bluuebunny/crossref_metadata_2025 huggingface dataset:
Sequence learning is driven by improvements in motor planning
Authors: Ariani Giacomo , Diedrichsen Jörn
Published: April 2019

The ability to perform complex sequences of movements quickly and accurately is critical for many motor skills. Although training improves performance in a large variety of motor sequence tasks, the precise mechanisms behind such improvements are poorly understood. Here we investigated the contribution of single-action selection, sequence preplanning, online planning, and motor execution to performance in a discrete sequence production task. Five visually presented numbers cued a sequence of five finger presses, which had to be executed as quickly and accurately as possible. To study how sequence planning influenced sequence production, we manipulated the amount of time that participants were given to prepare each sequence by using a forced-response paradigm. Over 4 days, participants were trained on 10 sequences and tested on 80 novel sequences. Our results revealed that participants became faster in selecting individual finger presses. They also preplanned three or four sequence items into the future, and the speed of preplanning improved for trained, but not for untrained, sequences. Because preplanning capacity remained limited, the remaining sequence elements had to be planned online during sequence execution, a process that also improved with sequence-specific training. Overall, our results support the view that motor sequence learning effects are best characterized by improvements in planning processes that occur both before and concurrently with motor execution.

NEW & NOTEWORTHY Complex skills often require the production of sequential movements. Although practice improves performance, it remains unclear how these improvements are achieved. Our findings show that learning effects in a sequence production task can be attributed to an enhanced ability to plan upcoming movements. These results shed new light on planning processes in the context of movement sequences and have important implications for our understanding of the neural mechanisms that underlie skill acquisition.
Hand forces and placement are modulated and covary during anticipatory control of bimanual manipulation
Authors: Lee-Miller Trevor , Santello Marco , Gordon Andrew M.
Published: April 2019

Dexterous object manipulation relies on the feedforward and feedback control of kinetics (forces) and kinematics (hand shaping and digit placement). Lifting objects with an uneven mass distribution involves the generation of compensatory moments at object lift-off to counter object torques. This is accomplished through the modulation and covariation of digit forces and placement, which has been shown to be a general feature of unimanual manipulation. These feedforward anticipatory processes occur before performance-specific feedback. Whether this adaptation is a feature unique to unimanual dexterous manipulation or general across unimanual and bimanual manipulation is not known. We investigated the generation of compensatory moments through hand placement and force modulation during bimanual manipulation of an object with variable center of mass. Participants were instructed to prevent object roll during the lift. Similar to unimanual grasping, we found modulation and covariation of hand forces and placement for successful performance. Thus this motor adaptation of the anticipatory control of compensatory moment is a general feature across unimanual and bimanual effectors. Our results highlight the involvement of high-level representation of manipulation goals and underscore a sensorimotor circuitry for anticipatory control through a continuum of force and placement modulation of object manipulation across a range of effectors.

NEW & NOTEWORTHY This is the first study, to our knowledge, to show that successful bimanual manipulation of objects with asymmetrical centers of mass is performed through the modulation and covariation of hand forces and placements to generate compensatory moments. Digit force-to-placement modulation is thus a general phenomenon across multiple effectors, such as the fingers of one hand, and both hands. This adds to our understanding of integrating low-level internal representations of object properties into high-level task representations.
How Do Kidneys Adapt to a Deficit or Loss in Nephron Number?
Authors: Fattah Hadi , Layton Anita , Vallon Volker
Published: April 2019

A deficit or loss in the number of nephrons, the functional unit of the kidney, can induce compensatory growth and hyperfunction of remaining nephrons. An increase in single nephron glomerular filtration rate (SNGFR) aims to compensate but may be deleterious in the long term. The increase in SNGFR is determined by the dynamics of nephron loss, total remaining GFR, the body’s excretory demand, and the functional capacity to sustain single nephron hyperfunction.
A Critical Evaluation of Current Concepts in Cerebral Palsy
Authors: Brandenburg Joline E. , Fogarty Matthew J. , Sieck Gary C.
Published: April 2019

Spastic cerebral palsy (CP), despite the name, is not consistently identifiable by specific brain lesions. CP animal models focus on risk factors for development of CP, yet few reproduce the diagnostic symptoms. Animal models of CP must advance beyond risk factors to etiologies, including both the brain and spinal cord.
Natural Plant Extracts as Acid-Base Indicator and Determination of Their pKa Value
Authors: Kapilraj N. , Keerthanan S. , Sithambaresan M.
Published: April 2019

Commonly used indicators for acid-base titrations are synthetic, and this work was focused to identify the eco-friendly natural indicators and to determine their pKa values. The analytical potential of the flower extracts is very promising as seen in its application in acid-base titrimetry. These selected flower extracts were found to perform well in titrating strong acid-strong base than in weak acid-strong base. We have obtained a sharp and clear colour change from red to brownish yellow for the Bougainvillea glabra extract, from red to yellow for the Bauhinia purpurea extract, and from red to brownish yellow for the Impatiens balsamina extract. All the three flower extracts gave clear colour change with acids and bases, and the colour change was maintained with different acids and bases. The sharp contrast between their colours in acid and base made the pigment suitable for use as acid-base indicators. As these flower extracts have very simple,cost-effective, environment friendly extraction procedure and excellent performance with sharp colour change in end points of the titrations, it would be possible to replace the standard indicators being used in conventional laboratories with natural flower indicators.
CD80 Expression Correlates with IL-6 Production in THP-1-Like Macrophages Costimulated with LPS and Dialyzable Leukocyte Extract (Transferon®)
Authors: Jiménez-Uribe Alexis P. , Valencia-Martínez Hugo , Carballo-Uicab Gregorio , Vallejo-Castillo Luis , Medina-Rivero Emilio , Chacón-Salinas Rommel , Pavón Lenin , Velasco-Velázquez Marco A. , Mellado-Sánchez Gabriela , Estrada-Parra Sergio , Pérez-Tapia Sonia M.
Published: April 2019

