bluuebunny/crossref_metadata_2025 huggingface dataset:
k-root-n: An Efficient Algorithm for Avoiding Short Term Double-Spending Alongside Distributed Ledger Technologies Such as Blockchain
Authors: Schreiber Zvi
Published: January 2020

Blockchains such as the bitcoin blockchain depend on reaching a global consensus on the distributed ledger; therefore, they suffer from well know scalability problems. This paper proposes an algorithm that avoids double-spending in the short term with just O(√n) messages; each node receiving money off-chain performs the due diligence of consulting k√n random nodes to check if any of them is aware of double-spending. Two nodes receiving double-spent money will in this way consult at least one common node with very high probability, due to the ‘birthday paradox’, and any common honest node consulted will detect the fraud. Since the velocity of money in the real world has coins circulating through at most a few wallets per day, the size of the due diligence communication is small in the short term. This `k-root-n’ algorithm is suitable for an environment with synchronous or asynchronous (but with fairly low latency) communication and with Byzantine faults. The presented k-root-n algorithm should be practical to avoid double-spending with arbitrarily high probability, while feasibly coping with the throughput of all world commerce. It is resistant to Sybil attacks even beyond 50% of nodes. In the long term, the k-root-n algorithm is less efficient. Therefore, it should preferably be used as a complement and not a replacement to a global distributed ledger technology.
Russian Trial ALGORITHM: Implementation of Combined Antihypertensive and Hypolipidemic Treatment for Clinical Efficacy Achievement in Routine Clinical Practice
Authors: Napalkov D. A.
Published: January 2020

Aim. To study the clinical outcomes (achievement of target blood pressure [BP]) and tolerability of antihypertensive and hypolipidemic therapy with fixed combinations of indapamide/perindopril, amlodipine/perindopril, amlodipine/indapamide/perindopril and rosuvastatin in patients with hypertension and high/very high cardiovascular risk in real clinical practice.

Material and methods. The study included 16,788 patients from 104 cities of the Russian Federation. The duration of observation was 12 weeks. All patients had three monitoring visits. BP level was measured twice during the visits: the arithmetic mean of the obtained parameters was calculated. The results of the study were analyzed and presented by descriptive statistics.

Results. The average age of the patients was 60.6±10.2 years; 42.2% of the patients were men and 57.8% women. Patients who demonstrated systolicdiastolic hypertension (BP>140/90 mm Hg) at the initial visit accounted for 73.9% (n=12,413) of the total number of participants. The average level of systolic BP at the inclusion into the study was 162.94±13.07 mm Hg, the level of diastolic BP was 93.43±8.61 mm Hg. As expected, the Russian population consists of over 90% of patients with very high (57%; n=9,586) and high (35.9%; n=6,022) additional cardiovascular risk. Despite the fact that the overwhelming majority of patients with hypertension had a high and very high additional risk, more than a third of patients received monotherapy to control their BP level (36.8%; n=6,182), while 13.8% of patients (n=2,321) had never received antihypertensive therapy before. According to the results of therapy with combination drugs based on perindopril, 92.7% of patients managed to reach the target BP levels of <140/90 mm Hg. After treatment the average level of systolic BP decreased from 162.94±13.07 mm Hg to 127.80±7.56 mm Hg, and the level of diastolic BP – from 93.43±8.61 mm Hg to 78.54±5.59. Adherence to the treatment in more than 97% of cases was recognized as very high and high. Only 10 adverse events were recorded on a large sample of patients during 12 weeks of treatment.

Conclusion. In the Russian population, 73.9% of patients with hypertension and high/very high risk do not achieve the target BP levels. Application of combined therapy based on fixed combinations with perindopril allows achieving effective BP control in 93% of patients with hypertension having high and very high risk during 12 weeks with good tolerability of treatment.
Characteristics of Patients with Reproducible Masked Hypertension and its Diagnosis Approach
Authors: Smirnova М. I. , Gorbunov V. M. , Koshelyaevskaya Ya. N. , Deev A. D. , Volkov D. A. , Furman N. V. , Dolotovskaya P. V.
Published: January 2020

Background. Early diagnostics of masked hypertension (MH) is one of the key problems in modern cardiology due to the association of this blood pressure (BP) phenotype with doubled cardiovascular risk in comparison with normotension (NT). The current hypertension guidelines list numerous conditions, when the ambulatory BP monitoring (ABPM) is desirable in patients with normal office BP. However this list does not represent clearly defined, agreed and approved indications for ABPM as a diagnostic tool for MH.

Aim. To develop a method of MH diagnostics for the use in routine clinical practice based on the comparing characteristics of patients with reproducible MH vs NT.

Material and methods. The patients were selected from two trials that used ABPM (n=1778). The selection criteria included age 40-79 years, office BP<140/90 mm Hg, the absence of “hypertension” diagnosis or antihypertensive drug intake, and available results of two examinations (winter and summer): standard questionnaire, information about family history, chronic diseases and drug intake, height, weight, office and orthostatic BP and ABPM. We used the following definition of MH: elevated ambulatory BP (24-hour ≥130 and/or 80 mm Hg, daytime ≥135 and/or 85 mm Hg, or nighttime ≥120 and 70 mmHg) registered at both visits.

