bluuebunny/crossref_metadata_2025 huggingface dataset:
The relationship between sleep duration and all-cause mortality in the older people: an updated and dose-response meta-analysis
Authors: He Mengyang , Deng Xiangling , Zhu Yuqing , Huan Luyao , Niu Wenquan
Published: July 2020

Background

Short or long sleep duration is proposed as a potential risk factor for all-cause mortality in the older people, yet the results of published studies are not often reproducible.

Methods

Literature retrieval, study selection and data extraction were completed independently and in duplicate. Only prospective cohort studies were included. Effect-size estimates are expressed as hazard ratio (HR) and 95% confidence interval (CI).

Results

Summary data from 28 articles, involving a total of 95,259 older people, were meta-analyzed. Overall analyses revealed a remarkably significant association between long sleep duration and all-cause mortality (adjusted HR = 1.24, 95% CI: 1.16–1.33,P < .001), whereas only marginal significance was observed for short sleep duration (adjusted HR = 1.04; 95% CI: 1.00–1.09;P = .033). Funnel plots suggested no publication bias for short sleep duration (P = .392). The probability of publication bias was high for long sleep duration (P = .020), yet the trim-and-fill method strengthened its significance in predicting all-cause mortality. In subgroup analyses, the association of long sleep duration with all-cause mortality was statistically significant in both women (HR = 1.48; 95% CI: 1.18–1.86;P = .001) and men (HR = 1.31; 95% CI: 1.10–1.58;P = .003). By contrast, with regard to short sleep duration, statistical significance was observed in men (HR = 1.13; 95% CI: 1.04–1.24;P = .007), but not in women (HR = 1.00; 95% CI: 0.85–1.18;P = .999) (Two-sample Z testP = .099). Besides gender, geographic region, sleep survey method, baseline age and follow-up interval were identified as possible causes of between-study heterogeneity in subgroup analyses. Further dose-response regression analyses revealed that trend estimation was more obvious for long sleep duration (regression coefficient: 0.13;P < .001) than for short sleep duration (regression coefficient: 0.02;P = .046).

Conclusions

Our findings indicate a significantly increased risk of all-cause mortality associated with long sleep duration, especially in women, as well as with short sleep duration in men only.
Evidence synthesis in pulmonary arterial hypertension: a systematic review and critical appraisal
Authors: Schlueter Max , Beaudet Amélie , Davies Evan , Gurung Binu , Karabis Andreas
Published: July 2020

Background

The clinical landscape of pulmonary arterial hypertension (PAH) has evolved in terms of disease definition and classification, trial designs, available therapies and treatment strategies as well as clinical guidelines. This study critically appraises published evidence synthesis studies, i.e. meta-analyses (MA) and network-meta-analyses (NMA), to better understand their quality, validity and discuss the impact of the findings from these studies on current decision-making in PAH.

Methods

A systematic literature review to identify MA/NMA studies considering approved and available therapies for treatment of PAH was conducted. Embase, Medline and the Cochrane’s Database of Systematic Reviews were searched from database inception to April 22, 2020, supplemented by searches in health technology assessment websites. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) checklist covering six domains (relevance, credibility, analysis, reporting quality and transparency, interpretation and conflict of interest) was selected for appraisal of the included MA/NMA studies.

Results

Fifty-two full publications (36 MAs, 15 NMAs, and 1 MA/NMA) in PAH met the inclusion criteria. The majority of studies were of low quality, with none of the studies being scored as ‘strong’ across all checklist domains. Key limitations included the lack of a clearly defined, relevant decision problem, shortcomings in assessing and addressing between-study heterogeneity, and an incomplete or misleading interpretation of results.

Conclusions

This is the first critical appraisal of published MA/NMA studies in PAH, suggesting low quality and validity of published evidence synthesis studies in this therapeutic area. Besides the need for direct treatment comparisons assessed in long-term randomized controlled trials, future efforts in evidence synthesis in PAH should improve analysis quality and scrutiny in order to meaningfully address challenges arising from an evolving therapeutic landscape.
Correlation between the HIF-1α/Notch signaling pathway and Modic changes in nucleus pulposus cells isolated from patients with low back pain
Authors: Xiong Zekang , Ding Jun , Zhou Jinge , Yao Sheng , Zheng Jin , Guo Xiaodong
Published: July 2020

Background

The HIF-1α/Notch signaling pathway regulates cell proliferation, apoptosis, and metabolism in the intervertebral discs (IVDs) and is implicated in disc degeneration. The nucleus pulposus (NP) is an important structure adjacent to the IVDs. However, the role of the HIF-1α/Notch signaling pathway in NP cells obtained from patients with different Modic changes (MCs) remains unclear. The purpose of the present study was to investigate the role of HIF-1α and components of the Notch pathway in the NP obtained from patients with various MCs.

Methods

A total of 85 NP tissue samples were collected from patients undergoing diskectomy for the treatment of low back pain. The NP tissues were divided into four groups based on the adjacent endplate degeneration, namely, MC I, II, III, and negative MC groups. The expression of HIF-1α and Notch-related components was measured and compared.

Results

The expression of HIF-1α, Notch1, and Notch2 was gradually increased in the MC I and MC II groups compared with that in the negative MC group. HIF-1α and Notch-related components were rarely detected in the MC III group.

