bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery
Authors: Zucco Liana , Levy Nadav , Li Yunping , Golen Toni , Shainker Scott A , Hess Philip E , Ramachandran Satya Krishna
Published: August 2020

Background: Preparedness efforts for a COVID-19 outbreak required redesign and implementation of a perioperative workflow for the management of obstetric patients. In this report we describe the rapid cycle implementation of a comprehensive perioperative checklist for care of the COVID-19 parturient and a retrospective analysis of the factors which influenced implementation success.Methods: A newly designed workflow for COVID-19 parturients requiring perioperative care was produced as a checklist, intended for use as a cognitive aid. Implementation and refinement of the workflow was accomplished through rapid-cycling, debriefing and on-site walkthroughs. Retrospective evaluation of the implementation experience was performed using a group deliberation approach, mapped against the Consolidated Framework for Implementation Research (CFIR). Results: Post-implementation, consistent use of the workflow was reported for all obstetric COVID-19 perioperative cases (100% compliance). Evaluation of our implementation using CFIR revealed domains of process implementation and innovation characteristics as overwhelming facilitators for success. Constructs within the outer setting, inner setting and characteristic of individuals (external pressures, baseline culture, and personal attributes) were felt to act as barriers. Constructs such as communication, shifted in influence over time.Conclusion: We describe the implementation of a comprehensive obstetric workflow checklist for care of the COVID-19 perioperative patient. A retrospective evaluation of our implementation experience was possible using CFIR, which enabled identification of barriers and facilitators for change within our unit. Furthermore, we observed that implementation success was possible, despite facilitation being perceived within only two domains at baseline. Emerging themes from this study highlight the importance of thoughtful innovation design, careful implementation planning and the establishment of a long-standing culture of improvement, in order to facilitate implementation of change during a time of crisis.
WITHDRAWN: Aging-related tumor microenvironment changes could worsen the prognosis of GBM patients
Authors: Song Hongwang , Fu Xiaojun , Wu Chenxing , Li Shouwei
Published: August 2020

Background: Glioblastoma multiforme (GBM) is the most malignant tumor in human brain, with highly heterogeneity among different patients. Age could function as an incidence and prognosis risk factor for many tumors.Method: A series of bioinformatic experiments were conducted to evaluate the differences of incidence, differential expressed genes, enriched pathways with the data from Surveillance, Epidemiology, and End Results (SEER) program, the cancer genome atlas (TCGA) and Chinese glioma genome atlas (CGGA) project.Results: We discovered in our present study that distinct difference of incidence and prognosis of different aged GBM patients. By a series of bioinformatic method, we found that the tumor associated fibroblasts (TAFs) was the most crucial tumor microenvironment (TME) component that led to this phenomenon. Epithelial-mesenchymal transition (EMT) could be the mechanism by which TAFs regulate the progression of GBM. Conclusion: We have proposed a close correlation between age and GBM incidence and prognosis, and propose the underlying mechanism behind this correlation by mining different databases, which laid the foundation for future research.
Large Autologous Ilium with Periosteum for Tibiotalar Joint Reconstruction in Rüedi-Allgöwer III Pilon Fractures
Authors: Li Dong , Li Jiao Jiao , Zhu Yuanyuan , Hou Fushan , Li Yuan , Zhao Bin , Wang Bin
Published: August 2020

Background: Management of Rüedi-Allgöwer III or AO type C3 pilon fracture present numerous challenges to the orthopaedic surgeon. A joint preservation technique using a large autologous ilium with periosteum in combination with internal implant fixation was reported to improve the outcome of reconstruction. Methods: Twenty-five patients with soft tissue injury of Tscherne-Gotzen I-II after Rüedi-Allgöwer III pilon fracture received a large autologous ilium with periosteum for tibiotalar joint reconstruction and open reduction and internal fixation (ORIF), between March 2015 and September 2018. The visual analog scale (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) score, and Burwell and Charnley criteria were used for outcome analysis.Results: Twenty patients with an average age of 45.2 years were followed for an average of 18.3 months. The VAS and AOFAS scores, and Burwell and Charnley ratings were recorded at the last follow-up after reconstructive surgery. Two patients developed redness and swelling at the wound site, but recovered after local care and dressing changes. No patient displayed deep surgical site infection, donor site complication, non-union or local complication during the final follow-up. The average bone union time was 18.3 months (range 3-36).Conclusions: Large autologous ilium with periosteum in combination with ORIF can be safely performed for tibiotalar joint reconstruction. This method greatly reduces the risk of post-operative complications following articular reconstruction for Rüedi-Allgöwer III pilon fractures.Level of Evidence: Level III, retrospective cohort study
Implementation of a Complex Health Services Intervention in Long-term Care Homes: A Process Evaluation Using Focus Groups
Authors: Warth Rieka von der , Kaiser Vanessa , Reese Christina , Brühmann Boris A. , Farin-Glattacker Erik
Published: August 2020

