bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Effects of Noninvasive, Individualized, Transcranial Neuromodulation Treatment for Voiding Dysfunction in Multiple Sclerosis Patients: Study Protocol for a Pilot Clinical Trial
Authors: Tran Khue , Shi Zhaoyue , Karmonik Christof , John Blessy , Rajab Hamida , Helekar Santosh A. , Boone Timothy , Khavari Rose
Published: January 2021

Background: Voiding dysfunction (VD) is a common neurogenic lower urinary tract dysfunction (NLUTD) in multiple sclerosis (MS) patients. Currently, the only effective management for VD and urinary retention in MS patients is catheterization, prompting us to look for novel therapeutic options beyond the bladder, such as the brain. Transcranial rotating permanent magnet stimulator (TRPMS) is a noninvasive, portable, multifocal neuromodulator that simultaneously modulates multiple cortical regions, enhancing or attenuating strengths of functional connections between these regions. The objective of this pilot clinical trial is to evaluate the therapeutic effects of TRPMS in modulating brain regions during voiding initiation and mitigating VD in female MS individuals.Methods: Ten adult female MS patients with VD (defined as having %post-void residual/bladder capacity (%PVR/BC) ≥ 40% or Liverpool nomogram percentile < 10%) will be recruited for this study. Concurrent urodynamic and functional MRI evaluation with a bladder filling/emptying task repeated three to four times will be performed at baseline and post-treatment. Predetermined regions of interest and their blood-oxygen-level-dependent (BOLD) activation at voiding initiation will be identified on each patient’s baseline anatomical and functional MRI scan, corresponding to the microstimulators placement on their individualized TRPMS treatment cap to either stimulate or inhibit these regions. Patients will receive ten 40-minute treatment sessions. Non-instrumented uroflow and validated questionnaires will also be collected at baseline and post-treatment to evaluate clinical improvement.Discussion: Despite the crucial role of the central nervous system in urinary control and its sensitivity to MS, there has been no treatment for urinary dysfunction targeting the brain centers that are involved in proper bladder function. This trial, to our knowledge, will be the first of its kind in humans to consider non-invasive and individualized cortical modulation for treating VD in MS patients. Results from this study will provide a better understanding of the brain control of neurogenic bladders and lay the foundation for a potential alternative therapy for VD in MS patients and other NLUTD in a larger neurogenic population in the future.Trial registration: This trial is registered at ClinicalTrials.Gov (NCT03574610, July 2, 2018, https://clinicaltrials.gov/ct2/show/NCT03574610) and Houston Methodist Research Institute IRB (PRO00019329).
WITHDRAWN: Analysis of Management Approach to Newborn Care of Infants Delivered to COVID-19 Positive Mothers at Five Tertiary Care Centers in the UAE over a 7 Month Period
Authors: Kaushal Monika , Tulasi Yamuna , Kaushal Ayush , Rakhecha Aditya , Memon Rafiq , Ramasamy Karvendhan , Khan Shoaib
Published: January 2021

ObjectivesTo assess newborn care practices, clinical characters and risks of mother to child transmission during rooming in and breastfeeding in infants born to mothers with COVID-19.DesignRetrospective observational study.Participants5 Tertiary care centers located in the UAE. Infants born to mothers diagnosed with COVID-19 at the time of delivery, born between April 1st and October 30th 2020.MethodsIn this retrospective observational study, we analyzed the newborn care practices in various tertiary care hospitals and the rate of transmission of SARS-CoV-2 from mother to infant (vertical or horizontal) while rooming in, breastfeeding and post discharge. Results40 infants were born to mothers with COVID-19 at the time of delivery. One infant tested positive for SARS-CoV-2 after birth and had respiratory symptoms and fever. 23 of the well infants were roomed in during their hospital stay and were breastfed. In 8 cases, the mother and baby were separated and isolated from the time of birth till discharge. 95% of the discharged infants were rooming in with mothers, 45% of the infants were exclusively breastfed and 55% were on mixed feeding (breast milk and formula milk) at the follow-up. None of the infants developed significant health issues or symptoms attributable to SARS-CoV-2.ConclusionThe risk of mother to infant transmission of COVID-19 in the perinatal period is very low. Our study reaffirms the AAP guidelines that rooming in and breastfeeding of newborns born to COVID-19 positive mothers is safe without an increased risk of transmission by following mandated safety precautions.
“Part of Getting to Where We Are is Because We Have Been Open to Change”Integrating Community Health Workers on Care Teams at Ten Ryan White HIV/AIDS Program Recipient Sites
Authors: Martinez Linda Sprague , Davoust Melissa , Rajabiun Serena , Baughman Allyson , Bachman Sara , Bowers-Sword Rachel , Rojo Maria Campos , Sullivan Marena , Drainoni Mari-Lynn
Published: January 2021

