bluuebunny/crossref_metadata_2025 huggingface dataset:
Challenge of Gastro-Intestinal Stromal Tumor Management in Low-Income Countries : Example of Benin
Authors: GBESSI Dansou Gaspard , GNANGNON Freddy Houéhanou Rodrigue , KPOSSOU Aboudou Raïmi , GBETCHEDJI Prudent Pacifique , Seidou Falilatou , SOUAÏBOU Yacoubou IMOROU , ATTOLOU Setondji Gilles Roger , LAWANI Ismaïl , LALEYE Marie-Christel , GANGBO Flore Armande , DOSSOU Francis Moïse , SEHONOU Jean , MEHINTO Delphin Kuassi
Published: October 2021

Background: GISTs are rare tumors but the most frequent mesenchymal tumors of the digestive tract. Diagnosis and treatment are challenging in low-income countries due to relatively poor access to immunohistochemistry and targeted therapy. In Africa there are few studies about it. This study described the diagnosis and therapeutic management of GIST in Cotonou, Benin.Methods: This was a descriptive cross-sectional study, with retrospective data collection over a 10-year period from 2010 to 2020, focused on patients with histological confirmed gastro-intestinal stromal tumor (GIST). Data analysis was performed with Epidata Analysis software version 3.0.0.1.Results: Fifteen GISTs were identified during the study period. The median age was 52 and the sex ratio was 2. The most frequent symptom was abdominal pain (n = 12). Delay in care seeking after onset of symptoms ranged from 24 hours to 15 years. The most common site for GISTs was the stomach (n = 8). The median tumor size was 11 cm and the majority (n=10) was metastatic or locally advanced at the time of diagnosis. The tumors were often spindle-shaped at histology (n = 13) and the majority expressed KIT (n = 14). Most of the tumors (n = 12) were at high risk of recurrence according to the Joensuu scoring system. The availability of imatinib have improved the outcome of GIST with response in all cases it was used in neoadjuvant setting (n = 7).Conclusion: GISTs are rare tumors and preferentially affect the stomach in Cotonou. Most of the tumors were large, unresectable at the time of diagnosis and at high risk of recurrence. Access to imatinib has revolutionized the management of those tumors in our country.
Ponderomotive Forces in the System of Two Nanoparticles
Authors: Lozovski Valeri Z. , Lysenko Volodymyr S. , Rusinchuk Natalia
Published: October 2021

Mechanical consequences of electromagnetic interaction of two nanoparticles have been studied theoretically. It has been shown that local field enhancement effect, which causes appearance of the local field gradients, can lead to ponderomotive forces acting on the nanoparticles. Distribution of the local field in the system has been calculated and ponderomotive forces directions and values were evaluated. It has been shown that in the system of two different-sized nanoparticles the forces act mainly on the surface of bigger nanoparticle and for some systems its value may acquire up to several tens of nanonewtons. Possible application of the results to study of biological systems has been also discussed.
A Coherent Accumulation Detection Method Based on SA-DPT for Highly Maneuvering Target
Authors: Pang Cunsuo , Guo Hualing , Hou Huiling
Published: October 2021

The emergence of highly maneuverable weak targets has led to a serious degradation or even failure of traditional radar detection. In this paper, a coherent accumulation algorithm based on combination of scaling algorithm(SA) and discrete polynomial-phase Transform(DPT) is proposed in terms of the calculation burden and detection performance, which can, firstly, perform fewer times of speed parameter compensation based on SA for the transmitted signal; secondly, use segmented FFT to estimate the time delay range of the target initial distance for the echo signal, and then use the DPT algorithm to complete the parameter estimation such as target speed and acceleration within the estimated time delay unit, while analyzing the effects of the number of segments, compensation speed and delay unit on the detection performance, and giving out the output SNR and the amount of complex multiplication of the proposed algorithm. Finally, the proposed algorithm has been verified by experimental data for its effectiveness in accumulation gain and parameter estimation. This method is for sub-optimal estimation, requiring much less computation than full-parameter search methods, but performs better than non-parametric search methods in detecting weak signals.
Nanofiber/hydrogel Core-shell Scaffolds With Three-dimensional Multilayer Patterned Structure for Accelerating Diabetic Wound Healing
Authors: Li Jiankai , Zhang Tianshuai , Pan Mingmang , Xue Feng , Lv Fang , Ke Qinfei , Xu He
Published: October 2021

Impaired angiogenesis is one of the predominant reasons for non-healing diabetic wounds. Herein, a nanofiber/ hydrogel core-shell scaffold with three-dimensional (3D) multilayer patterned structure (3D-PT-P/GM) was introduced for promoting diabetic wound healing with improved angiogenesis. The results showed that the 3D-PT-P/GM scaffolds possessed multilayered structure with interlayer spacing of about 15-80 μm, and the hexagonal micropatterned structures were uniformly distributed on the surface of each layer. The nanofibers in the scaffold exhibited distinct core-shell structures with Gelatin methacryloyl (GelMA) hydrogel as the shell and Poly (D, L-lactic acid) (PDLLA) as the core. The results showed that the porosity, water retention time and water vapor permeability of the 3D-PT-P/GM scaffolds increased to 1.6 times, 21 times, and 1.9 times than that of the two-dimensional (2D) PDLLA nanofibrous scaffolds, respectively. The in vitro studies showed that the 3D-PT-P/GM scaffolds could significantly promote cell adhesion, proliferation, infiltration and migration throughout the scaffolds, and the expression of cellular communication protein-related genes, as well as angiogenesis-related genes in the same group, was remarkably upregulated. The in vivo results further demonstrated that the 3D-PT-P/GM scaffolds could not only effectively absorb exudate and provide a moist environment for the wound sites, but also significantly promote the formation of a 3D network of capillaries. As a result, the healing of diabetic wounds was accelerated with enhanced angiogenesis, granulation tissue formation, and collagen deposition. These results indicate that nanofiber/ hydrogel core-shell scaffolds with 3D multilayer patterned structures could provide a new strategy for facilitating chronic wound healing.
Impact of radiotherapy-induced inflammatory responses on progression-free survival in a tri-racial/ethnic breast cancer population
Authors: Yang George R. , Reis Isildinha M. , Acosta Laura G. , Schindler Emma A. , Takita Cristiane , Wright Jean L. , Lee Eunkyung , Nelson Omar L. , Meshman Jessica , Hu Jennifer J.
Published: October 2021

