bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value of Three-Dimensional Printing Spine Model in Severe Spine Deformity Correction Surgery
Authors: Pan Aixing , Ding Hongtao , Hai Yong , Liu Yuzeng , Hai Junrui Jonathan , Yin Peng , Han Bo
Published: May 2021

Study Design:

Retrospective case-control study.

Objective:

We aimed to evaluate the value of 3-dimensional printing (3DP) spine model in the surgical treatment of severe spinal deformity since the prosperous development of 3DP technology.

Methods:

Severe scoliosis or hyper-kyphosis patients underwent posterior fixation and fusion surgery using the 3DP spine models were reviewed (3DP group). Spinal deformity surgeries operated by free-hand screw implantation during the same period were selected as the control group after propensity score matching (PSM). The correction rate, pedicle screw accuracy, and complications were analyzed. Class A and B screws were defined as accurate according to Gertzbein and Robbins criteria.

Results:

35 patients were enrolled in the 3DP group and 35 matched cases were included in the control group. The perioperative baseline data and deformity correction rate were similar between both groups ( P > .05). However, the operation time and blood loss were significantly less in the 3DP group (296.14 ± 66.18 min vs. 329.43 ± 67.16 min, 711.43 ± 552.28 mL vs. 1322.29 ± 828.23 mL, P < .05). More three-column osteotomies (Grade 3-6) were performed in the 3DP group (30/35, 85.7% vs. 21/35, 60.0%. P = .016). The screw placement accuracy was significantly higher in the 3DP group (422/582, 72.51% vs. 397/575, 69.04%. P = .024). The screw misplacement related complication rate was significantly higher in the free-hand group (6/35 vs. 1/35, P = .046).

Conclusions:

The study provided solid evidence that 3DP spine models can enhance surgeons’ confidence in performing higher grade osteotomies and improve the safety and efficiency in severe spine deformity correction surgery. 3D printing technology has a good prospect in spinal deformity surgery.
ESO Guideline on covert cerebral small vessel disease
Authors: Wardlaw Joanna M , Debette Stephanie , Jokinen Hanna , De Leeuw Frank-Erik , Pantoni Leonardo , Chabriat Hugues , Staals Julie , Doubal Fergus , Rudilosso Salvatore , Eppinger Sebastian , Schilling Sabrina , Ornello Raffaele , Enzinger Christian , Cordonnier Charlotte , Taylor-Rowan Martin , Lindgren Arne G
Published: May 2021

‘Covert’ cerebral small vessel disease (ccSVD) is common on neuroimaging in persons without overt neurological manifestations, and increases the risk of future stroke, cognitive impairment, dependency, and death. These European Stroke Organisation (ESO) guidelines provide evidence-based recommendations to assist with clinical decisions about management of ccSVD, specifically white matter hyperintensities and lacunes, to prevent adverse clinical outcomes. The guidelines were developed according to ESO standard operating procedures and Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. We prioritised the clinical outcomes of stroke, cognitive decline or dementia, dependency, death, mobility and mood disorders, and interventions of blood pressure lowering, antiplatelet drugs, lipid lowering, lifestyle modifications, glucose lowering and conventional treatments for dementia. We systematically reviewed the literature, assessed the evidence, formulated evidence-based recommendations where feasible, and expert consensus statements. We found little direct evidence, mostly of low quality. We recommend patients with ccSVD and hypertension to have their blood pressure well controlled; lower blood pressure targets may reduce ccSVD progression. We do not recommend antiplatelet drugs such as aspirin in ccSVD. We found little evidence on lipid lowering in ccSVD. Smoking cessation is a health priority. We recommend regular exercise which may benefit cognition, and a healthy diet, good sleep habits, avoiding obesity and stress for general health reasons. In ccSVD, we found no evidence for glucose control in the absence of diabetes or for conventional Alzheimer dementia treatments. Randomised controlled trials with clinical endpoints are a priority for ccSVD.
GlcNAc is a mast-cell chromatin-remodeling oncometabolite that promotes systemic mastocytosis aggressiveness
Authors: Agopian Julie , Da Costa Quentin , Nguyen Quang Vo , Scorrano Giulia , Kousteridou Paraskevi , Yuan Min , Chelbi Rabie , Goubard Armelle , Castellano Remy , Maurizio Julien , Teodosio Cristina , De Sepulveda Paulo , Asara John M. , Orfao Alberto , Hermine Olivier , Dubreuil Patrice , Brenet Fabienne
Published: May 2021

