bluuebunny/crossref_metadata_2025 huggingface dataset:
Health Assessment Questionnaire-Disability Index (HAQ-DI) use in modelling disease progression in diffuse cutaneous systemic sclerosis: an analysis from the EUSTAR database
Authors: Allanore Yannick , Bozzi Sylvie , Terlinden Augustin , Huscher Doerte , Amand Caroline , Soubrane Christina , Siegert Elise , Czirjak Laszlo , Carreira Patricia E , Hachulla Eric , Zanatta Elisabetta , Li Mengtao , Airò Palo , Mendoza Fabian A , Rosato Edoardo , Distler Oliver
Published: September 2020

Background: Patients with diffuse cutaneous systemic sclerosis (dcSSc) have a poor prognosis. The importance of monitoring subjective measures of functioning and disability, such as the Health Assessment Questionnaire-Disability Index (HAQ-DI), is important as dcSSc is rated by patients as worse than diabetes or hemodialysis for quality of life impairment. This European Scleroderma Trials and Research (EUSTAR) database analysis was undertaken to examine the importance of impaired functionality in dcSSc prognosis. The primary objectives were to identify predictors of death and HAQ-DI score progression over 1 year. HAQ-DI score, major advanced organ involvement, and death rate were also used to develop a comprehensive model to predict lifetime dcSSc progression. Methods: This was an observational, longitudinal study in patients with dcSSc registered in EUSTAR. Death and HAQ-DI scores were, respectively, analyzed by Cox regression and linear regression analyses in relation to baseline covariates. A microsimulation Markov model was developed to estimate/predict natural progression of dcSSc over a patient’s lifetime.Results: The analysis included dcSSc patients with (N = 690) and without (N = 4132) HAQ-DI score assessments from the EUSTAR database. Baseline HAQ-DI score, corticosteroid treatment and major advanced organ involvement were predictive of death on multivariable analysis; a 1-point increase in baseline HAQ-DI score multiplied the risk of death by 2.7 (p < 0.001) and multiple advanced major organ involvement multiplied the risk of death by 2.8 (p < 0.05). Multivariable analysis showed that baseline modified Rodnan Skin Score (mRSS) and baseline HAQ-DI score were associated with HAQ-DI score progression at 1 year (p < 0.05), but there was no association between baseline organ involvement and HAQ-DI score progression at 1 year. HAQ-DI score, major advanced organ involvement, and death were successfully used to model long-term disease progression in dcSSc.Conclusions: HAQ-DI score and major advanced organ involvement were comparable predictors of mortality risk in dcSSc. Baseline mRSS and baseline HAQ-DI score were predictive of HAQ-DI score progression at 1 year, indicating a correlation between these endpoints in monitoring disease progression. It is hoped that this EUSTAR analysis may change physician perception about the importance of the HAQ-DI score in dcSSc.
Percutaneous Endoscopic Unilateral Laminotomy and Bilateral Decompression under 3D Real-Time Image-Guided Navigation for Spinal Stenosis in Degenerative Lumbar Kyphoscoliosis Patient: An Innovative Preliminary Study
Authors: Ho Tsung-Yu , Lin Chung-Wei , Chang Chien-Chun , Chen Hsien-Te , Chen Yen-Jen , Lo Yuan-Shun , Hsiao Pan-Hsuan , Chen Po-Chen , Lin Chih-Sheng , Tsou Hsi-Kai
Published: September 2020

Background: The aim of this study is to introduce a new method of percutaneous endoscopic decompression under 3D real-time image-guided navigation for spinal stenosis in degenerative kyphoscoliosis patients without instability or those who with multiple comorbidities. Decompression alone using endoscope for kyphoscoliosis patient is technical demanding and may result in unnecessary bone destruction leading to further instability. The O-arm/StealthStation system is popular for its ability to provide automated registration with intraoperative, postpositioning computed tomography (CT) with no radiation exposure to operative staffs.Methods: In this study, we presented four cases. All patients were over seventy years old female with variable degrees of kyphoscoliosis and multiple comorbidities who could not endure major spine fusion surgery. Percutaneous endoscopic unilateral laminotomy and bilateral decompression under 3D real-time image-guided navigation were successfully performed. Patients’ demographics, image study parameters, and outcome measurements including pre- and post-operative serial Visual analog scale (VAS), and Oswestry Disability Index (ODI) were well documented. The follow-up time was one year.Results: Pre- and post-operative MRI showed average dural sac cross sectional area (DSCSA) improved from 81.62 (range 67.34-89.07) to 153.27 (range 127.96-189.73). Preoperative neurological symptoms including radicular leg pain improved postoperatively. The mean ODI (%) were 85 (range 82.5-90) at initial visit, 35.875 (range 25-51) at 1 month post-operatively, 26.875 (range 22.5-35) at 6 months post-operatively and 22.5 (range 17.5-30) at 12 months post-operatively (p <0.05). The mean VAS score were 9 (range 8-10) at initial visit, 2.25 (range 2-3) at 1 month post-operatively, 1.75 (range 1-2) at 6 months post-operatively and 0.25 (range 0-1) at 12 months post-operatively (p <0.05). There was no surgery-related complication.Conclusions: To the best of our knowledge, this is the first preliminary study of percutaneous endoscopic laminotomy under O-arm navigation with successful outcomes. The innovative technique may serve as a promising solution in treating spinal stenosis patients with lumbar kyphoscoliosis and multiple comorbidities.
Effects of physical and chemical factors on pseudorabies virus activity in vitro
Authors: Gong Lang , Deng Qiwei , Xu Runda , Ji Chihai , Wang Heng , Zhang Gui-Hong
Published: September 2020

