bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional Variation and Socioeconomic Inequalities in Obesity Prevalence Among Non-pregnant Women in Chad: Evidence From Three Waves of Chad Demographic and Health Surveys
Authors: Shibre Gebretsadik , Zegeye Betregiorgis Hailu , Garedew Gashaw Woldeamanuiel , Negash Wassie , Lemma Gorems , Mamo Mitku Taderegew
Published: August 2020

Background: While the prevalence of obesity is increasing worldwide, the growing rates of overweight and obesity in developing countries are alarming. Obesity is widely recognized as a risk factor for non-communicable diseases (NCDs), including diabetes, cancer and cardiovascular diseases. Available evidence on whether obesity has been more prevalent among higher or lower socioeconomic groups, across regions and urban-rural women’s are inconsistent. This study examined socioeconomic, urban-rural and sub-national regional inequalities in obesity among non-pregnant women in Chad.Method: Using cross-sectional data from Demographic and Health Surveys (DHS) from Chad conducted between 1996 and 2014, we used the World Health Organization Health Equity Assessment Toolkit to analyze the socio-economic and regional inequalities in obesity prevalence among non-pregnant women aged 15-49 years. Inequalities are assessed using socioeconomic and demographic indicators such as wealth index, education level and place of residence. We presented inequalities using both simple and complex summary measures, namely Difference (D), Population Attributable Risk (PAR), Population Attributable Fraction (PAF) and Ratio (R).Results: Though constant pattern overtime, both wealth-driven and place of residence inequality were observed in all three surveys by Difference measure and in the first and last surveys by Ratio measure. Similarly, including the recent survey (D=-2.80%, 95% CI:-4.15, -1.45, R= 0.37%, 95% CI: 0.23, 0.50) absolute (in 1996 & 2014 survey) and relative (in all three surveys) educational status inequality with constant pattern were observed. Substantial absolute (PAR=-2.2%, 95% CI: -3.21, -1.34) and relative (PAF= -91.9%, 95% CI: -129.58, -54.29) regional inequality was observed with increasing and constant pattern by simple (D) and complex (PAR, PAF) measures. Conclusion: Both socioeconomic and area-based obesity inequalities disfavoring women in the higher socioeconomic status and residing in urban areas. Prevention of obesity prevalence should be government and stakeholders’ priority through organizing the evidence, health promotion and prevention interventions for at risk population and general population.
A Congenital Right Sided Diaphragmatic Hernia Presented in Pregnancy: Rare Case Report
Authors: Gharde Pankaj , Dwivedi Sankalp , Gharde Pramita Muntode , Jamdade Piyush , Aalam Azeem
Published: August 2020

Background: Diaphragmatic hernias are infrequent and remain undiagnosed till the symptoms arise. One third of these patients are asymptomatic. Its diagnosis is only established on the emergence of gastrointestinal, respiratory or cardiovascular complications. Surgical intervention is needed if complications arise. These Diaphragmatic hernias usually involve the left side of diaphragm either through a congenital defect or from a trauma over abdomen or chest as the right side has a type of protective gear which is the Liver lying below the diaphragm. The occurrence of right sided diaphragmatic hernia is rarest of rare. Patients may present with shortness of breath, obstruction, strangulation, gangrene and perforation of gut. The mortality is very high. Symptomatic diaphragmatic hernia in pregnant females is a matter of greater concern. Case Report: A 21-yr-old female, primigravida, primipara, with 22 weeks gestation, complained of severe abdominal pain and intractable vomiting since the last 7 days and for this acute intestinal obstruction was admitted to the emergency department. At the local Primary Health Center her symptoms were partially relieved by symptomatic management, but due to recurrence of symptoms she was referred to our rural hospital.Her chest radiograph revealed a right sided diaphragmatic hernia with large and small intestine as its content. She had no abdominal or respiratory complaints in past. Initially the patient’s general condition improved by nasogastric aspiration but then she developed tachycardia, tachypnoea, nausea and vomiting despite nasogastric aspiration, so emergency exploration was done. Exploratory laparotomy along with right thoracotomy was performed. As the gut was gangrenous, resection anastomosis was done along with diaphragmatic hernia repair.Conclusion: Diaphragmatic hernia in adults and pregnancy is a very rare entity. The right sided diaphragmatic hernia is rarest of rare that too in pregnancy.What makes this case even extraordinary is, it being the first case in studied literature showing specific right sided presentation during pregnancy, as the rest are left sided. Even though the risk of morbidity and mortality is high, once complications arise, but early intervention improves the outcome.
Patient Involvement to Inform the Design of a Clinical Trial in Postbariatric Hypoglycemia
Authors: Hepprich Matthias , Donath Marc Y , Hemkens Lars G
Published: August 2020

