bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis and Modeling of Supply Chain Management of Fresh Products Based on Genetic Algorithm in E-commerce Environment
Authors: Chen Yaoting
Published: September 2020

BackgroundSupply chain provides the chance to enhance chain performances by decrease these uncertainties. It is a demand for some level of co-ordination of activities and processes within and between organization in the supply chain to decrease uncertainties and increase more cost for customers. Partner selection is an important issue in the supply chain management of fresh products in E-commerce environment. In this paper, we utilized a multi-objective genetic algorithm for evaluation supply chain of fresh products in E-commerce environment. ResultsThe proposed multi-objective genetic algorithm is to search the set of Pareto-optimal solutions for these conflicting objectives using by weighted sum approach. The proposed model suitable for fresh products in E-commerce environment to optimize supply chain are derived. The value of objective 1 (f1) performs approximately nonlinearly with the increasing the value of objective 2,3 and 4 (f2,f3 and f4). At the value of objective 1 of 3.2*105, f2, f3 and f4 is about 4.3*105, 86 and 5.6*104. When the value of objective 1 is increased to 7.6*105, the minimum f2, f3 and f4 is about 3.0*105, 38 and 2.56*104. It is noted that the value of objective 1 is increased from 6.4*105 to 7.6*105, the variation of f2, f3 and f4 is 11.7%, 17.4% and 3.4% respectively. It is pointed out that the variation of f2 and f3 with f1 and f4 is kept within obvious ranges. This practical result highlights the fact that the effects of the fact that effects of f2 and f3 are important factors affecting the performance supply chain network of fresh product in E-commerce environment.ConclusionsIn this paper, we utilized a multi-objective genetic algorithm for evaluation supply chain of fresh products in E-commerce environment. Four objectives for optimal process are included in the proposed model: (1) maximization of green appraisal score, (2) minimization of transportation time and total time comprised of product time, (3) maximization of average product quality, (4) minimization of transportation cost and total cost comprised of product cost. In order to evaluate optimal process, set of Pareto-optimal solutions is obtained based on the weighted sum method.
Service Demand for Psychological Interventions Among Australian adults: A Population Perspective
Authors: Page Imogen S , Sparti Claudia , Santomauro Damian , Harris Meredith
Published: September 2020

BackgroundPsychological interventions (PIs) are good practice treatment for both subthreshold and diagnosed mental disorders. Australia has implemented major reforms to expand the provision of subsidised psychological services for Australians with a diagnosed mental disorder. But there are gaps in knowledge about demand for PIs (i.e., use of and perceived need for PIs) across the population. This study uses nationally representative survey data to analyse demand for PIs in Australia. It also provides a method for analysing survey data to estimate demand for PIs when new survey data becomes available, along with suggestions to inform future survey development.MethodsNationally representative community survey respondents (n=8,841, 16–85 years) indicated their perceived need for nine types of help for mental health problems in the past 12 months, including three PIs (cognitive behavioural therapy, psychotherapy, and counselling), and whether these needs were unmet, partially met, or fully met. Types of help were grouped as: PIs only; PIs plus other; and other only.Results7.9% (95%CI: 7.2–8.6) received PIs. Receipt of PIs was positively associated with higher education and consulting a mental health specialist. Twice as many respondents received PIs plus medication as compared to PIs only (4.2% vs. 2.0%). Almost half (45.4%, 95%CI 36.5–4.6) incurred out-of-pocket costs for treatment. The most common reason for partially met need for PIs was cost (24.8%, 95%CI 17.2–34.3); for unmet need, it was preference for self-management (33.9%, 95%CI 21.2–49.5). Perceived unmet need for PIs only (3.1%, 95%CI 2.1–4.6) or PIs plus other (5.2%, 95%CI 3.9%-6.9%) was lower than for other only (22.8%, 95%CI 18.7–27.6). ConclusionsContinued reforms in Australia means that on-going monitoring of demand for PIs, using nationally representative data, is required. This study provides a baseline for comparison of the long-term effects of these reforms; this comparison may be undertaken using data from the third iteration of Australia’s NSMHWB, due for completion in 2020 – 2021.
Efficacy of Early Intervention on the Bowel Damage and Intestinal Surgery of Crohn’s Disease, Based on the Lémann Index
Authors: Zhu Mingming , Feng Qi , Xu Xitao , Qiao Yuqi , Cui Zhe , Yan Yunqi , Ran Zhihua
Published: September 2020

Background: Clinicians aim to prevent progression of Crohn’s disease (CD); however, many patients require surgical resection because of cumulative bowel damage. The aim of this study was to evaluate the impact of early intervention on bowel damage in patients with CD using the Lémann Index and to identify bowel resection predictors. Methods: We analyzed consecutive patients with CD retrospectively. The Lémann Index was determined at the point of inclusion and at follow-up termination. The Paris definition was used to subdivide patients into early and late CD groups. Results: We included 154 patients, comprising 70 with early CD and 84 with late CD. After follow-up for 17.0 months, more patients experienced a decrease in the Lémann Index (61.4% vs. 42.9%), and fewer patients showed an increase in the Lémann Index (20% vs. 35.7%) in the early compared with the late CD group. Infliximab and other therapies reversed bowel damage to a greater extent in early CD patients than in late CD patients. Twenty-two patients underwent intestinal surgery, involving 5 patients in the early CD group and 17 patients in the late CD group. Three independent predictors of bowel resection were identified: baseline Lémann index ≥ 8.99, disease behavior B1, and history of intestinal surgery. Conclusions: Early intervention within 18 months after CD diagnosis could reverse bowel damage and decrease short-term intestinal resection. Patients with CD with a history of intestinal surgery, and/or a Lémann Index > 8.99 should be treated aggressively and monitored carefully to prevent progressive bowel damage.
Antibiotics for Fever After Gastric Endoscopic Submucosal Dissection May Be Unnecessary: A Propensity Score-Matching Analysis
Authors: Lai Yongkang , Zhang Qian , Pan Xiaolin , Zhu Zhenhua , Long Shunhua , Zhou Xiaojiang , Li Guohua , Zhu Yin , Chen Youxiang , Shu Xu
Published: September 2020

