bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a robust immune-related risk signature for hepatocellular carcinoma
Authors: Liu Zaoqu , Jiao Dechao , Zhou Xueliang , Yao Yuan , Li Zhaonan , Li Jing , Chen Jianjian , Lei Qinyu , Han Xinwei
Published: March 2020

Background: A growing amount of evidence has suggested immune-related genes (IRGs) play a key role in the development of hepatocellular carcinoma (HCC). However, there have been no investigations proposing a reliable prognostic signature in terms of tumor immunology. This study aimed to develop a robust signature based on IRGs in HCC.Methods: A total of 597 HCC patients were enrolled. The TCGA database was utilized for discovery, and the ICGC database was utilized for validation. Multiple algorithms (including univariate Cox, LASSO, and multivariate Cox regression) were performed to identify key prognostic IRGs and establish an immune-related risk signature. Bioinformatics analysis and R soft tools were utilized to annotate underlying biological functions. Results: A total of 1416 differentially expressed mRNAs (DEMs) were screened in the TCGA cohort, of which 90 were differentially expressed IRGs (DEIRGs). Using univariate Cox regression analysis, we identified 33 prognostically relevant DEIRGs. Using LASSO regression and multivariate Cox regression analysis, we extracted 8 optimal DEIRGs (APLN, CDK4, CXCL2, ESR1, IL1RN, PSMD2, SEMA3F, and SPP1) to construct a risk signature with the ability to distinguish cases as having a high or low risk of unfavorable prognosis in the TCGA cohort, and the signature was verified in the ICGC cohort. The signature was prognostically significant in all stratified cohorts and was deemed an independent prognostic factor for HCC. We also built a nomogram with good performance by combining the signature with clinicopathological factors to increase the accuracy of predicting HCC prognosis. By investigating the relationship of the risk score and 8 risk genes from our signature with clinical traits, we found that the aberrant expression of the immune-related risk genes is correlated with the development of HCC. Moreover, the high-risk group was higher than the low-risk group in terms of tumor mutation burden (TMB), immune cell infiltration, and the expression of immune checkpoints (PD-1, PD-L1, and CTLA-4), and functional enrichment analysis indicated the signature enriched an intensive immune phenotype.Conclusions: This study developed a robust immune-related risk signature and built a predictive nomogram that reliably predict overall survival in HCC, which may be helpful for clinical management and personalized immunotherapy decisions.
Pathological significance of C3aR signaling in the tumor cells of clear cell renal cell carcinoma: a clinical observation
Authors: Zheng Jing-Min , Tian Xiong , Gan Mei-Fu , Yu Hong-Yuan , Mo Li-Cai
Published: March 2020

Background Increasing evidences suggest that anaphylotoxin-induced signaling is involved in tumor pathogenesis, but the exact role of C3a/C3aR signaling in clear cell renal cell carcinoma (ccRCC) still remains to be investigated. The aim of the study was to investigate the pathological significance of C3a/C3aR signaling in ccRCC. Methods The expression of C3aR and C3 mRNA in the tumor tissues of ccRCC patients were analyzed by using the data from TCGA database. The expression of C3aR and C3c protein in the tumor tissues of another 129 ccRCC patients were examined by immunohistochemistry. Results Compared with the normal controls, both C3aR and C3 mRNA increased in the tumor tissues. Patients with higher C3 mRNA had shorter survival time. Immunostaining for C3aR and C3c also increased in the tumor tissues when compared with the adjacent normal renal tissues. Higher level of C3aR in the tumor cells and C3c in the tumor tissues were found to be associated with indices reflecting poor prognosis including higher tumor grade, the presence of necrosis in tumor tissues and shorter survival time. Besides, the level of C3aR in the tumor cells and C3c in the tumor tissues were found to correlate with the level of Vimentin, E-Cadherin and the ratio of Ki-67 positive tumor cells. Conclusions These results support the idea that C3aR signaling is over-activated in the tumor cells and may contribute to the progression of ccRCC. Inducing EMT and promoting the proliferation of tumor cells might be among the mechanisms underlying the role of C3aR signaling in ccRCC.
Analysis of the mental health status and risk factors of the general population in Beijing, China: A cross-sectional study
Authors: XIE YUJIN , Shi Lei , Ying Liu , Liu Di , Yang Jiao , Hong Yu
Published: March 2020

