bluuebunny/crossref_metadata_2025 huggingface dataset:
Selection of sustainable material for the manufacturing of complex automotive products using a new hybrid Goal Programming Model for Best Worst Method–Proximity Indexed Value method
Authors: Wakeel Saif , Bingol Sedat , Bashir M. Nasir , Ahmad Shafi
Published: October 2020

Selection of the most suitable sustainable material to fulfill the requirements of a product in a specific application is a complex task. Material selection problems are basically multi-criteria decision making problems as selection of the optimal material is based on the evaluation of conflicting criteria. Considering the limitations such as ranking reversal problem of the various multi-criteria decision making methods available in the literature, a combination of two recently developed techniques, i.e. the Goal Programming Model for Best Worst Method and Proximity Indexed Value method, is employed in the present study. This hybrid method was used for selection of the best possible material for manufacturing of a complex automobile part for which F1 race car as advanced automotive and its gearbox casing as sensitive part was used. Available alternative materials considered in the present study are alloys of aluminum, magnesium, titanium, and carbon fiber/epoxy laminate. Whereas, criteria affecting gearbox casing’s performance are tensile strength/density, cost, stiffness, damping capacity, thermal conductivity, and sustainable criteria, such as CO2 emission and recycling energy. Goal Programming Model for Best Worst Method is used to determine weights of the criteria and Proximity Indexed Value method is employed for final selection of material. Furthermore, ranking of alternatives was also supported by other multi-criteria decision making methods namely, range of value, weighted product model, simple additive weighting, the technique for order of preference by similarity to ideal solution, a combined compromise solution, and the multi-attributive border approximation area comparison. Membership degree method was also employed to obtain the final optimal ranking of alternative materials from individual results of applied multi-criteria decision making methods. Besides, sensitivity analysis is done to validate reliability of the results and to determine the most critical evaluation criterion. The result of this study revealed that carbon fiber/epoxy laminate is the best alternative material.
Zur Eignung einer qualitativen Methodik für die Rekonstruktion von Bewältigungsstrategien und -prozessen
Authors: Frank Hermann , Korunka Christian
Published: October 2020

Führungskräfte sind mit heterogenen Fach- und Führungsanforderungen konfrontiert. Die erfolgreiche Bewältigung der daraus resultierenden Belastungen ist eine wesentliche Führungseigenschaft. Die Bewältigungsforschung geht von einer bidirektionalen Ursache/Wirkungsbeziehung zwischen Person und Situation aus. Als Bewältigungsformen gelten “Informationssuche”, “direkte Aktion”, “Aktionsaufschub” und “intrapsychische Verarbeitungsmechanismen”. Im Zusammenhang mit der Bewältigungsforschung steht das Konzept der sozialen Unterstützung. Unterstützungsdefizite wirken als Stressoren, ein hohes Maß an sozialer Untzerstützung wirkt als “Puffer”.

Die Autoren beschreiben und analysieren Bewältigungsstrategien und -prozesse von Führungskräften. Einer häufig erhobenen Forderung entsprechend wird ein qualitatives, exploratives Untersuchungsdesign angewendet. Die ausführliche Darstellung und Reflexion der damit gemachten Erfahrungen bilden ein weiteres Untersuchungsziel.
Zur Vorteilhaftigkeit von Cafeteria-Systemen
Authors: Föhr Silvia
Published: October 2020

Cafeteria-Systeme stellen einen alternativen Vergabemodus für freiwillige betriebliche Sozialleistungen dar. In diesem Beitrag wird zunächst die These belegt, daß Unternehmen sich aufgrund einer unternehmenspolitischen Strategie gegen die Verallgemeinerung von freiwilligen Sozialleistungen zu tariflichen bzw. gesetzlichen Sozialleistungen für ein Cafeteria-System entscheiden können, um personalpolitische Dispositionsspielräume zu erhalten. Weiterhin wird gezeigt, daß zwar zusätzliche, nicht zu vernachlässigende Kosten durch die Umsetzung von Cafeteria-Systemen entstehen, aber die Vorteile für Unternehmen erheblich sein können, was anhand humankapitaltheoretischer und informationsökonomischer Argumente vorgetragen wird. Ziel dieses Beitrags ist zu präzisieren, wann sich Nettovorteile ergeben, d.h. wann der Nutzen aus dem Einsatz von Cafeteria-Systemen größer ist als die zusätzlichen Kosten, und damit eine Entscheidungshilfe zur Einführung zu geben.
Integrierte Laufbahnplanung für Fach- und Führungskräfte in mittelständischen Unternehmen
Authors: Heimerl-Wagner Peter
Published: October 2020

