bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between Handgrip Strength, Mobility, Leg Strength, Flexibility, and Postural Balance in Older Adults under Long-Term Care Facilities
Authors: Wiśniowska-Szurlej Agnieszka , Ćwirlej-Sozańska Agnieszka , Wołoszyn Natalia , Sozański Bernard , Wilmowska-Pietruszyńska Anna
Published: September 2019

Introduction. Low muscle strength is common and important in geriatric syndromes including frailty and sarcopenia. The epidemiology of grip strength of older people under long-term care facilities has been little explored.Purpose. The aim of this study was to assess handgrip strength of older women and men covered by institutional care and to analyse the associations between HGS and mobility, leg strength, flexibility, and postural balance.Materials and Methods. This is a cross-sectional study carried out at care homes in southeastern Poland. After considering the inclusion criteria, 209 older people aged 65 to 85 were included in the study. Sociodemographic data were collected, and tests of muscular strength, mobility, flexibility, and postural balance were carried out by the use of the stabilometric platform CQ Stab 2P.Results. The average handgrip strength in the study group amounted to 19.8 kg, including 14.8 kg in women and 25.9 kg in men. Low grip strength was found in 67.83% women and 52.13% men in institutional care. A negative correlation between handgrip strength (HGS) and the Timed Up and Go (TUG) test was demonstrated, both with and without cognitive task and strength of lower limbs. Gait speed and dynamic balance were positively correlated with HGS. A negative correlation was found between the total length of the centre of pressure (COP) path, the length of the COP path in the lateral-medial direction, and the sway area delimited by the COP and HGS for the dominant hand. Speaking of women, gait speed was most strongly associated with HGS, while among men, it was upper limb flexibility.Conclusion. Regardless of gender, HGS is associated with mobility, strength of the lower limbs, and dynamic balance. By means of simple tools, early diagnosis will facilitate the planning of appropriate interventions in order to prevent disability and mortality in long-term care facilities.
Gold Standard Evaluation of an Automatic HAIs Surveillance System
Authors: Villamarín-Bello Beatriz , Uriel-Latorre Berta , Fdez-Riverola Florentino , Sande-Meijide María , Glez-Peña Daniel
Published: September 2019

Hospital-acquired Infections (HAIs) surveillance, defined as the systematic collection of data related to a certain health event, is considered an essential dimension for a prevention HAI program to be effective. In recent years, new automated HAI surveillance methods have emerged with the wide adoption of electronic health records (EHR). Here we present the validation results against the gold standard of HAIs diagnosis of the InNoCBR system deployed in the Ourense University Hospital Complex (Spain). Acting as a totally autonomous system, InNoCBR achieves a HAI sensitivity of 70.83% and a specificity of 97.76%, with a positive predictive value of 77.24%. The kappa index for infection type classification is 0.67. Sensitivity varies depending on infection type, where bloodstream infection attains the best value (93.33%), whereas the respiratory infection could be improved the most (53.33%). Working as a semi-automatic system, InNoCBR reaches a high level of sensitivity (81.73%), specificity (99.47%), and a meritorious positive predictive value (94.33%).
SHPB Test and Microstructure Analysis on Ready‐Mixed Concrete in Uniaxial Load and Passive Confining Pressure States
Authors: Zhang Jing-shuang , Duan Xue-lei , Yang Zi-yan
Published: September 2019

Ready‐mixed concrete has been used as a support in mine roadways, where the impact load of blasting excavation can cause damage to the concrete support of the roadway. However, limited studies are available on the effect of water content, storage period, and impact pressure on dynamic mechanical properties of ready‐mixed concrete in uniaxial load and passive confining pressure states. To investigate the effect of water contents (0%, 1.0%, 1.5%, and 2.0% by mass of dry sand), storage periods (0 d, 3 d, 7 d, 15 d, 20 d, and 30 d), and impact pressures (0.6 MPa and 0.9 MPa) on dynamic mechanical properties of ready‐mixed concrete in uniaxial load and passive confining pressure states, the dynamic compression test using split Hopkinson pressure bar (SHPB) has been carried out. In addition, the microscopic test based on the scanning electron microscope (SEM) is conducted to analyze the effect of water content and storage period on the microstructure of ready‐mixed concrete. The experimental results show that under the conditions of uniaxial load and passive confining pressure, the dynamic compressive strength of ready‐mixed concrete decreases with the increase of water content and storage period but increases with the increase of impact pressure. At the same impact pressure, the dynamic compressive strength in passive confining pressure state is larger than that in uniaxial load state. The dynamic stress‐strain curves of ready‐mixed concrete in uniaxial load and passive confining pressure states can be divided into three stages: elastic stage, plastic stage, and failure stage. The peak strain increases with increasing impact pressure, and the peak strain in passive confining pressure state is more than that in uniaxial load state. The degree of damage for ready‐mixed concrete specimens increases with the increase of the storage period and water content; however, the damage of specimens in passive confining pressure state is less than that of specimens in uniaxial load state. Meanwhile, an analysis to the microstructural mechanism of water content and storage period inside of ready‐mixed concrete has been performed.
Lovastatin Enhances Cytotoxicity of Temozolomide via Impairing Autophagic Flux in Glioblastoma Cells
Authors: Zhu Zhiyuan , Zhang Pingde , Li Ning , Kiang Karrie Mei Yee , Cheng Stephen Yin , Wong Vincent Kam-Wai , Leung Gilberto Ka-Kit
Published: September 2019