Transferon® is a complex drug based on a mixture of low molecular weight peptides. This biotherapeutic is employed as a coadjuvant in clinical trials of several diseases, including viral infections and allergies. Given that macrophages play key roles in pathogen recognition, phagocytosis, processing, and antigen presentation, we evaluated the effect of Transferon® on phenotype and function of macrophage-like cells derived from THP-1 monocytes. We determined the surface expression of CD80 and CD86 by flow cytometry and IL-1β, TNF-α, and IL-6 levels by ELISA. Transferon® alone did not alter the steady state of PMA-differentiated macrophage-like THP-1 cells. On the contrary, simultaneous stimulation of cells with Transferon® and LPS elicited a significant increase in CD80 (P≤0.001) and CD86 (P≤0.001) expression, as well as in IL-6 production (P≤0.05) compared to the LPS control. CD80 expression and IL-6 production exhibited a positive correlation (r=0.6, P≤0.05) in cells exposed to Transferon® and LPS. Our results suggest that the administration of Transferon® induces the expression of costimulatory molecules and the secretion of cytokines in LPS-activated macrophages. Further studies are necessary to determine the implication of these findings in the therapeutic properties of Transferon®.
Satisfaction with Maternal Healthcare Services in the Ketu South Municipality, Ghana: A Qualitative Case Study
Authors: Amu Hubert , Nyarko Samuel H.
Published: April 2019

Background. Women’s satisfaction with maternal healthcare services is vital in quality healthcare delivery. However, the dearth of in-depth information on the issue is a challenge in Ghana. In this study, we explore women’s satisfaction with maternal care services at a health facility in the Ketu South Municipality, Ghana. Methods. This is a qualitative study that used a purposive sampling technique to select 15 women who attended a child welfare clinic at the facility for in-depth interviews. The interviews were tape-recorded, and the results presented in quotes in accordance with the themes that emerged. Results. The study found that respondents were generally satisfied with the quality of maternal healthcare services provided to them. However, they were dissatisfied with drug administration procedures at the facility. Respondents generally reported poor attitudes on the part of healthcare providers at the health facility. Some logistics were also reported to be in unfavorable condition. Nonetheless, respondents generally had positive perceptions about maternal care services provided to them by the healthcare facility. Conclusions. Drug administration procedures and attitude of healthcare providers toward clients as well as logistics need to be improved to enhance satisfaction with services at the health facility, particularly among pregnant women and mothers.
Reissner-Nordström Black Holes Statistical Ensembles and First-Order Thermodynamic Phase Transition
Authors: Ghaffarnejad Hossein , Farsam Mohammad
Published: April 2019

We apply Debbasch proposal to obtain mean metric of coarse graining (statistical ensemble) of quantum perturbed Reissner-Nordstöm black hole (RNBH). Then we seek its thermodynamic phase transition behavior. Our calculations predict first-order phase transition which can take Bose-Einstein’s condensation behavior.
Electrical Remodeling of Ventricular Repolarization Abnormality after Treatment in Pheochromocytoma: U Wave Finding in a Retrospective Analysis
Authors: Stolfo Giuseppe Di , Mastroianno Sandra , Maggio Angela , De Luca Giovanni , Potenza Domenico R. , Salvatori Mauro Pellegrino , Russo Aldo
Published: April 2019

Background. Pheochromocytoma is a rare neuroendocrine tumor, clinically characterized by high blood pressure, palpitations, and headache. It is often associated with abnormalities of the ventricular repolarization phase; the dispersion of ventricular repolarization is the basis for ventricular arrhythmias (torsion de point, ventricular tachycardia or ventricular fibrillation). Objectives. Analysis of abnormal ventricular repolarization focused on the presence and amount of U wave in patients affected by pheochromocytoma and its modification after surgery. Materials and Methods. We reviewed pathology records of 722 patients admitted for adrenal nodule or suspected chromaffin-cell tumor and identified 39 patients affected by pheochromocytoma. Metanephrine, normetanephrine, and 3-methoxytyramine have been assessed by determining concentrations in 24-hour urine collection. Standard 12-lead electrocardiogram records have been reviewed with analysis of heart rate, P wave, PR interval, QRS duration, QTc, and U wave. Then we selected and compared 22 patients of 39 affected by pheochromocytoma, with both clinical and electrocardiographic data before and after surgery. Results. In our cohort of 39 patients affected by pheochromocytoma, we found U wave in ECG, before treatment, in 82.8 percent of patients, while only 37.0 percent after treatment (p<0.001) and we observed a statistically significant correlation between this wave and the urinary metanephrine. After surgery, in the selected 22 patients, we observed a clear significant reduction in systemic blood pressure, fasting glucose, metanephrine, normetanephrine, and 3-methoxytyramine. We found a significant reduction of U wave presence and leads involved in these patients after surgery (90.9% versus 9%). We observed a linear correlation between the amount of U waves in 12-lead electrocardiogram and metanephrine (r2=0.333, p=0.015), 3-methoxytyramine levels (r2=0.458, p=0.006), and tumor size (r2=0.429, p=0.003). Conclusions. In our retrospective analysis, patients affected by pheochromocytoma presented U wave in electrocardiogram. The presence and amount of U wave were associated with the metanephrine levels and the tumor size with significant reduction after surgical removal.
Primary CNS Lymphoma Arising from the 4th Ventricle: A Case Report and Review of the Literature
Authors: Brozovich Ava , Ewing Donald , Burns Ethan , Hatcher Courtney , Acosta Gonzalo , Khan Usman , Chung Betty , Samuel Leena , Randhawa Jasleen , Pingali Sai Ravi
Published: April 2019