Background

Inflammatory biomarker C-reactive protein (CRP) is associated with breast cancer risk and survival. We examined whether CRP levels before radiotherapy (pre-RT), after RT (post-RT), and RT-induced change impact breast cancer progression-free survival (PFS).
Methods

Plasma high-sensitivity CRP was measured, and patients were followed for up to 13 years after RT. PFS was calculated from the date of diagnosis to the date of disease progression or the last date of follow-up. Univariable and multivariable Cox proportional hazards regression models were used to evaluate the associations between CRP and PFS adjusted for other patient/clinical variables.
Results

In 469 patients (64 non-Hispanic Whites, 303 Hispanic Whites, and 102 African Americans), post-RT CRP levels were significantly higher in patients with progression compared to progression-free patients (mean±SD: 12.2±15.4 mg/L vs. 7.3±11.5, p=0.011). In univariable analyses, worse PFS was significantly associated with post-RT CRP ≥5.1 mg/L (hazard ratio [HR]: 2.67; 95% confidence interval [95% CI]: 1.65-4.30) and CRP change ≥2.3 mg/L (HR: 3.55; 95% CI: 2.25-5.64). In multivariable models, post-RT CRP ≥5.1 mg/L was associated with worse PFS in all (HR: 2.10; 95% CI: 1.29-3.42) or patients with tumor stage III (HR: 2.93, 95% CI: 1.20-7.18). CRP change ≥2.3 mg/L was associated with worse PFS in all (HR: 2.38; 95% CI: 1.45-3.92) or patients with tumor stage III (HR: 2.41, 95% CI: 1.09-5.33).
Conclusions

Our data suggest that an RT-induced hyper-inflammatory response may contribute to worse breast cancer PFS. Future larger studies are warranted to validate our findings and guide follow-up surveillance and targeted interventions.
A New Early Cretaceous lizard in Myanmar Amber with Exceptionally Preserved Integument
Authors: Čerňanský Andrej , Stanley Edward L. , Daza Juan D. , Bolet Arnau , Arias J. Salvador , Bauer Aaron M. , Vidal-García Marta , Bevitt Joseph J. , Peretti Adolf M. , Aung Nyi Nyi , Evans Susan E.
Published: October 2021

We here report on a well-preserved juvenile lizard specimen in Albian amber (ca. 110 mya) from the Hkamti site in Myanmar. This new taxon, Retinosaurus hkamtiensis gen. et sp. nov., is represented by an articulated skull and the anterior portion of the trunk, including the pectoral girdle and forelimbs. The ocular skeleton (scleral ossicles) and eyelid are also visible, and the specimen exhibits pristine detail of the integument (of both head and body). In a combined molecular and morphological analysis, Retinosaurus was consistently recovered as a scincoid lizard (i.e. Scinciformata), as the sister taxon to the Mexican Cretaceous genus Tepexisaurus + Xantusiidae. However, the phylogenetic position of Retinosaurus should be interpreted with caution. We cannot not rule out the possibility that Retinosaurus represents a separate lineage of uncertain phylogenetic position, as it is the case for many Jurassic and Cretaceous taxa. Nonetheless, this fossil offers a rare opportunity to glimpse the external appearance of one group of lizards during the Early Cretaceous.
Surgical Treatment for Olfactory Groove Meningiomas: A Meta-Analysis of the Literature
Authors: Wang Wei , Chen Cong , Chen Siqi
Published: October 2021

Background Surgical resection of olfactory groove meningiomas (OGMs) is challenging and lots of surgical approaches can be chosen. We conducted a systematic review and meta-analysis of the studies investigating surgical resection of OGMs to better understand the surgical treatment of OGMs.Methods PubMed, Embase and Cochrane Library were used to search the studies reporting treatment outcomes of surgery for patients with OGMs. The final eligible studies were assessed using the Oxford Center for Evidence Based Medicine for level of evidence. Relevant parameters were extracted to perform descriptive and/or quantitative analyses.Results A total of 42 studies including 1673 patients were included in this systematic review (8 level 3 studies and 34 level 4 studies). Surgeries through transcranial approaches (TCAs) and endoscopic endonasal approach (EEA) were done on 1596 and 77 patients, respectively. Based on a random effects model, rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak were determined to be 92.4% (CI: 88.6-95.5%) and 5.9% (95% CI: 3.4-9%), respectively. The mortality following surgery was 1.6% (95% CI: 0.9-2.5%) under a fixed effects model. Through subgroup analyses, TCAs were found to be more favorable in GTR and CSF leakage compared to EEA. Besides, anterolateral TCA was associated with better control of CSF leakage than anterior TCA. Conclusion Surgical treatment is capable of achieving GTR in the vast majority of patients with OGMs and postoperative mortality is under well control. Transcranial approach allows a better chance of GTR and better control of CSF leak in comparison to EEA. In comparison to anterior TCA, anterolateral TCA is associated less mortality. However, low evidence level and significant heterogeneity of the included studies prevent the formation of more solid conclusions.
Substrate Effect on Hydrogen Evolution Reaction in Two-Dimensional Mo2C Monolayers
Authors: Lee Sujin , Min Byungjoon , Bang Junhyeok
Published: October 2021

