africa: overview of programmes, faculty and sustainability
Authors: Akomeah Abena Obenewaa , Sawe Hendry Robert , Mfinanga Juma A , Runyon Michael S , Noste Erin Elizabeth
Published: January 2020

Background

The specialty of emergency medicine (EM) is new in most African countries, where emergency medicine registrar (residency) programmes (EMRPs) are at different stages of evolution and little is known about the programmes. Identifying and describing these EMRPs will facilitate planning for sustainability, collaborative efforts and curriculum development for existing and future programmes. Our objective was to identify and provide an overview of existing EMRPs in Africa and their applicant requirements, faculty characteristics and plans for sustainability.

Methods

We conducted a descriptive cross-sectional survey of Africa’s EMRPs between January and December 2017, identifying programmes through an online search supplemented by discussions with African EM leaders. Leaders of all identified African EMRPs were invited to participate. Data were collected prospectively using a structured survey and are summarised with descriptive statistics.

Results

We identified 15 programmes in 12 countries and received survey responses from 11 programmes in 10 countries. Eight of the responding EMRPs began in 2010 or later. Only 36% of the EMRPs offer a 3-year programme. Women make up an average of 33% of faculty. Only 40% of EMRPs require faculty to be EM specialists. In smaller samples that reported the relevant data, 67% (4/6) of EMRPs have EM specialists who trained in that EMRP programme making up more than half of their faculty; 57% of Africa’s 288 EMRP graduates to date are men; and an average of 39% of EMRP graduates stay on as faculty for 78% (7/9) of EMRPs.

Conclusion

EMRPs currently produce most of their own EM faculty. Almost equal proportions of men and women have graduated from a predominantly >3-year training programme. Graduates have a variety of opportunities in academia and private practice. Future assessments may wish to focus on the evolution of these programme’ curricula, faculty composition and graduates’ career options.
Factors influencing the intention of Indonesian nursing students to work in rural areas
Authors: Firdaus Amanatul , Efendi Ferry , Hadisuyatmana Setho , Aurizki Gading Ekapuja , Abdullah Khatijah Lim
Published: January 2020

Objective

The aim of this study was to analyse the factors associated with the intention of Indonesian nursing students to work in rural areas.

Design

This was a cross-sectional study. The instrument used was a self-developed questionnaire consisting of 13 questions.The data were analysed using the χ2 statistics test and binary logistic regression with a level of significance <0.05.

Setting

The study was conducted at a public nursing school located in urban Surabaya, East Java, Indonesia, in December 2017.

Participants

A total of 714 nursing students from four different programmes were involved.

Results

This study found that almost 60% of nursing students were reluctant to work in rural areas. Of the three variables which were significant in the χ2 analysis, only two were significant following the logistic regression test, namely the class programmes of undergraduate regulars (OR=2.274; 95% CI 1.326 to 3.900), profession regulars (OR=2.262; 95% CI 1.110 to 4.607) and rural place of origin (OR=1.405; 95% CI 1.036 to 1.906).

Conclusion

The education programme and place of origin were associated with the intention of nursing students to work in rural areas. Therefore, the recruitment of prospective nurses should consider these factors by considering the local context.
Decline in renal function and oral anticoagulation dose reduction among patients with atrial fibrillation
Authors: Inohara Taku , Holmes DaJuanicia N , Pieper Karen , Blanco Rosalia G , Allen Larry A , Fonarow Gregg C , Gersh Bernard J , Hylek Elaine M , Ezekowitz Michael D , Kowey Peter R , Reiffel James A , Naccarelli Gerald V , Chan Paul S , Mahaffey Kenneth W , Singer Daniel E , Freeman James V , Steinberg Benjamin A , Peterson Eric D , Piccini Jonathan P
Published: January 2020

Objective

Non-vitamin K oral anticoagulants (NOACs) require dose adjustment for renal function. We sought to investigate change in renal function over time in patients with atrial fibrillation (AF) and whether those on NOACs have appropriate dose adjustments according to its decline.

Methods

We included patients with AF enrolled in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II registry treated with oral anticoagulation. Worsening renal function (WRF) was defined as a decrease of >20% in creatinine clearance (CrCl) from baseline. The US Food and Drug Administration (FDA)-approved package inserts were used to define the reduction criteria of NOACs dosing.

Results

Among 6682 patients with AF from 220 sites (median age (25th, 75th): 72.0 years (65.0, 79.0); 57.1% male; median CrCl at baseline: 80.1 mL/min (57.4, 108.5)), 1543 patients (23.1%) experienced WRF with mean decline in CrCl during 2 year follow-up of −6.63 mL/min for NOACs and −6.16 mL/min for warfarin. Among 4120 patients on NOACs, 154 (3.7%) patients had a CrCl decline sufficient to warrant FDA-recommended dose reductions. Of these, NOACs dosing was appropriately reduced in only 31 (20.1%) patients. Compared with patients with appropriately reduced NOACs, those without were more likely to experience bleeding complications (major bleeding: 1.7% vs 0%; bleeding hospitalisation: 2.6% vs 0%) at 1 year.

