bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and Risk Factors of Postoperative Delirium Following Primary Elective Total Hip Arthroplasty: A Retrospective Nationwide Inpatient Sample Database Study
Authors: Yang Qinfeng , Wang Jian , Huang Xusheng , Xu Yichuan , Zhang Yang
Published: May 2020

Background: Postoperative delirium is a common complication following major surgeries, leading to a variety of adverse effects. However, there is a paucity of literatures studying the incidence and risk factors of delirium after primary elective total hip arthroplasty (THA) using a large-scale national database. Methods: A retrospective database analysis was performed based on Nationwide Inpatient Sample (NIS) from 2009-2014. Patients who underwent primary elective THA were included. Patient demographics, comorbidities, length of hospital stay (LOS), total charges, in-hospital mortality, and major and minor perioperative complications were evaluated. Results: A total of 388,424 primary elective THAs were obtained from the NIS database, and the general incidence of delirium after THA was 0.90%. Patients with delirium after THA presented more comorbidities, increased LOS, extra hospital charges, and higher in-hospital mortality rate (P<0.001). Delirium following THA was associated with major complications during hospitalization including acute renal failure and pneumonia. Risk factors of postoperative delirium included advanced age, alcohol or drug abuse, depression, neurological disorders, psychoses, fluid and electrolyte disorders, diabetes, weight loss, deficiency anemia, coagulopathy, hypertension, congestive heart failure, valvular disease, pulmonary circulation disorders, peripheral vascular disorders, and renal failure. Both female and obesity were detected to be protective factors. Conclusions: The results of our study identified a relatively low incidence of delirium after primary elective THA. Postoperative delirium of THA was associated with increased comorbidities, LOS, total charges, in-hospital mortality, and major perioperative complications including acute renal failure and pneumonia. It is of benefit to study risk factors of postoperative delirium to moderate its consequences.
Zebrafish xenograft model of human lung cancer for studying the function of LINC00152 in cell proliferation and invasion
Authors: Shen Wenyi , Pu Juan , Sun Jing , Tan Bing , Wang Wei , Wang Lili , Cheng Jianmeng , Zuo Yangsong
Published: May 2020

Background: Numerous studies have shown that long noncoding RNAs play important roles in human cancer progression. Although zebrafish xenografts have recently become a novel in vivo model for human cancer research, whether such models can be used to study the function of long noncoding RNAs remains unknown. Methods: In vitro studies validated the roles of LINC00152 in the proliferation and invasion of lung cancer cells. In vivo studies of zebrafish xenografts also confirmed these roles of LINC00152. In vivo confocal imaging was used to more accurately evaluate the function of LINC00152 in cell proliferation and migration. Pharmacological experiments were further performed to study the potential ability of LINC00152 downregulation combined with an EGFR inhibitor to treat tumors in cultured cells and the zebrafish xenograft model. Results: Silencing of LINC00152 suppressed cell proliferation and invasion in SPCA1 and A549 lung cancer cell lines in vitro . In the zebrafish xenograft model, knockdown of LINC00152 reduced the proliferation and migration of lung cancer cells, as indicated by the two imaging methods at different magnifications. Moreover, the knockdown of LINC00152 enhanced the inhibition effect of afatinib for lung cancer progression in cultured cells and the zebrafish xenograft model. Conclusion: Our study reveals the oncogenic roles and potential for LINC00152 to be a target for tumor treatment in lung cancer using zebrafish xenograft models, and the findings suggest that this model could be used for functional and application studies of human long noncoding RNAs in tumor biology.
Clinical significance of conversion surgery for gastric cancer with peritoneal dissemination: A retrospective study
Authors: Arigami Takaaki , Matsushita Daisuke , Okubo Keishi , Kijima Takashi , Shimonosono Masataka , Sasaki Ken , Noda Masahiro , Kita Yoshiaki , Mori Shinichiro , Kurahara Hiroshi , Yanagita Shigehiro , Uenosono Yoshikazu , Ishigami Sumiya , Natsugoe Shoji
Published: May 2020

Background: Although chemotherapy has been clinically recommended as the initial treatment for patients with peritoneal dissemination of gastric cancer, poor prognosis has been noted among the same patients. However, the prognostic significance of conversion surgery after chemotherapy remains unclear. The present study therefore aimed to assess the clinical impact of conversion surgery among patients with peritoneal dissemination of gastric cancer.Methods: A total of 93 patients with peritoneal dissemination of gastric cancer undergoing chemotherapy between February 2002 and October 2019 were retrospectively enrolled and subsequently divided into progressive disease (PD) and non-PD groups based on tumor response to chemotherapy.Results: Among the included patients, 17 developed distant metastases at another site besides peritoneal dissemination. Based on tumor response, 24 and 69 patients were determined to have PD and non-PD, respectively, with the former having significantly poorer prognosis than the latter (p < 0.0001). A total of 19 patients underwent conversion surgery after chemotherapy, with the presence or absence of conversion surgery being significantly correlated with age, first-line chemotherapy regimen, and tumor response (p = 0.0134, 0.0337, and 0.0024, respectively). Patients in the non-PD group who underwent conversion surgery or chemotherapy alone had 3-year overall survival rates of 55.6% and 6.6%, respectively. Multivariate analysis identified conversion surgery alone as an independent prognostic factor in the non-PD group (p < 0.0001).Conclusion: Our retrospective study demonstrated that conversion surgery for gastric cancer with peritoneal dissemination might improve the prognosis of responders who developed no peritoneal dissemination after chemotherapy.
Reporting Complex Multidisciplinary Healthcare Team Training Interventions: Development and Validation of a Checklist
Authors: KEIJSER Wouter A , Wisse Robert , Wilderom Celeste PM
Published: May 2020

