bluuebunny/crossref_metadata_2025 huggingface dataset:
One-year real life data of our patients with moderate-severe Crohn’s disease who underwent ustekinumab therapy
Authors: Bacaksız Ferhat , Arı Derya , Gökbulut Volkan , Öztürk Ömer , Kayaçetin Ertuğrul
Published: April 2021

Aim

The aim of this study was to present one-year real-life data of our patients with CD who showed unresponsiveness and/or intolerance to biological agents and then received ustekinumab treatment through an early access program.

Materials and methods

The retrospective study reviewed the 52-week clinical data of 10 patients with moderate or severe CD who underwent ustekinumab therapy.

Results

The 10 patients comprised 7 (70%) men and 3 (30%) women with a mean age of 38 ± 11.3 years. Mean disease duration was 13.5 ± 8.5 years. Mean pretreatment CDAI score was 273.5 ± 92 and mean pretreatment HBI score was 11.6 ± 3.8. At the end of the 8-week intravenous induction treatment, 5 (55%) patients showed clinical remission according to the CDAI and HBI scores. Additionally, 62.5% of the patients were in clinical remission at the end of week 52 according to the CDAI and HBI scores. No drug-related side effects were observed in any patient throughout the treatment.

Conclusion

Ustekinumab appears to be effective and safe in the treatment of moderate and severe CD, particularly in cases of unresponsiveness and intolerance to biological agents such as anti-TNF, and in the achievement of clinical remission.
Research progress of viscoelastic surfactants for enhanced oil recovery
Authors: Hu Ruizhi , Tang Shanfa , Mpelwa Musa , Jiang Zhaowen , Feng Shuyun
Published: April 2021

Although new energy has been widely used in our lives, oil is still one of the main energy sources in the world. After the application of traditional oil recovery methods, there are still a large number of oil layers that have not been exploited, and there is still a need to further increase oil recovery to meet the urgent need for oil in the world economic development. Chemically enhanced oil recovery (CEOR) is considered to be a kind of effective enhanced oil recovery technology, which has achieved good results in the field, but these technologies cannot simultaneously effectively improve oil sweep efficiency, oil washing efficiency, good injectability, and reservoir environment adaptability. Viscoelastic surfactants (VES) have unique micelle structure and aggregation behavior, high efficiency in reducing the interfacial tension of oil and water, and the most important and unique viscoelasticity, etc., which has attracted the attention of academics and field experts and introduced into the technical research of enhanced oil recovery. In this paper, the mechanism and research status of viscoelastic surfactant flooding are discussed in detail and focused, and the results of viscoelastic surfactant flooding experiments under different conditions are summarized. Finally, the problems to be solved by viscoelastic surfactant flooding are introduced, and the countermeasures to solve the problems are put forward. This overview presents extensive information about viscoelastic surfactant flooding used for EOR, and is intended to help researchers and professionals in this field understand the current situation.
A Person-centered Approach to Violence Exposure in Postwar Colombian Youth: Demographic Covariates and Positive Youth Development Outcomes
Authors: Fraser Ashley M. , Gaias Larissa M. , Guevara Ana Maria Melendez , Johnson Sarah Lindstrom
Published: April 2021

While the negative impact of extensive exposure to community violence and armed conflict is known, less emphasis has been focused on outcomes supportive of resilience. It is critical to begin exploring these constructs to both promote healing from decades-long conflict and to inform targeted interventions that focus on positive youth development in contexts of adversity. This study thus utilized a person-centered approach to estimate violence exposure profiles among 3,443 Colombian youth to explore what demographic covariates and positive youth development outcomes, such as school engagement, hope, goals, social competence, future expectations, and barriers to education were associated with each violence exposure profile. Four profiles emerged: a low exposure profile, a high community violence profile, a some combined exposure profile, and a high combined exposure profile, each with various levels of community violence witnessing and victimization as well as armed conflict exposure. Demographic covariance results showed older, urban, male youth were more likely to be in the high violence exposure profiles compared to the low exposure group. Youth in the high combined exposure profile were more likely to have lower hope, educational expectations, and social competence compared to the low exposure group. Findings highlight that a person-centered approach provides a more multidimensional view of adolescent violence exposure. Demographic differences suggested the importance of tailoring violence prevention initiatives to the local context. Finally, results concerning positive youth development outcomes suggest that resiliency-oriented constructs, which can be instrumental toward youth’s postwar healing and growth, should be emphasized among populations who experience high levels of co-occurring exposure.
“More of a Girl Thing?” Examining the Role of Gender and Campus Context in Perceptions of Risk and the Shadow of Sexual Assault
Authors: Jacobsen Shannon K.
Published: April 2021

One of the most consistent predictors of fear of crime is gender, whereby women are more fearful of crime than men, despite their lower rates of victimization. An often-cited explanation for this apparent paradox is the “shadow” of sexual assault, which has received overwhelming support in studies among college students. However, this work has been largely quantitative and rarely comparative in nature. Using in-depth qualitative interviews with 70 undergraduates attending a suburban and an urban university, the focus of the current study was to understand if and how gender shapes students’ fear of crime and perceptions of risk on campus, as well as whether the influence of gender varies across contexts. Consistent with the shadow hypothesis, this study found that students attending university in the relatively affluent suburban setting were most concerned about the sexual assault and rape of their female peers, especially by non-student outsiders. Yet in the less advantaged urban context, the shadow was missing from students’ remarks. Instead, participants believed they were most likely to be robbed and generally knew someone who had been a victim of the crime, had they not been robbed themselves. The findings from this study have theoretical implications for the role of context in the shadow of sexual assault hypothesis, as well as methodological implications for how scholars examine gender and students’ fear of crime.
Struggling Together: Examining the Narratives of Interdependence and Healing Within Romantic Relationships After Stroke
Authors: Abendschein Bryan , Basinger Erin D. , Wehrman Erin C.
Published: April 2021