Conclusions

In the US practice, about one-fourth of patients with AF had >20% decline in CrCl over time during 2 year follow-up. As a result, about 3.7% of those treated with NOACs met guideline criteria for dose reduction, but of these, only 20.1% actually had a reduction.
Relationship between serum uric acid level and all-cause and cardiovascular mortality in population with obesity
Authors: LI Jie , Huang Jia-Yi , Liu Lin , Lo Kenneth , Sun Shuo , Chen Chao-Lei , Zhang Bin , Feng Ying Qing , Huang Yu-Qing
Published: January 2020

Background

We aimed to investigate the association between serum uric acid (SUA) and all-cause or cardiovascular mortality among participants with obesity.

Method

All participants were included from the 1999 to 2014 National Health and Nutrition Examination Survey with follow-up mortality assessment through 31 December 2015. Cox proportional hazards models were built to estimate adjusted HRs and 95% CIs for mortality according to baseline uric acid in quartiles. Obesity was defined as body mass index ≥30 (kg/m2). Generalised additive model (GAM) and two-piecewise linear regression models were performed to explore any non-linearity in associations.

Results

There were 12 637 adults with obesity eligible for analysis. There were 999 (7.91%) all-cause and 147 (1.16%) cardiovascular mortality occurred during the mean follow-up of 98.11 months. Comparing with the lowest quartile of SUA, the highest SUA group did not have significant association with all-cause (HR 1.08, 95% CI 0.76 to 1.52) and cardiovascular mortality (HR 1.63, 95% CI 0.58 to 4.53) after adjusting for various confounding factors. GAM and two-piecewise linear regression model demonstrated a non-linearly relationship between SUA and all-cause mortality, and the corresponding cut-off point was 6.5 mg/dL. However, there is no significant relationship between uric acid and cardiovascular death on both sides of the cut-off value of 6.1 mg/dL.

Conclusions

SUA showed a J-shaped relationship with all-cause mortality, but no significant with cardiovascular mortality in adults with obesity.
Endovascular thrombectomy: 31 hours from symptom onset
Authors: Beharry James , Duncan Roderick , Krauss Martin , Colgan Frances , Lim Jen Yuh , Wu Teddy
Published: January 2020

Endovascular thrombectomy is an effective intervention for symptomatic intracranial large-vessel occlusion. This treatment has proven benefit up to 24 hours following onset in selected patients with prestroke functional independence. Limited case reports suggest that thrombectomy beyond 24 hours may also be effective. We describe a young woman managed with endovascular thrombectomy beyond 24 hours.
Impact of maternal HIV–HBV coinfection on pregnancy outcomes in an underdeveloped rural area of southwest China
Authors: Li Chunlin , Yang Yu , Wang Yingjian , Dong Shurong , Yang Ya , Shi Ying , Li Linhan , Jiang Feng , Chen Yue , Jiang Qingwu , Zhou Yibiao
Published: January 2020

Objectives

Our objective was to determine the impact of maternal HIV–hepatitis B virus (HBV) coinfection on pregnancy outcomes.

Methods

The current study was conducted in a county of Yi Autonomous Prefecture in southwest China. Data were abstracted from hospitalisation records, including maternal and infant information. The seroprevalences of HIV and HBV infections and HIV–HBV coinfection were determined and the impact of maternal HIV–HBV coinfection on adverse pregnancy outcomes was assessed using logistic regression analysis. A treatment effects linear regression model was also applied to examine the effect of HBV, HIV or coinfection to quantify the absolute difference in birth weight from a reference of HBV–HIV negative participants.

Results

A total of 13 198 pregnant women were included in our study, and among them, 99.1% were Yi people and 90.8% lived in rural area. The seroprevalences of HIV and HBV infections and HIV–HBV coinfection were 3.6% (95% CI: 3.2% to 3.9%), 3.2% (95% CI: 2.9% to 3.5%) and 0.2% (95% CI: 0.1% to 0.2%) among the pregnant women, respectively. Maternal HIV–HBV coinfection was a risk factor for low birth weight (adjusted OR (aOR)=5.52, 95% CI: 1.97 to 15.40). Compared with the HIV mono-infection group, the risk of low birth weight was significantly higher in the HIV–HBV coinfection group (aOR=3.62, 95% CI: 1.24 to 10.56). Maternal HIV infection was associated with an increased risk of low birth weight (aOR=1.90, 95% CI: 1.38 to 2.60) and preterm delivery (aOR=2.84, 95% CI: 1.81 to 4.47). Perinatal death was more common when mothers were infected with HBV (aOR=2.85, 95% CI: 1.54 to 5.26).

