bluuebunny/crossref_metadata_2025 huggingface dataset:
Prenatal Diagnosis of Fetal Skeletal Dysplasia Using 3-Dimensional Computed Tomography: A Prospective Study
Authors: Waratani Miyoko , Ito Fumitake , Tanaka Yukiko , Mabuchi Aki , Mori Taisuke , Kitawaki Jo
Published: September 2020

Background: Fetal skeletal dysplasia (FSD) comprises a complex group of systemic bone and cartilage disorders. Many FSD phenotypes have indistinct definitions, making definitive prenatal diagnosis difficult. The condition is typically diagnosed using sonography; however, three-dimensional computed tomography (3D-CT) also aids in making a prenatal diagnosis. This study aimed to examine the efficacy of 3D-CT in the prenatal diagnosis of FSD by comparing the diagnostic accuracy of fetal sonography and 3D-CT.Methods: On suspicion of FSD based on ultrasound examination, we performed 3D-CT prenatally to obtain detailed skeletal information on FSD. To minimize exposure of the fetuses to radiation without compromising image quality, we used predetermined 3D-CT settings for volume acquisition.Results: Nineteen fetuses were suspected of having skeletal dysplasia based on ultrasonography findings. Of these, 17 were diagnosed with FSD using 3D-CT. All 17 fetuses diagnosed with FSD prenatally were confirmed postnatally to have the condition. The postnatal diagnosis (campomelic dysplasia) differed from the prenatal diagnosis (osteogenesis imperfecta) in only one infant. Sixteen cases (94.1 %) were diagnosed both prenatally and postnatally with FSD. Five infants had lethal skeletal dysplasia; one died in utero, and four died as neonates. We determined the appropriate delivery method for each infant based on the prenatal diagnosis.Conclusions: 3D-CT is a valuable tool for augmenting ultrasound examinations in the diagnosis of FSD. While improving the diagnostic tool of sonography is essential in cases of suspected FSD, 3D-CT imaging is indispensable for diagnosis and classification, enabling better planning for resuscitation of the infant after birth.Trial registration: University Hospital Medical Information Network (UMIN) Center trial registration number is UMIN000034744. Registered 1 October, 2018 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=Roooo39610.
The Impact of COVID-19 Pandemic on Dental Practice in Iran: A questionnaire-based report
Authors: Ahmadi Hanie , Ebrahimi Alireza , Ghorbani Farhad
Published: September 2020

Background: The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), besides the fact that dental procedures commonly generate blood and saliva droplets that could lead to the contagion have resulted in the closure of many dental clinics. In the present study, we aimed to evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on dental practice by conducting an online questionnaire among the Iranian dental practitioners and finding their perspectives on the subject.Methods: This report is based on a questionnaire that was conducted among Iranian dentists. The survey included questions that evaluate the dentists’ perceptions and attitudes toward the COVID-19 pandemic and its effect on their personal life, financial status, and the quality of dental services for patients. Results: Overall, 240 dentists contributed to this study (214 general dentists and 26 specialists). The majority of the participants (n=170, 70%) did not perform non-emergency procedures during the pandemic. The dental practitioners have suggested several strategies to decrease the risk of contagion, such as reducing treatment sessions (n=90, 37%), strict triage of patients (n=156, 64%), and using personal protective equipment (n=108, 45%). However, most of the dentists (n=210, 87%) had problems, providing personal protective equipment during the pandemic. Moreover, 97% (n=234) of the participants reported that they encountered a decrease in their financial income since the eruption of the pandemic.Conclusion: Dental health care workers are at the highest risk of contracting COVID-19. Thus dental practioners ought to execute the standard protocols more cautiously during the pandemic. They could also lower their work hours and limit dental procedures to emergency treatments to reduce the risk of COVID-19 transmission. Besides, the public organizations should provide proper equipment for the dental practitioners to decrease the risk of contagion.
Impacts of Reopening Strategies for COVID-19 Epidemic: A Modeling Study in Piedmont Region
Authors: Pernice Simone , Castagno Paolo , Marcotulli Linda , Maule Milena Maria , Richiardi Lorenzo , Moirano Giovenale , Sereno Matteo , Cordero Francesca , Beccuti Marco
Published: September 2020

Background Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), the causative agent of the coronavirus disease 19 (COVID-19), is a highly transmittable virus. Since the first person-to-person transmission of SARS-CoV-2 was reported in Italy on February 21 st , 2020, the number of people infected with SARS-COV-2 increased rapidly, mainly in northern Italian regions, including Piedmont. A strict lockdown was imposed on March 21 st until May 4 th when a gradual relaxation of the restrictions started. In this context, computational models and computer simulations are one of the available research tools that epidemiologists can exploit to understand the spread of the diseases and to evaluate social measures to counteract, mitigate or delay the spread of the epidemic. Methods This study presents an extended version of the Susceptible-Exposed-Infected-Removed-Susceptible (SEIRS) model accounting for population age structure. The infectious population is divided into three sub-groups: (i) undetected infected individuals, (ii) quarantined infected individuals and (iii) hospitalized infected individuals. Moreover, the strength of the government restriction measures and the related population response to these are explicitly represented in the model. Results The proposed model allows us to investigate different scenarios of the COVID-19 spread in Piedmont and the implementation of different infection-control measures and testing approaches. The results show that the implemented control measures have proven effective in containing the epidemic, mitigating the potential dangerous impact of a large proportion of undetected cases. We also forecast the optimal combination of individual-level measures and community surveillance to contain the new wave of COVID-19 spread after the re-opening work and social activities. Conclusions Our model is an effective tool useful to investigate different scenarios and to inform policy makers about the potential impact of different control strategies. This will be crucial in the upcoming months, when very critical decisions about easing control measures will need to be taken.
Nanopolystyrene translocation and fetal deposition after acute lung exposure during late-stage pregnancy
Authors: Fournier Sara B , D’Errico Jeanine N , Adler Derek S , Kollontzi Stamatina , Goedken Michael J , Fabris Laura , Yurkow Edward J , Stapleton Phoebe A
Published: September 2020