The physical and chemical properties of atomically thin two-dimensional (2D) materials can be modified by the substrates. In this study, the substrate effect on the electrocatalytic hydrogen evolution reaction (HER) in 2D Mo2C monolayers was investigated using first principles calculations. The isolated Mo2C monolayer shows large variation in HER activity depending on hydrogen coverage: it has relatively low activity at low hydrogen coverage but high activity at high hydrogen coverage. Ag, Au, Cu, and graphene were used as substrates to study the substrate effect. While the effects of the Au and graphene substrates on the HER activity are insignificant, Ag and Cu substrates improve the HRE activity, especially at low hydrogen coverage, by modifying the valence electrons in the Mo2C layer; therefore, the HER activity of the Mo2C monolayer becomes high for any hydrogen coverage. Our results suggest that, in two-dimensional electrocatalysis, the substrate has a degree of freedom to tune the catalytic activity.
Multiple Endocrine Neoplasia Type 1 Involving Both Liver and Lung: A Case Report
Authors: Lai Jianlin , Huang Yangyang , Wu Junyi , Cheng Hui , Qiu Funan
Published: October 2021

Background: Multiple endocrine neoplasia type 1 (MEN1) is a rare autosomal dominant tumor syndrome with a high degree of heterogeneity in clinical phenotypes, generally involving parathyroid, anterior pituitary and enteropancreas. In recent years, several new insights on the clinical features of MEN1 have been reported in the literature. However, it is not clear whether MEN1-associated primary tumors may occur in the liver. Case presentation: we report the case of a 52-year-old man with multiple endocrine neoplasia type 1 diagnosed by next-generation sequencing. After Single-hole thoracoscopic right middle lobectomy, Laparoscopic radical resection of liver tumor and Radiofrequency ablation of parathyroid space, the parathyroid hormone decreased from 177pg/ml to normal(20pg/ml). No local tumor recurrence was observed during a follow up of 5 months. Conclusion: We report the first case of MEN1 with simultaneous liver and lung involvement who underwent radical resection of the tumors, and we propose the possibility that liver and other non-endocrine organs may also develop diseases associated with MEN1，though this view needs further verification. Gene detection has crucial clinical instructive significance for diagnosis and treatment.
Nesting Effects of Climate and Local Drivers on Long-Term Subalpine Fires in the Alps
Authors: Carcaillet Christopher , Boulley Benjamin , Carcaillet Frédérique
Published: October 2021

Background: The present article questions the relative importance of local- and large-scale processes on the long-term dynamics of fire in the subalpine belt in the western Alps. The study is based on soil charcoal dating and identification, several study sites in contrasting environmental conditions, and sampling of soil charcoal along the elevation gradient of each site. Based on local differences in biomass combustion, we hypothesize that local-scale processes have driven the fire history, while combustion homogeneity supports the hypothesis of the importance of large-scale processes, especially the climate. Results: The results show that biomass burning during the Holocene resulted from the nesting effects of climate, land use, and altitude, but was little influenced by topography (slope exposure: north versus south), soil (dryness, pH, depth), and vegetation. The mid-Holocene (6500–2700 cal BP) was an important period for climatic biomass burning in the subalpine ecosystems of the western Alps, while fires from about 2500 years ago appear much more episodic, prompting us to speculate that human society has played a vital role in their occurrence. Conclusion: Our working hypothesis assuming that the strength of mountain natural and local drivers should offset the effects of regional climate is not validated. The homogeneity of the fire regime between sites thus underscore that climate was the main driver during the Holocene of the western Alps. Long-term subalpine fires are controlled by climate at millennial scale. Local conditions count for little in determining variability at the century scale. The mid-Holocene was a chief period for climatic biomass burning in the subalpine zone, while fires during the late Holocene appear much more episodic, prompting the assumption that societal drivers has exercised key roles on their control.
Establishment of a Prognostic Prediction System Based on Tumor Microenvironment of Pancreatic Cancer
Authors: Liu Bo , Fu Tingting , He Ping , Xu Ke
Published: October 2021