Conclusions

The expression of HIF-1α/Notch increased in the NP cells of patients with MC I and MC II. HIF-1α and Notch-related components are potential biomarkers and the HIF-1α/Notch signaling pathway may serve as a promising therapeutic target for disc degeneration in patients with MCs.
Pancreatic fistula after pancreatoduodenectomy due to compression of the superior mesenteric vessels: a case report
Authors: Yang Hanteng , Ren Yanxian , Yu Zeyuan , Zhou Huinian , Zhang Shuze , Luo Changjiang , Jiao Zuoyi
Published: July 2020

Background

Pancreatic fistula is a common complication after pancreaticoduodenectomy, which could be caused by: soft pancreatic tissue, pancreatic duct diameter < 3 mm and body mass index ≥25 kg/m2. Here we report a case of pancreatic fistula due to obstruction of the jejunal loop due to compression of the jejunal loop by the superior mesenteric vessels.

Case presentation

A 68-year-old man was admitted to our ward due to intermittent epigastric distension and pain. After various examinations and treatments, he was diagnosed with middle bile duct cancer. Pancreaticoduodenectomy was performed, and pancreaticojejunostomy and hepaticojejunostomy were completed by lifting the jejunal loop from behind the superior mesenteric vessels to the upper region of the colon. On postoperative day 9, the patient developed acute diffuse peritonitis, and on postoperative day 10, the patient underwent a second exploratory laparotomy, during which it was confirmed that the pancreatic fistula was caused by obstruction of the jejunal loop due to compression of the jejunal loop by the superior mesenteric vessels, then the patient recovered and was discharged alive after retrograde drainage in the jejunum.

Conclusions

The superior mesenteric vessels after pancreaticoduodenal surgery can compress the jejunal loop and cause obstruction leading to serious complications, and it is recommended that general surgeons should avoid lifting the jejunal loop from the posterior aspect of the superior mesenteric vessels to complete the anastomosis.
The information imperative: to study the impact of informational discontinuity on clinical decision making among doctors
Authors: Gowda Naveen R. , Kumar Atul , Arya Sanjay K. , H Vikas
Published: July 2020

Background

Informational discontinuity can have far reaching consequences like medical errors, increased re-hospitalization rates and adverse events among others. Thus the holy grail of seamless informational continuity in healthcare has been an enigma with some nations going the digital way.

Digitization in healthcare in India is fast catching up. The current study explores the components of informational continuity, its impact on clinical decision-making and captures the general perception among the doctors towards a digital solution.

Methods

Cross-sectional study with snowball sampling. A survey questionnaire was developed and validated through a pilot study, then circulated through online platforms. Responses from doctors were obtained through an online Google form for a period of 3 months and analyzed using SPSS 20. The categorical variables were analyzed using Chi-square test.

Results

1413 responses were obtained through a national level survey. Respondents were from a wide range of work experiences, locations, sectors, specialties and patient load. Components of patient records like clinical notes, investigation reports, previous diagnosis and treatment details were rated to be very important.

41% reported about half and 20% reported about 3/4th of their patients do not bring relevant records. Patients from rural areas, visiting state government hospitals and visiting general practitioners were less likely to bring relevant records during consultations.

The fallouts of not having timely relevant patient information of the patients include more time per patient, repeat investigations, difficulty to arrive at definitive diagnosis, difficulty to take further treatment decisions and impaired overall clinical decision making which were said to be significant by respondents across the spectrum. The benefits of having timely relevant patient information were also reported consistently across the spectrum.

An overwhelming proportion (83%), from across the spectrum, unequivocally expressed their willingness to use digital platforms for accessing patients’ relevant medical records.

Conclusion

Prevalence of informational discontinuity and its impact on clinical decision making is significant with definite benefits of having timely relevant medical history. There is strong willingness among the doctors to use digital solution(s) without any extra investment or effort on their part making customized solutions pertinent.
What contributes to medical debt? Evidence from patients in rural China
Authors: Xin Yanjiao , Jiang Junnan , Chen Shanquan , Gong Fangxu , Xiang Li
Published: July 2020

Background

Rural households in developing countries usually have severe medical debt due to high out-of-pocket (OOP) payments, which contributes to bankruptcy. China implemented the critical illness insurance (CII) in 2012 to decrease patients’ medical expenditure. This paper aimed to explore the medical debt of rural Chinese patients and its influencing factors.

Methods

A questionnaire survey of health expenditures and medical debt was conducted in two counties of Central and Western China in 2017. Patients who received CII were used as the sample on the basis of multi-stage stratified cluster sampling. Descriptive statistics and multivariate analysis of variance were used in all data. A two-part model was used to evaluate the occurrence and extent of medical debt.

Results

A total of 826 rural patients with CII were surveyed. The percentages of patients incurring medical debt exceeded 50% and the median debt load was 20,000 Chinese yuan (CNY, 650 CNY = US$100). Financial assistance from kin (P < 0.001) decreased the likelihood of medical debt. High inpatient expenses (IEs,P < 0.01), CII reimbursement ratio (P < 0.001), and non-direct medical costs (P < 0.001) resulted in increased medical debt load.

Conclusions

Medical debt is still one of the biggest problems in rural China. High IEs, CII reimbursement ratio, municipal or high-level hospitals were the risk determinants of medical debt load. Financial assistance from kin and household income were the protective factors. Increasing service capability of hospitals in counties could leave more patiemts in county-level and township hospitals. Improving CII with increased reimbursement rate may also be issues of concern.
The prevalence and mechanism of fluoroquinolone resistance in Escherichia coli isolated from swine farms in China
Authors: Cheng Ping , Yang Yuqi , Li Fulei , Li Xiaoting , Liu Haibin , Fazilani Saqib Ali , Guo Wenxin , Xu Guofeng , Zhang Xiuying
Published: July 2020

Background

It has been demonstrated that swine waste is an important reservoir for resistant genes. Moreover, the bacteria carrying resistant genes and originating from swine feces and wastewater could spread to the external environment. Fluoroquinolones (FQs) are widely used in livestock and poultry for the treatment of bacterial infection. However, resistance to FQs has increased markedly.

