bluuebunny/crossref_metadata_2025 huggingface dataset:
The local concentration of Ca2+ correlates with BMP7 expression and osseointegration in patients with total hip arthroplasty
Authors: Fu Xiaodong , Wang Weili , Li Xiaomiao , Gao Yingjian , Li Hao , Shen Yi
Published: November 2020

Background

A successful osseointegration of total hip arthroplasty (THA) relies on the interplay of implant surface and bone marrow microenvironment. This study was undertaken to investigate the impact of perioperative biochemical molecules (Ca2+, Mg2+, Zn2+, VD, PTH) on the bone marrow osteogenetic factors (BMP2, BMP7, Stro-1+cells) in the metaphyseal region of the femoral head, and further on the bone mineral density (BMD) of Gruen R3.

Methods

Bone marrow aspirates were obtained from the discarded metaphysis region of the femoral head in 51 patients with THA. Flow cytometry was used to measure the Stro-1+expressing cells. ELISA was used to measure the concentrations of bone morphologic proteins (BMP2 and BMP7) and the content of TRACP5b in serum. TRAP staining was used to detect the osteoclast activity in the hip joint. The perioperative concentrations of the biochemical molecules above were measured by radioimmunoassay. The BMD of Gruen zone R3 was examined at 6 months after THA, using dual-energy X-ray absorptiometry (DEXA).

Results

Our data demonstrated that the concentration of Ca2+was positively correlated with BMP7 expression, and with the postoperative BMD of Gruen zone R3. However, the concentration of Mg2+had little impact on the R3 BMD, although it was negatively correlated with the expression of BMP7. Osteoclast activity in hip joint tissue of patients with femoral neck fractures was increased. Compared with the patients before THA, the levels of TRACP5b in serum of patients after THA were decreased. The data also suggested that the other biochemical molecules, such as Zn2+, VD, and PTH, were not significantly correlated with any bone marrow osteogenetic factors (BMP2, BMP7, Stro-1+cells). The postoperative R3 BMD of patients of different gender and age had no significant difference.

Conclusions

These results indicate the local concentration of Ca2+may be an indicator for the prognosis of THA patients.
Analysis of the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis
Authors: Zhang Hongqi , Yang Guanteng , Guo Chaofeng , Liu Jinyang , Tang Mingxing
Published: November 2020

Introduction

Strong halo-femoral traction has been widely used in the field of severe rigid scoliosis correction. The objective of this study was to analyze the corrective contribution of strong halo-femoral traction in the treatment of severe rigid nonidiopathic scoliosis and discuss its meaning.

Material and methods

A retrospective review was performed for patients with severe rigid nonidiopathic scoliosis who were treated with halo-femoral traction in our center from December 2008 to December 2015. All cases underwent halo-femoral traction for 2 to 4 weeks before a one-stage posterior operation, and the absolute and relative contribution rates of each orthopedic factor (bending, fulcrum, traction, surgery) were analyzed.

Results

A total of 38 patients were included (15 males and 23 females), with a mean age of 16.4 ± 3.73 years (10–22 years) and follow-up of 55.05 ± 6.63 months (range 40–68 months). The etiology was congenital in 17 patients, neuromuscular in 14 patients, neurofibromatosis-1 in 3 patients, and Marfan syndrome in 2 patients. Congenital high scapular disease with scoliosis was found in 2 patients. The mean coronal Cobb angle of the major curve was 97.99° ± 11.47° (range 78°–124°), with a mean flexibility of 15.68% ± 6.65%. The absolute contribution rate (ACR) of bending was 27.26% ± 10.16%, the ACR of the fulcrum was 10.91% ± 2.50%, the ACR of traction was 32.32% ± 11.41%, and the ACR of surgery was 29.50% ± 9.70%. A significant difference in correction was noted between the ACRs of traction and the fulcrum (P < 0.05).

Discussion

Strong halo-femoral traction plays a relatively significant role in the treatment of severe rigid nonidiopathic scoliosis while decreasing the risk of operation, and it is a safe and effective method for the treatment of severe rigid nonidiopathic scoliosis.
Predictive values of the postoperative neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio for the diagnosis of early periprosthetic joint infections: a preliminary study
Authors: Zhao Guanglei , Chen Jie , Wang Jin , Wang Siqun , Xia Jun , Wei Yibing , Wu Jianguo , Huang Gangyong , Chen Feiyan , Shi Jingsheng , Lyu Jinyang , Liu Changquan , Huang Xin
Published: November 2020

Background

Several studies have been conducted to report diagnostic values of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) in the many diseases, such as oncological, inflammatory, and some infectious diseases. However, the predictive value of these laboratory parameters for early periprosthetic joint infections (PJIs) has not yet been reported. The aim of this study was to determine predictive values of the postoperative NLR, PLR, and LMR for the diagnosis of PJIs.

Methods

In this retrospective study, 104 patients (26 early PJI cases and 78 non-PJI cases) who underwent total joint arthroplasty were enrolled in this study. All the patients were then categorized into two groups: PJI group, patients with the diagnosis of PJI (26 patients; 14 males, 12 females; mean age = 65.47 ± 10.23 age range = 51–81 ) and non-PJI group, patients without PJI (78 patients; 40 males, 38 females; mean age = 62.15 ± 9.33, age range = 41–92). We defined “suspected time” as the time that any abnormal symptoms or signs occurred, including fever, local swelling, or redness around the surgical site between 2 and 4 weeks after surgery and before the diagnosis. Suspected time and laboratory parameters, including NLR, PLR, LMR, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), were compared between both groups. The trends of postoperative NLR, LMR, PLR, CRP, and ESR were also reviewed. The predictive ability of these parameters at the suspected time for early PJI was evaluated by multivariate analysis and receiver operating characteristic (ROC) curve analysis.

