bluuebunny/crossref_metadata_2025 huggingface dataset:
An Exploratory Study of Pharmacist Perceptions of Opioid Interventions for Acute Pain
Authors: Webb Katie , Cernasev Alina , Li Minghui Sam , Gatwood Justin , Cochran Gerald , Hohmeier Kenneth C.
Published: October 2020

Background: As the last health care provider encountered before an opioid is dispensed, pharmacists have a vital role in reducing unnecessary opioid exposure while facilitating access to non-opioid alternatives. Objective: To characterize pharmacist perceptions in providing interventions for patients with an opioid prescription for acute pain. Methods: This cross-sectional survey was administered over 3 months to pharmacy preceptors affiliated with the University of Tennessee Health Science Center College of Pharmacy. The electronic survey utilized 7 demographical and baseline questions, 1 open-ended question, and 5 Likert-type scales to assess the following domains: responsibility in making decisions, willingness to provide information, comfort in speaking to patients, willingness to use a standing order, and importance of following up with patients. Results: Of the 380 participants invited to participate, 126 responded to at least one question and 90 completed all survey questions. Most participants were PharmD graduates practicing in hospital and community settings. Participants felt that opioids are frequently overprescribed and pharmacist interventions are often necessary. Most participants reported that pharmacists and physicians share similar responsibilities in making opioid-related decisions. Participants were willing to provide information about opioid alternatives but were only somewhat comfortable speaking to patients. Responses to the open-ended question revealed the following themes: Significance of educating the patient; Importance of alternatives to opioid medications; Impacts of pharmacist interventions; and Need for enhanced collaboration with physicians. Conclusions: Pharmacists face complex issues with limited clinical guidance when providing opioid-related interventions. Future research is needed to develop evidence-based clinical support tools and collaborative practice models.
Design of Self-Reconfigurable Multiarm Robot Mechanism Based on Deployable Kinematic Chains
Authors: Zhao Fu-Qun , Guo Sheng , Su Hai-Jun , Qu Hai-Bo , Chen Ya-Qiong
Published: October 2020

As the structures of multiarm robots are serially arranged, the packaging and transportation of these robots are often inconvenient. The ability of these robots to operate objects must also be improved. Addressing this issue, this paper presents a type of multiarm robot that can be adequately folded into a designed area. The robot can achieve different operation modes by combining different arms and objects. First, deployable kinematic chains (DKCs) are designed, which can be folded into a designated area and be used as an arm structure in the multiarm robot mechanism. The strategy of a platform for storing DKCs is proposed. Based on the restrictions in the storage area and the characteristics of parallel mechanisms, a class of DKCs, called base assembly library, is obtained. Subsequently, an assembly method for the synthesis of the multiarm robot mechanism is proposed, which can be formed by the connection of a multiarm robot mechanism with an operation object based on a parallel mechanism structure. The formed parallel mechanism can achieve a reconfigurable characteristic when different DKCs connect to the operation object. Using this method, two types of multiarm robot mechanisms with four DKCs that can switch operation modes to perform different tasks through autonomous combination and release operation is proposed. The obtained mechanisms have observable advantages when compared with the traditional mechanisms, including optimizing the occupied volume during transportation and using parallel mechanism theory to analyze the switching of operation modes.
Obstacle Avoidance and Multitarget Tracking of a Super Redundant Modular Manipulator Based on Bezier Curve and Particle Swarm Optimization
Authors: Chen Li , Ma Ying , Zhang Yu , Liu Jinguo
Published: October 2020

A super redundant serpentine manipulator has slender structure and multiple degrees of freedom. It can travel through narrow spaces and move in complex spaces. This manipulator is composed of many modules that can form different lengths of robot arms for different application sites. The increase in degrees of freedom causes the inverse kinematics of redundant manipulator to be typical and immensely increases the calculation load in the joint space. This paper presents an integrated optimization method to solve the path planning for obstacle avoidance and discrete trajectory tracking of a super redundant manipulator. In this integrated optimization, path planning is established on a Bezier curve, and particle swarm optimization is adopted to adjust the control points of the Bezier curve with the kinematic constraints of manipulator. A feasible obstacle avoidance path is obtained along with a discrete trajectory tracking by using a follow-the-leader strategy. The relative distance between each two discrete path points is limited to reduce the fitting error of the connecting rigid links to the smooth curve. Simulation results show that this integrated optimization method can rapidly search for the appropriate trajectory to guide the manipulator in obtaining the target while achieving obstacle avoidance and meeting joint constraints. The proposed algorithm is suitable for 3D space obstacle avoidance and multitarget path tracking.
Blade Segment with a 3D Lattice of Diamond Grits Fabricated via an Additive Manufacturing Process
Authors: Chen Bin , Chen Peng , Huang Yongjun , Xu Xiangxi , Liu Yibo , Wang Shuangxi
Published: October 2020