Background: Bariatric surgery may lead to symptomatic postprandial hypoglycemia as a major side effect without established therapy so far. We aimed to develop an evidence-based study design of a clinical trial that tests treatment options and can provide useful patient-relevant evidence.Methods: We searched systematically for guidance of core outcome sets to determine the most relevant types of outcomes and duration of such a trial. Our search comprised literature databases, a database of core outcome sets and self-help organizations. We then developed a simple online questionnaire based on interviews with German-speaking patients with postprandial hypoglycemia after bariatric surgery. We recruited participants by reaching out to all German speaking endocrinologists in Switzerland and large Swiss bariatric centers. We asked for preferences regarding outcome types and acceptable duration of being included in a corresponding clinical trial.Results: The systematic search did not identify evidence-based guidance for informing our study design. Experience of clinical and research routine as well as patient interviews helped in identifying potential outcomes and the design of an online questionnaire. Therein, a total of 29 persons started the questionnaire and 22 answered questions related to the primary outcome. Of these, 17 (77.3%) deemed quality of life more relevant as primary outcome than the rate of hypoglycemic episodes. A trial length of four weeks or longer was regarded as acceptable for 19 of 21 respondents to this question (91.4 %) and of six months or longer for 12 respondents (56 %). Conclusions: In situations with no other guidance, a simple questionnaire may help to inform trial design decisions. This study identifies a patient preference for “quality of life” as a primary outcome and supports the evidence-based conception of a patient-centered clinical trial in postbariatric hypoglycemia.
Chordoid Glioma of the Third Ventricular with Three less Common Patterns and Three Rare Patterns
Authors: ma xiaomei , zhu zhi , wang yin , li weiqing
Published: August 2020

BackgroundChordoid gliomas are rare, low-grade neoplasms of the third ventricle. In the updated 4th edition of the 2016 WHO classification of tumours of the CNS, it described some three less common histological patterns and rare tissue patterns. Case presentationHere we reported a case with all the uncommon patterns. It was a 52-year-old woman with dizziness and blurred vision. Imaging showed a solid tumor located in the third ventricle with a well-circumscribed border. Histological, almost tumor cells formed into atypical glands with different sizes and irregular shapes in an abundant of solid or loosely collagen matrix. Some tumor cells formed into papillary patterns, micro-papillary patterns. pseudoglandular patterns. Some focal tumor cells were spindle-shape. Only few epithelioid tumor cells formed into clusters and cords embedded into a myxoid stroma like the chordoma. No anaplastic features were identified in any lesion. Immunohistochemically, all the tumor cells were strong reactivity for TTF-1. Some tumor cells strong but focal reactivity for GFAP, NEU-N, and CD34. It showed a recurrent D463H missense mutation in PRKCA. All these findings confirm that the diagnosis was chordoid glioma of the third ventricular. ConclusionsThere may be lots of histopathological features in one chordoid glioma case. It maybe suggested that PRKCA D463H mutation and TTF-1 positive may help to diagnose it.
Development and verification of immune-related long non-coding RNA prognostic signature in bladder cancer
Authors: Lai Cong , Wu Zhenyu , Li Zhuohang , Yu Hao , Li Kuiqing , Tang Zhuang , Liu Cheng , Xu Kewei
Published: August 2020

Background: Bladder cancer is the second most common malignant tumor in urogenital system. The research aimed to investigate the prognostic role of immune-related long non-coding RNA (lncRNA) in bladder cancer. Methods: We extracted 411 bladder cancer samples from The Cancer Genome Atlas database. Single-sample gene set enrichment analysis was employed to assess the immune cell infiltration of these samples. We recognized differentially expressed lncRNAs between tumors and paracancerous tissues, and differentially expressed lncRNAs between the high and low immune cell infiltration groups. Venn diagram analysis detected differentially expressed lncRNAs that intersected the above groups. LncRNAs with prognostic significance were identified by regression analysis and survival analysis. Multivariate Cox analysis was used to establish the risk score model. The nomogram was established and evaluated by receiver operating characteristic (ROC) curve analysis, concordance index (C-index) analysis, calibration chart, and decision curve analysis (DCA). Additionally, we performed gene set enrichment analysis to explore the potential functions of the screened lncRNAs in tumor pathogenesis.Results: Three hundred and twenty differentially expressed lncRNAs were recognized. We randomly divided patients into the training data set and the testing data set at a 2: 1 ratio. In the training data set, 9 immune-related lncRNAs with prognostic significance were identified. The risk score model was constructed to classify patients as high- and low-risk cohorts. Patients in the low-risk cohort had better survival outcomes than those in the high-risk cohort. The nomogram was established based on the indicators including age, gender, TNM stage, and risk score. The model’s predictive performance was confirmed by ROC curve analysis, C-index analysis, calibration chart, and DCA. The testing data set also achieved similar results. Bioinformatics analysis suggested that the 9-lncRNA signature was involved in modulation of various immune responses, antigen processing and presentation, and T cell receptor signaling pathway.Conclusions: The immune-related lncRNAs have the potential to predict the prognosis of bladder cancer and may play a key role in bladder cancer biology.Trial registration: It was a retrospective study and the gene expression data were obtained from the TCGA database. Trial registration was not needed.
Dysregulated Bile Acid Receptor-mediated Signaling and IL-17A Induction are Implicated in Diet-associated Hepatic Health and Cognitive Function
Authors: JENA PRASANT KUMAR , Sheng Lili , Nguyen Michelle , Lucente Jacopo Di , Hu Ying , Li Yongchun , Maezawa Izumi , Jin Lee-way , Wan Yu-Jui
Published: August 2020