Background: Pseudorabies (PR) is latent and can persist in infected sows for a long time, and thus, convalescent sows can carry the virus throughout life, causing severe economic losses to farmers and posing a tremendous challenge to PR prevention and control. Here, to investigate the biological characteristics of pseudorabies virus (PRV), a variety of physical and chemical factors were analyzed under controlled conditions.Results: The results showed that a high ambient temperature and dry environment led to faster virus inactivation. PRV had a certain resistance to weakly acidic or alkaline environments and was rapidly inactivated in strongly acidic or alkaline environments. The effect of ultraviolet (UV) radiation on PRV activity primarily depended on the frequency, intensity, and irradiation time of the UV exposure. Exposure to sunlight inactivated PRV via multiple factors, including temperature, sunlight intensity, UV intensity, and environmental humidity, and any shielding from sunlight strongly lowered the killing effect. Conventional disinfectants had a good disinfection effect on PRV. Conclusions:. The biological characteristics of different PRV strains are variable. Generally, the activity of PRV is affected by multiple factors, which can show both synergy and antagonism. Real-world conditions should be taken into consideration to guide pork production.
Interferon-beta enhances sensitivity to gemcitabine in pancreatic cancer
Authors: Blaauboer Amber , Booy Stephanie , Koetsveld Peter M. van , Karels Bas , Dogan Fadime , Zwienen Suzanne van , Eijck Casper H.J. van , Hofland Leo J.
Published: September 2020

Background: Adjuvant gemcitabine for pancreatic cancer has limited efficacy in the clinical setting. Impaired drug metabolism is associated with treatment resistance. We aimed to evaluate the chemosensitising effect of interferon-beta (IFN-β).Methods: BxPC-3, CFPAC-1, and Panc-1 cells were pre-treated with IFN-β followed by gemcitabine monotherapy. The effect on cell growth, colony formation, and cell cycle was determined. RT-qPCR was used to measure gene expression. BxPC-3 cells were used in a heterotopic subcutaneous mouse model. Results: IFN-β increased sensitivity to gemcitabine (4-, 7.7-, and 1.7-fold EC50 decrease in BxPC-3, CFPAC-1, and Panc-1, respectively; all P<0.001). Findings were confirmed when assessing colony formation. The percentage of cells in the S-phase was significantly increased after IFN-β treatment only in BxPC-3 and CFPAC-1 by 12% and 7%, respectively (p<0.001 and p<0.05, respectively). Thereby, IFN-β upregulated expression of the drug transporters SLC28A1 in BxPC-3 (252%) and SLC28A3 in BxPC-3 (127%) and CFPAC-1 (223%) (all p<0.001). In vivo, combination therapy reduced tumor volume with 45% (P=0.01). Both ex vivo and in vivo data demonstrate a significant reduction in the number of proliferating cells, whereas apoptosis was increased. Conclusions: For the first time, we validated the chemosensitising effects of IFN-β when combined with gemcitabine in vitro, ex vivo, and in vivo. This was driven by cell cycle modulation and associated with an upregulation of genes involving intracellular uptake of gemcitabine. The use of IFN-β in combination with gemcitabine seems promising in patients with pancreatic cancer and needs to be further explored.
A preliminary multicenter evaluation of endoscopic sublay repair for ventral hernia from China
Authors: Tang Rui , Jiang Huiyong , WU Weidong , Wang Tao , Meng Mengxiang , Liu Guozhong , Cai Xiaoyan , Liu Jianwen , Cui Xijun , Si Xianke , Liu Nan , Wei Nina
Published: September 2020

Background: For ventral hernia, endoscopic sublay repair (ESR) may overcome the disadvantages of open sublay and laparoscopic intraperitoneal onlay mesh repair. This retrospective study presents the preliminary multicenter results of ESR from China. The feasibility, safety, and effectiveness of ESR were evaluated; its surgical points and indications were summarized. Methods: The study reviewed 156 ventral hernia patients planned to perform with ESR in ten hospitals between March 2016 and July 2019. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed.Results: ESR was performed successfully in 153 patients, 135 with totally extraperitoneal sublay (TES) and 18 with transabdominal sublay (TAS). In 19 patients, TES was performed with the total visceral sac separation (TVS) technique, in which the space separation is carried out along the peritoneum, avoiding damage to the aponeurotic structure. Endoscopic transversus abdominis release (eTAR) was required in 17.0% of patients, and only 18.3% of patients required permanent mesh fixation. The median operative time was 135 min. Most patients had mild pain and resume eating soon after operation. No severe intraoperative complications occurred. Bleeding in the extraperitoneal space occurred in two patients and was stopped by nonsurgical treatment. Seroma and chronic pain were observed in 5.23% and 3.07% of patients. One recurrence occurred after TAS repair for an umbilical hernia.Conclusion: ESR is feasible, safe, and effective for treating ventral hernias when surgeons get the relevant surgical skills, such as the technique of “partition breaking,” TVS, and eTAR. Small-to-medium ventral hernias are the major indications.
Serum IgE in the clinical features and disease outcome of IgG4-related disease: a large retrospective cohort study
Authors: Zhou Jiaxin , Peng Yu , Peng Linyi , Wu Di , Li Jing , Jiang Nan , Li Jieqiong , Lu Hui , Liu Zheng , Luo Xuan , Teng Fei , Fei Yunyun , Zhang Wen , Zhao Yan , Zeng Xiaofeng
Published: September 2020