Conclusions

The prevalence of HIV infection was high among pregnant women of the Yi region. Both HIV and HBV infections might have adverse effects on pregnancy outcomes. Maternal HIV–HBV coinfection might be a risk factor for low birth weight in the Yi region, which needs to be confirmed.
Studies on the oxidative degradation of paracetamol by a μ-oxo-diiron(III) complex
Authors: Singh Bula , Das Ranendu Sekhar
Published: January 2020

In higher organisms, metalloenzymes like cytochrome P450, containing a Fe(III) metal center, play an active role in metabolism of paracetamol (APAP). Here, we have chosen a mimicking μ-oxo-diiron complex, [Fe(III)2(μ-O)(phen)4(H2O)2]4+(1, phen = 1,10-phenanthroline), to study spectrophotometrically the kinetics of the redox interactions with APAP. In acidic buffer media (pH = 3.4–5.1), APAP quantitatively reduces 1 following first-order reaction kinetics. Each molecule of 1 accepts two electrons from APAP and is reduced to ferroin [Fe(phen)3]2+. On oxidation, APAP produces N-acetyl-p-benzoquinone imine (NAPQI), which on hydrolysis results in a mixture of benzoquinone, quinone oxime, acetamide, and acetic acid. In reaction media due to successive deprotonations, 1 exists in equilibrium with the species [Fe(III)2(μ-O)(phen)4(H2O)(OH)]3+(1a) and [Fe(III)2(μ-O)(phen)4(OH)2]2+(1b) (pKa= 3.71 and 5.28, respectively). The kinetic analyses suggest for an unusual reactivity order as 1 < 1a ≫ 1b. The mechanistic possibilities suggest that although 1 is reduced by concerted electron transfer (ET) – proton transfer (PT) mechanism, 1a and 1b may be reduced by a concerted PT–ET mechanism where a slow proton-abstraction step is followed by a rapid ET process. It seems that the initial activation of the bridging μ-oxo group by a proton-abstraction results in the higher reactivity of 1a.
Subalgebras, idempotents, ideals and quasi-units of two-dimensional algebras
Authors: Ahmed H. , Bekbaev U. , Rakhimov I.
Published: January 2020

All subalgebras, idempotents, left(right) ideals and left quasi-units of two-dimensional algebras are described. Classifications of algebras with given number of subalgebras, left(right) ideals are provided. In particular, a list of isomorphism classes of all simple two-dimensional algebras is given. In the study of ideals and subalgebras, the number of them depends on roots of certain system of polynomials at structure constants of the algebra. We also give explicit forms of the polynomials.
Dynamics of charged and rotating NUT black holes in Rastall gravity
Authors: Prihadi Hadyan L. , Sakti Muhammad F. A. R. , Hikmawan Getbogi , Zen Freddy P.
Published: January 2020

In this work, the Kerr–Newman-NUT black hole solution in Rastall gravity is proposed and it turns out that the horizon is [Formula: see text] dependence. Black hole dynamics such as the event horizons, ergosurface, zero angular momentum observer (ZAMO), thermodynamic properties, and the equatorial circular orbit around the black hole such as static radius limit, null equatorial circular orbit, and innermost stable circular orbit are investigated in this work. How the NUT and Rastall parameter affect the dynamic of the black hole is also shown.
Bound energies and states of the Yukawa potential through matrix representation
Authors: Cho Soyeon , Yoon Jin-Hee
Published: January 2020

We use the basis expansion method to solve the Schrödinger equation with the Yukawa potential, which is popular in most areas of physics but which cannot be solved analytically. This method is based on the basic principle in quantum physics that all particle states are represented by the complete set of eigenbases. We use the Coulomb eigenstates as a basis set for a particle state under the Yukawa potential and find the bound energies within more accuracy than ever using matrix representation. We justified the validity of this method in the choice of coupling constant of the Coulomb potential and in the choice of the number of bases included in the numerical calculation. We present the eigenenergies for [Formula: see text] states and compare our results to published ones. We find that the results are relatively precise with relative errors less than 2.2%. Our method is very efficient in a sense that all bound energies and eigenstates are obtained at the same time, which is not tried in other methods. The precision in calculation should be taken at least smaller than the energy difference between states.
Deformation of the seismogenic zone in the northeastern part of the Izu Peninsula, Japan, inferred from GNSS observations
Authors: Doke Ryosuke , Honda Ryou , Harada Masatake , Miyaoka Kazuki , Kato Teruyuki , Satomura Mikio
Published: January 2020

The Izu collision zone, which is characterized by the collision between the Izu-Bonin arc and the Honshu arc, is located in the northernmost part of the Philippine Sea Plate. Particularly in the northeastern margin of the zone, numerous large earthquakes have occurred throughout history. To clarify the convergent tectonics of this zone related to the occurrence of these large earthquakes, in this study we collected and analysed Global Navigation Satellite System (GNSS) observation data from the Izu collision zone. The result verified that a shear deformation zone exists in the northeastern part of the Izu Peninsula, which agrees with the maximum shear directions in the left-lateral slip of the active Kita-Izu Fault Zone in the study area. In the shear deformation zone, the seismic activities both in the eastern part of the Tanzawa Mountains and the northeastern part of the Izu Peninsula may be related to each other because the temporal patterns of the seismic activity in both areas are correlated. Based on the relative motion between the main part of the Izu Peninsula and the subducting forearc of the Philippine Sea Plate, the shear zone can be regarded as a transition zone affected by both plate collision and subduction.
Variations in sediment lithology of submarine flood deposits on the slope off Kumano River, Japan
Authors: Ikehara Ken , Usami Kazuko , Irino Tomohisa
Published: January 2020

