bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of canola or olive oil on plasma lipids, lipoprotein-associated phospholipase A2 and inflammatory cytokines in patients referred for coronary angiography
Authors: Khandouzi Nafiseh , Zahedmehr Ali , Nasrollahzadeh Javad
Published: August 2020

Background: The potential cardioprotective benefits of olive oil (OO) and canola oil (CO) consumption have been shown in some studies. The present study compared the effects of CO and OO on plasma lipids, some inflammatory cytokines, and lipoprotein-associated phospholipase A2 (Lp-PLA2) mass and activity in patients undergoing coronary angiography. Methods: The current randomized, controlled, parallel-arm, clinical trial involved 48 patients (44 men and 4 women, aged 57.63 ± 6.34 years) with at least one classic cardiovascular risk factor (hypertension, dyslipidemia, or diabetes) who referred for coronary angiography. Patients were randomly divided into two groups and received 25 mL/day refined olive oil (n=24) or canola oil (n=24) for 6 weeks. Plasma lipids, some selected inflammatory markers, and Lp-PLA2 levels were measured at baseline and after the intervention.Results: CO consumption produced a significant reduction in plasma Lp-PLA2 mass (-0.97 ± 1.84 vs. 0.34 ± 1.57 ng/mL, p = 0.008 for CO and OO, respectively), whereas the mean changes in interleukine-6 concentration were significantly lower after OO consumption compared with CO (-9.46 ± 9.46 vs. -0.90 ± 6.80 pg/mL, p = 0.008 for OO and CO, respectively). After 6 weeks of intervention, no significant changes were observed in plasma Lp-PLA2 activity, complement C3, C4, or lipid profiles in the two intervention groups.Conclusions: Comparing the two vegetable oils in subjects with cardiovascular risk factors showed that the consumption of olive oil is more effective in reducing the level of inflammatory cytokine interleukine-6, whereas canola oil was more effective in lowering Lp-PLA2 levels; however, this finding should be interpreted with caution, because Lp-PLA2 activity did not change significantly.Trial registration: IRCT20160702028742N5 at www.irct.ir (04/19/2019)
Advantage of pars plana vitrectomy combined with penetrating keratoplasty and transscleral-sutured intraocular lens implantation in complex eyes: a case series
Authors: Hayashi Takahiko , Ida Yasutsugu , Shimizu Toshiki , Kuroki Tsubasa , Kobashigawa Yuji , Iijima Yasuhito , Yuda Kentaro
Published: August 2020

Background The aim of this study was to evaluate the clinical outcomes of pars plana vitrectomy (PPV) combined with penetrating keratoplasty (PKP) and transscleral-sutured intraocular lens (IOL) implantation (IOL-suture) in complex eyes.Methods In this prospective, consecutive interventional case series, patients who underwent PKP combined with PPV and IOL implantation from July 2014 to March 2018 at Yokohama Minami Kyosai Hospital were enrolled. The postoperative best corrected visual acuity (BCVA) (converted to logarithm of the minimal angle of resolution [logMAR] units), intraocular pressure (IOP, mmHg), endothelial cell density (ECD, cells/mm2), graft survival, complications, astigmatism, and spherical equivalent (dioptres [D]) were evaluated. Results This study included 11 eyes of 11 patients (three females and eight males; mean age, 61.8 ± 13.9 years) with an injury (n = 6) or bullous keratopathy (n = 5). The BCVA significantly improved from 1.50 ± 0.66 logMAR preoperatively to 0.78 ± 0.59 logMAR (p < 0.001) postoperatively. The baseline ECD significantly decreased from 2396 ± 238 cells/mm2 preoperatively to 1132 ± 323 cells/mm2 (p < 0.001) postoperatively. Despite two rejection episodes, graft survival rates were 100%. The mean follow-up period was 38.0 ± 20.5 months. Two patients required combined glaucoma surgery, and three patients underwent subsequent glaucoma surgery. Postoperative astigmatism and spherical equivalent were 3.9 ± 3.2 D and 0.29 ± 2.18 D, respectively.Conclusion The combination of PKP, PPV, and IOL-suture implantation could be a safe and effective approach for eyes requiring anterior segment surgery; however, these eyes are associated with a higher incidence of glaucoma surgery.
Profiling B cell immune responses to identify neutralizing antibodies from convalescent COVID-19 patients
Authors: Huang Lisu , Shen Bingqing , Guo Yu , Shen Shu , Huang Heyu , Xie Qiuling , Chen Mingjie , Zeng Xinxin , Wang Shanshan , Huang Dakun , Huang Mengshi , Qiu Yushu , Han Xiaochen , Jing Qingqing , Lu Minmin , Pi Chunjiang , Wu Jia , Feng Minfang , Li Ouyang , Lu Yun-Yueh , Zhou He , Cui Cheryl , He Jeff , Pan Shuming , Chen Da , Zhou Xingdong , Wang Yuan , Tian Yujie , Wang Wei , Zhang Wanju , Deng Fei , Schweizer Liang , Zhang Hongkai , Sun Kun
Published: August 2020