Results

In this study, swine feces and wastewater were sampled from 21 swine farms of seven provinces in China to investigate the prevalence of FQ resistance, including plasmid-mediated fluoroquinolone resistance (PMQR) genes and the occurrence of target mutations. All isolates showed moderate rate of resistance to norfloxacin (43.0%), ciprofloxacin (47.6%), ofloxacin (47.0%) and levofloxacin (38.8%). The percentage of strains resistant to the four FQs antimicrobials was positively correlated with the danofloxacin (DANO) MIC. Among the 74 FQ-resistant isolates, 39 (52.70%) had mutations in gyrA (S83L and D87 to N, Y, G, or H), 21 (28.38%) had mutations in parC (S80I and E84K), 2 (2.70%) had mutations in parE (I355T and L416F), 26 (35.14%) had mutations in marR (D67N and G103S), 1 (1.35%) had mutations in acrR (V29G). While, no mutation was found in gyrB. There were 7 (9.46%) strains carried the qnrS gene, 29 (39.19%) strains carried the oqxAB gene, and 9 (12.16%) strains carried the aac (6′)-Ib-cr gene. In addition, the conjugation assays showed that qnrS, oqxAB and aac (6′)-Ib-cr could be successfully transferred to E. coli J53 from 4 (57.1%), 20 (69.0%) and 5 (55.6%) donor strains, respectively. There were no qnrA, qnrB, qnrC, qnrD and qepA genes detected.

Conclusion

The present study showed that DANO-resistant E. coli strains isolated from swine farms had significant cross-resistance to other four FQs antimicrobials. Further study revealed that the resistance mechanisms of swine-derived E. coli to FQs may be attributable to the occurrence of chromosomal mutations (gyrA, parC, parE, marR and acrR genes double-site or single-site mutation) and the presence of PMQR genes (qnrS, oqxAB and aac (6′)-Ib-cr). To the best of our knowledge, one novel mutation marR-D67N was found to be associated with FQ resistance, two mutations parE-L416F and acrR-V29G have never been reported in China.
Characterization and comparison of genomic profiles between primary cancer cell lines and parent atypical meningioma tumors
Authors: Kim Eunhye , Kim Mirae , So Kyungha , Park Young Seok , Woo Chang Gok , Hyun Sang-Hwan
Published: July 2020

Background

Meningiomas are the second most common primary tumors of the central nervous system. However, there is a paucity of data on meningioma biology due to the lack of suitable preclinical in vitro and in vivo models. In this study, we report the establishment and characterization of patient-derived, spontaneously immortalized cancer cell lines derived from World Health Organization (WHO) grade I and atypical WHO grade II meningiomas.

Methods

We evaluated high-resolution 3T MRI neuroimaging findings in meningioma patients which were followed by histological analysis. RT-qPCR and immunostaining analyses were performed to determine the expression levels of meningioma-related factors. Additionally, flow cytometry and sorting assays were conducted to investigate and isolate the CD133 and CD44 positive cells from primary atypical meningioma cells. Further, we compared the gene expression profiles of meningiomas and cell lines derived from them by performing whole-exome sequencing of the blood and tumor samples from the patients, and the primary cancer cell lines established from the meningioma tumor.

Results

Our results were consistent with earlier studies that reported mutations inNF2,SMO, andAKT1genes in atypical meningiomas, and we also observed mutations inMYBL2, a gene that was recently discovered. Significantly, the genomic signature was consistent between the atypical meningioma cancer cell lines and the tumor and blood samples from the patient.

Conclusion

Our results lead us to conclude that established meningioma cell lines with a genomic signature identical to tumors might be a valuable tool for understanding meningioma tumor biology, and for screening therapeutic agents to treat recurrent meningiomas.
Stem cell membrane-coated isotretinoin for acne treatment
Authors: Wang Shiyi , Jiang Rihua , Meng Tianqi , Zhang Fuqiang , Li Jing , Jin Yongri , Lee JeungHoon , Zhu Mingji , Jiang Jinlan
Published: July 2020

Background

Topical isotretinoin is commonly used to treat acne. However, topical isotretinoin has side effects and can hardly permeate through the stratum corneum, the most important skin barrier. Therefore, this study aimed to demonstrate the efficacy of nanoparticles as stable carriers with great curative effects, low side effects, and strong transdermal ability.

Results

In a rabbit model of hyperkeratinization, STCM-ATRA-NPs showed significant therapeutic efficacy. By contrast, negative therapeutic efficacy was observed in a golden hamster model of hyper sebum production. Scanning electron microscopy and Fourier transform infrared spectral analyses showed that nanoparticles could penetrate the stratum corneum. Western blotting demonstrated that the nanoparticles could enhance the transdermal efficacy of isotretinoin by reducing the effect of keratin and tight junction proteins. Further, nanoparticles enhanced endocytosis, thereby promoting drug penetration and absorption into the skin.

Conclusion

STCM-ATRA-NPs were demonstrated to control isotretinoin release, reducing its side effects, and efficiently permeating through the skin by reducing the effect of keratin and tight junction proteins and enhancing endocytosis.
PTC located in the upper pole is more prone to lateral lymph node metastasis and skip metastasis
Authors: Dou Yi , Hu Daixing , Chen Yingji , Xiong Wei , Xiao Qi , Su Xinliang
Published: July 2020

Background

Lateral lymph node metastasis (LLNM) is very common in papillary thyroid carcinoma (PTC). The influence of tumour location on LLNM remains controversial. The purpose of this study was to reveal the association between PTC tumours located in the upper pole and LLNM.

