bluuebunny/crossref_metadata_2025 huggingface dataset:
EL INCENDIO DE UN VEHÍCULO ESTACIONADO EN UN GARAJE PRIVADO CONSTITUYE UN “HECHO DE LA CIRCULACIÓN”. LA DOCTRINA DEL TRIBUNAL DE JUSTICIA DE LA UNIÓN EUROPEA Y LA SENTENCIA DEL TRIBUNAL SUPREMO (SALA DE LOS CIVIL, PLENO) DE 17 DE DICIEMBRE DE 2019.
Authors: Ortiz del Valle María Del Carmen
Published: July 2020

El Pleno del Tribunal Supremo, en sentencia de 17 de diciembre de 2019, confirma la tendencia jurisprudencial hacia una interpretación amplia del concepto “hecho de la circulación” considerando como tal el siniestro producido en un vehículo estacionado de forma no permanente por su propietario en una plaza de garaje privado.Para resolver el recurso de casación interpuesto por la aseguradora del vehículo,el Tribunal Supremo aplica la jurisprudencia del Tribunal de Justicia de la UniónEuropea, que, en respuesta a las cuestiones prejudiciales planteadas por el propio Tribunal Supremo, estableció que “[E]l artículo 3, párrafo primero, de la Directiva 2009/103, del Parlamento Europeo y del Consejo, de 16 de septiembre de 2009, relativa al seguro de responsabilidad civil que resulta de la circulación de vehículos automóviles, así como al control de la obligación de asegurar esta responsabilidad, debe interpretarse en el sentido de que está comprendida en el concepto de «circulación de vehículos» que figura en esta disposición una situación, como la del litigio principal, en la que un vehículo estacionado en un garaje privado de un inmueble y utilizado conforme a su función de medio de transporte comenzó a arder, provocando un incendio que se originó en el circuito eléctrico del vehículo y causando daños en el inmueble, aun cuando el vehículo llevara más de 24 horas parado en el momento en que se produjo el incendio”.
Feasibility of Using Infant Testing during Immunization to Estimate HIV Mother-to-Child-Transmission Rates in Zambia
Authors: Simbaya Joseph , Funjika Patricia , Moonga Arthur , Mwale John , Kankasa Chipepo
Published: July 2020

Background : This study piloted the feasibility of infant testing in immunization services as a strategy for estimating MTCT rates among the population of HIV exposed infants in Zambia. Methods : The study recruited a cross-sectional sample of 8,042 caregiver-baby pairs in 38 high volume immunization sites in 7 towns across 3 provinces of Zambia. All mothers who brought their children below the age of one year for immunization at the study facilities were invited to participate in the study. All consenting mothers were interviewed and blood drawn from their babies for; rapid HIV antibody test to determine exposure and DNA PCR test for samples of all HIV-exposed babies to determine HIV infection. Results : Of 8,042 recruited caregiver-baby pairs, 1,409 (17.5 %) babies were HIV-exposed. Approximately 90.2 percent of all mothers of HIV exposed infants reported that they attended ANC visits more than two times and facility based deliveries stood at 91.6 percent. Exclusive breastfeeding among HIV exposed infants reduced with increase in age of infant; it was highest at 6 weeks (82.2 %) followed by 10 weeks (74.0 %) and 14 weeks (58.2 %) . MTCT rates were relatively lower than what was reported before at 4.7 percent among Penta 1 seekers, 2.8 percent among Penta 2 seekers, 2.1 percent among Penta 3 seekers and 5.0 percent among Measles vaccination seekers. The overall MTCT rate stood at 3.8 percent. About 48.1 percent of HIV positive babies were male compared to 51.9 percent females. Babies of mothers below the age of 25 years accounted almost half (51.9 %) of all HIV infected babies in the study. Reported exclusive breastfeeding among HIV positive babies was 77.8 percent for Penta 1 seekers, 75.0 percent for Penta 2 seekers and 100 percent for Penta 3 seekers. Conclusion: The study succeeded in estimating MTCT rates using infant testing in immunization services, demonstrating that it is feasible to use routine infant testing in immunization services as a strategy for estimating MTCT rates among the population of HIV-exposed infants in countries with high HIV burden and immunization coverage.
Deletion of pgi gene in E. coli increases tolerance to furfural and 5-hydroxymethyl furfural in media containing glucose-xylose mixture
Authors: Jilani Syed Bilal , Dev Chandra , Eqbal Danish , Jawed Kamran , Prasad Rajendra , Yazdani Syed Shams
Published: July 2020