Background Multidisciplinary healthcare teamwork training is regarded as a means to improve patient safety and quality of care. However, it is increasingly characterized by highly complex and contextualized interventions, challenging scholars and practitioners in evaluating reports of such interventions effectively. Conflicting or weak evidence as to whether these complex interventions ultimately affect patient outcomes suggests the need for more comparability, reproducibility, and transparency in scientific reporting. In the absence of an existing reporting guideline, we developed a new checklist for effective reports on the planning, content and implementation design and outcomes of complex teamwork training programs.Methods The checklist was developed through pragmatically consulting existing relevant frameworks for evaluating complex interventional studies as well as related key literature on teamwork training. We followed a stepped approach in data retrieval, applying a configurative synthesis. Subsequently, the checklist’s validity and usability were tested based on a literature review of peer-reviewed journal articles describing the implementation of the widely used comprehensive TeamSTEPPS™ curriculum. We used our checklist to evaluate the reporting in the included articles based on specific selection criteria.Results The Reporting Complex Multidisciplinary Healthcare Teamwork Training (ReCoMuTe) checklist presented in this paper exists of four distinct categories, each containing components and various explicating elements: Context and preparation; Description; Execution and delivery; Mechanisms of impact. Despite its wide use across various healthcare institutions and settings and the increasing number of publications on its implementation, we found that the reporting in papers on TeamSTEPPS implementation is often inadequate.Conclusion More standardized scientific reporting on the design and content of complex teamwork training interventions, their contextualized implementation processes and outcomes, can bolster the understanding of effective intervention design, implementation, and evaluation, and can enable well-informed decision making on investments. The ReCoMuTe checklist provides an instrument for evaluating complex interventions, such as studies on TeamSTEPPS implementation, and can assist authors, reviewers, editors, and others in further contemporary research on multidisciplinary healthcare teamwork.
Molecular detection of Beta-lactamase blaCTX-M group 1 gene in Escherichia coli Isolated from Drinking Water in Khartoum State
Authors: Altayeb Hisham N , Khalid Eman , Moglad Ehssan h
Published: May 2020

BackgroundOne of the most common challenges facing the world today is the rapid spread of antibiotic-resistant bacteria. According to current evidence, this is mainly as a result of presumed use of antibiotics, the interaction between humans or from animal sources. Still, there is limited focus on the role of environmental factors, especially water. This study aimed to detect the blaCTX-M group 1 gene in Escherichia coli (E. coli) isolated from drinking water in Khartoum State. Methods Two hundred and eighty water samples were collected from different localities in Khartoum State and resources. Isolation and identification of E. coli performed by using lauryl tryptose broth, Brilliant Green Bile Broth, biochemical reaction, and culture characteristics on EMB media. Antimicrobial sensitivity tests were performed for all isolated bacteria using cefotaxime (30μg), gentamycin (10μg), tetracycline (25μg) and chloramphenicol (30μg) by agar diffusion method. DNA extracted by boiling method, bacterial genomic DNA used as a template to detect the blaCTX-M group 1 gene by PCR. Results The result displayed that eighty-six (30.7%) E. coli isolated out of two hundred and eighty water samples. Out of eighty-sixing isolated bacteria, 49% (42/86) were from Khartoum locality, 28% (24/86) were from Omdurman locality, and 23% (20/86) were from Khartoum North locality. Antimicrobial susceptibility testing revealed that the highest resistant percentage was 59% for tetracycline, followed by 35% for gentamycin. While for chloramphenicol and cefotaxime were 22% and 20%, respectively. CTX-M group 1 gene was detected in 40% of all isolates. Conclusion This study concludes that drinking water in Khartoum State might be contaminated with faces and be a possible source for the transmission of resistant bacteria to humans.
Polymerization of Bacillus Subtilis MreB on A Lipid Membrane Reveals Lateral Co-Polymerization of MreB Paralogs and Strong Effects of Cations on Filament Formation
Authors: Dersch Simon , Reimold Christian , Breddermann Hannes , Heimerl Thomas , Soufo Hervé Joel Defeu , Graumann Peter
Published: May 2020

