bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis to the clinical characteristics and prognosis of MDA5 positive patients with dermatomyositis
Authors: Yang Yiying , Zuo Xiaoxia , Zhang Huali , Luo Hui , Liu Sijia
Published: June 2020

Background: To explore the relationship between anti-MDA5 antibody and clinical manifestations of dermatomyositis(DM) and to explain the correlation of prognosis as well. Methods: Retrospective analysis was performed at the Department of Rheumatology and Immunology in Xiangya Hospital, Central South University from April 2017 to February 2019. The clinical data were collected from 109 patients with DM, and then the patients were divided into anti-MDA5 antibody positive group and negative group according to the results of antibody detection, after which statistical analysis was carried out with SPSS 23.0 software.Results: Among the 109 DM patients, the ratio of male to female is 1:2.3, with 58 positive anti-MDA5 antibody and 51 negative anti-MDA5 antibody. There is no difference in gender and age between the two groups, and patients with positive anti-MDA5 have a shorter course. The incidence of clinical symptoms, including Gottron sign, skin ulcer, joint pain, joint swelling, nail erythema, dyspnea, and cough in patients with anti-MDA5-positive DM is significantly higher than those in the anti-MDA5-negative group. Anti-MDA5 antibodies are inversely associated with tumorigenesis. Patients with anti-MDA5-positive DM have less elevation of muscle enzymes and are prone to ILD and RPILD, while patients with anti-MDA5-positive DM have a high mortality rate and poor prognosis.Conclusion: Combined with RP-ILD, the prognosis of DM is poor. When patients have these clinical manifestations and positive MDA5, they must actively undergo lung imaging examination and be alert to RP-ILD.
The relationship between miR-219-5p Gene Polymorphisms and the prognosis of colorectal cancer
Authors: Yan Yang , Du Xiaohui , Xia Shaoyou , Li Songyan , Teng Da , Hu Shidong , Wang Yufeng , Li Rong
Published: June 2020

Background

Colorectal cancer (CRC) is one of the most common malignant tumors, its morbidity and mortality are increasing year by year, it is a serious threat to people's health. Some studies have reported that miR-219-5p acts as a tumor suppressor in some malignant tumors. So the purpose of this study was to investigate the prognostic value of miR-219-5p expression in CRC patients.
Methods

QRT-PCR was used to detect the expression levels of miR-219-5p in CRC tissues and corresponding normal tissues (P < 0.001). The prognostic value of miR-219-5p in CRC was analyzed by Kaplan-Meier and Cox regression analysis.
Results

The results indicated that the expression of miR-219-5p was significantly lower in CRC tissues, and its expression was closely correlated with tumor differentiation, TNM staging and lymph node metastasis (all P < 0.05). Moreover, Kaplan Meier survival analysis showed that the patients with low expression of miR-219-5p had worse overall survival rates (P < 0.05). Cox regression analysis further demonstrated that miR-219-5p expression was an independent prognostic factor for survival time in CRC patients (P = 0.018, HR = 2.026 and 95%CI: 1.127–3.643).
Conclusions

All the results suggest that miR-219-5p expression can be used as a potential prognostic biomarker for CRC patients.
Improving the Assisting Efficiency of Ankle Robot through Energy Harvesting of Achilles Tendon
Authors: Huang Guowei , Wang Zhihou , Liu Biao , Zhou Zikang , Xian Xiaoming , Xie Longhan
Published: June 2020

Background The construction of lightweight robots poses one of the major challenges in the field of active robots since bearing the weight of an active robot significantly increases metabolic cost. However, few studies have achieved a substantial reduction in the robot weight. The primary reason is that the weight of the actuator, which comprises the main weight of the robot, is limited by the specific power, power requirements and assisting efficiency. Methods In this paper, we propose a new method that is utilizing the energy harvesting function of the Achilles tendon to improve the assistance efficiency of ankle robots to reduce the weight of the actuator and we design a novel ankle robot to test the validity of the method. The robot works with the ankle plantar flexor at 43%-60% of the gait cycle and has no other effects on the joints or the tendon of the lower limb. Healthy subjects were recruited to test the prototype in three conditions: free walking, power-on walking, and power-off walking. Data on the robot assisting power, metabolic cost and kinematics in different conditions were collected and analyzed. Result The results showed that the ankle robot can deliver forces at the controlled assistance timing. The average assisting power of 0.0650±0.0054 W/kg per leg resulted in an 8.7±8.1% and 19.0±6.4% net reduction in metabolic cost in power-on walking compared to free-walking and power-off walking, respectively. Conclusion Compared with the results of some of the best research, our initial result supports the validity of the method. This method can help to reduce the weight of active robots and the technical innovative method to determine the assistance timing more accurately and the novel design of the ankle robot can provide a reference for future research. To the best of our knowledge, this method is the first to use the human physiological structure to optimize the design of active robots.
Sensitivity and specificity of the URAM scale for Dupuytren contracture: A systematic review and meta-analysis
Authors: Gomez-Herrero Diego , Sanjuan-Cervero Rafael , Vazquez-Ferreiro Pedro , Carrera-Hueso Francisco Javier , Poquet-Jornet Jaime Eduardo , Garcia-Jimenez Emilio
Published: June 2020