Der Beitrag befaßt sich mit der Konzeption und Implementation eines integrierten Laufbahnplanungssystems für Fach- und Führungskräfte. Eine Integration des Fachpersonals in Laufbahnplanungssysteme erscheint angesichts der steigenden Bedeutung fachlicher Qualifikationen (vgl. Schein 1978, 1988) von besonderem Interesse. Insbesondere im Rahmen der aktuellen Diskussionen um das Konzept des Lean-Managements verdient dieser personalwirtschaftliche Aspekt besonderes Augenmerk. Dennoch erreichen Fachkräfte – insbesondere in mittelständischen Unternehmen – rasch Karriereplafonds. Damit wird ein Problem beleuchtet, das seitens der personalwirtschaftlichen Literatur bislang nur am Rande Beachtung findet. Es ist davon auszugehen, daß der singuläre Einsatz personalpolitischer Instrumente zu keiner nachhaltigen Entschärfung des Problems der Karriereplafonds führen. Nach einem kurzen Problemaufriß (1.) wird in diesem Beitrag ein Laufbahnplanungssystem für Fach- und Führungskräfte in mittelständischen Unternehmen vorgestellt, in das – entsprechend den unternehmensspezifischen Erfordernissen und Werthaltungen – verschiedene personalpolitische Instrumente integriert werden können (2.). Besonderes Augenmerk wird schließlich auf die Handhabung des Implementationsprozesses gelegt (3.). Das vorgestellte Modell beruht auf empirischen Erfahrungen und wird anhand eines authentischen Fallbeispiels illustriert. Abschließend erfolgt – und damit wird zum Ausgangspunkt zurückgekehrt – eine Evaluation (4.) des Systems anhand der Fluktuationsraten des Beispielunternehmens.
Personalentwicklungsveranstaltungen deutscher Großunternehmen. Eine empirische Analyse der Themen und Trends
Authors: Ennen Kathrin , Günther Ullrich
Published: October 2020

Bislang liegen bundesweit kaum Daten vor, wie sich die Ausgaben der privaten Wirtschaft für betriebliche Weiterbildung (in Deutschland über 36 Milliarden DM p.a.) auf einzelne Themenfelder verteilen und sich - etwa vor dem Hintergrund konjunktureller Veränderungen - entwickeln. Die beiden üblichen Untersuchungsmethoden, nämlich Fragebogenuntersuchungen bei Unternehmen und (seltener) firmenunabhängige Befragungen Erwerbstätiger (in repräsentativen Stichproben), erlauben dazu kaum Aussagen. Im Unterschied und als Ergänzung entwickeln die Autoren einen dritten Ansatz, nach dem objektiv erfaßbare (Planungs-)Daten contentanalytisch ausgewertet werden, die nicht überwiegend auf subjektiven Schätzungen von Betriebsangehörigen beruhen. In einer Dokumentenanalyse wurden die Weiterbildungsprogramme von 53 westdeutschen Großunternehmen für das Jahr 1994 und in einer Teilstichprobe für das Jahr 1990 analysiert. Die Autoren interpretieren die Ergebnisse sowohl vor dem konjunkturellen Hintergrund (bei geringen Neuinvestitionen weniger fachlicher Qualifikationsbedarf) als auch unternehmensstrategisch (stärkere Kundenorientierung und größere Selbständigkeit der Mitarbeiter erfordern mehr Verhaltenstraining).
Männliche Homosexualität in Organisationen: Argumente für eine überfällige Auseinandersetzung mit einem tabuisierten Thema
Authors: Maas Jörg
Published: October 2020

In diesem Aufsatz werden elf Thesen zur Arbeitssituation von homosexuellen Männern aufgestellt: Diese stützen sich auf empirische Untersuchungen, fokussieren den Homosexuellen in der Organisation, beleuchten das Verhalten der Organisation und gehen auf die rechtliche Seite der Thematik ein (Kapitel 2). Da der Umgang mit Homosexualität in Organisationen nur aus einem gesellschaftspolitischen Zusammenhang heraus zu analysieren ist, wird als Hinführung zuvor kurz auf den allgemeinen Umgang mit Sexualität und Geschlecht in den Organisationen unserer Gesellschaft eingegangen (Kapitel 1). Ein abschließendes Resümee versucht eine Vorhersage, ob sich an der Stigmatisierung von Schwulen in Organisationen in naher Zukunft etwas ändern wird (Kapitel 3).
Die Rolle der Kategorie Geschlecht in Personalbeurteilungsverfahren - eine Untersuchung der Praxis in der Münchner Stadtverwaltung
Authors: Schreyögg Friedel
Published: October 2020

Zum Einfluß der Kategorie Geschlecht in der Leistungsbeurteilung liegen bisher kaum Untersuchungen vor. Im öffentlichen Dienst spielt die dienstliche Beurteilung eine wesentliche Rolle bei der Personalauswahl. Geschlechtergerechten Beurteilungsverfahren kommt deshalb in Frauenförderplänen eine große Bedeutung zu. Die Münchner Frauengleichstellungsstelle hat die Statistiken über die Beurteilungsergebnisse des Jahres 1987 im Hinblick auf Unterschiede zwischen Frauen und Männern und die Gründe für die Benachteiligung von Frauen untersucht. Diese Untersuchung gab den Anstoß für eine generelle Reform der Beurteilungsrichtlinien der Stadtverwaltung München. Die Umsetzung der Gleichstellung der Geschlechter war eines der Reformziele. Maßnahmen, die ohne Änderung der Richtlinien möglich waren, wie Schulungsmaßnahmen zum Thema Gleichstellung, wurden sofort umgesetzt. Der eigentliche Reformprozeß nahm über drei Jahre in Anspruch und hatte eine Reihe von Hürden zu nehmen.
Acute exacerbations of idiopathic pulmonary fibrosis and the role of corticosteroids
Authors: Brereton Christopher J. , Jo Helen E.
Published: October 2020

An acute exacerbation of idiopathic pulmonary fibrosis (AEIPF) is a potentially fatal complication of an already debilitating disease. Management is currently centred on delivering excellent supportive care and identifying reversible triggers. Despite growing international awareness and collaboration, no effective therapies have been identified. Corticosteroids are often the mainstay of treatment; however, the evidence base for their use is poor. Here, we review our current understanding of the disease process and how to manage it, with a focus on the role of corticosteroid therapy.
Downregulation of the ubiquitin ligase KBTBD8 prevented epithelial ovarian cancer progression
Authors: Du Lei , Li Cong-Rong , He Qi-Feng , Li Xiao-Hua , Yang Lin-Fei , Zou Yuan , Yang Zhi-Xia , Zhang Dong , Xing Xiao-Wei
Published: October 2020

Objectives

Kelch repeat and BTB domain-containing protein 8, KBTBD8, has been identified as a female fertility factor. However, there have been no reports on the role of KBTBD8 in the progression of epithelial ovarian cancer, EOC. Our study aimed to address this issue.