A 65-year-old male with a history of ischemic strokes, seizures, and subarachnoid hemorrhage presented with a 4-week history of progressive diplopia, vertigo, nausea, and vomiting. Magnetic resonance imaging (MRI) revealed a 2.5×1.8×1.7 cm posterior fossa mass arising from the roof of the 4th ventricle extending into the cerebellar vermis. Posterior fossa craniotomy with stereotactic biopsy confirmed a locally invasive diffuse large B-cell lymphoma (DLBCL). Primary central nervous system lymphoma (PCNSL) arising from the 4th ventricle is a rare extranodal manifestation of non-Hodgkin lymphoma (NHL), with few cases documented in the literature. Review of available cases lends support that lymphoma arising from the 4th ventricle has a variable clinical presentation, occurs most commonly in immunocompetent males, and should be on the differential of any immunocompetent adult presenting with a posterior fossa mass. Optimal treatment modalities are based largely on phase 2 clinical trials, and recommended guidelines regardless of anatomic location should be adhered to.
Kriging Surrogate Model for Resonance Frequency Analysis of Dental Implants by a Latin Hypercube-Based Finite Element Method
Authors: Chu Liu , Shi Jiajia , Souza de Cursi Eduardo
Published: April 2019

The dental implantation in clinical operations often encounters difficulties and challenges of failure in osseointegration, bone formulation, and remodeling. The resonance frequency (RF) can effectively describe the stability of the implant in physical experiments or numerical simulations. However, the exact relationship between the design variables of dental implants and RF of the system is correlated, complicated, and dependent. In this study, an appropriate mathematical model is proposed to evaluate and predict the implant stability and performance. The model has merits not only in the prediction reliability and accuracy but also in the compatibility and flexibility, in both experimental data and numerical simulation results. The Kriging surrogate model is proposed to present the numerical relationship between RF and material parameters of dental implants. The Latin Hypercube (LH) sampling method as a competent and sophisticated method is applied and combined with the finite element method (FEM). The methods developed in this paper provide helpful guidance for designers and researchers in the implantation design and surgical plans.
Encapsulation of Bifidobacterium pseudocatenulatum Strain G4 within Bovine Gelatin-Genipin-Sodium Alginate Combinations: Optimisation Approach Using Face Central Composition Design-Response Surface Methodology (FCCD-RSM)
Authors: Khalil Khalilah Abdul , Mustafa Suhaimi , Mohammad Rosfarizan , Ariff Arbakariya Bin , Ahmad Siti Aqlima , Dahalan Farrah Aini , Abdul Manap Mohd Yazid
Published: April 2019

Bovine gelatin is a biopolymer which has good potential to be used in encapsulating matrices for probiotic candidate Bifidobacterium pseudocatenulatum strain G4 (G4) because of its amphoteric nature characteristic. Beads were prepared by the extrusion method using genipin and sodium alginate as a cross-linking agent. The optimisation of bovine gelatin-genipin-sodium alginate combinations was carried out using face central composition design (FCCD) to investigate G4 beads’ strength, before and after exposed to simulated gastric (SGF), intestinal fluids (SIF), and encapsulation yield. A result of ANOVA and the polynomial regression model revealed the combinations of all three factors have a significant effect (p<0.05) on the bead strength. Meanwhile, for G4 encapsulation yield, only genipin showed less significant effect on the response. However, the use of this matrix remained due to the intermolecular cross-linking ability with bovine gelatin. Optimum compositions of bovine gelatin-genipin-sodium alginate were obtained at 11.21% (w/v), 1.96 mM, and 2.60% (w/v), respectively. A model was validated for accurate prediction of the response and showed no significant difference (p>0.05) with experimental values.
Complete Genome Sequence ofPhotobacterium damselaeSubsp.damselaeStrain SSPD1601 Isolated from Deep-Sea Cage-CulturedSebastes schlegeliiwith Septic Skin Ulcer
Authors: Yu Yongxiang , Zhang Zheng , Wang Yingeng , Liao Meijie , Rong Xiaojun , Li Bin , Wang Kai , Chen Jing , Zhang Hao
Published: April 2019

