bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound evaluation of percutaneously created arteriovenous fistulae between radial artery and perforating vein at the elbow
Authors: Franco Gilbert , Mallios Alexandros , Bourquelot Pierre , Jennings William , Boura Benoit
Published: January 2020

Objective:

To investigate the hemodynamics of percutaneous arteriovenous fistulae (pAVF) created between the proximal radial artery and the deep communicating vein of the elbow.

Methods:

Consecutive patients with a percutaneously created proximal radial artery to perforating vein arteriovenous fistulae were evaluated and compared with control patients with clinically well-functioning surgical wrist radiocephalic arteriovenous fistulae (sWRC-AVF).

Results:

Thirty-one patients with a pAVF (21 males – 68%, mean age: 62 years, range: 53–81), with mean follow-up of 254 days (range: 60–443) and 32 patients with a surgical fistula (20 males – 62%, mean age of 63 years, range: 30–84) were evaluated. Mean access flow and distribution range were similar in the two study groups, with a mean flow of 859 mL/min vs 919 mL/min, respectively. There was no significant difference in the mean radial artery diameter (4 mm vs 4.3 mm, p = 0.2). Statistically significant trends were observed for resistive index (0.57 pAVF vs 0.52 (0.07) and brachial vein cross-sectional area (13 pAVF vs 33 mm2, p = 0.06). The arteriovenous anastomosis area was significantly smaller with pAVFs (13 vs 43 mm2, p = 0.002) and the pressure difference between extremities was less for the pAVF group vs sWRC-AVF (19 vs 27 mm Hg, respectively, p = 0.03). Existence of single cephalic or basilic versus cephalic and basilic outflow did not affect vein maturation or overall flow.

Conclusions:

pAVF have a favourable hemodynamic profile with many similarities when compared with surgically created wrist fistulae. Cephalic and/or basilic vein matured with only minor outflow shunted to the deep venous system.
Non-randomized safety and performance evaluation of the av-Guardian vascular access system
Authors: Tan Chieh Suai , Tan Seck Guan , Wong Chi Leung Julian , Wee Bernard , Wong Weng Kin , Choke Edward Tieng Chek , Tan Ru Yu , Liu Peiyun , Homer-Vanniasinkam Shervanthi , Lau Titus , Choong Lina Hui Lin
Published: January 2020

Introduction:

The ability to successfully cannulate the arteriovenous fistula reliably is a critical step in the delivery of hemodialysis therapy. The av-Guardian vascular access system (Advent Access, Singapore) is designed to overcome the technical barrier to establishing reliable blunt needle access in patients with mature arteriovenous fistula.

Methods:

This was a first-in-man, prospective, non-randomized trial (registered on the Australian New Zealand Clinical Trial Registry (ACTRN12617000501347)) performed to assess the safety and feasibility of achieving repeatable successful cannulation via av-Guardian vascular access system to facilitate blunt needling in patients with mature arteriovenous fistula. The primary endpoints of the study included rate of successful hemodialysis sessions via av-Guardian vascular access system cannulation over 3 months and safety of the implants.

Results:

A total of six patients (four patients with brachiocephalic and two with radiocephalic arteriovenous fistula) were enrolled in the study. A pair of av-Guardian vascular access system were implanted, one each at the arterial and venous cannulation sites, under local anesthesia. Overall, the rate of successful cannulation through the av-Guardian vascular access system over 3 months in 216 hemodialysis sessions was 98.1% (212/216) at the arterial site and 94.4% (204/216) at the venous site. Significantly, 90% and 85.5% of the cannulations at the arterial and venous site, respectively, were successful at first attempt. Blood flow rates within the arteriovenous fistula were unaffected by the devices.

Conclusion:

The results demonstrated the safety and feasibility of a subcutaneously implanted, extravascular device in achieving repeatable successful cannulation via a constant site, to facilitate blunt needling in matured arteriovenous fistula in limited number of patients.
Linkage Between Obesity Leptin and Breast Cancer
Authors: Atoum Manar Fayiz , Alzoughool Foad , Al-Hourani Huda
Published: January 2020

Many cancers might be influenced by obesity, including breast cancer, the leading cause of cancer death among women. Obesity is a complex state associated with multiple physiological and molecular changes capable of modulating the behavior of breast tumor cells and the surrounding microenvironment. This review discussed the inverse association between obesity and breast cancer among premenopausal breast cancer females and the positive association among postmenopausal. Four mechanisms may link obesity and breast cancer including leptin and leptin receptor expression, adipose chronic inflammation, sex hormone alternation, and insulin and insulinlike growth factor 1 (IGF-1) signaling. Leptin has been involved in breast cancer initiation, development, and progression through signaling transduction network. Leptin functions are strengthened through cross talk with multiple oncogenes, cytokines, and growth factors. Adipose chronic inflammation promotes cancer growth and angiogenesis and modifies the immune responses. A pro-inflammatory microenvironment at tumor site promotes cytokines and pro-inflammatory mediators adjacent to the tumor. Leptin stimulates pro-inflammatory cytokines and promotes T-helper 1 responses. Obesity is common of chronic inflammation. In obese patients, white adipose tissue (WAT) will promote pro-inflammatory mediators that will encourage tumor growth and WAT inflammation. Sex hormone alternation of estrogens is associated with increased risk for hormone-sensitive breast cancers. Estrogens cause tumorigenesis by its effect on signaling pathways that lead to DNA damage, stimulation angiogenesis, mutagenesis, and cell proliferation. In postmenopausal females, and due to termination of ovarian function, estrogens were produced extra gonadally, mainly in peripheral adipose tissues where adrenal-produced androgen precursors are converted to estrogens. Active estradiol leads to breast cancer development by binding to ERα, which is modified by receptor’s interaction of various signal transduction pathways. Hyperinsulinemia and IGF-1 activate the MAPK and PI3K pathways, leading to cancer-promoting effects. Cross talk between insulin/IGF and estrogen signaling pathways promotes hormone-sensitive breast cancer development. Hyperinsulinemia is a risk factor for breast cancer that explains the obesity-breast cancer association. Controlling IGF-1 level and targeting IGF-1 receptors among different breast cancer subtypes may be useful for breast cancer treatment. This review discussed several leptin signaling pathways, highlighting the potential advantage of targeting leptin as a potential target of the novel therapeutic strategies for breast cancer treatment.
Children with cerebral palsy: Family and parent demographic characteristics and family strengths in Greece and Italy
Authors: Tsibidaki Assimina
Published: January 2020