Background: Community Health Workers (CHWs) have long been integrated in the delivery of HIV care, in middle- and low-income countries. However, less is known about CHW integration into HIV care teams in the United States (US). To date, US based CHW integration studies have studies explored integration in the context of primary care and patient-centered medical homes.There is a need for research related to strategies that promote the successful integration of CHWs into HIV care delivery systems. In 2016, the Health Resources and Services Administration HIV/AIDS Bureau launched a three-year initiative to provide training, technical assistance and evaluation for Ryan White HIV/AIDS Program (RWHAP) recipient sites to integrate CHWs into their multidisciplinary care teams, and in turn strengthen their capacity to reach communities of color and reduce HIV inequities. Methods: Ten RWHAP sites were selected from across eight states. The multi-site program evaluation included a process evaluation guided by RE-AIM to understand how the organizations integrated CHWs into their care teams. Site team members participated in group interviews to walk-the-process during early implementation and following the program period. Directed content analysis was employed to examine program implementation. Codes developed using implementation strategies outlined in the Expert Recommendations for Implementing Change project were applied to group interviews (n=20). Findings: Implementation strategies most frequently described by sites were associated with organizational-level adaptations in order to integrate the CHW into the HIV care team. These included revising, defining, and differentiating professional roles and changing organizational policies. Strategies used for implementation, such as network weaving, supervision, and promoting adaptability, were second most commonly cited strategies, followed by training and TA strategies. Conclusions: Wrapped up in the implementation experience of the sites there were some underlying issues that pose challenges for health care organizations. Organizational policies and the ability to adapt proved significant in facilitating CHW implementation. The integration of the CHW role may present an occasion for health care delivery organizations to reassess policies that may unintentionally marginalize communities and both limit career opportunities and patient engagement.
Application of Laparoscopic Gastric Jejunum Uncut Roux-en-Y Anastomosis
Authors: Yu Chao , Yan Qiang , Li De-Guan , Wang Yi-Gao , Yang Xiao-Dong , Zhang Shang-Xin , Zhang Yong-Hong , Zhang Zhen
Published: January 2021

Background: Uncut Roux en-Y gastrojejunostomy, recently developed in China is useful in the treatment of distal gastric cancer. This study aims to compare laparoscopic gastric jejunum Uncut Roux-en-Y anastomosis with conventional anastomosis in the surgical treatment of distal gastric malignancy.Methods: A total of 178 cases diagnosed with distal gastric malignant tumors were surgically treated in the First affiliated Hospital of Anhui University of cavity mirrors. In this retrospective study, the clinical data of patients and their follow-up records were analyzed. Out of the 178 cases, 112 cases (uncut group) were the observation group for stomach jejunum Uncut Roux-en-Y anastomosis, the control group for the stomach, 66 cases (conventional group) were for jejunum Roux-en-Y anastomosis and Billroth Ⅰ and Billroth Ⅱ anastomosis. A comparison between the two groups was conducted based on the general situation of the patients, TNM stage, and one-year survival rate. A P-value of less than 0.05 was considered statistically significant (p<0.05), while a P-value of more than 0.05 was considered statistically insignificant (p>0.05).Results: There was no significant difference was reported between the two groups in terms of the general situation and TNM stage. A comparison on postoperative complications between the two groups revealed that the incidence rate of postoperative anastomotic bleeding was 0.9% (1/112), 6.1% (4/66), the incidence rate of alkaline reflux gastritis was 1.8% (2/112), 9.1% (6/66), the incidence rate of anastomotic fistula was 0.0% (0/112), 3.0% (3/66), and the Roux retention syndrome (RSS) incidence rate was 0.9% (1/112), 7.6% (5/66). The observation group significantly lower than the control group, and the difference was statistically significant. The incidence rate of overall complications was at 3.6% (4/112) and 25.8% (17/66), which was significantly lower in the observation group than in the control group, and the difference was statistically significant. Notably, there was no significant difference in 1-year survival rate between the two groups.Conclusion: Laparoscopic gastric jejunal Uncut Roux-en-Y anastomosis significantly reduces the risk of postoperative complications of the digestive tract. Its operation is easy and exhibits an effective curative effect. Moreover, it has a better surgical effect and a promising clinical application prospect compared to conventional gastric jejunal anastomosis.
Investigating The Efficiency of Photothrombosis-Associated Focal Cerebral Ischemia By Monitoring Histopathological Changes and Neurobehavioral Performance in Model of Mouse
Authors: Shabani Zahra , Farhoudi Mehdi , Rahbarghazi Reza , Karimipour Mohammad , Mehrad Hossein
Published: January 2021

Background: Photothrombotic (PT) stroke model is a reliable, reproducible, noninvasive and accessible method to induce ischemic stroke in the target site using excitation of photosensitive agents such as Rose Bengal (RB) dye after light illumination. Methods: The thirty animals were assigned into three groups of Laser irradiation, RB, and Laser irradiation+RB. We assessed ischemic stroke outcomes through multiple cellular and behavioral approaches. Laser irradiation+ RB promoted pale ischemic changes after 7 days. Microscopic staining revealed neural tissue degeneration and demarcated necrotic site and neuronal injury plus prominent astrogliosis in the periphery of irradiated sites. We performed (BrdU/NeuN) staining to examine the neurogenesis on day 28. The volume of the lesion site was calculated using unbiased stereological study and Cavalier’s principle. To assess the efficiency of ischemic stroke, modified neurological severity score (mNSS) and cylinder tests were done on days 1, 7, 14, and 28. Results: BrdU+/NeuN+ staining showed a significant increase in the number of proliferating cells in the Laser irradiation+ RB group compared to the other groups (p<0.05), while the percent of NeuN+ cells reduced. In Laser irradiation + RB group, we found the largest infarct cavity volume and functional deficits during post ischemic days 1-7 that reduced thereafter. Conclusion: Our study revealed that the PT although increased the cell proliferating in the periphery of the lesion site, but due to an undesirable microenvironment, the neurogenesis decreased concomitantly with the functional and infarct size alleviation.
Effects of Content Features and Lingual Form of Government Information Release on the Regulation of Public Negative Emotions During COVID-19 Epidemic in Wuhan
Authors: zhu yanchun , zhang wei , zhang mei , qin chunlei , wen jianbo
Published: January 2021