Photobacterium damselaesubsp.damselae(PDD) is a Gram-negative bacterium that can infect a variety of aquatic organisms and humans. Based on an epidemiological investigation conducted over the past 3 years, PDD is one of the most important pathogens causing septic skin ulcer in deep-sea cage-culturedSebastes schlegeliiin the Huang-Bohai Sea area and present throughout the year with high abundance. To further understand the pathogenicity of this species, the pathogenic properties and genome of PDD strain SSPD1601 were analyzed. The results revealed that PDD strain SSPD1601 is a rod-shaped cell with a single polar flagellum, and the clinical symptoms were replicated during artificial infection. The SSPD1601 genome consists of two chromosomes and two plasmids, totaling 4,252,294 bp with 3,751 coding sequences (CDSs), 196 tRNA genes, and 47 rRNA genes. Common virulence factors including flagellin,Fur,RstB,hcpA, OMPs,htpB-Hsp60,VasK, andvgrGwere found in strain SSPD1601. Furthermore, SSPD1601 is a pPHDD1-negative strain containing the hemolysin genehlyAchand three putative hemolysins (emrA, yoaF, and VPA0226), which are likely responsible for the pathogenicity of SSPD1601. The phylogenetic analysis revealed SSPD1601 to be most closely related to Phdp Wu-1. In addition, the antibiotic resistance phenotype indicated that SSPD1601 was not sensitive to ceftazidime, pipemidic, streptomycin, cefalexin, bacitracin, cefoperazone sodium, acetylspiramycin, clarithromycin, amikacin, gentamycin, kanamycin, oxacillin, ampicillin, and trimethoprim-sulfamethoxazole, but only the bacitracin resistance genebacAwas detected based on Antibiotic Resistance Genes Database. These results expand our understanding of PDD, setting the stage for further studies of its pathogenesis and disease prevention.
Computed Tomography versus Optical Scanning: A Comparison of Different Methods of 3D Data Acquisition for Tooth Replication
Authors: Kulczyk Tomasz , Rychlik Michał , Lorkiewicz-Muszyńska Dorota , Abreu-Głowacka Monica , Czajka-Jakubowska Agata , Przystańska Agnieszka
Published: April 2019

Objectives. The study aimed to compare the accuracy of different methods of data acquisition and data reconstruction and to assess their usefulness for 3D printing of tooth replicas. Methods. 3-dimensional models of molar and canine teeth obtain utilizing CBCT examination with different protocols, and optical scanning was compared with models derived from micro-computed (micro-CT) examination using Geomagic Studio Qualify software. A pairwise comparison of 3D models with analysis of standard deviation and the value of the mean distance of given surfaces was performed. Results. Standard deviation and the value of the mean distance were lowest for optical scanning followed by CBC in high and standard resolution in all tested protocols. Models, obtained with high-resolution CBCT protocols, of teeth in and outside of alveolar bone showed similar average distance parameters, but standard deviation parameter was significantly lower for models of teeth scanned outside of the socket. Good surface representation on all models was seen at relatively smooth areas while in areas of high changes in the geometry CBCT based models performed inferiorly to those obtained from an optical scanner. Conclusions. In case of teeth of noncomplicated texture, independently from a position (within or outside the alveolar socket), the high-resolution CBCT seems to be a sufficient method to obtain data for 3D printed tooth replica. Optical scanning performs better when a detailed replica is necessary.
Photovoltaic Panel Efficiency Estimation with Artificial Neural Networks: Samples of Adiyaman, Malatya, and Sanliurfa
Authors: Icel Yasin , Mamis Mehmet Salih , Bugutekin Abdulcelil , Gursoy Mehmet Ismail
Published: April 2019

The amount of electric energy produced by photovoltaic panels depends on air temperature, humidity rate, wind velocity, photovoltaic module temperature, and particularly solar radiation. Being aware of the behaviour patterns of the panels to be used in project and planning works regarding photovoltaic applications will set forth a realistic expense form; therefore, erroneous investments will be avoided, and the country budget will benefit from added value. The power ratings obtained from the photovoltaic panels and the environmental factors were measured and recorded for a year by the measurement stations established in three diverse regions (Adiyaman-Malatya-Sanliurfa). In the developed artificial neural network models, the estimation accuracy was 99.94%. Furthermore, by taking the data of the General Directorate of Meteorology as a reference, models of artificial neural networks were developed using the data from Adiyaman province for training; by using Malatya and Sanliurfa as test data, 99.57% estimation accuracy was achieved. With the artificial neural network models developed as a result of the study, the energy efficiency for the photovoltaic energy systems desired to be established by using meteorological parameters such as temperature, humidity, wind, and solar radiation of various regions anywhere in the world can be estimated with high accuracy.
Effect of Agave Fructans and Maltodextrin on Zn2+ Chlorophyll Microencapsulation by Spray Drying
Authors: Femat-Castañeda Cesar , Chávez-Rodríguez Alejandra , Chávez-Rodríguez Arturo Moises , Flores-Martínez Hector , Farías-Cervantes Vania Sbeyde , Andrade-González Isaac
Published: April 2019

Spray-drying technology is a suitable process for large-scale production of various advanced materials. This study describes the effect of the concentration (0.5, 1.0, and 1.5%) of novel carrier agents, agave fructans (FOS) and maltodextrin (MD), in a chlorophyll extract spray-drying process on colour, antioxidant activity, and stability. A pilot plant was employed with a spray-dryer feed flow rate of 13% and an atomisation level of 28000 rpm. The air inlet and outlet temperatures were 180 and 80°C, respectively. A MD concentration of 0.5% was enough to obtain a chemically and physiochemically stable encapsulated chlorophyll powder. High inlet air temperatures reduced the chlorophyll content from 18 to 6 mg/g; high concentrations of the carrier agent also decreased the chlorophyll content. The results showed that, under conditions of low inlet temperature and concentration, both wall materials were efficient in microencapsulating chlorophyll for potential use in the food industry.
Wearable Sensors Integrated with Virtual Reality: A Self-Guided Healthcare System Measuring Shoulder Joint Mobility for Frozen Shoulder
Authors: Cui Jianjun , Yeh Shih-Ching , Lee Si-Huei
Published: April 2019