Results. In total, 153 patients with reproducible (both winter and summer) BP phenotype were included: 127 with MH, and 26 with NT (mean age 49.1Ѓ}7.8 years, 36.1% males). In multivariate analysis, reproducible MH was associated with body mass index (β2.097; p<0.0001), office diastolic BP (β2.152; p<0.0001), orthostatic systolic BP (β1.031; p<0.023) and orthostatic heart rate (β0.773; p=0.19). These parameters were used in the original “MH coefficient” formula.

Conclusions. MH is often found in patients with normal and optimal office BP and without “hypertension” diagnosis. The method described in the article helps to detect MH with high probability and define the individual indications for ABPM. The MH phenomenon in the category of patients warrants further investigation.
Glycoprotein IIb/IIIa Receptor Inhibitors in Patients with ST-Segment Elevation Myocardial Infarction and Primary Percutaneous Coronary Intervention
Authors: Tereshchenko A. S. , Merkulov Е. V. , Samko A. M.
Published: January 2020

Recently, there has been a positive trend to reduce mortality from myocardial infarction. One of the reasons for such dynamics is the development of angiographic service in our country and the increase in the number of primary percutaneous coronary interventions. One of the most serious complications of endovascular interventions affecting the prognosis is the development of the phenomenon of slow or unrecoverable blood flow (≪slow/no-reflow≫ phenomenon). The reason for the development of this phenomenon is associated, first of all, with distal embolization by thrombotic masses and fragments of atherosclerotic plaque. In order to prevent this complication, manual thromboextraction was developed – the aspiration of thrombotic masses from the infarct-related artery. The manual thrombus aspiration has not been proven effective in a number of large randomized trials. In addition to the lack of influence on the prognosis, the method of manual thrombus aspiration significantly more often led to the development of ischemic strokes and currently should not be routinely carried out. Another method of preventing the phenomenon of delayed or unrecoverable blood flow is the use of glycoprotein IIb/IIIa receptor inhibitors which is, in contrast to the instrumental method, effective and relatively safe. According to a number of large randomized trials, drug treatment of this complication influences life expectancy in patients with ST-elevation myocardial infarction. At a time when there is already a meta-analysis on the routine use of glycoprotein IIb/IIIa receptor inhibitors during primary percutaneous coronary intervention and their positive impact on survival, in our country, unfortunately, the importance of these drugs is underestimated and according to the register they are used only in 3% of patients with ST-segment elevation myocardial infarction. This review presents studies and comparisons of glycoprotein IIb/IIIa receptor inhibitors existing on the market.
Validity and Reliability of Socio-Cognitive Determinants of Water Intake Questionnaire in Kidney Stones Patients
Authors: Mirzaei-Alavijeh Mehdi , Jalilian Farzad , Fatahi Halimeh , Solaimanizadeh Laleh , Saadatfar Abdollah , Khashij Shima
Published: January 2020

Background Developing a valid and reliable questionnaire is an important step in field studies. This study aimed to evaluate the psychometric propertiesof the socio-cognitive determinants of water intake questionnaire behaviors among patients with kidney stones in the west of Iran.Methods Construct items were elicited from interviews with kidney stones patients, experts and socio-cognitive items pool-related similar questionnaires. Internal consistency, face, content, and construct validity were evaluated. Data were analyzed by SPSS (ver. 20.0).Results Based on Eigenvalues of ≥ 1.00 and factor loadings of ≥ 0.40, five determinants were extracted. The calculated Kaiser–Meyer–Olkin (KMO) value was 0.697. The socio-cognitive determinants of water intake questionnaires were found to have acceptable internal consistency (Cronbach alpha of determinants between 0.65-0.85) and the theoretical assumptions for face, content, and construct validities were confirmed. The Intra-class Correlation Coefficient (ICC) of socio-cognitive determinants was high (ICC between 0.810 - 0.911). Overall, the five studied socio-cognitive determinants explained 73.83% of the variance in the proposed model.Conclusions The socio-cognitive determinants of water intake questionnaire were revealed to have an acceptable psychometric evaluation. The questionnaire could be used to predict or explain water intake behavior in order to develop programs to increase water intake behavior among kidney stones patients.
Mediating Effects of Metacognitive Learning Strategies in the Relationship between Learning-related Emotions and Academic Self-efficacy with Academic Performance in Medical Students
Authors: Hayat Ali Asghar , Shatery Karim , Amini Mitra , Shokrpour Nasrin
Published: January 2020

Recognition of the factors affecting the medical students’ academic success is one of the most important challenges and concerns in medical schools. Hence, this study aimed to investigate the mediating effect of metacognitive learning strategies in the relationship between learning-related emotions and academic self-efficacy with academic performance in medical students. Methods: The present study was carried out on 279 students of medicine studying in Shiraz University of Medical Sciences. The students filled out three questionnaires: academic emotions (AEQ), metacognitive learning strategies, and academic self-efficacy questionnaires. The data were analyzed using SPSS and Smart PLS3. Results: The results of structural equation modeling revealed that the students’ self-efficacy has an impact on their positive emotions and metacognitive learning strategies, and these in turn affect the students’ academic performance. Moreover, positive emotions influence the metacognitive learning strategies which in turn mediate the effect of positive emotions on the academic performance.Discussion: The results of this study revealed that metacognitive strategies can play a mediating role in the students’ self-efficacy, positive emotions, and academic performance. Therefore, in case we can strengthen the students’ self-efficacy and their positive academic emotions, their performance will improve. Keywords: Academic self-efficacy, learning related emotions, metacognitive strategies, academic performance, medical students
The significance of resilience in mental health promotion of marriage immigrant women: A qualitative study of factors and processes
Authors: Jo Yeonjae
Published: January 2020

