bluuebunny/crossref_metadata_2025 huggingface dataset:
Accelerated Reaction Kinetics in Microdroplets: Overview and Recent Developments
Authors: Wei Zhenwei , Li Yangjie , Cooks R. Graham , Yan Xin
Published: April 2020

Various organic reactions, including important synthetic reactions involving C–C, C–N, and C–O bond formation as well as reactions of biomolecules, are accelerated when the reagents are present in sprayed or levitated microdroplets or in thin films. The reaction rates increase by orders of magnitude with decreasing droplet size or film thickness. The effect is associated with reactions at the solution–air interface. A key factor is partial solvation of the reagents at the interface, which reduces the critical energy for reaction. This phenomenon is of intrinsic interest and potentially of practical value as a simple, rapid method of performing small-scale synthesis.
Highly Efficient Li−Air Battery Using Linear Porosity Air Electrodes
Authors: Li Jie , Yan Fangzheng , Su Zipeng , Zhang Tianyu , Zhang Xiaochen , Sun Hong
Published: April 2020

An advanced transient state model was developed based on the dynamic behavior of the porous air electrode of non-aqueous Li-air battery, which was determined by a numerical solution of the combined continuity, transport, and kinetics equations. The effects of linear porosity in air electrode on the detail performance such as the distribution of the oxygen concentration, Li2O2 volume fraction, porosity, and oxygen diffusion coefficient of non-aqueous Li-air battery during the discharge were investigated. The results revealed that the employing linear porosity air electrode leaded to the higher specific capacity, the uniform porosity and the preferable oxygen diffusion coefficient of Li-air battery caused by the high-efficiency utilization of porous air electrode and sufficient oxygen transfer. The discharge current density had significant effects on the property of Li-air battery based on linear porosity air electrode due to the great increasing of ohm polarization and serious air electrode passivation. The porosity became uniformly with the reaction, which indicated utilization rate of air electrode near membrane side was significantly improved due to the large initial oxygen concentration difference. The detailed results provided a deeper understanding of producing more efficient Li-air batteries as potential power sources to expand the range of electric vehicles.
Long-term hypercortisolism induces lipogenesis promoting palmitic acid accumulation and inflammation in visceral adipose tissue compared with HFD-induced obesity
Authors: García-Eguren Guillermo , Sala-Vila Aleix , Giró Oriol , Vega-Beyhart Arturo , Hanzu Felicia A.
Published: April 2020

Glucocorticoids (GCs) play critical roles in adipose tissue metabolism. Here, we compare in a mouse model the effects of chronic glucocorticoid excess and diet-induced obesity on white adipose tissue mass and distribution, by focusing on visceral adipose tissue (VAT) fatty acid composition changes, the role of de novo lipogenesis (DNL) and the inflammatory state. We used a noninvasive mouse model of hypercortisolism to compare GC-induced effects on adipose tissue with diet-induced obesity [high-fat diet (HFD) 45%] and control mice after 10 wk of treatment. Subcutaneous adipose tissue (SAT) and VAT mass and distribution were measured by nuclear magnetic resonance imaging (NMRI). Fatty acid composition in VAT was analyzed by NMR spectroscopy and gas chromatography. Gene expression of key enzymes involved in DNL was analyzed in liver and VAT. Macrophage infiltration markers and proinflammatory cytokines were measured by gene expression in VAT. HFD or GC treatment induced similar fat mass expansion with comparable distribution between SAT and VAT depots. However, in VAT, GCs induce DNL, higher palmitic acid (PA), macrophage infiltration, and proinflammatory cytokine levels, accompanied by systemic nonesterified fatty acid (NEFA) elevation, hyperinsulinemia, and higher homeostatic model assessment for insulin resistance (HOMA-IR) levels compared with diet-induced obesity. Thus, chronic hypercortisolism induces DNL and fatty acid composition changes toward increased SFA and reduced polyunsaturated fatty acid (PUFA) levels in VAT, promoting macrophage recruitment and proinflammatory cytokines, suggesting a worse cardiometabolic profile even compared with HFD mice.
Relationship of Platelet Counts and Inflammatory Markers to 30‐Day Mortality Risk in Patients with Acute Type A Aortic Dissection
Authors: Chen Yiping , Lin Yanjuan , Zhang Haoruo , Peng Yanchun , Li Sailan , Huang Xizhen
Published: April 2020

Markers of prothrombotic state and inflammation are associated with the prognosis of patients with acute type A aortic dissection (AAAD). However, it is unclear that the relationship between these biomarkers and their combined impact on risk stratification. The present study evaluated the prognostic value of platelet counts, lymphocyte to neutrophil ratio (LNR), and lymphocyte to monocyte ratio (LMR), alone and in combination. A retrospective analysis of clinical data of 744 AAAD patients was conducted to identify whether these biomarkers were related to the 30‐day mortality risk. A Kaplan‐Meier analysis and log‐rank test were used to compare survival between groups. A Cox hazard regression multivariable analysis was performed for 30‐day mortality. Individual biomarker (platelet count, LNR, or LMR) was unable to predict 30‐day mortality. However, combinations of all three biomarkers provided additive predictive value over either marker alone, the receiver operating characteristic (ROC) model had a prediction probability of 0.739 when platelet counts, LNR, and LMR were included. Cox hazard regression multivariable analysis showed that combinations of all three biomarkers were the strongest predictor of 30‐day mortality (p < 0.021). Combined with these three easily measurable biomarkers at admission, they could help identify AAAD patients with a high risk of 30‐day mortality.
Clinical Relevance and Psychometric Properties of the Swedish Version of the Cultural Competence Assessment Instrument
Authors: Holstein Jane , Liedberg Gunilla M. , Suarez-Balcazar Yolanda , Kjellberg Anette
Published: April 2020

