bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors associated with survival in Adult Patients with Traumatic Arrest: A Retrospective Cohort Study from US Trauma Centers
Authors: Ariss Abdel-Badih , Bachir Rana , Sayed Mazen El
Published: December 2020

Background: Traumatic arrests (TA) increasingly affect young adults worldwide with low reported survival rates. This study examines factors associated with survival (to hospital discharge) in traumatic arrests transported to US trauma centers. Methods: This retrospective cohort study used the US National Trauma Databank 2015 dataset and included patients who presented to trauma centers with “no signs of life”. Univariate and bivariate analyses were done. Factors associated with survival were identified using multivariate regression analyses. Results: The study included 5,980 patients with traumatic arrests. Only 664 patients (11.1%) survived to hospital discharge. Patients were predominantly in age group 16-64 (84.6%), were mostly males (77.8%) and white (55.1%). Most were admitted to Level I (55.5%) or Level II trauma centers (31.6%). Injuries were mostly blunt (56.7%) or penetrating (39.3%). Mean ISS was 23.71 (± 20.79). Factors associated with decreased survival included: Age group ≥65 (Ref: 16-24), male gender, self-inflicted and other or undetermined types of injuries (Ref: assault), injuries to head & neck, injuries to torso and injury severity score (ISS) ≥ 16 (Ref: <16). While factors associated with increased survival included: All injury mechanisms (with the exception of Motor Vehicle Transportation (MVT)) (Ref: firearm), injuries to extremities or spine & back and all methods of coverage (Ref: self-pay).Conclusion: Patients with traumatic arrests have poor outcomes with only 11.1 % surviving to hospital discharge. Factors associated with survival in traumatic arrests were identified. These findings are important for devising injury prevention strategies and help guide trauma management protocols to improve outcomes in traumatic arrests. Level of evidence: Level III
WITHDRAWN: Unraveling Dielectric Abnormality Based on the Effect of Defect Dipoles in Cr Ion Doped Multipurpose Properties of BCT Ceramics
Authors: Redhu Preeti , Sharma Preeti , Punia Rajesh , Singh Anupinder , Ohlan Anil , Hooda Ashima
Published: December 2020

With the motive of unraveling the effect of Cr incorporation on the structural, microstructural, dielectric, ferroelectric, energy storage, and magnetic properties of BCT (Barium Calcium Titanate) ceramics have been investigated. Ba0.80Ca0.20Ti1-3x/4CrxO3 (0.000 ≤ x ≤ 0.020) powder samples have been prepared using classical solid-state reaction method. Cr doped BCT ceramics showed a single phase perovskite structure having a tetragonal phase without phase transformation from P4mm to Pm-3m after the addition of Cr. With increased Cr content, the tolerance factor, lattice parameters, unit cell volume, c\a ratio, and grain size have been found to decrease. Both Debye-Scherrer and Williamson-Hall plot methods confirmed the reduction of crystallite size on increased Cr doping in BCT lattice. A dielectric anomaly “hump” (̴ 447 K) has been observed at low frequencies in the paraelectric region due to the presence of acceptor induced defect dipoles. The temperature-dependent dielectric properties of prepared BCT ceramic with Cr compositions possess diffused phase transition (DPT) and the width of DPT is increased. Room temperature energy storage density achieved the maximum value of 190.35 mJ/cm3 for the composition x = 0.005 at an electric field of 55 kV/cm. For the Cr composition of x = 0.015 and an electric field of 10 kV/cm, the highest energy storage efficiency (η) of about 60.5 % has been obtained at room temperature. % Temperature coefficient of capacitance has been obtained to vary between ± 15 % in the temperature range of 303 K to 523 K. Cr doped ceramic samples exhibit room temperature ferromagnetism at low magnetic fields and diamagnetism at a higher value of magnetic fields. These results suggest prepared ceramics as a suitable lead-free material for X8R multilayer ceramic capacitor devices and energy applications.
Studies on Structural, Morphological, Local Electrical, Optical and Magnetic Properties of Iron Site Manganese Substituted Yttrium Orthoferrite
Authors: Gholam Turghunjan , Peng Liu , Yu-Hui Dong , Hui-Qiong Wang
Published: December 2020

Yttrium orthoferrite (YFeO3) is of considerable interest for its potential application in magnetic field sensors and magneto optical data storage devices. Doping is one of the effective approaches to tune the compound properties. And it is important to determine the doping sites of the dopants to better understanding the related mechanism. In this work, Manganese (Mn) doped YFeO3, i.e., YFMxO powders with 0 ≤ x ≤ 0.1 were synthesized by hydrothermal method to study the influences of doping on their structural, morphological, local electrical, optical and magnetic properties. The experimental results show that Mn dopants occupy Iron (Fe) sites and that all these samples exhibit an orthorhombic structure with space group Pnma. Refined structure parameters are presented. Morphology images show the shape evolution from layered to multilayered with increasing Mn content. The Fe and Y K-edge local structure studies indicate that the valency of Fe and Y is mainly found in trivalent state, which also indicate that substitution of Mn ions not only affects the nearest neighbor atomic shell of Fe but also affects the nearest neighbor’s local structure of Y atoms. IR spectra reveal the characteristic vibrations of the obtained YFMxO samples. From the magnetic study, it is observed that the substitution of Y ions by Mn ions changes the magnetic property of YFeO3 from ferromagnetic to paramagnetic. Our results show that the addition of Mn exhibits an evident influent on the local structural and magnetic properties.
Pathogenic convergence of CNVs in genes functionally associated to a severe neuromotor developmental delay syndrome
Authors: García-Hernández Juan L. , Corchete Luis A. , Marcos-Alcalde Íñigo , Gómez-Puertas Paulino , Fons Carmen , Lazo Pedro A.
Published: December 2020