Background: Chronic consumption of high sugar and high fat diet associated with liver inflammation and cognitive decline. This paper tests a hypothesis that the development and resolution of diet-induced nonalcoholic fatty liver disease (NAFLD) has an impact on neuroplasticity and cognition. Methods: C57BL/6 wild-type mice were fed with either a healthy control diet (CD) or a fructose, palmitate, and cholesterol (FPC)-enriched diet since weaning. When mice were 3-months old, FPC diet-fed mice were randomly assigned to receive either FPC-enriched diet with or without 6% inulin supplementation. At 8 months of age, all three groups of mice were euthanized followed by analysis of inflammatory signaling in the liver and brain, gut microbiota, and cecal metabolites. Results: Our data shows that FPC diet intake induced hepatic steatosis and inflammation in the liver and brain along with elevated RORγ and IL-17A signaling. Accompanied by microglia activation and reduced hippocampal long-term potentiation, FPC diet intake also reduced postsynaptic density-95 and brain derived neurotrophic factor, whereas inulin supplementation prevented diet-reduced neuroplasticity and the development of NAFLD. In the gut, FPC diet increased Coriobacteriaceae and Erysipelotrichaceae, which are implicated in cholesterol metabolism, and the genus Allobaculum, and inulin supplementation reduced them. Furthermore, FPC diet reduced FXR and TGR5 signalling, and inulin supplementation reversed these changes. Untargeted cecal metabolomics profiling uncovered 273 metabolites, and 104 had significant changes due to FPC diet intake or inulin supplementation. Among the top 10 most affected metabolites, FPC-fed mice had marked increase of zymosterol, a cholesterol biosynthesis metabolite, and reduced 2,8-dihydroxyquinoline, which has known benefits in reducing glucose intolerance; these changes were reversible by inulin supplementation. Additionally, the abundance of Barnesiella, Coprobacter, Clostridium XIVa, and Butyrivibrio were negatively correlated with FPC diet intake and the concentration of cecal zymosterol but positively associated with inulin supplementation. suggesting their benefits. Conclusion: Taken together, the presented data suggest that diet alters the gut microbiota and their metabolites, including bile acids. This will subsequently affect IL-17A signaling, resulting in systemic impacts on both hepatic metabolism and cognitive function.
A Mixed Methods Evaluation of a 4-week Geriatrics Curriculum in Strengthening Knowledge and Comfort Among Orthopaedic Surgery Residents
Authors: Chan Adrian , Chuen Victoria , Perrella Andrew , Limfat Guillaume , Ng Karen , Chau Vicky
Published: August 2020

Background: In 2016, the University of Toronto Faculty of Medicine implemented a 4-week “Orthogeriatrics” rotation for orthopaedic surgery residents. We sought to assess the rotation’s impact on trainees’ knowledge, attitudes, and behaviours toward caring for older adults, and explore areas for improvement.Methods: We used a mixed methods concurrent triangulation design. The Geriatrics Clinical Decision-Making Assessment (GCDMA) and Geriatric Attitudes Scale (GAS) compared knowledge, attitudes, and behaviours between trainees who were or were not exposed to the curriculum. Rotation evaluations and semi-structured interviews with trainees and key informants explored learning experiences and the curriculum’s impact on resident physician growth and development in geriatric competencies.Results: Among trainees who completed the GCDMA (n=19), those exposed to the rotation scored higher in knowledge compared to the unexposed cohort (14.4±2.1 vs. 11.3±2.0, p<0.01). The following themes emerged from the qualitative analysis of 29 stakeholders: Increased awareness and comfort regarding geriatric medicine competencies, appreciation of the value of orthogeriatric collaboration, and suggestions for curriculum improvement. Conclusion: These results suggest that the Orthogeriatrics curriculum strengthens knowledge, behaviour, and comfort towards caring for older adults. Our study aims to inform further curriculum development and facilitate dissemination of geriatric education in surgical training programs across Canada and the world.
Repeat Pulmonary Resection for Lung Malignancies Does Not Affect the Postoperative Complications: A Retrospective Study
Authors: Motono Nozomu , Iwai Shun , Iijima Yoshihito , Usuda Katsuo , Uramoto Hidetaka
Published: August 2020

Background: Although repeat pulmonary resection (RPR) for multiple lung cancer (MLC) has been performed for non-small cell lung cancer (NSCLC) and metastatic lung tumor, with the prognostic benefit detailed in several reports, the risk of RPR has not been well analyzed.Methods: Patients with lung malignancies who underwent complete resection at Kanazawa Medical University between January 2010 and October 2019 were analyzed. The relationship between postoperative complications and preoperative and perioperative factors was analyzed. Postoperative complications were categorized into five grades according to the Clavien–Dindo classification system.Results: A total of 41 patients who were received RPR were enrolled in this study. Primary lung tumor was found in 31 patients, and metastatic lung tumor was found in 10 patients. The postoperative complication rate of the first operation was 29%, and that of the second operation was 29%. While there were no significant factors for an increased incidence of postoperative complication in a multivariate analysis, an operation time over 2 h at the second operation tended to affect the incidence of postoperative complication (p=0.06). Furthermore, the operation time was significantly longer (p=0.02) and wound length tended to be longer (p=0.07) in the ipsilateral group than in the contralateral group. The rate of postoperative complications and the length of the postoperative hospital stay were not significantly different between the two groups.Conclusion: RPR is safely feasible and is not associated with an increased rate of postoperative complications, even on the ipsilateral side.
Identification of Potential Tumor-educated Platelets RNA Biomarkers for Pan Cancer Detection and Staging
Authors: Ge Xinxin , Yuan Liuxia , Hu Ying , Cheng Bin , Shoaib Khan Muhammad , Dai Kesheng
Published: August 2020