Results

NLR, PLR, and LMR returned to preoperative levels within 2 weeks after surgery in the two groups. In the PJI group, NLR and PLR were significantly increased during the incubation period of infection or infection, and LMR was significantly reduced, although 61.5% (16/26) of the patients had normal white blood cells. Interestingly, ESR and CRP were still relatively high 2 weeks after surgery and were not different between the two groups before infection started (p = 0.12 and 0.4, respectively). NLR and PLR were significantly correlated with early PJI (Odds ratios for NLR and PLR = 88.36 and 1.12, respectively; p values for NLR and PLR = 0.005 and 0.01, respectively). NLR had great predictive ability for the diagnosis of early PJI, with a cut-off value of 2.77 (sensitivity = 84.6%, specificity = 89.7%, 95% CI = 0.86–0.97).

Conclusions

ESR and CRP seem not to be sensitive for the diagnosis of early PJI due to their persistently high levels after arthroplasty. The postoperative NLR at the suspected time may have a great ability to predict early PJI.
Effects of pedicle screw number and insertion depth on radiographic and functional outcomes in lumbar vertebral fracture
Authors: Liu Hao , Chen Weikai , Zhang Junxin , Jiang Xiaomin , Yang Huilin , Qu Rui , Liu Tao
Published: November 2020

Background

The influence of pedicle screw number and insertion depth on outcomes of lumbar fixation remains uncertain. The purpose of this study was to compare the imaging balance stability and clinical functional improvement of lumbar fracture patients with different pedicle screw numbers and insertion depths.

Methods

Sixty-five patients undergoing lumbar pedicle screw fixation from January 2016 to January 2018 were enrolled. They were included in long screw (LS) group and short screw (SS) group or 6 screw (6S) group and 4 screw (4S) group. The radiographic outcomes were assessed with lumbar lordosis (LL), segmental lordosis (SL), fractured vertebral lordosis (FL), sacral slope (SS), pelvic incidence (PL), and pelvic tilt (PT). The visual analog scale (VAS) and the Oswestry Disability Index (ODI) score were used for functional assessment. Multiple linear regression was performed to identify the risk factors of FL, SL, and LL correction at the final follow-up.

Results

FL, SL, and LL were significantly different in all matching subgroups to compare long and short screws and in most matching subgroups to compare 6 and 4 screws. The SS, PT, and PI seem to be similar in all subgroups in different periods. Significant differences of VAS and ODI were found between LS and SS in the 4S group and between 4S and 6S in the SS group. Insertion depth, screw number, BMD, age, and preoperative imaging data were significant factors for imaging balance stability correction at the final follow-up.

Conclusions

Long screws and 6 screws showed better fracture vertebral restoration and lumbar spinal sagittal stabilities. The surgery type, age, and BMD are important focus points for the treatment of lumbar vertebral fractures.
A telephone based assessment of the health situation in the far north region of Cameroon
Authors: Gignoux Etienne Marc Hugues , Donfack Sontsa Olivier Tresor , Mudasiru Ayoola , Eyong Justin , Ntone Rodrigue , Tamakloe Koku Modeste , Adji Dalil Mahamat , Etoundi Alain , Boum Yap , Jamet Christine , Cabrol Jean-Clément , Porten Klaudia
Published: November 2020

Background

In 2017, Field access was considerably limited in the Far North region of Cameroon due to the conflict. Médecins Sans Frontieres (MSF) in collaboration with Ministry of health needed to estimate the health situation of the populations living in two of the most affected departments of the region: Logone-et-Chari and Mayo-Sava.

Methods

Access to health care and mortality rates were estimated through cell phone interviews, in 30 villages (clusters) in each department. Local Community Health Workers (CHWs) previously collected all household phone numbers in the selected villages and nineteen were randomly selected from each of them. In order to compare telephone interviews to face-to-face interviews for estimating health care access, and mortality rates, both methods were conducted in parallel in the town of Mora in the mayo Sava department. Access to food was assessed through push messages sent by the three main mobile network operators in Cameroon. Additionally, all identified legal health care facilities in the area were interviewed by phone to estimate attendance and services offered before the conflict and at the date of the survey.

Results

Of a total of 3423 households called 43% were reached. Over 600,000 push messages sent and only 2255 were returned. We called 43 health facilities and reached 34 of them. In The town of Mora, telephone interviews showed a Crude Mortality Rate (CMR) at 0.30 (CI 95%: 0.16–0.43) death per 10,000-person per day and home visits showed a CMR at 0.16 (0.05–0.27), most other indicators showed comparable results except household composition (more Internally Displaced Persons by telephone).

Phone interviews showed a CMR at 0.63 (0.29–0.97) death per 10,000-person per day in Logone-et-Chari, and 0.30 (0.07–0.50) per 10,000-person per day in Mayo-Sava. Among 86 deaths, 13 were attributed to violence (15%), with terrorist attacks being explicitly mentioned for seven deaths. Among 29 health centres, 5 reported being attacked and vandalized; 3 remained temporally closed; Only 4 reported not being affected.

