bluuebunny/crossref_metadata_2025 huggingface dataset:
Travelers’ Attitudes Toward Mobile Application–Based Public Transport Services in Lahore
Authors: Javid Muhammad Ashraf , Ali Nazam , Hussain Shah Syed Arif , Abdullah Muhammad
Published: January 2021

Many cities in developing countries are facing challenges of providing quality public transport facilities to the public. The demand-responsive transport (DRT) initiatives in some cities have helped in providing transportation alternatives to the travelers, and in filling the gap between demand and supply. Recently introduced DRT initiatives in Lahore included the mobile app-based Airlift and Swvl bus services. This article is aimed at evaluating the travelers’ attitudes toward mobile application (app)–based DRT services in Lahore with the help of a questionnaire survey. A questionnaire was designed consisting of travelers’ personal and travel information and their perceptions on selected attributes of Airlift and Swvl bus services. A total of 440 samples were collected through interviews. An exploratory factor analysis (EFA) revealed three factors of service quality, that is, Accessibility and Scheduling Attributes (ASA), Instrumental Attributes (IA), and Service Attraction Attributes (SAA). The results of Structural Equation Modeling (SEM) showed that the ASA, IA, and SAA are significant determinants of travelers’ attitudes toward the existence of Airlift and Swvl bus services in Lahore. These factors have strong correlations with travelers’ intentions to use Airlift and Swvl services in the future. The waiting time at a stop, travelers’ income, vehicle ownership, trip purpose, and profession are also significant in determining the travelers’ attitudes and preferences with app-based public transport services. These findings would be helpful for the service providers and transport planners for making appropriate policies to improve the quality of these services.
Emigration, Tax on Remittances and Export Quality
Authors: Ganguly Shrimoyee , Acharyya Rajat
Published: January 2021

We examine the implications of the emigration of unskilled workers for the quality of a skill-based good exported by a small open economy. This issue is relevant in the context of quality constraints faced by the developing countries like China and India in promoting their exports, on the one hand, and the significantly large emigrations of workers, particularly unskilled workers, which lower their productive capacities, on the other hand. We show that even though unskilled workers are not directly used in the production of quality-differentiated export goods, their emigration would lower export quality when quality upgradation requires more intensive use of skilled workers relative to capital. This result follows from the complementarity between skilled and unskilled wages in a competitive general equilibrium model. A quality-content production subsidy in such a case can mitigate the adverse effects of emigration. The significantly large remittances received from unskilled emigrants create scope for taxing such remittances to finance the subsidy.

JEL Classification: F16, F20, F22, F24
Reliability and Validity of the Turkish Adaptation of Dental Environmental Stress Scale: A Methodological Study
Authors: Özyurtseven Betül Tas¸ , Güngörmüs¸ Zeynep
Published: January 2021

Aim:

This paper aims to develop the Turkish version of the dental environmental stress (DES) scale that can evaluate perceived DES in Turkish dental students.

Materials and Methods:

A methodological study was conducted to adapt the DES scale to Turkish language in Gaziantep University, Faculty of Dentistry. The study group consisted of 392 students in the academic year 2018/19. The students were surveyed using the DES scale, translated into Turkish language. The demographic characteristics were analyzed by using descriptive statistical analyses. Kaiser-Meyer-Olkin and Bartlett’s Test of Sphericity were employed to evaluate the suitability of the dataset. Exploratory factor analysis was performed to assess construct validity. Depression Anxiety Stress Scale-21 was used to predict the power of the scale. In reliability analysis, the instrument’s internal consistency and corrected item-total correlation, Cronbach’s α reliability were studied.

Results:

Content Validity Index of the scale items was found to have a high validity range of 0.97. Two items with an estimate value less than 0.4 were excluded and 30 items yielded five factor. Five factors having eigenvalues greater than 1.0 explained 52.299% of the total variance. Each factor showed adequate internal consistency. Factor loadings ranged from 0.46 to 0.77. In the concurrent validity, significant positive relationship was found between DASS-21 and Turkish DES.

Conclusion:

According to psychometric properties, the Turkish version of the DES presented good results, thus it could be a valid instrument to assess the perceived stress in Turkish dental students.
Comparing Intra-articular Injections of Leukocyte-Poor Platelet-Rich Plasma Versus Low–Molecular Weight Hyaluronic Acid for the Treatment of Symptomatic Osteoarthritis of the Hip: A Double-Blind, Randomized Pilot Study
Authors: Kraeutler Matthew J. , Houck Darby A. , Garabekyan Tigran , Miller Shannon L. , Dragoo Jason L. , Mei-Dan Omer
Published: January 2021

Background:

Hyaluronic acid (HA) and leukocyte-poor platelet-rich plasma (LP-PRP) are 2 nonoperative treatment options that have been studied in patients with hip osteoarthritis (OA).

Purpose:

To compare the efficacy of intra-articular injections of low–molecular weight (LMW) HA and LP-PRP in patients with hip OA.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

A total of 34 patients (36 hips) presenting with signs of hip OA were randomized to receive 3 blinded, weekly intra-articular injections of either LP-PRP or LMW-HA. Patients were prospectively evaluated before injections and at 6 weeks and then at 3, 6, 12, and 24 months. The primary outcome, conversion to total hip arthroplasty (THA) or a hip resurfacing procedure, was analyzed along with secondary outcomes including the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and hip range of motion.