Objective: The aim of this study was to investigate the role of serum IgE levels in the clinical features and outcomes of IgG4-related disease (IgG4-RD). Methods: We retrospectively enrolled 459 newly diagnosed IgG4-RD patients with serum IgE examined at baseline from 2012 to 2019 and compared the clinical features between group A (serum IgE level ≤ 60 KU/L) and group B (serum IgE level > 60 KU/L). Subsequently, 312 patients who had been followed up for ≥ 1 year were further selected to evaluate the correlation between serum IgE level and disease outcome. Results: At baseline, the serum IgE level was positively correlated with the serum IgG4 level (r=0.1779, P=0.0001), eosinophil count (r=0.3004, P<0.0001), and serum IgG level (r=0.2189, P<0.0001) in IgG4-RD patients. Compared with group A, group B had more patients with allergic diseases (P=0.004), more organ involvement (P=0.003), and higher IgG4-RD responder index scores (P=0.002). During follow-up, group A patients had a higher remission induction rate than group B patients (88.4% vs. 73.6%, P=0.035), while group B patients had a higher relapse rate than group A patients (29.0% vs. 16.2%, P=0.039). Multivariate analysis found that a serum IgE level > 125 KU/L at baseline was a risk factor for disease relapse (hazard ratio [HR], 1.894 [95% confidence interval (CI) 1.022–3.508]; P=0.042). Cox regression analysis showed that elevation of the eosinophil count was a risk factor for relapse in both group A and group B patients (HR, 8.504 [95% CI 1.071–42.511]; P=0.009; and HR, 2.078 [95% CI 1.277–3.380]; P=0.003, respectively), and the involvement of the lacrimal gland (HR, 1.756 [95% CI 1.108–2.782]; P=0.017), submandibular gland (HR, 1.654 [95% CI 1.037–2.639]; P=0.035), and kidney (HR, 3.413 [95% CI 1.076–10.831]; P=0.037) were also risk factors for relapse in group B patients.Conclusion: IgG4-RD patients with high serum IgE levels at baseline were more likely to have higher disease activity, and baseline high IgE levels were associated with disease relapse.
Membrane and lipid metabolism plays an important role in desiccation resistance in the yeast Saccharomyces cerevisiae
Authors: Ren Qun , Brenner Rebecca , Boothby Thomas C. , Zhang Zhaojie
Published: September 2020

BackgroundAnhydrobiotes, such as the yeast Saccharomyces cerevisiae, are capable of surviving almost total loss of water. Desiccation tolerance requires an interplay of multiple events, including preserving the protein function and membrane integrity, preventing and mitigating oxidative stress, maintaining certain level of energy required for cellular activities in the desiccated state. Many of these crucial processes can be controlled and modulated at the level of organelle morphology and dynamics. However, little is understood about what organelle perturbations manifest in desiccation-sensitive cells as a consequence of drying or how this differs from organelle biology in desiccation-tolerant organisms undergoing anhydrobiosis.ResultsIn this study, electron and optical microscopy was used to examine the dynamic changes of yeast cells during the desiccation process. Dramatic structural changes were observed during the desiccation process, including the diminishing of vacuoles, decrease of lipid droplets, decrease in mitochondrial cristae and increase of ER membrane, which is likely caused by ER stress and unfolded protein response. The survival rate was significantly decreased in mutants that are defective in lipid droplet biosynthesis, or cells treated with cerulenin, an inhibitor of fatty acid synthesis.ConclusionOur study suggests that the metabolism of lipid droplets and membrane may play an important role in yeast desiccation tolerance by providing cells with energy and possibly metabolic water. Additionally, the decrease in mitochondrial cristae coupled with a decrease in lipid droplets is indicative of a cellular response to reduce the production of reactive oxygen species.
Population Frequencies Determined by Next-generation Sequencing Provide Strategies for Prospective HLA Epitope Matching for Transplantation
Authors: Tran Jenny , Gunther Oliver , Sherwood Karen , Fenninger Franz , Allan Lenka , Lan James , Sapir-Pichhadze Ruth , Duquesnoy Rene , Claas Frans , Marsh Steven , McMaster W. Robert , Keown Paul
Published: September 2020

Compatibility for human leukocyte antigen (HLA) genes between transplant donors and recipients improves graft survival but prospective matching is rarely performed due to the vast heterogeneity of this gene complex. To reduce complexity, we have combined next-generation sequencing and in silico mapping to determine population frequencies and matching probabilities of 150 antibody-binding eplets across all 11 classical HLA genes in 2000 ethnically heterogeneous renal patients and donors. We show that eplets are more common and more uniformly distributed between donors and recipients than the respective HLA isoforms. Simulation of targeted eplet matching shows that a high degree of overall compatibility, and perfect identity at the clinically important HLA class II loci, can be obtained within a patient waiting list of approximately 250 subjects. Internal epitope-based allocation is thus feasible for most major renal transplant programs, while regional or national sharing may be required for other solid organs.
Comparative analysis of clinical factors associated with pedicle screw pull-out between intraoperative cone-beam computed tomography and postoperative computed tomography
Authors: Sumiya Satoshi , Fukushima Kazuyuki , Kurosa Yoshiro , Hirai Takashi , Inose Hiroyuki , Yoshii Toshitaka , Okawa Atsushi
Published: September 2020

