bluuebunny/crossref_metadata_2025 huggingface dataset:
Discussion on the Necessity of Bilateral Inguinal Lymphatic Area Irradiation for Cervical Cancer with Invasion of the Lower One Third of Vagina
Authors: Wang Lina , Huang Kejin , Wang Yuxia , Wang Le , Li Qi , Cheng Haiyan
Published: December 2020

Background

The rate of inguinal lymph node metastasis is relatively low in cervical cancer patients.According to the NCCN (National Comprehensive Cancer Network) guidelines for cervical cancer,patients with cervical cancer invading the lower 1/3 of the vagina require bilateral inguinal lymphatic area preventive irradiation. But do they need preventive inguinal area irradiation?
Methods

A total of 184 patients with cervical cancer accompanied by the lower 1/3 of the vagina invasion were selected as the study subjects.In this study, a trial and control method was used to select 180 patients without inguinal lymph node metastasis.The patients were divided into preventive radiotherapy group (109 cases) and non-preventive radiotherapy group (71 cases). During and after treatment, the occurrence of inguinal skin damage, lower extremity edema and femoral head necrosis was observed.
Results

Thirteen cases (7.07%) of 184 patients were found with inguinal lymph node enlargement by imaging examination, and only 4 cases (2.17%) were further confirmed by pathology.In prophylaxis irradiation group, there were 26(23.85%) cases of side injury.In the follow-up of two groups after treatment there was no recurrence in the inguinal lymph nodes.
Conclusion

The inguinal lymph node metastasis rate in patients with cervical cancer invading the lower third of the vagina is 2.17%.In order to avoid such a low incidence, we carry out preventive irradiation, which will cause 23.85% of local secondary injuries .And even if we do not perform preventive inguinal lymph node irradiation, there is no difference in the recurrence rate of inguinal lymph nodes between the two groups. Preventive inguinal lymph node irradiation isn’t necessary for these patients.
SMAD4 Loss is Associated with Response to Neoadjuvant Chemotherapy with Hydroxychloroquine in Patients with Pancreatic Adenocarcinoma
Authors: Fei Naomi , Wen Sijin , Ramanathan Rajesh , Hogg Melissa E. , Zureikat Amer , Lotze Michael T. , Bahary Nathan , Singhi Aatur D. , Zeh Herbert J. , Boone Brian A.
Published: December 2020

Background

SMAD4, a tumor suppressor gene, is inactivated or deleted in 60–90% of pancreatic adenocarcinomas (PDA). Loss of SMAD4 allows tumor progression by limiting cell cycle arrest and apoptosis and increasing metastases. SMAD4 deficient PDA cells are resistant to radiotherapy by upregulating autophagy, a cell survival mechanism that counteracts apoptotic mechanisms and allows intracellular recycling of macromolecules and organelles. Hydroxychloroquine (HCQ) is an orally available autophagy inhibitor with an established toxicity profile. We studied whether HCQ treatment in SMAD4 deficient PDA may prevent therapeutic resistance induced by autophagy upregulation.
Methods

We retrospectively analyzed the SMAD4 status of PDA patients enrolled in two prospective clinical trials evaluating administration of preoperative HCQ. The first dose escalation trial demonstrated the safety of preoperative gemcitabine with HCQ (NCT01128296). More recently, a randomized trial of gemcitabine/nab-paclitaxel +/- HCQ evaluated Evans Grade histopathologic response (NCT01978184). Immunohistochemistry of resected specimens for SMAD4 was previously performed. Patients not treated at the max HCQ dose (n = 5), not resected (n = 2) or with SMAD4 staining unavailable were excluded (n = 10). The effect of SMAD4 loss on response to HCQ and chemotherapy was studied for association with clinical outcome. Fisher’s exact test and log-rank test were used to assess response and survival.
Results

52 patients receiving HCQ with neoadjuvant chemotherapy were studied. 25 of these patients had SMAD4 loss (48%). 76% of HCQ treated patients with SMAD4 loss obtained a histopathologic response ≥ 2A, compared to only 37% with SMAD4 intact (p = 0.006). In contrast with prevailing views, loss of SMAD4 was not associated with a detriment in median overall survival in HCQ treated patients (34.43 months in SMAD4 loss vs. 27.27 months in SMAD4 intact, p = 0.18).
Conclusions

The addition of HCQ to neoadjuvant chemotherapy in patients with PDA may improve treatment response in those with SMAD4 loss. Further study of the relationship between SMAD4, autophagy and treatment outcomes in PDA is warranted.
Expression and Prognostic Significance of m6A-Related Genes in TP53-Mutant Non-small-cell Lung Cancer
Authors: Zhao Zhuochen , Wan Junhu , Guo Manman , Wang Yangxia , Yang Zhengwu , Li Zhuofang , Ming Liang
Published: December 2020