Background: This study explores a series of processes in which marriage immigrant women achieve positive mental health status after experiencing various marriage- and migrant-related difficulties through the framework of resilience theory. As marriage immigrant women face greater barriers to public health services than non-immigrant women, it is necessary to understand the related factors, process, and context to address these barriers and strengthen available assets. Methods: A qualitative case study design was used with the phenomenological approach. Eleven mental health promotion program managers and twelve marriage immigrant women from who experienced resilience were recruited from four public-funded multicultural community centers in Seoul and Gyeonggi-do, South Korea, between December 2015 and March 2016. Using data from in-depth semi-structured face-to-face interviews, the author applied theme analysis informed by the resilience theory in order to identify factors that affect resilience and its development process. Results: Findings indicated that the process of resilience follows enduring difficulties, collapse of stability, access to professional help, professional and social support, and experience of growth. A combination of the staged process of growth, absence of partner support, children as a driving force for change, the need for economic activity, factors affecting difference in growth: satisfaction levels of women’s need for recognition, respect, and reward, and level of spousal support were identified as factors affecting marriage immigrant women’s resilience. Conclusions: Spouses, children, and economic activity play key roles in resilience in positive and negative ways. The existing information barrier should be addressed at a structural level to improve the mental health of marriage immigrant women, and the optimum time for intervention is suggested within two years post-migration. Efforts to build supportive relationships with Korean spouses and meet the women’s needs for recognition, respect, and reward may also help promote these women’s resilience. Keywords: marriage immigrant women; women’s health; mental health; access to service; resilience theory; qualitative research
Endogenous endophthalmitis caused by group B streptococcus; case reports and review of 35 reported cases
Authors: Yoshida Masaaki , Yokokura Shunji , Nishida Takashi , Mochizuki Kiyofumi , Suzuki Takashi , Maruyama Kazuichi , Otomo Takaaki , Nishiguchi Koji M , Kunikata Hiroshi , Nakazawa Toru
Published: January 2020

Background: Group B streptococcus (GBS), a gram-positive coccus that occasionally causes neonatal sepsis or invasive infection in the elderly, has been considered a rare cause of endogenous bacterial endophthalmitis (EBE). However, the number of invasive GBS infections is increasing, particularly in elderly patients with underlying conditions such as diabetes mellitus (DM), cardiovascular disease and cancer. We report 6 cases of EBE caused by GBS and review the literature. Methods: Retrospective case series and literature review Results: In the current case series, 6 eyes of 6 patients developed EBE caused by GBS. The average age was 73.5 years. The focus of infection included the urinary tract, cellulitis, arthritis, peritonitis, catheter-associated infection and endocarditis. Four patients had DM. While all 6 strains were sensitive to β-lactams (penicillins and cephems), 4 strains were resistant to levofloxacin (no data for 1 isolate). Each case was treated with the systemic antibiotic to which the individual strain was sensitive. All cases showed poor visual acuity at presentation (decimal visual acuity: less than 0.03). Vitrectomy with intravitreal antibiotics injection was performed in 4 cases. Visual acuity recovered in 4 cases and did not recover in 2 cases, even after vitrectomy. The literature review of 53 eyes of 41 patients revealed that 60% of eyes finally lost all vision, and death occurred in 2 cases. Initial visual acuity of less than counting fingers was associated with a final outcome of lost vision. Of 41 patients, 13 (32%) had DM as an underlying medical condition. The most common extra-ocular infection site was endocarditis (37%). Conclusions: DM is common in patients with EBE caused by GBS. While the 4 cases in the current report had a relatively good visual acuity outcome, despite poor initial visual acuity, the literature review indicated that EBE caused by GBS is generally a severe condition with a poor prognosis. The current study also indicates the importance of considering the possibility of endocarditis on encountering EBE caused by GBS.
Evaluation of dialysis centres: Values and criteria of the stakeholders
Authors: Parra Eduardo , Arenas María Dolores , Luis María José Fernandez-Reyes , Forcén Angel Blasco , Alvarez-Ude Fernando , Joven Juan Aguarón , Casas Alfredo Altuzarra , Moreno-Jiménez José María
Published: January 2020