Background
Complex developmental encephalopathy syndromes might be the consequence of unknown genetic alterations are likely to contribute to the full neurological phenotype as a consequence of pathogenic gene combinations.
Methods
To identify the additional genetic contribution to the neurological phenotype, we studied as a test case a boy, with a KCNQ2 exon-7 partial duplication, by single nucleotide polymorphism (SNP) microarray to detect copy-number variations (CNVs).
Results
The proband presented a cerebral palsy like syndrome with a severe motor and developmental encephalopathy. The SNP array analysis detected in the proband several de novo CNVs, nine partial gene losses (LRRC55, PCDH9, NALCN, RYR3, ELAVL2, CDH13, ATP1A2, SLC17A5, ANO3), and two partial gene duplications (PCDH19, EFNA5). The biological functions of these genes are associated with ion channels such as calcium, chloride, sodium, and potassium; and with several membrane proteins implicated in neural cell-cell interactions, synaptic transmission and axon guidance. Pathogenically, these functions can be associated to cerebral palsy, seizures, dystonia, epileptic crisis, and motor neuron dysfunction, all present in the patient.
Conclusions
Severe motor and developmental encephalopathy syndromes of unknown origin can be the result of a phenotypic convergence by combination of several genetic alterations in genes whose physiological function contributes to the neurological pathogenic mechanism.
A Real-World Data Analysis of The Distribution of Traditional Chinese Medicine Syndromes and Their Elements Among Bronchiectasis Patients
Authors: Du Yijie , Kong Qing , Wu Xiaoli , Jin Ye , Tang Zihui , Yang Chang Jiang
Published: December 2020

Introduction: We sought to investigate the distribution of traditional Chinese medicine (TCM) syndromes and their elements among bronchiectasis patients using real-world data. Methods: A real-world study was performed to explore the relationship between TCM syndrome and bronchiectasis using electronic medical information from 1,113 patients in China. Factor analyses were used to reduce the dimensions of TCM syndrome elements and to detect common factors. Additionally, cluster analyses were employed to assess combinations of TCM syndrome elements. Finally, association rule analyses were performed to investigate the structures of TCM syndrome elements in order to estimate the patterns of TCM syndromes.Results: A total of 17 TCM syndrome elements were extracted using this method. There were four Shi TCM syndromes of Tan_Re_Yong_Fei (36.39%), Tan_Zhuo_Zu_Fei (12.94%), Gan_Huo_Fan_Fei (11.59%), and Feng_Re_Fan_Fei (11.32%) with >5.0% distribution frequency in total sample. The highest Xu TCM syndrome was Fei_Yin_Xu (18.24%). Factor analysis, cluster analysis, and association rule analysis found that Tan, Huo, Feng, Yin_Xu, Fei, and Gan were the core TCM syndrome elements.Conclusion: In this study, TCM Shi syndromes of Tan_Re_Yong_Fei, Tan_Zhuo_Zu_Fei, Gan_Huo_Fan_Fei, and Feng_Re_Fan_Fei were detected with a high frequency among bronchiectasis patients using real-world data, as was the TCM core Xu syndrome of Fei_Yin_Xu. The core elements of Huo, Tan, Feng, Yin_Xu, Fei and Gan were found across the entire sample.
Immobilization of Glucanobacter Xylinum Onto Natural Polymers to Enhance the Bacterial Cellulose Productivity
Authors: Abdelraof Mohamed , El-Saied Houssni , Hasanin Mohamed S.
Published: December 2020

Bacterial cellulose (BC) has profound applications in different sectors of biotechnology due to its unique properties preferring it about plant cellulose. Although this polymer is extremely important in various applications, many problems still hinder the sustainable production in terms of increasing productivity and low-cost production. In order to overcome these problems, this study will focuses on the continuous production of cellulose using immobilized Glucanobacter xylinum cells onto Sugar Cane Bagasse (SCB) and Ca-alginate beads. Comparatively, adsorption of Glucanobacter xylinum cells to the cavum of stalk cells of SCB could be efficiently stable while, entrapment of cells onto Ca-alginate has drawback observed by the rapid disruption and instability of the beads in the Potato Peel Waste (PPW) culture medium. Our findings demonstrate that a combination between alternative low-cost medium with continuous production mode by immobilization onto inexpensive natural polymer can promote a sustainable bioprocess and reduction the production cost.
CaRBoKem: A Biofilter to Treat Heavy Metals by using the Household Waste Products
Authors: Sajeev Milan Maria , Krishnakumar Uma , John Merrin , Raj Amal , Thomas Hanna
Published: December 2020