Major river flooding is a typical geohazard frequently characterized by the transportation of large quantities of terrigenous material from the land to the sea. However, the types and patterns of flood material deposition and the influence on seafloor environments differ because of the diversity in geological and climatic conditions. In September 2011, the activity of typhoon 201112 produced severe rainfall in the central Kii Peninsula and caused a large flood along the Kumano River. The event was considered a once-in-a-century-scale flood. We examined the occurrence of flood deposits along the slope off the mouth of Kumano River in four surface sediment cores collected around 2 months after the 2011 flood. We found a thin and muddy event bed at the core top of three cores, with two or three event beds corresponding to past historical flood events. The sediment thickness, grain size and sedimentary structures for three historical flood deposits demonstrated significant variation. The thicknesses and the grain sizes of the three flood deposits from the same river showed no relationship with the maximum discharge from each flood. The differences in the types and fate of sediments discharge during the floods probably account for the variations.
Advances in Bioconvection
Authors: Bees Martin A.
Published: January 2020

The term “bioconvection” describes hydrodynamic instabilities and patterns in suspensions of biased swimming microorganisms. Hydrodynamic instabilities arise from coupling between cell swimming behaviors; physical properties of the cells, such as density; and fluid flows. For instance, a combination of viscous and gravitational torques can lead to cells swimming toward downwelling fluid. If the cells are more dense than the fluid, then a gyrotactic instability results. Phototaxis describes the directed response of cells to light, which can also lead to instability. Bioconvection represents a classic system where macroscopic phenomena arise from microscopic cellular behavior in relatively dilute systems. There are ecological consequences for bioconvection and the mechanisms involved as well as potential for industrial exploitation. The focus of this review is on progress measuring and modeling gyrotactic and phototactic bioconvection. It builds on two earlier reviews of bioconvection and recent interest in active matter, describing progress and highlighting open problems.
Amorphous MnO2 Coated 3D Ni Nanomesh as a Thin-film Hybrid Cathode Material under O2 Atmosphere
Authors: Kee Yongho , Put Brecht , Bardé Fanny , Vereecken Philippe M.
Published: January 2020

In this study, we apply the economically feasible liquid ALD process to deposit a 2 nm amorphous MnO2 thin-film on our high surface-area 3D Ni nanomesh substrate, which shows a high surface to footprint area ratio (30 cm2:1 cm2 for 1 μm thick Ni nanomesh), and demonstrate its preliminary electrochemical activity as a cathode under N2 and O2. The excellent footprint charge density and faradaic efficiency can be attributed to the catalytic oxygen reduction reaction, followed by Li-intercalation thus forming a hybrid combination of Li-ion and Li-O2 activity, alleviating the detrimental deactivation process of pristine MnO2.
CMKLR1 deficiency attenuates androgen-induced lipid accumulation in mice
Authors: Huang Binbin , Zhao Huashan , Huang Chen , Wu Linlin , Xiang Liang , Chen Jie , Wang Baobei , Xiao Tianxia , Li Mengxia , Ren Lirong , Niu Jianmin , Zhang Jian V.
Published: January 2020

Excess androgen-induced obesity has become a public health problem, and its prevalence has increased substantially in recent years. Chemokine-like receptor 1 (CMKLR1), a receptor of chemerin secreted by adipose tissue, is linked to adipocyte differentiation, adipose tissue development, and obesity. However, the effect of CMKLR1 signaling on androgen-mediated adiposity in vivo remains unclear. Using CMKLR1-knockout mice, we constructed an androgen-excess female mouse model through 5α-dihydrotestosterone (DHT) treatment and an androgen-deficient male mouse model by orchidectomy (ORX). For mechanism investigation, we used 2-(α-Naphthoyl) ethyltrimethylammonium iodide (α-NETA), an antagonist of CMKLR1, to suppress CMKLR1 in vivo and wortmannin, a PI3K signaling antagonist, to treat brown adipose tissue (BAT) explant cultures in vitro . Furthermore, we used histological examination and quantitative PCR, as well as Western blot analysis, glucose tolerance tests, and biochemical analysis of serum, to describe the phenotypes and the changes in gene expression. We demonstrated that excess androgen in the female mice resulted in larger cells in the white adipose tissue (WAT) and the BAT, whereas androgen deprivation in the male mice induced a reduction in cell size. Both of these adipocyte size effects could be attenuated in the CMKLR1-knockout mice. CMKLR1 deficiency influenced the effect of androgen treatment on adipose tissue by regulating the mRNA expression of the androgen receptor (AR) and adipocyte markers (such as Fabp4 and Cidea). Moreover, suppression of CMKLR1 by α-NETA could also reduce the extent of the adipocyte cell enlargement caused by DHT. Furthermore, we found that DHT could reduce the levels of phosphorylated ERK (pERK) in the BAT, while CMKLR1 inactivation inhibited this effect, which had been induced by DHT, through the PI3K signaling pathway. These findings reveal an antiobesity role of CMKLR1 deficiency in regulating lipid accumulation, highlighting the scientific importance for the further development of small-molecule CMKLR1 antagonists as fundamental research tools and/or as potential drugs for use in the treatment of adiposity.
Trafficking of nonesterified fatty acids in insulin resistance and relationship to dysglycemia
Authors: Walker Rachel E. , Ford Jennifer L. , Boston Raymond C. , Savinova Olga V. , Harris William S. , Green Michael H. , Shearer Gregory C.
Published: January 2020