BackgroundWith increasing numbers of the elderly living in nursing homes in Germany, the need for on-site primary care increases. A lack of primary care in nursing homes can lead to unnecessary hospitalization, higher mortality, and morbidity in the elderly. Therefore, project CoCare (“coordinated medical care”) implements a complex health intervention in nursing homes, using among others regular medical rounds, a shared patient medical record and medication checks, aiming to improve the coordination of medical care. This study reports the results of a process evaluation assessing the perceived acceptance and barriers of the project by stakeholders.MethodsFocus group interviews were held between the fall of 2018 and the fall of 2019 with nursing staff, general practitioners and medical assistants working in or consulting a participating nursing home. A half-structured modular guideline was used to ask participants about their opinion on different aspects of CoCare. Focus groups were analyzed using qualitative content analysis. ResultsIn total, N=11 focus group interviews with N= 74 participants were conducted. Ten main themes with seven subthemes were identified, encompassing all aspects of CoCare. The overall acceptance of the project was good. Participants elected to talk most often about the project modules “communication and collaboration” and “medical rounds”, with participants concluding CoCare had prevented unnecessary hospitalizations. Main barriers were understaffing and complexity of the program.ConclusionImplementation of CoCare in nursing homes is complex and holds some barriers. However, the overall acceptance was good and first positive results were reported by participants. Furthermore, the project provides a good structure to overcome potential barriers.Trial Registration: German Clinical Trial Register (DRKS00012703)
Identification of regulatory networks and hub genes controlling mammary gland development and lactation in dairy goats during the late lactation, dry period, and late gestation stages
Authors: Xuan Rong , Chao Tianle , Zhao Xiaodong , Wang Aili , Chu Yunpeng , Li Qing , Zhao Yilin , Ji Zhibin , Wang Jianmin
Published: August 2020

Background

From the late lactation to late gestation stages, the mammary gland tissue of goats undergoes a process from involution to remodeling and then to high differentiation of mammary gland tissue. From the perspective of lactation, this is a continuous development process of the goat mammary gland from the termination of lactation to the restoration of lactation. We performed transcriptome sequencing on goat mammary gland tissues at three mammary gland developmental stages to screen for differentially expressed genes that affect mammary gland development and the physiological process of lactation and mapped their expression profiles in three stages. The objective of this study is to reveal the expression characteristics of these genes and their potential function during mammary gland development and lactation.
Results

We identified 1,381 differentially expressed genes in the mammary gland during three stages and found that the expression level of genes encoding casein, such as alpha-s1-casein (CSN1S1), alpha-s2-casein (CSN1S2), beta-casein (CSN2), and kappa-casein (CSN3), and alpha-lactalbumin (LALBA) were higher in mammary gland tissues during the late lactation stage and late gestation stage than those during the dry period. In addition, we constructed six functional networks related to differentially expressed genes and found that these genes are closely related to mammary gland growth and development, apoptosis, immunity, substance transport, biosynthesis, and metabolism. Finally, we identified 35 differentially expressed transcription factors, which were classified into 16 families, and predicted that transcription factors of the basic leucine zipper domain (bZIP) family and basic helix-loop-helix (bHLH) family regulated the expression levels of genes related to mammary gland development and lactation.
Conclusions

Among the late lactation, dry period, and late gestation stages, there are differences in the expression levels of genes related to mammary gland growth and development, apoptosis, immunity, basic substance transport, biosynthesis, and metabolism in mammary gland tissues. Some genes in the same family or with similar functions have similar expression patterns. These differentially expressed genes or transcription factors work synergistically to participate in the regulation of mammary gland development and the physiological process of lactation.
Protective Effect of Recombinant Ganoderma Lucidum Immunomodulatory Protein (rLZ-8) Against Scopolamine-Induced Alzheimer's Disease in Rats
Authors: Wang Haotian , Fu Jun , Tang Huan , Li Yan , Song Liping , Xu Dan , Hao Qiang , Li Qianwen , Ren Zhihui , Zhou Xiaowei , Chen Hongyu , Zhao Weitao , Jia Juan , Sun Fei , Pei Jin
Published: August 2020

Backgroud: Alzheimer's disease (AD) is one of the most common neurodegenerative diseases in the elderly, seriously threatening the health of the elderly. In this study, the protective effect of recombinant Ganoderma lucidum immunomodulatory protein (rLZ-8) against the scopolamine-induced Alzheimer's disease (AD) in rats was studied for the first time. Methods: Male Wistar rats in rLZ-8-treated groups were intraperitoneally injected with 56 μg/kg, 112 μg/kg, and 224 μg/kg rLZ-8, respectively, those in donepezil group were intraperitoneally injected with 1.0mg/kg donepezil, and those in the normal saline group were intraperitoneally injected with an equal volume of normal saline, successively for 14 days. On the 7th day after the administration, the learning and memory ability of rats was observed by Morris water maze test, and the biochemical indexes and cytokines in the serum and brain tissues of the rats were detected after the behaviour test for investigating the protective mechanism of rLZ-8 against the scopolamine-induced AD in rats. Results: In the water maze test, compared with that in the model group, the escape latency and the swimming distance of rats on the 5th and 6th day were significantly shortened in the three rLZ-8-treated groups. In the space exploration test, compared with that in the model group, the number of passing through the location of original platform was significantly increased and the time of rats’ staying in the second quadrant was significantly prolonged in the three rLZ-8-treated groups, and furthermore, the detectionresults related to Alzheimer's disease in the serum, hippocampus and cerebral cortex of ratsindicated that rLZ-8 could improve the contents or activities of the related indexes. Conclusion: In rlZ-8 could significantly improve the learning and memory ability of AD rats, and the possible mechanism was to improve the learning and memory ability by protecting the cholinergic system.
Potential Diagnostic Value of Circulating miRNA for Multiple Myeloma: A Meta-Analysis.
Authors: Zhang Wen-Ting , Gao Shuai-Shuai , Wang Yan-Jun , Zhang Guo-Xun
Published: August 2020