Diamond tools with orderly arrangements of diamond grits have drawn considerable attention in the machining field owing to their outstanding advantages of high sharpness and long service life. This diamond super tool, as well as the manufacturing equipment, has been unavailable to Chinese enterprises for a long time due to patents. In this paper, a diamond blade segment with a 3D lattice of diamond grits was additively manufactured using a new type of cold pressing equipment (AME100). The equipment, designed with a rotary working platform and 16 molding stations, can be used to additively manufacture segments with diamond grits arranged in an orderly fashion, layer by layer; under this additive manufacturing process, at least 216000 pcs of diamond green segments with five orderly arranged grit layers can be produced per month. The microstructure of the segment was observed via SEM and the diamond blade fabricated using these segments was compared to other commercial cutting tools. The experimental results showed that the 3D lattice of diamond grits was formed in the green segment. The filling rate of diamond grits in the lattice could be guaranteed to be above 95%; this is much higher than the 90% filling rate of the automatic array system (ARIX). When used to cut stone, the cutting amount of the blade with segments made by AME100 is two times that of ordinary tools, with the same diamond concentration. When used to dry cut reinforced concrete, its cutting speed is 10% faster than that of ARIX. Under wet cutting conditions, its service life is twice that of ARIX. By applying the machine vision online inspection system and a special needle jig with a negative pressure system, this study developed a piece of additive manufacturing equipment for efficiently fabricating blade segments with a 3D lattice of diamond grits.
Resignation of officials as independent directors and firm performance
Authors: Ren Ting , Xiao Youzhi , Yu Xinguo , Yang Hongyan , Ge Jianmei
Published: October 2020

In 2013, the Chinese government implemented Rule No. 18, which suspended the directorships of incumbent government officials and precluded those who retired within the past three years from serving as independent directors for listed firms. The surprise implementation of Rule No. 18 triggered a wave of resignations among official independent directors (OIDs). The event provided a unique opportunity to examine the impacts of the political connections of board members on firm performance. We applied a difference-in-difference technique to empirically investigate the effect of OID resignations on firm performance from the perspectives of resource dependence theory and social capital theory. The results indicate that the resignation of OIDs had a significantly negative effect on firm performance, as measured byTobin’s Qand firm leverage. This also confirmed the importance of independent directors’ political connection on firm performance, as discovered in prior research. However, this influence varied across OIDs’ heterogeneity, external environment and firm ownership. The results indicate that political connections may not be necessary channels for firms to achieve success.
Experience repatriation of citizens from epicentre using commercial flights during COVID-19 pandemic
Authors: Shaikh Abdul Karim Sarah , Md Tahir Fariza Anis , Mohamad Umul Khair , Abu Bakar Marlina , Mohamad Khairul Nizam , Suleiman Maria , Omar Khan Hussein , Md Noor Julina
Published: October 2020

Background

During the COVID-19 pandemic, many countries instituted closure of borders from international and local travels. Stranded citizens appeal to their governments to embark on citizen repatriation missions. Between February and April 2020, the Government of Malaysia directed repatriation of its citizens from China, Iran, Italy and Indonesia. We describe the preparation and execution of the repatriation mission using chartered commercial aircraft. The mission objectives were to repatriate as many citizens based on aircraft capacity and prevent onboard transmission of the disease to flight personnel.

Results

Five repatriation missions performed was led by the National Agency for Disaster Management (NADMA) with the Ministry of Health providing technical expertise. A total of 432 citizens were repatriated from the missions. The operations were divided into four phases: the pre-boarding screening phase, the boarding and in-flight phase, the reception phase and the quarantine phase. The commercial aircraft used were from two different commercial airlines. Each mission had flight crew members between 10 and 17 people. There were 82 positive cases detected among the repatriated citizens. There was a single positive case of a healthcare worker involved in the mission, based on the sample taken on arrival of the flight. There were no infections involving flight team members.

Conclusion

Medical flight crew must be familiar with aircraft fittings that differ from one commercial airline to another as it influences infection control practices. A clear understanding of socio-political situation of a country, transmission routes of a pathogen, disease presentation, and knowledge of aviation procedures, aircraft engineering and design is of great importance in preparing for such missions. Our approach of multidiscipline team involvement managed to allow us to provide and execute the operations successfully.
Perichondritis: inspect the lobule
Authors: Bress Eli , Cohn Jason E.
Published: October 2020

Case presentation

This is a brief report of a 57-year-old Caucasian female presented with a 4-day history of worsening left ear pain. Her symptoms began with left otalgia and otorrhea which progressed to helical erythema, prompting a visit to the emergency department. She was noted to have erythema of the left auricle and swelling of the left auditory meatus. Our otolaryngology service observed erythema of the auricle with sparing of the lobule.

Diagnosis

The diagnosis to be otitis externa with perichondritis was established, and we recommended otic ciprofloxacin-hydrocortisone, IV vancomycin, and ciprofloxacin. The patient had marked improvement and was discharged on an oral and otic fluoroquinolone. In this case, the diagnosis of perichondritis was made by a classic physical examination finding: erythema and edema with sparing of the fatty lobule. This key finding helps to distinguish perichondritis from otitis externa.
Cannabinoid hyperemesis syndrome in the pregnant patient: clinical case and literature review
Authors: Flament Julien , Scius Nathan , Thonon Henri
Published: October 2020

Background

Cannabis use is on the rise. Several cases of cannabinoid hyperemesis syndrome, secondary to chronic cannabis intoxication, have been described worldwide, but few cases have described this entity in pregnant women.