Background: Plastic is everywhere. It is used in food packaging, storage containers, electronics, furniture, clothing, and common single-use disposable items. Microplastic and nanoplastic particulates are formed from bulk fragmentation and disintegration of plastic pollution. Plastic particulates have recently been detected in indoor air and remote atmospheric fallout. Due to their small size, microplastic and nanoplastic particulate in the atmosphere can be inhaled and may pose a risk for human health, specifically in susceptible populations. When inhaled, nanosized particles have been shown to translocate across pulmonary cell barriers to secondary organs, including the placenta. However, the potential for maternal-to-fetal translocation of nanosized-plastic particles and the impact of nanoplastic deposition or accumulation on fetal health remain unknown. In this study we investigated whether nanopolystyrene particles can cross the placental barrier and deposit in fetal tissues after maternal pulmonary exposure.Results: Pregnant Sprague Dawley rats were exposed to 20 nm rhodamine-labeled nanopolystyrene beads (2.64 x 1014 particles) via intratracheal instillation on gestational day (GD) 19. Twenty-four hours later on GD 20, maternal and fetal tissues were evaluated using fluorescent optical imaging. Fetal tissues were fixed for particle visualization with hyperspectral microscopy. Using isolated placental perfusion, a known concentration of nanopolystyrene was injected into the uterine artery. Maternal and fetal effluents were collected for 180 minutes and assessed for polystyrene particle concentration. Twenty-four hours after maternal exposure, fetal and placental weights were significantly lower (7% and 8%, respectively) compared with controls. Nanopolystyrene particles were detected in the maternal lung, heart, and spleen. Polystyrene nanoparticles were also observed in the placenta, fetal liver, lungs, heart, kidney, and brain suggesting maternal lung-to-fetal tissue nanoparticle translocation in late stage pregnancy.Conclusion: These studies confirm that maternal pulmonary exposure to nanopolystyrene results in the translocation of plastic particles to placental and fetal tissues and renders the fetoplacental unit vulnerable to adverse effects. These data are vital to the understanding of plastic particulate toxicology and the developmental origins of health and disease.
BTG1 inhibits malignancy as a novel prognosis signature in endometrial carcinoma
Authors: Li Yibing , Huo Jianing , He Junjian , Zhang Yunzheng , Ma xiaoxin
Published: September 2020

Background: Endometrial carcinoma (EC) is one of the three major malignant tumors of the female reproductive system. In recent years, the incidence and mortality rate of EC have increased. B-cell translocation gene 1 (BTG1) is an anti-proliferation gene that regulates the occurrence and development of a variety of tumors, but there is no research regarding this gene in EC.Methods: Based on The Cancer Genome Atlas (TCGA) database, we used a variety of bioinformatics tools and databases to explore the expression and prognosis of BTG1. We verified expression and prognosis of BTG1 in EC using qRT-PCR and analyzed the relevant clinicopathological parameters. We functionally enriched BTG1 and related genes in EC patients through the bioinformatics website and analyzed miRNA targets of BTG1 and interacting protein networks. Cell proliferation, wound healing, transwell invasion, and cell apoptosis assays were used to detect the effects of BTG1 on the malignant biological behavior of endometrial carcinoma cells (ECCs). The effect of BTG1 on the epithelial-to-mesenchymal transition (EMT) process was detected using western blot.Results: We analyzed the expression and prognosis of BTG1 based on TCGA and found that low expression of BTG1 was associated with poor EC prognosis. The qRT-PCR suggested that BTG1 had low expression in EC. BTG1 expression was significantly correlated with overall survival (OS) shortening. Clinicopathological analysis suggested that expression of BTG1 was related to invasion depth and the International Federation of Gynecology and Obstetrics (FIGO) stage. EC pathological tissue type, fertility history, lymphatic metastasis, menopause, estrogen receptor (ER), progesterone receptor (PR), and age of diagnosis were not related. Functional enrichment analysis showed that BTG1 plays an important role in regulating embryonic development, tumorigenesis, apoptosis, and cell cycle. Biological behavior experiments suggest that BTG1 inhibits proliferation, migration, and invasion of ECCs, and promotes apoptosis of ECCs. Western blot indicated that BTG1 inhibited the EMT process of ECCs.Conclusions: BTG1 plays an important role in the occurrence and development of EC. BTG1, as a tumor suppressor gene, shows low expression in EC, which can inhibit malignant biological behavior and EMT process of ECCs. In addition, BTG1 can be used as a potential prognostic biomarker for EC.
Evaluation of curcumin and copper acetate against Salmonella Typhimurium infection, intestinal permeability, and cecal microbiota composition in broiler chickens
Authors: Leyva-Diaz Anaisa A. , Hernandez-Patlan Daniel , Solis-Cruz Bruno , Adhikari Bishnu , Kwon Young Min , Latorre Juan D. , Hernandez-Velasco Xochitl , Fuente-Martinez Benjamin , Hargis Billy M. , Lopez-Arellano Raquel , Tellez Guillermo
Published: September 2020