Background

The URAM (Unité Rhumatologique des Affections de la Main) scale is a patient-reported functional outcome measurement tool validated for exclusive use in Dupuytren contracture (DC) a condition in which one or more fingers become permanently bent in a flexed position. The current study´s purposes were to evaluate: How sensitive and specific is the URAM scale for defining quality of life in patients with in DC and how sensitive to change is the URAM scale after treatment.
Methods

We performed a meta-analysis of all relevant articles published in PubMed, Embase, Cochrane, Google Scholar, LILACS and in various gray literature databases that describe the use of the URAM. We built three models: a hierarchical summary receiver operating characteristic (HSROC) model to determine the optimal threshold for defining DC, a difference in means models to assess the magnitude of the effect of different treatment modalities, and a meta-regression model to determine the effect on patient quality of life questionnaires according to variations in Tubiana scores after treatment (URAM).
Results

The HSROC and bivariate models showed a sensitivity of 80.23% (95%CI: 75.66 to 84.14) and an overall specificity of 2.61% (95%CI: 1.11–6.05). The second model showed an overall difference in means of 1.95 (95%CI: -2.86 to -1.04). The coefficient obtained in the meta-regression model was − 1.666 (95%CI: -4.183 to 0.851).
Conclusion

The URAM scale is highly sensitive to changes in DC but has low specificity. It also showed a strong correlation with worsening of finger contracture.
Reintubation Rate and Mortality After Emergent Airway Management Outside the Operating Room
Authors: Yoon Uzung , Mojica Jeffrey , Wiltshire Matthew , Torjman Marc , Wolo Elizabeth
Published: June 2020

Background Little is known about reintubations that are performed outside of the operating room (outside-OR). Reintubation in general does not occur without risk and is associated with prolonged mechanical ventilation, higher incidence of nosocomial pneumonia, increased morbidity, mortality, and care of cost. The objective of this study was to evaluate the reintubation rate and mortality after emergent airway management outside-OR, including ICU and non-ICU settings. Methods A retrospectives cohort study design was used to review all emergent airway management outside-OR. The primary outcome measures were reintubation rate and mortality. Secondary outcome measures were demographics, location of intubation, indication for intubation, time until reintubation, total intubated days, ICU-stay, hospital stay, 30-day in-hospital mortality, and overall in-hospital mortality. Results A total of 336 outside-OR intubations were performed in 275 patients. Of those 275 patients, 51 (18.5%) were reintubated during the same hospital admission. Of the 336 performed intubations, 61 (18.1%) were reintubations. There was no statistical difference in admission demographics and comorbidities among reintubated and non-reintubated patients. Reintubations occurred after up to 30-days after extubation, including within 24-hours (8.2%, n=5), 24-72 hours (27.9%, n=17), 3-7 days, (23%, n=14), and 7-30 days after extubation (32.8%, n=20). Most of the reintubated patients were reintubated just once (56.9%; n=29), but some were reintubated two times (29.4%; n=15) or three times or more (13.7%; n=7). Reintubated patients had significant longer total ICU-stay (24±3 days vs. 12±1 day, p <0.001), hospital stay (37±3 vs.18±1, p<0.001), and total intubation days (8±1 vs. 7±0.6, p<0.02) than non-reintubated patients. The 30-day in-hospital mortality in reintubated patients was 13.7% (n=7) compared to non-reintubated patients 35.9% (n=80; p=0.002). Conclusion The reintubation rate was high, reaching 18%, in intubations performed outside-OR and is associated with a significant increase in hospital and ICU-stay. Almost half of the reintubation occurred in a non-ICU setting and more than 72-hours after extubation. The higher mortality rate among non-reintubated patients may indicate survival bias, in that severely sick patients did not survive long enough to attempt extubation. Further research is needed to identify the causes for increased reintubation outside-OR and the difference in mortality between the two groups.
Identification of dysregulated long noncoding RNA and associated mechanism in gastric cancer
Authors: Shao Liang , Ming Yanan , Zhou Zhaoming
Published: June 2020

Gastric cancer (GC) is one of the most malignant epithelial tumors. The incidence of GC varies worldwide, and nearly half of the cases occur in Asian countries, especially in Japan and China. GC is the second leading cause of cancer-related deaths in the world, and current prognosis of advanced GC remains dismal despite improvements in diagnosis and therapy. Our current study aimed to identify significant long noncoding RNAs (lncRNAs) that could be used for prognosis and for the elucidation of associated molecular mechanisms. This study identified a substantial variety of reports using high-throughput lncRNA detection to investigate the expression of lncRNAs in GC development. However, the reported potentially diagnostic lncRNAs were unsuitable for meta-analysis, so we verified the expression of diagnostic lncRNAs and selected eight of them using Gene Expression Profiling Interactive Analysis (GEPIA). Next, we explored interactions of selected lncRNAs using Qiagen’s IPA system. We also identified differentially expressed genes (DEGs) of GC using the GEO2R online tool and datasets GSE52149, GSE19826, and GSE79973. To reveal genes that could be regulated by the selected lncRNA in GC, we used a Venn diagram and selected IGF2BP3 and FOLR1 as potential downstream targets of lncRNAs H19 and PVT1, respectively. Expression of IGF2BP3 and FOLR1 in GC validated by GEPIA was related to the worse prognosis for GC patients as shown by Kaplan Meier plots. Considering that IGF2BP3 promotes the expression of H19 and PEG10, down-regulation of their expression may improve the prognosis for GC patients, although at this time there is no evidence for direct involvement of IGF2BP3 in the regulation of these lncRNAs. The second DEG, FOLR1, is a crucial component of cell metabolism and DNA synthesis/repair required for cancer cell division. However, the role of FOLR1 in the etiology and progression of GC requires further study. In conclusion, using an integrated bioinformatic approach we identified eight significantly altered lncRNAs with diagnostic potential in GC patients. We also identified two axes - H19-IGF2BP3 and PVT1-FOLR1 – that may be related to the prognosis of GC and provide new insights into the etiology of GC and management of GC patients.
Efficacy of Retreats on Resident Physician Well-being as Measured by Maslach Burnout Index Analysis: a Cross-sectional Study
Authors: McLeod Kristyn N , Hopp Shelby L , Woods Emily J , Lohse Christine M , Bellolio Fernanda , Battaglioli Nicole J , Colletti James E
Published: June 2020