Case presentation

We describe a 29-year-old pregnant patient that had consumed cannabis and experienced uncontrolled vomiting. The use of hot baths, the rapid improvement in symptoms, and results of complementary examinations suggested a diagnosis of cannabinoid hyperemesis syndrome. The patient could return home, and she continued her pregnancy and childbirth without peculiarities.

Conclusion

Cannabinoid hyperemesis syndrome should be considered in the differential diagnosis of vomiting in pregnancy. Consumption of cannabis must be systematically included in the anamnesis. However, it seems to be somewhat unacceptable socially or medically. Consumption must be stopped to manage symptoms.
Exact median-tree inference for unrooted reconciliation costs
Authors: Górecki Paweł , Markin Alexey , Eulenstein Oliver
Published: October 2020

Background

Solving median tree problems under tree reconciliation costs is a classic and well-studied approach for inferring species trees from collections of discordant gene trees. These problems are NP-hard, and therefore are, in practice, typically addressed by local search heuristics. So far, however, such heuristics lack any provable correctness or precision. Further, even for small phylogenetic studies, it has been demonstrated that local search heuristics may only provide sub-optimal solutions. Obviating such heuristic uncertainties are exact dynamic programming solutions that allow solving tree reconciliation problems for smaller phylogenetic studies. Despite these promises, such exact solutions are only suitable for credibly rooted input gene trees, which constitute only a tiny fraction of the readily available gene trees. Standard gene tree inference approaches provide only unrooted gene trees and accurately rooting such trees is often difficult, if not impossible.

Results

Here, we describe complex dynamic programming solutions that represent the first nonnaïve exact solutions for solving the tree reconciliation problems for unrooted input gene trees. Further, we show that the asymptotic runtime of the proposed solutions does not increase when compared to the most time-efficient dynamic programming solutions for rooted input trees.

Conclusions

In an experimental evaluation, we demonstrate that the described solutions for unrooted gene trees are, like the solutions for rooted input gene trees, suitable for smaller phylogenetic studies. Finally, for the first time, we study the accuracy of classic local search heuristics for unrooted tree reconciliation problems.
Rsp activates expression of the Cnt system in Staphylococcus aureus
Authors: Vinué Laura , Hooper David C.
Published: October 2020

Background

The Cnt system is crucial for the optimal import of essential metals in metal-limiting conditions and contributes to virulence inS. aureus. In a screen for regulators of efflux pumps in a phage-based ultra-high-density transposon library, we identified Rsp as a candidate regulator of thecntEgene.

Results

A two-fold decrease in expression of all genes of thecntoperon was observed by RT-qPCR in therspmutant compared to the parental strain, indicating that Rsp acts as an activator of thecntoperon. To determine whether the Rsp activation depends on iron, we compared mutant and parentcntexpression under varying metal conditions. A 2-fold reduction incntgene expression was detected in therspmutant in TSB, and a slightly smaller decrease (1.9, 1.7, and 1.5-fold changes forcntK,cmtA,andcntErespectively) was observed after addition of dipyridyl. The greatest decrease was seen with addition of FeSO4(4.1, 5.3 and 6.3-fold changes forcntK,cmtAandcntErespectively). These findings suggest that Rsp activates thecntoperon in low and high iron conditions. To study the relationship between Rsp and thecntrepressors Fur and Zur, we created single and double mutants. Bothfurandzursingle mutants had significant increases incntgene expression compared to the parental strain, as did thefur rspdouble mutant. Thezur rspdouble mutant also had a significant increase incntKexpression and a trend in increases incntAandcntEexpression just below statistical significance. Thus, the ability of Fur and Zur to represscntgene expression are not eliminated by the presence of Rsp. However, there were significantly smaller increases incntgene expression in the double mutants compared to single mutants, suggesting that Rsp activation can still occur in the absence of these repressors. To determine if Rsp directly modulates expression ofcntgenes, incubation of purified Rsp caused a DNA-specific band shift for thecntKandcntApromoters.

Conclusions

Rsp activation may act to maintain basal cellular levels of staphylopine to scavenge free metals when needed, in addition to metal dependent regulation by Fur and Zur.
Spie charts for quantifying treatment effectiveness and safety in multiple outcome network meta-analysis: a proof-of-concept study
Authors: Daly Caitlin H. , Mbuagbaw Lawrence , Thabane Lehana , Straus Sharon E. , Hamid Jemila S.
Published: October 2020

Background

Network meta-analysis (NMA) simultaneously synthesises direct and indirect evidence on the relative efficacy and safety of at least three treatments. A decision maker may use the coherent results of an NMA to determine which treatment is best for a given outcome. However, this evidence must be balanced across multiple outcomes. This study aims to provide a framework that permits the objective integration of the comparative effectiveness and safety of treatments across multiple outcomes.

Methods

In the proposed framework, measures of each treatment’s performance are plotted on its own pie chart, superimposed on another pie chart representing the performance of a hypothetical treatment that is the best across all outcomes. This creates a spie chart for each treatment, where the coverage area represents the probability a treatment ranks best overall. The angles of each sector may be adjusted to reflect the importance of each outcome to a decision maker. The framework is illustrated using two published NMA datasets comparing dietary oils and fats and psoriasis treatments. Outcome measures are plotted in terms of the surface under the cumulative ranking curve. The use of the spie chart was contrasted with that of the radar plot.

