bluuebunny/crossref_metadata_2025 huggingface dataset:
Factor 10 Expedience of Monthly Linac Quality Assurance via an Ion Chamber Array and Automation Scripts
Authors: Skinner Lawrie B. , Yang Yong , Hsu Annie , Xing Lei , Yu Amy S. , Niedermayr Thomas
Published: November 2019

Purpose:

While critical for safe and accurate radiotherapy, monthly quality assurance of medical linear accelerators is time-consuming and takes physics resources away from other valuable tasks. The previous methods at our institution required 5 hours to perform the mechanical and dosimetric monthly linear accelerator quality assurance tests. An improved workflow was developed to perform these tests with higher accuracy, with fewer error pathways, in significantly less time.

Methods:

A commercial ion chamber array (IC profiler, Sun Nuclear, Melbourne, Florida) is combined with automation scripts to consolidate monthly linear accelerator QA. The array was used to measure output, flatness, symmetry, jaw positions, gated dose constancy, energy constancy, collimator walkout, crosshair centering, and dosimetric leaf gap constancy. Treatment plans were combined with automation scripts that interface with Sun Nuclear’s graphical user interface. This workflow was implemented on a standard Varian clinac, with no special adaptations, and can be easily applied to other C-arm linear accelerators.

Results:

These methods enable, in 30 minutes, measurement and analysis of 20 of the 26 dosimetric and mechanical monthly tests recommended by TG-142. This method also reduces uncertainties in the measured beam profile constancy, beam energy constancy, field size, and jaw position tests, compared to our previous methods. One drawback is the increased uncertainty associated with output constancy. Output differences between IC profiler and farmer chamber in plastic water measurements over a 6-month period, across 4 machines, were found to have a 0.3% standard deviation for photons and a 0.5% standard deviation for electrons, which is sufficient for verifying output accuracy according to TG-142 guidelines. To minimize error pathways, automation scripts which apply the required settings, as well as check the exported data file integrity were employed.

Conclusions:

The equipment, procedure, and scripts used here reduce the time burden of routine quality assurance tests and in most instances improve precision over our previous methods.
Dosimetric Characterization of the Dual Layer MLC System for an O-Ring Linear Accelerator
Authors: Kim Michele M. , Bollinger Douglas , Kennedy Chris , Zou Wei , Scheuermann Ryan , Teo Boon-Keng Kevin , Metz James M. , Dong Lei , Li Taoran
Published: November 2019

The Halcyon is Varian’s latest linear accelerator that offers a single 6X flattening-filter-free beam with a jawless design that features a new dual layer multileaf collimator system with faster speed and reduced transmission. Dosimetric characteristics of the dual layer multileaf collimator system including transmission, dosimetric leaf gap, and tongue and groove effects were measured. Ionization chambers, diode arrays, and an electronic portal imaging device were used to measure various multileaf collimator characteristics. Transmission through both multileaf collimator banks was found to be 0.008%, while the distal and proximal banks alone had transmission values of 0.4%. The penumbra was slightly sharper for fields using only the distal multileaf collimator bank but found to be largely independent of leaf position with values between 2.7 to 3.0 mm at dmax for the combined multileaf collimator banks. The dosimetric leaf gap was measured for the proximal and distal multileaf collimator banks both individually and together and found to have values of −0.216 mm, −0.225 mm, and 0.964 mm, respectively. Measurements of dosimetric leaf gap at the leaf edge and midline were also performed. Tongue and groove effects were investigated with both the electronic portal imaging device and a 2-dimensional array of diodes.
Pseudoaneurysm of Patent Ductus Arteriosus Following Previous PDA Closure: Case Report and Literature Review
Authors: Mikael Amarseen , Andacheh Iden , Yufa Ann , Nurick Harvey
Published: November 2019

Background:

Pseudoaneurysm developing after repair of a patent ductus arteriosus (PDA) is uncommon, with only a handful of cases reported in the literature. While older literature cites infection, recent series suggest that formation of pseudoaneurysm off of a ligated PDA attributed to breakdown in the suture line. Thoracic endovascular aortic repair (TEVAR) for this rare pathology has been demonstrated in selected case reports.

Methods/Results:

A 61-year-old woman presented with enlarging left chest mass and shortness of breath. The patient reported a history of a PDA with 2 attempts at closure. At age 6, she had undergone an attempt at endovascular closure of the PDA; this subsequently resulted in right lower extremity limb ischemia with resultant below-knee amputation. At age 12, she underwent open thoracotomy with ligation of the PDA; at this procedure, she had injury to her recurrent laryngeal nerve, resulting in permanent hoarseness of voice. A computed tomography angiogram of the chest was obtained, which demonstrated a saccular 4.5 × 3.8 cm pseudoaneurysm in the region of the PDA with calcific wall changes. Recommendation was made to proceed with operative repair and she agreed. A TEVAR was performed using a commercially available stent graft. During the procedure, intravascular ultrasound was performed; however, the connection between the PDA pseudoaneurysm and the aorta was not visualized. She had an uncomplicated operative and postoperative course. Follow-up imaging showed complete thrombosis of the pseudoaneurysm.