Conclusion

Telephone interviews are feasible in areas with limited access, although special attention should be paid to the initial collection of phone numbers. The use of text messages to collect data was not satisfactory is not recommended for this purpose. Mortality in Logone-et-Chari and Mayo-Sava was under critical humanitarian thresholds although a considerable number of deaths were directly related to the conflict.
Experiences of barriers to trans-sectoral treatment of patients with severe mental illness. A qualitative study.
Authors: Davidsen Annette Sofie , Davidsen Johan , Jønsson Alexandra Brandt Ryborg , Nielsen Maria Haahr , Kjellberg Pia Kürstein , Reventlow Susanne
Published: November 2020

Background

Patients with severe mental illness (SMI) have shorter life expectancy than people without SMI, mainly due to overmortality from physical diseases. They are treated by professionals in three different health and social care sectors with sparse collaboration between them, hampering coherent treatment. Previous studies have shown difficulties involved in establishing such collaboration. As the preparatory phase of an intervention to improve physical health of people with SMI and increase collaboration across sector borders, we explored different actors’ experiences of barriers for collaboration.

Method

We collected qualitative data from patients, professionals in general practice, psychiatry and social psychiatry involved in the treatment of these patients. Data consisted of notes from meetings and observations, interviews, focus groups and workshops. Analysis was by Interpretative Phenomenological Analysis.

Results

The study revealed many obstacles to collaboration and coherent treatment, including the consultation structures in general practice, sectors being subject to different legislation, and incompatible IT systems. Professionals in general practice and social psychiatry felt that they were left with the responsibility for actions taken by hospital psychiatry without opportunity to discuss their concerns with psychiatrists. There were also cultural differences between health care and social psychiatry, expressed in ideology and language. Social psychiatry had an existential approach to recovery, whereas the views of health professionals were linked to symptom control and based on outcomes. Meanwhile, patients were left in limbo between these separate ideologies with no leadership in place to promote dialogue and integrate treatments between the sectors.

Conclusion

Many obstacles to integrated trans-sectoral treatment of patients with SMI seem related to a lack of an overriding leadership and organizational support to establish collaboration and remove barriers related to legislation and IT. However, professional and ideological barriers also contribute. Psychiatry does not consider general practice to be part of the treatment team although general practitioners are left with responsibility for decisions taken in psychiatry; and different ideologies and treatment principles in psychiatry and municipal social psychiatry hamper the dialogue between them. There is a need to rethink the organization to avoid that the three sectors live autonomous lives with different cultures and lack of collaboration.
Amino acid transporter LAT1 in tumor-associated vascular endothelium promotes angiogenesis by regulating cell proliferation and VEGF-A-dependent mTORC1 activation
Authors: Quan Lili , Ohgaki Ryuichi , Hara Saori , Okuda Suguru , Wei Ling , Okanishi Hiroki , Nagamori Shushi , Endou Hitoshi , Kanai Yoshikatsu
Published: November 2020

Background

Tumor angiogenesis is regarded as a rational anti-cancer target. The efficacy and indications of anti-angiogenic therapies in clinical practice, however, are relatively limited. Therefore, there still exists a demand for revealing the distinct characteristics of tumor endothelium that is crucial for the pathological angiogenesis. L-type amino acid transporter 1 (LAT1) is well known to be highly and broadly upregulated in tumor cells to support their growth and proliferation. In this study, we aimed to establish the upregulation of LAT1 as a novel general characteristic of tumor-associated endothelial cells as well, and to explore the functional relevance in tumor angiogenesis.

Methods

Expression of LAT1 in tumor-associated endothelial cells was immunohistologically investigated in human pancreatic ductal adenocarcinoma (PDA) and xenograft- and syngeneic mouse tumor models. The effects of pharmacological and genetic ablation of endothelial LAT1 were examined in aortic ring assay, Matrigel plug assay, and mouse tumor models. The effects of LAT1 inhibitors and gene knockdown on cell proliferation, regulation of translation, as well as on the VEGF-A-dependent angiogenic processes and intracellular signaling were investigated in in vitro by using human umbilical vein endothelial cells.

Results

LAT1 was highly expressed in vascular endothelial cells of human PDA but not in normal pancreas. Similarly, high endothelial LAT1 expression was observed in mouse tumor models. The angiogenesis in ex/in vivo assays was suppressed by abrogating the function or expression of LAT1. Tumor growth in mice was significantly impaired through the inhibition of angiogenesis by targeting endothelial LAT1. LAT1-mediated amino acid transport was fundamental to support endothelial cell proliferation and translation initiation in vitro. Furthermore, LAT1 was required for the VEGF-A-dependent migration, invasion, tube formation, and activation of mTORC1, suggesting a novel cross-talk between pro-angiogenic signaling and nutrient-sensing in endothelial cells.