Methods

We reviewed a total of 1773 PTC patients who underwent total thyroidectomy with central and lateral lymph node dissection between 2013 and 2018. Patients were divided into two groups according to tumour location. Univariate and multivariate analyses were performed to identify risk factors associated with LLNM and “skip metastasis”.

Results

In the upper pole group, LLNM and skip metastasis were significantly likely to occur. Multivariate analysis showed that tumours located in the upper pole, male sex, extrathyroidal extension (ETE), central lymph node metastasis (CLNM) and tumour size were independent risk factors for LLNM, with odds ratios ([ORs], 95% confidence intervals [CIs]) of 2.136 (1.707–2.672), 1.486 (1.184–1.867), 1.332 (1.031–1.72), 4.172 (3.279–5.308) and 2.496 (1.844–3.380), respectively. Skip metastasis was significantly associated with the primary tumour location in the upper pole and age > 55 years, with ORs of 4.295 (2.885–6.395) and 2.354 (1.522–3.640), respectively.

Conclusions

In our opinion, papillary thyroid tumours located in the upper pole may have an exclusive drainage pathway to the lateral lymph nodes. When the tumour is located in the upper pole, lateral neck dissection should be evaluated meticulously.
The critical role of dysregulated Hh-FOXM1-TPX2 signaling in human hepatocellular carcinoma cell proliferation
Authors: Wang Yiting , Wang Hailong , Yan Zhengwei , Li Guohua , Hu Guohui , Zhang Hong , Huang Dengliang , Wang Yao , Zhang Xiang , Yan Yehong , Lu Quqin , Cheng Minzhang , Luo Shiwen
Published: July 2020

Background

Aberrant activation of the Hedgehog (Hh) signaling pathway is frequently observed in hepatocellular carcinoma (HCC), nevertheless, the precise molecular mechanism remains unclear. Forkhead box M1 (FOXM1), a target of the Hh pathway, is a key oncofetal transcription factor and a master cell cycle regulator. Targeting protein for Xenopus kinesin-like protein 2 (TPX2) is an oncogene critical for mitosis. However, how these molecular events affect HCC progression remains unclear.

Methods

Realtime PCR, immunohistochemistry, western blotting, and analyses of datasets TCGA and Gene Expression Omnibus (GEO) were conducted to assess the expression of TPX2 and FOXM1 at the mRNA and protein levels in HCC samples or HCC cells. Expression and knockdown of TPX2 and FOXM1 were performed to assess their role in regulating HCC cell proliferation in vitro and in vivo. Dual luciferase report assay and chromosome immunoprecipitation (ChIP) were investigated to seek the FOXM1 binding sites in the promoter of TPX2.

Results

Specific antagonists (cyclopamine and GANT61) of the Hh pathway down-regulated TPX2, whereas activation of Hh signaling stimulated TPX2 expression. Furthermore, TPX2 over-expression accelerated HCC cell proliferation when upstream events of Hh signaling were inhibited, and TPX2 knockdown significantly alleviated Sonic Hh ligand (Shh)-induced HCC cell proliferation. Reporter assays and ChIP showed that FOXM1 bound to the TPX2 promoter, confirming that TPX2 is a direct downstream target of FOXM1. Xenograft model further verified the cell function and expression regulation of TPX2 and FOXM1 in vivo. Furthermore, FOXM1 regulated TPX2 activity to drive HCC proliferation. Immunohistochemical (IHC) analysis indicated that FOXM1 and TPX2 were highly-expressed in HCC samples and cohort study revealed that FOXM1 and TPX2 may act as negative predictors for the prognosis of patients with HCC.

Conclusions

TPX2 acts as a novel downstream target and effector of the Hh pathway, and Hh signaling contributes to HCC proliferation via regulating the FOXM1-TPX2 cascade, suggesting that this signaling axis may be a novel therapeutic target for HCC.

Graphical abstract
BNIP3 decreases the LPS-induced inflammation and apoptosis of chondrocytes by promoting the development of autophagy
Authors: Ma Zetao , Wang Deli , Weng Jian , Zhang Sheng , Zhang Yuanshi
Published: July 2020

Background

Inflammation and apoptosis of chondrocytes are the pathological bases of osteoarthritis. Autophagy could alleviate the symptoms of inflammation and apoptosis. Previous study has shown that BCL2/adenovirus E1B 19 kDa protein-interacting protein 3 (BNIP3) can induce the occurrence and development of autophagy. However, it is unknown whether autophagy induced by BNIP3 can alleviate the inflammation and apoptosis of chondrocytes.

Methods

We used the lentivirus to construct the overexpression BNIP3 chondrocytes. Next, the lipopolysaccharide (LPS) was used to stimulate these cells to simulate the physiological environment of osteoarthritis. After that, the enzyme-linked immunosorbent assays (ELISA) were performed to determine the levels of tumor necrosis factor-α (TNF-α), interleukin-1 beta (IL-1β), and interleukin-6 (IL-6) and the flow cytometry was performed to detect the apoptosis rates of chondrocytes. At last, the expression of autophagy-related proteins was detected with the western blotting.

Results

The expression of BNIP3 was suppressed after treatment with LPS. However, overexpression of BNIP3 inhibited the secretion of proinflammatory factors (TNF-α, IL-1β, and IL-6) and decreased the apoptosis of chondrocytes. Furthermore, overexpression of BNIP3 led to the upregulation of autophagy-related protein expression including little computer 3 (LC3), autophagy-related protein 7 (ATG7), and Beclin-1. Application of autophagy inhibitor recovered the expression of proinflammatory factors and apoptosis rates of chondrocytes.

