bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoscopic resection of giant gastrointestinal stromal tumor at the esophagogastric junction: a case report
Authors: Xue Feng , Wang Wei , Shi Ning , Ma Xing-Bin , Liu Cheng-Xia
Published: December 2019

Background

Gastrointestinal stromal tumors (GISTs) at the esophagogastric junction are rare and its treatment is complicated and challenging. Endoscopic resection has advantages with less complications compared to open and laparoscopic surgery.

Case presentation

We report a 33-year-old male patient who was admitted to our department complaining of abdominal fullness for 20 days. A huge submucosal tumor at the esophagogastric junction was found by upper gastrointestinal endoscopy. We successfully resected the lesion through endoscopic submucosal excavation without complications, which was pathologically confirmed to be a GIST. The patient was discharged 5 days after operation and has been doing well, and there was no recurrence 8 months after the operation.

Conclusion

ESE is possibly an effective and minimally invasive method of giant esophagogastric junction stromal tumor.
Risk factors for vancomycin-resistant enterococcus acquisition during a large outbreak in patients aged 65 years and older
Authors: Mathis Benjamin , Haïne Max , Girard Raphaële , Bonnefoy Marc
Published: December 2019

Background

In the context of an aging population, identifying risk factors for Vancomycin-resistant enterococci (VRE), specific to older people, is important. However, if age is a known risk factor for VRE infection, a limited number of studies have focused on older patients. This study aimed to identify potential risk factors for VRE acquisition in a population aged 65 years and older, during a large VRE outbreak that occurred in a teaching hospital in Lyon, France, from December 2013 to July 2014.

Methods

The present retrospective, multi-center, descriptive, and analytical study used part of a previous cohort, and included only a sub-group of patients aged 65 years and older. The analysis of the factors included in the original study was completed with factors more specific to geriatric patients. Inclusion criteria were patients aged 65 years and older, in contact with a VRE index patient. Patients were screened by rectal swabs. Univariate and multivariate logistic regression analyses were performed.

Results

A total of 180 VRE contacts were included and 18 patients became carriers. Multivariate analysis showed that risk factors for VRE acquisition in older people included major contact type (RR: 5.31, 95%CI [1.33; 21.19]), number of antibiotics used (RR: 1.36, 95%CI [1.04; 1.76]), a score of McCabe = 2 (RR: 116.39, 95%CI [5.52; 2455.98]), ethylism (RR: 5.50, 95%CI [1.49; 20.25]), and dementia (RR: 7.50, 95%CI [1.89; 29.80]).

Conclusions

This study was able to demonstrate risk factors for VRE acquisition in older people. These risk factors should be taken into account when in the presence of older people in a VRE infected unit.
Elevated expression of AGGF1 predicts poor prognosis and promotes the metastasis of colorectal cancer
Authors: Zhang Xin , Sun Huimin , Chen Wanyuan , He Xianglei
Published: December 2019

Background

Angiogenic factor with G-patch and FHA domains 1 (AGGF1) can promote angiogenesis and increasing evidence has highlighted the important roles of AGGF1 in tumorigenesis. However, the differential expression as well as the biological functions of AGGF1 in colorectal cancer (CRC) remain to be established. The purpose of the present study is therefore to identify the effect of AGGF1 on prognosis and metastasis in CRC patients.

Methods

The expression level of AGGF1 in CRC was examined by qPCR, western blot and immunohistochemistry in a tissue microarray containing 236 CRC specimens and paired normal mucosae. And the effect of AGGF1 on CRC cell malignance was investigated in our established stable AGGF1 upregulated and knockdown CRC cell lines.

Results

The expression level of AGGF1 in CRC tissue was not significantly different to that in adjacent normal mucosa at the mRNA level. However, at the protein level, AGGF1 expression in CRC tissues was significantly higher than in paired normal mucosa, which showed a clear association with TNM stage, AJCC stage, vascular invasion, and differentiation. Further, we revealed an apparent correlation between AGGF1 expression and poorer disease-free survival and overall survival of CRC patients. In addition, we discovered that AGGF1 significantly promoted CRC cell wound healing, migration, and invasion in vitro and distant metastasis in vivo.

Conclusions

Our study demonstrates the aberrant overexpression of AGGF1 in CRC and provides a basis on which to explore the application of AGGF1 as a potential therapeutic target for CRC patients, especially for CRC patients with distant metastasis.
Psychiatric advance directives for people living with schizophrenia, bipolar I disorders, or schizoaffective disorders: Study protocol for a randomized controlled trial – DAiP study
Authors: Tinland Aurélie , Leclerc Léa , Loubière Sandrine , Mougeot Frederic , Greacen Tim , Pontier Magali , Franck Nicolas , Lançon Christophe , Boucekine Mohamed , Auquier Pascal
Published: December 2019

Background

Compulsory admission to psychiatric hospital is rising despite serious ethical concerns. Among measures to reduce compulsory admissions, Psychiatric Advance Directives (PAD) are the most promising, with intensive PAD (i.e. facilitated and shared) being the most effective. The aim of the study is to experiment Psychiatric Advance Directives in France.