The consequences of a brain injury can introduce ripple effects within a family for years after the initial event. In this study, we focused on the experiences of couples negotiating their relationship after stroke. We specifically concentrated on the changes to couples’ interdependence and the relational ramifications of those changes. Interview data from 41 participants (including 20 people who have had a stroke and 21 caregiving partners) suggest that as individuals noticed changes in themselves and their partner, they also noted significant changes within their relationship. As couples encountered their new relational dynamic, they had to manage various struggles including how to provide assistance, how to communicate effectively, and how to reframe their situation. Overall, couples relayed a trajectory of post-stroke life that involved a level of mutual influence that did not seem to exist prior to stroke.
Ophthalmologic manifestations of adult patients with cystic fibrosis
Authors: Giannakouras Panagiotis , Kanakis Menelaos , Diamantea Filia , Tzetis Maria , Koutsandrea Chrysanthi , Papaconstantinou Dimitrios , Georgalas Ilias
Published: April 2021

Introduction:

Cystic fibrosis (CF) is the most common life-shortening recessive genetic disease in Caucasians, affecting primarily the lungs. The objective of our study was to investigate potential ophthalmologic involvement in adult patients with CF.

Methods:

Fifty adult patients with cystic fibrosis and 60 age- and sex-matched controls underwent complete ophthalmologic examination including tear-film Break-Up Time (BUT), Macular Thickness, and peripapillary Retinal Nerve Fiber Layer (pRNFL) thickness measurements using Spectral Domain-OCT.

Results:

CF patients had significantly lower nasal-inferior pRNFL thickness (median 82 IQR 67–102 vs 92.5 IQR 82–107, p = 0.005) and lower percentage of normal tear Break-Up Time (56.0% vs 96.7%, p = 0.001) than healthy controls. All CF patients with BUT <10 s were diagnosed with blepharitis at the time of our assessement. The subgroup of patients homozygous for the most common CF mutation, F508del, had lower nasal-inferior pRNFL thickness ( p = 0.014) and lower percentage of normal tear Break-Up Time ( p = 0.001) compared to the control group. Additional findings, present in the CF group only, were punctuate retinal hemorrhages (four patients), vessel tortuosity (four patients), snail-track degeneration, and retinal tufts (two patients without refractive error). There were no significant differences in visual acuity, refractive errors, gonioscopic findings, or intraocular pressure between the groups.

Conclusions:

Our study is, to the best of our knowledge, the largest ophthalmologic study of patients with cystic fibrosis. We found that CF patients had significantly decreased inferior-quadrant peripapillary retinal nerve fiber layer thickness and decreased tear-film break-up time compared to controls. We highlight the importance of careful regular ophthalmologic assessment and follow-up of these patients.
Using digital image correlation to evaluate the bond between carbon fibre-reinforced polymers and timber
Authors: Biscaia Hugo C , Canejo João , Zhang Shishun , Almeida Raquel
Published: April 2021

The use of optic measurements such as digital image correlation to take strain measurements of fibre-reinforced polymers bonded to a substrate has been on the increase recently. This technique has proven to be useful to fully characterize the bond behaviour between two materials. Although modern digital cameras can take high-definition photos, this task is far from simple due to the tiny displacements that need to be measured. Consequently, digital image correlation measurements lead to relative errors that, at an initial stage of the debonding process, are higher than those calculated close to the debonding of the fibre-reinforced polymer from the substrate. This study aims to evaluate and analyse the use of the digital image correlation technique on the bond between carbon fibre-reinforced polymer laminates and timber when subjected to a pull-out load consistent with fracture Mode II. To allow the quantification of the relative errors obtained from the digital image correlation measurements during the full debonding process, several strain gauges were used to measure the strains in the carbon fibre-reinforced polymer composite. The accuracy of the digital image correlation measurements is analysed by comparing it with those obtained from the strain gauges, which is a very well-established measuring technique. Another contribution of this study is to check the versatility of the digital image correlation measurements on a broader range of situations. To that end, several timber prisms were bonded with seven different bonding techniques with and without the installation of a mechanical anchorage at the carbon fibre-reinforced polymer unpulled end. The results showed that the digital image correlation technique was able to track the slips calculated from the strain gauge measurements until the debonding load, but after that, some difficulties to measure the displacements of the anchored carbon fibre-reinforced polymer-to-timber joints were detected. The digital image correlation technique also over predicted bond stresses when compared with those taken from the strain gauges, which led to bond–slip relationships with higher bond stresses.
Möbius Band Surprise: A Systematic Illusion in Imagery
Authors: Haugland Mons Daniel , Pearson David G. , Ekroll Vebjørn
Published: April 2021

When a Möbius loop is cut along the middle of the band, the result is a single connected loop, yet anecdotal evidence from science demonstrations and the use of this effect in magic tricks suggest that most people are thoroughly surprised by this because they strongly believe that the result should be two separate loops. Here, we present results from a behavioral experiment confirming this anecdotal evidence and discuss potential theoretical explanations for why this demonstration evokes strong, but misleading intuitions and a related illusion of impossibility.
One or several granular geographies?
Authors: Jamieson William
Published: April 2021