Background MreB is a bacterial ortholog of actin and forms mobile filaments underneath the cell membrane, perpendicular to the long axis of the cell, which play a crucial role for cell shape maintenance. We wished to visualize Bacillus subtilis MreB in vitro and therefore established a protocol to obtain monomeric protein, which could be polymerized on a planar membrane system, or associated with large membrane vesicles. Results Using a planar membrane system and electron microscopy, we show that Bacillus subtilis MreB forms bundles of filaments, which can branch and fuse, with an average width of 70 nm. Fluorescence microscopy of non-polymerized YFP-MreB, CFP-Mbl and mCherry-MreBH proteins showed uniform binding to the membrane, suggesting that 2D diffusion along the membrane could facilitate filament formation. After addition of divalent ions, all three proteins formed highly disordered filaments that appeared to branch and fuse, such that at high protein concentration, MreB and its paralogs generated a network of filaments extending away from the membrane. Filament formation was positively affected by divalent ions and negatively by monovalent ions. YFP-MreB or CFP-Mbl also formed filaments between two adjacent membranes, which frequently has a curved appearance. New MreB, Mbl or MreBH monomers could add to the lateral side of preexisting filaments, and MreB paralogs co-polymerized, indicating direct lateral interaction between MreB paralogs. Conslusions Our data show that B. subtilis MreB paralogs do not easily form ordered filaments in vitro, possibly due to extensive lateral contacts, but can co-polymerase. Monomeric MreB, Mbl and MreBH uniformly bind to a membrane, and form irregular and frequently branched filamentous structures, facilitated by the addition of divalent ions, and counteracted by monovalent ions, suggesting that intracellular potassium levels may be one important factor to counteract extensive filament formation and filament branching in vivo.
Extreme Risk Protection Orders in King County, Washington: The Epidemiology of Dangerous Behaviors and an Intervention Response
Authors: Frattaroli Shannon , Omaki Elise , Molocznik Amy , Allchin Adelyn , Hopkins Renee , Shanahan Sandra , Levinson Anne
Published: May 2020

Background. Extreme Risk Protection Order (ERPO) laws are a promising gun violence prevention strategy. ERPO laws allow specific categories of people (law enforcement in all states, family in most) to petition the court to request that an individual be temporarily prohibited from purchasing and possessing firearms because that individual is behaving dangerously and at risk of violence, either to themselves or others. In 2017 Washington’s ERPO law took effect. King County developed a comprehensive approach to implementing ERPOs. The early experience of King County offers important insight into how early adopters of this policy are incorporating EPRO into their approach to gun violence prevention.Methods. We systematically reviewed, abstracted and coded data from every ERPO petition filed in King County in 2017 and 2018, and all ERPO court records associated with those petitions. We conducted descriptive analyses of the coded data.Results: Seventy-five ERPO petitions were filed in King County during the study period. Judges granted a temporary ERPO in all 75 cases; 65 (87%) of these cases resulted in a one-year ERPO. Law enforcement initiated 73 (97%) of these petitions, and family members filed the remaining two. The 75 petitions filed described respondents’ risk as to “themselves only” in 30 cases (40%), to “others only” in 20 cases (27%) and “to themselves and others” in 25 cases (33%). Five cases where the threat was to “others only” met a definition of mass shooting threat. For 95% of the temporary ERPOs issued, the courts’ reasoning for issuing ERPOs included either current violence or brandishing a firearm. Court records for the 75 cases detail firearms removed and/or include receipts for removed firearms in 61 cases (81%) either as part of ERPO precipitating events (n=13, 17%) or in conjunction with ERPO service (n=48, 64%).Conclusions. These findings suggest that Washington’s ERPO law is being applied when someone is threatening violence or brandishing a gun and at least one other risk factor is present. The early experience of King County provides insight into how this law is being implemented in one jurisdiction and how courts are evaluating such cases.
Feasibility and Efficacy of Lung Ultrasound to Diagnose Postoperative Hypoxemia-A Prospective Study
Authors: Xie Chen , Sun Kai , You Yueyang , Ming Yue , Yu Xiaoling , Yu Lina , Huang Jiapeng , Yan Min
Published: May 2020

Background Postoperative hypoxemia is associated with morbidity and mortality. We aim to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose pulmonary complications in patients suffering from hypoxemia after general anesthesia, and compare to thoracic computed tomography (CT).Methods Adult patients received general anesthesia and suffered from hypoxemia in the PACU, were analyzed. Hypoxemia was defined as a SPO2 less than 92% for greater than 30 seconds on room air. LUS was performed by a trained anesthesiologist once hypoxemia occurred. After LUS examination, each patient was transported to radiology department for thoracic CT scan within 1 hour before returning to the ward.Results From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopedics surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) and other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%).Conclusions Lung ultrasound is feasible, efficient and accurate in diagnosing different etiologies of postoperative hypoxia in the PACU.
Top coal caving parameters of the thick lower seam in ultra-close multiple seams with combined mining
Authors: Zhang Ningbo , Liu Changyou , Zhou Jingfeng , Guo Fengqi
Published: May 2020

In the combined mining of ultra-close multiple seams with thin upper seam and thick lower seam, the mining of thin upper seam may lead to damages of the interburden and collapse of overburden. As a result, the roof of the thick lower seam in the fully mechanized caving process is turned into layers consisting of parts with different medium characteristics, in terms of damage severity and rock size, and the caving and recovery of top coal is significantly affected. Therefore, we propose a study of top coal caving and roof rock movement law under different fracture conditions based on two dimensional discrete element numerical simulation software program. The results revealed that roof rock channeling into the top coal was observed in the coal caving process in the presence of a huge difference between the lump sizes of roof rock and top coal of the lower seam, resulting in low recovery ratio. And the one cut/one caving upward caving pattern was the optimized top coal caving parameter. This study serves as a reference for future studies of top coal recovery in the combined mining of contiguous coal seams with thin upper seam and thick lower coal seam.
Opposing functions of β-arrestin 1 and 2 in Parkinson’s disease via microglia inflammation and Nprl3
Authors: Fang Yinquan , Jiang Qingling , Li Shanshan , Zhu Hong , Ding Xiao , Xu Rong , Chen Miaomiao , Song Nanshan , Song Mengmeng , Ding Jianhua , Lu Ming , Wu Guangyu , Hu Gang
Published: May 2020