In adipose, insulin functions to suppress intracellular lipolysis and secretion of nonesterified fatty acid (NEFA) into plasma. We applied glucose and NEFA minimal models (MM) following a frequently sampled intravenous glucose tolerance test (FSIVGTT) to assess glucose-specific and NEFA-specific insulin resistance. We used total NEFA and individual fatty acids in the NEFA MM, comparing the model parameters in metabolic syndrome (MetSyn) subjects ( n = 52) with optimally healthy controls (OptHC; n = 14). Results are reported as mean difference (95% confidence interval). Using the glucose MM, MetSyn subjects had lower [−73% (−82, −57)] sensitivity to insulin (Si) and higher [138% (44, 293)] acute insulin response to glucose (AIRg). Using the NEFA MM, MetSyn subjects had lower [−24% (−35, −13)] percent suppression, higher [32% (15, 52)] threshold glucose (gs), and a higher [81% (12, 192)] affinity constant altering NEFA secretion (ϕ). Comparing fatty acids, percent suppression was lower in myristic acid (MA) than in all other fatty acids, and the stearic acid (SA) response was so unique that it did not fit the NEFA MM. MA and SA percent of total were increased at 50 min after glucose injection, whereas oleic acid (OA) and palmitic acid (PA) were decreased ( P < 0.05). We conclude that the NEFA MM, as well as the response of individual NEFA fatty acids after a FSIVGTT, differ between OptHC and MetSyn subjects and that the NEFA MM parameters differ between individual fatty acids.
Association of Lactate Dehydrogenase with In-Hospital Mortality in Patients with Acute Aortic Dissection: A Retrospective Observational Study
Authors: He Huaping , Chai Xiangping , Zhou Yang , Pan Xiaogao , Yang Guifang
Published: January 2020

Background. Evidence regarding the relationship between serum lactate dehydrogenase (LDH) levels and in-hospital mortality in acute aortic dissection (AAD) patients is extremely limited. We aimed to investigate the relationship between LDH and in-hospital mortality in AAD patients. Methods. The present study was a retrospective observational study. A total of 1526 participants with acute aortic dissection were involved in a hospital in China from January 2014 to December 2018. The target-independent variable was LDH measured at baseline, and the dependent was all-cause mortality during hospitalization. Covariates involved in this study included age, gender, body mass index (BMI), hypertension, diabetes, smoking, stroke, atherosclerosis, systolic blood pressure (SBP), diastolic blood pressure (DBP), white blood cell (WBC), hemoglobin (Hb), alanine transaminase (ALT), aspartate aminotransferase (AST), albumin (ALB), creatinine (Cr), symptom, type of AAD (Stanford), and management. Results. The average age of 1526 selected participants was 52.72 ± 11.94 years old, and about 80.41% of them were male. The result of the fully adjusted model showed LDH was positively associated with in-hospital mortality in AAD patients after adjusting confounders (OR = 1.09, 95% CI 1.05 to 1.13). A nonlinear relationship was detected between LDH and in-hospital mortality in AAD patients after adjusting for potential confounders (age, gender, BMI, hypertension, diabetes, stroke, atherosclerosis, smoking, symptom, SBP, DBP, WBC, Hb, ALT, AST, ALB, Cr, type of AAD (Stanford), and management), whose point was 557. The effect sizes and the confidence intervals of the left and right sides of the inflection point were 0.90 (0.74–1.10) and 1.12 (1.06–1.19), respectively. Subgroup analysis in participants showed that the relationship between LDH and in-hospital mortality was stable, and all of the P value for the interaction in different subgroup were more than 0.05. Conclusions. The relationship between LDH and in-hospital mortality in AAD patients is nonlinear. LDH was positively related with in-hospital mortality when LDH is more than 557.
The Peroxisome Proliferator-Activated Receptor γ Agonist Pioglitazone Protects Vascular Endothelial Function in Hypercholesterolemic Rats by Inhibiting Myeloperoxidase
Authors: Zhang Dapeng , Wang Yehong , Yi Ming , Zhang Suli , Wu Ye
Published: January 2020

