bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular surveillance of antimalarial drug resistance in the Democratic Republic of Congo: high variability of chloroquinoresistance and lack of amodiaquinoresistance
Authors: Yobi Doudou Malekita , Kayiba Nadine Kalenda , Mvumbi Dieudonné Makaba , Boreux Raphael , Kabututu Pius Zakayi , Situakibanza Hippolyte Nani-Tuma , Likwela Joris Losimba , De Mol Patrick , Okitolonda Emile Wemakoy , Speybroeck Niko , Mvumbi Georges Lelo , Hayette Marie-Pierre
Published: February 2020

Background The loss of chloroquine (CQ) effectiveness has led to its withdrawal from national policies as a first-line treatment for uncomplicated malaria in several endemic countries, such as the Democratic Republic of Congo (DRC). The K76T mutation on the pfcrt gene has been identified as a marker of CQ resistance and the SVMNT haplotype in codons 72–76 on the same gene has been associated with resistance to amodiaquine (AQ). In the DRC, the prevalence of K76T has decreased from 100% in 2000 to 63.9% in 2014. The purpose of this study was to determine the prevalence of K76T mutations in circulating strains of P. falciparum , sixteen years after CQ withdrawal in the DRC and to investigate the presence of the SVMNT haplotype. Methods In 2017, ten geographical sites across the DRC were selected. Dried blood samples were collected from patients attending health centres. Malaria was first detected by a rapid diagnostic test (RDT) available on site (SD Bioline Malaria Ag P.f or CareStart Malaria Pf ) or thick blood smear and then confirmed by a P. falciparum species-specific real-time PCR assay. A pfcrt gene segment containing a fragment that encodes amino acids at positions 72-76 was amplified by conventional PCR before sequencing. Results A total of 1070 patients were enrolled. Of the 806 PCR-confirmed P. falciparum positive samples, 764 were successfully sequenced. The K76T mutation was detected in 218 samples (28.5%; 95% CI: 25.4%–31.9%), mainly (96%) with the CVIET haplotype. Prevalence of CQ resistance marker was unequally distributed across the country, ranging from 1.5% in Fungurume to 89.5% in Katana. The SVMNT haplotype, related to AQ resistance, was not detected. Conclusion Overall, the frequency of the P. falciparum CQ resistance marker has decreased significantly and no resistance marker to AQ was detected in the DRC in 2017. However, the between regions variability of CQ resistance remains high in the country. Further studies are needed for continuous monitoring of the CQ resistance level for its prospective re-use in malaria management. The absence of the AQ resistance marker is in line with the use of this drug in the current DRC malaria treatment policy.
Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)
Authors: Muddu Martin , Tusubira Andrew K. , Nakirya Brenda , Nalwoga Rita , Semitala Fred C. , Akiteng Ann R. , Schwartz Jeremy I , Ssinabulya Isaac
Published: February 2020

Background: Persons Living with HIV (PLHIV) receiving antiretroviral therapy have increased risk of cardiovascular disease (CVD). Integration of services for hypertension (HTN), the primary CVD risk factor, into HIV clinics is recommended in Uganda. Our prior work demonstrated multiple gaps in implementation of integrated HTN care along the HIV treatment cascade. In this study, we sought to explore barriers to and facilitators of integrating HTN screening and treatment into HIV clinics in Eastern Uganda. Methods: We conducted a qualitative study at three HIV clinics with low, intermediate, and high HTN care cascade performance, which we classified based on our prior work. Guided by the Consolidated Framework for Implementation Research (CFIR), we conducted semi-structured interviews and focus group discussions with health services managers, health care providers and hypertensive PLHIV (n=83). Interviews were transcribed verbatim. Three qualitative researchers used the deductive (CFIR-driven) method to develop relevant codes and themes. Ratings were performed to determine valence and strengths of each CFIR construct regarding influencing HTN/HIV integration. Results: Barriers to HTN/HIV integration arose from six CFIR constructs: organizational incentives & rewards, available resources, access to knowledge & information, knowledge & beliefs about the intervention, self-efficacy and planning. The barriers include: lack of functional BP machines, inadequate supply of anti-hypertensive medicines, additional workload to providers for HTN services, PLHIV’s inadequate knowledge about HTN care, sub-optimal knowledge, skills and self-efficacy of healthcare providers to screen and treat HTN and inadequate planning for integrated HTN/HIV services. Relative advantage of offering HTN and HIV services in a one-stop centre, simplicity (non-complex nature) of HTN/HIV integrated care, adaptability and compatibility of HTN care with existing HIV services are the facilitators for HTN/HIV integration. The remaining CFIR constructs were non-significant regarding influencing HTN/HIV integration. Conclusion: Using the CFIR, we have shown that while there are modifiable barriers to HTN/HIV integration, HTN/HIV integration is of interest to patients, healthcare providers and managers. Improving access to HTN care among PLHIV will require overcoming barriers and capitalizing on facilitators using a health system strengthening approach. These findings are a springboard for designing contextually appropriate interventions for HTN/HIV integration in low- and middle-income countries.
Highly-selective μ-opioid receptor antagonism does not block L-DOPA-induced dyskinesia in a rodent model
Authors: Bartlett Mitchell J. , So Lisa Y. , Szabò Lajos , Skinner David P. , Parent Kate L. , Heien Michael L. , Vanderah Todd W. , Polt Robin , Sherman Scott J. , Falk Torsten
Published: February 2020

