bluuebunny/crossref_metadata_2025 huggingface dataset:
‘We just look at the well-being of the baby and not the money required’: a qualitative study exploring experiences of quality of maternity care among women in Nairobi’s informal settlements in Kenya
Authors: Oluoch-Aridi Jackline , Wafula Francis , Kokwaro Gilbert , Adam Mary B
Published: September 2020

Objective

To examine how women living in an informal settlement in Nairobi perceive the quality of maternity care and how it influences their choice of a delivery health facility.

Design

Qualitative study.

Settings

Dandora, an informal settlement, Nairobi City in Kenya.

Participants

Six focus group discussions with 40 purposively selected women aged 18–49 years at six health facilities.

Results

Four broad themes were identified: (1) perceived quality of the delivery services, (2) financial access to delivery service, (3) physical amenities at the health facility, and (4) the 2017 health workers’ strike.

The four facilitators that influenced women to choose a private health facility were: (1) interpersonal treatment at health facilities, (2) perceived quality of clinical services, (3) financial access to health services at the facility, and (4) the physical amenities at the health facility. The three barriers to choosing a private facility were: (1) poor quality clinical services at low-cost health facilities, (2) shortage of specialist doctors, and (3) referral to public health facilities during emergencies.

The facilitators that influenced women to choose a public facility were: (1) physical amenities for dealing with obstetric emergencies and (2) early referral to public maternity during antenatal care services. Barriers to choosing a public facility were: (1) perception of poor quality clinical services, (2) concerns over security for newborns at tertiary health facilities, (3) fear of mistreatment during delivery, (4) use of unsupervised trainee doctors for deliveries, (5) poor quality of physical amenities, and (6) inadequate staffing.

Conclusion

The study provides insights into decision-making processes for women when choosing a delivery facility by identifying critical attributes that they value and how perceptions of quality influence their choices.
Prevalence and epidemiological characteristics of inmates diagnosed with infectious diseases living in a region with a high number of prisons in São Paulo state, Brazil
Authors: do Nascimento Charlene Troiani , Pena Danilo Zangirolami , Giuffrida Rogério , Bandeira Monteiro Fernanda Nobre , da Silva Francisco Assis , Flores Edilson Ferreira , Prestes-Carneiro Luiz Euribel
Published: September 2020

Objective

To determine the prevalence and epidemiological characteristics of inmates diagnosed with infectious diseases living in a region with a high number of prisons, São Paulo, Brazil.

Design

This is a retrospective and descriptive study conducted from November 2017 to October 2018.

Setting

Prisons located in the western and northwestern regions of São Paulo, Brazil.

Methods

We conducted a retrospective analysis on infectious diseases and coinfections (HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and tuberculosis (TB)) of inmates from 28 prisons. Inmates were previously diagnosed following the protocol for control and surveillance of infectious diseases, through laboratory or imaging methods. A questionnaire was completed by the healthcare staff. Prevalence was obtained by dividing the number of individuals with positive results by the number of inmates in each prison. Locations of prisons were obtained and maps were constructed using geographic information systems.

Results

A total of 741 of 37 497 inmates (1.97%) were diagnosed with HIV, HBV, HCV, syphilis or TB. HIV was the most prevalent infectious disease (0.68%), followed by TB (0.66%), syphilis (0.2%), HCV (0.2%) and HBV (0.04%). For all of these diseases, prevalence rates varied from very low to high (3.11% and 2.45%) for TB and HIV, respectively, in the five prisons where they were most prevalent. HIV-syphilis was the most associated coinfection (OR, 63.7; 95% CI 41.4 to 96.7). Three of those diagnosed with the infection were female and the ratio of female to men was 0.004:1.

Conclusions

Our findings demonstrate that the number of cases of infectious disease among inmates in the northwestern and western region of São Paulo is probably underestimated, with lower rates of HCV, HBV and syphilis. This represents a challenge to prisoners’ health. Improvements in diagnosis, mainly to reduce viral hepatitis, are crucial with benefits for inmates and the general population.
Is body mass index associated with the incidence of endometriosis and the severity of dysmenorrhoea: a case–control study in China?
Authors: Tang Yunhui , Zhao Mingzhi , Lin Luling , Gao Yifei , Chen George Qiaoqi , Chen Shouzhen , Chen Qi
Published: September 2020

Objective

Endometriosis is considered as a serious gynaecological disease in women at a reproductive age. Lower body mass index (BMI) is thought to be a risk factor. However, recent studies indicated that women with normal BMI were also more likely to develop endometriosis, suggesting the association with BMI is controversial. We therefore investigated the association of BMI and surgically diagnosed endometriosis in a cohort of Chinese women.

Design

Retrospective case–control study.

Setting

Tertiary hospital.

Patients

709 women with endometriosis and 807 age matched controls between January 2018 and August 2019.

Intervention

Age at diagnosis, parity, gravida, BMI and self-reported dysmenorrhoea status were collected and the association of BMI and endometriosis was analysed.