Objective. Hypercholesterolemia- (HC-) induced endothelial dysfunction is the first step of atherogenesis, and the peroxisome proliferator-activated receptor γ (PPARγ) has been reported to attenuate atherosclerosis formation; however, the underlying mechanisms are not fully understood. The present study was designed to determine whether myeloperoxidase (MPO) mediates HC-induced endothelial dysfunction and the role of the PPARγ agonist pioglitazone (PIO) in attenuating endothelial dysfunction. Methods. Male Wistar rats were fed with normal or high cholesterol diets for 8 weeks. HC rats were randomized to receive dapsone (DDS, the MPO inhibitor) during the last 6 days or PIO for the remaining 4 weeks. Vascular endothelial function was determined by comparing vasorelaxation to ACh, an endothelium-dependent vasodilator, and SNP, an endothelium-independent vasodilator in vascular rings in vitro. The vascular MPO activity, NOx content, and cGMP level were measured by the MPO activity assay kit, NO assay kit, and cGMP RIA kit. Results. Compared with rats fed with normal diet, endothelium-dependent vasodilation, NOx content, and cGMP level were decreased, and MPO activity was increased in thoracic aortas of rats fed with HC diet. There was a negative correlation between vascular endothelial function, NOx content or cGMP level, and MPO activity. PIO obviously reduced the MPO activity, increased NOx content and cGMP level, and improved endothelium-dependent vasodilation function in HC rats, which was essentially the same as that seen with DDS. And, there was a negative correlation between vascular endothelial function, NOx content or cGMP level, and MPO activity in the HC group and the PIO intervention group. Conclusion. MPO might provoke vascular endothelial dysfunction in hypercholesterolemic rats by reducing the NO biological activity and impairing the NO/cGMP/cGK signaling pathway. PIO might inhibit vascular MPO activity and increase NO bioavailability with the net result of reversing endothelial dysfunction.
Clinical and Prognostic Implications of P21 (WAF1/CIP1) Expression in Patients with Esophageal Cancer: A Systematic Review and Meta-Analysis
Authors: Wu Junbo , Liu Liang , Wu Feng , Qiu Li , Luo Ming , Ke Qing , Deng Xinzhou , Luo Zhiguo
Published: January 2020

Background. Previous studies have demonstrated that P21 (WAF1/CIP1) is a valuable prognostic factor in several malignant tumors. However, it is not known whether P21 can predict the prognosis in patients with esophageal cancer (EC). The aim of this research was to investigate the contribution of P21 expression to the clinicopathological characteristics and of EC. Methods. A systematic review and meta-analysis of study focusing on P21 expression, clinicopathological characteristics, and clinical outcomes in patients with EC was performed using seven databases (PubMed, Embase, Web of Science, and four Chinese databases). Pooled hazard ratios and odds ratios were used to explore the association between P21 expression, clinicopathological characteristics, and outcomes in patients with EC. The heterogeneity of the studies was classified by the I2 statistic. The sensitivity analysis was then utilized to assess the robustness of the results. Finally, the funnel plot and Begg’s test were used to evaluate the publication bias. Results. Forty-five studies with 3098 patients were eligible for inclusion in the meta-analysis. Thirty of these studies reported on clinicopathological characteristics and 15 on clinical outcomes. The pooled hazard ratio of 1.456 (95% confidence intervals 1.033–2.053, P=0.032) for overall survival indicated that a low P21 expression level was an unfavorable prognostic factor for a clinical outcome in patients with EC. Furthermore, the pooled odds ratio confirmed an association between decreased P21 expression and poor clinicopathological characteristics, including differentiation, lymph node metastasis, invasion, and higher grade and clinical stage. Notably, high P21 expression was a significant predictor of a favorable response to chemotherapy. There was no evidence of publication bias. Conclusion. Reduced P21 expression is associated with a poor outcome in patients with EC.
Secure Green-Oriented Multiuser Scheduling for Wireless-Powered Internet of Things
Authors: Shang Xiaohui , Yin Hao , Liu Aijun , Li Mu , Wang Yida , Wang Yong
Published: January 2020

In this paper, we consider the secure green-oriented multiuser scheduling for the wireless-powered Internet of Things (IoT) scenario, in which multiple source sensors communicate with a controller assisted by an intermediate sensor with the existence of a passive tapping device. Due to the limited energy, all sensors must acquire energy from external power beacons (PBs). Specifically, for the security improvement, we introduce two multiuser scheduling schemes possessing the optimal PB chosen by the relay, i.e., the best source sensor is scheduled in a random way (BSR), while the best source sensor is decided by the best PB (BSBP). Furthermore, for every scheme, we derive the analytical expressions for the secrecy outage probability (SOP) and investigate the secure energy efficiency (SEE) optimization problem with constricted transmission power in PBs. Simulation results reveal that the BSBP scheme provides better secrecy performance, and elevating the PBs quantity or reducing both the ratio of distance from PBs to source users and the total communication distance to some extent is helpful for improving SEE. In addition, the time-switching factor shows an important effect upon secrecy performance of the considered system.
A Case of Torsion of the Gallbladder Suspected with SPECT-CT: Review and Recommendations
Authors: Bergeron Eric , Désilets Etienne , Do Xuan Vien , McNamara Daniel , Chergui Sami , Bensoussan Michael
Published: January 2020

Torsion or volvulus of the gallbladder is a rare situation that rapidly progresses to gangrene and linked with a poor prognosis, even death, if unrecognized and untreated. An interesting and rare case of gallbladder volvulus in which diagnosis was obtained by comparing CT images and HIDA scan with SPECT-CT is presented. Relevant literature is reviewed, and recommendations are outlined.
The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis
Authors: Bitar Zouheir Ibrahim , Maadarani Ossama Sajeh , El-Shably AlAsmar Mohammed , Elshabasy Ragab Desouky , Zaalouk Tamer Mohamed
Published: January 2020