BackgroundTP53 is an important tumor suppressor gene located on human chromosome 17. TP53 mutations have been confirmed in more than 60% of tumor patients' somatic cells. N6-methyladenosine is an enzyme that plays an important role in mRNA splicing, translation, and stabilization. It is a common internal modification of nucleotides, that is regulated by methyltransferases ("writer"), binding proteins ("reader"), and demethylases ("eraser"). However, its role in TP53 mutant non-small-cell lung cancer remains unknown. In this study, we investigated 17 common N-6-Methyladenosine regulators' contributions and prognostic values.Methods and MaterialsThe expression sets of 233 TP53 mutant NSCLC and 236 TP53 wild type NSCLC patients were downloaded from the Cancer Genome Atlas (TCGA) databases with their simple nucleotide variation and their clinical messages. 17 m6A regulators were systematically analyzed in our study, which including 8 "writers" (METTL3/14/16, WTAP, RBM15/15B, KIAA1429, ZC3H13), 7 "readers" (YTHDF1/2/3, YTHDC1/2, HNRNPA2B1, HNRNPC), 2 "erasers" (FTO, ALKBH5). Consensus clustering was used to classify TP53 mutant NSCLC and TP53 wild type NSCLC into two subgroups. Univariate and multivariate cox regression were used to construct a prognostic signature and compute risk score based to m6A regulators’ expression in TP53 mutant and wild type NSCLC. Gene Ontology (GO), Gene Set enrich analysis (GSEA), STRING and Cytoscape tools were used to find different signaling pathways and biological processes between TP53 mutant and wild type NSCLC.ResultsWilcox test showed that 9 of 17 m6A regulators were expressed differently between TP53 mutant and wild type NSCLC (p < 0.05). Then consensus clustering has been used for tumor typing and a new way of typing is attempted, while the groups obtained by consensus clustering couldn’t predict prognostic well in mutant and wild type patients (p = 0.121 in wild type and p = 0.089 in mutant). Using univariate cox regression analysis, ALKBH5, HNRNPA2B1 were associated with the prognostic of TP53 mutant patients. Then we built signatures of N-6-Methyladenosine regulators with prognostic ability based on the multivariate cox regression in TP53 mutant cohorts. Moreover, we found that this signature could predict the prognostic in mutant cohort well (p < 0.001, AUG > 0.6). With this signature, patients with TP53 mutations can be divided into high and low risk groups. Finally, we found 338 DEGs between high and low risk groups, then GO enrichment analysis, PPI network was used to analysis different signaling pathways between two groups.ConclusionIn conclusion, our study showed m6A regulators can be used as predictive prognostic tools in TP53 mutant patients.
Lymph Node Maximum Uptake of 18F-ALF-NOTA-PRGD2 II PET/CT Predicts Lung Cancer Survival
Authors: Wei Yuchun , Ma Li , Zheng Jinsong , Pei Yanqing , Qin Xueting , Luan Xiaohui , Zhou Yue , Wang Yongzheng , Yuan Shuanghu
Published: December 2020

Background:Tumor angiogenesis plays a key role in tumor growth, development, and metastasis, so the exploratory study of tumor neovascularization imaging is one of the potential methods to predict survival. This study aims to examine the predictive capacity of 18F-ALF-NOTA-PRGD2 II (denoted 18F-Alfatide II) positron emission tomography (PET)/computed tomography (CT) before antitumor therapy (ATR) in patients with lung cancer.Results The median follow-up was 31 (1.3~57.0) months. Among the patients, 6 were lost to follow-up. The overall survival (OS) and progression-free survival (PFS) were 40.0 (3.50~57.0) months and 21.30 (2.0~56.0) months, respectively. The maximum uptake values (SUVmax) of the metastatic lymph nodes (SUVLN) and tumor node metastasis (TNM) staging were significant predictors of PFS and OS (all P<0.05) in a multivariate Cox regression analysis. Statistical significance was not reached by any other variable in the multivariate analysis. Receiver operating curve (ROC) analysis for survival revealed an area under the curve of 0.93 (P<0.001) for SUVLN and 0.96 for the TNM stage (P<0.001). The SUVLN and TNM stage cutoff values were 2.50 and II, and their sensitivity, specificity and positive and negative prediction were 77.42%, 80.0% and 82.76% and 74.07%; and 87.10%, 60.0% and 72.97% and 78.95%, respectively. Patients with a lower SUVLN and early stage had a longer PFS and OS (all P<0.05).Conclusions For lung cancer, low SUVLN and an early TNM stage (≤stage II) as assessed before ATR by 18F-alfatide II PET/CT represents a favorable subgroup with increased PFS and OS.
Disseminated Intravascular Coagulation Immediately after Trauma Predicts a Poor Prognosis in Severely Injured Patients: A Sub-analysis of a Multicenter Prospective Study on Disseminated Intravascular Coagulation in Trauma
Authors: Wada Takeshi , Shiraishi Atsushi , Gando Satoshi , Yamakawa Kazuma , Fujishima Seitaro , Saitoh Daizoh , Kushimoto Shigeki , Ogura Hiroshi , Abe Toshikazu , Mayumi Toshihiko , Sasaki Junichi , Kotani Joji , Takeyama Naoshi , Tsuruta Ryosuke , Takuma Kiyotsugu , Yamashita Norio , Shiraishi Shin-ichiro , Ikeda Hiroto , Shiino Yasukazu , Tarui Takehiko , Nakada Taka-aki , Hifumi Toru , Okamoto Kohji , Sakamoto Yuichiro , Hagiwara Akiyoshi , Masuno Tomohiko , Ueyama Masashi , Fujimi Satoshi , Umemura Yutaka , Otomo Yasuhiro
Published: December 2020