Conclusions:

Pseudoaneurysm from previous PDA repair is a rare pathology. We present a unique case in which the patient had undergone attempts at both endovascular and open surgical repair. Open repair for PDA is still advocated; however, TEVAR appears to be a safe treatment in adults with this pathology following failed open closure.
Research on a mixed prediction method to vehicle integrated navigation systems
Authors: Zhao Di , Qian Huaming , Xu Dingjie
Published: November 2019

Aiming to improve the positioning accuracy of vehicle integrated navigation system (strapdown inertial navigation system/Global Positioning System) when Global Positioning System signal is blocked, a mixed prediction method combined with radial basis function neural network, time series analysis, and unscented Kalman filter algorithms is proposed. The method is composed by dual modes of radial basis function neural network training and prediction. When Global Positioning System works properly, radial basis function neural network and time series analysis are trained by the error between Global Positioning System and strapdown inertial navigation system. Furthermore, the predicted values of both radial basis function neural network and time series analysis are applied to unscented Kalman filter measurement updates during Global Positioning System outages. The performance of this method is verified by computer simulation. The simulation results indicated that the proposed method can provide higher positioning precision than unscented Kalman filter, especially when Global Positioning System signal temporary outages occur.
The Musculoskeletal Health Benefits of Tennis
Authors: Jackson Matthew J. , Roche Denise M. , Amirabdollahian Farzad , Koehn Stefan , Khaiyat Omid A.
Published: November 2019

Background:

The prevalence of musculoskeletal (MSK) conditions is increasing, and although current guidelines for physical activity attempt to combat this, many fail to achieve the recommended targets. The present study sought to investigate whether regular tennis participation is more effective at enhancing MSK function than meeting the current international physical activity guidelines.

Hypothesis:

Tennis players will display significantly enhanced MSK function when compared with age-matched healthy active nonplayers.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

Ninety participants (age range, 18-65 years) took part in this study; there were 43 tennis players (18 men, 25 women) and 47 nonplayers (26 men, 21 women). MSK function was assessed by cluster analysis of 3 factors: (1) electromyographic fatigability of prime movers during handgrip, knee extension, and knee flexion; (2) isometric strength in the aforementioned movements; and (3) body composition measured by bioelectrical impedance analysis. Maximal oxygen uptake was also assessed to characterize cardiorespiratory fitness.

Results:

Tennis players displayed significantly greater upper body MSK function than nonplayers when cluster scores of body fat percentage, handgrip strength, and flexor carpi radialis fatigue were compared by analysis of covariance, using age as a covariate (tennis players, 0.33 ± 1.93 vs nonplayers, −0.26 ± 1.66; P < 0.05). Similarly, tennis players also demonstrated greater lower extremity function in a cluster of body fat percentage, knee extension strength, and rectus femoris fatigue (tennis players, 0.17 ± 1.76 vs nonplayers, −0.16 ± 1.70; P < 0.05).

Conclusion:

The present study offers support for improved MSK functionality in tennis players when compared with age-matched healthy active nonplayers. This may be due to the hybrid high-intensity interval training nature of tennis.

Clinical Relevance:

The findings suggest tennis is an excellent activity mode to promote MSK health and should therefore be more frequently recommended as a viable alternative to existing physical activity guidelines.
Examining the effectiveness of a holistic nutrition programme among community-dwelling elderly in Singapore
Authors: Lee James Chong Boi , Robert Caroline , Naharudin Nurhazimah Binte , Erdt Mojisola , Vijayakumar Harsha , Theng Yin-Leng
Published: November 2019

Background:

Singapore faces challenges in providing efficient health-care services for the ageing population.

Objectives:

We evaluated the effectiveness of a novel holistic nutrition programme among the elderly who were staying in several senior activity centres in Singapore.

Methods:

A total of 83 elderly participants (>55 years old) took part in a mixed-methods experimental study. Participants were assigned to the control group (CG), the intervention group without health talks (IGH–) or the intervention group with health talks (IGH+). Demographics, perceived satisfaction score of the administered programme and pre–post measurement on nutritional knowledge and perceived competence were measured. Subsequently, in-depth interviews were also carried out with some participants.

Results:

One-way analysis of variance revealed significantly higher scores for the IGH– and IGH+ groups compared to the CG in terms of perceived satisfaction of the programme ( p=0.009 and p=0.005, respectively). There was also a significant difference in terms of the change in nutritional knowledge before and after the programme between the IGH– and IGH+ groups ( p=0.002) but not for perceived competence ( p=0.26). Several determinants of dietary behaviours in the elderly such as living arrangements, attitudes and finances were identified from thematic analyses of the interviews.

Conclusions:

The findings from the study demonstrate the effectiveness of an holistic programme in effecting changes in nutritional knowledge but not perceived competence.
Myogenic differentiation of human amniotic mesenchymal cells and its tissue repair capacity on volumetric muscle loss
Authors: Zhang Di , Yan Kai , Zhou Jing , Xu Tianpeng , Xu Menglei , Lin Jiayi , Bai Jiaxiang , Ge Gaoran , Hu Dan , Si Weibing , Hao Yuefeng , Geng Dechun
Published: November 2019