Measurement and main results

Overall, the median BMI was not different between patients and controls (21.1 kg/m2 vs 20.9 kg/m2, p=0.223). According to the BMI categories for Asians/Chinese by WHO (underweight: <18.5 kg/m2, normal weight: 18.5–22.99 kg/m2, overweight: 23–27.49 kg/m2, obese: ≥27.50 kg/m2), overall, there was no difference in the association of BMI and endometriosis (p=0.112). 60% of patients were of normal weight. However, the OR of obese patients (BMI over 27.50 kg/m2) having endometriosis was1.979 (95% CI 1.15 to 3.52, p=0.0185), compared with women with normal weight. 50.3% patients reported dysmenorrhoea, and the OR of developing severe dysmenorrhoea in obese patients (BMI over 27.50 kg/m2) was 3.64 (95% CI 1.195 to 10.15, p=0.025), compared with patients with normal weight.

Conclusion

Our data demonstrate that overall there was no association between BMI and the incidence of endometriosis, but there was a significant increase in the incidence of endometriosis in obese women, compared with women with normal weight. Obesity was also a risk factor for severe dysmenorrhoea.
Determining barriers and facilitators to engagement for families in a family-based, multicomponent healthy lifestyles intervention for children and adolescents: a qualitative study
Authors: Wild Cervantée EK , Rawiri Ngauru T , Willing Esther J , Hofman Paul L , Anderson Yvonne C
Published: September 2020

Objectives

Recruitment and retention in child and adolescent healthy lifestyle intervention services for childhood obesity is challenging, and inequalities across social groups are persistent. This study aimed to understand the barriers and facilitators to engagement in a multicomponent assessment-and-intervention healthy lifestyle programme for children and their families, based in the home and community.

Design

Qualitative interview-based study of past users (n=76) of a family-based multicomponent healthy lifestyle programme in a mixed urban–rural region of New Zealand. Semistructured, home-based interviews were conducted and thematically analysed with peer debriefing for validity.

Participants

Families were selected through stratified random sampling to include a range of levels of engagement, including those who declined their referral, with equal numbers of interviews with Indigenous and non-Indigenous families.

Results

Three interactive and compounding determinants were identified as influencing engagement in Whānau Pakari: acute and chronic life stressors, societal norms of weight and body size and historical experiences of healthcare. These determinants were present across societal, system and healthcare service levels. A negative referral experience to Whānau Pakari often resulted in participants declining further input or disengaging from the programme. A fourth domain, respectful and compassionate healthcare, was identified as a mitigator of these three themes, facilitating participant engagement despite previous negative experiences.

Conclusions

While participant engagement in healthy lifestyle programmes is affected by determinants which appear to operate outside immediate service provision, the programme is an opportunity to acknowledge past instances of stigma and the wider challenges of healthy lifestyle change. The experience of the referral to Whānau Pakari is important for setting the scene for future engagement in the programme. Respectful, compassionate care is critical to enhanced retention in multidisciplinary healthy lifestyle programmes and ongoing engagement in healthcare services overall.
Multiprofessional leadership development: reflections from a doctor in training
Authors: Chen Yang
Published: September 2020

Background

In July 2020, the National Health Service (NHS) People Plan was refreshed, giving further impetus to staff development and leadership training. Through a series of interwoven tales, I discuss my own journey of leadership development and offer an analysis of the value of dedicated courses and the importance of providing this to the wider workforce.

Story of self

I am a doctor in training and was among the first three cohorts placed onto the new Rosalind Franklin programme, organised by the NHS Leadership Academy. I share my key reflections of the impact of this course on my personal and professional development.

Story of us

My cohort contained professionals from a diverse range of backgrounds—their challenges, views and insights contrasted greatly with my own. Having the protected time to build trust, form teams and discuss issues that crossed organisational boundaries provided novel insights that helped all of us.

Story of now

As the COVID-19 pandemic has taken hold, we are in a state of extreme flux. As a result, I have become aware of how important it is to marry expertise with generalist skills and knowledge of the wider healthcare system. Enduring the initial surge of COVID-19 was about staff working together and blending specialism with generalist pragmatism. The ability to harness and sustain this type of working will represent a legacy from COVID-19 that is positive and one which galvanises our greatest asset—the talents and experiences of our diverse workforce—in order to meet future healthcare challenges.
Electroweak physics in inclusive deep inelastic scattering at the LHeC
Authors: Britzger Daniel , Klein Max , Spiesberger Hubert
Published: September 2020

At the proposed electron-proton collider LHeC electroweak interactions can be uniquely studied in a largely unexplored kinematic region of spacelike momentum transfer. We simulate inclusive neutral- and charged-current deep-inelastic lepton proton scattering cross section data at center-of-mass energies of 1.2 and 1.3 TeV, and estimate the uncertainties of Standard Model parameters as well as of parameters describing physics beyond the Standard Model. A precision at sub-percent level is expected for the measurement of the weak neutral-current couplings of the light-quarks to the Z boson, $$g_{A/V}^{u/d}$$

g

A
/
V

u
/
d

, improving their present precision by more than an order of magnitude. The weak mixing angle can be determined with a precision of about $$\Delta \sin ^2\theta _\text {W}=\pm \,0.00015$$

Δ

sin
2

θ
W

=
±

0.00015

, and its scale dependence can be studied in the range between about 25 and 700 GeV. An indirect determination of the W-boson mass in the on-shell scheme is possible with an experimental uncertainty down to $$\Delta m_{W}=\pm \,6\,\text {MeV}$$