Conclusions

BNIP3 decreased the LPS-induced inflammation and apoptosis of chondrocytes by activating the autophagy.
The use of Transcollation Technology for Video-Assisted Thoracic Surgery lobectomy
Authors: Menna Cecilia , Poggi Camilla , Andreetti Claudio , Ciccone Anna Maria , Baccarini Alberto Emiliano , Maurizi Giulio , D’Andrilli Antonio , Vanni Camilla , Cascone Roberto , Fiorelli Alfonso , Santini Mario , Venuta Federico , Rendina Erino Angelo , Ibrahim Mohsen
Published: July 2020

Background

Video-Assisted Thoracic Surgery (VATS) lobectomy is now considered the preferred approach at many centers for early stage lung cancer. However, it needs an adequate learning curve, and it may be challenging in non-expert hands. The aim of this study was to evaluate the effectiveness of Transcollation Technology over Traditional Electrocautery to perform hilar and mediastinal dissection during VATS lobectomy.

Methods

This is a single-center retrospective study including consecutive patients undergoing VATS lobectomy for lung cancer. Patients were divided in two groups based on whether Transcollation Technology (TT Group) or Traditional Electrocautery (TE Group) was used for hilar and mediastinal lymphadenectomy. Operative time and surgical outcome, including number of transfusions, length of chest drainage, length of hospital stay, morbidity and mortality were registered, and the inter-group differences were statistically analyzed.

Results

53 patients were included in the final analysis. The TT Group (n = 24) compared to the TE Group (n = 29) showed significant shorter operative time (75.2 ± 25.8 min versus 98.1 ± 33.3 min; p = 0.023), and reduction of length of chest tube stay (4.7 ± 0.8 days vs. 6.8 ± 1.1 days, p = 0.013) and length of hospital stay (5.3 ± 1.9 days vs. 6.8 ± 1.1 days, p = 0.007). No intraoperative or major postoperative complications were observed in either groups.

Conclusions

Transcollation Technology represents a valid alternative to standard electrocautery instruments during VATS lobectomy. It contributes to reduce the operative time and length of hospital stay. Further larger prospective studies are required to confirm our data.
Colonic perforation due to inadvertent intraperitoneal LVAD driveline placement
Authors: Shnaydman Ilya , Abdelhamid Mohamed O. , Kaufman Joyce , Lieberman Howard , Ruiz Gabriel
Published: July 2020

Background

Left ventricular assist devices (LVAD) are placed for patients with advanced heart failure or cardiogenic shock as destination therapy or as a bridge to cardiac transplantation. Significant complications associated with LVAD placement include bleeding, infection, pump thrombosis, right heart failure, device malfunction and stroke. The case below illustrates inadvertent intraperitoneal driveline placement causing colonic perforation and the subsequent management.

Case presentation

A 54 year old male with a history of Wolff-Parkinson-White syndrome resulting in multiple readmissions for heart failure, ultimately required placement of a left ventricular assist device (LVAD). Several weeks later, he was found to have stool draining from the driveline site. The patient was taken to the operating room for limited exploration by the Cardiothoracic Surgery team and a bowel injury was identified and repaired. Three days after this repair, stool was once again leaking from the driveline site, requiring re-exploration by the Acute Care Surgery team. Intraoperatively, the prior repair was found to be leaking and multiple intra-abdominal abscesses were discovered. The transverse colon was resected and left in discontinuity. On a planned second look operation, the LVAD driveline was relocated to be extra-peritoneal and a colostomy was formed.

Discussion and conclusion

This case demonstrates the importance of early recognition and involvement of an Acute Care Surgeon in the management of this complex problem. Appropriate treatment involves a complete exploration, source control, driveline relocation and possible fecal diversion. Although the incidence of this complication is low, it must be considered in the differential in a septic LVAD patient.
Characteristics and outcomes of Stanford type A aortic dissection patients with severe post-operation hyperbilirubinemia: a retrospective cohort study
Authors: Chen Xiaolan , Bai Ming , Zhao Lijuan , Li Yangping , Yu Yan , Zhang Wei , Ma Feng , Sun Shiren , Chen Xiangmei
Published: July 2020

Background

Hyperbilirubinemia is one of the common complications after cardiac surgery and is associated with increased mortality. However, to the best of our knowledge, the reports on clinical significance of postoperative severe hyperbilirubinemia in Stanford type A aortic dissection (AAD) patients were limited.

Methods

Patients who underwent surgical treatment for AAD in our center between January 2015 and December 2018 were retrospectively screened. In-hospital mortality, long-term mortality, acute kidney injury (AKI), and the requirement of continuous renal replacement therapy (CRRT) were assessed as endpoints. Univariate and multivariate regression models were employed to identify the risk factors of these endpoints.

Results

After screening, 271 patients were included in our present study. Of the included patients, 222 (81.9%) experienced postoperative AKI, and 50 (18.5%) received CRRT. The in-hospital mortality was 30.3%. The 1-year, 2-year, and 3-year cumulative mortality were 32.9, 33.9, and 35.3%, respectively. Multivariate Logistic regression analysis indicated that age (P < 0.033), AKI stage 3 (P < 0.001), the amount of blood transfusion after surgery (P = 0.019), mean arterial pressure (MAP) in the first postoperative day (P = 0.012), the use of extracorporeal membrane oxygenation (ECMO) (P = 0.02), and the peak total bilirubin (TB) concentration (P = 0.023) were independent risk factors of in-hospital mortality. The optimal cut-off value of peak TB on predicting in-hospital mortality was 121.2 μmol/L. Patients with post-operation TB ≥ 121 μmol/L was associated with worse long-term survival as well.