Background: Emergencies and their associated negative emotions have a great effect on public health. As a key part of the emergency management, government information release (GIR) not only meets the public's health information seeking, but also helps to eliminate the breeding and spreading of negative social emotions. Method: From the two aspects of content features and lingual forms, a regression model was built to explore the mechanism of GIR on the regulation of netizens' negative emotions by adopting the theoretical methods of content analysis, emotion calculation, and case analysis. Results: During the emergency outbreak, if the government can timely release information on the incident and respond to the public using rational language, netizens' negative emotions can be alleviated. During the emergency peak, the government should release the event progress, resolution and disposal information to improve the recognition of netizens and eliminate negative emotions. Conclusions: According to different stages of emergencies, the government should timely and reasonably utilize the attitude tendency, content type and lingual form of GIR to effectively regulate the negative emotions of netizens.
Increased Risk of Osteoporosis in Patients With Nephrotic Syndrome. A Nationwide Population-Based Retrospective Cohort Study
Authors: Liao Chen-Yi , Chung Chi-Hsiang , Wei Kuang-yu , Feng Tseng-Min , Lin Fu-Huang , Tsao Chang-Huei , Wu Chia-Chao , Chu Pauling , Chien Wu-Chien
Published: January 2021

Corticosteroid (CS) is commonly used in nephrotic syndrome (NS) and a risk factor for osteoporosis. We evaluated the risk of osteoporosis in patients with nephrotic syndrome using a nationwide population-based dataset. After adjusting for covariates, osteoporosis risk was found to be 3.279 times greater in the NS cohort than in the non-NS cohort, when measured over 11 years after NS diagnosis. Stratification revealed that age older than 18 years, congestive heart failure, hyperlipidemia, chronic kidney disease, liver cirrhosis, and NS-related disease including diabetes mellitus, hepatitis B infection, hepatitis C infection, lymphoma, and hypothyroidism, increased the risk of osteoporosis is when comparing the NS cohort with the non-NS cohort. Additionally, osteoporosis risk was significantly higher in NS patients with CS use (aHR = 3.397). The risk of osteoporosis in NS patients was positively associated with risk of hip and vertebral fracture (aHR = 2.130 and 2.268, respectively). A significant association exists between NS and subsequent risk for osteoporosis. Therefore NS patients, particularly those treated with CS, should be evaluated for subsequent risk of osteoporosis.
Molecular Serotyping and Resistance of Clinical Strains of Haemophilus (Glaesserella) Parasuis in Chinese Pig Farms From 2016 to 2018.
Authors: Liu Jinjin , Guo Long , Yuan Yi , Song Wenbo , Li Qianqian , Huang Ying , Long Yunzhi , Yang Liu , Liang Gong , Huang Chao , Tang Xibiao
Published: January 2021

Haemophilus parasuis (H. parasuis) is the etiological agent of Glässer's disease and brings great economic losses to the pig industry. The goal of our research is to reveal the serotypes of H. parasuis isolated from large-scale pig farms in China from 2016 to 2018. From 2016 to 2018, 8153 H. parasuis field strains were isolated from 14610 clinical samples of sick pigs with clinical symptoms from 26 provinces and cities of China. Among them, 1386 strains were identified as H. parasuis by PCR, and the isolation rate was 9.49%. Through multiplex PCR, we showed that type 5/12 and type 4 strains had the highest separation rate, followed by type 13 and type 14 strains. Using disk diffusion method, we found cephalosporin antibiotics and peptide antibiotics all had good inhibitory effect on H. parasuis. Our conclusion may play a positive role in the prevention and treatment of H. parasuis.
Ultrasound Elastographic Features of the Fetlock Joint Capsule in Horses
Authors: Straticò Paola , Guerri Giulia , Palozzo Adriana , Francesco Paola Di , Vignoli Massimo , Varasano Vincenzo , Petrizzi Lucio
Published: January 2021

Background: Capsulitis leads to the release of inflammatory mediators into the joint causing capsular fibrosis and osteoarthrosis (OA). Strain elastosonography (SE) measures the elasticity of tissue evaluating its strain to an operator-dependent deformation. Aims of the study were to assess the feasibility of SE for evaluating the distal attachment of the joint capsule (DJC) of fore fetlocks in sound horses and in horses with fetlock OA and to evaluate differences in their elastosonographic aspect. After a whole lameness examination, fore fetlocks DJC were assigned to Group S and Group P and examined by two operators using SE. The inter-rater reliability (IRR), the intraclass (intra-CC) and interclass (inter-CC) correlation coefficients were used to compare colour grading scores, repeatability, reproducibility of elasticity index (EI) and strain ratio (SR). The same parameters were compared between groups. Findings were significant for P < 0.05. Results: Forty-one horses were included, 11 in Group S, 30 in Group P (16 with bilateral OA, 8 left and 6 right OA). IRRs ranged from good to excellent. For transverse and longitudinal scans, the EIs of Group S were 0.57-0.51, SRs were 0.32-0.28. Inter-CC and intra-CC were always > 0.8. In Group P, EI was 1.09-0.89, SRs was 0.78-0.72 with intra-CC and inter-CC >0.57. Significative differences of EI and SR were detected between groups, and between Group S and the affected limb of Group P.Conclusions: SE is a useful technique for evaluating the DJC, with good repeatability and reproducibility. DJC appears softer in sound horses.
Association of Food Insecurity With Dietary Patterns and Expenditure on Food, Alcohol and Tobacco Amongst Indigenous Inuit in Greenland: Results From a Population Health Survey.
Authors: Bjerregaard Peter , Olesen Ingelise , Larsen Christina
Published: January 2021