Multiple myeloma (MM) is the second incurable hematological malignancy. In recent years, due to the rise of microRNA (miRNA), many scholars have participated in the study of its value in the diagnosis of MM, and have obtained good but inconsistent results. Therefore, in order to determine the role of miRNA in the early diagnosis of MM, we searched for related studies including PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Wanfang Database as of July 20, 2020 to conduct this meta-analysis. To improve the accuracy, the quality assessment of Diagnostic Accuracy Study 2 (QUADAS-2) was used. We also applied random effects models to summarize sensitivity and specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR) and area under the curve (AUC) to measure diagnostic values, and subgroup analysis used to discover potential sources of heterogeneity. Finally, we collected 32 studies from 15 articles that included a total of 2053 MM patients and 1118 healthy controls. The overall sensitivity, specificity, PLR, NLR, DOR and AUC were 0.81, 0.85, 5.5, 0.22, 25 and 0.90, respectively. Subgroup analysis shows that the down-regulation of microRNA clusters with larger samples size of plasma type could carry out a better diagnostic accuracy of MM patients. In addition, publication bias was not found. In conclusion, circulating miRNA could be a potential non-invasive biomarker for early diagnosis of MM. However, multi-center, more rigorous, and larger-scale studies are needed to verify our conclusions.
Translation, Adaptation and Validation of the Middle East Lower Limb Score (MELLS) Into Arabic
Authors: Hanna Sager , AlKhalaf Fahad , AlSamhan Awdhah , AlHamdan Hend , AlAdwani Bader , Khaja Aliaa
Published: August 2020

Background: The Middle East Lower Limb Score (MELLS) is an adaptation of the WOMAC questionnaire, specifically adjusted according to the cultural issues of the middle eastern patients with Knee or hip disabilities. The primary objective of this study was to verify if the translation and adaptation of the MELLS into Arabic could be used with ease and consistency by Arab-speaking patients suffering lower limb disabilities.Methods: 110 participants were involved in this study. We performed the internal consistency tests with Cronbach’s alpha. We also calculated floor effects, ceiling effects, as well as test-retest reliability (intra-correlation coefficient). To estimate the validity of MELLS, we used two validated questionnaires – WOMAC and OHS. We confirmed the validity of MELLS questionnaire using Spearman’s correlation.Results: MELLS had a Cronbach’s alpha of 0.88 in the first assessment and 0.92 in the second assessment, which was very high and reliable. Both subscales of MELLS had an internal consistency higher than 0.85. No relevant ceiling and floor effect were observed among the responses. Furthermore, strong significant correlation with WOMAC subscales and OHS was observed, which suggested a good construct validity. Responsiveness of MELLS, however, proved to be lower (but not considerably) than other two questionnaires.Conclusion: The Arabic Middle East Lower Limb Score (MELLS) is a useful and reliable diagnostic tool for Middle eastern patients with knee and hip problems.
A Method to Pre-Screen Rat Mammary Gland Whole Tissue Mounts followed by RNAscope in situ hybridization
Authors: Duderstadt Emily , Sanders Mary Ann , Samuelson David J.
Published: August 2020

Background: RNA in situ hybridization is an extremely useful gene expression analysis technique that preserves the spatiotemporal nature of tissue and allows for evaluation of specific cell populations and morphologies. This technique is especially useful in evaluating expression changes in disease progression models. Tissue processing procedures used to identify pathological disease morphologies in situ could compromise RNA integrity and the reproducibility and quantitative accuracy of RNA in situ hybridization assays. Methods: A combinatorial approach to pre-screen rat mammary gland tissue whole mounts for hyperplastic and malignant lesions that were not visually discernible without staining was used. This pre-screening process was followed by an RNA in situ hybridization analysis method known as RNAscope. Results: We show that there are no differences in the quantitative nature of RNAscope assays between tissue that was immediately formalin-fixed and paraffin embedded (FFPE), which is recommended by the manufacturer, and tissue that was whole mounted and pre-screened for lesions of interest prior to RNAscope. Conclusions: Preserving the integrity of RNA and quantitative nature of the RNAscope assay is important, as it allows unpalpable lesions to be directly identified, bypassing a need for labor-intensive serial sectioning of FFPE tissues to find lesions. This method is applicable to any epithelial-based disease progression model using whole-tissue mounts.
Effect of Occupational Exposure to Whole-Body Vibration and Noise on Sex Hormone Levels: A Case Study in an Automobile Parts Manufacturing Plant
Authors: Mohammadi Hamzeh , Golbabaei Farideh , Dehghan Somayeh Farhang , Ardakani Soheila Khodakarim , Imani Hossein , Tehrani Fahimeh Ramezani
Published: August 2020