The study focuses on families raising a child with cerebral palsy to investigate family strengths and their association with family and parent demographic characteristics in Greece and Italy. Participants were 120 parents raising a biological child with cerebral palsy. Data collection used a self-report questionnaire and the Family Strengths Inventory. According to the findings, families share a high sense of family strengths, which is mainly represented in the high sense of ‘pride’ and ‘accord’. In addition, demographic characteristics seem to be important predictors of well-being and strengthen parents and families raising a child with cerebral palsy.
Insights from user reviews to improve mental health apps
Authors: Alqahtani Felwah , Orji Rita
Published: January 2020

Mental health applications hold great promise as interventions for addressing common mental issues. Although many people with mental health issues use mobile app interventions, their adherence level remains low. Low engagement affects the effectiveness of mobile interventions. However, there is still a dearth of research to explain the reasons for low engagement. User experience and usability are two factors that determine the adoption and usage of apps. Analyzing user reviews of mobile apps for mental health issues reveals user experience and what features users liked and disliked in the apps and hence informs future app design and refinements. This research aims to analyze user reviews of publicly available mental health applications to uncover their strengths, weaknesses, and gaps, hence revealing why users are likely to cease using these applications. We mined reviews of 106 mental health apps retrieved from Apple’s App Store and Google Play and employed thematic analysis on 13,549 reviews. The review analysis shows that users placed more emphasis on the user interface and the user-friendliness of the app. Users also appreciated apps that present them with a variety of options, functionalities, and content that they can choose. Again, apps that offer adaptive functionalities that allow users to adapt some app features also received high ratings. In contrast, poor usability emerged as the most common reason for abandoning mental health apps. Other pitfalls include lack of a content variety, lack of personalization, lack of customer service and trust, and security and privacy issues.
Autotransplantation of a surgically removed canine using a customised 3D-printed surgical template
Authors: Curtis Jacob M T , Foster Emma C , Ananth Sankaranarayanan , Eckhardt Charlotte E , Knox Jeremy , Gonzalez Alvarez Alba , Newton Richard
Published: January 2020

Autotransplantation is a treatment option with high reported survival rates to replace failing teeth in the anterior maxilla. This treatment requires a multidisciplinary approach from orthodontists, paediatric dentists, restorative dentists, and oral and maxillofacial surgeons to achieve successful outcomes. Success is dependent on many factors including stage of root development, handling of the periodontal ligament, extra-alveolar time and splinting. This case report presents the novel use of digitally designed and three-dimensional (3D) printed surgical templates to aid intraoperatively and reduce the extra-alveolar time. A preoperative cone-beam computed tomography scan allowed digital planning and construction of surgical templates that replicated the exact root dimensions of impacted maxillary canines. These templates were subsequently 3D printed in resin, sterilised and utilised intraoperatively to aid socket preparation before the surgical autotransplantation.
Understanding public-stigma and self-stigma in the context of dementia: A systematic review of the global literature
Authors: Nguyen Trang , Li Xiaoming
Published: January 2020

Stigma negatively impact quality of life of people with dementia and their family members. Yet the literature in stigma and dementia remains scant. This article systematically reviews manifestations of and associated factors with public-stigma and self-stigma in the context of dementia. After searching and screening on the three major databases of PubMed, Embase, and psycINFO, 26 articles, including 17 quantitative papers and nine qualitative papers, were selected for synthesis. Results show consistently limited knowledge, as well as stereotype, prejudice, and discrimination of public toward people with dementia and their family caregivers. Demographic characteristics of general public were found to be associated with the level of their stigma against dementia. People with dementia and their family caregivers also perceived negative stereotype, prejudice, and discrimination from general public and healthcare professionals. They reported negative feelings of themselves and tended to delay help-seeking. Psychological factors rather than sociodemographic factors shaped self-stigma of people with dementia and their families. This systematic review highlights the need of future studies in both public-stigma and self-stigma in dementia research in different contexts and cultures, as well as the development of evidence-based and culturally competent interventions and mass media campaigns to reconstruct public perception of dementia.
A review on the mechanical performance of three-dimensional warp interlock woven fabrics as reinforcement in composites
Authors: Li Mengru , Wang Peng , Boussu François , Soulat Damien
Published: January 2020