Drug resistance to temozolomide (TMZ) contributes to the majority of tumor recurrence and treatment failure in patients with glioblastoma multiforme (GBM). Autophagy has been reported to play a role in chemoresistance in various types of cancer, including GBM. The anticancer effect of statins is arousing great research interests and has been demonstrated to modulate autophagic function. In this study, we investigated the combinational effects of lovastatin and TMZ on treating U87 and U251 GBM cell lines. Cytotoxicity was measured by MTT and colony formation assays; apoptosis was measured by flow cytometry; the cellular autophagic function was detected by the EGFP-mRFP-LC3 reporter and western blot assay. The results showed that lovastatin might enhance the cytotoxicity of TMZ, increase the TMZ-induced cellular apoptosis, and impair the autophagic flux in GBM cells. Lovastatin triggered autophagy initiation possibly by inhibiting the Akt/mTOR signaling pathway. Moreover, lovastatin might impair the autophagosome-lysosome fusion machinery by suppressing LAMP2 and dynein. These results suggested that lovastatin could enhance the chemotherapy efficacy of TMZ in treating GBM cells. The mechanism may be associated with impaired autophagic flux and thereby the enhancement of cellular apoptosis. Combining TMZ with lovastatin could be a promising strategy for GBM treatment.
Study on Disease Mechanism and Theoretical Quantification Method of Tunnel Structure
Authors: Liu Yu , Tang Chun-an , Wang Peng-yu , Guan Yong-ping , Wang Shu-hong
Published: September 2019

Most tunnel structures tend to have different degrees of structural damage such as leakage, concrete cracking, lining salinization, and falling blocks after the operation for a period. Compared with the diversity of tunnel disease detection methods, there are few studies on the methods of quantifying and evaluating the main structural diseases of the lining. Based on the regular inspection data of expressway tunnels in Liaoning Province, this paper summarizes the distribution characteristics and laws of existing structural defects of tunnel lining. In addition, based on the in‐depth study of the main structural diseases of the tunnel, the extenics theory is used to extract, quantify and classify several indicators that can accurately reflect the health status of the structure, and then establish the corresponding matter‐element model to determine the weight of each indicator and the tunnel structure. The comprehensive correlation degree of disease grades is combined with the qualitative evaluation and quantitative research of lining structure diseases to construct a health evaluation system for tunnel lining structures, which is convenient for managers to make reasonable decisions. At the same time, combined with the actual test data of tunnel engineering, the calculation and analysis of the extension model are carried out to verify the engineering applicability of the model.
Gynura procumbens Standardised Extract Reduces Cholesterol Levels and Modulates Oxidative Status in Postmenopausal Rats Fed with Cholesterol Diet Enriched with Repeatedly Heated Palm Oil
Authors: Ahmad Nazri Khuzaidatul Azidah , Fauzi Norsyahida Mohd , Buang Fhataheya , Mohd Saad Qodriyah Haji , Husain Khairana , Jantan Ibrahim , Jubri Zakiah
Published: September 2019

Gynura procumbens (Lour.) Merr. (GP) has been reported in previous studies to possess antihyperlipidaemic, antioxidative, and cardioprotective properties. This study was aimed to determine the effect of standardised 80% ethanol extract of GP on lipid profiles and oxidative status of hypercholesterolemic rats. Postmenopausal (PM) Sprague-Dawley rats were ovariectomised and fed with 2% cholesterol diet fortified with five times heated palm oil to develop hyperlipidaemia status. Two doses of the extract (250 and 500 mg/kg) and atorvastatin (10 mg/kg) were administered once daily via oral gavage for 24 weeks. Systolic blood pressure (SBP) was increased during the first month in the postmenopausal group and decreased with GP supplementation. Lipid droplets accumulation was shown at the tunica media (TM) area of the aorta in the postmenopausal group and reduced with GP supplementation. Total cholesterol (TC), total triglycerides (TG), low-density lipoprotein (LDL), and malondialdehyde (MDA) levels increased (p<0.05) at 3 and 6 months in the postmenopausal group and were reduced with GP supplementation. GP also increased high-density lipoprotein (HDL) level in the postmenopausal group. Superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx) activities were reduced in the postmenopausal group compared to control in the sham group but increased (p<0.05) with GP supplementation. The results showed that the higher dose of GP (500 mg/kg) gave better effect. GP has the ability to reduce oxidative stress and prevent membrane cell damage through antioxidant enzyme activity modification and lipid profile changes in postmenopausal rats related to atherosclerosis.
Accuracy of Intraocular Lens Power Calculation Using Anterior Chamber Depth from Two Devices with Barrett Universal II Formula
Authors: Muniz Castro Hannah , Tai Audrey X. , Sampson Samuel J. , Wade Matthew , Farid Marjan , Garg Sumit
Published: September 2019

Purpose. To compare the preoperative measurements of the anterior chamber depth (ACD) by the IOLMaster and Catalys; additionally, to compare the accuracy of the IOL power calculated by the Barrett Universal II formula using the two different measurements. Setting. University of California, Irvine, Gavin Herbert Eye Institute in Irvine, California. Design. Retrospective comparative study. Methods. This study included 144 eyes of 90 patients with a mean age of 72.0 years (range 40.8 to 92.1 years) that underwent femtosecond laser-assisted cataract surgery using Catalys. Preoperative measurements of ACD were taken by the IOLMaster and Catalys. Manifest refraction and refractive spherical equivalent were measured 1 month postoperatively. Expected refractive results were compared with actual postoperative refractive results. Results. The correlation between the ACD values from the two devices was good (r = 0.80). The Catalys ACD measurements yielded a larger ACD compared to the IOLMaster, with a mean difference of 0.22 mm (P<0.0001). The correlation between the postoperative and predicted RSE of the implanted IOL power was excellent (r = 0.96). There was no statistically significant difference between the mean absolute error derived from the IOLMaster, 0.37 diopter (D) ± 0.34 (SD), and the Catalys, 0.37 ± 0.35 D (P=0.50). Conclusions. The Catalys biometry yielded a significantly larger ACD value than the IOLMaster. This difference in ACD value, however, did not reflect in a statistically significant difference in IOL power calculation and refractive prediction error using the Barrett Universal II Formula.
Determinants of Under-Five Pneumonia at Gondar University Hospital, Northwest Ethiopia: An Unmatched Case-Control Study
Authors: Markos Yordanos , Dadi Abel Fekadu , Demisse Abayneh Girma , Ayanaw Habitu Yohannes , Derseh Behailu Tariku , Debalkie Getu
Published: September 2019