Background. Central venous-arterial carbon dioxide difference (PCO2 gap) can be a marker of cardiac output adequacy in global metabolic conditions that are less affected by the impairment of oxygen extraction capacity. We investigated the relation between the PCO2 gap, serum lactate, and cardiac index (CI) and prognostic value on admission in relation to fluid administration in the early phases of resuscitation in sepsis. We also investigated the chest ultrasound pattern A or B. Method. We performed a prospective observational study and recruited 28 patients with severe sepsis and septic shock in a mixed ICU. We determined central venous PO2, PCO2, PCO2 gap, lactate, and CI at 0 and 6 hours after critical care unit (CCU) admission. The population was divided into two groups based on the PCO2 gap (cutoff value 0.8 kPa). Results. The CI was significantly lower in the high PCO2 gap group (P=0.001). The high PCO2 gap group, on admission, required more administered fluid and vasopressors (P=0.01 and P=0.009, respectively). There was also a significant difference between the two groups for low mean pressure (P=0.01), central venous O2 (P=0.01), and lactate level (P=0.003). The mean arterial pressure was lower in the high PCO2 gap group, and the lactate level was higher, indicating global hypoperfusion. The hospital mortality rate for all patients was 24.5% (7/28). The in-hospital mortality rate was 20% (2/12) for the low gap group and 30% (5/16) for the high gap group; the odds ratio was 1.6 (95% CI 0.5–5.5; P=0.53). Patients with a persistent or rising PCO2 gap larger than 0.8 kPa at T = 6 and 12 hours had a higher mortality change (n = 6; in-hospital mortality was 21.4%) than patients with a PCO2 gap of less than 0.8 kPa at T = 6 (n = 1; in-hospital mortality was 3%); this odds ratio was 5.3 (95% CI 0.9–30.7; P=0.08). The PCO2 gap had no relation with the chest ultrasound pattern. Conclusion. The PCO2 gap is an important hemodynamic variable in the management of sepsis-induced circulatory failure. The PCO2 gap can be a marker of the adequacy of the cardiac output status in severe sepsis. A high PCO2 gap value (>0.8 kPa) can identify situations in which increasing CO can be attempted with fluid resuscitation in severe sepsis. The PCO2 gap carries an important prognostic value in severe sepsis.
Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma
Authors: Paramythiotis Daniel , Karakatsanis Anestis , Moysidis Moysis , Pagkou Diamantoula , Bangeas Petros , Michalopoulos Antonios
Published: January 2020

Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed.
Some Hyperbolic Iterative Methods for Linear Systems
Authors: Niazi Asil K. , Ghasemi Kamalvand M.
Published: January 2020

The indefinite inner product defined by J=diagj1,…,jn, jk∈−1,+1, arises frequently in some applications, such as the theory of relativity and the research of the polarized light. This indefinite scalar product is referred to as hyperbolic inner product. In this paper, we introduce three indefinite iterative methods: indefinite Arnoldi’s method, indefinite Lanczos method (ILM), and indefinite full orthogonalization method (IFOM). The indefinite Arnoldi’s method is introduced as a process that constructs a J-orthonormal basis for the nondegenerated Krylov subspace. The ILM method is introduced as a special case of the indefinite Arnoldi’s method for J-Hermitian matrices. IFOM is mentioned as a process for solving linear systems of equations with J-Hermitian coefficient matrices. Finally, by providing numerical examples, the FOM, IFOM, and ILM processes have been compared with each other in terms of the required time for solving linear systems and also from the point of the number of iterations.
Runx2 Deficiency in Osteoblasts Promotes Myeloma Progression by Altering the Bone Microenvironment at New Bone Sites
Authors: Xu Xiaoxuan , Zhang Chao , Trotter Timothy N. , Gowda Pramod S. , Lu Yun , Ponnazhagan Selvarangan , Javed Amjad , Li Juan , Yang Yang
Published: January 2020

Multiple myeloma is a plasma cell malignancy that thrives in the bone marrow (BM), with frequent progression to new local and distant bone sites. Our previous studies demonstrated that multiple myeloma cells at primary sites secrete soluble factors and suppress osteoblastogenesis via the inhibition of Runt-related transcription factor 2 (Runx2) in pre- and immature osteoblasts (OB) in new bone sites, prior to the arrival of metastatic tumor cells. However, it is unknown whether OB-Runx2 suppression in new bone sites feeds back to promote multiple myeloma dissemination to and progression in these areas. Hence, we developed a syngeneic mouse model of multiple myeloma in which Runx2 is specifically deleted in the immature OBs of C57BL6/KaLwRij mice (OB-Runx2−/− mice) to study the effect of OB-Runx2 deficiency on multiple myeloma progression in new bone sites. In vivo studies with this model demonstrated that OB-Runx2 deficiency attracts multiple myeloma cells and promotes multiple myeloma tumor growth in bone. Mechanistic studies further revealed that OB-Runx2 deficiency induces an immunosuppressive microenvironment in BM that is marked by an increase in the concentration and activation of myeloid-derived suppressor cells (MDSC) and the suppression and exhaustion of cytotoxic CD8+ T cells. In contrast, MDSC depletion by either gemcitabine or 5-fluorouracil treatment in OB-Runx2−/− mice prevented these effects and inhibited multiple myeloma tumor growth in BM. These novel discoveries demonstrate that OB-Runx2 deficiency in new bone sites promotes multiple myeloma dissemination and progression by increasing metastatic cytokines and MDSCs in BM and inhibiting BM immunity. Importantly, MDSC depletion can block multiple myeloma progression promoted by OB-Runx2 deficiency.