Background: The present study investigated the effects of exposure to noise and whole body vibration (WBV) on the levels of sex hormones in an automobile parts manufacturing plant.Methods: The level of workers' exposure (n=162) to each of the mentioned stressors, was measured through standard methods and for each person the time-weighted average (TWA) of exposure was calculated. In order to determine serum sex hormones (free testosterone, LH and FSH), blood samples were taken from all participants after 8-10 hours of fasting between 7-9 am and then the blood samples were analyzed by ELISA method. Results: In general, regarding testosterone as the main male sex hormone, only 49% of the participants were in the normal range. In total of three sections, the lowest mean testosterone levels was observed in the third exposure group (WBV>1.93 m/s2; noise >92.69 dB) of the studied stressor, however, only the difference in testosterone levels between the three different groups of exposure to noise was statistically significant (P = 0.001). The relationship between demographic variables and levels of noise and WBV exposure with sex hormones was not linear and only the relationship between noise exposure and testosterone levels was statistically significant (R = -0.201, P = 0.013). Conclusion: According to the results of Logistic Regression, the WBV had the greatest effect on testosterone levels as the main male hormone. However, according to the results of the correlation test, only the relationship between noise exposure and testosterone levels is statistically significant.
The Nrf2-NLRP3-Caspase1 axis mediates the neuroprotective effects of Celastrol in Parkinson's disease
Authors: Zhang Chenyu , Zhao Miao , Wang Bingwei , Su Zhijie , Guo Bingbing , Zheng Ruimao
Published: August 2020

Background: Parkinson’s disease (PD) is characterized by the loss of dopaminergic neurons in the substantia nigra pars compacta (SNc), accompanied by chronic neuroinflammation, oxidative stress, and widespread accumulation of α-synuclein. Celastrol (Cel), a potent anti-inflammatory and anti-oxidative pentacyclic triterpene, has emerged as a neuroprotective agent. However, the mechanisms by which celastrol is neuroprotective in PD has not yet been elucidated. Methods: The MPTP and AAV-mediated human wild-type α-syn overexpression within SNc induced PD mouse models were employed in this study. By using multiple genetically modified mice (Nrf2-KO, NLRP3-KO and Caspase1-KO), we identified that celastrol effectively inhibited the NLRP3 inflammasome activation, mitigated motor deficits and nigrostriatal dopaminergic degeneration through Nrf2-NLRP3-Caspase1 pathway. Results: Here we show that celastrol protected against the loss of dopaminergic neurons, mitigated the neuroinflammation and motor deficits in both MPTP-induced PD mouse model and AAV-mediated human α-syn overexpression PD model. Whole-genome deep sequencing analysis reveals that Nrf2, NLRP3 and Caspase1 in SNc may be associated with the neuroprotective actions of celastrol in PD. Conclusions: These findings suggest that Nrf2-NLRP3-Caspase1 axis may be a key target of celastrol in PD treatment, and highlight the favorable properties linked to neuroprotection of celastrol, making celastrol as a promising disease-modifying agent for PD.
An optimized segmentation and quantification approach in microvascular imaging for OCTA-based fibrovascular regression monitoring
Authors: Wu Sheng , Wu Shaowei , Feng Hui , Hu Zizhong , Xie Yejing , Su Yun , Feng Ting , Li Li
Published: August 2020

Background: Quantification of neovascularization changes in fibrovascular membrane (FVM) acquired from optical coherence tomography angiography (OCTA) imaging is extremely important for diagnosis and treatment monitoring of proliferative diabetic retinopathy (PDR). However, few vessel extraction methods have been reported for quantifying the neovascular changes on fibrovascular membrane (FVM) in proliferative diabetic retinopathy PDR based on OCTA imaging.Methods: We propose an optimized approach to segment blood vessels based on an improved vascular connectivity analysis (VCA) algorithm with a combined effort of morphological characterization as well as noise and artifacts elimination. The length and width of vessels are also obtained in quantitative assessment of the microvascular network. Furthermore, we also study the feasibility of the proposed method by monitoring changes of neovascularization on FVM, which is based on the OCTA images of PDR patients after treatment by intravitreal injection of conbercept (IVC).Results: The proposed method has achieved better performance compared with existing algorithms on accuracy and can be used for PRD treatment monitoring. In the study of PDR treatment monitoring, the data show that from the beginning (0 day) to 5th day of treatment, the total length of neovascularization on FVM in this area has been significantly shortened by an 77.8% reduction, indicating significant effects from the treatment applied. Besides, the average width of the neovascularization on FVM at the 7th day after treatment has been increased by 158%, which indicates that most of the narrow neovascularization has been reduced. Conclusion: The result and analysis have confirmed that the proposed optimization process with improved VCA method is both effective and feasible to segment and quantify the neovascularization on FVM with less noise and artifacts, thus can be readily applied to monitor the fibrovascular regression within the treatment period.Clinical Trial Registration: This trial is registered with the Chinese Clinical Trial Registry (Registered 27 December 2017, http://www.chictr.org.cn, registration number 17014160).
Transcatheter Arterial Embolization is an Efficient and Safe for Paediatric Blunt Torso Trauma: A Case Control Study
Authors: Gakumazawa Masayasu , Toida Chiaki , Muguruma Takashi , Yogo Naoki , Shinohara Mafumi , Takeuchi Ichiro
Published: August 2020