Background. Pneumonia causes about two million under-five deaths each year, accounting for nearly one in five child deaths globally. Knowing the determinants of under-five pneumonia is useful for prevention and intervention programs that are aimed to control the disease. Thus, the main aim of this study was to assess the determinants of under-five pneumonia at Gondar University Hospital, Ethiopia. Methods. An institution-based unmatched case-control study was carried out from April 1 to April 30, 2015, taking a sample size of 435 study participants (145 cases and 290 controls). The researchers used a systematic random sampling technique for selecting cases and controls. Data were entered and cleaned using Epi Info version 7 and exported to SPSS version 20 for analysis. Bivariable analysis was performed, and variables with a p value less than 0.2 were entered into multivariable logistic regression. Determinant factors were identified based on p value less than 0.05 and adjusted odds ratio with 95% confidence interval (AOR with 95% CI). Results. An increased odds of pneumonia was associated with children who had diarrhea in the past fifteen days of data collection (AOR = 6.183; 95% CI: 3.482, 10.977), children’s mothers who did not hear about how to handle domestic smoking (AOR = 5.814; 95% CI: 2.757, 12.261), and children of mothers who did not follow proper handwashing practice (AOR = 3.469; 95% CI: 1.753, 6.863). Conclusions. Being infected with diarrhea, not knowing how to handle domestic smoking, and poor compliance with proper handwashing practice were identified as determinants of pneumonia. Dedicated, coordinated, and integrated intervention needs to be taken to enhance proper handwashing practice by mothers/caregivers, improve the indoor air quality, and prevent diarrheal diseases at the community level.
Predicting the 1p/19q Codeletion Status of Presumed Low-Grade Glioma with an Externally Validated Machine Learning Algorithm
Authors: van der Voort Sebastian R. , Incekara Fatih , Wijnenga Maarten M.J. , Kapas Georgios , Gardeniers Mayke , Schouten Joost W. , Starmans Martijn P.A. , Nandoe Tewarie Rishie , Lycklama Geert J. , French Pim J. , Dubbink Hendrikus J. , van den Bent Martin J. , Vincent Arnaud J.P.E. , Niessen Wiro J. , Klein Stefan , Smits Marion
Published: September 2019

Purpose:

Patients with 1p/19q codeleted low-grade glioma (LGG) have longer overall survival and better treatment response than patients with 1p/19q intact tumors. Therefore, it is relevant to know the 1p/19q status. To investigate whether the 1p/19q status can be assessed prior to tumor resection, we developed a machine learning algorithm to predict the 1p/19q status of presumed LGG based on preoperative MRI.

Experimental Design:

Preoperative brain MR images from 284 patients who had undergone biopsy or resection of presumed LGG were used to train a support vector machine algorithm. The algorithm was trained on the basis of features extracted from post-contrast T1-weighted and T2-weighted MR images and on patients' age and sex. The performance of the algorithm compared with tissue diagnosis was assessed on an external validation dataset of MR images from 129 patients with LGG from The Cancer Imaging Archive (TCIA). Four clinical experts also predicted the 1p/19q status of the TCIA MR images.

Results:

The algorithm achieved an AUC of 0.72 in the external validation dataset. The algorithm had a higher predictive performance than the average of the neurosurgeons (AUC 0.52) but lower than that of the neuroradiologists (AUC of 0.81). There was a wide variability between clinical experts (AUC 0.45–0.83).

Conclusions:

Our results suggest that our algorithm can noninvasively predict the 1p/19q status of presumed LGG with a performance that on average outperformed the oncological neurosurgeons. Evaluation on an independent dataset indicates that our algorithm is robust and generalizable.
Role of KEAP1/NFE2L2 Mutations in the Chemotherapeutic Response of Patients with Non–Small Cell Lung Cancer
Authors: Jeong Youngtae , Hellyer Jessica A. , Stehr Henning , Hoang Ngoc T. , Niu Xiaomin , Das Millie , Padda Sukhmani K. , Ramchandran Kavitha , Neal Joel W. , Wakelee Heather , Diehn Maximilian
Published: September 2019

Purpose:

Activation of NFE2L2 has been linked to chemoresistance in cell line models. Recently, somatic mutations that activate NFE2L2, including mutations in NFE2L2, KEAP1, or CUL3, have been found to be associated with poor outcomes in patients with non–small cell lung cancer (NSCLC). However, the impact of these mutations on chemoresistance remains incompletely explored.

Experimental Design:

We investigated the effect of Keap1 deletion on chemoresistance in cell lines from Trp53-based mouse models of lung squamous cell carcinoma (LSCC) and lung adenocarcinoma (LUAD). Separately, we identified 51 patients with stage IV NSCLC with KEAP1, NFE2L2, or CUL3 mutations and a matched cohort of 52 wild-type patients. Time to treatment failure after first-line platinum doublet chemotherapy and overall survival was compared between the two groups.

