bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the directionality in the relationship between descriptive and injunctive parental and peer norms and snacking behavior in a three-year-cross-lagged study
Authors: Bevelander K. E. , Burk W. J. , Smit C. R. , van Woudenberg T. J. , Buijs L. , Buijzen M.
Published: June 2020

Background

People’s eating behavior is assumed to be influenced by what other people do (perceived descriptive norms) and what others approve of (perceived injunctive norms). It has been suggested that adolescents are more susceptible to peer norms than parental norms, because they experience a strong need for group acceptance that leads to conforming to peer group norms. The current study examined changes in snacking behavior and four types of social norms (i.e., parental and peer descriptive and injunctive norms) that promoted fruit and vegetable intake among adolescents. This study was the first to examine whether snacking behavior also influenced norm perceptions by testing the directionality of these associations.

Methods

The study consisted of 819 participants (M [SD] age = 11.19 [1.36]; 46.1% boys), collected at three time points (T1 = 2016, T2 = 2017 and T3 = 2018) during the MyMovez project. Self-reported frequency of snack consumption, perceived parental and peer descriptive and injunctive norms were assessed. The primary analysis consisted of a series of cross-lagged autoregressive models specified in a structural equation modeling framework.

Results

Model comparisons testing the descriptive and injunctive norms in separate models and in an additional combined model revealed evidence for bi-directional associations between norms and snacking behavior. Descriptive peer and parent norms were not found to have an effect on subsequent snacking behaviors. Perceived injunctive parental norms were positively associated with healthy snack food intake and negatively associated with unhealthy snack intake (forward direction). Injunctive peer norms were negatively associated with healthy snack food intake. In addition, higher unhealthy snack food intake was negatively associated with the perception of descriptive and injunctive parental norms 1 year later (reversed direction). We did not find peer norms to be more closely associated with changes in snacking behaviors compared to parental norms.

Conclusions

Parents expecting their children to snack healthy had a positive influence on healthy snacking behavior whereas only acting as a healthy role model did not. Future research should address the possible interaction between descriptive and injunctive norms. Research should also take into account the bi-directional relations between eating behaviors and normative perceptions.
Development and validation of a prognostic model of resectable small-cell lung cancer: a large population-based cohort study and external validation
Authors: Wang Yu , Pang Zhaofei , Chen Xiaowei , Yan Tao , Liu Jichang , Du Jiajun
Published: June 2020

Background

Survival outcomes of patients with resected SCLC differ widely. The aim of our study was to build a model for individualized risk assessment and accurate prediction of overall survival (OS) in resectable SCLC patients.

Methods

We collected 1052 patients with resected SCLC from the Surveillance, Epidemiology, and End Results (SEER) database. Independent prognostic factors were selected by COX regression analyses, based on which a nomogram was constructed by R code. External validation were performed in 114 patients from Shandong Provincial Hospital. We conducted comparison between the new model and the AJCC staging system. Kaplan–Meier survival analyses were applied to test the application of the risk stratification system.

Results

Sex, age, T stage, N stage, LNR, surgery and chemotherapy were identified to be independent predictors of OS, according which a nomogram was built. Concordance index (C-index) of the training cohort were 0.721, 0.708, 0.726 for 1-, 3- and 5-year OS, respectively. And that in the validation cohort were 0.819, 0.656, 0.708, respectively. Calibration curves also showed great prediction accuracy. In comparison with 8th AJCC staging system, improved net benefits in decision curve analyses (DCA) and evaluated integrated discrimination improvement (IDI) were obtained. The risk stratification system can significantly distinguish the ones with different survival risk. We implemented the nomogram in a user-friendly webserver.

Conclusions

We built a novel nomogram and risk stratification system integrating clinicopathological characteristics and surgical procedure for resectable SCLC. The model showed superior prediction ability for resectable SCLC.
White-coat hypertension and incident end-stage renal disease in patients with non-dialysis chronic kidney disease: results from the C-STRIDE Study
Authors: Wang Qin , Wang Yu , Wang Jinwei , Zhang Luxia , Zhao Ming-hui ,   the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE), Zhao Ming-Hui , Zhang Luxia , Wang Xiaoqin , Yuan Jun , Zhou Qiaoling , Yuan Qiongjing , Chen Menghua , Zhou Xiaoling , Fu Shuxia , Li Shaomei , Zha Yan , Huang Rongsai , Liu Zhangsuo , Zhang JunJun , Wang Li , Pu Lei , Liu Jian , Li Suhua , Xiong Zuying , Liang Wei , Zhao Jinghong , Mu Jiao , Lian Xiyan , Liao Yunjuan , Gan Hua , Liao Liping , Wang Rong , Lv Zhimei , Liao Yunhua , Pan Ling , Yang Xiaoping , Lin Zhifeng , Tong Zongwu , Zhu Yun , He Qiang , Wu Fuquan , Li Rong , Rong Kai , Wang Caili , Zhang Yanhui , Wang Yue , Tang Wen , Wu Hua , Zhao Ban , Li Rongshan , Wang Lihua , Li Detian , Du Feng , Wu Yonggui , Zhang Wei , Lin Shan , Xu Pengcheng , Lin Hongli , Hu Zhao , Pei Fei , Zhang Haisong , Gao Yan , Sun Luying , Li Xia , Wang Wenke , Lv Fengling , Wang Deguang , Wang Xuerong , Xu Dongmei , Tang Lijun , Ma Yingchun , Wang Tingting , Fu Ping , Wang Tingli , Xing Changying , Zhang Chengning , Xu Xudong , He Haidong , Liao Xiaohui , Xie Shuqin , Hu Guicai , Huang Lan
Published: June 2020

Background

Controversy remains whether white coat hypertension (WCH) is associated with renal prognosis in patients with chronic kidney disease (CKD).