Systemic mastocytosis (SM) is a KIT-driven hematopoietic neoplasm characterized by the excessive accumulation of neoplastic mast cells (MCs) in various organs and, mainly, the bone marrow (BM). Multiple genetic and epigenetic mechanisms contribute to the onset and severity of SM. However, little is known to date about the metabolic underpinnings underlying SM aggressiveness, which has thus far impeded the development of strategies to leverage metabolic dependencies when existing KIT-targeted treatments fail. Here, we show that plasma metabolomic profiles were able to discriminate indolent from advanced forms of the disease. We identified N-acetyl-d-glucosamine (GlcNAc) as the most predictive metabolite of SM severity. High plasma levels of GlcNAc in patients with advanced SM correlated with the activation of the GlcNAc-fed hexosamine biosynthesis pathway in patients BM aspirates and purified BM MCs. At the functional level, GlcNAc enhanced human neoplastic MCs proliferation and promoted rapid health deterioration in a humanized mouse model of SM. In addition, in the presence of GlcNAc, immunoglobulin E-stimulated MCs triggered enhanced release of proinflammatory cytokines and a stronger acute response in a mouse model of passive cutaneous anaphylaxis. Mechanistically, elevated GlcNAc levels promoted the transcriptional accessibility of chromatin regions that contain genes encoding mediators of receptor tyrosine kinases cascades and inflammatory responses, thus leading to a more aggressive phenotype. Therefore, GlcNAc is an oncometabolite driver of SM aggressiveness. This study suggests the therapeutic potential for targeting metabolic pathways in MC-related diseases to manipulate MCs effector functions.
Long-term outcomes after gene therapy for adenosine deaminase severe combined immune deficiency
Authors: Reinhardt Bryanna , Habib Omar , Shaw Kit L. , Garabedian Elizabeth , Carbonaro-Sarracino Denise A. , Terrazas Dayna , Fernandez Beatriz Campo , De Oliveira Satiro , Moore Theodore B. , Ikeda Alan K. , Engel Barbara C. , Podsakoff Gregory M. , Hollis Roger P. , Fernandes Augustine , Jackson Connie , Shupien Sally , Mishra Suparna , Davila Alejandra , Mottahedeh Jack , Vitomirov Andrej , Meng Wenzhao , Rosenfeld Aaron M. , Roche Aoife M. , Hokama Pascha , Reddy Shantan , Everett John , Wang Xiaoyan , Luning Prak Eline T. , Cornetta Kenneth , Hershfield Michael S. , Sokolic Robert , De Ravin Suk See , Malech Harry L. , Bushman Frederic D. , Candotti Fabio , Kohn Donald B.
Published: May 2021

Patients lacking functional adenosine deaminase activity have severe combined immunodeficiency (ADA SCID), which can be treated with ADA enzyme replacement therapy (ERT), allogeneic hematopoietic stem cell transplantation (HSCT), or autologous HSCT with gene-corrected cells (gene therapy [GT]). A cohort of 10 ADA SCID patients, aged 3 months to 15 years, underwent GT in a phase 2 clinical trial between 2009 and 2012. Autologous bone marrow CD34+ cells were transduced ex vivo with the MND (myeloproliferative sarcoma virus, negative control region deleted, dl587rev primer binding site)–ADA gammaretroviral vector (gRV) and infused following busulfan reduced-intensity conditioning. These patients were monitored in a long-term follow-up protocol over 8 to 11 years. Nine of 10 patients have sufficient immune reconstitution to protect against serious infections and have not needed to resume ERT or proceed to secondary allogeneic HSCT. ERT was restarted 6 months after GT in the oldest patient who had no evidence of benefit from GT. Four of 9 evaluable patients with the highest gene marking and B-cell numbers remain off immunoglobulin replacement therapy and responded to vaccines. There were broad ranges of responses in normalization of ADA enzyme activity and adenine metabolites in blood cells and levels of cellular and humoral immune reconstitution. Outcomes were generally better in younger patients and those receiving higher doses of gene-marked CD34+ cells. No patient experienced a leukoproliferative event after GT, despite persisting prominent clones with vector integrations adjacent to proto-oncogenes. These long-term findings demonstrate enduring efficacy of GT for ADA SCID but also highlight risks of genotoxicity with gRVs. This trial was registered at www.clinicaltrials.gov as #NCT00794508.
Chassis Coordinated Control for Full X-by-Wire Vehicles-A Review
Authors: Zhang Lei , Zhang Zhiqiang , Wang Zhenpo , Deng Junjun , Dorrell David G.
Published: May 2021

An X-by-wire chassis can improve the kinematic characteristics of human-vehicle closed-loop system and thus active safety especially under emergency scenarios via enabling chassis coordinated control. This paper aims to provide a complete and systematic survey on chassis coordinated control methods for full X-by-wire vehicles, with the primary goal of summarizing recent reserch advancements and stimulating innovative thoughts. Driving condition identification including driver's operation intention, critical vehicle states and road adhesion condition and integrated control of X-by-wire chassis subsystems constitute the main framework of a chassis coordinated control scheme. Under steering and braking maneuvers, different driving condition identification methods are described in this paper. These are the trigger conditions and the basis for the implementation of chassis coordinated control. For the vehicles equipped with steering-by-wire, braking-by-wire and/or wire-controlled-suspension systems, state-of-the-art chassis coordinated control methods are reviewed including the coordination of any two or three chassis subsystems. Finally, the development trends are discussed.
Studying Formability Limits By Combining Conventional and Incremental Sheet Forming Process
Authors: Lora Fabio Andre , Fritzen Daniel , Alves de Sousa Ricardo , Schaffer Lirio
Published: May 2021