In recent years, the research interest on three-dimensional warp interlock woven fabrics (3DWIFs) as reinforcement in composites is warranted and obtained popularity due to their advantages over two-dimensional laminated fabrics. The current literature tends to address the aspects of mechanical properties of 3DWIFs by experimental and numerical approaches. This review aims at providing an overview and comprehensive understanding of dry 3DWIFs. The filaments/yarns used, the common structures, and categories of 3DWIFs are reviewed. Recent characterizations of the mechanical performance of dry 3DWIFs are discussed. Theoretical and numerical models for predicting the mechanical properties of dry 3DWIFs are also delineated. The critical review can provide valuable ideas and guidance for future studies.
A Novel Evaluation Model for a Mixed-Reality Surgical Navigation System: Where Microsoft HoloLens Meets the Operating Room
Authors: Zuo Yan , Jiang Taoran , Dou Jiansheng , Yu Dewang , Ndaro Zaphlene Nyakuru , Du Yunxiao , Li Qingfeng , Wang Shuyi , Huang Gang
Published: January 2020

HoloLens-based mixed-reality surgical navigation system (MR-SNS) technology has made great progress. However, the methodology for evaluating users’ perceptions concerning the safety, comfort, and efficiency of MR-SNS is still in its infancy. This study was intended to develop a method to systematically evaluate an existing MR-SNS system during actual clinical applications. This method differs from other existing methods currently used in industry, education, and device maintenance. Based on analytical hierarchy process theory and ergonomics evaluation methods, in this article, we propose a novel multicriteria evaluation model for a HoloLens-based MR-SNS. The model includes factors such as comfort, safety, and effectiveness, and is performed in an actual clinical application. A comprehensive experimental platform and scoring system that can analyze all indicators was built. The validation test showed no statistically significant differences in the accuracy of the 3 different movement patterns ( P = .95, P > .05). However, the static pattern showed the best accuracy. In addition, no significant difference ( P = .68, P > .05) in accuracy was found under 4 kinds of illuminance. A comparison of the results of this evaluation model and the input from experts who use the HoloLens-based MR-SNS in hospitals, indicated that this model has good precision (100%), recall (80%), and F1-measure (88.89%). The results highlighted the full efficacy of the proposed model in determining whether this system can be used in clinical trials to provide indicators for preliminary ex ante feasibility studies. This article describes the lessons learned from conducting this evaluation study of MR-SNS as part of the design process.
Effects of chemical pre-treatment on structure and property of polyacrylonitrile based pre-oxidized fibers
Authors: Sun Xiaolu , Song Jiayin , Zhang Jin , Liu Jingyan , Ke Huizhen , Wei Qufu , Cai Yibing
Published: January 2020

Polyacrylonitrile-based pre-oxidized fibers with improved thermal stability, flame retardant, and mechanical properties were made from the pristine polyacrylonitrile fibers through chemical pretreatment followed by pre-oxidation in air. The morphological structure of the polyacrylonitrile-based pre-oxidized fibers was investigated by Fourier transfer infrared spectra, X-ray diffraction, scanning electron microscopy, and X-ray energy dispersive spectrometer. The changes of characteristic functional groups and chemical compositions confirmed the successful modification of the polyacrylonitrile fibers during pre-treatment. The grooves and cracks on the surface of polyacrylonitrile-based pre-oxidized fibers were remarkably decreased in comparison with that of pristine polyacrylonitrile fibers. The evolution of crystalline structure of the polyacrylonitrile fibers proved the occurrence of cyclization reactions during pre-oxidation. Meanwhile, thermal stability, flame retardant, and mechanical properties of polyacrylonitrile-based pre-oxidized fibers were also investigated by thermogravimetric analyzer, oxygen index meter, micro combustion calorimeter, and single fiber tensile tester, respectively. The results demonstrated that the polyacrylonitrile-based pre-oxidized fibers initially pre-treated by hydroxylamine hydrochloride, followed by monoethanolamine, had a high limiting oxygen index of 40.1 and breaking strength of 2.03 cN/dtex. The peak of heat release rate and total heat release of polyacrylonitrile-based pre-oxidized fibers decreased significantly while its charred residues increased, contributing to the improved flame retardant property.
Feature analysis of indoor particulate matter concentration using fiber filtration for mechanical ventilation
Authors: Xie Wei , Fan Yuesheng , Yu Junwei , Zhang Xin , Si Pengfei
Published: January 2020

Experiments and theoretical analyses are conducted in an office in Xi’an to study indoor particle concentration through establishing a mass balance equation and real-time monitoring. Meanwhile, the filtration efficiencies for different grades of filter media have been tested and verified by experiments. Studies are conducted on indoor particulate emission source and concentration change in combination with equation of linear regression, linear fitting curve of indoor–outdoor concentration, as well as indoor concentration decay profile. The results indicate that coarse filters G1 to G4 are used in mechanical ventilation to filter larger particles. However, it can only achieve 1.6%–15.2% for PM2.5 filtration efficiency. On the other hand, F7 to H10 filters could reach the high efficiency of 55.6%–69.7%. Furthermore, indoor PM2.5 concentration with a coarse filter using G4 filter can obviously reduce the indoor particulate concentration to 69–75 μg/m3. It ranges from 87 to 90 μg/m3 using a G3 filter, while the outdoor PM2.5 concentration is 135–150 μg/m3.
Design and wrench-feasible workspace analysis of a cable-driven hybrid joint
Authors: Zhang Shan , Cao Dongxing , Min Hong , Li Shuai , Zhang Xinglei
Published: January 2020