Methods

We first examine KBTBD8 expression in EOC tissues and cells. Next, we performed RNA sequencing to reveal the overall mechanism. Then we investigated the roles of KBTBD8 in the proliferation, migration, and health status of cultured EOC cells. Finally, we employed tumor xenograft models to evaluate the role of KBTBD8 in vivo.

Results

First, KBTBD8 level was significantly higher in EOC tissues and cells. Next, comparative RNA sequencing identified more tumorigenesis-related genes that KBTBD8 might regulate. Then we found that KBTBD8 knockdown significantly decreased EOC cell proliferation, migration, and the activities of multiple tumorigenesis-related kinases. Finally, KBTBD8 knockdown significantly diminished ovarian tumor formation in vivo.

Conclusion

Proper KBTBD8 level is essential for the healthy growth of ovarian somatic cells, such as ovarian epithelial cells. Excessive KBTBD8 might be a significant impetus for EOC progression. KBTBD8 reduction greatly inhibits EOC proliferation and migration.
Intravascular Endothelin-1 does not trigger or increase susceptibility to Spreading Depolarizations
Authors: Sugimoto Kazutaka , Morais Andreia , Sadeghian Homa , Qin Tao , Chung David Y. , Ashina Messoud , Hougaard Anders , Ayata Cenk
Published: October 2020

Objectives

Spreading depolarizations (SD) likely manifest as aura in migraineurs. Triggers are unknown although vascular events have been implicated. Direct carotid puncture has been reported to trigger migraine with aura. The potent vasoconstrictor endothelin-1 (ET-1), which can be released from the endothelium under pathological conditions, may play a role. Here, we tested whether intracarotid ET-1 infusion triggers SD and whether systemic ET-1 infusion increases the susceptibility to SD.

Methods

Carotid infusions were performed in mice (C57BL/6, male) through a catheter placed at the carotid bifurcation via the external carotid artery. Intracarotid ET-1 (1.25 nmol/ml) was infused at various rates (2–16 μl/min) with or without heparin in the catheter and compared with vehicle infusion (PBS with 0.01% acetic acid) or sham-operated mice (n = 5). Systemic infusions ET-1 (1 nmol/kg, n = 7) or vehicle (n = 7) infusions were performed in rats (Sprague-Dawley, male) via the tail vein. Electrical SD threshold and KCl-induced SD frequency were measured after the infusion.

Results

Intracarotid infusion of saline (n = 19), vehicle (n = 7) or ET-1 (n = 12) all triggered SDs at various proportions (21%, 14% and 50%, respectively). These were often associated with severe hypoperfusion prior to SD onset. Heparinizing the infusion catheter completely prevented SD occurrence during the infusions (n = 8), implicating microembolization from carotid thrombi as the trigger. Sham-operated mice never developed SD. Systemic infusion of ET-1 did not affect the electrical SD threshold or KCl-induced SD frequency.

Conclusion

Intravascular ET-1 does not trigger or increase susceptibility to SD. Microembolization was the likely trigger for migraine auras in patients during carotid puncture.
Early response to heat stress in Chinese tongue sole (Cynoglossus semilaevis): performance of different sexes, candidate genes and networks
Authors: Wang Qian , Hao Xiancai , Liu Kaiqiang , Feng Bo , Li Shuo , Zhang Zhihua , Tang Lili , Mahboob Shahid , Shao Changwei
Published: October 2020

Background

Temperature is known to affect living organisms and alter the expression of responsive genes, which affects a series of life processes, such as development, reproduction and metabolism. Several genes and gene families have been involved in high temperature responses, such as heat shock protein (hsp) family, Jumonji family and genes related to cortisol synthesis. Gonad is a vital organ related to the existence of a species. However, the comprehensive understanding of gonadal responses to environmental temperature is limited.

Results

To explore the effects of environmental temperature on genes and gene networks in gonads, we performed acute heat treatment (48 h) on Chinese tongue sole (Cynoglossus semilaevis). Gonadal transcriptome analysis was conducted on females, pseudomales and males exposed to high (28 °C) and normal (22 °C) temperatures. A total of 1226.24 million clean reads were obtained from 18 libraries. Principal component analysis (PCA) and differentially expressed gene (DEG) analysis revealed different performance of sex responses to heat stress. There were 4565, 790 and 1117 specific genes altered their expression level in females, pseudomales and males, respectively. Of these, genes related to hsp gene family, cortisol synthesis and metabolism and epigenetic regulation were involved in early heat response. Furthermore, a total of 1048 DEGs were shared among females, pesudomales and males, which may represent the inherent difference between high and normal temperatures. Genes, such as eef1akmt3, eef1akmt4, pnmt and hsp family members, were found.

