bluuebunny/crossref_metadata_2025 huggingface dataset:
The Value and Feasibility of South-South Medical Elective Exchanges in Africa
Authors: Daniels Katy , Thomson Emma , Nawagi Faith , Flinkenflogel Maaike
Published: May 2020

Background
An elective is part of the curriculum where students have the flexibility to choose both the study topic and location. International medical electives are a well-established part of curricula at most medical schools in high-income countries. They are highly valued by students and have proven educational benefits, though do come with challenges, such as lack of reciprocity. Low and middle-income countries frequently host students from high-income countries providing learning opportunities, yet also carry the burden of supervision and resource consumption, whilst their students get few elective opportunities. This study explores the value and feasibility of South-South Medical Elective Exchanges (SSMEE), which creates elective opportunities for African medical students in other African countries to create reciprocity within the elective system.
Method
A qualitative evaluation of the South-South Medical Elective Exchanges was conducted using a case study approach. Four African medical schools, College of Medicine, Malawi; University of Rwanda, Rwanda; University of Witwatersrand, South Africa and Makerere University, Uganda participated in the pilot in 2017/18. Each institution selected two students to participate in a four-week elective to another participating institute. Participating students completed a pre-elective questionnaire and a post-elective interview exploring expectations, learning outcomes, challenges and how they are applying this learning. Data was analysed thematically.
Results
Data presented is from six of the eight participating students. All students found the elective a valuable experience and learning was demonstrated in four key areas: clinical knowledge and skills; attitudes; personal and professional development and global perspectives. For some, it challenged their assumptions of what an elective is because valuable learning can be achieved whilst remaining in Africa. The main challenge found related to funding the elective.
Conclusions
The SSMEE model is feasible and provides valuable learning for participating students and their peers/colleagues. Financing electives remains the biggest challenge. Since this pilot, SSMEE has become part of a regional elective exchange network in Africa with an additional four institutions in three other countries. As such SSMEE has resulted in increased opportunities for African medical students and better educational outcomes that are likely to have a positive effect on healthcare systems in Africa.
The effectiveness of antiviral treatment in severe COVID-19 patients in Wuhan: a retrospective cohort study
Authors: Zhou Xianlong , Ding Guoyong , Yang Luyu , Liu Ruining , Hou Haifeng , Wang Ping , Ma Min , Hu Zhuanzhuan , Huang Lei , Xu Xizhu , Hu Quan , Zhao Yan , Xing Weijia , Zhao Zhigang
Published: May 2020

Background Since the outbreak of COVID-19, the application of appropriate treatment strategy for COVID-19 patients, notably for the severe patients, was a huge challenge in case management. Therefore, we aimed to evaluate the effectiveness of antiviral treatment in severe COVID-19 patients.Methods A retrospective cohort study was conducted from January 8, 2020 to March 9, 2020 in four designated hospitals of COVID-19 in Wuhan, China. 138 severe COVID-19patients with above 18 years were included in this study. 109 patients receiving the antiviral treatment were selected in antiviral group. The remaining 29 patients were in control group. The primary outcome of the study was in-hospital death and length of hospitalization. Secondary outcomes included ICU admission, length of stays in ICU, use of mechanical ventilation, length of mechanical ventilation, and the development of complications. Univariate analysis and Kaplan-Meier curves were used to examined the association between antiviral treatment and the clinical outcomes of the COVID-19 patients.Results 48 (44.0%) and 15 (51.7%) deaths were occurred in antiviral and control groups, respectively. Antiviral treatment was not associated with the rate of fatal outcome in COVID-19 patients (P > 0.05). Among the survival patients, the median length of hospitalization was 11.0 days (IQR: 6.5–18.0) and 16.0 days (IQR: 8.5–26.0) in antiviral and control groups, respectively. No significant association was identified between the antiviral treatment and the length of hospitalization in survival patients (P > 0.05). Moreover, the antiviral treatment was not statistically associated with ICU admission, mechanical ventilation and length of mechanical ventilation (P > 0.05, respectively). However, the length of ICU stays in deaths was different both groups (P < 0.05). The median length of ICU stays in deaths was 7.0 days (IQR: 3.0-14.3) and 15.5 days (IQR: 8.3–21.8) in antiviral and control groups, respectively. The occurrence of majority of complications were similar both groups. Sepsis was the single complication in which the occurrence rates were statistical different between the antiviral group and control group (40.4% vs 13.8%, P < 0.01).Conclusion No benefit of antiviral treatment in severe COVID-19 patients was observed in our study. Clinical physicians should cautiously prescribe the antiviral drugs in severe COVID-19 patients.
Nasal Decolonization of Staphylococcus Aureus and the Risk of Surgical Site Infection After Surgery: A Meta-Analysis
Authors: Tang Jia , Hui Jiangjin , Ma Jing , Chen Mingquan
Published: May 2020