Background: Endoscopic submucosal dissection (ESD) has been widely used and has gradually become the main endoscopic treatment for gastrointestinal mucosal and submucosal lesions. Whether antibiotics are necessary for fever after gastric ESD remains unclear. The aim of this study was to analyse the value of the use of antibiotics for fever after ESD. Methods: In this retrospective study, patients with fever after ESD from January 2014 to January 2019 were included and divided into 2 groups: the antibiotic group and the non-antibiotic group. Fever and hospitalization time were compared between the 2 groups after propensity score (PS) matching. Results: A total of 451 patients with fever after ESD were included in the present study. with 240 patients in the non-antibiotics group and 211 patients in antibiotics group before matching and 96 patients in the non-antibiotics group and 96 patients in antibiotics group after matching with all baseline characteristics balanced (p > 0.05). Fever duration was not significantly different between the 2 groups (p=0.074). However, the median hospital stay in the antibiotic group was longer than that in the non-antibiotic group (8 vs 7, p=0.006). Conclusions: Antibiotics for fever after gastric ESD may be unnecessary.
Microvascular Density In The Evaluation Of Neoplastic Cervical Lesions
Authors: Ling Lim Sin , Krishnappa Purushotham , Nalliah Sivalingam , Shamsudin Noor Hasni , Othman Azizon Binti , Ravindran Rashindra
Published: September 2020

Aims: To evaluate the diagnostic value of CD31 immunohistochemical (IHC) investigation in neoplastic lesions of the uterine cervix among patients of Hospital Tuanku Jaafar (HTJ), Seremban, Malaysia.Methods: This is a retrospective correlation study constituting 105 cases in total, selected over a 10-year period from March 2005 to March 2015. It was conducted in the research laboratories of the International Medical University, Bukit Jalil, and sample collection was performed at the Department of Pathology of HTJ. Patients diagnosed with “cervicitis”, “cervical intraepithelial neoplasia (CIN) grades I through III” and “squamous cell carcinoma” were included in the study. Non-epithelial cervical lesions were excluded. Demographic data and representative paraffin blocks with H&E slides of each case were reviewed. Sectioned samples were stained immunohistochemically with CD31 to mark endothelial cells. Staining density of the microvessels was then observed under high power. The average of three hotspots per sample was obtained and recorded as the microvascular density (MVD) score. Means for each diagnostic group were tabulated and results were statistically analysed using SPSS version 18.Results: Patients’ age ranged from 23 to 85 years with mean of 49.2 years. Cases of carcinoma were most prevalent among 60-69 year-olds. Mean MVD score increases with increasing dysplasia from cervicitis (8.84), CIN (12.57) to carcinoma cervix (29.6).Conclusion: MVD CD31 immunohistochemistry investigation can aid in differentiating cervical lesions; benign, intraepithelial neoplasia and invasive malignancy, and could play an adjuvant role in diagnosing neoplastic cervical lesions.
Patients’ and HIV Service Managers’ Perceptions of The Impact of Loss of PEPFAR Support on HIV Services in Transitioned Health Facilities in Uganda: A Qualitative Study
Authors: Zakumumpa Henry , Paina Ligia , Wilhelm Jess , Ssengooba Freddie , Ssegujja Eric , Mukuru Moses , Bennett Sara Charlotte
Published: September 2020

Background: Although donor transitions from HIV programs are more frequent, little research exists seeking to understand the perceptions of patients and providers on this process. Between 2015 and 2016, PEPFAR implemented the ´geographic prioritization´ (GP) policy in Uganda whereby it withdrew direct support for HIV services from 734 health facilities and 10 districts with low HIV burden and intensified support to select facilities in high-burden districts. Our analysis intends to explore patient and provider perspectives on the impact of loss of PEPFAR support on HIV services in transitioned health facilities in Uganda.Methods: In this paper we report qualitative findings from a larger mixed-methods evaluation. Six facilities were purposefully selected as case studies seeking to ensure diversity in facility ownership, size, and geographic location. Five out of the six selected facilities had experienced transition. A total of 62 in-depth interviews were conducted in June 2017 (round 1) and November 2017 (round 2) with facility in-charges (n=13), ART clinic in-charges (n=12), representatives of PEPFAR implementing organizations (n=14), district health managers (n=23) and 12 patient focus group discussions (n=72) to elicit perceived effects of transition on HIV service delivery. Data were analyzed using thematic analysis. Results: While core HIV services, such as testing and treatment, offered by case-study facilities prior to transition were sustained, patients and providers reported changes in the range of HIV services offered and a decline in the quality of HIV services offered post-transition. Specifically, in some facilities we found that specialized pediatric HIV services ceased, free HIV testing services stopped, nutrition support to HIV clients ended and the ‘mentor mother’ ART adherence support mechanism was discontinued. Patients at three ART-providing facilities reported that HIV service provision had become less patient-centred compared to the pre-transition period. Patients at some facilities perceived waiting times at clinics to have become longer, stock-outs of anti-retroviral medicines to have been more frequent and out-of-pocket expenditure to have increased post-transition. Conclusions: Overall, participants perceived transition to have had important impacts on HIV service delivery in transitioned health facilities. Replacing the HIV programming gap left by PEPFAR in transition districts with Uganda government services is critical to the attainment of 90-90-90 targets in Uganda.
Prognostic Factors for Improvement in Pain and Disability after Multidisciplinary Rehabilitation in Patients with Chronic Neck Pain
Authors: Weigl Martin , Letzel Josefine , Angst Felix
Published: September 2020