Δ

m
W

=
±

6

MeV

. We discuss how measurements in deep-inelastic scattering compare with those in the timelike domain, and which aspects are unique, for instance electroweak parameters in charged-current interactions. We conclude that the LHeC will determine electroweak physics parameters, in the spacelike region, with unprecedented precision leading to thorough tests of the Standard Model and possibly beyond.
Experiments on Stability Performance of Thin-Walled, Open-Top Steel Storage Tanks Subjected to Local Support Settlement
Authors: Naseri Hamid , Showkati Hossein , Zirakian Tadeh , Nasernia Sina
Published: September 2020

Local support settlement is a typical differential settlement which may take place under steel storage tanks and can adversely affect the stability performance of such thin-walled structures. Considering the practical applications of the thin-walled steel storage tanks in industry, proper treatment of this problem is essential to ensure the high structural performance of such members which albeit requires detailed investigations. On this basis, this study investigates the effects of the local support settlement on the buckling stability of two tanks without and with a top stiffening ring through the experimental and numerical approaches. The considered tanks are small-scale models with the height-to-radius and radius-to-thickness (slenderness) ratios of 1.0 and 834, respectively. Both experimental and numerical results show that the behavior of the tank under the local support settlement is nonlinear. Moreover, the effectiveness of the top stiffening ring in limiting the buckling deformation and improving the buckling performance of the tank is demonstrated in this study.
Bending Analysis of Bidirectional FGM Timoshenko Nanobeam Subjected to Mechanical and Magnetic Forces and Resting on Winkler–Pasternak Foundation
Authors: Khoram Mehdi Mousavi , Hosseini Mohammad , Hadi Amin , Shishehsaz Mohammad
Published: September 2020

Bending of bidirectional functionally graded nanobeams under mechanical loads and magnetic force was investigated. The nanobeam is assumed to be resting on the Winkler–Pasternak foundation. Eringen’s nonlocal elasticity theory and Timoshenko beam model are utilized to describe the mechanical behavior of the nanobeam. Material properties of the functionally graded beam are assumed to vary in the thickness and length of the nanobeam. Hamilton’s principle is employed to derive the governing equation and related boundary conditions. These equations are solved using the generalized differential quadrature method. The obtained results are compared with the results presented in other studies, to ensure the validity and versatility of this method. This comparison shows a good agreement between the results. Results are presented and discussed for different values of functionally graded materials indices, different aspect ratios, and different boundary conditions. The effect of the magnetic field and elastic foundation on buckling load has also been studied. The difference in nanobeam behavior for different values of the size-effect parameter is clearly shown.
An analysis of TCM disease syndromes of 36 cases of coronavirus disease 2019 (COVID-19) in Kunming, China
Authors: Zhu Jiangchun , Gan Shunkui , Bai Jinsong , Du Yingrong , Gao Jianpeng , Peng Jiangli , Yang Chunyan , Liu Qing , Li Jinghua , Fu Yi
Published: September 2020

Objective: To analyze the distribution characteristics of syndrome of TCM of the patients with COVID-19 in Kunming, China.

Methods: To classify and summarize the TCM syndrome types of COVID-19 patients via Cluster analysis combining with tongue image, chest CT and clinical expertise of 36 Covid-19 patients in Kunming.

Results: In the 36 cases of Kunming region confirmed COVID-19 patients, 17 cases had fever (47.2%), 18 cases had cough (50%), 16 cases felt bitter taste in the mouth (44.4%), 18 cases felt dry throat (50.0%), 17 cases had poor appetite (47.2%), 15 cases had nausea (41.7%); 12 cases had diarrhea (33.3%), 15 cases had insomnia (41.7%); 12 cases had chest tightness (33.3%); 3 cases had dyspnea (8.3%); 6 cases had nasal congestion and running nose (16.7%); 15 cases had fatigue (41.7%); 6 cases had headache and body pain (16.7%); 5 cases had red tongue (13.9%); 18 cases had pale red tongue (50%); 8 cases had tongue with red edge and tip (22.2%); 3 cases had dark red tongue (8.3%); 2 cases had cyanosis (5.6%); 3 cases had swollen tongue (8.3%); 18 cases had dentate tongue (50%); 4 cases had yellow tongue coating (11.1%); 5 cases had yellow sticky tongue coating (13.9%); 12 cases had white sticky tongue coating (33.3%); 6 cases had thin white tongue coating (16.7%); 2 cases had no tongue coating (5.6%).

The chest CT results showed that: There were five cases without lesions. The lesions were located in the upper lobe of one lung in 13 cases located in the lower lobe of one lung in seven cases, located in the upper middle lobe in three cases, located in the lower lobe in five cases, and in the upper middle and lower lobes of double lung in 13 cases. There were 14 cases of Shaoyang syndrome, 17 cases of wet Resistance Tir-juao Syndrome. According to the time of onset, the disease was followed by Shaoyang Syndrome (1 day), the Wet blocked tri-jiao Syndrome (3 days), epidemic poison retention lung syndrome and syndrome of flaring heat in qifen and yingfen (5 days), and dampness-toxicity lung-stagnation syndrome (6 days).