Results

In the NMA comparing the effects of dietary oils and fats on four lipid biomarkers, the ease of incorporating the lipids’ relative importance on spie charts was demonstrated using coefficients from a published risk prediction model on coronary heart disease. Radar plots produced two sets of areas based on the ordering of the lipids on the axes, while the spie chart only produced one set. In the NMA comparing psoriasis treatments, the areas inside spie charts containing both efficacy and safety outcomes masked critical information on the treatments’ comparative safety. Plotting the areas inside spie charts of the efficacy outcomes against measures of the safety outcome facilitated simultaneous comparisons of the treatments’ benefits and harms.

Conclusions

The spie chart is more optimal than a radar plot for integrating the comparative effectiveness or safety of a treatment across multiple outcomes. Formal validation in the decision-making context, along with statistical comparisons with other recent approaches are required.
Thymic carcinoma metastasize to the small intestine: a case report
Authors: Yuan Yi , Pu Hong , Pang Ming-hui , Liu Yi-sha , Li Hang
Published: October 2020

Background

Thymic carcinoma is a rare mediastinal neoplasm with a high malignant potential. It often shows pleural invasion and distant metastasis. The metastasis of thymic carcinoma to the small intestine is rarely reported and difficult to distinguish from other gastrointestinal tract tumors.

Case presentation

An elderly man presented with lower abdominal pain for 2 months. Abdominal CT showed a mass communicated with the small intestinal lumen. After radical resection of the small intestinal tumor, resected specimens showed moderately differentiated squamous-cell carcinoma with lymph nodes metastases. The patient received chest CT and was found to have a mass in anterior mediastinum. Biopsies of the mass revealed thymic squamous-cell carcinoma.

Conclusions

We highlighted the metastasis of thymic carcinoma to the small intestine is rare and easily misdiagnosed. In patients with a mass communicated with the small intestinal lumen, a suspicion of thymic carcinoma metastasis should not be overlooked and we should make accurate differential diagnosis from the other small intestinal tumors.
Developing the Patient Health Questionnaire-8 for a greater impact on the quality of life of patients with functional dyspepsia compared to Somatic Symptom Scale-8
Authors: Yuan Chaoqun , Yong Guizhen , Wang Xi , Xie Ting , Wang Chunyan , Yuan Yuan , He Guobin
Published: October 2020

Background

To develop the Patient Health Questionnaire-8 (PHQ-8) as a more reliable approach than the Somatic Symptom Scale-8 (SSS-8), evaluating somatization which might be a critical factor influencing the quality of life (QoL) in patients with functional dyspepsia (FD). Also, the effects of somatization on QoL of FD patients were assessed by these two approaches.

Methods

Herein, 612 FD patients completed a questionnaire involving 25 items. 8/25 items were selected to develop the PHQ-8 by four methods of discrete degree, correlation coefficient, factor analysis, and Cronbach’s α coefficient. Reliability and validity of the PHQ-8 and the SSS-8 were compared by principal component and confirmatory factor analyses. The effects of somatization, depression, and anxiety on the Nepean Dyspepsia Index (NDI) for QoL were explored by Pearson’s correlation coefficient and linear regression analysis.

Results

The Cronbach’s α coefficient for the PHQ-8 and the SSS-8 was 0.601 and 0.553, respectively, and the cumulative contribution rate of three extracted factors for the developed PHQ-8 and SSS-8 was 55.103% and 51.666%, respectively. Somatization evaluated by the PHQ-8 (r = 0.309, P < 0.001) and the SSS-8 (r = 0.281, P < 0.001) was found to be correlated to NDI. The model used for the PHQ-8 showed that the values of goodness-of-fit index (GFI) and adjusted GFI (AGFI) were 0.984 and 0.967, respectively, which indicated that the model fitted well. Linear regression analysis unveiled that somatization (β = 0.270, P < 0.001), anxiety (β = 0.163, P < 0.001), and depression (β = 0.136, P = 0.003) assessed by the PHQ-8 were correlated to NDI. In addition, somatization (β = 0.250, P < 0.001), anxiety (β = 0.156, P < 0.001), and depression (β = 0.155, P = 0.001) evaluated by the SSS-8 were correlated to NDI.

Conclusions

PHQ-8 showed a superior reliability and validity, and somatization assessed by the developed PHQ-8 showed a greater influence on the QoL of FD patients as compared to the SSS-8. Our findings suggested that the developed PHQ-8 may show improvement in a reliable assessment of the effects of somatization on FD patients in lieu of the SSS-8.
High-sensitivity Troponin T in hemodialysis patients: a randomized placebo-controlled sub-study investigating angiotensin-II-blockade, variation over time and associations with clinical outcome
Authors: Peters Christian D. , Kjaergaard Krista D. , Christensen Kent L. , Bibby Bo M. , Jespersen Bente , Jensen Jens D.
Published: October 2020

Background

Troponin T (TnT) is a well-known risk factor for negative outcome in hemodialysis (HD) patients, but little is known about variation over time, and the impact of clinical and dialysis specific factors. This study investigated the effect of angiotensin II receptor blockade (ARB), short and long-term variation in TnT and associations with clinical parameters.