The pandemic Coronavirus Disease 2019 (COVID-19) causes noticeable morbidity and mortality worldwide. In addition to vaccine and antiviral drug therapy, the use of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) neutralizing antibodies for treatment purposes is a viable alternative. In this study, we aimed to profile the humoral responses and identify neutralizing antibodies against SARS-CoV-2 using high-throughput single-cell sequencing that tailored to B cell receptor sequencing. From two convalescent patients with high serum titer against SARS-COV-2, we identified seven antibodies specifically binding to SARS-CoV-2. Among these, the most potent antibody, P4A1 was demonstrated to block the binding of spike protein to its receptor angiotensin-converting enzyme 2 (ACE2), and prevent the viral infection in neutralization assays with pseudovirus as well as live virus at nM to sub-nM range. Moreover, antibody P4A1 can also bind strongly to spike protein with N354D/D364Y, R408I, W436R, V367F or D614G mutations respectively, suggesting that the antibody alone or in combination with other antibodies that recognize different variations of SARS-CoV-2, may provide a broad spectrum therapeutic option for COVID-19 patients. Authors Lisu Huang, Bingqing Shen, Yu Guo, and Shu Shen contributed equally to this work.
Improving mucosal anesthesia for awake endotracheal intubation with a novel method using dyclonine hydrochloride: A prospective, assessor-blinded, randomized controlled trial
Authors: Han Chunji , Li Peng , Guo Zhenggang , Guo Ying , Sun Li , Chen Gang , Qiu Xiaojue , Mi Weidong , Zhang Changsheng , Berra Lorenzo
Published: August 2020

Background: Topical anesthesia is a crucial step in awake endotracheal intubation for providing favorable intubation conditions. The standard of care technique for awake intubation at our institution, which consists of oropharyngeal tetracaine spray, can result in inadequate mucosal anesthesia. Therefore, we sought to compare the effectiveness of dyclonine hydrochloride mucilage to the standard of care tetracaine in achieving anesthesia of the upper airways for awake endotracheal intubation. Methods: This is a randomized, assessor-blinded, prospective study. From Jun. 1st, 2019 to Aug. 1st, 2019, patients scheduled for either endoscopic submucosal dissection or peroral endoscopic myotomy were enrolled and randomly allocated into two groups after obtaining written informed consent: patients allocated to novel awake intubation care (Group N-AIC) received a single administration of oral dyclonine hydrochloride mucilage, whereas patients allocated to standard awake intubation care (Group S-AIC) received three oropharyngeal tetracaine sprays before transcricoid tetracaine injection before awake intubation. Mean arterial pressure (MAP), which was the primary outcome of this study, as well as heart rate (HR) were recorded throughout the procedure and compared between the two groups. Feeling of numbness, nausea, and intubation conditions after topical anesthesia were also assessed. Results: Sixty patients were enrolled and completed the study. Baseline MAP and HR were similar between the two groups. However, hemodynamic responses to intubation and gastrointestinal endoscopy, especially MAP, were significantly less elevated in Group N-AIC. The degree of numbness of the oropharyngeal mucosa after topical anesthesia did not differ between the two groups, neither did the feeling of nausea during laryngoscopy. The amount of pharyngeal secretions before intubation was less in Group N-AIC. Total intubation time was significantly shorter in Group N-AIC when compared to Group S-AIC (18.4 ± 2.86 vs. 22.3 ± 6.47, P < 0.05). Extubation bucking was significantly less frequent in Group N-AIC (13.3% vs. 76.7%). Patients received in Group N-AIC had a lower rate of post-extubation sore throat compared to Group S-AIC (6.7% vs. 43.3%). Conclusions: In awake endotracheal intubation, novel care using oral dyclonine mucilage can provide more favorable mucosal anesthesia and better intubation conditions compared to standard of care practice using oropharyngeal tetracaine spray.
An Approach to Assessing Patient Satisfaction in HCAHPS Databases by Analyses Using Distances.
Authors: Okuda Masumi , Yasuda Akira , Tsumoto Shusaku
Published: August 2020

Background: Patient satisfaction studies have explored domains of patient satisfaction, the determinants of domains, and score differences of domains by patient/hospital characteristics but reports on the structure of patient satisfaction with respect to similarities among domains are scarce.Objective: To explore whether similarities among patient-satisfaction domains are influenced by hospital characteristics by analyses using distances, and to design a model evaluating relationships between the structure of patient satisfaction and hospital characteristics.Methods: Hospital Consumer Assessment of Healthcare Providers and Systems 2012 survey scores and their structural measures from the Hospital Compare website reported the adjusted percentages of scale for each hospital. Contingency tables of nine measures and their ratings were designed based on hospital characteristics, followed by clustering, correspondence analysis and ordinal multidimensional scaling. The measures were divided into three groups plus cleanliness.Results: Certain combinations of these groups were shown to be dependent on hospital characteristics. High value ratings for communication and low value ratings for medication explanation, quietness and staff responsiveness were not influenced by hospital characteristics, but the varied-ratings domain group similarities, including items such as global evaluation and pain management, were affected by hospital characteristics.Conclusions: Analyses using distances can reveal the hidden structure of patient satisfaction. This study suggests that hospital characteristics including hospital size, the ability to provide acute surgical treatment, and hospital interest in improving medical care quality are factors which may influence the structure of patient satisfaction.
DEA Analysis of Municipal Hospital Services and Scale After Hierarchical Medical Treatment Policy Was Implemented in China
Authors: Li Yuanyuan , Wang Yuzhu , Zhao Yongqiang
Published: August 2020