Background: Trauma patients die from massive bleeding due to DIC with a fibrinolytic phenotype in the early phase, which transforms to DIC with a thrombotic phenotype in the late phase of trauma, contributing to the development of MODS and a consequent poor outcome. The aim of this study is to evaluate the effect of a disseminated intravascular coagulation (DIC) diagnosis on the survival probability and predictive performance of DIC scores for massive transfusion, multiple organ dysfunction syndrome (MODS), and hospital death in severely injured trauma patients.Methods: Severely injured adult patients (Injury Severity Score >16) were prospectively evaluated for their DIC scores and molecular markers of coagulation and fibrinolysis immediately after emergency department presentation (0 h) and 3 h after admission. Organ dysfunction was assessed by the sequential organ failure assessment (SOFA) score at 24 h after admission. The performance of DIC scores in predicting massive transfusion, MODS, and hospital death, and the effect of a DIC diagnosis on the survival probability were investigated.Results: The 276 enrolled patients included 121 DIC and 155 non-DIC patients. DIC patients showed larger transfusion volume and higher SOFA scores than non-DIC patients at 24 h after admission. A DIC diagnosis on admission was associated with a lower survival probability (Log Rank p<0.001), higher frequency of massive transfusion and MODS, and higher mortality rate than no such diagnosis. DIC scores at 0 h and 3 h predicted massive transfusion, MODS, and hospital death with significance (all areas under the receiver operating characteristic curves, p<0.001). Markers of thrombin and plasmin generation and fibrinolysis inhibition also showed a good predictive ability for these three items.Conclusions: A DIC diagnosis on admission was associated with a low survival probability. DIC scores obtained immediately after trauma predicted a poor prognosis of severely injured trauma patients.Trial registration: UMIN-CTR, UMIN000019588. Registered on 16 November 2015.
Metagenomic Next-Generation Sequencing Improves the Prognosis of Patients with Infectious Diseases on Mechanical Ventilation in the Intensive Care Unit (ICU)
Authors: Xi Yin , Zhou Jing , Lin Zhimin , Liang Weibo , Yang Chun , Liu Dongdong , Xu Yonghao , Nong Lingbo , Chen Sibei , Yu Yuheng , He Weiqun , Zhang Jie , Zhang Rong , Pan Ying , Pan Jieyi , Li Jianchun , Chen Qiang , Liu Xiaoqing , Sang Ling , Xu Yuanda , Li Yimin
Published: December 2020

Background: Metagenomic Next-Generation Sequencing (mNGS) has gradually shown its advantages in pathogen identification for clinical infectious disease. However, few studies were conducted on the evaluation between this technique and conventional methods like culture and PCR and the prognosis of patients with infectious diseases on mechanical ventilation in ICUMethods: We conducted this retrospective study from March 2018 to May 2020 in the first Affiliated Hospital of Guangzhou Medical University, a total of 228 patients with suspected infectious diseases on mechanical ventilation were included, including 104 cases of mNGS group and 124 cases of non-mNGS. Statistical analyses were performed between the two groups and subgroup of whether were immunocompromised. The concordance between mNGS, culture and PCR was also assessed.Results: The 28-day mortality rate of the patients in the mNGS group was lower after the baseline difference correction (19.23% vs. 29.03%，p=0.039), indicating that mNGS may improve the prognosis of patients in ICU. And subgroup analysis showed that mNGS could improve the 28-day mortality of nonimmunosuppressive patients（14.06% vs. 29.82%, p=0.018）. According to the analysis of Logistic Regression, not performing mNGS, high APACHE II score and hypertension were independent risk factors for 28-day mortality, which strongly suggested that mNGS was one of the key factors affecting prognosis. A total of 157 samples performed mNGS, 116 of them received both mNGS and culture. mNGS presented advantages of positivity (69.8% double positive and 25.0% mNGS positive only) and concordance (79.0%, match and partly match).Conclusions: mNGS may improve the prognosis and reduce the 28-day mortality rate of patients with infectious diseases on mechanical ventilation in ICU. This technique has shown its advantages comparing with conventional methods, and will be wildly used as a promising technology for infectious disease.
Extracorporeal Membrane Oxygenation in Patients with Burns, Hero or Futile Medical Care? A Systematic Review and Meta-Analysis
Authors: Chiu Yu-Jen , Huang Yu-Chen , Chen Tai-Wei , King Yih-An , Ma Hsu
Published: December 2020

Background

Severely burned patients, particularly when compounded with inhalation injuries, are at high risk for cardiopulmonary failure. Recently, promising studies have stimulated interest in using extracorporeal membrane oxygenation (ECMO) as a potential therapy for burn patients with refractory cardiac and/or respiratory failure. Several observational studies have been reported, but the findings in these vary.
Methods

In this study, we conducted a systematic review and meta-analysis using standardized mortality ratios (SMRs) to elucidate the benefits associated with the use of ECMO in patients with burn and/or inhalation injuries. A literature search using PubMed, EMBASE, MEDLINE, and the Cochrane Library were performed from inception to October 20, 2020. Clinical outcomes in the selected studies were compared.
Results