Based on the increasing diversity of Swedish society, health professionals, like occupational therapists, find it challenging to provide culturally competent services to international clients. Consequently, cultural competence among professionals needs to be measured and improved using psychometrically tested instruments. This study examines the clinical relevance, construct validity, and reliability of the Swedish version of the Cultural Competence Assessment Instrument among Swedish occupational therapists. Material and Methods. A randomised sample of 312 Swedish occupational therapists answered a survey based on the Swedish version of the Cultural Competence Assessment Instrument with supplementary questions on the clinical relevance of the instrument. Descriptive statistics were used to examine the clinical relevance of the Swedish version of the Cultural Competence Assessment Instrument. Factor analyses, both exploratory and confirmatory, were run to examine the factor structure. Cronbach’s alpha was performed to assess the internal consistency of the instrument. Results. The participants reported that the 24 items had high clinical relevance. The validation yielded a three-factor model: openness and awareness, workplace support, and interaction skills. All three of these factors showed high loadings. Conclusions. The study results indicated positive clinical relevance and psychometric properties for the Swedish version of the Cultural Competence Assessment Instrument and strong support to be utilised in Sweden. The implications of this study are important given the rapid growth in migration over the last few decades. A self-rating instrument measuring cultural competence could support occupational therapists’ professional knowledge and development when they interact with international clients. As the tool was originally developed in English in the United States, the feedback from the Swedish version could potentially be useful for the instrument in modified form and for use by occupational therapists in English-speaking countries.
A Stochastic Differential Equation Driven by Poisson Random Measure and Its Application in a Duopoly Market
Authors: Wang Tong , Liang Hao
Published: April 2020

We investigate a stochastic differential equation driven by Poisson random measure and its application in a duopoly market for a finite number of consumers with two unknown preferences. The scopes of pricing for two monopolistic vendors are illustrated when the prices of items are determined by the number of buyers in the market. The quantity of buyers is proved to obey a stochastic differential equation (SDE) driven by Poisson random measure which exists a unique solution. We derive the Hamilton-Jacobi-Bellman (HJB) about vendors’ profits and provide a verification theorem about the problem. When all consumers believe a vendor’s guidance about their preferences, the conditions that the other vendor’s profit is zero are obtained. We give an example of this problem and acquire approximate solutions about the profits of the two vendors.
Assessment of Hematological Parameters in Malaria, among Adult Patients Attending the Bamenda Regional Hospital
Authors: Omarine Nlinwe Nfor , Nange Tang Bertilla
Published: April 2020

Malaria, which is responsible for a substantial amount of deaths in endemic countries, has been shown to have both direct and indirect effects on the hematological parameters. Notwithstanding, some hematological parameters among populations living in malaria endemic regions have not been described consistently, as a standard for measuring malaria burden. Based on the above fact, this study was designed to assess some hematological changes and their diagnostic values in malaria infected patients. A total of 160 malaria positive adult patients, together with 81 healthy control adults were recruited for the study. For the malaria positive group, the female to male ratio was 1.38 : 1. Specifically, 74.38%, 10.00%, and 15.62% of those in the malaria positive group had mild, moderate, and severe parasitaemia, respectively. Leukemia, anemia, and thrombocytopenia were found to be significantly associated with malaria and were all estimated to be specific for the diagnosis of malaria. Anemia was, however, estimated to be both sensitive and specific for malaria diagnosis. Therefore, anemia offers the most diagnostic value in the malaria infected patients of this study.
Radix Angelica Sinensis and Radix Hedysari Ultrafiltration Extract Protects against X‐Irradiation‐Induced Cardiac Fibrosis in Rats
Authors: Ma Chengxu , Zhao Xinke , Chang Juan , Guo Huan , Wei Huiping , Fu Zhaoyuan , Li Yingdong
Published: April 2020

Radiation‐induced myocardial fibrosis (RIMF) is the main pathological change associated with radiation‐induced heart toxicity after radiation therapy in patients with thoracic tumors. There is an antifibrosis effect of Radix Angelica Sinensis and Radix Hedysari (RAS‐RH) ultrafiltration extract from Danggui Buxue decoction (DBD) in X‐irradiation‐induced rat myocardial fibrosis, and this study aimed to investigate whether that effect correlated with apoptosis and oxidative stress damage in primary rat cardiac fibroblasts; further, the potential mechanisms were also explored. In this study, we first found that the RAS‐RH antifibrosis effect was associated with the upregulation of microRNA‐200a and the downregulation of TGF‐β1/smad3 and COL1α. In addition, we also found that the antifibrosis effect of RAS‐RH was related to the induction of apoptosis in primary rat cardiac fibroblasts and to the prevention of damage caused by reactive oxygen species (ROS). Interestingly, primary rat cardiac fibroblasts exposed to X‐ray radiation underwent apoptosis less frequently in the absence of RAS‐RH. Therefore, RAS‐RH has the ability to protect against fibrosis, which could be occurring through the induction of apoptosis and the resistance to oxidative stress in rats with X‐irradiation‐induced myocardial fibrosis; thus, in a model of RIMF, RAS‐RH acts against X‐irradiation‐induced cardiac toxicity.
Chemical Characterization and Wound Healing Property of Jacaranda decurrens Cham. (Bignoniaceae): An Experimental Study Based on Molecular Mechanisms
Authors: Serra Mariana B. , Barroso Wermerson A. , Rocha Cláudia , Furtado Pablo G.R. , Borges Antônio C.R. , Silva Selma N. , Tangerina Marcelo M. P. , Nascimento Jessyane R. do , Vilegas Wagner , Alves Ademilton C. , Barbeiro Denise F. , de Souza Heraldo P. , Abreu Iracelle C. , Borges Marilene O.R.
Published: April 2020