Background: We aimed to provide decision basis for optimizing resource allocation by hospital administrators in China.Methods: The samples were 18 municipal TCM hospitals of all public TCM hospitals of Gansu province in 2017. The BCC DEA model was employed to evaluate the relative efficiency of hospital operation. The slack variables in non DEA effective hospitals were employed to give the guidance how to achieve to the DEA effective.Results: Firstly, the demands for medical services kept surging will lead to the scale return of most municipal-level TCM hospitals tend to the stable although part of it appear the decline or increase in return scale. Therefore, these municipal-level TCM hospitals should further pay attention to make full use of existing resources. Secondly, some municipal-level TCM hospitals with decline in return scale or increase in return scale should adopt different management measures for different situations, which in details in results and discussions sections.Conclusion: After the implementation of healthcare policy such as graded diagnosis and treatment, hospital managers should learn advanced management concepts, use scientific management tools and software, carry out closed-loop management, make constant adjustments according to evaluation indicators, reduce management costs, and ensure the vitality of hospital operation.
When to Resume Bariatric Surgery After COVID-19 Pandemic? – Results of Patients’ and Surgeons’ Survey.
Authors: Dudek Alicja , Wysocki Michał , Walędziak Maciej , Szeliga Jacek , Proczko-Stepaniak Monika , Pedziwiatr Michał , Major Piotr
Published: August 2020

BackgroundCoronavirus Disease 2019 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state.MethodsThe study was conducted in two groups: Group 1 – bariatric patients; Group 2 – bariatric surgeons. Two online surveys were distributed.Results A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p<0.001) and contact with COVID+/quarantined persons (p<0.001) had impact on the response to resumption of bariatric procedures. ConclusionsPatients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel. Trial registration: 1072.6120.103.2020
Polytobacco Use Among a Nationally-Representative Sample of Black High School Students
Authors: Gilreath Tamika D. , Dangerfield Derek T. , Ishino Francisco A. Montiel , Hill Ashley V. , Johnson Renee M.
Published: August 2020

Introduction. Studies of the patterns of polytobacco use have increased. However, understanding the patterns of using multiple tobacco products among Black adolescents is minimal. This study identified the patterns of polytobacco use among U.S. Black adolescents. Methods. Latent class analysis (LCA) was used to identify patterns of adolescent polytobacco use among a representative sample of Black youth from the 2017 Youth Risk Behavior Survey (n = 2,782). Ever and recent (past 30 day) use of cigarettes, electronic cigarettes, cigars, and dip or chewing tobacco were used as latent class indicators. Multinomial regression was conducted to identify the association if smoking adjusting for age, grade, and marijuana use. Results. Most students were in the 9th grade (29%), e-cigarette users (21%) and were current marijuana users (25%). Three profiles of tobacco use were identified: Class 1: Non-smokers (81%), Class 2: E-cigarette Users (14%), and Class 3: Polytobacco Users (5%). Black adolescent Polytobacco users were the smallest class, but had the highest conditional probabilities of recent cigarette use, e-cigarette use, ever smoking cigars or chewing tobacco. Ever and current use of marijuana were associated with increased odds of being in the e-cigarette user versus non-smoker group, and current marijuana use was associated with increased odds of polytobacco use (aOR = 24.61, CI = 6.95–87.11). Conclusions. Findings suggests the need for targeted interventions for reducing tobacco use and examining the unique effects of polytobacco use on Black adolescents. Findings confirm a significant association of marijuana use with tobacco use.
Fostering Innovative Behavior in Health Organizations – a PLS-SEM Analysis of Norwegian Hospital Employees
Authors: Mutonyi Barbara Rebecca , Slåtten Terje , Lien Gudbrand
Published: August 2020

Background: Health organization research is experiencing a strong refocus on employees’ individual innovative behavior (IIB), revealing that many of its influential factors at work remain uncertain. Hence, this study empirically examines how hospital employees’ IIB is fostered by focusing on antecedents such as organizational culture (here labeled an internal market-oriented culture, IMOC), psychological capital (PsyCap), and outcomes such as organizational commitment (OC). In addition, the study examines the mediating role of PsyCap.Methods: The study focused on a sample of 1008 hospital employees, using a partial least squares structural equation modeling method to analyze and test the relationships hypothesized in this study. A multigroup comparison was performed to test the heterogeneity of personal characteristics. The indirect effects of PsyCap were tested by mediator analyses.Results: Our results reveal that IMOC has a positive and significant influence on employees’ PsyCap and IIB. PsyCap is directly related to IIB and acts a mediator between IMOC and IIB. Furthermore, the study found that IIB is related to the outcome variable OC.Conclusions: This study extends the current debate on how IIB is fostered at work by examining PsyCap and IMOC as antecedents of IIB. The study has added to the IIB research area by introducing OC as an outcome variable. The study is among the first attempts in its category to contribute to health organizations and managers by empirically examining the influence of IMOC on employees’ PsyCap and IIB and in turn their OC.
Does Admission Prevalence Change After Reconfiguration of Inpatient Services?
Authors: Turner Steve , Martin Joanne , Raja Edwin Amalraj
Published: August 2020