22 studies were included in the final review and analysis. 13 studies with a total of 75 patients were included in SMR quantitative analysis. The overall pooled mortality rate of burn patients receiving ECMO was 48%. The meta-analysis found that the observed mortality was significantly higher than the predicted mortality in patients receiving ECMO, with a pooled SMR of 2.07 (95% CI: 1.04–4.14). However, in the subgroup of burn patients with inhalation injuries, all patients receiving V-V ECMO had lower mortality rates compared to their predicted mortality rates, with a pooled SMR of 0.95 (95% CI: 0.52–1.73). Other subgroup analyses, including an adult group, pediatric group, V-V setting group, and a V-A setting group reported no benefits from ECMO; however, these results were not statistically significant. Interestingly, the pooled SMR values decreased as the selected patients’ revised Baux scores increased (R=-0.92), indicating that the potential benefits from the ECMO treatment increased as the severity of patients with burns increased, especially when the patients’ revised Baux scores exceeded 90.
Conclusions

Our meta-analysis revealed that burn patients receiving ECMO treatment were at a higher risk of death. However, select patients, including those with inhalation injuries and those with the revised Baux scores over 90, would benefit from ECMO treatment. We suggest that burn patients with inhalation injuries or with revised Baux scores exceeding 90 should be considered for ECMO treatment and early transfer to an ECMO centre.
Avian leukosis virus subgroup J infection influences the gut microbiota composition in chicken
Authors: Chen Yuan , Ni Jiajia , Li Hongwei
Published: December 2020

Background: Avian leukosis virus (ALV) is a major cause of disease in poultry. Probiotics play a critical role in maintaining animal health. Studies have indicated that viral infection can alter the composition of the chicken gut microbiota. We hypothesized that ALV-J infection alters the probiotics composition in the chicken fecal bacterial microbiome. We performed high-throughput 16S rRNA gene sequencing and evaluated the gut microbiota proﬁles using feces from ALV-J-infected and healthy chickens.Results: The relative abundance at the phylum and species levels was calculated. The phylum Proteobacteria was more abundant in ALV-J-infected chickens than in healthy chickens. Additionally, the abundance of the opportunistic pathogen Propionibacterium acnes was significantly increased in ALV-J-infected chickens. Interestingly, ALV-J infection tended to be significantly decreased by the probiotics Lactobacillus helveticus and Lactobacillus reuteriConclusions: The study indicates that ALV-J infection significantly altered the gut microbiota distribution in chickens. Additionally, ALV-J infection significantly influenced the abundance of L. helveticus and L. reuteri in the chicken gut.
An implementation history of primary health care transformation: Alberta’s primary care networks and the people, time and culture of change
Authors: Leslie Myles , Khayatzadeh-Mahani Akram , Birdsell Judy , Forest PG , Henderson Rita , Gray Robin Patricia , Schraeder Kyleigh , Seidel Judy , Zwicker Jennifer , Green Lee A.
Published: December 2020

Background: Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementationhistory of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment.Methods: Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n=20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses.Results: Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success.Conclusions: Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.
Accuracy of telephone triage in patients suspected of transient ischaemic attack or stroke: A cross-sectional study
Authors: Erkelens Daphne Carmen , Rutten Frans H. , Wouters Loes T. , Dolmans L. Servaas , de Groot Esther , Damoiseaux Roger A. , Zwart Dorien L.
Published: December 2020

Background: The Netherlands Triage Standard (NTS) is a widely used decision support tool for telephone triage at Dutch out-of-hours primary care services (OHS-PC), which, however, has never been validated against clinical outcomes. We aimed to determine the accuracy of the NTS urgency allocation for patients with neurological symptoms suggestive of a transient ischaemic attack (TIA) or stroke, with the clinical outcomes TIA, stroke, and other (neurologic) life-threatening events (LTEs) as the reference. Method: A cross-sectional study of telephone triage recordings of patients with neurological symptoms calling the OHS-PC between 2014 and 2016.The allocated NTS urgencies were derived from the electronic medical records of the OHS-PC. The clinical outcomes were retrieved from the electronic medical records of the patients’ own general practitioners. The accuracy of a high NTS urgency allocation (medical help within three hours) was calculated in terms of sensitivity, specificity, positive and negative predictive values (PPV and NPV) with the clinical outcomes TIA/stroke/other LTEs as the reference. Results: Of 1,269 patients, 635 (50.0%) received the diagnosis TIA/stroke (34.2% TIA/minor stroke, 15.8% major ischaemic or haemorrhagic stroke), and 4.8% other LTEs. For TIA/stroke/other LTEs, the sensitivity and specificity of the NTS urgency allocation were 0.72 (95%CI 0.68-0.75) and 0.48 (95%CI 0.43-0.52), and the PPV and NPV were 0.62 (95%CI 0.60-0.64) and 0.58 (95%CI 0.54-0.62). Conclusions: The NTS decision support tool used in Dutch OHS-PC performed poor to moderately regarding safety (sensitivity) and efficiency (specificity) in allocating adequate urgencies to patients with and without TIA/stroke/other LTEs.
Three redescriptions in Tintinnopsis (Protista: Ciliophora: Tintinnina) from coastal waters of China, with cytology and phylogenetic analyses based on ribosomal RNA genes
Authors: Bai Yang , Wang Rui , Song Wen , Li Lifang , Santoferrara Luciana F. , Hu Xiaozhong
Published: December 2020