Conclusions

These results demonstrate that the endothelial LAT1 is a novel key player in tumor angiogenesis, which regulates proliferation, translation, and pro-angiogenic VEGF-A signaling. This study furthermore indicates a new insight into the dual functioning of LAT1 in tumor progression both in tumor cells and stromal endothelium. Therapeutic inhibition of LAT1 may offer an ideal option to potentiate anti-angiogenic therapies.
Loss of miR-192-5p initiates a hyperglycolysis and stemness positive feedback in hepatocellular carcinoma
Authors: Gu Yuanzhuo , Ji Fubo , Liu Niya , Zhao Yongzhi , Wei Xiyang , Hu Shiyuan , Jia Wei , Wang Xin Wei , Budhu Anuradha , Ji Juling , Zhao Bin , Roessler Stephanie , Zheng Xin , Ji Junfang
Published: November 2020

Background

Emerging studies revealed that cancer stem cells (CSCs) possessed peculiar metabolic properties, which however remained largely unknown in hepatocellular carcinoma (HCC). Genetic silencing of liver-abundant miR-192-5p was a key feature for multiple groups of CSC-positive HCCs. We thus aimed to investigate essential metabolic features of hepatic CSCs via using HCCs with miR-192-5p silencing as a model.

Methods

Datasets from two independent HCC cohorts were used. Data integration analyses of miR-192-5p with metabolome and mRNA transcriptome data in HCC Cohort 1 were performed to investigate miR-192-5p related metabolic features, which was further validated in Cohort 2. Cellular and molecular assays were performed to examine whether and how miR-192-5p regulated the identified metabolic features. Co-culture systems consisting of HCC cells and LX2 (human hepatic stellate cell line) or THP1 (human monocyte cell line) were established to explore effects of the identified metabolic properties on stemness features of HCC cells via interacting with co-cultured non-tumor cells.

Results

High levels of glycolysis-related metabolites and genes were present in HCCs with low miR-192-5p and CSC-positive HCCs in two independent HCC cohorts. miR-192-5p knockout cells displayed CSC features and miR-192-5p loss led to an enhanced glycolytic phenotype via upregulating three bona fide targets, GLUT1 and PFKFB3 (two glycolytic enzymes) and c-Myc (regulating glycolytic genes’ expression). Meanwhile, c-Myc suppressed miR-192-5p transcription, ensuring a low-miR-192-5p/high-c-Myc loop to maintain hyperglycolysis. Moreover, over-produced lactic acid from hyperglycolytic HCC cells stimulated the ERK phosphorylation of co-cultured LX2 and THP1 non-tumor cells partially via NDRG3 and MCT1, which in turn promoted cell malignancy and stemness of HCC cells. Consistently, HCC patients with low level of miR-192-5p in their tumor tissues and high level of NDRG3 or MCT1 in their non-tumor tissues had the shortest overall survival.

Conclusions

In CSC-positive HCCs, miR-192-5p loss enhanced glycolysis and over produced lactate might further increase HCC malignant features via interacting with environmental non-tumor cells.
Improved prognosis for recurrent epithelial ovarian cancer by early diagnosis and 125I seeds implantation during suboptimal secondary cytoreductive surgery: a case report and literature review
Authors: Xiao Lin , Tang Junying , Li Wenbo , Xu Xuexun , Zhang Hao
Published: November 2020

Background

Epithelial ovarian cancer (EOC) has the worst prognosis in all of gynecologic malignant tumors because of its high recurrence and eventually chemo-resistance. Early diagnosis of recurrence is crucial to avoid diffuse dissemination. Failure of traditional treatment in recurrent epithelial ovarian cancer remains a challenge for clinicians. On the other hand, 125I brachytherapy has been accepted as a useful and hopeful treatment for multiple advanced cancers in recent years. However, its success in advanced epithelial ovarian cancer is limited. Here we report a case of recurrent ovarian cancer who had been early diagnosis of isolated recurrence and successfully treated with 125I seeds implantation during suboptimal cytoreductive surgery.

Case presentation

A 59-year-old woman presented with recurrent epithelial ovarian cancer who have had a history of ovarian cancer stage IIIB and an R0 resection had been achieved nearly 2 years before presented in our hospital. She underwent suboptimal secondary cytoreductive surgery after four cycles of chemotherapy with little effectiveness and severe chemotherapy-related side effects. Approximately 70% of the cancer-bulk was resected during surgery. For residual lesion which fixed around the right ureter and right external iliac vessel, 125I seeds implantation was performed. Postoperatively, the patient was treated with two cycles of combination chemotherapy with paclitaxel and carboplatin. The patient was free of disease at 26 months’ follow-up period.

Conclusion

In recurrent EOC patients with unresectable isolated lesion, salvage 125I seeds implantation are feasible and may contribute to survival.
Best practices, challenges and innovations in pediatrics in 2019
Authors: Caffarelli Carlo , Santamaria Francesca , Santoro Angelica , Procaccianti Michela , Castellano Fabio , Nastro Francesca Fiori , Villani Alberto , Bernasconi Sergio , Corsello Giovanni
Published: November 2020

This paper runs through key progresses in epidemiology, pathomechanisms and therapy of various diseases in children that were issued in the Italian Journal of Pediatrics at the end of last year. Novel research and documents that explore areas such as allergy, critical care, endocrinology, gastroenterology, infectious diseases, neonatology, neurology, nutrition, and respiratory tract illnesses in children have been reported. These observations will help to control childhood illnesses.
Test evaluation trials present different challenges for trial managers compared to intervention trials
Authors: Rick Caroline , Mallett Sue , Brown James , Ottridge Ryan , Palmer Andrew , Parker Victoria , Priest Lee , Deeks Jonathan J.
Published: November 2020

Introduction

Test evaluation trials present different challenges for trial managers compared to intervention trials. There has been very little research on the management of test evaluation trials and how this impacts on trial success, in comparison with intervention trials. Evaluations of medical tests present specific challenges, because they are a pivot point bridging the complexities of pathways prompting testing with treatment decision-making. We systematically explored key differences in the trial design and management of test evaluation trials compared to intervention trials at the different stages of study design and delivery. We identified challenges in test evaluation trials that were more pronounced than in intervention trials, based on experience from 10 test evaluation trials.

