bluuebunny/crossref_metadata_2025 huggingface dataset:
New insulin delivery devices and glycemic outcomes in young patients with type 1 diabetes: a protocol for a systematic review and meta-analysis
Authors: Dos Santos Tiago Jeronimo , Donado Campos Juan de Mata , Fraga Medin Cristina Alexandra , Argente Jesús , Rodríguez-Artalejo Fernando
Published: November 2019

Background

Optimal type 1 diabetes mellitus (T1D) care requires lifelong appropriate insulin treatment, which can be provided either by multiple daily injections (MDI) of insulin or by continuous subcutaneous insulin infusion (CSII). An increasing number of trials and previous systematic reviews and meta-analyses (SRMA) have compared both CSII and MDI but have provided limited information on equity and fairness regarding access to, and the effect of, those insulin devices. This study protocol proposes a clear and transparent methodology for conducting a SRMA of the literature (1) to assess the effect of CSII versus MDI on glycemic and patient-reported outcomes (PROs) among young patients with T1D and (2) to identify health inequalities in the use of CSII.

Methods

This protocol was developed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P), the PRISMA-E (PRISMA-Equity 2012 Guidelines), and the Cochrane Collaboration Handbook. We will include randomized clinical trials and non-randomized studies published between January 2000 and June 2019 to assess the effectiveness of CSII versus MDI on glycemic and PROs in young patients with T1D. To assess health inequality among those who received CSII, we will use the PROGRESS framework. To gather relevant studies, a search will be conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews, and the Health Technology Assessment (HTA) database. We will select studies that compared glycemic outcomes (the glycosylated hemoglobin values, severe hypoglycemia episodes, diabetic ketoacidosis events, and/or time spent in range or in hyper-hypoglycemia), and health-related quality of life, as a PRO, between therapies. Screening and selection of studies will be conducted independently by two researchers. Subgroup analyses will be performed according to age group, length of follow-up, and the use of adjunctive technological therapies that might influence glycemic outcomes.

Discussion

Studies of the average effects of CSII versus MDI may have not assessed their impact on health equity, as some intended populations have been excluded. Therefore, this study will address health equity issues when assessing effects of CSII. The results will be published in a peer-review journal. Ethics approval will not be needed.

Systematic review registration

PROSPERO CRD42018116474
Equivalent properties of a reverse half-discrete Hilbert’s inequality
Authors: Wang Ai-zhen , Yang Bi-cheng , Chen Qiang
Published: November 2019

By using the weight functions, the idea of introduced parameters and the Euler–Maclaurin summation formula, a reverse half-discrete Hilbert’s inequality with the homogeneous kernel and the reverse equivalent forms are given (for${p<0}$p<0,${0< q<1}$0<q<1). The equivalent statements of the best possible constant factor related to a few parameters are considered. As applications, two corollaries about the case of the non-homogeneous kernel and some particular cases are obtained.
Naturally occurring Piper plant amides potential in agricultural and pharmaceutical industries: perspectives of piperine and piperlongumine
Authors: Jeon Hwang-Ju , Kim Kyeongnam , Kim Yong-Deuk , Lee Sung-Eun
Published: November 2019

Piperaceae plants consist of about 3600 species, of which about 2000 are Piper plants. Their habitat is distributed across pantropical regions. The representative plant is Piper nigrum, known as black pepper. These plants have been widely used in folk medicine in Korean traditional medicine. This review collected papers identifying and separating the amides obtained from these Piper plants, with a focus on Piper amides potential to control the production and growth of fungal strains that cause plant disease and their insecticidal properties against agricultural pests. Piper amide benefits include antiaflatoxigenic activities, antiparasitic activities, anticancer properties, antiplatelet activities, and anti-inflammatory activities, among other therapeutic properties for the treatment of human diseases. In addition, this review paper provides a total synthesis study on the mass production of Piper amides and their derivatives, with a formulation study for industrial use. This review paper is designed to help inform future studies on Piper amide applications.
Heat stress affects fecal microbial and metabolic alterations of primiparous sows during late gestation
Authors: He Jianwen , Guo Huiduo , Zheng Weijiang , Xue Yongqiang , Zhao Ruqian , Yao Wen
Published: November 2019

Background

Heat stress (HS) jeopardizes intestinal barrier functions and augments intestinal permeability in pigs. However, whether HS-induced maternal microbial and metabolic changes in primiparous sows during late gestation remains elusive. We present here, a study investigating the fecal microbial and metabolic responses in late gestational primiparous sows when exposed to HS.

Methods

Twelve first-parity Landrace × Large White F1 sows were randomly assigned into two environmental treatments including the thermoneutral (TN) (18–22 °C; n = 6) and HS (28–32 °C; n = 6) conditions. Both treatments were applied from 85 d of gestation to farrowing. The serum and feces samples were collected on d 107 of gestation, for analyses including intestinal integrity biomarkers, high-throughput sequencing metagenomics, short-chain fatty acid (SCFA) profiles and nontargeted metabolomics.