Bacground Evaluation of renal replacement therapy with haemodialysis is essential for its improvement. However, the methods used have important epistemological limitations. The present study aimed to determine the opinions and preferences of stakeholders (patients, clinicians, and managers) and establish their relative importance to facilitating an adequate evaluation. Methods Successive working groups (WGs) were established using a multicriteria methodology. WG1 created a draft of criteria and sub-criteria, WG2 agreed, and WG3 was composed of three face-to-face subgroups (WG3-A, WG3-B, and WG3-C) that weighted them using two methodologies: weighting sum (WS) and analytic hierarchy process (AHP). Subsequently, they determined a preference for the WS or AHP results. Finally, via the Internet, WG4 weighted the criteria and sub-criteria by the method preferred by WG3, and WG5 analysed the results. Results WG1 and WG2 identified and agreed on the following evaluation criteria: evidence-based variables (EBVs), annual morbidity, annual mortality, PROMs, and PREMs. The EBVs consisted of five sub-criteria: type of vascular access, dialysis dose, haemoglobin concentration, ratio of catheter bacteraemia, and bone mineral disease. The patients rated the PROMs with greater weight than the other stakeholders in both face-to-face WG3 (WS and AHP) and WG4 via the Internet. The type of vascular access was the most valued sub-criterion. A performance matrix of each criterion and sub-criterion is presented as a reference for assessing the results based on the preferences of the stakeholders. Conclusions The use of a multicriteria methodology allows the relative importance of the indicators to be determined, reflecting the values of the different stakeholders. In a performance matrix, the inclusion of values and intangible aspects in the evaluation could help in making clinical and organizational decisions.
Gene Loss and Evolution of the Plastome
Authors: Mohanta Tapan Kumar , Khan Adil , Khan Abdul Latif , Hashem Abeer , Abd_Allah Elsayed Fathi , Al-Harrasi Ahmed
Published: January 2020

Chloroplasts are unique organelles within plant cells and are ultimately responsible for sustaining life forms on the earth due to their ability to conduct photosynthesis. Multiple functional genes within the chloroplast are responsible for a variety of metabolic processes that occur in the chloroplast. Considering its fundamental role in sustaining life on earth, it is important to identify the level of diversity present in the chloroplast genome, what genes and genomic content have been lost, what genes have been transferred to the nuclear genome, duplication events, and the overall origin and evolution of the chloroplast genome. Our analysis of 2511 chloroplast genomes indicated that the genome size and number of CDS in the chloroplasts of algae are higher relative to other lineages. Approximately 10.31% of the examined species have lost the inverted repeats (IR) that span across the lineages that comprise algae, bryophytes, pteridophytes, gymnosperm, angiosperms, magnoliids, and protists. Genome-wide analyses revealed that the loss of the Rbcl gene in parasitic and heterotrophic plant species occurred approximately 56 Ma ago. PsaM, Psb30, ChlB, ChlL, ChlN, and Rpl21 were found to be characteristic signature genes of chloroplast genome of algae, bryophytes, pteridophytes, and gymnosperms; while none of these genes were found in the angiosperm or magnoliid lineage which appeared to have lost them approximately 203-156 Ma ago. A variety of chloroplast encoding genes were lost across different species lineages throughout the evolutionary process. The Rpl20 gene, however, was found to be the most stable and intact gene in the chloroplast genome and was not lost in any of the analysed species; suggesting that it is a signature gene of the plastome. Our evolutionary analysis indicated that chloroplast genomes evolved from multiple common ancestors ~1293 Ma ago and have undergone vivid recombination events across different taxonomic lineages. Additionally, our findings support the hypothesis that these recombination events are the most probable cause behind the dynamic loss of chloroplast genes and inverted repeats in different species.
Abnormal Cisatracurium Pharmacodynamics and Pharmacokinetics among Patients with Severe Aortic Regurgitation during Anesthetic Induction
Authors: Huang Xiaocong , Chen Lei , Cai Yujing , Wei Jinfeng , Lin Lina , Sun Jie , Peng Xuemei , Wang Sheng
Published: January 2020

Background This study was designed to examine whether severe aortic regurgitation will affect the pharmacodynamics (PD) and pharmacokinetics (PK) of cisatracurium during anesthetic induction.
Methods A total of 32 patients were divided into two groups: the AR group (n=16) and the control group (n=16). Arterial blood samples were drawn before and at 1, 2, 4, 6, 8, 10, 16 and 20 minutes after intravenous injection of 0.15mg/kg cisatracurium. TOF tests were applied to determine the onset time of maximal muscle relaxation. The concentration of cisatracurium in plasma was determined by high-performance liquid chromatography.
Results The onset time to maximal neuromuscular block was prolonged from 2.07(0.08) minutes to 4.03±0.14 minutes, which indicated that the PD responses to cisatracurium were significantly delayed in the AR group (P<0.05) compared to the control group.
A conventional two-compartment PK model showed a higher plasma concentration of cisatracurium among the AR group with markedly reduced intercompartment transfer rate (K12= 0.19±0.02 and K21= 0.11±0.01 in the AR group vs. K12=0.26±0.01 and K21= 0.19±0.01 in the control group, P<0.01) compared to the control group.
Conclusion Backward blood flow during diastole in severe AR impaired distribution of cisatracurium from the central compartment to the peripheral compartment, which accounted for the lagged PD responses.Findings in this study underlie the importance of muscular blockade monitoring among patients with severe aortic regurgitation during anesthetic induction.
Comparison of hierarchical EMAX and NDLM models in dose-response for early phase clinical trials
Authors: Gajewski Byron , Huang Xiaqing
Published: January 2020