Purpose: Pancreatic cancer (PC) is an inflammatory tumor. Tumor microenvironment (TME) plays an important role in the development of PC. This study aims to explore hub genes of TME and establish a prognostic prediction system for PC.Methods: High throughput RNA-sequencing and clinical data of PC were downloaded from TCGA and ICGC database, respectively. PC Patients were divided into High- and low-score group by using stromal, immune scores system based on ESTIMATE. Differentially expressed genes (DEGs) between High- and low-score patients were screened and survival related DEGs were identified as candidate genes by univariate COX regression analysis. Final variables for establishment of the prognostic prediction system were determined by LASSO analysis and multivariate COX regression analysis. The predictive power of the prognostic system was evaluated by internal and external validation. Results: A total of 210 candidate genes were identified by stromal, immune scores system and survival analyses. Finally, the prognostic risk score system was constructed by the following genes: FAM57B, HTRA3, CXCL10, GABRP, SPRR1B, FAM83A, LY6D. In process of internal validation, Harrell's C-index of this prognostic risk score system was 0.73, and the area under the receiver operating characteristic curve (AUC) value of 1-year, 2-year and 3-year OS period was 0.67, 0.76 and 0.86, respectively. In the external validation set, the survival prediction C-index was 0.71, and the AUC was 0.81, 0.72, 0.78 at 1-year, 2-year and 3-year, respectively.Conclusion: This prognostic risk score system based on TME demonstrated a good predictive capacity to the prognosis of PC.
The Analgesic Efficacy of Ultrasound-guided Bilateral Transversus Thoracic MusclePlane Block after Open-Heart Surgeries: A Randomized Controlled Study
Authors: Hamed Mohamed Ahmed , Boules Maged Labib , Sobhy Mina Mahrous , Abdelhady Mahdy Ahmed
Published: October 2021

Background: We aimed to evaluate the analgesic efficacy of ultrasound-guided bilateral Transversus Thoracic Muscle Plane Block after Open-Heart Surgeries. Methods: 70 patients aged above 18 years and scheduled for valve replacement or adult congenital via median sternotomy were enrolled in this study. Patients were divided into two groups, randomized by computer-generated random numbers: the block group, which had the ultrasound-guided bilateral transversus thoracic muscle plane block, and the control group, which had a sham block. The primary outcome was total fentanyl consumption in the first 24-hours. The secondary outcomes were pain score, time to the first analgesic request, time to extubation , ICU stays, and hospital stay. Results: The total fentanyl consumption in the first 24 hours was significantly lower in the block group, with a mean difference of -158.286 (95% CI = (-179.271 to -137.300; p=<0.0001). The time to the first analgesic request was statistically significantly shorter in the non-block group (median 3 hours) than the block group (median 14 hours). During the postoperative period (0.5-24 hours), at-rest pain scores were 1.86 units lower in the block group (the estimate was -1.80, 95% CI = -2.14 to -1.45, t = -10.323 with p <0.0001). Likewise, pain scores with cough were 3.29 units lower in the block group (the estimate was -3.29, 95% CI = -3.80 to -2.77, t = -12.703, p <0.0001).Conclusion: Bilateral Transversus Thoracic Muscle Plane Block is a promising and effective technique in reducing opioid consumption and controlling post-sternotomy pain after open-heart surgery via median sternotomy.Trial Registration: This study is registered on ClinicalTrials.gov (NCT04116554; principal investigator: Mohamed Ahmed Hamed; date of registration: October 4, 2019).
Effect of Surya Namaskara on Mental Health, Self-control and Mindfulness of Adolescent School Children.
Authors: Parajuli Niranjan , Shindhe Mutturaj , Pradhan Balaram
Published: October 2021

BackgroundA big portion of adolescent school children suffers from mental health problems. Low self-control and mindfulness are positively associated with poor mental health. Therefore, the present study was designed to assess the effect of Surya Namaskara (SN) on mental health, self-control, and mindfulness among school children.Method63(39 female and 24 male) students (mean age = 14.24 years and SD = 0.42 years) studying at 9th grade in a private school in Karnataka, India were recruited as participants of the study. The design of the present study was a non-randomized two arms design. Students in grade 9 section ‘A’ (N= 33) were selected as the intervention group. Whereas, students in grade 9 section ‘B’ (N = 30) were considered as a control group. Students in the intervention group were given SN for 15 days. The participants were administrated the Brief Self-control Scale (BSCS), Mindfulness, Attention and Awareness Scale for Adolescents (MAAS-A), and General Health Questionnaire-12 (GHQ-12) questionnaires on the baseline and after 15 days of intervention. ResultsFindings of the present study showed a significant difference in MAAS-A scores [F (1, 54) = 18.47, p < 0.001, ηp2 = 0.26] in within group comparison. There was also a significant interaction (Times*Groups) for BSCS [F (1, 54) = 4.89, p = 0.031, ηp2 = 0.08] and MAAS-A [F (1, 54) = 6.63, p = 0.013, ηp2 = 0.12] scores. Post-hoc analysis showed SN group has significantly high post BSCS score (p = 0.005) and MAAS-A score (p = 0.005) compared to control group. Similarly, there was a significant high BSCS score (p = 0.003) and MAAS-A score (p < 0.001) after SN intervention compare to their respective pre scores. There was no significant change in the GHQ-12 scores in both groups in pre-post comparison.ConclusionThe finding of the present study showed that SN improves self-control and mindfulness in adolescent school children. However, the results of the current study should be confirmed by future studies with robust research design, a large sample size, and advanced tools.
Photothermal Conversion of Biodegradable Fluids And Carbon Black Nanofluids
Authors: Kosinska Anna , Balakin Boris V. , Kosinski Pawel
Published: October 2021