This response addresses the issues and potentialities raised by the commentaries on my article, ‘For Granular Geography’. It clarifies some of the tensions within my original presentation of granular geography, and then outlines two diverging trajectories for granular geographies to come. The first outlines a geophilosophical and geomorphological trajectory of granular assemblages that map how sand binds elemental and non-human relations to interrogate the emerging global sand crisis. The second trajectory consists of developing granular relations for the ecological critique of political economy as a set of tools for theorising unstable relations between capital and nature, complementing existing metaphors of metabolism.
Drivers of Cost in Primary Single-Level Lumbar Fusion Surgery
Authors: Hwang Raymond W. , Golenbock Samuel W. , Kim David H.
Published: April 2021

Study Design:

Retrospective cohort.

Objectives:

Allocating cost is challenging with traditional hospital accounting. Time-driven activity-based costing (TDABC) is an efficient method to accurately assign cost. We sought to characterize the variation in direct total hospital cost (THC) among both lumbar fusion approaches and surgeons.

Methods:

Patients were treated with single-level anterior interbody (ALIF), lateral interbody (LLIF), transforaminal interbody (TLIF), instrumented posterolateral (PLF) or in-situ fusion (ISF) for degenerative disease. Process maps were developed for preoperative, intraoperative and postoperative care. THC was composed of implant, medication, other supply, and personnel costs. Linear regression and descriptive statistics were used to analyze THC variation.

Results:

A total of 696 patients underwent surgery by 8 surgeons. Approximately 50% of THC variation was associated with procedure choice while patient characteristics explained 10%. Implants (including biologics) accounted for 45% of cost. With reference to PLF, THC ranged from 0.6x (ISF) to 1.7x (LLIF). Implant cost ranged from 2.5x reference (LLIF) to 0.1x (ISF). There was a 1.7x difference between the highest THC surgeon and the lowest. The fusion type with the highest THC variation was TLIF. The surgeon with the highest TLIF THC was 1.5x more expensive than the surgeon with the lowest.

Conclusions:

Surgeon-based choices have the greatest effect on THC variation and represent the largest opportunities for cost savings. Primary single-level lumbar fusion THC is driven primarily by fusion type. Implants, including biologics, account for nearly half this cost. Future work should incorporate outcomes data to characterize the differential value conferred by higher THC fusions.
Relationships Between Time-at-Bedside During Hospital Ward Rounds, Clinician–Patient Agreement, and Patient Experience
Authors: Ratelle John T , Herberts Michelle , Miller Donna , Kumbamu Ashok , Lawson Donna , Polley Eric , Beckman Thomas J
Published: April 2021

Hospital medicine ward rounds are often conducted away from patients’ bedsides, but it is unknown if more time-at-bedside is associated with improved patient outcomes. Our objective is to measure the association between “time-at-bedside,” patient experience, and patient–clinician care agreement during ward rounds. Research assistants directly observed medicine services to quantify the amount of time spent discussing each patient’s care inside versus outside the patient’s room. “Time-at-bedside” was defined as the proportion of time spent discussing a patient’s care in his or her room. Patient experience and patient–clinician care agreement both were measured immediately after ward rounds. Results demonstrated that the majority of patient and physicians completely agreement on planned tests (66.3%), planned procedures (79.7%), medication changes (50.6%), and discharge location (66.9%), but had no agreement on the patient’s main concern (74.4%) and discharge date (50.6%). Time-at-bedside was not correlated with care agreement or patient experience ( P > .05 for all comparisons). This study demonstrates that spending more time at the bedside during ward rounds, alone, is insufficient to improve patient experience.
Patients With Health-Related Social Needs More Likely to Report Poor Clinic Experiences
Authors: Gray Mary , Jones Kyle G , Wright Bill J
Published: April 2021

Measuring patients’ care experience is necessary to understanding and improving health care quality and is a core component of patient-centered care. In this study, we test whether patient health care experiences differed between patients with and without health-related social needs, above and beyond demographic differences previously studied. This study relies on survey data from 2341 patients who visited 1 of 7 primary care clinics in Portland, Oregon, and surrounding communities during the latter half of 2018. Survey analysis reveal that patients with at least 1 health-related social need had greater odds of reporting staff not always answering questions, not getting all the care they need, not getting the information to manage care, not being treated with respect by their provider, and getting care being a hassle. The findings from this study suggest that patients with health-related social needs are not getting the holistic care they expect in their primary care clinics and find it a hassle to get care regardless of their demographic characteristics and insurance status. This study may help to inform how health care systems and clinics can best serve patients with health-related social needs.
Association between apolipoprotein gene polymorphisms and hyperlipidemia: a meta-analysis
Authors: Zhao Xiao-Ning , Sun Quan , Cao You-Qin , Ran Xiao , Cao Yu
Published: April 2021

Background

Hyperlipidemia plays an important role in the etiology of cardio-cerebrovascular disease. Over recent years, a number of studies have explored the impact of apolipoprotein genetic polymorphisms in hyperlipidemia, but considerable differences and uncertainty have been found in their association with different populations from different regions.