Cancer is a disturbing disease with high morbidity and mortality. Although medical technology has been developed rapidly, diagnosis of cancer is still complicated, difficult, as well as expensive. Furthermore, cancers are mostly diagnosed at an advanced stage. Platelets mRNA profiles are altered after educated by tumors. Thereby, tumor-educated platelets (TEPs) mRNA profiles have the potentially diagnostic value for cancers currently. We downloaded and analyzed the next-generation sequencing datasets, GSE68086 and GSE89843, by integrated bioinformatics. A total of 43 biomarker genes were selected for further pathway enrichment analysis and correlation analysis, as well as diagnostic analysis. Gene ontology (GO) analysis showed these 43 TEPs mRNAs were mostly involved in protein binding, extracellular matrix and cellular protein metabolic process. Kyoto encyclopedia of genes and genomes (KEGG) pathway enrichment analysis revealed that genes were mainly enriched in metabolic process. Eventually, after taking these 43 genes into spearman correlation analysis and receiving operating characteristic (ROC) curve analysis, we identified: 1) TEPs RSL24D1 mRNA was negatively related to early pan cancer as compared to healthy controls, and potential for early pan cancer diagnosis with a sensitivity of 71.8%, and a specificity of 64.3%; 2) HPSE, IFI27, LGALS3BP, CRYM, HBD, COL6A3, LAMB2, and IFITM3 showed an upward trend in the expression from early to more advanced pan cancer stages. The sensitivity of the diagnostic value for pan cancer of these genes was 60.9%, 59.1%, 56.5%, 57.8%, 54.3%, 55.2%, 55.2%, 60.9%, and a specificity of 94.5%, 90.9%, 87.3%, 89.1%, 72.7%, 85.5%, 89.1%, 94.5% respectively; 3) ARL2, FCGR2A, and KLHDC8B were positively associated with advanced, metastatic pan cancer as compared to healthy controls and could be diagnostic indicators for advanced pan cancer with a sensitivity of 59.2%, 61.8%, 59.7%, and a specificity of 80%, 89.1%, 83.6%, respectively. In summary, our findings identified that the 12-gene TEP liquid-biopsy biomarkers will not only facilitate early diagnosis of pan cancer, but also be beneficial to pan cancer staging.
Clinical and Cytogenetical Characteristics-Related Nomograms for Assessing Outcome of Acute Myeloid Leukemia Patients Post IA Induction
Authors: Wang Na , Dai Kanchun , Desai Aakash , Ge Bei , Lin Weihong , Ye Haige
Published: August 2020

Background: Acute myeloid leukemia(AML) is a highly heterogeneous hematological malignancy. Despite, increase in treatment options for AML over the past decade, prognosis for AML remain dismal. Numerous prognostic models have been developed for this disease, however nomograms predicting long-term survival in AML patients after induction chemotherapy(IA regimen) have not been described.Method: We constructed nomograms to predict disease-free survival(DFS) and overall survival(OS) by analyzing the cohort of patients with de novo non-M3 AML patients who underwent induction chemotherapy between June 2008 to August 2019. We utilized univariable and multivariable Cox proportional hazards regression analyses to obtain the selected variables for the nomograms. The discriminative ability and calibration were tested using C statistics, calibration plots, and Kaplan-Meier curves.Results: A total of 360 patients who underwent induction chemotherapy with IA regimen were included in the study. Of these 55% were male with a median age was 48 years. Using the univariate and multivariate analyses, the following variables were identified in the prediction of DFS: age(HR, 1.770; 95%CI, 1.160-2.702; P = 0.008), Hb(HR, 0.634; 95%CI, 0.462-0.870; P = 0.005), albumin(HR, 0.473; 95%CI, 0.363-0.615; P < 0.001) and cyto/molecular risk group(intermediate vs. favorable: HR, 1.614; 95%CI, 1.128-2.309; P = 0.001; poor vs. favorable: HR, 2.459; 95%CI, 1.645-3.676; P < 0.001) at the time of diagnosis, and allo-HSCT treatment(HR, 0.341; 95%CI, 0.234-0.497; P < 0.001). Factors which predicted OS were Hb (HR, 0.616; 95%CI, 0.438-0.866; P = 0.005), albumin (HR, 0.448; 95%CI, 0.340-0.591; P < 0.001), cyto/molecular risk group (intermediate vs. favorable: HR, 1.558; 95%CI, 1.068-2.275; P = 0.021; poor vs. favorable: HR, 2.348; 95%CI, 1.523-3.620; P < 0.001), allo-HSCT treatment (HR, 0.256; 95%CI, 0.166-0.396; P < 0.001), and age (HR, 1.528; 95%CI 0.980-2.382; P = 0.061). The discriminative ability and calibration of the nomograms revealed good predictive ability as indicated by the C statistics (0.715 for DFS and 0.731 for OS). Conclusion: Independent predictors of survival and relapse risk after IA regimen for AML can be utilized to obtain survival nomograms. These nomograms were able to predict DFS and OS while having good calibration accuracy and discriminative ability on internal validation.
Clinical Application of Confidence Interval for Monitoring Changes in Tumor Markers to Determine the Responsiveness to Cancer Treatment
Authors: Cho Jooyoung , Seo Dong Min , Uh Young
Published: August 2020