Background Amongst the indigenous Greenlandic Inuit, the experience of food insecurity has been attributed to a lack of money to buy enough food of sufficient quality to sustain a family, although a preference for alcohol and tobacco over food has also been cited. The purpose of the article was to compare dietary patterns and expenditure on food, alcoholic beverages and tobacco between survey participants who reported food insecurity and those who did not.Methods Countrywide cross-sectional health survey among 1886 adult Greenlandic Inuit in 2018. Diet was estimated by a food frequency questionnaire. Food insecurity status was based on the household hunger scale. Analyses were carried out by univariate general linear models adjusted for age, sex and social position. ResultsNine percent of the participants reported food insecurity. Food insecurity was unevenly distributed according to age, sex and social position. Food insecure participants more often chose an unhealthy dietary pattern (43% vs. 32%) and they reported a higher energy intake. The food insecure spent the same amount of money on food as other participants but less on nutritious food and more on non-nutritious food. The cost per kJ of the food of the food insecure was lower than that of the food secure (DKK 8.0 and 9.0 per 1000 kJ, respectively). The food insecure participants also spent considerably more on alcohol and tobacco. Conclusions The results suggest that it is not only unemployment and lack of money that creates food insecurity and unhealthy dietary patterns in Greenland but probably also social inequality, lack of resources for planning, prioritising, living one’s daily life and limited knowledge about food. There seems to be at least two population subgroups in Greenland with poverty and substance use, respectively, as the immediate determinants for food insecurity, but behind these causes is a web of underlying social causes. The results are important for the design of interventions against food insecurity and unhealthy dietary patterns.
A germline variant of human IgG1+ B cell receptor represses colorectal tumorigenesis and progression by shaping the tumor microenvironment
Authors: Liu Wanli , Yang Bing , Zhang Zheng , Chen Xiangjun , Wang Xu-Yan , Qin Shishang , Du Liaoqi , Yang Changjiang , Sun Wenbo , Zhu Liyu , Zheng Qinwen , Zhu Yongjie , Song Xiya , Zhao Shidong , Wang Quan , Zhao Long , Lin Yilin , Yan Xiaohan , Gao Ji , Huang Jinghe , Wu Fan , Lu Lu , Wang Fei , Zheng Wenjie , Zhou Xiao-Hua , Zhao Xiaozhen , Wang Ziye , Sun Xiaolin , Ye Yingjiang , Wang Shan , Li Zhan-Guo , Qi Hai , Zhang Zemin , Kuang Dong-Ming , Zhang Lei , Shen Zhanlong
Published: January 2021

The presence of B lymphocytes in tumor tertiary lymphoid structures (TLSs) is an important prognostic indicator for different types of cancers. However, whether B cell responses in the tumor microenvironment (TME) can be harnessed for immunotherapy is unclear. Here we report that a protective germline variant of human immunoglobulin heavy constant gamma 1 gene (IGHG1) containing a Gly396 to Arg396 substitution (hIgG1-G396R) confers improved survival of colorectal cancer (CRC) patients. These hIgG1-G396R homozygous CRC patients displayed elevated tumor-associated antigen (TAA)-specific IgG1 antibody production and plasma cell infiltration into tumors. In murine colon carcinoma models, mice expressing the murine functional homolog IgG2c-Gly400Arg variant (mIgG2c-G400R) also produce higher levels of tumor-specific IgG2c antibodies via enhanced plasma cell differentiation, together with alleviated tumorigenesis and progression. Mechanistically, this variant potentiates TAA-specific antibody-dependent cellular phagocytosis and antigen presentation. Comprehensive immune profiling of the TME of CRC patients revealed that hIgG1-G396R prominently promotes broad mobilization of immune cells (IgG1+ plasma cells, CD8+ T cells, CD103+ DCs) and efficient TLS formation, both key components of an anti-tumor microenvironment. Notably, adoptive transfer of tumor-primed B cells with this variant exhibited therapeutic efficacy in murine tumor models, demonstrating clinical potential. These results prompt a prospective investigation of hIgG1-G396R in CRC patients as a biomarker for clinical prognosis and demonstrate that manipulating the functionality of IgG1+ B cells in tumors could improve immunotherapy outcomes.
Fecal microbiota Profiling in Irritable Bowel Syndrome and Inflammatory Bowel Disease Patients with Irritable Bowel Syndrome-Type Symptoms
Authors: Cui Xiufang , Wang Haiyang , Ye Ziping , Li Yi , Qiu Xinyun , Zhang Hongjie
Published: January 2021