Objectives Dopamine-replacement utilizing L-DOPA is still the mainstay treatment for Parkinson’s disease (PD), but often leads to development of L-DOPA-induced dyskinesia (LID), which can be as debilitating as the motor deficits. There is currently no satisfactory pharmacological adjunct therapy. The endogenous opioid peptides enkephalin and dynorphin are important co-transmitters in the direct and indirect striatofugal pathways and have been implicated in genesis and expression of LID. Opioid receptor antagonists and agonists with different selectivity profiles have been investigated for anti-dyskinetic potential in preclinical models. In this study we investigated effects of the highly-selective μ-opioid receptor antagonist CTAP (>1,200-fold selectivity for μ- over δ-opioid receptors) and a novel glycopeptide congener (gCTAP5) that was glycosylated to increase stability, in the standard rat LID model. Results Intraperitoneal administration (i.p.) of either 0.5 mg/kg or 1 mg/kg CTAP and gCTAP5 completely blocked morphine’s antinociceptive effect (10 mg/kg; i.p.) in the warm water tail-flick test, showing in vivo activity in rats after systemic injection. Neither treatment with CTAP (10 mg/kg; i.p.), nor gCTAP5 (5 mg/kg; i.p.) had any effect on L-DOPA-induced limb, axial, orolingual, or locomotor abnormal involuntary movements. The data indicate that highly-selective μ-opioid receptor antagonism alone might not be sufficient to be anti-dyskinetic.
How to recover from a bad start: size at metamorphosis affects growth and survival in a tropical amphibian
Authors: Szekely Diana , Cogalniceanu Dan , Szekely Paul , Armijos-Ojeda Diego , Espinosa-Mogrovejo Valentina , Denoel Mathieu
Published: February 2020

Background:
In species with complex life cycles, size at metamorphosis is a key life-history trait which reflects the complex interactions between costs and benefits of life in the aquatic and terrestrial environments. Whereas the effects of a deteriorating larval habitat (e.g. pond desiccation) on triggering an early metamorphosis have been extensively investigated in amphibians, the consequences of the resulting reduced size at metamorphosis on fitness in the post-metamorphic terrestrial stage remain poorly understood. We tested the hypothesis that a smaller size at metamorphosis negatively affects performance and survival in the ensuing terrestrial stage. Using as model a tropical amphibian (Ceratophrys stolzmanni) showing a large phenotypic plasticity in metamorphosing traits, we evaluated the effects of size at metamorphosis on fitness-related trophic and locomotor performance traits, as well as on growth and survival rates.
Results:
Our results support the hypothesis that a larger size at metamorphosis is correlated with better survival and performance. The survival rate of large metamorphosing individuals was 95%, compared to 60% for those completing metamorphosis at a small size. Locomotor performance and gape size were positively correlated with body size, larger animals being more mobile and capable to ingest larger prey. However, smaller individuals achieved higher growth rates, thus reducing the size gap.
Conclusions:
Overall, size at metamorphosis affected profoundly the chances of survival in the short term, but smaller surviving individuals partly compensated their initial disadvantages by increasing growth rates.
Intention to stop khat chewing and associated factors among khat chewers in Gondar city, northwest Ethiopia: using Trans Theoretical Model
Authors: Adugna Asmamaw , Azale Telake , Handebo Simegnew
Published: March 2020

Background Khat chewing practice is rapidly increasing worldwide and currently an estimated over 10 million people chew khat. Trans Theoretical Model (TTM) is a promising model to assess the of stages of behavior change is a combination of intention. Given a sufficient control over the behavior, people carry out their intentions when the enabling environments arises. Assessing intention to quit chewing khat, motivational factors that influence behavior, is important to design effective interventions. Methods Community-based cross-sectional study was conducted from March to April 2019 in Gondar city, northwest Ethiopia. Six hundred five khat chewers were selected from six kebeles using cluster sampling method. Structured interviewer-administered questionnaire was used to collect data. Bivariate and multi-variable logistic regression model were fitted. Adjusted Odds ratio (AOR) with 95% confidence interval and p-values <0.05 in the multi-variable model were used to declare significant association. Results Out of the total participants, 69.3% (95% CI: 65.8-72.9) had intention to stop khat chewing within six months from the day of interview or before. Majority of the study participants 55.4% were on contemplation stage. Higher self-reevaluation [AOR=2.8, (95%CI: 1.6-5.0)], environmental reevaluation [AOR=1.9, (95%CI: 1.1-3.3)] and social liberation [AOR=1.8, (95% CI: 1.0-3.1)] process of changes were associated with intention to quit khat chewing. In addition, using additional substances and start chewing at earlier age were associated with lower intention to quit chewing. Conclusion Majority of the khat chewers had the intention to stop khat chewing. Increased self-reevaluation, environmental reevaluation and social liberation process of changes enhance the intention of quitting khat chewing. Thus, stage-based interventions should be done to motivate Khat chewers to stop khat chewing.
The effects of computer-assisted cognitive-behavior therapy as an adjunct to enhance postoperative recovery during perioperative period: study protocol for a randomized controlled trial
Authors: Yang Yang , Li Yuling , Liu Zhifen , Zhang Haibin , Li Xinrong , Xu Yong , Wang Binquan
Published: February 2020