Conclusions

Our results depicted for the first time the gonadal gene expression under acute high temperature treatment in Chinese tongue sole. The findings may provide a clue for understanding the responses of genes and networks to environmental temperature.
Exogenous melatonin enhances salt secretion from salt glands by upregulating the expression of ion transporter and vesicle transport genes in Limonium bicolor
Authors: Li Junpeng , Yuan Fang , Liu Yanlu , Zhang Mingjing , Liu Yun , Zhao Yang , Wang Baoshan , Chen Min
Published: October 2020

Background

Salt, a common environmental stress factor, inhibits plant growth and reduces yields. Melatonin is a pleiotropic molecule that regulates plant growth and can alleviate environmental stress in plants. All previous research on this topic has focused on the use of melatonin to improve the relatively low salt tolerance of glycophytes by promoting growth and enhancing antioxidant ability. It is unclear whether exogenous melatonin can increase the salt tolerance of halophytes, particularly recretohalophytes, by enhancing salt secretion from the salt glands.

Results

To examine the mechanisms of melatonin-mediated salt tolerance, we explored the effects of exogenous applications of melatonin on the secretion of salt from the salt glands of Limonium bicolor (a kind of recretohalophyte) seedlings and on the expression of associated genes. A pretreatment with 5 μM melatonin significantly improved the growth of L. bicolor seedlings under 300 mM NaCl. Furthermore, exogenous melatonin significantly increased the dry weight and endogenous melatonin content of L. bicolor. In addition, this treatment reduced the content of Na+ and Cl− in leaves, but increased the K+ content. Both the salt secretion rate of the salt glands and the expression level of genes encoding ion transporters (LbHTK1, LbSOS1, LbPMA, and LbNHX1) and vesicular transport proteins (LbVAMP721, LbVAP27, and LbVAMP12) were significantly increased by exogenous melatonin treatment. These results indicate that melatonin improves the salt tolerance of the recretohalophyte L. bicolor via the upregulation of salt secretion by the salt glands.

Conclusions

Our results showed that melatonin can upregulate the expression of genes encoding ion transporters and vesicle transport proteins to enhance salt secretion from the salt glands. Combining the results of the current study with previous research, we formulated a novel mechanism by which melatonin increases salt secretion in L. bicolor. Ions in mesophyll cells are transported to the salt glands through ion transporters located at the plasma membrane. After the ions enter the salt glands, they are transported to the collecting chamber adjacent to the secretory pore through vesicle transport and ions transporter and then are secreted from the secretory pore of salt glands, which maintain ionic homeostasis in the cells and alleviate NaCl-induced growth inhibition.
Efficacy of non-opioid analgesics to control postoperative pain: a network meta-analysis
Authors: Carter John A. , Black Libby K. , Sharma Dolly , Bhagnani Tarun , Jahr Jonathan S.
Published: October 2020

Background

The aim of this network meta-analysis (NMA) was to evaluate the safety and efficacy of intravenous (IV) Meloxicam 30 mg (MIV), an investigational non-steroidal anti-inflammatory drug (NSAID), and certain other IV non-opioid analgesics for moderate-severe acute postoperative pain.

Methods

We searched PubMed and CENTRAL for Randomized Controlled Trials (RCT) (years 2000–2019, adult human subjects) of IV non-opioid analgesics (IV NSAIDs or IV Acetaminophen) used to treat acute pain after abdominal, hysterectomy, bunionectomy or orthopedic procedures. A Bayesian NMA was conducted in R to rank treatments based on the standardized mean differences in sum of pain intensity difference from baseline up to 24 h postoperatively (sum of pain intensity difference: SPID 24). The probability and the cumulative probability of rank for each treatment were calculated, and the surface under the cumulative ranking curve (SUCRA) was applied to distinguish treatments on the basis of their outcomes such that higher SUCRA values indicate better outcomes. The study protocol was prospectively registered with by PROSPERO (CRD42019117360).

Results

Out of 2313 screened studies, 27 studies with 36 comparative observations were included, producing a treatment network that included the four non-opioid IV pain medications of interest (MIV, ketorolac, acetaminophen, and ibuprofen). MIV was associated with the largest SPID 24 for all procedure categories and comparators. The SUCRA ranking table indicated that MIV had the highest probability for the most effective treatment for abdominal (89.5%), bunionectomy (100%), and hysterectomy (99.8%). MIV was associated with significantly less MME utilization versus all comparators for abdominal procedures, hysterectomy, and versus acetaminophen in orthopedic procedures. Elsewhere MME utilization outcomes for MIV were largely equivalent or nominally better than other comparators. Odds of ORADEs were significantly higher for all comparators vs MIV for orthopedic (gastrointestinal) and hysterectomy (respiratory).

Conclusions

MIV 30 mg may provide better pain reduction with similar or better safety compared to other approved IV non-opioid analgesics. Caution is warranted in interpreting these results as all comparisons involving MIV were indirect.
Small intestinal mucosal injury and its risk factors in patients with gastrointestinal cancer who developed complicated fluoropyrimidine-induced diarrhea
Authors: Sakumura Miho , Ando Takayuki , Hosokawa Ayumu , Nakajima Takahiko , Motoo Iori , Mihara Hiroshi , Ueda Akira , Kajiura Shinya , Nanjo Sohachi , Fujinami Haruka , Ogawa Kohei , Yasuda Ichiro
Published: October 2020

Background

Diarrhea is a common adverse event of fluoropyrimidine-based chemotherapy. However, limited data are available on the frequency and risk factors of complicated chemotherapy-induced diarrhea (CID) and small intestinal mucosal damage. In this current study, we aimed to determine the incidence of complicated CID and mucosal injury among patients with complicated CID receiving fluoropyrimidine via small bowel capsule endoscopy (CE) and determined baseline risk factors associated with complicated CID.