Aim: To assess the effects of nasal decontamination on preventing surgical site infections (SSIs) in people who are S aureus carriers undergoing different types of surgeries. Methods: Relevant randomized controlled trials (RCTs) were identified through systematic searches of the PubMed, Embase, Web of science, and the Cochrane Library databases. The risk ratios (RRs) and 95% confidence intervals (CIs) were calculated and the effects model was chosen according to the heterogeneity. Subgroup analyses were performed according to different types of surgeries that S aureus carriers were applied.Results: Twenty RCTs published between 1996 and 2019 involving 10526 patients were included. Pooled results showed that the overall SSIs and pulmonary surgery SSIs presented with a statistical difference in measures of nasal decontamination (RR=0.59 and 0.47, respectively, both p<0.01). However, the associations between nasal decolonization and increased risks of SSIs in orthopedics surgery or cardiovascular surgery remained insignificant in studies.Conclusion: It seems that nasal decolonization of Staphylococcus aureus may be associated with a reduction of SSI in these patients, especially in patients receiving pulmonary surgeries.
INSURE (INtubate, SURfactant and Extubate) method in preterm infants with respiratory distress syndrome: a retrospective study
Authors: Mohideen Mohamed Mubarak Shaik Kidur , Wagh Deepika , Athikarisamy Sam
Published: May 2020

Background: Preterm infants with severe respiratory distress syndrome (RDS) are usually managed with endotracheal intubation and surfactant administration followed by mechanical ventilation however this has immediate and long-term complications. Hence, INSURE (Intubate, surfactant administration and extubate) method combined with continuous positive airway pressure (CPAP) support has been accepted as an alternative method in eligible infants. Aim of this study is to look at our experience of administering INSURE and to look at the factors predisposing to the failure of INSURE. Methods: A retrospective chart review was done of all the babies who were born in a tertiary hospital between 1 st January 2014 to 31 st December 2015 (2 years) and received surfactant through INSURE method. Infants requiring reintubation and mechanical ventilation within 3 days post INSURE are considered as INSURE failure for our study purpose. Results: Eighty-five infants were included in the review with gestational age (GA) ranging from 26 +3 to 35 +5 weeks and birth weight ranging from 680 to 3340 grams. Of these, 22 infants (26%) had INSURE failure. INSURE failure rate was higher in infants born <30 weeks gestation (40%). Higher FiO2 requirement prior to INSURE (mean FIO 2 0.5 vs 0.3, P value <0.001) and preeclampsia in mothers of infants < 30 weeks of GA (P value 0.027) were strongly associated with INSURE failure. No mortality was noted in either group. Conclusion: We found that INSURE method may be useful in preventing the need for mechanical ventilation in late preterm infants with RDS. However, this method may be less successful in preterm infants with lower GA (<30 weeks) and higher FiO2 requirement (≥0.5). More prospective studies are needed to assess the effectiveness of INSURE method.
Time Spent Abroad Predicts Late Presentation for HIV among HIV-positive Tajikistani Migrants to the Russian Federation
Authors: Alaei Arash , Bromberg Daniel J , Tate Mary M , Alaei Kamiar , Karimov Saifuddin , Saidi Dilshod
Published: May 2020

Background Between 700 thousand and 1.2 million citizens of Tajikistan currently live in the Russian Federation, one of the only countries where the HIV epidemic continues to worsen. Given the previously reported barriers to healthcare access for migrants to the Russian Federation, and the rapidly expanding HIV epidemic in Eastern Europe and Central Asia, this present study set out to determine whether these barriers impact late presentation with HIV among Tajik migrants upon their return to Tajikistan. Method This study uses data from the Tajikistan Ministry of Health surveillance system (2006 – 2019). At time of diagnosis, patients are interviewed by staff of AIDS centers, and doctors complete routine intake forms and complete medical exam. Descriptive characteristics of HIV-positive migrant who had lived in the Russian Federation (n=503) were calculated and compared with those of HIV-positive non-migrants (n=9519). Missing data were imputed using a multiple imputation (predictive means matching, logistic regression imputation, and polytomous regression imputation). Two logistic models were created to model the probability of late presentation for HIV. The first model shows unadjusted associations between predictor variables and late presentation for HIV. The second model is shows multivariable associations between significant study variables identified in the univariate model, and late presentation. Results Compared to non-migrants, HIV-positive migrants are more likely to be from Gorno-Badakhshan region, are less likely to use illicit drugs, are more likely to have purchased the services of sex workers, and have more sexual partners on average. The unadjusted logistic model found that for every year spent in the Russian Federation, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.3-7.7). The multivariate model showed that when age, sex, and region of origin are held constant, the risk of late presentation for an HIV-positive Tajikistani migrant increases by 4.0% (95% CI: 0.1-7.8) for each year spent in the Russian Federation. Conclusion The results of this paper suggest that if the Russian Federation were loosen its restrictions of HIV care for foreign nationals, it might improve the treatment outcomes of migrant laborers. Further research is needed to explicate the causal pathways of the associations found in the present analysis.
Creating a ‘simulacrum’ of in-class learning environment employing distance learning modality during the COVID-19 pandemia: Quod Erat Demonstrandum
Authors: Azar Aida , Khamis Amar Hassan , Naidoo Nerissa , Lindsbro Marjam , Gonuguntla Suneetha , Banerjee Yajnavalka
Published: May 2020