Background: It remains unclear whether transcatheter arterial embolization (TAE) is as safe and effective for paediatric patients with blunt torso trauma as it is for adults in Japan, owing to few trauma cases and sporadic case reports. The study aimed to compare the efficacy and safety of TAE in paediatric patients (age ≤ 15 years) with blunt torso trauma to those of TAE in adult patients. Methods: This was a single-centre, retrospective chart review study that included blunt torso trauma patients who underwent TAE in the trauma centre from 2012 to 2017. The comparative study was carried out between a “paediatric patient group” and an “adult patient group”.The outcome measures for TAE were the success of haemorrhage control and complications and standardised mortality ratio (SMR). Results: A total of 504 patients with blunt torso trauma were transported to the trauma centre. Among them, 23% (N=114) of patients with blunt torso trauma underwent TAE, including 15 paediatric and 99 adult patients. There was no significant difference between the use of TAE in paediatric and adult patients with blunt torso trauma (29% vs. 22%, P=.221). The median age was 11 (IQR 7–14) years for paediatric patients. The predicted mortality (PMR) rate and SMR for paediatric patients were lower than that for adult patients (18.3% vs. 25.9%, P =.026, and 0.37 vs. 0.54). The rate of effective haemorrhage control without repeated TAE or additional surgical intervention was 93% in paediatric patients, which was similar to that in adult patients (88%). There were no complications in the paediatric patients at our centre. There were no significant differences in the proportion of paediatric patients that underwent surgery before TAE or urgent blood transfusion (33% vs. 26%, P =.566, or 67% vs. 85%, P =.084). Conclusions: It is possible to provide an equal level of care related to TAE for both paediatric and adult patients as it relates to TAE for blunt torso trauma with haemorrhage in the trauma centre. We should prepare alternative haemorrhage control procedures as soon as possible whenever the patients reach a hemodynamic unstable state.
Blind Dates - Potential Killers: Jujube Kernel Caused Enterobrosis Need to be Differentiated with Acute Appendicitis – A Chinese Single Center Case Series Study
Authors: Bao Zhi ye , Zhang Chun hu , Liu Bo qian , Zhu Jia yi , Wang Zhan sheng , Li Ye , Zhang Zhi shuo , Liu Hao
Published: August 2020

Background: Accidentally swallowed date kernels are high risk factors for enterobrosis. Most patients showed no obvious symptoms at the beginning but later developed lower abdominal pain, which should be differentiated with acute appendicitis, especially in elder patients without a clear medical history. This study investigated the clinical features, diagnosis and treatment of enterobrosis caused by accidentally swallowed kernel of Chinese date in adults. Methods: A retrospective analysis was performed on 14 cases of adult patients suffered from date kernel - induced enterobrosis during June 2016 to June 2019. All these patients received treatment in the first hospital of China medical university. Results: Eleven female and three male patients were diagnosed, and they were mainly in the middle to elderly age, with 12/14 patients (86%) above 50 years old. The main clinical manifestations were abdominal pain, with onset times from seven hours to four days, and all patients visited the emergency department. Physical signs of local or diffuse peritonitis were presented as guarding tenderness, rebounding, and increased rigidity. Through full-abdominal enhanced CT examination, high density linear objects were identified at the terminal or distal ileum segments in 11/14 (78%) patients. During emergent laparotomy, enterobrosis were found in all patients. Secondary perforations were also detected in 6/14 (42%) patients on the opposing side of the first puncturing sites. The fusiform kernels with two sharp tips were extracted by minimal enterotomies in 13 patients. In one patient with colonic perforation, sigmoid colostomy was performed. All patients were cured and 93% of them were discharged within two weeks. Conclusions: Full-abdominal enhanced CT examination is of great diagnostic value for the intestinal perforation caused by date kernels, and patients can benefit from early surgical treatment after definite diagnosis. Thorough exploration should be performed to detect whether a second perforation was formed on the contrary site of first piercing site. Caution should be taken to void “blind dates” ingestion, and special tools such as seeders and slicers are recommended to removal kernels in advance, thus prevent the potential killing threats of enterobrosis.
Conflict Affected, Parallel Health Systems: Challenges to Collaboration Between Ethnic and Government Health Systems in Kayin State, Myanmar
Authors: Biesty Colette Pang , Ja Brang Aung , Munslow Barry
Published: August 2020