Background: Recent clinical studies support the effectiveness of chronic neck pain specific multidisciplinary biopsychosocial rehabilitation programmes, but prognostic factors for improvement in pain and disability are unknown. The aim of this study was to identify predictors of improvement in patients with chronic neck pain after participation in a three-week multidisciplinary biopsychosocial rehabilitation programme. Methods: In this observational prospective cohort study patients were assessed at the beginning and the end of a multidisciplinary biopsychosocial rehabilitation programme. Inclusion for participation in the rehabilitation programme depended upon an interdisciplinary pain assessment. Consecutive patients who fulfilled the inclusion criteria were invited to participate in the study. A total of 112 patients participated. The primary outcomes, pain and disability, were measured by the Northern American Spine Society questionnaire (NASS), quantified by effect sizes (ES), and modelled with various co-factors. Secondary outcomes were mental health measured by the Short-Form 36 and total cervical active range of motion measured by a reliable, validated cervical range of motion instrument.Results: Patients’ mean age was 59.7 years (standard deviation=10.8); 70.5% were female. Patients improved significantly (p<0.001) in pain+disability (ES=0.56), mental health (ES=0.45) and cervical range of motion (ES=0.39). Prognostic factors for improvement in pain+disability were worse baseline scores (partial, adjusted correlation r=0.41, p<0.001), higher age (r=0.22, p=0.024), higher improvement in cervical range of motion (r=0.21, p=0.033) and higher improvement in mental health scale (r=0.20; p=0.047). Conclusions: Better outcomes for patients with improvement in neck range of motion, improvement of mental health, and higher age support the use of multidisciplinary biopsychosocial rehabilitation that combines physical and psychological treatment components. Furthermore, the results suggest that older patients may improve more compared to younger patients.
Comparison of Percutaneous Mesh-Container-Plasty and Pedicle Screw Fixation Plus Vertebroplasty for Thoracolumbar Osteoporotic Vertebral Burst Fractures: A Retrospective Study
Authors: Tang Chengxuan , Tang Xiaojun , Li Yimin , Zhong Xiqiang , Zhang Weihao , He Shaoqi
Published: September 2020

Background: Percutaneous mesh-container-plasty (PMCP) and pedicle screw fixation plus vertebroplasty (PSFV) were developed with advantages of bone cement leakage, height restoration and kyphotic angle reduction in osteoporotic vertebral compression fractures (OVBF). The purpose of the current study was to compare the effects and safety between PMCP and PSFV for treatment of thoracolumbar OVBF. Methods: A retrospective study of 227 consecutive patients with thoracolumbar OVBF without neurologic deficit who underwent PMCP (n=109) or PSFV (n=118) was conducted. The epidemiological data, surgical outcomes, clinical and radiological features were compared between the 2 groups. Clinical evaluation of VAS and ODI, and radiological evaluation of height restoration, deformity correction, cement leakages and canal compromise were calculated on preoperative, postoperative and 2 years postoperative.Results: Cost(4.82±0.21 vs. 5.50±0.29, P<0.05), blood loss(7.36±3.67 vs. 22.52±4.79, P<0.05), operation time(34.35±8.72 vs. 92.70±17.24, P<0.05) and hospital day(4.42±1.62 vs. 5.46±2.31, P<0.05) were significantly lower in the PMCP group than in the PSFV group. VAS [2(1,3) vs. 3(2.75,4), P<0.05] and ODI (21.01±7.90 vs. 33.81±8.81, P<0.05) scores were significantly lower in the PMCP group than in the PSFV group postoperative. However, no statistical difference was found in VAS and ODI between group PMCP and PSFV 2 years postoperative. Anterior(85.63±8.22% vs. 74.86±12.60%; 83.49±8.95% vs. 68.77±11.32%; P<0.05) and middle vertebral body height ratio(84.68±7.69% vs. 71.05±12.68%; 82.47±8.34% vs. 74.96±12.90%; P<0.05) were significantly higher in the PSFV group than in the PMCP group postoperative. Cobb angle(7.95±4.42 vs. 11.99±5.69, 8.59±4.46 vs. 12.95±5.74; P<0.05) and canal compromise(19.85±6.18 vs. 10.18±6.99, 10.03±7.20 vs. 19.90±5.98; P<0.05) were significantly lower in group PSFV than in the PMCP group postoperative. No statistical difference was found in cement leakage between group PMCP and PSFV. Conclusion: Despite of relative worse radiological results, PMCP is a safe, minimally invasive, and cost-effective surgical method and can obtain better satisfactory clinical results compared to PSFV for OVBF.
Work-Related and Personal Factors in Shoulder Disorders Among Electronics Workers
Authors: Chu Po-Ching , Wang Tyng-Guey , Guo Yue Leon
Published: September 2020