BACKGROUND: The intestinal microbiota is thought to be involved in the occurrence of Inflammatory Bowel Disease in remission (IBDR) with Irritable Bowel Syndrome (IBS)-type symptoms, but the specific distinct profile of these bacteria remains unclear. Therefore, the purpose of this research is to investigate this issue by conducting a cross-sectional study.METHODS: IBS patients were diagnosed according to Rome Ⅳ criteria, IBD diagnosed according to the criteria of European Crohn & Colitis Organization (ECCO), IBDR patients with IBS-type symptoms were defined according to related IBS-type symptoms meeting the Rome IV criteria in IBDR patients, and were included Crohn’s disease in remission (CDR) and ulcerative colitis in remission (UCR) based on Crohn’s Disease Activity Index (DAI) and Mayo Scoring System respectively. Healthy controls come from the physical examination center and exclude people with underlying diseases. All enrolled subjects were divided into six groups, as followed: Health Control, IBS, CDR with IBS-type symptoms (CDR-IBS+), CDR without IBS-type symptoms (CDR-IBS-), UCR-IBS+ and UCR-IBS-. We collected fresh fecal samples from all subjects and applied 16S rRNA sequencing analysis to detect the structure and diversity of the microbiota among different groups. RESULTS: A total of 97 subjects were included in this study, of which 18 were health controls, 34 IBS patients, 25 CDR and 20 UCR. The richness of intestinal microbiota in CDR-IBS-was significantly lower than that in the control and IBS groups based on the analysis of observed species and Chao index (P<0.05). The observed species index in CDR-IBS+ was significantly higher than CDR-IBS- group (median index: 254.8 vs 203, P=0.036). No difference was found in Alpha diversity between UCR-IBS+ and UCR-IBS-. At phylum level, there was no significant difference between UC or CD with IBS-type symptoms and those without related symptoms. At genus level, the number of Faecalibacterium in CDR-IBS+ increased significantly while Fusobacterium decreased compared with CDR-IBS-(mean relative abundance of Faecalibacterium: 20.35% vs 5.18%, P<0.05; Fusobacterium: 1.51% vs 5.2%, P<0.05). However, compared with UCR-IBS - group, the number of Faecalibacterium in UCR-IBS+ group decreased, while the number of Streptococcus increased, but there was no statistical difference in the genus structure. Regardless of the phylum or genus level, the abundance and composition of the microbiota of IBS patients were not distinct from those of healthy people.CONCLUSIONS: CD patients in remission with IBS-type symptoms may be related to the increase of Faecalibacterium and decrease of Fusobacterium. UC patients in remission with IBS-type symptoms cannot be explained by changes in the abundance and structure of intestinal microbiota from our across-sectional study.
Cellulose Intrafibrillar Mineralization of Biological Silica in a Rice Plant
Authors: Nakamura Eri , Ozaki Noriaki , Oaki Yuya , Imai Hiroaki
Published: January 2021

The essence of morphological design has been a fascinating scientific problem with regard to understanding biological mineralization. Particularly shaped amorphous silicas (plant opals) play an important role in the vital activity in rice plants. Although various organic matters are associated with silica accumulation, their detailed functions in the shape-controlled mineralization process have not been sufficiently clarified. In the present study, cellulose nanofibers (CNFs) were found to be essential as a scaffold for silica accumulation in rice husks and leaf blades. Prior to silicification, CNFs ~10 nm wide are sparsely stacked in a space between the epidermal cell wall and the cuticle layer. Silica nanoparticles 20–50 nm in diameter are then deposited in the framework of the CNFs. The shape-controlled plant opals are formed through the interfibrillar mineralization of silica nanoparticles on the CNF scaffold.
Prehospital Triage Tools across the World: A Scoping Review of the Published Literature
Authors: Bhaumik Smitha , Hannun Merhej , Dymond Chelsea , DeSanto Kristen , Barrett Whitney , Wallis Lee A , Mould-Millman Nee-Kofi
Published: January 2021

BackgroundAccurate triage of the undifferentiated patient is a critical task in prehospital emergency care. This scoping review aims to identify published tools used for prehospital triage across the world and describe their performance characteristics.MethodsA comprehensive search was performed of primary literature in English-language journals from 2009 to 2019. Papers included focused on emergency medical services (EMS) triage of single patients. Two blinded reviewers and a third adjudicator performed independent title and abstract screening and subsequent full-text reviews. ResultsOf 1521 unique articles, 55 (3.6%) were included in the final synthesis. The majority of prehospital triage tools focused on stroke (n=19; 35%), trauma (19; 35%), and general undifferentiated patients (15; 27%). All studies, and resulting articles, were performed in high income countries, with the majority in North America (23, 42%) and Europe (22, 40%). 4 (7%) articles focused on the pediatric population. The general triage tools aggregated prehospital vital signs, mental status assessments, and sometimes, features of the history, exam, and anticipated resource need, to categorize patients into numerical or color categories to represent level of acuity. The studies assessed the tools’ ability to accurately predict emergency department triage assignment, hospitalization and short-term mortality. The stroke triage tools were designed to promote rapid identification of patients with acute large vessel occlusion ischemic stroke to trigger timely transport to diagnostically- and therapeutically-capable hospitals. Stroke triage literature evaluates tools’ diagnostic performance, impact on tissue plasminogen activator administration rates, and correlation with in-hospital stroke scales. Trauma triage tools sought to identify patients that require immediate transport to trauma centers with emergency surgery capability. The studies on trauma triage evaluate prediction of trauma center need, under-triage and over-triage rates for major trauma, and survival to discharge.ConclusionsThe published literature on prehospital triage tools predominantly derive from high-income health systems and mostly focus on adult stroke and trauma populations. Most studies sought to further simplify existing triage tools, without sacrificing triage accuracy, or assessed the predictive capability of the triage tool. There was no clear ‘gold-standard’ singular prehospital triage tool for acute undifferentiated patients. Trial RegistrationNot applicable.
The Transition From Minimal Change Disease to Focal and Segmental Glomerulosclerosis in a Patient With Nephrotic Syndrome: a Case Report
Authors: Tang Long , Cai Zhen , Meng Yuan , Zhao Wen-jing , Wang Su-Xia
Published: January 2021