Background: Furfural and 5-hydroxymethyl furfural (5-HMF) are key furan inhibitors that are generated due to breakdown of lignocellulosic sugars at high temperature and acidic treatment conditions. Both furfural and 5-HMF act in a synergistic manner to inhibit microbial metabolism and resistance to both is a desirable characteristic for efficient conversion of lignocellulosic carbon to ethanol. Genetic manipulations targeted toward increasing cellular NADPH pools have successfully imparted tolerance against furfural and 5-HMF. In present study, deletion of pgi gene as a strategy to augment carbon flow through pentose phosphate pathway (PPP) was studied in ethanologenic Escherichia coli strain SSK101 to impart tolerance towards either furfural or 5-HMFor both inhibitors together.Results: A key gene of EMP pathway, pgi, was deleted in an ethanologenic E. coli strain SSK42 to yield strain SSK101. In presence of 1 g/L furfural in minimal AM1 media, the rate of biomass formation for strain SSK101 was up to 1.9-fold higher as compared to parent SSK42 strain, and it was able to clear furfural in half the time. Tolerance to inhibitor was associated with glucose as carbon source and not xylose, and the tolerance advantage of SSK101 was neutralized in LB media. Bioreactor studies were performed under binary stress of furfural and 5-HMF (1 g/L each) and different glucose concentrations in a glucose-xylose mixture with final sugar concentration of 5.5%, mimicking major components of dilute acid treated biomass hydrolysate. In the mixture having 6 g/L and 12 g/L glucose, SSK101 strain produced ~18 g/L and 20 g/L ethanol, respectively. Interestingly, the maximum ethanol productivity was better at lower glucose load with 0.46 g/(L.h) between 96-120 h, as compared to higher glucose load where it was 0.33 g/(L.h) between 144-168 h. Importantly, parent strain SSK42 did not exhibit significant metabolic activity under similar conditions of inhibitor load and sugar concentration.Conclusions: E. coli strain SSK101 with pgi deletion had enhanced tolerance against both furfural and 5-HMF, which was associated with presence of glucose in media. Strain SSK101 also had improved fermentation characteristics under both hyperosmotic as well as binary stress of furfural and 5-HMF in media containing glucose-xylose mixture.
Influence of diabetes on short-term outcome after major hepatectomy – an underestimated risk?
Authors: Fischer Alexander , Fuchs Juri , Stravodimos Christos , Hinz Ulf , Billeter Adrian , Büchler Markus W. , Mehrabi Arianeb , Hoffmann Katrin
Published: July 2020

Background: Patient-related risk factors such as diabetes mellitus and obesity are increasing in western countries. At the same time the indications for liver resection in both benign and malignant diseases have been significantly extended in recent years. Major liver resection is performed more frequently in a patient population of old age, comorbidity and high rates of neoadjuvant chemotherapy. The aim of this study was to evaluate whether diabetes mellitus, obesity and overweight are risk factors for the short-term post-operative outcome after major liver resection.Methods: Four hundred seventeen major liver resections (≥3 segments) were selected from a prospective database. Exclusion criteria were prior liver resection in patient’s history and synchronous major intra-abdominal procedures. Overweight was defined as BMI ≥ 25 kg/m² and < 30 kg/m² and obesity as BMI ≥ 30 kg/m². Primary end point was 90-day mortality and logistic regression was used for multivariate analysis. Secondary end points included morbidity, complications according to Clavien-Dindo classification, unplanned readmission, bile leakage, and liver failure. Morbidity was defined as occurrence of a post-operative complication during hospital stay or within 90 days postoperatively.Results: Fifty-nine patients had diabetes mellitus (14.1%), 48 were obese (11.6%) and 147 were overweight (35.5%). There were no statistically significant differences in mortality rates between the groups. In the multivariate analysis, diabetes was an independent predictor of morbidity (OR = 2.44, p = 0.02), Clavien-Dindo grade IV complications (OR = 3.6, p = 0.004), unplanned readmission (OR = 2.44, p = 0.04) and bile leakage (OR = 2.06, p = 0.046). Obese and overweight patients did not have an impaired post-operative outcome compared patients with normal weight. Conclusions: Diabetes has direct influence on the short-term postoperative outcome with an increased risk of morbidity but not mortality. Preoperative identification of high-risk patients will potentially decrease complication rates and allow for individual patient counseling as part of a shared decision-making process. For obese and overweight patients, major liver resection is a safe procedure.
IRLnc: A novel functional noncoding RNA contributes to intramuscular fat deposition
Authors: Wang Ligang , Zhou Zhong-Yin , Zhang Tian , Zhang Longchao , Hou Xinhua , Yan Hua , Wang Lixian
Published: July 2020

Background Intramuscular fat (IMF) is associated with meat quality and insulin resistance in animals. Research on genetic mechanism of IMF decomposition has positive meaning to pork quality and diseases such as obesity and type 2 diabetes treatment. In this study, an IMF trait segregation population was used to perform RNA sequencing and to analyze the joint or independent effects of genes and long intergenic non-coding RNAs (lincRNAs) on IMF. Results A total of 26 genes including 6 LincRNA genes show significantly different expression between high- and low-IMF pigs. Interesting, one lincRNA gene, named IMF related LincRNA (IRLnc) not only has a 292-nt conserved region in 100 vertebrates but also has conserved up and down stream genes (<10 kb) in pig and humans. Real-time quantitative polymerase chain reaction (RT-qPCR) validation study indicated that nuclear receptor subfamily 4 group A member 3 (NR4A3) which located at the downstream of IRLnc has similar expression pattern with IRLnc. RNAi-mediated loss of function screens identified that IRLnc silencing could inhibit both of the RNA and protein expression of NR4A3. And the in-situ hybridization co-expression experiment indicates that IRLnc may directly binding to NR4A3. As the NR4A3 could regulate the catecholamine catabolism, which could affect insulin sensitivity, we inferred that IRLnc influence IMF decomposition by regulating the expression of NR4A3.Conclusions In conclusion, a novel functional noncoding variation named IRLnc have been found contribute to IMF by regulating the expression of NR4A3. These finding suggest novel mechanistic approach for treatment of insulin resistance in human beings and meat quality improvement in animal.
Effect of different bonding techniques on marginal adaptation of Harmonize composite resin at different storage times.
Authors: Alagha Ebaa Ibrahim
Published: July 2020