This article proposes a cable-driven hybrid joint (CDHJ), focuses on the effects of external wrench payload and structural parameters on the wrench-feasible workspace for the preliminary design of the mechanism, and further discusses the wrench exertion capability of the mechanism under a certain configuration. This CDHJ has central rigid support with a revolute pair and a central compression spring support. Due to the unilateral property of cables and the flexible compression spring, the kinematic model cannot define the workspace directly; it should be combined with the statics for possible solution, including the spring lateral buckling model based on the elliptic integral solution. Moreover, a global tension index which is to evaluate the wrench-closure property of the global workspace, combined with an index which is to assess the size of the workspace, is proposed to better compare the effects of different external wrench payloads and different structural parameters on the workspace. Simulations were performed and demonstrated the correctness and feasibility of the inverse kinematics and workspace analysis of the joint. Hence, the proposed mechanism has potential use in robotics especially in wheelchair-mounted robotic manipulator joint.
Accuracy of GPS sport watches in measuring distance in an ultramarathon running race
Authors: Johansson Rebecca E , Adolph Steffen T , Swart Jeroen , Lambert Mike I
Published: January 2020

Purpose

The aim of the study was to determine the accuracy of various global positioning system (GPS) sport watches in measuring distance throughout a 56 km running race.

Methods

The measured distance between timing mats was compared to the reported distance of GPS devices at the 2017 Two Oceans Marathon. Runners (n = 255) were divided into eight different categories based on GPS sport watch brand and model. The difference between distance measured by GPS and race markers was represented in metres (m) and as a relative error (%).

Results

The Garmin Fenix and cell phone categories had higher errors in measuring distance from the 16 km to finish (56 km) point compared to all other devices, except for activity watches.

Conclusions

The GPS sport watches in this study have an accuracy of 0.6 ± 0.3% to 1.9 ± 1.5% (median ± interquartile range) in reporting distance covered. This indicates that GPS sport watches are a valid and feasible method for sport scientists and coaches to measure performance and track training load. However, the small error associated with each brand needs to be considered when data are interpreted.
Acute right heart failure: future perspective with the PERKAT RV pulsatile right ventricular support device
Authors: Ferrari Markus W. , Schulze P. Christian , Kretzschmar Daniel
Published: January 2020

Acute right heart failure is associated with impaired prognosis in cardiogenic shock. Since most pharmacological therapies are not evaluated for the failing right ventricle, or even contraindicated, there is a need for rapid minimal invasive circulatory right heart support. The PERKAT RV is such a device for acute therapy in congestive heart failure. It reduces the central venous pooling by pumping blood from the inferior vena cava into the pulmonary artery with flow rates of up to 4 litres/min. The device was evaluated in an animal model of acute pulmonary embolism after careful in vitro tests. PERKAT RV increased cardiac output by 59% in sheep suffering from acute right heart failure. We await the first human implantation in the near future. Based on the PERKAT concept, future devolvement will also focus on left heart support.
Le développement d’une collaboration inter organisationelle durable en promotion de la santé : une analyse processuelle
Authors: Corriveau Anne-Marie , Dufour Yvon
Published: January 2020

Résumé :

En raison de l’éventail, de la diversité et de la complexité des déterminants de la santé, les bénéfices recherchés par les efforts de promotion ne peuvent généralement être générés sans la collaboration de plusieurs organisations. Toutefois, le développement d’une collaboration durable n’est pas facile. Cet article est le fruit d’une recherche empirique portant sur une collaboration durable en promotion de la santé. Les données ont été recueillies dans le cadre d’une étude longitudinale qui examine les principaux évènements qui ont marqué la collaboration au cours d’une période de vingt ans. L’analyse montre que la collaboration inter organisationnelle est un phénomène complexe digne de sa réputation, et elle invite les chercheurs comme les praticiens à distinguer les enjeux de la collaboration autour de projets spécifiques et ceux liés à ce que nous appelons la collaboration durable.
Long-Term Sinonasal Function Following Transnasal Pituitary Surgery: A Comparison of Surgical Approach
Authors: Cho Jemma , Grayson Jessica W. , Christensen Jenna , Winder Mark J. , Sheehy John , Steel Tim , Bentivoglio Peter , Barham Henry P. , McCormack Ann , Harvey Richard J.
Published: January 2020

Background

Surgical approaches to the pituitary have undergone significant changes from transcranial, sublabial, direct transnasal microscopic, and now endoscopic. This study compares sinonasal outcomes from patients from these techniques.

Methods

A cross-sectional study of patients who underwent pituitary surgery in a tertiary setting was conducted. Patients were recruited via phone, mail, e-mail, and in person. Surveys with questions on nasal function, subsequent nasal treatment, the Nasal Symptom Score (NSS), Sinonasal Outcome Test-22 (SNOT-22), Chronic Sinusitis Survey (CSS), and Short Form 36 version 2 (SF-36v2) were obtained.

Results

A total of 252 surveys were sent, of which 165 were returned (65.48% response rate) and 16 were excluded (3 records destroyed, 13 transcranial approach). A total of 149 patients (age 60.10 ± 13.99 years, 47.83% female) were assessed with the following breakdown: sublabial (n = 69), transnasal microscopic (n = 28), and endoscopic (n = 52) approaches. Sublabial and transnasal microscopic, compared to endoscopic, had more sinus treatment (30.43%, 39.29%, and 15.38%; P = .05), medication use (28.99%, 32.14%, and 11.54%; P = .04), and new allergy symptoms (21.74%, 7.14%, and 1.92%; P < .01). Compared to sublabial and transnasal microscopic, endoscopic patients had superior NSSs (0.40 [1.00], 0.60 [1.75], and 0.20 [0.60]; P = .05), SNOT-22 total scores (1.02 ± 0.58, 1.40 ± 0.78, and 1.00 ± 0.59; P < .01), and CSS medication subscores (100.00 [8.33], 100.00 [8.33], and 100.00 [0.00]; P = .03). Endoscopic patients also reported superior SF-36v2 physical subscores (44.02 ± 11.14, 41.13 ± 9.86, and 47.60 ± 10.12; P = .03).