Phase II clinical trials are primarily aimed to find the optimal dose and investigate the relation between dose and efficacy relative to standard of care (control). Therefore, before moving forward to phase III confirmatory trial, the most effective dose is needed to be identified. The primary endpoint of phase II trial is typically a binary endpoint of success or failure. The EMAX model, ubiquitous in pharmacology research, was fit for many compounds and described the data well, except for a single compound, which had nonmonotone dose–response (Thomas et al., 2014). To mitigate the risk of nonmonotone dose response one of the alternative options is Bayesian hierarchical EMAX model (Gajewski et al., 2019). The hierarchical EMAX is a Proteus dose-response model, it adapts to its environment. When dose-response is monotonic it enjoys efficiency of EMAX. When dose-response is non-monotonic the additional random effect hyperprior makes the hierarchical EMAX model more adjustable and flexible. However, the normal dynamic linear model (NDLM) is a useful model to explore dose-response relation in that the efficacy at the current dose depends on the efficacy of the previous dose(s). Previous research has compared the EMAX to the hierarchical EMAX (Gajewski et al., 2019) and the EMAX to the NDLM (Liu et al., 2017), however, the hierarchical EMAX has not been directly compared to the NDLM. The focus of this paper is to compare these models and discuss the relative merit for each of their uses for an ongoing early phase dose selection study.
Worse treatment response to neoadjuvant chemoradiotherapy in young patients with locally advanced rectal cancer
Authors: Zhang Yiyi , Xu Meifang , Wu Yong , Li Shoufeng , Liu Xing , Guan Guoxian
Published: January 2020

Background To evaluate the impact of age on the efficacy of neoadjuvant chemoradiotherapy (NCRT) in patients with locally advanced rectal cancer (LARC) and explore the underlying mechanism.Method LARC patients undergoing NCRT and radical surgery from 2011 to 2018 were divided into young (<40 years) and old (≥40 years) groups. Multivariate analyses were performed to identify predictive factors for pathological complete response (pCR). Predictive nomograms and decision curve analysis were used to compare the models including/excluding age groups. Immunohistochemical analysis was performed to detect CD133 expression in LARC patients.Result A total of 901 LARC patients were analyzed. The young group was associated with poorly differentiated tumors, more metastatic lymph nodes, higher perineural invasion, and a lower tumor regression grade (P = 0.008; P < 0.001; P < 0.001; P = 0.003). Logistic regression analysis demonstrated that age <40 years (HR = 2.190, P = 0.044), tumor size (HR = 0.538, P < 0.001), pre-NCRT cN stage (HR = 0.570, P = 0.036), and post-NCRT CEA level (HR = 0.877, P = 0.001) were significantly associated with pCR. Predictive nomograms and decision curve analysis demonstrated that the predictive ability of models including the age group was superior to that of models excluding the age group. Higher CD133 expression was more common in young LARC patients.Conclusion Young patients with LARC were associated with lower pCR rates following NCRT. The ability of the predictive model was greater when based on the age group. Young LARC patients were associated with a higher CD133+ tumor stem cell burden, which contributed to the lower pCR rates.
Hospital readmission and mortality: associations to a hospital frailty risk score in a national sample of US older adults with pre-existing coronary heart disease, an observational study.
Authors: Davis-Ajami Mary Lynn , Chang Pei-Shuin , Wu Jun
Published: January 2020

Background Coronary heart disease (CHD) is the most common form of heart disease and a leading cause of death in cardiovascular disease (CVD). Although frailty has been studied in CVD, a condition encompassing heart disease and stroke, frailty in hospitalized elders with CHD is under researched. The study aimed to examine how a Hospital Frailty Risk Score (HFRS) influenced readmission and in-hospital mortality rates in older patients with CHD.Methods Adults > 65 years with pre-existing CHD identified by ICD-10-CM codes from the 2016 Nationwide Readmissions Database (NRD) were included in the study. Frailty risk was determined using a validated Hospital Frailty Risk Score (HFRS) based on ICD-10-CM codes. Readmission was defined as a) any subsequent inpatient readmission and b) 30-day readmission after an index event. In-hospital mortality was measured as death during index event, any readmission death, and death during a 30-day readmission.Results Frailty risk was identified in 92.4% of the 1.09 million eligible adults with CHD. Readmission and in-hospital mortality rates were higher in frail patients. Compared to the non-frail, patients with low, intermediate, and high frailty risk showed 27% vs 28%, 47% vs 49%, and 42% vs 49% greater risk for readmission and 30-day readmission, respectively. Patients with intermediate and high frailty risk were 2.31 and 3.44 times more likely to die during the index events, 2.15 and 2.44 times more likely to die during readmission, and 2.26 and 2.68 times more likely to die during 30-day readmission.Conclusion Readmission and mortality rates increased proportionally to the level of frailty risk in older adults with CHD. CHD, frailty, and older age together profoundly impact patients’ health outcomes in negative ways and places patients at a higher risk of mortality and readmission rate than non-frail patients. Further research should investigate interventions to improve frailty risk in CHD.
Psychosocial resources in middle-aged and older adults with complex health care needs: results of a qualitative study
Authors: Maatouk Imad , Wilke Stefanie , Böhlen Friederike , Nikendei Christoph , Schöttker Ben , Herzog Wolfgang , Wild Beate
Published: January 2020