Background: Tumor markers are used to monitor disease progression and determine the responsiveness to cancer treatment. However, there are no standardized criteria for monitoring serial tumor marker measurements. Herein, we have developed our own monitoring system for interpreting changes in tumor markers using overlapping 95% confidence intervals (CIs) to determine whether the changes are significant.Methods: Two-year data, including 117,289 results for 11 tumor markers in our laboratory, were analyzed. The distributions of absolutely delta% and cut-off values for certain percentiles were calculated. CI ranges for each tumor marker were set based on biological variation, and data were analyzed for each patient assessed at health check-ups and clinics, individually and overall.Results: Most tumor markers had low indices of individuality, with between inter-individual variability. The 95th percentile cut-offs for each tumor marker were much higher in the health check-up group than in the clinic group. In decreasing order, the percentages of results with no overlap in 95% CIs were thyroglobulin antigen, 14.9%; protein induced by vitamin K absence-II (PIVKA), 11.9%; prostate-specific antigen, 9.8%; and cancer antigen 72-4, 8.7%. After correction using the reference interval, the percentages decreased to less than 5%, except for PIVKA (10.9%).Conclusions: We suggest that our own monitoring system can serve as a criterion for delta check and auto-verification of tumor markers. Further studies are required to validate and demonstrate this concept in real clinical situations using actual clinical data reflecting disease progression in cancer patients and responsiveness to cancer treatment.
Infiltration of CD1a-Positive Dendritic Cells in Advanced Laryngeal Cancer Correlates with Unfavorable Outcomes Post-Laryngectomy
Authors: Minesaki Akimichi , Kai Keita , Kuratomi Yuichiro , Aishima Shinichi
Published: August 2020

Background: The prognosis of advanced laryngeal cancer is unfavorable despite the progress of multidisciplinary therapy. Dendritic cells (DCs) play a central role in antitumor immunity. Tumor-infiltrating CD1a+ DCs have been reported to be associated with clinical outcomes in carcinomas of various organs, but the clinical impact of CD1a+ DCs in laryngeal cancer has not been clear.Patients and Methods: We retrospectively analyzed the cases of 57 patients with Stage Ⅲ or Ⅳ laryngeal cancer who underwent a total laryngectomy. Immunohistochemistry for CD1a, S100, and CD8 was performed using representative resected specimens. CD1a+ DCs, S100+ DCs, and CD8+ cytotoxic T-lymphocytes (CTLs) were evaluated, and we divided the cases into high and low groups by the cut-off of the median value for each of these three parameters.Results: Compared to the CD1a-low group, the CD1a-high group had more advanced cases and showed significantly worse disease-specific survival (DSS) (p=0.0082) and overall survival (OS) (p=0.0324). The analyses of S100 DCs and CD8+ CTLs revealed no significant impact on clinical outcomes. Multivariate analyses indicated that the infiltration of CD1a+ DCs ​​​is an independent unfavorable prognostic factor in both DSS (p=0.0093) and OS (p=0.0132).Conclusions: Our results demonstrated that the infiltration of CD1a+ DCs was associated with unfavorable clinical outcomes. It is not yet known why the presence of CD1a+ DCs lead to an unfavorable clinical outcome in laryngeal cancer. Further studies are necessary to validate our results and clarify the function(s) of tumor-infiltrating CD1a+ DCs.
The Effect of Staged Surgical Treatment for Cubitus Valgus After Non-Union of Lateral Condylar Fracture of Distal Humerus in Older Children
Authors: Liu Xin , Xie Li-wei , Deng Zhi-qiang , Ye Jia-jun
Published: August 2020

Background: The purpose of this study was to investigate the effect of staged surgery (open reduction/internal fixation and osteotomy) for cubitus valgus after non-union of lateral condylar fractures of the distal humerus in older children.Methods: From January 2010 to January 2013, 9 patients were treated with two-staged surgery (open reduction/internal fixation and osteotomy). The study included 5 males and 4 females, with a mean age of 12.7 years. The minimum interval from fracture to the first surgery was 7 years and the maximum interval was 10 years (average 8.2 years). All patients had symptoms of injury of the ulnar nerve and instability of the elbow. The first surgery included internal reduction, internal fixation, and bone grafting, exposing the elbow through a Kocher lateral approach. The procedure included clearing the peripheric callus and proximal distal fracture end cicatrix with rongeur until cancellous bone was exposed, and fixation of the lateral condylar fragment with a hollow screw 4.0 mm in diameter and smooth Kirschner wire. The limb was immobilized in a long arm cast with the elbow at 90 degrees of flexion and the forearm in neutral rotation for 3 weeks, and active exercises were begun after removal. The internal fixation hardware was removed after 3 months. The second surgery, osteotomy of the supracondylar humerus, was completed after 6 months to correct cubitus valgus. Internal fixation from the osteotomy was removed 6 months later.Results: Six months after the second surgery, follow-up revealed that in all patients the lateral condylar fractures attained clinical union and cubitus valgus was corrected. Elbow function recovered well without arthrochalasis or humeral condylar avascular necrosis. All patients’ ulnar nerve injury symptoms disappeared.Conclusion: Staged surgery to treat cubitus valgus secondary to lateral condylar fracture non-union in older children serves to first provide elbow stability, then to correct cubitus valgus. Staged treatment may make up for the deficiencies of conventional treatment. However, due to our relatively short follow-up time, the long term effects are unknown.
Evaluation of Cardiovascular Risk Factors In Patients With Familial Hypercholesterolemia From The North-Eastern Area of Romania
Authors: Vlad Cristiana-Elena , Foia Liliana , Florea Laura , Costache Irina-Iuliana , Covic Andreea , Popescu Roxana , Reurean-Pintilei Delia , Covic Adrian
Published: August 2020