Conclusion

Nasal function was superior, and further sinus therapy and medication use was lower in patients with endoscopic approaches. Disease-specific quality of life was superior and the endoscopic approach resulted in reduced long-term sinonasal morbidity.
Assessing Workplace Breastfeeding Support Among Working Mothers in the United States
Authors: McCardel Rachel E. , Padilla Heather M.
Published: January 2020

Background: Workplace breastfeeding resources (e.g., break times and private spaces) help working mothers exclusively breastfeed for 6 months. However, not every employer offers lactation resources as specified in the Affordable Care Act. This study examined working mothers’ access to workplace breastfeeding resources, their barriers and facilitators to combining breastfeeding and work, and their recommendations to improve access to breastfeeding resources. Methods: Working mothers between the ages of 18 to 50 years who had given birth in the previous 2 years were recruited online to participate in the study. An online, cross-sectional survey collected qualitative and quantitative data from working mothers on their access to workplace breastfeeding resources and experiences with breastfeeding at work. Descriptive statistics were used to report the quantitative results from the survey, and the qualitative data were examined using the constant comparative method. Findings: Fifty-two participants met the inclusion criteria for the study and completed the survey. Most of the participants in the study were White, college-educated women who worked in clerical or administration support and education occupations. Approximately 78.8% of the participants reported access to private spaces and 65.4% reported access to break times for breastfeeding. Fewer participants reported access to breast pumps, lactation consultants, and support groups. Conclusions/Application to Practice: There are gaps in access to workplace breastfeeding resources, but occupational health nurses can inform and help employers implement lactation resources to reduce breastfeeding disparities.
Black Mothering in Action: The Racial-Class Socialization Practices of Low-Income Black Single Mothers
Authors: Turner Jennifer L.
Published: January 2020

African Americans have long dealt with racism, discrimination, and racialized state and vigilante violence. As such, African American parents must educate their children about the realities of racism in the United States and how to cope with racism and discrimination. This practice, known as racial socialization, is a key aspect of Black parents’ parenting practices. Much of this labor tends to fall on the shoulders of Black mothers. To date, most of the scholarship on Black mothers’ racial socialization practices focuses on Black middle-class mothers. In this study, the author uses in-depth interviews with low-income African American single mothers in Virginia to examine how low-income Black single mothers racially socialize their children, what major concerns they express regarding raising Black children, and how their racial socialization practices and the concerns they express compare with those of Black middle-class mothers. Paralleling previous studies, the findings show that low-income Black single mothers generally fear for their children’s, especially their sons’, safety. They also invoke respectability politics when racially socializing their children, encouraging them not to dress or behave in ways that will reinforce stereotypes of Black boys as thugs or criminals. Diverging from previous research, however, the author argues that low-income Black single mothers’ employment of respectability politics is largely aspirational, as, unlike middle-class mothers, they are not able to assert their class status in an effort to prevent their children from experiencing discrimination.
Absorbable suture can be effectively and safely used to close the mesenteric defect in a gastric bypass Sprague-Dawley rat model
Authors: Yao Libin , Dolo Ponnie Robertlee , Shao Yong , Li Chao , Widjaja Jason , Hong Jian , Zhu Xiaocheng
Published: January 2020

Background

To observe if closing the mesenteric defect with absorbable sutures creates a safe adhesion compared to non-absorbable suture after Roux-en-Y gastric bypass.

Methods

Rats were randomly assigned to 5 experimental groups according to the different suture materials used in closing the mesenteric defects (Peterson’s space) after Roux-en-Y gastric bypass. Group A (control group), Group B (non-absorbable suture, Prolene suture), Group C (biological glue), Group D (non-absorbable suture, polyester suture) and Group E (absorbable suture). All rats were followed up for 8 weeks postoperatively and underwent laparotomy to observe the degree of adhesion and closure of the mesenteric defect.

Results

No significant difference was found in the decrease in food intake and body weight among all groups. No internal hernia (IH) occurred in any group. The mesenteric defects of Group A remained completely visible without any closure or adhesion. Multiple gaps were found between the Prolene suture and the mesentery along the suture line in Group B. The mesenteric defects of Group C were complete closed with multiple adhesions of the small intestine and the greater omentum. The mesenteric defects in both Group D and Group E closed completely. The average adhesion scores in Group A and Group B were 0 and 0.33 ± 0.52 respectively. The average adhesion score in group C (3.83 ± 0.41) was higher than the other groups (p<0.05). The average adhesion scores in Group D and E were similar (3.17 ± 0.41 and 3.00 ± 0.00 respectively).