Background The COVID-19 pandemic has forced medical schools to suspend on-campus live-sessions and shift to distance-learning (DL). This precipitous shift presented medical educators with a challenge, “to create a ‘simulacrum’ of the learning environment that students experience in classroom, in DL”. Aim We define a DL framework that provides a ‘simulacrum’ of classroom experience and can be effectively employed for course delivery in a competency-based curriculum during unprecedented times. Methodology The framework’s blueprint was designed amalgamating principles of: Garrison’s community inquiry, Siemens’ connectivism and Harasim’s online collaborative-learning; and improved using Anderson’s DL-model. Effectiveness of the designed framework in course delivery was demonstrated using the exemplar of fundamentals in epidemiology and biostatistics (FEB) course in our curriculum during COVID-19 lockdown. Virtual live-sessions integrated in the framework employed a blended-approach informed by instructional-design strategies of Gagne and Peyton. The efficiency of the framework was evaluated using first two levels of Kirkpatrick’s framework i.e. perception and cognitive development. Results Of 60 students, 51 (85%) responded to the survey assessing perception towards DL (Kirkpatrick’s Level:1). The survey-items, validated using exploratory factor analysis, were classified into four categories: computer expertise; DL flexibility; DL usefulness; and DL satisfaction. The overall mean (SD) score of 62.0 (9.0) for the four categories, highlighted respondents’ overall satisfaction with the framework. Scores for specific survey-items attested that students had an enriched learning experience, which promoted collaborative-learning and student-autonomy. For, Kirkpatrick’s Level:2 i.e. cognitive-development, performance in FEB’s summative-assessment of students experiencing DL was compared with students taught using traditional methods. Similar, mean-scores for both groups indicated that shift to DL didn’t have an adverse effect on students’ learning. Conclusion QED, we have demonstrated that the framework is an efficient pedagogical approach, pertinent for medical schools to adopt (elaborated using Bourdieu’s Theory of Practice) to address students’ learning trajectories during unprecedented times.
Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach.
Authors: Zhao Chen , Luo Lei , Liu Liehua , Li Pei , Liang Lichuan , Gao Yongjian , Luo Fei , Xu Jianzhong , Zhou Qiang
Published: May 2020

Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis.Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores and complications were compared between the two groups.Results: There was no significant difference in the operation time or blood loss between groups A and B (P>0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2±15.2° and 27.9±7.7°, respectively, which significantly decreased to 4.9±11.8° and 10.4±5.6° after the operation, respectively (P<0.05). At the final follow-up, the angles were 7.1±10.5° and 14.6±8.0°, respectively. The correction angle and correction rate in group A (31.3±16.6°, 88.6±43.6%) were greater than those in group B (17.5±4.4°, 64.9±14.0%) (P<0.05). There was no significant difference in the loss angle between groups A and B (P>0.05), but the loss rate in group B (24.0±27.8%) was higher than that in group A (9.6±10.2%) (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.
Magnetic Resonance Imaging and Dynamic X-ray's correlations with Dynamic Electrophysiological Findings in Cervical Spondylotic Myelopathy: a retrospective cohort study.
Authors: Yu Zhengran , Lin Kaiyuan , Chen Jiacheng , Chen Kuan-Hung , Guo Wei , Dai Yuhu , Chen Yuguang , Zou Xuenong , Peng Xinsheng
Published: May 2020

Background
Dynamic somatosensory evoked potentials (DSSEP) can be used to disclose abnormalities of ascending sensory pathways at dynamic positions and diagnose cervical spondylotic myelopathy (CSM). However, radiographic tests including magnetic resonance imaging (MRI) and dynamic X-ray are used much more widely in the management of CSM. Our study aims to clarify the correlations between several radiographic parameters and the DSSEP results, and further determine their reliability with clinical data.
Methods
We retrospectively enrolled 38 CSM patients with surgical intervention. DSSEP tests were performed before surgery. Amplitude ratios of DSSEP N13 and N20 waves at extension and flexion were calculated and recorded as N13_E, N20_E, N13_F, N20_F respectively. Baseline severity was evaluated with the modified Japanese Orthopedic Association (mJOA) score and the Nurick grades. Prognosis was evaluated based on the 2-year recovery rate. Sagittal diameter and transverse areas of the cord and canal were measured and the Spinal cord/Canal Area Ratio were calculated. The compressive ratios at the compressed site (Compression_Ratio), central (Central_Ratio) and 1/4-lateral points (1/4-Lateral_Compression_Ratio), and intramedullary T2 hyperintensity patterns (Ax-CCM types) were also collected from MRI axial images. Dynamic X-rays were used to test for segmental instability of the cervical spine. The correlations between radiologic findings, DSSEP data, and clinical assessments were investigated.
Results
We found that DSSEP N13_E and N13_F correlated with the Compression_Ratio, Central_Ratio, 1/4-Lateral_Compression_Ratio (Pearson, p < 0.05) and Ax-CCM types (ANOVA, p < 0.05) in MRI axial images and cervical segmental instability in dynamic X-ray (t-test, p < 0.05). Apart from the 1/4-Lateral_Compression_Ratio, these radiographic parameters above also correlated with the baseline clinical assessments (Spearman or ANOVA or t-test, p < 0.05) and postoperative recovery rate (Pearson or ANOVA or t-test, p < 0.05).
Conclusions
We found that the preoperative Compression_Ratio, Central_Ratio and 1/4-Lateral_Compression_Ratio in MRI and cervical segmental instability in dynamic X-ray could reflect the dynamic neural dysfunction of the spinal cord. Different Ax-CCM types corresponded to different DSSEP results at extension and flexion, suggesting divergent pathophysiology. These radiographic parameters could help evaluate disease severity and predict postoperative prognosis.
Trial registration:
The trial was retrospectively registered on April 30th, 2020 and the registration number is "[2020]151".
Predictive value of pentraxin-3 on disease severity and prognosis in patients with hemorrhagic fever with renal syndrome
Authors: Du Hong , Hu Haifeng , Wang Pingzhong , Wang Xiaoyan , Zhang Ying , Jiang Hong , Li Jing , Bai Xuefan , Lian Jianqi
Published: May 2020