Background. Familial hypercholesterolemia (FH) is one of the most frequent and important monogenic cholesterol pathology. Traditional and nontraditional cardiovascular risk factors increase the prevalence of atherosclerotic cardiovascular disease (ASCVD) in this population. Objective. To establish the prevalence and the cardiovascular risk factors of FH population, to identify the ASCVD through the clinico-biological and imaging modifications during the 24-months follow-up.Methods. This first prospective study in the north-eastern part of Romania, carried out between October 2017-October 2019, out of 980 patients with dyslipidemia evaluated with the Dutch Lipid Network (DLCN) and Simone Broome (SM) scores, only 61 patients with DLCN score above 3 and FH possible/probably (SM score) were included.Results. The 61 FH subjects recorded a mean age of 48.46±12.53 years, with more women compared to men. Regarding the traditional cardiovascular risk factors, we identified that high blood pressure was the main factor in all patients, followed by sedentary lifestyle, obesity, smoker status, personal cardiovascular history and type 2 diabetes. The measured DLCN score recorded: “possible” FH identified in 39.4%, the “probable”FH in 45.9% and the “definite” FH in 14.7%. After the administration of the lipid-lowering agents for 24 months, TC and LDL-C levels, carotid intima-media thickness (cIMT) and ankle-brachial index (ABI) decreased and HDL-C levels increased, but without reaching the guideline goals. In addition, the high-dose of statin alone, the high-dose of statin with fenofibrate, subjects with „possible” FH, the normal values of cIMT and ABI, had a reduced time of ASCVD occurrence. Also, the high cIMT values, physical inactivity, high TC, TG and high-sensitivity C-reactive protein (hsCRP) levels were associated with an increased risk of ASCVD. Conclusions. To reduce cardiovascular risk, the FH patients need a cascade screening and a specific management. Even though it was the first observational study in the north-eastern part of Romania, further molecular genetics studies are needed to confirm the FH cases.
Detecting Hub Genes Associated With Lauren Subtype of Gastric Cancer by Weighted Gene Co-Expression Network Analysis
Authors: LIU XU , Yao Li , Qu Jingkun , Liu Lin , LIU XU , Wang Jiansheng , Calin George A. , Zhang Jia
Published: August 2020

Background Gastric cancer is a rather heterogeneous type of malignant tumor. Among the several classification system, Lauren classification can reflect biological and pathological differences of different gastric cancer.Method to provide systematic biological perspectives, we employ weighted gene co-expression network analysis to reveal transcriptomic characteristics of gastric cancer. GSE15459 and TCGA STAD dataset were downloaded. Co-expressional network was constructed and gene modules were identified. Result Two key modules blue and red were suggested to be associated with diffuse gastric cancer. Functional enrichment analysis of genes from the two modules was performed. Validating in TCGA STAD dataset, we propose 10 genes TNS1, PGM5, CPXM2, LIMS2, AOC3, CRYAB, ANGPTL1, BOC and TOP2A to be hub-genes for diffuse gastric cancer. Finally these ten genes were associated with gastric cancer survival. Conclusion More attention need to be paid and further experimental study is required to elucidate the role of these genes.
The YAP/HIF-1α/miR-182/EGR2 Axis is Implicated in Asthma Severity by Control of Th17 Cell Differentiation
Authors: Zhou Jing , Zhang Ning , Zhang Wei , Lu Caiju , Xu Fei
Published: August 2020

The authors have withdrawn this preprint due to erroneous posting.
A risk score for predicting postoperative complications in non-intubated thoracic surgery
Authors: Lan Lan , Jiang Long , Duan Chongyang , Lu Weixiang , Zhang Canzhou , Cen Yanyi , He Jianxing
Published: August 2020

Background

The risk factors for postoperative complications in non-intubated video-assisted thoracoscopic surgery (VATS) has not been observed before. Here to develop a simple risk score to predict the risk of postoperative complications for patients who scheduling non-intubated VATS, which is beneficial to guide the clinical interventions.
Methods

1837 patients who underwent non-intubated VATS were included from January 2011 to December 2018. A development data set and a validation data set were allocated according to an approximate 3:2 ratio of total cases. The stepwise logistic regression was used to establish a risk score model, and the methods of bootstrap and split-sample were used for validation.
Results

Multivariable analysis revealed that the forced expiratory volume in the first second in percent of predicted, the anesthesia method, blood loss, surgical time, and preoperative neutrophil ratio were risk factors for postoperative complications. The risk score was established with these 5 factors, varied from 0–53, with the corresponding predicted probability of postoperative complications occurrence ranged from 1%-92%, and was calibrated (Hosmer-Lemeshow χ2 = 6.261; P = 0.618). Good discrimination was acquired in the development and validation data sets (C-statistic 0.705 and 0.700). A positive correlation was between the risk score and postoperative complications (P for trend < 0.01). Three levels of low-risk (0–15 points], moderate-risk (15–30 points], and high-risk (> 30 points] were established based on the score distribution of postoperative complications.
Conclusions

This simple risk score model based on risk factors of postoperative complications can validly identify the high-risk patients with postoperative complications in the non-intubated VATS, and allow for early interventions.
Temporary extracorporeal femoro-femoral crossover bypass to treat critical limb ischemia due to occlusive femoral transaortic microaxial left ventricular assist device – A novel technique and case series
Authors: Richarz Sabine , Siegemund Martin , d’Amico Rosalinda , Bachofen Bernadette , Döbele Thomas , Gürke Lorenz , Mujagic Edin
Published: August 2020