Methods

In total, 536 patients with advanced or recurrent gastrointestinal cancer who received fluoropyrimidine-based chemotherapy were retrospectively analyzed. Diarrhea was evaluated using the Common Terminology Criteria for Adverse Events version 4. Complicated CID was defined according to the American Society of Clinical Oncology guidelines. To evaluate small intestinal mucosal injury in patients with complicated CID, CE was performed. Multivariate analysis was performed to identify risk factors for complicated CID.

Results

Total number of 32 (6%) patients developed complicated CID. Complicating symptoms were noted in 25 (78%) patients, with cramping, vomiting, and sepsis being observed in 15 (60%), 8 (32%), and 3 (12%) patients, respectively. Among the 13 patients who underwent CE, 11 (85%) showed abnormal findings. Multivariate analysis revealed that oral fluoropyrimidine administration was a risk factor for complicated CID (odds ratio 2.95; 95% confidence interval 1.06–8.19).

Conclusions

Despite the relatively low incidence of complicated CID, mucosal injury of small intestine was common in patients with complicated fluoropyrimidine-induced diarrhea and oral fluoropyrimidine was an independent risk factor.
Dropout from farm-based day care for people with dementia in Norway: a follow-up study
Authors: Ibsen T. L. , Kirkevold Ø. , Patil G. G. , Eriksen S.
Published: October 2020

Background

Farm-based day care services (FDCs) for people with dementia are intending to provide social relationships and meaningful activities in an agricultural landscape and offer respite for next of kin. As this requires a certain cognitive and physical functioning, it is of interest to investigate how this service contribute during the course of dementia. In this study we aim to explore the individual characteristics predicting dropout from FDC. Furthermore, we investigate whether the participants who drop out of the service continue to live at home with another day care service or if they move to a residential care facility.

Methods

The study includes 92 people with dementia attending FDCs in Norway, assessed with standardized instruments at baseline between January 2017 and January 2018. They were followed for 1 year, and dropouts from FDC during this period were mapped. The association between individual characteristics and dropout was assessed using a Cox proportional hazards regression analysis.

Results

Thirty-eight people stopped attending FDCs during the study. Twenty-six moved to residential care. Among the 12 who continued to live in their own homes, 9 people started in a regular day care service. Higher score on educational level and more severe dementia, as well as lower scores on social support, increased the probability of stopping FDC.

Conclusion

FDCs appeared as a service that is stable over time for most participants, as more than two-third could use the care facility until the need of residential care. The transfers within care services and levels of care seemed to be characterized by continuity. More research on the growing population of educated older adults with dementia are warranted, to facilitate for their course of care needs. Finally, extended knowledge is needed to improve the collaboration between private and public networks, such as day care services, to improve the experience of social support for people with dementia.
Revisiting the hypothesis of syndromic frailty: a cross-sectional study of the structural validity of the frailty phenotype
Authors: Béland François , Julien Dominic , Wolfson Christina , Bergman Howard , Gaudreau Pierrette , Galand Claude , Fletcher John , Zunzunegui Maria-Victoria , Shatenstein Bryna , Kergoat Marie-Jeanne , Morais José A. , Fülöp Tamàs
Published: October 2020

Background

Fried’s Phenotype Model of Frailty (PMF) postulates that frailty is a syndrome. Features of a syndrome are a heterogeneous population that can be split into at least two classes, those presenting and those not presenting the syndrome. Syndromes are characterized by a specific mixture of signs and symptoms which increase in prevalence, from less to more severe classes. So far, the null hypothesis of homogeneity – signs and symptoms of frailty cannot identify at least two classes – has been tested using Latent Class Analysis (LCA) on the five dichotomized components of PMF (unintentional weight loss, exhaustion, weakness, slowness, and low physical activity). The aim of this study is to investigate further the construct validity of frailty as a syndrome using the extension offered by Factor Mixture Models (FMM).

Methods

LCA on dichotomized scores and FMM on continuous scores were conducted to test homogeneity on the five PMF components in a sample of 1643 community-dwelling older adults living in Québec, Canada (FRéLE).

Results

With dichotomized LCA, three frailty classes were found: robust, prefrail and frail, and the hypothesis of homogeneity was rejected. However, in FMM, frailty was better represented as a continuous variable than as latent heterogeneous classes. Thus, the PMF measurement model of frailty did not meet the features of a syndrome in this study.

Conclusion

Using the FRéLE cohort, the PMF measurement model validity is questioned. Valid measurement of a syndrome depends on an understanding of its etiological factors and pathophysiological processes, and on a modelling of how the measured components are linked to these processes. Without these features, assessing frailty in a clinical setting may not improve patient health. Research on frailty should address these issues before promoting its use in clinical settings.
Patient delay in the diagnosis of tuberculosis in Ethiopia: a systematic review and meta-analysis
Authors: Alene Muluneh , Assemie Moges Agazhe , Yismaw Leltework , Gedif Getnet , Ketema Daniel Bekele , Gietaneh Wodaje , Chekol Tadele Demilew
Published: October 2020

Background

Delay in the diagnosis of Tuberculosis (TB) remains a major challenge against achieving effective TB prevention and control. Though a number of studies with inconsistent findings were conducted in Ethiopia; unavailability of a nationwide study determining the median time of patient delays to TB diagnosis is an important research gap. Therefore, this study aimed to determine the pooled median time of the patient delay to TB diagnosis and its determinants in Ethiopia.