Conclusion

Absorbable suture created a safe adhesion score between the mesentery which was not inferior to non-absorbable sutures.
Impact of diffusing lung capacity before and after neoadjuvant concurrent chemoradiation on postoperative pulmonary complications among patients with stage IIIA/N2 non-small-cell lung cancer
Authors: Shin Sumin , Choi Yong Soo , Jung Jae Jun , Im Yunjoo , Shin Sun Hye , Kang Danbee , Cho Jong Ho , Kim Hong Kwan , Kim Jhingook , Zo Jae Ill , Shim Young Mog , Park Keunchil , Ahn Myung-Ju , Ahn Yong Chan , Lee Genehee , Cho Juhee , Lee Ho Yun , Park Hye Yun
Published: January 2020

Background and objective

This study aims to evaluate the impact of diffusing capacity of the lung for carbon monoxide (DLco) before and after neoadjuvant concurrent chemoradiotherapy (CCRT) on postoperative pulmonary complication (PPC) among stage IIIA/N2 non-small-cell lung cancer (NSCLC) patients.

Methods

We retrospectively studied 324 patients with stage IIIA/N2 NSCLC between 2009 and 2016. Patients were classified into 4 groups according to DLco before and after neoadjuvant CCRT; normal-to-normal (NN), normal-to-low (NL), low-to-low (LL), and low-to-very low (LVL). Low DLco and very low DLco were defined as DLco < 80% predicted and DLco < 60% predicted, respectively.

Results

On average, DLco was decreased by 12.3% (±10.5) after CCRT. In multivariable-adjusted analyses, the incidence rate ratio (IRR) for any PPC comparing patients with low DLco to those with normal DLco before CCRT was 2.14 (95% confidence interval (CI) = 1.36–3.36). Moreover, the IRR for any PPC was 3.78 (95% CI = 1.68–8.49) in LVL group compared to NN group. The significant change of DLco after neoadjuvant CCRT had an additional impact on PPC, particularly after bilobectomy or pneumonectomy with low baseline DLco.

Conclusions

The DLco before CCRT was significantly associated with risk of PPC, and repeated test of DLco after CCRT would be helpful for risk assessment, particularly in patients with low DLco before neoadjuvant CCRT.
Lung-protective ventilation worsens ventilator-induced diaphragm atrophy and weakness
Authors: Zhou Xian-Long , Wei Xiao-Jun , Li Shao-Ping , Ma Hao-Li , Zhao Yan
Published: January 2020

Background

Lung–protective ventilation (LPV) has been found to minimize the risk of ventilator–induced lung injury (VILI). However, whether LPV is able to diminish ventilator–induced diaphragm dysfunction (VIDD) remains unknown. This study was designed to test the hypothesis that LPV protects the diaphragm against VIDD.

Methods

Adult male Wistar rats received either conventional mechanical (tidal volume [VT]: 10 ml/kg, positive end–expiratory pressure [PEEP]: 2 cm H2O; CV group) or lung-protective (VT: 5 ml/kg, PEEP: 10 cm H2O; LPV group) ventilation for 12 h. Then, diaphragms and lungs were collected for biochemical and histological analyses. Transcriptome sequencing (RNA–seq) was performed to determine the differentially expressed genes in the diaphragms between groups.

Results

Our results suggested that LPV was associated with diminished pulmonary injuries and reduced oxidative stress compared with the effects of the CV strategy in rats. However, animals that received LPV showed increased protein degradation, decreased cross–sectional areas (CSAs) of myofibers, and reduced forces of the diaphragm compared with the same parameters in animals receiving CV (p < 0.05). In addition, the LPV group showed a higher level of oxidative stress in the diaphragm than the CV group (p < 0.05). Moreover, RNA–seq and western blots revealed that the peroxisome proliferator–activated receptor γ coactivator–1alpha (PGC–1α), a powerful reactive oxygen species (ROS) inhibitor, was significantly downregulated in the LPV group compared with its expression in the CV group (p < 0.05).

Conclusions

Compared with the CV strategy, the LPV strategy did not protect the diaphragm against VIDD in rats. In contrast, the LPV strategy worsened VIDD by inducing oxidative stress together with the downregulation of PGC–1α in the diaphragm. However, further studies are required to determine the roles of PGC–1α in ventilator-induced diaphragmatic oxidative stress.
Sodium–glucose cotransporter 2 inhibitor Dapagliflozin attenuates diabetic cardiomyopathy
Authors: Arow M. , Waldman M. , Yadin D. , Nudelman V. , Shainberg A. , Abraham N. G. , Freimark D. , Kornowski R. , Aravot D. , Hochhauser E. , Arad M.
Published: January 2020

Background

Diabetes mellitus type 2 (DM2) is a risk factor for developing heart failure but there is no specific therapy for diabetic heart disease. Sodium glucose transporter 2 inhibitors (SGLT2I) are recently developed diabetic drugs that primarily work on the kidney. Clinical data describing the cardiovascular benefits of SGLT2Is highlight the potential therapeutic benefit of these drugs in the prevention of cardiovascular events and heart failure. However, the underlying mechanism of protection remains unclear. We investigated the effect of Dapagliflozin—SGLT2I, on diabetic cardiomyopathy in a mouse model of DM2.

Methods

Cardiomyopathy was induced in diabetic mice (db/db) by subcutaneous infusion of angiotensin II (ATII) for 30 days using an osmotic pump. Dapagliflozin (1.5 mg/kg/day) was administered concomitantly in drinking water. Male homozygous, 12–14 weeks old WT or db/db mice (n = 4–8/group), were used for the experiments. Isolated cardiomyocytes were exposed to glucose (17.5–33 mM) and treated with Dapagliflozin in vitro. Intracellular calcium transients were measured using a fluorescent indicator indo-1.