Stem cell–based tissue engineering therapy is the most promising method for treating volumetric muscle loss. Human amniotic mesenchymal cells possess characteristics similar to those of embryonic stem cells. In this study, we verified the stem cell characteristics of human amniotic mesenchymal cells by the flow cytometry analysis, and osteogenic and adipogenic differentiation. Through induction with the DNA demethylating agent 5-azacytidine, human amniotic mesenchymal cells can undergo myogenic differentiation and express skeletal muscle cell–specific markers such as desmin and MyoD. The Wnt/β-catenin signaling pathway also plays an important role. After 5-azacytidine-induced human amniotic mesenchymal cells were implanted into rat tibialis anterior muscle with volumetric muscle loss, we observed increased angiogenesis and improved local tissue repair. We believe that human amniotic mesenchymal cells can serve as a potential source of cells for skeletal muscle tissue engineering.
Which factors affect the ability to kneel following total knee arthroplasty? An outpatient study of 100 postoperative knee replacements
Authors: Wilding Christopher P , Snow Martyn , Jeys Lee
Published: November 2019

Background:

Kneeling is an important activity of daily living, holding social, religious and occupational value. Following total knee replacement (TKR), many patients report they are unable to kneel or have been advised not to kneel.

Methods:

We observed 100 consecutive knee replacements in 79 patients attending outpatient clinic at a minimum 5 months post-TKR. The patients were asked to fill out a questionnaire detailing whether they were able to kneel prior to their knee replacement and whether they thought they were able to kneel since their knee replacement. The patients were then asked to kneel on a padded examination couch and then onto a pillow on the floor for 15 s. Degree of flexion achievable was also recorded.

Results:

Of the knees with patella resurfacing, 78.6% were able to kneel compared to only 45.6% knees with native patellae. Two-tailed Fisher’s exact test showed this difference to be statistically significant ( p = 0.001). The χ 2 analysis showed that those patients with an achievable flexion of angle of greater than 100° were significantly more likely to be able to kneel than those with a flexion angle of less than 100° ( p = 0.0148). Comparing posterior cruciate ligament (PCL) retaining against PCL sacrificing implants, there was no statistically significant difference in kneeling ability ( p = 0.541).

Conclusion:

Kneeling remains an important function in patients undergoing TKR, with patella resurfacing significantly improving the likelihood of a patient being able to kneel.
Saharanpur’s Heritage of Woodcraft: Prototyping a Future
Authors: Verma Aayushi , Gupta Ila
Published: November 2019

This study examines practice status and design possibilities for new markets at the wood carving cluster of Saharanpur (SRE) district (Uttar Pradesh, India). Wood carving undoubtedly possessed a prominent place amongst the greatest art forms ever since antiquity. In context of the same, SRE is one the commercial districts of Uttar Pradesh. Wood is a preliminary material here which is available in abundance and is extensively used for making various products of daily needs. Broadly, this abstract throws light on practice status and new design possibilities in the field of woodcraft of SRE. The purpose of the study is to create new prototype samples which depict the identity of woodcraft. In the market of SRE, majority of products are available for single usage, while several of them are bulky in weight and not very user-friendly. To test the feasibility of products, the survey method has been used and data has been collected from the selected samples of 44 respondents. Interview schedules have been used as a tool to collect the relevant information. The results indicate that positive reviews have been obtained from the survey regarding design, cost of products, and their sustainable and economical aspects. The respondents were willing to buy the products for home/office use.
Water governmentalities: The shaping of hydrosocial territories, water transfers and rural–urban subjects in Latin America
Authors: Hommes Lena , Boelens Rutgerd , Bleeker Sonja , Duarte-Abadía Bibiana , Stoltenborg Didi , Vos Jeroen
Published: November 2019

With increasing water consumption and pollution in cities and expanding urban areas, impacts on rural areas as water extraction and waste disposal zones are intensifying. To unravel these hydro-territorial dynamics, this paper studies the intersecting and overlapping Foucauldian ‘arts of government’ (‘governmentalities’) deployed to convey water from rural to urban areas in three Latin American cities: Lima (Peru), San Luis Potosí (Mexico) and Bucaramanga (Colombia). We examine conventional (cemented) water transfers, broadly promoted payment for ecosystem services schemes and their conjunction, combining scholarship about hydrosocial territories and governmentality. We demonstrate how particular urban-based imaginaries about rural areas, their inhabitants, norms, practices and identities become embedded in governmentality schemes, and how these are justified, materialized and sustained, producing particular entwined rural–urban subjectivities. We explore how these are accepted, negotiated or contested. Our application of the governmentalities framework to analyze the material and socio-political effects of rural–urban water transfers contributes to existing scholarship on the (re)shaping of rural–urban hydrosocial territorialities showing the ‘hidden’ and ‘invisible’ workings of subjectification. It also contributes to the literature on governmentalities by scrutinizing the importance of technology (including physical infrastructure) in creating rural subjects.
Modern slavery, environmental degradation and climate change: Fisheries, field, forests and factories
Authors: Brown David , Boyd Doreen S , Brickell Katherine , Ives Christopher D , Natarajan Nithya , Parsons Laurie
Published: November 2019