Background: Interest in the use of natural feed additives as an alternative to antimicrobials in the poultry industry has increased in recent years because of the risk of bacterial resistance. One of the most studied groups are polyphenolic compounds, given their advantages over other types of additives and their easy potentiation of effects when complexes are formed with metal ions. Therefore, the objective of the present study was to evaluate the impact of dietary supplementation of copper acetate (CA), curcumin (CR), and their combination (CA-CR) against Salmonella Typhimurium colonization, intestinal permeability, and cecal microbiota composition in broiler chickens through a laboratory Salmonella infection model, indirect determination of intestinal integrity by measuring fitc-d in serum and microbiota analysis by DNA extraction.Results: The obtained results showed that in two independent studies, all experimental treatments were able to significantly reduce the S. Typhimurium colonization in cecal tonsils (CT, P< 0.0001) compared to the positive control (PC) group. However, CR and CA-CR were the most effective treatments in reducing S. Typhimurium counts. Furthermore, the serum fluorescein isothiocyanate dextran (FITC-d) concentration in chickens treated with CR was significantly lower when compared to PC (P= 0.0084), which is related to a decrease in intestinal permeability and therefore intestinal integrity. The effect of dietary treatments in reducing S. Typhimurium colonization was further supported by the Linear discriminant analysis effect size (LEfSe) analysis of microbiota data, where Salmonella was significantly enriched in PC group (LDA score > 2.0 and P<0.05). In addition, Coprobacillus, Eubacterium, and Clostridium were significantly higher in the PC group compared to other treatment groups. On the contrary, Fecalibacterium and Enterococcus in CR, unknown genus of Erysipelotrichaceae at CA-CR, and unknown genus of Lachnospiraceae at CA were significantly abundant respectively.Conclusions: CR treatment was the most effective treatment to reduce S. Typhimurium intestinal colonization and maintain better intestinal homeostasis which might be achieved through modulation of cecal microbiota.
Automatic Segmentation of Coronary Lumen and External Elastic Membrane in Intravascular Ultrasound Images Using 8-layer U-Net
Authors: Dong Liang , Lu Wei , Jiang Jun , Zhao Ya , Song Xiangfen , Leng Xiaochang , Zhao Hang , Wang Jian’an , Li Changling , Xiang Jianping
Published: September 2020

Background: Intravascular ultrasound (IVUS) is the golden standard in accessing the coronary lesions, stenosis, and atherosclerosis plaques. In this paper, a fully-automatic approach by an 8-layer U-Net is developed to segment the coronary artery lumen and the area bounded by external elastic membrane, i.e. EEM cross section area (EEM-CSA). The database comprises of single-vendor and single-frequency IVUS data. Particularly, the proposed data augmentation of MeshGrid combined with flip and rotation operations is implemented, improving the model performance without pre- or post-processing of the raw IVUS images.﻿Results: The mean intersection of union (mIoU) of 0.941 and 0.750 for the lumen and EEM-CSA respectively were achieved, which exceeded the manual labeling accuracy of the clinician. Conclusion: The accuracy shown by the proposed method is sufficient for subsequent reconstruction of 3D IVUS images, which is essential for doctors’ diagnosis in the tissue characterization of coronary artery walls and plaque compositions, qualitatively and quantitatively.
Analysis Of Candidate Genes Expected To Be Essential For Melanoma Surviving
Authors: Krivosheeva Irina , Filatova Alexandra , Moshkovskii Sergei , Baranova Ancha , Skoblov Mikhail
Published: September 2020

Cancers may be treated by selective targeting of the genes vital for their survival. A number of attempts have led to discovery of several genes essential for surviving of tumor cells of different types. In this work, we tried to analyze genes that were previously predicted to be essential for melanoma surviving. Here we present the results of transient siRNA-mediated knockdown of the four of such genes, namely, UNC45A, STK11IP, RHPN2 and ZNFX1, in melanoma cell line A375, then assayed the cells for their viability, proliferation and ability to migrate in vitro. In our study, the knockdown of the genes predicted as essential for melanoma survival does not lead to statistically significant changes in cell viability. On the other hand, for each of the studied genes, mobility assays showed that the knockdown of each of the target genes accelerates the speed of cells migrating. Possible explanation for such counterintuitive results may include insufficiency of the predicting computational models or the necessity of a multiplex knockdown of the genes.AimsTo examine the hypothesis of essentiality of hypomutated genes for melanoma surviving we have performed knockdown of several genes in melanoma cell line and analyzed cell viability and their ability to migrate.MethodsKnockdown was performed by siRNAs transfected by Metafectene PRO. The levels of mRNAs before and after knockdown were evaluated by RT-qPCR analysis. Cell viability and proliferation were assessed by MTT assay. Cell migration was assessed by wound healing assay.ResultsThe knockdown of the genes predicted as essential for melanoma survival does not lead to statistically significant changes in cell viability. On the other hand, for each of the studied genes, mobility assays showed that the knockdown of each of the target genes accelerates the speed of cells migrating. ConclusionOur results do not confirm initial hypothesis that the genes predicted essential for melanoma survival as a matter of fact support the survival of melanoma cells.
Inhibition of circRNA circVPS33B reduces cell malignant behaviors and Warburg effect through regulation of the miR-873-5p/HNRNPK axis in infiltrative gastric cancer 
Authors: Lu Yizhuo , Cheng Jia , Cai Wangyu , Zhuo Huiqin , Wu Guoyang , Cai Jianchun
Published: September 2020