Background. Jacaranda decurrens Cham., known as carobinha, is prevalent in the Cerrado biome and presents popular use in treatment of dermatological diseases. The present study aimed to investigate the healing action of topical formulation of Jacaranda decurrens Cham. (FtEHJ) in mice cutaneous lesions. Methods. Phytochemical analysis of J. decurrens hydroalcoholic extract was carried out by using HPLC‐PDA‐ESI‐MS and FIA‐ESI‐IT‐MSn. Swiss mice were treated topically with formulation base (FtB) or Fibrinase® or ointment FtEHJ (15 mg/g; 50 mg/Kg). At the end of treatment periods, the inflammatory cytokines (TNF‐α, IL‐1β, and IL‐6) in the lesions were measured by using ELISA and gene expression of TGF‐β, Collagen I, and Collagen III was demonstrated by RTqPCR method and histological evaluation. Results. Ten compounds were identified in the extract, distributed among the classes of flavonoids and triterpenes. Treatment with FtEHJ increased the wound contraction in 24 hours, such as reduction of TNF‐α, IL‐1β, and IL‐6 (pg/mL) cytokines in the lesion. The TGF‐β and collagen gene expression was increased and the wound closure accelerated to nine days, with discrete inflammation, collagenization, and accented reepithelialization. Conclusions. The results obtained suggest chemical compounds present in the FtEHJ accelerates wound healing by being a gene expression modulator, and protein content of different molecules are involved in tissue repair.
Anti-Inflammatory and Antioxidant Activities of the Methanolic Extract of Cyrtocarpa procera Bark Reduces the Severity of Ulcerative Colitis in a Chemically Induced Colitis Model
Authors: Rodriguez-Canales Mario , Martinez-Galero Elizdath , Nava-Torres Alma D. , Sanchez-Torres Luvia E. , Garduño-Siciliano Leticia , Canales-Martinez Maria Margarita , Terrazas Luis I. , Rodriguez-Monroy Marco A.
Published: April 2020

Cyrtocarpa procera is a plant used in traditional Mexican medicine to treat different gastrointestinal problems. Here, we investigated the effects of a C. procera methanolic extract in DSS-induced colitis mice. Ulcerative colitis (UC) was induced by administering 4% DSS in drinking water to female BALB/c mice. Compared to untreated mice with UC, the treatment group receiving the C. procera extract presented less severe UC symptoms of diarrhea, bleeding, and weight loss. Additionally, colon shortening was significantly reduced, and at the microscopic level, only minor damage was observed. Levels of proinflammatory cytokines such as TNF-α, IL-1β, and IFNγ in serum as well as the MPO activity in the colon were significantly reduced in the C. procera methanolic extract-treated group. Moreover, the extract of C. procera reduced oxidative stress during UC, preventing the deterioration of the activity of antioxidant enzymes such as SOD, CAT, and GPx. Additionally, the extract decreased lipid peroxidation damage and its final products, such as malondialdehyde (MDA). In agreement with this, in vitro assays with the C. procera extract displayed good antioxidant capacity, probably due to the presence of polyphenolic compounds, in particular the flavonoids that were identified, such as chrysin, naringenin, kaempferol, and catechin, which have been reported to have anti-inflammatory and antioxidant activities. Therefore, the improvement of UC by the C. procera methanolic extract may be related to the action mechanisms of these compounds.
Serum miR‐375 Levels Are Closely Related to Disease Progression from HBV Infection to HBV‐Related Hepatocellular Carcinoma
Authors: Zhang Weilu , Fu Ting , Guo Zhenjun , Zhang Ye , Zhang Lei , Su Haixia , Long Yong , Ji Zhaohua , Yan Yongping , Shao Zhongjun
Published: April 2020

Background. There is an urgent need to identify ideal serological biomarkers that not only are closely related to disease progression from hepatitis B virus (HBV) infection to hepatocellular carcinoma (HCC) but also have high specificity and sensitivity. We conducted this study to analyze whether miR‐375 has a potential value in the early prediction of the progression from HBV‐related hepatitis or cirrhosis to HCC. Methods. A total of 177 participants were enrolled. Receiver operating characteristic (ROC) curve was used to evaluate the predictive capability of selected miR‐375 for HBV‐HCC. We upregulated the miR‐375 expression in HepG2, HepG2.2.15, and HepAD38 cells to determine its effect on cellular proliferation and migration, in vitro using Cell Counting Kit‐8 (CCK‐8) assays. Results. Serum miR‐375 levels decreased in order from healthy controls to chronic hepatitis B (CHB) without cirrhosis, followed by cirrhosis, and finally, HBV‐HCC patients. miR‐375 levels were significantly lower in HBeAg‐positive and HBV DNA‐positive patients than negative (P < 0.05) and significantly lower in patients with elevated alpha‐fetoprotein (AFP) and carcinoembryonic antigen (CEA) than normal levels (P < 0.05). miR‐375 might be a biomarker for HBV‐HCC, with a high area under the curve (AUC) of 0.838 (95% confidence interval (CI) 0.780 to 0.897; sensitivity: 73.9%; specificity: 93.0%). The AUC (0.768 vs. 0.584) and sensitivity (93.8% vs. 75.0%) for miR‐375 were higher than those for AFP. The overexpression of miR‐375 noticeably inhibited proliferation and migration in HepG2, HepG2.2.15, and HepAD38, especially in HepG2.2.15 and HepAD38, which are stably infected with HBV. Conclusions. Serum miR‐375 levels are closely related to disease progression from HBV‐related hepatitis or cirrhosis to HCC.
Dental and Periodontal Treatment Need after Dental Clearance Is Not Associated with the Outcome of Induction Therapy in Patients with Acute Leukemia: Results of a Retrospective Pilot Study
Authors: Schmalz Gerhard , Tulani Lulzim , Busjan Rilana , Haak Rainer , Kottmann Tanja , Trümper Lorenz , Hasenkamp Justin , Ziebolz Dirk
Published: April 2020