Results

Our results show that HS group has higher serum Heat shock protein 70 (HSP70), lipopolysaccharide (LPS) and lipopolysaccharide-binding protein (LBP) levels. The gut microbial community can be altered upon HS by using β-diversity and taxon-based analysis. In particular, the relative abundance of genera and operational taxonomic units (OTUs) related to Clostridiales and Halomonas are higher in HS group, the relative abundance of genera and OTUs related to Bacteroidales and Streptococcus, however, are lower in HS group. Results of metabolic analysis reveal that HS lowers the concentrations of propionate, butyrate, total SCFA, succinate, fumarate, malate, lactate, aspartate, ethanolamine, β-alanine and niacin, whereas that of fructose and azelaic acid are higher in HS group. These metabolites mainly affect propanoate metabolism, alanine, aspartate and glutamate metabolism, phenylalanine metabolism, β-alanine metabolism, pantothenate and CoA biosynthesis, tricarboxylic acid cycle (TCA) and nicotinate and nicotinamide metabolism. Additionally, correlation analysis between significant microbes and metabolites indicated that the HS-induced microbiota shift is likely the cause of changes of intestinal metabolism.

Conclusions

Taken together, we reveal characteristic structural and metabolic changes in maternal gut microbiota as a result of late gestational HS, which could potentially provide the basis for further study on offspring gut microbiota and immune programming.
Short group psychoeducation followed by daily electronic self-monitoring in the long-term treatment of bipolar disorders: a multicenter, rater-blind, randomized controlled trial
Authors: Petzold Johannes , Mayer-Pelinski René , Pilhatsch Maximilian , Luthe Susan , Barth Thomas , Bauer Michael , Severus Emanuel
Published: November 2019

Background

Despite various pharmacological and psychological treatment interventions, bipolar disorders rank among the leading causes of global disease burden. Group psychoeducation has been demonstrated an effective add-on to pharmacotherapy, but it may be difficult to implement in practice depending on the clinical setting and available human resources.

Methods

Multicenter, rater-blind, randomized controlled trial to investigate the efficacy of a new intervention program consisting of an initial 6-week psychoeducation protocol plus a subsequent structured daily computer-based self-charting program (ChronoRecord) over 54 weeks in remitted patients with bipolar disorders. The control condition included non-structured group sessions followed by daily computer-based self-reports (unstructured like a diary). Both groups received treatment-as-usual.

Results

Over 2 years, 41 mood episodes occurred in the experimental group (n = 39) compared to 27 in the control group (n = 34), without reaching statistical significance. Time to recurrence did not significantly differ between the experimental and control group (25% relapsed after 112 and 273 days, respectively). There were no significant group-by-time interactions in mood symptoms, quality of life, self-efficacy expectations or perceived involvement in care.

Conclusions

Six weekly psychoeducational group sessions followed by daily self-monitoring via ChronoRecord for 54 weeks may not be superior to non-structured group meetings followed by unstructured self-reporting. Other psychotherapeutic interventions may be needed to optimize the treatment of patients with bipolar disorders, especially for those at later disease stages.

Trial registration Retrospectively registered at German Clinical Trials Register on May 24, 2019; DRKS00017319
BRAF V600E mutation in Juvenile Xanthogranuloma family neoplasms of the central nervous system (CNS-JXG): a revised diagnostic algorithm to include pediatric Erdheim-Chester disease
Authors: Picarsic J. , Pysher T. , Zhou H. , Fluchel M. , Pettit T. , Whitehead M. , Surrey L. F. , Harding B. , Goldstein G. , Fellig Y. , Weintraub M. , Mobley B. C. , Sharples P. M. , Sulis M. L. , Diamond E. L. , Jaffe R. , Shekdar K. , Santi M.
Published: November 2019

The family of juvenile xanthogranuloma family neoplasms (JXG) with ERK-pathway mutations are now classified within the “L” (Langerhans) group, which includes Langerhans cell histiocytosis (LCH) and Erdheim Chester disease (ECD). Although theBRAFV600E mutation constitutes the majority of molecular alterations in ECD and LCH, only three reported JXG neoplasms, all in male pediatric patients with localized central nervous system (CNS) involvement, are known to harbor theBRAFmutation. This retrospective case series seeks to redefine the clinicopathologic spectrum of pediatric CNS-JXG family neoplasms in the post-BRAF era, with a revised diagnostic algorithm to include pediatric ECD. Twenty-two CNS-JXG family lesions were retrieved from consult files with 64% (n = 14) having informativeBRAFV600E mutational testing (molecular and/or VE1 immunohistochemistry). Of these, 71% (n = 10) were pediatric cases (≤18 years) and half (n = 5) harbored theBRAFV600E mutation. As compared to theBRAFwild-type cohort (WT), theBRAFV600E cohort had a similar mean age at diagnosis [BRAF V600E: 7 years (3–12 y), vs. WT: 7.6 years (1–18 y)] but demonstrated a stronger male/female ratio (BRAF V600E: 4 vs WT: 0.67), and had both more multifocal CNS disease ( BRAFV600E: 80% vs WT: 20%) and systemic disease (BRAF V600E: 40% vs WT: none). Radiographic features of CNS-JXG varied but typically included enhancing CNS mass lesion(s) with associated white matter changes in a subset ofBRAFV600E neoplasms. After clinical-radiographic correlation, pediatric ECD was diagnosed in theBRAFV600E cohort. Treatment options varied, including surgical resection, chemotherapy, and targeted therapy with BRAF-inhibitor dabrafenib in one mutated case.BRAFV600E CNS-JXG neoplasms appear associated with male gender and aggressive disease presentation including pediatric ECD. We propose a revised diagnostic algorithm for CNS-JXG that includes an initial morphologic diagnosis with a final integrated diagnosis after clinical-radiographic and molecular correlation, in order to identify cases of pediatric ECD. Future studies with long-term follow-up are required to determine if pediatricBRAFV600E positive CNS-JXG neoplasms are a distinct entity in the L-group histiocytosis category or represent an expanded pediatric spectrum of ECD.
Association between dexmedetomidine use for the treatment of alcohol withdrawal syndrome and intensive care unit length of stay
Authors: Yavarovich Ekaterina R. , Bintvihok Maythawee , McCarty Justin C. , Breeze Janis L. , LaCamera Peter
Published: November 2019

Purpose

Alcohol withdrawal syndrome (AWS) is commonly treated in medical ICUs and typically requires high resource utilization. Dexmedetomidine for AWS has not been extensively investigated, and guidelines regarding its use are lacking. We evaluated the association between dexmedetomidine use in AWS and ICU length of stay (LOS).