Background: Circular RNA VPS33B (circVPS33B) is upregulated in gastric cancer (GC) tissues. However, the role of circVPS33B in infiltrative GC is indistinct. Methods: Expression of circVPS33B, miR-873-5p, and heterogeneous nuclear ribonucleoprotein K (HNRNPK) mRNA was detected using quantitative real-time polymerase chain reaction (qRT-PCR). The proliferation, colony formation, migration, and invasion of infiltrative GC cells (XGC-1) were determined by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide (MTT), plate clone, wound healing, or transwell assays. Several protein levels were examined by western blotting. The extracellular acidification rate (ECAR) and oxygen consumption rate (OCR) of XGC-1 cells were evaluated by XF96 extracellular flux analyzer. Glucose uptake and lactate production were analyzed by glycolysis assay. The relationship between circVPS33B or HNRNPK and miR-873-5p was verified by dual-luciferase reporter and/or RNA pull-down assays. In vivo tumorigenesis assay was executed for verifying the in vitro results.Results: CircVPS33B and HNRNPK were upregulated while miR-873-5p was downregulated in infiltrative GC tissues and XGC-1 cells. CircVPS33B silencing decreased tumor growth in vivo and inhibited proliferation, colony formation, migration, invasion, and Warburg effect of XGC-1 cells in vitro. CircVPS33B regulated HNRNPK expression via sponging miR-873-5p. The inhibitory influence of circVPS33B knockdown on the malignancy and Warburg effect of XGC-1 cells was overturned by miR-873-5p inhibitor. HNRNPK overexpression reversed the repression of the malignancy and Warburg effect of XGC-1 cells caused by miR-873-5p mimic.Conclusions: CircVPS33B accelerated infiltrative GC progression through regulating the miR-873-5p/HNRNPK axis, manifesting that circVPS33B might be a promising target for infiltrative GC treatment.
Evaluation of hepatic fibrosis in HIV/HCV Co-infected individuals in Yaoundé, Cameroon: Usefulness of APRI score in resource-constrained settings
Authors: Dobseu Rodolphe Steven , Nanfack Aubin Joseph , Kowo Mathurin , Ambada Georgia , Kamgaing Rachel Simo , Chenwi Collins , Fainguem Nadine , Ka’e Aude , Ngangoum Eric , Sosso Samuel Martin , Tchiegang Clergé , Ndjolo Alexis
Published: September 2020

Background: HIV infection exacerbates the prognosis of HCV infection, with a faster progression of hepatitis. Hepatic fibrosis is the major disruption of the hepatic tissue architecture characterized by anarchic deposition and excess of the extracellular matrix. The objective of this study was to evaluate hepatic fibrosis in HIV/HCV co-infected individuals as compared to HCV mono-infected. Methods: A total of 97 participants (mean age 60.2±14.3 years and 0.76 male/female sex ratio) was enrolled in a study conducted in Yaoundé, Cameroon from November 2018 to January 2019. Liver fibrosis was assessed by the APRI score (Aspartate Aminotransferase or AST/Platelet Ratio Index) which identifies the stage of fibrosis classified by the Metavir system (F0 to F4). CD4 counts and plasmatic HIV viral load of HIV/HCV co-infected individuals were determined and the correlation between hepatic fibrosis and immuno-virological status established. Statistical analysis was done using Microsoft Excel 2016 and EpiInfo7 software.Results: A high proportion (63.6%) of HIV/HCV co-infected participants had an abnormal AST level: 73.6±45.8 IU/L as compared to 58.5±39.3 IU/L (59.3%) among HCV mono-infected participants. The frequency of thrombocytopenia was 63.6% with a mean platelet count of 137±50x103 IU/L in HIV/HCV co-infected participants as compared to 176±67x103 IU/L in HCV mono-infected participants (38.4%). The progression of hepatic fibrosis in participants with clinically significant fibrosis: F2, F3 and F4 was higher among HIV/HCV co-infected and the mean APRI score was 1.7±1.4 versus 1±0.8 among HCV mono-infected (26.7%). All participants (100%) with detectable HIV viral load had clinically significant fibrosis compared to 33.4% in those with undetectable HIV viral load (p=0.55). Only 42.9% participants with CD4>500 cells/µL had clinically significant fibrosis (p=0.72) while 100% participants with CD4<200 cells/µL had clinically significant fibrosis (p=0.58). Conclusions: A high level of AST combined with thrombocytopenia (APRI score>1.5) is an indicator of hepatic fibrosis in HIV/HCV co-infected individuals. Because of its non-invasive and less costly nature, the APRI score can be a suitable biomarker to monitor hepatic fibrosis in HIV/HCV co-infected individuals in resource constrained settings.
Elevated serum triglyceride predicts recurrence of colorectal polyps in patients with advanced adenomas
Authors: Liu Boying , Wen Pingwu , Gu Xiaodong , Weng Ruiqiang , Liu Sudong
Published: September 2020