Background

Awareness of burnout has led residency programs to seek interventions to promote well-being, resiliency, camaraderie and social network development. Limited evidence exists on the efficacy of specific interventions. This study evaluated the efficacy of an emergency medicine residency program’s semi-annual retreat using serial administration of the Maslach burnout index and resident well-being survey.
Methods

Surveys were administered to all emergency medicine residents (n = 25) in July 2018 and before and after fall 2018 and winter 2019 retreats. Retreats included a meal, team building, and social networking opportunities (bowling, softball, snow tubing, and sledding). Comparisons of responses between baseline, pre-retreat, and post-retreat were evaluated using two-sample t, Wilcoxon rank sum, and Fisher exact tests.
Results

Sixteen emergency medicine residents (64%) responded at baseline. Response rates on subsequent surveys ranged from 14 (56%) to 21 (84%). Nineteen percent of residents exhibited burnout at baseline. This peaked at 36% pre-winter retreat. Burnout decreased after each retreat (fall: 29–6%, winter: 36–13%). Mean Maslach burnout index subscores for emotional exhaustion (13 to 9) and depersonalization (7 to 5) decreased from baseline to post-fall retreat, but neither changed significantly over the entire study period (emotional exhaustion: 13 to 12, depersonalization: 7 to 6). Resident well-being survey pre- and post-retreat responses were similar on all items.
Conclusion

Meaningful, but not statistically significant differences were detected on the Maslach burnout index and resident well-being survey in association with a retreat. Mean emotional exhaustion, depersonalization and burnout decreased after retreats. Larger studies would provide further insight into the significance of these trends.
Opportunities and Challenges of Implementing Service Agreement between the Government and Faith Based Organizations in Ilala Municipality, Dar Es Salaam, Tanzania
Authors: luoga pankras wilbard , Gasto Frumence
Published: June 2020

Background

Access to essential health services is an important aspect of development. Due to the population increase and technological advancement, governments could no longer cater for the services needed. One of the solutions was to involve private sector through Public Private Partnerships (PPPs) in provision of the services. In 2007 Tanzania made a generic Service Agreement (SA) to govern PPPs in health sector. However, since its establishment, less is known on opportunities and challenges of implementing SA in the provision of health services in Tanzania. Therefore, the focus of this study was to assess the opportunities and challenges of implementing SA in Tanzania using a case of SA between the Cardinal Rugambwa Mission Hospital (CRMH) and the Ilala Municipality in Dar es Salaam.
Methods

The study employed a case study design using qualitative method of data collection. Data were collected by using in depth interview guide. Purposive sampling was used to select participants. The sample size was based on the principle of saturation level of the information collected. Data were analyzed using a thematic analysis approach.
Results

The opportunities of implementing SA in CRMH, Ilala Municipality include: the existence of guidelines and policies, Patients receive some health Services free of charges, availability of some services at reduced prices, presence of SA review meetings, good coordination, availability of supervision, training and mentorship opportunities, presence of political support, trust of the hospital by suppliers and trust between government and the hospital. The identified challenges in implementing SA include: - partial fulfillment of financial commitment, inadequacy deployment of HRH to CRMH by government, lack of transport for supervision and donor dependence.
Conclusion

There are a number of available opportunities for partnering between the private sector and the government in the delivery of health services. However, for the PPP to achieve its desired objective of improving access to health services particularly to most vulnerable population such as women and children, there is a need for the two parties (private and public) to address the identified challenges such as partial fulfillment of financial commitment and inadequacy deployment of HRH from the government to the private health facilities as per SA.
A Modified Prone Position Using A Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Surgeries
Authors: Ding Zhiyu , Li Yuezhan , Wang Weiguo , Wang Jianlong , Cai Deyang , Zheng Ruping , Yu Haiyang , Chen Shijie , Miao Jinglei , Li Jinsong
Published: June 2020

Background

A modified prone cervical spine surgical position using a body-shape plaster bed with skull traction (BSPST) was compared with the traditional prone surgical position with horseshoe headrests.
Methods

Forty-seven patients undergoing posterior cervical spine surgery for cervical spine fracture were retrospectively classified into two groups, BSPST group (n = 24) and traditional group (n = 23) and underwent posterior instrumented fusion with or without decompression. Multiple indicators were used to evaluate the advantages of the BSPST compared with the traditional position.
Results