Background: This study sought to understand the mental health status of Beijing’s general population, analyze the risk factors that affect it, and provide a scientific basis for promoting the physical and mental health of the general population.Methods: A cross-sectional design was used. Overall sampling was used to select 6,364 people who had undergone a physical examination from January to December 2018 and volunteered to participate in an assessment of their mental health. We used the SCL-90 to establish the current normal mental health model of the general population in Beijing. After using the PEM System to export and automatically generate Excel files, SPSS 19.00 was utilized for statistical analysis. Descriptive statistical analysis methods were used to analyze the mental health status of the respondents and the mean and standard deviation of each factor. A t-test was used to compare the mental health of the general population in Beijing with the Chinese norm in 1986. Multiple linear regression analysis was used to explore the influencing factors of the mental health of the general population in Beijing.Results: The average score of each factor of the SCL-90 in Beijing's general population was between 1.28 and 1.75, with no significant peaks. The scores of various factors in the general population in Beijing were relatively close, and their mental health remained stable. The analysis of the demographic variables of gender, education, age, marital status, and monthly income showed that monthly income (β=-0.027, p<0.05) and gender (β=-0.026, p<0.05) had significant effects on the SCL-90 score of the general population.Conclusion: The mental health level of Beijing’s general population was lower than the Chinese norm in 1986. Male mental health problems were prominent and low-income people were prone to psychological problems. It is imperative to strengthen the construction of a mental health service system and standardized management among the Chinese population. Strengthening the popularization of mental health knowledge, guiding the Chinese population to cultivate a positive attitude, preventing bad attitudes, encouraging the use of scientific methods to deal with psychological behavioral problems, and early targeted measures can reduce the occurrence of serious psychological problems.
Modelling community structure and temporal spreading on complex networks
Authors: Kuikka Vesa
Published: March 2020

We present methods for analysing hierarchical and overlapping community structure and spreading phenomena on complex networks. Different models can be developed for describing static connectivity or dynamical processes on a network topology. In this study, classical network connectivity and influence spreading models are used as examples for network models. Analysis of results is based on a probability matrix describing interactions between all pairs of nodes in the network. One popular research area has been detecting communities and their structure in complex networks. The community detection method of this study is based on optimising a quality function calculated from the probability matrix. The same method is proposed for detecting underlying groups of nodes that are building blocks of different sub-communities in network structure. We present different quantitative measures for comparing and ranking solutions of the community detection algorithm. These measures describe properties of sub-communities: strength of a community, probability of formation and robustness of composition. We illustrate the community detection methods with two small network topologies. In case of network spreading models, time development of spreading in the network can be studied. Two different temporal spreading distributions demonstrate the methods with three real-world social networks of different sizes. The Poisson distribution describes a random response time and the e-mail forwarding distribution describes a process of receiving and forwarding messages.
Quantifying flight aptitude variation in wild A. gambiae s.l. in order to identify long-distance migrants
Authors: Faiman Roy , YARO Alpha Seydou , Diallo Moussa , Dao Adama , Samake Djibril , Sanoga Zana Lamissa , Sullivan Margery , Krishna Asha , Krajacich Benjamin J , Lehmann Tovi
Published: March 2020

Background In the West African Sahel, during the 5-7 month-long dry season mosquito reproduction is halted due to the absence of surface waters required for larval development. Recent studies have suggested that both Anopheles gambiae s.s and A. arabiensis persist in this region by migration from distant locations where larval sites are perennial, and A. coluzzii engages in long-distance migration, presumably within the Sahel, following shifting resources due to the ever-changing patterns of Sahelian rainfall. Understanding mosquito migration is key to malaria control, a disease that still kills >400,000 people, mostly children in Africa. Methods We used a new tethered-flight assay to characterize flight in the three primary malaria vectors mentioned above and evaluated seasonal differences in their flight activity. The flight of tethered wild mosquitoes was audio-recorded from 21:00h to 05:00h in the following morning and three flight aptitude indices were examined: total flight duration, longest flight bout, and the number of flight bouts during the assay. Based on recent studies, we predicted that (i) the distribution of the flight aptitude indices would exhibit bi-modality and/or marked skewness, indicating a subpopulation of high flight activity (HFA) associated with long-distance migrants, in contrast to low flight activity (LFA) in appetitive flyers. Additionally, flight aptitude would (ii) increase in the wet season, (iii) increase in gravid females, and (iv) vary among the vector species. ResultsThe distributions of all flight indices departed sharply from a normal curve, and were strongly skewed to the right, consistent with the division of the population into a majority of LFAs and a minority of HFAs, e.g., the median total flight was 586 seconds, and its maximum value was 16,110 seconds (~4.5 h). As predicted, flight aptitude peaked in the wet season and was higher in gravid females than in non-bloodfed females. Flight aptitude was higher in A. coluzzii than in A. arabiensis, but A. gambiae s.s. was not statistically different from either. We evaluated differences in wing size and shape between LFAs and HFAs. During the wet season, wing size of HFA A. coluzzii was larger than that of LFAs; it was wider than predicted by its length, indicating a shape change. However, no statistically significant differences were found in wings of A. gambiae s.s. or A. arabiensis. ConclusionsThe partial agreement between the assay results and predictions suggest a degree of discrimination between appetitive flyers and long-distance migrants. Wing size and shape seems to indicate higher flight activity in A. coluzzii during the wet season.
Mediastinal Tumor Resection in a Patient with Spinocerebellar Degeneration
Authors: Tsuboi Eiyu , Azuma Yoko , Makino Takashi , Terada Takashi , Otsuka Hajime , Sano Atsushi , Koezuka Satoshi , Sakai Takashi , Tochigi Naobumi , Iyoda Akira
Published: March 2020