Methods

We performed a multi-institutional retrospective cohort study of patients in the ICU with the primary diagnosis of AWS. ICU LOS of those treated with benzodiazepines alone vs. benzodiazepines plus dexmedetomidine was compared. Negative binomial regression was performed to test whether dexmedetomidine use was associated with increased ICU LOS after adjustment for age, gender, body mass index, and the time between hospital and ICU admission.

Results

Four hundred thirty-eight patients from eight institutions were included. Patients treated with benzodiazepines plus dexmedetomidine had higher Clinical Institute Withdrawal Assessment for Alcohol scores at ICU admission, spent longer on the medical wards prior to ICU admission, and had longer unadjusted ICU LOS (p < 0.0001). After covariate adjustment, dexmedetomidine remained associated with longer ICU LOS (relative mean to non-dexmedetomidine group 2.14, 95% CI 1.78–2.57,p < 0.0001).

Conclusions

Compared to benzodiazepines alone, dexmedetomidine for the treatment of AWS was associated with increased ICU LOS. These results provide evidence that dexmedetomidine may increase resource utilization.
Local application of doxorubicin- loaded Iron oxid nanoparticles and the vascular disrupting agent via the hepatic artery: chemoembolization–photothermal ablation treatment of hepatocellular carcinoma in rats
Authors: Yuan Hongjun , Li Xin , Tang Jing , Zhou Min , Liu Fengyong
Published: November 2019

Objectives

This study investigates the effectiveness of local application of doxorubicin(Dox)-loaded, polydopamine (PDA)- coated single crystal hematite (α- Fe2O3) nanocubes (Fe2O3-PDA-Dox) and combretastatin A-4 phosphate disodium(CA4P)in treating hepatocellular carcinoma (HCC) in rats.

Methods

The magnetic characteristics and photothermal effects of the nanoparticles were determined in vitro. Tumor-bearing Sprague–Dawley rats were divided into 3 groups of 8 according to treatment: controls, transarterial chemoembolization–photothermal ablation (pTACE) (Lipidol+Fe2O3-PDA-Dox + NIR), and CA4P + pTACE (CA4P+ Lipidol+Fe2O3-PDA-Dox + NIR). Drugs were administered through the hepatic artery, and the tumors exposed to 808-nm near-infrared radiation. The Fe content of tumors was assessed using neutron activation analysis. Treatment effectiveness was assessed using heating curves, magnetic resonance imaging, pathology results, and immunohistochemical analysis.

Results

The mean tumor Fe content was greater in rats treated with CA4P + pTACE (1 h, 23.72 ± 12.45 μg/g; 24 h, 14.61 ± 8.23 μg/g) than in those treated with pTACE alone (1 h, 5.66 ± 4.29 μg/g; 24 h, 2.76 ± 1.33 μg/g). The tumor T2 imaging signal was lower in rats treated with CA4P + pTACE. Following laser irradiation, the tumor temperature increased, with higher temperatures reached in the CA4P + pTACE group (62 °C vs 55 °C). Tumor cells exhibited necrosis, apoptosis, and proliferation inhibition, with greater effects in the CA4P + pTACE group. Transient liver and kidney toxicity were observed on day 3, with more severe effects after CA4P + pTACE.

Conclusions

Fe2O3-PDA-Dox nanoparticles are effective for TACE–PTA. Pretreatment with CA4P increases nanoparticle uptake by tumors, increasing the treatment effectiveness without increasing hepatorenal toxicity.
Inclination of houses induced by liquefaction in the 2018 Hokkaido Iburi-tobu earthquake, Japan
Authors: Serikawa Yuko , Miyajima Masakatsu , Yoshida Masaho , Matsuno Kenji
Published: November 2019

Background

On September 6th, 2018, at 3:07 local time, a strong earthquake of magnitude Mw = 6.6 struck the east Iburi region in Hokkaido, Japan. Many serious damages such as landslide, liquefaction and collapse of houses occurred from this earthquake. Liquefaction caused road deformation and inclination of houses in Sapporo city, Hokkaido. In order to understand the damage caused by the earthquake, and find a solution to mitigate the liquefaction-induced damage in Sapporo city, a preliminary investigation of the 2018 Hokkaido Iburi-tobu earthquake was conducted from 18 to 20 September 2018.

Results

The damages to the houses at Satozuka town and Utsukushigaoka town in Sapporo city are focused on. The damage at Satozuka was so enormous that the residents could not continue to live in their houses. Although the inclination of houses can be seen by visual inspection at Satozuka, there were few houses where the inclination can be judged visually at Utsukushigaoka. Therefore we did a field survey of inclined houses by using a digital angle meter at Utsukushigaoka.