All the operations went smoothly. The mean recovery rate was 56.30% in the BSPST group and 48.55% in the traditional group, with no significant difference. Intraoperative blood loss and total incidence of complications were significantly less in the BSPST group than in the traditional group. In addition, the BSPST position provided greater comfort level for the operators and allowed convenient intraoperative radiography.
Conclusions

This is the first study to describe a combined body-shape plaster bed and skull traction as a modified cervical spine prone surgical position that is simple, safe and stable, adjustable during surgery, reproducible and economical for posterior cervical spine fracture surgery and potentially other cervical and upper dorsal spine surgeries in the prone position. Additionally, this position provides surgeons a comfortable surgical field and can be easily achieved in most orthopedic operation rooms.
Food Choice Decisions of Collegiate Division I Athletes: Qualitative Interviews
Authors: Eck Kaitlyn , Byrd-Bredbenner Carol
Published: June 2020

Background

Limited research has examined athletes’ food and health beliefs and decisions and the congruence of these decisions with recommendations from nutrition professionals. This study aimed to improve understanding of athletes’ food-related beliefs and practices to enable nutrition professionals to more effectively enhance performance while protecting athletes’ health.
Methods

Division I college athletes (n = 14, 64% female) from a variety of sports were recruited to participate in 20-minute semi-structured phone interviews about their food and nutrition-related behaviors and cognitions. Data were content analyzed to identify themes and trends.
Results

Prominent factors that influenced athletes’ food choices were potential benefits to health and performance, availability of foods, and recommendations from sports dietitians. Foods commonly consumed by athletes, including fruits, vegetables, and lean protein, were generally healthy and aligned with sports nutrition recommendations. Athletes reported avoiding energy-dense nutrient-poor foods, such as fast food and fried foods, with the goal of improving performance. Some athletes took supplements (i.e., multivitamin, iron, protein) on the premise that they would improve health and enhance performance or recovery.
Conclusions

While athletes’ nutrition behaviors are generally congruent with current recommendations, findings highlighted misconceptions held by athletes related to the benefits of some supplements, and the belief that packaged/processed foods were inherently less healthy than other options. Nutrition misconceptions held by athletes and incongruities between athletes’ nutrition knowledge and behaviors suggest that dietitians should aim to dispel nutrition misconceptions held by athletes and provide additional guidance and information to support athletes’ current healthful behaviors to ensure these behaviors extend beyond their college athletic career.
Standardized management of an outpatient service schedule in a large general hospital
Authors: Yao Yingchun , He Xiaoli , Gao Qin , Yang Ling
Published: June 2020

Background: An outpatient schedule should have attending physician names, number of consultations, consultation agenda, and information based on which patients book their appointments. Regulating physician discipline while ensuring improved service quality and high-quality physician–patient relationships have become critical issues in outpatient management. The purpose of this study is to identify the effects of an outpatient service schedule on patient satisfaction.Methods: This study is based on a mixed-methods approach and investigates the standardization of outpatient schedules’ formulation and operation processes. Following the implementation of standardized formulation, operation, and evaluation of outpatient service schedule, we analyzed the outpatient service data as well as third-party patient satisfaction between 2016 and 2018 about 2000 outpatients, and introduced interventions on the corresponding influencing factors. Results: The outpatient service-suspension rate fell from 2.5% in 2017 to 1.9% in 2018, while the service-substitution rate fell from 2.9% in 2017 to 2.5% in 2018. The service-suspension rates also decreased for attending physicians and professors; rates for senior doctors were higher than for junior doctors. Furthermore, the suspension and substitution rates were at their lowest in the first quarter and at their highest in the third quarter of each year. Patient loyalty, overall satisfaction, and registration convenience improved annually.Conclusions: The standardized management of outpatient-service schedules is a solemn commitment of public hospitals to honest and lawful practices; however, it also serves as a solid base for the consolidation and development of the medical-service reservation system.
CHD5 may be a promising novel bio-marker for the diagnosis of lung cancer patients
Authors: Yang Jun , Zhong Hua , Yang Qinghui , Yu Jian , Jin Cailing , Li Xiaorui
Published: June 2020

Background

Chromodomain helicase DNA binding protein 5 (CHD5) is a new tumor suppressor gene in various types of cancer. And it is still not clear about the role of CHD5 in lung cancer. In this study, we aim to assess diagnostic value of CHD5 in patients with lung cancer.
Methods

CHD5 expression in 108 lung cancer serum samples and 65 healthy controls were determined by quantitative Real-Time PCR (qRT-PCR). A receiver operating characteristic (ROC) curve was established to analyze the effect of CHD5 in the diagnosis of lung cancer.
Results

The expression of CHD5 was significantly decreased in lung cancer samples compared with the healthy controls (P < 0.0001). Advanced TNM stage (P = 0.020), gender (P = 0.001) and smoking history (P = 0.000) were associated with the decreased CHD5 expression. Besides, the results of ROC analysis showed that the area under ROC curve (AUC) was 0.855 with a sensitivity of 87.1% and a specificity of 81.3%.
Conclusions

In conclusion, this study suggested that CHD5 expression is down-regulated in lung cancer. Furthermore, CHD5 expression could be a potential diagnosis bio-marker in lung cancer patients.
Diagnosis of Tuberculosis Pleurisy with Three Endoscopic Features via Pleuroscopy
Authors: Lee Chung-Shu , Li Shih-Hong , Chang Chih-Hao , Chung Fu-Tsai , Chiu Li-Chung , Chou Chu-Liang , Wang Chih-Wei , Lin Shu-Min
Published: June 2020