Conclusion: The TCM syndromes of COVID-19 in Kunming are mainly the Wet Resistance Tri-Jiao Syndrome and Shaoyang syndrome, followed by dampness-toxicity lung-stagnation syndrome, epidemic poison retention lung and syndrome of flaring heat in qifen and yingfen.
Numerical Approximation of Riccati Fractional Differential Equation in the Sense of Caputo-Type Fractional Derivative
Authors: Liu Xin , Kamran  , Yao Yukun
Published: September 2020

The Riccati differential equation is a well-known nonlinear differential equation and has different applications in engineering and science domains, such as robust stabilization, stochastic realization theory, network synthesis, and optimal control, and in financial mathematics. In this study, we aim to approximate the solution of a fractional Riccati equation of order 0<β<1 with Atangana–Baleanu derivative (ABC). Our numerical scheme is based on Laplace transform (LT) and quadrature rule. We apply LT to the given fractional differential equation, which reduces it to an algebraic equation. The reduced equation is solved for the unknown in LT space. The solution of the original problem is retrieved by representing it as a Bromwich integral in the complex plane along a smooth curve. The Bromwich integral is approximated using the trapezoidal rule. Some numerical experiments are performed to validate our numerical scheme.
Use of Edoxaban for the Treatment of Heparin-Induced Thrombocytopenia
Authors: Kanamoto Ryo , Hiromatsu Shinichi , Anegawa Tomoyuki , Sakurai Kanako , Yoshida Shohei , Shintani Yusuke , Otsuka Hiroyuki , Tobinaga Satoru , Tanaka Hiroyuki
Published: September 2020

Heparin-induced thrombocytopenia (HIT) is a life-threatening adverse drug reaction of heparin therapy, which increases a patient’s risk of developing venous and/or arterial thromboembolism. HIT should be treated through discontinuation of heparin and administration of nonheparin anticoagulants such as argatroban. For long-term anticoagulation, parenteral nonheparin anticoagulants are generally converted to oral treatment with a vitamin K antagonist such as warfarin. Although administration of warfarin is recommended to overlap with a nonheparin anticoagulant for a minimum of 5 days, overlapping with argatroban and warfarin presents high risks of bleeding. We describe a case of HIT treated with edoxaban. A 78-year-old man underwent surgery for esophageal cancer and was administered heparin perioperatively. After surgery, he was diagnosed with HIT and venous thromboembolism. We immediately stopped heparin and initiated parenteral argatroban. The patient was subsequently started on edoxaban without any overlap between the two drugs. The treatment was successful. The treatment of edoxaban following argatroban for HIT could reduce bleeding complications and shorten the length of hospital stay. To the best of our knowledge, this is the first report of the use of edoxaban for HIT treatment.
Quantitative Definition of Seismic Performance Levels for Precast Bridge Piers with Continuous Reinforcement
Authors: Park Seongjun , Koem Chandara , Shim Changsu
Published: September 2020

For construction sites within cities, which require fast construction because of restrictions in road occupation time, or for other occasions where construction period is an important factor because of similar reasons, application of a modular construction method using precast members is efficient in terms of shortening the construction period. The substructures of bridges are normally constructed using cast‐in‐place, which has been a major cause of delays in construction. Application of a modular construction method could decrease the occupation time in the sites. A prime example is the Accelerated Bridge Construction (ABC) by the Texas Department of Transportation (TDOT) and Federal Highway Administration (FHWA). Precast members are the key components of ABC. The main purpose of this paper is to provide clear seismic performance standards for precast bridge piers. Current seismic design codes require force‐based design checks and provide qualitative evaluation of the overall structure. They do not provide specific qualitative criteria for individual structures with particular types. Previous research has been focused on reinforced‐concrete bridge piers, while lacking on research towards prefabricated bridge piers with continuous reinforcements. In order to quantitatively evaluate the seismic performance level of prefabricated bridge piers, the seismic performance was quantitatively suggested in accordance with the classification of four which are operational, immediate occupancy, life safety, and collapse prevention. These criteria are cracking of cover concrete, crushing of cover concrete, yielding of axial steels, and fracture of axial steels. Based on the given seismic performance evaluation criteria, evaluation and verification were conducted on four prefabricated bridge piers with continuous reinforcement that have undergone quasistatic cyclic experiments. The moment‐curvature analysis model was constructed for the parametric study and verified through experimental results. Based on the developed M‐Phi model, prefabricated bridge piers with continuous reinforcement, which were designed force‐based using response correction factor, were evaluated. In addition, parametric study was also conducted focusing on concrete strength, magnitude of prestress, and transverse reinforcement. Depending on the level of individual performance produced by ranges of these variables within possible runs on actual piers, the impact of 3 variables was analyzed. Furthermore, in response to changes in each variable, the impact on the relevant seismic performance level was verified through response spectrum analysis.
Robot-Assisted Partial Splenectomy for Splenic Epidermoid Cyst
Authors: kirih Mubarak Ali , Liang Xiao , Xie Yangyan , Cai Jingwei , Zheng Junhao , Xu Feng , He Shilin , Tao Liye , Abdi Faisa Ali
Published: September 2020