Methods

A multicentre randomized controlled trial and qualitative approach conducted from January 2019 to January 2021 with intent-to-treat analysis.

Setting

Seven hospitals in three French cities: Lyon, Marseille, and Paris. Research assistants meet each participant at baseline, 6 months and 12 months after inclusion for face-to-face interviews.

Participants

400 persons with a DSM-5 diagnosis of bipolar I disorder (BP1), schizophrenia (SCZ), or schizoaffective disorders (SCZaff), compulsorily admitted to hospital within the last 12 months, with capacity to consent (MacCAT-CR), over 18 years old, and able to understand French.

Interventions

The experimental group (PAD) (expected n = 200) is invited to fill in a document describing their crisis plan and their wishes in case of loss of mental capacity. Participants meet a facilitator, who is a peer support worker specially trained to help them. They are invited to nominate a healthcare agent, and to share the document with them, as well as with their psychiatrist. The Usual Care (UC) group (expected n = 200) receives routine care.

Main outcomes and measures

The primary outcome is the rate of compulsory admissions to hospital during the 12-month follow-up. Secondary outcomes include quality of life (S-QoL18), satisfaction (CSQ8), therapeutic alliance (4-PAS), mental health symptoms (MCSI), awareness of disorders (SUMD), severity of disease (ICG), empowerment (ES), recovery (RAS), and overall costs.

Discussion

Implication of peer support workers in PAD, potential barriers of supported-decision making, methodological issues of evaluating complex interventions, evidence-based policy making, and the importance of qualitative evaluation in the context of constraint are discussed.

Trial registration

ClinicalTrials.gov identifier: NCT03630822. Registered 14th August 2018.
Prevalence and factors associated with utilization of rehabilitation services among people with physical disabilities in Kampala, Uganda. A descriptive cross sectional study
Authors: Zziwa Swaibu , Babikako Harriet , Kwesiga Doris , Kobusingye Olive , Bentley Jacob A. , Oporia Frederick , Nuwematsiko Rebecca , Bachani Abdulgafoor , Atuyambe Lynn M. , Paichadze Nino
Published: December 2019

Background

Worldwide, fifteen percent (15%) of the world’s population or one (1) billion people live with some form of disability. In Uganda, 12.4% of the Uganda’s population lives with some form of disability and Kawempe division accounts for (22.6%) of all persons with disabilities living in Kampala district. Rehabilitation services are provided within Kawempe division at Mulago hospital physiotherapy department and Katalemwa rehabilitation center in Kampala district, Uganda at a free and a subsidized cost to help to improve the function, independence, and quality of life of persons with physical disabilities. However, many people with physical disabilities do not utilize the services and the reasons are not clear.

Methods

The study design was a descriptive cross-sectional study employing quantitative methods of data collection. A total of 318 participants were included in the study. Simple random sampling was used to select the study participants. Ethical issues were maintained at all levels during data collection and dissemination of results.

Results

The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Kampala, Uganda. Factors that were significantly associated with utilization of rehabilitation services among people with physical disabilities at multivariable logistic regression analysis included; age (AOR: 0.30; 95% CI: 0.12–0.74), socioeconomic status (AOR: 2.13; 95% CI: 1.03–4.41), education level (AOR: 4.3; 95% CI: 1.34–13.91) and awareness of the participants about the rehabilitation services (AOR: 5.1; 95% CI: 2.74–9.54) atpvalue ≤0.05.

Conclusion

The study revealed a prevalence of 26.4% of the utilization rehabilitation services among people with physical disabilities in Kawempe division, Uganda. Factors that were significantly associated with utilization of rehabilitation services included; age, socioeconomic status, education level and awareness of the participants about the services. Therefore, the government and other relevant stake holders should increase sensitization and awareness of rehabilitation services, their benefits and facilities providing such services to people with physical disabilities, healthcare professionals and the general public.
Moderate-to-vigorous physical activity attenuates the detrimental effects of television viewing on the cardiorespiratory fitness in Asian adolescents: the Asia-fit study
Authors: Kidokoro Tetsuhiro , Suzuki Koya , Naito Hisashi , Balasekaran Govindasamy , Song Jong Kook , Park Soo Yeon , Liou Yiing Mei , Lu Dajiang , Poh Bee Koon , Kijboonchoo Kallaya , Hui Stanley Sai-chuen
Published: December 2019

Background

Moderate-to-vigorous physical activity (MVPA) and television viewing are independently associated with cardiorespiratory fitness. However, limited evidence is available on their combined effects, specifically of MVPA and watching television, on cardiorespiratory fitness in the young Asian population. Therefore, the present study examined whether MVPA can attenuate the detrimental effects of prolonged television viewing on the cardiorespiratory fitness of Asian adolescents.

Methods

This is a cross-sectional study on 9553 adolescents (aged 12–15 years) from 8 Asian metropolitan cities (Tokyo, Hong Kong, Shanghai, Taipei, Bangkok, Kuala Lumpur, Seoul, and Singapore). Cardiorespiratory fitness was assessed by using a 15-m progressive aerobic capacity endurance run (PACER) test. The time spent on MVPA and watching television was assessed using the International Physical Activity Questionnaire-Short Form.