Background

Pentraxin-3 is an acute-phase protein involved in the processes of inflammatory and infection. This study aimed to analyze the changes of plasma pentraxin-3 prospectively and evaluate its predictive value on disease severity and prognosis in patients with hemorrhagic fever with renal syndrome (HFRS).
Methods

105 patients with HFRS admitted by the Second Affiliated Hospital of Air Force Medical University from October 2012 to December 2014 were randomly enrolled in this study. All patients were divided into a mild-type group (17 cases), a moderate-type group (27 cases), a severe-type group (26 cases) and a critical-type group (35 cases) according to the HFRS criteria for clinical classification. 96 venous blood samples of acute phase and 65 of convalescent phase were collected from patients during hospitalization, while venous blood samples of 27 healthy volunteers were taken as controls. The levels of plasma pentraxin-3 were detected using the enzyme linked immunosorbent assay (ELISA), and which were compared among the acute and convalescent phases in different types of patients, as well as the control group. Spearman correlation analysis was used to evaluate the correlation between pentraxin-3 and conventional laboratory parameters. The predictive effectiveness for prognosis of pentraxin-3 was evaluated by receiver operating characteristic (ROC) curve analysis.
Results

There was no significant difference in gender and age distribution between all types of patients and control group (P > 0.05). In all types of patients, the levels of pentraxin-3 in acute phase were significantly higher than that of control group and convalescent phase of the same type (P < 0.05). The levels of pentraxin-3 increased with the aggravation of the disease, and showed the highest expression in critical-type patients (P < 0.05). Pentraxin-3 was positively correlated with WBC, AST and APTT, and negatively correlated with PLT, ALB and Fib (|rs|>0.500, P < 0.001). Pentraxin-3 showed significant predictive value for the prognosis of patients with HFRS, with the area under ROC curve (AUC) of 0.753 (95%CI: 0.593 ~ 0.914, P = 0.003).
Conclusions

The detection of plasma pentraxin-3 can be beneficial to the evaluation of disease severity and prognosis in patients with HFRS.
Dental Students’ Perceptions of Undergraduate Oral and Maxillofacial Surgery Teaching in an Integrated Curriculum at Kuwait University
Authors: Kamal Mohammad , Abdulwahab Mohammad
Published: May 2020

Background:To evaluate dental students’ perceptions of the undergraduate oral and maxillofacial surgical training teaching curriculum according to a validated questionnaire originally developed by the Association of British Academic Oral Maxillofacial Surgeons (ABAOMS) to assess their self-confidence.Methods:A cross-sectional survey of all 6th-year (n=22) and 7th-year (n=21) dentistry students that was conducted Kuwait University Faculty of Dentistry between 1 and 15 May 2020. A previously implemented and validated questionnaire by ABAOMS was used in the study which is made of 17 questions assessing various areas of the undergraduate OMFS curriculum in the clinical years. The response options to the questionnaire questions were on a Likert scale. Independent sample t-tests were performed to assess the difference in responses between the two groups. Spearman’s Rho correlations were calculated to measure the strength of association between confidence in all aspects of surgical and forceps exodontia. Statistical significance was considered to be a p-value <0.05.Results:A total of 39 questionnaire were completed by the students, with a response rate of 90,90% for the sixth-year students and 90,47% of the seventh-year students. 37 respondents were female (94.9%) reflecting the majority of female students at the faculty. The majority of students expressed that they feel confident that they have enough knowledge to undertake independent practice (61%). General aspects of the questionnaire were answered favourably except for the step of surgical extraction of teeth, in which both classes reported lower level of confidence.Conclusions:This survey revealed the students’ self-confidence undertaking independent practice and preforming basic oral surgery procedures. Students felt comfortable with exodontia using forceps and elevators, root removal, managing acute pericoronitis, managing haemorrhage from a socket, assessing impacted teeth, and recognizing the clinical features of potentially malignant and malignant lesions of the oral cavity. They reported lower level of confidence for performing the steps of surgical procedures. The ABAOMS survey instrument is a useful and thorough tool to assess the self-confidence of the dental students according to their undergraduate oral and maxillofacial surgery teaching.
Radiomics for intracerebral hemorrhage: are all small hematomas benign?
Authors: Zhan Chen-yi , Chen Qian , Zhang Ming-yue , Liu Jin-jin , Xiang Yi-lan , Chen Jie , Zhu Dong-qin , Chen Chao , Xia Tian-yi , Yang Yunjun
Published: May 2020