This retrospective pilot study aimed to detect whether remaining dental/periodontal treatment need and periodontal inflammation after dental clearance would be associated with the initial therapy outcome of adult patients with acute leukemia undergoing induction chemotherapy. Different parameters were assessed from the patients’ records: initial blood parameters, blood parameters during initial chemotherapy, leukemia/therapy related complaints, duration of fever, microbiological findings (blood and urine), as well as patients’ survival. Dental treatment need was defined as the presence of at least one carious tooth; periodontal treatment need was determined by the presence of probing depth ≥3.5 mm in at least two sextants. To reflect periodontal inflammation, the periodontal inflamed surface area (PISA) was applied. Thirty-nine patients were included. A dental treatment need of 75% and periodontal treatment need of 76% as well as an average PISA of 153.18 ± 158.09 were found. Only two associations were detected: periodontal treatment need was associated with thrombocyte count after 7 days (p=0.03), and PISA was associated with erythrocyte count three days after induction of therapy (p=0.01). It can be concluded that remaining dental and periodontal treatment need as well as periodontal inflammation after dental clearance is not associated with the outcome of induction therapy in adult patients with acute leukemia.
Adaptive Decentralized Output Feedback Tracking Control for Large-Scale Interconnected Systems with Time-Varying Output Constraints
Authors: Wan Min , Yin Yanxia
Published: April 2020

This paper investigates a novel adaptive output feedback decentralized control scheme for nonstrict feedback large-scale interconnected systems with time-varying constraints. A decentralized linear state observer is designed to estimate the unmeasurable states of subsystems. Time-varying barrier Lyapunov functions are designed to ensure outputs are not violating constraints. A variable separation approach is applied to deal with the nonstrict feedback problem. Moreover, dynamic surface control and minimal parameter learning technologies are adopted to reduce the computation burden, and there are only two parameters for every subsystem to be updated online. The proof of stability is obtained by the Lyapunov method. Finally, simulation results are given to show the effectiveness of the proposed control scheme.
Exploring the Epidemic Spreading in a Multilayer Metapopulation Network by considering Individuals’ Periodic Travelling
Authors: Han Dun , Shao Qi , Li Dandan
Published: April 2020

The convenience of transportation brings the diversity of individuals’ travelling modes; in this paper, we present an improved epidemic diffusion model in a multilayer metapopulation network. Firstly, we construct the metapopulation network with different travelling ways, and then, the epidemic spreading threshold is calculated by means of the mean-field method. Taking the periodicity of individuals’ travelling into account, we further explore the epidemic diffusion model with individuals’ periodic travelling and deduce the epidemic spreading threshold using the Perron–Frobenius theorem. Our results show that if all individuals in each area decide to move, the epidemic threshold can be effectively raised while each individual chooses an unbiased region to arrive. In addition, with the increase of individuals’ mobility rate or regional heterogeneous infection coefficient, the fluctuation range of the density of infected becomes larger, while the fluctuation period is almost unchanged. However, the change of individuals’ periodic motion could cause the change of the fluctuation period of infected density. We try to provide a new perspective for the research of metapopulation.
Etiology, Clinical Features, and Diagnosis of Vulvar Lichen Sclerosus: A Scoping Review
Authors: Singh Nilanchali , Ghatage Prafull
Published: April 2020

Objective. Vulvar lichen sclerosus (VLS) is a chronic inflammatory disorder, which affects women of all ages. With numerous controversies as regards to the nomenclature, diagnosis and its association with neoplastic conditions, we decided to conduct a scoping review on this subject.Data Source. A review protocol was developed, and the Knowledge Resource Services website was used to do a search of articles pertaining to VLS with keywords “Vulvar,” “Vulval,” “diagnosis,” “lichen sclerosus et atrophicus,” “kraurosis,” “vulvar dystrophy,” and “Lichen Sclerosus”.Study Selection. The search was limited to published data from the last ten years, i.e., from July 2009 onwards and in the English language. A total of 338 articles pertaining to VLS were obtained. Older data were accessed if particular information was sought for.Results & Conclusion. The presentation is bimodal, i.e., one in prepubertal girls (average age: 7.6 years) and the other in peri- and postmenopausal women (average age: 52.6 years). However, many cases also present during reproductive years. Studies suggest a multifactorial origin as far as etiology is concerned, including a genetic, autoimmune, hormonal, and local infectious background. It affects the genital labial, perineal, and perianal areas and manifests as a patchy, thin, glistening, ivory-white area. Diagnosis is mainly based on clinical features. Biopsy is seldom required. It has been well established as a precursor lesion of dVIN and vulvar carcinoma.
Gastrointestinal Cryptococcosis Associated with Intestinal Lymphangiectasia
Authors: Naranjo-Saltos Fernando , Hallo Alejandro , Hallo Carlos , Mayancela Andres , Rojas Alejandra
Published: April 2020