Background. Service reconfiguration of inpatient services in a hospital includes complete and partial closure of all emergency inpatient facilities. The “natural experiment” of service reconfiguration may give insight into drivers for emergency admissions to hospital. This study addressed the question does the prevalence of emergency admission to hospital for children change after reconfiguration of inpatient services?Methods. There were five service reconfigurations in Scottish hospitals between 2004 and 2018 where emergency admissions to one “reconfigured” hospital were halted (permanently or temporarily) and directed to a second “adjacent” hospital. The number of emergency admissions per month to the “reconfigured” and “adjacent” hospitals was obtained for five years prior to reconfiguration and up to five years afterwards. An interrupted time series analysis considered the association between reconfiguration and admissions across pairs comprised of “reconfigured” and “adjacent” hospitals, with adjustment for seasonality and an overall rising trend in admissions.Results. Of the five episodes of reconfiguration, two were immediate closure, two involved closure only to overnight admissions and one with overnight closure for a period and then closure. In “reconfigured” hospitals there was an average fall of 117 admissions/month [95% CI 78, 156] in the year after reconfiguration compared to the year before, and in “adjacent” hospitals admissions rose by 82/month [32, 131]. Across paired reconfigured and adjacent hospitals, in the months post reconfiguration, the overall number of admissions to one hospital pair slowed, in another pair admissions accelerated, and admission prevalence was unchanged in three pairs. After reconfiguration in one hospital, there was a rise in admissions to a third hospital which was closer than the named “adjacent” hospital. Conclusions. There are diverse outcomes for the number of emergency admissions post reconfiguration of inpatient facilities. Factors including resources placed in the community after local reconfiguration, distance to the “adjacent” hospital and local deprivation may be important drivers for admission pathways after reconfiguration. Policy makers considering reconfiguration might consider a number of factors which may be important determinants of admissions post reconfiguration.
Hidden Bedside Rationing in the Netherlands: a Cross-sectional Survey Among Internists
Authors: de Ruijter Ursula , Lingsma Hester , Bax Willem , Legemaate Johan
Published: August 2020

Background Healthcare rationing can be defined as withholding beneficial care for cost reasons. One form in particular, hidden bedside rationing, is problematic because it may result in conflicting loyalties for physicians, unfair inequality among patients and illegitimate distribution of resources. Our aim is to establish whether bedside rationing occurs in the Netherlands, whether it qualifies as hidden and what physician characteristics are associated with its practice.Methods Cross-sectional online questionnaire on knowledge of -, experience with -, and opinion on rationing among physicians in internal medicine within the Dutch healthcare system. Multivariable ordinal logistic regression was used to explore relations between hidden bedside rationing and physician characteristics.Results The survey was distributed among 1139 physicians across 11 hospitals with a response rate of 18% (n=203). Most participants (n=129; 64%) had experience prescribing a cheaper course of treatment while a more effective but more expensive alternative was available, suggesting bedside rationing. Subsequently, 32 (24%) participants never disclosed this decision to their patient, qualifying it as hidden. The majority of participants (n=153; 75%) rarely discussed treatment cost. Employment at an academic hospital was independently associated with more bedside rationing (OR=17 95%CI 6.1-48). Furthermore, residents were more likely to disclose rationing to their patients than internists (OR=3.2, 95%CI 2.1-4.7), while salaried physicians were less likely to do so than physicians in private practice (OR=0.5, 95%CI 0.4-0.8).Conclusion Hidden bedside rationing occurs in the Netherlands: patient choice is on occasion limited with costs as rationale and this is not always disclosed. The questions of how distribution of healthcare ought to take place, and to what degree that should include bedside rationing, remain topical and warrant a more public debate.
General Practitioners’ Experiences of Emergency Care and Treatment Planning in England: A Focus Group Study
Authors: Huxley Caroline , Eli Karin , Hawkes Claire A. , Perkins Gavin D. , George Rob , Griffiths Frances , Slowther Anne-Marie
Published: August 2020

BackgroundEmergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs’ experiences of using ReSPECT and how it transfers across the primary care and secondary care interface.MethodsWe conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. GPs were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis. ResultsGPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a ‘good death’ is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient’s preferences around death, and GPs’ lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings. ConclusionConceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting.
Investigation of health professionals’ knowledge retention in CPR after completing the Advance Life Support in Gynecology (ALSG) Course
Authors: Vrachnis Nikolaos , Antonakopoulos Nikolaos , Tsigirlioti Antigoni , Pergialiotis Vasilios , Iacovidou Nicoleta , Iliodromiti Zoi
Published: August 2020