Background: No studies to date have elucidated the clinical factors associated with pedicle screw pull-out. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with scans acquired postoperatively using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods: This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results: Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 (34.2%) patients. There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval, 1.12–10.00).Conclusions: Several cases of intraoperative pedicle screw pull-out may be caused by use of connecting rods. Older age and DISH are risk factors for pedicle screw pull-out.
Tennis Elbow, study protocol for a randomized clinical trial: Needling With and Without Platelet-rich Plasma After Failure of Up-to-date Rehabilitation
Authors: SCHWITZGUEBEL ADRIEN J-P , Bogoev Mitko , Nikolov Viktor , Ichane Freddy , Laedermann Alexandre
Published: September 2020

Background: The conservative management of lateral epicondylitis is known to be a difficult-to-treat annoying condition. A treatment with platelet-rich plasma (PRP) is often performed, but its efficacy remains controversial. Methods: This study is a single-center, randomized double-blind controlled trial, preceded by a case series. All the 232 planned patients of the case series will undergo an up-to-date comprehensive rehabilitation program, including focused extracorporeal shock waves therapy. This rehabilitation program is expected to have a maximum success rate 75%. It is therefore aimed to allocate a minimum of 58 patients with rehabilitation failure into the 1:1 randomized trial. Stratification is planned on age and lesion pattern. The masking will be quadruple (Participant, Care Provider, Investigator & Outcome Assessor). The patients will undergo an ultrasound (US)-guided needling combined with either PRP (intervention group) or saline (Control group). The primary endpoint will be the pain improvement from baseline (month 0) at 3 months on a 0-10 visual analog scale (VAS) during a maximal strength isometric contraction of the extensor carpialis brevis muscle. The main secondary endpoints will include the rehabilitation success rate and improvements from baseline at 3, 6 and 12 months of the following outcomes: (i) Single Assessment Numeric Evaluation (SANE) score, (ii) Patient-Rated Tennis Elbow Evaluation (PRTEE) score, (iii) maximal grip strength on Jamar test, and (iv) the ultrasonographic evaluation of the US of the epicondylar tendons.Discussion: The study results will provide insight into the effect of PRP as adjuvant therapy to tendon fenestration, and may contribute to identify the best preceding and concomitant rehabilitation protocol. Trial registration: ClinicalTrials.gov: NCT03987256, registered 20 August 2019
Bayesian Multilevel Model on Maternal Mortality in Ethiopia
Authors: Dugasa Shibiru Jabessa , Dugasa Dabala Jabessa
Published: September 2020

Maternal mortality is one of the socio-economic problems and widely considered a serious indicator of the quality of a health. Ethiopia is considered to be one of the top six sub-Saharan countries with severe maternal mortality. The objective of this study was to investigate the effects of the Demographic and Socio-economic determinant factors of maternal mortality in Ethiopia. Data from the 2016 Ethiopia Demographic and Health Survey indicated that the sample of women (15-49) was (n=10103). The Bayesian multilevel l was used to explore the major risk factors and regional variations in maternal mortality in Ethiopia. MCMC methods with non-informative priors have been applied. The DIC model selection criteria were used to select the appropriate model. The analysis result, 145(1.43%) mothers were died due to pregnancy. Using model selection criteria Bayesian multilevel random coefficient was found to be appropriate. With this model, Age of mother, marital status, number of living children, wealth index and Education are found to be the significant determinants of maternal mortality in Ethiopia. The study indicated that there was within and between regional variations in maternal mortality. Inference is the fully Bayesian multilevel model based on recent Markov chain Monte Carlo techniques. Some of the socioeconomic, demographic and environmental determinants included in the study were found to be statistically significant. The result of the Bayesian multilevel model in this study has shown that educational attainment, wealth index, an age of mother, marital status and number of living children was a significant factor of maternal mortality.
Continuous extracorporeal treatments in a dialysis patient with COVID-19
Authors: Nihei Yoshihito , Nagasawa Hajime , Fukao Yusuke , Kihara Masao , Ueda Seiji , Gohda Tomohito , Suzuki Yusuke
Published: September 2020

The coronavirus disease 2019 (COVID-19) pandemic is now a major global health threat. More than half a year have passed since the first discovery of severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), no effective treatment has been established especially in intensive care unit. Inflammatory cytokine storm caused by SARS-CoV-2 infection has been reported to play a central role in COVID-19; therefore, treatments for suppressing cytokines, including extracorporeal treatments, are considered to be beneficial. However, until today the efficacy of removing cytokines by extracorporeal treatments in patients with COVID-19 is unclear. Herein, we report our experience with a 66-year-old male patient undergoing maintenance peritoneal dialysis who became critically ill with COVID-19 and underwent several extracorporeal treatment approaches including plasma exchange, direct hemoperfusion using a polymyxin B-immobilized fiber column and continuous hemodiafiltration. Though the patient developed acute respiratory distress syndrome (ARDS) repeatedly and subacute cerebral infarction and finally died for respiratory failure on day 30 after admission, these attempts appeared to dampen the cytokine storm based on the observed decline in serum IL-6 levels and were effective against ARDS and secondary haemophagocytic lymphohistiocytosis. This case suggests the significance of timely initiation of extracorporeal treatment approaches in critically ill patients with COVID-19.
Risk factors for pulmonary interstitial fibrosis in patients with systemic sclerosis
Authors: Yang Ji , Cui Xiangxiang , Li Ming
Published: September 2020