Background: Tuberculosis (TB) is a constant threat even with worldwide active public health campaign. Diagnosis of TB pleurisy is challenging in case of pleural effusion of unknown origin after aspiration analysis. The study was designated to demonstrate a simple image interpretation technique to differentiate TB pleurisy from non-TB pleurisy using semi-rigid pleuroscopy. Methods: The study retrospectively enrolled 117 patients who underwent semi-rigid pleuroscopy from April 2016 to August 2018 in a tertiary hospital. We analyzed the possibility of TB pleurisy using three simple pleuroscopic images via semi-rigid pleuroscopy. Results: Among 117 patients, 28 patients (23.9%) were diagnosed with TB pleurisy. Sago-like nodules/micronodules, adhesion, and discrete distribution were noted in 20 (71.4%), 20 (71.4%), and 19 (67.9%) patients with TB pleurisy, respectively. Sago-like nodules/micronodules, adhesion, and discrete distribution were noted in 6 (6.7%), 37 (41.6%), and 0 (0.0%) patients with non-TB pleurisy, respectively. The positive and the negative predictive values of any two out of three pleuroscopic patterns for TB pleurisy were 100.0% and 93.7%, respectively. Conclusions: A high positive predictive value for TB pleurisy was demonstrated by the presence of any two out of the three characteristic features. Absence of all three features had an excellent negative predictive value for TB pleurisy. Our diagnostic criteria reconfirm that pleuroscopic images can be used as predictors for TB pleurisy.
The interrelationship between ventilatory inefficiency and left ventricular ejection fraction in terms of cardiovascular outcomes in heart failure outpatients
Authors: Chen Shyh-Ming , Wang Lin-Yi , Wu Po-Jui , Liaw Mei-Yun , Chen Yung-Lung , Chen An-Ni , Tsai Tzu-Hsien , Hang Chi-Ling , Lin Meng-Chih
Published: June 2020

BackgroundThe relationship between left ventricular ejection fraction (LVEF) and cardiovascular (CV) outcome is well documented in patients with low LVEF. Ventilatory inefficiency is an important prognostic predictor in all spectrums of heart failure (HF). In stable HF outpatients, whether the relationship between LVEF and CV outcome is affected by ventilatory inefficiency remains unknown. We hypothesized that the presence of ventilatory inefficiency influences the prognostic predictability of LVEF in chronic HF outpatients.Materials and MethodsIn total, 169 HF outpatients underwent the cardiopulmonary exercise test (CPET) and were followed up for a median of 9.25 years. Subjects were divided into five groups of similar size according to baseline LVEF (£39%, 40-58%, 59-68%, 69-74%, and ³75%). The primary endpoints were CV mortality and first HF hospitalization. The Cox proportional hazard model was used for simple and multiple regression analyses to evaluate the interrelationship between LVEF and ventilatory inefficiency (ventilatory equivalent for carbon dioxide [VE/VCO2] at anaerobic threshold [AT] >34.3, optimized cut-point).ResultsOnly LVEF and VE/VCO2 at AT were significant predictors of major CV events. The lower LVEF subgroup (LVEF £39%) was associated with an increased risk of CV mortality or HF hospitalization relative to the LVEF ³75% subgroup except for patients with ventilatory inefficiency (p=0.400). The interaction effect between LVEF and ventilatory inefficiency was not significant (p=0.579).ConclusionsVentilatory inefficiency influenced the prognostic predictability of LVEF in reduced LVEF outpatients. Ventilatory inefficiency can be used as the therapeutic target in HF management.Trial registrationClinicalTrials.gov (identifier: NCT04141345), 10/24/2019, retrospectively registered
Risk factors for esophagojejunal anastomotic leakage in curative total gastrectomy combined with D2 lymph node dissection for gastric cancer: A retrospective cohort study
Authors: Xing Jiadi , Liu Maoxing , Qi Xinyu , Yu Jianhong , Fan Yingcong , Xu Kai , Gao Pin , Tan Fei , Yao Zhendan , Zhang Nan , Yang Hong , Zhang Chenghai , Cui Ming , Su Xiangqian
Published: June 2020

Background: This study aimed to explore the risk factors associated with esophagojejunal anastomotic leakage (EJAL) in curative total gastrectomy combined with D2 lymph node dissection for gastric cancer.Methods: 390 consecutive patients receiving Roux-en-Y esophagojejunostomy reconstruction after surgery were reviewed. Multivariate analysis was performed using a logistic regression model to identify independent risk factors for EJAL.Results: Of the 390 patients enrolled in this study, EJAL occurred in 10 patients (2.6%). One patient (1/10) with EJAL died. Univariate analysis identified age (P = 0.025), alcohol consumption (P = 0.019), pulmonary insufficiency (P = 0.049), and intraoperative blood loss (P = 0.015) as risk factors for EJAL. Of these four risk factors, age (P = 0.043) and alcohol consumption (P = 0.043) were retained as independent risk factors by multivariate analysis.Conclusions: Surgeons should be very careful about anastomotic leakage during the perioperative period, especially in patients with advanced age and a history of alcohol consumption. Pulmonary insufficiency and intraoperative blood loss, although not being identified as independent risk factors, should also be considered.
First-Trimester Fasting Hyperglycemia without Gestational Diabetes Mellitus is not Associated with Adverse Pregnancy Outcomes:A Prospective Cohort Study in China
Authors: Guo Zhiheng , Shan Yanhong , Xiu Caifeng , Yang Yi , Zheng Shu , Peng Min
Published: June 2020