Background The electronics industry is one of the largest global industries, and significant numbers of workers are engaged in this industry. Evidence suggests two associations: between ergonomic risks and shoulder disorders, and between psychological stress and psychological problems among workers in this industry. There have been very few investigations on ergonomic risks, psychological stress, and gender effect for shoulder disorders in this industry. This study aimed to explore personal and work-related factors associated with shoulder disorders, and to investigate the combined effect of similar ergonomic risk factors. Methods In this cross-sectional study, 931 workers aged 20 to 58 from an electronics factory were recruited. Nordic musculoskeletal questionnaire was used to assess shoulder symptoms. The socio-demographic factors and work-related factors, including psychological stress, were assessed. 100 random sample workers with shoulder symptoms underwent a standardized clinical test for the evaluation of subacromial impingement syndrome. The ergonomic risks were assessed by the risk filter of “Upper limb disorders in the workplace”, including repetition, posture, force, vibration, and duration of exposure. Results The prevalence of shoulder symptoms was 30.5%, and 19% of those with shoulder symptoms had subacromial impingement syndrome. In multivariable analyses, older age (adjusted odds ratio (aOR) = 1.37, 95% CI 1.01-1.86), repetition (aOR = 1.73, 95% CI 1.15-2.60) and posture (aOR = 1.85, 95% CI 1.10-3.11) were associated with shoulder symptoms. About the gender effect, older age (aOR = 1.46, 95% CI 1.01-2.11), repetition (aOR = 1.64, 95% CI 1.00-2.68), posture (aOR = 1.89, 95% CI 1.01-3.52), and force (aOR = 1.68, 95% CI 0.99-2.85) were associated with shoulder symptoms in men, while repetition (aOR = 2.73, 95% CI 1.52-4.93) and posture (aOR = 2.12, 95% CI 0.99-4.57) were associated with the symptoms in women. Conclusions This study implies that repetition and posture were important risk factors for shoulder disorders in the electronics industry. The risk showed gender differences, and force was more important for shoulder disorders in men. Such information is useful to help occupational health practitioners and policy makers conduct preventive programs on shoulder disorders in this working population. Future longitudinal studies on work-related shoulder disorders are warranted.
Adaptive Response of HK-2 Cells to High Levels of COM Crystals Highlights CaSR as an Enhancer of Crystal Adhesion
Authors: Chen Siyu , Bao Junsheng , Lu Jianzhong , Ning Zhongyun , Yue Zhongjin , Li Xiaoran
Published: September 2020

Background: Calcium oxalate monohydrate (COM) is an aetiologic factor for urolithiasis. However, how Human Kidney-2 (HK-2) cells respond to a high COM has not yet been completely elucidated.Materials and methods: A gel-based proteomics approach was applied to investigate COM-induced cellular proteomic changes. The COM-induced upregulation of calcium-sensing receptor (CaSR) in HK-2 cells was studied. Surface phospholipids (PS), which play a role in urolithiasis formation by mediating adhesion of HK-2 cells, were labelled in the inner or outer leaflet of the plasma membrane of HK-2 cells with fluorescent nitrobenzoxadiazole (NBD) to form NBD-PS to detect transmembrane movements of PS. After labelling, HK-2 cells were exposed to COM in the presence of the CaSR-specific agonist gadolinium chloride (GdCl3) or the CaSR-specific antagonist NPS2390. Inward and outward transmembrane movements of PS were tracked with a fluorescence quenching assay. Surface-expressed PS was detected by an annexin V binding assay. Changes in aminophospholipid translocase (APLT), oxidative stress (OS), levels of apoptosis-related proteins in HK-2 cells and crystal adhesion were also assessed.Results: COM increased CaSR and surface-expressed PS levels, decreased APLT activity, impaired inward transport of PS, and enhanced outward transport of PS. However, pretreatment with GdCl3 further effectively inhibited the inward movement of PS and APLT activity and increased surface-expressed PS levels compared with COM treatment alone. In contrast, NPS2390 promoted the inward movement of PS and APLT activity and decreased surface-expressed PS levels compared with COM treatment alone. COM increased OS, apoptosis of HK-2 cells and crystal adhesion onto cells, and this increase was further enhanced by GdCl3 pretreatment but attenuated by NPS2390 treatment.Conclusions: These results strongly suggest that COM-induced CaSR generation may affect crystal adhesion by regulating PS externalization, apoptosis and OS in HK-2 cells.
The Hydricity and Reactivity Relationship in [ FeFe ]-hydrogenases
Authors: Artz Jacob , Mulder David , Ratzloff Michael , Peters John , King Paul
Published: September 2020

Reactivity of transition metal catalysts is controlled by covalent and non-covalent interactions that tune thermodynamic properties including hydricity. Hydricity is critical to catalytic activity and for modulating the reduction or oxidation of chemical compounds. Likewise, enzymes can employ transition metal cofactors and use metal-hydride intermediates tuned by protein frameworks to selectively control reactivity. One example, the [FeFe]-hydrogenases, catalyze reversible H2 activation with H2 oxidation to H+ reduction ratios spanning ~107 in rate, offering a model to determine the extent that hydricity controls reactivity. To address this question, the hydricity of the catalytic H cluster of two [FeFe]-hydrogenases, CpI and CpII, were compared. We show that for CpI, the higher rates of H+ reduction correspond to a more hydridic H cluster, whereas CpII, which strongly favors H2 oxidation, has a less hydridic H cluster. The results demonstrate that enzymes manipulate metal cofactor hydricity to enable an extraordinary range of chemical reactivity.
A Method for Extracting Travel Patterns Using Data Polishing
Authors: Hosoe Mio , Kuwano Masashi , Moriyama Taku
Published: September 2020