Results:

Deletion of Keap1 in Trp53-null murine LUAD and LSCC resulted in increased clonogenic survival upon treatment with diverse cytotoxic chemotherapies. In patients with NSCLC, median time to treatment failure (TTF) after first-line chemotherapy for the KEAP1/NFE2L2/CUL3-mutant cohort was 2.8 months compared with 8.3 months in the control group (P < 0.0001). Median overall survival (OS) was 11.2 months in the KEAP1/NFE2L2/CUL3-mutant group and 36.8 months in the control group (P = 0.006).

Conclusions:

Keap1 deletion confers chemoresistance in murine lung cancer cells. Patients with metastatic NSCLC with mutations in KEAP1, NFE2L2, or CUL3 have shorter TTF and OS after first-line platinum doublet chemotherapy compared with matched controls. Novel approaches for improving outcomes in this subset of patients with NSCLC are therefore needed.
Hepatic Adenomatosis: A Challenging Liver Disease
Authors: Gonçalves Diana Leite , Leite José Pedro , Silva Rafael , Pissarra António Pedro , Caetano Oliveira Rui , Silva Dilva
Published: September 2019

Hepatic adenomatosis is defined as the presence of 10 or more adenomas in an otherwise normal liver. Half of the cases are clinically silent and detected incidentally in imaging exams. A 42-year-old woman with previous history of arterial hypertension and mixed dyslipidemia had multiple liver nodules incidentally identified in an abdominal computed tomography scan. She was asymptomatic and her physical examination was unremarkable but laboratory analysis revealed increased alkaline phosphatase and mildly persistent elevated systemic inflammatory markers. A subsequent hepatic magnetic resonance imaging (MRI) suggested the diagnosis of hepatic adenomatosis and the liver biopsy confirmed the presence of inflammatory adenomas. The patient stopped oral contraception and, at 6 months of follow-up, laboratory inflammatory markers had normalized. She is now under biannual follow-up with MRI and alpha-fetoprotein dosing. This case provides an example of the complex management of this disease in terms of diagnosis, treatment, and follow-up.
Topical Corticosteroids Decrease IL-25 Expression by Immunohistochemistry
Authors: Moustafa Hany Samir , Qotb Mohamed , Hussein Mohammed Ahmed , Eid Ahmed , Ayad Essam Ezzat , Fawzy Tamer
Published: September 2019

Background: Interleukin-25 (IL-25) is an important contributing factor in the pathogenesis of allergic rhinitis. It leads to increasing peripheral and infiltrating eosinophilia as well as serum IgE, IgG, and Th2 cytokines (IL-4, IL-5, IL-13), which are responsible for the allergic symptoms. Intranasal steroids (INS) are effective in treating allergic rhinitis, but their effect on IL-25 release has not been studied. We aimed to study the link between IL-25 and the pathophysiology of allergic rhinitis as well as the effect of INS on its release. Methodology: This was a cohort, prospective, nonrandomized study that included 60 patients, 35 allergic rhinitis patients and 25 controls. We studied the effect of INS on IL-25 release. Results: Of allergic rhinitis patients 68.6% had strong cytoplasmic stain of IL-25 in the epithelial layer, while 25.7% had intermediate stain. INS caused significantly reduced IL-25 stain as only 14.3% of patients had intermediate stain and 85.7% had weak stain. Moreover, a correlation was found between nasal smear eosinophilia and the degree of IL-25 staining in the epithelial layer. Conclusion: Intranasal corticosteroids appear to be effective in the downregulation of IL-25, which may explain some of the utility of intranasal corticosteroid treatment in improving allergic rhinitis symptoms.
Systematic Review of Normal Subjects Harbouring BCR-ABL1 Fusion Gene
Authors: Kuan Jew Win , Su Anselm Ting , Leong Chooi Fun , Osato Motomi , Sashida Goro
Published: September 2019

The treatment of chronic myeloid leukaemia (CML) requires quantitative polymerase chain reaction (qPCR) to monitor BCR-ABL1 in International Scale (IS). Some normal subjects were found to harbour BCR-ABL1. We performed a systematic review on normal subjects harbouring BCR-ABL1. A literature search was done on July 16, 2017 using EBSCOhost Research Databases interface and Western Pacific Region Index Medicus. Two authors selected the studies, extracted the data, and evaluated the quality of studies using the modified Appraisal Tool for Cross-Sectional Studies independently. The outcomes were prevalence, level of BCR-ABL1IS, proportion, and time of progression to CML. The initial search returned 4,770 studies. Eleven studies, all having used convenient sampling, were included, with total of 1,360 subjects. Ten studies used qualitative PCR and one used qPCR (not IS). The mean prevalence of M-BCR was 5.9, 15.5, and 15.9% in cord blood/newborns/infants (CB/NB/I) (n = 170), children (n = 90), and adults (n = 454), respectively, while m-BCR was 15, 26.9, and 23.1% in CB/NB/I (n = 786), children (n = 67), and adults (n = 208), respectively. No study reported the proportion and time of progression to CML. Nine studies were graded as moderate quality, one study as poor quality, and one study as unacceptable. The result of the studies could neither be inferred to the general normal population nor compared. Follow-up data were scarce.
Massive Silicone-Induced Orbital Granuloma
Authors: Shue Ann , Joseph Jeffrey M. , Tao Jeremiah P. , Barker-Griffith Ann E. , Abraham Jerrold L. , Minckler Donald S.
Published: September 2019