Environmental toxic waste from heavy metals along with minerals within the waste matter is one of the most significant issue in an Asian country. The activities like industrial operations particularly mining, agricultural processes and disposal of industry waste materials; their concentration has redoubled to hazardous levels. Major metals in industrial sewage represent Cu, Cr3+and Pb etc. So far, varieties of inexpensive strategies are reviewed for the removal of these metals. The various processes include chemical precipitation, reverse diffusion, electro qualitative analysis, nanofiltration and floatation. But these strategies have many disadvantages like high chemical agent demand, unpredictable metal particle elimination, and production of unhealthful sludge. Surface absorption method being terribly straightforward, economical, effective and versatile has become the most popular strategies for removal of unhealthful contaminants from waste matter. This paper gives a new idea for the utilization of natural materials as adsorbents for significant metal removal from industrial waste water. The components used are mustard plant roots, human hair and some common house hold waste products such as, egg shell and coconut shell. Utilizing their adsorbent properties in an efficient way, it can be used to filter industrial heavy metals which cause pollution.
Smartphone Addiction and Associated Factors among Postgraduate Students in an Arabic Sample: A Cross-Sectional Study.
Authors: Alageel Asem , Alyahya Rayyan Abdullah , Bahatheq Yasser , Alzunaydi Norah , Alghamdi Raed , Alrahili Nader , McIntyre Roger , Iacobucci Michelle
Published: December 2020

Background
With the wide variety of convenient functionalities, smartphones have become an integral part of society, and in such a small period. It is imperative to examine the adverse effect and consequences of such highly impactful technologies on our individual lives and society as a whole. Like smartphone addiction, behavioral addictions have been established to accompany social, physical, and mental health issues. In this article, we will be investigating the prevalence of smartphone addiction among postgraduate students as well as assessing its relationship to social demographics, depression, ADHD, and nicotine dependence.

Objectives
· The prevalence of smartphone addiction among middle eastern postgraduate students.
· Ascertain the associated factors of smartphone addiction.
· Measure the incidence of MDD, ADHD, insomnia, and nicotine addiction among postgraduate students with smartphone addiction.

Methods
A Cross-sectional online survey, a self-questionnaire is divided into six sections; 1st section is Socio-demographic (age, gender, academic year). 2nd section is the Arabic-validated versions of the Smartphone Addiction Scale (SAS) 3rd section is Patient Health Questionnaire for Depression (PHQ9). 4 th is Athens Insomnia Scale (AIS) to assess the quality of sleep. 5th concerns nicotine dependence and uses the Fagerstrom Test for Cigarette Dependence Questionnaire (FTCd). The 6th section is the Adult ADHD Self-Report Scale (ASRS-v1.1)

Results
The total number of participants in this study is 506, 158 (31.23%) males, and 348 (68.77%) females. According to the Smartphone Addiction Scale, 51.0% of the participants appear to be high smartphone users, while 49.0% are low smartphone users. The PHQ-9 questionnaire for depression showed a significant association between high smartphone use and MDD (p=0.001). 41.5% of smokers are addicted to smartphones (p=0.039). Smartphone addicts have about two times the risk of developing insomnia (OR= 2.113) (P= 0.013). Those who were addicted to smartphone use had a significant risk of developing ADHD symptoms (OR =2.712) (P <0.001).

Conclusion
Confirming several studies, we found a positive association between Insomnia, Depression, Adult ADHD, and Smartphone addiction. Therefore, we encourage the scientific community to study the impacts of smartphone addiction and the mental health of post-graduate students.
Cost Effectiveness Analysis Of High-Risk Group Tb Screening In Malaysia
Authors: Hassan Nor Zam Azihan Mohd , Razali Asmah , Shahari Mohd Ridzwan , Kunusagaran Mohd Shaiful Jefri Mohd Nor Sham , Halili Juanita , Zaimi Nur Amalina , Bahari Mohd Shahri , Aminuddin Farhana
Published: December 2020

Background: Screening of high-risk groups for TB is considered as the cornerstone for TB elimination but the measure of cost-effectiveness is also crucial in deciding the strategy for TB screening. This study aims to measure the cost-effectiveness of TB screening between the various high-risk groups in Malaysia.Methods: A decision tree model was developed to assess the cost-effectiveness of TB screening among the high-risk group from provider perspective using a secondary data from year 2016 to 2018. The outcome is presented in term of cost per TB case detected and the ICER. Deterministic and Probabilistic Sensitivity Analysis were also performed to measure the robustness of the model.Results: The most cost-effective strategy was TB screening among PL HIV, with MYR 2,597.00 per one TB case detected. This is followed by elderly, prisoners and smokers with MYR 2,868.62, MYR 3,065.24 and MYR 4,327.76 per one TB case detected respectively. There was an incremental costs of MYR 2.49 per screening, and 3.4 TB case detection per 1000 screening for TB screening among PL HIV in relation to TB screening among prisoners. The probability of symptomatic cases diagnosed as TB was the key driver for increasing cost effectiveness efficacy among PL HIV.Conclusions: Results of the study suggest prioritization of high-risk group TB screening programme by focusing on the most cost-effective strategy such as screening among PL HIV, prisoners and elderly, which has lower cost per TB case detected.
Using a Competing-Risks Model to Predict the Prognosis of Meningioma Patients: Fine-Gray and Cause-Specific Hazard Analyses
Authors: Yang Jin , He Yujing , Huang Qiao , Zhao Fanfan , Feng Xiaojie , Lyu Jun
Published: December 2020