Background
Although β-arrestins (ARRBs) regulate diverse physiological and pathophysiological processes, their function and regulation in Parkinson’s disease (PD) remain poorly defined.
Methods
We measured expression of ARRB1 and ARRB2 in liposaccharide (LPS)-induced and 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP)-induced PD mice. ARRB1-deficient and ARRB2-deficient mouse were used to assess the impact of ARRBs on dopaminergic (DA) neuron loss and microglia activation in PD mouse models. After primary mouse DA neurons were exposed to the conditioned medium from ARRB1 knockdown or ARRB2 knockout microglia stimulated by LPS plus interferon γ (IFN-γ), the degeneration of DA neurons was quantified. Gain- and loss-of-function studies were used to study the effects of ARRBs on microglia activation in vitro. To further understand the mechanism, we measured the activation of classical inflammatory pathways and used RNA sequencing to identify the novel downstream effector of ARRBs.
Result
In this study, we demonstrate that expression of ARRB1 and ARRB2, particularly in microglia, is reciprocally regulated in PD mouse models. ARRB1 ablation ameliorates, whereas ARRB2 knockout aggravates, the pathological features of PD, including DA neuron loss, neuroinflammation and microglia activation in vivo, as well as microglia-mediated neuron damage and inflammation in vitro. In parallel, ARRB1 and ARRB2 produce adverse effects on the activation of inflammatory signal transducers and activators of transcription 1 (STAT1) and nuclear factor-κB (NF-κB) pathways in microglia. We also show that two ARRBs competitively interact with activated p65 in the NF-κB pathway and that nitrogen permease regulator-like 3 (Nprl3), a functionally poorly characterized protein, is a novel effector acting downstream of both ARRBs.
Conclusion
Collectively, these data demonstrate that two closely related ARRBs have completely opposite functions in microglia-mediated inflammatory responses, via Nprl3, and differentially affect the pathogenesis of PD, and suggest a potential therapeutic strategy.
Assessing the external validity of the VALIDATE-SWEDEHEART trial
Authors: Rylance Rebecca , Wagner Philippe , Omerovic Elmir , Held Claes , James Stefan , Koul Sasha , Erlinge David
Published: May 2020

Background The VALIDATE-SWEDEHEART trial was a registry-based randomized trial comparing bivalirudin and heparin in patients with acute myocardial infarction undergoing percutaneous coronary intervention. It showed no differences in mortality at 30 or 180 days. This study examines how well the trial population results may generalize to all of the screened patients with fulfilled inclusion criteria for mortality at 30 and 180 days.Methods The standardized difference in the mean propensity score for trial inclusion between the trial population and the screened not-enrolled with fulfilled inclusion criteria population was calculated as a metric of similarity. A predefined criterion of ≤ 0.25 was used. Predictions were futher used to standardize the observed trial results to all the screened patients with fulfilled inclusion criteria through an inverse-probability weighted Cox regression analysis, thereby evaluating the generalizability of the trial results to this population. An adjusted Cox regression analysis was applied to analyze differences in mortality with respect to anticoagulant treatment between the trial population and the screened not enrolled with fulfilled inclusion criteria.Results The propensity-score difference was 0.61, above the limit defining similar populations. There were no significant differences in mortality between bivalirudin and heparin in the inverse-probability weighted analysis [HR 1.11, 95% CI (0.73 1.68)]. In the interaction analysis, the neutral effect of bivalirudin vs. heparin remained in the screened not-enrolled with fulfilled inclusion criteria population [HR 1.01, 95% CI (0.63 1.61)].Conclusion The propensity-score difference demonstrated that the screened not enrolled with fulfilled inclusion criteria and the trial population were not similar. The inverse-probability weighted analysis showed no significant differences in mortality associated with treatment in either of the populations as was reiterated by the Cox analysis. From these analyses, we conclude that the VALIDATE trial results may be generalized.
Transcriptome analysis reveals the genetic basis underlying the development of skin appendages and immunity in hedgehog(Atelerix albiventris)
Authors: Li Hui-Ming , Yang Bi-Ze , Zhang Xiu-Juan , Jiang Hai-Ying , Li Lin-Miao , Ahmad Hafiz Ishaq , Chen Jinping
Published: May 2020