We report a large subconjunctival-orbital granuloma in a 51-year-old male presenting with a blind painful right eye and marked chemosis 15 months after undergoing vitrectomy and silicone oil retinal tamponade for retinal detachment with no reported intraoperative complications. Gross and histopathologic examination of the enucleated eye and episcleral tumor revealed a bosselated mass measuring 17 × 10 × 5 mm containing prominent vacuoles with surrounding epithelioid histiocytes and foreign body multinucleated giant cells. Such a large silicone-induced orbital granuloma following uncomplicated retinal surgery in a grossly intact eye has not been previously reported to the authors’ knowledge. High intraocular pressure and emulsification of oil may facilitate silicone extravasation through scleral wounds after retinal surgery.
Accuracy and Psychometric Properties of the Brazilian Version of the Montreal Cognitive Assessment as a Brief Screening Tool for Mild Cognitive Impairment and Alzheimer’s Disease in the Initial Stages in the Elderly
Authors: Pinto Tiago Coimbra Costa , Machado Leonardo , Costa Maria Lúcia G. , Santos Marilia S.P. , Bulgacov Tatiana M. , Rolim Ana Paula P. , Silva Gabriela A. , Rodrigues-Júnior Antônio L. , Sougey Everton B. , Ximenes Rosana C.C.
Published: September 2019

Objective: To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer’s disease (AD) with the accuracy of Mini-Mental State Examination (MMSE). Method: A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups. Results: There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly. Conclusions: The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD.
The Contribution Plot: Decomposition and Graphical Display of the RV Coefficient, with Application to Genetic and Brain Imaging Biomarkers of Alzheimer’s Disease
Authors: Choi JinCheol , Lu Donghuan , Beg Mirza Faisal , Graham Jinko , McNeney Brad ,   for the Alzheimer’s Disease Neuroimaging Initiative (ADNI)
Published: September 2019

Background/Aims: Alzheimer’s disease (AD) is a chronic neurodegenerative disease that causes memory loss and a decline in cognitive abilities. AD is the sixth leading cause of death in the USA, affecting an estimated 5 million Americans. To assess the association between multiple genetic variants and multiple measurements of structural changes in the brain, a recent study of AD used a multivariate measure of linear dependence, the RV coefficient. The authors decomposed the RV coefficient into contributions from individual variants and displayed these contributions graphically. Methods: We investigate the properties of such a “contribution plot” in terms of an underlying linear model, and discuss shrinkage estimation of the components of the plot when the correlation signal may be sparse. Results: The contribution plot is applied to simulated data and to genomic and brain imaging data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI). Conclusions: The contribution plot with shrinkage estimation can reveal truly associated explanatory variables.
Late-Evening Carbohydrate and Branched-Chain Amino Acid Snacks Improve the Nutritional Status of Patients Undergoing Hepatectomy Based on Bioelectrical Impedance Analysis of Body Composition
Authors: Kobayashi Kosuke , Kaneko Junichi , Yamaguchi Takamune , Kawaguchi Yoshikuni , Arita Junichi , Akamatsu Nobuhisa , Ishizawa Takeaki , Sekine Rie , Ijichi Hideaki , Kubota Naoto , Fukatsu Kazuhiko , Kokudo Norihiro , Hasegawa Kiyoshi
Published: September 2019

Background: This prospective study measured body composition based on bioelectrical impedance analysis (BIA) in relation to preoperative and postoperative nutritional support and status in patients undergoing liver surgery. Methods: Thirty-sevenpatients with impaired liver function (indocyanine green retention rate at 15 min >15%) undergoing hepatectomy for hepatocellular carcinoma or colorectal liver metastasis were enrolled. The control group (n = 10) received no nutritional supplementation. The late-evening snack (LES, n = 26) group received a 210-kcal snack comprising a carbohydrate with branched-chain amino acids for 2 weeks before surgery through to 12 weeks after surgery. BIA of body composition, including body cell mass and skeletal muscle volume, was performed. Results: Although there was no sarcopenia based on the consensus report of the Asian Working Group 2 weeks before surgery, the skeletal muscle volumes in the control and LES groups were at the lower limit of the normal range. Body cell mass and skeletal muscle volume were significantly lower in the control group than in the LES group at 4 (p = 0.03) and 12 (p = 0.02) weeks after surgery. Conclusion: Late-evening carbohydrate and branched-chain amino acid snack supplementation may improve nutritional status in patients with impaired liver function undergoing hepatectomy.
Wide Sexual Dimorphism of Hepatocellular Carcinoma Presentation in Algeria
Authors: Chikhi Yazid , Cheraitia Salima , Ould Gougam Rachid , Lounes Fadila , Zemmouchi Chahrazed , Belal Nassila , Bendaoud Maroua , Ait Younes Sonia , Bensalem Aicha , Berkane Saadi , Asselah Hocine , Pineau Pascal , Lahcene Mustapha
Published: September 2019