Results:

The final analysis included 33 hips (mean Kellgren-Lawrence grade, 2.73) (LMW-HA: n = 14; LP-PRP: n = 19) in 31 patients (18 male; mean age, 53.8 years). Significantly more patients converted to THA or a hip resurfacing procedure in the LMW-HA group (7/14; 50.0%) (mean, 1.3 years after first injection) than the LP-PRP group (3/19; 15.8%) (mean, 0.73 years after first injection) ( P = .035). There was no significant improvement or decline in any outcome scores within the LMW-HA group from before injections to 6 weeks or 3, 6, and 12 months. For the LP-PRP group, WOMAC overall ( P = .032), joint ( P = .030), and function scores ( P = .025) significantly improved from before injections to 6 weeks, and WOMAC joint scores significantly improved from before injections to 6 months ( P = .036). When comparing the difference between groups in internal rotation at 90° of hip flexion from before injections to 6 months, the LP-PRP group demonstrated a mean 5.0° improvement, while the LMW-HA group showed a mean 1.5° decrease ( P = .028).

Conclusion:

Intra-articular hip injections of LP-PRP in patients with hip OA resulted in an improvement in WOMAC scores and hip internal rotation at 6 months and delayed the need for THA or a hip resurfacing procedure compared with treatment with LMW-HA. A longer follow-up is necessary to further compare the effects of LP-PRP and LMW-HA injections in patients with hip OA.

Registration:

NCT01920152 ( ClinicalTrials.gov identifier).
Changes in Shoulder Rotator Strength After Arthroscopic Capsulolabral Reconstruction in Patients With Anterior Shoulder Instability
Authors: Rhee Sung-Min , Nashikkar Piyush Suresh , Park Joo Hyun , Jeon Young Dae , Oh Joo Han
Published: January 2021

Background:

The correlation between isokinetic internal and external rotation (IR and ER) strength and functional outcomes in patients with anterior shoulder instability treated by arthroscopic capsulolabral reconstruction (ACR) has not been studied.

Purpose:

To analyze isokinetic IR and ER strength and their correlation with clinical outcomes in patients with anterior shoulder instability treated by ACR.

Study Design:

Case series; Level of evidence, 4.

Methods:

Between January 2004 and June 2015, a total of 104 patients who underwent ACR for anterior shoulder instability were analyzed. The mean peak torque (PT) in IR (IRPT) and ER (ERPT), PT deficit (PTD; %) relative to the opposite healthy shoulder, and PT ratio (PTR; ERPT/IRPT) were calculated before and 1 year after surgery. Functional scores were evaluated before surgery and at every follow-up visit. Recurrence and postoperative apprehension during ER at 90° of arm abduction were evaluated at 1 year and the final follow-up (76.6 ± 64.4 months).

Results:

IR and ER strength were measured for 68 of 104 patients at 1 year after surgery. ERPT and IRPT were less on the involved side than on the uninvolved side before surgery (0.29 ± 0.10 vs 0.33 ± 0.10 N·m/kg, respectively, for ERPT [ P = .002]; 0.36 ± 0.14 vs 0.41 ± 0.16 N·m/kg, respectively; for IRPT [ P = .01]). At 1 year after surgery, IRPT on the involved side recovered (0.40 ± 0.20 N·m/kg), whereas ERPT remained weak (0.30 ± 0.13 N·m/kg) relative to the baseline value. PTD in IR (PTDIR) improved to 2.2% ± 24.4% ( P = .012), whereas PTD in ER (PTDER) showed no improvement (13.5% ± 13.8%; P = .569). PTR on the involved side improved from 1.07 ± 1.71 to 0.86 ± 0.23 at 1 year ( P < .001). All functional scores improved significantly at the final follow-up. At 1 year, 9 of 68 (13.2%) patients showed positive apprehension. PTDIR and PTDER on the involved side were worse in patients with positive apprehension than in those with negative apprehension ( P = .039 and .014, respectively). PTDER was worse than PTDIR in patients with positive apprehension at 1 year ( P = .022).

Conclusion:

For those with anterior shoulder instability, preoperative IR and ER strength of the involved shoulder were lower than those of the uninvolved shoulder. IRPT recovered, whereas ERPT remained weak after ACR. To prevent positive apprehension after surgery, IR and ER strengthening exercises are important, with more emphasis on exercises for ER.
Preseason Upper Extremity Range of Motion and Strength in Relation to In-Season Injuries in NCAA Division I Gymnasts
Authors: Heck Kaysha , Zeppieri Giorgio , Bruner Michelle , Moser Michael , Farmer Kevin W. , Pozzi Federico
Published: January 2021

Background:

Gymnastics is a demanding sport that places unique forces on the upper extremity. The repetitive nature of the sport and the high-impact forces involved may predispose the gymnast to overuse injuries. Risk factors for injuries in gymnastics are not well understood.

Purpose/Hypothesis:

The purpose of this study was to ascertain whether preseason upper extremity range of motion (ROM) and strength differ between National Collegiate Athletic Association (NCAA) Division I collegiate gymnasts who sustain an in-season upper extremity injury and those who do not. We hypothesized that gymnasts who sustain an upper extremity injury would demonstrate reduced ROM and strength compared with noninjured gymnasts.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Over 4 seasons, from 2014 to 2018, a total of 15 female NCAA Division I collegiate gymnasts underwent preseason upper extremity ROM (shoulder: flexion, internal and external rotation; elbow: extension; wrist: extension) and strength (shoulder: internal and external rotation, and middle and lower trapezius) testing. Overuse upper extremity injuries were tracked in each subsequent season. Gymnasts were dichotomized into injured and noninjured groups, and a 2 × 2 analysis of variance was used to measure differences in preseason measures between the groups as well as within arms (injured vs noninjured arm for the injured group; dominant vs nondominant arm for the noninjured group).