Background: The taxonomy of tintinnine ciliates is vastly unresolved because it has traditionally been based on the lorica (a secreted shell) and it has only recently incorporated cytological and molecular information. Tintinnopsis, the most speciose tintinnine genus, is also the most problematic: it is known to be non-monophyletic, but it cannot be revised until more of its species are studied with modern methods.Results: Here, T. hemispiralis Yin, 1956, T. kiaochowensis Yin, 1956, and T. uruguayensis Balech, 1948, from coastal waters of China, were studied. Lorica and cell features were morphometrically investigated in living and protargol-stained specimens, and sequences of three ribosomal RNA (rRNA) loci were phylogenetically analyzed. The three species show a complex ciliary pattern (with ventral, dorsal, and posterior kineties and right, left, and lateral ciliary fields), but differ in lorica morphology, details of the somatic ciliature and rRNA gene sequences. Tintinnopsis hemispiralis is further distinguished by a ciliary tuft (a ribbon of very long cilia originated from the middle portion of the ventral kinety and extending out of the lorica) and multiple macronuclear nodules. Both T. kiaochowensis and T. uruguayensis have two macronuclear nodules, but differ in the number of somatic kineties and the position of the posterior kinety. Two neotypes are fixed for T. hemispiralis and T. kiaochowensis to stabilize the species names objectively, mainly because of the previous unavailability of type materials. By phylogenetic analysis and comparison with closely-related species, we infer that the ciliary tuft and details such as the commencement of the rightmost kinety in the lateral ciliary field are synapomorphies that may help clarify the systematics of Tintinnopsis-like taxa.Conclusion: The redescriptions of three poorly known Tintinnopsis species, namely T. hemispiralis, T. kiaochowensis, and T. uruguayensis firstly revealed their ciliary patterns and rRNA sequences. This study expands knowledge and database of tintinnines and helps in identifying potential synapomorphies for future taxonomic rearrangements.
Clinical characteristics and prognostic factors in elderly patients with COVID-19
Authors: Cheng Qin , Liao Yixuan , Lin Yujing , Tao Liyuan , Wang He , Li Mohan , Ge Qinggang , Li Yanming , Shen Ning
Published: December 2020

Background: The COVID-19 pandemic posed tremendous threats to the world. Elderly patients were among the high-risk population, and apt to experience worse outcomes.Methods: Elderly patients (age ≥60 years old) were enrolled from January 28 to February 29, 2020, in Tongji Hospital, one of designated COVID-19 medical centers in Wuhan, China. A retrospective study was performed to describe clinical characteristics and outcomes of elderly COVID-19 patients. COX regression was used to analyze predictors for 28-day mortality. Linear regression models were constructed to analyze factors associated with length of hospital stay (LOS).Result: A total of 186 elderly patients (aged 70.4 ± 7.1 years, 95 males (51.6%)) were enrolled, 120 patients (64.5%) were severe or critical type, and mortality rate was 16.1%. Patients in non-survival group had a higher smoking rate, more symptoms of dyspnea, lab results indicative of poorer health. Age (HR 1.128, 95% CI 1.066-1.194), lymphocyte count (HR 0.261, 95% CI 0.073-0.930), LDH (HR 1.003, 95% CI 1.002-1.005), procalcitonin (HR 1.061, 95% CI 1.002-1.125), and qSOFA (HR 3.162, 95% CI 1.646-6.072) were independently associated with 28-day mortality. CURB-65 plus LDH on admission were predictors of mortality by ROC analysis (AUROC=0.891). Among surviving patients, consolidation on CTs, elevated ferritin level and neutrophil count were associated with increased LOS.Conclusion: High incidence of comorbidities and mortality were observed in elderly patients. Decreased lymphocyte, older age, higher qSOFA score, procalcitonin and LDH levels were independent factors associated with mortality, CURB-65 plus LDH could be a predictive model of fatal outcome. Consolidation on CTs, elevated ferritin and neutrophil level correlated with increased LOS. Further prospective studies should be performed to test our findings and explore potential treatments.
Can a penalized-likelihood estimation algorithm be used to reduce the injected dose or the acquisition time in 68Ga-DOTATATE PET/CT studies?
Authors: Chicheportiche Alexandre , Goshen Elinor , Godefroy Jeremy , Grozinsky-Glasberg Simona , Oleinikov Kira , Meirovitz Amichay , Gross David J. , Ben-Haim Simona
Published: December 2020