Frozen shoulder is a common clinical shoulder condition. Measuring the degree of shoulder joint movement is crucial to the rehabilitation process. Such measurements can be used to evaluate the severity of patients’ condition, establish rehabilitation goals and appropriate activity difficulty levels, and understand the effects of rehabilitation. Currently, measurements of the shoulder joint movement degree are typically conducted by therapists using a protractor. However, along with the growth of telerehabilitation, measuring the shoulder joint mobility on patients’ own at home will be needed. In this study, wireless inertial sensors were combined with the virtual reality interactive technology to provide an innovative shoulder joint mobility self-measurement system that can enable patients to measure their performance of four shoulder joint movements on their own at home. Pilot clinical trials were conducted with 25 patients to confirm the feasibility of the system. In addition, the results of correlation and differential analyses compared with the results of traditional measurement methods exhibited a high correlation, verifying the accuracy of the proposed system. Moreover, according to interviews with patients, they are confident in their ability to measure shoulder joint mobility themselves.
Noninvasive Recanalization of a Coronary Chronic Total Occlusion
Authors: Kos Nikola , Radeljić Vjekoslav , Pavlović Nikola , Kordić Krešimir , Đula Kristijan , Bulj Nikola , Krčmar Tomislav , Brkljačić Diana Delić , Zeljković Ivan , Manola Šime
Published: April 2019

Background. Spontaneous recanalization of a chronically occluded artery is rare and reported anecdotally. Case Summary. We report a case of a patient with a chronically occluded right coronary artery, found on a coronary angiography performed due to acute ST elevation myocardial infarction with an occluded circumflex artery as a culprit lesion. Three months later, a follow-up angiography was performed and a recanalization of the occluded right coronary artery was detected. Discussion. There is a possibility that intrinsic fibrinolytic mechanisms with the additional effect of standard antithrombotic drugs administrated after the acute coronary event led to the recanalization.
Genome-Wide Analysis of theTCPGene Family in Switchgrass (Panicum virgatumL.)
Authors: Huo Yuzhu , Xiong Wangdan , Su Kunlong , Li Yu , Yang Yawen , Fu Chunxiang , Wu Zhenying , Sun Zhen
Published: April 2019

The plant-specific transcription factor TCPs play multiple roles in plant growth, development, and stress responses. However, a genome-wide analysis of TCP proteins and their roles in salt stress has not been declared in switchgrass (Panicum virgatumL.). In this study, 42 PvTCP genes (PvTCPs) were identified from the switchgrass genome and 38 members can be anchored to its chromosomes unevenly. NinePvTCPswere predicted to bemicroRNA319(miR319) targets. Furthermore,PvTCPscan be divided into three clades according to the phylogeny and conserved domains. Members in the same clade have the similar gene structure and motif localization. Although allPvTCPswere expressed in tested tissues, their expression profiles were different under normal condition. The specific expression may indicate their different roles in plant growth and development. In addition, approximately 20cis-acting elements were detected in the promoters ofPvTCPs, and 40% were related to stress response. Moreover, the expression profiles ofPvTCPsunder salt stress were also analyzed and 29PvTCPswere regulated after NaCl treatment. Taken together, thePvTCPgene family was analyzed at a genome-wide level and their possible functions in salt stress, which lay the basis for further functional analysis ofPvTCPsin switchgrass.
Evaluation of Hypoglycemia and Associated Factors among Patients with Type 1 Diabetes on Follow-Up Care at St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
Authors: Kahsay Halefom , Fantahun Bereket , Nedi Teshome , Demoz Gebre Teklemariam
Published: April 2019

Background. Hypoglycemia is one of the most common acute complications of type 1 diabetes mellitus (T1DM). The knowledge of the factors associated with hypoglycemia will help in the prevention and management of the problem. Therefore, this study was conducted to assess hypoglycemia and its associated factors among T1DM patients who attended the diabetes outpatient clinic of St. Paul’s Hospital Millennium Medical College (SPHMMC). Methods. A cross-sectional study was conducted at the diabetes clinic of SPHMMC. Data on sociodemographic and clinical characteristics including duration of diabetes, type of insulin they have been taking, the factors associated with hypoglycemia, and the severity stage of hypoglycemia was obtained. Data was collected using a structured questionnaire and chart review. Multivariate logistic regression model was used to identify factors associated with hypoglycemia. Result. Out of the 247 participants who were recruited into the study, 233 (94.3%) of them experienced hypoglycemia. A total of 6.9 events of hypoglycemia per patient per year happened. Particularly, the events were categorized as 3.1 mild events, 2.3 moderate events, and 0.93 severe events of hypoglycemia. Shorter duration of diabetes history (<1 year) was significantly associated with less experience of hypoglycemia (AOR=0.09, 95% CI: 0.01-0.90). However, blood glucose monitoring at home was found to be significantly associated with more report of hypoglycemia (AOR=5.77, 95% CI: 1.16-28.66). Conclusion. The prevalence of hypoglycemia among T1DM patients was found as substantially high. Self/family blood glucose monitoring at home could not guarantee to minimize the occurrence of hypoglycemia events. Finger stick home blood glucose monitoring should be given a special attention. Therefore, the involvement of health care providers in diabetes care should be encouraged to address the occurrence of hypoglycemia in T1DM patients.
Associations of P2X7 Polymorphisms with the Odds of Tuberculosis: A Meta-Analysis
Authors: Chi Xu , Song Shuanbao , Cai Huafeng , Chen Juan , Qi Yun
Published: April 2019