Methods

We formed a focus group of 7 trial managers and a statistician who had been involved in the day-to-day management of both test evaluation trials and intervention trials. We used discussion and content analysis to group challenges from 10 trials into a structured thematic format. The trials covered a range of medical conditions, diagnostic tests, clinical pathways and conditions including chronic kidney disease, chronic pelvic pain, colitis, detrusor over-activity, group B streptococcal colonisation, tuberculosis and colorectal, lung, ovarian and thyroid cancers.

Results

We identified 10 common themes underlying challenges that are more pronounced in test evaluation compared to intervention trials. We illustrate these themes with examples from 10 trials, including with 31 specific challenges we experienced. The themes were ethics/governance; accessing patient populations; recruitment; patient preference; test processes, clinical pathways and samples storage; uncertainty of diagnostic results; verifying diagnosis (reference standard); follow-up; adverse effects; and diagnostic impact.

Conclusion

We present 10 common themes, including 31 challenges, in test evaluation trials that will be helpful to others designing and managing future test evaluation trials. Proactive identification of potential challenges at the design and planning stages of test evaluation trials will enable strategies to improve trial design and management that may be different from standard strategies used for intervention trials. Future work could extend this topic to include challenges for other trial stakeholders including participants, clinicians, statisticians and funders.

Trial registration

All trials reviewed in this project were registered and are provided in Table 1.
Neurological and psychological mechanisms of the specific and nonspecific effects of acupuncture on knee osteoarthritis: study protocol for a randomized, controlled, crossover trial
Authors: Li Jin-Ling , Liu Cun-Zhi , Zhang Na , Yan Chao-Qun , Tu Jian-Feng , Wang Li-Qiong , Qi You-Sheng , Liu Jun-Hong , Wang Xu
Published: November 2020

Background

Acupuncture, as one of the promising non-pharmacological interventions, has been proved to be beneficial for patients. However, the magnitude of acupuncture’s specific and nonspecific effects, as well as their neurological and psychological determinants, remains unclear. Therefore, this study is designed to examine the acupuncture efficacy, investigate whether the brain mechanisms between the specific and nonspecific effects of acupuncture are different, and to evaluate how psychological factors affect the acupuncture effects.

Methods

This is a randomized, controlled, crossover clinical trial. A total of 60 patients with knee osteoarthritis will receive 4 weeks of acupuncture treatment and 4 weeks of sham acupuncture treatment in a random order separated by a washout period of 2 weeks. The changes in clinical characteristics based on pain-related scales will be assessed to investigate the clinical efficacy of acupuncture. Resting state functional magnetic resonance imaging (fMRI) scans will be used to identify the brain activity changes related to the specific and nonspecific effects of acupuncture. The questionnaires of psychological factors will be used to evaluate patients’ psychological properties. Correlation and mediation analyses will be conducted among psychological factors, brain activity changes, and symptoms improvement to explore the neurological and psychological correlates of the acupuncture effects.

Discussion

This study will concentrate on distinguishing and clarifying the specific and nonspecific effects of acupuncture. The results of this study may contribute to rationally optimize the acupuncture therapies by flexible application of the specific and nonspecific effects of acupuncture.

Trial registration

Chinese Clinical Trial Registry ChiCTR1900025807. Registered on 9 September 2019
Water-soluble chlorophyll-binding proteins from Brassica oleracea allow for stable photobiocatalytic oxidation of cellulose by a lytic polysaccharide monooxygenase
Authors: Dodge N. , Russo D. A. , Blossom B. M. , Singh R. K. , van Oort B. , Croce R. , Bjerrum M. J. , Jensen P. E.
Published: November 2020

Background

Lytic polysaccharide monooxygenases (LPMOs) are indispensable redox enzymes used in industry for the saccharification of plant biomass. LPMO-driven cellulose oxidation can be enhanced considerably through photobiocatalysis using chlorophyll derivatives and light. Water soluble chlorophyll binding proteins (WSCPs) make it is possible to stabilize and solubilize chlorophyll in aqueous solution, allowing for in vitro studies on photostability and ROS production. Here we aim to apply WSCP–Chl a as a photosensitizing complex for photobiocatalysis with the LPMO, TtAA9.

Results

We have in this study demonstrated how WSCP reconstituted with chlorophyll a (WSCP–Chl a) can create a stable photosensitizing complex which produces controlled amounts of H2O2 in the presence of ascorbic acid and light. WSCP–Chl a is highly reactive and allows for tightly controlled formation of H2O2 by regulating light intensity. TtAA9 together with WSCP–Chl a shows increased cellulose oxidation under low light conditions, and the WSCP–Chl a complex remains stable after 24 h of light exposure. Additionally, the WSCP–Chl a complex demonstrates stability over a range of temperatures and pH conditions relevant for enzyme activity in industrial settings.