Results

MVPA was more closely associated with the PACER score than the duration of watching television. Compared with the reference group (i.e. those with the lowest levels of MVPA [< 30 min/day] and the most sedentary [≥3 h/day of television time]), PACER scores were significantly higher for those who met the physical activity recommendation (≥60 min/day in MVPA), regardless of the duration of television viewing. Conversely, girls in the least active group (< 30 min/day of MVPA) who watched television < 1 h/day demonstrated better PACER scores than the reference group.

Conclusions

Sufficient MVPA (≥60 min/day) can attenuate the detrimental effects of excessive television viewing with cardiorespiratory fitness in Asian adolescents. In addition, the duration of television viewing had significant but weaker associations with cardiorespiratory fitness compared to MVPA.
Lethal thrombosis of the iliac artery caused by Aspergillus fumigatus after liver transplantation: case report and review of the literature
Authors: Gundlach Jan-Paul , Günther Rainer , Fickenscher Helmut , Both Marcus , Röcken Christoph , Becker Thomas , Braun Felix
Published: December 2019

Background

Aspergillus fumigatus infections frequently occur after solid organ transplantation. Yet, a fungal thrombosis after liver transplantation is an exceptional finding.

Case presentation

We report on a 44-year-old female with an aspergillosis after liver transplantation for autoimmune hepatitis. On postoperative day (pod) 7, seizures occurred and imaging diagnostics revealed an intracranial lesion. Anidulafungin was initiated in suspicion of mycosis and switched to voriconazole on suspicion of an Aspergillus spp. infection. Progression of the cerebral lesion prompted craniotomy (pod 48) and the aspergillosis was verified. The patient was discharged with oral voriconazole therapy. Re-admission was necessary with acute-on-chronic renal failure after a tacrolimus overdose on pod 130. The patient received a pelvic angiography due to a temperature difference in the legs. It showed a complete iliac artery thrombosis which was subsecutively surgically removed. The histopathological examination revealed an Aspergillus fumigatus conglomerate. The patient died on pod 210 due to systemic aspergillosis.

Conclusion

The acute development of focal neurologic deficits is common in patients with an aspergillosis of the brain. Nevertheless, arterial thrombosis after Aspergillus fumigatus is less frequent and, to the best of our knowledge, its occurrence after liver transplantation has not yet been reported so far. Due to its rarity, we added a review of the literature to this manuscript.
Metachronous renal cell carcinoma with metastasis to the urinary bladder, and distant organs, 28 years after radical nephrectomy: a case report
Authors: Babar Mustufa , Hamdani Saad , Liu Corinne , Vedula Jogarao , Schnapp David S.
Published: December 2019

Background

Metachronous renal cell carcinoma after radical nephrectomy is extremely rare. Renal cell carcinoma commonly metastasizes to distant organs. However, metastasis to the urinary bladder is very uncommon.

Case presentation

Herein, we report a case of metachronous renal cell carcinoma with metastasis to the urinary bladder, left acetabulum, left rib, lungs, thyroid, right renal vein and inferior vena cava. The patient had undergone a left-sided radical nephrectomy 28 years ago. The pathological diagnosis of a fragment of the bladder tumor was consistent with Fuhrman grade 2 clear cell renal cell carcinoma.

Conclusions

Although metachronous renal cell carcinoma after radical nephrectomy is rare, active surveillance should be still considered. Renal cell carcinoma has shown to unusually metastasize to the urinary bladder, a rarely reported organ of metastasis. Treatment options, such as immunotherapy, are available to patients with such metastasis and long-term survivorship can be achieved.
Changes in body composition with a hypocaloric diet combined with sedentary, moderate and high-intense physical activity: a randomized controlled trial
Authors: Hernández-Reyes A. , Cámara-Martos F. , Molina-Luque R. , Romero-Saldaña M. , Molina-Recio G. , Moreno-Rojas R.
Published: December 2019

Background

There is evidence showing the effectiveness of a hypocaloric diet and the increase in physical activity on weight loss. However, the combined role of these factors, not only on weight loss but also body composition, remains unclear. The purpose of this study was to investigate the effect of a hypocaloric diet on the body composition of obese adult women throughout different degrees of physical activity during a weight loss program.

Methods

One hundred and seventeen healthy female volunteers were randomly assigned to one of the experimental groups: a control group with a low-level prescription of physical activity (1–4 METs), moderate physical activity group that performed 10.000 steps walking (5–8 METs) and intense physical activity group that trained exercises by at least 70% of VO2max three times a week (> 8 METs). All subjects followed a hypocaloric diet designed with a reduction of 500 kcal/day. Nutritional counseling was provided throughout the study period to help ensure dietary adherence.

Results

We found no differences in body weight compared to moderate and intense physical activity (ßstand. = − 0.138 vs. ßstand. = − 0.139). Body fat was lower in women following an intense activity (ßstand. = − 0.436) than those with moderate exercise (ßstand. = − 0.231). The high-intense activity also increased muscle mass at the end of the intervention, standing out above the moderate activity (ßstand. = 0.182 vs. ßstand. = 0.008).