Background: In spinocerebellar degeneration (SCD) patients, general and regional anesthesia may cause postoperative dysfunction of respiratory, nerve and muscle systems. We present the surgical case of thymoma developed in patient with SCD.Case presentation: A 47-year-old woman with spinocerebellar degeneration was admitted because of a well-defined mass measuring 48 x 31 mm in anterior mediastinum. She showed limb, truncal, ocular, and speech ataxia; hypotonia; areflexia; sensory disturbances; and muscle weakness. Her eastern cooperative oncology group performance status was 4. Surgical resection was performed via video-assisted thoracic surgery and under general anesthesia only without epidural analgesia. The mass was diagnosed as type B1 thymoma without capsular invasion (Masaoka stage I). The patients got a good postoperative course by cooperation with anesthesiologists and neurologists in perioperative managements. She has been well over 3 years of follow-up.Conclusions: In conclusion, careful surgical and anesthesia management is essential for providing an uneventful postoperative course in patients with SCD. Especially, selection of minimal invasive approach and avoid diaphragmatic nerve damage are the most important points in surgical procedures.
Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture
Authors: Yang Yongliang , Jia Honglei , Zhang Wupeng , Xu Shihong , Wang Fu , Wang Bomin , Li Qinghu , Wang Yonghui , Han Shumei
Published: March 2020

Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute AT rupture.
The microbiota diversity following antibiotic treatment in Clostridium difficile infection
Authors: Binyamin Dana , Nitzan Orna , Azrad Maya , Hamo Zohar , Koren Omry , peretz avi
Published: March 2020

Background Clostridium difficile ( C. difficile ) is a major nosocomial pathogen that infect the human gut and can cause C. difficile infection (CDI), a diarrheal disease. A dominant risk factor is antibiotic treatment that disrupts the normal gut microbiota. The aim of the study is to examine the correlation between antibiotic treatment received prior to C. difficile infection (CDI) onset and patient gut microbiota Methods Stool samples were collected from patients with CDI, presenting at the Baruch Padeh Medical Center Poriya, Israel. Demographic and clinical information, including previous antibiotic treatments, was collected from patient charts, and CDI severity score was calculated. Bacteria were isolated from stool samples, and gut microbiome was analyzed by sequencing the 16S rRNA gene using the Illumina MiSeq platform and QIIME2. Results In total, 84 patients with C. difficile infection were enrolled in the study; all had received antibiotics prior to disease onset. Due to comorbidities, 46 patients (55%) received more than one class of antibiotics. The most common class of antibiotics used was cephalosporins (n=44 cases). The intestinal microbiota of the patients was not uniform. Differences in intestinal microbiome were influenced by the different combinations of antibiotics that the patients received ( p = 0.022) Conclusions The number of different antibiotics combinations has a major impact on the CDI patients gut microbiome, mainly on bacterial richness.
IRPact: An Actor-centered framework for Innovation Diffusion in Integrated Resource Planning
Authors: Johanning Simon , Scheller Fabian , Bruckner Thomas
Published: March 2020

Insights into the diffusion process can help decision makers to detect weak points of potential business models. Yet, due to the multitude of factors to consider, modeling the diffusion of innovations is a very challenging task. In the literature, various models and methodologies to address this problem can be found. Among these, empirically grounded agent-based modeling turns out to be one of the most promising approaches. However, the current culture is dominated by papers that fail to document critical methodological details. Thus, existing agent-based models for real-world analysis differ extensively in their design and grounding and therefore also in their predictions and conclusions. Being aware of this, this research paper seeks to identify requirements as building blocks in order to design and develop a versatile, but robust model to assess innovation diffusion processes. Subsequently, a formal approach is developed based on the derived model entities, dynamics and foundations. The main objective of this modeling approach is to achieve modularity and flexibility, as well as clarity through an explicit description of the concepts used. This is achieved by a three-layer approach, with a super agent layer, an agent layer and a sub-agent layer. Building on this, an object-oriented code base, organized in 24 packages and 273 classes is created. This empirically grounded agent-based modeling framework can be utilized by innovation diffusion researchers in order to build upon existing frameworks and concepts and to model a diverse range of domains in innovation diffusion.
The association of depression and child maltreatments among Indonesian adolescents
Authors: Dhamayanti Meita , Noviandhari Anindita , Masdiani Nina , Pandia Veranita , Sekarwana Nanan
Published: March 2020

Background Depression is one of the most prevalent emotional mental health problem among adolescents. Mental health problem might be contributed by child maltreatment. Prevalence of mental health problem and maltreatment among adolescent in Indonesia are increasing. This study aims at determining association between depression and history of maltreatment among adolescent Methods The analytic cross-sectional study was conducted to 786 junior high school students of Bandung City, West Java, Indonesia. Subject was selected by using two stage clustered method. The questionnaire of Children’s Depression Inventory (CDI) and ISPCAN Child Abuse Screening Tool (ICAST) were used to assess depression and history of maltreatment respectively. Depression confirmation was diagnosed by psychiatry based on scored positive in CDI. Data were analyzed using chi-square and multiple regression test. Results History of child maltreatment is associated with depressive disorders in adolescents (p = 0.03). All dimension of child maltreatment had significant association with depression (p <0.05). Psychological violence was the highest risk factor for the occurrence of depressive disorders (PR = 6.51), followed by violence exposure and physical violence. Sexual violence was not a common dimension of child maltreatment experienced by students. The history of psychological violence has the strongest association with depression, which three times more likely to have depression (POR = 3.302, p = 0.004) Conclusion The study showed association between a history of child maltreatment and depression in adolescents.
Endovascular treatment of ruptured aneurysms in anterior cerebral circulation with double microcatheter technique
Authors: Zhao Xintong , Liu Jiaqiang , Wang Huifang , Zhang Zihuan , Li Zhenbao
Published: March 2020