Background

Pulmonary interstitial fibrosis (PIF) is a frequent manifestation of systemic sclerosis (SSc). However, there is a lack of good clinical indicators for predicting PIF. Here, we evaluated autoantibodies and clinical phenotypes to predict the involvement of PIF in SSc.
Methods

Peripheral blood was collected from the 86 SSc patients enrolled in this study to detect autoantibodies. PIF, lung function, and heart function were analyzed by lung high-resolution computed tomography, pulmonary function test, and standard transthoracic echocardiography, respectively. The correlation between autoantibodies, clinical phenotype, and internal organ involvement were summarized.
Results

PIF occurred in 68.4% anti-SCL-70 antibody positive SSc patients (p = 0.0045), 59.8% anti-centromere antibody negative SSc patients (p = 0.0013), and 71.4% anti-SSA antibody positive SSc patients (p = 0.0107). PIF occurred in 94.1% anti-SCL-70 antibody and anti-SSA antibody double positive SSc patients, which was higher than in anti-SCL-70 antibody single positive patients, p = 0.0452. More SSc patients with digital ulcers had PIF (73.5%) than SSc patients without digital ulcers (p = 0.0008).
Conclusion

These data suggest that SSc patients with double positive for anti-SCL-70 and anti-SSA antibodies are more prone to develop PIF. In addition, digital ulcers are an important and convenient predictor for PIF in SSc patients.
Clinical and Hemodynamic Characterization Super Responders to IV Prostacyclin
Authors: Conger Adrienne K , Halliday Steven J , Pugh Meredith E , Robbins Ivan M , Hemnes Anna R
Published: September 2020

BackgroundParenteral prostacyclins are the only therapy proven to extend survival in pulmonary arterial hypertension (PAH), yet at the bedside clinicians have no tools to predict which patients are most likely to benefit from this medication class. MethodsWe retrospectively analyzed all PAH patients treated with IV epoprostenol therapy at our center from 1/1/1996 to 12/31/2016. We analyzed survival in patients and defined the 90 th percentile of survival. Patients were divided into those who survived past this point (super responders) and those who had had an event prior to this time point after initiation of iv epoprostenol (usual responders).ResultsThe median survival after IV epoprostenol initiation was 4.32 years, and the 90 th percentile of event-free survival was 11.09 years. Fourteen patients met criteria for super responder and 45 had a survival <90 th percentile, comprising the usual responder group. Super responders tended to be younger, have longer six-minute walk distances and higher mean pulmonary arterial pressure (p<0.05 for all). In follow up, super responders continued to have a higher six-minute walk distance and were more likely to have achieved normal or only mildly impaired right ventricular function, though no differences in hemodynamics were observed.ConclusionsThere may be a super responder phenotype that can be defined in patients with PAH by >90 th percentile of survival. Super responders were more likely that usual responders to be younger and were more likely to have achieved favorable right ventricular function at follow up, however, differences in hemodynamics were not observed.
Blood pressure prediction by exploiting informative features from ICU patients’ ECG and PPG signals under a heterogeneous ensemble learning framework
Authors: Qin Keke , Xu Guobiao , Huang Jun
Published: September 2020

BackgroundAlthough invasive methods are currently used to monitor blood pressure (BP) for intensive care patients, accurate and timely non-invasive BP monitoring in non-invasive way is still significant. Yet, physiological signal data of patients is irregular, with more noise and abnormal patterns included, making accurate and stable prediction challenging. The traditional BP measurement methods are cuff-based, and the prediction accuracy and stability of the machine learning based cuff-less prediction model needs to be further improved. Additionally, data must be cleaned and effective features must be grubbed from the irregular signals, which is a prerequisite for model training.ResultsIn the present study, we proposed a novel heterogeneous ensemble learning BP prediction (ELBP) model, where: 1) Related features are systematically extracted and selected for systolic, diastolic and mean BP prediction tasks; 2)Then, multiple regression models are trained and then are weighted for final prediction, wherein the weights are learned from data; 3) Hyper-parameters of each model are optimised using Bayesian optimisation based on cross-validation. We experimentally verified the ELBP effectiveness, the mean absolute error of ELBP is 1.802 mmHg, 3.936 mmHg and 3.121 mmHg for diastolic, systolic and mean BP respectively on mimic-1, and 2.722 mmHg, 5.039 mmHg and 3.812 mmHg respectively on mimic-2. Further experiments demonstrated that ELBP performance is superior to state-of-the-art algorithms on seven evaluation metrics.ConclusionIn conclusion, BP prediction precision can be further improved by integrating multiple learners appropriately, and this study is valuable in promoting BP prediction in practical application.
Improving Efficiency for Discovering Business Processes Containing Invisible tasks in Non-free Choice
Authors: Sarno Riyanarto , Sungkono Kelly Rossa , Taufiqulsa’di Muhammad , Darmawan Hendra , Fahmi Achmad , Triyana Kuwat
Published: September 2020