Methods

In this analysis based on the SAFIR-cohort (Clinical Trials ID: NCT00791830) 81 HD patients were randomized double-blind for placebo (n = 40) or angiotensin II receptor blocker (ARB) treatment (n = 41) with irbesartan (150–300 mg) and followed for 12 months with six serial measurements of TnT using a high-sensitivity assay.

Results

Fifty-four patients (67%) completed follow-up. Baseline TnT-medians (min-max) were (placebo/ARB): 45(14–295)/46(10–343) ng/L. ARB-treatment did not significantly affect mean TnT-levels over the 12-month study period. Median week-to-week and one-year TnT-variation (5th–95th-percentile range) using all samples regardless of intervention were: 0(− 14–10) ng/L (week-to-week) and 3(− 40–71) ng/L (12 months). Median TnT-amplitude, capturing the change from the lowest to the highest TnT-value observed during the one-year study period was 38% or 20.5 ng/L. Median ratios with 95% limits of agreement were: 1.00(0.73–1.37); P = 0.92 (1 week/baseline; n = 77) and 1.07(0.52–2.25); P = 0.19 (12 months/baseline; n = 54). Baseline TnT was positively correlated with diabetes, ultrafiltration volume, arterial stiffness, change in intradialytic total peripheral resistance and N-terminal pro b-type natriuretic peptide (NT-proBNP) and negatively correlated with hematocrit, residual renal function and change in intradialytic cardiac output. High baseline TnT was associated with a higher risk of admission and cardiovascular (CV) events during follow-up. Increase in TnT over time (ΔTnT = 12-months-baseline) was significantly associated with increase in left ventricular (LV) mass and NT-proBNP and decrease in LV ejection fraction and late intradialytic stroke volume. ΔTnT was not significantly associated with admissions, CV or intradialytic hypotensive events during follow-up. Admissions were significantly more likely with a high (TnT-amplitude> 20.5 ng/L) than a low TnT-amplitude. Peaks in TnT were less frequent in aspirin-treated patients.

Conclusion

ARB-treatment had no significant effect on TnT-levels. Week-to-week variation was generally low, yet over 12 months individual patients had considerable TnT fluctuations. Rise in TnT over time was significantly correlated with markers of cardiac deterioration.

Trial registration

ClinicalTrials.gov Identifier: NCT00791830. Date of registration: November 17, 2008. EudraCT no: 2008–001267-11.
Angiogenin, FGF-α, and IL-36β have higher expression levels in aqueous humor of nAMD patients in comparison to cataract patients
Authors: Chen Kailin , Xu Wen , Zheng Jiao , Shen Yupeng , Ma Jian , Chen Zhiqing
Published: October 2020

Background

Numerous cytokines have been proven to participate in the pathogenesis of neovascular age-related macular degeneration (nAMD). The present study aimed to investigate the aqueous humor cytokine expression profile in nAMD patients before and after ranibizumab treatments in comparison to cataract patients.

Methods

This prospective study included 20 treatment-naïve nAMD eyes of 20 patients who received three consecutive monthly injections of ranibizumab. Aqueous humor samples were collected before the first (baseline), second (1 month later), and third (2 months later) injections. Controls were 20 age- and gender-matched cataract patients without any other ocular disease. The aqueous concentrations of 28 cytokines were measured using a multiplex bead assay. Central macular thickness (CMT) and maximum retinal thickness (MRT)-3 mm were measured by spectral domain optical coherence tomography (SD-OCT). The greatest linear diameter (GLD) was measured by fundus fluorescein angiography (FA).

Results

Three cytokines in aqueous humor, including angiogenin, interleukin-36β (IL-36β), and fibroblast growth factor-acidic (FGF-α) were significantly higher in nAMD patients in comparison to cataract patients, both before and after two consecutive monthly ranibizumab injections. Compared with the nAMD patients’ basal levels, two consecutive monthly ranibizumab injections effectively reduced the aqueous concentrations of VEGF-A and placental growth factor (PlGF), as well as the values of CMT, MRT-3 mm, and GLD.

Conclusions

Angiogenin, IL-36β, and FGF-α have higher expression levels in nAMD patients in comparison to cataract patients, both before and after 2 months of ranibizumab therapy. These cytokines may have correlations with the pathogenesis of nAMD.
Association between obesity, common chronic diseases and health promoting lifestyle profiles in Hong Kong adults: a cross-sectional study
Authors: Leung Yan Sin , Lee Jack Jock Wai , Lai Maria Ming Po , Kwok Chole Kei Ming , Chong Ka Chun
Published: October 2020

Background

Recent surveys revealed that the health status of many people from Hong Kong is far from ideal. Although non-communicable diseases are largely preventable, few relevant health promotion and disease prevention programs are available. Thus, we assessed the health indicators of Chinese adults in Hong Kong to investigate the relationship between obesity, common chronic diseases, and health-promoting lifestyle profiles to provide inspirations for decision makers in formulating targeted disease prevention and health management programs.