In this commentary paper, the current state of research on the tightly connected and bi-directional relationships among modern slavery, environmental degradation and climate change is critically assessed and reviewed. An emerging branch of research has begun to conceptualize linkages between slavery and environmental change. Responding to a gap in the extant literature, this paper synthesizes and makes sense of this emerging research base and proposes a future research agenda for exploring the slavery–environment nexus. Through an exploration of 19 key texts which explicitly examine the relationship between slavery and environmental change, spanning across diverse disciplines and spatial scales, we draw out two key arguments that can be adopted in proposing a future research agenda. Firstly, we identify the sectoral emergence of the nexus, forming primarily around four key sectors: (i) Fisheries, (ii) Fields, (iii) Forests and (iv) Factories. The review suggests that a sufficient exploration of slavery–environment linkages needs to transverse these sectoral boundaries. Secondly, the paper highlights the bi-directional interactions among modern slavery, climate change and environmental degradation. Accordingly, we argue for a holistic lens which explores how slavery practices and environmental change are continually shaping one another. Existing research has provided initial understandings of the relationship among modern slavery, environmental destruction and climate change. However, there remains considerable scope for the connections between the three to be further interrogated and unpacked. Based on the review, the paper sets out three key research agendas, highlighting the need to move beyond a spatially and sectorally confined exploration of slavery–environment interactions towards an integrated and sophisticated interrogation of the nexus. Additionally, we propose the future examination of the deep underlying drivers of slavery–environment interactions and to situate these within contemporary capitalist social and economic relations.
Market Orientation and Export Performance under ASEAN–India Free Trade Agreement: The Case of India’s Rubber and Rubber Products
Authors: Joseph Joby , Hari K. S.
Published: November 2019

The countries involved in the ASEAN–India Free Trade Agreement (AIFTA) are major producers/exporters of tropical commodities including natural rubber (NR). India is the sixth largest producer and second largest consumer of NR in the world. The country is also a major importer of NR and exporter of rubber products. The import of NR worth US$ 785.44 million and export earnings of rubber products worth US $244.17 million from ASEAN region during the year 2017–18 indicated the importance of AIFTA in the rubber sector of India. Therefore, an in-depth analysis on the pattern and specialisation of rubber and rubber products exported from India is done using trade indicators such as revealed comparative advantage, regional orientation, intra-industry trade and Galtonian regression. The results indicate no considerable change after the establishment of AIFTA in the pattern and specialisation in exports of rubber and rubber products from India to ASEAN.
Stress-Activated Protein Kinase OsSAPK9 Regulates Tolerance to Salt Stress and Resistance to Bacterial Blight in Rice
Authors: Zhang Fan , Zeng Dan , Huang Liyu , Shi Yingyao , Chen Tengjun , Zhang Fan , Zhou Yongli
Published: November 2019

Background

Salt stress and bacterial blight caused by Xanthomonas oryzae pv. oryzae (Xoo) are key limiting factors of rice (Oryza sativa L.) yields. Members of sucrose non-fermenting 1 (SNF1)-related protein kinase 2 (SnRK2), which is a family of plant-specific Ser/Thr kinases, are important components of signaling pathways involved in plant developmental processes and responses to stresses. There are 10 members of the SnRK2 family in rice; however, their functions are poorly understood, as are the underlying molecular mechanisms.

Results

In this study, we found that OsSAPK9, which belongs to the SnRK2 family, positively regulated salt-stress tolerance and strain-specific resistance to bacterial blight in rice. RNA sequencing revealed that there were 404 and 1324 genes differentially expressed in OsSAPK9-RNAi in comparison with wild-type plants under salt-stress conditions and after Xoo inoculation, respectively, which participate in basic metabolic processes. In total, 65 common differentially expressed genes involved mainly in defense responses were detected both under salt-stress conditions and after Xoo inoculation. Moreover, in vivo and in vitro experiments demonstrated that OsSAPK9 forms a protein complex with the molecular chaperones OsSGT1 and OsHsp90, and transgenic plants overexpressing OsSGT1 exhibited decreased tolerances to salt stress and significantly increased resistance levels to bacterial blight. Thus, OsSAPK9 may function as a center node regulator of salt-stress responses and disease-resistance pathways through its interaction with OsSGT1 in rice.

Conclusion

This study confirms that OsSAPK9 functions as a positive regulator of salt-stress responses and disease resistance through its interaction with OsSGT1 in rice.
How does being out at work relate to discrimination and unemployment of gays and lesbians?
Authors: Fric Karel
Published: November 2019

This article empirically investigates the relationships in the workplace between homonegativity, the disclosure of sexual orientation, perceived discrimination, the reporting of discriminatory incidents and an individual’s employment status. I utilize information reported by gays and lesbians in the EU lesbian, gay, bisexual and transgender (LGBT) survey. The data was analysed using generalised structural equation modelling and the logistic regression model. The results indicate that gays and lesbians conceal their sexual orientation more in hostile workplaces. A higher level of concealment is linked with an increased perception of discrimination and with a lower likelihood of reporting discriminatory incidents. Perceived discrimination and (unlike hypothesised) also concealment of sexual orientation positively relate to the probability of being unemployed. This implies a vicious circle in which hostile attitudes force gay employees to conceal their sexuality which in turn limits their ability to confront discriminatory behaviour.
The influence of the infusion of ephedrine and phenylephrine on the hemodynamic stability after subarachnoid anesthesia in senior adults - a controlled randomized trial
Authors: Žunić Miodrag , Krčevski Škvarč Nevenka , Kamenik Mirt
Published: November 2019

Background

We studied the influence of ephedrine or phenylephrine infusion administered immediately after spinal anesthesia (SA) on hemodynamics in elderly orthopedic patients.