Conclusions

The inclination of 57 houses at Utsukushigaoka was measured, and the maximum value and direction of inclination are shown on the map. The houses located at the reclaimed land of the former river and former valley plain were inclined. Therefore, the old terrain greatly affected to the inclination of houses. These liquefaction-induced damage occurred in the same area where liquefaction occurred during the 2003 Tokachi-oki earthquake.
Nutritional status and associated factors among high school adolescents in Debre Tabor Town, South Gondar Zone, Northcentral Ethiopia
Authors: Zemene Melkamu Aderajew , Engidaw Melaku Tadege , Gebremariam Alemayehu Digssie , Asnakew Desalegn Tesfa , Tiruneh Sofonyas Abebaw
Published: November 2019

Background

Adolescents are among the nutritionally vulnerable group due to their nutritional demand for pubertal spurt. At this age, adequate nutrition, nutritional education, and counseling are very important to halt the consequence and its impact on this segment of the population. So, the aim of this study was to assess the prevalence and its associated factors of nutritional status among high school adolescents aged 10–19 years in Debre Tabor Town, South Gondar Zone, and North central Ethiopia.

Methods

A cross-sectional study was conducted from September to October 2017. A total of 349 high school adolescents were selected by using simple random sampling. Data were collected through face to face interview and physical measurement. The data were entered into Epi info version 7 software and then exported into SPSS version 20 software for further analysis. Ap-value < 0.2 was used to select independent variables for multivariable logistic regression. A p-value ≤0.05 was used to declare the statistical significance. Also, odd ratios were calculated with a 95% of the confidence interval to check the existence of the association.

Result

A total of 327 adolescents participated in this study with the overall response rate of 93.69%. The magnitude of stunting and thinness was 15% (95% CI: 11, 19) and 4.9% (95% CI: 2.4, 7.4) respectively. Sex (AOR: 2.24, 95% CI: 1.15, 4.36), residency (AOR: 2.48, 95% CI: 1.28, 4.82), and family size (AOR: 3.41, 95% CI: 1.65, 7.05) were the associated factors for stunting. Residence (AOR: 3.67, 95% CI: 1.16, 11.56), and living away from the family (AOR: 4.37, 95% CI: 1.20, 15.95) were the associated factors for the development of thinness.

Conclusion

Stunting is a mild public health problem but not thinness. Sociodemographic variables were the determinant factors for the development of stunting and thinness. To halt this, integrated adolescent related school and nutrition services is very important with adequate and quality food access to adolescents. In addition to this the government shall have to increase the access of education.
Influence of breast reconstruction on technical aspects of echocardiographic image acquisition compared with physician-assessed image quality
Authors: Duarte Ow Joaquin , Hemu Mohamad , Yakupovich Anel , Bhatt Parva , Gaddam Hannah , Prabhu Nicole , Fughhi Ibtihaj , Cobleigh Melody , Tracy Melissa , Fogg Louis , Okwuosa Tochukwu
Published: November 2019

Introduction

Assessment of cardiac function after treatment for breast cancer relies on interval evaluation of ventricular function through echocardiography. Women who undergo mastectomy more frequently choose to undergo breast reconstruction with implant. This could impede assessment of cardiac function in those with left-sided implant. We aimed to examine whether left-sided breast reconstruction with tissue expanders (TE) affect echo image acquisition and quality, possibly affecting clinical decision-making.

Methods

A retrospective case-control study was conducted in 190 female breast cancer patients who had undergone breast reconstruction with TE at an urban academic center. Echocardiographic technical assessment and image quality were respectively classified as excellent/good or adequate/technically difficult by technicians; and excellent/good or adequate/poor by 2 board-certified cardiologist readers. Likelihood ratio was used to test multivariate associations between image quality and left-sided TE.

Results

We identified 32 women (81.3% white; mean age 48 years) with left-sided/bilateral TE, and 158 right-sided/no TE (76.6% white, mean age 57 years). In multivariable analyses, we found a statistically significant difference in technician-assessed difficulty in image acquisition between cases and controls (p = 0.01); but no differences in physician-assessed image quality between cases and controls (p = 0.09, Pearson’s r = 0.467).

Conclusions

Left-sided breast TE appears to affect the technical difficulty of echo image acquisition, but not physician-assessed echo image quality. This likely means that echo technicians absorb most of the impediments associated with imaging patients with breast TE such that the presence of TE has no bearing on downstream clinical decision-making associated with echo image quality.
Clinical features and outcomes of prolonged mechanical ventilation: a single-center retrospective observational study
Authors: Nagata Isao , Takei Tetsuhiro , Hatakeyama Junji , Toh Masafumi , Yamada Hiroyuki , Fujisawa Michiko
Published: November 2019

Background

Information on epidemiology of prolonged mechanical ventilation (PMV) patients in the acute care setting in Japan is totally lacking. We aimed to investigate clinical features, impact, and long-term outcomes of PMV patients.

Methods

This was a retrospective observational study conducted in a tertiary care hospital. Adult patients who were admitted to our intensive care unit (ICU) from April 2009 to March 2014 and required mechanical ventilation (MV) for ≥ 2 days were included. PMV was defined as having MV for ≥ 21 consecutive days.