Background: Some serious surgeries may pose likelihood of developing complications such as anxiety, depression, insomnia, chronic pain, which may aggravate discomfort, impair quality of life and even increase mortality after surgery. Non-pharmacological mind–body interventions for psychosomatic symptom is are an area of growing interest. CBT is the most recommended treatment for anxiety, depression, insomnia and pain. However, access to trained therapists is limited. A growing amount of research is producing effective evidence of CCBT. But , CCBT used for surgery patients have been not reported at present, and the effectiveness and feasibility have been not research ed and validated too. The primary aim of this trial is to explore targeted psychotherapy technique based on CCBT for surgical patients and assess the effectiveness and feasibility of the newly developed software of CCBT-Prs to improve anxiety, depression, insomnia and postoperative pain as an adjunct to UC by subjective and objective indexes. Methods and analysis : It is a prospective, multi-centers, randomized controlled superiority trial which comprises two parallel groups (CCBT-Prs +UC and UC alone) . Participants who has been scheduled for surgery will be randomized to either of the two groups : (1) receiv ing CCBT- Prs software intervention based on UC as trial group (2) receiving UC intervention only as control group. All participants will undergo assessments using STAI-S, PHQ-9, AIS and VAS-Pain-10 at various time points in the perioperative period. Blood samples will be collected at baseline and pre - anesthesia to assess for Stress hormone markers(Cor and ACTH). Functional near infrared spectroscopy( fNIRS) will be applied to evaluate brain function before and after intervention. Discussion: Some difficulty is inevitable and encountered in all clinical trials. The ultimate aim is that mental health services benefit more non-psychiatric inpatients. CCBT can have more wider dissemination and implementation in mental health. Ethics and dissemination : This study has been approved by Ethics Committee of First Hospital of Shanxi Medical University in China. Research findings will be disseminated in the form of at least one peer reviewed article and presentations at conferences. Trial registration: Chinese Clinical Trial Registry (ChiCTR)( www.chictr.org.cn ) ChiCTR1900025994 . Registered on 17 September 2019. http://www.chictr.org.cn/ChiCTR1900025994.
Adjuvant Esophagectomy versus Definitive Chemoradiotherapy for Patients with Clinical Stage N0 and Pathological Stage T1b Esophageal Squamous Cell Carcinoma After Endoscopic Submucosal Dissection: Study Protocol for A Multicenter Randomized Controlled Trial (Ad-ESD Trial)
Authors: Yang Yang , Su Yuchen , Zhang Xiaobin , Liu Jun , Zhang Hong , Li Bin , Hua Rong , Tan Lijie , Chen Hezhong , Li Zhigang
Published: February 2020

Background: Esophagectomy is still the prior additional treatment for pathological T1b (pT1b) esophageal squamous cell carcinoma (ESCC) after endoscopic resection (ER). ER followed with definitive chemoradiotherapy (dCRT) has showed increased quality of life as well as comparable oncological outcomes to esophagectomy. However, there is no well-designed, phase III trial to compare the two treatment for patients with pT1b ESCC.Methods: One hundred seventy-six patients with clinical stage N0 (cN0) and pT1b ESCC will be recruited at three centers and randomized to the esophagectomy group or the dCRT group. The clinical lymph node status will be measured by image examination including computer tomography and positron emission tomography-computed tomography. The pathological tumor status will be diagnosed after endoscopic submucosal dissection (ESD). All patients will be followed up for 60 months after randomization. The primary endpoint is the 5-year overall survival. The secondary endpoints are quality of life, related adverse events, 3-year overall survival and relapse-free survival rates.Discussion: To the best of our knowledge, this is the first phase III randomized controlled trial to compare the esophagectomy and dCRT for patients with cN0-pT1b ESCC after ESD. Based on the results of this study, we will show whether dCRT will benefit patients more than esophagectomy. which will contribute more high-quality evidence to the primary salvage treatment for these patients.Trial registration : ClinicalTrials.gov, NCT04135664. Registered on 10 August 2019.
Formaldehyde formation in the glycine cleavage system and its use for an aldolase-based biosynthesis of 1,3-prodanediol
Authors: Xu Yingying , Meng Hao , Ren Jie , Zeng An-Ping
Published: February 2020

Glycine cleavage system (GCS) occupies a key position in one-carbon (C1) metabolic pathway and receives great attention for the use of C1 carbons like formate and CO 2 via synthetic biology. In this work, we demonstrate that formaldehyde exists as a substantial byproduct of the GCS reaction cycle. Three causes are identified for its formation. First, the principal one is the decomposition of N 5 ,N 10 -methylene-tetrahydrofolate (5,10-CH 2 -THF) to form formaldehyde and THF. Increasing the rate of glycine cleavage promotes the formation of 5,10-CH 2 -THF, thereby increasing the formaldehyde release rate. Next, formaldehyde can be produced in the GCS even in the absence of THF. The reason is that T-protein of the GCS can degrade methylamine-loaded H-protein (H int ) to formaldehyde and ammonia, accompanied with the formation of dihydrolipoyl H-protein (H red ), but the reaction rate is less than 0.16% of that in the presence of THF. Increasing T-protein concentration can speed up the release rate of formaldehyde by H int . Finally, a certain amount of formaldehyde can be formed in the GCS due to oxidative degradation of THF. Based on a formaldehyde-dependent aldolase, we elaborated a glycine-based one carbon metabolic pathway for the biosynthesis of 1,3-propanediol (1,3-PDO) in vitro . This work provides quantitative data and mechanistic understanding of formaldehyde formation in the GCS and a new biosynthetic pathway of 1,3-PDO.
Case report: A Re-operation Case of Asymptomatic Left Giant Pheochromocytoma and Literature Review
Authors: Dai Wei , Liu Xiaoguang , Dai Jialiang , Chen Minqiang , Mo Jian , Chen Ming , Tan Xiaoyu , Chen Xiaofeng , Lin Qiongyan , Wang Jie , Fang Shuo , Chen Nianping
Published: February 2020