Conclusions

These findings indicate that a hypocaloric diet, without prescription of physical activity, is adequate to lose weight in the short term (12 weeks), but physical activity is vital to modify the body composition in women with obesity. Body fat was lower when women practiced a moderate exercise compared to hypocaloric diet only, but an intense physical activity was the most effective protocol to obtain a reduction of body fat and maintain muscle mass.

Trial registration

The study protocol complied with the Declaration of Helsinki for medical studies, it was approved by the bioethical committee of Córdoba University, in the Department of Health at the Regional Government of Andalusia (Act n°284, ref.4156) and retrospectively registered in clinicaltrials.gov (NCT03833791). Registered 2 January 2019.
Data accuracy in the Ontario birth Registry: a chart re-abstraction study
Authors: Dunn Sandra , Lanes Andrea , Sprague Ann E. , Fell Deshayne B. , Weiss Deborah , Reszel Jessica , Taljaard Monica , Darling Elizabeth K. , Graham Ian D. , Grimshaw Jeremy M. , Harrold JoAnn , Smith Graeme N. , Peterson Wendy , Walker Mark
Published: December 2019

Background

Ontario’s birth Registry (BORN) was established in 2009 to collect, interpret, and share critical data about pregnancy, birth and the early childhood period to facilitate and improve the provision of healthcare. Since the use of routinely-collected health data has been prioritized internationally by governments and funding agencies to improve patient care, support health system planning, and facilitate epidemiological surveillance and research, high quality data is essential. The purpose of this study was to verify the accuracy of a selection of data elements that are entered in the Registry.

Methods

Data quality was assessed by comparing data re-abstracted from patient records to data entered into the Ontario birth Registry. A purposive sample of 10 hospitals representative of hospitals in Ontario based on level of care, birth volume and geography was selected and a random sample of 100 linked mother and newborn charts were audited for each site. Data for 29 data elements were compared to the corresponding data entered in the Ontario birth Registry using percent agreement, kappa statistics for categorical data elements and intra-class correlation coefficients (ICCs) for continuous data elements.

Results

Agreement ranged from 56.9 to 99.8%, but 76% of the data elements (22 of 29) had greater than 90% agreement. There was almost perfect (kappa 0.81–0.99) or substantial (kappa 0.61–0.80) agreement for 12 of the categorical elements. Six elements showed fair-to-moderate agreement (kappa <0.60). We found moderate-to-excellent agreement for four continuous data elements (ICC >0.50).

Conclusion

Overall, the data elements we evaluated in the birth Registry were found to have good agreement with data from the patients’ charts. Data elements that showed moderate kappa or low ICC require further investigation.
Utilisation and financial protection for hospital care under publicly funded health insurance in three states in Southern India
Authors: Garg Samir , Chowdhury Sayantan , Sundararaman T.
Published: December 2019

Background

Many LMICs have implemented Publicly Funded Health Insurance (PFHI) programmes to improve access and financial protection. The national PFHI scheme implemented in India for a decade has been recently modified and expanded to cover free hospital care for 500 million persons. Since increase in annual cover amount is one of the main design modifications in the new programme, the relevant policy question is whether such design change can improve financial protection for hospital care. An evaluation of state-specific PFHI programmes with vertical cover larger than RSBY can help answer this question.

Three states in Southern India - Andhra Pradesh, Karnataka and Tamil Nadu have been pioneers in implementing PFHI with a large insurance cover.

Methods

The current study was meant to evaluate the PFHI in above three states in improving utilisation of hospital services and financial protection against expenses of hospitalization. Two cross-sections from National Sample Survey’s health rounds, the 60th round done in 2004 and the 71st round done in 2014 were analysed. Instrumental Variable method was applied to address endogeneity or the selection problem in insurance.

Results

Enrollment under PFHI was not associated with increase in utilisation of hospital care in the three states. Private hospitals dominated the empanelment of facilities under PFHI as well as utilisation. Out of Pocket Expenditure and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PFHI in the three states. The size of Out of Pocket Expenditure was significantly greater for utilisation in private sector, irrespective of insurance enrollment.

Conclusion

PFHI in the three states used substantially larger vertical cover than national scheme in 2014. The three states are known for their good governance. Yet, the PFHI programmes in all three states failed in fulfilling their fundamental purpose. Increasing vertical cover of PFHI and using either ‘Trusts’ or Insurance-companies as purchasers may not give desired results in absence of adequate regulation. The study raises doubts regarding effectiveness of contracting under PFHIs to influence provider-behavior in the Indian context. Further research is required to find solutions for addressing gaps that contribute to poor financial outcomes for patients under PFHI.
A method for assessing links between objectively measured food store scores and store & neighborhood favorability
Authors: Sadler Richard C. , Sanders-Jackson Ashley N. , Introne Josh , Adams Robyn
Published: December 2019