Background
This study evaluated the effect of different bonding techniques on marginal adaptation of Harmonize composite resin at different storage times.
Methods
Hundred twenty upper premolars were divided into two main groups (n = 60) according to the type of the adhesive system used (self-etch adhesive system or total etch adhesive system). Each group was further divided into three subgroups (20 teeth each) according to the storage times into one day, three months and six months. Standardized Class II cavities were prepared and restored with Harmonize composite incrementally. Teeth were stored in distilled water at room temperature. After each storage time, teeth were sectioned buccolingually into two halves and examined under digital stereomicroscope for the purpose of gap formation detection and scanning electron microscope examination was done to evaluate resin-dentin interfaces. The recorded values were tabulated and statistically analyzed. Regression model using three-way Analysis of Variance (ANOVA) was used for testing significance of the effect of adhesive system, storage period and their interactions on the mean gap area. Tukey’s post-hoc test was used for pair-wise comparisons between the groups when ANOVA test is significant. The significance level was set at P ≤ 0.05.
Results
Self-etch adhesive system showed statistically significant higher mean gap area than Total-etch adhesive system at the occlusal and cervical margins. Six months period showed the statistically significant highest mean gap area. There was no statistically significant difference between 1 day and 3 months periods; both showed the statistically significant lowest mean gap area values respectively at the occlusal and cervical margins.
Conclusions
Total-etch adhesive system enhances the marginal adaptation when compared to self-etch adhesive system and the storage period of composite resin in water has adverse effect on the marginal adaptation to all groups with time.
An Internet Investigation of Mental Health Status of 1144 Different Status Identities in South China during Outbreak of COVID-19
Authors: Luo Qianyi , Deng Shaomin , Wu Kai , Wu Zhiyao , Mai Weiyang , Ning Yuping , He Hongbo , Zhang Shuangchun , Wang Dexian , Peng Hongjun
Published: July 2020

Background At the end of 2019, the Coronavirus disease 2019 (COVID-19), with highly infectious, transmits rapidly. So it has caused people panic to a certain degree. Methods This cross-sectional study performed via an online survey run from January 30 to March 30, 2020. 1144 people in South China (287 of level 1 population, 121 of level 2 population, 160 of level 3 population, 576 of level 4 population ) were investigated. GAD-7 scale, PHQ-9 scale, and PSS-10 scale were used to evaluate the mental health status of different populations. Results Among 1144 subjects, the average GAD-7 score was 4(1,8), the average PHQ-9 score was 4(1,9), and the average PSS-10 score was 16(11,19). There were statistically significant differences in the scores of GAD-7 (H = 15.235, P <0.01), PHQ-9 (H = 9.265, P = 0.026), and PSS-10 (H = 8.435, P = 0.049) among different levels of population. In the score of GAD-7: The anxiety degree of the level 1 population is higher than that of the level 2 population and the level 4 population. The difference between the two pairs is statistically significant (Z = -2.932, -4.012, -2.949, P <0.005). There are significant differences in items of“becoming easily annoyed or irritable”, "seemingly terrible things will happen"(Z = -3.399 ~ -2.055, P <0.005); Score of PHQ-9: The depression degree of the level 1 population and the level 2 population is higher than that of the level 4 population, and the difference between the two pairs is statistically significant (Z = -3.38, -2.682, P <0.005). There are significant differences in items of "difficult to fall asleep or not awake", "feeling depressed" and other related items (Z = -2.885 ~ -2.003, P <0.005); Score of PSS-10: The stress degree of the level 3 population is higher than that of the level 1 population and the level 4 population (Z = -3.693 ~ -2.702, P <0.005). There are significant differences in items of "feel confident", "life are as expected", "the ability to control anger", "the things are all under control" and other related items (Z = -4.782 ~ -2.102, P <0.005). Conclusion There are differences in the effects of COVID-19 on the mental health of people with different identities. Appropriate psychological interventions should be provided for different populations in combination with their mental health status.
How Professionals Tinker With Ethical Tensions Collectively When Fostering Service User Autonomy: An Ethnographic Study In Long-term Care
Authors: Heerings Marjolijn , Bovenkamp Hester van de , Cardol Mieke , Bal Roland
Published: July 2020

Background: The value of patient autonomy has become central in healthcare. However, care practices involve a plurality of possibly conflicting values. These values often transgress the borders of the individual professional-client relationship as they involve family members, other professionals and community organizations. Good care should acknowledge this complexity, which requires a collective handling of the tensions between values. To better understand this process, we draw on Mol (2008, 2010) by developing the notion of collective tinkering. Methods: Through ethnographic study in two teams in community housing services for people with intellectual disability and serious mental illness, we analyze how professionals tinker collectively. This research design enables in-depth analysis of care practices as they unfold in their situated context. Data were gathered by means of participant observation, interviews and focus groups with professionals, service users, peer support workers and family members. Results: Collective tinkering is analyzed 1) within teams of professionals working together with family members; 2) between professionals from different organizations providing care for the same client; and 3) in organizing practices for a collective of clients. Collective tinkering involves assembling values into a care practice, attentively experimenting with these care practices and adjusting care accordingly within a collective of those involved in care for a particular client or collective of clients. When collective tinkering does not occur, the stakeholders excluded from the tinkering (e.g. clients or family members) may experience poor quality of care.Conclusion: Collective tinkering differs from ‘individual’ tinkering between professionals and clients in several ways. First, by including stakeholders involved with the client, collective tinkering adds values and ontologies important in dealing with the situation and aids the creative process of inventing and experimenting with the care practices that assemble these values. Second, collective tinkering needs organizational structures beyond direct professional-client contacts. Structures that provide the time and space for the wider collective involved in care to come together, reflect and co-design care practices. The results also show that collective tinkering runs the risk of excluding clients in negotiating value tensions. Including clients should be carefully considered when structuring collective tinkering.
Supracondylar Fractures: A retrospective chart review comparing infection rate, antibiotic use, surgical time and cost of full surgical preparation and draping vs “semi-sterile” technique
Authors: Laxdal Ian , Stockwell Kevin , Xu Mark , Tan Jon , McRae Sheila , Jellicoe Paul
Published: July 2020