Introduction: Pheochromocytoma (PCC) is a rare tumor which derives from adrenal medulla, when maximum diameter of pheochromocytoma is greater than 10CM, it is divided into Giant pheochromocytoma(GPCC), which is extremely rare and usually asymptomatic.Clinically, a huge and asymptomatic adrenal pheochromocytoma was usually misdiagnosed as other types of tumors, which result in notable increase of complication rates and death rates.Case presentation:In this case report, we described a clinically asymptomatic GPCC patient. Diagnosis:According to computed tomography (CT) scan, nuclear magnetic resonance(MR) scan, the patient is initially diagnosed as liposarcoma.After laparotomy, biochemical detection of catecholamine (CA) intermediate metabolites methoxyepinephrine (MN) and methoxy norepinephrine (NMN) and the pathological examination , diagnosis of GPCC was obtained. Intervention：The laparotomy was suspended and a diagnosis of pheochromocytoma was confirmed, because of unstable blood pressure and hypertension during separating and moving the mass during surgery. After consultation of multi-disciplinary team, adequate preoperative preparation was conducted according to the procedure of PCC surgical preparation. By the end of the regular phenoxybenzamine and intravenous fluids treatment for three weeks, the blood pressure of the patient was kept at an acceptable average. Therefore, the patient underwent the operationagain for radical resection. Outcome: After the operation, CA was basically normal in rechecking process, and the tumor was successfully removed. Pathological diagnosis of the mass after operation: Immunohistochemical resulted conformed to (epigastrium) pheochromocytoma. Immunohistochemistry: CgA(+), Inhibin-α(-), ki-67(<1%+), Syn(+). Pheochromocytoma had the definite pathological diagnosis. Conclusion: GPCC has the high diagnostic identification difficulty, it should be combined with imaging examination and biochemical measurement to identify. Before operation, the detailed imageological examination provides important reference for excision and surgical planning. Individualized and multi-disciplinary cooperation of management strategy in perioperative period should be recommended. Patients should conduct long-term follow-up.
Prediction of different airway gradings in T1-2 laryngeal cancer with anterior vocal commissure involvement
Authors: Luo Chunlin , Lei Wenbin
Published: February 2020

Background To investigate the clinical efficacy of the modified Mallampati test (MMT) combined with indirect laryngoscopy in measuring glottic exposure levels of early glottic laryngeal carcinoma (T1-2) with anterior vocal commissure involvement. Methods One hundred eighty-two patients with early glottic laryngeal cancer were divided into two groups: one group comprised patients treated with transoral carbon dioxide laser microsurgery (TLM, 65 patients), and the other group comprised patients treated with open partial laryngectomy (OPL, 117 patients). The MMT and indirect laryngoscopy were used to re-evaluate the level of glottic exposure and to classify the patients based on these levels. The local control and disease-free survival rates of those patients were measured based on their MMT and indirect laryngoscopy classifications. Results The 5-year local control rate was significantly different between the two groups according to the MMT (log-rank test: χ2=4.020, P=0.045, 90.9% in the OPL group vs. 71.4% in the TLM group). For patients diagnosed with grade IV tumors using indirect laryngoscopy, the 5-year local control rate was significantly different between the two groups (log-rank test: χ2=4.076, P=0.044, 91.7% in the OPL group vs. 54.7% in the TLM group). Among patients diagnosed with grade III or IV tumors using indirect laryngoscopy and with class III or IV tumors using MMT, the 5-year local control rate was significantly different between the two groups (log-rank test: χ 2 = 8.037, P = 0.005, 97.14% in the OPL group vs. 75.47% in the TLM groups). Conclusions The combination of the MMT and indirect laryngoscopy to evaluate difficult airways is relatively simple and is very useful for surgeons to better prepare for surgery.
An improved morphological staging method of midpalatal suture and its relationship with cervical vertebrate maturation (CVM) method
Authors: Gao Lu , Gu Yan
Published: February 2020