Methods

In the present multicenter, prospective study, we analyzed data of participants with CKD stage 1–4 from the Chinese Cohort Study of Chronic Kidney Disease (C-STRIDE). WCH was defined according to two criteria as follows: A, clinical blood pressure (BP) ≥ 140/90 mm Hg and average 24-h ambulatory BP < 130/80 mm Hg; B, clinical BP ≥ 130/80 mm Hg and daytime ambulatory BP < 130/80 mm Hg. Renal outcome was defined as initiation of renal replacement therapy. The association of WCH with renal events was evaluated by Cox regression model.

Results

A total of 1714 patients with CKD were included in the present analysis. The mean age of the population was 48.9 ± 13.8 years and 56.8% were men. The mean baseline estimated glomerular filtration rate (eGFR) was 52.2 ± 30.1 ml/min/1.73 m2and urinary protein was 1.0 (0.4, 2.4) g/day. The overall prevalence of WCH was 4.7% and 16.6% according to criteria A and B, respectively. Incidence rates of renal events were 49.58 and 26.51 according to criteria A and B, respectively, per 1000 person-years during a median follow-up of 4.8 years. After full adjustment, WCH was associated with an increased risk of renal event (criterion A: hazard ratio 2.36, 95% confidence interval 1.29–4.34; for criterion B: hazard ratio 1.90, 95% confidence interval 1.04–3.49) compared with patients with normal BP.

Conclusions

WCH is associated with a greater risk for renal events in non-dialysis dependent Chinese patients with CKD.
Neonatal Kawasaki disease with multiple arterial aneurysms: a case report
Authors: Zhao Qu-ming , Liang Xue-cun , Wu Lin , Liu Fang
Published: June 2020

Background

Kawasaki disease (KD) is a medium vessel vasculitis that typically occurs in children aged between 6 months and 5 years. It is extraordinarily rare in the neonatal period. KD-related systemic artery aneurysms (SAAs) have never been reported in neonates.

Case presentation

A male infant was transferred to our institution for persistent high-grade fever lasting 16 days. Symptoms started at day 14 of life, and he was admitted to a children’s hospital on the second day of fever. Physical examination at the time found no signs suggestive of KD. The only laboratory parameters which were of significance were values suggestive of systemic inflammation. However, his fever persisted and inflammatory markers continued to rise despite 2 weeks of antibiotic therapy. KD as a noninfectious cause of fever was considered when he came to our institution, and echocardiographic findings of left and right medium coronary artery aneurysms (CAAs) confirmed our suspicions. Full-body magnetic resonance angiography also revealed bilateral axillary artery aneurysms. Administration of intravenous gamma globulin resulted in rapid improvement. His fever resolved on the next day and CAAs and SAAs regressed to normal at 6 months and 3 months after diagnosis, respectively.

Conclusion

This unique case of incomplete KD highlights the importance of considering KD in neonates with unexplained prolonged fever and reinforces the need to remain vigilant for SAAs in KD.
Aucubin alleviates oxidative stress and inflammation via Nrf2-mediated signaling activity in experimental traumatic brain injury
Authors: Wang Han , Zhou Xiao-Ming , Wu Ling-Yun , Liu Guang-Jie , Xu Wei-Dong , Zhang Xiang-Sheng , Gao Yong-Yue , Tao Tao , Zhou Yan , Lu Yue , Wang Juan , Deng Chu-Lei , Zhuang Zong , Hang Chun-Hua , Li Wei
Published: June 2020

Background

Aucubin (Au), an iridoid glycoside from natural plants, has antioxidative and anti-inflammatory bioactivities; however, its effects on a traumatic brain injury (TBI) model remain unknown. We explored the potential role of Au in an H2O2-induced oxidant damage in primary cortical neurons and weight-drop induced-TBI in a mouse model.

Methods

In vitro experiments, the various concentrations of Au (50 μg/ml, 100 μg/ml, or 200 μg/ml) were added in culture medium at 0 h and 6 h after neurons stimulated by H2O2 (100 μM). After exposed for 12 h, neurons were collected for western blot (WB), immunofluorescence, and M29,79-dichlorodihydrofluorescein diacetate (DCFH-DA) staining. In vivo experiments, Au (20 mg/kg or 40 mg/kg) was administrated intraperitoneally at 30 min, 12 h, 24 h, and 48 h after modeling. Brain water content, neurological deficits, and cognitive functions were measured at specific time, respectively. Cortical tissue around focal trauma was collected for WB, TdT-mediated dUTP Nick-End Labeling (TUNEL) staining, Nissl staining, quantitative real time polymerase chain reaction (q-PCR), immunofluorescence/immunohistochemistry, and enzyme linked immunosorbent assay (ELISA) at 72 h after TBI. RNA interference experiments were performed to determine the effects of nuclear factor erythroid-2 related factor 2 (Nrf2) on TBI mice with Au (40 mg/kg) treatment. Mice were intracerebroventricularly administrated with lentivirus at 72 h before TBI establishment. The cortex was obtained at 72 h after TBI and used for WB and q-PCR.