In this work it is assessed the potential of combining conventional and incremental sheet forming processes in a same sheet of metal. This so-called hybrid forming approach is performed through the manufacture of a pre-forming by conventional forming, followed by incremental sheet forming. The main objective is analyzing strain evolution. The pre-forming induced in the conventional forming stage will determine the strain paths, directly influencing the strains produced by the incremental process. To conduct the study, in the conventional processes, strains were imposed in three different ways with distinct true strains. At the incremental stage, the pyramid strategy was adopted with different wall slopes. From the experiments, the true strains and the final geometries were analyzed. Numerical simulation was also employed for the sake of comparison and correlation with the measured data. It could be observed that single-stretch pre-strain was directly proportional to the maximum incremental strains achieved, whereas samples subjected to biaxial pre-strain influenced the formability according to the degree of pre-strain applied. Pre-strain driven by the prior deep-drawing operation did not result, in this particular geometry, in increased formability.
The Interaction between Rice Genotype and Magnaporthe oryzae Regulates the Assembly of Rice Root-Associated Microbiota
Authors: Tian Dagang , Chen Zaijie , Lin Yan , Liang Tingmin , Chen Ziqiang , Guo Xinrui , Wang Feng , Wang Zonghua
Published: May 2021

Background

Utilizating the plant microbiome to enhance pathogen resistance in crop production is an emerging alternative to the use of chemical pesticides. However, the diversity and structure of the microbiota, and the assembly mechanisms of root-associated microbial communities of plants are still poorly understood.

Results

We invstigated the microbiota of the root endosphere and rhizosphere soils of the rice cultivar Nipponbare (NPB) and its Piz-t-transgenic line (NPB-Piz-t) when infected with the filamentous fungus Magnaporthe oryzae (M. oryzae) isolate KJ201, using 16S rRNA and internal transcribed spacer 1 (ITS1) amplicon sequencing. The rhizosphere soils showed higher bacterial and fungal richness and diversity than the endosphere except for fungal richness in the rhizosphere soils of the mock treatment. Bacteria richness and diversity increased in the endospheric communities of NPB and Piz-t under inoculation with KJ201 (referred to as ‘NPB-KJ201’ and ‘Piz-t-KJ201’, respectively) compared with the corresponding mock treatments, with the NPB-KJ201 showing the highest diversity in the four bacterial endocompartments. In contrast, fungal richness and diversity decreased in the endospheric communities of NPB-KJ201 and Piz-t-KJ201, relative to the corresponding mock treatments, with NPB-KJ201 and Piz-t-KJ201 having the lowest richness and diversity, respectively, across the four fungal endocompartments. Principal component analysis (PCA) indicated that the microbiota of Piz-t-KJ201 of root endophytes were mostly remarkablely distinct from that of NPB-KJ201. Co-occurrence network analysis revealed that the phyla Proteobacteria and Ascomycota were the key contributors to the bacterial and fungal communities, respectively. Furthermore, a comparative metabolic analysis showed that the contents of tryptophan metabolism and indole alkaloid biosynthesis were significantly lower in the Piz-t-KJ201 plants.

Conclusions

In this study, we compared the diversity, composition, and assembly of microbial communities associated with the rhizosphere soils and endosphere of Piz-t-KJ201 and NPB-KJ201. On the basis of the different compositions, diversities, and assemblies of the microbial communities among different compartments, we propose that the host genotype and inoculation pattern of M. oryzae played dominant roles in determining the microbial community assemblage. Further metabolomics analysis revealed that some metabolites may influence changes in bacterial communities. This study improves our understanding of the complex interactions between rice and M. oryzae, which could be useful in developing new strategies to improve rice resistance through the manipulation of soil microorganisms.
Combining genetic algorithm with machine learning strategies for designing potent antimicrobial peptides
Authors: Boone Kyle , Wisdom Cate , Camarda Kyle , Spencer Paulette , Tamerler Candan
Published: May 2021

Background

Current methods in machine learning provide approaches for solving challenging, multiple constraint design problems. While deep learning and related neural networking methods have state-of-the-art performance, their vulnerability in decision making processes leading to irrational outcomes is a major concern for their implementation. With the rising antibiotic resistance, antimicrobial peptides (AMPs) have increasingly gained attention as novel therapeutic agents. This challenging design problem requires peptides which meet the multiple constraints of limiting drug-resistance in bacteria, preventing secondary infections from imbalanced microbial flora, and avoiding immune system suppression. AMPs offer a promising, bioinspired design space to targeting antimicrobial activity, but their versatility also requires the curated selection from a combinatorial sequence space. This space is too large for brute-force methods or currently known rational design approaches outside of machine learning. While there has been progress in using the design space to more effectively target AMP activity, a widely applicable approach has been elusive. The lack of transparency in machine learning has limited the advancement of scientific knowledge of how AMPs are related among each other, and the lack of general applicability for fully rational approaches has limited a broader understanding of the design space.

Methods

Here we combined an evolutionary method with rough set theory, a transparent machine learning approach, for designing antimicrobial peptides (AMPs). Our method achieves the customization of AMPs using supervised learning boundaries. Our system employs in vitro bacterial assays to measure fitness, codon-representation of peptides to gain flexibility of sequence selection in DNA-space with a genetic algorithm and machine learning to further accelerate the process.

Results

We use supervised machine learning and a genetic algorithm to find a peptide active againstS. epidermidis, a common bacterial strain for implant infections, with an improved aggregation propensity average for an improved ease of synthesis.

Conclusions

Our results demonstrate that AMP design can be customized to maintain activity and simplify production. To our knowledge, this is the first time when codon-based genetic algorithms combined with rough set theory methods is used for computational search on peptide sequences.
A detailed map of coupled circadian clock and cell cycle with qualitative dynamics validation
Authors: Rougny Adrien , Paulevé Loïc , Teboul Michèle , Delaunay Franck
Published: May 2021

Background

The temporal coordination of biological processes by the circadian clock is an important mechanism, and its disruption has negative health outcomes, including cancer. Experimental and theoretical evidence suggests that the oscillators driving the circadian clock and the cell cycle are coupled through phase locking.