Background: Radiomics is a valuable tool for predicting hematoma expansion (HE) but has not been used for small intracerebral hemorrhage (ICH). We hypothesized that not all small hematomas are benign and that radiomics could predict HE and short-term outcomes in small hematomas.Methods: We analyzed 313 patients with small ICH who underwent baseline noncontrast CT within 6 h of symptom onset between September 2013 and February 2019. Small ICH was defined as baseline hematoma volume <10 mL. A radiomic score (R-score) was developed in a training (n=218) and validated in a test cohort (n=95). Poor outcome was defined as a Glasgow Outcome Scale score ≤3. The relationship of the R-score with HE and outcomes was investigated using univariate and multivariate analyses. Predictive performance was assessed by the area under the receiver operating characteristic (ROC) curve (AUC).Results: R-score was an independent predictor of HE in the training (odds ratio [OR]: 2.557; 95% CI, 1.455–4.492) and test cohorts (OR, 3.985; 95% CI, 1.051–14.453). In the 3–10 mL subgroup, but not in the <3 ml subgroup, the R-score was independently associated with HE (OR, 4.293; 95% CI, 2.095–8.796) and poor outcome (OR, 1.297; 95%CI, 1.004–1.674) after adjusting for confounders. The R-score achieved good discrimination ability for HE in the training and test cohorts and the 3–10 mL subgroup (AUCs 0.728, 0.717, and 0.740, respectively).Conclusions: Radiomics provides an objective and effective approach for discriminating between benign and malignant course in patients with small ICH, particularly 3–10 mL hematomas.
Increased Expression of KNSTRN in Lung Adenocarcinoma Predicts Poor Prognosis: A Bioinformatics Analysis Based on TCGA Data
Authors: Deng Pengbo , Zhou Rongrong , Zhang Jinghui , An Jian , Cao Liming
Published: May 2020

Background: Available evidence indicates that kinetochore-localized astrin/SPAG5-binding protein (KNSTRN) is an oncogene in skin carcinoma. This study aimed to evaluate the prognostic value of KNSTRN in lung adenocarcinoma (LUAD) underlying the Cancer Genome Atlas (TCGA) database. Methods: The relationship between clinicopathological features and KNSTRN was analyzed with the Wilcoxon signed-rank test and logistic regression. The clinicopathological characteristics associated with overall survival (OS) were evaluated using Cox regression and the Kaplan–Meier method. Gene ontology (GO) analysis, gene set enrichment analysis (GSEA), and single-sample GSEA (ssGSEA) were performed using TCGA data.Results: The KNSTRN expression level was found to be significantly higher in LUAD tissue than in normal lung tissue. Also, it correlated significantly with advanced clinicopathological characteristics. The Kaplan–Meier survival curve revealed a significant relationship of high expression of KNSTRN with poor OS in patients with LUAD. The multivariate Cox regression hazard model demonstrated the KNSTRN expression level as an independent prognostic factor for patients with LUAD. GO and GSEA analyses indicated the involvement of KNSTRN in cell cycle checkpoints, DNA replication, and G2-M checkpoint M phase. Based on ssGSEA analysis, KNSTRN had a positive relationship with Th2 cells and CD56dim natural killer cells. The KNSTRN expression levels in several types of immune cells were significantly different.Conclusion: The findings suggested that the increased expression level of KNSTRN was significantly associated with the progression of LUAD and could also serve as a novel prognostic biomarker for patients with LUAD.
Initial dip predicts renal protective effects after the administration of sodium-glucose cotransporter 2 inhibitors in patients with type 2 diabetes and chronic kidney disease with normoalbuminuria
Authors: Takahashi Kiyohiko , Nakamura Akinobu , Furusawa Sho , Yokozeki Kei , Sugawara Hajime , Yanagisawa Hideyuki , Akikawa Kazumasa , Kikuchi Hideaki
Published: May 2020

Background: We investigated the renoprotective effects of sodium-glucose cotransporter 2 inhibitors (SGLT2is) on renal function in patients with type 2 diabetes and chronic kidney disease (CKD) with normoalbuminuria. Methods: A retrospective review of clinical records of Japanese participants with type 2 diabetes and CKD (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m 2 ) with normoalbuminuria (urine albumin to creatinine ratio < 30 mg/g Cr and/or urinary protein to creatinine ratio < 150 mg/g Cr) was conducted. Participants were categorized into two groups depending on whether they had started using SGLT2is. The main study outcome was a comparison of the change in renal function evaluated by eGFR after 1 year (ΔeGFR + 1 y) between the two groups. Then, we identified predictors that were associated with the outcome. Results: Among the 48 participants, 21 were treated with SGLT2is (SGLT2 group) and 25 were treated with other antidiabetic medications (control group). Although eGFR was significantly decreased at 1 year in the control group, the decline in eGFR was not observed in the SGLT2 group. The change in eGFR was significantly greater in the SGLT2 group than in the control group (ΔeGFR + 1 year, -4.0 [-7.7 to -0.3] mL/min/1.73 m 2 in the control group, 0.9 [-3.9 to 5.7] mL/min/1.73 m 2 in the SGLT2 group; P = 0.0231). Additionally, multiple linear regression analysis showed that an initial dip was an independent factor associated with the worsening of renal function in the SGLT2 group. Conclusions: Although more favorable effects of SGLT2is on renal function were observed in patients with type 2 diabetes and CKD with normoalbuminuria, the higher initial dip was a possible marker of worsening renal function after the initiation of SGLT2is.
Original Scientific Report Anastomosis technique for pancreatojejunostomy and early removal of drainage tubes may reduce postoperative pancreatic fistula
Authors: Kawaida Hiromichi , Kono Hiroshi , Amemiya Hidetake , Hosomura Naohiro , Watanabe Mitsuaki , Saito Ryo , Nakata Yuuki , Shoda Katsutoshi , Shimizu Hiroki , Furuya Shinji , Akaike Hidenori , Kawaguchi Yoshihiko , Sudo Makoto , Matsuda Masanori , Itakura Jun , Fujii Hideki , Ichikawa Daisuke
Published: May 2020