Results:

A total of 12 overuse upper extremity injuries (10 shoulders; 2 wrist/forearm) occurred during 31 gymnast-seasons. There were no significant interactions for preseason ROM and strength measurements between groups (injured vs noninjured) or within arms (injured and noninjured arm for the injured group; dominant and nondominant arm for the noninjured group; P = .07).

Conclusion:

Preseason upper extremity ROM and strength were not different between gymnasts who sustained an in-season upper extremity overuse injury and those who did not. It is possible that ROM and strength measures used to screen other overhead athletes may not capture the unique features and requirements of gymnastics. Further, it may be challenging to discern differences in clinical measures of ROM and strength in gymnastics populations owing to the bilateral nature of the sport.
Internal Medicine Residents’ Views About Care Transitions: Results of an Educational Intervention
Authors: Sheikh Fatima , Gathecha Evelyn , Arbaje Alicia I , Christmas Colleen
Published: January 2021

Problem:

Suboptimal care transitions can lead to re-hospitalizations.

Intervention:

We developed a 2-week “Transitions of Care Curriculum” to train first-year internal medicine residents to improve their knowledge and skills to deliver optimal transitional care. Our objective was to use reflective writing essays to evaluate the impact of the curriculum on the residents.

Methods:

The rotation included: Transition of Care Teaching modules, Transition Audit, Transitional Care Site Visits, and Transition of Care Conference. Residents performed the above elements of care transitions during the curriculum and wrote reflective essays about their experiences. These essays were analyzed to assess for the overall impact of the curriculum on the residents. Qualitative analysis of reflective essays was used to evaluate the impact of the curriculum. Of the 20 residents who completed the rotation, 18 reflective essays were available for qualitative analysis.

Results:

Five major themes identified in the reflective essays for improvement were: discharge planning, patient-centered care, continuity of care, goals of care discussions, and patient safety. The most discussed theme was continuity of care, with following subthemes: fragmentation of the healthcare system, disjointed care to the patients, patient specific factors contributing to lack of continuity of care, lack of primary care provider role as a coordinator of care, and challenges during discharge process. Residents also identified system-based gaps and suggested solutions to overcome these gaps.

Conclusions:

This experiential learning and use of reflective writing enhanced the residents’ self-identified awareness of gaps in care transitions and prompted them to generate ideas for systems improvement and personal actions to improve their practice during care transitions.
DHODH inhibition synergizes with DNA-demethylating agents in the treatment of myelodysplastic syndromes
Authors: Kayamori Kensuke , Nagai Yurie , Zhong Cheng , Kaito Satoshi , Shinoda Daisuke , Koide Shuhei , Kuribayashi Wakako , Oshima Motohiko , Nakajima-Takagi Yaeko , Yamashita Masayuki , Mimura Naoya , Becker Hans Jiro , Izawa Kiyoko , Yamazaki Satoshi , Iwano Satoshi , Miyawaki Atsushi , Ito Ryoji , Tohyama Kaoru , Lennox William , Sheedy Josephine , Weetall Marla , Sakaida Emiko , Yokote Koutaro , Iwama Atsushi
Published: January 2021

Dihydroorotate dehydrogenase (DHODH) catalyzes a rate-limiting step in de novo pyrimidine nucleotide synthesis. DHODH inhibition has recently been recognized as a potential new approach for treating acute myeloid leukemia (AML) by inducing differentiation. We investigated the efficacy of PTC299, a novel DHODH inhibitor, for myelodysplastic syndrome (MDS). PTC299 inhibited the proliferation of MDS cell lines, and this was rescued by exogenous uridine, which bypasses de novo pyrimidine synthesis. In contrast to AML cells, PTC299 was inefficient at inhibiting growth and inducing the differentiation of MDS cells, but synergized with hypomethylating agents, such as decitabine, to inhibit the growth of MDS cells. This synergistic effect was confirmed in primary MDS samples. As a single agent, PTC299 prolonged the survival of mice in xenograft models using MDS cell lines, and was more potent in combination with decitabine. Mechanistically, a treatment with PTC299 induced intra-S-phase arrest followed by apoptotic cell death. Of interest, PTC299 enhanced the incorporation of decitabine, an analog of cytidine, into DNA by inhibiting pyrimidine production, thereby enhancing the cytotoxic effects of decitabine. RNA-seq data revealed the marked downregulation of MYC target gene sets with PTC299 exposure. Transfection of MDS cell lines with MYC largely attenuated the growth inhibitory effects of PTC299, suggesting MYC as one of the major targets of PTC299. Our results indicate that the DHODH inhibitor PTC299 suppresses the growth of MDS cells and acts in a synergistic manner with decitabine. This combination therapy may be a new therapeutic option for the treatment of MDS.
TLR7/8 regulates type I and type III interferon signalling in rhinovirus 1b-induced allergic asthma
Authors: Krug Jasmin , Kiefer Alexander , Koelle Julia , Vuorinen Tytti , Xepapadaki Paraskevi , Stanic Barbara , Chiriac Mircea T. , Akdis Mübeccel , Zimmermann Theodor , Papadopoulos Nikolaos G. , Finotto Susetta
Published: January 2021

Introduction

Interferon (IFN) responses have been reported to be defective in rhinovirus (RV)-induced asthma. The heterodimeric receptor of type I IFN (IFN-α/β) is composed of IFN-αR1 and IFN-αR2. Ligand binding to the IFN-α/β receptor complex activates signal transducer and activator of transcription (STAT) proteins STAT1 and STAT2 intracellularly. Although type III IFN (IFN-λ) binds to a different receptor containing IFN-λR1 and interleukin-10R2, its triggering leads to activation of the same downstream transcription factors. Here, we analysed the effects of RV on IFN type I and III receptors, and asked about possible Toll-like receptor 7/8 (TLR7/8) agonist R848-mediated IFN-αR1 and IFN-λR1 regulation.