Results

We present a detailed and documented map of known mechanisms related to the regulation of the circadian clock, and its coupling with an existing cell cycle map which includes main interactions of the mammalian cell cycle. The coherence of the merged map has been validated with a qualitative dynamics analysis. We verified that the coupled circadian clock and cell cycle maps reproduce the observed sequence of phase markers. Moreover, we predicted mutations that contribute to regulating checkpoints of the two oscillators.

Conclusions

Our approach underlined the potential key role of the core clock protein NR1D1 in regulating cell cycle progression. We predicted that its activity influences negatively the progression of the cell cycle from phase G2 to M. This is consistent with the earlier experimental finding that pharmacological activation of NR1D1 inhibits tumour cell proliferation and shows that our approach can identify biologically relevant species in the context of large and complex networks.
Transcriptomics analysis of differentially expressed genes in subcutaneous and perirenal adipose tissue of sheep as affected by their pre- and early postnatal malnutrition histories
Authors: Ahmad Sharmila , Drag Markus Hodal , Salleh Suraya Mohamad , Cai Zexi , Nielsen Mette Olaf
Published: May 2021

Background

Early life malnutrition is known to target adipose tissue with varying impact depending on timing of the insult. This study aimed to identify differentially expressed genes in subcutaneous (SUB) and perirenal (PER) adipose tissue of 2.5-years old sheep to elucidate the biology underlying differential impacts of late gestation versus early postnatal malnutrition on functional development of adipose tissues. Adipose tissues were obtained from 37 adult sheep born as twins to dams fed either NORM (fulfilling energy and protein requirements), LOW (50% of NORM) or HIGH (110% of protein and 150% of energy requirements) diets in the last 6-weeks of gestation. From day 3 to 6 months of age, lambs were fed high-carbohydrate-high-fat (HCHF) or moderate low-fat (CONV) diets, and thereafter the same moderate low-fat diet.

Results

The gene expression profile of SUB in the adult sheep was not affected by the pre- or early postnatal nutrition history. In PER, 993 and 186 differentially expressed genes (DEGs) were identified in LOW versus HIGH and NORM, respectively, but no DEG was found between HIGH and NORM. DEGs identified in the mismatched pre- and postnatal nutrition groups LOW-HCHF (101) and HIGH-HCHF (192) were largely downregulated compared to NORM-CONV. Out of 831 DEGs, 595 and 236 were up- and downregulated in HCHF versus CONV, respectively. The functional enrichment analyses revealed that transmembrane (ion) transport activities, motor activities related to cytoskeletal and spermatozoa function (microtubules and the cytoskeletal motor protein, dynein), and responsiveness to the (micro) environmental extracellular conditions, including endocrine and nervous stimuli were enriched in the DEGs of LOW versus HIGH and NORM. We confirmed that mismatched pre- and postnatal feeding was associated with long-term programming of adipose tissue remodeling and immunity-related pathways. In agreement with phenotypic measurements, early postnatal HCHF feeding targeted pathways involved in kidney cell differentiation, and mismatched LOW-HCHF sheep had specific impairments in cholesterol metabolism pathways.

Conclusions

Both pre- and postnatal malnutrition differentially programmed (patho-) physiological pathways with implications for adipose functional development associated with metabolic dysfunctions, and PER was a major target.
Gut microbiota of homologous Chinese soft-shell turtles (Pelodiscus sinensis) in different habitats
Authors: Wu Benli , Huang Long , Chen Jing , Zhang Ye , Wang Jun , He Jixiang
Published: May 2021

Background

Chinese soft-shell turtle (Pelodiscus sinensis) is an important commercial species for their high nutritional value and unique taste, but it has been a vulnerable species due to habitat loss. In this study, homologous juvenile turtles were allocated to lake, pond and paddy field to investigate the habitat effects on turtles.

Results

The growth, morphology and gut microbial communities were monitored during the 4 months cultural period. It showed higher growth rate of turtles in paddy field and pond. The appearance, visceral coefficients, gut morphology and microbial communities in turtles were distinct among different habitats. The microbial community richness on Chao1 was obviously lower in initial turtle guts from greenhouses, whereas it was relative higher in turtle guts sampled from paddy fields than ponds and lake. Significant differences on dominant microbes were found among initial and subsequent samples from different habitats. Firmicutes was the most abundant phylum in the guts of turtles sampled from the greenhouse initially, while Proteobacteria was the most abundant phylum after cultivation in different habitats, followed by Bacteroidetes. The microbial composition were distinct in different habitats at 60d, and the appearance of dominant phyla and genera was more driven by sampling time than habitats at 120d. Both the sampling time and habitats affected the appearance of dominant phyla and genera during the cultivation. The functional predictions indicated that both habitat type and sampling time had significant effects on metabolic pathways, especially amino acid and carbohydrate metabolism.