Methods

A prospective, randomized, double-blind, placebo-controlled study.

After a subarachnoid injection of 15 mg of levobupivacaine, the participants received an infusion of either ephedrine 20 mg (E group), phenylephrine 250 mcg (P group) or saline (C group) within 30 min. We measured blood pressure, cardiac index (CI) and heart rate (HR) from 15 min before to 30 min after SA.

Results

Seventy patients were included in the final analysis. At the end of measurements, mean arterial pressure (MAP) decreased significantly after SA in comparison to the baseline value in the C group but was maintained in the P and E group, with no significant differences between the groups. CI decreased after SA in the C group, was maintained in the P group, and increased significantly in the E group with significant differences between the C and E group (p = 0.049) also between the P and E (p = 0.01) group at the end of measurements. HR decreased significantly after SA in the C and P group but was maintained in the E group, with significant differences between the P and E group (p = 0.033) at the end of measurements.

Conclusions

Hemodynamic changes after SA in elderly orthopedic patients can be prevented by an immediate infusion of phenylephrine or ephedrine. In addition to maintaining blood pressure, the ephedrine infusion also maintains HR and increases CI after SA.

Trial registration

ISRCTN registry with registration numberISRCTN44377602, retrospectively registered on 15 June 2017.
Role of ethambutol and rifampicin in the treatment of Mycobacterium avium complex pulmonary disease
Authors: Kim Hyung-Jun , Lee Jong Sik , Kwak Nakwon , Cho Jaeyoung , Lee Chang-Hoon , Han Sung Koo , Yim Jae-Joon
Published: November 2019

Background

A three-drug regimen (macrolide, ethambutol, and rifampicin) is recommended for the treatment of Mycobacterium avium complex pulmonary disease (MAC-PD). Although macrolide has proven efficacy, the role of ethambutol and rifampicin in patients without acquired immune deficiency syndrome is not proven with clinical studies. We aimed to clarify the roles of ethambutol and rifampicin in the treatment of MAC-PD.

Methods

Patients treated for MAC-PD between March 1st, 2009 and October 31st, 2018 were reviewed retrospectively. Rates of culture conversion, microbiological cure, treatment failure, and recurrence were compared according to the maintenance (≥6 months) of ethambutol or rifampicin with macrolide.

Results

Among the 237 patients, 122 (51.5%) maintained ethambutol and rifampicin with macrolide, 58 (24.5%) maintained ethambutol and macrolide, 32 (13.5%) maintained rifampicin and macrolide, and 25 (10.6%) maintained macrolide only. Culture conversion was reached for 190/237 (80.2%) patients and microbiological cure was achieved for 129/177 (72.9%) who completed the treatment. Treatment failure despite ≥12 months of treatment was observed in 66/204 (32.4%), and recurrence was identified in 16/129 (12.4%) who achieved microbiological cure. Compared with maintenance of macrolide only, maintenance of ethambutol, rifampicin or both with macrolide were associated with higher odds of culture conversion [odds ratio (OR), 95% confidence interval (CI): 18.06, 3.67–88.92; 15.82, 2.38–105.33; and 17.12, 3.93–74.60, respectively]. Higher odds of microbiological cure were associated with maintenance of both ethambutol and rifampicin with macrolide (OR, 95% CI: 5.74, 1.54–21.42) and macrolide and ethambutol (OR, 95% CI: 5.12, 1.72–15.24) but not macrolide and rifampicin. Maintenance of both ethambutol and rifampicin with macrolide was associated with lower odds of treatment failure (OR, 95% CI: 0.09, 0.01–0.53) compared with macrolide only, while maintenance of one of these with macrolide was not. Maintenance of both ethambutol and rifampicin or one of these with macrolide did not decrease the probability of recurrence when compared with macrolide only.

Conclusions

Maintenance (≥6 months) of ethambutol and rifampicin with macrolide was associated with the most favorable treatment outcomes among patients with MAC-PD. Given the association between ongoing ethambutol use and microbiological cure, clinicians should maintain ethambutol unless definite adverse events develop.
A rare case of symptomatic grossly-visible biliary intraepithelial neoplasia mimicking cholangiocarcinoma
Authors: Yoshida Naohiro , Aoyagi Takeshi , Kimura Yoshizo , Naito Yoshiki , Izuwa Aya , Mizoguchi Kimihisa , Ishii Kota , Tanaka Yu , Ohnishi Emi , Miura Shun , Shimamura Satoshi , Shirahama Nobuhisa , Kaneshiro Kazuhisa , Saruwatari Akihiro , Iwanaga Ayako , Sadakari Yoshihiko , Hirokata Gentaro , Ogata Toshiro , Taniguchi Masahiko
Published: November 2019

Background

Biliary intraepithelial neoplasia (BilIN) is often distinguished by what it is not: the precancerous lesions are not mass-forming, are not the cause of bile duct obstruction, and are small enough (less than 5 mm long) to evade detection by the naked eye. Here, we describe an atypical case of BilIN resembling cholangiocarcinoma (CC) that was large enough to be identified by diagnostic imaging and presented with obstructive jaundice caused by a hematoma in the common bile duct (CBD).