Background: Recurrence of colorectal polyps is common and impacted by various factors. This study was performed to explore the association between lipid profiles and recurrence of colorectal polyps.Methods: This study retrospectively analyzed the lipid profiles of 435 patients who underwent colonoscopy with removal of colorectal polyps and assessed recurrence of polyps by follow-up colonoscopy. Multivariate regression logistic analysis was used to evaluate the association between lipid profiles and polyp recurrence.Results: During the 1.5-year follow-up, recurrence of colorectal polyps was observed in 135 of 435 patients (30.34%). Patients with recurrent polyps showed a higher level of triglycerides (P = 0.006) and lower levels of high-density lipoprotein cholesterol (P = 0.008) and apolipoprotein A1 (P = 0.033). The multivariate regression logistic model suggested that an elevated triglyceride level was an independent risk factor for polyp recurrence (odds ratio, 1.55; 95% confidence interval, 1.02 - 2.35; P = 0.039) in patients with advanced adenoma.Conclusions: Lipid profiles are associated with recurrence of colorectal polyps. An elevated triglyceride level is an independent risk predictor of polyp recurrence in patients with advanced adenoma.
Identification of collagen genes related to immune infiltration and epithelial-mesenchymal transition in glioma
Authors: Yin Wen , Tan Jun , Xin Zhaoqi , Zhou Quanwei , Cao Yudong , Wu Zhaoping , Lei Wang , Jiang Xingjun , Ren Caiping , Tang Guihua
Published: September 2020

Background: Gliomas account for the majority of fatal primary brain tumors, and there is much room for research in the underlying pathogenesis, the multistep progression of glioma, and how to improve survival. In our study, we aimed to identify potential biomarkers or therapeutic targets of glioma and study the mechanism underlying the tumor progression. Methods: We downloaded the microarray datasets (GSE43378 and GSE7696) from the Gene Expression Omnibus (GEO) database. Then, we used weighted gene co-expression network analysis (WGCNA) to screen potential biomarkers or therapeutic targets related to the tumor progression. ESTIMATE (Estimation of STromal and Immune cells in MAlignant Tumors using Expression data) algorithm and TIMER (Tumor Immune Estimation Resource) database were used to analyze the correlation between the selected genes and the tumor microenvironment. Real-time reverse transcription polymerase chain reaction was used to measure the selected gene. Transwell and wound healing assay were used to measure the cell migration and invasion capacity.Results: We identified specific module genes that were positively correlated with the WHO grade but negatively correlated with OS of glioma. Importantly, we identified that 6 collagen genes (COL1A1, COL1A2, COL3A1, COL4A1, COL4A2, and COL5A2) could regulate the immunosuppressive microenvironment of glioma. Moreover, we found that these collagen genes were significantly involved in the epithelial-mesenchymal transition (EMT) process of glioma. Finally, taking COL5A2 as a further research object, the results showed that knockdown of COL5A2 significantly inhibited the migration and invasion of SHG44 and A172 cells. Conclusions: In summary, our study demonstrated that collagen genes play an important role in regulating the immunosuppressive microenvironment and EMT process of glioma and could serve as potential therapeutic targets for glioma management.
Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice
Authors: Paul Caroline R , Joyce Alanna Higgins , Dallaghan Gary Beck , Keeley Meg , Lehmann Corinne , Schmidt Suzanne , Simonsen Kari , Christy Cynthia
Published: September 2020

Background: Acute otitis media (AOM) is the most frequent indication for antibiotic treatment of children in the United States. Its diagnosis relies on visualization of the tympanic membrane, a clinical skill acquired through a deliberate approach. Instruction in pediatric otoscopy begins in medical school. Medical students receive their primary experience with pediatric otoscopy during the required pediatric clerkship, traditionally relying on an immersion, apprentice-type learning model. A better understanding of their preceptors’ clinical and teaching practices could lead to improved skill acquisition. This study investigates how pediatric preceptors (PP) and members of the Council on Medical Student Education in Pediatrics (COMSEP) perceive teaching otoscopy. Methods: A 30-item online survey was administered to a purposeful sample of PP at six institutions in 2017. A comparable 23-item survey was administered to members through the 2018 COMSEP Annual Survey. Only COMSEP members who identified themselves as teaching otoscopy to medical students were asked to complete the otoscopy-related questions on the survey. Results: Survey respondents included 58% of PP (180/310) and 44% (152/348) of COMSEP members. Forty-one percent (62/152) of COMSEP member respondents identified themselves as teaching otoscopy and completed the otoscopy-related questions. The majority agreed that standardized curricula are needed (PP 78%, COMSEP members 97%) and that all graduating medical students should be able to perform pediatric otoscopy (PP 95%, COMSEP members 79%). Most respondents reported usefulness of the American Academy of Pediatrics (AAP) AOM guidelines (PP 95%, COMSEP members 100%). More COMSEP members than PP adhered to the AAP’s diagnostic criteria (pediatric preceptors 42%, COMSEP members 93%). The most common barriers to teaching otoscopy were a lack of assistive technology (PP 77%, COMSEP members 56%), presence of cerumen (PP 58%, COMSEP members 60%), time to teach in direct patient care (PP 46%, COMSEP members 48%), and parent anxiety (PP 62%, COMSEP members 54%). Conclusions: Our study identified systemic and individual practice patterns and barriers to teaching pediatric otoscopy. These results can inform education leaders in supporting and enabling preceptors in their clinical teaching. This approach can be adapted to ensure graduating medical students obtain intended core clinical skills.
Diagnostic Value of Combined Pleural IL-33, ADA and Peripheral T-SPOT.TB for Tuberculous Pleurisy
Authors: Fenhua Jin , Daohui Wang , Hui Lin , Xiaodong Xia , huang wen
Published: September 2020