Conclusions

The turtles could adapt to natural lakes, artificial ponds and paddy fields. The gut microbial abundance was different among the habitats and sampling time. The species of microbes were significantly more diverse in paddy field specimens than in those from ponds and lakes. Rice-turtle coculture is a potential ecological and economic farming mode that plays important roles in wild turtle protection and food security.
Prognostic value of the neutrophil-to-lymphocyte ratio in acute ischemic stroke patients treated with intravenous thrombolysis: a systematic review and meta-analysis
Authors: Wang Chengbing , Zhang Qian , Ji Mingwei , Mang Jing , Xu Zhongxin
Published: May 2021

Background

The relationship between the neutrophil-to-lymphocyte ratio (NLR) and poor prognostics in acute ischemic stroke (AIS) patients who receive intravenous thrombolysis (IVT) remains controversial. The purpose of this systematic review and meta-analysis was to evaluate the association between the NLR and poor prognosis after IVT. Furthermore, we aimed to determine whether the NLR at admission or post-IVT plays a role in AIS patients who received IVT.

Methods

The PubMed, Embase, Web of Science and China National Knowledge Infrastructure databases were searched for relevant articles until October 7, 2020. Cohort and case-control studies were included if they were related to the NLR in AIS patients treated with IVT. Odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were pooled to estimate the relationship between NLR and poor prognosis after IVT. A random effects model was used to calculate the pooled data.

Results

Twelve studies, including 3641 patients, met the predefined inclusion criteria. Higher NLRs were associated with an increased risk of hemorrhagic transformation (HT) (OR = 1.33, 95 % CI = 1.14–1.56,P < 0.001) and a poor 3-month functional outcome (OR = 1.64, 95 % CI = 1.38–1.94,P < 0.001) in AIS patients who received IVT. Subgroup analysis suggested that the NLR at admission rather than post-IVT was associated with a higher risk of HT (OR = 1.33, 95 % CI = 1.01–1.75,P = 0.039). There was no statistically significant difference between higher NLRs and 3-month mortality (OR = 1.14, 95 % CI = 0.97–1.35,P = 0.120).

Conclusions

A high NLR can predict HT and poor 3-month functional outcomes in AIS patients who receive IVT. The NLR at admission rather than the post-IVT NLR was an independent risk factor for an increased risk of HT after IVT.
The role of surgical resection in primary central nervous system lymphoma: a single-center retrospective analysis of 70 patients
Authors: Wu Shiqiang , Wang Junwen , Liu Weihua , Hu Feng , Zhao Kai , Jiang Wei , Lei Ting , Shu Kai
Published: May 2021

Background

The aim of this study was to evaluate the effect of surgical resection and stereotactic biopsy on the complication rate, progression-free survival (PFS) and overall survival (OS) of 70 patients diagnosed at a single institution with primary central nervous system lymphoma (PCNSL) and to explore the predictors of selection for resection and the prognostic factors of PCNSL.

Methods

A retrospective analysis was performed of 70 patients with PCNSL that was diagnosed by surgical resection or stereotactic brain biopsy in our department from January 2013 to May 2019. We divided the patients into two groups: a resection group (n = 28) and a stereotactic biopsy group (n = 42). Data on clinical characteristics, imaging findings, complication rates, PFS and OS were retrospectively reviewed and compared between these two groups. We also analysed the predictors of selection for resection and prognostic factors of PCNSL by multivariate analysis.

Results

The median age was 53.3 ± 14.3 years, and there was a male predominance with a sex ratio of 1.33:1. The most common clinical manifestation was a headache. The complication rate in the resection group was 10.7% versus 7.1% in the stereotactic biopsy group, and there was no statistically significant difference. The rate of improvement in symptoms of the resection group was significantly higher than that of the stereotactic biopsy group. Multivariable analysis identified a single tumour and not involving deep structures as predictors of selection for resection. With a median follow-up of 30 months (range 1–110), the mean OS and PFS of all patients were 16.1 months and 6.2 months, respectively. Patients who underwent surgical resection had a mean OS of 23.4 months and PFS of 8.6 months versus 11.2 months and 4.6 months for those who had a brain biopsy performed. In addition, multivariable analysis showed that not involving deep structures and resection were favourable prognostic factors for PCNSL.

Conclusions

The outcomes of patients with PCNSL treated in our cohort are still poor. In our series, surgical resection might play a role in significantly improving OS and PFS compared with stereotactic biopsy in a subset of patients. The type of surgery and tumour location are prognostic factors for PCNSL.
Prenatal diagnosis of megaduodenum using ultrasound: a case report
Authors: Zeng Kaihui , Li Dongmei , Zhang Yao , Cao Chengcheng , Bai Ruobing , Yang Zeyu , Chen Lizhu
Published: May 2021

Background

Congenital megaduodenum is a rare disorder; however, its prenatal diagnosis has not been reported previously. We report the case of an abdominal cystic mass in a fetus that was later diagnosed as megaduodenum.

Case presentation

An abdominal cystic mass was found during ultrasonography of a fetus at 11 weeks of gestation. The mass progressively enlarged with gestation. The amniotic fluid volume decreased and then returned to normal. During the last prenatal ultrasound examination, the mass was observed communicating with the stomach; therefore, duodenal dilation was suspected. Finally, the patient was diagnosed with megaduodenum caused by a developmental defect in the nerve plexus.

Conclusions

Congenital megaduodenum is a differential diagnosis of massive fetal abdominal cystic masses. Ultrasound examinations of such masses communicating with the stomach may help determine the diagnosis.
Comparison of clinical outcomes between the depot gonadotrophin-releasing hormone agonist protocol and gonadotrophin-releasing hormone antagonist protocol in normal ovarian responders
Authors: Xia Min , Zheng Jie
Published: May 2021

Background

The gonadotrophin-releasing hormone (GnRH) antagonist protocol has some advantages, such as a simple method, short medication duration, and low incidence of ovarian hyperstimulation syndrome, but whether the GnRH antagonist protocol is suitable for normal ovarian responders has been controversial. We compared the clinical outcomes of fresh and frozen-thawed transfer cycles between the depot GnRH agonist protocol and GnRH antagonist protocol in normal ovarian responders.