Case presentation

A 64-year-old man presented to our hospital with upper abdominal pain and anorexia. Initial laboratory examinations revealed increased total bilirubin and a computed tomography (CT) scan revealed a dilated CBD. Gastroenterologists performed an endoscopic sphincterotomy (EST), which revealed that the cause of obstructive jaundice was a hematoma in the CBD. Enhanced CT scan and magnetic resonance cholangiopancreatography (MRCP) performed after the hematoma was drained showed improved dilation of the CBD and an enhanced wall thickness of bile duct measuring 25 × 10 mm at the union of the cystic and common hepatic ducts. A cholangioscope detected an elevated tumor covered by sludge in the CBD, and we performed an extrahepatic bile duct resection and cholecystectomy. The postoperative course was uneventful and the pathological examination of the resected tumor revealed that although the ulcerated lesion had inflammatory granulation tissue, it did not contain the components of invasive carcinoma. Many consecutive intraepithelial micropapillary lesions spread around the ulcerated lesion, and the epithelial cells showed an increased nucleus-to-cytoplasm ratio, nuclear hyperchromasia, and architectural atypia. The pathological diagnosis was BilIN-1 to -2. Immunohistochemical staining showed that S100P was slightly expressed and MUC5AC was positive, while MUC1 was negative and p53 was not overexpressed.

Conclusion

We experienced an atypical case of BilIN mimicking CC that presented with obstructive jaundice caused by a hematoma in the CBD. Our case suggested that the occurrence of BilIN can be triggered by factors other than inflammation, and can grow to a size large enough to be detected by image analyses.
HO-1 promotes resistance to an EZH2 inhibitor through the pRB-E2F pathway: correlation with the progression of myelodysplastic syndrome into acute myeloid leukemia
Authors: He Zhengchang , Zhang Siyu , Ma Dan , Fang Qin , Yang Liping , Shen Shaoxian , Chen Ying , Ren Lingli , Wang Jishi
Published: November 2019

Background

Myelodysplastic syndrome (MDS) can progress to acute myeloid leukemia (AML), and conventional chemotherapy (decitabine) does not effectively inhibit tumor cells. Enhancer of zeste homologue 2 (EZH2) and Heme oxygenase-1 (HO-1) are two key factors in patients resistance and deterioration.

Methods

In total, 58 MDS patients were divided into four groups. We analyzed the difference in HO-1 and EZH2 expression among the groups by real-time PCR. After treatment with Hemin or Znpp IX, flow cytometry was used to detect apoptosis and assess the cell cycle distribution of tumor cells. Following injection of mice with very high-risk MDS cells, spleen and bone marrow samples were studied by immunohistochemistry (IHC) and hematoxylin and eosin (H&E) staining. MDS cells overexpressing EZH2 and HO-1 were analyzed by high-throughput sequencing. The effect of HO-1 on the pRB-E2F pathway was analyzed by Western blotting. The effects of decitabine on P15INK4B and TP53 in MDS cells after inhibiting HO-1 were detected by Western blotting.

Results

Real-time PCR results showed that EZH2 and HO-1 expression levels were higher in MDS patients than in normal donors. The levels of HO-1 and EZH2 were simultaneously increased in the high-risk and very high-risk groups. Linear correlation analysis and laser scanning confocal microscopy results indicated that EZH2 was related to HO-1. MDS cells that highly expressed EZH2 and HO-1 infiltrated the tissues of experimental mice. IHC results indicated that these phenomena were related to the pRB-E2F pathway. High-throughput sequencing indicated that the progression of MDS to AML was related to EZH2. Using the E2F inhibitor HLM006474 and the EZH2 inhibitor JQEZ5, we showed that HO-1 could regulate EZH2 expression. HO-1 could stimulate the transcription and activation of EZH2 through the pRB-E2F pathway in MDS patients during chemotherapy, which reduced TP53 and P15INK4B expression.

Conclusions

EZH2 was associated with HO-1 in high-risk and very high-risk MDS patients. HO-1 could influence MDS resistance and progression to AML.
Long-term multidisciplinary integrative therapy management resulted in favorable outcomes for ovarian cancer during pregnancy: a case report and literature review
Authors: Xu Tianmin , Wang Liang , Jia Yan , Jia Zanhui , Li Zhuo , Cui Shaohai , Cui Manhua
Published: November 2019

Background

Ovarian cancer during pregnancy is relatively rare and treatment strategies are inexperienced in surgery and chemotherapy. Multidisciplinary management of advanced epithelial ovarian cancer in pregnant patients with strong desire of fertility including sufficient mental and medical understanding, perioperative consideration, intraoperative decision, chemotherapy sensitivity and follow-up after treatment can gain successful outcomes for both maternal disease and fetus’s development.

Case presentation

A 34-year-old primigravidae was diagnosed with advanced epithelial ovarian tumor and then first cytoreductive surgery to resect macroscopical lesions and protect the uterus for fetus was performed following with four chemotherapy courses (docetaxel and carboplatin) before delivery and four other chemotherapy courses after delivery. Chemotherapy drugs were decided by sensitivity test and the patient’s anaphylaxis. Second surgery involved cesarean section with a healthy offspring and secondary cytoreductive surgery. Operative strategies were considered to gain a balance of disease and risk for fetus. Psychosocial support was provided during the course of diagnosis and treatment for a healthy coping situation. This patient relapsed 19 months after the last chemotherapy course and was treated by additional adjuvant therapy to a clinical remission. The 33-month baby boy has no evidence with disease until now. The follow-up of both mother and baby is still continuing.