Hepatocellular carcinoma (HCC) represents a worrying public health problem in North Africa and particularly in Egypt. The situation is unclear in western North Africa where HCC has been rarely submitted to careful scrutiny. We decided to analyze demographic, biochemical, virological, and clinical data of a series of HCC from Algerian patients to establish the landscape of this tumor in the country. In the present work, we described 337 cases of primary liver cancer from Bologhine Hospital in Algiers, the capital of Algeria. The mean age of patients was 63.8 ± 11.4 years with a male:female sex ratio of 1.5. The most prevalent risk factors were hepatitis C, hepatitis B, and metabolic pathologies (type 2 diabetes and obesity). The mean BMI was 25.6 ± 4.7 at tumor diagnosis. A strong duality of risk factors and tumor presentation between male and female patients was apparent. Women tended to be older (mean 65.4 vs. 62.7 years, p = 0.039) and either seropositive for anti-HCV (60.0 vs. 41.6%, p = 0.0018) resulting primarily from tattoos and/or scarification (47.2 vs. 25.7%, p = 1.0 × 10–4) or more often affected by metabolic disorders (mean BMI 26.1 ± 0.7 vs. 25.1 ± 0.5, p = 0.0248) commonly associated with personal antecedents of cholecystectomy (21.2 vs. 5.8%, p = 4.4 × 10–5). By contrast, men were younger, poorer survivors (mean 9.3 vs. 13.3 months, p = 0.005), more frequently HBsAg carriers (27.8 vs. 10.5%, p = 4.8 × 10–5), and more exposed to lifestyle risk factors such as smoking (39.4 vs. 3.0%, p = 3.9 × 10–16) or alcohol use (19.1 vs. 0.7%, 1.5 × 10–8). Finally, geographic disparities throughout Algeria were reminiscent of the situation of chronic hepatitis C in the country. A significant excess of cases originated from the region of Batna, Eastern Algeria, already known for its high rate of hepatitis C. Our results suggest that due to culture or sex-dependent biological differences, the tumor process affecting the liver is drastically different between sexes in Algeria.
Proinsulin-Secreting Neuroendocrine Tumors of the Pancreas: A Single-Centre Experience
Authors: Kriger Andrey Germanovich , Berelavichus Stanislav Valer’evich , Kaldarov Ayrat Radikovich , Panteleev Vladimir Igorevich , Gorin David Semjonovich , Dugarova Rimma Sangaevna , Yukina Marina Yur’evna
Published: September 2019

Background: Proinsulinoma is a neuroendocrine tumor (NET) of the pancreas that produces prohormone proinsulin. These tumors are very rare. In the literature, they are most often presented in the form of case reports. Materials and Methods: We studied 177 patients with NET of the pancreas who underwent surgical treatment in the A.V. Vishnevsky National Medical Research Centre of Surgery from January 2007 to December 2018. Results: Of 81 patients with organic hyperinsulinism caused by functioning NETs of the pancreas during the study period, 3 (3.7%) had a proinsulinoma; 2 were female; and 1 was male. None of them admitted to weight gain during this period, and their BMI was normal. All patients presented with Whipple’s triad during the 72-h fast. Tumor-enucleating surgery was performed: one robot assisted, two laparotomies. A normal glucose level after treatment was achieved in all cases. Conclusion: In cases where clinical hypoglycemia is present, but the serum insulin level is within the normal range or even decreased, proinsulinoma should be suspected. For now, surgical resection remains the only effective method of treatment. Further investigation of pro­insulinomas is needed.
The Role of Long-Lived Plasma Cells in Antibody-Mediated Rejection of Kidney Transplantation: An Update
Authors: Su Hua , Zhang Chun-Yun , Lin Ji-hong , Hammes Hans-Peter , Zhang Chun
Published: September 2019

Background: Antibody-mediated rejection (ABMR) following kidney transplant is closely associated with poor prognosis of the recipients. Long-lived plasma cells (LLPCs) produce alloantibodies as long as life time and play a crucial role in ABMR. Summary: LLPCs generate from germinal centers and reside in survival niches in the bone marrow as well as the inflamed tissues. They are the main and long-term source of the antibodies. LLPCs mediate ABMR via the generation of preformed antibodies in sensitized patients and de novo antibodies after transplantation. They have been acknowledged as the leading causes of ABMR; however, LLPCs are insensitive to traditional immunosuppressive therapy that removes B cells. Strategies targeting LLPCs, such as antithymocyte globulin, proteasome inhibitors as well as monoclonal antibodies, are promising methods to persistently and thoroughly clear the entire PC pool. Key Message: LLPCs play an important role in ABMR by producing alloantibodies continually, and targeting LLPCs might be a novel and effective approach against ABMR.
The Prognostic Value of Early Repolarization Pattern for the Ventricular Tachyarrhythmias of Acute Myocardial Infarction Patients: A Meta-Analysis
Authors: Xu Shangbo , Yang Lihua , Hong Danhua , Chen Lan , Wang Xin
Published: September 2019

Several studies have indicated that early repolarization (ER) is a risk factor for ventricular tachyarrhythmias (VTAs) in acute myocardial infarction (AMI) patients. The prognostic values of ER detail characteristics except J-point morphology, and inferior leads ER location for VTAs are still unclear. We searched PubMed, Embase, and the Cochrane Library for eligible studies up to March 4, 2019. Studies to investigate the relationship between ER and the incidence of VTAs in AMI patients were extracted. A total of 10 studies with 2,672 participants were included in the analysis. ER significantly predicted the incidence of VTAs (odds ratio [OR] 3.62, 95% confidence intervals [CI] 2.77–4.73), regardless of the type of AMI. The presence of ER before AMI (OR 5.58, 95% CI 3.41 to 9.12) and after AMI (OR 3.02, 95% CI 2.19–4.15) increased the risk of VTAs. The prognostic value of ER for VTAs in the long follow-up (≥30 days) (OR 2.39, 95% CI 1.59–3.59) fell by half compared to the short follow-up duration (<30 days) (OR 4.97, 95% CI 3.48–7.09). Patients with ER displayed a higher risk of developing ventricular fibrillation (VF) (OR 6.94, 95% CI 3.87–12.43) than those without ER. However, neither J-point elevation with OR = 2.48 nor lateral leads’ ER location with OR = 3.83 remarkably increased the risk of VTAs in patients with AMI. ER is significantly associated with increasing risk of VTAs, particularly VF, in AMI patients. This relationship is weaker in the 30-day follow-up and is not reinforced by J-point elevation and lateral leads’ ER location.
Prenatal Imaging Features and Postnatal Factors Associated with Gastrointestinal Morbidity in Congenital Diaphragmatic Hernia
Authors: Verla Mariatu A. , Style Candace C. , Mehollin-Ray Amy R. , Fallon Sara C. , Vogel Adam M. , Fernandes Caraciolo J. , Ikedionwu Chioma A. , Lee Timothy C. , Keswani Sundeep G. , Olutoye Oluyinka O.
Published: September 2019