Background Older adults with multiple chronic somatic diseases are challenged by mental comorbidities and social environmental changes resulting in complex bio-psychosocial healthcare needs. Comparatively few studies have addressed the coping strategies and resources of this highly vulnerable group. This study used the INTERMED interview method as a basis to investigate the resources of home-dwelling older adults with complex health care needs. Methods Following a randomized controlled trial this qualitative study analyzed detailed notes taken by a trained psychosomatic doctor during 24 interventional supportive counseling home visits. The randomized controlled trial participants were recruited from the ESTHER cohort study, a population-based study of older adults conducted in the state of Saarland, Southwest Germany. Patients with complex health care needs identified with the INTERMED interview received the supportive counseling home visit intervention, which followed the principles of narrative-based medicine and explored the personal resources of the participants. Notes from 24 supportive counseling home visits were analyzed using thematic content analysis. Results The qualitative analysis from 24 home visits identified 387 single codes, from which two main categories and 14 subcategories were derived. Participants with complex health care needs named currently available present resources and personal/long-lasting resources representing the main categories. Eight main categories were derived within the field of currently available resources that were deemed helpful to cope with the actual situation. Personal/long-lasting resources comprise statements that reflect personal experiential and attitudinal resources gained through socialization and internalization of interpersonal experiences. Conclusion The highly vulnerable group of complex patients reported many social, personal and structural resources that play significant roles in helping them to deal with their current situation. Home care professionals need skills to recognize and use the many different potential resources each client is able to access, which could enhance their well-being.
Management of Severe Hand, Foot and Mouth Disease in Xiangyang, China from 2008-2013.
Authors: Liu Jian , Qi Jing
Published: January 2020

Therapeutic strategies for severe hand, foot and mouth disease (HFMD) are currently either inconsequent or deficient in evidence. We retrospectively surveyed HFMD outbreaks in Xiangyang from June 2008 to December 2013. FHMD is staged form I to V according to clinical severity and the case with central nervous system involvement is defined as a severe one. Most severe cases were investigated to analyse risk factors for fatality and to compare the efficiency and outcome of some therapies by binary logistic regression. The overall HFMD cases included 637 (1.26%) severe cases, 38 fatal cases (0.75‰). Analysis indicates that age (<3 y), enterovirus 71 (+), autonomic nervous system dysregulation, pulmonary edema/hemorrhage, CRP (>40 mg/L) and cardiac troponin I (>0.04 ng/mL) are risk factors for fatality (all P < 0.05). Intravenous immunoglobulin (IVIG) and mechanical ventilation applied in early stage IV significantly improved HFMD progression (both P < 0.05) with odds ratios of 0.24 (95% CI: 0.10-0.57) and 0.01 (95% CI: 0.00-0.10), respectively. Methylprednisolone and milrinone administered in any stage, and all therapies applied in stage III made no significant difference on mortality (all P > 0.05). Precise recognition of the severe HFMD cases in early stage IV and timely IVIG and mechanical ventilation application may decrease mortality. Mechanical ventilation training programs and dispatching specialists to county-level or district hospitals when there is no chance for severe HFMD cases to be transferred to superior hospitals are two key successful administrative initiatives.
Relationships of Accelerometer-based Measured Objective Physical Activity and Sedentary Behaviour with Cognitive Function: A Comparative Cross-sectional Study of China’s Elderly Population
Authors: Wu Zhi jian , Wang Zhu ying , Hu Bing qian , Zhang Xu hui , Zhang Fan , Wang Hou lei , Li Fang hui
Published: January 2020

This study aims to explore the effects of physical activity and sedentary behaviour on the decline of cognitive ability among the elderly. It uses objective measures to compensate for the limitations of self-reported physical activity. A cross-sectional survey of 308 people aged over 60 in Nanjing, China, was conducted. Physical activity was measured using the ActiGraph GT3X+, and cognitive function was measured using the Montreal Cognitive Assessment (MoCA). The overall participant model, adjusted for age, BMI, education, and monthly average income found that light physical activity (LPA; β=0.006, p<0.01), moderate-vigorous physical activity (MVPA; β=0.068, p<0.001), and total physical activity (β=0.006, p<0.01) had a significant linear relationship with cognitive ability, while sedentary time (SED) did not (β=-0.020, p＞0.05). Further, LPA only affects the cognitive ability of elderly females (β=0.006, p<0.05). In addition, there was an inverted ‘U’ dose-response relationship between MVPA and cognitive ability. Dose-effect relationship models found that MVPA in the 22.13 min·day–1～38.79 min·day–1 range affected cognitive ability most beneficially. The beta coefficient was higher than the other three groups (β=0.091, p<0.05). In conclusion, while physical activity can significantly improve cognitive ability among the elderly, sedentary behaviour has no significant effect on it.
Hearing loss and cognitive function among Chinese older adults: The role of participation in leisure activities
Authors: Gao Jiamin , Armstrong Nicole M. , Deal Jennifer A. , Lin Frank R. , He Ping
Published: January 2020