Worldwide, interest in research on methods to define access to healthy food at the local level has grown, given its central connection to carrying out a healthy lifestyle. Within this research domain, papers have examined the spatial element of food access, or individual perceptions about the food environment. To date, however, no studies have provided a method for linking a validated, objective measure of the food environment with qualitative data on how people access healthy food in their community. In this study, we present a methodology for linking scores from a modified Nutrition Environment Measures Survey in Stores (conducted at every store in our study site of Flint, Michigan) with perceptions of the acceptability of food stores and shopping locations drawn from seven focus groups (n = 53). Spatial analysis revealed distinct patterns in visiting and avoidance of certain store types. Chain stores tended to be rated more highly, while stores in neighborhoods with more African-American or poor residents were rated less favorably and avoided more frequently. Notably, many people avoided shopping in their own neighborhoods; participants traveled an average of 3.38 miles to shop for groceries, and 60% bypassed their nearest grocery store when shopping. The utility of our work is threefold. First, we provide a methodology for linking perceived and objective definitions of food access among a small sample that could be replicated in cities across the globe. Second, we show links between perceptions of food access and objectively measured food store scores to uncover inequalities in access in our sample to illustrate potential connections. Third, we advocate for the use of such data in informing the development of a platforms that aim to make the process of accessing healthy food easier via non-food retail based interventions. Future work can replicate our methods to both uncover patterns in distinct food environments and aid in advocacy around how to best intervene in the food environment in various locales.
Patient satisfaction with physician assistant/associate care: an international scoping review
Authors: Hooker Roderick S. , Moloney-Johns Amanda J. , McFarland Mary M.
Published: December 2019

Background

As the role of the physician assistant/associate grows globally, one question is: what is the level of patient satisfaction with PAs? Driven by legislative enactments to improve access to care, the PA has emerged as a ready and able medical professional to address workforce shortages. The aim of this study was to review the literature on patient satisfaction of PAs.

Objectives

The basis for this review was to clarify working definitions, synthesize the evidence, and establish conceptual boundaries around the topic of patient satisfaction with PAs. The intent was to identify gaps in the literature and offer suggested undertakings for more clarification on the subject.

Methods

A scoping review was undertaken. Literature from 1968 to 2019 was searched and filtered for eligibility. Those that met criteria were categorized by date, method, geography, themes, and design.

Results

In total, there were 987 papers or reports that were identified through bibliography database searching. Additional articles found through snowball methodology-reviewing references (n= 11). Only English language articles emerged for analysis. From this effort, 25 articles surfaced from the filtering process for final inclusion. Most (72%) of the articles came from the United States of America, three from the United Kingdom, and one each from Ireland, the Netherlands, and New Zealand. Most articles were descriptive in nature. Some variations in methods emerged.

Conclusion

PAs are operational in 15 nations; their acceptance appears successful and satisfaction with their care largely indistinguishable from physicians. Findings from this analysis highlight one theory that when patient’s needs are met, satisfaction is high regardless of the medical provider. Areas for further research are identified.
Effects of whey protein hydrolysate ingestion on post-exercise muscle protein synthesis compared with intact whey protein in rats
Authors: Nakayama Kyosuke , Tagawa Ryoichi , Saito Yuri , Sanbongi Chiaki
Published: December 2019

Background

It is well known that ingestion of protein sources can stimulate muscle protein synthesis (MPS). The intake of whey protein is highly effective especially for accelerating MPS. Whey protein hydrolysate (WPH) can raise postprandial plasma concentration of amino acids, which impact stimulation of MPS more rapidly and highly than intact whey protein. However, it is unclear which is more effective for stimulating MPS, WPH or intact whey protein. The aim of the present study was to compare the effects of the WPH and whey protein on MPS in rats after exercise.

Methods

Rats were first subjected to a 2 h. swimming protocol. After this, in experiment 1, we evaluated time-dependent changes in the fractional synthetic rate (FSR) of the triceps muscle in Male Sprague-Dawley rats after ingestion of intact whey protein (30, 60, 90 or 120 min after ingestion). Then in experiment 2, at the time point that the results of Experiment 1 revealed postprandial FSR was highest (60 min after ingestion), we measured the FSR after ingestion of the WPH or whey protein at two different doses (0.5 or 2.0 g protein/kg body weight), or with deionized water (control), again after exercise. Plasma components and mammalian target of rapamycin (mTOR) signaling were also measured.

Results

In experiment 1, postprandial FSR was highest 60 min after whey protein was administered. In experiment 2, the FSR 60 min after ingestion of the WPH was higher than that of whey protein (significant treatment main effect). Moreover, at a lower dose, only the WPH ingestion caused greater MPS and phosphorylated 4E-binding protein 1 (4E-BP1) levels compared with the control group.

Conclusion

These results indicate that ingestion of the WPH was associated with greater post-exercise MPS compared with intact whey protein, especially at lower doses.
Hepatotoxicity and the role of the gut-liver axis in rats after oral administration of titanium dioxide nanoparticles
Authors: Chen Zhangjian , Zhou Di , Han Shuo , Zhou Shupei , Jia Guang
Published: December 2019

Background

Due to its excellent physicochemical properties and wide applications in consumer goods, titanium dioxide nanoparticles (TiO2 NPs) have been increasingly exposed to the environment and the public. However, the health effects of oral exposure of TiO2 NPs are still controversial. This study aimed to illustrate the hepatotoxicity induced by TiO2 NPs and the underlying mechanisms. Rats were administered with TiO2 NPs (29 nm) orally at exposure doses of 0, 2, 10, 50 mg/kg daily for 90 days. Changes in the gut microbiota and hepatic metabolomics were analyzed to explore the role of the gut-liver axis in the hepatotoxicity induced by TiO2 NPs.