Background:Although minimal change disease (MCD) and focal segmental glomerulosclerosis (FSGS) have been described as two separate forms of nephrotic syndrome(NS), they are not completely independent. We report a patient presenting a transition from MCD to FSGS, review the literature and explore the relationship between the two diseases.Case presentation:A 42-year-old male welder, Asian, presenting lower extremity edema and elevated serum creatinine, had laboratory exams indicating NS and end-stage renal disease(ESRD). The patient had a kidney biopsy 20 years earlier for NS, which indicated MCD, and this repeated kidney biopsy suggested FSGS. After treatment follow-up, the patient was eventually admitted to renal replacement therapy. Conclusions:MCD and FSGS may be different stages of the same disease. The transition from MCD to FSGS in this case indicates the progression of the disease, which may be related to the excessive metal caused by occupation.
Soluble CD14 and Th 17-Related Interleukins in Bronchoalveolar Lavage Fluid are Potential Triage Biomarkers for Pulmonary Tuberculosis
Authors: Liu Jian , Li Ling Ling , Dong Wen Xiao , Liu Qiao Dan , Hong Zhong Si , Peng Xiao Mou
Published: January 2021

Background: Soluble CD14 (sCD14) and T helper 17-related interleukins (IL-17 and IL-22) in bronchoalveolar lavage fluid (BALF) are preliminarily reported to be increased in pulmonary tuberculosis (PTB). Their significances to the bacteriological confirmation and activity differentiation of PTB, however, are not completely clarified. Methods: A observational study was conducted in 154 consecutive adult patients who were primarily diagnosed with PTB based on radiographic abnormalities. Bacteriological confirmation was made using sputum/BALF smearing, TB-DNA, Xpert test and Mycobacterium tuberculosis (Mtb) culture. BALF and serum sCD14, IL-17 and IL-22 were measured using ELISA assays. Their associations with clinical/bacteriological characteristics were analyzed. Results: Finally, 103, 16, 7 and 28 patients were diagnosed with active, inactive, gray zone and non-PTB, respectively. Among active PTB patients, 82 (79.6%) cases, 33 (32.0%) based on sputum and additional 49 (47.6%) depended on BALF were bacteriologically confirmed. BALF levels of sCD14, IL-17 and IL-22 were similar between patients with PTB and non-PTB, but significantly higher in active PTB and bacteriologically-confirmed patients. The BALF levels of these biomarkers to some extent predicted bacteriological confirmation failure (AUC of IL-22 = 0.866), nonresponders to empiric antibacterial therapy, Xpert test (AUC of IL-22 = 0.760) and Mtb cultures. When the sensitivities were set at ³ 90% (WHO's minimal requirement for a triage test), the specificities of bacteriological confirmation failure prediction and empiric antibacterial therapy nonresponder prediction in interferon-g release assay-positive patients were about 67%, very close to the WHO's minimal requirement (³ 70%) for a triage test. In addition, serum levels of sCD14, IL-17 and IL-22 were relatively lower and had no predictive values. Conclusions: BALF levels of sCD14, IL-17 and IL-22, superior to their serum levels, are potential triage biomarkers and may be used to replace the expensive Xpert test in particular occasions or refer proper patients to conduct lung biopsy and expensive molecular tests in the first week or to start nondelayed anti-TB therapy bypassing empiric antibacterial therapy and time-consuming Mtb culture.
Incidence and Prognostic Significance of Liver Metastases for Newly Diagnosed Ovarian Cancer in Relation to Subtypes
Authors: Zhu Ying , Zhang Yifang , Zhai Lingyun , Zhang Zhigang , Zhou Jianwei
Published: January 2021

Background: Ovarian cancer is a heterogeneous and aggressive malignant tumor, and the liver is one of the most common metastases target visceral organs of ovarian cancer. We aim to analysis the incidence and prognostic relevance of histological subtypes for patients with liver metastases in newly diagnosed ovarian cancer.
Methods: In the Surveillance, Epidemiology, and End Results (SEER) database, we identified the ovarian cancer patients from 2010 to 2016. Multivariable logistic regression was used to determine whether histological types were associated with the presence of liver metastases at diagnosis. The Kaplan-Meier method and multivariable Cox regression was performed to identify covariates associated with survival using the histological types.
Results: Among 25293 ovarian cancer patients, 1749 cases presented with liver metastases. The incidence proportions were highest among ovarian carcinosarcoma patients (OR=17.76, 95% CI=9.26-34.09), and liver metastasis specificity was the highest in the clear cell type (70.69% of the metastatic subset). The median cancer-specific survival (CSS) for non-metastatic ovarian cancer patients was 77 months, but the ovarian cancer with only liver metastasis was 21 months. The mucinous (5 months; vs nonepithelial subtype, HR=0.26; 95% CI, 0.14-0.49) subtype experienced the shortest median survival among all histologic types.
Conclusion: This population-based study provides that liver was one of the most common distant visceral organs for ovarian cancer metastasis, and the incidence proportions of liver metastasis were highest for carcinosarcomas subtype, and the mucinous ovarian cancer with liver metastasis being associated with the poorest survival.
“A Modified Anterolateral Swashbuckler Approach for Distal Femoral Fractures: Description and Outcomes”
Authors: Ghirardelli Stefano , TOULOUPAKIS GEORGIOS , THEODORAKIS EMMANOUIL , Antonini Guido , Violante Bruno , Indelli Pier Francesco
Published: January 2021