Conclusions

Severe post-operation hyperbilirubinemia is a common clinical situation in patients had AAD repair. In AAD patients with severe post-operation hyperbilirubinemia, older age, lower MAP, increased blood transfusion, stage 3 AKI, the use of ECMO, and the increased peak TB lead to increase in-hospital mortality.
Quality standard of traditional Chinese medicines: comparison between European Pharmacopoeia and Chinese Pharmacopoeia and recent advances
Authors: Leong Fong , Hua Xue , Wang Mei , Chen Tongkai , Song Yuelin , Tu Pengfei , Chen Xiao-Jia
Published: July 2020

Traditional Chinese medicine (TCM) are becoming more and more popular all over the world. However, quality issues of TCM may lead to medical incidents in practice and therefore quality control is essential to TCM. In this review, the state of TCM in European Pharmacopoeia are compared with that in Chinese Pharmacopoeia, and herbal drugs that are not considered as TCM and not elaborated by TCM working party at European Directorate for the Quality of Medicines & Health Care (EDQM) but present in both European Pharmacopoeia and Chinese Pharmacopoeias are also discussed. Different aspects in quality control of TCM including origins, identification, tests and assays, as well as sample preparation, marker selection and TCM processing are covered to address the importance of establishing comprehensive quality standard of TCM. Furthermore, advanced analytical techniques for quality control and standard establishment of TCM are also reviewed.
ETV6-ACSL6 fusion gene in myeloid neoplasms: clinical spectrum, current practice, and outcomes
Authors: Wu Xia , Cai Hao , Qiu Yu , Li Jian , Zhou Dao-bin , Cao Xin-xin
Published: July 2020

Background

ETV6-ACSL6 is a fusion gene rarely reported in myeloid malignancies, and its clinical characteristics, proper treatment strategies, and effect on prognosis are poorly understood.

Results

Sixteen patients with the ETV6-ACSL6 fusion gene were identified, with a median age of 50 years. Twelve patients were male. Clinical diagnoses included chronic eosinophilic leukemia, not otherwise specified, acute myeloid leukemia, and other types of myeloproliferative and myelodysplastic disorders. Ten out of 12 patients had increased levels of eosinophils, and four out of five had increased levels of basophils in peripheral blood. Treatment with tyrosine kinase inhibitors was ineffective. The prognosis of the patients was poor, with seven patients dying within 1 year.

Conclusions

Patients with the ETV6-ACSL6 fusion gene mainly present with myeloproliferative and myelodysplastic disorders, typically with increased eosinophils and/or basophils and poor survival. Intensive therapies such as allogenic stem cell transplantation should be an initial consideration for eligible patients.
Prevalence and associated factors of depression among Jimma University students. A cross-sectional study
Authors: Ahmed Gutema , Negash Alemayehu , Kerebih Habtamu , Alemu Daniel , Tesfaye Yonas
Published: July 2020

Background

Depression is a common health problem among university students. It is debilitating and has a detrimental impact on students psychosocial, emotional, interpersonal functioning and academic performance, However, there is a scarcity of information on this regard in higher education institutions in Ethiopia, so the current study was conducted to assess the prevalence of depression and its associated factors among Jimma University students.

Methods

An institution-based quantitative cross-sectional study was conducted on a total of 556 sampled students selected by a multistage stratified sampling technique. Beck Depression Inventory (BDI-II) was used to screen depression severity. Data was collected through a pretested, structured, and self-administered questionnaire. The collected data were checked manually for completeness and entered into Epidata manager Version 2.0.8.56 data entry software then exported to SPSS version 20 Statistical software for analysis. The obtained data were described using descriptive statistics as well as logistic regression analysis was done to determine the independent predictors of the outcome variable. First bivariate analysis was done and variables significant atpvalue ≤ 0.25 were entered into a multivariate logistic regression analysis to control for confounders. The significance of association was determined at a 95% confidence interval and p-value < 0.05.

Result

The prevalence of depression among the students was 28.2%. Having a mentally ill family member (OR = 2.307, 95%CI 1.055–5.049), being from the college of Social science and humanity (OR = 2.582, 95%CI 1.332–5.008), having sex after drinking (OR = 3.722, 95%CI 1.818–7.619), being hit by sexual partner (OR = 3.132, 95%CI 1.561–6.283), having childhood emotional abuse (OR = 2.167, 95%CI 1.169–4.017), having monthly pocket money between 500-999 ETB (OR = 0.450, 95% CI 0.204–0.995), and promoted academic performance (OR = 2.912, 95% CI 1.063–7.975) were significantly associated with depression.

Conclusion

The prevalence of depression among Jimma University students was high and positively associated with being from the college of social science and humanity, history of a hit by a sexual partner, having a mentally ill family member, having more monthly pocket money, promoted academic performance, having sex after drinking and childhood emotional abuse. Therefore, establishing depression screening services on the campus and designing proper mental health intervention programs is recommended to tackle the problem.
Paper-based in vitro tissue chip for delivering programmed mechanical stimuli of local compression and shear flow
Authors: Kaarj Kattika , Madias Marianne , Akarapipad Patarajarin , Cho Soohee , Yoon Jeong-Yeol
Published: July 2020

Mechanical stimuli play important roles on the growth, development, and behavior of tissue. A simple and novel paper-based in vitro tissue chip was developed that can deliver two types of mechanical stimuli—local compression and shear flow—in a programmed manner. Rat vascular endothelial cells (RVECs) were patterned on collagen-coated nitrocellulose paper to create a tissue chip. Localized compression and shear flow were introduced by simply tapping and bending the paper chip in a programmed manner, utilizing an inexpensive servo motor controlled by an Arduino microcontroller and powered by batteries. All electrical compartments and a paper-based tissue chip were enclosed in a single 3D-printed enclosure, allowing the whole device to be independently placed within an incubator. This simple device effectively simulated in vivo conditions and induced successful RVEC migration in as early as 5 h. The developed device provides an inexpensive and flexible alternative for delivering mechanical stimuli to other in vitro tissue models.