Background: We aimed to identify the risk factors for meningioma using a competing-risks model.Method: Patients entered into the Surveillance, Epidemiology, and End Results (SEER) database between 1973 and 2015 were selected. Univariate analysis was performed using the cumulative incidence function (CIF) to show the probability of each event and Gray’s test to estimate the difference in the CIF between groups. Multivariate analysis using the Fine-Gray model and the cause-specific (CS) hazard model to explore factors affecting the cumulative incidence rate of meningioma patients.Result: Of the 1502 eligible patients, 419 died of meningioma and 398 died of competing events. The Fine-Gray model showed that age at diagnosis (35–64 vs 18–34 years: hazard ratio [HR]=2.490, p=0.031; >64 vs 18–34 years: HR=4.486, p<0.001), sex (male vs female: HR=1.388, p=0.002), tumor grade (II/III vs unknown: HR=1.630, p<0.001), and SEER stage (distant vs localized: HR=1.711, p<0.001) were risk factors for patients. The CS model showed that age at diagnosis (35–64 vs 18–34 years: HR=2.677, p=0.031; >64 vs 18–34 years: HR=5.982, p<0.001), marital status (divorced/separated/widowed vs married: HR=1.277, p=0.047), sex (male vs female: HR=1.486, p<0.001), tumor grade (II/III vs unknown: HR=1.775, p<0.001), and SEER stage (distant vs localized: HR=1.660, p<0.001) were risk factors for patients.Conclusion: This study is the first to establish a competing-risks analysis model for the risk assessment of meningioma patients. These results may help clinicians to better understand meningioma patients and provide them with appropriate support.
Identification of Differential Genes by Microarray and COL6A1 Induced the Bone Metastasis of Non-Small Cell Lung Cancer
Authors: Li Nan , Cao Xiaohui , Li Wei , Li Yunfang , Zhao Zongmao , Liu Ming
Published: December 2020

Background: Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death worldwide with bone metastasis as the most prevalent events in advanced cancer patients. However, its pathogenesis has not been clearly described. Methods: In the present study, differentially expressed genes (DEGs) were filtered through gene expression microarray between NSCLC tissue samples with or without bone metastasis. Subsequently, collagen family collagen 6A1 (COL6A1) was chosen as the target gene through Ingenuity Pathway Analysis and qRT-PCR validation of the 8 Top genes. And we evaluated the osteogenic capacity of HOB and hES-MP 002.5 cells through RT-qPCR, Western blot, Alizarin Red Staining and ALP staining.Results: A total of 364 DEGs including 140 up-regulated genes and 224 down-regulated genes were identified in NSCLC tissues with bone metastasis. GO analysis indicated that the upregulated and downregulated genes were mainly enriched in cellular process, metabolic process and biological regulation. KEGG pathway analysis revealed that the upregulated genes were mainly concentrated in cysteine and methionine metabolism, oxidative phosphorylation, and ribosome; the downregulated genes were mainly concentrated in the transcriptional misregulation in cancer, ribosome, and mitophagy-animal. Besides, the results of RT-qPCR, western blot and immunohistochemistry proved that COL6A1 was highly expressed in NSCLC tissue samples with bone metastasis. And we revealed that HOB and hES-MP 002.5 cells have osteogenic capacity through RT-qPCR, Western blot, Alizarin Red Staining and ALP staining . Moreover, the results of cell adhesion assay also proved that high expression of COL6A1 in HARA-B cells can induce its adhesion ability on osteoblasts, and low expression of COL6A1 in HARA-B cells can reduce its adhesion ability on osteoblasts. Conclusions: Therefore, our data revealed that the COL6A1 might represent a diagnostic marker or therapeutic target for bone metastasis in NSCLC.
Current status and influencing factors of self-management in patients with non-valvular atrial fibrillation under different anticoagulant therapy in Jiangsu province, China: A multi-center across‑sectional study
Authors: Liu ting , Ren mengxiao , Cui lingling , Lu bingqing , Hui jie , Ojo Omorogieva , Wang xiaohua
Published: December 2020

Background: There is little research focusing on the current status and influencing factors of self-management in patients with non-valvular atrial fibrillation (NVAF) under different anticoagulant therapy. This study aims to explore the current status of self-management of NVAF who took Warfarin, New Oral Anticoagulant (NOAC), Aspirin and No medication, and analyze the factors associated with their self-management ability in Jiangsu province, China. Methods: This was a multi-center, cross-sectional study that was conducted in six hospitals from December 2017 to October 2018. The general information and self-management of patients were collected by questionnaires and from the medical records. Multivariate linear regression analysis was used to identify factors associated with self-management.Results: A total of 555 participant completed the survey. The status of self-management was unsatisfactory in patients with NVAF, there were significant differences (P＜0.01) of self-management among patients in different anticoagulant groups and Warfarin group was relatively better (71.21±12.33). Multiple linear regression analysis demonstrated that the determinants of poor self-management in Warfarin group was the lower educational status (P＜0.01); in Aspirin group, comorbidities (P=0.015) and age＜65 years (P＜0.01) were the determinants of self-poor management; while in No medication group, age＜65 years (P=0.047), single (P＜0.01), poor sleep quality (P＜0.01) and permanent AF (P＜0.01) were the determinants of poor self-management. Conclusion: The current status of self-management among Chinese patientswith NVAF in Jiangsu province does not appear optimistic. Therefore, further studies should focus on how to improve the self-management among NVAF patients. In addition, policy makers should pay attention to identify patients at risk of poor self-management and take measures to improve their self-management.
Analysis of Two Bronze Mirrors With Tin-rich Surface
Authors: Yao Zhihui , Zhao Jiatian , Wang Xinguang
Published: December 2020