Results

Au enhanced the translocation of Nrf2 into the nucleus, activated antioxidant enzymes, suppressed excessive generation of reactive oxygen species (ROS), and reduced cell apoptosis both in vitro and vivo experiments. In the mice model of TBI, Au markedly attenuated brain edema, histological damages, and improved neurological and cognitive deficits. Au significantly suppressed high mobility group box 1 (HMGB1)-mediated aseptic inflammation. Nrf2 knockdown in TBI mice blunted the antioxidant and anti-inflammatory neuroprotective effects of the Au.

Conclusions

Taken together, our data suggest that Au provides a neuroprotective effect in TBI mice model by inhibiting oxidative stress and inflammatory responses; the mechanisms involve triggering Nrf2-induced antioxidant system.
Determinants of long acting contraceptive utilization among HIV positive reproductive age women attending care at ART clinics of public health facilities in Arba Minch town, Southern Ethiopia, 2019: a case control study
Authors: Yirsaw Betselot , Gebremeskel Feleke , Gebremichael Gebrekiros , Shitemaw Tewoderos
Published: June 2020

Background

Long acting and permanent contraceptive methods by far are the most effective, very safe and convenient methods than short acting contraceptive methods. But in less developed countries, use of long acting reversible contraceptive or permanent methods (LARCs/PMs) is very low. Therefore the aim of this study was to identify determinants of long acting contraceptive method utilization among HIV positive reproductive age women.

Methods

An institutional based case control study was conducted among random sample of 354 HIV positive reproductive age women (total of 97.8% response rate) at Anti-Retroviral Therapy clinics from February 20 to March 20, 2019. Case to control ratio was 1:2. A structured questionnaire and information recorded from ART card review were used to collect the data. Each variable was entered in Bivariate analysis with dependent variables and those variables with P-value of ≤ 0.25 were included in the Multivariate analysis. Significance was determined at the level of P-value < 0.05 with 95% CI of AOR.

Results

A total of 354 (33.3% cases and 66.7% controls) HIV positive reproductive age women were interviewed with response rate of 97.8%. The study revealed being in age group of 39 and above [AOR = 0.17, 95% CI (0.06, 0.48)], being divorced/separated and widowed [AOR = 0.05, 95% CI (0.003, 0.61)], having supportive opinion and strongly supportive opinion regarding family planning service availability in ART clinic [AOR = 5.01, 95% CI (1.79, 14.07)], [AOR = 7.81, 95% CI (2.54, 24.01)] and having no future fertility intention [AOR = 7.03, 95% CI (2.73, 18.06)] were statistically significant determinants for long acting contraceptive method utilization.

Conclusion

Woman in age group of 39 and above, having no future fertility intention and being divorced/separated and widowed was found to be determinants of long acting contraceptive method utilization among HIV positive reproductive age women. In addition our study support the WHO Strategic Considerations for Strengthening the Linkages between Family Planning and HIV/AIDS Policies, Programs, and Services.
Transcranial direct current stimulation combined with physical or cognitive training in people with Parkinson’s disease: a systematic review
Authors: Beretta Victor Spiandor , Conceição Núbia Ribeiro , Nóbrega-Sousa Priscila , Orcioli-Silva Diego , Dantas Luana Karla Braz Fonseca , Gobbi Lilian Teresa Bucken , Vitório Rodrigo
Published: June 2020

Background

Pharmacologic therapy is the primary treatment used to manage Parkinson’s disease (PD) symptoms. However, it becomes less effective with time and some symptoms do not respond to medication. Complementary interventions are therefore required for PD. Recent studies have implemented transcranial direct current stimulation (tDCS) in combination with other modalities of interventions, such as physical and cognitive training. Although the combination of tDCS with physical and cognitive training seems promising, the existing studies present mixed results. Therefore, a systematic review of the literature is necessary.

Aims

This systematic review aims to (i) assess the clinical effects of tDCS when applied in combination with physical or cognitive therapies in people with PD and; (ii) analyze how specific details of the intervention protocols may relate to findings.

Methods

The search strategy detailed the technique of stimulation, population and combined interventions (i.e. cognitive and/or physical training). Only controlled studies were included.

Results

Seventeen of an initial yield of 408 studies satisfied the criteria. Studies involved small sample sizes. tDCS protocols and characteristics of combined interventions varied. The reviewed studies suggest that synergistic effects may be obtained for cognition, upper limb function, gait/mobility and posture when tDCS is combined with cognitive and/or motor interventions in PD.