Methods

We followed PRISMA checklist to present this study. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. The comprehensive search for relevant studies was done by two of the authors (MA and LY) up to the 10th of October 2019. Risk of bias was assessed using the Newcastle-Ottawa scale adapted for observational studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall median time of patient delay and its determinants in Ethiopia. Furthermore, subgroup analyses were conducted to investigate how the median time of patient delay varies across different groups of studies.

Results

Twenty-four studies that satisfied the eligibility criteria were included. Our meta-analysis showed that the median time of the patient delay was 24.6 (95%CI: 20.8–28.4) days. Living in rural area (OR: 2.19, 95%CI: 1.51–3.18), and poor knowledge about TB (OR: 2.85, 95%CI: 1.49–5.47) were more likely to lead to prolonged delay. Patients who consult non-formal health providers (OR: 5.08, 95%CI: 1.56–16.59) had a prolonged delay in the diagnosis of TB. Moreover, the narrative review of this study showed that age, educational level, financial burden and distance travel to reach the nearest health facility were significantly associated with a patient delay in the diagnosis of TB.

Conclusions

In conclusion, patients are delayed more-than three weeks in the diagnosis of TB. Lack of awareness about TB, consulting non-formal health provider, and being in the rural area had increased patient delay to TB diagnosis. Increasing public awareness about TB, particularly in rural and disadvantaged areas could help to early diagnosis of TB.
Coagulation parameters are associated with the prognosis of immunoglobulin a nephropathy: a retrospective study
Authors: Xia Ming , Liu Di , Peng Liang , Li Yan , Liu Haiyang , Wu Lingzhi , Chen Guochun , Liu Yu , Liu Hong
Published: October 2020

Background

Interstitial fibrosis/tubular atrophy (T) score is a known determinant of the progression of immunoglobulin A nephropathy (IgAN). Strong evidence indicates that the components of the coagulation system closely linked with fibrotic events have been highlighted in the kidney. However, whether the coagulation system can affect the renal outcome of IgAN remains unclear. Herein, we investigated the association of coagulation parameters and pathological phenotype of IgAN and their combined effects on the deterioration of renal function.

Methods

This retrospective study included N = 291 patients with biopsy-proven IgAN from May 2009 to April 2013 in the Second Xiangya Hospital. Clinical data, pathological features were collected, and the associations of coagulation parameters at biopsy, T score, and renal outcome were evaluated. T score indicated the degree of tubular atrophy or interstitial fibrosis. The renal outcome was defined as an end-stage renal disease (ESRD) or an irreversible 50% estimated glomerular filtration rate (eGFR) reduction.

Results

Shorter prothrombin time (PT) and the activated partial thromboplastin time (APTT) were significantly associated with T (both p < 0.001). PT (< 11.15 s) or APTT (< 29.65 s) had worse cumulative survival rate (p = 0.008, p = 0.027 respectively) and were significantly but not independently associated with a higher risk of renal outcome (p = 0.012, p = 0.032 respectively). In the combined analyses of PT, APTT, and T lesions, the odd ratios for the outcome were significantly higher in the presence of T with PT (< 11.15 s) or APTT (< 29.65 s).

Conclusion

Shorter PT and APTT are associated with an increased incidence of the T lesion and are additional factors that portend a poorer prognosis in IgAN. Monitoring coagulation function might be important when assessing the risk of progression. Additional studies exploring the molecular mechanism between coagulation and IgAN pathology are needed.
Disseminated inflammation of the central nervous system associated with acute hepatitis E: a case report
Authors: Rahmig Jan , Grey Arne , Berning Marco , Schaefer Jochen , Lesser Martin , Reichmann Heinz , Puetz Volker , Barlinn Kristian , Siepmann Timo
Published: October 2020

Background

Hepatitis E infection affects over 20 million people worldwide. Reports of neurological manifestations are largely limited to the peripheral nervous system. We report a middle-aged genotype 3c male patient with acute hepatitis E virus (HEV) infection and severe neurological deficits with evidence of multiple disseminated inflammatory lesions of the central nervous system.

Case presentation

A 42-year-old male patient presented to our emergency department with musculoskeletal weakness, bladder and bowel retention, blurred vision and ascending hypoesthesia up to the level of T8. Serology showed elevated liver enzymes and positive IgM-titers of hepatitis E. Analysis of cerebrospinal fluid (CSF) showed mild pleocytosis and normal levels of glucose, lactate and protein. HEV-RNA-copies were detected in the CSF and stool. Within 3 days after admission the patient became paraplegic, had complete visual loss and absent pupillary reflexes. MRI showed inflammatory demyelination of the optic nerve sheaths, multiple subcortical brain regions and the spinal cord. Electrophysiology revealed axonal damage of the peroneal nerve on both sides with absent F-waves. Treatment was performed with methylprednisolone, two cycles of plasma exchange (PLEX), one cycle of intravenous immunoglobulins (IVIG) and ribavirin which was used off-label. Liver enzymes normalized after 1 week and serology was negative for HEV-RNA after 3 weeks. Follow-up MRI showed progressive demyelination and new leptomeningeal enhancement at the thoracic spine and cauda equina 4 weeks after admission. Four months later, after rehabilitation was completed, repeated MRI showed gliotic transformation of the spinal cord without signs of an active inflammation. Treatment with rituximab was initiated. The patient remained paraplegic and hypoesthesia had ascended up to T5. Nevertheless, he regained full vision.