Background: Image quality and quantitative accuracy of Positron Emission Tomography (PET) depend on several factors such as uptake time, scanner characteristics and image reconstruction methods. Ordered subset expectation maximization (OSEM) is considered the gold standard for image reconstruction. Penalized-likelihood estimation (PL) algorithms have been recently developed for PET reconstruction to improve quantitation accuracy while maintaining or even improving image quality. In PL algorithms a regularization parameter β controls the penalization of relative differences between neighboring pixels and determines image characteristics. In the present study, we aim to compare the performance of Q.Clear (PL algorithm, GE Healthcare) and OSEM (3 iterations, 8 subsets, 6 mm post-processing filter) for 68Ga-DOTATATE (68Ga-DOTA) PET studies, both visually and quantitatively.Thirty consecutive whole-body 68Ga-DOTA studies were included. The data were acquired in list mode and were reconstructed using 3D OSEM and Q.Clear with various values of β, and various acquisition times per bed position (bp), thus generating images with reduced injected dose (1.5 min/bp: β=300-1100; 1.0 min/bp: β=600-1400 and 0.5 min/bp: β=800-2200). An additional analysis adding β values up to 1500, 1700 and 3000 for 1.5, 1.0 and 0.5 min/bp, respectively, was performed for a random sample of 8 studies. Evaluation was performed using a phantom and clinical data. Two experienced nuclear medicine physicians blinded to the variables assessed the image quality visually.Results: Clinical images reconstructed with Q.Clear, set at 1.5, 1.0 min/bp and 0.5 min/bp using β = 1100, 1300, 3000 respectively, resulted in images with noise equivalence to 3D OSEM (1.5 min/bp) with a mean increase in SUVmax of 14%, 13% and 4%, an increase in SNR of 30%, 24% and 10%, and in SBR of 13%, 13% and 2%, respectively. Visual assessment yielded similar results for β values of 1300-1500 and 1500-1700 for 1.5 and 1.0 min/bp, respectively although for 0.5 min/bp there was no significant improvement compared to OSEM.Conclusion: 68Ga-DOTA reconstructions with Q.Clear, 1.5 and 1.0 min/bp resulted in increased tumor SUVmax and in improved SNR and SBR at a similar level of noise compared to 3D OSEM. Q.Clear with β =1500-1700 enables one-third reduction of acquisition time or injected dose, with similar image quality compared to 3D OSEM.
Is achieving 7,000 steps/day cross-sectionally and prospectively associated with older adults’ lower-extremity performance?
Authors: Hsueh Ming-Chun , Lin Chien-Yu , Lai Ting-Fu , Yu Yi Chien , Chang Shao-Hsi , Bae Ju Yong , Liao Yung
Published: December 2020

Background: Evidence regarding the association between daily steps recommendation and older adults’ lower limb strength is lacking; thus, this study investigated whether taking at least 7,000 steps/day is cross-sectionally and prospectively related to lower-extremity performance in older Taiwanese adults. Methods: There were 89 community-dwelling adults aged over 60 years (mean age: 69.5 years) attending both baseline and follow-up surveys. This study used adjusted logistic regression analysis to explore cross-sectional and prospective relationships between their accelerometer-assessed daily steps and lower-extremity performance (five-times-sit-to-stand test). Results: This study found the older adults who took 7,000 steps/day were more likely to have better lower-extremity performance cross-sectionally (odds ratio [OR] = 3.82; 95% confidence interval [CI]: 1.04, 13.95; p = 0.04), as well as to maintain or increase their lower-extremity performance prospectively (OR=3.53; 95% CI: 1.05, 11.84; p = 0.04). Conclusions: Our findings support a minimum recommended level of step-based physical activity for older adults, namely, 7,000 steps/day, as beneficial for maintaining or increasing older adults’ lower-extremity performance.
Trends in out of pocket payments and catastrophic health expenditure in the Kyrgyz Republic post “Manas Taalimi” and “Den Sooluk” health reforms, 2012 - 2018
Authors: Iamschikova Mariia , Mogilevskii Roman , Onah Michael N
Published: December 2020

Background: Over the years, the Kyrgyz Republic has implemented health reforms that target health financing with the aim of removing financial barriers to healthcare including out-of-pocket health payments (OOPPs). This study examines the trends in OOPPs and the incidence of catastrophic health expenditure (CHE) post the “Manas Taalimi” and “Den Sooluk” health reforms. Methods: We used data from the Kyrgyzstan Integrated Household Surveys (2012 – 2018). Population-weighted descriptive statistics were used to examine the trends in OOPPs and CHE at three thresholds; 10 percent of total household consumption expenditure (Cata10), 25 percent of total household consumption expenditure (Cata25) and 40 percent of total household non-food consumption expenditure (Cata40). Panel and cross-sectional logistic regression with marginal effects were used to examine the predictors of Cata10 and Cata40. Findings: Between 2012 and 2018, OOPPs increased by about US $6 and inpatient costs placed the highest cost burden on users (US $13.6), followed by self-treatment (US $10.7), and outpatient costs (US $9). Medication continues to predominantly drive inpatient, outpatient, and self-treatment OOPPs. About 0.378 to 2.084 million people (6 – 33 percent) of the population incurred catastrophic health expenditure at the three thresholds between 2012 and 2018. Residing in households headed by a widowed or single head, or residing in rural regions, increases the likelihood of incurring catastrophic health expenditure. Conclusions: The initial gains in the reduction of OOPPs and catastrophic health expenditure appear to gradually erode since costs continue to increase after an initial decline and catastrophic health expenditure continues to rise unabated. This implies that households are increasingly incurring economic hardship from seeking healthcare. Considering that this could result to forgone expenditure on essential items including food and education, efforts should target the sustainability of these health reforms to sustain the reduction of catastrophic health payments and its dire consequences.
Treatment of Volar Defects of the Finger using Dorsal Digital–metacarpal Flap Versus Free Medial Plantar Artery Flap: A Comparative Study
Authors: Liu Quanzhe , Guo Wenlai , Qu Wenrui , Ou Xiaolan , Li Rui , Tian Heng
Published: December 2020