Results

TiO2 NPs caused slight hepatotoxicity, including clear mitochondrial swelling, after subchronic oral exposure at 50 mg/kg. Liver metabolomics analysis showed that 29 metabolites and two metabolic pathways changed significantly in exposed rats. Glutamate, glutamine, and glutathione were the key metabolites leading the generation of energy-related metabolic disorders and imbalance of oxidation/antioxidation. 16S rDNA sequencing analysis showed that the diversity of gut microbiota in rats increased in a dose-dependent manner. The abundance of Lactobacillus_reuteri increased and the abundance of Romboutsia decreased significantly in feces of TiO2 NPs-exposed rats, leading to changes of metabolic function of gut microbiota. Lipopolysaccharides (LPS) produced by gut microbiota increased significantly, which may be a key factor in the subsequent liver effects.

Conclusions

TiO2 NPs could induce slight hepatotoxicity at dose of 50 mg/kg after long-term oral exposure. The indirect pathway of the gut-liver axis, linking liver metabolism and gut microbiota, played an important role in the underlying mechanisms.
Clinical outcomes of previously untreated patients with unresectable intrahepatic cholangiocarcinoma following proton beam therapy
Authors: Shimizu Shosei , Okumura Toshiyuki , Oshiro Yoshiko , Fukumitsu Nobuyoshi , Fukuda Kuniaki , Ishige Kazunori , Hasegawa Naoyuki , Numajiri Haruko , Murofushi Keiko , Ohnishi Kayoko , Mizumoto Masashi , Nonaka Tetsuo , Ishikawa Hitoshi , Sakurai Hideyuki
Published: December 2019

Background

The effectiveness of proton beam therapy (PBT) as initial treatment for patients with unresectable intrahepatic cholangiocarcinoma (ICC) is unclear, particularly as related to ICC histological subtypes. We performed this study to address this gap in knowledge.

Methods

Thirty-seven patients with unresectable ICC who underwent PBT as their initial treatment were evaluated. Twenty-seven patients had Child-Pugh class A liver function, 11 exhibited jaundice, and 10 had multiple tumors. Nineteen, 7, and 11 tumors were classified as mass forming (MF), periductal infiltrating (PI), and intraductal growth (IG) types, respectively, based on gross appearance in imaging studies. Patients were classified into the curative group (n = 25) and palliative group (n = 12) depending on whether the planning target volume covered all the macroscopic tumors.

Results

The 1- and 2-year overall survival rates were 60.3, and 41.4%, respectively; the median survival time (MST) was 15 months for all patients. The MSTs for curative and palliative groups were 25 and 7 months, respectively. Curative treatment and adjuvant chemotherapy significantly improved overall survival, while the presence of periductal infiltrating type tumors was a negative prognostic factor. In the curative group, the 1- and 2-year local control rates were 100 and 71.5%, respectively, while the 1-, and 2-year progression-free survival rates were 58.5, and 37.6%, respectively. No severe acute toxicities were observed. Three patients experienced grade 3 biliary tract infection, although it was unclear whether this was radiotherapy-related.

Conclusion

PBT may yield to improve survival and local tumor control among patients with unresectable ICC.
A collaboration between service users and professionals for the development and evaluation of a new program for cardiovascular risk management in persons with a diagnosis of severe mental illness: French multicenter qualitative and feasibility studies
Authors: Baleige Antoine , Besnard Jean-François , Meunier-Beillard Nicolas , Demassiet Vincent , Monnier Alain , Ouezini Amel , Lambert Olivier , Charrel Claire , Mazas Olivier , Oberlin Joël , Roelandt Jean-Luc , Denis Frédéric
Published: December 2019

Background

Persons with a diagnosis of severe mental illness have a life expectancy that is 20 years lower than the general population, and they are disproportionately affected by cardiovascular disorders. Improving the management of cardiovascular risk is one of the main challenges for the public health system. In the care pathway of persons with a diagnosis of severe mental illness, a better understanding of limiting and facilitating factors is required. The objective was to include persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals in the creation and evaluation (feasibility) of a health promotion program designed to improve cardiovascular risk management through empowerment.

Methods

This study combines a mixed methodology with qualitative and quantitative components. A multicenter prospective qualitative study was conducted in seven mental health units in France and was coordinated by a steering committee composed of persons with a diagnosis of severe mental illness, carers, and primary and mental health professionals.

Results

This health promotion program must enable persons with a diagnosis of severe mental illness to assert their right to self-determination and to exercise greater control over their lives, beyond their diagnosis and care. Following a preliminary feasibility study, the effectiveness of this new tool will be evaluated using a randomized controlled trial in a second study.