Background (1) Establish an improved morphological staging method of midpalatal suture. (2) Investigate the correlation between morphological stages of midpalatal suture (MPS stage) and cervical vertebrate maturation (CVM) stages. (3) Compare effects of traditional tooth-borne rapid maxillary expansion (RME) at different MPS stages. Methods 1076 CBCT images (675 females, 401 males, 6.0 to 21.0 years old) are included. MPS stages are classified based on observation of horizontal view. Correlation between MPS stage and CVM stage are investigated by Spearman correlation coefficient and diagnostic test analysis. Effects of traditional tooth-borne RME at different MPS stages were analyzed based on pre- and post-expansion dental casts. Results Five stages of midpalatal suture are established. Spearman coefficient between MPS stage and CVM stage is 0.803. Diagnostic pairs with the largest area under ROC curve (AUC) value are: CS 6 - MPS 5,CS 5 - MPS 4s2,CS 1 - MPS 1, CS 4 - MPS 4s1, CS 2 - MPS 1, CS 3 - MPS 3. 309/340 (90.9%) of individuals at CS 1-3 are at MPS 1-3, 31/340 (9.1%) are at MPS 4s1. 107/324 (31.2%) of individuals at CS 4 are at MPS 3, 151/324 (46.6%) are at MPS 4s1. Conclusion (1) An improved morphological staging method of midpalatal suture is established. (2) MPS stages have close relationship with CVM stages. (3) Pre-treatment CBCT is recommended for individuals at CS 4 to estimate the possibility of skeletal expansion with traditional tooth-borne RME.
In vitro cell culture of patient derived malignant pleural and peritoneal effusions for personalised drug screening
Authors: Wu Cheng-Guang , Chiovaro Francesca , Curioni Alessandra , Casanova Ruben , Soltermann Alex
Published: February 2020

Background Malignant serous effusion (MSE) denotes a manifestation of metastatic disease with typical high concentrations of both cancer and immune cells, making them an ideal resource for in vitro cytologic studies. Hence, the aim of the study was to investigate the features of 2D and 3D MSE culture systems as well as their feasibilities for in vitro drug screening. Methods Pleural and peritoneal effusions from 8 patients were collected and processed for 2D monolayer and 3D hanging drop cell culture into GravityPLUS™ plates. Representative markers for cell components, proliferation rate and tumour classification were investigated by immunohistochemistry, followed by absolute quantification using a digitalised image analysis approach. Further, we implemented another 3D cell culture model based on a low attachment method for in vitro drug sensitivity testing of carboplatin, pemetrexed and pembrolizumab for 5 patients. Results Monolayer cell culture was favourable for the growth of mesothelial cells, while hanging drop culture in GravityPLUS™ plates showed better ability for preserving cancer cells, inducing positive diagnostic markers expression and restraining the growth of mesothelial cells. For in vitro drug testing, MSE from five patients presented various drug sensitivities, and one case showed strong response to PD-1 checkpoint inhibition (pembrolizumab). For some patients, the application of combinatorial drugs had better therapeutic responses compared to monotherapy. Conclusions Digitalised quantification of data offers a better understanding of different MSE culture models. More importantly, the proposed platforms are practical and amenable for performing in vitro chemo-/immunotherapeutic drug testing by using routine cytologic MSE in a personalised manner. Next to cell blocks, our work demonstrates the prognostic and predictive value of cytologic effusion samples.
Mechanical stretching induces the apoptosis of parametrial ligament fibroblasts via the actin cytoskeleton and Nr4a1
Authors: Li Yang , Zeng Wanling , Li Bingshu , Liu Cheng , Hong Shasha , Tang Jianming , Li Sutinng , Wang Tingting , Yang Lian , Li Lu , Hong Li
Published: February 2020

Background The anatomical positions of pelvic floor organs are maintained mainly by ligaments and muscles. Long-term excessive mechanical tension stimulation of pelvic floor tissue beyond the endurance of ligaments or muscles will lead to the occurrence of pelvic organ prolapse (POP). In addition, cytoskeletal reconstitution is a key process by which cells respond to mechanical stimulation. The aim of the present study was to investigate the protective effect of actin cytoskeleton in resist mechanical stretching (MS)-induced apoptosis of parametrial ligament fibroblasts (PLFs) and the underlying mechanisms. Methods 8 women who underwent hysterectomy surgery for reasons excluding the presence of malignant tumors and POP served as controls, and 7 patients who underwent hysterectomy surgery for only advanced POP comprised the POP group. MS was provided by a fourpoint bending device. We examined the effects of MS on actin cytoskeleton and apoptosis of PLFs. Then the apoptosis was detected after latrunculin A (Lat-A, a potent inhibitor of actin) exposure and the interference of Nr4a1. Results MS could significantly induce apoptosis of PLFs from non-POP patients, which exhibited an apoptosis rate close to that of PLFs from POP patients, and the apoptosis rate was higher following latrunculin A treatment. In addition, Nr4a1 and Bax expression was increased while Bcl-2 and caspase-3 expression was clearly decreased after treatment with MS and Lat-A. However, the MS-induced apoptosis of PLFs was reduced when treatment with siRNA targeting Nr4a1 was used to downregulate the level of Nr4a1. Conclusions These outcomes reveal a novel mechanism that links the actin cytoskeleton and apoptosis in PLFs by Nr4a1; this mechanism will provide insight into the clinical diagnosis and treatment of POP.
Correlation study between flash dual source CT perfusion imaging and regional lymph node metastasis of non-small cell lung cancer
Authors: Huang Tingting , Sun Hui , Luo Xianli , Zhang Xuemei , Jin Kaiyuan , Wang Feng , Sun Lv , Cheng Nianlan , Wu Shuo , Lou Qin , Li Bangguo
Published: February 2020