Conclusion

The reported results encourage further research to better understand the therapeutic utility of tDCS and to inform optimal clinical use in PD. Future studies in this field should focus on determining optimal stimulation parameters and intervention characteristics for maximal benefits in people with PD.
Upper limb kinematics during the first year after stroke: the stroke arm longitudinal study at the University of Gothenburg (SALGOT)
Authors: Thrane Gyrd , Sunnerhagen Katharina Stibrant , Murphy Margit Alt
Published: June 2020

Background

Reduction of compensation and improved movement quality indicate recovery after stroke. Since clinical measures alone are often inadequate to distinguish between behavioral recovery and compensation, kinematic analysis of functional tasks has been recommended.

Objective

To quantify longitudinal changes and residual deficits in movement performance and quality during the first year after stroke using kinematic analysis of drinking task.

Methods

A total of 56 participants with first ever stroke causing upper extremity impairment were extracted from a non-selected stroke unit cohort (Stroke Arm Longitudinal Study at the University of Gothenburg-SALGOT). Participants needed to able to perform the drinking task with the more-affected arm at least on 2 occasions out of 6 (3 days, 10 days, 4 weeks, and 3, 6, and 12 months) during the first year to be included. A cohort of 60 healthy individuals was used as reference. Longitudinal changes were analyzed using linear mixed models.

Results

Movement time, number of movement units, peak angular velocity of the elbow, peak hand velocity, and trunk displacement improved significantly over the first 3 months with a peak at 6 months. Movement time and peak hand velocity reached levels comparable to healthy at 3 months, but number of movement units, peak elbow angular velocity, trunk displacement, and arm abduction remained different from healthy over the first year after stroke.

Conclusions

Even when the recovery patterns of kinematics follow the known nonlinear pattern, not all kinematic measures reach the levels in par with healthy controls at one year post stroke. Since the number of movement units, peak angular velocity, trunk displacement, and arm abduction remained impaired over the first year, they might be the most suited measures to distinguish behavioral recovery from compensation strategies.

Trial registration

ClinicalTrials:NCT01115348. 4 May 2010. Retrospectively registered.
Effects of high fat diet-induced obesity on vitamin D metabolism and tissue distribution in vitamin D deficient or supplemented mice
Authors: Park Chan Yoon , Shin Yongho , Kim Jeong-Han , Zhu Shuang , Jung Young Sun , Han Sung Nim
Published: June 2020

Background

Vitamin D deficiency has been often observed in obese persons. One of the mechanisms suggested for low vitamin D status in obesity was decreased bioavailability of vitamin D (VD) due to sequestration in adipose tissue. However, only few studies have investigated this mechanism via quantifying vitamin D levels from tissues from the obese.

Methods

Six-wk-old C57BL/6 mice were fed 10 or 45% kcal fat (CON or HFD) diets containing 50, 1000 or 25,000 IU vitamin D/kg diet (LVd, CVd or HVd) for 13 wks. Serum 25-hydroxyvitamin D (25(OH)D) levels were determined by radioimmunoassay and liver and adipose tissue cholecalciferol (VD) and 25-hydrocholecalciferol (25(OH)D) levels were measured by LC-MS/MS. mRNA levels of jejunal Mttp, Cd36, Sr-b1, Npc1l1, and Abca1 and liver and adipose tissue 25-hydroxylases (Cyp2r1 and Cyp27a1) were determined by real-time PCR.

Results

Serum 25(OH)D levels were affected by dietary vitamin D content but differential effects were observed between HFD and CON groups. When vitamin D intake was at a supplementary level, the HFD-HVd group had lower serum 25(OH)D levels than the CON-HVd group, while there was no significant difference between the HFD and CON groups fed LVd or CVd. Total amount of VD in liver and adipose tissue were significantly higher in HFD-HVd group compared with the CON-HVd group. However, no difference in total amount of tissue VD was observed between the CON and HFD groups fed CVd. In jejunum, mRNA levels of Mttp and Abca1 were significantly higher in HFD groups than CON groups. There was no difference in mRNA levels of liver 25-hydroxylases by both dietary fat amount and vitamin D content.

Conclusion

A significant amount of VD seemed to be stored in the liver and adipose tissue when dietary vitamin D is at a supplementation level; thus excess body adiposity could contribute to relatively low serum 25(OH)D level when vitamin D was supplemented.
Modic changes of the lumbar spine—their association with the lumbar sagittal parameters: A retrospective imaging study
Authors: Mu Xiaoping , Peng Wei , Yu Chengqiang , Xiong Jian , Wei Jianxun , Ou Yufu , Wang Chenglong
Published: June 2020

Background

The Lumbar sagittal parameters might be related to modic changes (MCs). However, studies on this topic have rarely been reported. The aim of this study was to identify the relationships between the lumbar sagittal parameters and the development of MCs.

Methods

The lumbar sagittal parameters of 321 patients with chronic low back pain from May 2016 to August 2018 were measured on X-ray by using Surgimap surgical planning software. Univariable analyses were used to test the potential variables of interest. Logistic regression models were then performed for the significant parameters to identify the independent factors associated with the development of MCs.

Results

More patients in the MCs group were older with more number of female than in the disc degeneration group (p < 0.05). In the univariate analysis, significant differences were detected for the parameters of lumbar lordosis, sacral slope, intervertebral height index, endplate concave angle, and intervertebral angle only at the L5/S1 level between the two groups. The results of logistic regression analysis showed that a smaller intervertebral height index was positively associated with the development of MCs at the level of L3/4 (p < 0.05). However, the positive role of gender was only for MCs at the L5/S1 level (p < 0.05).