Background Postoperative pancreatic fistula (POPF) is one of the most serious complications after pancreaticoduodenectomy (PD). Various factors have been reported as POPF risks, but the most serious of these is soft pancreas. To reduce POPF occurrences, many changes to the PD process have been proposed. This study evaluates short-term results of anastomosis technique for PD.Methods In total, 120 patients with soft pancreases who had undergone PD at Yamanashi University between January 2012 and December 2019 were analyzed. We divided these patients into two groups: a conventional group (n = 67) and a modified group (n = 53).Results The rate of clinically relevant POPF was significantly lower in the modified group than that in the conventional group (1.9% vs 22.4%, p < 0.001), with there being only one case of POPF in the modified group. There were no cases of POPF-related hemorrhaging in the modified group. On the third day after the operation, the amylase levels in the drainage fluid for the modified group had reduced to one third of those in the conventional group (1696 vs 643 U/L).Conclusions Our novel anastomosis technique for pancreatojejunostomy reduced POPF in PD, especially in cases where the patient had a soft pancreas.
Cervicogenic Headache and the Relationship Between the Position and Movement of the Upper Cervical Spine and Dura
Authors: Sillevis Rob , Shamus Eric , Wyss Karen
Published: May 2020

Background: It has been demonstrated that cervicogenic headaches (CGH) is caused by dysfunction of the upper cervical spine. Due the soft tissue connection between muscle, cervical fascia and dura, this region might contribute to the development of CGH’s. This study evaluated if subjects with CGH have concurrent neural tension signs. The secondary aim of this study was to investigate if there is a correlation between the position of atlas and mobility of atlantoaxial joint in those experiencing cervicogenic headaches compared to a healthy control group.Methods: A convenience sample of 60 subjects were recruited for this study. Each subjected completed self-reported outcome measures, after which the passive neck flexion rotation test, upper limb tension test (ULTT), slump test, and straight leg raise test (SLR) was performed by the physical therapist.Outcomes: There was a significant difference in the passive atlantoaxial rotation to the right between the CGH and the control group p = 0.025. There was a no statistically significance in left rotation. There was no significant relationship between CGH and the ULTT, slump ad SLR with P > 0.05. The position of atlas was significantly related with CGH with P < 0.001 and position of atlas was significantly related to AA motion with p < 0.001Discussion: The results of this study demonstrate that there is a direct relationship between the position of atlas, unilateral restriction in AA rotation, and the presence of CGH’s. The presence of fascial connections between structures of the high cervical spine and the dura motion could result in dural tension and should be considered by physical therapists when managing patients with CGH. The use of the ULTT, Slump test, and SLR test do not appear beneficial identifying those with CGH.
Improving clinical outcomes and patient satisfaction among patients with coronary artery disease: an example of enhancing regional integration between a cardiac centre and a referring hospital
Authors: Veghel Dennis van , Hamad Mohamed Soliman , Schulz Daniela , Cost Bernard , Simmers Timothy , Dekker Lukas
Published: May 2020

Background Value-based healthcare (VBHC) is a promising strategy to increase patient value. For a successful implementation of VBHC, intensive collaborations between organizations and integrated care delivery systems are key conditions. Our aim was to evaluate the effects of a pilot study regarding enhancing regional integration between a cardiac centre and a referring hospital on patient-relevant clinical outcomes and patient satisfaction.Methods The study population consisted of a sample of patients treated for coronary artery disease by use of a coronary artery bypass graft or a percutaneous coronary intervention between 2011 and 2016. Since 2013, the two hospitals have implemented different interventions to improve clinical outcomes and the degree of patient satisfaction, e.g. improvement of communication, increased consultant capacity, and introduction of outpatient clinic for complex patients. To identify intervention effects, logistic regression analyses were conducted. Patients’ initial conditions, like demographics and health status, were included in the model as predictors. Clinical data extracted from the electronic health records and the hospitals’ cardiac databases as well as survey-based data were used.Results Our findings indicate a non-significant increase of event-free survival of patients treated between 2014 and 2016 compared to patients treated between 2011 and 2013 (97.4% vs. 96.7% respectively). This non-significant improvement over time has led to significant better outcomes for patients referred from the study referring hospital compared to patients referred from other hospitals. The level of patient satisfaction (response rate 32.2%;216 out of 669) was improved and reached statistically significant higher scores regarding patient information and education (p=.013), quality of care (p=.007), hospital admission and stay (p=.032), personal contact with the physician (p=.024), and total impression (p=.007).Conclusions This study shows a promising effect of regional integration. An intensified collaboration in the care chain, organized in a structured manner between a cardiac centre and a referring hospital and aiming at high quality, resulted in successful improvement of clinical outcomes and degree of patient satisfaction. The applied method may be used as a starting point of regional integration with other referring hospitals. We encourage others to organize the whole care chain to continuously improve patient-relevant outcomes and patient satisfaction.Trial registration: ISRCTN11311830. Registered 01 October 2018 (retrospectively registered)
Up-regulated Expression and Related Gene Regulatory Networks of ANLN Predict Poor Prognosis and Correlate with Immune Infiltration in Hepatocellular Carcinoma
Authors: Hu Bo , Yang Xiao-Bo , Sang Xinting
Published: May 2020