Background Gestational diabetes mellitus (GDM) is a common pregnancy-induced metabolic complication worldwide. At present, a variety of strategies for diagnosis and management of GDM have been recommended. Our aim is to investigate the clinical features and pregnancy outcomes among women in whom a first-trimester fasting glucose value (≥ 5.10 mmol/L but < 7.0 mmol/L) was detected and a 2-h 75-g oral glucose tolerance test (OGTT) between 24–28 weeks was negative.Methods This is a prospective cohort study of women who registered and delivered between June 2016 and November 2019 at First Hospital, Jilin University. Pregnant women who met the inclusion criteria were categorized as normal first-trimester fasting plasma glucose(FPG)(< 5.10 mmol/L) and first-trimester fasting hyperglycemia (≥ 5.10 mmol/L but < 7 mmol/L).Outcomes included weeks at time of delivery, neonatal birth weight, Apgar score at 1 min, Apgar score at 5 min, prevalence of macrosomia, hypertensive disorders of pregnancy ,primary cesarean delivery, preterm delivery ,premature rupture of membranes and sillbirth or neonatal death were compared after women who developed gestational diabetes mellitus (GDM) were excluded.Results In our population of 2124 eligible subjects, pregnant women with first-trimester fasting hyperglycemia (≥ 5.10 mmol/L but < 7 mmol/L) constituted 20.8% of the total study population and accounted for 27.6% of subsequent GDM diagnosis. The other 1683 had a normal first-trimester FPG (< 5.1 mmol/L), accounting for 11.6% of all subsequent GDM diagnosis (p < 0.01).After excluding women with a diagnosis of GDM between 24 and 28 weeks of gestation, we observed no significant difference between groups for adverse maternal and prenatal outcomes.Conclusion More than two thirds of first-trimester fasting hyperglycemia pregnant women will have a normal OGTT performed at 24–28 week and of these women whom in no increased risk of adverse pregnancy outcomes have been identified.
Sulfur intermediates as new biogeochemical hubs in an aquatic model microbial ecosystem
Authors: Vigneron Adrien , Cruaud Perrine , Culley Alexander I. , Couture Raoul-Marie , Lovejoy Connie , Vincent Warwick F.
Published: June 2020

BackgroundThe sulfur cycle encompasses a series of complex aerobic and anaerobic transformations of S-containing molecules, and plays a fundamental role in cellular and ecosystems level-processes, influencing biological carbon transfers and other biogeochemical cycles. Despite their importance, the microbial communities and metabolic pathways involved in these transformations remain poorly understood, notably for inorganic sulfur compounds of intermediate oxidation states (thiosulfate, tetrathionate, sulfite, polysulfides). Isolated and highly stratified, the extreme geochemical and environmental contexts of the meromictic ice-capped Lake A, in the Canadian High Arctic, provides an outstanding model ecosystem to resolve the distribution and metabolism of aquatic sulfur cycling microorganisms along redox and salinity gradients. ResultsApplying complementary molecular approaches, we identified sharply contrasting microbial communities and metabolic potentials among the distinct water layers of the Lake A, with homologies to diverse fresh, brackish and saline water microbiomes. Sulfur cycling genes were abundant at all depths, with oxidative processes in the oxic freshwater layers, reductive reactions in the anoxic and sulfidic bottom waters and genes for both transformations at the chemocline, and co-varied with bacterial abundance. Up to 154 different genomic bins with potential for sulfur transformation were recovered, revealing a panoply of taxonomically diverse microorganisms with complex metabolic pathways for biogeochemical sulfur reactions. Metabolism of sulfur cycle intermediates was widespread throughout the water column, co-occurring with sulfate reduction or sulfide oxidation pathways. The genomic bin composition suggested that in addition to chemical oxidation, these intermediate sulfur compounds were likely produced by the predominant sulfur chemo- and photo-oxidizers at the chemocline and by diverse microbial organic sulfur molecule degraders. ConclusionsThe Lake A microbial ecosystem provided an ideal opportunity to identify new features of the biogeochemical sulfur cycle. Our detailed metagenomic analyses across the broad physico-chemical gradients of this highly stratified lake extend the known diversity of microorganisms and metabolic pathways involved in sulfur transformations over a wide range of environmental conditions. The results identify the importance of sulfur cycle intermediates and organic sulfur molecules as major sources of electron donors and acceptors for aquatic and sedimentary microbial communities in association with the classical sulfur cycle.
Verrucous carcinoma of the esophagus with complete response after chemoradiotherapy
Authors: Hashimoto Masashi , Shirakawa Yasuhiro , Tanabe Shunsuke , Tanaka Takehiro , Kobayashi Teruki , Maeda Naoaki , Noma Kazuhiro , Sakurama Kazufumi , Fujiwara Toshiyoshi
Published: June 2020