The splenic cyst is a rare disease with unknown etiology. The inner wall of the cyst has lining epithelium. The cyst can be unilocular or multilocular. According to pathology, it can be divided into four types: epidermoid cyst, dermoid cyst, cystic lymphangioma, and cystic hemangioma. Ultrasound examination is often the first choice for splenic cysts because of its nonradiation, low cost, and convenient examination. The images are mostly cystic masses with clear borders and dark areas without echoes, after the detection of splenic space-occupying lesions by ultrasonography, CT, and MRI. Here, we report robot-assisted partial splenectomy for a splenic cyst. Imaging diagnosis of abdominal CT enhancement: the cystic space-occupying of the spleen is considered. We should improve the preoperative examination and exclude operative contraindications. During the operation, there was about 8 cm of the upper pole of the spleen, and the boundary was clear. There was no obvious abnormality in the exploration of the abdominal viscera. The operation was successful. The operative time was 115 minutes, and the blood loss was 20 ml. On the first day after the operation, the patient took a liquid diet. The time of first anal exhaust was on the second day after operation. The patient was discharged at the fourth day. Postoperative pathology revealed epidermoid cyst. The therapy strategy of the splenic cyst is ambiguous. Better understanding of the splenic segmental anatomy and surgical skills has made minimally invasive partial splenectomy a preferred treatment for splenic cysts. In this paper, we report a case of splenic epidermoid cyst managed successfully by robot-assisted partial splenectomy.
Deciphering the Underlying Mechanism of Eucommiae Cortex against Osteoporotic Fracture by Network Pharmacology
Authors: Shuai Yongming , Jiang Zhili , Yuan Qiuwen , Tu Shuqiang , Zeng Fanhui
Published: September 2020

Background. Du Zhong (DZ), or Eucommiae Cortex, a traditional Chinese herbal medicine, has been used to treat osteoporosis. Although it has been reported that DZ can improve bone mass in ovariectomized rats, its pharmacological mechanisms in treating osteoporotic fractures (OPF) remain unclear. Methods. In this study, we used a network pharmacological manner to explore its potential complicated mechanism in treating OPF. We obtained DZ compounds from TCMSP and BATMAN‐TCM databases and collected potential targets of these compounds through target fishing based on TCMSP and BATMAN‐TCM databases. Next, we collected the OPF targets by using CTD, GeneCards, OMIM, HPO, and GenCLiP 3 databases. And then the overlapping genes between DZ potential targets and OPF targets were used to build up the protein‐protein interaction (PPI) network and to analyze their interactions and find out the big hub genes in this network. Subsequently, clusterProfiler package in R language was utilized to conduct the enrichment of Gene Ontology biological process and KEGG pathways. Results. There were totally 93 active compounds and 916 related targets in DZ. After the enrichment analysis, we collected top 25 cellular biological processes and top 25 pathways based on the adjusted P value and found that the DZ anti‐OPF effect was mainly associated with the regulation of ROS and inflammatory response. Furthermore, 64 hub genes in PPI network, such as MAPK1 (degree = 41), SRC (degree = 39), PIK3R1 (degree = 36), VEGFA (degree = 31), TP53 (degree = 29), EGFR (degree = 29), JUN (degree = 29), AGT (degree = 29), MAPK1, SRC, PIK3R1, VEGFA, and TP53, were considered as potential therapeutic targets, implying the underlying mechanisms of DZ acting on OPF. Conclusion. We investigated the possible therapeutic mechanisms of DZ from a systemic perspective. These key targets and pathways provided promising directions for the future research to reveal the exact regulating mechanisms of DZ in treating OPF.
Amygdalin Promotes Fracture Healing through TGF-β/Smad Signaling in Mesenchymal Stem Cells
Authors: Ying Jun , Ge Qinwen , Hu Songfeng , Luo Cheng , Lu Fengyi , Yu Yikang , Xu Taotao , Lv Shuaijie , Zhang Lei , Shen Jie , Chen Di , Tong Peijian , Xiao Luwei , Li Ju , Jin Hongting , Wang Pinger
Published: September 2020

Chondrogenesis and subsequent osteogenesis of mesenchymal stem cells (MSCs) and angiogenesis at injured sites are crucial for bone fracture healing. Amygdalin, a cyanogenic glycoside compound derived from bitter apricot kernel, has been reported to inhibit IL-1β-induced chondrocyte degeneration and to stimulate blood circulation, suggesting a promising role of amygdalin in fracture healing. In this study, tibial fractures in C57BL/6 mice were treated with amygdalin. Fracture calluses were then harvested and subjected to radiographic, histological, and biomechanical testing, as well as angiography and gene expression analyses to evaluate fracture healing. The results showed that amygdalin treatment promoted bone fracture healing. Further experiments using MSC-specific transforming growth factor- (TGF-) β receptor 2 conditional knockout (KO) mice (Tgfbr2Gli1-Cre) and C3H10 T1/2 murine mesenchymal progenitor cells showed that this effect was mediated through TGF-β/Smad signaling. We conclude that amygdalin could be used as an alternative treatment for bone fractures.
Improvement of Severe COVID-19 in an Elderly Man by Sequential Use of Antiviral Drugs
Authors: Yatomi Masakiyo , Takazawa Tomonori , Yanagisawa Kunio , Kanamoto Masafumi , Matsui Yusuke , Tsukagoshi Hiroyuki , Saruki Nobuhiro , Saito Shigeru , Tokue Yutaka , Maeno Toshitaka
Published: September 2020