Methods

We measured IFN-α, IFN-β and IFN-λ and their receptor levels in peripheral blood mononuclear cell (PBMC) supernatants and cell pellets stimulated with RV1b and R848 in two cohorts of children with and without asthma recruited at pre-school age (PreDicta) and at primary school age (AGENDAS) as well as in cell supernatants from total lung cells isolated from mice.

Results

We observed that R848 induced IFN-λR mRNA expression in PBMCs of healthy and asthmatic children, but suppressed IFN-αR mRNA levels. In murine lung cells, RV1b alone and together with R848 suppressed IFN-αR protein in T-cells compared with controls and in total lung IFN-λR mRNA compared with RV1b infection alone.

Conclusions

In PBMCs from pre-school age children, IFN-αR mRNA was reduced and IFN-λR1 mRNA was induced upon treatment with the TLR7/8 agonist R848, thus suggesting new avenues for induction of antiviral immune responses in paediatric asthma.
Functional respiratory imaging provides novel insights into the long-term respiratory sequelae of bronchopulmonary dysplasia
Authors: Vanhaverbeke Kristien , Slaats Monique , Al-Nejar Mohammed , Everaars Niek , Snoeckx Annemiek , Spinhoven Maarten , El Addouli Haroun , Lauwers Eline , Van Eyck Annelies , De Winter Benedicte Y. , Van Hoorenbeeck Kim , De Dooy Jozef , Mahieu Ludo , Mignot Benjamin , De Backer Jan , Mulder Antonius , Verhulst Stijn
Published: January 2021

Rationale

Bronchopulmonary dysplasia (BPD) is a common complication of preterm birth. Lung function and imaging are classically used to assess BPD. Functional respiratory imaging (FRI) combines a structural and functional assessment of the airways and their vasculature. We aimed to assess BPD using FRI and to correlate these findings with the clinical presentation.

Methods

We included 37 adolescents with a history of preterm birth (22 BPD cases and 15 preterm controls). The study protocol included a detailed history, lung function testing and computed tomography (CT) (at total lung capacity (TLC) and functional residual capacity (FRC)) with FRI. CT images were also assessed using the Aukland scoring system.

Results

BPD patients had lower forced expiratory volume in 1 s to forced vital capacity ratio (p=0.02) and impaired diffusion capacity (p=0.02). Aukland CT scores were not different between the two groups. FRI analysis showed higher lobar volumes in BPD patients at FRC (p<0.01), but not at TLC. Airway resistance was significantly higher in the BPD group, especially in the distal airways. Additionally, FRI showed more air trapping in BPD patients, in contrast to findings on conventional CT images.

Conclusion

This study is the first to use FRI in research for BPD. FRI analysis showed higher lobar volumes in BPD patients, indicating air trapping and reduced inspiratory capacity. In contrast to Aukland CT scores, FRI showed more air trapping in the BPD group, suggesting that FRI might be a more sensitive detection method. Importantly, we also showed increased distal airway resistance in BPD patients. By combining structural and functional assessment, FRI may help to better understand the long-term sequelae of BPD.
Validation of the BRODERS classifier (BenignversusaggRessive nODule Evaluation using Radiomic Stratification), a novel HRCT-based radiomic classifier for indeterminate pulmonary nodules
Authors: Maldonado Fabien , Varghese Cyril , Rajagopalan Srinivasan , Duan Fenghai , Balar Aneri B. , Lakhani Dhairya A. , Antic Sanja L. , Massion Pierre P. , Johnson Tucker F. , Karwoski Ronald A. , Robb Richard A. , Bartholmai Brian J. , Peikert Tobias
Published: January 2021

Introduction

Implementation of low-dose chest computed tomography (CT) lung cancer screening and the ever-increasing use of cross-sectional imaging are resulting in the identification of many screen- and incidentally detected indeterminate pulmonary nodules. While the management of nodules with low or high pre-test probability of malignancy is relatively straightforward, those with intermediate pre-test probability commonly require advanced imaging or biopsy. Noninvasive risk stratification tools are highly desirable.

Methods

We previously developed the BRODERS classifier (BenignversusaggRessive nODule Evaluation using Radiomic Stratification), a conventional predictive radiomic model based on eight imaging features capturing nodule location, shape, size, texture and surface characteristics. Herein we report its external validation using a dataset of incidentally identified lung nodules (Vanderbilt University Lung Nodule Registry) in comparison to the Brock model. Area under the curve (AUC), as well as sensitivity, specificity, negative and positive predictive values were calculated.

Results

For the entire Vanderbilt validation set (n=170, 54% malignant), the AUC was 0.87 (95% CI 0.81–0.92) for the Brock model and 0.90 (95% CI 0.85–0.94) for the BRODERS model. Using the optimal cut-off determined by Youden's index, the sensitivity was 92.3%, the specificity was 62.0%, the positive (PPV) and negative predictive values (NPV) were 73.7% and 87.5%, respectively. For nodules with intermediate pre-test probability of malignancy, Brock score of 5–65% (n=97), the sensitivity and specificity were 94% and 46%, respectively, the PPV was 78.4% and the NPV was 79.2%.