Background The Impella transaortic microaxial left ventricular assist device (MLVAD) is a temporary circulatory support (TCS). It's percutaneous insertion through the common femoral artery (CFA) bears the risk of severe ipsilateral limb ischemia. As long as the MLVAD is required for cardio - circulatory support, treatment options are limited. To approach this problem, we developed a temporary extracorporeal femoral - femoral crossover bypass to restore and maintain perfusion of the affected leg.The aim of this report is to introduce our novel technique and present results of a case series of accordingly treated patients.Methods From October 2018, we treated all patients with severe limb ischemia due to the MLAVD with a femoral - femoral crossover bypass and collected their data prospectively. For comparison, all consecutive patients undergoing placement of the MLAVD between January 2011 and July 2019 were identified retrospectively.The primary outcome of the study is the feasibility and safety of our percutaneously established extracorporeal femoral - femoral crossover bypass. As secondary endpoints, we report overall 30 - day mortality and limb salvage rates.Results Between January 2011 and July 2019, 25 of 245 (10.3%) patients developed a severe limb ischemia of the ipsilateral leg following the MLVAD placement.Until October 2018, 20 patients were treated conventionally (C - cohort) and since October 2018, five (consecutive) patients have been treated by an extracorporeal femoral - femoral cross over bypass (BP - Cohort).Following the BP - procedure, an immediate improvement of the perfusion of the affected limb was seen clinically and on Duplex ultrasound in all patients. 20% of the BP - cohort needed additional surgical salvage procedures compared to 25% of the C - Cohort. Limb salvage was documented in 100% of our patients and 30 days mortality was 60% in both groups.Conclusion This is the first case series reporting on a novel technique of limb salvage in patients with severe limb ischemia due to an MLVAD. We demonstrated that the percutaneous creation of an extracorporeal crossover bypass is feasible, safe and effective and should therefore be promoted.
Posterior Fixation Can Further Improve the Segmental Alignment of Lumbar Degenerative Spondylolisthesis with Oblique Lumbar Interbody Fusion
Authors: WU JINGYE , Ge Tenghui , Zhang Ning , Li Jianing , Tian Wei , Sun Yuqing
Published: August 2020

Background: For patients with degenerative spondylolisthesis, whether additional posterior fixation can further improve segmental alignment is unknown, compared with stand-alone cage insertion in oblique lumbar interbody fusion (OLIF) procedure. The aim of this study was to compare changes of the radiographical segmental alignment following stand-alone cage insertion and additional posterior fixation in the same procedure setting of OLIF for patients with degenerative spondylolisthesis.Methods: A retrospective observational study. Selected consecutive patients with degenerative spondylolisthesis underwent OLIF procedure from July 2017 to August 2019. Three radiographic parameters of disc height (DH), slip ratio and segmental lordosis (SL) were measured on preoperative CT scans and intraoperative fluoroscopic images. Comparisons of those radiographic parameters prior to cage insertion, following cage insertion and following posterior fixation were performed.Results: A total of thirty-three patients including six males and twenty-seven females, with an average age of 66.9±8.7 years, were reviewed. Totally thirty-six slipped levels were assessed with thirty levels at L4/5, four at L3/4 and two at L2/3. Intraoperatively, with only anterior cage support, DH was increased from 8.2±1.6mm to 11.8±1.7mm (p<0.001), the slip ratio was reduced from 11.1±4.6% to 8.3±4.4% (p=0.020) with the slip reduction ratio 25.6±32.3%, and SL was slightly changed from 8.7±3.7° to 8.3±3.0°(p=1.000). Following posterior fixation, the DH was unchanged (from 11.8±1.7mm to 11.8±2.3mm, p=1.000), the slip ratio was reduced from 8.3±4.4% to 2.1±3.6 % (p<0.001) with the slip reduction ratio 57.9±43.9%, and the SL was increased from 8.3±3.0° to 10.7±3.6° (p=0.008). Conclusions: Compared with stand-alone cage insertion, additional posterior fixation provides better segmental alignment improvement in terms of slip reduction and segmental lordosis in OLIF procedures in the treatment of lumbar degenerative spondylolisthesis.
Structural Characterization of Water-Soluble Polysaccharides from Sophora flavescensAit. and Their Anti-Inflammatory Evaluation Based on NO Release
Authors: Li Yi-Xuan , Linghu Ke-Gang , Jiang Si-Liang , Cui Yong-Sheng , Dong Cai-Xia , Yu Hua , Du Juan
Published: August 2020