Background: The expression of hair features is an evolutionary adaptation resulting from interactions between many organisms and their environment. Elucidation of the mechanisms that underlie the expression of such traits is a topic in evolutionary biology research; however, the genetic basis of skin appendage development and differentiation remains poorly understood. Therefore, we assessed the de novo transcriptome of the hedgehog ( Atelerix albiventris ) at three developmental stages and compared gene expression profiles between abdomen hair and dorsal spine tissues. Results: We identified 328,576 unigenes in our transcriptome, among which 3,598 were differentially expressed between hair- and spine-type tissues. We identified 3 keratin genes related to hair and spine development through comparative analysis of tissues before and after growth of skin appendages. Dorsal and abdomen skin tissues 5 days after birth were compared and the resulting differentially expressed genes (DEGs) were mainly enriched in keratin filament, intermediate filament, epithelium cell differentiation, and epidermis development based on GO enrichment analysis, and tight junction, p53, and cell cycle signaling pathways based on KEGG enrichment analysis. Expression variations of MBP8, SFN, Wnt10, KRT1 , and KRT2 may be the main factors regulating hair and spine differentiation for the hedgehog. Strikingly, DEGs in hair-type tissues were also significantly enriched in immune-related terms and pathways with hair-type tissues exhibiting more upregulated immune genes than spine-type tissues. Thus, we propose that spine development was an adaptation that provided protection against injuries or stress and reduced hedgehog vulnerability to infection. Conclusion: Our study provided a list of potential genes involved in the regulation of skin appendage development and differentiation in A. albiventris . This is the first transcriptome survey of hair traits for a non-model mammal species, and the candidate genes provided here may provide valuable information for further studies of skin appendages and skin disorder treatments.
Are health literacy and lifestyle of undergraduates related to the educational field? An Italian survey
Authors: Gallè Francesca , Calella Patrizia , Napoli Christian , Liguori Fabrizio , Orsi Giovanni Battista , Liguori Giorgio , Valerio Giuliana
Published: May 2020

Background. Health literacy is a fundamental ability that allows individuals to manage their health. This study was aimed to assess health literacy and lifestyles among healthcare undergraduates in comparison to students attending other degree courses from two Italian universities. Methods. The Health Literacy Assessment Tool (HLAT-8) and the Newest Vital Sign (NVS) were used to assess health literacy. Demographic and anthropometric data, adherence to Mediterranean diet, physical activity levels and smoking habit were assessed in the enrolled sample to highlight possible associations. Results. Adequate health literacy scores were registered in the sample (27.4±4.4 HLAT-8; 4.2±1.8 NVS), with higher values among healthcare students (p<0.01). However, unhealthy behaviors were reported mainly be healthcare undergraduates. Significant associations were found between health literacy scores and adherence to the Mediterranean diet (p<0.01).Conclusions. Attending a healthcare related degree course was associated with higher health literacy scores but not with healthy behaviors. This issue should be addressed considering that the future healthcare professionals should represent a behavioral model for their patients.
The impact of Maternal and Child Health and Nutrition Improvement Project on maternal and child health outcomes and service utilization in Ghana: An interrupted time series analysis
Authors: Mohammed Arif , Dwomoh Duah , Nonvignon Justice
Published: May 2020

Background

Improving maternal and child health outcomes (MCH) continues to be a major public health concern to governments in sub-Saharan Africa and the international development community. The Maternal and Child Health and Nutrition Improvement Project (MCHNP) was a nationwide project that sought to improve the utilization of maternal and child health services in Ghana through financial incentive packages. The objective of this study was to determine the differential impact of MCHNP on maternal and child health outcomes.
Methods

A retrospective longitudinal pre-test post-test study design was employed. The study used monthly data from the District Health Information Management System between January 2014 to December 2018. Interrupted time series analysis was applied to estimate the impact of MCHNP on MCH for each region of the country.
Results

Neonatal mortality rate increased significantly in the Western,Upper East and Upper West regions with impact estimates of 0.144 (95% CI: 0.100, 0.188; p-value < 0.001), 0.124 (95% CI: 0.076, 0.172; p-value < 0.001) and 0.082 (95% CI: 0.048, 0.117; p-value < 0.001) respectively. The proportion of women who had four ANC visits decreased significantly in the Volta region with an impact of -0.011 (95% CI: -0.020, -0.002; p-value < 0.01), but increased in the Central, Western, Eastern, Upper East, and Upper West with estimated impacts of 0.004 (95% CI: -0.003, 0.011), 0.003 (95% CI: -0.003, 0.008), 0.002 (95% CI: -0.004, 0.008), 0.011 (95% CI: -0.004, 0.026) and 0.007 (95% CI: -0.012, 0.026) respectively though none of the increase was statistically significant. Skilled deliveries reduced in the Greater Accra, Volta, Ashanti and Brong-Ahafo regions with statistically insignificant estimated impacts of 0.006 (95% CI: -0.019, 0.007), 0.005 (95% CI: -0.015, 0.006), 0.005 (95% CI: -0.011, 0.002) and 0.004 (95% CI: -0.010, 0.002) respectively. Maternal mortality rate declined in Greater Accra by; 0.001 (95% CI: -0.018, 0.017), Volta; -0.010 (95% CI: -0.035, 0.016), Western; -0.009 (95% CI: -0.031, 0.013), Brong-Ahafo; -0.018 (95% CI: -0.052, 0.017), Eastern; -0.025 (95% CI: -0.064, 0.013) and Northern − 0.024 (95% CI: -0.060, 0.011) regions.
Conclusion