Methods

Data of normal ovarian responders who underwent in vitro fertilization-embryo transfer (IVF-ET) or intracytoplasmic sperm injection-embryo transfer (ICSI-ET) between January 2017 and December 2018 in our hospital were retrospectively analysed. In this study, there were 1119 fresh transfer cycles, including 502 GnRH antagonist cycles (GnRH antagonist group) and 617 depot GnRH agonist cycles (depot GnRH agonist group), as well as 468 frozen-thawed transfer cycles, includng 191 GnRH antagonist cycles (GnRH antagonist group) and 277 depot GnRH agonist cycles (depot GnRH agonist group). The clinical outcomes were compared between the GnRH antagonist group and the depot GnRH agonist group.

Results

With the fresh transfer cycles, there were no statistically significant differences in the anti-Mullerian hormone level, number of transferred embryos or high-quality embryo rate between the two groups. The total dosage of gonadotropin (Gn), duration of Gn stimulation, number of oocytes retrieved, clinical pregnancy rate and incidences of moderate and severe ovarian hyperstimulation syndrome (OHSS) were significantly lower but the abortion rate was significantly higher in the GnRH antagonist group than in the depot GnRH agonist group (all P < 0.05). With the frozen-thawed transfer cycles, there were no statistically significant differences in the number of transferred embryos, clinical pregnancy rate or abortion rate between the two groups (all P > 0.05).

Conclusions

With the fresh transfer cycles, the GnRH antagonist protocol had a lower clinical pregnancy rate and lower incidences of moderate and severe OHSS than the depot GnRH agonist protocol, but with the frozen-thawed transfer cycles, both protocols had similar clinical pregnancy rates. These results remain to be further confirmed through large-sample, prospective, randomized and controlled studies.
Comparison between FOLFIRINOX and gemcitabine plus nab-paclitaxel including sequential treatment for metastatic pancreatic cancer: a propensity score matching approach
Authors: Chun Jung Won , Lee Sang Hyub , Kim Joo Seong , Park Namyoung , Huh Gunn , Cho In Rae , Paik Woo Hyun , Ryu Ji Kon , Kim Yong-Tae
Published: May 2021

Background

FOLFIRINOX (FFX) and Gemcitabine plus nab-paclitaxel (GnP) have been recommended as the first-line chemotherapy for metastatic pancreatic cancer (mPC). However, the evidence is lacking comparing not only two regimens, but also sequential treatment (FFX–GnP vs. GnP–FFX).

Methods

Data of 528 patients (FFX, n = 371; GnP, n = 157) with mPC were collected retrospectively. Propensity score matching was conducted to alleviate imbalance of the two groups. Overall survival (OS), progression free survival (PFS), and toxicity of patients were analyzed.

Results

In the whole population, OS (12.5 months vs. 10.3 months, P = 0.05) and PFS (7.1 months vs. 5.8 months, P = 0.02) were longer in the FFX group before matching and after matching (OS: 11.8 months vs. 10.3 months, P = 0.02; PFS: 7.2 months vs. 5.8 months, P <  0.01). For sequential treatment, OS and PFS showed no significant difference. Interruptions of chemotherapy due to toxicities were more frequent (6.8 vs. 29.3%, P <  0.001) in the GnP group, and cessation of chemotherapy showed a significant association with mortality (z = − 1.94, P = 0.03).

Conclusions

FFX achieved a longer overall survival than GnP in mPC, but not in the comparison for sequential treatment. More frequent adverse events followed by treatment interruptions during GnP might lead to a poor survival outcome. Therefore, FFX would be a better first-line treatment option than GnP for mPC.
Evaluation of optical coherence tomography angiography parameters in patients treated with Hydroxychloroquine
Authors: Akhlaghi Mohammadreza , Kianersi Farzan , Radmehr Hamed , Dehghani Alireza , Naderi Beni Afsaneh , Noorshargh Pegah
Published: May 2021

Background

One of the major side effects of Hydroxychloroquine (HCQ) is retinopathy. The aim of this study was to evaluate the Optical coherence tomography angiography (OCTA) parameters in a group of patients who have Hydroxychloroquine-induced retinopathy based on Multifocal electroretinography (mfERG) with a group who do not have retinopathy.

Method

This is a Cross-Sectional Study. In this study, patients with Rheumatoid arthritis (RA) or Systemic lupus erythematosus (SLE) who had been taking Hydroxychloroquine for at least 7 years were included. MfERG and OCTA imaging were performed for all patients. Patients were divided into Normal mfERG and Abnormal mfERG groups based on mfERG results. OCTA parameters were studied in these two groups.