Conclusion

With WSCP–Chl a as the photosensitizer, the need to replenish Chl is greatly reduced, enhancing the catalytic lifetime of light-driven LPMOs and increasing the efficiency of cellulose depolymerization. WSCP–Chl a allows for stable photobiocatalysis providing a sustainable solution for biomass processing.
Refinement and validation of infrared thermal imaging (IRT): a non-invasive technique to measure disease activity in a mouse model of rheumatoid arthritis
Authors: Nosrati Zeynab , Bergamo Marta , Rodríguez-Rodríguez Cristina , Saatchi Katayoun , Häfeli Urs O.
Published: November 2020

Background

The discovery and development of new medicines requires high-throughput screening of possible therapeutics in a specific model of the disease. Infrared thermal imaging (IRT) is a modern assessment method with extensive clinical and preclinical applications. Employing IRT in longitudinal preclinical setting to monitor arthritis onset, disease activity and therapeutic efficacies requires a standardized framework to provide reproducible quantitative data as a precondition for clinical studies.

Methods

Here, we established the accuracy and reliability of an inexpensive smartphone connected infrared (IR) camera against known temperature objects as well as certified blackbody calibration equipment. An easy to use protocol incorporating contactless image acquisition and computer-assisted data analysis was developed to detect disease-related temperature changes in a collagen-induced arthritis (CIA) mouse model and validated by comparison with two conventional methods, clinical arthritis scoring and paw thickness measurement. We implemented IRT to demonstrate the beneficial therapeutic effect of nanoparticle drug delivery versus free methotrexate (MTX) in vivo.

Results

The calibrations revealed high accuracy and reliability of the IR camera for detecting temperature changes in the rheumatoid arthritis animal model. Significant positive correlation was found between temperature changes and paw thickness measurements as the disease progressed. IRT was found to be superior over the conventional techniques specially at early arthritis onset, when it is difficult to observe subclinical signs and measure structural changes.

Conclusion

IRT proved to be a valid and unbiased method to detect temperature changes and quantify the degree of inflammation in a rapid and reproducible manner in longitudinal preclinical drug efficacy studies.
Glycopenia - induced sympathoadrenal activation in diabetes mellitus and uncontrolled arterial hypertension: an observational study
Authors: Abobarin-Adeagbo Abimbola , Wienke Andreas , Girndt Matthias , Pliquett Rainer U.
Published: November 2020

Background

Aim of this study is to investigate a possible association of hypoglycemic episodes and arterial hypertension. We hypothesize that hospitalized insulin-treated diabetes patients with hypertensive crisis have more hypoglycemic episodes than their counterparts without hypertensive crisis on admission.

Methods

In a prospective, observational cohort study, 65 insulin-treated diabetes patients (type 1, type 2, type 3c) were included in Group 1, when a hypertensive crisis was present, as control patients in Group 2 without hypertensive crisis or hypoglycemia, in Group 3, when a symptomatic hypoglycemia was present on admission. All patients were subjected to open-label continuous glucose monitoring, 24-h blood-pressure- and Holter electrocardiogram recordings, and to laboratory tests including plasma catecholamines.

Results

53 patients, thereof 19 Group-1, 19 Group-2, 15 Group-3 patients, completed this study. Group-1 patients had the highest maximum systolic blood pressure, a higher daily cumulative insulin dose at admission, a higher body-mass index, and a higher plasma norepinephrine than control patients of Group 2. Group-3 patients had more documented hypoglycemic episodes (0.8 ± 0.5 per 24 h) than Group-2 patients (0.2 ± 0.3 per 24 h), however, they were not different to the ones in Group-1 patients (0.4 ± 0.4 per 24 h). Plasma norepinephrine and mean arterial blood pressure were higher Group-1 and Group-3 patients than in control patients of Group 2. At discharge, the daily cumulative insulin dose was reduced in Group-1 (− 18.4 ± 24.9 units) and in Group-3 patients (− 18.6 ± 22.7 units), but remained unchanged in Group-2 control patients (− 2.9 ± 15.6 units).

Conclusions

An association between hypoglycemic events and uncontrolled hypertension was found in this study.
Linear behavior in Covid19 epidemic as an effect of lockdown
Authors: Bambusi Dario , Ponno Antonio
Published: November 2020

We propose a mechanism explaining the approximately linear growth of Covid19 world total cases as well as the slow linear decrease of the daily new cases (and daily deaths) observed (in average) in USA and Italy. In our explanation, we regard a given population (the whole world or a single nation) as composed by many sub-clusters which, after lockdown, evolve essentially independently. The interaction is modeled by the fact that the outbreak time of the epidemic in a sub-cluster is a random variable with probability density slowly varying in time. The explanation is independent of the law according to which the epidemic evolves in the single sub cluster.
Promoting patients’ rights through hospital accreditation
Authors: Engel Carsten
Published: November 2020

Legislation and accreditation standards both address patients’ rights. The two approaches differ in important ways; they should not be seen as competing but as complementing efforts. Laws define minimum standards, whereas accreditation standards describe optimal performance; laws focus on the rights, whereas accreditation standards also point out ways in which hospitals may act to deliver these rights, which both serves to help hospitals implementing the rights and to standardize the measures taken across hospitals. A recent Israeli study underpins this view, but also highlights that international accreditation standards and national legislation may differ, when it comes to the definition of the actual rights.
Relationship between patient ethnicity and prevalence of anemia during pregnancy and the puerperium period and compliance with healthcare recommendations - implications for targeted health policy
Authors: Yefet Enav , Yossef Avishag , Massalha Manal , Suleiman Abeer , Hatokay Aliza , Kamhine-Yefet Moria , Nachum Zohar
Published: November 2020

Background

Anemia is common during pregnancy and the puerperium. The association of ethnicity as well as other characteristics with anemia and compliance with healthcare recommendations has not been studied sufficiently and needs to be explored in order to implement a targeted health policy. We examined the association between ethnicity and the risk for prenatal and puerperium anemia and the compliance with healthcare recommendations. This effort aims to guide reforms in policies and practices that will assist in decreasing anemia prevalence in Israel.