Background

Studies have shown that immediate and effective cardiopulmonary resuscitation plays a major role in the survival of victims of cardiac arrest. Numerous studies also demonstrate the need for continuous training of health professionals. In Greece life support courses are established in various fields including pediatrics, obstetrics and gynecology. The ALSG (Advanced Life Support in Gynecology) course was initiated in 2011 and covers gynecological emergencies that often lead to cardiopulmonary arrest, including ruptured ectopic pregnancy, toxic shock syndrome and postoperative collapse. The purpose of this study was to investigate knowledge retention in CPR after completion of the ALSG course and to define the factors affecting it.
Methods

A descriptive qualitative study was, designed and conducted through anonymous questionnaires sent electronically to past ALSG course participants.
Results

A total of 100 questionnaires were sent and 50 were completed and returned. Mean knowledge retention was 87.4 ± 18.2. The multivariate analysis revealed that the time interval since training in life support significantly correlated with the actual score. Additionally, more correct answers were given by course instructors than certified course graduates.
Conclusion

Instructors in life support courses achieve longer retention of their knowledge than trainees, while increased time interval between training and knowledge recall results in lower scores. In conclusion, continuing education of health professionals and adoption of algorithms, such as those taught in the ALSG course, are likely to help maintain knowledge and achieve high standards of care.
Why do pre-clinical medical students learn ultrasound? Exploring learning motivation through ERG theory
Authors: Wang Ting-Cheng , Chen Wei-Ting , Kang Yi-No , Lin Che-Wei , Cheng Chung-Yi , Suk Fat-Moon , Chen Hao-Yu , Wang Chin-Wang , Fong Tsorng-Harn , Huang Wen-Cheng
Published: August 2020

Background
Point-of-care ultrasound (POCUS) has become a hot issue and trend in medical education in recent years. Ultrasound is an indispensable skill for clinical physicians. Previous studies have already discussed the importance of and advancements in ultrasound education. However, learning motivations with regard to ultrasound education have seldom been discussed in the literature. For medical students, learning ultrasound could have a strong connection with their future career. ERG theory extended Maslow's hierarchy of needs through the concepts of existence, relatedness, and growth. The theory has been widely used in the workplace to analyze employee job performance but has not been applied in medical education. As mentioned above, we seek to analyze pre-clinical medical students’ learning motivation toward ultrasound education with regard to their future careers by applying ERG theory.
Method
This mixed method design used questionnaires for data collection. We also produced further qualitative and quantitative results. The research team asked learners neutral and open-ended questions. After data collection, three steps for analysis were followed based on grounded theory. Finally, the results of the thematic coding were used to complete the quantitative analysis.
Results
Our study involved 140 pre-clinical medical students, and their responses fell into 13 categories. Our test showed that students’ motivations toward ultrasound learning were unbalanced across the three ERG domains (F = 41.257, p < .001). Pairwise comparisons showed that students mentioned existence motivation (MD = 39.3%; p < .001) and growth motivation (MD = 40.7%; p < .001) more than relatedness motivation. However, there was no significant difference between existence motivation and growth motivation (MD = -1.4%; p = .830).
Conclusion
Based on our survey, first, we found that students placed a high value on existence and growth needs rather than relatedness. In addition, we recommend that ERG theory be applied in medical education motivation analysis.
Rapid Ventilator Splitting During COVID-19 Pandemic Using 3D Printed Devices and Numerical Modeling of 200 Million Patient Specific Air Flow Scenarios
Authors: Bishawi Muath , Kaplan Michael , Chidyagwai Simbarashe , Cappiello Jhaymie , Cherry Anne , MacLeod David , Gall Ken , Evans Nathan , Kim Michael , Shaha Rajib , Whittle John , Hollidge Melanie , Truskey George , Randles Amanda
Published: August 2020

There has been a pressing need for an expansion of the ventilator capacity in response to the recent COVID19 pandemic. To address this need, we present a system to enable rapid and efficacious splitting between two or more patients with varying lung compliances and tidal volume requirements. Reserved for dire situations, ventilator splitting is complex, and has been limited to patients with similar pulmonary compliances and tidal volume requirements. Here, we report a 3D printed ventilator splitter and resistor system (VSRS) that uses interchangeable airflow resistors to deliver optimal tidal volumes to patients with differing respiratory physiologies, thereby expanding the applicability of ventilator splitting to a larger patient pool. We demonstrate the capability of the VSRS using benchtop test lungs and standard-of-care ventilators, which produced data used to validate a complementary, patient-specific airflow computational model. The computational model allows clinicians to rapidly select optimal resistor sizes and predict delivered pressures and tidal volumes on-demand from different patient characteristics and ventilator settings. Due to the inherent need for rapid deployment, all simulations for the wide range of clinically-relevant patient characteristics and ventilator settings were pre-computed and compiled into an easy to use mobile app. As a result, over 200 million individual computational simulations were performed to maximize the number of scenarios for which the VSRS can provide assistance. The VSRS will help address the pressing need for increased ventilator capacity by allowing ventilator splitting to be used with patients with differing pulmonary physiologies and respiratory requirements, which will be particularly useful for developing countries and rural communities with a limited ventilator supply.
Ex Vivo Porcine Model Study on the Treatment Outcomes of Scissor-type Knife Versus Needle-type Knife in Endoscopic Submucosal Dissection Performed by Trainees
Authors: Ichijima Ryoji , Esaki Mitsuru , Yamakawa Shun , Minoda Yosuke , Suzuki Sho , Kusano Chika , Ikehara Hisatomo , Gotoda Takuji
Published: August 2020