Background: Semi-sterile and full preparation and draping techniques are commonly used in closed reduction percutaneous pinning (CRPP) of supracondylar fractures. Debate exists whether full preparation and draping is safer than semi-sterile technique in regards to infection risk and the utility of pre-operative antibiotics. This study is a comparison of infection rates, pre-operative antibiotic administration, cost and surgical time between techniques.Methods: A retrospective chart review of 336 pediatric patients with supracondylar fractures repaired with CRPP at our institution was completed between January 2014 and April 2018, 168 per technique. Infection rates, pre-operative antibiotic administration, preparation-to-incision time and cost in semi-sterile draping versus full preparation and draping techniques were compared. Results: Of the 336 patients, 1/168(0.1%) in the full preparation and draping group developed an infection compared to 0/168(0%) patients in the semi-sterile group. Pre-operative antibiotics (Cefazolin) were administered to 76/168(23%) patients in the full preparation and draping group and 0/168(0%) in the semi-sterile group. The infection found received pre-operative antibiotics. Mean preparation-to-incision time for the semi-sterile group was 2.4±2.0 minutes and the full preparation and draping group was 9.9 ±4.2 minutes(p <0.001). Surgical supply cost was $80.72 [CDN] and 108.24$ [CDN], respectively, for the semi-sterile and full preparation and draping groups. Conclusion: Risk of infection using a semi-sterile draping technique was safe and comparable to a full preparation and draping technique when used in CRPP of supracondylar fractures. The administration of pre-operative antibiotics does not appear to make a difference in infection rates. Semi-sterile operative technique is cost effective and has decreased preparation-to-incision time.
Neuroprotective Effects of Curcumin-Loaded Emulsomes on Laser Axotomy-Induced CNS Injury Model
Authors: Yilmaz Elif Nur , Bay Sadik , Ozturk Gurkan , Ucisik Mehmet Hikmet
Published: July 2020

Background

Curcumin, a polyphenol isolated from the rhizomes of turmeric, holds a great potential as a neuroprotective agent along with its anti-inflammatory and antioxidant characteristics. Its poor bioavailability and low stability in water lie as foremost restraints against the clinical use. This study aims at investigating the neuroprotective effect of curcumin on axonal injury by delivering the lipophilic polyphenol to primary hippocampal neuron by means of a lipid-based drug delivery system, named emulsomes.
Methods

To study the neuroregeneration on ex vivo, an injury model was established through single-cell laser axotomy on hippocampal neurites. Upon treatment with curcumin-loaded emulsomes (CurcuEmulsomes), curcumin and CurcuEmulsome uptake into neurons were verified by 3-dimensional z-stack images acquired with confocal microscopy. Neuron survival after axonal injury were tracked by PI and Hoechst staining. Alterations in expression levels of physiological markers such as anti-apoptotic marker Bcl-2, apoptotic marker cleaved caspase 3, neuroprotective marker Wnt3a and the neuronal survival marker mTOR were investigated by immunocytochemistry analyses.
Results

Results indicated significant improvement in the survival rates of injured neurons upon CurcuEmulsome treatment. Bcl-2 expression became significantly higher for injured neurons treated with curcumin or CurcuEmulsome. Caspase 3 expressions decreased in both curcumin- and CurcuEmulsome-treatments, whereas Wnt3a and mTOR expressions did not alter significantly.
Conclusions

The established laser-axotomy model was exposed as a reliable methodology to study neurodegenerative models ex vivo. CurcuEmulsomes delivered curcumin to primary hippocampal neurons successfully. Treated with CurcuEmulsomes, injured hippocampal neurons benefit from neuroprotective effects of curcumin in terms of higher survival rate and increased anti-apoptotic marker levels.
The neuroprotective effects of α7 nicotinic acetylcholine receptor against mutant copper-zinc superoxide dismutase 1-mediated toxicity
Authors: Hozumi Isao , Ito Taisei , Inden Masatoshi , Ueda Tomoyuki , Asaka Yuta , Kurita Hisaka
Published: July 2020

BackgroundAmyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by the selective and progressive loss of motor neurons. Although many drugs have entered clinical trials, few have shown effectiveness in the treatment of ALS. Previous studies searching for causal genes associated with familial ALS identified the copper-zinc superoxide dismutase 1 (SOD1). Other studies have shown that the stimulation of α7 nicotinic acetylcholine receptor (nAChR) can have neuroprotective effects in some models of neurodegenerative disease, as well as prevent glutamate-induced motor neuronal death. However, the effect of α7 nAChR agonists on mutant SOD1 aggregates in motor neurons remains unclear.MethodsWe examined whether α7 nAChR activation had a neuroprotective effect against SOD1G85R-induced toxicity in a cellular model for ALS. Furthermore, the mechanism was also examined by Western blot analysis and qRT-PCR.ResultsWe found that α7 nAChR activation showed significant neuroprotective effects against SOD1G85R-induced toxicity via the reduction of intracellular protein aggregates. This reduction also correlated with the activation of autophagy through the AMP-activated protein kinase (AMPK)–mammalian target of rapamycin (mTOR) signaling pathway. Furthermore, the activation of α7 nAChRs was found to increase the biogenesis of lysosomes by inducing translocation of the transcription factor EB (TFEB) into the nucleus.ConclusionsThese results support the therapeutic potential of α7 nAChR activation in diseases that are characterized by SOD1G85R aggregates, such as ALS.
Gotfried reduction and cannulated screws fixation in the treatment of femoral neck fracture in young adults
Authors: Huang Kai , Fang Xiaohui , Li Guijun , Yue Jiajun
Published: July 2020