Objective To explore the correlation of flash dual source computed tomography perfusion imaging (CTPI) and regional lymph node metastasis of non-small cell lung cancer (NSCLC), and to evaluate the value of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC. Methods 120 consecutive patients with NSCLC confirmed by postoperative histopathology were underwent flash dual source CT perfusion imaging in pre-operation. The CT perfusion parameters of NSCLC, such as blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability (PMB) were obtained by the image post-processing. Then microvessel density (MVD), luminal vascular number (LVN), luminal vascular area (LVA) and luminal vascular perimeter (LVP) of NSCLC were counted by immunohistochemistry. These cases were divided into two groups that patient with regional lymph node metastasis group (group A, 58 cases) and without regional lymph node metastasis group (group B, 62 cases) according to their pathological results. The CT perfusion parameters and the microvessel parameters were contrastively analysed between the two groups. Receiver operating characteristic (ROC) curve was used to assess the diagnostic efficiency of CT perfusion parameters in predicting regional lymph node metastasis of NSCLC in pre-operation. Results Group A presented signiﬁcantly lower LVA, BF and higher MTT, PMB than Group B ( P <0.05), while BV, LVN, LVP and MVD were no significant difference ( P >0.05). Correlation analysis showed that BF was correlated with LVA and LVP ( P <0.05), while BV, MTT and PMB were not correlated with LVN, LVA and LVP ( P >0.05). All the perfusion parameters were not correlated with MVD. According to the ROC curve analysis, when BF<85.16 ml/100 ml/min as a cutoff point to predict regional lymph node metastasis of NSCLC, the sensitivity, speciﬁcity, accuracy, positive predictive value and negative predictive value were 60.8%, 81.7%, 71.5%, 75.6% and 69.5% respectively. Conclusion Flash dual source CT perfusion imaging can non-invasively indicate the luminal vascular structure of tumor and BF can be used as one of the important indexes in predicting regional lymph node metastasis of NSCLC in pre-operation.
Risk factors for postoperative delirium in patients with triple-branched stent graft implantation
Authors: Lin Yanjuan , Chen Qiong , Zhang Haoruo , Chen Liang-Wan , Peng Yanchun , Huang Xizhen , Chen Yiping , Li Sailan , Lin Lingyu
Published: February 2020

Background: The incidence of neurological complications is relatively high after novel triple-branched stent graft implantation in patients with Stanford type A aortic dissection (AAD). But the incidence and risk factors of postoperative delirium (POD) have not been studied. The aim of this study was to investigated the incidence and risk factors of POD after novel triple-branched stent graft implantation.Methods: An observational study of AAD patients who underwent novel triple-branched stent graft implantation between January 2017 and July 2019 was followed up after surgery. Patients’ delirium is screened by the Richmond Agitation-Sedation Scale and the Confusion Assessment Method for the intensive care unit from the first day after the operation, lasted 5 days. The risk factors of POD was analyzed by the Cox proportional hazard models.Results: A total of 280 cases of AAD patients were enrolled in this research, the incidence of POD was 37.86%. Adjusting for age, body mass index, and mechanical ventilation duration, multivariate Cox regression analysis model revealed that non-manual work (adjusted hazard ratio [AHR] = .554; 95% CI: 0.335-0.915; P = .021), Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores > 20 (AHR = 3.359, 95% CI: 1.707-6.609, P < .001), hypoxemia (AHR = 1.846, 95% CI: 1.118-3.048, P = .017), and more than two types of analgesics and sedatives were independently associated with POD.Conclusions: This study showed that risk factors independently associated with POD were APACHE-II score > 20, hypoxemia and more types of analgesics and sedatives, and non-manual work was the protective factor.Trial registration: This study was retrospectively registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR1900022408; Date: 2019/4/10)
Short-term Outcomes of Modified Y-Graft Technique in Acute Type A Aortic Dissection Using the Femoral Artery Bypass and One Minute Systemic Circulatory Arrest Technique
Authors: Sun Xiangfei , Zhao Qi , Huo Yufeng , Zhou Jinfeng , Zhao Fen , Liu Yimin , Du Yonghai , He Songxiong , Liu Chao , Jiang Detian , Sun Wenyu
Published: February 2020

Objective: Aortic arch replacement in acute type A aortic dissection patients remains a most challenging cardiovascular operation. This article aims to show our Modified Y-Graft Technique using the Femoral Artery Bypass (FAB) and the One Minute Systemic Circulatory Arrest (OSCA) Technique and assess the short-term outcomes of the patients.Methods: Between February 2015 and November 2017, 51 patients with acute type A aortic dissection underwent aortic arch replacement. Among them, 23 patients’ procedure used FAB and 28 patients utilized both FAB and OSCA. The intraoperative data and postoperative follow-up data were recorded. The follow-up data of patients with traditional Y-graft technique were collected from previous reported studies.Results: In FAB group, two patients died for pulmonary infection (30-day survival rate 91.3%), and two patients paralyzed from the waist down. The hemodialysis was performed for five patients (21.7%) before hospital discharge. Fifteen patients (65.2%) received more than 2-day’s respiratory support and 8 patients (34.8%) received more than 5-day’s respiratory support. These follow-up data are basically flat or precede to the patients with traditional Y-graft technique. Furthermore, compared to the FAB Group, the morbidity of the neurologic dysfunction and the acute renal failure was significantly reduced in FAB+OSCA Group. Besides, the respiratory support, the length of the postoperative stay and the ICU stay were shortened.Conclusions: This study clarified the feasibility of FAB and OSCA technique in modifying Y-graft technique. The acute type A aortic dissection patients tend to have less surgical complications and favorable short-term outcomes by this surgery.
Adaptive filter based on Monte Carlo method to improve the target tracking in radar systems
Authors: Zarai Khaireddine , Adnane Cherif
Published: February 2020