The nationwide implementation of MCHNP produced mixed results as some regions recorded positive (significant) impacts whereas others had no significant impacts on the outcome variables as expected following the implementation of the intervention, therefore the need for further studies to understand why the intervention failed to produce positive impacts in some regions.
Do We Need to Suture the Pronator Quadratus Muscle When We do Open Reduction and Internal Fixation for Fracture of the Distal Radius
Authors: fang kaibin , Lin Xiaocong , Liu Xiaolin , Shi Shaojian , Dai Zhangsheng
Published: May 2020

Background: For fracture of the distal radius, open reduction and internal fixation are often used for treatment. In the process of open reduction and internal fixation, it is often necessary to open the pronator quadratus muscle to achieve sufficient exposure. So it's important to know if it's necessary to suture the pronator quadratus muscle. Purpose: To see if suturing the pronator quadratus during the treatment of fracture of the distal radius would improve limb function. Methods: 126 patients were selected for our study. These patients had open reduction and internal fixation.During the procedure, the pronator quadratus is cut open to allow the plate to be placed.Before the surgery was completed, the pronator quadratus muscles of these patients were stitched together. After the fracture healed, the patients underwent surgery to remove the internal fixation. These patients received wrist function scores prior to removal of internal fixation.The healing of the pronator quadratus was investigated during surgery. These patients were grouped according to the healing of the pronator quadratus. Functional scores were compared between the two groups Results: 23 patients were considered to have muscle healing during surgery. However, in these patients, the PQ muscles were obviously atrophic, with scar hyperplasia and fibrosis.The muscle fibers were loose and thin, and the number was reduced. At the same time, the remaining muscle fibers have different degrees of adhesion with radial carpal flexor muscles, steel plates and interosseous membrane. According to the intraoperative situation,23 patients were included in group A and 103 patients were included in group B. There were no statistically significant differences in age and fracture type between group A and group B.At the same time, there were no statistically significant differences in isokinetic forearm pronation strength and clinical outcomes including grip strength, wrist ROM, and PRWE scores between the two groups.Conclusions: this study demonstrates that whether the PQ muscle healing or not does not affect the outcomes of volar plating for distal radius fractures in terms of isokinetic forearm rotation strength, grip strength, wrist ROM, and PRWE scores.
Retrospective study of quadratus lumborum block for postoperative analgesia in patients undergoing percutaneous nephrolithotomy
Authors: Chen Luning , Tian Yali , Ji Jingjing , Sun Qing , Qiu Xuefeng , Li Xiaogong , Li Bingbing
Published: May 2020

Background:
The postoperative analgesic effect of transmuscular quadratus lumborum block (QLB-TM) in patients following lower abdominal surgeries has been identified, however, the efficacy of QLB using the lateral approach (QLB-L) is still in debate. Therefore, this retrospective study was conducted to investigate the effect of a single-shot block with QLB-L on postoperative analgesia for patients undergoing percutaneous nephrolithotomy (PCNL).
Methods:
The medical information of the patients undergoing PCNL was retrieved from the electronic charter system (Medisystem, Suzhou, China) in our Nanjing Drum Tower Hospital during the period of Jan/2019 to Jun/2019. Among the total of 57 patients, there are 17, 18, and 22 patients subjected to QLB-L, QLB-TM, or routine treatment respectively. The primary observational parameter was to assess postoperative pain with visual analog scales (VAS) at rest 30 min after extubation, 24 h, and 48 h after surgery respectively. The secondary observatory endpoints including the consumption of intraoperative opioids, the cumulative dose of non-steroid anti-inflammatory drugs (NSAIDs) and the incidence of adverse events related to postoperative analgesia were evaluated as well.
Results:
The static VAS score at 24 h after surgery and the intraoperative consumption of sufentanil were significantly lower in patients receiving either intervention of QLB-L or QLB-TM as compared with those receiving routine treatment. However, one shot of QLB had no impact on VAS scores at 30 min post-extubation, 48 h after PCNL procedure compared with the patients receiving routine treatment. The percentage of non-ambulatory patients within 24 h post-PCNL was significantly higher in the QLB-TM group compared with the routine treatment group (P = 0.04). There were no significant differences in the incidence of postoperative nausea and vomit (PONV), respiratory depression, the time for the first defecation and the length of hospital stay (LOS) among the three groups.
Conclusions:
QLB-L procedure exerts as equivalent as QLB-TM in terms of abrogating postoperative pain within 24 h post-surgery and decreasing intraoperative sufentanil consumption in patients undergoing PCNL procedure as well. The caution should be taken to avoid lower extremities weakness in the patients after QLB-TM within the first 24 h post-PCNL.
Leaf Open Time Sinogram (LOTS): A novel approach for Patient specific quality assurance of Total marrow irradiation
Authors: Thiyagarajan Rajesh , Sharma Dayananda Shamurailatpam , Kaushik Suryakant , Sawant Mayur , Krishnan Ganapathy , Nambiraj Arunai , CHILUKURI SRINIVAS , Patro Kartikeswar , Arjunan Manikandan , MP Noufal , Sivaraman Rangasamy , Easoee Jose , Jalali Rakesh
Published: May 2020