Background: The dried roots of Sophora flavescens Ait. are traditionally used as Sophora Flavescens (Kushen in Chinese) to treat inflammatory diseases. It is traditionally served as a decoction, and polysaccharides represent one the major chemical constituents of this decoction. How about the structure of S. flavescens polysaccharides and whether they have anti-inflammatory activity should be uncovered.Methods: The purified polysaccharides were isolated through a combination of ion-exchange chromatography on DEAE 650 M and gel filtration on Superdex G-200 from hot water extract of S. flavescens. Structure was characterized by chemical derivatization as well as HPLC, FT-IR, GC-MS and NMR technologies. The preliminary in vitro antiinflammation activity was tested on RAW 264.7 cells upon NO release inhibition.Results: In this study, four polysaccharides, namely, SFNP-1, SFNP-2, SFAP-1, and SFAP-2, were isolated from S. flavescens. Results showed that both SFNP-1 and SFNP-2 contained (1→4)-linked glucans with small amounts of side chains at the O-4 position of the backbone chain residues. The two acidic polysaccharides (i.e.,SFAP-1 and SFAP-2) were identified to be pectin-type polysaccharides mainly containing a homo-galacturanan backbone consisting of α-(1→4)-linked GalAp and methyl-esterified α-(1→4)-linked GalAp residues at a ratio ofapproximately1:1. The bioactivity test revealed that the four purified polysaccharides have no cytotoxicity on RAW264.7andthat SFNP-1 and SFNP-2 show significant stimulating activity. Although the decoction of S. flavescens has been traditionally used as an anti-inflammatory agent, NO release inhibition results showed thatSFAP-1 and SFAP-2, as the major polysaccharides of SFCP, do not have significant anti-inflammatory effects. Conclusions: This result suggests that the anti-inflammatory effect of the decoction of S. flavescens may depend on the presence of alkaloids and not the polysaccharides it contains.
Comparison of thermoregulation and metabolic characteristics in Phrynocephalus vlangalii (Lacertilia, Agamidae) from different altitudes
Authors: Tang Xiaolong , Wang Huihui , Chen Qiang
Published: August 2020

Background: Exploring thermoregulation and metabolic characteristics responses to high altitudes is important for understanding ectothermic animal high-altitude adaptation mechanisms. However, how could these species compensate for adverse environmental impacts are controversial and poorly understood. In the present study, the selected body temperature, mitochondrial consumption, proton leak and enzyme activity of a lizard Phrynocephalus vlangalii from different altitudes (Maduo and Golmud, with altitude at 4270 and 2750 m, respectively) were analyzed to investigate the thermoregulatory and metabolic regulation strategies of this native high-altitude lizard at Qinghai-Tibet Plateau.Results:The results indicated that the Maduo population had a faster heating rate and selected significantly lower body temperatures than those of the Golmud population. The mitochondrial oxygen consumption rates in both the liver and skeletal muscle of the Maduo population were significantly lower than those of the Golmud population, but the thermal sensitivity of skeletal muscle mitochondrial in Maduo population was significantly lower than that in Golmud population. The proton leak of liver mitochondria in the Maduo population account for a lower percentage of state III than that of the Golmud population (11.4~14.6% VS. 22.5~25.1%), which indicate a higher ATP production in liver mitochondria. The results of three enzyme activities reflect significant both tissue- and population specificity. Especially, a low ratio of LDH/CS and HOAD/CS in the liver of the Maduo population indicating that metabolism of the liver mainly depended on aerobic metabolism and especially the use of carbohydrate as a metabolic substrate in Maduo population.Conclusions: These distinct variable characteristics between two populations of P. vlangalii could be considered important strategies in thermoregulation and metabolic regulation for living at different altitudes and could be especially necessary for lizards to effectively compensate for the negative influence of cold and hypoxia at high altitude.
Dual-Task Training with Cisual Stimulation Affect Cognitive and Physical Performances and Brain Wave Ratio of Patients with Alzheimer's Disease: A Randomized Controlled Trial
Authors: Parvin Elnaz , Mohamadian Fatemeh , Amani-Shalamzari Sadegh , bayati mahdi , Tazesh Behnaz
Published: August 2020

Background: This study aimed to investigate the effect of a 12-week period dual-task training on cognitive status, physical performance and brain waves of patients with Alzheimer's disease (AD). Methods: Twenty-six AD patients were randomly assigned to two groups, training group (TG) and control group (CG). TG executed progressive combined exercises with visual stimulation twice a week for 12 weeks. Training included muscle endurance, balance, flexibility and aerobic exercises with eyes closed and opened. Brain waves on EEG and a series of physical, cognitive and mental tests were taken prior and post intervention. Results: There was a significant improvement after training protocol in cognitive function, particularly in short-term memory, attention, working memory and executive function (p<0.01). In addition, there were substantial improvements in depression status (GDS scale), aerobic fitness (6 min walking), flexibility (chair sit and reach) functional ability (chair stand, timed up and go test), strength (knee extensions, preacher biceps curl, handgrip) in TG compare to CG. These progresses was associated with significantly increase (p<0.05) in the frequency of brain waves and decreased in the theta/alpha ratio. Conclusions: In addition to physical performance, the regular combined training with visual stimulation improve brain health as indicated by improving cognitive function and reducing the theta/alpha ratio. Trial registration: Iranian Registry of Clinical Trials, IRCT20190504043468N1.
Exercise for Cognitive Improvement and Rehabilitation (EXCIR) Improves Attention and Executive Functions in Children with ADHD
Authors: Nejati Vahid
Published: August 2020

Background: Physical activities improves cognitive functioning. The purpose of the present study is to effect of physical activity with progressive cognitive demands on attention and executive functions in children with ADHD. Methods: Thirty children with ADHD were randomly assigned into two equal experimental and control groups. The experimental group received 12 sessions of exercise for cognitive improvement and rehabilitation (EXCIR). Working memory, selective attention, sustained attention, inhibitory control and cognitive flexibility were administered pre- and post-intervention through 1-back test, Stroop test, attention registration test, go no go test and trial making test in order. The repeated measure ANOVAs were used for analysis.Results: The results showed that experimental group has a greater performance in selective attention, sustained attention, inhibitory control and cognitive flexibility compared to control group. Conclusions: These findings implicate that the cognitive rehabilitation program is advantageous for improvement of attention and executive functions in children with ADHD.