Although a variety of existing drugs are being tested for patients with coronavirus disease 2019 (COVID-19), no efficacious treatment has been found so far, particularly for severe cases. We report successful recovery in an elderly patient with severe pneumonia requiring mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Despite administration of multiple antiviral drugs, including lopinavir/ritonavir, chloroquine, and favipiravir, the patient’s condition did not improve. However, after administration of another antiviral drug, remdesivir, we were able to terminate invasive interventions, including ECMO, and subsequently obtained negative polymerase chain reaction results. Although further validation is needed, remdesivir might be effective in treating COVID-19.
Updating a Strategy for Histone Deacetylases and Its Inhibitors in the Potential Treatment of Cerebral Ischemic Stroke
Authors: Xu Yuzhen , Wang Qian , Chen Jianxin , Ma Yihong , Liu Xueyuan
Published: September 2020

Background. Cerebral ischemic stroke is one of the severe diseases with a pathological condition that leads to nerve cell dysfunction with seldom available therapy options. Currently, there are few proven effective treatments available for improving cerebral ischemic stroke outcome. However, recently, there is increasing evidence that inhibition of histone deacetylase (HDAC) activity exerts a strong protective effect in in vivo and vitro models of ischemic stroke. Review Summary. HDAC is a posttranslational modification that is negatively regulated by histone acetyltransferase (HATS) and histone deacetylase. Based on function and DNA sequence similarity, histone deacetylases (HDACs) are organized into four different subclasses (I-IV). Modifications of histones play a crucial role in cerebral ischemic affair development after translation by modulating disrupted acetylation homeostasis. HDAC inhibitors (HDACi) mainly exert neuroprotective effects by enhancing histone and nonhistone acetylation levels and enhancing gene expression and protein modification functions. This article reviews HDAC and its inhibitors, hoping to find meaningful therapeutic targets. Conclusions. HDAC may be a new biological target for cerebral ischemic stroke. Future drug development targeting HDAC may make it a potentially effective anticerebral ischemic stroke drug.
A Xeno-Free Strategy for Derivation of Human Umbilical Vein Endothelial Cells and Wharton’s Jelly Derived Mesenchymal Stromal Cells: A Feasibility Study toward Personal Cell and Vascular Based Therapy
Authors: Kunkanjanawan Hataiwan , Kunkanjanawan Tanut , Khemarangsan Veerapol , Yodsheewan Rungrueang , Theerakittayakorn Kasem , Parnpai Rangsun
Published: September 2020

Coimplantation of endothelial cells (ECs) and mesenchymal stromal cells (MSCs) into the transplantation site could be a feasible option to achieve a sufficient level of graft-host vascularization. To find a suitable source of tissue that provides a large number of high-quality ECs and MSCs suited for future clinical application, we developed a simplified xeno-free strategy for isolation of human umbilical vein endothelial cells (HUVECs) and Wharton’s jelly-derived mesenchymal stromal cells (WJ-MSCs) from the same umbilical cord. We also assessed whether the coculture of HUVECs and WJ-MSCs derived from the same umbilical cord (autogenic cell source) or from different umbilical cords (allogenic cell sources) had an impact on in vitro angiogenic capacity. We found that HUVECs grown in 5 ng/ml epidermal growth factor (EGF) supplemented xeno-free condition showed higher proliferation potential compared to other conditions. HUVECs and WJ-MSCs obtained from this technic show an endothelial lineage (CD31 and von Willebrand factor) and MSC (CD73, CD90, and CD105) immunophenotype characteristic with high purity, respectively. It was also found that only the coculture of HUVEC/WJ-MSC, but not HUVEC or WJ-MSC mono-culture, provides a positive effect on vessel-like structure (VLS) formation, in vitro. Further investigations are needed to clarify the pros and cons of using autogenic or allogenic source of EC/MSC in tissue engineering applications. To the best of our knowledge, this study offers a simple, but reliable, xeno-free strategy to establish ECs and MSCs from the same umbilical cord, a new opportunity to facilitate the development of personal cell-based therapy.
Primary Appendiceal Adenocarcinoma Presenting with Hematochezia due to the Invading Tumor in the Sigmoid Colon
Authors: Suzuki Tatsuya , Yamamoto Yasuhiro , Torigoe Toshihiko , Mizukami Shoichiro , Shigehara Kengo
Published: September 2020

Primary appendiceal tumors are rare malignancies; some cases have been described to invade other organs, and this represents a very rare clinical condition. We report a case of appendiceal adenocarcinoma invading the sigmoid colon and a review of similar cases. A 69-year-old woman with complaints of hematochezia was admitted to the hospital. Colonoscopy revealed a tumor in the sigmoid colon, which was a well-differentiated tubular adenocarcinoma. A computed tomography scan showed an appendiceal mass that involved the sigmoid colon, suggesting an appendiceal cancer invading the sigmoid colon. Ileocecal resection with extended lymphadenectomy and en bloc resection of the sigmoid colon was performed. The appendiceal tumor involved the sigmoid colon and the terminal ileum. The ileocecal part which included the tumor and the involved sigmoid colon was resected in total. Macroscopic findings showed that the appendiceal tumor made a fistula with the sigmoid colon. Pathological examination revealed that the tumor was a well-differentiated tubular adenocarcinoma that invaded the sigmoid colon. The final pathological stage was T4bN0M0, stage IIC. The patient was discharged from the hospital uneventfully. She was alive without relapse after a 20-month follow-up. Although an appendiceal tumor invading the rectosigmoid region is rare, a preoperative diagnosis can be obtained that facilitates the planning of a suitable surgical procedure: en bloc resection of the ileocecal part and the rectosigmoid part.
Liquid Levothyroxine Formulation Taken during Lunch in Italy: A Case Report and Review of the Literature
Authors: Cappelli Carlo , Pirola Ilenia , Castellano Maurizio
Published: September 2020