Background: Although many available surgical procedures for displaced femoral neck fractures in young patients, there are still many challenges to achieve satisfactory results. The incidence of avascular necrosis and nonunion rates remain relatively high despite the progress in our understanding and surgical technique. The purpose of this study was to evaluate the clinical efficacy of gotfried reduction and cannulated screw fixation in the treatment of femoral neck fracture for young adults.Methods: A retrospective analysis was made on 67 cases from May 2013 to March 2019. They were divided into three groups according to the first postoperative anteroposterior view of hip X-ray: Anatomic reduction (group A), Gotfried positive buttress reduction (group B), and Gotfried negative buttress reduction (group C). The incidence of avascular osteonecrosis of the femoral head (AVN) and the Harris scores of hip joints were compared in three groups at the last follow-up.Results: There were 21 cases (mean age,49.7 ± 11.6) in group A, 24 cases (mean age, 48.6 ± 11.3) in group B, 22 cases (mean age,48.3 ± 12.4) in group C. No significant difference in general preoperative demographics (P>0．05).The incidence of avascular necrosis of femoral head in Group A, B, and C was 19.05%,20.83%, and 22.73 %, respectively, showing no significant difference between groups(P=0．156). The mean Harris hip scores at the final follow-up for groups A (85．6±6．7)and B (84．5±6．2) were significantly higher than group C (74．3±8.3), and the difference was statistically significant(P=0．043).Conclusions: Gotfried positive buttress reduction and fixation for femoral neck fracture may lead to similar clinical results with anatomic reduction, but much better than Gotfried negative buttress reduction. For the patients of femoral neck fracture with severe displacement and difficulty in reduction, it is not necessary to pursue anatomical reduction。Achieving positive valgus reduction can also obtain satisfactory clinical results, and should try to avoid negative buttress.
Feasibility and Long-Term Safety of Ho:YAG Laser Lithotripsy in Broncholithiasis Patients
Authors: Cheng Yuan , Wang Guangfa , Zhang Wei , Zhang Hong , Wang Xi
Published: July 2020

Background Treatment of broncholithiasis is complex, especially in the case of a large or transbronchial broncholith. Holmium-yttrium aluminum garnet (Ho:YAG) laser lithotripsy may be a useful treatment in broncholithiasis; however, as it is not yet common practice, the optimal parameters are unknown.Objectives We investigated the feasibility and long-term safety of Ho:YAG lithotripsy in broncholithiasis patients.Method We performed a single-center retrospective analysis of the clinical data of 13 broncholithiasis patients who underwent Ho:YAG laser lithotripsy from May 2012 to October 2018.Result For the 13 patients (2 males and 11 females), Ho:YAG laser lithotripsy was performed 17 times, in total. All procedures were performed under general anesthesia with rigid bronchoscopy. We initially set the Ho:YAG laser to a pulse frequency of 5 Hz and a pulse energy of 0.8 J, gradually increasing these as required. The pulse frequency range we employed was 5-15 Hz, and the pulse energy range was 0.8-1.6 J. All broncholiths were successfully extracted after lithotripsy, and all symptoms improved. Hemoptysis, bronchial esophageal fistula, and pneumonia were the most common complications; however, there were no long-term complications.Conclusions Ho:YAG laser lithotripsy is an effective and safe treatment for broncholithiasis, over a long-term follow up.
Data Quality of the Routine Health Management Information System at the Primary Healthcare Facility and District Levels in Tanzania
Authors: RUMISHA SUSAN F. , LYIMO EMANUEL P. , MREMI IRENE R. , TUNGU PATRICK K. , MWINGIRA VICTOR S. , MBATA DORIS , MALEKIA SIA E. , JOACHIM CATHERINE , Mboera Leonard
Published: July 2020

Background: Effective planning for disease prevention and control requiresaccurate, adequately-analysed, interpreted and communicated data. This study assessed the quality of routine Health Management Information System (HMIS) data at healthcare facility (HF) and district levels in Tanzania. Methods: HMIS tools used at primary health care facilities (dispensary, health centre, hospital) and district office were reviewed to assess their availability, completeness, and accuracy of collected data. The assessment involved seven health service areas namely, Outpatient department, Inpatient department, Antenatal care, Family Planning, Post-natal care, Labour and Delivery and Provider-initiated Testing and Counselling.Results: A total of 115 HFs in 11 districts were assessed. Registers (availability rate=91.1%; interquartile range (IQR):66.7%-100%) and reportforms (86.9%;IQR:62.2%-100%) were the most utilized tools. There was a limited use of tally-sheets (77.8%;IQR:35.6%-100%). Tools availability at dispensary was 91.1%, health-centre 82.2% and hospital 77.8%, and was poor in urban districts. The availability rate atthe district level was 65% (IQR:48%-75%). Reports were highly over-represented in comparison to registers’ records, with large differences observed at HF phase of the data journey and more profound in hospitals.Tool availability and data quality varied by service-areas, indicators, facility level, and districts, however, with a remarkable improvement over the years.Conclusion: There are high variations and improvements in the tool utilisation and data accuracy at facility and district levels. The routine HMIS is weak and data at district level inaccurately reflects what is available at the HFs. These results highlight the need to design tailored and inter-service strategies for improving data quality.
Comparative Mapping and Correlation Analysis Revealed Differentiation in the Genetic Basis of Stem Trichome Development Between Cultivated Tetraploid Cotton Species
Authors: Yuan Rong , Cao Yuefen , Li Tengyu , Yang Feng , Yu Li , Qin Yuan , Du Xiongming , Liu Fang , Ding Mingquan , Jiang Yurong , Zhang Hua , Paterson Andrew H. , Rong Junkang
Published: July 2020