Conclusions

Ovarian cancer during pregnancy has low incidence which must increase in future as women delay reproduction age. Ovarian cancer cytoreductive surgery and chemotherapy have limitation to handle conditions under a desire of fetus protection. Multidisciplinary treatment model is a therapeutic solution and a challenge for gynecological surgeons, medical oncologists, pathologists, obstetricians, neonatologists, pharmacists, anesthetist, and psychologists.
DNA damage response and repair in perspective: Aedes aegypti, Drosophila melanogaster and Homo sapiens
Authors: Mota Maria Beatriz S. , Carvalho Marcelo Alex , Monteiro Alvaro N. A. , Mesquita Rafael D.
Published: November 2019

Background

The maintenance of genomic integrity is the responsibility of a complex network, denominated the DNA damage response (DDR), which controls the lesion detection and DNA repair. The main repair pathways are base excision repair (BER), nucleotide excision repair (NER), mismatch repair (MMR), homologous recombination repair (HR) and non-homologous end joining repair (NHEJ). They correct double-strand breaks (DSB), single-strand breaks, mismatches and others, or when the damage is quite extensive and repair insufficient, apoptosis is activated.

Methods

In this study we used the BLAST reciprocal best-hit methodology to search for DDR orthologs proteins inAedes aegypti. We also provided a comparison betweenAe. aegypti,D. melanogasterand human DDR network.

Results

Our analysis revealed the presence of ATR and ATM signaling, including the H2AX ortholog, inAe. aegypti. Key DDR proteins (orthologs to RAD51, Ku and MRN complexes, XP-components, MutS and MutL) were also identified in this insect. Other proteins were not identified in bothAe. aegyptiandD. melanogaster, including BRCA1 and its partners from BRCA1-A complex, TP53BP1, PALB2, POLk, CSA, CSB and POLβ. In humans, their absence affects DSB signaling, HR and sub-pathways of NER and BER. Seven orthologs not known inD. melanogasterwere found inAe. aegypti(RNF168, RIF1, WRN, RAD54B, RMI1, DNAPKcs, ARTEMIS).

Conclusions

The presence of key DDR proteins inAe. aegyptisuggests that the main DDR pathways are functional in this insect, and the identification of proteins not known inD. melanogastercan help fill gaps in the DDR network. The mapping of the DDR network inAe. aegyptican support mosquito biology studies and inform genetic manipulation approaches applied to this vector.
Magnitude of intestinal parasitic infections and associated factors among food handlers working at Woldia University student’s cafeteria, Northeastern Ethiopia: an institution based cross-sectional study
Authors: Alemnew Birhan , Belay Yalemzewud , Demis Asmamaw
Published: November 2019

Objectives

The main aim of this study was to assess the Magnitude of intestinal parasitic infections and associated factors among food handlers working at Woldia University Student’s cafeteria, Northeastern Ethiopia. Institutional based cross-sectional study was conducted among 256 study participants in Woldia university student’s cafeteria, Northern Ethiopia. Systematic random sampling method was used to select the study participants. Data was collected using a standardized questionnaire by direct interviewing of study participants. Logistic regression was carried out to identify factors associated with intestinal parasitic infections.

Results

A total of 256 food handlers were enrolled making the overall magnitude of the intestinal parasite which was stool specimens positive for different diagnostic stages of parasites was found to be 43 (16.8%). Entamoeba histolytica/dispar was the most prevalent parasites 14 (5.5%), followed by Giardia lamblia 10 (3.9%). Lack of food safety training (AOR = 6.58; 95% CI 2.46–17.62), no regular medical checkup (AOR = 2.41; 95% CI 1.47–4.24), no handwashing practice after toilet by soap (AOR = 3.24; 95% CI 1.28–8.19), no handwashing practice before eating by soap (AOR = 4.03; 95% CI 1.64–9.91) and haven’t food preparation license (AOR = 6.13; 95% CI 2.18–17.22) were significantly associated with parasitic infection among food handlers.
Non-linear impact of exchange rate changes on U.S. industrial production
Authors: Habibi Arash
Published: November 2019

This paper contributes to the literature on the nexus between production and exchange rate in the United States (U.S.) by considering non-linear adjustments of exchange rate effects on industrial production in several sectors of the U.S. economy. We employ a Non-linear Autoregressive Distributed Lags (NARDL) model which is built upon the Solow model. We show that there exists a non-linear relationship between these two variables in some of the MMIGs. We document short-run non-linear effects of exchange rate on production of non-energy materials, durable manufacturing, consumer goods and business equipment. The short-run effects last into the long-run for all the sectors. While exchange rate changes have short-run linear effects on production of electricity in the U.S., there are no effects of exchange rate movements on the production of mining, and energy materials. Moreover, the paper finds misspecification error of the model for the case of durable manufacturing. The existence of non-linearities considering import content of exports, support our hypothesis and conclusions. Further, the factors that influence demand provide justifications for our results.
Factors contributing to medicines wastage in public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia: a qualitative study
Authors: Gebremariam Esayas Tadesse , Gebregeorgise Dawit Teshome , Fenta Teferi Gedif
Published: November 2019

Background

Medicines wastage is one of the challenges of health supply chain management in developing countries including Ethiopia. However, there is lack of objective evidence on the detailed underlying causes of medicines wastage. Therefore, the aim of this study is to explore factors contributing for medicines wastage in selected public health facilities of South West Shoa Zone, Oromia Regional State, Ethiopia.