Methods

This study was a secondary analysis of a prospective cohort study database including 1558 women who delivered vaginally at Emek Medical Center. Anemia was assessed before delivery by obtaining a complete blood count (CBC). After delivery, CBCs were taken in cases of postpartum hemorrhage, symptoms consistent with anemia, prenatal anemia or other clinical indications. The study population was divided according to their ethnicity (Jews and Arabs).

The primary outcomes were anemia before delivery, anemia in the immediate postpartum and 6 weeks postpartum, and compliance with healthcare recommendations, which was defined as the rate of women who performed a routine CBC test 6-weeks-postpartum.

Results

The rates of anemia before delivery and in the puerperium period were similar between Jews and Arabs (before delivery: 88 (11%) versus 98 (14%); 6 weeks postpartum: 55 (21%) vs 68 (28%), respectively;p > 0.05). Iron supplementation was high in both groups during pregnancy (~ 90%) and lower during the postpartum for Jews compared to Arabs (72% vs 83%,respectively;P < .0001). Only one third of the patients performed a CBC 6-weeks-postpartum regardless of ethnicity.

Conclusion

Overall compliance with health recommendation was high during pregnancy but low postpartum and was reflected in anemia persistence regardless of ethnicity.

Because of the adverse long term impact of anemia on patient’s health, new policies need to be developed to improve patient’s compliance postpartum. A possible strategy is to combine the follow-up of the mother with the one of the newborn in the family health stations (Tipat Halav) and the community clinics similarly to the close follow-up during pregnancy. Additional methods may include active summoning for CBC test and assuring iron supplement consumption.
Stochastic and deterministic mathematical model of cholera disease dynamics with direct transmission
Authors: Tilahun Getachew Teshome , Woldegerima Woldegebriel Assefa , Wondifraw Aychew
Published: November 2020

In this paper we develop a stochastic mathematical model of cholera disease dynamics by considering direct contact transmission pathway. The model considers four compartments, namely susceptible humans, infectious humans, treated humans, and recovered humans. Firstly, we develop a deterministic mathematical model of cholera. Since the deterministic model does not consider the randomness process or environmental factors, we converted it to a stochastic model. Then, for both types of models, the qualitative behaviors, such as the invariant region, the existence of a positive invariant solution, the two equilibrium points (disease-free and endemic equilibrium), and their stabilities (local as well as global stability) of the model are studied. Moreover, the basic reproduction numbers are obtained for both models and compared. From the comparison, we obtained that the basic reproduction number of the stochastic model is much smaller than that of the deterministic one, which means that the stochastic approach is more realistic. Finally, we performed sensitivity analysis and numerical simulations. The numerical simulation results show that reducing contact rate, improving treatment rate, and environmental sanitation are the most crucial activities to eradicate cholera disease from the community.
Coupled fixed point analysis in fuzzy cone metric spaces with an application to nonlinear integral equations
Authors: Chen Gui-Xiu , Jabeen Shamoona , Rehman Saif Ur , Khalil Ahmed Mostafa , Abbas Fatima , Kanwal Arzoo , Ullah Hayat
Published: November 2020

In this paper, we introduce the concept of coupled type and cyclic coupled type fuzzy cone contraction mappings in fuzzy cone metric spaces. We establish some coupled fixed point results without the mixed monotone property, and also present some coupled fixed results using the partial order metric in the said space. We present some strong coupled fixed point theorems using cyclic coupled type fuzzy cone contraction mappings in fuzzy cone metric spaces. Moreover, we present an application of nonlinear integral equations for the existence of a unique solution to support our work.
Efficacy of universal preoperative decolonization with Polyhexanide in primary joint arthroplasty on surgical site infections. A multicenter before-and after-study
Authors: Wandhoff Björn , Schröder Christin , Nöth Ulrich , Krause Robert , Schmidt Burkhard , David Stephan , Scheller Eike-Eric , Jahn Friedrich , Behnke Michael , Gastmeier Petra , Kramer Tobias Siegfried
Published: November 2020

Background

Surgical site infections (SSI) are rare but severe complications after total joint arthroplasty (TJA). Decolonization measures prior to elective orthopedic surgeries have shown to reduce the risk of SSI with Staphylococcus aureus (S. aureus).

Objective

To determine the efficacy of universal decolonization with Polyhexanide on SSI rates with a focus on Staphylococcus aureus in patients with TJA.

Methods

Patients scheduled for elective hip or knee TJA in 5 participating certified orthopedic centers were included between 2015 and 2018 into this before and after study. Data on patients, surgeries and infections were prospectively collected. CDC-criteria were used to define and categorize Infections within 90 days after surgery. From January 2017 on, patients received decolonization sets containing Polyhexanide. Patients performed a 5 day decolonization regimen starting 4 days prior to surgery which included wipes, nasal decontamination and oral solution.