With the development of ICT (Information and Communication Technology), interest in using the large amount of accumulated data for traffic policy planning has been increasing. In recent years, data polishing has been proposed as a new methodology for big data analysis. Data polishing is one of the graphical clustering methods. This method can be used to extract patterns that are similar or related to each other by clarifying the cluster structures in the data. The purpose of this study is to reveal travel patterns of railway passengers by applying data polishing to smart card data collected in Kagawa Prefecture, Japan. This study uses 9,008,709 data points collected during the 15 months from December 1st, 2013 to February 28th, 2015. This data set includes such information as trip histories and types of passengers. The study uses the data polishing method to cluster 4,667,520 combinations of information about individual rides: day of the week, time of day, passenger type, origin station, and destination station. As a result, 127 characteristic travel patterns were specified from those combinations.
(Not-so) Unexpected Tumor Response to Palliative Pelvic Radiotherapy in Mismatch Repair-Deficient Advanced Prostate Cancer
Authors: Aluisio Giovanni , Mazzeo Ercole , Lohr Frank , Fiocchi Federica , Bettelli Stefania , Baldessari Cinzia , Paterlini Maurizio , Bruni Alessio
Published: September 2020

Mismatch-repair-deficiency resulting in microsatellite instability (MSI) may confer increased radiosensitivity in locally advanced/metastatic tumors and thus radiotherapy (RT) potentially might have a changing role in treating this subset of patients, alone or in combination with checkpoint inhibitors. We report a 76year-old patient presenting with locally advanced undifferentiated prostate cancer (LAPC), infiltrating bladder and rectum. Molecular analysis revealed high-MSI with an altered expression of MSH2 and MSH6 at immunohistochemistry. Two months after 6 chemotherapy cycles with Docetaxel associated to an LHRH analogue, a CT scan showed stable disease. After palliative RT (30Gy/10 fractions) directed to the tumor mass with a 3D-conformal setup, a follow-up CT scan at 8 weeks revealed an impressive response, that remained stable at CT after 9 months, with sustained biochemical response. To our knowledge, this is the first case of such a sustained response to low dose RT alone in H-MSI LAPC.Routine evaluation of MSI in patients with locally problematic advanced tumors might change treatment strategy and treatment aim in this setting, from a purely palliative approach to a quasi-curative paradigm.
A Nomogram Based on CENPP Expression for Survival Prediction in Breast Cancer
Authors: Chen Heyan , Pu Shengyu , Yu Shibo , Liao Xiaoqin , He Jianjun , Zhang Huimin
Published: September 2020

Introduction: In recent years, it has been found that the expression of 17 centromere proteins (CENPs) is closely related to malignant tumors. This study intends to investigate the prognostic value of CENPs in breast cancer (BC). Methods: A total of 800 BC patients were included from the TCGA database. The Cox proportional regression models was used to develop a CENPs-related prognostic signature. Furthermore, the mRNA expression and overall survival (OS) of CENPP (centromere protein P) in BC patients with different clinicopathological featureswas analyzed via GEPIA, bcGenExMiner v4.4 and Kaplan-Meier plotter. Finally, the nomogram was established based on the independent predictors recognized by multivariate Cox regression analysis and further validated by receiver-operating characteristic (ROC) curves and calibration plots internally and externally. Results: The result shown that age, Her2 status, pathologic_T stage, pathologic_M stage and CENPP expression with independent prognostic values for BC. CENPP was overexpressed in BC tissues and CENPP high expression was associated with better OS. We then established a nomogram based on those independent predictors, and the calibration curve demonstrated good fitness of the nomogram for OS prediction. In the training set, the AUC of 3−year and 5−year survival were 0.757 and 0.797, respectively. In the validation set, the AUC of 3−year and 5−year survival were 0.727 and 0.71. Conclusion: Our study showed that CENPP is a novel prognostic factor for patients with BC, and the established nomogram can provide valuable information on prognostic prediction for patients with BC.
The Impact of Radiotherapy Parameters on Lymphopenia and Overall Survival in Patients With Esophageal Cancer
Authors: Liu Ming , Li Xiaoyang , Cheng Huaidong , Wang Yansu , Tian Ye
Published: September 2020

PurposeWe sought to perform survival analysis of patients with thoracic esophageal squamous cell carcinoma (ESCC) receiving definitive radiotherapy and identify prognostic factors among hematological and dosimetric factors.MethodsCases of thoracic ESCC treated with chemoradiation between 2014 and 2017 were identified. The impact of clinicopathological factors’ on overall survival (OS) was analyzed via Cox proportional hazards model. Absolute lymphocyte counts (ALC) and the neutrophil-to-lymphocyte ratio (NLR = ANC/ALC) were assessed before radiotherapy (RT), during RT, and after RT. Cox regression was used to correlate clinical factors with both hematologic toxicities and overall survival. Multiple logistic regression analyses were used to find associations between lymphopenia and dosimetric parameters. The receiver operating characteristics (ROC) curve was used to determine cut-off points.ResultsNinety-nine ESCC patients were enrolled with the median overall survival of 23 months. The median RT dose was 55.75Gy(46–66Gy), and the mean does (Dmean) of thoracic vertebrae dose (TVB) was 27.04±9.65Gy. Based on multivariate analysis, V20 of TVB, pretreatment NLR, and ALC nadir were associated with a worse OS significantly. Concurrent CRT, increasing mean TVB dose and V20 of TVB were associated with higher odds of lymphopenia risk (P＜0.05) through multiple logistic regression analysis.ConclusionsIn ESCC patients who received definitive RT, V20 of TVB, pretreatment NLR, and ALC nadir during RT were independent prognostic factors and chemotherapy regimen, mean TVB dose, and V20 of TVB were associated with lymphopenia.
Optimization of Solid-State Fermentation Conditions of Astragali Radix Residues and Changes of Its Nine Constituents Content Before and After Fermentation
Authors: Liu Cuiyan , Zhu Yun , Fan Guangtai , Gu Jingang , Han Chunyang
Published: September 2020