Levothyroxine (L-T4) is among the most widely prescribed medications in the world, and it is considered by the World Health Organization an essential medicine for basic health care. Replacement therapy has always been considered straightforward although different factors may interfere with intestinal absorption of L-T4, including food, dietary fibre, coffee, drugs, and gastrointestinal diseases. For these reasons, current guidelines recommend that L-T4 should be taken in a fasting state because its absorption is maximised when it is taken on an empty stomach, reflecting the importance of gastric acidity in the absorption process. In addition to sodium L-T4 in tablet form, various formulations (soft-gel capsules and liquid solutions) have become available for clinical use in the last years promising improved absorption. We described a 31-year-old Italian man who took liquid levothyroxine formulation during lunch. He was under replacement therapy with liquid levothyroxine 75 mcg daily for hypothyroidism due to Hashimoto thyroiditis for three years. During confirmation of the L-T4 replacement therapy, the patient stated that he was going to continue to “take liquid levothyroxine during (his) lunch every day.” We recommended taking the medication correctly in the morning at least thirty minutes before breakfast and repeating TSH, fT4, and fT3 after three months. The thyroid hormonal profiles taken after 3 and 6 months were comparable to those when the patient was taking the medication during lunch. In conclusion, liquid levothyroxine formulation should be preferred in case of malabsorption or potential malabsorption. Liquid formulation should be preferred due to the possibility of taking it during breakfast, which significantly improves the compliance of patients. Further studies are needed to evaluate the possibility of taking liquid L-T4 during lunch.
Colorectal Cancer Related to Chronic Strongyloides stercoralis Infection
Authors: Sava M. , Huynh T. , Frugoli A. , Kong L. , Salehpour M. , Barrows B.
Published: September 2020

The majority of individuals with Strongyloides stercoralis (S. stercoralis) colitis are clinically asymptomatic. Symptomatic individuals may complain of nonspecific gastrointestinal symptoms, such as abdominal pain, intermittent or persistent diarrhea, nausea, or loss of appetite. In addition, skin manifestations such as recurrent urticaria can occur. If infection is not diagnosed and left untreated, it can lead to chronic inflammation of the gastrointestinal tract. It is well documented that chronic colitis such as inflammatory bowel disease can predispose individuals to colorectal cancer. Additionally, there is evidence of chronic parasitic infections inducing the development of cancers in other organs within the gastrointestinal tract. In this case vignette, we describe a case of chronic Strongyloides stercoralis infection in a Peruvian woman presenting with colorectal cancer.
Investigation of Energy and Damage Evolutions in Rock Specimens with Large‐Scale Inclined Prefabricated Cracks by Uniaxial Compression Test and AE Monitoring
Authors: Chi Xiaolou , Yang Ke , Wei Zhen
Published: September 2020

To explore the energy dissipation mechanism and damage evolution characteristics of rock specimens under compressive loading, we performed the acoustic emission (AE) testing under uniaxial compression in intact rock specimens and those with large‐scale prefabricated cracks. The basic mechanical properties of both types of specimens were analyzed comprehensively, and the evolution patterns of strain energy indicators (total strain, elastic, and dissipative energies) in rock specimens before the peak on the stress‐strain curve were identified. We further revealed the effect of the prefabricated crack dip angle, which controlled the surplus energy conversion of the following peak deformation and failure in the rock specimens. Using the modified equation of rock specimen damage evolution characterized by the AE energy and examining the fracture surface morphology via the scanning electron microscopy (SEM), the AE distribution law for rock specimen damage was revealed. An increase in the prefabricated crack dip angle was shown to reduce the peak stress and strain of rock specimens, which experienced a transition from the tensile and splitting failure mode to shear and slip one. Cracked rock specimens exhibited strain energy accumulation at the elastic deformation stage of the stress‐strain diagram and rapid energy consumption at the plastic stage. By contrast, the intact rock specimens had a smoother energy evolution pattern. As the prefabricated crack dip angle increased, the dissipated and surplus strain energies’ shares increased. Moreover, the first peak of the AE energy occurred earlier, and the stress needed for its occurrence decreased as the dip angle increased. According to the damage evolution equation for rock specimens, their damage process can be subdivided into the initial damage, stable damage increase, and the accelerating damage increase stages. An increase in the prefabricated crack dip angle accelerated the damage accumulation in rock specimens. The locking effect of the sawtooth‐like structures on the fracture surface was less conspicuous, and the fracture surface roughness increased. Thus, microcracks gradually developed, and rock specimens became more susceptible to sudden unstable failure.
Dynamic Analysis of Pantograph-Catenary System considering Ice Coating
Authors: Yao Yongming , Zhou Ning , Mei Guiming , Zhang Weihua
Published: September 2020