Background: The aberrant Anillin (ANLN) expression is reported to be associated with carcinogenesis. In this study, sequencing data collected from the Cancer Genome Atlas database were utilized to analyze ANLN expression in hepatocellular carcinoma (HCC).Methods: The relationships of clinicopathological features with ANLN were investigated, and gene set enrichment analysis (GSEA) was performed to reveal the ANLN-related functions. LinkedOmics was employed to identify the co-expressed genes of ANLN and to examine the target networks of kinases, microRNAs (miRNAs) and transcription factors (TFs). Besides, the correlation of ANLN expression with cancer immune infiltrates was analyzed by TIMER. Results: ANLN over-expression predicted dismal prognosis, and GESA results revealed several functions that were related to cell cycle and mRNA binding. Moreover, functional network analysis indicated that, ANLN might regulate DNA replication and cell cycle signaling through pathways that involved several cancer-related kinases, miRNAs and E2F1. Additionally, ANLN was suggested to be associated with the infiltration of several immune cells, which was proved to be upregulated in both HCC cells and tissues. Conclusion: Those efficiently mined data reveal information regarding ANLN expression, the potential regulatory networks and the relationship with immune infiltration in HCC, which lay a foundation for further study on the role of ANLN in carcinogenesis.
Circulating microRNA-762 upregulates colorectal cancer might through Wnt-1/β-catenin signaling
Authors: Lai Peng-Sheng , Chang Wei-Min , Chen Ying-Yin , Lin Yi-Feng , Liao Hui-Fen , Chen Chung-Yu
Published: May 2020

Background

A number of microRNAs (miRNAs) have been demonstrated to be correlated with the diagnosis, progression and prognosis of colorectal cancer (CRC). However, the key miRNAs and the associated signaling pathways that regulate the growth and metastasis of CRC remain unclear.
Methods

miRNA array was analyzed in CRC CT26 cell-transplanted BALB/c mice. The effects of miR-762 mimics and inhibitors on the growth, invasion, cell cycle, and regulatory pathways of CRC CT26 cells were assessed. Cell cycle and sub-G1 assay were collected from the treated CT26 cells. Finally, blood samples were collected from patients with CRC. Further analysis to compare miR-762 levels in blood samples collected from CRC patients and normal control donors. Patients’ basic data were retrieved from electronic medical records and analyzed for age, gender, tumor staging, and survival.
Results

The miRNA levels in mice with CRC cell implantation indicated that plasma mmu-miR-762 was upregulated. Transfection of mmu-miR-762 mimic to CT26 cells increased cell viability, invasion, and EMT, whereas transfection of mmu-miR-762 inhibitor decreased the above abilities. Cells treated with high-concentration mmu-miR-762 inhibitor induced cell cycle arrest at G0/G1 phase. However, mmu-miR-762 did not cause apoptosis of cells. Western blot analysis showed that mmu-miR-762 mimic transfection upregulated the expression of Wnt-1 and β-catenin, as well as increased the nuclear translocation of β-catenin. Further analysis was performed to demonstrate the correlation of has-miR-762 with CRC, and blood samples were collected from CRC patients and control donors. The results showed that serum has-miR-762 levels in CRC patients were higher than in control donors. Among the CRC patients, patients with distant metastasis showed higher serum has-miR-762 levels than patients without distant metastasis.
Conclusions

The present study demonstrated that circulating miR-762 might be a biomarker with upregulation of CRC cell growth and invasion through the Wnt/β-catenin signaling.
Tespa1 negatively modulates asthmatic attack is associated with IL-4/STAT-6 pathway of mast cell
Authors: Yang Ruhui , Wang Guangli , Li Lingyun , He Hanjiang , Zheng Mingzhu , Lu Linrong , Wu Songquan
Published: May 2020