Background: For the last few years huge quantity of herb residues are discharged in China, and so far there is not a good solution. The current methods of disposal and utilization of herb residues (stacking, incineration, and landfill) were not only great harmful to the ecological environment, but also cause the waste of medicinal herb resources. The fermentation can further decompose and transform the active ingredients and nutrients in herb residue, so the fermentation technology has good application prospect in the treatment of herb residues. In this study, we investigated the applicability of fermentation processes with the Aspergillus niger (ACCC 30583) strain for the reuse of Astragali Radix residues (ARR) by comparing the content changes of its nine constituents before and after fermentation. The contents of total protein and crude fat in the ARR were determined via near-infrared scanning; the iron, copper, zinc, and manganese contents were assayed with atomic absorption spectroscopy, the calycosin-7-glucoside and astragaloside Ⅳ content were determined by HPLC, and the polysaccharide content was determined via phenol sulfuric acid spectrophotometry. Results: The optimum fermentation conditions for ARR with ACCC 30583 was culture medium content 60%, fermentation time 5 days, and fermentation temperature 28 ℃. Compared with the residues before fermentation, the contents of total protein, calycosin-7-glucoside, astragaloside Ⅳ, Astragali Radix polysaccharides (ARP), and manganese increased significantly, the iron content decreased significantly, and the crude fat, zinc, and copper contents exhibited no significant changes. Conclusions: The solid fermentation of ARR with the Aspergillus niger (ACCC 30583) strain effectively promoted the separation of astragaloside Ⅳ and ARP from ARR, which provided methodological basis for the effective reuse of herb residues.
Impact of Clinical and Sociodemographic Factors on Fatigue Among Patients With Substance Use Disorder: A Cohort Study From Norway for The Period 2016-2020
Authors: Vold Jørn Henrik , Gjestad Rolf , Aas Christer F. , Chalabianloo Fatemeh , Skurtveit Svetlana , Løberg Else-Marie , Johansson Kjell Arne , Fadnes Lars Thore
Published: September 2020

Background The impact of clinical and sociodemographic factors on fatigue remains unknown among patients with substance use disorders (SUD). This study aims to evaluate fatigue among patients with SUD using a nine-item fatigue severity scale (FSS-9) and identify the impact that clinical and sociodemographic factors – such as injecting substance use, chronic infectious diseases, liver fibrosis, opioid agonist therapy (OAT), debt difficulties, and housing situation – have on fatigue.Methods We used data from a cohort of patients with SUD in Norway with annual health assessments surveying FSS-9 and some clinical and sociodemographic factors. A total of 915 FSS-9 measurements were collected from 654 patients during the period 2016-2020. We defined baseline as the first annual health assessment when the health assessments were listed chronologically. Time was defined as months from baseline. We used a linear mixed model to analyse whether the clinical and sociodemographic factors affected the FSS-9 sum score, presented with beta coefficients (β) with 95% confidence intervals (CI). Results The mean sum score of the FSS-9 was 43 (standard deviation: 16) at baseline. Being female (change in FSS-9 sum score: 4.1, 95 % CI: 1.3-7.0), having debt difficulties (2.9;0.4-5.3), and using benzodiazepines (5.7;3.0-8.4), amphetamine or cocaine (-5.0;-8.0--2.0) affected the FSS-9 sum score. The other clinical and sociodemographic factors did not predict any clinically relevant change in the FSS-9 sum score from baseline to the following health assessments.Conclusion Patients with SUD suffer from high levels of fatigue. Focusing on closer follow-up of females and reducing debt difficulties and the use of benzodiazepines may mitigate fatigue in the SUD population.
Diastolic Dysfunction and Impaired Cardiac Output Reserve in Dysmetabolic Nonhuman Primate With Proteinuria
Authors: Wikstrom Johannes , Liu Yongqiang , Whatling Carl , Gan Li-ming , Konings Peter , Mao Binchen , Zhang Chao , Ji Yanqin , Xiao Yong-Fu , Wang Yixin
Published: September 2020

Background Cardiorenal complications are common in patients with dysmetabolism and diabetes. The present study aimed to examine if a nonhuman primate (NHP) model with spontaneously developed metabolic disorder and diabetes develops similar complications to humans, such as proteinuria and cardiac dysfunction at resting condition or diminished cardiac functional reserve following dobutamine stress echocardiography (DSE).Methods and Results A total of 66 dysmetabolic and diabetic cynomolgus (Macaca fascicularis) NHPs were enrolled to select 19 NHPs (MetS) with marked metabolic disorders and diabetes (fasting blood glucose: 178+18 vs. 61+3 mg/dL) accompanied by proteinuria (ACR: 134+34 vs. 1.5+0.4 mg/mmol) compared to 8 normal NHPs (CTRL). Under resting condition, MetS NHPs showed mild left ventricular (LV) diastolic dysfunction (E/A: 1+0.06 vs. 1.5+0.13), but with preserved ejection fraction (EF: 65+2 vs. 71+3%) compared to CTRL. DSE with an intravenous infusion of dobutamine at ascending doses (5, 10, 20, 30 and 40 μg/kg/min, 7 min for each dose) resulted in a dose-dependent increase in cardiac function, however, with a significantly diminished magnitude at the highest dose of dobutamine infusion (40 μg/kg/min) in both diastole (E/A: -12+3 vs. -38+5%) and systole (EF: 25+3 vs. 33+5%) as well as ~42% reduced cardiac output reserve (COR: 63+8 vs. 105+18%, p<0.02) in the MetS compared to CTRL NHPs.Conclusion These data demonstrate that MetS NHPs with cardiorenal complications: proteinuria, LV diastolic dysfunction and preserved LV systolic function under resting conditions displayed compromised cardiac functional reserve under dobutamine stress. Based on these phenotypes, this NHP model of diabetes with cardiorenal complications can be used as a highly translational model mimic human disease for pharmaceutical research.
Nomogram Based on Preoperative CT Imaging Predicts The EGFR Mutation Status in Lung Adenocarcinoma
Authors: Zhang Guojin , zhang Jing , Cao Yuntai , Zhao Zhiyong , Li Shenglin , Deng Liangna , Zhou Junlin
Published: September 2020