Background Verrucous carcinoma of the esophagus (VCE) is a rare tumor that is difficult to diagnose. In most cases, biopsies show nonspeciﬁc inﬂammatory and hyperkeratotic changes and do not show malignant findings. Most VCEs are slowly growing, locally advanced tumors with few metastases. Treatments for VCE are the same as for normal esophageal cancer, involving combined chemotherapy, surgical resection, and radiation therapy. However, it has been reported that VCE has a poor response to radiation or chemoradiotherapy (CRT). A case of VCE with complete response (CR) after CRT is presented. Case presentation A 70-year-old man was found to have white, irregular esophageal mucosa four years earlier. He had been followed-up as an outpatient as having candidal esophagitis. However, his tumor grew gradually, and biopsy was performed by endoscopic mucosal resection. He was finally diagnosed with VCE. He had no metastases to distant organs, but some lymph node metastases were suspected. The tumor invaded his left bronchus. First, the esophagostomy and gastrostomy were constructed. The patient then underwent definitive CRT. Four weeks after the end of CRT, two-stage esophagectomy was performed. First, he underwent esophagectomy with thoracic lymph node dissection. A latissimus dorsi flap was patched to the bronchus after primary suture of the hole. Six weeks later, reconstruction of the gastric tube was performed through the antethoracic route. The pathological findings showed complete response to CRT, with no proliferative cancer cells in the specimen. Six months after the first-stage operation, no recurrence has been observed. Conclusions A case of locally advanced VCE that achieved a complete response to CRT was presented. In cases in which local resection would be difficult, CRT might be an appropriate neoadjuvant treatment for VCE.
Sedentary Behaviors Of A School Population In Brazil And Related Factors Descriptive Research With Questionnaire
Authors: Ponce-Blandón José Antonio , Deitos-Vasquez María Eduarda , Romero-Castillo Rocío , Rosa-Viana Diogo da , Robles-Romero José Miguel , Mendes-Lipinski Jussara
Published: June 2020

Background Overweight and obesity arise from a complex range of genetic, environmental, behavioural, educational, and socioeconomic factors. Poor eating habits and poor physical activity increase the probability that children will become obese adolescents. The sedentary lifestyle, encouraged by the rapid evolution of technology, has been accentuated in recent years. Strategies to accelerate obesity prevention include modifying the child's environment for healthy eating and physical activity. For this, it is essential to analyze the characteristics and life habits of children population. This study tries to know the sedentary practices and some life habits related to health among children from the school population of Uruguaiana (RS, Brazil), identifying the sociodemographic factors that can influence it.Methods The sample was composed of 470 school boys and girls, aged between 9 and 10 years. In order to obtain the sample, a random plampling was performed by clusters of the 24 urban public schools of the city. Sociodemographic variables and sedentary habits were measured.Results As regards the variables linked to habits, 24% of the boys and girls answered they had not had breakfast the day they completed the questionnaire. 51.8% stated they did not have breakfast any given day of the week. Regarding to sedentary habits, 25.3% of children watched TV or played video games 5 or more hours a day and 9% rarely played sports with their parents or caregivers. Statistical significance was recorded between “number of hours watching TV and playing video games” and “playing sports with parents or caregivers” (p < 0.05).Conclusions Association between the times spent watching TV or playing video games and the practice of physical exercise in the family, proves once again the importance of the family in education for the health of children. The school provides direct Access to schoolchildren and their parents to launch numerous health education programs.
Performance and Emissions of a Premixed Combustion Engine Fueled by Methanol–Gasoline Blends
Authors: Wang Jibai , Zhang Peng , Zhang Chunhua , Jing Zheng
Published: June 2020

Background: Methanol is abundant, safe, and environmentally friendly and has physicochemical properties similar to those of gasoline. It is a promising alternative fuel in China because it can be directly used in both spark- and compression-ignition internal combustion engines. The current development of spark-ignition engines focuses on the reduction of the fuel volume and increase in the compression ratio (CR), which would benefit the engine’s thermal efficiency. However, increasing the CR may deteriorate particulate matter (PM) due to the high temperature.Methods: Herein, an experimental study was conducted on methanol–gasoline blends in a spark-ignition engine. We examined the performance and formaldehyde emissions of methanol–gasoline blends by using three volume fractions (M0, M15, and M100). In addition, the effects of the CR on PM emissions were investigated.Results: The following relationships were observed: (1) When methanol was blended with gasoline, the formaldehyde emissions increased significantly. The formaldehyde emissions of 100% methanol were higher than those of the methanol–gasoline blend with a methanol volume fraction of 15%; both of these emissions were higher than those of pure gasoline; (2) Increasing the CR resulted in increased PM emissions; (3) For a given blending ratio, the PM emissions were positively correlated with the CR; and (4) The PM emissions were negatively correlated with the methanol volume fraction.Conclusions: Methanol reduces the heat loss at the wall surface. As the ratio of methanol in gasoline increases, the PM emissions decrease. On the other hand, the PM emissions are positively correlated with the CR. The addition of lower alcohols dilutes the concentrations of soot precursors, thereby reducing the soot emissions.
Prostate-Specific Antigen Dynamics After Carbon Ion Radiotherapy for Prostate Cancer
Authors: Takakusagi Yosuke , Oike Takahiro , Kano Kio , Anno Wataru , Tsuchida Keisuke , Mizoguchi Nobutaka , Serizawa Itsuko , Yoshida Daisaku , Kamada Tadashi , Katoh Hiroyuki
Published: June 2020