Background To investigate the correlation between pleural fluid interleukin-33 (IL-33) and adenosine deaminase （ADA） and peripheral blood tuberculosis T cell spot detection (T-SPOT.TB), and the combined value of the three tests for the diagnosis of tuberculous pleurisy.Method 79 patients with pleural effusion admitted from June 2017 to December 2018 were enrolled. They were divided into tuberculous pleural effusion (TPE) group (57 cases, 72.2%) and malignant pleural effusion group (17 cases,21.5%), pneumonia-like pleural effusion group (5 cases, 6.3%). Correlation between pleural fluid IL-33,pleural effusion ADA and peripheral blood T-SPOT.TB was analyzed, comparison of the three separate and combined diagnostic efficacy was also performed.Result The levels of IL-33, ADA and peripheral blood T-SPOT.TB in patients with TPE were significantly higher than those in non-TPE (P<0.001). The level of pleural fluid IL-33 was positively correlated with pleural effusion ADA and peripheral blood T-SPOT.TB. The Area under the ROC curve（AUC）of TPE diagnosed by pleural IL-33, ADA and peripheral blood T-SPOT.TB were 0.753, 0.912 and 0.865, respectively. AUC for combined detection of pleural effusion IL-33, ADA and peripheral blood T-SPOT.TB is the largest, with a value of 0.962. Specificity is 100% and sensitivity is 88.5%.Conclusion Combined detection of pleural effusion IL-33, ADA and peripheral blood T-SPOT.TB can improve the diagnostic efficacy of tuberculous pleurisy.
Validation of subscales of the Severe Asthma Questionnaire (SAQ) using exploratory factor analysis (EFA)
Authors: Lanario Joseph W. , Hyland Michael , Menzies-Gow Andrew , Mansur Adel H , Dodd James W. , Fowler Stephen J , Jones Rupert C , Masoli Matthew
Published: September 2020

BackgroundThe Severe Asthma Questionnaire (SAQ) is a health related quality of life (HRQoL) questionnaire validated for use in severe asthma. It is scored using the mean value of 16 items (SAQ score) in addition to a single item global rating of HRQoL (SAQ-global). The aim was to validate clinically relevant subscales using exploratory factor analysis (EFA).MethodsThe SAQ was completed, along with measures of asthma control and EQ5D-5L by patients attending six UK severe asthma centres. Clinical data were included in the analysis. EFA using principal axis factoring and oblimin rotation was used to achieve simple structure of data. Results460 patients with severe asthma participated, 65% women, mean age 51 (16-83) yrs. A three factor solution achieved best fit and showed that the SAQ items formed three distinct but inter-correlated groups of items where items were grouped in a way that was consistent with item content. The three subscales were differentially associated with clinically relevant variables (lung function and mood). Males and females interpreted the question of night disturbance in different ways.ConclusionsThis paper provides a template for best practice in the use of EFA when validating HRQoL subscales. The SAQ can be scored as three subscales with content reflecting three different constructs people with severe asthma use when making judgements about their lives. The subscale ‘My Life’ assesses the impact of severe asthma on different life activities, ‘My Mind’ assesses the perceived emotional impact and ‘My Body’ the impact of extra-pulmonary symptoms and side effects.
Microbial upgrading of acetate into 2,3-butanediol and acetoin by E. coli W
Authors: Novak Katharina , Kutscha Regina , Pflügl Stefan
Published: September 2020

Background Acetate is an abundant carbon source and its use as an alternative feedstock has great potential for the production of fuel and platform chemicals. Acetoin and 2,3-butanediol represent two of these potential platform chemicals. Results The aim of this study was to produce 2,3-butanediol and acetoin from acetate in Escherichia coli W. The key strategies to achieve this goal were: strain engineering, in detail the deletion of mixed acid fermentation pathways E. coli W ΔldhA ΔadhE Δpta ΔfrdA 445_Ediss and the development of a new defined medium containing five amino acids and seven vitamins. Stepwise reduction of the media additives further revealed that diol production from acetate is mediated by the availability of aspartate. Other amino acids or TCA cycle intermediates did not enable growth on acetate. Cultivation under controlled conditions in batch and pulsed fed-batch experiments showed that aspartate was consumed before acetate, indicating that co-utilization is not a prerequisite for diol production. The addition of aspartate gave cultures a start-kick and was not required for feeding. Pulsed fed-batches resulted in the production of 1.43 g l-1 from aspartate and acetate and 1.16 g l-1 diols (2,3-butanediol and acetoin) from acetate alone. The yield reached 0.09 g diols per g acetate, which accounts for 26 % of the theoretical maximum.Conclusion This study for the first time showed acetoin and 2,3-butanediol production from acetate as well as the use of chemically defined medium for product formation from acetate in E. coli. Hereby, we provide a solid base for process intensification and the investigation of other potential products.
Alimentary System is Directly Attacked by SARS-COV-2 and Further Prevents Immune Dysregulation Caused by COVID-19
Authors: Chen Sai , Zhou Jing , UG Xiaoqi Ou , Cheng Wei , Qin Yun , Guo Yingqiang , Jiang Yunhan
Published: September 2020