Results

Among 1282 MV patients, 93 (7.3%) required PMV, and median duration of MV was 37.0 days. Compared with the non-PMV patients, PMV patients had longer total ICU and high care unit (HCU) stay (34.0 vs. 7.0 days, p < 0.001), longer hospital stay (74.0 vs. 35.0 days, p < 0.001), and higher hospital mortality (54.8 vs. 21.4%, p < 0.001). In multivariable logistic regression analysis, emergency ICU admission and steroid use during MV were associated with PMV. The Kaplan–Meier curves for MV withdrawal and ICU/HCU discharge were almost identical. Among PMV patients, 52 (55.9%) died, 29 (31.2%) were successfully liberated from MV during hospitalization, and 12 (12.9%) still required MV at discharge.

Conclusion

In this investigation, 7.3% of the patients with MV required PMV. Most PMV patients were liberated from MV during hospitalization, while occupying critical care beds for an extended period. A nationwide survey is required to further elucidate the overall picture of PMV patients and to discuss whether specialized weaning centers to treat PMV patients are required in Japan.
The effects of hemodynamic management using the trend of the perfusion index and pulse pressure variation on tissue perfusion: a randomized pilot study
Authors: Godai Kohei , Matsunaga Akira , Kanmura Yuichi
Published: November 2019

Background

Intraoperative hemodynamic management is challenging because precise assessment of the adequacy of the intravascular volume is difficult during surgery. Perfusion index (PI) has been shown to reflect changes in peripheral circulation perfusion. Pulse pressure variation (PPV) reflects the preload responsiveness. The hypothesis of this study was that hemodynamic management using the trend of the PI and PPV would improve tissue perfusion.

Methods

This was a prospective, randomized, parallel design, single-blind, single-center pilot study. Patients undergoing elective open gynecological surgery requiring a direct arterial line were included. The patients were randomly allocated to two groups. The intervention group received hemodynamic management using the trend of the PI and PPV in an effort to improve tissue perfusion. The control group received hemodynamic management at the discretion of the anesthesia care provider. The primary outcome was the peak lactate level during surgery. The secondary outcomes were the duration of hypotension, intraoperative fluid balance, intraoperative urine output, and postoperative complication rate. Statistical analysis was performed using Student’sttest and Fisher’s exact test. APvalue of < 0.05 was considered statistically significant.

Results

Although the intervention significantly decreased the duration of hypotension and intraoperative fluid balance, the peak lactate level was not different between the intervention group and the control group. Intraoperative urine output and postoperative complication rate were not different between the groups.

Conclusion

Hemodynamic management using the trend of the PI and PPV does not improve tissue perfusion in patients undergoing open gynecological surgery.

Trial registration

This trial was prospectively registered on a publicly accessible database (UMIN Clinical Trials Registry ID: UMIN 000026957. Registered 12 April 2017,https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000030916).
Fully automating fine-optics manufacture - why so tough, and what are we doing?
Authors: Walker David Douglas , McCluskey Thomas Leo , Yu Guoyu , Petrovic Sanja , Li Hongyu
Published: November 2019

Precision and ultra-precision surfaces are crucial for many products – quality optics, joint & cranial implants, turbine blades, and industrial moulds & dies, to name a few. Automation in this context is distinct from standard procedures in industry, where the identical sequence of operations can be repeated over and over again. Ultraprecision tolerances may be tens to hundreds of times tighter, and this is compounded by the hundreds of diverse substrate materials in use. Even with modern computer numerically controlled (CNC) machines, skilled craftspeople are needed to plan a process-chain for a new material or geometry. Processes working at these tight tolerances, fall short of being fully-deterministic, so repeated process-metrology iterations are required. Surface-correction loops may be automated, but expert assessment should be performed at each step to check for unexpected anomalies. The ultimate goal of importing a part, processing autonomously, and delivering a finished part to an “optical” specification with no human intervention, is still a long way off. This paper describes the challenge and why it is important. It then melds together process-monitoring, psychology, artificial intelligence and robotics, to take a far-sighted view of how the ultimate goal can be realised.
Use of a steerable microcatheter during superselective angiography: impact on radiation exposure and procedural efficiency
Authors: Hoffmann Jason C. , Minkin Jonathan , Primiano Nicholas , Yun Jung , Eweka Abieyuwa
Published: November 2019

Background/purpose

To study steerable microcatheter (SM) use in moderate and highly difficult vessel selection compared to conventional pre-shaped microcatheter (CM) use.

Material and methods

An IRB approved, single institution analysis of 40 complex angiographic procedures with and without superselective microcatheter use during an eight-month period in 2017 was performed. Target vessels were deemed moderate or highly difficult to select based on vessel size, tortuosity, and/or angulation during non-selective initial angiography. Data collected included type of microcatheter used (SM or CM), number of microcatheters and microwires used, procedure time, radiation exposure index (dose area product/DAP), target vessel location, and time to target vessel selection (TTVS; time from device placement to vessel selection). Comparison between the SM and CM groups was performed using Wilcoxon test.

Results

A SM (SwiftNinja, Merit Medical, South Jordan, UT, USA) was used to select 46 vessels in 20 patients. One or more CMs were used in 20 patients to select 34 vessels. Median TTVS, number of microwires used, total procedure time, and DAP (microGray.m2) were 12 vs. 462.5 s (p < 0.0001), 0 vs. 2 (p < 0.001), and 26,948 vs. 30,904 (p = 0.15) in the SM vs. CM groups, respectively. When adjusted for body mass index (BMI) using a linear model for radiation exposure, patients in the SM group had lower radiation exposure than those in the CM group (p = 0.05).