Background: The treatment of defects on the volar surface of the finger has been scarcely reported, and its utility for digital resurfacing remains unclear. This study compared the outcomes of free medial plantar artery flap (MPAF) and dorsal digital–metacarpal flap (DDMF) in finger reconstruction.Methods: This retrospective cohort study included 24 patients with soft-tissue defects on the volar surface of the finger from March 2014 to March 2017. The patients were divided into two groups: the MPAF group and the DDMF group. The operation time, complications, such as flap necrosis, graft loss, infection, paresthesia, and donor-site morbidity, as well as two-point discrimination (2-PD) were carefully recorded. The Michigan Hand Outcomes Questionnaire was used for conduct follow-up assessment.Results: After more than 12 months of follow-up, the MPAF group had a longer operative time compared with DDMF group, but there was no significant difference between postoperative complications and 2-PD test result in patients without nerve injury. And in terms of overall function, Modified VSS score and 2-PD test (the patients with nerve injury), There were relatively obvious statistical differences, MPAF was superior to DDMF (p < 0.005).Conclusion: MPAF and DDMF are reliable for reconstruction of the volar surface of the finger; however, MPAF offers better functional outcomes and is associated with a lower incidence of postoperative complications.
IFI27 may predict and evaluate the severity of respiratory syncytial virus infection in preterm infants
Authors: Gao Junyan , Zhu Xueping , Wu Mingfu , Jiang Lijun , Wang Fudong , He Shan
Published: December 2020

Background: Preterm infants are a special population that vulnerable to respiratory syncytial virus (RSV) infection and the lower respiratory tract infections (LRTIs) caused by RSV could be severe and even life-threating. The purpose of the present study was to identify candidate genes of preterm infants who are susceptible to RSV infection and provide a new insight into the pathogenesis of RSV infection. Methods: Three datasets (GSE77087, GSE69606 and GSE41374) containing 183 blood samples of RSV infected patients and 33 blood samples of healthy controls from Gene Expression Omnibus (GEO) database were downloaded and the differentially expressed genes (DEGs) were screened out. The function and pathway enrichments were analyzed through Database for Annotation, Visualization and Integrated Discovery (DAVID) website. The protein‐protein interaction (PPI) network for DEGs was constructed through Search Tool for the Retrieval of Interacting Genes (STRING). The module analysis was performed by Cytoscape software and hub genes were identified. Clinical verification was employed to verify the expression level of top five hub genes among 72 infants including 50 RSV infected patients and 22 non-RSV-infected patients hospitalized in our center. Further, the RSV infected infants with high-expression IFI27 and those with low-expression IFI27 were compared (defined as higher or lower than the median mRNA level). Finally, the gene set enrichment analysis (GSEA) focusing on IFI27 was carried out. Results: Totally, 4028 DEGs were screened out and among which, 131 most significant DEGs were selected. Subsequently, 13 hub genes were identified and function and pathway enrichments of hub genes mainly were: response to virus, defense response to virus, regulation of viral genome replication and regulation of viral life cycle. Furthermore, IFI27 was confirmed to be the most significantly expressed in clinical verification. Gene sets associated with calcium signaling pathway, arachidonic acid metabolism, extracellular matrix receptor interaction and so on were significantly enriched when IFI27 was highly expressed. Moreover, high-expression IFI27 was associated with more severe cases (p=0.041), more requirements of mechanical ventilation (p=0.034), more frequent hospitalization (p<0.001) and longer cumulative hospital stay (p=0.012). Conclusion: IFI27 might serve to predict RSV infection and evaluate the severity of RSV infection in preterm infants.
Initial result of unselective implementation of enhanced recovery after surgery in a low-volume bariatric unit: a feasibility and safety study
Authors: Lo Hung Chieh , Chiu Wen-Kuan , Chiu Yu-Chi , Hsu An-Chih , Tai Yu-Ting
Published: December 2020