Results

A total of 59 articles were included, containing in total 13,843 hyperlipidemia patients in the case group and 15,398 healthy controls in the control group. Meta-analysis of the data indicated that APOA5–1131 T > C, APOA1 -75 bp, APOB XbaI, and APOE gene polymorphisms were significantly associated with hyperlipidemia, with OR values of 1.996, 1.228, 1.444, and 1.710, respectively. AllP-values were less than 0.05.

Conclusions

Meta-analysis of the data indicated that the C allele of APOA5 1131 T > C, the A allele at APOA1-75 bp, the APOB XbaI T allele, and the ε2 and ε4 allele of APOE were each a risk factor for susceptibility for hyperlipidemia.
Effect of quadratus lumborum block on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy: a randomized controlled trial
Authors: Zhu Manhua , Qi Yong , He Huijuan , Zhang Song , Mei Yuliu
Published: April 2021

Background

Quadratus lumborum block (QLB) is a novel and effective postoperative analgesia method for abdominal surgeries. However, whether QLB can affect early postoperative cognitive function by inhibiting surgical traumatic stress and the inflammatory response remains unclear. This study aimed to explore the effect of QLB on postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy.

Methods

Sixty-four elderly patients who underwent laparoscopic radical gastrectomy were randomly divided into the QLB group (Q group,n = 32) and control group (C group,n = 32). The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to measure cognitive function 1 day before and 7 days after surgery. Postoperative cognitive dysfunction (POCD) was defined as a decline of ≥ 1 SD in both tests. The visual analog scale (VAS) scores 6 h (T1), 24 h (T2), and 48 h (T3) after surgery were measured. The serum levels of high mobility group box protein 1 (HMGB1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were evaluated 1 day before surgery (baseline), and 1 day (day 1) and 3 days after surgery (day 3). The intraoperative remifentanil dosage, sufentanil consumption 24 h after surgery, recovery time from anesthesia, and adverse effects were also compared.

Results

POCD was present in two patients in the QLB group and eight patients in the C group 7 days after surgery (6.7 % vs. 27.6 %,P = 0.032). The MMSE and MoCA scores were similar in both groups preoperatively, and the two scores were higher in the QLB group than in the C group 7 days after surgery (P < 0.05). The VAS scores were significantly lower in the Q group at all times after surgery (P < 0.05). Compared with the C group, the levels of HMGB1, TNF-α, and IL-6 were significantly decreased 1 and 3 days after surgery in the QLB group (P < 0.05). The remifentanil consumption intraoperatively and sufentanil 24 h postoperatively were significantly lower in the QLB group (P < 0.05). The recovery time from anesthesia was shorter in the QLB group (P < 0.05). No severe adverse effects occurred in either group.

Conclusions

QLB could improve postoperative cognitive function in elderly patients undergoing laparoscopic radical gastrectomy. This may be related to the suppression of the inflammatory response after surgery.

Trial registration

Chictr.org.cnidentifier ChiCTR1900027574 (Date of registry: 19/11/2019, prospectively registered).
The effects of vitamin E supplementation on malondialdehyde as a biomarker of oxidative stress in haemodialysis patients: a systematic review and meta-analysis
Authors: Bergin Peter , Leggett Aoife , Cardwell Chris R. , Woodside Jayne V. , Thakkinstian Ammarin , Maxwell Alexander P. , McKay Gareth J.
Published: April 2021

Background

Haemodialysis (HD) patients tend to have higher levels of oxidative stress (OS), associated with increased morbidity and premature mortality, compared to the general population. Levels of malondialdehyde (MDA), a biomarker of OS, are reduced by the antioxidant properties of vitamin E (VE) but outcomes from randomised control trials of VE supplementation on MDA in HD patients have been inconsistent.

Methods

We undertook a systematic review and meta-analysis of adult HD patients from VE supplementation studies with measures of MDA. The following search criteria of MEDLINE and EMBASE were considered from inception to January 2020: ‘dialysis’ AND ‘Vitamin E OR tocopherol’ AND ‘malondialdehyde OR MDA’. Two reviewers independently extracted study data and assessed risk of bias. Mean MDA levels and standard deviation were determined before and after VE supplementation. Standardised mean difference (SMD) and standard error were calculated as the within person difference and units of measure were not consistently recorded across all studies. The SMD were pooled using random effects meta-analysis.

Results

The SMD of MDA levels from 18 comparisons was significantly lower in HD patients following VE supplementation (− 1.55; confidence interval: − 2.17 to − 0.94,P < 0.00001). There were significant levels of heterogeneity between studies (I2value = 91%; P < 0.00001) with evidence of potential publication bias toward smaller studies.

Conclusions

Our findings support the use of VE to reduce the effects of OS in HD patients although high levels of heterogeneity and variation in the methodological approaches used by some studies highlight the need for further investigation.
In-vitro Immunomodulatory activity of Azadirachta indica A.Juss. Ethanol: water mixture against HIV associated chronic CD4+ T-cell activation/ exhaustion
Authors: Olwenyi Omalla A. , Asingura Bannet , Naluyima Prossy , Anywar Godwin Upoki , Nalunga Justine , Nakabuye Mariam , Semwogerere Michael , Bagaya Bernard , Cham Fatim , Tindikahwa Allan , Kiweewa Francis , Lichter Eliezer Z. , Podany Anthony T. , Fletcher Courtney V. , Byrareddy Siddappa N. , Kibuuka Hannah
Published: April 2021

Background

In Sub-Saharan Africa, herbal therapy continues to be utilized for HIV-1 disease management. However, the therapeutic benefits of these substances remain ambiguous. To date, little is known about the effects of these plant extracts on chronic CD4 + T-cell activation and exhaustion which is partly driven by HIV-1 associated microbial translocation.