Result

Sixty-one patients (61 eyes) were included. Forty-one patients had SLE and 20 patients had RA. Forty patients (66.7%) had Abnormal mfERG. The mean vascular density (VD) in Superficial capillary plexus (SCP) layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). Mean VD in SCP layer was not significantly different between Normal mfERG and Abnormal mfERG groups (P-Value> 0.05). In RA subgroup, mean VD in SCP layer in PeriFovea region in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). Mean VD in deep capillary plexus (DCP) layer in Whole Image, Superior Hemi, Inferior Hemi, PeriFovea area in Abnormal mfERG group was significantly lower than normal group (P-Value < 0.05). This discrepancy was also observed in the RA subgroup but not in the SLE subgroup. The mean of none of the parameters of foveal avascular zone (FAZ) (mm2), Flow Area of Outer Retina (mm2) and Flow Area of Choriocapillaris (mm2) were not statistically significant between the groups Abnormal mfERG and Normal mfERG. (p-value> 0.05).

Conclusion

VD in the DCP layer decreased in abnormal mfERG patients compared to patients with normal mfERG. But it seems that VD in SCP layer, FAZ Area and Flow Area are similar in both groups. OCTA may be used as a non-invasive tool in the diagnosis of early stages of HCQ-induced retinopathy, especially in RA patients, but further studies are needed.
A focused ethnography in the context of a European cancer research hospital accreditation program
Authors: Mazzini Elisa , Soncini Francesco , Cerullo Loredana , Genovese Lucia , Apolone Giovanni , Ghirotto Luca , Mazzi Giorgio , Costantini Massimo
Published: May 2021

Background

A quality accreditation program (AP) is designed to guarantee predefined quality standards of healthcare organizations. Evidence of the impact of quality standards remains scarce and somewhat challenging to document. This study aimed to investigate the accreditation of a cancer research hospital (Italy), promoted by the Organization of European Cancer Institutes (OECI), by focusing on the individual, group, and organizational experiences resulting from the OECI AP.

Methods

A focused ethnography study was carried out to analyze the relevance of participation in the accreditation process. Twenty-nine key informants were involved in four focus group meetings, and twelve semistructured interviews were conducted with professionals and managers. Inductive qualitative content analysis was applied to examine all transcripts.

Results

Four main categories emerged: a) OECI AP as an opportunity to foster diversity within professional roles; b) OECI AP as a possibility for change; c) perceived barriers; and d) OECI AP-solicited expectations.

Conclusions

The accreditation process is an opportunity for improving the quality and variety of care services for cancer patients through promoting an interdisciplinary approach to care provision. Perceiving accreditation as an opportunity is a prerequisite for overcoming the barriers that professionals involved in the process may report. Critical to a positive change is sharing the values and the framework, which are at the basis of accreditation programs. Improving the information-sharing process among managers and professionals may limit the risk of unmet expectations and prevent demotivation by future accreditation programs. Finally, we found that positive changes are more likely to happen when an accreditation process is considered an activity whose results depend on managers’ and professionals’ joint work.
The hospital management practices in Chinese county hospitals and its association with quality of care, efficiency and finance
Authors: Zhu Yidan , Zhao Yifei , Dou Lixia , Guo Ruya , Gu Xuefei , Gao Runlin , Wu Yangfeng
Published: May 2021

Background

County hospitals as the backbone of the China’s healthcare system are providing services for over 70% of the total population. However, the hospital management practice (HMP) and its links with quality of care, efficiency and finance in these hospitals are unknown.

Methods

We did two cross-sectional surveys of HMP in 2013 and 2015 among 101 county hospitals across rural China. Three managing roles (hospital director, director of medical affairs office and director of cardiology) and a cardiologist were invited to the surveys. A novel HMP rating scale, with 100 as full score, was used to measure the HMP in 17 indicators under four dimensions (target, operation, performance, and talent management) for each hospital. We analyzed the association of HMP score with variables on quality of care, efficiency and finance using linear mixed models with and without adjustment for potential confounders.

Findings

A total of 95 hospitals participated in at least one survey and were included in the analysis. The overall mean HMP score varied dramatically across the hospitals and 84% of them scored less than 60. The dimension mean HMP score was 38.6 (target), 56.4 (operation), 53.2 (performance) and 55.7 (talent), respectively. The pattern of indicator mean HMP score, however, was almost identical between hospitals with high and low overall HMP score, showing the same ‘strength’ (staff satisfaction, staff performance appraisal, ‘hard wares’, patient-centered services, etc.) and ‘weakness’ (target balance, target setting, continuous quality improvement, penalties on staff with dissatisfied performance, etc.). The associations of overall mean HMP score with quality of care and efficiency variables and cost per hospitalization was not statistically significant. The statistical significance in the association with hospital annual total income disappeared after adjusting for region, teaching status, number of competitors, number of staff and number of beds in use.

Conclusion

The HMP in Chinese county hospitals scores low in general and was not significantly associated with hospital care quality, efficiency and finance. The current healthcare reform in China should address the micro level issues in hospital management practices.
Biogenesis, cellular effects, and biomarker value of circHIPK3
Authors: Fu Yihan , Sun Hong
Published: May 2021

Competing endogenous RNAs (ceRNAs) can indirectly regulate gene expression by competitively binding to microRNA(miRNA) through miRNA response elements (MREs) to affect miRNA-induced gene regulation, which is of great biological significance. Among them, circular RNA (circRNA) has become a hotspot due to its highest binding capacity. A specific circRNA discussed in this review, circHIPK3, has been studied for its biological characteristics, function, cellular effects and its relationship with tumors and various diseases. Here, we review the recent researches about circHIPK3 in detail and aim to elucidate accurate conclusions from them. These circHIPK3-miRNAs-mRNA pathways will further advance the application of circHIPK3 in diseases development, early diagnosis and gene targeting therapy.
Altered alcohol consumption during COVID-19 pandemic lockdown
Authors: Steffen Julius , Schlichtiger Jenny , Huber Bruno C. , Brunner Stefan
Published: May 2021

Background

Since the onset of the COVID-19 pandemic in December 2019, many countries around the world have imposed lockdown measures in order to reduce virus spread. Social isolation is known to have a significant psychological impact, potentially triggering alcohol misuse in adults. In our study, we aimed to investigate the effect of COVID-19 lockdown measures on alcohol consumption in adults in Bavaria.