Purpose Single coiling may be the optimal strategy for ruptured aneurysms. But assisted techniques may be needed in some aneurysms. The authors report their experience of double microcatheter technique in the treatment of ruptured aneurysms in anterior cerebral circulation. Methods Between 2012 and 2018, 82 patients with ruptured aneurysms in anterior cerebral circulation were treated with double microcatheter technique. The clinical records, angiographic results, procedure-related complications were reviewed. Clinical and angiographic follow-up was performed. Results Completely occlusion, neck remnant and partial occlusion were achieved in 56.6%, 36.1% and 7.2% in the whole procedures, respectively. The overall rate of morbidity was 8.5% (7/82). The rate of permanent morbidity was 3.7% (3/82). Three patients (3.7%) died before discharge. There was no procedure-related mortality. The favorable outcomes were obtained in 75.6% (62/82) of the whole patients at discharge. High Hunt-Hess grade and suffering from craniotomy or EVD were risk factors for clinical outcomes at discharge. Sixty-eight patients received clinical follow-up at a mean interval of 15.75±12.71 months. Favorable outcomes were obtained in 61 (89.7%) patients. Angiographic follow-up was performed in 44 patients at an average of 13.16±13.12 months. The recurrence rate is 34.1%. Seven of them (15.9%) received retreatment. Conclusion Double microcatheter technique is a safe and effective method for treatment of ruptured aneurysms in anterior cerebral aneurysms with low morbidity. Recurrence remains a problem. Patients should be followed up regularly.
Tongue microbiome of smokeless tobacco users
Authors: Halboub Esam , Alakhali Mohammed , Al-Amir Abdulwahhab H. , Homeida Husham E. , Baraniya Divyashri , Chen Tsute , Al-hebshi Nezar Noor
Published: March 2020

Background The possibility that smokeless tobacco may contribute to oral carcinogenesis by influencing the oral microbiome has not been explored. This cross sectional study sought to assess the effect of using shammah, a form of smokeless tobacco prevalent in Arabia, on the tongue microbiome. Tongue scarping samples were obtained from twenty-nine shammah users (SU; 27.34±6.9 years) and 23 shammah non-users (SNU; 27.7±7.19 years) and analyzed with 16S rRNA gene sequencing (V1-V3). Species-level taxonomy assignment of the high-quality, merged reads was obtained using a previously described BLASTn-based algorithm. Downstream analyses were performed with QIIME, LEfSe, and R. Results A total of 178 species, belonging to 62 genera and 8 phyla were identified. Genera Streptococcus , Leptotrichia , Actinomyces , Veillonella , Haemophilus , Prevotella and Neisseria accounted for more than 60% of the average microbiome. There were no differences between the two groups in species richness and alpha-diversity, but PCoA showed significant separation (P=0.015, ANOSIM). LEfSe analysis identified 22 species to be differentially abundant between the SU and SNU. However, only 7 species maintained a false discovery rate of ≤ 0.2 and could cluster the two groups separately: Rothia mucilaginosa , Streptococcus sp. oral taxon 66, Actinomyces meyeri , Streptococcus vestibularis Streptococcus sanguinis and a potentially novel Veillonella species in association with SU, and Oribacterium asaccharolyticum with SNU. Conclusion Shammah use induces tongue microbiome changes that may be relevant to oral carcinogenesis, namely enrichment of species with high acetaldehyde production potential, which warrants further investigation.
Oral lactobacilli reduce cytotoxicity and cytokine release from peripheral blood mononuclear cells exposed to Aggregatibacter actinomycetemcomitans subtypes in vitro.
Authors: Pahumunto Nuntiya , Basic Amina , Östberg Anna-Karin , Teanpaisan Rawee , Dahlen Gunnar
Published: March 2020