"black lacquer " and “silver lacquer”are very special categories of ancient chinese bronze mirrors, and the cause of the formation of lacquer surface has attracted much attention. In this paper, metallographic microscope, scanning electron microscope are used to analyze one "black lacquer " and one “silver lacquer”bronze mirror. The matrix of the two mirrors is copper-tin alloy with lead and the metallographic structure is as cast. The tin-rich layer with uneven thickness exists on the surface of the 2 mirrors. Based on the analysis of tin-rich layer, it is concluded that the“silver lacquer” is intentionally artificial, and its surface is treated with lead-tin amalgam, which is composed of mechanical combination and micro-metallurgy. The "black paint" was formed by natural corrosion in the underground environment.
Epidemiological Patterns of Ocular Morbidity Among Under-Five Children in Khartoum State- Sudan 2020
Authors: Ibrahim Mohanad Kamaleldin Mahmoud , Ibrahim Hadeel Kamaleldin Mahmoud , Mohamed Alaa Saifaldawla Ahmed
Published: December 2020

BackgroundDevelopment of the visual system begins prenatally and continues after birth. Visual impairment in early childhood can significantly impair development of visual, motor, and cognitive functions and lead to adverse psychosocial consequences. This research objective is to study the epidemiological patterns of ocular morbidity among children aged less than five years old aiming to reveal information for prevention and control.MethodsThe study is a retrospective patient’s records study carried out in three tertiary eye care hospitals in Khartoum State- Sudan. Records of all children attended in 2019 amounting 10886were reviewed. The data had been summarized and analyzed using Statistical Package for the Social Sciences (SPSS) version 21.0. The prevalence of under-five children was estimated in contrast to the overall population and as a proportion from the total children number. The patterns of ocular morbidity were identified according to type, age groups and gender. ResultsThe prevalence of under- five children with ocular morbidity was 5% and they represented 45% of the total children below 16 years. The predominant age group affected with ocular morbidity was (3-5 years old with 53%). Eye infections affected (19%), allergic eye diseases (16.8%), orbital diseases (12.4%), refractive errors (10.8%), squint (9.3%), corneal diseases (6.6%), cataract (6%), glaucoma (2.3%), neurogenic eye (2%) and tumors (0.23%).There were some variations in morbidities according to age groups and gender among the study participants.Conclusions﻿The proportion of under-five children is high. The predominant ocular morbidity affecting children of this age is eye infections, followed by allergic eye diseases and refractive errors while other serious blinding eye diseases mounted a considerable percentage. Although of small percentage but worth mentioning that malignant eye tumors were one of the patterns of ocular morbidities affecting under-five children. Patterns of ocular morbidity showed some gender variations.
Exploring Mid-Market Strategies for Big Data Governance
Authors: Knapton Ken
Published: December 2020

Many data scientists are struggling to adopt effective data governance practices as they transition from traditional data analysis to big data analytics. Data governance of big data requires new strategies to deal with the volume, variety, and velocity attributes of big data. The purpose of this qualitative multiple case study was to explore big data governance strategies employed by data scientists to provide a holistic perspective of those data for making decisions. The participants were 10 data scientists employed in multiple mid-market companies in the greater Salt Lake City, Utah area who have strategies to govern big data. This study’s data collection included semi-structured in-depth individual interviews (n = 10) and analysis of process documentation relating to big data governance in those organizations (n = 4). Through thematic analysis, 4 major themes emerged from the study: ensuring business centricity, striving for simplicity, establishing data source protocols, and designing for security. The strategies outlined in this study can lead to positive social change by proactively addressing the ethical use of personally identifiable information in big data. By implementing strategies relating to the segregation of duties, encryption of data, and personal information, data scientists can mitigate contemporary concerns relating to the use of private information in big data analytics.
Dysfunction of a Peripheral Lipid Sensor Gpr120 Causes Pgd2-microglia-provoked Neuroinflammation
Authors: Iwasa Kensuke , Yamamoto Shinji , Yamashina Kota , Sakemoto Chiaki , Yagishita-kyo Nan , Maruyama Kei , Awaji Takeo , Takei Yoshinori , Hirasawa Akira , Yoshikawa Keisuke
Published: December 2020