Conclusions

The results of this study revealed that there were negative relationships between the lumbar sagittal parameters and MCs. Furthermore, being female and having a narrow intervertebral space were the independent risk factors for the development of MCs at the corresponding lumbar levels. Interestingly, body mass index might be not associated with MCs for the Chinese population.
Clinical outcomes and hemodynamic performance of Dafodil™ aortic and mitral pericardial bioprosthesis: 1-year results from Dafodil-1 first-in-human trial
Authors: Hiremath C. S. , Jain Anil R. , Garg Anurag , Gupta Nirmal , Mishra Yugal K. , Meharwal Zile Singh , Thakur Nityanand , Maslekar Atul A. , Shastri Naman
Published: June 2020

Background

Bioprosthesis has been increasingly implanted for the treatment of transvalvular disease across the world. A new Dafodil™ pericardial bioprosthesis (Meril Life Sciences Pvt. Ltd., India) recently approved by Conformité Européenne (CE) is a tri-leaflet, stented, bovine valve. The purpose of Dafodil-1 first-in-human trial was to evaluate clinical safety and performance (including hemodynamic parameters) of the Dafodil pericardial bioprosthesis in patients who underwent aortic or mitral valve replacement.

Methods

This prospective, multicenter clinical trial enrolled 60 patients (Aortic: 30 patients; Mitral: 30 patients) from seven sites across India. Safety endpoints were early (≤30 days) and late (> 30 days) mortality and valve-related morbidity. The performance endpoints were hemodynamic performance, improvement in NYHA functional class, and change in the quality of life using SF-12v1 health survey.

Results

From July 2017 to July 2018, 60 patients underwent implantation of the Dafodil pericardial bioprosthesis. Post-operatively, NYHA functional class significantly improved in all the patients (Aortic: 90% NYHA class-I and 10% NYHA class-II; Mitral: 96.55% NYHA class-I and 3.45% NYHA class-II; P < 0.001). There was no death in aortic valve replacement patients till 12-month. In mitral valve replacement patients, early mortalities occurred in three patients, and late mortality occurred in one patient; none of these were valve-related. Freedom from all-cause mortality reported was 93.33% at 12-month. Mean aortic pressure gradient decreased from 52.71 ± 24.47 mmHg [with 0.89 ± 0.70 cm2 effective orifice area (EOA)] pre-operatively to 14.49 ± 6.58 mmHg (EOA: 1.85 ± 0.27 cm2) at 12-month. Overall, the mitral mean pressure gradient and EOA were 4.41 ± 1.69 mmHg and 2.67 ± 0.48 cm2, respectively, at 12-month. Significant improvement (P < 0.05) in the patients’ quality of life was reported at all follow-ups.

Conclusions

The clinical safety and performance of the Dafodil pericardial bioprosthesis were favourable at 12-month. Moreover, a study with a larger patient population and longer follow-up is warranted to further assess the device.

Trial registration

Dafodil-1 trial has been prospectively registered on 10/07/2017 under Clinical Trial Registry-India (http://www.ctri.nic.in). (Registration number: CTRI/2017/07/009008).
The protective effects of liguzinediol on congestive heart failure induced by myocardial infarction and its relative mechanism
Authors: Chen Qi , Zhang Dini , Bi Yunhui , Zhang Weiwei , Zhang Yuhan , Meng Qinghai , Li Yu , Bian Huimin
Published: June 2020

Background

Heart failure (HF) is one of the most common causes of cardiovascular diseases in the world. Currently, the drugs used to treat HF in the clinic may cause serious side effects. Liguzinediol, 2, 5-dimethyl-3, 6-dimethyl-pyrazine, is a compound synthesized after the structural modification of ligustrazine (one active ingredient ofSzechwan Lovage Rhizome). We aimed to observe the effects of liguzinediol on preventing HF and explore the related mechanisms.

Methods

The ligation of left anterior descending coronary artery was operated to established the myocardial infarction (MI) model in Sprague–Dawley rats. Cardiac functions were recorded by echocardiography and hemodynamics. The changes in the Renin–Angiotensin–Aldosterone System (RAAS), inflammation, and oxidative stress were detected by radioimmunoassay and Elisa kits. Western blot and real-time PCR were applied to determine the expressions of the TGF-β1/Smads pathway.

Results

Firstly, liguzinediol enhanced the systolic and diastolic functions of the heart in MI rats. Liguzinediol improved ventricular remodeling by reducing myocardial cell necrosis, as well as reducing collagen deposition and myocardial fibrosis. Then, liguzinediol suppressed the activation of RAAS, inhibited the synthesis of pro-inflammation factors, and reduced oxidative stress. In the end, liguzinediol also down-regulated the expressions of the TGF-β1/Smads pathway.