Methods

Effects of Azadirachta indica, Momordica foetida and Moringa oleifera ethanol: water mixtures on cell viability were evaluated using the Guava PCA system. Then, an in-vitro cell culture model was developed to mimic CD4+ T cell exposures to antigens following HIV-1 microbial translocation. In this, peripheral blood mononuclear cells (PBMCs) isolated from HIV negative (n = 13), viral load < 1000 copies per mL (n = 10) and viral load > 1000 copies per mL (n = 6) study participants from rural Uganda were treated with Staphylococcus enterotoxin B (SEB). Then, the candidate plant extract (A. indica) was added to test the potential to inhibit corresponding CD4+ T cell activation. Following BD Facs Canto II event acquisition, variations in %CD38, %CD69, Human Leukocyte Antigen -DR (HLA-DR), Programmed cell death protein 1 (PD-1), T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3), interferon gamma (IFN γ) and interleukin 2 (IL-2) CD4 + T cell expression were evaluated.

Results

Following exposure to SEB, only A. indica demonstrated a concentration-dependent ability to downregulate the levels of CD4 + T cell activation. At the final concentration of 0.500 μg/mL of A. indica, a significant downregulation of CD4 + CD38 + HLA-DR+ expression was observed in HIV negative (p < 0.0001) and both HIV infected groups (P = 0.0313). This plant extract also significantly lowered SEB induced % CD4+ T cell HLADR, PD-1 and Tim-3 levels. PD-1 and CD69 markers were only significantly downmodulated in only the HIV negative ((p = 0.0001 and p = 0.0078 respectively) and viral load< 1000 copies per ml (p = 0.0078) groups.

Conclusion

A. indica exhibited the in-vitro immunomodulatory potential to inhibit the continuum of SEB induced CD4+ T-cell activation/ exhaustion without impacting general T-cell specific functions such as cytokine secretion. Additional studies are needed to confirm A. indica as a source of natural products for targeting persistent immune activation and inflammation during ART.
Letter to the editor: Vitamin D levels in acute illness and clinical severity in COVID-19 patients
Authors: Lohia Prateek , Kapur Shweta , Patel Pragnesh , Seyoum Berhane
Published: April 2021

We would like to comment on the recently published article titled: “Circulating Vitamin D levels status and clinical prognostic indices in COVID-19 patients” by Ricci et al. The authors grouped the patients into two groups according to the vitamin D levels measured at the time of admission into the hospital and reported that lower vitamin D levels are associated with elevated D-dimer and IL-6 levels, low CD4/CD8 ratio and compromised clinical findings with elevated LIPI and SOFA scores. However, review of recent literature shows this association to be debatable. The 25-hydroxyvitamin D levels in the initial phase of critical illness have been reported to drop rapidly and hence consideration of the time of measurement from symptom onset would have enhanced the clinical relevance of these findings. Inferred association between vitamin D levels and disease severity based on SOFA score in COVID-19 patients, needs to be further explored in the light of the recent literature which casts doubt on using SOFA score at admission to predict mortality in COVID-19.
Literature-based considerations regarding organizing and performing cardiac surgery against the backdrop of the coronavirus pandemic
Authors: Juraszek Andrzej , Kuriata Jarosław , Kołsut Piotr , Hryniewiecki Tomasz , Różewicz-Juraszek Monika , Dziodzio Tomasz , Kuśmierczyk Mariusz
Published: April 2021

Background

The ongoing coronavirus disease 2019 (Covid-19) pandemic presents challenges for surgeons of all disciplines, including cardiologists. The volume of cardiac surgery cases has to comply with the mandatory constraints of healthcare capacities. The treatment of Covid-19-positive patients must also be considered. Unfortunately, no scientific evidence is available on this issue. Therefore, this study aimed to offer some consensus-based considerations, derived from available scientific papers, regarding the organization and performance of cardiac surgery against the backdrop of the Covid-19 pandemic.

Methods

Key recommendations were extracted from recent literature concerning cardiac surgery.

RESULTSː Reducing elective cardiac procedures should be based on frequent clinical assessment of patients on the waiting list (every one or two weeks) and the current local status of the Covid-19 pandemic. Screening tests at admission for every patient are broadly recommended. Where appropriate, alternative treatment methods can be considered, including percutaneous techniques and minimally invasive surgery, if performed by experienced cardiac surgery teams.

Conclusions

There is little evidence on the strategies to organize cardiac surgery in the Covid-19 pandemic. Most authors agree on reducing elective operations based on patients’ clinical condition and the status of the Covid-19 pandemic. Admission screenings and the use of percutaneous or minimally invasive approaches should be preferred to reduce in-hospital stays.
Comparison of the survival outcomes of laparoscopy versus laparotomy in treatment of early-stage ovarian cancer: a systematic review and meta-analysis
Authors: Kong Qingduo , Wei Hongyi , Zhang Jing , Li Yilin , Wang Yongjun
Published: April 2021

Background

Laparoscopy has been widely used for patients with early-stage epithelial ovarian cancer (eEOC). However, there is limited evidence regarding whether survival outcomes of laparoscopy are equivalent to those of laparotomy among patients with eEOC. The result of survival outcomes of laparoscopy is still controversial. The aim of this meta-analysis is to analyze the survival outcomes of laparoscopy versus laparotomy in the treatment of eEOC.