Background Neuroinflammation is a key pathological component of neurodegenerative disease and is characterized by microglial activation and the secretion of proinflammatory mediators. We previously reported that a surge in prostaglandin D2 (PGD2) production and PGD2-induced microglial activation could provoke neuroinflammation. We also reported that a lipid sensor GPR120 (free fatty acid receptor 4), which is expressed in enteroendocrine cells in the intestine, could be activated by polyunsaturated fatty acids (PUFA), thereby mediating secretion of glucagon-like peptide-1 (GLP-1). Dysfunction of GPR120 results in obesity in both mice and humans. To reveal the relationship between PGD2-microglia-provoked neuroinflammation and intestinal PUFA/GPR120 signaling, we investigated neuroinflammation and neuronal function in GPR120 knockout (KO) mice. Results In the current study, we discovered notable PGD2-microglia-provoked neuroinflammation (increased PGD2 production and microglial activation) and neurodegeneration (declines in neurogenesis, hippocampal volume, and cognitive function) in GPR120 KO mice. We also found that Hematopoietic-prostaglandin D synthase (H-PGDS) was expressed in microglia, microglia were activated by PGD2, H-PGDS expression was upregulated in GPR120 KO hippocampus, and inhibition of PGD2 production attenuated this neuroinflammatory pathway, suggesting that PGD2-microglia-provoked neuroinflammation was constantly occurring in the hippocampus of GPR120 KO mice. GPR120 mRNA was detected in the intestinal tissues, but not in the brain tissue of WT mice. GPR120 KO mice exhibited reduced intestinal, plasma, and intracerebral GLP-1 levels. Peripheral administration of a GLP-1 analogue, liraglutide, reduced PGD2-microglia-provoked neuroinflammation and further neurodegeneration in GPR120 KO mice. Conclusions Our results suggest that PGD2-microglia-provoked neuroinflammation and neurodegeneration observed in GPR120 KO mice are probably caused by defects in intestinal GPR120 function, and not in the CNS. Our results also suggest that GLP-1 secretion, stimulated by intestinal GPR120, may remotely contribute to suppression of PGD2-microglia-provoked neuroinflammation and further neurodegeneration in the hippocampus.
WITHDRAWN: Predictive potentials of 8 muscle strength actions, KOOS-pain, and Örebro-psychosocial difficulties on self-reported activities-of-daily-life function in patients with knee osteoarthritis: an exploratory regression-based cross-sectional study
Authors: Vårbakken Kjartan , Lorås Håvard , Nilsson Kjell , Engdal Monika , Stensdotter Ann-Katrin
Published: December 2020

BackgroundThe aim of the study was to explore the relative predictive potentials of a discriminative and comprehensive set of lower-limb muscle strength factors onto self-reported physical-activities-of-daily-life-function (SR-ADL-function) in patients with knee osteoarthritis (KOA), when adjusting for prior known strong prospective predictors in a statistical model which covers the functional domains of the International Classification of Function, Disability, and Health (ICF). MethodsThe design was exploratory, patient-only, cross-sectional, and multivariable regression-based, rotating 8 strength-variables onto a hierarchical model. The setting was an Osteoarthritis-school in a secondary-care hospital in Norway. The participants were 28 Caucasian patients with mild-to-moderate symptomatic and radiographic KOA (mean age 61; 64% women) referred by general physicians to an osteoarthritis-school. Excluded patients had trauma to the lower limbs, BMI >35, and age beyond 45 to 70. The dependent/outcome variable was SR-ADL-function (Knee Injury and Osteoarthritis Outcome Score [KOOS-ADL]). The known predictors were prior documented discriminative KOOS-Pain and psychosocial difficulties (Örebro Musculoskeletal Pain Questionnaire), together with 8 candidate predictor lower-limb muscle-strength actions (Biodex and Commander II dynamometer recorded).ResultsMutually adjusted for pain and psychosocial difficulties (R2 = 0.71), the predicting muscle-strength actions explained the following unique variances in SR-ADL-function: hip external rotation 7.6% (p<0.010), ankle eversion 4.0% (p=0.050), hip internal rotation 3.8% (p=0.060), ankle inversion 3.6% (p=0.066). The remaining 4 muscle-strength actions explained from 2.0% to 1.2% (p>0.099), where knee extensor strength explained the least unique variance. Flipped, the current three best potential prediction models explained the following substantial proportions of variance in SR-ADL-function: 1) KOOS-pain, 66%; 2) KOOS-pain and Örebro psychosocial difficulties, 71%; and 3) KOOS-pain, Örebro psychosocial difficulties, and hip external rotation strength, 78%.ConclusionsAdjusted for pain and psychosocial difficulties, hip rotations and ankle eversion-inversion strength indicate substantial cross-sectional potentials for predicting SR-ADL-function for patients with KOA aged 45 to 70 in primary/hospital health-care. Relevant for future prevention and prediction/treatment studies, however, we suggest clinical researchers to consider the current muscle-strength actions together with the even stronger biopsychosocial predictors KOOS-pain and Örebro psychosocial difficulties for future ICF domain-covering models of SR-ADL. Future confirmative studies are needed to refute or generalize these pioneering exploratory conclusions.
Individualization of PEEP and Tidal Volume in ARDS Patients with Electrical Impedance Tomography
Authors: Becher Tobias Hermann , Buchholz Valerie , Hassel Daniel , Meinel Timo Alexander , Schädler Dirk , Frerichs Inéz , Weiler Norbert
Published: December 2020