BackgroundThe feasibility and safety of unselectively applying an enhanced recovery after surgery (ERAS) protocol in a low-volume bariatric unit were determined. MethodsWe retrospectively reviewed all patients undergoing bariatric surgeries under a single surgeon between January 2015 and December 2018. Our ERAS protocol initiated in January 2017 with all patients enrolled unselectively. For those receiving non-primary procedures or with BMI<32.5 kg/m2 were excluded from this analysis. Demographic features and all 30-day outcome measures, including operation time, length of stay (LOS), ER visits, readmissions, reoperations were collected and compared between the ERAS (2017–2018) and control (2015-2016) groups. Results One hundred eighty-four consecutive patients underwent bariatric surgeries during the study period. Of those fulfilling the inclusion criteria, 62 (40.8%) were treated before and 90 (59.2%) were treated after ERAS implementation. No differences in baseline demographics were found between the groups except ERAS group had more Roux-en-Y gastric bypass procedures (58.9% vs. 12.9%). A markedly reduced operation time (101 min vs. 147 min; p<0.001) and shortened LOS (2.6 days vs. 3.3 days; p<0.001) were observed, with significantly more ERAS patients achieving POD1 discharge (45.6% vs. 1.6%; p<0.001). There were no significant differences in terms of ER visits (2.2% vs. 8%), readmissions (1.1% vs. 4.8%) or total complication rates between the groups (5.5% vs. 9.7%). ConclusionUnselective ERAS implementation in low-volume units is feasible and safe, with significantly reduced operation times and a shortened LOS without increased complications.
Reporting of screening and diagnostic AI rarely acknowledges ethical, legal and social implications: a mass media frame analysis
Authors: Frost Emma Kellie , Carter Stacy M
Published: December 2020

Background: Healthcare is a rapidly expanding area of application for Artificial Intelligence (AI). Although there is considerable excitement about its potential, there are also substantial concerns about the negative impacts of these technologies. Since screening and diagnostic AI tools now have the potential to fundamentally change the healthcare landscape, it is important to understand how these tools are being represented to the public via the media. Methods: Using a framing theory approach, we analysed how screening and diagnostic AI was represented in the media and the frequency with which media articles addressed the benefits and the ethical, legal, and social implications (ELSIs) of screening and diagnostic AI. Results: All the media articles coded (n=136) fit into one of three frames: social progress (n=132), economic development (n=59), and alternative perspectives (n=9). The vast majority of the articles were positively framed, with 135 of the articles discussing benefits of screening and diagnostic AI, and only 9 articles discussing the ethical, legal, and social implications. Conclusions: We found that media reporting of screening and diagnostic AI was overwhelmingly positive. Screening and diagnostic AI may be represented more positively in the mass media than AI in general. This represents an opportunity for health journalists to provide publics with deeper analysis of the ethical, legal and social implications of screening and diagnostic AI, and to do so now before these technologies become firmly embedded in everyday healthcare delivery.
Cloning of long sterile lemma (lsl2), a single recessive gene regulating spike germination in rice (Oryza sativa L.)
Authors: Yang Dewei , He Niqing , Zheng Xianghua , Zhen Yanmei , Xie Zhenxin , Cheng Chaoping , Huang Fenghuang
Published: December 2020

Background: Rice is a typical monocotyledonous plant and an important cereal crop. The structural units of rice flowers are spikelets and florets, and floral organ development and spike germination affect rice reproduction and yield.Results: In this study, we identified a novel long sterile lemma (lsl2) mutant from an EMS population. First, we mapped the lsl2 gene between the markers Indel7-22 and Indel7-27, which encompasses a 25-kb region. The rice genome annotation indicated the presence of four candidate genes in this region. Through gene prediction and cDNA sequencing, we confirmed that the target gene in the lsl2 mutant is allelic to LONG STERILE LEMMA1 (G1)/ELONGATED EMPTY GLUME (ELE), hereafter referred to as lsl2. Further analysis of the lsl2 and LSL2 proteins showed a one-amino-acid change, namely, the mutation of serine (Ser) 79 to proline (Pro) in lsl2 compared with LSL2, and this mutation might change the function of the protein. Knockout experiments showed that the lsl2 gene is responsible for the long sterile lemma phenotype. The lsl2 gene might reduce the damage induced by spike germination by decreasing the seed germination rate, but other agronomic traits of rice were not changed in the lsl2 mutant. Taken together, our results demonstrate that the lsl2 gene will have specific application prospects in future rice breeding.Conclusions: The lsl2 gene is responsible for the long sterile lemma phenotype and might reduce the damage induced by spike germination by decreasing the seed germination rate.
A qualitative inquiry of access to and quality of primary healthcare in seven communities in East and West Africa (SevenCEWA): perspectives of stakeholders, healthcare providers and users
Authors: Ameh Soter , Akeem Bolarinwa Oladimeji , Ochimana Caleb , Oluwasanu Abayomi Olabayo , Mohamed Shukri F , Okello Samson , Muhihi Alfa , Danaei Goodarz
Published: December 2020

Background: Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in East and West Africa. The aim of this study was to describe the viewpoints of healthcare users, healthcare providers and other stakeholders on health-seeking behaviour, access to and quality of healthcare in seven communities in East and West Africa.Methods: A qualitative study was conducted in four communities in Nigeria and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit: 155 respondents (mostly healthcare users) for 24 focus group discussions, 25 healthcare users, healthcare providers and stakeholders for in-depth interviews and 11 healthcare providers and stakeholders for key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four ‘As’ of access to care, and pathway model to better understand the a priori themes on access to and quality of primary healthcare as well as health-seeking behaviours of the study respondents. A content analysis of the data was done using MAXQDA 2018 qualitative software to identify these a priori themes and emerging themes.Results: Access to primary healthcare in the seven communities was limited, especially use of health insurance. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Health providers and users as well as stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in the Nigerian sites. Conclusions: There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery that address social and health inequities, through affordable health insurance, can be used to fill this gap and facilitate achieving universal health coverage.