Conclusions

Utilization of a steerable microcatheter, without or with a guidewire, leads to easier and faster target vessel selection with shorter procedure times in complex vessel anatomy.
A putative N-BAR-domain protein is crucially required for the development of hyphae tip appressorium-like structure and its plant infection in Magnaporthe oryzae
Authors: Lin Lili , Chen Xiaomin , Shabbir Ammarah , Chen Si , Chen Xuewen , Wang Zonghua , Norvienyeku Justice
Published: November 2019

Membrane remodeling modulates many biological processes. The binding of peripheral proteins to lipid membranes results in membrane invaginations and protrusions, which regulate essential intra-cellular membrane and extra-cellular trafficking events. Proteins that bind and re-shape bio-membranes have been identified and extensively investigated. The Bin/Amphiphysin/Rvs (BAR) domain proteins are crescent-shape and play a conserved role in tubulation and sculpturing of cell membranes. We deployed targeted gene replacement technique to functionally characterize two hypothetical proteins (MoBar-A and MoBar-B) containing unitary N-BAR domain in Magnaporthe oryzae. The results obtained from phenotypic examinations showed that MoBAR-A deletion exerted a significant reduction in the growth of the defective ∆Mobar-A strain. Also, MoBAR-A disruption exclusively compromised hyphae-mediated infection. Additionally, the targeted replacement of MoBAR-A suppressed the expression of genes associated with the formation of hyphae tip appressorium-like structure in M. oryzae. Furthermore, single as well as combined deletion of MoBAR-A and MoBAR-B down-regulated the expression of nine different membrane-associated genes. From these results, we inferred that MoBAR-A plays a key and unique role in the pathogenesis of M. oryzae through direct or indirect regulation of the development of appressorium-like structures developed by hyphae tip. Taken together, these results provide unique insights into the direct contribution of the N-BAR domain proteins to morphological, reproduction, and infectious development of M. oryzae.
Assessment of left ventricular systolic and diastolic functions in severely malnourished children
Authors: Bebars Gihan M. , Askalany Hany T.
Published: November 2019

Background

Malnourished children endure many changes in body composition and lose heart and skeletal muscle mass. Diastolic dysfunction is one of the major causes of heart failure with preserved ejection fraction.

Aim

To assess left ventricular systolic and diastolic functions in children with severe acute malnutrition using tissue Doppler imaging technique and to evaluate the effect of nutritional rehabilitation.

Patients and Methods

A follow-up case-control study conducted on 60 severely malnourished children (WHZ < -3SD) and 120 age and sex-matched healthy children as a control group. Tissue Doppler imaging (TDI) was done for all included malnourished children at admission and for control to measure left ventricular systolic and diastolic functions. Nutritional rehabilitation was done according to WHO protocol and tissue doppler was repeated after rehabilitation when (WHZ > -2SD) to detect any changes in systolic or diastolic functions.

Results

Systolic function was normal in malnourished children and control. Grade I diastolic dysfunction was detected in 40% and grade II in 30% of severely malnourished children in comparison to 100% normal diastolic function in control group. No correlations between diastolic dysfunction and either anthropometric measurements, electrolyte disturbances or Hb% in malnourished children before nutritional rehabilitation. Mortality from sepsis with associated ventricular dysfunction grade II documented in 3.3% of malnourished children. After nutritional rehabilitation diastolic function improved significantly as 65.6% of children attained normal diastolic function, 31% grade1 and 3.4% grade II. Positive correlations between diastolic function and WAZ, HAZ, WHZ and MUAC after rehabilitation.

Conclusion

Severe acute malnutrition affects diastolic function in children which is reversible in most of these cases with rehabilitation. TDI is an easy and practical method for detection and follow-up of ventricular function in malnourished children.
Role of annexin A2 and osteopontin for early diagnosis of hepatocellular carcinoma in hepatitis C virus patients
Authors: Hanno Abd El-Fattah F. , Abd El-Aziz Fatma M. , Deghady Akram A. , El-Kholy Ehab H. , Aborawy Aborawy I.
Published: November 2019

Background

Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Early stages of hepatocellular carcinoma (0&A) can be treated with curative procedures. The aim of this work was to evaluate the role of annexin A2 and osteopontin for early diagnosis of hepatocellular carcinoma in hepatitis C virus patients.

Methods

The study was carried out on 80 patients classified into two groups. Group A had 40 chronic hepatitis C patients without hepatocellular carcinoma, while group B had 40 chronic hepatitis C patients with early hepatocellular carcinoma (stages; 0&A). All patients were subjected to thorough history taking, clinical examination, liver function tests, renal function tests, serum alpha-fetoprotein, serum osteopontin, and serum annexin A2.

Results

Serum alpha-fetoprotein was found to be statistically significantly higher in patients with the hepatocellular carcinoma group than the chronic hepatitis C group. The ROC curve for alpha-fetoprotein for detection of HCC was significant, its diagnostic performance was 0.818* (p < 0.001*), and the cutoff point for predicting the probability for HCC was 6.0 (ng/ml) with sensitivity of 77.50%, specificity of 82.50%, positive predictive value of 81.60%, negative predictive value of 78.6%, and accuracy of 80%. Serum osteopontin was found to be statistically significantly higher in patients from the hepatocellular carcinoma group than the chronic hepatitis C group. The ROC curve for osteopontin was significant, its diagnostic performance was 0.739* (p < 0.001*), the cutoff point was 13.2 (ng/ml) with sensitivity of 65.0%, specificity of 90.0%, positive predictive value of 86.70%, negative predictive value of 72.0%, and accuracy of 77.0%. Serum annexin A2 was found to be statistically significantly higher in patients from the hepatocellular carcinoma group than the chronic hepatitis C group. The ROC curve for annexin A2 was significant, its diagnostic performance was 0.927* (p < 0.001*), the cutoff point was 10.1(ng/ml) with sensitivity of 85.0%, specificity of 85.0%, positive predictive value of 85.0%, negative predictive value of 85.0%, and accuracy of 85.0%.