Background
Myanmar has had a long history of civil wars with its minority ethnic groups and is yet to see a sustainable peace accord. The conflicts have had a significant impact on health in Myanmar, with ethnic populations experiencing inequitable health outcomes. Consequently, to meet the health needs of ethnic people, Ethnic Health Organisations and Community-Based Health Organisations (EHO/CBHOs) created their own health system. The EHO/CBHO and Government health systems, provided by the Myanmar Ministry of Health and Sports (MoHS), remain parallel, despite both stakeholders discussing unification of the health systems within the context of ongoing but unresolved peace processes. EHO/CBHOs discuss the ‘convergence’ of health systems, whilst the MoHS discuss the integration of health providers under their National Health Plan.
Methods
A qualitative study design was used to explore the challenges to collaboration between EHO/CBHOs and the MoHS in Kayin state, Myanmar. 12 health workers from different levels of the Karen EHO/CBHO health system were interviewed. Semi-structured, in-depth interviews were digitally recorded, transcribed, and coded. Data was analysed thematically using the Framework method. Topic guides evolved in an iterative process, as themes emerged inductively from the transcripts. A literature review and observation methods were also utilised to increase validity of the data.
Results
The challenges to collaboration were identified in the following five themes: (1) the current situation is not ‘post conflict’ (2) a lack of trust (3) centralised nature of the MoHS (4) lack of EHO/CBHO health worker accreditation (5) the NHP is not implemented in some ethnic areas.
Conclusions
Ultimately, all five challenges to collaboration stem from the lack of peace in Myanmar. The health systems cannot be ‘converged or ‘integrated’ until there is a peace accord which is acceptable to all actors. EHO/CBHOs want a federal political system, where the health system is devolved, equitable and accessible to all ethnic people. External donors should understand this context and remain neutral by supporting all health actors in a conflict sensitive manner.
Choroidal metastasis from gastric carcinoma:a case report
Authors: Huang Yan-Ying , Zhang Yue , Geng Yan-Hua , Zhu Li-Yan , Sun Ai-Hua
Published: August 2020

BackgroundChoroidal metastasis in patients with gastric cancer is extremely rare. Furthermore, orbital and intraocular metastasis are generally associated with a bad prognosis. Here, we retrospectively report a patient with gastric carcinoma and choroidal metastasis.Case presentationA 59-year-old man with a history of gastric cancer was admitted to the Ophthalmology Department of our hospital due to a one-week history of eye pain; It was only eight months since the gastric cancer was diagnosed. The patient was diagnosed with gastric cancer at a local hospital two years previously, but had then spread to the left femur. The patient then received systemic chemotherapy at the local hospital. However, scans of his eyes in our hospital revealed a choroidal tumor in his left eye. The histopathological and immunohistochemical features of the removed eyeball suggested metastatic carcinoma, most likely originating in the gastrointestinal tract, and were consistent with a moderately well-differentiated gastric cancer.ConclusionsChoroidal metastasis can masquerade as glaucoma. Consequently, choroid metastasis of gastric cancer should be a consideration when a patient with a history of gastric cancer presents with eye pain, impaired vision, or high intraocular pressure.
Revising the Role of Integrin Subunit β4 Expression in Colon Cancer Progression and Survival: A Retrospective Study
Authors: Rademaker Eva , Bastiaannet Esther , Oosting Jan , Dekker-Ensink Neeltje G. , Kuppen Peter J. K. , Miranda Noel F. C. C. De , Liefers Gerrit-Jan
Published: August 2020

Background: Integrin subunit β4 (β4) has been proposed to play an important role in colon cancer progression through its involvement in hemidesmosome disassembly processes and tumor cell migration. However, no consensus has yet been achieved regarding its association with clinical outcomes, particularly in colon cancer. The aim of this study was to reveal the relation between β4 expression and clinicopathological features and colon cancer outcomes.Methods: Expression of β4 was assessed by immunohistochemistry in a large cohort of 651 colon cancer patients, the largest colon cancer cohort so far. Chi-square tests were used to study the association between β4 expression and clinicopathological features while its relation with disease-free survival was assessed by Cox proportional hazard models. Furthermore, a potential relation between levels of ITGB4 expression and patient outcomes was also investigated with the TCGA dataset.Results: No association between β4 expression and disease-free survival was encountered (P = 0.767), which disputes the role of β4 as a biomarker of malignant behavior in colon cancer. Strikingly, loss of β4 expression was instead associated with advanced pathological tumor (pT) stage of the primary tumor. Only 17.9% of the pT1 tumors displayed weak β4 expression level versus 28.1% of pT4 tumors, and 25.0% of the pT1 tumors had a high expression level versus 8.6% of the pT4 tumors (P = 0.012). Additionally, no relation was observed between β4 expression and colon cancer stage (P = 0.138), tumor differentiation grade (P = 0.097) or mismatch repair (MMR) status (P = 0.878).Conclusions: Contradictory reports have suggested opposite roles for β4 expression in (colon) cancer progression. In the present large cohort of colon cancer patients we found that β4 expression was not associated with worse clinical prognosis and tumor differentiation grade, but decreased with advanced pathological tumor stage. Future studies should establish whether loss of β4 expression promotes invasive characteristics of colon cancer cells.
Clinical Course and Management of 73 Hospitalized Moderate Patients with COVID-19 Outside Wuhan
Authors: Peng Xiaojuan , Liu Qi , Chen Zhaolin , Wen Guiyan , Li Qing , Chen Yanfang , Xiong Jie , Meng Xinzhou , Ding Yuanjin , Shi Ying , Tang Shaohui
Published: August 2020