Conclusions

The findings can be used by health organizations as a starting point for developing new and improved services for persons with a diagnosis of severe mental illness.

Trial registration Clinical Trials Gov NCT03689296. Date registered September 28, 2018
Biological characteristics of transcription factor RelB in different immune cell types: implications for the treatment of multiple sclerosis
Authors: Yang Meng-ge , Sun Li , Han Jinming , Zheng Chao , Liang Hudong , Zhu Jie , Jin Tao
Published: December 2019

Transcription factor RelB is a member of the nuclear factror-kappa B (NF-κB) family, which plays a crucial role in mediating immune responses. Plenty of studies have demonstrated that RelB actively contributes to lymphoid organ development, dendritic cells maturation and function and T cells differentiation, as well as B cell development and survival. RelB deficiency may cause a variety of immunological disorders in both mice and humans. Multiple sclerosis (MS) is an inflammatory and demyelinating disease of the central nervous system which involves a board of immune cell populations. Thereby, RelB may exert an impact on MS by modulating the functions of dendritic cells and the differentiation of T cells and B cells. Despite intensive research, the role of RelB in MS and its animal model, experimental autoimmune encephalomyelitis, is still unclear. Herein, we give an overview of the biological characters of RelB, summarize the updated knowledge regarding the role of RelB in different cell types that contribute to MS pathogenesis and discuss the potential RelB-targeted therapeutic implications for MS.
Proton therapy in the most common pediatric non-central nervous system malignancies: an overview of clinical and dosimetric outcomes
Authors: Sardaro Angela , Carbonara Roberta , Petruzzelli Maria Fonte , Turi Barbara , Moschetta Marco , Scardapane Arnaldo , Stabile Ianora Amato Antonio
Published: December 2019

Radiation therapy represents an important approach in the therapeutic management of children and adolescents with malignant tumors and its application with modern techniques – including Proton Beam Therapy (PBT) – is of great interest. In particular, potential radiation-induced injuries and secondary malignancies – also associated to the prolonged life expectancy of patients – are still questions of concern that increase the debate on the usefulness of PBT in pediatric treatments. This paper presents a literary review of current applications of PBT in non-Central Nervous System pediatric tumors (such as retinoblastoma, Hodgkin Lymphoma, Wilms tumor, bone and soft tissues sarcomas). We specifically reported clinical results achieved with PBT and dosimetric comparisons between PBT and the most common photon-therapy techniques. The analysis emphasizes that PBT minimizes radiation doses to healthy growing organs, suggesting for reduced risks of late side-effects and radiation-induced secondary malignancies. Extended follow up and confirms by prospective clinical trials should support the effectiveness and long-term tolerance of PBT in the considered setting.
The effect of low level laser irradiation on oxidative stress, muscle damage and function following neuromuscular electrical stimulation. A double blind, randomised, crossover trial
Authors: Jówko Ewa , Płaszewski Maciej , Cieśliński Maciej , Sacewicz Tomasz , Cieśliński Igor , Jarocka Marta
Published: December 2019

Background

Low level laser therapy (LLLT) is among novel methods for preventing and treating muscle damage and soreness induced by volitional exercise, but little is known about using LLLT before neuromuscular electrical stimulation. The aim of this first randomised, double blind, crossover trial addressing this issue was to evaluate effects of LLLT on muscle damage and oxidative stress, as well as recovery of muscle function after a single session of isometric neuromuscular electrical stimulation(NMES).

Methods

Twenty four moderately active, healthy men aged 21–22 years received 45 electrically evoked tetanic, isometric contractions of the quadriceps femoris, preceded by LLLT or sham-LLLT. Maximal isometric voluntary muscle torques, perceived soreness, and blood samples were analysed from baseline to 96 h post intervention. We measured plasma markers of muscle damage (the activity of creatine kinase), and inflammation (C-reactive protein), and evaluated redox state parameters.

Results

NMES-evoked contractions induced oxidative stress, demonstrated by an increase in lipid peroxidation and impairments in enzymatic antioxidant system. LLLT irradiations had a protective effect on NMES-induced decrease in enzymatic antioxidant defence and shortened the duration of inflammation. This effect of irradiations on redox state and inflammation did not affect lipid peroxidation, muscle damage, and muscle torque.

Conclusions

LLLT may protect from impairments in enzymatic antioxidant system and may shorten inflammation induced by a single NMES session in moderately active, healthy men. However, the effects of LLLT on redox state and inflammatory processes do not seem to affect muscle damage and recovery of muscle function after NMES.

Trial registration

The study was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR); The trial registration number: ACTRN12619000678190; date of registration: 6 May 2019.
A survey of primary-care pediatricians regarding the management of Helicobacter pylori infection and celiac disease
Authors: Ben Tov Amir , Na’amnih Wasef , Bdair-Amsha Amna , Cohen Shlomi , Tzamir Judith , Chodick Gabriel , Muhsen Khitam
Published: December 2019

Background

Adherence of primary-care pediatricians to guidelines in pediatric gastroenterology is essential to achieve optimal clinical outcomes. The study aim was to examine adherence of primary-care pediatricians to the European and North American Societies for Pediatric Gastroenterology, Hepatology and Nutrition guidelines on the management of Helicobacter pylori (H. pylori) infection and celiac disease.