Background. SARS-COV-2 causes digestive system symptom, the effect of which remains equivocal.Methods. Patients with COVID-19 were classified into 4 groups according to symptom. The study traced the onset and duration of symptoms, compared laboratory examinations and conducted bioinformatic analysis. Immune indices were further analyzed.Results. By March 16, 25 patients with COVID-19 and 13 with suspect COVID-19 were admitted to West China Hospital, Sichuan University. Digestive system symptom group had the highest level of ESR (mm/h, P＜0.0001), serum ferritin (ng/ml, P＜0.0001), hepatic enzymes (P＜0.05), and retentive lymphocyte count/percentage (P＜0.05) and its subsets (P＜0.05). Combined group (respiratory combined with subsequent digestive system symptom) had the highest level of IL-6 (pg/ml, P=0.0046), CRP (mg/L, P=0.0004) and moderate lymphocyte depletion. Respiratory system symptom and asymptomatic groups suffered the most from lymphocyte depletion (P＜0.05). Bioinformatic analysis indicated co-expression of binding related proteins of SARS-COV-2 (ACE2, TMPRSS2 and Furin) in small intestine. CD147 was extensively expressed in alimentary tract. CTSL, PIKfyve, TPC2 and CTSB could be detected with ≥moderate expressions in a variety of organs including alimentary system.Conclusions. Alimentary system is directly attacked by SARS-COV-2 other than hyperinflammation and immune dysregulation. Involvement of alimentary system might further protect mild and moderate cases from lymphocyte depletion caused by COVID-19.
Parametric model construction of solid mechanics based on wireless environment and cloud computing mode
Authors: Jian Longji , Song Feifei , Huang Yuansong
Published: September 2020

Traditional parametric models of solid mechanics have disadvantages such as poor lightweight level of cloud data and low integrity of operations of solid mechanics. To solve the above problems, a parametric model for solid mechanics in engineering research based on cloud computing models is designed. By calculating the number of cloud data copy optimizations, the upper limit of resources required for engineering research is estimated, and the specific values is assessed by continuously cycling the demand, so as to complete the basic conflict analysis, and set up a cloud computing engineering research environment. On this basis, the modeling index is selected. By analyzing the sensitivity of the index, the purpose of optimizing the modeling parameters is achieved, and a new solid mechanics parametric model is constructed. Analyzing and contrasting the experimental data shows that after applying the parametric model of solid mechanics in the engineering research based on the cloud computing model, the lightweight level of cloud data can be increased by up to 24 levels, and the operational integrity of solid mechanics can be increased by about 30%.
Advanced Care Planning During the COVID-19 Pandemic: Ceiling of Care Decisions and Their Implications for Observational Data
Authors: Straw Sam , McGinlay Melanie , Drozd Michael , Slater Thomas A , Cowley Alice , Kamalathasan Stephe , Maxwell Nicholas , Bird Rory , Koshy Aaron O , Prica Milos , Patel Peysh A , Relton Samuel D , Gierula John , Cubbon Richard M , Kearney Mark T , Witte Klaus K
Published: September 2020

BackgroundObservational studies investigating risk factors in coronavirus disease 2019 (COVID-19) have not considered the confounding effects of advanced care planning, such that a valid picture of risk for elderly, frail and multi-morbid patients is unknown. We aimed to report ceiling of care and cardiopulmonary resuscitation (CPR) decisions and their association with demographic and clinical characteristics as well as outcomes during the COVID-19 pandemic.MethodsRetrospective, observational study conducted between 5th March and 7th May 2020 of all hospitalised patients with COVID-19. Ceiling of care and CPR decisions were documented using the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process. Unadjusted and multivariate regression analyses were used to determine factors associated with ceiling of care decisions and death during hospitalisation.ResultsA total of 485 patients were included, of whom 409 (84·3%) had a documented ceiling of care which was level one for 208 (50·9%), level two for 75 (18·3%) and level three for 126 (30·8%). CPR decisions were documented for 451 (93·0%) and 336 (74·5%) were not for resuscitation. Advanced age, frailty, White-European ethnicity, a diagnosis of any co-morbidity and receipt of cardiovascular medications were associated with ceiling of care decisions. In a multivariate model only advanced age (odds 0·89, 0·86-0·93 p<0·001), frailty (odds 0·48, 0·38-0·60, p<0·001) and the cumulative number of co-morbidities (odds 0·72, 0·52-1·0, p=0·048) were independently associated. Death during hospitalisation was independently associated with age, frailty and requirement for level two or three care.ConclusionCeiling of care decisions were made for the majority of patients during the COVID-19 pandemic, broadly in line with known predictors of poor outcomes in COVID-19, but with a focus on co-morbidities suggesting ICU admission might not be a reliable end-point for observational studies where advanced care planning is routine.
Pannexin-1 Characterization after Spinal Cord Injury in Rats
Authors: Huang Yu , Lin Jin , Chen Xuanwei , Lin Jianhua
Published: September 2020

Background

Pannexin-1 (Panx-1) is a homomeric membrane semi-channel mostly expressed in the central nervous system of mammals, including neurons and glial cells. Panx-1 channels are highly permeable to calcium and Adenosine Triphosphatase (ATP), it plays an important role in Hypoxic injury of cerebral ischemia through a variety of signal pathways, nerve cell apoptosis and inflammatory response. However, its specific role in spinal cord injury (SCI) is not clear. In the current study, we aimed to investigate the characterization of Panx-1 after SCI in rats, and further analysis were made on its effect and possible mechanism in SCI in order to provide the experimental evidence for potential interfering target spot on SCI therapy.
Methods

A rat SCI model (Allen’s model) was established by NYU Impactor-III and the hind limb motor function of rats was observed by BBB score. The expression of Panx-1 was detected by Real-time PCR and Western Blot. The correlation between Panx-1 expression and the BBB score in rats after SCI was analyzed to reveal the role of Panx-1 in SCI.
Results

We found that the BBB score gradually recovered after SCI, but declined significantly at day 2 after SCI. Real-time PCR and Western Blot detection showed that compared with the normal control group and the sham operation group, the expression of Panx-1 increased significantly with time after SCI, and reached a peak at day 2 after SCI. Moreover, there was a significant negative correlation between the expression of Panx-1 protein and the BBB score of rat hind limb motor function at day 1, day 2, day 3 and day 5 after SCI.
Conclusions