Background: Moderate cases account for the majority in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and can also progress to severe/critical condition. Here, we investigated the clinical course and management of hospitalized moderate SARS-CoV-2 patients.Methods: The medical records and follow-up data were analyzed from the SARS-CoV-2 patients outside Wuhan.Results: A total of 73 moderate patients (38 men, 35 women) were included, with median age of 47.0 (38.5-57.5) years. Among them, only one patient (1.4%) died using active treatment to improve symptoms. The median duration of the four main symptoms cough, fever, chest tightness, and fatigue were about 1-2 weeks; the median duration of the positive nucleic acid test (NAT) results for SARS-CoV-2 was slightly more than 2 weeks; the median hospitalization time was almost four weeks in 72 moderate survivors. The duration of cough and fever was positively correlated with the duration of the positive NAT results. On admission, 50% had lymphopenia; less than 30% had abnormal blood biochemistry findings involving hyperglycemia, liver function and myocardial enzymes. At discharge, the laboratory indexes were substantially improved. Two weeks after discharge, 5.6% survivors experienced a recurrence of the positive NAT results. Conclusions: Moderate SARS-CoV-2 patients have a good prognosis by the active treatment. After discharge, it is necessary that moderate survivors undergo at least a 2-week collective medical observation in quarantine places, which can identify and treat a proportion of patients with re-positive NAT results and to prevent the spread of the potential sources of infection.
Prediction of Biomass in Dry Tropical Forests: an Approach on the Importance of Total Height in the Development of Local and Pan-Tropical Models
Authors: Lima Robson Borges de , Oliveira Cinthia Pereira de , Ferreira Rinaldo Luiz Caraciolo , Silva José Antônio Aleixo da , Silva Emanuel Araújo , Júnior Francisco Tarcísio Alves
Published: August 2020

Background: Dry tropical forests in arid lands cover large areas in Brazil, but few studies report the total biomass stock showing the importance of height measurements, in addition to applying and comparing local and pan-tropical models of biomass prediction for the domain of trees and shrubs found in that environment. Here, we use a biomass data set of 500 trees and shrubs, covering 15 species harvested in a management plan in the state of Pernambuco, in Brazil. We seek to develop local models and compare them with the equations traditionally applied to dry forests - showing the importance of tree height measurements. Due to the non-linear relationships with the independent variables of the tree, we used a nonlinear least squares modeling technique when adjusting models, we adopted the cross-validation procedure. The selection of the models was based on the likelihood measures (AIC), total explained variation (R2) and forecast error (RSE, RMSE and Bias). Results: In summary, our above-ground biomass data set is best represented by the Schumacher-Hall equation: exp [3.5336 + 1.9126 × log (D) + 1.2438 × log (Ht)], which shows that height measurements are essential to estimate accurately biomass. The biggest prediction errors observed when testing pan-tropical models in our data demonstrated the importance of developing new local models and indicated that careful considerations should be made if generic “pantropical” models without height measurements are planned for application in dry forests in Brazil. Conclusions: Thus, local equations can be used for carbon accounting in REDD + and sustainable incentive projects that initiate the development of dry forests and assess ecosystem services.
Oral, but not rectal delivery of epigallocatechin-3-gallate alleviates colitis by regulating the gut microbiota, oxidative stress, inflammation, and barrier integrity
Authors: Wu Zhenhua , Huang Shimeng , Li Tiantian , Li Na , Han Dandan , Zhang Shiyi , Pang Jiaman , Wang Shilan , Zhang Guolong , Wang Junjun
Published: August 2020

Background: Alteration of the gut microbiota may contribute to the development of inflammatory bowel diseases (IBDs). Epigallocatechin-3-gallate (EGCG), a major bioactive constituent of green tea, is known to be beneficial in IBDs alleviation. However, it is unclear whether EGCG attenuates IBDs through direct improvement of gastrointestinal function or indirect alteration of the structure and function of the gut microbiota.Results: We first investigated the therapeutic effects of EGCG on disease severity, oxidative stress, inflammation, barrier function, and gut microbiota in murine colitis model, and further demonstrate it via EGCG pre-supplementation. We revealed that, oral, but not rectal, delivery of EGCG alleviated the severity of colitis through attenuation of anti-oxidative and anti-inflammatory response. Mucin-secreting goblet cell number, barrier function gene expression levels, and the integrity of tight junctions in the colon were also enhanced by oral EGCG. Additionally, we observed distinct EGCG-mediated alternation in the gut microbiome, as highlighted by increased Akkermansia abundance and butyrate production. Furthermore, we revealed that prophylactic oral application of EGCG for 21 days prior to the onset of dextran sodium sulfate (DSS)-induced colitis also ameliorated colonic damage, oxidative stress, and inflammatory response. Prophylactic EGCG significantly enriched Akkermansia, Faecalibaculum, and Bifidobacterium and enhanced acetate, propionate and butyrate production in DSS-treated mice. Moreover, scores of differential microbes, in particular Akkermansia, showed a strong positive correlation with short-chain fatty acids (SCFAs) and antioxidant enzyme levels in both the plasma and colon, but a negative association with inflammatory cytokines and malondialdehyde.Conclusions: EGCG is capable of treating DSS-induced colitis both therapeutically and prophylactically by inducing a pronounced anti-oxidative and anti-inflammatory response. Attenuation of colitis by oral, but not rectal administration of, EGCG suggests an intimate involvement of the gut microbiota. Increased Akkermansia and subsequent protective SCFAs production may be largely responsible for the anti-inflammatory and anti-oxidative function of EGCG, leading to restoration of intestinal epithelial homeostasis of the host. These findings provide novel insights into EGCG-mediated remission of IBDs and the rationale for devising more effective therapeutic strategies for IBDs.
Global research in cartilage defects: a bibliometric and visualized study
Authors: Li Hui , Li Jiaojiao , Dong Shengjie , Chen Yaolong , Zhao Yu , Xing Dan , Lin Jianhao
Published: August 2020