Conclusions

The BRODERS radiomic predictive model performs well on an independent dataset and may facilitate the management of indeterminate pulmonary nodules.
Structure and function of small airways in asthma patients revisited
Authors: van den Bosch Wytse B. , James Alan L. , Tiddens Harm A.W.M.
Published: January 2021

Small airways (<2 mm in diameter) are probably involved across almost all asthma severities and they show proportionally more structural and functional abnormalities with increasing asthma severity. The structural and functional alterations of the epithelium, extracellular matrix and airway smooth muscle in small airways of people with asthma have been described over many years usingin vitrostudies, animal models or imaging and modelling methods. The purpose of this review was to provide an overview of these observations and to outline several potential pathophysiological mechanisms regarding the role of small airways in asthma.
The transcriptome-wide association search for genes and genetic variants which associate with BMI and gestational weight gain in women with type 1 diabetes
Authors: Ludwig-Słomczyńska Agnieszka H. , Seweryn Michał T. , Kapusta Przemysław , Pitera Ewelina , Mantaj Urszula , Cyganek Katarzyna , Gutaj Paweł , Dobrucka Łucja , Wender-Ożegowska Ewa , Małecki Maciej T. , Wołkow Paweł P.
Published: January 2021

Background

Clinical data suggest that BMI and gestational weight gain (GWG) are strongly interconnected phenotypes; however, the genetic basis of the latter is rather unclear. Here we aim to find genes and genetic variants which influence BMI and/or GWG.

Methods

We have genotyped 316 type 1 diabetics using Illumina Infinium Omni Express Exome-8 v1.4 arrays. The GIANT, ARIC and T2D-GENES summary statistics were used for TWAS (performed with PrediXcan) in adipose tissue. Next, the analysis of association of imputed expression with BMI in the general and diabetic cohorts (Analysis 1 and 2) or GWG (Analysis 3 and 4) was performed, followed by variant association analysis (1 Mb around identified loci) with the mentioned phenotypes.

Results

In Analysis 1 we have found 175 BMI associated genes and 19 variants (p < 10–4) which influenced GWG, with the strongest association for rs11465293 in CCL24 (p = 3.18E−06). Analysis 2, with diabetes included in the model, led to discovery of 1812 BMI associated loci and 207 variants (p < 10–4) influencing GWG, with the strongest association for rs9690213 in PODXL (p = 9.86E−07). In Analysis 3, among 648 GWG associated loci, 2091 variants were associated with BMI (FDR < 0.05). In Analysis 4, 7 variants in GWG associated loci influenced BMI in the ARIC cohort.

Conclusions

Here, we have shown that loci influencing BMI might have an impact on GWG and GWG associated loci might influence BMI, both in the general and T1DM cohorts. The results suggest that both phenotypes are related to insulin signaling, glucose homeostasis, mitochondrial metabolism, ubiquitinoylation and inflammatory responses.
Anatomical and Pathological Observation and Analysis of SARS and COVID-19: Microthrombosis Is the Main Cause of Death
Authors: Chen Wenjing , Pan Jing Ye
Published: January 2021

The spread of the coronavirus (SARS-CoV-2, COVID-19 for short) has caused a large number of deaths around the world. We summarized the data reported in the past few months and emphasized that the main causes of death of COVID-19 patients are DAD (Diffuse Alveolar Damage) and DIC (Disseminated intravascular coagulation). Microthrombosis is a prominent clinical feature of COVID-19, and 91.3% of dead patients had microthrombosis.

Endothelial damage caused by SARS-CoV-2 cell invasion and subsequent host response disorders involving inflammation and coagulation pathways play a key role in the progression of severe COVID-19. Microvascular thrombosis may lead to microcirculation disorders and multiple organ failure lead to death.

The characteristic pathological changes of DAD include alveolar epithelial and vascular endothelial injury, increased alveolar membrane permeability, large numbers of neutrophil infiltration, alveolar hyaline membrane formation, and hypoxemia and respiratory distress as the main clinical manifestations. DAD leads to ARDS in COVID-19 patients. DIC is a syndrome characterized by the activation of systemic intravascular coagulation, which leads to extensive fibrin deposition in the blood. Its occurrence and development begin with the expression of tissue factor and interact with physiological anticoagulation pathways. The down-regulation of fibrin and the impaired fibrinolysis together lead to extensive fibrin deposition.

DIC is described as a decrease in the number of platelets and an increase in fibrin degradation products, such as D-dimer and low fibrinogen. The formation of microthrombus leads to the disturbance of microcirculation, which in turn leads to the death of the patient. However, the best prevention and treatment of COVID-19 microthrombosis is still uncertain.

This review discusses the latest findings of basic and clinical research on COVID-19-related microthrombosis, and then we proposed the theory of microcirculation perfusion bundle therapy to explore effective methods for preventing and treating COVID-19-related microthrombosis. Further research is urgently needed to clarify how SARS-CoV-2 infection causes thrombotic complications, and how it affects the course and severity of the disease. To cultivate a more comprehensive understanding of the underlying mechanism of this disease. Raise awareness of the importance of preventing and treating microthrombosis in patients with COVID-19.
Identification and analysis of long non-coding RNAs and mRNAs in chicken macrophages infected with avian infectious bronchitis coronavirus
Authors: Li Hao , Cui Pengfei , Fu Xue , Zhang Lan , Yan Wenjun , Zhai Yaru , Lei Changwei , Wang Hongning , Yang Xin
Published: January 2021

Background

Avian infectious bronchitis virus (IBV) is a gamma coronavirus that severely affects the poultry industry worldwide. Long non-coding RNAs (lncRNAs), a subset of non-coding RNAs with a length of more than 200 nucleotides, have been recently recognized as pivotal factors in the pathogenesis of viral infections. However, little is known about the function of lncRNAs in host cultured cells in response to IBV infection.