Methods

A qualitative study was conducted in 10 public health facilities (1 General hospital and 9 health centers). An in-depth interview with flexible probing techniques was employed to collect the data from 20 key informants from May 2, 2016 to May 27, 2016. A semi structured interview guide was prepared to explore key informants’ idea about current situation of contributing factors and efforts made to reduce medicines wastage in public health facilities. A thematic analysis was then used to analyze the data.

Results

Almost all key informants felt that medicines wastage is increasing from time to time in their health facility due to supplier’s issuing of medicines without health facilities’ needs and request, failure to follow first expired first out principle in issuing medicines from stores to different dispensing units, lack of communication between supplier and health facilities, inadequate number of pharmacy personnel and weak monitoring system of supply chain in the health facilities. They also revealed budget constraint, stock out of medicines and congested store are of the major challenge that are compromising their service provision.

Conclusion

Medicine wastage is an ever-increasing problem in public health facilities of South West Shoa Zone. The problem is exacerbated due to absence of mechanisms to minimize the wastage. Health facilities, therefore, should place a mechanism to exchange medicines from overstocked facilities to under stocked ones; has to improve store management capacity by employing competent professionals, equipping the store with necessary technology and introducing a monitoring and evaluating health supply chain performance system in the health facilities.
Investigation of the solubility and dispersion degree of calf skin collagen in ionic liquids
Authors: Liu Sicong , Li Qian , Li Guoying
Published: November 2019

The dissolution of collagen in ionic liquids (ILs) was highly dependent on the polarity of ILs, which was influenced by their sorts and concentrations. Herein, the solubility and dispersion degree of collagen in two sorts of ILs, namely 1-ethyl-methylimidazolium tetrafluoroborate ([EMIM][BF4]) with low polarity and 1-ethyl-3-methylimidazolium acetate ([EMIM][Ac]) with high polarity in a concentration range from 10% to 70% at 10 °C were investigated. When 150 mg of collagen was added to 30 mg of ILs, the minimum soluble collagen concentration was 0.02 mg/mL in 70% [EMIM][BF4] with lowest polarity and the maximum was 3.57 mg/mL in 70% [EMIM][Ac] with highest polarity, which indicates that soluble collagen and insoluble collagen fibers were both present. For insoluble collagens, differential scanning calorimetry showed that the thermal-stability was weakened when increasing the ILs concentration and polarity, and the fiber arrangement was looser with a more uniform lyophilized structure, observed by atomic force microscopy and scanning electron microscopy. For soluble collagens, electrophoresis patterns and Fourier transform infrared spectroscopy showed that no polypeptide chain degradation occurred during dissolution, but the thermal denaturation temperature decreased by 0.26 °C~ 7.63 °C with the increase of ILs concentrations, measured by ultra-sensitive differential scanning calorimetry. Moreover, the aggregation of collagen molecules was reduced when ILs polarity was increased as determined by fluorescence measurements and dynamic light scattering, which resulted in an increased loose fiber arrangement observed by atomic force microscopy. If the structural integrity of collagen needs to be retained, then the ILs sorts and concentrations should be considered.

Graphical abstract
Long-termin vivowear of different bearing types used for the Oxford Unicompartmental Knee Replacement
Authors: Mohammad Hasan R. , Campi Stefano , Kennedy James A. , Judge Andrew , Murray David W. , Mellon Stephen J.
Published: November 2019

Objectives

The aim of this study was to determine the polyethylene wear rate of Phase 3 Oxford Unicompartmental Knee Replacement bearings and to investigate the effects of resin type and manufacturing process.

Methods

A total of 63 patients with at least ten years’ follow-up with three bearing types (1900 resin machined, 1050 resin machined, and 1050 resin moulded) were recruited. Patients underwent full weight-bearing model-based radiostereometric analysis to determine the bearing thickness. The linear wear rate was estimated from the change in thickness divided by the duration of implantation.

Results

The wear rate for 1900 resin machined (n = 19), 1050 machined (n = 21), and 1050 moulded bearings (n = 23) were 60 µm/year (sd 42), 76 µm/year (sd 32), and 57 µm/year (sd 30), respectively. There was no significant difference between 1900 machined and 1050 machined (p = 0.20), but 1050 moulded had significantly less wear than the 1050 machined (p = 0.05). Increasing femoral (p < 0.001) and tibial (p < 0.001) component size were associated with increasing wear.

Conclusion

Wear rate is similar with 1050 and 1900 resin, but lower with moulded bearings than machined bearings. The currently used Phase 3 bearings wear rate is low (1050 moulded, 57 µm/year), but higher than the previously reported Phase 2 bearings (1900 moulded, 20 µm/year). This is unlikely to be due to the change in polyethylene but may relate to the minimally invasive approach used with the Phase 3. This approach, as well as improving function and thus increasing activity levels, may increase the risk of surgical errors, such as impingement or bearing overhang, which can increase wear. Surgeons should aim to use 4 mm thick bearings rather than 3 mm thick bearings in young patients, unless they are small and need conservative bone resections. Cite this article: Bone Joint Res 2019;8:535–543.