Methods

According to the keywords, Pubmed, Embase, Cochrane Library and Clinicaltrials.gov were searched for studies from January 1994 to January 2021. Studies comparing the efficacy and safety of laparoscopy versus laparotomy for patients with eEOC were assessed for eligibility. Only studies including outcomes of overall survival (OS) were enrolled. The meta-analysis was performed using Stata software (Version 12.0) and Review Manager (Version 5.2).

Results

A total of 6 retrospective non-random studies were included in this meta-analysis. The pooled results indicated that there was no difference between two approaches for patients with eEOC in OS (HR = 0.6, P = 0.446), progression-free survival (PFS) (HR = 0.6, P = 0.137) and upstaging rate (OR = 1.18, P = 0.54). But the recurrence rate of laparoscopic surgery was lower than that of laparotomic surgery (OR = 0.48, P = 0.008).

Conclusions

Laparoscopy and laparotomy appear to provide comparable overall survival and progression-free survival outcomes for patients with eEOC. Further high-quality studies are needed to enhance this statement.
Diabetes related distress is high in inpatients with diabetes
Authors: Kuniss Nadine , Kramer Guido , Müller Ulrich A. , Wolf Gunter , Kloos Christof
Published: April 2021

Objective

The aim of the present study was to assess diabetes-related distress in inpatients and its association with metabolic control in people with diabetes type 1 (DM1) and type 2 (DM2).

Research design and methods

In a cross-sectional study, 107 inpatients with DM1 (age 45.9 years, diabetes duration 18.7 years, HbA1c 8.4%/67.8 mmol/mol) and 109 with DM2 (age 62.0 years, diabetes duration 16.2 years, HbA1c 8.9%/74.3 mmol/mol) from a University department for endocrinology and metabolic diseases (Germany) were included over 2 years. Diabetes-related distress was assessed with the PAID questionnaire (range 0–100, higher scores imply higher diabetes-related distress, cut-off ≥ 40). The PAID questionnaire was completed by 214 of 216 participants.

Results

Fifty-one of 214 individuals (23.8%) showed high distress (PAID score ≥ 40). The mean PAID score was 28.1 ± 17.5 in all participants with no difference between DM1 and DM2 (28.1 ± 17.4 vs. 26.2 ± 16.9, p = 0.532). Individuals with DM2 on insulin scored higher than patients without insulin (27.8 ± 17.6 vs. 18.7 ± 8.5, p = 0.004). Additionally, people with DM1 treated with a system for continuous glucose monitoring (n = 50, 33.1 ± 18.8) scored higher than participants without such system (n = 32, 20.6 ± 13.3, p = 0.001). HbA1c was not correlated with the PAID score in both, DM1 (r = 0.040, p = 0.684) and DM2 (r = − 0.024, p = 0.804). Participants with DM2 and severe hypoglycaemia/last 12 months scored higher than people without (PAID score 43.0 ± 20.4 vs. 25.1 ± 16.5, p = 0.026). Frequency of non-severe hypoglycaemia was not associated with the PAID score in DM1 and DM2.

Conclusions

Patients with diabetes treated in hospital for problems with diabetes suffer frequently from diabetes-related distress (~ 24%) regardless of diabetes type.
Molecular mechanisms of vitamin D plus Bisphenol A effects on adipogenesis in human adipose-derived mesenchymal stem cells
Authors: Salehpour Amin , Shidfar Farzad , Hedayati Mehdi , Farshad Ali Asghar , Tehrani Asal Neshatbini , Mohammadi Saeed
Published: April 2021

Background

Obesity is considered a major health concern and mounting evidence suggests that the exposure to environmental endocrine disruptors, including Bisphenol-A (BPA), may enhance the risk to develop the disease. Moreover, growing documents propose that the vitamin D may contribute to adipogenic signaling and lipid accumulation during adipocyte differentiation. We focused on the molecular mechanism of vitamin D and BPA in human adipose-derived mesenchymal stem cells (hADMSCs) which vitamin D and BPA may influence adipose tissue development and function.

Methods

Human adipose-derived mesenchymal stem cells were cultured for 14 days in lipogenic differentiation media containing continuous concentrations of vitamin D plus BPA (0.1 nM or 10 nM). The expression of adipogenic markers including the peroxisome proliferator-activated receptor γ (PPARγ), CCAAT-enhancer-binding protein α (C/EBP α) CCAAT-enhancer-binding protein β (C/EBP β), fatty acid synthase (FASN), lipoprotein lipase (LPL), sterol regulatory element-binding protein-1c (SREBP1c), insulin-induced gene-2 (INSIG2), vitamin D receptor (VDR), estrogen receptor-beta (ER-β), fatty acid-binding protein-4 (FABP4), and glucose transporter-4 (GLUT4) was measured using Quantitative polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA). Lipid accumulation was visualized with staining with Oil Red O.