Conclusions

Our case indicates a possible association of acute HEV infection with widespread disseminated central nervous system inflammation. Up to now, no specific drugs have been approved for the treatment of acute HEV infection. We treated our patient off-label with ribavirin and escalated immunomodulatory therapy considering clinical progression and the possibility of an autoimmune response targeting nerve cell structures.

While response to treatment was rather limited in our case, detection of HEV in patients with acute neurological deficits might help optimize individual treatment strategies.
circCRAMP1L is a novel biomarker of preeclampsia risk and may play a role in preeclampsia pathogenesis via regulation of the MSP/RON axis in trophoblasts
Authors: Zhang Yonggang , Yang Hongling , Zhang Yipeng , Shi Junzhu , Chen Ronggui
Published: October 2020

Background

Preeclampsia is a severe disease in pregnant women, which is primarily managed by early screening and prevention. Circular RNAs (circRNAs) have increasingly been shown to be important biological regulators involved in numerous diseases. Further, increasing evidence has demonstrated that circRNAs can be used as diagnostic biomarkers. This study was conducted to evaluate the potential of circCRAMP1L, previously identified to be downregulated in preeclampsia, as a novel biomarker for predicting the development of preeclampsia.

Methods

We measured the expression of circCRAMP1L, which is reportedly relevant to trophoblast physiology, in plasma samples from 64 patients with preeclampsia and 64 age-, gestational age-, and body mass index-matched healthy pregnant women by qRT-PCR. MTT proliferation and transwell invasion assays revealed the biological role of circCRAMP1L in preeclampsia pathogenesis. RNA immunoprecipitation and dual-luciferase reporter assays clarified the mechanism underlying the biological function of circCRAMP1L in TEV-1 cells.

Results

circCRAMP1L circulating levels were significantly lower in patients with preeclampsia (2.66 ± 0.82, △Ct value) than in healthy pregnant women (3.95 ± 0.67, △Ct value, p <  0.001). The area under the receiver operating characteristic curve for circCRAMP1L was 0.813. Univariate and multivariate analyses identified circCRAMP1L as an independent predictor of preeclampsia. Furthermore, when circCRAMP1L was utilised in combination with its target protein macrophage stimulating protein (MSP), the predictive performance increased, with an area under the receiver operating characteristic curve of 0.928 (95% CI 0.882–0.974), 80.0% sensitivity, and 80.0% specificity. The in vitro results indicated that circCRAMP1L regulates cell proliferation, and invasion via MSP and RON proteins. We investigated the molecular mechanisms of these effects. In vitro, relative to the control group, circCRAMP1L overexpression significantly enhanced cell proliferation; furthermore, trophoblast cell invasion increased proportionally with circCRAMP1L expression. RNA immunoprecipitation and luciferase reporter gene illustrated that circCRAMP1L participated in regulation of trophoblast cell by regulating MSP.

Conclusion

Reduced plasma levels of circCRAMP1L may be associated with an increased risk of preeclampsia, and circCRAMP1L may be a novel biomarker of preeclampsia risk.
Impact of submandibular gland preservation in neck management of early-stage buccal squamous cell carcinoma on locoregional control and disease-specific survival
Authors: Gu Bo , Fang Qigen , Wu Yao , Du Wei , Zhang Xu , Chen Defeng
Published: October 2020

Background

The feasibility of submandibular gland (SMG) preservation in oral squamous cell carcinoma (SCC) has occasionally been analyzed, but the differences in survival associated with the presence or absence of SMG preservation remain unknown. We aimed to prospectively evaluate the oncologic results of SMG preservation in cT1-2 N0 buccal SCC.

Methods

This was a prospective, non-randomized cohort study. Patients with surgically treated cT1-2 N0 buccal SCC were prospectively enrolled and divided into two groups based on the management of the SMG. Level 1b lymph nodes were categorized into six groups based on the positional relationship between the lymph node and the SMG. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS).

Results

A total of 31 of the 137 included patients underwent SMG-sparing neck dissection. Patients with SMG preservation were likely to be young persons. Superior metastasis occurred in 11 patients with a prevalence of 8.0%, followed by an anterior metastasis rate of 5.1%, and no metastases developed deeply or within the SMG. The 5-year LRC rates in the SMG-sparing and SMG-excision groups were 74 and 75%, respectively, and the difference was not significant (p = 0.970). The 5-year DSS rates in the SMG-sparing and SMG-excision groups were 74 and 69%, respectively, and the difference was not significant (p = 0.709).

Conclusions

SMG involvement was rare, and the superior group carried the highest risk for lymph node metastasis. SMG-sparing neck dissection is selectively suggested in cT1-2 N0 buccal SCC patients, and could avoid postoperative asymmetric appearance and dry mouth.
Study protocol of a cluster randomized controlled trial of strategies to increase antenatal iron and folic acid supplementation and malaria prophylaxis in rural south-central Côte d’Ivoire
Authors: Koné Siaka , Utzinger Jürg , Probst-Hensch Nicole , Dao Daouda , Fink Günther
Published: October 2020

Background

Coverage of antenatal iron and folic acid supplementation (IFAS) and intermittent preventive treatment of malaria in pregnancy (IPTp) remains low in many countries. Evidence on the most effective ways to increase both IFASIPTp is mixed overall, with only few studies directly identifying cost-effective ways to increase coverage of both interventions. The proposed study aims to assess the cost, impact and relative cost-effectiveness of two complementary strategies of increasing IFAS and malaria chemoprophylaxis coverage among pregnant women relative to the current default system in a rural low-income setting of sub-Saharan Africa.