Process discovery helps companies to automatically discover their existing business processes based on the huge, stored event log. The algorithms of process discovery have been developed rapidly to discover several types of relations, i.e., choice relations, non-free choice relations with invisible tasks. Invisible tasks in non-free choice, introduced by α $ method, is a type of relation that combines the non-free choice and the invisible task. α $ proposed rules of ordering relations of two activities for determining invisible tasks in non-free choice. The event log records sequences of activities, so the rules of α $ check the combination of invisible task within non-free choice. The checking processes is time consuming, and results in high computing times of α $. This research proposes Graph-based Invisible Task (GIT) method to discover efficiently invisible tasks in non-free choice. GIT method develops sequences of business activities as graphs and determines rules to discover invisible tasks in non-free choice based on relations of the graphs. The analysis of the graph relations by rules of GIT is more efficient than the iterative process of checking combined activities by α $. This research measures the time efficiency of storing the event log and discovering a process model to evaluate GIT algorithm. Storing a streaming event log in a graph-database has the lowest computing time than storing in other databases, i.e., SQL and MongoDB. Discovering a process model by GIT algorithm has less time complexity than that by α $, wherein GIT obtains O(n3) and α $ obtains O(n4) . In terms of computing time, GIT algorithm is 0.89 faster on batch event log and 0.85 seconds faster on streaming event log than α $. Those results of the evaluation show a significant improvement of GIT method in term of time efficiency.
Consequences of Exposure to Prenatal Famine on Estimated Glomerular Filtration Rate and Risk of Chronic Kidney Disease Among Survivors of the Great Ethiopian Famine (1983-85): A Historical Cohort Study
Authors: Abate Kalkidan Hassen , Abdulahi Misra , Abdulhay Fedlu , Aragie Getachew , Abafogi Mohammed Mecha , Yenuss Mohammed , Hassen Habtamu , Belachew Tefera
Published: September 2020

Background: The impact of an adverse prenatal environment such as famine exposure on development of adulthood non communicable chronic illnesses, including diabetes and hypertension has been well articulated in the recent past and supported by evidence. However, there exist a limited number of longitudinal studies on long term consequences of prenatal famine on adulthood kidney function. Hence, we set out to examine whether prenatal exposure to the Ethiopian Great Famine (1983–1985) was associated with changes in estimated glomerular filtration rate (GFR) and risk of developing chronic kidney disease (CKD) during adulthood.Methods: The study was conducted in 219 famine exposed and 222 non exposed cohorts in Raya Kobo district, North Wollo Zone, Northern Ethiopia. Estimated GFR was computed using the CKD Epidemiology Collaboration (The CKD-EPI) equation. CKD was defined as eGFR= <60 mL/min per 1.73 m2. Linear and logistic regression analyses were employed to examine the independent effect of prenatal famine exposure on eGFR and CKD respectively.Results: The mean (SD) serum creatinine of exposed and non-exposed groups were 0.78 (0.2) and 0.75 (0.2) respectively. The mean (SD) eGFR of exposed groups was 107.95 (27.49) while the non-exposed 114.48 (24.81) ml/min. In linear regression, unadjusted model to examine the association between famine exposure and eGFR resulted in a significant negative beta coefficient (β = -0.124: 95% CI: -11.43, -1.64). Adjusting the exposure for outstanding covariates of kidney health, including systolic blood pressure, fasting blood sugar and blood glucose did not alter the inverse relationship (β = -.114 95% CI:-10.84, -1.17). In binary unadjusted logit model, famine exposure resulted in nearly 2.7 times increased odds of developing CKD (OR: 2.68, 95% CI: 1.16, 6.2). The odds remained equivalent after adjusting for systolic blood pressure, fasting blood glucose and BMI (OR= 2.61: 95% CI: 1.120, 6.09).Conclusion: prenatal exposure to the Great Ethiopian Famine was associated with decreased eGFR and greater risk of CKD among survivors. These findings may imply that famine in early life may play significant role in the development of kidney dysfunction in adulthood.
The Pattern of Road Accidents in Fog and the Related Factors in North of Iran in 2014-2018 ​
Authors: Khodadadi-Hassankiadeh Naema , Rad Enayatollah Homaei , Koohestani Hannaneh Shafei , Kouchakinejad-Eramsadati Leila
Published: September 2020