Background: To perform a comprehensive assessment of postnatal gastrointestinal (GI) morbidity and determine the prenatal imaging features and postnatal factors associated with its development in patients with congenital diaphragmatic hernia (CDH). Materials and Methods: A retrospective review was conducted of all infants evaluated for CDH at a quaternary fetal center from February 2004 to May 2017. Prenatal imaging features and postnatal variables were analyzed. GI morbidity was the primary outcome. The Mann-Whitney U test, the Kruskal-Wallis test with Dunnett’s T3 post hoc analysis and logistic regression, and the χ2 test were performed when appropriate. Results: We evaluated 256 infants; 191 (75%) underwent CDH repair and had at least 6 months of follow-up. Of this cohort, 60% had gastroesophageal reflux disease (GERD), 13% had gastroparesis, 32% received a gastrostomy tube (G-tube), and 17% needed a fundoplication. Large defect, patch repair, extracorporeal membrane oxygenation (ECMO), and prolonged use of mechanical ventilation were significantly associated with having GERD, gastroparesis, G-tube placement, and fundoplication (p < 0.05). Fetuses with stomach grades 3 and 4 were most likely to have GERD, a G-tube, and a long-term need for supplemental nutrition than fetuses with stomach grades 1 and 2 (p < 0.05). Conclusion: Survivors of CDH with large defects, prolonged use of mechanical ventilation, or that have received ECMO may be at an increased risk for having GERD, gastroparesis, and major GI surgery. Marked stomach displacement on prenatal imaging is significantly associated with GI morbidity in left-sided CDH.
Dose Response to Transnasal Pulmonary Administration of Bronchodilator Aerosols via Nasal High-Flow Therapy in Adults with Stable Chronic Obstructive Pulmonary Disease and Asthma
Authors: Li Jie , Zhao Minghua , Hadeer Maierbati , Luo Jian , Fink James B.
Published: September 2019

Background: There has been increasing interest in transnasal pulmonary aerosol administration, but the dose-response relationship has not been reported. Objectives: To determine the accumulative bronchodilator dose at which patients with stable mild-to-moderate asthma and chronic obstructive pulmonary disease (COPD) achieve similar spirometry responses before and after bronchodilator tests using albuterol via a metered dose inhaler with a valved holding chamber (MDI + VHC). Method: Adult patients who met ATS/ERS criteria for bronchodilator responses in pulmonary function laboratory were recruited and consented to participate. After a washout period, patients received escalating doubling dosages (0.5, 1, 2, and 4 mg) of albuterol in a total volume of 2 mL delivered by vibrating mesh nebulizer via a nasal cannula at 37°C with a flow rate of 15–20 L/min using a Venturi air entrainment device. Spirometry was measured at baseline and after each dose. Titration was stopped when an additional forced expiratory volume in 1 second (FEV1) improvement was <5%. Results: 42 patients (16 males) with stable mild-to-moderate asthma (n = 29) and COPD (n = 13) were enrolled. FEV1 increment after a cumulative dose of 1.5 mg of albuterol via nasal cannula at 15–20 L/min was similar to 4 actuations of MDI + VHC (0.34 ± 0.18 vs. 0.34 ± 0.12 L, p = 0.878). Using ATS/ERS criteria of the bronchodilator test, 33.3% (14/42) and 69% (29/42) of patients responded to 0.5 and 1.5 mg of albuterol, respectively. Conclusions: With a nasal cannula at 15–20 L/min, transnasal pulmonary delivery of 1.5 mg albuterol resulted in similar bronchodilator response as 4 actuations of MDI + VHC.
Prognostic Role of a New Index (RAPID Index) in Advanced Hepatocellular Carcinoma Patients Receiving Sorafenib: Training and Validation Cohort
Authors: Casadei-Gardini Andrea , Solaini Leonardo , Riggi Laura , Molinaro Eleonora , Dadduzio Vincenzo , Rizzato Mario Domenico , Pellino Antonio , Faloppi Luca , Marisi Giorgia , Ulivi Paola , Canale Matteo , Orsi Giulia , Rovesti Giulia , Andrikou Kalliopi , Spallanzani Andrea , Gelsomino Fabio , Foschi Francesco Giuseppe , Conti Fabio , Cucchetti Alessandro , Ercolani Giorgio , Biason Paola , Lonardi Sara , Cascinu Stefano , Scartozzi Mario
Published: September 2019