Graphical abstract
Manual therapy versus therapeutic exercise in non-specific chronic neck pain: a randomized controlled trial
Authors: Bernal-Utrera Carlos , Gonzalez-Gerez Juan Jose , Anarte-Lazo Ernesto , Rodriguez-Blanco Cleofas
Published: July 2020

Background

Nonspecific chronic neck pain is a fairly common disorder that causes a great impact, and it is greatly influenced by psychosocial factors. Among a number of treatment modalities described for its management, the most common approach is based on manual therapy and specific therapeutic exercise, which have shown a moderate effect on subjects with chronic non-specific neck pain. However, the effect times of these treatments have not been accurately detailed. Our study aims to break down and compare the effects of two experimental treatments based on manual therapy and therapeutic exercise.

Methods

The short-term and mid-term changes produced by different therapies on subjects with non-specific chronic neck pain were studied. The sample was randomized divided into three groups: manual therapy, therapeutic exercise, and placebo. As dependent variables of our research, we studied (a) pain, based on the visual analog scale and the pressure pain threshold, and (b) cervical disability, through the Neck Disability Index (NDI). Outcomes were registered on week 1, week 4, and week 12. The findings were analyzed statistically considering a 5% significance level (P ≤ 0.05).

Results

No statistically significant differences (P 0.05) were obtained between the experimental groups, if they exist against the control group. Nonetheless, we found that manual therapy improved perceived pain before than therapeutic exercise, while therapeutic exercise reduced cervical disability before than manual therapy. Effect size (R2) shows medium and large effects for both experimental treatments.

Conclusion

There are no differences between groups in short and medium terms. Manual therapy achieves a faster reduction in pain perception than therapeutic exercise. Therapeutic exercise reduces disability faster than manual therapy. Clinical improvement could potentially be influenced by central processes.

Trial registration

Brazilian Clinical Trial Registry, RBR-2vj7sw. Registered on 28 November 2018.
Classification of geothermal systems in Madagascar
Authors: Rajaobelison M. , Raymond J. , Malo M. , Dezayes C.
Published: July 2020

Classification schemes for geothermal energy sources have recently been improved to include the concept of geothermal play. Our comprehensive review for the island of Madagascar aims to enhance the understanding of the factors controlling the country’s geothermal energy sources. The result is the first catalogue of geothermal systems in Madagascar. The geothermal systems of six prospective areas were categorized into three classes using the geological and tectonic context combined with the temperature of the potential geothermal reservoir. The three classes are (1) graben border-fault liquid-dominated moderate-temperature (Ambilobe and Miandrivazo areas), (2) fossil magmatic liquid-dominated moderate-temperature (Ambanja, Itasy and Antsirabe areas), and (3) sedimentary liquid-dominated low-temperature (Morondava Basin). The hydrothermal resources of Madagascar are commonly associated with extensional domains referred to as geothermal plays. A conceptual model was developed for each prospective area to better understand the factors controlling the heat source, formation permeability and fluid migration. Our results can be used to guide exploration strategies and have implications for assessing and quantifying Madagascar’s geothermal potential.
Quantitative assessment of cardiovascular autonomic impairment in cancer survivors: a single center case series
Authors: Noor Benjamin , Akhavan Shannel , Leuchter Michael , Yang Eric H. , Ajijola Olujimi A.
Published: July 2020

Background

Cardiovascular autonomic dysfunction in cancer survivors is poorly understood.

Objectives

To better characterize the clinical characteristics and types of autonomic dysfunction in this population.

Methods

A retrospective analysis of cancer survivors within an academic cardio-oncology program referred for suspected autonomic dysfunction was performed. Autonomic reflex testing of adrenergic, cardiovagal, and sudomotor function was done. Autonomic impairment was graded on severity based on the Composite Autonomic Severity Score system. Patients with pre-existing autonomic dysfunction prior to their cancer diagnosis were excluded.

Results

Of approximately 282 total patients in the UCLA Cardio-Oncology program, 24 were referred for suspected autonomic dysfunction and met the inclusion criteria. 22 had autonomic impairment on autonomic reflex testing. Eight patients were female, and the mean age at time of autonomic testing was 51.3 years. The average duration from cancer diagnosis to autonomic testing was 10.3 years. The reasons for referral included dizziness, tachycardia, palpitations, and syncope. The majority of patients (75%) had hematologic disorders. The most common chemotherapies administered were vinca alkaloids (54.2%), alkylating agents (66.7%), and anthracyclines (54.2%). Most patients received radiation to the thorax (66.7%) and neck (53.3%). Eleven patients had mild autonomic impairment, 7 had moderate, and 4 had severe autonomic impairment. Dysfunction was commonly present in the sympathetic and parasympathetic branches, but most pronounced in the sympathetic system. The majority of patients were diagnosed with orthostatic hypotension (50%), inappropriate sinus tachycardia (20.8%), and postural orthostatic tachycardia syndrome (12.5%) and had subjective improvement with treatment.