Background: Tyrosine kinase inhibitors (TKIs) provide clinical benefits to the lung cancer patients with epidermal growth factor receptor (EGFR) mutations. However, non-invasively determine EGFR mutation status in patients before targeted therapy remains a challenge. This study aimed to develop and validate a nomogram for preoperative prediction of EGFR mutation status in patients with lung adenocarcinoma.Methods: This study retrospectively collected medical records of 403 patients with histologically confirmed lung adenocarcinoma from January 2016 and June 2020. The patients were divided into development and validation cohorts. The preoperative information on all patients was obtained, including clinical characteristics and computed tomography (CT) features. Multivariate logistic regression analysis was used to develop the predictive model. We combined CT features and clinical risk factors and used them to build a prediction nomogram. The performance of the nomogram was evaluated in terms of calibration, discrimination, and clinical usefulness. The nomogram was further validated in an independent external cohort.Results: The predictive factors incorporated in the personalized prediction nomogram included smoking history (OR, 0.2; 95% CI: 0.1, 0.4; P < 0.001), bubble-like lucency (OR, 2.2; 95% CI: 1.3, 3.8; P = 0.003), pleural attachment (OR, 0.4; 95% CI: 0.2, 0.7, P = 0.001) and thickened adjacent bronchovascular bundles (OR, 3.1; 95% CI: 1.8, 5.3; P < 0.001). Based on these parameters, the prediction model has good discrimination and calibration ability. The area under the curve in the development and validation cohorts were 0.784 (95% CI: 0.733, 0.835) and 0.740 (95% CI: 0.643, 0.838), respectively. Decision curve analysis showed that the model was clinically useful.Conclusions: This study presented a nomogram that contained CT features and clinical risk factors, which could conveniently and non-invasively predict EGFR mutation status in patients with lung adenocarcinoma before surgery.
A Global Genome-Wide Scan with Optimal Cutoff Mining for Emerging Biomarkers in Head and Neck Squamous Cell Carcinoma
Authors: Chi Li-Hsing , Wu Alexander TH , Hsiao Michael , Li Yu-Chuan (Jack)
Published: September 2020

Background: The survival analysis of the Cancer Genome Atlas (TCGA) dataset is a well-known method to discover the gene expression-based prognostic biomarkers of head and neck squamous cell carcinoma (HNSCC). In order to utilize a continuous gene expression for survival analysis, it is necessary to determine a cutoff point by the dichotomization of the patients. There is some optimization software for cutoff determination. However, those predetermined cutoffs by software usually set at the median, 1/4 quantile, or 3/4 quantile of RNA sequencing (RNA-Seq) value to find a significant P-value of the Kaplan-Meier curve. There are few clinicopathological features available on their pre-processed data sets. Methods: We developed a comprehensive workflow by R script, running on the Rstudio platform. It includes data retrieving and pre-processing, feature selection, cutoff mining engine, Kaplan-Meier survival analysis, Cox proportional hazard modeling, and biomarker discovery. Results: Using this workflow on the TCGA HNSCC cohort, we scanned human protein-coding genes (20,500) programmatically. After adjustment with other confounders, we found that the clinical tumor stage and the surgical margin involvement are independent risk factors in patient survival. According to the resulting tables with Bonferroni adjusted P-value under optimal cutoff as well as hazard ratio (>=1.5), there were ten candidate biomarkers, named as DKK1, CAMK2N1, STC2, PGK1, SURF4, USP10, NDFIP1, FOXA2, STIP1, and DKC1, which are significantly associated with the poor prognosis of overall survival (OS). At the same time, the other ten genes were over-expressed in the better survival patients (with hazard ratio <=0.5), named as ZNF557, ZNF266, IL19, MYO1H, FCGBP, LOC148709, EVPLL, PNMA5, IQCN (previous name as KIAA1683), and NPB. Further validations are warranted.Conclusions: We suggested this analysis tool equipped with an optimal cutoff finder will help with biomarker discovery of protein-coding genes, in terms of tumor-agnostic therapy.
Implementation Support for Contingency Management: Preferences of Opioid Treatment Program Leaders and Staff 
Authors: Scott Kelli , Jarman Shelly , Moul Samantha , Murphy Cara M , Yap Kimberly , Garner Bryan , Becker Sara J
Published: September 2020