Significance: This study demonstrates that Runx2 deficiency in immature osteoblasts at distant bone sites attracts myeloma cells and allows myeloma progression in new bone sites via OB-secreted metastatic cytokines and MDSC-mediated suppression of bone marrow immunity.
miR-149 Suppresses Breast Cancer Metastasis by Blocking Paracrine Interactions with Macrophages
Authors: Sánchez-González Ismael , Bobien Anja , Molnar Christian , Schmid Simone , Strotbek Michaela , Boerries Melanie , Busch Hauke , Olayioye Monilola A.
Published: January 2020

Paracrine activation of cells contained in the tumor microenvironment promotes tumor progression and metastasis. In breast cancer, malignant cells recruit and educate macrophages into a M2 tumor–promoting phenotype that supports the metastatic spread of cancer cells. Here, we show that miR-149 functions as a metastasis-suppressing microRNA in breast cancer cells by limiting colony-stimulating factor-1 (CSF1)–dependent recruitment and M2 polarization of macrophages. In lymph node–positive, triple-negative breast cancer (TNBC) tissues, low miR-149 expression correlated with macrophage infiltration and reduced patient survival. By directly targeting CSF1, miR-149 expression in TNBC cell lines (MDA-MB-231 and BT-549) inhibited the recruitment of human monocytic THP-1 cells and primary human macrophages. Furthermore, in macrophages cocultured with MDA-MB-231 cells expressing miR-149, epidermal growth factor (EGF) and amphiregulin expression levels were strongly reduced, resulting in reduced EGF receptor activation in the cancer cells. In vivo, lung metastases developing from orthotopic MDA-MB-231 tumors were reduced by 75% by miR-149 expression, and this was associated with impaired M2 macrophage infiltration of the primary tumors. These data suggest that miR-149 downregulation functionally contributes to breast tumor progression by recruiting macrophages to the tumor and facilitating CSF1 and EGF receptor cross-talk between cancer cells and macrophages.

Significance:

These findings contribute to the understanding of tumor–stroma interactions by showing that miR-149 downregulation in TNBC enhances reciprocal growth factor signaling between macrophages and cancer cells, which promotes tumor progression and metastasis.
Inhibiting Translation Elongation with SVC112 Suppresses Cancer Stem Cells and Inhibits Growth in Head and Neck Squamous Carcinoma
Authors: Keysar Stephen B. , Gomes Nathan , Miller Bettina , Jackson Brian C. , Le Phuong N. , Morton J. Jason , Reisinger Julie , Chimed Tugs-Saikhan , Gomez Karina E. , Nieto Cera , Frederick Barbara , Pronk Gijsbertus J. , Somerset Hilary L. , Tan Aik-Choon , Wang Xiao-Jing , Raben David , Su Tin Tin , Jimeno Antonio
Published: January 2020

Cancer stem cells (CSC) drive growth, therapy resistance, and recurrence in head and neck squamous cell carcinoma (HNSCC). Regulation of protein translation is crucial for normal stem cells and CSCs; its inhibition could disrupt stemness properties, but translation inhibitors are limited clinically due to toxicity. SVC112 is a synthetic derivative of bouvardin, a plant-derived translation elongation inhibitor. SVC112 had greater antiproliferative effects on HNSCC cells compared with the FDA-approved translation inhibitor omacetaxine mepesuccinate (HHT). SVC112 preferentially inhibited cancer cells compared with patient-matched cancer-associated fibroblasts, whereas HHT was equally toxic to both. SVC112 reduced sphere formation by cell lines and CSCs. SVC112 alone inhibited the growth of patient-derived xenografts (PDX), and SVC112 combined with radiation resulted in tumor regression in HPV-positive and HPV-negative HNSCC PDXs. Notably, CSC depletion after SVC112 correlated with tumor response. SVC112 preferentially impeded ribosomal processing of mRNAs critical for stress response and decreased CSC-related proteins including Myc and Sox2. SVC112 increased cell-cycle progression delay and slowed DNA repair following radiation, enhancing colony and sphere formation radiation effects. In summary, these data demonstrate that SVC112 suppresses CSC-related proteins, enhances the effects of radiation, and blocks growth of HNSCC PDXs by inhibiting CSCs.

Significance:

Inhibiting protein elongation with SVC112 reduces tumor growth in head and neck squamous cell carcinoma and increases the effects of radiation by targeting the cancer stem cell pool.