BackgroundTrainee endoscopists find endoscopic submucosal dissection (ESD) for gastrointestinal neoplasms difficult to perform independently; furthermore, there is no consensus on which endo-knife type is the most suitable for them. Therefore, we conducted a prospective study comparing the treatment outcomes of scissor-type and needle-type knives in ESD performed by trainees in an ex vivo porcine model.MethodsAround 22 trainees from 13 institutions, divided into two groups according to their endoscopic experience, performed ESD in a porcine model. Each trainee performed two ESDs under expert supervision: one with a scissor-type knife (ESD-S) and the other with a needle-type knife (ESD-N). The efficacy and safety, including the procedure time and rates of self-completion, en bloc resection, and complications, were compared between ESD-S and ESD-N. ResultsEight trainees had an experience of over 1,000 endoscopies (senior trainee: S-Trainee), whereas the remaining had an experience of less than 1,000 endoscopies (junior trainee: J-Trainee). Among the S-Trainees, no significant differences were observed in any treatment outcome between ESD-S and ESD-N. Among the J-Trainees, the total procedure and mucosal incision times were significantly shorter in ESD-S than in ESD-N [total procedure time: 16.5 min (range: 10.0–31.0) vs. 22.3 min (range: 10.0–38.0), P = 0.018; circumferential incision time: 10.0 min (range: 6-16) vs. 17.0 min (range: 5.0–31.5); P = 0.019]. Regarding complications, muscular injury occurred in two patients during ESD-N performed by J-Trainees; however, no muscular injury occurred during ESD-S.ConclusionsS-Trainees could perform ESD safely in an ex vivo porcine model under expert supervision, regardless of the endo-knife type used. However, the scissor-type knife is desirable if J-Trainees were to perform the ESD procedure.
ZBTB7A functioned as an oncogene in colorectal cancer
Authors: Wang Li , Zhang Meng-Xia , Zhang Mei-Fang , Tu Zi-Wei
Published: August 2020

Background
Despite zinc finger and BTB domain-containing 7A (ZBTB7A) documented importance in multiple tumors, the function and clinical value in Colorectal cancer (CRC) remain elusive. The aim of this study was to evaluate the functional roles and the clinical value of ZBTB7A in CRC progression.
Methods
The level of ZBTB7A was detected in a large cohort of CRC patients (n = 189) by immunohistochemistry (IHC), and we analyzed the diagnostic and prognostic value of the protein. In addition, the functional roles of ZBTB7A on CRC were explored in vitro and in vivo.
Results
Survival analyses indicated that patients with high ZBTB7A expression made the prognosis worse (P = 0.024). Functionally, knockdown of ZBTB7A could markedly inhibit tumor proliferation in vitro and in vivo, whereas ZBTB7A overexpression displayed the opposite results.
Conclusions
ZBTB7A was associated with poor survival outcomes and functioned as an oncogene in CRC patients, indicating that it is a potential prognostic biomarker and therapeutic target for CRC patients.
Cost-effectiveness of Lung Cancer Screening in Urban Chinese Populations
Authors: Sun Chengyao , Zhang Xin , Guo Sirou , Liu Yang , Zhou Liangru , Shi Ju-Fang , Wu Ning , Zhai Zhao , Liu Guoxiang
Published: August 2020

Background: Lung cancer is the leading cause of cancer-related death. Currently, lung cancer screening trials have demonstrated that low-dose computed tomography (LDCT) screening can reduce lung cancer specific and overall mortality. The effectiveness of LDCT has been proven, but its economical efficiency should also be assessed. The purpose of the study is to analyze the cost-effectiveness of annual LDCT screening of high-risk populations in Chinese urban areas.Method: We use Markov model to evaluate LDCT screening from sociological perspective. The sample size is 100,000 smokers who will undergo annual LDCT screening until 76. The study contains 5 screening strategies, the initial screening ages for the five screening strategies and their corresponding unscreened strategies are 40, 45, 50, 55, and 60 years, respectively. Parameters come from the China Lung Cancer Screening Project, cancer registry data, etc. The Incremental Cost-effectiveness Ratio (ICER) between screening and non-screening strategies at the same initial age is evaluated.Result: In base-case scenario, compared with those who are not screened, specific mortality of lung cancer decreased by 18.52%-23.13% of 5 screening strategies. The ICER of LDCT screening is from 13056.82USD to 15736.06USD per quality-adjusted life year (QALY), which is greater than one time and less than three times GDP per capita in China. Initial screening age of 55 is the most cost-effective strategy.Conclusion: Baseline analysis shows that annual LDCT screening in heavy smokers in Chinese urban areas is likely to be cost-effectiveness. Sensitivity analysis shows that sensitivity, specificity and over-diagnosis rate have an impact on cost-effectiveness of LDCT screening, but the results are relatively robust，unless the sensitivity, specificity of LDCT screening and over-diagnosis rate take the worst value at the same time. Therefore, the cost-effectiveness of screening strategy depends on the performance of LDCT screening.
VCP functions to maintain nuclear size by managing DNA damage-induced MDC1–p53–autophagy axis
Authors: Chang Ya-Chu , Peng Yu-Xiang , Shih Chao-Jie , Chang Henry , Sang Tzu-Kang
Published: August 2020