Background: Cotton stem trichomes and seed fibers are each single celled structures formed by protrusions of epidermal cells, and were found sharing the overlapping molecular mechanism . Compared with fibers, cotton stem trichomes are more easily observed, but the molecular mechanisms underlying their development are still poorly understood. Results: In this study, Gossypium hirsutum (Gh ) and G . barbadense ( Gb ) were found to differ greatly in percentages of varieties/accessions with glabrous stems and in trichome density, length, and number per trichopore. Gh varieties normally had long singular and clustered trichomes, while Gb varieties had short clustered trichomes. Genetic mapping using five F2 populations from crosses between glabrous varieties and those with different types of stem trichomes revealed that much variation among stem trichome phenotypes could be accounted for by different combinations of genes/alleles on Chr.06 and Chr.24. The twenty six F1 generations from crosses between varieties with different types of trichomes had varied phenotypes, further suggesting that the trichomes of tetraploid cotton were controlled by different genes/alleles. Compared to modern varieties, a greater proportion of Gh wild accessions were glabrous or had shorter and denser trichomes; whereas a smaller proportion of Gb primitive accessions had glabrous stems. A close correlation between fuzz fiber number and stem trichome density was observed in both Gh and Gb primitive accessions and modern varieties. Conclusion: Based on these findings, we hypothesize that stem trichomes evolved in parallel with seed fibers during the domestication of cultivated tetraploid cotton. In addition, the current results illustrated that stem trichome can be used as a morphological index of fiber quality in cotton conventional breeding.
Effectiveness of Assertive Case Management for Patients with Suicidal Intent Admitted to Emergency Departments Following Attempted Suicide by Self-Poisoning: A Secondary Analysis of the ACTION-J Study
Authors: Inui-Yukawa Masami , Miyaoka Hitoshi , Yamamoto Kenji , Kamijo Yoshito , Takai Michiko , Yonemoto Naohiro , Kawanishi Chiaki , Otsuka Kotaro , Tachikawa Hirokazu , Hirayasu Yoshio
Published: July 2020

Background: Self-poisoning is commonly observed in individuals as a component of suicide attempts and self-harm. The effectiveness of interventions for self-poisoning is unclear. The objective of this study was to examine the effectiveness of assertive case management intervention in preventing suicidal behaviour in self-poisoning patients.Methods: We conducted a secondary analysis of data from the ACTION-J study. Participants were self-poisoning patients with clear suicidal intent who were admitted to emergency departments and who had a primary psychiatric diagnosis (as per DSM-IV-TR axis 1). Patients were randomly assigned either to assertive case management (intervention group) or enhanced usual care (control group). The primary outcome measure was the incidence of a first recurrent suicidal attempt within 6 months after group assignment.Results: There were 297 self-poisoning patients in the intervention group and 295 in the control group. The primary outcome was significantly lower in the intervention group than in the control group (risk ratio [RR]: 0.473, 95% confidence interval [CI]: 0.284 to 0.788). The incidence of a first recurrent suicidal attempt within 1 and 3 months after group assignment was also significantly lower in the intervention group, as was the number of overall self-harm episodes over the entire study period (incidence rate ratio [IRR]: 0.711, 95% CI: 0.582 to 0.866). Furthermore, the number of non-suicidal self-harm episodes and suicide attempts was significantly lower in the intervention group than in the control group.Conclusion: Assertive case management is effective when promptly introduced in a hospital setting as an intervention following a suicide attempt, particularly for self-poisoning patients.Trial Registration: This study is registered at ClinicalTrials.gov (NCT00736918) and UMIN-CTR (C000000444).
Synovial Fluid Ghrelin Levels in Patients With or Without Cartilage Injury Undergoing Anterior Cruciate Ligament Reconstruction
Authors: Mao Zimu , Chen Zeyi , Wang Xinjie , Sun Zewen , Guan Jian , Jiang Dong , Yu Jiakuo , Zhang Jiying
Published: July 2020

Objectives

The aim of our study was to measure synovial fluid levels of ghrelin in patients with ACL injury to evaluate its potential function as a diagnostic biomarker for cartilage injury.
Methods

Patients were prospectively recruited in this study, compromising a cohort of subjects that had synovial fluid samples collected. Patients’ synovial fluid sampling was collected to evaluate ghrelin level. Venous blood samples were taken from all subjects to test inflammation markers IL-6, TNF-α, MMP-3, MMP-13 and also serum ghrelin level. Correlation between synovial fluid ghrelin level and inflammatory biomarkers were analyzed using spearman’s correlation analysis. The best cut-off of synovial fluid ghrelin level was defined using Medcalc.
Results