Conclusions

Liguzinediol could alleviate HF caused by MI in rats, and the protective effect was associated with the regulation of the TGF-β1/Smads pathway.
Transoral robotic surgery in head and neck district: a retrospective study on 67 patients treated in a single center
Authors: Ionna Fraco , Guida Agostino , Califano Luigi , Motta Gaetano , Salzano Giovanni , Pavone Ettore , Aversa Corrado , Longo Francesco , Villano Salvatore , Ponzo Ludovica Marcella , Franco Pierluigi , Losito Simona , Buonaguro Franco Maria , Tornesello Maria Lina , Maglione Maria Grazia
Published: June 2020

Background

The anatomical complexity of the oropharynx and the difficulty in reaching its distal portion have always conditioned the surgical accessibility.

Robotic surgery represents an excellent alternative in the treatment of cervico-facial oncological diseases.

Methods

This series comprises all patients managed for head and neck cancer by Trans Oral Robotic Surgery TORS.

The staging assessment, including neck ultrasound and total body PET/CT scan, was performed in each patient according to the TNM classification.

All charts were recorded with the following data: name and surname, age, gender, date of surgery intra or post-operative hemorragia, tumor site, histology, TNM stage, robot set-up time, tumor resection time, whether or not tracheotomy was performed, whether or not neck dissection was performed, insertion of a nasogastric tube or gastrostomy, time to resumption of oral feeding, surgical margins, mean length of hospital stay, adjuvant treatment and follow-up.

Results

From February 2013 to February 2018, TORS was performed in 67 consecutive patients affected by head and neck tumours.

We divided, our sample, in 3 subsites: supraglottic larynx, parapharyngeal space and oropharynx.

Pathology reports confimed malignancy in 44 cases: 8 cases lymphomas, 36 cases of Squamous cell carcinoma (SCC), 5 cases of benign salivary glands tumors and 18 miscellaneous cases. Neck dissection was performed in 12 cases.

Tracheotomy was perfomed in 3/67 cases for respiratory failures. A nasogastric tube was inserted at the end of the surgical procedure in 21 patients. The mean length of hospital stay was 10 days .

Major complications included post-operative bleeding in 3 patients, 1 exitus for massive bleeding 20 days post-surgery and 1 respiratory failure treated with tracheotomy and monitoring in the Intensive Care Unit (ICU) for 3 days.

Conclusions

Robotic surgery has been considered a valid alternative to traditional open treatment in many specializations with the advantages of an endoscopic procedure, with the same oncological and functional results and with fewer complications. The advantages of this type of surgical technique have been discussed, it is mandatory to focus on the indications and contraindications.
Schizophrenia in the context of mental health services in Palestine: a literature review
Authors: Marie Mohammad , Shaabna Zareefa , Saleh Manahel
Published: June 2020

Background

Mental health conditions remain a significant cause of disability in the Arab World. Palestinians are predominantly at a higher risk for mental health problems due to their chronic exposure to political violence, prolonged displacement, and others as limited professional, educational, financial opportunities and mental health services. Schizophrenia is an overwhelming mental illness that affects nearly one percent of the various populations throughout the world. Studies have shown patients with schizophrenia die prematurely and have lower life expectancy compared to the general population. Moreover, antipsychotic medications and client’s lifestyle play a significant role in increased morbidity and mortality in these patients. The present study willingly undertakes a literature review on schizophrenia in the context of mental health services in Palestine.

Methods

Studies were identified through PubMed, Science Direct, Google Scholar, CINAHL, Semantic Scholar and Elsevier.

Results

Twenty-four studies were included in this review; 11 articles related to schizophrenia and thirteen articles related to mental health services in Westbank and Gaza. Results revealed the life of patients with schizophrenia in Palestine is complicated. Barriers as lacking awareness about mental illness, stigma, inconsistent availability of medications, absence of multidisciplinary teamwork, insufficient specialists, fragmented mental health system, occupation, and other obstacles stand in the face of improving the quality of life among these patients.

Limitations

Palestine is a state that is seeking independence with a scarcity of resources. It has been described as “uncharted territories’’ due to a lack of data, resources and records. As a result, there is insufficient data regarding schizophrenia in Palestine. Therefore, a thesis study that estimated 10 years’ risk of coronary heart diseases in patients with schizophrenia was included.

Conclusions

Recommendations include ending the occupation as the leading cause of mental illness for Palestinians and implementing efficient and effective mental health nursing care through the multidisciplinary work and raising awareness regarding mental illness to fight the stigma.
Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis
Authors: Meng Yifan , Lu Wanrong , Guo Ensong , Liu Jia , Yang Bin , Wu Ping , Lin Shitong , Peng Ting , Fu Yu , Li Fuxia , Wang Zizhuo , Li Yuan , Xiao Rourou , Liu Chen , Huang Yuhan , Lu Funian , Wu Xue , You Lixin , Ma Ding , Sun Chaoyang , Wu Peng , Chen Gang
Published: June 2020

Background

Although research on the effects of comorbidities on coronavirus disease 2019 (COVID-19) patients is increasing, the risk of cancer history has not been evaluated for the mortality of patients with COVID-19.

Methods

In this retrospective study, we included 3232 patients with pathogen-confirmed COVID-19 who were hospitalized between January 18th and March 27th, 2020, at Tongji Hospital in Wuhan, China. Propensity score matching was used to minimize selection bias.