Background: Recently, the roles of purinergic receptor P2X ligand-gated ion channel 7 (P2X7) polymorphisms in tuberculosis (TB) were analyzed by some pilot studies, but the results of these studies were inconsistent. We performed this study to better assess the relationship between P2X7 polymorphisms and the odds of TB. Methods: Eligible studies were searched in PubMed, MEDLINE, and Embase. Odds ratios and 95% confidence intervals were calculated. Results: A total of 21 studies were included for analyses. Significant associations with the odds of TB were detected for rs3751143 polymorphism in dominant (p = 0.01), recessive (p < 0.0001), additive (p = 0.0002), and allele models (p < 0.0001) in overall analyses. Further subgroup analyses based on the ethnicity of participants revealed that the rs1718119 polymorphism is significantly associated with the odds of TB in Asians and the rs3751143 polymorphism with the odds of TB in Caucasians. Conclusion: Our findings indicate that rs1718119 polymorphism may serve as a potential biological marker of TB in Asians and the rs3751143 polymorphism as a potential biological marker of TB in Caucasians.
Posttransplantation Anemia in Kidney Transplant Recipients
Authors: Gafter-Gvili Anat , Gafter Uzi
Published: April 2019

Posttransplantation anemia (PTA) is common among kidney transplant patients. Early PTA is usually defined as anemia which develops up to 6 months after transplantation, and late PTA is defined as anemia which develops after 6 months. There are multiple causes, with iron deficiency being the major contributor. The occurrence of late PTA has been associated with impaired graft function. Early PTA has been shown to be a predictor of late PTA. PTA is associated with reduced mortality, reduced graft survival, and a decline in GFR. The association with mortality is related to the severity of the anemia and to specific causes of anemia. Treatment of PTA should probably begin as soon as possible after kidney transplantation. The optimal target hemoglobin level in kidney transplant recipients with anemia is higher than recommended in chronic kidney disease and should probably be up to 12.5–13 g/dL. In order to achieve this target, appropriate treatment with erythropoiesis-stimulating agents (ESA) and iron is indicated.
Detection of Novel Fusion Transcript VTI1A-CFAP46 in Hepatocellular Carcinoma
Authors: Tsuge Shunichi , Saberi Behnam , Cheng Yulan , Wang Zhixiong , Kim Amy , Luu Harry , Abraham John M. , Ybanez Maria D. , Hamilton James P. , Selaru Florin M. , Villacorta-Martin Carlos , Schlesinger Felix , Philosophe Benjamin , Cameron Andrew M. , Zhu Qingfeng , Anders Robert , Gurakar Ahmet , Meltzer Stephen J.
Published: April 2019

Background: Hepatocellular carcinoma (HCC) is now the second-highest cause of cancer death worldwide. Recent studies have discovered a wide range of somatic mutations in HCC. These mutations involve various vital signaling pathways such as: Wnt/β-Catenin, p53, telome­rase reverse transcriptase (TERT), chromatin remodeling, RAS/MAPK signaling, and oxidative stress. However, fusion transcripts have not been broadly explored in HCC. Methods: To identify novel fusion transcripts in HCC, in the first phase of our study, we performed targeted RNA sequencing (in HCC and paired non-HCC tissues) on 6 patients with a diagnosis of HCC undergoing liver transplantation. Results: As a result of these studies, we discovered the novel fusion transcript, VTI1A-CFAP46. In the second phase of our study, we measured the expression of wild-type VTI1A in 21 HCC specimens, which showed that 10 of 21 exhibited upregulation of wild-type VTI1A in their tumors. VTI1A (Vesicle Transport via Interaction with t-SNARE homolog 1A) is a member of the Soluble N-ethylmaleimide-Sensitive Factor (NSF) attachment protein receptor (SNARE) gene family, which is essential for membrane trafficking and function in endocytosis, autophagy, and Golgi transport. Notably, it is known that autophagy is involved in HCC. Conclusions: The link between novel fusion transcript VTI1A-CFAP46 and autophagy as a potential therapeutic target in HCC patients deserves further investigation. Moreover, this study shows that fusion transcripts are worthy of additional exploration in HCC.
Management of Iron Deficiency in Heart Failure
Authors: Zusman Oren , Itzhaki Ben Zadok Osnat , Gafter-Gvili Anat
Published: April 2019

Anemia is a common finding in patients with heart failure (HF). The cause for anemia is multifactorial, with iron deficiency being the most common cause. Anemia with HF is an established predictor of morbidity and mortality. Iron deficiency in systolic HF, even without anemia, has been associated with increased mortality, increased hospitalizations, and decreased functional capacity and quality of life measures. Data from several randomized controlled trials and meta-analyses of iron deficiency and systolic HF show a beneficial effect for intravenous (IV) iron in terms of quality of life and functional capacity (improvements in 6-min walk test, and improvements in New York Heart Association functional class), as well as decreased hospitalizations for HF and reduction in cardiovascular mortality rates. Limited evidence exists for a beneficial effect of IV iron in diastolic dysfunction. Patients with symptomatic systolic HF should undergo an anemia diagnostic work-up. When iron deficiency (defined as ferritin <100 ng/mL or serum ferritin 100–299 ng/mL and transferrin saturation <20%) is present, current evidence supports treating HF patients with iron deficiency with IV iron.
Impact of Allergy and Eosinophils on the Morbidity of Chronic Rhinosinusitis with Nasal Polyps in Northwest China
Authors: Chen Fuquan , Wen Liting , Qiao Li , Shi Zhaohui , Xue Tao , Chen Xiaodong , Li Xiaoyuan
Published: April 2019