BackgroundHearing loss, a highly prevalent sensory impairment affecting older adults, is a risk factor for cognition decline. However, there were very limited studies on this association in low-resource countries. This study aimed to assess whether having hearing loss were associated with cognitive decline and engagement in leisure activities modified this association among Chinese elderly.MethodsUsing data from the nationally representative survey of China Longitudinal Healthy Longevity Survey (CLHLS) between 2011-2014, 9,710 individuals aged 65 years old or above with self-reported measures of hearing status and global cognition, as measured by the Modified Mini Mental Examination (MMSE), were included in this study. Fixed-effects models were used to estimate whether leisure activity engagement moderated the association of self-perceived hearing loss with global cognitive change in the overall sample and by sex.ResultsPeople with self-reported hearing loss was associated with cognitive impairment, with an odds ratio of 2.48 [1.22, 5.06]. Sex difference on the association of hearing loss and cognitive impairment was not found. Self-reported hearing loss was associated with cognitive function decline with 8% [-1.22, -0.39] increase in risk compared with those with normal hearing. Frequent engagement in leisure activities moderated the association between hearing loss and cognition. Actively participating in leisure activities modified the relationship between hearing loss and cognitive decline in males, while leisure activity engagement did not modify any associations among females.ConclusionHearing loss was associated with cognitive decline, and leisure activities engagement moderated the association among males rather than females.
ATP hydrolysis determines cold tolerance in rice by regulating available energy for glutathione synthesis
Authors: Yu Pinghui , Jiang Ning , Fu Weimeng , Zheng Guangjie , Li Guangyan , Feng Baohua , Chen Tingting , Ma Jiaying , Li Hubo , Tao Longxing , Fu Guanfu
Published: January 2020

Background Glutathione (GSH) is important for plants to resist against abiotic stress, and a large amount of energy is required in the process. However, it is not clear how the energy status affects the accumulation of GSH in plants under cold stress. Results Two rice genotypes, Zhongzao39 (ZZ39) and its recombinant inbred line 82 (RIL82) were subjected to cold stress for 48 h. Under cold stress, RIL82 suffered more damages than ZZ39 plants, in which the latter had higher increases in APX activity and GSH content than the former compared with their respective controls. This indicated that GSH was mainly responsible for the different cold tolerance between these two rice plants. Interestingly, under cold stress, greater increases in contents of carbohydrate, NAD(H), NADP(H) and ATP as well as the expression levels of GSH1 and GSH2 were showed in RIL82 than ZZ39 plants. In contrast, ATPase activity in RIL82 plants was adversely inhibited by cold stress while it significantly increased in ZZ39 plants. This indicated that cold stress reduced the accumulation of GSH in RIL82 plants mainly due to the inhibition on ATP hydrolysis rather than energy deficit. Conclusion We inferred that the energy status determined by ATP hydrolysis involved in regulating the cold tolerance of plants by controlling GSH synthesis.
Blocking Pins Instead of Blocking Screws in the Treatment of Distal Tibial Fractures with Intramedullary Nail
Authors: Bai Xiaodong , Song Zhaohui , Yao Shuangquan , Liu Song , Ma Lijie , Ren Pengcheng , Wang Pengcheng , Wu Haotian
Published: January 2020

Background: Distal tibial fractures have a high risk of malalignment when treated with intramedullary nails. The use of blocking screws can aid in achieving satisfactory alignment. The aim of this study was to compare the clinical and radiographic outcomes of temporary blocking pins with those of blocking screws for distal tibial fractures. Methods: From June 2011 through November 2018, a total of 90 patients with distal tibial fractures were enrolled in this prospective randomized controlled study. The patients were randomly received either blocking pins or blocking screws reduction during nailing. After reduction, 5 points at the distal fragment were effectively fixed. Results: The operating time in the BP group was 73.77±6.25 min, which was significantly shorter than 80.05±8.51 min in the BS group (P<0.001). The time to healing in the BP group was shorter than that in the BS group (18.52±4.57 vs. 21.51±3.17 weeks; P=0.001). The coronal and sagittal plane deformities at any time points were comparable (all P＞0.05). During the 12-month follow-up period, patients had an average change in the coronal plane of 1.34 degrees in the BP group and 1.00 degrees in the BS group (P=0.120), as well as an average change in the sagittal plane of 1.09 degrees and 0.81 degrees (P=0.110), respectively. Malunion was seen in two patients (5%) in the BP group and one patient (2%) in the BS group ( P＞0.05). Conclusion: The blocking pins can help achieve satisfactory alignment for distal tibial fractures during nailing. Intramedullary nails without blocking screws can afford adequate stability to maintain the reduction during the healing process when an effective five-point anchoring fixation is achieved.
Clinical effects of dynamic stabilization with far cortical locking system in the treatment of simple distal-third tibia fractures: A cohort study
Authors: Peng Jing , Fan Jun , Li Yang , Long Xiaotao , Chen Shiyang , Ren Huanhuan
Published: January 2020