Results

We used next-generation high throughput sequencing to reveal the expression profiles of mRNAs and lncRNAs in IBV-infected HD11 cells. Compared with the uninfected cells, we identified 153 differentially expressed (DE) mRNAs (106 up-regulated mRNAs, 47 down-regulated mRNAs) and 181 DE lncRNAs (59 up-regulated lncRNAs, 122 down-regulated lncRNAs) in IBV-infected HD11 cells. Moreover, gene ontology (GO) and pathway enrichment analyses indicated that DE mRNAs and lncRNAs were mainly involved in cellular innate immunity, amino acid metabolism, and nucleic acid metabolism. In addition, 2640 novel chicken lncRNAs were identified, and a competing endogenous RNA (ceRNAs) network centered on gga-miR-30d and miR-146a-5p was established.

Conclusions

We identified expression profiles of mRNAs and lncRNAs during IBV infection that provided new insights into the pathogenesis of IBV.
Unplanned hospital readmission after surgical treatment for thoracic spinal stenosis: incidence and causative factors
Authors: Wang Hui , Wang Longjie , Sun Zhuoran , Jiang Shuai , Li Weishi
Published: January 2021

Background

To assess the incidence and causative factors of unplanned hospital readmission within 90 days after surgical treatment of thoracic spinal stenosis (TSS).

Methods

Hospital administrative database was queried to identify patients who underwent surgical treatment of TSS from July 2010 through December 2017. All unplanned readmissions within 90 days of discharge were reviewed for causes and the rate of unplanned readmissions was calculated. Patients of unplanned readmission were matched 1:3 to a control cohort without readmission.

Results

Twenty-one patients (incidence of 1.7 % in 1239 patients) presented unplanned hospital readmission within a 90-day period and enrolled as the study group, 63 non-readmission patients (a proportion of 1: 3) were randomly selected as the control group. Causes of readmission include pseudomeningocele (8 patients; 38 %), CSF leakage combined with poor incision healing (6 patients; 29 %), wound dehiscence (2 patient; 9 %), surgical site infection (2 patients; 9 %), spinal epidural hematoma (1 patient; 5 %), inadequate original surgical decompression (2 patients; 9 %). Mean duration from re-admission to the first surgery was 39.6 ± 28.2 days, most of the patients readmitted at the first 40 days (66.7 %, 14/21 patients). When compared to the non-readmitted patients, diagnosis of OPLL + OFL, circumferential decompression, dural injury, long hospital stay were more to be seen in readmitted patients.

Conclusions

The incidence of 90-day unplanned readmission after surgical treatment for TSS is 1.7 %, CSF leakage and pseudomeningocele were the most common causes of readmission, the peak period of readmission occurred from 10 to 40 days after surgery, patients should be closely followed up within this period.
Pathogenicity of novel goose-origin astrovirus causing gout in goslings
Authors: Yin Dan , Tian Jiajun , Yang Jing , Tang Yi , Diao Youxiang
Published: January 2021

Background

A novel goose-origin astrovirus (GoAstV) has broken out across China in recent years, causing gout in goslings with a mortality rate of around 50%. However, our understanding of the dynamic distribution, tissue tropism and pathogenesis of GoAstV is incomplete. In order to assess its pathogenicity, one-day-old goslings were inoculated separately with GoAstV via oral and subcutaneous injection routes.

Results

Clinical symptoms, gross and microscopic lesions, blood biochemical parameters and viral loads were detected and recorded for 20 days after infection. Typical gout was observed in experimental goslings. GoAstV can be replicated in tissues and cause pathological damage, especially in the kidney, liver, heart and spleen. Virus-specific genomic RNA was detected in blood, cloacal swabs and all representative tissues, and virus shedding was detected up to 20 days after inoculation, suggesting that GoAstV has a wide tissue tropism and spread systematically after inoculation. The viral copy numbers examined in kidney were the highest, followed by spleen and liver.

Conclusion

This experiment determined the accurate value of viral loads and biochemical indicators of GoAstV-induced goslings. These findings increase our understanding of the pathogenicity of GoAstV in goslings and provide more reference for future research.
Circular RNA circSDHC serves as a sponge for miR-127-3p to promote the proliferation and metastasis of renal cell carcinoma via the CDKN3/E2F1 axis
Authors: Cen Junjie , Liang Yanping , Huang Yong , Pan Yihui , Shu Guannan , Zheng Zhousan , Liao Xiaozhong , Zhou Mi , Chen Danlei , Fang Yong , Chen Wei , Luo Junhang , Zhang Jiaxing
Published: January 2021

Background

There is increasing evidence that circular RNAs (circRNAs) have significant regulatory roles in cancer development and progression; however, the expression patterns and biological functions of circRNAs in renal cell carcinoma (RCC) remain largely elusive.

Method

Bioinformatics methods were applied to screen for circRNAs differentially expressed in RCC. Analysis of online circRNAs microarray datasets and our own patient cohort indicated that circSDHC (hsa_circ_0015004) had a potential oncogenic role in RCC. Subsequently, circSDHC expression was measured in RCC tissues and cell lines by qPCR assay, and the prognostic value of circSDHC evaluated. Further, a series of functional in vitro and in vivo experiments were conducted to assess the effects of circSDHC on RCC proliferation and metastasis. RNA pull-down assay, luciferase reporter and fluorescent in situ hybridization assays were used to confirm the interactions between circSDHC, miR-127-3p and its target genes.