Background and Aims: The aim of the present study is to evaluate a new index influenced by the balance between the immune system, α-fetoprotein (AFP), and lactate dehydrogenase (LDH) (RAPID index) as a prognostic factor in patients treated with sorafenib. Methods: This study was conducted on a training cohort of 159 hepatocellular carcinoma (HCC) patients and a validation cohort of 68 HCC patients treated with sorafenib. The RAPID index was calculated as neutrophil/lymphocyte count × LDH × AFP. Results: In the training cohort, the median overall survival (OS) was 23.2 months (95% CI 11–25) and 12.1 months (95% CI 9–15) for patients with a low (≤3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.56, 95% CI 0.35–0.88, p = 0.017). Following adjustment for clinical covariates, multivariate analysis confirmed the RAPID index ≤3,226 versus >3,226 (HR = 0.37, 95% CI 0.18–0.74, p = 0.0054) as an independent prognostic factor for OS. In the validation cohort, the median OS was 26.9 months (95% CI 17.6–26.9) and 7.0 months (95% CI 6.2–9.2) for patients with a low (≤ 3,226) and high (>3,226) RAPID index, respectively (ref. <3,226, HR = 0.19, 95% CI 0.10–0.36, p < 0.0001). Performing the same multivariate analysis of the training cohort (AFP, Eastern Cooperative Oncology Group, aspartate aminotransferase, neutrophil, platelet, systemic inflammatory index and RAPID index), the RAPID index <3,226 versus >3,226 (HR = 3.86, 95% CI 1.45–10.29, p = 0.007) was found to be an independent prognostic factor for predicting OS. Conclusion: The low cost, easy assessment, and reproducibility of a full blood count make the RAPID index a promising tool for assessing HCC prognosis in future clinical practice.
Cognitive Behaviour Therapy Complemented with Emotion Regulation Training for Patients with Persistent Physical Symptoms: A Randomised Clinical Trial
Authors: Kleinstäuber Maria , Allwang Christine , Bailer Josef , Berking Matthias , Brünahl Christian , Erkic Maja , Gitzen Harald , Gollwitzer Mario , Gottschalk Japhia-Marie , Heider Jens , Hermann Andrea , Lahmann Claas , Löwe Bernd , Martin Alexandra , Rau Jörn , Schröder Annette , Schwabe Johannes , Schwarz Jeanine , Stark Rudolf , Weiss Frauke Dorothee , Rief Winfried
Published: September 2019

Introduction: Persistent medically unexplained symptoms (MUS) are a major burden for health care. Cognitive behaviour therapy (CBT) is efficacious for patients with MUS, with small to medium effects. The current study investigates whether therapy outcomes of a CBT for MUS patients can be improved by complementing it with emotion regulation training. Methods: In a multicentre trial 255 patients with at least three persisting MUS were randomised to 20 sessions of either conventional CBT (n = 128) or CBT complemented with emotion regulation training (ENCERT; n = 127). Somatic symptom severity and secondary outcomes were assessed at pre-treatment, therapy session 8, end of therapy, and 6-month follow-up. Results: Linear mixed-effect models revealed medium to large effects in both study arms for almost all outcomes at the end of therapy and 6-month follow-up. ENCERT and CBT did not differ in their effect on the primary outcome (d = 0.20, 95% CI: –0.04 to 0.44). Significant time × group cross-level interactions suggested ENCERT to be of more benefit than conventional CBT for a few secondary outcomes. Moderator analyses revealed higher effects of ENCERT in patients with co-morbid mental disorders. Discussion/Conclusions: Current findings are based on a representative sample. Results demonstrate that both CBT and ENCERT can achieve strong effects on primary and secondary outcomes in MUS patients. Our results do not indicate that adding a training in emotion regulation skills generally improves the effect of CBT across all patients with MUS. Large effect sizes of both treatments and potential specific benefits of ENCERT for patients with co-morbid mental disorders are discussed.
Whole-Scalp Cobblestone Plica Neuropathica with Alopecia
Authors: Monteiro Ana Filipe , Lencastre André
Published: September 2019

Plica neuropathica (PN) is an uncommon scalp condition that usually presents as a compact mass of scalp hair. We report a case of a 55-year-old woman presenting with PN. She presented with a 40-year history of thick plaques of yellow scale afflicting the entire scalp, progressive alopecia, and seeming lack of care of her own condition. Histology showed epidermal nevus-like features and severe miniaturization.
Atypical Prader-Willi and 15q13.3 Microdeletion Syndromes in a Patient with an Unbalanced Translocation
Authors: Colovati Mileny E.S. , Grossi Beatriz M. , Nunes Gabriela D. , Fock Rodrigo A. , Guedes Dulce R. , Melaragno Maria I. , Cernach Mirlene C.S.P.
Published: September 2019

Prader-Willi syndrome (PWS) and recurrent 15q13.3 microdeletion syndrome can be caused by genomic rearrangements in the complex 15q11q13 chromosomal region. Here, we describe the first female child with PWS and 15q13.3 microdeletion syndrome resulting from an unusual 10.7-Mb deletion from 15pter to 15q13.3 due to an unbalanced de novo 15;19 translocation. The patient presents with hypotonia, microcephaly, developmental delay with lack of speech, intellectual disability, happy demeanor, clinodactyly of the 4th and 5th fingers, and dysmorphic facial features discordant for PWS and consistent with an atypical phenotype.
Influence of Voice Focus Adjustments on Oral-Nasal Balance in Speech and Song
Authors: Santoni Charlene , de Boer Gillian , Thaut Michael , Bressmann Tim
Published: September 2019

Objectives: This study investigated the effect of training backward and forward voice focus adjustments on oral-nasal balance in speech and singing in typical speakers. Methods: Twenty participants (10M/10F) aged 24.25 (SD 3.73) years read phonetically balanced, nasal and oral speech stimuli, and sang a song in both forward and backward voice focus conditions. A Nasometer 6450 was used to obtain nasalance scores in the different conditions. Results: Results indicated that forward voice focus resulted in more nasality (p < 0.01) for the oral stimulus and song. Backward voice focus caused a decrease in nasality (p < 0.01) for the nasal stimulus, the phonetically balanced paragraph, and the song. During production of the song, males were more nasal in the forward voice focus condition than females (p = 0.01). Conclusions: Voice focus can influence oral-nasal balance in normal speakers. More research is needed to investigate whether voice focus adjustments could be helpful to speakers with oral-nasal balance disorders.