Background: This study evaluated the effect of oral lactobacilli on the cytotoxicity and cytokine release from peripheral blood mononuclear cells (PBMC) when exposed to Aggregatibacter actinomycetemcomitans subtypes in vitro. The supernatants and cell wall extracts (CWEs) of eight A. actinomycetemcomitans strains, representing different subtypes, and three Lactobacillus strains were used. The PBMC cells from six blood donors were exposed to supernatants and CWEs of A. actinomycetemcomitans or Lactobacillus strains alone or combinations and untreated cells as control. The cytotoxicity was determined by trypan blue exclusion-method and IL-1β secretion by ELISA. TNF-α, IL-6 and IL-8 secretions were measured using Bioplex Multiplex Immunoassay. Results: Supernatants or CWEs from all bacterial strains showed cytotoxicity and IL-1β secretion and the subtypes of A. actinomycetemcomitans showed generally a significantly higher effect on PBMC´s than that of the Lactobacillus strains. Two highly toxic A. actinomycetemcomitans strains (JP2 and JP2-like) induced a higher response than all other strains. Two non-serotypable strains (NS1 and NS2) showed a weaker although significant effect than other A. actinomycetemcomitans or Lactobacillus strains tested. CWEs showed generally a higher effect on PBMC´s than the supernatants. When combined, Lactobacillus significantly reduced the toxicity and IL-1β secretion induced by A. acinomycetemcomitans. The effect varied between the subtypes and the reduction was highest for the JP2 and JP2-like strains. The Lactobacillus paracasei strain SD1 had a higher reducing effect that the other Lactobacillus strains. This strain had a consistent reducing effect on all subtypes of A. actinomycetemcomitans cytotoxicity, and release of IL-1β and TNF-α from PBMC´s of the blood donors. A strong and significant variation in cytokine release between the 6 blood donors was noticed. Conclusions: Lactobacillus spp and L. paracasei strain SD1 in particular, showed a significant reducing interaction with A. actinomycetemcomitans toxicity and release of cytokines in vitro.
Identification of active small-molecule modulators targeting the novel immune checkpoint VISTA
Authors: Li Ting-ting , Jiang Jing-wei , Qie Chenxin , Xuan Chun-xiao , Hu Xin-lei , Liu Wan-mei , Chen Wen-ting , Liu Jun
Published: March 2020

Background: Cancer immunotherapy has gained increasing popularity as a novel approach to treat cancer. A member of the B7 family, V-domain immunoglobulin suppressor of T-cell activation (VISTA) is a novel immune checkpoint that regulates a broad spectrum of immune responses. VISTA is an acidic pH-selective ligand for P-selectin glycoprotein ligand-1(PSGL-1). CA-170, a first-in-class small-molecule dual antagonist of VISTA/PD-L1, was collaboratively developed by Aurigene Discovery Technologies Limited and Curis, Inc. It is currently in Phase I clinical trial.Results: In this study, we develop homology modeling for the VISTA 3D structure and subsequent virtual screening for VISTA small-molecule hit ligands. Visualization of the binding postures of docked ligands with the VISTA protein indicates that some small molecular compounds target VISTA. The ability of antagonist to disrupt immune checkpoint VISTA pathways was investigated though functional studies in vitro.Conclusions: Affinity active molecule for VISTA was obtained through virtual screening, and the antagonist compound activity to VISTA was assayed in cellular level. We reported a small molecule with high VISTA affinity as antagonist , providing ideas for development VISTA-targeted small molecule compound in cancer immunotherapy.
High serum IgA and proportion of activated Th17 and Treg predict efficacy of abatacept in patients with early, seropositive rheumatoid arthritis
Authors: Inamo Jun , Kaneko Yuko , Kikuchi Jun , Takeuchi Tsutomu
Published: March 2020

Background To identify the predictive biomarkers for achieving remission with abatacept in patients with seropositive rheumatoid arthritis (RA). Methods We enrolled patients with RA who were treated with abatacept. We compared the baseline laboratory results and longitudinal immune-phenotyping data between patients who achieved remission and those who did not achieve remission at 6 months according to the clinical disease activity index. Results One hundred and twenty RA patients were enrolled. In the seropositive patients with early RA, high serum IgA levels, anti-CCP titers and neutrophil counts before treatment were predictors of remission (area under the curve [AUC], 0.659, 0.741, and 0.704, respectively). Additionally, activated Th17 (aTh17) cells and activated Treg (aTreg) cells before treatment were found to be significantly higher in patients with remission compared to those without remission (2.9% vs 1.1%, P = 0.02; 34.3% vs 17%, P = 0.03, respectively). The measurement of longitudinal cell subpopulation revealed a decrease in the effector CD4 T cell population after abatacept treatment, which correlated with anti-CCP titers and neutrophil counts, and was associated with remission achievement. In seropositive patients with established RA, high RF titers and low IFN-γ levels may be possible biomarkers for remission. Conclusion Our study has shown that serum IgA levels, anti-CCP titer and neutrophil counts are predictive biomarkers for evaluating the response to abatacept in patients with seropositive and early RA, and may reflect the inhibition of effector CD4 T cell subpopulations by abatacept.
Performance of Ultrasound in the Clinical Evaluation of Gout and Hyperuricemia
Authors: Cao Ling , Zhao Tianyi , Xie Chunmei , Zheng Shucong , Wan Weiguo , Zou Hejian , Zhu Xiaoxia
Published: March 2020