Intestinal lymphangiectasia is a pathological dilation of enteric lymphatic vessels resulting in lymph leakage to the intestinal lumen. This chronic lymph leakage leads to a state of immunosuppression secondary to the loss of humoral and cellular components of the immune system and represents a potential risk factor for opportunistic infections. We report a case of protein-losing enteropathy in a seemingly immunocompetent patient. An intestinal histopathological study revealed the unusual association of lymphangiectasia and intestinal cryptococcosis. Although cryptococcal infection is common in immunocompromised patients, intestinal involvement is rarely reported. We found no reports on the association of intestinal cryptococcosis in patients with lymphangiectasia. This case report is the first to describe intestinal cryptococcosis associated with intestinal lymphangiectasia.
Estimation of a Finite Population Mean under Random Nonresponse Using Kernel Weights
Authors: Bii Nelson Kiprono , Onyango Christopher Ouma , Odhiambo John
Published: April 2020

Nonresponse is a potential source of errors in sample surveys. It introduces bias and large variance in the estimation of finite population parameters. Regression models have been recognized as one of the techniques of reducing bias and variance due to random nonresponse using auxiliary data. In this study, it is assumed that random nonresponse occurs in the survey variable in the second stage of cluster sampling, assuming full auxiliary information is available throughout. Auxiliary information is used at the estimation stage via a regression model to address the problem of random nonresponse. In particular, auxiliary information is used via an improved Nadaraya–Watson kernel regression technique to compensate for random nonresponse. The asymptotic bias and mean squared error of the estimator proposed are derived. Besides, a simulation study conducted indicates that the proposed estimator has smaller values of the bias and smaller mean squared error values compared to existing estimators of a finite population mean. The proposed estimator is also shown to have tighter confidence interval lengths at 95% coverage rate. The results obtained in this study are useful for instance in choosing efficient estimators of a finite population mean in demographic sample surveys.
Spatial Distribution and Factors Associated with Khat Chewing among Adult Males 15-59 Years in Ethiopia Using a Secondary Analysis of Ethiopian Demographic and Health Survey 2016: Spatial and Multilevel Analysis
Authors: Tessema Zemenu Tadesse , Zeleke Tadele Amare
Published: April 2020

Background. Khat chewing has become prevalent in the world due to the improvement of road and air transportation. In Ethiopia, khat chewing is more prevalent and widely practiced by men. Khat has a negative effect on social, economic, and mental health. There is variation in khat cultivation, use, and factors that associated with khat chewing in the Ethiopian regions. Therefore, this study is aimed at showing spatial distribution and factors associated with khat chewing among male adults 15-59 years in Ethiopia.Methods. A total of 12,594 men were included in this study. ArcGIS version 10.7 software was used to show the spatial distribution of chewing khat among adult men in Ethiopia. The Bernoulli model was applied using Kilduff SaTScan version 9.6 software to identify significant purely spatial clusters for chewing khat in Ethiopia. A multilevel logistic regression model was fitted to identify factors associated with khat chewing. APvalue < 0.05 was taken to declare statistically significant predictors.Results. The EDHS 2016 survey showed that the high proportion of chewing khat was found in Dire Dawa, Harari, Southern Oromia, Somali, and Benishangul Gumuz regions. In spatial scan statistics analysis, a total of 126 clusters (LLR=946.60,Pvalue < 0.001) were identified. Age group 30-44 years old (AOR=1.60, 95% CI: 1.37, 1.86) and 45-59 years old (AOR=1.33, 95% CI: 1.09, 1.61), being single (AOR=1.86, 95% CI: 1.64, 2.12), Muslim religion followers (AOR=15.03, 95% CI: 11.90, 18.90), media exposed (AOR=0.77, 95% CI: 0.68, 0.86), had work (AOR=2.48, 95% CI: 2.08, 2.95), alcohol drinker (AOR=3.75, 95% CI: 3.10, 4.53), and region (Afar, Amhara, Benishangul Gumuz, Gambela, Harari, Oromia, Somali, Southern Nations, Nationalities, and People’s Region (SNNPR), and Tigray) and two cities (Addis Ababa and Dire Dawa) were statistically significant factors affecting chewing khat in Ethiopia.Conclusions. In Ethiopia, the spatial distribution of khat chewing among adult men was nonrandom. A high proportion of khat chewing was observed in Dire Dawa, Harari, Southern Oromia, Somali, and Benishangul Gumuz regions. Older age group, being single marital status, alcohol drinker, media unexposed, had no work, and Muslim religion follower were factors affecting khat chewing. Policymakers should be given spatial attention in reducing the prevalence of chewing khat by teaching the health impact of khat chewing through media in the identified regions.
Is Mitochondrial Oxidative Stress the Key Contributor to Diaphragm Atrophy and Dysfunction in Critically Ill Patients?
Authors: Duan Hongjie , Bai Hailiang
Published: April 2020