Conclusions

Osteopontin had better specificity but lower sensitivity than serum alpha-fetoprotein for early diagnosis of hepatocellular carcinoma. Annexin A2 had better diagnostic sensitivity and specificity than alpha-fetoprotein for early diagnosis of hepatocellular carcinoma.
Problems posed by the Werther effect as a ‘net effect’: a comment on recent scholarly work on the effects of 13 Reasons Why
Authors: Arendt Florian , Romer Daniel
Published: November 2019

Recent research estimated that an additional 195 suicides among 10- to 17-year-old youths occurred following the release of the television series 13 Reasons Why. There is an underrecognised aspect in this line of research that this effect represents a net effect based on different possible underlying patterns (e.g. +195/−0 or +395/−200).
Opioid Epidemic or Pain Crisis? Using the Virginia All Payer Claims Database to Describe Opioid Medication Prescribing Patterns and Potential Harms for Patients With Cancer
Authors: LeBaron Virginia T. , Camacho Fabian , Balkrishnan Rajesh , Yao Nengliang (Aaron) , Gilson Aaron M.
Published: November 2019

PURPOSE:

A key challenge regarding the current opioid epidemic is understanding how concerns regarding opioid-related harms affect access to pain management, an essential element of cancer care. In certain regions of the United States where disproportionately high cancer mortality and opioid fatality rates coexist (such as southwest Virginia in central Appalachia), this dilemma is particularly pronounced.

METHODS:

This longitudinal, exploratory, secondary analysis used the Commonwealth of Virginia All Payer Claims Database to describe prescription opioid medication (POM) prescribing patterns and potential harms for adult patients with cancer living in rural southwest Virginia between 2011 and 2015. Descriptive and inferential statistical analyses were conducted at the patient, prescriber, and prescription levels to identify patterns and predictors of POM prescribing and potential harms. To explore geographic patterns, choropleth and heat maps were created.

RESULTS:

Of the total sample of patients with cancer (n = 4,324), less than 25% were prescribed a Controlled Substance Schedule II POM at least three times in any study year. More than 60% of patients never received a Controlled Substance Schedule II POM prescription. Six hundred fifty-two patients (15.1%) experienced 1,599 hospitalizations for any reason; 10 or fewer patients were admitted for 11 opioid use disorder–related hospitalizations. The main findings suggest potential undertreatment of cancer-related pain; no difference in risk for opioid-related hospitalization on the basis of frequency of POM prescriptions; and geographic disparities where opioid overdoses are occurring versus where POM prescription use is highest.

CONCLUSION:

These findings have significant opioid policy and practice implications related to the need for cancer-specific prescribing guidelines, how to optimally allocate health delivery services, and the urgent need to improve data interoperability and access related to POMs.
IGFBP-1 in Cardiometabolic Pathophysiology—Insights From Loss-of-Function and Gain-of-Function Studies in Male Mice
Authors: Haywood Natalie J , Slater Thomas A , Drozd Michael , Warmke Nele , Matthews Connor , Cordell Paul A , Smith Jessica , Rainford Jethro , Cheema Harneet , Maher Caitlyn , Bridge Katherine I , Yuldasheva Nadira Y , Cubbon Richard M , Kearney Mark T , Wheatcroft Stephen B
Published: November 2019

We have previously reported that overexpression of human insulin-like growth factor binding protein (IGFBP)-1 in mice leads to vascular insulin sensitization, increased nitric oxide bioavailability, reduced atherosclerosis, and enhanced vascular repair, and in the setting of obesity improves glucose tolerance. Human studies suggest that low levels of IGFBP-1 are permissive for the development of diabetes and cardiovascular disease. Here we seek to determine whether loss of IGFBP-1 plays a causal role in the predisposition to cardiometabolic disease. Metabolic phenotyping was performed in transgenic mice with homozygous knockout of IGFBP-1. This included glucose, insulin, and insulin-like growth factor I tolerance testing under normal diet and high-fat feeding conditions. Vascular phenotyping was then performed in the same mice using vasomotor aortic ring studies, flow cytometry, vascular wire injury, and angiogenesis assays. These were complemented with vascular phenotyping of IGFBP-1 overexpressing mice. Metabolic phenotype was similar in IGFBP-1 knockout and wild-type mice subjected to obesity. Deletion of IGFBP-1 inhibited endothelial regeneration following injury, suggesting that IGFBP-1 is required for effective vascular repair. Developmental angiogenesis was unaltered by deletion or overexpression of IGFBP-1. Recovery of perfusion following hind limb ischemia was unchanged in mice lacking or overexpressing IGFBP-1; however, overexpression of IGFBP-1 stimulated hindlimb perfusion and angiogenesis in insulin-resistant mice. These findings provide new insights into the role of IGFBP-1 in metabolic and vascular pathophysiology. Irrespective of whether loss of IGFBP-1 plays a causal role in the development of cardiometabolic disorders, increasing IGFBP-1 levels appears effective in promoting neovascularization in response to ischemia.
Anesthesia Infrastructure and Resources in Bangladesh
Authors: Meadows Jonathan W. , Al Imran T. M. Tanzil , LeBrun Drake G. , Mannan Moinul I. , Sharraf Samin , Gaznavee Zibran Z. , McQueen Kelly K. A.
Published: November 2019

BACKGROUND:

Monitoring improvements in nationwide anesthesia capacity over time is critical to ensuring that population anesthesia needs are being met and identifying areas for targeted health systems interventions. Anesthesia resources in Bangladesh were previously measured using a cross-sectional nationwide hospital-based survey in 2012. No follow-up studies have been conducted since then.