Results

Angiotensin II infusion induced cardiomyopathy in db/db mice, manifested by cardiac hypertrophy, myocardial fibrosis and inflammation (TNFα, TLR4). Dapagliflozin decreased blood glucose (874 ± 111 to 556 ± 57 mg/dl, p < 0.05). In addition it attenuated fibrosis and inflammation and increased the left ventricular fractional shortening in ATII treated db/db mice. In isolated cardiomyocytes Dapagliflozin decreased intracellular calcium transients, inflammation and ROS production. Finally, voltage-dependent L-type calcium channel (CACNA1C), the sodium–calcium exchanger (NCX) and the sodium–hydrogen exchanger 1 (NHE) membrane transporters expression was reduced following Dapagliflozin treatment.

Conclusion

Dapagliflozin was cardioprotective in ATII-stressed diabetic mice. It reduced oxygen radicals, as well the activity of membrane channels related to calcium transport. The cardioprotective effect manifested by decreased fibrosis, reduced inflammation and improved systolic function. The clinical implication of our results suggest a novel pharmacologic approach for the treatment of diabetic cardiomyopathy through modulation of ion homeostasis.
HMGB1/RAGE axis mediates stress-induced RVLM neuroinflammation in mice via impairing mitophagy flux in microglia
Authors: Zhang Shutian , Hu Li , Jiang Jialun , Li Hongji , Wu Qin , Ooi Kokwin , Wang Jijiang , Feng Yi , Zhu Danian , Xia Chunmei
Published: January 2020

Background

Microglial mediated neuroinflammation in the rostral ventrolateral medulla (RVLM) plays roles in the etiology of stress-induced hypertension (SIH). It was reported that autophagy influenced inflammation via immunophenotypic switching of microglia. High-mobility group box 1 (HMGB1) acts as a regulator of autophagy and initiates the production of proinflammatory cytokines (PICs), but the underlying mechanisms remain unclear.

Methods

The stressed mice were subjected to intermittent electric foot shocks plus noises administered for 2 h twice daily for 15 consecutive days. In mice, blood pressure (BP) and renal sympathetic nerve activity (RSNA) were monitored by noninvasive tail-cuff method and platinum-iridium electrodes placed respectively. Microinjection of siRNA-HMGB1 (siHMGB1) into the RVLM of mice to study the effect of HMGB1 on microglia M1 activation was done. mRFP-GFP-tandem fluorescent LC3 (tf-LC3) vectors were transfected into the RVLM to evaluate the process of autolysosome formation/autophagy flux. The expression of RAB7, lysosomal-associated membrane protein 1 (LAMP1), and lysosomal pH change were used to evaluate lysosomal function in microglia. Mitophagy was identified by transmission electron microscopic observation or by checking LC3 and MitoTracker colocalization under a confocal microscope.

Results

We showed chronic stress increased cytoplasmic translocations of HMGB1 and upregulation of its receptor RAGE expression in microglia. The mitochondria injury, oxidative stress, and M1 polarization were attenuated in the RVLM of stressed Cre-CX3CR1/RAGEfl/fl mice. The HMGB1/RAGE axis increased at the early stage of stress-induced mitophagy flux while impairing the late stages of mitophagy flux in microglia, as revealed by decreased GFP fluorescence quenching of GFP-RFP-LC3-II puncta and decreased colocalization of lysosomes with mitochondria. The expressions of RAB7 and LAMP1 were decreased in the stressed microglia, while knockout of RAGE reversed these effects and caused an increase in acidity of lysosomes. siHMGB1 in the RVLM resulted in BP lowering and RSNA decreasing in SIH mice. When the autophagy inducer, rapamycin, is used to facilitate the mitophagy flux, this treatment results in attenuated NF-κB activation and reduced PIC release in exogenous disulfide HMGB1 (ds-HMGB1)-stimulated microglia.

Conclusions

Collectively, we demonstrated that inhibition of the HMGB1/RAGE axis activation led to increased stress-induced mitophagy flux, hence reducing the activity of microglia-mediated neuroinflammation and consequently reduced the sympathetic vasoconstriction drive in the RVLM.
Isotalatizidine, a C19-diterpenoid alkaloid, attenuates chronic neuropathic pain through stimulating ERK/CREB signaling pathway-mediated microglial dynorphin A expression
Authors: Shao Shuai , Xia Huan , Hu Min , Chen Chengjuan , Fu Junmin , Shi Gaona , Guo Qinglan , Zhou Yu , Wang Wenjie , Shi Jiangong , Zhang Tiantai
Published: January 2020

Background

Isotalatizidine is a representative C19-diterpenoid alkaloid extracted from the lateral roots of Aconitum carmichaelii, which has been widely used to treat various diseases on account of its analgesic, anti-inflammatory, anti-rheumatic, and immunosuppressive properties. The aim of this study was to evaluate the analgesic effect of isotalatizidine and its underlying mechanisms against neuropathic pain.

Methods

A chronic constrictive injury (CCI)-induced model of neuropathic pain was established in mice, and the limb withdrawal was evaluated by the Von Frey filament test following isotalatizidine or placebo administration. The signaling pathways in primary or immortalized microglia cells treated with isotalatizidine were analyzed by Western blotting and immunofluorescence.

Results

Intrathecal injection of isotalatizidine attenuated the CCI-induced mechanical allodynia in a dose-dependent manner. At the molecular level, isotalatizidine selectively increased the phosphorylation of p38 and ERK1/2, in addition to activating the transcription factor CREB and increasing dynorphin A production in cultured primary microglia. However, the downstream effects of isotalatizidine were abrogated by the selective ERK1/2 inhibitor U0126-EtOH or CREB inhibitor of KG-501, but not by the p38 inhibitor SB203580. The results also were confirmed in in vivo experiments.