Ice coating on overhead contact system (OCS) will affect the sliding of pantograph, and arc discharge phenomena will occur between pantograph and catenary, which will threaten the normal operation of train. This paper presents a comprehensive model to analyze the dynamics of icing on pantograph-catenary (PAC) system. The finite element model (FEM) is used for building the catenary, the pantograph is modeled as lumped-mass model, and the ice section of the cable is fan-shaped. The increased density method, uniform load method, and combinatorial material method of icing are used to analyze the icing problem of PAC system. The similarities and differences between the three simulation methods are compared. The influence of the ice thickness on the current collection quality between the pantograph and catenary at the different operating speeds calculated by the three methods is basically the same, which fully illustrates the effectiveness of the simulated ice coating method. In comparison, the combinatorial material method is a more reasonable method for calculating the icing of catenary systems. The research also shows that the influence of icing on the current collection quality of PAC system is different when the train runs at different speeds. Specifically, as the speed of trains increases, the effect of ice thickness on the current collection quality of the PAC system is becoming increasingly apparent.
Numerical Investigation on Influential Factors for Quality of Smooth Blasting in Rock Tunnels
Authors: Zou Baoping , Xu Zhipeng , Wang Jianxiu , Luo Zhanyou , Hu Lisheng
Published: September 2020

The quality of smooth blasting including the volume of over‐/underbreak and blasting‐induced damage of surrounding rocks has been extensively considered to be highly correlated to both the cost and advancement rate of rock tunnelling excavated by the drill‐blast method. A general control strategy for smooth blasting is too difficult to be available due to the uncertainties and complexity of rock masses, as well as the varying blasting operations. As prerequisite for the evaluation of the blasting quality, effective identification of the influential factors affecting smooth blasting usually plays a significant role in the improvement of smooth blasting design. Compared to the expensive and time‐consuming experiments including physical modelling and field tests, numerical modelling, as a cost‐efficient approach, offers an attractive alternative to investigate the influential factors in terms of weight, which might be more applicable and reliable for the optimization of smooth blasting parameters. In this case, the dominant factors and secondary factors can be quantitatively identified. Considering the dominant factors often orient the development of things; in this work, a numerical‐based approach was proposed to quantitatively identify the dominant factors influencing the quality of smooth blasting. Proposed 3‐dimensional blasting modelling was based on LS‐DYNA to simulate the occurrence of smooth blasting in rock masses, and the erosion algorithm was also employed to determine the fracturing of jointed rocks. The orthogonal experimental design method was utilized to optimize the experimental arrangement. Seven factors with 4 levels including the perimeter hole spacing, line of least resistance, charge concentration, charging explosive, type of rock mass, detonation velocity, and drilling deviation were taken into account. The geological setting and project background of a real rock tunnel served for the Chengdu‐Chongqing high‐speed railway were selected as the site conditions to perform the numerical investigation. Calculated area and distance of overbreak as the observed parameters indicating the quality of smooth blasting were utilized to determine sensitivities of factors based on the range analysis of orthogonal experiments. The results suggested that the type of rock mass has the greatest influence on the blasting quality, whereas the charge concentration and detonation velocity can be considered as the secondary factors under the specific site conditions. The proposed numerical approach for assessing influential factors of quality of smooth blasting under specified geological conditions is expected to improve the parameter design and operation of smooth blasting in practical applications.
Tailored Sublingual Immunotherapy in a Monosensitized Child with Natural Rubber Latex Allergy
Authors: Giovannini Mattia , Mori Francesca , Barni Simona , Liccioli Giulia , Sarti Lucrezia , Novembre Elio
Published: September 2020

Adverse reactions to natural rubber latex (NRL) represent a group of clinical manifestations that include non-allergic reactions and immediate-type or delayed-type allergic reactions. NRL sublingual immunotherapy (SLIT) has been demonstrated to be an effective and safe practice for latex clinical manifestations with good patient tolerance. A pediatric case of NRL allergy managed with an effective tailored SLIT is described. This case is compelling because the girl, who did not have an atopic background, suffered from NRL allergy with high reactivity and unique monosensitization. To the best of our knowledge, this is the first case with this characteristic described to date. Moreover, the SLIT follow-up time reported was unusually long, extending from childhood to adulthood. The case described highlights several problems of real-life management, and it demonstrates how the pediatric allergist plays a key role in the management of all these issues in order to succeed in guiding the patient through the immunotherapy process with a personalized approach, in line with the precision medicine principles. However, further long-term clinical studies are needed to better define the natural history of NRL allergy and find new potential biomarkers of response to NRL immunotherapy.
Cystoid Macular Oedema as a Presenting Feature of Vitreoretinal Lymphoma
Authors: Chiu Stephanie , Mudhar Hardeep Singh , Harrison Beth , Spiteri-Cornish Kurt , Sears Katharine
Published: September 2020

A 69-year-old female presented with right vitreous cells and cystoid macular oedema (CMO). One year previously, she had received two cycles of attenuated methotrexate-based chemotherapy for primary central nervous system (CNS) lymphoma, abandoned due to toxicity. There was no past ocular history of note aside from mild cataract. Due to her history of previous CNS lymphoma, we suspected vitreoretinal lymphoma (VRL), but the presence of the CMO made this unlikely. She underwent a diagnostic vitrectomy. Histology and immunohistochemistry showed the presence of a high-grade B-cell VRL.