Anomalies in nuclear morphology have been linked to aging-related diseases and malignant transformation, although the mechanism responsible for this connection remains unclear. By expressing dominant-negative TER94 (TER94K2A) mutants in Drosophila photoreceptors, we show disruption of VCP (valosin-containing protein, TER94 ortholog in human), an AAA (ATPase associated with various cellular activities) ATPase essential for ubiquitin-dependent segregation or degradation of proteins, causes an age-dependent nuclear size increase. Loss of VCP function leads to accumulations of MDC1 (mediator of DNA damage checkpoint protein 1), a key DNA damage response gene, and increased γH2AV (an indicator of DNA damage), linking excessive DNA damages and associated responses to this enlarged nuclei defect. Indeed, MDC1-overexpression, similar to TER94K2A, increases γH2AV staining and nuclear size. Moreover, TER94 negatively influences MDC1 level and could interact with MDC1, suggesting that MDC1 is a VCP substrate. MDC1 accumulation increases p53 stability, and this VCP-MDC1-p53 connection is functional, as removal of p53 function suppresses the ability of TER94K2A and MDC1 overexpression to increase nuclear size. While p53 is capable of generating multiple isoforms, our genetic evidence suggests that the p53A isoform specifically contributes to this TER94K2A-associated nuclear size increase. Combining our results with a previous report that p53A expression disrupts autophagic flux, we propose that the failure of removing MDC1 in TER94K2A-expressing cells stabilizes p53A, which blocks autophagy and likely hinders the removal of nuclear content, resulting in aberrant nuclear size increase.
Transformer-Based Deep Neural Network Language Models for Alzheimer's Disease Detection from Targeted Speech
Authors: Roshanzamir Alireza , Aghajan Hamid , Baghshah Mahdieh Soleymani
Published: August 2020

Background: We developed transformer-based deep learning models based on natural language processing for early diagnosis of Alzheimer’s disease from the picture description test.Methods: The lack of large datasets poses the most important limitation for using complex models that do not require feature engineering. Transformer-based pre-trained deep language models have recently made a large leap in NLP research and application. These models are pre-trained on available large datasets to understand natural language texts appropriately, and are shown to subsequently perform well on classiﬁcation tasks with small training sets. The overall classiﬁcation model is a simple classiﬁer on top of the pre-trained deep language model.Results: The models are evaluated on picture description test transcripts of the Pitt corpus, which contains data of 170 AD patients with 257 interviews and 99 healthy controls with 243 interviews. The large bidirectional encoder representations from transformers (BERTLarge) embedding with logistic regression classiﬁer achieves classiﬁcation accuracy of 88.08%, which improves the state-of-the-art by 2.48%.Conclusions: Using pre-trained language models can improve AD prediction. This not only solves the problem of lack of suﬃciently large datasets, but also reduces the need for expert-deﬁned features.
Predicting Tumor Response to Drugs Based on Gene-expression Biomarkers of Sensitivity Learned From Cancer Cell Lines
Authors: Li YuanYuan , Umbach David M. , Krahn Juno M. , Shats Igor , Li Xiaoling , Li Leping
Published: August 2020

Background: human cancer cell line profiling and drug sensitivity studies provide valuable information about the therapeutic potential of drugs and their possible mechanisms of action. The goal of those studies is to translate the findings from in vitro studies of cancer cell lines into in vivo therapeutic relevance and, eventually, patients’ care. Tremendous progress has been made. Results: in this work, we built predictive models for 453 drugs using data on gene expression and drug sensitivity (IC50) from cancer cell lines. We identified many known drug-gene interactions and uncovered several potentially novel drug-gene associations. Importantly, we further applied these predictive models to ~17,000 bulk RNA-seq samples from The Cancer Genome Atlas (TCGA) and the Genotype-Tissue Expression (GTEx) database to predict drug sensitivity for both normal and tumor tissues. We created a web site for users to visualize and download our predicted data (https://edelgene.niehs.nih.gov/cancerRxTissue). Using trametinib as an example, we showed that our approach can faithfully recapitulate the known tumor specificity of the drug. Conclusions: we demonstrated that our approach can predict drugs that 1) are tumor-type specific; 2) elicit higher sensitivity from tumor compared to corresponding normal tissue; 3) elicit differential sensitivity across breast cancer subtypes. If validated, our predictions could have clinical relevance for patients’ care.
Precision-Cut Bovine Udder Slices (PCBUS) as an in-vitro-model of an early phase of infection of bovine mastitis
Authors: Filor Viviane , Petry Monique , Meißner Jessica , Kietzmann Manfred
Published: August 2020