Methods

In this cross-sectional study, we enrolled 2067 participants, with 1961 young adults (mean age 23.3 ± 4.1) and 106 mature adults (mean age 66.7 ± 9.7). Participants were asked to complete a standardized questionnaire, semi-quantitatively evaluating the alcohol drinking behaviour before and during the pandemic lockdown.

Results

After implementation of lockdown, the alteration of alcohol consumption was significantly different between young and mature adults (p <  0.001). Among young adults, 42% reported unchanged drinking behaviour compared to 76% in the mature adult group; 44% of young adults reported to drink less compared to only 7% of mature adults. An increase in alcohol consumption was only reported by 14% of young adults and 17% of mature adults. Interestingly, in the entire cohort, the change of alcohol intake was most pronounced among moderate drinkers (> 0 to < 5 drinks/week) in both age groups (p <  0.001). Ordinal logistic regression revealed female sex, low BMI and younger age to be associated with a decrease in number of self-reported drinks/week.

Conclusion

The COVID-19 pandemic lockdown significantly affected alcohol drinking behaviour. Further studies exploring long-term effects on potential alcohol misuse and the relevance on public health are warranted.

Trial registration

The study was retrospectively registered at ClinicalTrials.gov (NCT04361877) on April 24, 2020.
Understanding the influence of left ventricular assist device inflow cannula alignment and the risk of intraventricular thrombosis
Authors: Neidlin Michael , Liao Sam , Li Zhiyong , Simpson Benjamin , Kaye David M. , Steinseifer Ulrich , Gregory Shaun
Published: May 2021

Background

Adverse neurological events associated with left ventricular assist devices (LVADs) have been suspected to be related to thrombosis. This study aimed to understand the risks of thrombosis with variations in the implanted device orientation. A severely dilated pulsatile patient-specific left ventricle, modelled with computational fluid dynamics, was utilised to identify the risk of thrombosis for five cannulation angles. With respect to the inflow cannula axis directed towards the mitral valve, the other angles were 25° and 20° towards the septum and 20° and 30° towards the free wall.

Results

Inflow cannula angulation towards the free wall resulted in longer blood residence time within the ventricle, slower ventricular washout and reduced pulsatility indices along the septal wall. Based on the model, the ideal inflow cannula alignment to reduce the risk of thrombosis was angulation towards the mitral valve and up to parallel to the septum, avoiding the premature clearance of incoming blood.

Conclusions

This study indicates the potential effects of inflow cannulation angles and may guide optimised implantation configurations; however, the ideal approach will be influenced by other patient factors and is suspected to change over the course of support.
Concurrent smoking and alcohol consumers had higher triglyceride glucose indices than either only smokers or alcohol consumers: a cross-sectional study in Korea
Authors: Baek Wonhee , Lee Ji-Won , Lee Hye Sun , Han Donghee , Choi Su-Yeon , Chun Eun Ju , Han Hae-Won , Park Sung Hak , Sung Jidong , Jung Hae Ok , Lee Hyangkyu , Chang Hyuk-Jae
Published: May 2021

Background

The triglyceride glucose (TyG) index is a noninsulin-based marker for insulin resistance (IR) in general practice. Although smoking and heavy drinking have been regarded as major risk factors for various chronic diseases, there is limited evidence regarding the combined effects of smoking and alcohol consumption on IR. This study aimed to investigate the relationship between the TyG index and smoking and alcohol consumption using two Korean population-based datasets.

Methods

This study included 10,568 adults in the Korean National Health and Nutrition Examination Survey (KNHANES) and 9586 adults in the Korean Initiatives on Coronary Artery Calcification (KOICA) registry datasets. Multivariate logistic analysis was conducted to explore the relationship between smoking and alcohol consumption and the TyG index. To assess the predictive value of smoking and alcohol consumption on high TyG index, the area under the curve (AUC) were compared and net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses were derived.

Results

The combined effect of smoking and alcohol consumption was an independent risk factor of a higher TyG index in the KNHANES (adjusted odds ratio: 4.33, P < .001) and KOICA (adjusted odds ratio: 1.94, P < .001) datasets. Adding smoking and alcohol consumption to the multivariate logistic models improved the model performance for the TyG index in the KNHANES (AUC: from 0.817 to 0.829, P < .001; NRI: 0.040, P < .001; IDI: 0.017, P < .001) and KOICA (AUC: from 0.822 to 0.826, P < .001; NRI: 0.025, P = .006; IDI: 0.005, P < .001) datasets.

Conclusions

Smoking and alcohol consumption were independently associated with the TyG index. Concurrent smokers and alcohol consumers were more likely to have a TyG index that was ≥8.8 and higher than the TyG indices of non-users and those who exclusively consumed alcohol or smoking tobacco.