There is no ideal detector-phantom combination to perform patient specific quality assurance (PSQA) for total marrow (TMI) and Lymphoid (TMLI) irradiation plan. In this study, 3D dose reconstruction using mega voltage computed tomography detectors measured leaf open time sinogram (LOTS) was investigated for PSQA of TMI/TMLI patients in helical tomotherapy. The feasibility of this method was first validated for ten non-TMI/TMLI patients, by comparing reconstructed dose with a) ion-chamber (IC) and helical detector array (ArcCheck) measurement and b) planned dose distribution using 3Dγ analysis for 3%@3mm and dose to 98%(D98%) and 2%(D2%) of PTVs. Same comparison was extended for ten treatment plans from five TMI/TMLI patients. In all non-TMI/TMLI patients, reconstructed absolute dose was within ±1.8% of planned and IC measurement. The planned dose distribution agrees with reconstructed and ArcCheck measured dose with mean(SD) 3Dγ of 98.7%(1.57%) and 2Dγ of 99.48%(0.81%). The deviation in D98% and D2% were within 1.71% and 4.1% respectively. In all 25 measurement locations from TMI/TMLI patients, planned and IC measured absolute dose agrees within ±1.2%. Although sectorial fluence verification using ArcCHECK measurement for PTVs chest from five upper body TMI/TMLI plans showed mean±SD 2Dγ of 97.82%±1.27%, the reconstruction method resulted poor mean(SD) 3Dγ of 92.00%(±5.83%), 64.80%(±28.28%), 69.20%(±30.46%), 60.80%(±19.37%) and 73.2% (±20.36%) for PTVs brain, chest, torso, limb and upper body respectively. The corresponding deviation in median D98% and D2% of all PTVs were <3.8% and 9.5%. Re-optimization of all upper body TMI/TMLI plans with new pitch and modulation factor of 0.3 and 3 leads significant improvement with 3Dγ of 100% for all PTVs and median D98% and D2% <1.6%. LOTS based PSQA for TMI/TMLI is accurate, robust and efficient. A field width, pitch and modulation factor of 5cm, 0.3 and 3 for upper body TMI/TMLI plan is suggested for better dosimetric outcome and PSQA results.
PODXL Might Be a New Prognostic Biomarker in Various Cancers: A Meta-analysis and Sequential Verification with TCGA Datasets
Authors: He Siying , Du Wenjie , Li Menglan , Yan Ming , Zheng Fang
Published: May 2020

Background Several studies have investigated the associations between the podocalyxin-like protein (PODXL) expression quantity or locations and cancers survival, but the results were far from conclusive. Therefore, we proceeded a meta-analysis on PODXL in various human cancers to find its prognostic value and followed confirmation using the TCGA datasets. Methods We performed a systematic search, and 18 citations, including 5705 patients were pooled in meta-analysis. The results were verified with TCGA datasets. Results Total eligible studies comprised 5705 patients with 10 types of cancer. And the result indicated that PODXL high-expression or membrane-expression were significantly related to poor overall survival (OS). However, subgroup analysis showed a significant association between high expressed PODXL and poor OS in the colorectal cancer, pancreatic cancer, urothelial bladder cancer, renal cell carcinoma and glioblastoma multiforme. Then, we validated the inference using TCGA datasets, and the consistent results were demonstrated in patients with pancreatic cancer, glioblastoma multiforme, gastric cancer, esophageal cancer and lung adenocarcinoma. Conclusion The result of meta-analysis showed that high expressed PODXL was significantly linked with poor OS in pancreatic cancer and glioblastoma multiforme, but not in gastric cancer, esophageal cancer or lung adenocarcinoma. And the membrane expression of PODXL might also associate with poor OS. PODXL may act as tumor promotor and may serve as a potential target for antitumor therapy.
EP300 Knockdown Abrogates Cancer Stem Cell Phenotype, Tumor Growth and Metastasis in Triple Negative Breast Cancer
Authors: Ring Alexander , Kaur Pushpinder , Lang Julie E.
Published: May 2020

Background:Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype with basal features, lacking the expression of receptors targeted successfully in other breast cancer subtypes. Treatment response to adjuvant and neoadjuvant chemotherapy is often short-lived and metastatic spread occurs at higher rates than other subtypes within the first five years after diagnosis. TNBCs exhibit stem cell features and are enriched for cancer stem cell (CSC) populations. E1A Binding Protein P300(EP300) is a large protein with multiple cellular functions, including as an effector in stem cell biology.Methods: We used a genetic knockdown (KD) model of EP300 in TNBC cell lines to investigate the effect on CSC phenotype, tumor growth and metastasis. Side population assay and tumorsphere suspension culture were used in vitro. Xenograft mouse models were used for in vivo studies. We performedin silico analysis of publicly available gene expression data sets to investigate CSC gene expression and molecular pathways as well as survival outcomes associated with EP300 expression in patients with TNBC and basal-like BC.Results: EP300 KD abolishedthe CSC phenotype by reducing ABCG2 expression, side population cells andtumorsphere formation capacityin vitro as well as tumor formation in a xenograft mouse model in vivo. Metastatic capacity was markedly reduced in EP300 KD cells in vivo, with no detection of circulating tumor cells.TCGA data analysis demonstrated that genes positively correlated with EP300 expression in TNBC and basal-like BC were associated with CSC biology. Survival analysis demonstrated that EP300 expression predicts poor recurrence free survival in TNBC and basal BC. Conclusion:We report a novel oncogenic role for EP300 in driving CSC phenotyperepresentinga potential target to address tumor initiation and metastatic spread in TNBC and basal-like BC. EP300 might serve as a prognostic marker and potential therapeutic target in TNBC.
LncRNA RP11-757G1.5 sponges miR-139-5p and upregulates YAP1 thereby promoting the proliferation and liver, spleen metastasis of colorectal cancer
Authors: zhu xiaojian , Tan Ting , Luo Qilin , Zhu Jingfeng , Lin Kang , Bu Fanqin , Luo Chen , Zhu Zhengming
Published: May 2020