Results

Clinically, high circSDHC expression was correlated with advanced TNM stage and poor survival in patients with RCC. Further, circSDHC promoted tumor cell proliferation and invasion, both in vivo and in vitro. Analysis of the mechanism underlying the effects of circSDHC in RCC demonstrated that it binds competitively to miR-127-3p and prevents its suppression of a downstream gene, CDKN3, and the E2F1 pathway, thereby leading to RCC malignant progression. Furthermore, knockdown of circSDHC caused decreased CDKN3 expression and E2F1 pathway inhibition, which could be rescued by treatment with an miR-127-3p inhibitor.

Conclusion

Our data indicates, for the first time, an essential role for the circSDHC/miR-127-3p/CDKN3/E2F1 axis in RCC progression. Thus, circSDHC has potential to be a new therapeutic target in patients with RCC.
Reliability and validity of the Chinese version of the LMC Skills, Confidence & Preparedness Index (SCPI) in patients with type 2 diabetes
Authors: Wang Ximin , Lyu Weibo , Aronson Ronnie , Li Aihua , Lu Gendi , Xu Weijin , Cao Yang , Yu Ying , Wang Liting , Lin Huiting
Published: January 2021

Background

A variety of diabetes self-management instruments have been developed but few of them consist of the preparedness for diabetes self-management behavior. The novel psychometric evaluation tool “the LMC Skills, Confidence & Preparedness Index (SCPI)” measures three key aspects of a patient’s diabetes self-management: knowledge of the skill, confidence in being able to perform skill and preparedness to implement the skill. The objective of this study was to translate, adapt and validate the SCPI for use in Chinese adult patients with type 2 diabetes.

Methods

This study followed the guideline recommended by the American Academy of Orthopaedic Surgeons Evidence Based Medicine Committee (AAOS) to indigenize the scale. Forward and back translation, and cross-cultural language debugging were completed according to the recommended steps. A convenience sample of Chinese patients with type 2 diabetes (n = 375) were recruited from a university-affiliated hospital in Shanghai. The validity (criterion, discriminant validity, and construct validity), reliability (internal consistency and test–retest reliability) and the interpretability of the instrument were examined. The content validity was calculated by experts’ evaluation.

Results

The Chinese version of SCPI (C-SCPI) has good internal consistency with a Cronbach’s alpha of 0.92. The ceiling effects of the preparedness subscales is 21%. The criterion validity of three dimensions of C-SCPI was established with significantly moderate correlations between the DKT, DES-SF and SDSCA (p < 0.05). The S-CVI of the whole scale was 0.83. Except for entry 21, the I-CVI values of all entries were greater than 0.78. The C-SCPI has also shown good discriminative validity with statistically significant differences between the patients with good and poor glycemic control. Confirmatory factor analysis showed that modified results indicate that the fitting degree of the model is good, χ2/df = 2.775, RMSEA = 0.069, CFI = 0.903, GFI = 0.873, TLI = 0.889, IFI = 0.904. The test–retest reliability coefficient was 0.61 (p < 0.01).

Conclusion

We established a Chinese version of SCPI through translation and cross-cultural adaptation. The C-SCPI is reliable and valid for assessment of the level of self-management in Chinese patients with type 2 diabetes.
Atypical parathyroid adenoma: clinical and anatomical pathologic features
Authors: Galani Alessandro , Morandi Riccardo , Dimko Mira , Molfino Sarah , Baronchelli Carla , Lai Silvia , Gheza Federico , Cappelli Carlo , Casella Claudio
Published: January 2021

Background

Primary hyperparathyroidism is an endocrine pathology that affects calcium metabolism. Patients with primary hyperparathyroidism have high concentrations of serum calcium or high concentrations of parathyroid hormone, or incorrect parathyroid hormone levels for serum calcium values. Primary hyperparathyroidism is due to the presence of an adenoma/single-gland disease in 80–85%. Multiple gland disease or hyperplasia accounts for 10–15% of cases of primary hyperparathyroidism. Atypical parathyroid adenoma and parathyroid carcinoma are both responsible for about 1.2–1.3% and 1% or less of primary hyperparathyroidism, respectively.

Methods

We performed a retrospective cohort study and enrolled 117 patients with primary hyperparathyroidism undergoing minimally invasive parathyroidectomy. Histological and immunohistochemical examination showed that 107 patients (91.5%) were diagnosed with typical adenoma (group A), while 10 patients (8.5%) were diagnosed with atypical parathyroid adenoma (group B). None of the patients were affected by parathyroid carcinoma.

Results

Significant statistical differences were found in histological and immunohistochemical parameters as pseudocapsular invasion (p <  0.001), bands of fibrosis (p <  0.001), pronounced trabecular growth (p <  0.001), mitotic rates of > 1/10 high-power fields (HPFs) (p <  0.001), nuclear pleomorphism (p = 0.036), thick capsule (p <  0.001), Ki-67+ > 4% (p <  0.001), galectin-3 + (p = 0.002), and protein gene product (PGP) 9.5 + (p = 0.038).