Methods

This is a secondary analysis of a data set of 270 community-dwelling Hong Kong adults who were within the eligible age range between 18 and 80 years without eye diseases that affect retinal photographs. The study exposure variable, health-promoting lifestyle profiles, was measured using the Health-Promoting Lifestyle Profile II (HPLP-II) questionnaire. The primary outcome variable, obesity, was defined using body mass index and waist-hip ratio. The secondary study outcome, estimated chronic diseases, including of anemia, chronic kidney disease, and cardiovascular disease, were estimated using automatic retinal image analysis from the retinal images. Data were analyzed using tests of proportion, the independent sample t-tests, Welch’s t-test, and binary logistic regression models.

Results

All HPLP-II subscales had positive responses (≥ 2.5). Significant differences were noted between men and women in the health responsibility and nutrition subscales (Health Responsibility: p = 0.059; Nutrition: p = 0.067). Regression models revealed that nutrition (adjusted odds ratio [AOR] = 0.41; p = 0.017), physical activity (AOR = 0.50; p = 0.015), interpersonal relations (AOR = 2.14; p = 0.016), and stress management (AOR = 2.07; p 0.038) were associated with obesity; while spiritual growth (AOR = 0.24; p = 0.077) and interpersonal relations (AOR = 5.06; p 0.069) were associated with estimated chronic kidney disease.

Conclusions

Improving health behaviors may control or alleviate the prevalence of obesity and chronic kidney disease. These findings could arouse concern about lifestyle behaviors and promote self-assessment of health-promoting lifestyles to the general public. The study also provided new insights into the relationship between the HPLP-II and other common chronic diseases that warrant further study.
Two conformations of DNA polymerase D-PCNA-DNA, an archaeal replisome complex, revealed by cryo-electron microscopy
Authors: Mayanagi Kouta , Oki Keisuke , Miyazaki Naoyuki , Ishino Sonoko , Yamagami Takeshi , Morikawa Kosuke , Iwasaki Kenji , Kohda Daisuke , Shirai Tsuyoshi , Ishino Yoshizumi
Published: October 2020

Background

DNA polymerase D (PolD) is the representative member of the D family of DNA polymerases. It is an archaea-specific DNA polymerase required for replication and unrelated to other known DNA polymerases. PolD consists of a heterodimer of two subunits, DP1 and DP2, which contain catalytic sites for 3′-5′ editing exonuclease and DNA polymerase activities, respectively, with both proteins being mutually required for the full activities of each enzyme. However, the processivity of the replicase holoenzyme has additionally been shown to be enhanced by the clamp molecule proliferating cell nuclear antigen (PCNA), making it crucial to elucidate the interaction between PolD and PCNA on a structural level for a full understanding of its functional relevance. We present here the 3D structure of a PolD-PCNA-DNA complex fromThermococcus kodakarensisusing single-particle cryo-electron microscopy (EM).

Results

Two distinct forms of the PolD-PCNA-DNA complex were identified by 3D classification analysis. Fitting the reported crystal structures of truncated forms of DP1 and DP2 fromPyrococcus abyssionto our EM map showed the 3D atomic structural model of PolD-PCNA-DNA. In addition to the canonical interaction between PCNA and PolD via PIP (PCNA-interacting protein)-box motif, we found a new contact point consisting of a glutamate residue at position 171 in a β-hairpin of PCNA, which mediates interactions with DP1 and DP2. The DNA synthesis activity of a mutant PolD with disruption of the E171-mediated PCNA interaction was not stimulated by PCNA in vitro.

Conclusions

Based on our analyses, we propose that glutamate residues at position 171 in each subunit of the PCNA homotrimer ring can function as hooks to lock PolD conformation on PCNA for conversion of its activity. This hook function of the clamp molecule may be conserved in the three domains of life.
Correction to: CRISPR-Cas, a robust gene-editing technology in the era of modern cancer immunotherapy
Authors: Miri Seyed Mohammad , Tafsiri Elham , Cho William Chi Shing , Ghaemi Amir
Published: October 2020

An amendment to this paper has been published and can be accessed via the original article.
Theory driven analysis of social class and health outcomes using UK nationally representative longitudinal data
Authors: Wami Welcome , McCartney Gerry , Bartley Mel , Buchanan Duncan , Dundas Ruth , Katikireddi Srinivasa Vittal , Mitchell Rich , Walsh David
Published: October 2020

Background

Social class is frequently used as a means of ranking the population to expose inequalities in health, but less often as a means of understanding the social processes of causation. We explored how effectively different social class mechanisms could be measured by longitudinal cohort data and whether those measures were able to explain health outcomes.

Methods

Using a theoretically informed approach, we sought to map variables within the National Child Development Study (NCDS) to five different social class mechanisms: social background and early life circumstances; habitus and distinction; exploitation and domination; location within market relations; and power relations. Associations between the SF-36 physical, emotional and general health outcomes at age 50 years and the social class measures within NCDS were then assessed through separate multiple linear regression models. R2values were used to quantify the proportion of variance in outcomes explained by the independent variables.

Results

We were able to map the NCDS variables to the each of the social class mechanisms except ‘Power relations’. However, the success of the mapping varied across mechanisms. Furthermore, although relevant associations between exposures and outcomes were observed, the mapped NCDS variables explained little of the variation in health outcomes: for example, for physical functioning, the R2values ranged from 0.04 to 0.10 across the four mechanisms we could map.