Methods/design

This study will be carried out in the Taabo health and demographic surveillance system (HDSS) in south-central Côte d’Ivoire. This is a cluster-randomized trial targeting 720 consenting pregnant women aged ≥15 years. The 118 clusters constituting the Taabo HDSS monitoring area will be randomly allocated to one of the following three groups with equal probability: a control group, an information only group, and an information plus home delivery group. To assess the relative effectiveness of each strategy, we will conduct an endline survey within the first 2 weeks after delivery. The primary outcomes of the trial will be maternal post-partum anaemia and malaria infection. Anaemia will be assessed using HEMOCUE devices; malaria infections will be assessed using standard rapid diagnostic tests named CareStart™ Malaria Pf (HRP2) Ag RDT (Multi Kit with capped lancet and inverted cup specimen transfer device). Other outcomes will include self-reported adherence to supplementation and malaria chemoprophylaxis, as well as miscarriages, stillbirths and low birth weight deliveries.

Discussion

This study will assess the cost-effectiveness of two alternative strategies to increase antenatal IFAS and malaria chemoprophylaxis coverage among pregnant women in rural Côte d’Ivoire and similar settings.

Trial registration

ClinicalTrials.govNCT04250428; Registered 31 January 2020.
Treatment of pediatric lateral condylar humerus fractures with closed reduction and percutaneous pinning
Authors: Xie Li-wei , Wang Juan , Deng Zhi-qiang , Zhao Ren-huan , Chen Wei , Kang Chi , Ye Jia-jun , Liu Xin , Zhou Ying , Shen Hai
Published: October 2020

Background

Lateral condylar humerus fractures (LCHFs) are the second most common pediatric distal humerus fractures. Open reduction and internal fixation is recommended for fractures displaced by more than 2 mm. Few studies described using closed reduction and percutaneous pinning (CRPP) for treating fractures with greater displacements. This study aims to explore the feasibility of CRPP in treating displaced LCHFs.

Methods

All patients underwent attempted CRPP first. Once a satisfying reduction was obtained, as determined using fluoroscopy based on the relative anatomical position of the fragments, an intraoperative arthrogram was performed to further confirm the congruence of the articular surface of the distal humerus. Open reduction is necessary to ensure adequate reduction if the fracture gap is more than 2.0 mm on either anteroposterior view or oblique internal rotational view by fluoroscopy after CRPP. All included fractures were treated by a single pediatric surgeon.

Results

Forty-six patients were included, 29 boys and 17 girls, with an average age of 5.2 years. Of these, 22/28 (78%) Jakob type II fractures and 14/18 (78%) Jakob type III fractures were treated with CRPP. All cases in Song stages II and III, 19/25 (76%) cases in Song stage IV, and 14/18 (78%) cases of Song stage V were treated with CRPP. The remaining converted to open reduction with internal fixation. Overall, 36 of the 46 patients (78%) were treated with CRPP. The average pre-op displacement was 7.2 mm, and the average post-op displacement was 1.1 mm on the anteroposterior or oblique internal rotational radiograph in cases treated with CRPP. CRPP was performed in an average of 37 min. The average casting period was 4 weeks and the average time of pin removal was 6 weeks postoperatively. The average time of follow-up was 4 months. All patients achieved union, regardless of closed or open reduction. No infection, delayed union, cubitus varus or valgus, osteonecrosis of the trochlea or capitellum, or pain were recorded during follow-up.

Conclusions

Closed reduction and percutaneous pinning effectively treats LCHFs with displacement more than 4 mm. More than 3/4 of Song stage V or Jakob type III patients can avoid an incision.
Effectiveness of oral health promotion program for persons with severe mental illness: a cluster randomized controlled study
Authors: Kuo Mei-Wen , Yeh Shu-Hui , Chang Heng-Ming , Teng Po-Ren
Published: October 2020

Objective

To evaluate the effectiveness of a composite oral health promotion program designed to reduce dental plaque among persons with severe mental illness in a psychiatric institution.

Methods

A cluster randomized controlled study was carried out in chronic psychiatric wards of a general hospital in central Taiwan. Sixty-eight eligible male individuals admitted to 2 wards were randomly assigned to an experimental and a control group. Participants in the experimental group underwent an oral health promotion program that consisted of biweekly group education sessions, and a 12-week individual behavioral modification for oral hygiene course. The participants in the control group received usual care only. Dental plaque (measured by the Plaque Control Index) was examined by a single dentist before and after the experiment. Each participant responded to a questionnaire regarding oral health knowledge, attitude and behavior before and after the experiment.

Results

Fifty-eight individuals completed the study. Before the experiment, the plaque index was similar between the intervention group (68.9; N = 27) and the control group (69.8; N = 31). After the experiment, the plaque index was significantly better in the intervention group than in the control group (42.6 vs. 61.8;P < 0.001). Participants in the intervention group also demonstrated better oral health knowledge, attitude and behavior than those in the control group after the experiment.

Conclusions

A composite oral health promotion program using both group education and individual behavioral methods over a 12-week period was effective in both reducing dental plaque and improving the oral health knowledge of persons with severe mental illness in the institution.

Trial registration: This study was retrospectively registered in Clinicaltrials.gov, with number NCT04464941, dated 7/7/2020.https://register.clinicaltrials.gov/RD103035018.