Objective Evaluation of monosodium urate (MSU) crystal deposition and related lesion in joints using ultrasound in gout and hyperuricemia patients. Methods Total 202 gout patients and 43 asymptomatic hyperuricemia patients were included, the clinical data and ultrasounic assessment results were collected and statistically analyzed. Results Deposition of MSU crystals were found in 25.58% (11/43) of the patients with asymptomatic hyperuricemia and 76.24% (154/202) of the patients with gout. In the all examined 1082 joints from gout patients, 33.09% (358/1082) of them were detected MSU crystals. In MSU crystal positive joints, 77.37% (277/358) of them had history of attacks. Among the joints of gouty arthritis, 56.88% (277/487) of them were found MSU crystals. Double contour sign (DCS), hyperechoic aggregate (HAG) and Tophi were found in 32.65% (159/487), 7.80% (38/487) and 24.64% (120/487) of the joints, respectively. DCS and Tophi, but not HAG, appeared inceasingly in gout duration extension. In the patients with more than 15 years of gout history, DCS, Tophi and HAG were found in 48.18%, 40.00%, 6.36% of US assessed joints, respectively. In the gout patients, synovial lesion and bone erosion were found in 17.74% (192/1082) and 7.58% (82/1082) of joints, respectively. Synovial lesion was related with HAG, while bone erosion was related to tophi and DCS. Conclusion HAG is the early sign of MSU crystal deposition in joints. Early urate lowering therapy (ULT) may reduce HAG and ameliorate synovitis and synovial hypertrophy. DCS and tophi are the risk factors of bone erosion. Early ULT should be considered in the gout patients with DCS or tophi.
Robust clutter suppression in heterogeneous environments based on multi frames and similarities
Authors: Wu Yifeng , Cheng Yufeng , Tang Jun , Duan Jia , Deng Xiaobo
Published: March 2020

A method of robust clutter suppression with space time adaptive processing (STAP) for airborne radar in heterogeneous environments is proposed, which is based on multi frames and the similarity between the cell under test and each training sample. The proposed method deals with the problem of covariance matrix estimation for radar signal processing, and it provides a solution to overcome the performance degradation of STAP in heterogeneous environments and training samples limitation. Firstly, the method expands the set of training samples by selecting training frames from past frames. Secondly, initial training samples are selected from the expended training samples set, which is composed by the samples of current frame and past frames. Thirdly, general inner product method is adopted to discard heterogeneous samples. Fourthly, the similarities between the cell under test and the remaining training samples are estimated, and training samples which are more similar with the cell under test take higher weight in the estimation of clutter covariance matrix. The accuracy of the estimated clutter character is improved significantly, and thus the performance of clutter suppression is improved. Experimental results based on measured data demonstrate the performance of the proposed method.
Association of anthropomorphic measures across the life-course with refractive error and ocular biometry at age 15 years
Authors: Bruce Alison , Santorelli Gillian , Mojarrad Neema
Published: March 2020

Background: A recent Genome-wide association meta-analysis (GWAS) of refractive error reported shared genetics with anthropometric traits such as height, BMI and obesity. To explore a potential relationship with refractive error and ocular structure we performed a life-course analysis including both maternal and child characteristics using data from the Avon Longitudinal Study of Parents and Children cohort. Methods: Measures collected across the life-course were analysed to explore the association of height, weight, and BMI with refractive error and ocular biometric measures at age 15 years from 1613children. The outcome measures were the mean spherical equivalent (MSE) of refractive error (dioptres), axial length (AXL; mm), and radius of corneal curvature (RCC; mm). Potential confounding variables; maternal age at conception, maternal education level, parental socio-economic status, gestational age, breast-feeding, and gender were adjusted for within each multi-variable model. Results: Maternal height was positively associated with teenage AXL (0.010 mm; 95% CI: 0.003, 0.017) and RCC (0.005 mm; 95% CI: 0.003, 0.007), increased maternal weight was positively associated with AXL (0.004 mm; 95% CI: 0.0001, 0.008). Birth length was associated with an increase in teenage AXL (0.067 mm; 95% CI: 0.032, 0.10) and flatter RCC (0.023 mm; 95% CI: 0.013, 0.034) and increasing birth weight was associated with flatter RCC (0.005 mm; 95% CI: 0.0003, 0.009). An increase in teenage height was associated with a lower MSE (-0.007 D; 95% CI: -0.013, -0.001), an increase in AXL (0.021 mm; 95% CI: 0.015, 0.028) and flatter RCC (0.008 mm; 95% CI: 0.006, 0.010). Weight at 15 years was associated with an increase in AXL (0.005 mm; 95% CI: 0.001, 0.009). Conclusions: At each life stage (pre-natal, birth, and teenage) height and weight, but not BMI, demonstrate an association with AXL and RCC measured at age 15 years. However, the negative association between refractive error and an increase in height was only present at the teenage life stage. Further research into the growth pattern of ocular structures and the development of refractive error over the life-course is required, particularly at the time of puberty.
Comparison of ocular biometry profiles in urban and rural cataract candidates in eastern China
Authors: Liu Hui , Xu Zequan , Qian Zhuyun , Wei Kunqiao , Liang Jianheng , Chen Xu
Published: March 2020