Background Thymocyte-expressed, positive selection-associated 1 (Tespa1) is a critical signaling molecule in thymocyte development. This study aimed to investigate the regulatory effect of Tespa1 on mast cells in the pathogenesis of asthma and its relationship with the interleukin (IL)-4 /signal transducers and activators of transcription 6 (STAT6) signaling pathway. Methods Tespa1 mRNA expression analysis and IgE levels were carried out using the induced sputum of 33 adults with stable asthma and 36 healthy controls. Tespa1- knockout mice ( Tespa1 -/- , KO) and C57BL/6 background (wild-type, WT) mice were sensitized and treated with ovalbumin (OVA) to establish an asthma model. Pathological changes, number and activity of mast cells, and changes in activity of the IL-4 /STAT-6 pathway in lung tissue were detected. The changes of enzyme activity and STAT6 activity after mast cell gene knockout were analyzed in vitro . The changes of enzyme activity and STAT6 activity after mast cell gene knockout were analyzed in vitro . The association between the Tespa1 and P-STAT6 was analyzed by immunoprecipitation method. Results Compared with the healthy controls, Tespa1 expression was decreased, and IgE levels were elevated in the sputum of asthmatic patients. Animal experiments showed that Tespa1 -/- mice exhibited more severe inflammation, higher quantity of goblet cells and mast cells in the bronchium, and greater activity of mast cell tryptase, which is induced by ovalbumin, than WT mice. And IL-4, IL-13, phospho-Janus kinase 1, and P-STAT6 expressions presented a higher increase in the Tespa1 -/- mouse model than in the WT mouse model. Further in vitro studies confirmed that IL-4 could more significantly promote tryptase and P-STAT6 activities in Tespa1 -/- mast cells than their WT counterparts. Correlation analysis results showed a negative correlation between Tespa1 and P-STAT6. Immunoprecipitation results showed a direct link between Tespa1 and P-STAT6. Conclusions Altogether, our results indicate that Tespa1 can negatively regulate mast cell activity, and this event is related to the mast cell IL-4/STAT6 signaling pathway and could be therapeutically exploited to treat asthma attacks.
Evaluation of Larvicidal Activities of Parthenium Hysterophorus L. Against Anopheles Arabiensis (Diptera: Culicidae), the Major Malaria Vector in Ethiopia
Authors: Tarekegn Mihretu Nigatu , Wolde-hawariat Yitbarek , Dugassa Sisay , Tekie Habte
Published: May 2020

Background: Malaria is a leading public health problem in Ethiopia despite the implementation of effective indoor vector control strategies over several decades. Vector control operations in the country largely depend on the application of Indoor Residual Spraying (IRS) of synthetic insecticides and Long Lasting Insecticidal Nets (LLINs) which resulted in a significant reduction in the malaria burden. The spread of resistance to insecticides in these indoor vector control tools in vector species is a serious challenge. Alternatively, reports indicate that botanicals which are relatively safe possess toxic compounds with high larvicidal activities. However, there are limited evidences on the larvicidal effect of botanicals against the malaria vectors, Anopheles arabiensis . This study aimed to evaluate the larvicidal activities of the extracts of the roots, stems, and leaves of Parthenium hysterophorus against the 4 th instar larvae of An. arabiensis . Methods: Field collected leaves, stems and root parts of P. hysterophorus were dried and separately ground to powder and extracted in petroleum ether, hexane, acetone, and ethanol solvents. The extracts were concentrated using a Rota evaporator, and stock solutions were subject to serial dilutions for use as test concentrations. Laboratory reared 4 th instar larvae of An. arabiensis were used for the larvicidal bioassays. Mortality data were subjected probit analysis to determine LC 50 and LC 90 of the extracts. Results: The results showed that there were significant differences in percentage larval mortalities (P<0.05) among different concentrations of the leaf, stem, and root solvent extracts, respectively. Hexane extracts of leaves and stem of P. hysterophorus at 480ppm caused the highest mortality of 4 th larval instar of An. arabiensis (85% and 96.7%, respectively) compared to those of ethanolic, acetone, and petroleum ether extracts of these plant parts. Petroleum ether extracts of the root of P. hysterophorus were the most effective in causing very high larval mortality at 360ppm and 480ppm (98.3%). The LC 50 value of petroleum ether root extract (10.7ppm) and LC 90 value of petroleum ether root extract (105.5ppm) were significantly lower than those of ethanol, acetone, and hexane root extracts, respectively. Conclusion: Petroleum ether root extract of P. hysterophorus has remarkably high larvicidal potential against 4 th instar larvae of An. arabiensis which could be exploited for malaria vector control. Further studies on the larvicidal efficacy of the extracts under field conditions and identification of the bioactive components in the root parts of this weed plant are recommended.
High-entropy (Nd0.2Sm0.2Eu0.2Y0.2Yb0.2)4Al2O9 with good high temperature stability, low thermal conductivity and anisotropic thermal expansivity
Authors: Zhao Zifan , Xiang Huimin , Chen Heng , Dai Fu-zhi , Wang Xiaohui , Peng Zhijian , Zhou Yanchun
Published: May 2020

The critical requirements for the environmental barrier coating (EBC) materials of silicon-based ceramic matrix composites (CMCs) including good tolerance to harsh environments, thermal expansion match with the interlayer mullite, good high-temperature phase stability and low thermal conductivity. Cuspidine-structured rare-earth aluminates RE4Al2O9 have been considered as candidates of EBCs for their superior mechanical and thermal properties, but the phase transition at high temperatures is a notable drawback of these materials. To suppress the phase transition and improve the phase stability, a novel cuspidine-structured rare-earth aluminate solid solution (Nd0.2Sm0.2Eu0.2Y0.2Yb0.2)4Al2O9 was designed and successfully synthesized inspired by entropy stabilization effect of high entropy ceramics. The as-synthesized (Nd0.2Sm0.2Eu0.2Y0.2Yb0.2)4Al2O9 exhibits close thermal expansion coefficient (6.96×10-6 /K at 300-1473 K) to that of mullite, good phase stability from 300 K to 1473 K, and low thermal conductivity (1.50 W·m-1·K-1 at room temperature). In addition, strong anisotropic thermal expansion has been observed compared to Y4Al2O9 and Yb4Al2O9. The mechanism for low thermal conductivity is attributed to the lattice distortion and mass difference of the constituent atoms while the anisotropic thermal expansion is due to the anisotropic chemical bonding enhanced by the large size rare earth cations.