Diaphragm dysfunction is prevalent in the progress of respiratory dysfunction in various critical illnesses. Respiratory muscle weakness may result in insufficient ventilation, coughing reflection suppression, pulmonary infection, and difficulty in weaning off respirators. All of these further induce respiratory dysfunction and even threaten the patients’ survival. The potential mechanisms of diaphragm atrophy and dysfunction include impairment of myofiber protein anabolism, enhancement of myofiber protein degradation, release of inflammatory mediators, imbalance of metabolic hormones, myonuclear apoptosis, autophagy, and oxidative stress. Among these contributors, mitochondrial oxidative stress is strongly implicated to play a key role in the process as it modulates diaphragm protein synthesis and degradation, induces protein oxidation and functional alteration, enhances apoptosis and autophagy, reduces mitochondrial energy supply, and is regulated by inflammatory cytokines via related signaling molecules. This review aims to provide a concise overview of pathological mechanisms of diaphragmatic dysfunction in critically ill patients, with special emphasis on the role and modulating mechanisms of mitochondrial oxidative stress.
Prognostic Significance of the Tumor-Stromal Ratio in Invasive Breast Cancer and a Proposal of a New Ts-TNM Staging System
Authors: Xu Qian , Yuan Jing-Ping , Chen Yuan-Yuan , Zhang Hong-Yan , Wang Lin-Wei , Xiong Bin
Published: April 2020

Background. Previous studies have demonstrated that the tumor-stromal ratio (TSR) was an independent prognostic factor in several types of carcinomas. This study aimed at exploring the prognostic significance of the TSR in invasive breast cancer using immunohistochemistry (IHC)-stained tissue microarrays (TMAs) and integrating the TSR into the traditional tumor-node-metastasis (TNM) staging system. Methods. The prepared 7 TMAs containing 240 patients with 480 invasive BC specimens were stained with cytokeratin (CK) by the IHC staining method. The ratio of tumor cells and stromal cells was visually assessed. TSR > 1 and TSR ≤ 1 were categorized as the high TSR (low stroma) and low TSR (high stroma) groups, respectively, and the prognostic value of the TSR at 5-year disease-free survival (5-DFS) was analyzed. A new Ts-TNM (tumor stroma-tumor-node-metastasis) staging system was established and assessed. Results. IHC staining of CK could specifically label tumor cells with clear contrast, making it easy to manually assess TSR. High TSR (low stroma) and low TSR (high stroma) were observed in 52.5% (n = 126) and 47.5 (n = 114) of the cases, according to the division of value 1. A Kaplan–Meier analysis showed that patients in the low TSR group had a worse 5-DFS compared with patients in the high TSR group (P=0.022). Multivariable analysis indicated that the T stage (P=0.014), N status (P<0.001), histological grade (P<0.001), estrogen receptor status (P=0.015), and TSR (P=0.011) were independent prognostic factors of invasive BC patients. The new Ts-TNM staging system combining TSR, tumor staging, lymph node status, and metastasis staging was established. The receiver operating characteristic (ROC) curve analysis demonstrated that the ability of the Ts-TNM staging system to predict recurrence was not lower than that of the TNM staging system. Conclusions. This study confirms that the TSR is a prognostic indicator for invasive breast cancer. The Ts-TNM staging system containing stromal and tumor information may optimize risk stratification for invasive breast cancer.
The Association of TNF-Alpha Inhibitors and Development of IgA Nephropathy in Patients with Rheumatoid Arthritis and Diabetes
Authors: Premužić Vedran , Padjen Ivan , Cerovec Mislav , Ćorić Marijana , Jelaković Bojan , Anić Branimir
Published: April 2020

IgA nephropathy (IgAN) is a rather uncommon complication of TNF-alpha inhibition with a range of findings such as asymptomatic microscopic/macroscopic hematuria or different degrees of proteinuria and could progress to end-stage renal disease. We are reporting three patients with longstanding rheumatoid arthritis (RA), which developed IgAN while receiving TNF-alpha inhibitors. All off our three patients had RA, which lasted 2–4 years, and none of them had a prior history of chronic kidney disease. Two patients were treated with adalimumab while one patient was treated with golimumab. Discontinuation of anti-TNF-alpha therapy and initiation of immunosuppressive therapy led to improvement in serologic abnormalities and renal function in two patients, while the third patient’s 24-hour proteinuria was only partially reduced, which supports previous reports on TNF-alpha inhibitor induced autoimmunity. Two of our patients had previously been diagnosed with type 2 diabetes mellitus while the third patient developed diabetes years after the onset of IgAN. This is in line with the previously described association of IgAN and diabetes mellitus. To our best knowledge, this is the first report to analyze the development of IgAN as a potential consequence of anti-TNF-alpha therapy and its possible association with pretreatment or posttreatment diabetes.
Leptomeningeal Enhancement due to Neurosarcoidosis Mimicking Malignancy
Authors: Saltijeral Sahara N. , Grosu Horiana B. , De La Garza Henriette , O’Brien Barbara , Iliescu Gloria
Published: April 2020

The present report describes the case of a 56-year-old African American man experiencing progressive disequilibrium, lower extremity weakness, difficulty walking, and hearing loss. Brain magnetic resonance imaging showed leptomeningeal enhancement. Initial differential diagnosis was broad, including malignant, infectious, and inflammatory etiologies. The cerebrospinal fluid analyses demonstrated lymphocytic pleocytosis, hypoglycorrhachia, and hyperproteinorrachia but no other abnormalities. An extensive infectious disease workup was negative. Positron emission tomography revealed hypermetabolic lymph nodes in the right mediastinum and right hilum, correlating with findings on endobronchial ultrasonography. Subsequently, image-guided fine-needle aspiration of the right upper paratracheal lymph node was performed, and biopsy studies showed noncaseating granulomatous inflammation. Based on the clinical picture, the diagnosis of neurosarcoidosis was made, and high-dose steroids were started and resulted in significant improvement.
Functional Genetic Variant in ATG5 Gene Promoter in Acute Myocardial Infarction
Authors: Zhang Yexin , He Xiaohui , Li Jiarui , Yang Wentao , Cui Yinghua , Pang Shuchao , Wang Haihua , Yan Bo
Published: April 2020