Purpose: To compare ocular biometric parameters between urban and rural cataract patients in Shanghai, China.Methods: A study of ocular biometry records from urban and rural hospitals was performed for cataract patients at least 50 years of age. The ocular biometrical parameters, which were measured with partial coherence laser interferometry (IOL Master, Zeiss), were axial length (AL), anterior chamber depth (ACD), radius of corneal curvature (K, including steep/flat/average K), astigmatism and axis. Only the right eye record of each patient was analysed.Results: Ocular biometric data included 2839 urban patients (73.15 ± 9.54 years) and 2646 rural patients (73.64 ± 7.32 years). Mean AL, ACD and K were 24.35 ± 2.34 mm, 3.14 ± 0.58 mm, and 44.38 ± 1.52 D, respectively, in urban patients and 23.58 ± 1.70 mm, 3.08 ± 0.57 mm, 44.53 ± 1.50 D, respectively, in rural patients. The urban subjects had significantly longer axial lengths and deeper ACDs than rural subjects (p < 0.01). There was no significant difference in steep K, flat K and average K between the two groups. A total of 49.71% patients exhibited against-the-rule (ART) astigmatism, and there was a significant difference in the number of patients who exhibited with-the-rule (WRT) astigmatism (32.58%) and oblique astigmatism (17.71%).Conclusions: We report biometry and astigmatism data in a large cohort of urban and rural subjects for the first time. In our study, a short AL, shallow ACD and axis turned in an ATR direction had higher prevalence rates in the rural subjects. This profile of ocular biometric data and corneal astigmatism will be helpful in planning for intraocular lens (IOL) power calculations and astigmatism correction in subjects in different locations.
Increased dose primary thromboprophylaxis in ambulatory patients with advanced pancreatic ductal adenocarcinoma, a single centre cohort study
Authors: Maraveyas Anthony , Haque Farzana , Muazzam Iqtedar Ahmed , Il Waqas MD , Bozas George
Published: March 2020

BackgroundAdvanced pancreatic ductal adenocarcinoma (aPDAC) patients have a lifetime all type thromboembolic event (ATTE) rate of 25- 35%. Efficacy and safety of increased dose primary thromboprophylaxis (IDPTP) with low molecular heparin (LMWH) given for 3 months has been shown in two prospective randomized trials.ObjectivesTo report on efficacy -reduction of all type thromboembolic events (ATTE)-, safety -incidence of Major Bleeding (MB)- and compliance in a single-centre cohort of receiving first line chemotherapy and LMWH-IDPTP.MethodsFrom May 2009 to October 2016, eighty two patients received IDPTP –LMWH with dalteparin. Schedule: 55kg and below: 7500 IU, between 55 and 80kg: 10,000 IU, above 80kg: 12,500 IU. MB is reported using the International Society of Thrombosis and Haemostasis (ISTH) criteria. ATTE was defined as any arterial or venous event, incidental or clinically symptomatic, including visceral VTE.ResultsMean and median time on dalteparin was 10.2 (95%CI 8.1, 12.4) and 8.0 (95%CI 6.2, 9.7) months respectively. ATTE was observed in 7 (8.5%) of patients, with a mean time on IDPTP of 6.8 months (95% CI 3.5-10.2). MB was seen in 10 (12.2%) patients with a mean time on IDPTP of 7.4 months (95% CI 3.9-10.9). Six major bleeds (60%) were the direct or indirect result of aPDAC. Eighty-one patients had died at the time of data collection with a median overall survival time of 8.7 months (95%CI 6.4, 11.0). Thromboembolism and bleeding were late events. No impact of thromboembolism or bleeding on overall survival was observed. ConclusionsIDPTP-dalteparin was associated with lower ATTE occurrence rates than expected and comparable major bleeding rates. ATTE and MB were late events, the majority of MB was from direct or indirect result of locally progressing aPDAC. Since these conditions can frequently arise in aPDAC, IDPTP should be regularly reviewed beyond 3 months.
Impact Of Surgical Technique And Analgesia On Clinical Outcomes After Lung Transplantation
Authors: Gimenez-Milà Marc , Videla Sebastián , Pallares Natalia , Sabate Antoni , Parmar Jasvir , Catarino Pedro , Tosh Will , Rafiq Muhammad Umar , Nalpon Jacinta , Valchanov Kamen
Published: March 2020

Background: Lung transplantation is the ultimate treatment for end stage lung disease. There is paucity of data on the impact of surgical incision and analgesia on clinically relevant outcomes. Methods: A single centre retrospective study was performed between July 2007 and August 2017 of patients undergoing single or double lung transplantation. Gender, age, indication for lung transplantation, and the three types of surgical access (Thoracotomy (T), Sternotomy (S) and Clamshell (C)) were used, as well as two analgesic techniques: epidural and intravenous opioids. Outcome variables of the study were: Pain scores; Postoperative hemorrhage in the first 24 hours, duration of mechanical ventilation and length of stay at ICU. Results: 341 patients were identified. Thoracotomy was associated with higher pain scores than Sternotomy (OR 1.66, 95% CI: 1.01;2.74, p: 0.045) and no differences were found between Clamshell and Sternotomy incision.The median blood loss was 800 ml [IQR: 500; 1238], thoracotomy patients had 500 ml [325;818] (p < 0.001). Median duration of mechanical ventilation in Thoracotomy, Sternotomy and Clamshell groups were 19 [11; 37] hours, 34 [IQR 16; 57.5] hours and 27 [IQR 15; 50.5] hours respectively. Thoracotomy group were discharged earlier from ICU (p<0.001). Conclusions : Thoracotomy access produces less postoperative hemorrhage, duration of mechanical ventilation and lower length of stay in ICU, but higher pain scores and need for epidural analgesia.
Rural-urban disparities in unmet long-term care needs and the demand for community care services among elderly people in China
Authors: Zeng Yanbing , Lin Chenxi , Wang Lixia , Zhang Liangwen , Fang Ya
Published: March 2020