Objective: Cartilage defects represent an area of intense research interest worldwide among basic scientists and clinicians. This study evaluates the current global status of research into cartilage defects and predicts future trends through bibliometric and visualized analyses.Method: Publications from 1980 to 2018 on research into cartilage defects were obtained from the Science Citation Index-Expanded Web of Science. Bibliometric methods were used to analyze and index the source data. For visualization studies, VOSviewer software was used conduct bibliographic coupling, co-authoring, co-citation, and co-occurrence analyses.Result: A total of 9,194 publications were included in this study. The total number of publications in the field is generally on the rise, but in recent years the rate of increase in publications and relative research interest have declined. The USA made the greatest contribution to research on cartilage defects, with the highest number of citations and H-index. The American Journal of Sports Medicine published the highest number of articles, and Harvard University had the highest institutional contribution to the field. The most prominent research directions relating to cartilage defects are clinical studies, tissue engineering studies, chondrocyte-based studies, and stem cell-related studies.Conclusion: The number of publications per year on cartilage defects will likely stabilize in the next 10 years based on current global trends. Future research in the field will likely focus on clinical studies and new directions based on regenerative medicine.
Association Between FSIP2 Mutation and an Improved Prognosis in Patients With Skin Cutaneous Melanoma Treated With Immune Checkpoint Inhibitors
Authors: Ying Haoxuan , Lin Anqi , Zhang Jian , Luo Peng
Published: August 2020

Background

Immune checkpoint inhibitors (ICIs) have been remarkably successful in skin cutaneous melanoma (SKCM), however the response to treatment varies greatly among different patients. Considering that the efficacy of ICI treatment is affected by many factors, we selected the Fibrosheath interacting protein 2 (FSIP2) gene and systematically analyzed its potential as a predictor of ICI treatment prognosis.
Methods

Patient data were collected from an ICI treatment cohort (n = 120) and The Cancer Genome Atlas (TCGA)-SKCM cohort (n = 467). The data was divided into an FSIP2-mutant (MT) group and FSIP2-wild-type (WT) group according to the FSIP2 mutation status. In this study we analyzed the patients’ overall survival rate, tumor mutational burden (TMB), neoantigen load (NAL), copy number variation (CNV), cell infiltration data and immune-related genes. We used gene set enrichment analysis (GSEA) to delineate biological pathways and processes associated with the prognosis of immunotherapy.
Results

The prognosis of SKCM patients with FSIP2-MT receiving ICIs was significantly better than that of those with FSIP2-WT. The patients in the FSIP2-MT group had higher tumor immunogenicity and lower regulatory T cell (Treg) infiltration. Results of GSEA showed that pathways related to tumor progression (MAPK and FGFR), immunomodulation, and IL-2 synthesis inhibition were significantly downregulated in the FSIP2-MT group.
Conclusion

Our research suggests that the FSIP2 gene has the potential to predict the prognosis of ICI treatment. The higher tumor immunogenicity and lower Treg levels may be closely related to the fact that patients with FSIP2-MT can benefit more from ICI treatment.
A Novel Traveling Wave Sandwich Piezoelectric Transducer With Single Phase Drive: Theoretical Modeling , Experimental Validation and Application Investigation
Authors: Wang Liang , Bai Fushi , Hofmann Viktor , Jin Jiamei , Twiefel Jens
Published: August 2020

Most of traditional traveling wave piezoelectric transducers are driven by two phase different excitation signals, leading to a complex control system and seriously limiting their applications in industry. To overcome these issues, a novel traveling wave sandwich piezoelectric transducer with a single-phase drive is proposed in this study. Traveling waves are produced in two driving rings of the transducer while the longitudinal vibration is excited in its sandwich composite beam, due to the coupling property of the combined structure. This results in the production of elliptical motions in the two driving rings to achieve the drive function. An analytical model is firstly developed using the transfer matrix method to analyze the dynamic behavior of the proposed transducer. Its vibration characteristics are measured and compared with computational results to validate the effectiveness of the proposed transfer matrix model. Besides, the driving concept of the transducer is investigated by computing the motion trajectory of surface points of the driving ring and the quality of traveling wave of the driving ring. Additionally, application example investigations on the driving effect of the proposed transducer are carried out by constructing and assembling a tracked mobile system. Experimental results indicated that 1) the assembled tracked mobile system moved in the driving frequency of 19410 Hz corresponding to its maximum mean velocity through frequency sensitivity experiments; 2) motion characteristic and traction performance measurements of the system prototype presented its maximum mean velocity with 59 mm/s and its maximum stalling traction force with 1.65 N, at the excitation voltage of 500 V RMS . These experimental results demonstrate the feasibility of the proposed traveling wave sandwich piezoelectric transducer.