The paper is devoted to the topic of direct absorption solar collectors (DASCs). The main focus is on comparing two kinds of working fluids that can be used in DASCs, namely carbon black nanofluids and biodegradable coffee colloids. At first, the fluids were tested by exposing them to artificial light (indoor experiments) and real solar irradiation (field experiments). The indoor experiments used a system of relatively large geometry, so most of the heat absorption occurred close to the irradiated surface. This resulted in a similar performance by both fluids. The field experiments involved a smaller system, and the light was concentrated by a solar collector. Here the nanofluid outperformed the coffee colloids. Next, the process was analysed using a theoretical analysis that gave good correspondence with the experiments. Finally, we extended the theoretical analysis to a DASC with a flowing fluid. The model was validated against results from the literature, but it also supported our experimental findings.
Symptom Burden and Quality of Life After Successful Ablation in Patients With Low Burden of Symptomatic Premature Ventricular Complexes
Authors: Amir Muzakkir , Kabo Peter , Tandean Pendrik , Patellongi Ilham Jaya , Siregar Muchtar Nora Ismail , Zam Sitti Multa
Published: October 2021

Background: It is essential to enhance life quality in patients with premature ventricular complexes (PVCs) with the use of radiofrequency ablation (RFA). The aim of the study was to assess symptom burden and life quality in patients with a low PVC burden following RFA. Methods: 31 individuals with a low PVC burden in whom RFA was indicated were included in the study. At baseline and after a year following RFA, the Arrhythmia-Specific questionnaire in Tachycardia and Arrhythmia (ASTA) scale was used for appraisal. A 24-hour Holter electrocardiogram was used to detect recurrent PVCs 12 months after the RFA intervention.Results: ASTA scores related to symptom burden, including the near-syncope score, healthrelated quality of life (HRQOL) scales pertaining to physical and mental health, and consequently the total HRQOL score, were all diminished a year after RFA (p<0.001). The ASTA score for syncope symptoms was also reduced (p<0.05). A fall in mean PVC burden was seen from 8.0% to 0.8% (p<0.001). Conclusion: The long-term clinical endpoint in individuals with a low PVC burden following RFA is reported. Symptom load, life quality and ultimate PVC burden were all enhanced. Additional studies incorporating longer follow-up and monitoring periods, respectively, would be beneficial.
Case Report About Extraperitoneal Metastasis of Cervical Adenocarcinoma In Situ
Authors: Le Aiwen , Han Lirong , Wang Peng , Kang Kai
Published: October 2021

Background: adenocarcinoma in situ(AIS) cells are often misdiagnosed, and recognizing AIS in cervical cytology is challenging. Here, we present a case of extraperitoneal metastasis 5 years after a missed diagnosis of AIS.Case presentation: We report a 49-year-old Chinese woman who presented with a retroperitoneal mass 5 years after cervical conization for AIS. The retroperitoneal mass was composed of glands lined by malignant mucinous epithelium; these tumors were metastases from her previous AIS which were misdiagonised cervical intraepithelial neoplasia(CIN) III in 2013. The patient is alive and well 2 years after resection of the tumors.Conclusions: An experienced pathologist or multiple pathologists should take part in endocervical AIS diagnosis. We should follow these patients for over 15 years. When Cancer Antigen 125(CA125) or Carcinoembryonic antigen(CEA) levels are elevated, the occurrence of metastases should be strictly monitored.
Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy in Younger Patients with Peritoneal Metastasis from Colorectal Cancer
Authors: Chen Haipeng , Zhou Sicheng , Jiang Yujuan , Zheng Zhaoxu , Liu Zheng , Liu Qian , Xu Jianping , Pei Wei , Liang Jianwei , Wang Xishan
Published: October 2021

Background Currently, few studies have evaluated effectiveness of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in young patients with peritoneal metastasis (PM) of colorectal cancer (CRC) origin.Method Clinicopathological characteristics, perioperative data and survival outcomes in young patients, defined as being 50 years or less (n=23), performing CRS+HIPEC between June 2017 to June 2019 were reviewed and compared with older patients, defined as aged over 50 years (n=47).Results Compared with older patients, young patients were more likely to present with PM at the time of diagnosis (78.3% vs 51.1%, P=0.029) and exhibit a mucinous and signet-ring histology (60.9% vs 29.8%, P=0.013). The cancer-specific survival (CSS) after CRS+HIPEC in two groups are similar. On multivariate Cox regression, rectal origin (HR, 2.51, 95%CI, 1.11-5.67; P=0.027) and mucinous/signet adenocarcinoma (HR, 2.20, 95%CI, 1.02-4.74; P=0.044) were independent risk factors for poor CSS.Conclusion Younger patients (aged ≤50 years) with PM of CRC origin presented more often with synchronous PM than older patients. Although tend to exhibit a aggressive nature, they derive similar benefit from CRS+HIPEC as older patients.
“Why them, why me, why us?” The Experiences of Parents of Children with Lysomal Acid Lipase Deficiency: An Interpretative Phenomenological Analysis Study
Authors: Hassell Sadie , Smith Debbie M , Rust Stewart , Jones Simon , Wittkowski Anja
Published: October 2021