Objectives: Road fog can form suddenly which necessitates more caution by the researchers as well as drivers due to low vision and related morbidities and mortalities. This study aimed at determining the pattern of accidents in fog and the relationship between driver, road, and accident with injury level in Guilan, Iran from 2014 to 2018. Methods: This is a retrospective descriptive-analytical study that investigated all accidents that had occurred in Guilan from 2014 to 2018. All of the data were entered into STATA software. The time-series estimators were used as the multivariate regression model for the presence or absence of any relationship between variables.Results: In fog, the fatality rate of traffic accidents was significantly higher than other climatic conditions (IRR = 1.471). The likelihood of fatalities in fog decreased with age while it increased when drivers were female (p = 0.001). Most of the accidents in fog condition had occurred in December (p=0.000), February (p=0.001) and November (p=0.012). The number of related injuries at 2 AM (p = 0.032), 3 AM (p = 0.019), and 2 PM (p = 0.02) significantly reduced. Moreover, the rate of mortality at 2 AM (p = 0.005), 9 AM (p = 0.012), 11 AM (p = 0.004), 13 PM (p = 0.008) and 19 PM (p = 0.003) were significantly lower. The rate of injuries was significantly higher in Anzali (P = 0.042) and Rasht (P = 0.018), respectively.Conclusion: In the fog, the fatality rate was significantly higher than that of other conditions. The pattern of accidents in fog decreased with age and increased in accidents involving female drivers. Most of the fatal accidents had occurred in fog in November, January and February, respectively. Road accidents in Anzali and Rasht cities were more fatal.
Tunneling current modulation in atomically precise graphene nanoribbon heterojunctions
Authors: Senkovskiy Boris , Nenashev Alexey , Alavi Seyed , Falke Yannic , Hell Martin , Bampoulis Pantelis , Rybkovskiy Dimitry , Usachov Dmitry , Fedorov Alexander , Chernov Alexander , Gebhard Florian , Meerholz Klaus , Hertel Dirk , Arita Masashi , Okuda Taichi , Miyamoto Koji , Shimada Kenya , Fischer Felix , Michely Thomas , Baranovskii Sergei , Lindfors Klas , Szkopek Thomas , Grueneis Alexander
Published: September 2020

Lateral heterojunctions of atomically precise graphene nanoribbons (GNRs) hold promise for applications in nanotechnology, yet their charge transport and most of the spectroscopic properties have not been investigated. Here, we synthesize a monolayer of multiple aligned heterojunctions consisting of quasi-metallic and wide-bandgap GNRs, and report characterization by scanning tunneling microscopy, angle-resolved photoemission, Raman spectroscopy, and charge transport. Comprehensive transport measurements as a function of bias and gate voltages, channel length, and temperature reveal that charge transport is dictated by tunneling through the potential barriers formed by wide-bandgap GNR segments. The current-voltage characteristics are in agreement with calculations of tunneling conductance through asymmetric barriers. We fabricate a GNR heterojunctions based sensor and demonstrate greatly improved sensitivity to adsorbates compared to graphene based sensors. This is achieved via a new concept in sensing, namely the modulation of the tunneling barriers by adsorbates.
Low Birth Weight Trends in OECD Countries, 2000-2015: Economic and Health System Conditionings
Authors: Alonso-Molero Jéssica , Erasun Diego , Gómez-Acebo Inés , Dierssen-Sotos Trinidad , Llorca Javier , Schneider José
Published: September 2020

Background: Low birth weight rates are increasing in developed countries. However, little is known of economic or organization factors influencing this increase. This study aims to ascertain the 21st century relationships between the contextual country factors and low birth weight rates.Methods: We analyse trends of low birth weight rates in OECD countries. Data from 2000 to 2015 were obtained from the OECD data base. Their relationships with demographic and economic variables, health habits, woman-related preventive measures, health care system organization and funding, health care work force and obstetric care were analysed using random-effects linear regression.Results: Low birth weight rates are higher in Southern Europe and lower in Northern Europe. Low birth weight rates escalated about 20% in Southern Europe and to less extent in Easter Europe and Asian/Oceanian countries, while remained stable in America, Central Europe and Northern Europe. Investment in health care, private health system coverage, ratios of paediatricians and obstetricians, average length of admission due to pregnancy or birth and Caesarean section rate were associated with higher low birth weight rates. Factors associated with lower low birth weight rates were health care coverage, public health system coverage, hospitals per million inhabitants, and ratios of health care workers, physicians, midwives and nurses.Conclusions: Low birth weight rates are higher and are stepping faster in Southern Europe than in other developed countries. Many factors on health care system organization and funding as well as rations of health care workers were associated with low birth weight rates.
“Since I’m a little bit more mature”: Contraception and the Arc of Time for Women in Midlife
Authors: Alspaugh Amy , Reibel Melody , Im Eun-Ok , Barroso Julie
Published: September 2020

Background: Birth control methods have rapidly evolved over the past several decades, but little research has explored how women interact with contraception over time. Exploring contraceptive beliefs, perceptions, and attitudes of women in midlife can reveal much about how lived experience affects contraceptive decisions and reproductive health choices. Methods: Individual, semi-structured interviews were conducted with 20 women between the ages of 40 and 55 who had not reached menopause and did not have a permanent method of sterilization. Data were coded using qualitative descriptive methods.Results: Three major themes were identified: 1) journey toward empowerment; 2) finding the right fit: evolution over time; and 3) anticipating a transition. Past experiences with or fear of side effects and hormones were common reasons to change or avoid certain birth control methods. Most participants were happy with their contraceptive method; however, those who were unhappy were more likely to vocalize fatigue at continuing to need contraception as menopause approached.Conclusion: Approaching contraceptive counseling from a place that considers the journey with contraception over a reproductive life span will help identify how beliefs, perceptions, and attitudes of women affect their contraceptive practices and choices.
Cross-platform Profiling of ctDNA Using ddPCR: Standardization of the Liquid Biopsy for Pediatric Diffuse Midline Glioma
Authors: Li Daphne , Bonner Erin R , Wierzbicki Kyle , Panditharatna Eshini , Huang Tina , Lulla Rishi , Mueller Sabine , Koschmann Carl , Nazarian Javad , Saratsis Amanda Muhs
Published: September 2020