Conclusion

Taken together, isotalatizidine specifically activates the ERK1/2 pathway and subsequently CREB, which triggers dynorphin A release in the microglia, eventually leading to its anti-nociceptive action.
A microRNA signature of toxic extrasynaptic N-methyl-D-aspartate (NMDA) receptor signaling
Authors: Bas-Orth Carlos , Koch Mirja , Lau David , Buchthal Bettina , Bading Hilmar
Published: January 2020

The cellular consequences of N-Methyl-D-Aspartate receptor (NMDAR) stimulation depend on the receptors’ subcellular localization. Synaptic NMDARs promote plasticity and survival whereas extrasynaptic NMDARs mediate excitotoxicity and contribute to cell death in neurodegenerative diseases. The mechanisms that couple activation of extrasynaptic NMDARs to cell death remain incompletely understood. We here show that activation of extrasynaptic NMDARs by bath application of NMDA or L-glutamate leads to the upregulation of a group of 19 microRNAs in cultured mouse hippocampal neurons. In contrast, none of these microRNAs is induced upon stimulation of synaptic activity. Increased microRNA expression depends on the pri-miRNA processing enzyme Drosha, but not on de novo gene transcription. These findings suggest that toxic NMDAR signaling involves changes in the expression levels of particular microRNAs.
Performance of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) in diagnosis of ovarian cancer: a systematic review and meta-analysis
Authors: Li Kexin , Pei Yuqing , Wu Yue , Guo Yi , Cui Wei
Published: January 2020

Background

To evaluate the diagnostic performance of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) for ovarian cancer.

Patients and methods

A thorough research was conducted in PubMed, Web of Science and Embase (until November 2018) to identify studies evaluating the accuracy of MALDI-TOF-MS for ovarian cancer. Using Meta-Disc1.4, Review Manager 5.3 and Stata 15.1 software to analyze the pooled results: sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), and 95% confidence intervals (CI). The summary receiver operating characteristic curves (SROC) and area under the curve (AUC) show the overall performance of MALDI-TOF-MS.

Results

Eighteen studies were included in the meta-analysis. Methodological quality analysis of the included studies showed that these articles were at low risk of bias and applicability concerns in total. Summary estimates of the diagnostic parameters were as follows: sensitivity, 0.77 (95% CI: 0.73–0.80); specificity, 0.72 (95% CI: 0.70–0.74), PLR, 2.80 (95% CI: 2.41–3.24); NLR, 0.30 (95% CI: 0.22–0.40) and DOR, 10.71 (95% CI: 7.81–14.68). And the AUC was 0.8336. Egger’s test showed no significant publication bias in this meta-analysis.

Conclusion

In conclusion, MALDI-TOF-MS shows a good ability for diagnosing ovarian cancer. Further evaluation and optimization of standardized procedures are necessary for complete relying on MALDI-TOF-MS to diagnose ovarian cancer.
Clinical guided computer tomography decisions are advocated in potentially severely injured trauma patients: a one-year audit in a level 1 trauma Centre with long pre-hospital times
Authors: Bågenholm Anna , Dehli Trond , Eggen Hermansen Stig , Bartnes Kristian , Larsen Marthe , Ingebrigtsen Tor
Published: January 2020

Background

The International Commission on Radiological Protection’s (ICRP) justification principles state that an examination is justified if the potential benefit outweighs the risk for radiation harm. Computer tomography (CT) contributes 50% of the radiation dose from medical imaging, and in trauma patients, the use of standardized whole body CT (SWBCT) increases. Guidelines are lacking, and reviews conclude conflictingly regarding the benefit. We aimed to study the degree of adherence to ICRP’s level three justification, the individual dose limitation principle, in our institution.

Methods

This is a retrospective clinical audit. We included all 144 patients admitted with trauma team activation to our regional Level 1 trauma centre in 2015. Injuries were categorized according to the Abbreviated Injury Scale (AIS) codes. Time variables, vital parameters and interventions were registered. We categorized patients into trauma admission SWBCT, selective CT or no CT examination strategy groups. We used descriptive statistics and regression analysis of predictors for CT examination strategy.

Results

The 144 patients (114 (79.2%) males) had a median age of 31 (range 0–91) years. 105 (72.9%) had at least one AIS ≥ 2 injury, 26 (18.1%) in more than two body regions. During trauma admission, at least one vital parameter was abnormal in 46 (32.4%) patients, and 73 (50.7%) underwent SWBCT, 43 (29.9%) selective CT and 28 (19.4%) no CT examination. No or only minor injuries were identified in 17 (23.3%) in the SWBCT group. Two (4.6%) in the selective group were examined with a complement CT, with no new injuries identified. A significantly (p < 0.001) lower proportion of children (61.5%) than adults (89.8%) underwent CT examination despite similar injury grades and use of interventions. In adjusted regression analysis, patients with a high-energy trauma mechanism had significantly (p = 0.028) increased odds (odds ratio = 4.390, 95% confidence interval 1.174–16.413) for undergoing a SWBCT.

Conclusion

The high proportion of patients with no or only minor injuries detected in the SWBCT group and the significantly lower use of CT among children, indicate that use of a selective CT examination strategy in a higher proportion of our patients would have approximated the ICRP’s justification level three, the individual dose limitation principle, better.