Conclusions

This study has demonstrated both the potential and the limitations of available cohort studies in measuring aspects of social class theory. The relatively small amount of variation explained in the outcome variables in this study suggests that these are imperfect measures of the different social class mechanisms. However, the study lays an important foundation for further research to understand the complex interactions, at various life stages, between different aspects of social class and subsequent health outcomes.
Association between triglyceride glucose-body mass index and non-alcoholic fatty liver disease in the non-obese Chinese population with normal blood lipid levels: a secondary analysis based on a prospective cohort study
Authors: Li Yaling , Zheng Rui , Li Jie , Feng Shuyi , Wang Li , Huang Zhiming
Published: October 2020

Background

Both triglyceride glucose-body mass index (TyG-BMI) and non-alcoholic fatty liver disease (NAFLD) are linked to insulin resistance (IR). Prospective studies linking TyG-BMI to NAFLD have been limited by short follow-up. This study investigated the longitudinal association between TyG-BMI and NAFLD occurrence in the non-obese Chinese individuals.

Methods

This study determined TyG-BMI at baseline and the incidence of NAFLD at follow-up and performed a post hoc analysis of a prospective cohort study that involved assessing the risk of NAFLD in non-obese Chinese residents from January 2010 to December 2014. The incidence of NAFLD during the 5-year follow-up was identified as the endpoint. Cox proportional hazards regression analysis was used to evaluate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for the incidence of NAFLD. Receiver operating characteristic (ROC) curve analysis was conducted to estimate the predictive power of TyG-BMI and its components for NAFLD. Subgroup analysis was performed to better understand other factors that may affect the association between TyG-BMI and NAFLD to identify potential special populations.

Results

During the follow-up period, 841 (8.61%) of 9767 non-obese subjects who met the screening criteria were diagnosed with NAFLD. After confounding factors were fully adjusted for, the HR of NAFLD was 3.09 (95% CI 2.63–3.63) per standard deviation (SD) increase in TyG-BMI. Furthermore, TyG-BMI had a strong predictive value (area under ROC = 0.85; 95% CI 0.84–0.86) for the incidence of NAFLD, with a specificity of 0.73 and sensitivity of 0.82. Additionally, in the male population, each SD increase in TyG-BMI was linked to an increased risk of NAFLD (HR = 2.85, 95% CI 2.30–3.53), but the risk was higher in the female population (HR = 3.58, 95% CI 2.80–4.60). Gender and TyG-BMI interacted significantly with NAFLD incidence (P < 0.0001).

Conclusion

In the normolipidaemic and non-obese subset of the Chinese population, an increase in TyG-BMI is related to an increased incidence of NAFLD. TyG-BMI may have clinical significance in identifying groups at high risk of NAFLD.
Temporal hemiarthroplasty for distal femoral osteosarcoma in early childhood: a case report
Authors: Imanishi Jungo , Tanabe Masayuki , Kurihara Taisei , Torigoe Tomoaki , Kikkawa Jun , Ohta Atsuhiko , Watanabe Atsuko , Tanaka Ryuhei , Saita Kazuo , Kadono Yuho , Yazawa Yasuo
Published: October 2020

Background

Prosthetic reconstruction for distal femoral osteosarcoma is challenging for younger children. We herein report a successful case of limb-sparing surgery for a younger patient with distal femoral osteosarcoma requiring osteo-articular resection.

Case presentation

A 5-year-old girl with high-grade conventional osteosarcoma in the left distal femur underwent a series of surgeries. After three cycles of neoadjuvant chemotherapy, limb-salvage surgery was planned because femoral rotationplasty had been refused. At 6 years and 2 months old, distal femoral resection and temporary spacer insertion using a 7-mm-diameter intramedullary nail and molded polymethylmethacrylate was performed. At 7 years and 8 months old, secondary surgery was performed because the first spacer had been dislocated and the residual femur became atrophic. The distal end of the residual femur was removed by 1 cm, but the periosteum and induced membrane around polymethylmethacrylate was preserved. In order to stabilize the spacer against the tibia, a custom-made ceramic spacer with a smooth straight 8-mm-diameter stem was utilized. The bone-spacer junction was fixed with polymethylmethacrylate and then covered with the preserved periosteum and induced membrane. After surgery, the bone atrophy improved. At 9 years and 7 months old, the second spacer was removed because it had loosened, and the knee joint was reconstructed using a custom-made growing femoral prosthesis with a curved porous 8.5-mm-diameter stem. Cancellous bone tips from the proximal tibia were grafted around the bone-prosthesis junction underneath the induced membrane. At 10 years and 5 months old, the patient was able to walk unsupported and a radiograph showed further thickening of the cortex of the residual femur without any stress shielding. Although having 5 cm of limb length discrepancy, the patient and her mother were satisfied with the function. The MSTS score was 24 out of 30 points. Repeated limb length extensions are planned.