Results

In total, 2665 patients with complete clinical outcomes were analyzed. The impacts of age, sex, and comorbidities were evaluated separately using binary logistic regression analysis. The results showed that age, sex, and cancer history are independent risk factors for mortality in hospitalized COVID-19 patients. COVID-19 patients with cancer exhibited a significant increase in mortality rate (29.4% vs. 10.2%, P < 0.0001). Furthermore, the clinical outcomes of patients with hematological malignancies were worse, with a mortality rate twice that of patients with solid tumors (50% vs. 26.1%). Importantly, cancer patients with complications had a significantly higher risk of poor outcomes. One hundred nine cancer patients were matched to noncancer controls in a 1:3 ratio by propensity score matching. After propensity score matching, the cancer patients still had a higher risk of mortality than the matched noncancer patients (odds ratio (OR) 2.98, 95% confidence interval (95% CI) 1.76–5.06). Additionally, elevations in ferritin, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, procalcitonin, prothrombin time, interleukin-2 (IL-2) receptor, and interleukin-6 (IL-6) were observed in cancer patients.

Conclusions

We evaluated prognostic factors with epidemiological analysis and highlighted a higher risk of mortality for cancer patients with COVID-19. Importantly, cancer history was the only independent risk factor for COVID-19 among common comorbidities, while other comorbidities may act through other factors. Moreover, several laboratory parameters were significantly different between cancer patients and matched noncancer patients, which may indicate specific immune and inflammatory reactions in COVID-19 patients with cancer.
Strategies to measure and improve emergency department performance: a scoping review
Authors: Austin Elizabeth E. , Blakely Brette , Tufanaru Catalin , Selwood Amanda , Braithwaite Jeffrey , Clay-Williams Robyn
Published: June 2020

Background

Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs’ capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance.

Methods and findings

We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Frameworkhttps://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies’ titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients’ decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains.

Conclusions

ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.
Opportunistic treatment of hepatitis C virus infection (OPPORTUNI-C): study protocol for a pragmatic stepped wedge cluster randomized trial of immediate versus outpatient treatment initiation among hospitalized people who inject drugs
Authors: Midgard H. , Finbråten A. K. , Malme K. B. , Berg-Pedersen R. M. , Tanum L. , Olsen I. C. , Bjørnestad R. , Dalgard O.
Published: June 2020

Background

Scaled-up direct-acting antiviral (DAA) treatment of hepatitis C virus (HCV) infection among people who inject drugs (PWID) is crucial to reach the World Health Organization HCV elimination targets within 2030. One of the critical obstacles to HCV care in this population is the lack of treatment models within specialist healthcare adapted to marginalized individuals.

Methods

OPPORTUNI-C is a pragmatic stepped wedge cluster randomized trial comparing the efficacy of immediate initiation of HCV treatment with the current standard of care among PWID admitted for inpatient care. Screening for HCV RNA will be performed as soon as possible after admission. The intervention includes immediate non-invasive liver disease assessment, counseling, and initiation of pan-genotypic DAA treatment with individualized follow-up. Standard of care is a referral to outpatient care at discharge. To mimic usual clinical practice as closely as possible, we will use a pragmatic clinical trial approach utilizing clinical infrastructure, broad eligibility criteria, flexible intervention delivery, clinically relevant outcomes, and collection of data readily available from the electronic patient files. The stepped wedge design involves a sequential rollout of the intervention over 16 months, in which seven participating clusters will be randomized from standard of care to intervention in a stepwise manner. Randomization will be stratified according to cluster size to keep high prevalence clusters separated. The trial will include approximately 220 HCV RNA positive individuals recruited from departments of internal medicine, addiction medicine, and psychiatry at Akershus University Hospital, Oslo University Hospital, and Lovisenberg Diaconal Hospital, Oslo, Norway. Individuals not able or willing to give informed consent and those with ongoing HCV assessment or treatment will be excluded. The primary outcome is treatment completion, defined as dispensing of the final prescribed DAA package from the pharmacy within 6 months after inclusion. Secondary outcomes include treatment uptake, virologic response, reinfection incidence, and resistance-associated substitutions.

Discussion

Representing a novel model of care suited to reach and engage marginalized PWID in HCV care, this study will inform HCV elimination efforts locally and internationally. If the model proves efficacious and feasible, it should be considered for broader implementation, replacing the current standard of care.

Trial registration

ClinicalTrials.gov, NCT04220645. Registered on 7 January 2020.
Structure-guided protein engineering increases enzymatic activities of the SGNH family esterases
Authors: Li Zhengyang , Li Long , Huo Yingyi , Chen Zijun , Zhao Yu , Huang Jing , Jian Shuling , Rong Zhen , Wu Di , Gan Jianhua , Hu Xiaojian , Li Jixi , Xu Xue-Wei
Published: June 2020

Background

Esterases and lipases hydrolyze short-chain esters and long-chain triglycerides, respectively, and therefore play essential roles in the synthesis and decomposition of ester bonds in the pharmaceutical and food industries. Many SGNH family esterases share high similarity in sequences. However, they have distinct enzymatic activities toward the same substrates. Due to a lack of structural information, the detailed catalytic mechanisms of these esterases remain barely investigated.