BackgroundLysosomal acid lipase deficiency (LALD) is an ultra-rare, inherited metabolic disease within the category of lysosomal storage disorders, affecting an infant’s ability to metabolise cholesterol. Developments in treatment, including Enzyme Replacement Therapy, have proven successful, with some children living for a number of years post-diagnosis, although the future still remains unknown. The aim of this study was to explore the lived experiences of parents of children with LALD. Main textParticipants were recruited from across the United Kingdom between 2020-2021. Eight parents (five mothers and three fathers) whose child had a confirmed diagnosis of LALD were interviewed. Data collected from the semi-structured interviews were audio-record, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Three superordinate and nine subordinate themes emerged from the data: 1) Uncertainty - a double-edged sword (plunged into an uncertain world, living life with worry and walking the tightrope of stability), 2) Powerless against a shared battle (a helpless parent, a joint battle, protection against distress and a vulnerable parent needing to be held) and 3) Accepting a life with LALD - the camouflage of a “normal” child (trying to make sense of ‘why’ and a condition disguised by normality). ConclusionsThe findings of this study highlighted that the diagnosis of LALD proves to be a very vulnerable time in parents’ lives, eliciting strong emotional reactions against an unknown future. This study signified the importance of clinical pathways and service provisions to support parents and their children through this period, raising important issues around diagnosis.
Diagnostic Efficacy of CCTA And CT-FFR Based On Risk Factors For Myocardial Ischemia
Authors: Gao Yongguang , Shi Yibing , Xia Ping , Zhang Jinyao , Fu Yufei , Huang Yayong , Xu Yuanshun , Li Gutao
Published: October 2021

Background: Coronary artery CCTA can observe the degree of coronary artery stenosis and FFR can evaluate the physiological function of coronary artery. However, noninvasive imaging examination that can both observe the above two methods at the same time has not yet been elucidated.Objective: To investigate the diagnostic efficacy of coronary computed tomography angiography (CCTA) and computed tomography-derived fractional flow reserve (CT-FFR) based on different risk factors for myocardial ischemia.Methods: Patients undergoing CCTA in our hospital from August 18, 2020 to April 28, 2021 were randomly selected, and the data were subjected to CT-FFR analysis. Vascular characteristics were measured, including total plaque volume, calcified plaque volume, non-calcified plaque volume, plaque length, and lumen stenosis, and the patients were categorized into a non-ischemia group (FFR>0.8) and an ischemia group (FFR≤0.8). Plaque characteristics were compared between the two groups, and logistic regression analysis was employed to explore the correlations between plaque characteristics and ischemic lesions.Results: From a total of 122 patients enrolled in the study, there were 218 vascular branches with FFR>0.8 and 174 vascular branches with FFR≤0.8. There were significant group differences in total plaque volume, calcified plaque volume, plaque length, and lumen stenosis >50% (n). The obtained data were as follows: non-ischemic group 10.57 (4.80, 259.65), ischemic group 14.87 (3.39, 424.45), Z=9.772, p=0.002, non-ischemic group 10.57 (0, 168.77), ischemic group 14.87 (0, 191.00), Z=2.503，p≤0.001), non-ischemic group 8.17 (37.05, 40.53), ischemic group 8.38 (56.66, 86.47), Z=5.923, p=0.016, and lumen stenosis >50%, non-ischemic group 46, ischemic group 90, x2=14.77，p≤0.001. The regression analysis results indicated that total plaque volume, calcified plaque volume, plaque length and lumen stenosis >50% were risk factors for myocardial ischemia, with ORs and p values of (2.311, p=0.002), (1.021, p=0.004), (2.159, p<0.001), and (0.181, p<0.001), respectively.Conclusion: Total plaque volume, calcified plaque volume, plaque length and lumen stenosis >50% are predictors for myocardial ischemia. Coronary artery CCTA combined with CT-FFR could simultaneously observe the anatomical stenosis and evaluate myocardial blood supply at the functional level. Thus, myocardial ischemia could be better diagnosed.
Association of Long Sleep and Physical Inactivity with Incident Disability in Community-Dwelling Older Adults: A 5-Year Longitudinal Study
Authors: Nakakubo Sho , Doi Takehiko , Tsutsumimoto Kota , Kurita Satoshi , Ishii Hideaki , Kiuchi Yuto , Shimada Hiroyuki
Published: October 2021

Background
Good sleep durations and physical activity are essential factor for maintaining good health. This study examined whether sleep duration and physical inactivity were associated with incident disability among community-dwelling older adults.
Methods
A total of 4,372 adults aged ≥ 70 years participated in a baseline assessment. We also assessed self-reported sleep duration and physical activity using the International Physical Activity Questionnaire – Short Form at baseline assessment. We measured monthly incident disability, defined as the onset of being certified for personal support or care as required by Japanese public long-term care insurance over 5 years. The Cox proportional hazard regression analysis estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for incident disability according to long sleep duration (≥ 9 h) and physical inactivity.
Results
Long sleep duration (HR 1.32, CI 95% 1.05–1.67) and physical inactivity (HR 1.33, CI 95% 1.13–1.57) were associated with incident disability in multivariate analyses. These results were also sustained in the model where both long sleep duration and physical inactivity were simultaneously submitted as independent variables. Furthermore, coexistence of long sleep duration and physical inactivity had higher risk of incident disability than each factor individually (HR 1.69, CI 95% 1.11–2.58), even though the synergistic interaction was mildly effective.
Conclusions
This study revealed that long sleep duration and physical inactivity were independently associated with the risk of incident disability among older adults. More attention should be paid to both sleep duration and physical activity in order to prevent incident disability.
Using the Problem Tree and Results Chain to Improve Uptake of Intermittent Preventive Treatment in Pregnancy Services—Case Study of the Malaria Action Program for Districts in Uganda
Authors: Ngabirano Thomson , Kigozi Ruth , Lugemwa Myers , Gudoi Sam , Tetteh Gladys , Nabakooza Jane , Opigo Jimmy , Tibenderana James
Published: October 2021