Background: Nasal polyps are a common health problem that can significantly impact the quality of life. Objective: To analyze the impact of allergy and peripheral eosinophils (EOS) on the morbidity of chronic rhinosinusitis with nasal polyps (CRSwNP) in Northwest China. Methods: A retrospective cohort of 323 patients who underwent endoscopic sinus surgery (ESS) for chronic rhinosinusitis without nasal polyps (CRSsNP) and CRSwNP in Xijing Hospital was studied between January 5, 2011, and January 4, 2015. All of the patients underwent an allergen skin prick test and peripheral blood EOS inspection. Detailed information regarding the impact of allergy and EOS on the morbidity of CRSwNP was collected. Potential risk factors associated with nasal polyps were explored using logistic regression analysis. Multivariate logistic regression was performed to identify independent risk factors. Results: The results revealed that EOS is an important risk factor for nasal polyps. In the univariate analysis, the adjusted OR was 2.01 (95% CI 1.08–3.72; p = 0.027). In the multivariate analysis, the adjusted OR was 2.02 (95% CI 1.08–3.76; p = 0.027). Compared to allergic rhinitis and normal EOS levels, nonallergic rhinitis and elevated EOS levels constituted a risk factor for CRSwNP (OR = 2.70; 95% CI 1.32–5.50). Compared to allergen-positive and EOS-normal status, allergen-negative and elevated-EOS status constituted a risk factor for CRSwNP (OR = 2.95; 95% CI 1.38–6.33). Conclusion: EOS is a significant factor related to the morbidity of CRSwNP in Northwest China. Elevated EOS levels occurring in the context of nonallergic rhinitis constitute a risk factor for CRSwNP. Similarly, elevated EOS levels occurring in the context of allergen-negative rhinitis are also an important risk factor for morbidity of CRSwNP.
Transvaginal Repair of Vesico Vaginal Fistula: A 10-Year Experience with Analysis of Factors Affecting Outcomes
Authors: Kumar Manoj , Agarwal Samarth , Goel Apul , Sharma Ashish , Agarwal Ajay , Pandey Siddharth , Sankhwar Satya Narain
Published: April 2019

Objectives: To highlight the transvaginal route as an excellent approach for repair of a simple trigonal, supra-trigonal vesico-vaginal and urethrovaginal fistulae without compromising on the successful patient outcomes. We also determine factors affecting outcomes in such patients. Materials and Methods: A retrospective analysis was carried out on 58 patients with simple trigonal, supra trigonal and urethrovaginal fistula who underwent transvaginal repair in the last 10 years. Simple fistulas were defined as fistula less than 3 cm in size or recurrent fistulae less than 1.5–2 cm in size and located either supra-trigonally (above the bar of mercier) or sub-trigonally (below the bar of mercier) as determined by cystoscopy. Results: Obstetric cause, due to obstructed labour, was the most common cause of fistula formation (68.96%), while remaining (29.31%) were attributed to hysterectomy. Primary fistulae were found in 68.9% of patients and recurrent fiistulae in 31.1% patients. The mean age of patients was 33.4 years. Average fistula size was 1.5 cm. The success rate of primary operation was 84.12% (50/58). On using a multivariate regression model, the underlying aetiology (OR 2.2), fistula location (OR 2.5) and history of previous repair (OR 2.4) were found to be significant factors affecting outcome. Conclusion: The transvaginal approach is less invasive and achieves comparable success rates as compared to other methods of vesico-vaginal fistula repair. This surgery with Foley catheter has a high success rate with reduced morbidity. We postulate that vaginal approach should be preferred over abdominal approach for repair of all vaginally accessible vesico vaginal fistulae, both of obstetrical and gynaecological origin.
A Case of Leptomeningeal Carcinomatosis from Aggressive Metastatic Prostate Cancer
Authors: Carroll Ryan David , Leigh E. Cindy , Curtis Zachary , Thorpe Anthony , Ballengee Jason , Pacioles Toni
Published: April 2019

Leptomeningeal carcinomatosis (LC) is a rare leptomeningeal spread of diffusely metastatic tumors. It occurs more commonly with hematologic tumors, less commonly with solid tumors, and is exceedingly rare in prostate cancer. Due to its scarcity, it has traditionally been difficult to diagnose LC but advancement of MRI has helped considerably. However, even with technological improvements, pre-mortem diagnosis of LC remains difficult and controversial. Our case is a 71-year-old male with prostate cancer with bone metastases who presented to our facility with altered mental status (AMS), lower extremity weakness, and worsening diarrhea. The diarrhea was responsive to antibiotic therapy, but his AMS did not resolve. A head CT without contrast was negative but follow-up brain MRI revealed leptomeningeal enhancement highly suggestive of LC. Cerebrospinal fluid (CSF) cytology results were negative and other CSF studies were inconclusive. Although further studies were planned, the patient continued to deteriorate, and the family elected to withdraw care. He passed away without beginning treatment for the LC. Despite advances in cancer therapies, LC remains difficult to diagnose and treat. Imaging may be suggestive of the condition but the confirmatory tests such as repeated CSF cytology or meningeal biopsy are not only invasive but also usually occur postmortem. Additional methods of CSF testing have been studied to evaluate their role in accurately diagnosing LC but low specificity for LC has somewhat limited their use. Although treatment options are mainly palliative in nature, prompt recognition and early treatment could grant valuable time for patients and families.
FUNGAL POPULATION, AFLATOXIN AND FREE FATTY ACID CONTENTS OF PEANUTS PACKED IN DIFFERENT BAG TYPES
Authors: BULAONG SONIA S P
Published: April 2019