Conclusions

Atypical parathyroid adenoma is a tumor that has characteristics both of typical adenoma and parathyroid carcinoma. The diagnosis is reached by excluding with strict methods the presence of malignancy criteria. Atypical parathyroid adenoma compared to typical adenoma showed significant clinical, hematochemical, histological, and immunohistochemical differences. We did not find any disease relapse in the 10 patients with atypical parathyroid adenoma during 60 months of follow-up time.
Effect of somatometric parameters on the prevalence and severity of varicocele: a systematic review and meta-analysis
Authors: Li Runqing , Liu Junjie , Li Yushan , Wang Quanxian
Published: January 2021

Background

Published studies have shown contradictory results regarding the relationship between somatometric parameters and varicoceles. We performed a systematic review and meta-analysis to investigate the possible effects of age, height, weight, and body mass index (BMI) on the presence and severity of varicoceles.

Methods

Databases including EMBASE, MEDLINE, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Web of Science, and Google Scholar were systematically searched to identify relevant articles published up to March 2020. Two researchers independently identified eligible articles and extracted data. Cochran’s Q statistic and I2statistics were used to assess heterogeneity. Meta-analysis was performed using StataSE 12.0 software (StataCorp LP, USA). Random-effects models were used to obtain the weighted mean differences (WMDs) and 95% confidence intervals (CIs). Publication bias was assessed using Begg’s funnel plot and Egger’s regression test.

Results

The search strategy produced 272 articles, of which 18 articles were eligible according to the inclusion/exclusion criteria. A total of 56,325 patients with varicocele and 1,334,694 patients without varicocele were included in the meta-analysis to evaluate the effect of somatometric parameters on the presence and severity of varicocele. The overall results demonstrated that the presence of varicoceles was significantly associated with height (WMD = 1.41, 95% CI = 1.07 to 1.74,P < 0.001) and inversely correlated with BMI (WMD = − 1.35, 95% CI = -1.67 to − 1.03,P < 0.001) but not with age (WMD = -0.93, 95% CI = -2.19 to 0.33,P = 0.149) or weight (WMD = 0.24, 95% CI = -2.24 to 2.72,P = 0.850). The severity of varicocele was inversely correlated with increased BMI but not with age.

Conclusion

The presence of varicoceles was significantly associated with height and inversely correlated with BMI.
Lockdowns and low- and middle-income countries: building a feasible, effective, and ethical COVID-19 response strategy
Authors: Eyawo Oghenowede , Viens A. M. , Ugoji Uchechukwu Chidiebere
Published: January 2021

Lockdowns can be an effective pandemic response strategy that can buy much needed time to slow disease transmission and adequately scale up preventative, diagnostic, and treatment capacities. However, the broad restrictive measures typically associated with lockdowns, though effective, also comes at a cost – imposing significant social and economic burdens on individuals and societies, especially for those in low- and middle-income countries (LMICs). Like most high-income countries (HICs), many LMICs initially adopted broad lockdown strategies for COVID-19 in the first wave of the pandemic. While many HICs experiencing subsequent waves have returned to employing lockdown strategies until they can receive the first shipments of COVID-19 vaccine, many LMICs will likely have to wait much longer to get comparable access for their own citizens. In leaving LMICs vulnerable to subsequent waves for a longer period of time without vaccines, there is a risk LMICs will be tempted to re-impose lockdown measures in the meantime. In response to the urgent need for more policy development around the contextual challenges involved in employing such measures, we propose some strategies LMICs could adopt for safe and responsible lockdown entrance/exit or to avoid re-imposing coercive restrictive lockdown measures altogether.
Molecular detection of urogenital mollicutes in patients with invasive malignant prostate tumor
Authors: Abdul-Wahab Osama Mohammed Saed , Al-Shyarba Mishari H. , Mardassi Boutheina Ben Abdelmoumen , Sassi Nessrine , Al Fayi Majed Saad Shaya , Otifi Hassan , Al Murea Abdullah Hassan , Mlik Béhija , Yacoub Elhem
Published: January 2021

Background

The etiology of prostate cancer (PCa) is multiple and complex. Among the causes recently cited are chronic infections engendered by microorganisms that often go unnoticed. A typical illustration of such a case is infection due to mollicutes bacteria. Generally known by their lurking nature, urogenital mollicutes are the most incriminated in PCa. This study was thus carried out in an attempt to establish the presence of these mollicutes by PCR in biopsies of confirmed PCa patients and to evaluate their prevalence.

Methods

A total of 105 Formalin-Fixed Paraffin-Embedded prostate tissues collected from 50 patients suffering from PCa and 55 with benign prostate hyperplasia were subjected to PCR amplification targeting species-specific genes of 5 urogenital mollicutes species, Mycoplasma genitalium, M. hominis, M. fermentans, Ureaplasma parvum, and U. urealyticum. PCR products were then sequenced to confirm species identification. Results significance was statistically assessed using Chi-square and Odds ratio tests.

Results

PCR amplification showed no positive results for M. genitalium, M. hominis, and M. fermentans in all tested patients. Strikingly, Ureaplasma spp. were detected among 30% (15/50) of PCa patients. Nucleotide sequencing further confirmed the identified ureaplasma species, which were distributed as follows: 7 individuals with only U. parvum, 5 with only U. urealyticum, and 3 co-infection cases. Association of the two ureaplasma species with PCa cases proved statistically significant (P < 0.05), and found to represent a risk factor. Of note, Ureaplasma spp. were mostly identified in patients aged 60 and above with prostatic specific antigen (PSA) level > 4 ng/ml and an invasive malignant prostate tumor (Gleason score 8–10).

Conclusions

This study uncovered a significant association of Ureaplasma spp. with PCa arguing in favour of their potential involvement in this condition. Yet, this finding, though statistically supported, warrants a thorough investigation at a much larger scale.