Conclusion

Cardiovascular autonomic dysfunction occurs in cancer survivors, and commonly affects both the sympathetic and parasympathetic systems. Symptom recognition in patients should prompt autonomic testing and treatment where appropriate.
Re-emergence of the Glossy Ibis (Plegadis falcinellus) in inland South Korea
Authors: Lee Sang-Yeon , Sung Ha-Cheol , Han Donguk , Cha Jin-Yeol
Published: July 2020

Glossy Ibis (Plegadis falcinellus), which has never been recorded in South Korea, appeared on Jeju Island in 2018 and re-emerged in the inland area of Seocheon-gun (South Chungcheong Province) and in Goyang-si (Gyeonggi Province) in the following year. This study aims to report the progress in observingP.falcinellusin the inland areas of South Korea in 2019 and to predict its origin region and future propensity for habitats in the country through literature review. On 5 May 2019, an individual ofP.falcinelluswith breeding feathers was observed in a farmland in Wolsan-ri, Seocheon-gun. Twelve days later, another one was identified in a farmland in Janghang-dong, Goyang-si, about 173 km north of Wolsan-ri. The observed birds fed and rested in the area and stayed for only a day. The individual birds spotted in South Korea in 2019 are conjectured to have come from either Southeast Asia or Australia, among areas located in East Asian-Australasian Flyway (EAAF). This is becauseP.falcinellus, a species with excellent dispersal capacity, forms a population in new areas during extreme environmental changes in their current habitats, especially droughts. For 2 years,P.falcinelluswas observed to be migrating in spring; however, in the future, they may exhibit the same propensity for breeding and habitats as that of birds migrating in autumn. As it is a conspicuous species, effective detection of their arrival requires a survey system that classifies the country by habitat type and involves periodic and multiple observations by experts and citizens.
Effect of entomopathogenic fungi against invasive pest Spodoptera frugiperda (J. E. Smith) (Lepidoptera: Noctuidae) in maize
Authors: B. Ramanujam , B. Poornesha , A. N. Shylesha
Published: July 2020

Ten indigenous entomofungal strains ofBeauveria bassiana,Metarhizium anisopliae, andM. rileyiwere evaluated against 2nd instar larvae of the maize fall armyworm (FAW)Spodptera frugiperda(J. E. Smith) (Lepidoptera: Noctuidae) in a laboratory bioassay. Among the ten strains tested,M. anisopliaeICAR-NBAIR Ma-35 caused 67.8% mortality, followed byB. bassianaICAR-NBAIR Bb-45 with 64.3%, and ICAR-NBAIR Bb-11 with 57.1% mortality. Rest of the isolates showed 10.7–28.6% mortality. ICAR-NBAIR Ma-35 showed LC50of 1.1 × 107spores/ml and LT50at 1 × 108spores/ml is 86.04 h and ICAR-NBAIR Bb-45 showed LC50of 1.9 × 107spores/ml and LT50at 1 × 108spores/ml is 88.30 h. Field evaluation with these two promising strains were conducted against maize fall armyworm for 2 years (2018 and 2019) at ICAR-National Bureau of Agricultural Insect Resources experimental farm, Bengaluru, Karnataka, India. Field trial results indicated 68 and 69% reduction of FAW infestation and 55 and 62% increase in yield in the plots treated withM. anisopliaeICAR-NBAIR Ma-35/B. bassianaICAR-NBAIR Bb-45, respectively, during 2018. In 2019, 70 and 76% reduction of FAW infestation and 44 and 55% increase in yield were observed in the plots treated with these two entomofungal pathogens, respectively.
The role of hepatic transcription factor cAMP response element-binding protein (CREB) during the development of experimental nonalcoholic fatty liver: a biochemical and histomorphometric study
Authors: Awaad Ashraf K. , Kamel Maher A. , Mohamed Magdy M. , Helmy Madiha H. , Youssef Magda I. , Zaki Eiman I. , Essawy Marwa M. , Hegazy Marwa G. A.
Published: July 2020

Background

Several molecular mechanisms contribute to the initiation and progression of nonalcoholic fatty liver disease (NAFLD); however, the exact mechanism is not completely understood. Cyclic adenosine monophosphate (cAMP) is one of the most promising pathways that regulates various cellular functions including lipid and carbohydrate metabolism. cAMP induces gene transcription through phosphorylation of the transcription factor, cAMP response element-binding protein (CREB). The action of cAMP is tightly regulated by its level and repression. Among the repressors, Inducible cAMP Early Repressor (ICER) is the only inducible CRE-binding protein. The present study aimed to evaluate the role of hepatic CREB level in the development of experimental NAFLD model to clarify the pathogenesis of the disease. NAFLD 35 male Wistar rats fed a high fat diet for a period of 14 weeks were studied compared with 35 control rats fed a standard diet. Five fasting rats were sacrificed each 2 weeks intervals for a period of 14 weeks.

Results

NAFLD group revealed a remarkable duration—dependent elevation in cAMP and CREB levels in the liver tissue compared to control group (P value < 0.004, P value < 0.006, respectively). In contrast, ICER gene expression, as a dominant-negative regulator of CREB, was downregulated in the liver of NAFLD group compared to control group. We also demonstrated that CREB levels were positively correlated with liver function tests, and glucose homeostasis parameters.

Conclusions

Our results indicate that cAMP/CREB pathway provides an early signal in the progression to NAFLD representing a noninvasive biomarker that can early detect NAFLD and a promising therapeutic target for the treatment of the disease as well.