Results

In this study, we identified two SGNH family esterases, CrmE10 and AlinE4, from marine bacteria with significantly different preferences for pH, temperature, metal ion, and organic solvent tolerance despite high sequence similarity. The crystal structures of these two esterases, including wild type and mutants, were determined to high resolutions ranging from 1.18 Å to 2.24 Å. Both CrmE10 and AlinE4 were composed of five β-strands and nine α-helices, which formed one compact N-terminal α/β globular domain and one extended C-terminal domain. The aspartic residues (D178 in CrmE10/D162 in AlinE4) destabilized the conformations of the catalytic triad (Ser-Asp-His) in both esterases, and the metal ion Cd2+ might reduce enzymatic activity by blocking proton transfer or substrate binding. CrmE10 and AlinE4 showed distinctly different electrostatic surface potentials, despite the similar atomic architectures and a similar swap catalytic mechanism. When five negatively charged residues (Asp or Glu) were mutated to residue Lys, CrmE10 obtained elevated alkaline adaptability and significantly increased the enzymatic activity from 0 to 20% at pH 10.5. Also, CrmE10 mutants exhibited dramatic change for enzymatic properties when compared with the wide-type enzyme.

Conclusions

These findings offer a perspective for understanding the catalytic mechanism of different esterases and might facilitate the industrial biocatalytic applications.
Alkaline organosolv pretreatment of different sorghum stem parts for enhancing the total reducing sugar yields and p-coumaric acid release
Authors: Li Dandan , Long Liangkun , Ding Shaojun
Published: June 2020

Background

The sorghum stem can be divided into the pith and rind parts with obvious differences in cell type and chemical composition, thus arising the different recalcitrance to enzyme hydrolysis and demand for different pretreatment conditions. The introduction of organic solvents in the pretreatment can reduce over-degradation of cellulose and hemicellulose, but significance of organic solvent addition in pretreatment of different parts of sorghum stem is still unclear. Valorization of each component is critical for economy of sorghum biorefinery. Therefore, in this study, NaOH–ethanol pretreatment condition for different parts of the sorghum stem was optimized to maximize p-coumaric acid release and total reducing sugar recovery.

Result

Ethanol addition improved p-coumaric acid release and delignification efficiency, but significantly reduced hemicellulose deconstruction in NaOH–ethanol pretreatment. Optimization using the response surface methodology revealed that the pith, rind and whole stem require different NaOH–ethanol pretreatment conditions for maximal p-coumaric acid release and xylan preservation. By respective optimal NaOH–ethanol pretreatment, the p-coumaric acid release yields reached 94.07%, 97.24% and 95.05% from pith, rind and whole stem, which increased by 8.16%, 8.38% and 8.39% compared to those of NaOH-pretreated samples. The xylan recoveries of pith, rind and whole stem reached 76.80%, 88.46% and 85.01%, respectively, which increased by 47.75%, 15.11% and 35.97% compared to NaOH pretreatment. Adding xylanase significantly enhanced the enzymatic saccharification of pretreated residues. The total reducing sugar yields after respective optimal NaOH–ethanol pretreatment and enzymatic hydrolysis reached 84.06%, 82.29% and 84.09% for pith, rind and whole stem, respectively, which increased by 29.56%, 23.67% and 25.56% compared to those of NaOH-pretreated samples. Considering the separation cost of the different stem parts, whole sorghum stem can be directly used as feedstock in industrial biorefinery.

Conclusion

These results indicated that NaOH–ethanol is effective for the efficient fractionation and pretreatment of sorghum biomass. This work will help to understand the differences of different parts of sorghum stem under NaOH–ethanol pretreatment, thereby improving the full-component utilization of sorghum stem.
Stab wound of the superficial femoral artery early diagnosed by point-of-care Doppler ultrasound
Authors: Blanco Pablo , Menéndez María Fernanda
Published: June 2020

Background

Traumatic vascular injury of the limbs has the potential to cause substantial patient morbidity and mortality, and therefore, early recognition and treatment are crucial to improve outcomes. While patients with hard signs of arterial injury mandate for an immediate surgical intervention, patients presenting with soft signs of arterial injury need further diagnostic evaluation.

Case presentation

A 24-year-old male was admitted to the emergency department after suffering a stab wound in the anterolateral aspect of his left upper thigh. Entry wound measures approximately 3 cm × 0.7 cm; no exit wound was observed. On examination of the injured limb, the thigh was swollen and painful. Skin color was mildly pale and skin temperature was slightly diminished in his leg; leg numbness was also pointed out by the patient. Common femoral artery pulse was normal, while distal pulses were diminished. Point-of-care Doppler ultrasound (DUS) showed a subfascial hematoma in the thigh, which filled on color Doppler, corresponding to a pseudoaneurysm. On spectral Doppler, signs of distal low blood supply were noted. The patient was immediately transferred to the operating room where a 1-cm laceration was found in the anterior aspect of the superficial femoral artery. The involved artery was successfully repaired and distal flow was reestablished, as assessed by clinical examination, pulse palpation and DUS.

Conclusions

Based on its several advantages, DUS should be considered as the first-line diagnostic tool in the diagnostic workup of patients with soft signs of arterial injury.