METHODS:

A follow-up cross-sectional study was performed in 16 public hospitals; 8 of which are public district hospitals, and 8 are medical college (tertiary) hospitals in Bangladesh. A survey tool assessing hospital anesthesia capacity, developed by Vanderbilt University Medical Center, was utilized. Nationwide data were obtained from the Ministry of Health and Family Welfare and from the Bangladesh Society of Anaesthesiologists. Institutional Review Board approvals were obtained in the United States and Bangladesh, and informed consent was waived.

RESULTS:

Bangladesh has 952 anesthesiologists (0.58 anesthesiologists per 100,000 people), which represents a modest increase from 850 anesthesiologists in 2012. Significant improvements in electricity and clean water availability have occurred since the 2012 survey. Severe deficiencies in patient safety and monitoring equipment (eg, pulse oximetry, electrocardiography, blood pressure, anesthesia machines, and intubation materials) were noted, primarily at the district hospital level.

CONCLUSIONS:

Despite modest improvements in certain anesthesia metrics over the past several years, the public health care system in Bangladesh still suffers from substantial deficiencies in anesthesia care.
Ishiguro at the Limit: The Corporation and the Novel
Authors: Holmes Chris
Published: November 2019

The early twenty-first century has seen a radical shift in how the aesthetic form of the novel addresses the abstraction of labor and the precarity of minority communities that have come to epitomize neoliberal capital. Novels increasingly attempt to formulate institutions apart from the privatizing drive that seeks to corporatize all civil society. This ambition to differentiate the novel from the primary ideology of this period has been marked by the emergence of a particular mode of critical rejoinder to the pervasive corporatist mind-set, a mode called limit thinking, in which novels draw attention to themselves as texts with which to produce new forms of thinking rather than as storehouses of information or political treatises. The writer Kazuo Ishiguro's novels Remains of the Day and Never Let Me Go present limit thinking as a means to offset the prevailing form of totalizing thinking in the West: corporate personhood. That corporate body, with its obvious intentions toward absolute privatization, has been allowed a unique form of embodiment. The imagined body of the corporation has been gifted the presumption of thought. Understanding the limits of the novel—and by contrast the seeming limitlessness of the corporate state of mind—prepares us to understand how the novel resists an epistemological system into which it incorporated and how, in doing so, it shifts the kinds of questions we ask of the novel from those of what does the novel know? to how is the novel thinking?
Improving Trip- and Slip-Resisting Skills in Older People: Perturbation Dose Matters
Authors: Karamanidis Kiros , Epro Gaspar , McCrum Christopher , König Matthias
Published: November 2019

Aging negatively affects balance recovery responses after trips and slips. We hypothesize that older people can benefit from brief treadmill-based trip and slip perturbation exposure despite reduced muscular capacities, but with neuropathology, their responsiveness to these perturbations will be decreased. Thus, to facilitate long-term benefits and their generalizability to everyday life, one needs to consider the individual threshold for perturbation dose.
Age-related Deficits in Voluntary Activation: A Systematic Review and Meta-analysis
Authors: ROZAND VIANNEY , SUNDBERG CHRISTOPHER W. , HUNTER SANDRA K. , SMITH ASHLEIGH E.
Published: November 2019

Whether there are age-related differences in neural drive during maximal effort contractions is not clear. This review determined the effect of age on voluntary activation during maximal voluntary isometric contractions. The literature was systematically reviewed for studies reporting voluntary activation quantified with the interpolated twitch technique (ITT) or central activation ratio (CAR) during isometric contractions in young (18–35 yr) and old adults (>60 yr; mean, ≥65 yr). Of the 2697 articles identified, 54 were eligible for inclusion in the meta-analysis. Voluntary activation was assessed with electrical stimulation and transcranial magnetic stimulation on five different muscle groups. Random-effects meta-analysis revealed lower activation in old compared with young adults (d= −0.45; 95% confidence interval, −0.62 to −0.29;P< 0.001), with moderate heterogeneity (52.4%). To uncover the sources of heterogeneity, subgroup analyses were conducted for muscle group, calculation method (ITT or CAR), and stimulation type (electrical stimulation or transcranial magnetic stimulation) and number (single, paired, or train stimulations). The age-related reduction in voluntary activation occurred for all muscle groups investigated except the ankle dorsiflexors. Both ITT and CAR demonstrated an age-related reduction in voluntary activation of the elbow flexors, knee extensors, and plantar flexors. ITT performed with paired and train stimulations showed lower activation for old than young adults, with no age difference for the single electrical stimulation. Together, the meta-analysis revealed that healthy older adults have a reduced capacity to activate some upper and lower limb muscles during maximal voluntary isometric contractions; however, the effect was modest and best assessed with at least paired stimulations to detect the difference.