Background: Contingency management (CM), a behavioral intervention that provides incentives for achieving treatment goals, has strong evidence for its effectiveness when combined with medication to treat opioid use disorder. Unfortunately, many front-line treatment providers do not utilize CM, likely due to contextual barriers that limit effective training and ongoing support for evidence-based practices. User-informed approaches offer a unique opportunity to adapt implementation strategies to support CM implementation. Methods: Leaders and treatment providers working in community-based opioid treatment programs (OTPs; N = 43) completed qualitative interviews inquiring about their preferences for implementation support (didactic training, performance feedback, and ongoing facilitation). Interviews were coded using a reflexive team approach to identify common a priori and emergent themes. Results: Leaders and providers expressed a preference for brief training that included case examples and research data, along with experiential learning strategies. They reported a desire for performance feedback from internal supervisors, patients, and clinical experts. Providers and leaders had mixed feelings about audio recording sessions but were open to the use of rating sheets to evaluate CM performance. Finally, participants desired both on-call and regularly scheduled ongoing facilitation to support their continued use of CM. Conclusions: This study provides an exemplar of a user-informed approach to adapt implementation support strategies for CM scale-up in community OTPs. Study findings highlight the need for user-informed approaches to training, performance feedback, and facilitation to support sustained CM use in this setting.
Analysis of the Clinical and Genetic Characteristics of 3 Cases of A20 Haploinsufficiency
Authors: Zhang Dan , Zhou Zhixuan , Lai Jianming , Su Gaixiu
Published: September 2020

Background To evaluate the clinical and genetic characteristics of 3 children with HA20. Methods The clinical and genetic testing data of 3 children with HA20 treated at CIP between August 2016 and October 2019 were retrospectively analysed. Results Patient 1 presented with arthritis and inflammatory bowel disease, patient 2 presented with axial spinal arthritis and lupus-like syndrome, and patient 3 presented with recurrent oral ulcers, gastrointestinal ulcers, and perianal abscesses. For laboratory examination, In patient 1, the WBC,CRP and AESR showed high. In patient 2, the WBC was normal, but CRP and AESR showed high. In patient 3, the WBC, CRP, and AESR showed high. Patient 2 was positive for antinuclear antibodies, anti-Sjögren’s syndrome antigen A, dsDNA, rheumatoid factor and Coombs test. Genetic testing showed that the 3 patients were heterozygous for mutations in the TNFAIP3 gene. For treatment, patient 1 used TNFα antagonist and thalidomide, patient 2 used TNFαantagonist and sulfasalazine, and patient 3 used hormones and thalidomide. Patients 1 and 2 were followed up for 4 and 3 months, respectively. There was improvement in joint and gastrointestinal symptoms, inflammatory indices and RF were normal, dsDNA and Coombs test became negative. Patient 3 was treated at an outside hospital and showed gradual improvement in oral ulcers and perianal abscesses. Conclusion HA20 is a single-gene auto-inflammatory disease caused by mutation in the TNFAIP3 gene. It presents clinically as a Behçet-like syndrome and can present as various other autoimmune diseases as well. Hormones and immunosuppressive agents are effective treatments, and cytokine antagonists can be used in refractory cases. Whole-exome genetic testing should be proactively performed for children with an early age of onset or Behçet-like presentation to achieve early diagnosis and accurate treatment.
Mixed Phenotype Acute Leukemia With Pml-rarα Positive: A Case Report and Literature Review
Authors: Zheng Yanlong , Shen Huafei , Zhu Mingyu , Shi Yuanfei , Jin Jie , Xie Wanzhuo
Published: September 2020

Mixed phenotype acute leukemia (MPAL) is an uncommon type of leukemia. It is one kind of malignant clonal diseases that expresses more than one genealogical specific antigen simultaneously. Most MPAL patients are associated with clonal chromosomal abnormalities and molecular genetic changes, such as t(9;22) (q34;q11) and KMT2A (MLL) rearrangement. These specific abnormalities usually have important guiding significance in MPAL diagnosis, targeted therapy and prognosis judgment. In this paper, we reported a case of MPAL, T/myeloid (M5) with an unfrequent combination of PML-RARα positivity and t(15;17). The treatment was successful with chemotherapy for both AML and ALL with daunorubicin, cytarabine (DA) and vincristine, prednisone (VP). We reported here this suggestive MPAL case of rare disease condition and effective treatment, in order to provide experience for the early diagnosis and treatment of similar patients.
Comparative whole-genome approach to identify traits underlying microbial interactions
Authors: Zoccarato Luca , Sher Daniel , Miki Takeshi , Segrè Daniel , Grossart Hans-Peter
Published: September 2020

BackgroundInteractions among microorganisms affect the structure and function of microbial communities, potentially affecting ecosystem health and biogeochemical cycles. The functional traits mediating microbial interactions are known for several model organisms, but the prevalence of these traits across microbial diversity is unknown.ResultsWe developed a new genomic approach to systematically explore the occurrence of metabolic functions and specific interaction traits, and applied it to 473 sequenced genomes from marine bacteria. The bacteria could be divided into coherent genome functional clusters (GFCs), some of which are consistent with known bacterial ecotypes (e.g. within pico-Cyanobacteria and Vibrio taxa) while others suggest new ecological units (e.g. Marinobacter, Alteromonas and Pseudoalteromonas). Some traits important for microbial interactions, such as the production of and resistance towards antimicrobial compounds and the production of phytohormones, are widely distributed among the GFCs. Other traits, such as the production of siderophores and secretion systems, as well as the production and export of specific B vitamins, are less common. Linked Trait Clusters (LTCs) include traits that may have evolved together, for example chemotaxis, motility and adhesion are linked with regulatory systems involved in virulence and biofilm formation.ConclusionsOur results highlight specific GFCs, such as those comprising Alpha- and Gammaproteobacteria, as particularly poised to interact both synergistically and antagonistically with co-occurring bacteria and phytoplankton. Similar efficient processing of multidimensional microbial information will be increasingly essential for translating genomes into ecosystem understanding across biomes, and identifying the fundamental rules that govern community dynamics and assembly.