Background
The aim of this study was the establishment of precision-cut bovine udder slices (PCBUS) as an in-vitro-model to investigate pathophysiological processes in the early phase of mastitis in order to have the possibility to investigate new therapeutic approaches for the treatment of such udder inflammation in later studies. Furthermore, this model should contribute to substitute in-vivo-experiments. Bovine mastitis is one of the most common and costly infectious diseases in the dairy industry, which is largely associated with the use of antimicrobial agents. Given this problem of antimicrobial resistance, it is essential to step up research into bacterial infectious diseases. Thus, the transfer of the in-vitro-model of precision-cut tissue slices to the bovine udder enables broad research into new therapeutic approaches in this area and can also be used to address issues in basic research or the characterization of complex pathophysiological processes.
Results
A stimulation with LPS, PGN or the combination of both substances (LPS:PGN) demonstrated the ability of the PCBUS to react with a significant secretion of IL-1ß, TNF-α and PGE2.
Conclusion
The slices represent an instrument for investigating pharmacological interactions with udder tissue, which can be useful for studies on pharmacological questions and the understanding of complex pathophysiological processes of infection and inflammation.
Psychometric validation of the Laval Developmental Benchmarks Scale for Family Medicine
Authors: Renaud Jean-Sebastien , Lacasse Miriam , Côté Luc , Théorêt Johanne , Rheault Christian , Simard Caroline
Published: August 2020

Background
With the implementation of competency-based education in family medicine, there is a need for summative end-of-rotation assessments that are criterion-referenced rather than normative. Laval University’s family residency program therefore developed the Laval Developmental Benchmarks Scale for Family Medicine (DBS-FM), based on competency milestones. This psychometric validation study investigates its internal structure and its relation to another variable, two sources of validity evidence.
Methods
We used the assessment data from a cohort of residents (n = 1 432 assessments) and the Rasch Rating Scale Model to investigate its reliability, dimensionality, rating scale functioning, targeting of items to residents’ competency levels, biases (differential item functioning), items hierarchy (adequacy of milestones ordering), and score responsiveness. Convergent validity was estimated by its correlation with the clinical rotation decision (pass, in difficulty/fail).
Results
The DBS-FM can be considered as a unidimensional scale with good reliability for non-extreme scores (.83). The correlation between expected and empirical items hierarchies was of .78, p < .0001.Year 2 residents achieved higher scores than year 1 residents. It was associated with the clinical rotation decision.
Conclusion
Advancing its validation, this study found that the DBS-FM has a sound internal structure and demonstrates convergent validity.
Analysis of the Impact of Cervical Excision Procedure on Delivery Mode
Authors: YUAN Min , WU Jian-hong , ZHANG Chun-liu , YANG Fan , WEI Zhi-yao , Dai Yin-mei
Published: August 2020

Background: Many young women with a history of prior cervical excision procedure have reproductive intention. However, the relationship between having a prior cervical excision procedure and delivery mode has not drawn enough attention from physicians. The aim of this study was to observe the delivery mode of women with a prior cervical excision procedure, and analyze the relationship between having a prior cervical excision procedure and delivery mode.Methods: In this retrospective cohort study of nulliparous women with a singleton pregnancy who have given birth at Beijing Obstetrics and Gynecology Hospital, Capital Medical University between May 2016 and April 2018, delivery mode of women with a history of prior cervical excision procedure were compared with those without such a history. Bivariable analysis were performed to identify whether there was a correlation between having a prior cervical excision procedure and delivery mode, and logistic regression were used modeling on cervical excision procedure for delivery mode outcome.Results: (1) The proportion of premature rupture of fetal membrane (38.3% vs 27.0%, p=0.034) , forceps delivery (12.2% vs 5.9%, p=0.043), and Caesarean sections delivery (33.9% vs. 30.2%,p=0.484 ) were higher among women with a prior cervical excision procedure. (2) The main indication for forceps delivery was to shorten the second stage of labor among women with a prior cervical excision procedure, significantly higher (50% vs 7.7%, p=0.033) among women without such a history. There were no differences in indications for Caesarean sections delivery in two groups (p>0.05). (3) The time interval between cervical excision procedure and pregnancy was not associated with delivery mode (p=0.445). (4) By setting spontaneous labor as control, forceps delivery was associated with cervical excision procedure (OR=0.403, 95%CI=0.179-0.906, p=0.028).Conclusions: Our findings revealed a relationship between having a prior cervical excision procedure and delivery mode. Women with a prior cervical excision procedure were at an increased risk of forceps delivery. The time interval between cervical excision procedure and pregnancy did not affect delivery mode.