Methods

We conducted a cross-sectional study during March–July 2017 using the survey platform of Maccabi Healthcare Services, the second largest state-mandated health organization in Israel. We sent the study questionnaire to a random sample of 300 pediatricians via electronic mails and to increase the response rate, we performed a telephone interview. Overall, 108 (36%) pediatricians provided completed questionnaires.

Results

Using professional guidelines for the management of H. pylori infection and celiac disease was reported by 34 and 37% of pediatricians, respectively. Referral to H. pylori testing was reported by 78 and 52% of pediatricians in children with suspected duodenal ulcer and unexplained iron deficiency anemia, respectively, with the stool antigen enzyme immunoassay being mostly (51%) used as the first choice diagnostic test. Most pediatricians reported prescription of triple therapy; proton pump inhibitors/clarithromycin/amoxicillin (59%) or metronidazole (21%). For celiac disease, overall adherence to all guidelines was high both for initial evaluation and for confirmation of diagnosis.

Conclusions

Adherence to the guidelines on management of H. pylori infection was low, while adherence to the guidelines on celiac disease management was high among primary-care pediatricians. Educational interventions are needed to improve H. pylori infection management among primary-care pediatricians.
On Gaussian covert communication in continuous time
Authors: Wang Ligong
Published: December 2019

The paper studies covert communication over a continuous-time Gaussian channel. The covertness condition requires that the channel output must statistically resemble pure noise. When the additive Gaussian noise is “white” over the bandwidth of interest, a formal coding theorem is proven, extending earlier results on covert Gaussian communication in discrete time. This coding theorem is applied to study scenarios where the input bandwidth can be infinite and where positive or even infinite per-second rates may be achievable.
Exploiting prospect theory and risk-awareness to protect UAV-assisted network operation
Authors: Vamvakas Panagiotis , Tsiropoulou Eirini Eleni , Papavassiliou Symeon
Published: December 2019

In this paper, a novel resource management framework is introduced and exploited to ensure the efficient and smooth operation of a wireless network, assisted by an unmanned aerial vehicle (UAV), operating under the non-orthogonal multiple access (NOMA) scheme and consisting of both normal and malicious risk-aware users. User devices are assumed capable of splitting their transmission power in two different communication alternatives, established via either the UAV or the macro base station (MBS). The bandwidth offered by the UAV is accessible by everyone, delivers potentially higher rate of return taking into account the enhanced communication channel gains owing to its proximity to the serving users, but is prone to failure due to its potential over-exploitation. Accordingly, the UAV’s bandwidth is considered as common pool of resources (CPR). In contrast, the MBS’s bandwidth is considered as a safe resource offering to the users a more limited but guaranteed level of service, due to the fact that though it has less available bandwidth it operates under a more controlled access scheme. The theory of the tragedy of the commons is used to capture the probability of failure of the CPR, while the prospect theory is adopted to study the normal and malicious users’ risk-aware behavior in the UAV-assisted network. A non-cooperative power control game among the users is formulated and solved, in order to determine the users’ power investment to the dual communication environment. The existence and uniqueness of a Pure Nash Equilibrium point is shown and a distributed algorithm is introduced to converge to the PNE point. This overall resource allocation framework is intelligently exploited as the vehicle to detect malicious user behavior and therefore protect the network from the undesired effects of such behaviors. The performance and inherent attributes of the proposed user-centric risk-aware operation framework, in terms of its capability to effectively utilize the available system and user resources (i.e., bandwidth and power), while succeeding in identifying potential abnormal or malicious user behaviors is assessed via modeling and simulation, under different operation scenarios.
Publicly verifiable and efficiency/security-adjustable outsourcing scheme for solving large-scale modular system of linear equations
Authors: Meng Panpan , Tian Chengliang , Cheng Xiangguo
Published: December 2019

Solving large-scale modular system of linear equations ($\mathcal {LMSLE}$ℒℳSℒE) is pervasive in modern computer and communication community, especially in the fields of coding theory and cryptography. However, it is computationally overloaded for lightweight devices arisen in quantity with the dawn of the things of internet (IoT) era. As an important form of cloud computing services, secure computation outsourcing has become a popular topic. In this paper, we design an efficient outsourcing scheme that enables the resource-constrained client to find a solution of the$\mathcal {LMSLE}$ℒℳSℒEwith the assistance of a public cloud server. By utilizing affine transformation based on sparse unimodular matrices, our scheme has three merits compared with previous work: 1) Our scheme is efficiency/security-adjustable. Our encryption method is dynamic, and it can balance the security and efficiency to match different application scenarios by skillfully control the number of unimodular matrices. 2) Our scheme is versatile. It is suit for genericm-by-ncoefficient matrixA, no matter it is square or not. 3) Our scheme satisfies public verifiability and achieves the optimal verification probability. It enables any verifier which is not necessarily the client to verify the correctness of the results returned from the cloud server with probability 1. Finally, theoretical analysis and comprehensive experimental results confirm our scheme’s security and high efficiency.