Results

In the morphological assessment of mesenchymal stem cells treated with a concentration of 10 nM vitamin D plus BPA, more lipid accumulations were observed in comparison with the group with 0.1 nM concentration. Treatment of hADMSCs with vitamin D plus BPA (0.1 nM) significantly inhibited the induction of PPARγ, C/EBP β, C/EBP α, and FASN related to adipocyte differentiation and development. However, the exposure of cells to the concentration of 10 nM vitamin D plus BPA induced the expression of these genes associated to the adipogenesis. The remarkable increase in the level of SREBP1c was associated to the suppression of INSIG2 in treated preadipocytes with 10 nM vitamin D plus BPA. Our findings showed that the expression of VDR, ERβ, GLUT4, and FABP4 were upregulated through differentiation with the highest concentrations in 0.1 nM vitamin D plus BPA group for VDR, ERβ, and GLUT4.

Conclusions

Vitamin D plus BPA at concentration of 10 nM boosted the adipogenesis during the critical stages of adipocytes development, whereas it seems to inhibit this process at concentration of 0.1 nM.
Correlations between isokinetic knee torques and single-leg hop distances in three directions in patients after ACL reconstruction
Authors: Aizawa Junya , Hirohata Kenji , Ohji Shunsuke , Ohmi Takehiro , Mitomo Sho , Koga Hideyuki , Yagishita Kazuyoshi
Published: April 2021

Background

When planning rehabilitation and conditioning for performance enhancement and a return to sports after anterior cruciate ligament reconstruction, identifying the elements of physical function associated with single-leg hop is important. The purpose of this study was to clarify the relationship between single-leg hop distances in three directions and knee extensor and flexor strengths at 6 months after reconstruction.

Methods

Participants were 47 patients taking part in training sessions for sports involving cutting, pivoting, and jump-landing 6 months after reconstruction using a hamstring tendon. Single-leg hop distances in 3 directions (anterior, lateral, and medial) and isokinetic concentric strengths of knee extension and flexion were assessed at an angular velocity of 60°/s and 180°/s. Simple regression analyses using Spearman’s rank correlation coefficient were performed to assess relationships between single-leg hop distances and knee strengths.

Results

In the involved limb, correlations between single-leg hop distances in 3 directions and knee strengths were significant (P< 0.01) and correlation coefficients ranged from 0.48 to 0.65. Correlation coefficients between all single-leg hop parameters and knee extension/flexion strengths at an angular velocity of 180°/s were greater than those of 60°/s.

Conclusions

In this cross-sectional study of patients who participated in sports training sessions that required jump-landings and cutting approximately 6 months after reconstruction using hamstring grafts, isokinetic knee flexor, and extensor torques were moderately to strongly associated with single-leg hop distances in lateral, medial, and anterior directions. Given these relationships, assessments and exercises for knee strength and single-leg hop distances should be planned.
Associations among phthalate exposure, DNA methylation of TSLP, and childhood allergy
Authors: Wang Wan-Ru , Chen Nai-Tzu , Hsu Nai-Yun , Kuo I-Ying , Chang Hsin-Wen , Wang Jiu-Yao , Su Huey-Jen
Published: April 2021

Background

Dysregulation of thymic stromal lymphopoietin (TSLP) expressions is linked to asthma and allergic disease. Exposure to phthalate esters, a widely used plasticizer, is associated with respiratory and allergic morbidity. Dibutyl phthalate (DBP) causes TSLP upregulation in the skin. In addition, phthalate exposure is associated with changes in environmentally induced DNA methylation, which might cause phenotypic heterogeneity. This study examined the DNA methylation of the TSLP gene to determine the potential mechanism between phthalate exposure and allergic diseases.

Results

Among all evaluated, only benzyl butyl phthalate (BBzP) in the settled dusts were negatively correlated with the methylation levels of TSLP and positively associated with children’s respiratory symptoms. The results revealed that every unit increase in BBzP concentration in the settled dust was associated with a 1.75% decrease in the methylation level on upstream 775 bp from the transcription start site (TSS) of TSLP (β =  − 1.75, p = 0.015) after adjustment for child’s sex, age, BMI, parents’ smoking status, allergic history, and education levels, PM2.5, formaldehyde, temperature; and relative humidity. Moreover, every percentage increase in the methylation level was associated with a 20% decrease in the risk of morning respiratory symptoms in the children (OR 0.80, 95% CI 0.65–0.99).

Conclusions

Exposure to BBzP in settled dust might increase children’s respiratory symptoms in the morning through decreasing TSLP methylation. Therefore, the exposure to BBzP should be reduced especially for the children already having allergic diseases.
The crucial roles of N6-methyladenosine (m6A) modification in the carcinogenesis and progression of colorectal cancer
Authors: Fang Zhihao , Hu Yiqiu , Hu Jinhui , Huang Yanqin , Zheng Shu , Guo Cheng
Published: April 2021

As the predominant modification in RNA, N6-methyladenosine (m6A) has attracted increasing attention in the past few years since it plays vital roles in many biological processes. This chemical modification is dynamic, reversible and regulated by several methyltransferases, demethylases and proteins that recognize m6A modification. M6A modification exists in messenger RNA and affects their splicing, nuclear export, stability, decay, and translation, thereby modulating gene expression. Besides, the existence of m6A in noncoding RNAs (ncRNAs) could also directly or indirectly regulated gene expression. Colorectal cancer (CRC) is a common cancer around the world and of high mortality. Increasing evidence have shown that the changes of m6A level and the dysregulation of m6A regulatory proteins have been implicated in CRC carcinogenesis and progression. However, the underlying regulation laws of m6A modification to CRC remain elusive and better understanding of these mechanisms will benefit the diagnosis and therapy. In the present review, the latest studies about the dysregulation of m6A and its regulators in CRC have been summarized. We will focus on the crucial roles of m6A modification in the carcinogenesis and development of CRC. Moreover, we will also discuss the potential applications of m6A modification in CRC diagnosis and therapeutics.
Economic evaluation of diagnostic sleep studies for obstructive sleep apnoea: a systematic review protocol
Authors: Natsky Andrea N. , Vakulin Andrew , Coetzer Ching Li Chai , McEvoy R. D. , Adams Robert J. , Kaambwa Billingsley
Published: April 2021