The state estimation and tracking of random target is an attractive research problem in radar system. The information received in the radar receiver was reflected by the target, that it is received with many white and Gaussian noise due to the characteristics of the transmission channel and the radar environment. After detection and location scenarios, the radar system must track the target in real time. We aim to improve the state estimation process for too random target at the given instant in order to converge to the true target state and smooth their true path for a long time, it simplifies the process of real-time tracking. In this framework, we propose a new approach based on the numerical methods presented by MONTE CARLO (MC) counterpart the method conventionally used named Extended KALMAN Filter (EKF), we showed that the first are more successful. Keywords: Radar, Monte Carlo, Extended KALMAN Filter, Tracking, PF, Random target.
The relationship between thyroid hormone and lipid metabolism/body fat content in euthyroid male patients with type 2 diabetes mellitus in China: A cross-sectional study
Authors: Sun Xia , Chen Liping , Wu Rongzhen , Zhang Dan , He Yinhui
Published: February 2020

Background: This study compared the relationship between thyroid hormones and lipid metabolism/body fat content in euthyroid male patients with type 2 diabetes mellitus (T2DM) in China. Methods: A total of 64 male patients who were diagnosed as T2DM and 64 non-diabetic males who underwent health examination were matched according to age at a 1:1 ratio. Results: The 32 subjects in each sub-group showed differences in age, body mass index (BMI), mean arterial pressure, waist circumference, visceral fat content, body fat percentage, HbA1c, HOMA-IR, FT3, TSH, HDL-c, adiponectin, leptin, visfatin and TNF-α (all P < 0.05). In the overall population, FT3 was positively correlated with body fat percentage (r=0.21, P=0.02), and negatively correlated with HOMA-IR (r=-0.18, P=0.04) and visfatin (r=-0.47, P <0.01); TSH was positively correlated with body fat percentage (r=0.23, P=0.01). In the T2DM-OB group FT3 was positively correlated with BMI (r=0.45, P <0.05), visceral fat content (r=0.50, P <0.05), and body fat percentage (r=0.44, P <0.05); FT4 was positively correlated with visceral fat content (r=0.38, P <0.05); and TSH was positively correlated with HOMA-IR (r=0.39, P <0.05). Conclusion: TSH increased in obese people and FT3 was lower in patients with T2DM.
How to Design a Remote Patient Monitoring System A French Case Study
Authors: Ferrua Marie , Minvielle Etienne , Fourcade Aude , Lalloué Benoît , Sicotte Claude , Palma Mario Di , Mir Olivier
Published: February 2020

Background Remote Patient Monitoring Systems (RPMS) based on e-health, Nurse Navigators (NNs) and patient engagement can improve patient follow-up and have a positive impact on quality of care (by limiting adverse events) and costs (by reducing readmissions). However, the extent of this impact depends on effective implementation which is often restricted. This is partly due to the lack of attention paid to the RPMS design phase prior to implementation. The content of the RPMS can be carefully designed at this stage and various obstacles anticipated. Our aim was to report on an RPMS process design to provide an insight into the methodology required in order to manage this phase and the ultimate outcome in terms of RPMS content. Methods This study was carried out at Gustave Roussy, a comprehensive cancer centre in France. A multidisciplinary team comprising hospital managers, healthcare professionals and health service researchers coordinated the CAPRI RPMS design process (2013-2015). It is based on data collected during eight studies conducted in accordance with the principle framework of the UK Medical Research Council (MRC). This project was approved by the French National Data Protection Authorities. Results Based on the study results, the multidisciplinary team defined strategies for resolving obstacles and risks prior to the implementation of CAPRI. Consequently, the final CAPRI design includes a web app with two interfaces (patient and health care professionals) and two NNs. The NNs provide regular follow-up via telephone and/or email to manage patients' symptoms and toxicity, treatment compliance and care packages. Patients contact the NNs via a secure messaging system. Eighty graduation and orientation algorithms enable NNs to prioritise and decide on the course of action to be taken. Conclusion In our experience, the RPMS design process and, more generally, that of any complex intervention programme, is an important phase that requires a sound methodological basis. This study also suggests that an RPMS is more than a technological innovation. Indeed, it is an organisational innovation, the merits of which will depend on the precise definition given to the action taken by NNs and other healthcare professionals as well as patients throughout their interactions.
The impact of commercial drivers with type 2 diabetes on the risk for road traffic collisions in TBDCS study
Authors: Wang Ying Chuan , Lin Yu-Jen , Wu Trong-Neng , Liou Saou-Hsing , Wu Wei-Te
Published: February 2020