Results

Thirteen thousand, three hundred fifteen patients received TJA. During intervention 4437 decolonization sets were distributed among 7175 patients.

Overall SSI rates increased from 0.68 /100 surgeries to 0.91/ 100 surgeries after implementation of the intervention (IRR 1.32; 95% CI 0.90–1.96). Time series analysis identified an increasing trend of SSI prior to the intervention. After implementation overall SSI rates plateaued. Regression analysis revealed surgery during intervention period to be an independent risk factor for developing a SSI (OR 1.34; 95%CI 1.18–1.53).

Initial SSI rates due to S. aureus were 0.24/100 surgeries and decreased to 0.14/100 surgeries (IRR 0.57; 95% CI 0.25–1.22) after introduction of decolonization. Regression analysis revealed surgery during intervention period to be an independent protective factor for developing a SSI with S. aureus (OR 0.57, 95% CI: 0.33–0.99).

Overall deep S. aureus SSI decreased significantly from 0.22/100 surgeries to 0.00/100 surgeries in patients adherent to protocol (IRR 0.00, 95% CI 0.00–.85).

Conclusion

Universal decolonization with Polyhexanide did not reduce overall surgical site infections, but was effective in reducing Staphylococcus aureus - surgical site infections following elective joint arthroplasty. Polyhexanide could extend the list of alternatives to already established decolonization strategies.

Trial registration

The trial was registered at the German Registry for clinical studies www.drks.de (DRKS00011505).
Eating disorders amongst Aboriginal and Torres Strait Islander Australians: a scoping review
Authors: Burt Adam , Mitchison Deborah , Doyle Kerrie , Hay Phillipa
Published: November 2020

Background

Aboriginal and Torres Strait Islander Australians (Indigenous Australians) have poorer mental health compared to other Australians. Yet, there is a lack of research into mental disorders among this population, especially for eating disorders (ED), which are amongst the most lethal and debilitating mental disorders.

Aim

We aimed to answer 2 questions: 1. What is the volume and content of literature on ED among Indigenous Australians? 2. Has a screening or diagnostic tool/instrument been developed for the assessment of ED amongst Indigenous Australians?

Method

We conducted a scoping review of electronic databases (Pubmeb, Embase, PsychInfo, Proquest, Cochrane Library, Indigenous HealtInfoNet and Scopus), for studies addressing ED, body image, muscle dysmorphia, weight and shape concern among Indigenous Australians, as well as diagnostic and screening tools. All relevant studies were reviewed in full by 2 researchers. Narrative synthesis of the data was performed.

Results

There is limited evidence for ED among Indigenous Australians, however, the evidence available strongly suggests that ED are more common among Indigenous Australians compared to other Australians. Eating disorders among Indigenous Australians are also associated with high levels of overvaluation of weight and shape. The increased risk of ED among Indigenous Australians was largely explained by factors such as poorer psychosocial wellbeing. No evidence was found for the existence of validated diagnostic or screening tools for ED in Indigenous Australians.

Conclusion

The evidence suggests ED are common among Indigenous Australians, and there are no diagnostic or screening tools available to assist clinicians in assessing them. More research is required in this field, especially towards the development of a validated and culturally specific screening or diagnostic tool for ED among Indigenous Australians.
Presentations of tetramethylammonium hydroxide dermal exposure and the valuable potential of diphoterine solution in decontamination: a retrospective observational study
Authors: Huang Chih-Kang , Hall Alan H. , Wu Ming-Ling , Yang Chen-Chang , Hung Dong-Zong , Mao Yan-Chiao , Deng Jou-Fang
Published: November 2020

Background

Tetramethylammonium hydroxide (TMAH) is a quaternary ammonium compound that is both a base corrosive and a cholinergic agonist, and it is widely used in the photoelectric and semiconductor industries. It causes corrosive skin injuries and systemic cholinergic toxicity with death primarily resulting from respiratory failure without efficacious early decontamination.

Methods

A retrospective observational study was performed of all cases of TMAH exposure reported to the Taiwan Poison Control Center between July 2010 and October 2017. Retrieved medical records were independently reviewed by two trained clinical toxicologists.

Results

Despite immediate (< 5 min) skin decontamination with copious amounts of tap water, one patient exposed to 25% TMAH involving ≥5% of total body surface area (TBSA) developed significant systemic toxicity. Patients exposed to 25% TMAH involving ≤1% TBSA developed first-degree chemical skin injuries but no systemic toxicity. Among patients exposed to lower concentrations (≤2.38%) of TMAH, the majority only experienced first-degree chemical skin injuries without systemic signs. Patients exposed to 0.5% TMAH involving nearly their entire TBSA developed no chemical skin injuries or systemic toxicity. All patients who had only first-degree chemical skin injuries did not develop systemic toxicity after exposure to either 2.38% or 25% TMAH.

Conclusions

TMAH acts as an alkaline corrosive and cholinergic agonist. Systemic signs attributable to TMA+ can rapidly lead to respiratory failure and death after dermal exposure. We have demonstrated that an amphoteric solution may be efficacious for skin decontamination on-site immediately to prevent or ameliorate such toxicity. This practice especially carries a valuable potential in managing victims (patients) who have been exposed to those chemicals with immediate life-threatening toxicity (e.g. TMAH), suggesting that its early utilization deserves further study.