Background: The treatment of distal femur fractures represents a challenging task. General and local factors, including bone quality, articular surface involvement, fracture comminution, associated soft tissue injuries and ultimately fixation system, all play a role in the final clinical outcome. Current surgical approaches often undermine patellar vascularization and integrity of the extensor apparatus, not guaranteeing sufficient visualization of the medial condyle. This technical note presents the efficacy and safety a new surgical technique to address distal femoral fractures. Methods: The original "swashbuckler" surgical approach was modified in order to obtain a better visualization of the lateral and medial femoral condyles without affecting the knee extensor mechanism and the anastomotic arterial supply of the patella. This modified surgical approach was utilized in a consecutive series of patients presenting with a Müller AO 33 distal femur or periprosthetic fracture of the knee. The final outcome was recorded according to a functional evaluation scoring system.Results: Twelve patients (2 males and 10 females) with a mean age of 67,8 years (min. 18; max 90 years) were included in this series. The same, modified "swashbuckler" surgical approach was applied in all cases. Multiple internal fixation techniques, including a single lateral plate, a combination of a lateral and medial plate, a single lateral plate associated with lag screws, were used to obtain a satisfactory stabilization of the fracture site. All patients were reviewed at a minimum one-year follow up (median 15 months): all patients regained their level of activities of daily living. No major intraoperative or postoperative complications were recorded. Conclusions: The modified swashbuckler approach allows anatomical reduction and appropriate fixation with minimal severance of the blood supply to the patella and ensures rapid weight bearing resumption thanks to an intact extensor mechanism.
Up-regulated Vitamin D Receptor by Pelargonium Sidoides Extract EPs® 7630 Contributes to Rhinovirus Defence in Bronchial Epithelial Cells
Authors: Roth Michael , Sun Qingzhu , Tamm Michael
Published: January 2021

Background: The Pelargonium sidoides herbal drug preparation EPs®7630 reduces the severity of viral upper respiratory tract infections. Vitamin D a secosteroid also improves anti-viral host defence. The anti-viral effect of both compounds was linked to similar signalling pathways in immune and epithelial cells. This study assessed if EPs®7630 modifies vitamin D receptor (VDR) expression by human bronchial epithelial cells. Methods: Bronchial epithelial cells were incubated with EPs®7630 over 48 hours before calcitriol stimulation and/or infection with Rhinovirus (RV)-16. The VDR expression and regulation was determined by Western-blotting. Intracellular signalling was studied by inhibition of mitogen activated protein kinases; Erk1/2, p38, and JNK. The anti-viral effect was assessed by immunofluorescence for RV-16 protein.Results: Treatment with EPs®7630 up-regulated the expression of the VDR through activation of Erk1/2 and thereby increased the cells sensitivity to calcitriol, reflected as the increased shift of the VDR from the cytosol into the nucleus. Compared to cells not pre-treated with EPs®7630 this VDR shift occurred at a 5.3 times lower calcitriol concentration. EPs®7630 increased Erk1/2 MAPK dependent signalling, but reduced the phosphorylation of p38. It had not effect on the activation and expression of JNK. EPs®7630 pre-treatment improved the anti-viral effect of vitamin D on RV-16 infection by 2.1 folds compared to vitamin D alone or to untreated cells. Furthermore, EPs®7630 improved the differentiation of epithelial cells by upregulating E-cadherin expression through Erk1/2.Conclusions: The results suggest that EPs®7630 increases host defence against rhinovirus infection by upregulating the VDR and thus increasing the response of epithelial cells to vitamin D.
Unilateral Transforaminal Approach (UTFA) in Percutaneous Vertebroplasty for Osteoporotic Vertebral Compression Fractures: A Novel Puncture Technique
Authors: yefeng wang , suoyuan Li , xiaoqiang Cai , jun Shen , tianming Zou
Published: January 2021