BackgroundIn mechanically ventilated patients with acute respiratory distress syndrome (ARDS), electrical impedance tomography (EIT) provides information on alveolar cycling and overdistension as well as assessment of recruitability at the bedside. We developed a protocol for individualization of positive end-expiratory pressure (PEEP) and tidal volume (VT) utilizing EIT-derived information on recruitability, overdistension and alveolar cycling. The aim of this study was to assess whether the EIT-based protocol allows individualization of ventilator settings without causing lung overdistension, and to evaluate its effects on respiratory system compliance, oxygenation and alveolar cycling. Methods20 patients with ARDS were included. Initially, patients were ventilated according to the recommendations of the ARDS-Network with a VT of 6 ml per kg predicted body weight and PEEP adjusted according to the fraction of inspired oxygen. Subsequently, ventilator settings were adjusted according to the EIT-based protocol once every 30 minutes for a duration of 4 hours. To assess global overdistension, we determined whether lung stress and strain remained below 27 and 2.0, respectively. ResultsWe found that prospective optimization of mechanical ventilation with EIT led to global lung stress below 27 mbar in all patients and global strain below 2.0 in 19 out of 20 patients. Compliance remained similar while oxygenation was significantly improved and alveolar cycling was reduced after EIT-based optimization.ConclusionsAdjustment of PEEP and VT using the EIT-based protocol led to individualization of ventilator settings with improved oxygenation and reduced alveolar cycling without promoting global overdistension. Trial registrationThis study was registered at clinicaltrials.gov (NCT02703012) on March 9, 2016 before including the first patient.
Effect of Aggressive Diuresis in Acute Heart Failure with Reduced and Preserved Ejection Fraction
Authors: Liu Chen , He Xin , Dong Bin , Xue Ruicong , Zhao Jingjing , Wu Zexuan , Wu Yuzhong , Zhou Yuanyuan , Wu Dexi , Dong Yugang , He Jiangui
Published: December 2020

Background: HFrEF and HFpEF had distinct hemodynamic characteristics in the setting of acute heart failure (AHF). The objective of our study is to evaluate the differential response to aggressive diuresis in Heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Methods: Patients in DOSE trial with left ventricular ejection fraction (LVEF) measurement were included (n=300), and classified into HFrEF (n=193) and HFpEF (n=107). Effect of high-dose versus low-dose furosemide strategy was compared separately in HFrEF and HFpEF. Results: High-dose strategy significantly increased change in creatinine and cystatin C at 72 hours in HFpEF (treatment difference: 0.16; 95% confidence interval [CI]: 0.02-0.30 mg/dl; P=0.03 for creatinine, and treatment difference: 0.26; 95% CI: 0.09-0.43 mg/dl; P=0.003 for cystatin C) but not in HFrEF (treatment difference: -0.05, 95% CI: -0.14-0.03 mg/dl; P=0.24 for creatinine, and treatment difference: -0.06, 95% CI: -0.15-0.02 mg/dl; P=0.15 for cystatin C) (P for interaction<0.01 for both). There were significantly more net fluid loss, weight loss, and congestion-free patients at 72 hours in high-dose group in HFrEF, but not in HFpEF. Compared with low-dose group, high-dose group had a significantly lower risk of composite clinical outcome of death, total hospitalizations and unscheduled visits due to heart failure (hazard ratio [HR]: 0.50, 95% CI: 0.27-0.93; P=0.03) in HFrEF, but a comparable risk (HR: 0.99, 95% CI: 0.48-0.23; P=0.98) in HFpEF.Conclusions: AHF on the basis of HFrEF and HFpEF responded differently to aggressive diuresis. Future trials should be designed separately for HFrEF and HFpEF.
Listening to Pedestrian; What are the Influential Factors on Bridge use?
Authors: Saadati Mohammad , Dorosti Abbasali , Dahim Mahin , Hemmati Elnaz , Edalatzadeh Monireheh , Hosseinpor Tina , Naglisar Tahereh , Moradi Hassan , Biparva Akbar Javan
Published: December 2020

The authors have requested that this preprint be removed from Research Square.
Determinants of Women’s Empowerment in Pakistan: Evidence from Demographic and Health Surveys, 2012–13 and 2017–18
Authors: Abbas Safdar , Isaac Noman , Zia Munir , Zakar Rubeena , Fischer Florian
Published: December 2020

Background: Women’s empowerment has always remained a contested issue in the complex socio-demographic and cultural milieu of Pakistani society. Women are ranked lower than men on all vital human development indicators. Therefore, studying various determinants of women’s empowerment is urgently needed in the Pakistani context.Methods: The present study empirically operationalized the concept of women’s empowerment and investigated its determinants through representative secondary data taken from the Pakistan Demographic and Health Surveys, 2012–13 and 2017–18. The study used simple binary logistic and multivariable regression analysis. Results: The results of the binary logistic regression highlighted that almost all of the selected demographic, economic, social, and access to information variables were significantly associated with women’s empowerment (p<0.05) in both PDHS datasets. In the multivariable regression analysis, the adjusted odds ratios highlighted that reproductive-age women in higher age groups, having children, with a higher level of education and wealth index, involved in skilled work, who were the head of household, and had access to information were reported to be more empowered. Conclusions: Women’s empowerment is determined by a number of social, economic, demographic, and other factors. The study proposes some evidence-based policy options to improve the status of women in Pakistan.
Two giant connected retroperitoneal schwannomas: A rare case report
Authors: Yang Tao , Cao Lanqing , Li Wei , Zhang Kai , Zhu Yuecheng , Liu Tongjun , Li Jiannan
Published: December 2020