Background Diffuse midline glioma (DMG) is a highly morbid pediatric brain tumor. Up to 80% of DMGs harbor mutations in histone H3-encoding genes, associated with poorer prognosis. We previously showed the feasibility of detecting H3 mutations in circulating tumor DNA (ctDNA) in the liquid biome of children diagnosed with DMG. However, detection of low ctDNA concentrations is highly dependent on platform sensitivity and sample type. To address this, we optimized ctDNA detection sensitivity and specificity across two commonly used digital droplet PCR (ddPCR) platforms (RainDance and BioRad), and validated methods for detecting H3F3A mutations in DMG CSF, plasma, and primary tumor specimens across three different institutions. Methods DNA was extracted from H3.3K27M mutant and H3 wildtype (H3WT) specimens, including H3.3K27M tumor tissue (n=4), CSF (n=6), plasma (n=4), and human primary pediatric glioma cells (H3.3K27M, n=2; H3WT, n=1). ctDNA detection was enhanced via PCR pre-amplification and use of distinct custom primers and fluorescent LNA probes for c.83 AàT H3F3A mutation detection. Mutation allelic frequency (MAF) was determined and validated through parallel analysis of matched H3.3K27M tissue specimens (n=3). Results We determined technical nuances between ddPCR instruments, and optimized sample preparation and sequencing protocols for H3F3A mutation detection and quantification. We observed 100% sensitivity and specificity for mutation detection in matched DMG tissue and CSF across assays, platforms and institutionsConclusion Our study demonstrates that ctDNA is reliably and reproducibly detected in ctDNA using ddPCR, representing a clinically feasible and reproducible minimally invasive approach for DMG diagnosis, molecular subtyping and therapeutic monitoring.
Circular RNA circFADS2 is Overexpressed in Sepsis and Suppresses LPS-Induced Lung Cell Apoptosis by Inhibiting the Maturation of miR-15a-5p
Authors: Hong Xiaoyang , Li Shuanglei , Wang Jie , Zhao Zhe , Feng Zhichun
Published: September 2020

Circular RNA circFADS2 plays protective roles in LPS-induced inflammation, which promotes sepsis, suggesting its involvement of circFADS2 in sepsis. We then analysis the involvement of circFADS2 in LOS Expression of circFADS2, mature miR-15a-5p and miR-15a-5p precursor in plasma samples (collected at two time points) from sepsis patients (n=60) and healthy controls (n=60) was determined by RT-qPCR. The expression vector of circFADS2 was transfected in lung cells, followed by the measurement of the expression levels of mature miR-15a-5p and miR-15a-5p precursor to study the role of circFADS2 in the maturation of miR-15a-5p. Cell apoptosis was analyzed by cell apoptosis assay.CircFADS2 was upregulated in sepsis and inversely correlated with mature miR-15a-5p, but not miR-15a-5p precursor. In lung cells, overexpression of circFADS2` decreased the levels of mature miR-15a-5p expression, but not miR-15a-5p precursor. LPS treatment decreased the expression levels of miR-15a-5p, and increased the expression levels of circFADS2. Cell apoptosis analysis showed that circFADS2 overexpression reduced the enhancing effects of miR-15a-5p overexpression on the apoptosis of lung cells induced by LPS.Therefore, circFADS2 is upregulated in sepsis and suppresses LPS-induced lung cell apoptosis by inhibiting the maturation of miR‑15a‑5p.
Complementary Local and Nonlocal Measurements of Conjugate Transformation - Unified Logic Representation of Conjugate 0-1 Vectors
Authors: Zheng Jeffrey
Published: September 2020

Bohr proposed the complementarity principle in 1927 as the foundation of quantum mechanics, since then relevant debates have been critically discussed for many years. Applying a pair of spin particles, Einstein proposed the EPR paradox in 1935. Using nonlocal potential properties, Aharonov and Bohm proposed the AB effect to test complementary measurement results. Under locality conditions, Bell established a Bell inequality under classical logic. Using a pair of particles and double sets of ZMI devices for complementarity measurements, Hardy proposed the Hardy paradox in 1992. During the past 50 years, locality and nonlocality tests on complementarity were hot-topics among the advanced quantum information, computing and measurement directions with various theoretical extensions and solid experimental results.These complementarity approaches separated local/nonlocal parameters to form different equations without an integrated logic framework to describe these equations including both local and nonlocal features consistently. The main results provide a series of paradoxes that conflict with each other. This paper uses conjugate transformation. Based on the m+1 kernel form of 0-1 states, n pairs of conjugate partitions were established. Under a given configuration in N bits, a set of 2n 0-1 feature vectors are applied to construct conjugate transformation operators in logic levels with intrinsic measurements to be a set of measurement operators.The key results of the paper are listed in Theorem 5. Two special functions of vector logic (CNF or DNF expression) and four equivalent expressions of the elementary equation are examples to show local and nonlocal variables in equations consistently. Applying two pairs of conjugate sets  and their complementary sets , 4 meta measures are established corresponding to <±aA;±bB> quantitative features under measurement operators. The main results of the paper are represented in Lemma (1-4), Theorem (1-5) and Corollary (1-7). From a vector logic viewpoint, conjugate complementary scheme can organize local and nonlocal variables to satisfy the comprehensive properties of modern logic constructions on completeness, non-conflict and consistence in a united logic framework.