Shelled peanuts of Gajah var. with initial moisture content of 7% were stored at 11 kg/bag in four bag types namely: jute bag, polypropylene bag, jute bag doubled with thin polyethylene (PE), and jute bag doubled with thick PE. Storage was done for six months under warehouse conditions with monitoring of relative humidity and temperature. Samples taken at the beginning of storage and every month thereafter were analyzed for moisture content, fungal population, aflatoxin and free fatty acid contents. Statistical analyses showed that moisture content, fungal population, and free fatty acid contents were significantly higher in jute and polypropylene bags than in PE-dou,bled jute bags. No significant differences were obtained in aflatoxin contents among bag types but at the end of six months storage, toxin level in jute bag exceeded the 30 ppb limit. Polypropylene had second highest toxin level at 23 ppb. The PE-doubled bags had 17 and 19 ppb total aflatoxins for thin and thick films, respectively. The results indicated that the immediate packaging of dried shelled peanuts at safe moisture level in plastic films with water vapor transmission rated of 1 g/m2/24 hr or lower is recommended. This packaging will delay critical increases in moisture content, fungal population, aflatoxin and free fatty acid contents of peanut kernels at ambient storage conditions. Keywords: Peanuts / bag types / fungal population / aflatoxin content / free fatty acid content.
Association of Echocardiographic Parameters of Right Ventricular Remodeling and Myocardial Performance With Modified Task Force Criteria in Adolescents With Arrhythmogenic Right Ventricular Cardiomyopathy
Authors: Pieles Guido E. , Grosse-Wortmann Lars , Hader Majeda , Fatah Meena , Chungsomprasong Paweena , Slorach Cameron , Hui Wei , Fan Chun-Po Steve , Manlhiot Cedric , Mertens Luc , Hamilton Robert , Friedberg Mark K.
Published: April 2019

Background:

The usefulness of echocardiographic indices, including those already used by modified Task Force Criteria (mTFC), and others such as strain imaging, to identify arrhythmogenic right ventricular cardiomyopathy (ARVC) in adolescence is not well established.

Methods:

Echocardiograms from 120 adolescents investigated for ARVC (13±4 years) were retrospectively analyzed. According to the mTFC, patients were classified into definite (n=38), borderline (n=39), or possible (n=43) ARVC. Results were compared with 35 healthy controls. mTFC echocardiographic parameters were analyzed, as well as comprehensive right ventricular (RV) and left ventricular assessment of function including parameters not included in mTFC such as pulsed-wave tissue Doppler and RV 2-dimensional speckle strain.

Results:

mTFC parameters indexed for body surface area were significantly more abnormal in patients with possible, borderline, or definite ARVC compared with controls for parasternal long-axis view of the RV outflow tract. RV end-diastolic diameters were significantly larger in patients versus controls, a difference that increased with likelihood of ARVC. Left ventricular ejection fraction, tricuspid annular peak systolic excursion, and systolic and diastolic pulsed-wave tissue Doppler imaging indices were similar to controls for all groups. Average and segmental RV peak longitudinal systolic strain was significantly lower in patients with definite ARVC (−21±4%) and disease subgroups versus controls (−25±3%). Multivariable risk analysis showed that reduced RV strain was significantly associated with ARVC diagnosis and its likelihood (multivariable odds ratio [95% CI]=1.23 [1.1–1.37];
P
<0.001) as was increased end-diastolic diameter at the apical third of the RV (multivariable odds ratio [95% CI]=1.51 [1.33–1.72];
P
<0.001).

Conclusions:

mTFC echocardiographic criteria are significantly different between patients and controls and between the different diagnostic groups. However, in our cohort, current echocardiographic mTFC are not met by the majority of adolescent ARVC patients, particularly when indexed to body surface area. Measurement of RV apical dimensions and strain may increase the diagnostic yield of echocardiography for ARVC.
Formation and Changes of Uluses in the Mongol Empire
Authors: Kim Hodong
Published: April 2019

Ulus is a key concept for understanding the Mongol Empire; the Mongols called the empire they had created the ‘Mongol Ulus’ or the ‘Yeke (= Great) Mongol Ulus.’ It was a single huge ulus containing within itself a large number of multilayered smaller uluses. The sizes of these uluses differed. The three large western uluses of Chaghadai, Jochi, and Hülegü were so large that they looked like independent empires, and in fact they were politically quite autonomous from the Qa’an Ulus in the east. However, their enormous size or political independence notwithstanding, to the Mongols of that time they were after all individual uluses comprising part of the Yeke Mongol Ulus. The notion of ulus appears to have been an important basis that enabled the Mongols to retain a sense of unity within their empire.
What Is Possible and What Is Not? The Development of a Legal Framework for Drug Pricing Mechanisms in the EU
Authors: Ernst Gisela
Published: April 2019

As a result of the constantly increasing number of innovative but exceedingly high priced medicines, many Member States have implemented price-regulating mechanisms to ensure the financial viability of their healthcare systems. However, the European Court of Justice applies strict criteria to these measures – some of them have already been suspended for the purposes of the free movement of goods. The European Union (EU) allowed the development of an ever-stricter case law on one hand, without changing the legal frame on the other hand. Considering the importance and the binding nature of the Court’s judgements, this leaves great uncertainty for national legislators about which measures to remedy the pricing problem are legally possible and which are not. In order to provide clarity, this article seeks to analyse the development of the case law and to define the legal scope for pharmaceutical pricing mechanisms in the EU.