Background This study aimed to explain the dynamics of prostate-specific antigen (PSA) levels in patients with prostate cancer who were treated with carbon ion radiotherapy (CIRT) and neoadjuvant androgen-deprivation therapy (ADT). Methods Eighty-five patients with intermediate-risk prostate cancer who received CIRT and neoadjuvant ADT from December 2015 to December 2017 were analyzed in the present study. The total dose of CIRT was set at 51.6 Gy (relative biological effectiveness) delivered in 12 fractions over 3 weeks. The PSA bounce was defined as a ≥0.4 ng/ml increase of PSA levels from the nadir, followed by any decrease. PSA failure was defined using the Phoenix criteria.Results The median patient age was 68 (range, 48–81) years. The median follow-up duration was 33 (range, 20–48) months. The clinical T stage was T1c, T2a, and T2b in 26, 44, and 14 patients, respectively. The Gleason score was 6 in 3 patients and 7 in 82 patients. The median pretreatment PSA level was 7.37 (range, 3.33–19.0) ng/ml. All patients received neoadjuvant ADT for a median of 6 (range, 2–116) months. PSA bounces were observed in 39 patients (45.9%), occurring a median of 12 (range, 6–30) months after CIRT. PSA failure was observed in eight patients (9.4%), occurring a median of 21 (range, 15–33) months after CIRT. The 3-year PSA failure-free survival rate was 88.5%. No clinical recurrence was observed during the follow-up period. Younger age was a significant predictor of PSA bounces and PSA failure. Conclusions The dynamics of PSA levels after CIRT was investigated in the present study. Further follow-up is needed to reveal the clinical significance of PSA dynamics.
A Pilot Randomized Study of Atorvastatin As Adjunct Therapy in Patients with Acute Venous Thromboembolism
Authors: Wang Tzu-Fei , Waller Amanda P. , Lin Ella , Wei Lai , Bartosic Abigail , Riedl Ken , Kerlin Bryce A.
Published: June 2020

Background: Venous thromboembolism (VTE) is a considerable public health threat. Improving the management of VTE may achieve better long-term outcomes. In this single-center pilot study, we sought to investigate the effects of statins in addition to anticoagulation in patients with acute VTE.Methods: We enrolled patients over the age of 18 presenting with an acute proximal lower extremity deep vein thrombosis with or without pulmonary embolism. Patients were randomized to anticoagulation alone (with either warfarin or rivaroxaban) or anticoagulation plus atorvastatin 40 mg daily and followed for 9 months. The primary objective was to determine if adjunct atorvastatin reduced thrombin generation, estimated by endogenous thrombin potential and/or peak thrombin concentration. Secondary endpoints included recurrent VTE, arterial thrombosis, bleeding events, and more.Results: A total of 21 patients (11 randomized to anticoagulation only and 10 to anticoagulation plus atorvastatin) were enrolled over 3.5 years. The addition of atorvastatin significantly reduced the mean low-density lipoproteins at 3 months, but did not reduce either endogenous thrombin potential, peak thrombin, D-dimer, or high sensitivity-C reactive protein. Given the low recruitment rate, continuation of the study was deemed futile and the study was terminated early. Barriers to enrollment and completion of study included the many ineligible patients due to the exclusion criteria (e.g. pre-existing statin use, active malignancy, etc) and high rate of lost follow-up.Conclusions: The pilot study did not enroll sufficient number of patients, but was able to inform obstacles for future similar studies investigating the effects of statins in the management of patients with VTE.Trial registration: The study was registered with ClinicalTrials.gov (NCT02331095), January 6, 2015. https://clinicaltrials.gov/ct2/show/NCT02331095
Malnutrition Precipitated Measles Outbreak in Gewane District, Afar Regional State, Northeastern Ethiopia, 2016
Authors: Ayele Wolde Melese
Published: June 2020

Background: Measles is a contagious viral and vaccine-preventable disease that is continuing a public health problem. It is occurring as an outbreak not only in developing but also in developed countries.Methods: A 1:2 ratios, unmatched case-control study was conducted from September 19/2016- October 08/2016 in Undufo Kebele, Gewane district, Northeastern Ethiopia. Both confirmed by laboratory and epidemiologically linked measles cases were involved. Controls were those who had no clinical signs of measles during the data collection period and residents of the same community where cases were identified. An interviewer-administered questionnaire was used to collect data. Nutritional status was measured using MUAC and the result decided based on the world health organization's nutritional categorization of children by MUAC. Data were entered into Epi-info 7 and analyzed using SPSS-21. Binary logistic regression was done to identify risk factors for measles infection with 95% confident level of Odds ratio.Result: Fifty cases and 100 controls have participated in this investigation. Four out of five samples collected were positive for measles IgM antibody. There were three deaths reported. There was no vaccination history of cases and controls. The majority of cases were female and between 6–15 years of age. In multivariable analysis, malnutrition (AOR = 3.21; 95%CI 1.871,6.334), and contact history (AOR = 12.24; 95%CI 6.992,28.121) increased the risk of contracting measles infection.Conclusion: children under 15-year age were more affected groups. The absence of vaccination in the area precipitated by a high rate of malnutrition was the main cause that aggravates the number of new infections. Contact history and malnutrition were the identified risk factors for measles infection. Therefore, increasing immunization coverage of more than 80%, and securing food security decrease the susceptibility of outbreak occurrence.