Background: Percutaneous vertebroplasty (PVP) via various puncture approaches was an effective minimally invasive treatment for osteoporotic vertebral compression fractures (OVCFs). In recent years, unilateral puncture techniques had been increasingly used with advantages of shorter operation time, lower X-ray exposure. The aim of this study was to explore the safety and efficacy of the unilateral transforaminal approach (UTFA) in PVP for the treatment of OVCFs. Methods: A retrospective study was designed to review 155 cases of single-level OVCFs from July 2018 to December 2019. We treated 77 patients with PVP via the UTFA and 78 via the bilateral transpedicular approach (BTPA). Operation time, number of intraoperative fluoroscopic X-rays, volume of bone cement injection and distribution of bone cement were recorded. We used Visual Analog Scale (VAS) score and Oswestry disability index (ODI) presurgery and at 1 day, 3 months and last follow-up after surgery to assess clinical outcomes. Results: The operation was successfully completed in both groups, with no complications of neurovascular injuries or bone cement embolism. UTFA group had significantly shorter operation time and less-frequent fluoroscopy than BTPA group (P < 0.05). There were no significant differences between the two groups in volume or distribution of injected bone cement (P > 0.05). Postoperative VAS scores and ODI of the two groups were significantly improved over their presurgical values (P < 0.05), but there were no significant differences in VAS or ODI at each time point between the two groups (P > 0.05). Conclusions: Both unilateral transforaminal PVP and bilateral transpedicular PVP were safe and effective treatments for OVCFs, but the former approach had the advantages of shorter operation time and less X-ray radiation exposure and therefore is worthy of greater clinical application.
More Metalwork Removals of Olecranon Fractures After Tension Banding Wiring than Plate Fixation-A Propensity Score Matching Analysis
Authors: Li Yi , Qiu Longhai , Wu Hongbo , Chen Ruixiong , Zhang Zhiwen , Wang Xiaofeng , Huang Yuliang
Published: January 2021

Background: Traditional tension band wiring and plate fixation represent the most common methods for treating olecranon fractures. However, there is no agreement as to which method provides the best outcome. The aim of this retrospective study was to compare the outcomes of tension band wiring (TBW) and plate fixation (PF) for treating displaced olecranon fractures. This is the first study to use propensity score matching analysis to compare treatment methods for olecranon fracture.Method: A total of 107 patients aged between 18 and 85 years old had acute isolated and displaced olecranon fractures. The patients were divided into either TBW (n=49) or PF (n=58) groups. To conduct propensity score matching for the treatment method (TBW versus PF), 58 patients were analyzed by logistic regression (29 patients in each group). Various demographic and treatment-related variables were examined and analyzed to determine their correlation. Results: Functional effects between two groups are similar( in terms of Mayo Elbow Performance Score (MEPS), the patients’ range of elbow motion (ROM) and forearm rotation (RFR), the time return to work (RTW)). The total adverse events rate and metalwork removal events rate are higher in TBW than that in PF. After propensity score matching analysis, the similar primary treatment efficacy (indicated by excellent MEPS) and higher primary adverse events rate ( indicated by metalwork removal) were perceived in TBW than that in PF. Logistic regression analysis revealed that fracture type was an independent factor that affected the efficacy of a treatment (regression coefficient=-1.24<0, P=0.03), indicating that fracture severity was inversely proportional to the efficacy of a treatment for olecranon fracture. Furthermore, logistic regression analysis demonstrated that the treatment method was an independent factor that affected metalwork removal of olecranon fracture (regression coefficient 2.38 > 0, OR = 10.77, P < 0.01), indicating that the risk of metalwork removal in the TBW Group was 10.77 times that in the PF Group.Conclusion: The results indicated that plate fixation should be the first choice of treatment method for olecranon fractures, especially in younger patients with higher quality of life requirements.Trial regislation: The study was not registered in the clinical trial registration center, because it was a retrospective case-control study, which was an observational study with no intervention measures.Level of evidence: Level III; Retrospective Cohort Comparison; Treatment Study
CardiOvaScular Mechanisms In Covid-19: Methodology of a prospective observational multimodality imaging study (COSMIC-19 study)
Authors: Alam Shirjel , Shah Anoop , Onyinkwa Kevin , Nganga Edward , Gitau Samuel , Makhdomi Khalid , Chung Michael , Vinayak Sudhir
Published: January 2021

Background: 8-28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections.Methods: This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA & 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels. Discussion: The results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic. TRIAL REGISTRATION: This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at www.isrctn.com/ISRCTN12154994
Smoking and inequalities in mortality in 11 European countries: a birth cohort analysis
Authors: Long Di , Mackenbach Johan , Martikainen Pekka , Lundberg Olle , Brønnum-Hansen Henrik , Bopp Matthias , Costa Giuseppe , Kovács Katalin , Leinsalu Mall , Rodríguez-Sanz Maica , Menvielle Gwenn , Nusselder Wilma
Published: January 2021

Purpose: To study the trends of smoking-attributable mortality among the low- and high-educated in consecutive birth cohorts in 11 European countries. Methods: Register-based mortality data were collected among adults aged 30 to 79 years in 11 European countries between 1971 and 2012. Smoking-attributable deaths were estimated indirectly from lung cancer mortality rates using the Preston-Glei-Wilmoth method. Rate ratios and rate differences among the low and high-educated were estimated and used to estimate the contribution of inequality in smoking-attributable mortality to inequality in total mortality.Results: In most countries, smoking-attributable mortality decreased in consecutive birth cohorts born between 1906 and 1961 among low and high-educated men and high-educated women, but not among low-educated women among whom it increased. Relative educational inequalities in smoking-attributable mortality increased among both men and women with no signs of turning points. Absolute inequalities were stable among men but slightly increased among women. The contribution of inequality in smoking-attributable mortality to inequality in total mortality decreased in consecutive generations among men but increased among women. Conclusions: Smoking might become less important as a driver of inequalities in total mortality among men in the future. However, among women, smoking threatens to further widen inequalities in total mortality.