Patients in the ACL reconstruction with cartilage damage had lowest synovial fluid ghrelin level (ACL reconstruction with cartilage damage group: 264.6±65 pg/ml, ACL reconstruction without cartilage damage group: 466.8±92.6 pg/ml, healthy controls: 471.5±89.3 pg/ml, P < 0.001). Synovial fluid ghrelin level was negatively associated with IL-6 (r=-0.700, P < 0.001), MMP-3 (r=-0.702, P < 0.001) and MANKIN score (r=-0.768, P < 0.001). Patients with synovial fluid ghrelin level ≤ 333 pg/ml had higher chance of cartilage injury with specificity of 91.7% and sensitivity of 87.5%.
Discussion

In conclusion, synovial fluid ghrelin was a useful biomarker to predict cartilage injury for patients undergoing ACL reconstruction. Synovial fluid ghrelin was negatively correlated with IL-6, MMP-3 and MANKIN score. Synovial fluid ghrelin ≤ 333 pg/ml was a useful biomarker for cartilage damage in patients with ACL injury.
Less Invasive Surfactant Administration via Thin Catheter in Late Preterm Infants With Respiratory Distress Syndrome
Authors: Arenas Juan José Agüera , Guiard María del Valle Viedma , García Cristina Martínez , Martínez Olga Micol , Saura Miguel Alcaraz , Crespo María del Rocío Pérez , Pidre Manuel Cidrás
Published: July 2020

Background: The use of less invasive surfactant administration (LISA) has been increasingly investigated, since neonatal respiratory distress syndrome (RDS) due to surfactant deficiency is associated with high morbidity and mortality in preterm infants. However, this technique has been barely studied in late preterm newborns with RDS. In the present study, we analyzed the use of LISA using a thin catheter in late preterm infants with RDS who required noninvasive ventilation (NIV).Methods: A retrospective study was conducted on late preterm infants admitted to the Neonatal Intensive Care Unit –­ Virgen de la Arrixaca University Hospital in Murcia (Spain), between June 2017­­­ and March 2020. Maternal and prenatal data, as well as safety and efficacy variables related to the technique were collected. Statistical analyses were performed using SPSS version 20.0.Results: A total of 20 patients were included. The mean gestational age was 35 (341/7-366/7) weeks. There were 12 males (60.0%) and 8 females (40.0%). Seven infants (35.0%) received prenatal corticosteroids for fetal lung maturation. Mothers had a mean age of 31.0 (16-40) years and only one had a medical condition (HELLP syndrome). The more frequent type of delivery was C-section (75.0%). Ten newborns (50.0%) required resuscitation to breathe with nCPAP or nIPPV, with no signs of acute fetal distress. Before LISA, mean pCO2, pH and FiO2 values were 53 (40-81) mmHg, 7.28 (7.19-7.48), and 0.41 (0.3-0.6), respectively. Thirteen patients (65.0%) were treated with nCPAP and seven (35.0%) with nIPPV. Premedications administered were caffeine (50.0%) and ketamine/morphine sedation (20.0%). During LISA, oxygen saturation decreased in fifteen patients (75.0%). Redosing was needed in two infants (10.0%). Response was favorable, with a rapid and sustained reduction in FiO2 (FiO2 of 0.21 in 85.0% of cases) and NIV mean time of 70 hours. Patients with final diagnosis of RDS (90.0%) did not required invasive mechanical ventilation (IMV). No severe comorbidities and no deaths occurred.Conclusions: LISA procedure was a safe and effective method of surfactant delivery in late premature neonates with RDS, improving respiratory outcomes with no need for IMV. These findings add to the knowledge of respiratory management of late preterm infants.
Study on the isoprene-producing co-culture system of Synechococcus elongatus- Escherichia coli through omics analysis
Authors: Liu Hui , Cao Yujin , Guo Jing , Xu Xin , Long Qi , Song Lili , Xian Mo
Published: July 2020

Background: The majority of microbial fermentations are currently performed in the batch or fed-batch manner with the high process complexity, huge water consumption and so on. The continuous microbial production can contribute to the green sustainable development of the fermentation industry. The co-culture systems of photo-autotrophic and heterotrophic species can play important roles in establishing the continuous fermentation mode for the bio-based chemicals production. Results: In the present paper, the co-culture system of Synechococcus elongatus- Escherichia coli was established and put into operation stably for isoprene production. Compared with the axenic culture, the fermentation period of time was extended from 100h to 400h in the co-culture and the isoprene production was increased to 8-fold. For in depth understanding this novel system, the differential omics profiles were analyzed. The responses of BL21(DE3) to S. elongatus PCC 7942 were triggered by the oxidative pressure through the Fenton reaction and all these changes were linked with one another at different spatial and temporal scales. The oxidative stress mitigation pathways might contribute to the long-lasting fermentation process. The performance of this co-culture system can be further improved according to the fundamental rules discovered by the omics analysis. Conclusions: The isoprene-producing co-culture system of S. elongatus- E. coli was established and then analyzed by the omics methods. This study on the co-culture system of the model S. elongatus- E. coli is of significance to reveal the common interactions between photo-autotrophic and heterotrophic species without natural symbiotic relation, which could provide the scientific basis for rational design of microbial community.
Comparison of intra-gastric pressure between endotracheal tube and supraglottic airway devices in laparoscopic hepatectomy:A randomised, controlled, non-inferiority study
Authors: Ahn Jin Hee , Jeong Jiseon , Kang Se Hee , Yeon Ji Eun , Cho Eun A , Choi Gyu Sung , Kim Jong Man , Kim Gaab soo
Published: July 2020