Background

Obstructive sleep apnoea (OSA) is a significant public health problem affecting a large proportion of the population and is associated with adverse health consequences and a substantial economic burden. Despite the existence of effective treatment, undiagnosed OSA remains a challenge. The gold standard diagnostic tool is polysomnography (PSG), yet the test is expensive, labour intensive and time-consuming. Home-based, limited channel sleep study testing (levels 3 and 4) can advance and widen access to diagnostic services. This systematic review aims to summarise available evidence regarding the cost-effectiveness of limited channel tests compared to laboratory and home PSG in diagnosing OSA.

Methods

Eligible studies will be identified using a comprehensive strategy across the following databases from inception onwards: MEDLINE, PsychINFO, SCOPUS, CINAHL, Cochrane Library, Emcare and Web of Science Core Collection and ProQuest databases. The search will include a full economic evaluation (i.e. cost-effectiveness, cost-utility, cost-benefit, cost-consequences and cost-minimisation analysis) that assesses limited channel tests and PSG. Two reviewers will screen, extract data for included studies and critically appraise the articles for bias and quality. Meta-analyses will be conducted if aggregation of outcomes can be performed. Qualitative synthesis using a dominance ranking matrix will be performed for heterogeneous data.

Discussion

This systematic review protocol uses a rigorous, reproducible and transparent methodology and eligibility criteria to provide the current evidence relating to the clinical and economic impact of limited channel and full PSG OSA diagnostic tests. Evidence will be examined using standardised tools specific for economic evaluation studies.

Trial registration

PROSPERO (CRD42020150130)
Profiling of somatic mutations and fusion genes in acute myeloid leukemia patients with FLT3-ITD or FLT3-TKD mutation at diagnosis reveals distinct evolutionary patterns
Authors: Guan Wei , Zhou Lei , Li Yan , Yang Erna , Liu Yangyang , Lv Na , Fu Lin , Ding Yi , Wang Nan , Fang Nan , Liu Qian , Wang Binan , Li Fuwei , Zhang Juan , Wang Maoquan , Wang Lili , Jing Yu , Li Yonghui , Yu Li
Published: April 2021

Background

The receptor tyrosine kinase FLT3 with internal tandem duplications within the juxtamembrane domain (FLT3-ITD) is a poor prognostic factor; however, the prognostic significance of missense mutation in the tyrosine kinase domain (FLT3-TKD) is controversial. Furthermore, the accompanying mutations and fusion genes with FLT3 mutations are unclear in acute myeloid leukemia (AML).

Methods

We investigated FLT3 mutations and their correlation with other gene mutations and gene fusions through two RNA-seq based next-generation sequencing (NGS) method and prognostic impact in 207 de novo AML patients.

Results

FLT3-ITD mutations were positive in 58 patients (28%), and FLT3-TKD mutations were positive in 20 patients (9.7%). FLT3-ITD was associated with a higher white blood cell count (WBC, mean 72.9 × 109/L vs. 24.2 × 109/L, P = 0.000), higher bone marrow blasts (mean 65.9% vs. 56.0%, P = 0.024), and NK-AML (normal karyotype) (64.8% vs. 48.4%, P = 0.043). NPM1 and DNMT3A mutations were enriched in FLT3-ITD (53.5% vs. 15.3%, P = 0.000; 34.6% vs. 13%, P = 0.003). However, the mutations of CEBPA were excluded in FLT3-AML (3.8% vs. 0% vs. 19.8%, P = 0.005). Mutations of Ras and TP53 were unlikely associated with FLT3-ITD (1.9% vs. 20.6%, P = 0.006; 0% vs. 6.1%, P = 0.04). The common fusion genes (> 10%) in FLT3-ITD had MLL-rearrangement and NUP98-rearrangement, while the common fusion genes in FLT3-TKD had AML1-ETO and MLL-rearrangement. Two novel fusion genes PRDM16-SKI and EFAN2-ZNF238 were identified in FLT3-ITD patients. Gene fusions and NPM1 mutation were mutually excluded in FLT3-ITD and FLT3-TKD patients. Their patterns of mutual exclusivity and cooperation among mutated genes suggest that additional driver genetic alterations are required and reveal two evolutionary patterns of FLT3 pathogenesis. Patients with FLT3-ITD had a lower CR (complete remission) rate, lower 3-year OS (overall survival), DFS (disease-free survival), and EFS (event-free survival) compared to FLT3wtAML. NK-AML with FLT3-ITD had a lower 3-year OS, DFS, and EFS than those without, while FLT3-TKD did not influence the survival in whole cohort and NK-AML. Besides, we found that FLT3-ITD/TET2 bimutation defined a poor prognostic subgroup.

Conclusions

Our study offers deep insights into the molecular pathogenesis and biology of AML with FLT3-ITD and FLT3-TKD by providing the profiles of concurrent molecular alterations and the clinical impact of FLT3-ITD and FLT3-TKD on AML patients.