Background：There are few reports of large retroperitoneal schwannomas and few guidelines for the diagnosis and surgical treatment.Case presentation：A 40-year-old female came to our department due to abdominal pain for 1 day and there are no other specific symptoms. There were no abnormalities in the patient's tumor markers. Plain computer tomography (CT) scan of the whole abdomen revealed two mass soft tissue density shadows behind the peritoneum, with uneven internal density, cystic low-density shadows and patchy calcification shadows. The larger mass was about 12.0 cm × 12.3 cm in size. Then tumors were completely excised by a reasonable surgical approach while the surrounding organs closely related to the tumor were preserved. Postoperative pathology confirmed that the tumor was benign schwannoma. In the 18-month follow-up, the patient had no recurrences and was asymptomatic.Conclusion：We summarize the diagnosis and treatment of a rare giant retroperitoneal schwannoma. Laparotomy for the management of retroperitoneal giant schwannomas may be a safe and effective method.
Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants Compared to Vitamin K Antagonists for the Treatment of Ventricular Thrombus: A Systematic Review and Meta-analysis of Observational Studies
Authors: Yang Qing , He Liyun , Liang Yan
Published: December 2020

Background To compare the effectiveness and safety of non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs) on the rate of thrombus resolution and clinical outcomes.Method MEDLINE, PUBMED, EMBASE, Cochrane Library, Web of Science, China National Knowledge Infrastructure Database and Wanfang Database, were searched up to August 16, 2020. Observational studies of patients with ventricular thrombus which compared the effect of two agents on the primary outcome were included. The primary outcome was rate of thrombus resolution, and the secondary outcomes were systemic embolism, bleeding and all-cause death. Odds ratio (OR) and 95% confidential intervals (CI) were utilized for the pooled results.Result Eight studies with 905 participants were finally included. Among these cases, 66.6% of patients received VKAs and 33.4% of patients received NOACs. Rivaroxaban (71.9%) was the most commonly used NOACs. There were no significant differences between NOACs and VKAs groups in thrombus resolution (OR 1.18, 95% CI 0.73-1.91), systemic embolism (OR 0.83, 95% CI 0.34-2.05), bleeding (OR 0.65, 95% CI 0.35-1.19) and all-cause death (OR 0.95, 95% CI 0.53-1.71). In studies with rivaroxaban predominantly or only rivaroxaban in the NOACs groups, NOACs group showed high thrombus resolution rate (OR 2.31, 95% CI 1.31-4.07) and lower systemic embolism rate (OR 0.32, 95% CI 0.11-0.96) than VKAs group, but no differences in bleeding.Conclusion Our findings showed that NOACs had a comparative complete resolution of thrombus compared with VKAs, as well as systemic embolism, bleeding events and all-cause death. In subgroups with rivaroxaban predominantly or only rivaroxaban in the NOACs group, NOACs showed better efficacy and safety profiles than VKAs, indicating that rivaroxaban might have favorable effectiveness over VKAs, though the sample size of NOACs in ventricular thrombus is small and the studies are most non-randomized. Further randomized controlled trials are urgently required to assess the effectiveness and safety of NOACs in patients with ventricular thrombus.
Implementation and sustainability factors of two early-stage breast cancer conversation aids in diverse practices
Authors: Schubbe Danielle , Yen Renata W. , Saunders Catherine H. , Elwyn Glyn , Forcino Rachel C. , O'Malley A. James , Politi Mary C. , Margenthaler Julie , Volk Robert J. , Sepucha Karen , Ozanne Elissa , Percac-Lima Sanja , Bradley Ann , Goodwin Courtney , Muijsenbergh Maria van den , Aarts Johanna WM , Scalia Peter , Durand Marie-Anne
Published: December 2020

Background Conversation aids can facilitate shared decision making and improve patient-centered outcomes. However, few examples exist of sustained use of conversation aids in routine care due to numerous barriers at clinical and organizational levels. We explored factors that will promote the sustained use of two early-stage breast cancer conversation aids. We examined differences in opinions between the two conversation aids and across socioeconomic strata. Methods We nested this study within a randomized controlled trial that demonstrated the effectiveness of two early-stage breast cancer surgery conversation aids, one text-based and one picture-based. These conversation aids improved shared decision making and the decision process, among other outcomes, across four health systems with socioeconomically diverse patient populations. We conducted semi-structured interviews with a purposive sample of patient participants across conversation aid assignment and socioeconomic status (SES), and collected observations and field-notes. We interviewed trial surgeons and other stakeholders. Two independent coders conducted framework analysis using the NOrmalization MeAsure Development through Normalization Process Theory. We also conducted an inductive analysis and additional sub-analyses based on conversation aid assignment and patient SES. Results We conducted 73 semi-structured interviews with 43 patients, 16 surgeons, and 14 stakeholders like nurses, cancer center directors, and electronic health record (EHR) experts. Patients and surgeons felt the conversation aids should be used in breast cancer care in the future and were open to various methods of giving and receiving the conversation aid (EHR, email, patient portal, before consultation). Patients of higher SES were more likely to note the conversation aids influenced their treatment discussion, while patients of lower SES noted more influence on their decision making. Intervention surgeons reported using the conversation aids did not lengthen their typical consultation time. Most intervention surgeons felt using the conversation aids was similar to their usual care after using it a few times, and most patients felt it appeared part of their normal routine. Conclusions Key factors that will guide the future sustained implementation of the conversation aids include adapting to existing clinical workflows, flexibility of use, patient characteristics and communication preferences.Trial registration ClinicalTrials.gov Identifier: NCT03136367, registered on May 2, 2017, https://clinicaltrials.gov/ct2/show/NCT03136367