Malaria in pregnancy contributes considerably to poor pregnancy outcomes. The U.S. Agency for International Development’s Malaria Action Program for Districts project in Uganda used the Problem Tree and Results Chain tool to identify demand and supply barriers responsible for the low uptake of intermittent preventive treatment of malaria in pregnancy (IPTp) in 52 districts of Uganda. The key supply-side barriers identified were related to leadership/governance, health financing, medicines and technologies, health information systems, human resources, service delivery, and users. The project used the results to plan and implement interventions targeting the barriers. As a result, from October 2018 to September 2019, the project reported an apparent improvement in uptake of three or more doses of IPTp (49–67%). Malaria in pregnancy cases and stock out of sulfadoxine-pyrimethamine (SP) did not change considerably. The Problem Tree and Results Chain tool is a useful and complementary project management tool to identify root causes and their solutions during planning and implementation. Projects using this tool should periodically re-assess performance of IPTp policy implementation and develop appropriate solutions to address the key bottlenecks identified to increase the likelihood of sustained improvement. Further evaluation of the utility of the tool in other settings is recommended.
Clinical Efficacy of Different Approaches for Laparoscopic Intersphincteric Resection of Low Rectal Cancer: A Comparison Study
Authors: Ou Wenquan , Wu Xiaohua , Zhuang Jinfu , Yang Yuanfeng , Zhang Yiyi , Liu Xing , Guan Guoxian
Published: October 2021

Background: The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. We compared the efficacy of different approaches for LAISR of low rectal cancer and discussed the surgical indications for each approach.Methods: We retrospectively reviewed data from 235 patients with low rectal cancer treated via LAISR from October 2010 to September 2016. Patients underwent either the transabdominal approach for ISR (TAISR, n=142), the transabdominal perineal approach for ISR (TPAISR, n=57), or the transanal pull-through approach for ISR (PAISR, n=36).Results: The PAISR and TAISR groups exhibited shorter operation times and less intraoperative blood loss than the TPAISR group. The anastomotic distance was shorter in the PAISR and TPAISR groups than in the TAISR group. No differences in the ability to perform radical resection, overall complications, postoperative recovery, Wexner score recorded 12 months after ostomy closure, three-year disease-free survival, local recurrence-free survival, distant metastasis-free survival, or overall survival (OS) were observed among the three groups.Conclusions: TAISR, TPAISR, and PAISR have unique advantages and do not differ in terms of operation safety, patient outcomes, or anal function. TPAISR requires a longer time to complete and is associated with more bleeding and a slower recovery of anal function. PAISR should be considered when TAISR cannot ensure a negative distal margin and the tumor and BMI are relatively small; otherwise, TPAISR is required.
Clinical Characteristics and Genetic Analysis of Interstitial Lung Disease in Chinese Children (Genes and Interstitial Lung Disease)
Authors: Huang Mei-Xia , Qin Lu , Zhang Fei-Zhou , Wu Lei , Yu Jia-Hui , Tang Lanfang
Published: October 2021

BackgroundMutation in the surfactant protein C gene (SFTPC) is a cause of interstitial lung disease (ILD). Our objective was to investigate the clinical characteristics, outcome and influencing factors of ILD in Chinese children with SFTPC mutations.MethodA total of 8 Chinese children with ILD heterozygous for SFTPC mutations that were treated in our hospital from January 2014 to December 2020 were included in our study. Candidate genes responsible for surfactant dysfunction were sequenced by next-generation sequencing. The clinical and genetic data were reviewed retrospectively.ResultsThe children’s onset age was before the age of 2 years, and one case was just after birth. The most significant clinical manifestations were cough, tachypnea, hypoxemia and failure to thrive. The most common mutation was p. lle73Thr, which accounted for 87.5% (7/8) of our patients. Four patients whose onset was within 3 months, including 3 children with CMV infection, died. Conclusionp. lle73Thr mutation of SFTPC was an important and common cause of ILD in the Chinese children. The clinical manifestations of ILD associated with this mutation are not specific. The severity and outcome of the disease may be affected by factors such as onset age and viral infection.
Describing long-term opioid use utilizing Nordic Prescription Registers – A Norwegian example
Authors: Hamina Aleksi , Hjellvik Vidar , Handal Marte , Odsbu Ingvild , Clausen Thomas , Skurtveit Svetlana
Published: October 2021

Previous studies have defined long-term opioid use in varying ways, decreasing comparability, reproducibility and clinical applicability of the research. Based on recent systematic reviews, we aimed to estimate long-term opioid use defined as use persisting more than three months using one of the Nordic prescription registers. We used the Norwegian Prescription Register (NorPD) to extract data on all opioid dispensations between January 1st 2004 and October 31st 2019. New users of opioids (washout 365 days) were defined as long-term users if they filled two criteria: 1) they had ≥2 dispensations of opioids, 91-180 days apart; 2) days 0-90 included ≥90 dispensed administration units (e.g., tablets) of opioids. Overall, there were 2,543,224 new users of opioids during the study period. Of these, 354,666 (13.9%) filled the criteria for long-term opioid use at least once. Compared to those who did not fill the criteria (short-term users), long-term users were older, more likely women, and used tramadol, oxycodone, and buprenorphine more frequently as their first opioid. In conclusion, we found that 1/7 of opioid users continued use longer than 3 months. Future outcome research should identify the clinically most important dose requirements for long-term opioid use criteria.
The Occupational Stress from Workplace Violence and the 2019-nCoV Pandemic in Chinese Healthcare Professionals: A Mobile App-Based Survey
Authors: Sun Chao , Zhao Lanbo , He Lisong , Ma Zhihua , Zou Junkai , Jing Wei , Li Qing , Guo Lin , Du Jiang , Li Qiling
Published: October 2021