Background : Identification of the relationship between diabetes mellitus (DM) and road traffic collision (RTC) that lead to hospital admissions and death in commercial motor vehicle (CMV) drivers is crucial to develop preventive strategies. A cohort study was used to follow up the outcomes of DM and receiving blood glucose-lowering therapy to assess the 6-year risk of RTCs in CMV drivers. Methods: This cohort recruited 1,650 CMV drivers in 2005. Each subject completed the basic and working patterns questionnaire. Researchers found 84 DM cases in 2005, and 152 RTC events between 2005 and 2010. The data analysis was conducted in 2015. The Cox model and the extended Cox model were used to estimate the hazard ratio (HR) for first RTC events only and recurrent RTC events. Results: Type 2 DM ( T2DM) increased the 6-year RTC risks among CMV drivers (HR: 2.39, 95% CI: 1.35 to 4.24), after adjusting for confounders. The extended Cox models were used and showed that T2DM increased HR of the recurrent RTC events. Conclusion: T2DM and oral antidiabetic drugs (OADs) used days pose possible risk factors for RTCs in CMV drivers. Labor or health care professionals and authorities should be aware of the risks and contribute in establishing effective RTC- prevention strategies for DM drivers with or without insulin treatment.
Public awareness and knowledge of factors associated with dementia in China
Authors: Zheng Yong-bo , Shi Le , Gong Yi-Miao , Wang Xiao-Xiao , Lu Qing-Dong , Que Jian-Yu , Khan Muhammad Zahid , Bao Yan-Ping , Lu Lin
Published: February 2020

Background Dementia is a global public health priority. Many modifiable factors have been shown to influence the development of dementia, but these factors are not adequately known by the general public. This study assessed public awareness of the factors that are associated with dementia among the general population in China. Methods A cross-sectional study was conducted from May to October 2019 using an Internet-based questionnaire. We collected basic sociodemographic characteristics and investigated participants’ knowledge of risk and protective factors that are associated with dementia. The primary outcome measures were the proportions of participants who identified each option as a risk or protective factor. Logistic regression analysis was performed to compare levels of the knowledge of factors that are associated with dementia across populations with different demographic characteristics. Results Data from a total of 3,338 respondents were analyzed. The percentages of participants who accurately identified dementia risk factors were the following: 84.24% for negative affect, 65.07% for alcohol use, 56.68% for smoking, 48.74% for hypertension, and 42.66% for diabetes. The percentages of participants who accurately identified dementia protective factors were the following: 90.00% for exercise, 84.69% for social activity, 80.92% for intelligence games, 74.45% for reading, and 6.14% for antihypertensive or hypolipidemic drugs. The majority of Chinese people correctly recognized the role of lifestyle factors in the development of dementia but not medical factors. Levels of knowledge of the factors that are associated with dementia were significantly distinct across populations with different characteristics. The following sociodemographic characteristics were associated with more comprehensive knowledge of dementia risk and protective factors: women, young age, high education levels, white-collar jobs, and contact with individuals with dementia. Conclusions Public awareness and knowledge of risk and protective factors for dementia in China are still insufficient. More efforts are needed to publicize information about dementia to reduce risk and prevent dementia.
Hardware design for Blind Source Separation using a Fast Time-Frequency Mask Technique
Authors: Tsai Tsung-Han , Liu Pei-Yun , Chiou Yu-He
Published: February 2020

In this paper, we propose a fast time-frequency mask technique for blind source separation in order to separate a mixture of two input sounds in single signal automatically. Mostly previous methods utilize a linear sensor array, and therefore they cannot separate symmetrically positioned sources. To overcome such problems, we first define two features which are normalized level-ratio and phase-difference. Next, we use our method to decrease Direction of Arrival (DOA), this can reduce the variance of features so that it can reduces iterations of k-means. Finally, according to the clustered features, a mask is generated. Our method does not require any prior information or parameter estimation and we have made a real demonstration system. We use Signal to Distortion Ratio ( SDR ) and Signal to Interference Ratio ( SIR ) to compare our method. Then we present hardware design. Hardware design uses TSMC 90-nm CMOS process. As a cost-effective result, it consumes about 120K gates and executes with frequency of 10MHz. The power consumption is only 2.92 mW with low power design considerations.
Sildenafil for Treating Peripheral Ischemia and Gangrene: A Case Report and Review
Authors: Hsieh Miyuki Hsing-Chun , Tsai Chi-Lun , Su Hui-Chen , Lai Edward Chia-Cheng
Published: February 2020

Background Peripheral gangrene is a clinical condition characterized with digital ischemia of extremities usually seen in patients with sepsis or shock that resulted in a hypoperfusion state. It is not common but often complicated with high mortality rate. Currently, there is no definite treatment for peripheral gangrene which often result in amputation. Methods We reported a 74-year-old female case of shock-related peripheral gangrene of both feet who was partially and successfully treated by oral sildenafil with a dose of 50mg twice daily. We also reviewed present evidences regarding effectiveness of sildenafil in managing distal ischemia caused by different clinical conditions. Results Except for limited regions which had already shown evident dark discoloration (i.e., the 4 th and 5 th toe on the right foot) at the time of treatment initiation, all other region of peripheral ischemia significantly improved after systemic oral sildenafil treatment for 7 days. The 4 th and 5 th toe of the right foot eventually turned into a darker area of necrosis with an obvious margin, in contrast to recovered regions. Literature showed relief of pain and reversal of other ischemic symptoms after a few days to months sildenafil therapy. Conclusions In accordance with the reported case and current literature, systemic sildenafil shows great potential in ameliorating peripheral ischemia and gangrene as an off-label drug of choice.