Objective This study aimed to examine the urban-rural differences in unmet needs and the demand for community long-term care (LTC) services among community-dwelling elderly people in China.Methods The data come from the 2014 Chinese Longitudinal Health Longevity Survey (CLHLS). A total of 1587 community residents aged 65+ with disabilities in the activities of daily living (ADLs) were included in this study. Based on the Andersen theoretical model, binary logistic regression was used to estimate the correlates of unmet needs in LTC. A chi-square test was used to examine the differences in expected needs for community-based LTC services between urban and rural areas.Results Over half (55.07%) of the participants reported their needs were unmet. For both rural and urban residents, poor economic status and reluctant caregivers seriously affected unmet needs. In addition, among urban older adults, those who were male and lonely reported more unmet needs. Among rural elderly people, those with severe ADL disability and poor self-rated health reported more unmet needs. In addition, access to medication and home visit services were negatively associated with unmet needs. Living with children (69.12%) was viewed as the most desirable living arrangement among older people, while living in a LTC facility seemed to be more accepted for rural residents with unmet needs than for other elderly respondents. Residents showed a high demand for community LTC care services, with 82.55% of them expecting to need home visits and 74.29% to healthcare education. Specifically, rural residents had greater expected needs for every community care service than their urban counterparts. However, only 4.66% to 36.42% of the respondents reported that all eight types of services were available, which was far below the demand for these services.Conclusion The risk of having unmet needs associated with ADL disability in LTC is largely determined by elderly people’s economic status and caregivers’ willingness to provide care for both rural and urban elderly residents. More attention should be paid to psychological consulting services in urban areas, as well as personal care, home visits, psychological consulting and healthcare education services in rural areas.
Health-Care Equity in Indonesia
Authors: Sufrian Iman , Simanjuntak Robert Arthur , Mahi Benedictus Raksaka , Qibtiyyah Riatu
Published: March 2020

Purpose – The health-care equity has been adopted as the principle in the health system in Indonesia since the enactment of Law No. 40 of 2004 concerning the National Social Security System. This study evaluates the achievement of health-care equity in Indonesia and investigates the spatial dimension of inequity by using a measure of inequity that can be decomposed completely into Theil index. Third, this study conducts a before and after comparison of the change in the degree of decentralization in Indonesia. Besides, this study also conducts a period with economic crisis and period without economic crisis comparison for within-area health-care inequity.Design/methodology/approach – The secondary cross-sectional data originate from the Indonesian Socioeconomic Surveys of 1996, 1998, 2000, 2002, 2005, 2008, 2011, and 2014. The Theil index was used to describe the inequity in health care. Subsequently, the Theil index is decomposed into between- and within-region at the province and district level. This paper compares health-care equity before and after decentralization in Indonesia. This paper also compares the health-care equity between periods with and without an economic crisis in Indonesia.Findings – The Theil index of health-care inequity provides an initial description that there was an improvement of equity in health care in 1996-2014. However, findings suggest the health-care inequity had worsened during the economic crisis of 1998 despite improved health-care equity, especially during the second phase of decentralization in the period of 2005-2014.Value/Originality – The findings suggest that an increase in the degree of decentralization in Indonesia is associated with a lower degree of overall, within-province, within-district and between-district inequity in both outpatient health care and inpatient health care. In addition, the economic crisis is related to higher overall, within- and between-region health-care inequities.
Early Chest CT Features of Patients with 2019 Novel Coronavirus (COVID-19) Pneumonia: Relationship to Diagnosis and Prognosis
Authors: Chen Hui Juan , Qiu Jie , Wu Biao , Huang Tao , Gao Yunsuo , Wang Zhen Ping , Chen Yang , Chen Feng
Published: March 2020

Objective: To elucidate the consistency between CT findings and real time reverse-transcription–polymerase chain- reaction (RT-PCR) results and investigate the relationship between CT features and clinical prognosis in COVID-19.Methods: The clinical manifestations, laboratory parameters and CT imaging findings were analyzed in thirty-four patients with COVID-19 confirmed by RT-PCR from January 20 to February 4 in Hainan province. CT score was compared between the discharged patients and ICU patients.Results: Fever (85%) and cough (79%) were most commonly seen. 10 (29%) patients demonstrated negative results on their first RT-PCR.22/34(65%) patients showed pure ground glass opacity (GGO). 17/34 (50%) patients had five lobes of lung involvement, while the 23(68%) patients had lower lobes were involved and 24/34 (71%) were subpleural. Lesions of 24 (71%) patients were distributed mainly in the subpleural. During follow-up, the initial CT lesions of ICU patients are distributed in both subpleural and parenchyma (80%) and the lesions are scattered. 60% of ICU patients had five lobes involved, while this was seen in only 25% discharged patients. Lesions of discharged patients are mainly in the subpleural (75%). 62.5% of discharged patients showed pure ground-glass opacity. 80% ICU demonstrated progressive stage on their first CT scan. 75 % discharged patients were at an early stage. CT score of ICU patients were significantly higher than that of the discharged patients.Conclusion: Chest CT plays a crucial role in the early diagnosis of COVID-19, particularly for those patients with negative RT-PCR. The initial features in CT may be associated with prognosis.Authors Hui Juan Chen and Jie Qiu contributed equally to this work.