Objectives: To investigate the medical occupational risk and stress level of workplace violence (WPV) and novel coronavirus 2019 ( 2019-nCoV) pandemic in Chinese healthcare professionals (HPs).Methods: A national questionnaire survey was created to investigate HPs from 21 provinces of China. Seven questions in environment part and eight questions in stress part were used to assess medical occupation risk and stress respectively. Categorical data were statistically analyzed using chi-square tests. Structural equation model was performed to examine the correlations and differences among experiences of WPV, the 2019-nCoVpandemic, and occupational stress.Results:Totally, 1241 HPs completed the online survey from March 1st, 2020 to May 25th, 2020. The majority of the participants thought the current Chinese medical occupation was in inferior circumstance (n = 433, 34.89%), at high risk (n = 1082, 81.19%) and was in middle class (n = 717, 57.78%). Work-related stress ranked first of medical occupational risk (n = 786, 63.34%). When being asked the possility for their children to choose medicine, most HPs were uncertain (n = 542, 43.67%) or opposed (n = 547, 44.08%). More HPs thought there was no stress under 2019-nCoV pandemic (n = 303, 24.42%) than that under WPV (n = 48, 3.87%). WPV (Stress index = 3.23) put more pressure on HPs than the 2019-nCoV pandemic did (Stress index = 2.33) with significant difference (P = 0.006). WPV had a positive relationship with increasing doctor-patient conflicts (E=0.5, P0.000), and a negative correlation with ego-enhancement (E=-0.2, P=0.000) and public concern (E=-0.2, P=0.000). The 2019-nCoV pandemic had a positive correlation with ego-enhancement (E=0.09, P=0.006), the public's concern (E=0.1, P=0.002) and healthcare reform (E=0.1, P=0.000).Conclusions: Most HPs believe that the current environment for Chinese medical occupation is abominable and at high risk. Compared with WPV, the 2019-nCoV pandemic increases personal risks and reduces psychological stress to HPs. WPV weakens enthusiasm and significantly intensifies doctor-patient conflicts.
Novel Metabolic Biomarker for Early Detection and Prognosis to the Patients with Gastric Cardia Adnocarcinoma
Authors: Wei Mengxia , Zhao Xueke , Wang Panpan , Song Xin , Hu Jingfeng , Zhong Kan , Lei Lingling , Xu Ruihua , Han Wenli , Yang Miaomiao , Han Xuena , Fan Zongmin , Wang Ran , Li Bei , Ji Jiajia , Li Liuyu , Chen Yao , Yang Yuanze , Zhao Keke , Zhou Fuyou , Li Aili , Li Zhiqiang , Bao Qide , Wang Li Dong
Published: October 2021

Background: Gastric cardia adenocarcinoma (GCA), which has been normalized as type II of adenocarcinoma at esophagogastric junction in western countries. In clinical, most of the GCA patients are lack of early alarming symptoms, more than 90% of GCA patients were diagnosed at advanced stage, resulted in a very poor prognosis, with less than 20% of 5-year survival. Obviously, early detection for GCA plays crucial role in decreasing the high mortality. Metabolomics allows for appraisal of small molecular mass compounds in a biofluid, which may provide a way for finding biomarkers for GCA. Methods: The serum metabolic features of 276 curatively resected GCA patients and 588 healthy control participates were collected from the database of State Key Laboratory of Esophageal Cancer Prevention & Treatment and Henan Key Laboratory for Esophageal Cancer Research of The First Affiliated Hospital of Zhengzhou University to discover the metabolic dysregulation by using the ultraperformance liquid chromatography-mass spectrometry (UPLC-MS). Joint pathway analysis with metabolites identified, survival analysis and auxiliary diagnosis metabolites were discussed in present work. Results: A sum of 200 known differential metabolites were obtained with p＜0.05 and fold change FC≥1.25 or FC≤0.8 by comparison GCA and healthy control participates. 12 metabolites significant correlated with survival (p＜0.05) and 17 metabolites for potential auxiliary diagnosis(FC＞1.5 or FC＜0.67) for GCA. Dysregulated arginine biosynthesis was an important pathway of GCA. 9 differential metabolites of 12-ketolithocholic acid, 2-Hydroxybutanoic acid, Aldosterone, All-trans-13,14-dihydroretinol, Hododeoxycholic acid, L-histidine, Malonic acid, Prostaglandin E2 and Sphingosine were identified as potential metabolic markers for distinguishing the GCA and healthy control (AUC=0.976, sensitivity =0.913, specificity =0.027, optimal cut off value=0.470). Conclusions: This work was first identified 12 metabolites significant correlated with survival and 17 metabolites for potential auxiliary diagnosis for GCA. In addition, arginine biosynthesis pathway metabolism showed important roles in GCA. Results provide the understanding of the molecular difference between GCA and healthy control. The novel plasma biomarkers panel could clearly distinguish GCA patients from the healthy control group. This finding may form the basis for the development of a minimally invasive method for GCA detection.