Background: Locked plating constructs provided rigid fixation and may suppress callus formation at the fracture site, while far cortical locking (FCL) constructs have been shown to reduce the stiffness, thereby promoting fracture healing. A few publications have demonstrated that FCL construct increased axial dynamization and improved fracture healing. However, it is unclear whether the FCL construct was superior over locked plating construct for treating simple tibia fractures. Thus, we aimed to compare the clinical effect of FCL construct and locked plating construct for these fracture types.Methods: We retrospectively analyzed 18 patients treated with locked plating (control group) and 22 patients treated with the FCL construct (FCL group) from January 2016 to January 2018; the simple distal-third tibia fractures were included (AO/OTA classification: 42A1-A3 or 43A1). Patients were followed up regularly at 1, 2, 3, 6, and 12 months postoperatively, and data from clinical and radiological examinations were obtained. Patients’ demographics, operative time, time to radiological fracture union, time to full weight bearing, callus index, radiographic union score in tibia (RUST), and surgery-related complications were analyzed between the two groups.Results: The baseline patients’ demographics were similar between the two groups (P>0.05). There were no significant differences in of the operative time, time to radiological fracture union, or time to full weight bearing (P>0.05). However, the median callus index was 1.15 (IQR=1.08–1.25) in the FCL group and 1.09 (IQR=1.00–1.14) in the control group, showing a significant difference between the two groups (Z=-2.35, P<0.05), and the RUST was significantly higher at 2 months postoperatively (6.50±0.92 vs 7.59±1.37, P =0.006). Seven out of 18 patients in the control group and 2 out of 22 patients in the FCL group had no callus formation (callus index=1.0). All patients ultimately healed, and the complication rates were similar between the two groups.Conclusions : The FCL construct could promote fracture healing and was superior to locked bridge plating, as it did not lead to more surgery-related complications. Level of Evidence : Ⅲ, retrospective cohort study
Inhibition of Stat3 Phosphorylation Attenuates Impairments in Learning and Memory in 5XFAD Mice, an Animal Model of Alzheimer’s Disease
Authors: Choi Moonseok , Kim Hyunju , Yang Eun-Jeong , Kim Hye-Sun
Published: January 2020

The novel functions of astrocytes under normal conditions have been extensively investigated in terms of synaptogenesis and memory formation. Meanwhile, the pathophysiological roles of astrocytes in the reactive state are thought to have important significance in the pathogenesis of neurodegenerative diseases, including Alzheimer’s disease (AD). However, the detailed mechanisms underlying the transition of astrocytes from the resting state to the reactive state during neurodegenerative disease largely remain to be defined. Here, we investigated the pathways involved in activating astrocytes from the resting state to the reactive state in primary cultured astrocytes treated with oligomeric Aβ and in the hippocampus of 5XFAD mice, an animal model of AD. Treatment with oligomeric Aβ induced an increase in reactive astrocytes, as assessed by the protein level of glial fibrillary acidic protein (GFAP), a marker of reactive astrocytes and this increase was caused by STAT3 phosphorylation in primary cultured astrocytes. The administration of Stattic, an inhibitor of STAT3, rescued the activation of astrocytes in primary cultured astrocytes and in the hippocampus of 6-month-old 5XFAD mice as well as impairments in learning and memory. Collectively, these results demonstrated that reactive astrocytes in the AD brain are induced via STAT3 phosphorylation and that the increase in reactive astrocytes and the impairments in learning and memory observed in 5XFAD mice are rescued by STAT3 inhibition, suggesting that the inhibition of STAT3 phosphorylation in astrocytes may be a novel therapeutic target for cognitive impairment in AD.
Resistance Training Alleviates Skeletal Muscle Atrophy in Rats Exposed to Hypoxia by inhibiting Autophagy Mediated by Acetyl-FoxO1
Authors: FU Pengyu , Zhaowei KONG , Lijing GONG , Holmberg Hans-Christer , Yanchun LI , Jiabei YU , Rongxin ZHU , Jie JIA , Yang HU
Published: January 2020

Background: Skeletal muscle atrophy induced by hypoxia could affect the physical fitness and training effect of the athletes in the rapid altitude, and also affect the production and life of the general public. Resistance training in a hypoxic environment could effectively alleviate the occurrence of muscular atrophy. Whether autophagy lysosomal pathway, as an important proteolysis pathway, is involved in this process, and whether FoxO1, the key gene of atrophy, plays a role by regulating autophagy is unclear. Methods: Male Sprague-Dawley (SD) rats were randomly divided into normoxic control group (group C), normoxic resistance-training group (group R), hypoxic control group (group H), and hypoxic resistance-training group (group HR). The H and HR groups were exposed to 12.4% oxygen for four weeks. The R and HR groups underwent incremental loaded training by climbing a ladder every other day for four weeks. Results: Compared to parameters in group H, resistance training increased lean body mass (LBM) and wet weight and decreased the expression of atrogin1 of the extensor digitorum longus (EDL) after four weeks ( P <0.05). Resistance training decreased the levels of FoxO1 and Ac-FoxO1 and the extent of their localization in the nucleus and cytoplasm, respectively ( P <0.05), as well as the LC3II/LC3I ratio, the integrated optical density (IOD) of LC3 and the levels of autophagy-related gene 7 (Atg7), and elevated the levels of sequestosome 1 (SQSTM1/p62) ( P <0.05). Most differentially expressed autophagy-related genes (ATGs) interacted with FoxO1, and the functions of these ATGs were mainly enriched in the early autophagy phase. Conclusions: Our findings demonstrate that resistance training lowers the levels of both nuclear FoxO1 and cytoplasmic Ac-FoxO1, as well as reduced autophagic flux in the EDL of rats exposed to hypoxia.