Conclusions

This case report provides an example of limb-salvage surgery after distal femoral resection in a small child. The use of a temporary spacer utilizing partial cementation and preservation of the periosteum and induced membrane appears to afford a viable limb-salvage option after distal femoral resection for younger children.
LncRNAH19 improves insulin resistance in skeletal muscle by regulating heterogeneous nuclear ribonucleoprotein A1
Authors: Gui Weiwei , Zhu Wei Fen , Zhu Yiyi , Tang Shengjie , Zheng Fenping , Yin Xueyao , Lin Xihua , Li Hong
Published: October 2020

Background

Skeletal muscle is essential for glucose and lipid metabolism. Growing evidence reveals the importance of long non-coding RNAs (LncRNAs) in metabolism. This study aimed to investigate the function of LncRNA H19 (H19) in lipid metabolism of skeletal muscle and its potential mechanisms.

Methods

Glucose tolerance, serum insulin and lipid content in serum and skeletal muscle were determined in control and H19-overexpressed db/db mice. Lipid metabolism was evaluated in H19-overexpressed or H19-silencing muscle cells by detecting lipid contents and mitochondria related functions. The underlying mechanisms were explored by RNA pull-down, mass spectrometry and RNA immunoprecipitation (RIP).

Results

H19 was downregulated in skeletal muscle of db/db mice. H19 overexpression in db/db mice inhibited lipid ectopic deposition in skeletal muscle, meanwhile improved glucose intolerance and insulin resistance as compared with control db/db mice treated with ad-GFP. Furthermore, overexpression of H19 reversed FFA-induced lipid accumulation and increased cellular respiration in muscle cells, while H19 knockdown exhibited opposite effects in muscle cells. Mechanistically, H19 interacted with heterogeneous nuclear ribonucleoprotein (hnRNPA1) which was validated by RNA pulldown and RIP analysis, which increased translation of fatty acid oxidation closely related genes PGC1a and CPT1b.

Conclusion

Our data suggest that overexpression of H19 ameliorates insulin resistance by reducing ectopic lipid accumulation in skeletal muscle. The possible underlying mechanisms are that overexpression of lncRNAH19 promotes fatty acids oxidation via targeting of hnRNPA1.
The ferroptosis and iron-metabolism signature robustly predicts clinical diagnosis, prognosis and immune microenvironment for hepatocellular carcinoma
Authors: Tang Bufu , Zhu Jinyu , Li Jie , Fan Kai , Gao Yang , Cheng Shimiao , Kong Chunli , Zheng Liyun , Wu Fazong , Weng Qiaoyou , Lu Chenying , Ji Jiansong
Published: October 2020

Background

In this study, we comprehensively analyzed genes related to ferroptosis and iron metabolism to construct diagnostic and prognostic models and explore the relationship with the immune microenvironment in HCC.

Methods

Integrated analysis, cox regression and the least absolute shrinkage and selection operator (LASSO) method of 104 ferroptosis- and iron metabolism-related genes and HCC-related RNA sequencing were performed to identify HCC-related ferroptosis and iron metabolism genes.

Results

Four genes (ABCB6, FLVCR1, SLC48A1 and SLC7A11) were identified to construct prognostic and diagnostic models. Poorer overall survival (OS) was exhibited in the high-risk group than that in the low-risk group in both the training cohort (P < 0.001, HR = 0.27) and test cohort (P < 0.001, HR = 0.27). The diagnostic models successfully distinguished HCC from normal samples and proliferative nodule samples. Compared with low-risk groups, high-risk groups had higher TMB; higher fractions of macrophages, follicular helper T cells, memory B cells, and neutrophils; and exhibited higher expression of CD83, B7H3, OX40 and CD134L. As an inducer of ferroptosis, erastin inhibited HCC cell proliferation and progression, and it was showed to affect Th17 cell differentiation and IL-17 signaling pathway through bioinformatics analysis, indicating it a potential agent of cancer immunotherapy.

Conclusions

The prognostic and diagnostic models based on the four genes indicated superior diagnostic and predictive performance, indicating new possibilities for individualized treatment of HCC patients.

Graphical abstract
The characteristics of video capsule endoscopy in pediatric Henoch–Schönlein purpura with gastrointestinal symptoms
Authors: Fang Youhong , Peng Kerong , Zhao Hong , Chen Jie
Published: October 2020

Background

Henoch–Schönlein purpura (HSP) is a systemic small-vessel vasculitis also named IgA vasculitis that commonly affects the gastrointestinal tract. The video capsule endoscopy (VCE) characteristics of pediatric HSP patients are rarely reported.

Methods

Patients diagnosed with HSP and analyzed by VCE examination at our hospital from February 2010 to January 2020 are enrolled. The clinical features, laboratory findings, and the characteristics of VCE findings are studied.

Results

There are 30 patients enrolled in this investigation from February 2010 to January 2020. The mean age of these patients is 96.9 ± 35.8 months, and the most frequent finding of VCE is mucosal erosion, which account for 79.3% of the patients, and followed by mucosal erythema or petechia accounted for 69% of the patients. Regarding the disease location detected by endoscopy, jejunum is the most common involved part of the gastrointestinal tract in pediatric HSP patients. All the patients had the jejunum involved except in one patient the VCE did not pass through the pylorus. One third of the patients involved the descending portion of duodenum. No side effect is observed in this study.

Conclusions

VCE may be an excellent adjust tool for evaluation of the gastrointestinal tract in children with abdominal symptoms without typical purpura in suspected pediatric HSP patients. VCE appears to be superior to esophagogastroduodenoscopy in detecting small intestinal lesions of HSP and has an excellent safety profile.