Coronary artery disease (CAD) including acute myocardial infarction (AMI) is an inflammatory and metabolic disease mainly caused by atherosclerosis. Dysfunctional autophagy has been associated with abnormal lipid metabolism and inflammation. In previous studies, we have reported altered autophagic activity in AMI patients. As autophagy-related protein 5 (ATG5) is a core protein in autophagy, we speculated that altered ATG5 level may contribute to CAD and AMI development. In this study, the promoter of the ATG5 gene was genetically and functionally investigated in large groups of AMI patients (n = 378) and ethnic-matched healthy controls (n = 386). The results showed that a total of 15 genetic variants including 6 single-nucleotide polymorphisms (SNPs) in the ATG5 gene promoter were found in this study population. A novel deletion variant (g.106326168_70delTCT) and an SNP [g.106325757C > G (rs190825454)] were found in one 66-year-old male patient with non-ST-segment elevated AMI, but in none of controls. In cultured HEK-293 and H9c2 cells, the deletion variant significantly decreased the transcriptional activity of the ATG5 gene promoter (P<0.01). In contrast, the genetic variants either identified only in controls or found in both AMI patients and controls did not affect the transcriptional activity of the ATG5 gene promoter (P>0.05). Furthermore, an electrophoretic mobility shift assay showed that the deletion variant evidently affected the binding of a transcription factor. Therefore, the genetic variant identified in AMI may affect the activity of the ATG5 gene promoter and change the ATG5 level, contributing to AMI as a rare risk factor.
Gestational Diabetes and Risk of Breast Cancer in African American Women
Authors: Bertrand Kimberly A. , Castro-Webb Nelsy , Cozier Yvette C. , Li Shanshan , O'Brien Katie M. , Rosenberg Lynn , Palmer Julie R.
Published: April 2020

Background:

Gestational diabetes mellitus (GDM) has been hypothesized to increase breast cancer risk, but results from the few prior epidemiologic studies are conflicting, and no studies have examined the association in African American women.

Methods:

We analyzed data from the prospective Black Women's Health Study to evaluate associations of history of GDM with breast cancer risk among 41,767 parous African American women, adjusting for potential confounders. HRs and 95% confidence intervals (CI) were estimated from multivariable Cox proportional hazards regression models.

Results:

There was no evidence of an association between history of GDM and risk of invasive breast cancer, overall or by estrogen receptor status.

Conclusions:

Results of this study do not support the hypothesis that GDM is an important risk factor for breast cancer in African American women overall.

Impact:

On the basis of these data, breast cancer risk is not increased among African American women with a history of GDM compared with parous women without a history of GDM.
Prognostic Value of Cystatin C-Derived Estimated Glomerular Filtration Rate in Patients with Acute Heart Failure
Authors: Jang Se Yong , Yang Dong Heon , Kim Hyeon Jeong , Park Bo Eun , Park Yoon Jung , Kim Hong Nyun , Kim Nam Kyun , Bae Myung Hwan , Lee Jang Hoon , Park Hun Sik , Cho Yongkeun , Chae Shung Chull
Published: April 2020

Background: Renal function is closely related to cardiac function and an important prognostic marker in heart failure. Objective: We aimed to test the prognostic value of cystatin C (cysC)-derived estimated glomerular filtration rates (eGFR) in comparison with eGFRs from creatinine solely based equations in patients with acute heart failure (AHF). Methods: This study included 262 patients (65.8 ± 14.9 years old, 126 male) with AHF. Prognostic value of the eGFRs, from cysC-based equations chronic kidney disease epidemiology collaboration (CKD-EPI-cysC and CKD-EPI-creatinine [cr]-cysC equations) were compared with eGFRs calculated from serum creatinine levels only (Modification of Diet in Renal Disease [MDRD]-4 and CKD-EPI-cr equations). Prognosis was evaluated with the composite of all-cause mortality and hospitalization for heart failure within 1 year. Results: During the follow-up period (mean follow-up period, 264.0 ± 136.1 days), 67 (25.6%) events occurred. Estimated GFR using CKD-EPI-cysC was the best for predicting 1-year outcome using receiver operating characteristic curve analysis (area under curve 0.585, 0.607, 0.669, and 0.652 for eGFRs from MDRD-4, CKD-EPI-cr, CKD-EPI-cysC, and CKD-EPI-cr-cysC respectively). The Kaplan-Meier survival curve analysis showed that only the eGFRs classification from the equations based on cysC significantly predicted 1-year outcome in patients with AHF. Conclusions: Estimated GFRs calculated with cysC predicted the prognosis more accurately in patients with AHF than the eGFRs from creatinine only equations.
Incidental Accumulation of Fluciclovine in Neuroendocrine Tumour in a Patient with Oncological Duplicity
Authors: Balážová Zuzana , Černý Igor , Vyškovský Petr
Published: April 2020