The characterization of of Panx-1 expression after SCI in rats suggests that Panx-1 had a significant effect on the motor function recovery after SCI, and it was one of the important mechanisms that aggravate the secondary injury after SCI in rats. This provided experimental basis for further exploring the potential intervention target of SCI.
Is It Possible to Define Reference Values for Radiographic Parameters Evaluating Juvenile Flatfoot Deformity? A Case-Control Study
Authors: Hamel Johannes , Hörterer Hubert , Harrasser Norbert
Published: September 2020

BackgroundNumerous radiographic parameters are described to evaluate juvenile flexible flatfeet. Reference values for these measurements are based on few studies. The purpose of this study was to determine boundary values among the most widely used radiographic measurements to evaluate juvenile flatfeet.MethodsTwenty-two patients with normal hind-, midfoot configuration (group A: control group; 22 feet, mean age: 12,1 years) and 19 patients with flatfoot deformity (group B: study group; 22 feet, mean age: 12,4 years) were retrospectively analyzed. Nine radiographic parameters were measured (Talocalcaneal-angles, Calcaneal-pitch-angle, Costa-Bartani-angle, Talo-metatarsal-I-angles, Talo-first-metatarsal-base-angle, Talo-navicular-coverage, Calcaneus-fifth-metatarsal-angle). ROC curve analysis was used to calculate optimal differentiating thresholds of each parameter.ResultsFour out of nine parameters (TC-dp, TC-lat, Calc-MTV, Calc-P) were not statistically different between the groups and their ability to distinct between normal foot and flatfoot was low (AUC values= 0,660 - 0,819). Calculation of reference values for these parameters was not performed due to threshold ranges between the groups of >10°. Reference values could be defined only for three parameters: TMTInd >(-)31°, TMTIB >(-)7,5°, TMT-lat >(-)13,5°. The TMTInd was shown to be a very reliable and valid combination of two measurements (TMTIB and TMT-lat) in the differentiation of normal feet and flatfeet (AUC=0,998).ConclusionThe calculation of reference values for established radiographic parameters used to evaluate juvenile flatfeet is difficult for most parameters. The TMTInd as a combination of TMTIB and TMT-lat has been shown to be reliable and valuable to distinct normal feet from flatfeet.
An Unusual Ectopic Thymoma in the Lung and Anterior Mediastinum: A Case Report
Authors: Meng Rui , WU Lu , LI Zhenyu , LI Qianwen , ZHU Kuikui , ZONG Yan
Published: September 2020

Background: Ectopic thymoma, a subtype of thymomas, is a rare clinical entity. Understanding the pathogenesis and evolution of Ectopic thymoma may lead to greater insight into tumor initiation and maintenance and may guide therapeutic interventions. We report a case of a multiple thymoma in the lung and anterior mediastinum.Case presentation: we presented a case of 62-year-old man with type A ectopic pulmonary thymoma and thymoma in the anterior mediastinum, which were diagnosed postoperatively. Mediastinal lesion resection and thoracoscopic pulmonary wedge resection were performed. The tumors were completely resected, and the patient was disease-free and without recurrence. we performed whole-exome sequencing (WES), and found eight gene mutations that was co-mutated in both lesions. Consistent with a previous exome sequencing analysis of Thymoma and Thymic Carcinoma, HRAS was also observed in mediastinal lesion and lung lesion tissues. We also evaluated the intratumor heterogeneity of nonsilent mutations, and the mediastinal lesion tissue has higher degree of heterogeneity in detected variants, and the pulmonary tissue has a relatively low amount of variant heterogeneity. Conclusions: Ectopic thymoma is a highly rare clinical entity. Full recognition of its Molecular characteristics will help to better diagnose this disease.
Unique Light-gated Ion Channel Properties of a Novel Modular Cation Channelrhodopsin from an Evolutionary Important Terrestrial Green Alga
Authors: Tashiro Rintaro , Sushmita Kumari , Hososhima Shoko , Sharma Sunita , Kateriya Suneel , Kandori Hideki , Tsunoda Satoshi
Published: September 2020

Channelrhodopsins are a family of microbial rhodopsins that function as a light-gated ion channel. We report the molecular properties of a novel channelrhodopsin KnRh3 from an evolutionary important filamentous terrestrial alga Klebsormidium nitens. KnRh3 is constituted of a 7-transmembrane domain, followed by a long C-terminus moiety that encodes a peptidoglycan binding domain (FimV). When functionally expressed in mammalian cells, KnRh3 showed light-induced cation channel currents. The maximum action spectrum exhibited was at 430 nm and 460 nm, the former making KnRh3 one of the most blue-shifted channelrhodopsins characterized thus far. The channel closure rate was relatively fast (τ0ff = 10 ms). Surprisingly, photocurrent kinetics were affected by the C-terminus moiety of KnRh3. When this moiety was truncated to various lengths, this prolonged the channel open lifetime by more than 10-fold. We identified two arginine residues, R287 and R291, those are crucial for altering the kinetics. We propose that electrostatic interaction between the 7-TM domain and the C-terminus domain accelerates the photocycle. The most blue-shifted action spectrum of KnRh3 serves as a novel prototype of channelrhodopsin for studying the molecular mechanism of color tuning. In addition, KnRh3 would expand the optogenetics tool kit, especially for when short wavelength excitation is required.