Background Supraglottic airway (SGA) devices do not definitively protect the airway from regurgitation of gastric contents. Increased gastric pressure and long operation time are associated with development of complications such as aspiration pneumonia. The aim of this study was to compare intra-gastric pressure between second-generation SGA and endotracheal tube (ETT) devices during long-duration laparoscopic hepatectomy.Methods A total of 66 patients was randomly assigned to two groups; 33 patients each in the ETT and SGA groups. Intra-gastric pressure was continuously measured via a gastric drainage tube with a three-way stopcock connected to the pressure monitoring device. Normal saline was added to the end of the gastric drainage tube at each operation time point.Results Intra-gastric pressure during pneumoperitoneum was no different between the two groups (p = 0.146) or over time (p = 0.094). The mean (SD) pH of the SGA tip measured after operation was 6.7 (0.4), and a pH less than 4 was not observed. Relative risk of postoperative complications was significantly higher in the ETT group relative to the SGA group (sore throat, 5.5; cough,13.0).Conclusions Use of SGA devices does not further increase intra-gastric pressure, even during prolonged upper abdominal laparoscopic surgery. Also, the frequency of postoperative sore throat and cough was significantly lower when the second-generation SGA device was used.Clinical trial registration of Korea (https://cris.nih.go.kr/cris/index.jsp): KCT0003512 Principle investigator: G S K; date of registration February 15, 2019, https://cris.nih.go.kr/cris).
Analysis of the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) database to identify factors associated with postoperative mortality after elective non-cardiac surgery
Authors: Malviya Amit K. , Bruceta Melanio , Singh Preet M. , Bonavia Anthony , Karamchandani Kunal
Published: July 2020

Background Various surgical risk assessment tools, including the American College of Surgeons National Surgical Quality Improvement Program® (ACS NSQIP®) risk calculator have been devised to predict post-operative mortality. However, the role of individual factors on mortality is unclear. We sought to identify patient characteristics from the database that were associated with postoperative mortality in patients undergoing elective, non-cardiac surgery.Methods Data from the ACS NSQIP® database at a tertiary care academic medical center was analyzed from January 2011 to September 2016. Relevant patient related variables were extracted from the database and univariable logistic regression was used to assess the association of each potential risk factor with 30-day mortality. A multivariable logistic regression model was then used to assess the adjusted effect of each potential risk factor on the outcome.Results 5,254 database patient records were identified and among the analyzed variables, American Society of Anesthesiologists (ASA) physical status III and IV (odds ratio and 95%CI : 16.75 [2.29, 122.69] ), poor preoperative functional health status (Odds ratio and 95%CI : 38.52 [2.46, 604.12] ), and low serum albumin (Odds ratio and 95%CI : 3.76 [1.35, 10.44]) were significant predictors of 30-day postoperative mortality.Conclusions In a comprehensive analysis of the ACS NSQIP®database, spreading across multiple surgical specialties, we found an association between ASA physical status, preoperative albumin levels, and functional health status with 30-day mortality after elective non-cardiac surgery.
Patients >40 years with a glenohumeral dislocation have a lower incidence of Symptomatic Rotator Cuff Tear than previously reported and can be managed safely without routine advanced imaging
Authors: Manafa Chibuzo , Barakat Ahmed , Auld Felicity , Phadnis Joideep
Published: July 2020

Background Incidence of rotator cuff tears (RCT) following primary anterior glenohumeral dislocation in patients over 40 years is thought to be high. Current guidelines recommend specialist clinic review and advanced imaging for all patients. The aim of this study was to report the incidence of symptomatic RCT in a large cohort of patients and to assess the safety and efficacy of a physiotherapy led virtual protocol where patients were selectively investigated and treated based on symptoms. Methods 238 consecutive patients over 40 years of age with a primary anterior glenohumeral dislocation were identified between January 2015 and June 2018 (42 months). All patients were managed initially through a physiotherapy led virtual clinic with selective referral of patients with red flag symptoms to a specialist shoulder clinic. Advanced imaging (MRI or USS) was performed at the discretion of the shoulder specialist following patient assessment. The incidence of symptomatic RCT was assessed and compared between two groups (Group 1: 40-70 years, Group 2: >70 years). All surgical interventions were recorded. Patients were assessed at a mean of 22 months (range 10-54) using the Oxford shoulder score; patient satisfaction and return to pre-injury functional level. Cost analysis was performed to compare management using this protocol versus published guidelines.Results A total of 238 patients were identified with mean age of 65 years (range 40-96). 69% (n=164/238) were symptomatic and were referred to specialist clinic. The other 31% (n=74/238) were asymptomatic and were discharged to physiotherapy. Of those referred to a specialist clinic, only 46% (n=75/164) were sent for advanced imaging following clinical examination. The incidence of symptomatic RCTs was 31% (n=51/164) in this group and only 22% (n=11/51) of those underwent subsequent surgical repair of their rotator cuff. Of those patients discharged to physiotherapy, 62% (n=47/74) responded to the questionnaire with 89% fully satisfied, 85% returned to pre-injury level and mean Oxford score was 42 (33-38, SD 3.2) indicating excellent shoulder function. With all patients pooled excluding those lost to follow-up (n=27), the incidence of symptomatic RCTs was 24% (51/211). The incidence in group 1 was 16% (n=22/137) and was significantly lower than in group 2 which was 39% (n=29/74) (p<0.05). Cost analysis demonstrated 49% cost reduction using this protocol.Conclusion Incidence of symptomatic cuff tears following a primary glenohumeral dislocation in patients over 40 years was lower than previously reported. A protocol based on selective referral and investigation for symptomatic patients was cost effective and safe.