Background
Accumulating evidence indicates that long non-coding RNAs (lncRNAs) play a crucial role in tumorigenesis. However, the biological functions of lncRNAs in colorectal cancer (CRC) remain unclear.
Methods
Microarray dataset analysis, FISH, RT-qPCR was used to detect RP11-757G1.5 expression in CRC tissues. The biological function of RP11-757G1.5 in CRC was determined by colony formation, Edu cell proliferation, wound healing and transwell assays. Bioinformatics binding site analysis, Luciferase reporter assay, Ago2 immunoprecipitation assays and western blot were performed to demonstrate the mechanism of RP11-757G1.5 acts as a molecular sponge of miR-139-5p. Moreover, we further explore the potential role of RP11-757G1.5 in CRC orthotopic xenografts.
Results
We discovered a novel lncRNA RP11-757G1.5, that was overexpressed in CRC tissues,especially in aggressive cases. Moreover, upregulation of RP11-757G1.5 strongly correlated with poor prognosis of patients with CRC. Functional analyses revealed that RP11-757G1.5 promotes cell proliferation in vitro and in vivo. Furthermore, RP11-757G1.5 enhanced cell migration and invasion in vitro and in vivo. Mechanistic studies demonstrated that RP11-757G1.5 regulated the expression of YAP1 through sponging miR-139-5p and inhibiting its activity thereby promoting CRC progression and development.
Conclusions
Altogether, these results reveal a novel RP11-757G1.5/miR-139-5p/YAP1 regulatory axis that participates in CRC progression and development.
Obesity and Telomere Status in the Prognosis of Colorectal Cancer Patients Submitted to Curative Intention Surgical Treatment
Authors: García-Martínez Sergio , González-Gamo Daniel , Fernández-Marcelo Tamara , Serna Sofía de la , Serrano Inmaculada , Cano-Valderrama Oscar , Barabash Ana , de Juan Carmen , Torres Antonio , Iniesta Pilar
Published: May 2020

Background: Considering that the risk of colorectal cancer (CRC) development has been related to telomere dysfunction and obesity. However, these parameters have not clearly investigated in relation to the clinical evolution of CRC patients. The aim of this study was to evaluate the impact of obesity and telomere status in the prognosis of patients affected by CRC and submitted to curative surgical treatment.Methods: We performed a prospective study including 162 CRC patients submitted to curative surgical treatment. Subjects were classified according to their Body Mass Index (BMI). Telomere status was established through telomere length and telomerase evaluation. Statistical analyses were performed using the SPSS software package version 22.Results: Patients with shorter telomeres, both in the tumor (median telomere length < 6.5 kb) and their non-tumor paired tissues (median telomere length < 7.1 kb), had the best clinical evolution, independently of the Dukes' stage of cancers (P = 0.025, for tumor samples; P = 0.003, for non-tumor samples).Telomere shortening was inversely associated with BMI in CRC patients. Also, subjects with a BMI > 31.85kg/m2 showed the worse clinical outcomes. Of interest, the impact of BMI showed gender dependence, since only the group of men showed significant differences in CRC prognosis in relation to obesity status (P = 0.037).Conclusions: Telomere length constitutes a useful biomarker to predict prognosis in CRC. Independently of BMI values, the better clinical evolution was associated with shorter telomeres. The impact of BMI seems to be related to other factors such as gender.
The Impact of Writing on Academic Performance for Medical Students
Authors: Kim Songeui , Yang Ji Won , Lim Jaeseo , Lee Seunghee , Ihm Jungjoon , Park Jooyong
Published: May 2020

Background Since the 1970s, writing has been widely used in classroom settings. Writing enhances learning, but there are limited studies that prove its effectiveness, especially in the medical education setting. The purpose of this study, therefore, is to investigate the effect of writing on medical students’ academic performance. Methods An experiment was conducted with 139 medical students from Seoul National University College of Medicine. They were randomly assigned to three different groups: self-study (SS), expository writing (EW), and argumentative writing (AW) group. Each group studied the given material by the method they were assigned, and they were tested on their understanding and transfer of knowledge. We also tested students’ higher-order thinking ability using Remote Association Test (RAT). Results The results showed that the writing groups displayed better performance than the SS group in transfer type items, while there was no difference in scores between the EW and AW group. The three groups did not show any difference in rote-memory type items, but RAT scores have a positive correlation with rote-memory scores. Conclusions This study provides empirical evidence for writing to be adopted in classrooms for greater educational benefits, especially in medical education. These findings indicate that writing can enhance learning and higher-order thinking, which are critical for medical students.