18F-fluciclovine is a PET radiopharmaceutical used for the detection of recurrent prostate cancer in adult men after primary curative treatment with suspicion of recurrence based on elevated prostate-specific antigen level. Several incidental uptakes of 18F-fluciclovine in other tumour types have been described in the literature so far – in breast cancer, hepatocellular carcinoma, and malignant melanoma. Our case report presents a patient with oncological duplicity (prostate gland carcinoma and newly diagnosed neuroendocrine tumour) and with accumulation of fluciclovine in pathologically proved neuroendocrine tumour, later imagined also by octreotide SPECT/CT. To our knowledge, this is the first case of fluciclovine accumulated in a neuroendocrine tumour described in the literature.
Controlling Blood Pressure Under Transcranial Doppler Guidance after Endovascular Treatment in Patients with Acute Ischemic Stroke
Authors: Chen Hongbo , Su Yingying , He Yanbo , Zhang Yingbo , Sun Yijia , Fan Linlin , Liu Gang , Chen Zhongyun
Published: April 2020

Objective: This study aimed to control blood pressure (BP) under transcranial Doppler (TCD) guidance in patients with anterior circulation acute ischemic stroke after endovascular treatment (EVT) to reduce the incidence of early neurological deterioration (END) and improve neurological prognosis. Methods: This prospective randomized controlled study included 95 patients who were randomly divided into a TCD-guided BP control (TBC) group and a non-TCD-guided BP control (NBC) group. The patients were monitored by TCD within 72 h after EVT. In the TBC group, BP decreased, BP increased, or intracranial pressure decreased when TCD showed blood flow acceleration, deceleration, or intracranial hypertension respectively. The BP of the NBC group was controlled according to the guidelines. The incidence of END and the prognosis was compared between the 2 groups. Results: TCD identified 18 patients with blood flow acceleration, but the prognosis of the 2 groups was not significantly different. TCD identified 23 patients with blood flow deceleration, and the poor prognosis rate at discharge was lower in the TBC group than in the NBC group (45.5 vs. 91.7%, p = 0.027). TCD identified 34 patients with intracranial hypertension, and the 3-month mortality rate of the TBC group was lower than that of the NBC group (0 vs. 36.8%, p = 0.011). The incidence rates of END and 3-month mortality in the TBC group were lower than those in the NBC group (13.8 vs. 37.5%, p = 0.036; 0 vs. 25.0%, p = 0.012) when TCD parameters were abnormal. Multivariable logistic regression analysis showed that the TBC group (adjusted OR 0.267, 95% CI 0.074–0.955; p = 0.042) was an independent protective factor against the incidence of END when TCD parameters were abnormal. Conclusion: These findings indicated that TCD-guided BP and intracranial pressure control improved the prognosis of patients with blood flow deceleration and intracranial hypertension.
Small Bowel Enteroscopy – A Joint Clinical Guideline from the Spanish and Portuguese Small Bowel Study Groups
Authors: Pérez-Cuadrado-Robles Enrique , Pinho Rolando , Gonzalez Begoña , Mão de Ferro Susana , Chagas Cristina , Esteban Delgado Pilar , Carretero Cristina , Figueiredo Pedro , Rosa Bruno , García Lledó Javier , Nogales Óscar , Ponte Ana , Andrade Patrícia , Juanmartiñena-Fernández Jose Francisco , San-Juan-Acosta Mileidis , Lopes Sandra , Prieto-Frías César , Egea-Valenzuela Juan , Caballero Noemí , Valdivieso-Cortazar Eduardo , Cardoso Hélder , Gálvez Consuelo , Almeida Nuno , Borque Barrera Pilar , Gómez-Rodríguez Blas José , Sánchez Ceballos Francisco , Bernardes Carlos , Alonso Pedro , Argüelles-Arias Federico , Mascarenhas Saraiva Miguel , Pérez-Cuadrado-Martínez Enrique ,   Capsule Endoscopy and Enteroscopy Group of the Spanish Society of Gastrointestinal Endoscopy (SEED),   Portuguese Small Bowel Study Group (GEPID)
Published: April 2020

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication and on its diagnostic and therapeutic yields. A set of recommendations were issued accordingly.
Triadin Knockout Syndrome Is Absent in a Multi-Center Molecular Autopsy Cohort of Sudden Infant Death Syndrome and Sudden Unexplained Death in the Young and Is Extremely Rare in the General Population
Authors: Clemens Daniel J. , Gray Belinda , Bagnall Richard D. , Tester David J. , Dotzler Steven M. , Giudicessi John R. , Matthews Emma , Semsarian Christopher , Behr Elijah R. , Ackerman Michael J.
Published: April 2020

Background:

Triadin knockout syndrome (TKOS) is a potentially lethal arrhythmia disorder caused by recessively inherited null variants in
TRDN
-encoded cardiac triadin. Despite its malignant phenotype, the prevalence of TKOS in sudden infant death syndrome and sudden unexplained death in the young is unknown.

Methods:

Exome sequencing was performed on 599 sudden infant death syndrome and 258 sudden unexplained death in the young cases. Allele frequencies of all
TRDN
null variants identified in the cardiac-specific isoform of
TRDN
in the Genome Aggregation Database were used to determine the estimated prevalence and ethnic distribution of TKOS.

Results:

No triadin null individuals were identified in 599 sudden infant death syndrome and 258 sudden unexplained death in the young exomes. Using the Genome Aggregation Database, we estimate the overall prevalence of TKOS to be ≈1:22.7 million individuals. However, TKOS prevalence is 5.5-fold higher in those of African descent (≈1:4.1 million).

Conclusions:

TKOS is an exceedingly rare clinical entity that does not contribute meaningfully to either sudden infant death syndrome or sudden unexplained death in the young. However, despite its rarity and absence in large sudden death cohorts, TKOS remains a malignant and potentially lethal disorder which requires further research to better care for these patients.