bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of comminuted mid-shaft clavicular fractures: Comparison between dual-plate fixation treatment and single-plate fixation
Authors: Zhuang Yunqiang , Zhang Yadi , Zhou Long , Zhang Jun , Jiang Gangqiang , Wu Ji
Published: April 2020

Background:

We consider dual-plate fixation to improve construct rigidity in cases with fracture complexity. The purpose of this study is to compare the rate of nonunion, prognosis, and complications at 6–12 months for surgically treated acute mid-shaft clavicle fractures when extra-periosteal dual-plate fixation is used in place of the conventional single-plate fixation.

Materials and Methods:

The comparative study was conducted on 47 patients who received acute mid-shaft clavicular fracture treatment in our hospital from March 2015 to July 2018. All patients were divided into dual-plate fixation treatment (group A) and single-plate fixation (group B). Patients undergoing single-plate fixation were compared to dual-plate fixation. Patients were followed up for 6–12 months. Charts were reviewed to assess union rates, prognosis, and complications.

Results:

Forty-seven clavicles (30 single plates and 17 dual plates) were evaluated. All patients (100%) in dual plating group and 128 (93.3%) in single plating group obtained bony union by 1 year. When comparing groups at 3 months, radiographic union was present in 50.0% of single plates and 64.7% in the dual plating group ( p = 0.032). However, at 6 months, no significant difference existed (90.0% vs. 94.1%, p = 0.297). Comparing groups at 1.5 and 6 months, Constant–Murley outcome scores were present with no significant difference ( p = 0.129, p = 0.054) between single plates and dual plating group. However, at 3 months, significance difference existed.

Discussion:

Three months after the operation, patients with dual-plate fixation showed good functional recovery. Extra-periosteal dual plating for acute mid-shaft clavicle fractures can be safely considered for the treatment of complex acute mid-shaft clavicle fractures without increasing the risk of nonunion or revision.

Conclusions:

Open reduction and internal fixation with an extra-periosteal dual plating technique is a reliable option for treatment of acute mid-shaft clavicle fractures, especially in the setting of severely comminuted fractures and in situations where bone quality is questionable and additional fixation is desired.
Does Clinical Legal Education Need Theory?
Authors: McFaul Hugh
Published: April 2020

Clinical legal education (CLE) is an increasingly common feature of legal education programmes in higher education around the world. The growth in this area has led to a developing academic literature facilitated by specialist journals and conferences, which have produced a largely pragmatic and practice-orientated discourse, with relatively little discussion of wider theoretical issues and their relevance to this area of academic practice. This conceptual study contextualizes the growth of CLE in the UK by considering the influence of two neoliberal policy drivers: marketization and the decline in publicly funded legal advice and representation. It proceeds to consider how these policies have helped to shape the practice-oriented focus of the literature on this area before making an argument that giving more explicit focus to theoretical issues has the potential to enrich the growing body of CLE literature.
Selection and screening of drought tolerant high yielding chickpea genotypes based on physio-biochemical indices and multi-environmental yield trials
Authors: Shah Tariq Mahmud , Imran Muhammad , Atta Babar Manzoor , Ashraf M. Yasin , Hameed Amjad , Waqar Irem , Shafiq M. , Hussain Khalid , Naveed M. , Aslam M. , Maqbool Muhammad Amir
Published: April 2020

Background

Chickpea is one of the major legume crops being cultivated in the arid and semi-arid regions of Pakistan. It is mainly grown on the marginal areas where, terminal drought stress is one of the serious threats to its productivity. For defining the appropriate selection criteria for screening drought tolerant chickpea genotypes, present study was conducted. Distinct chickpea germplasm was collected from different pulses breeding institutes of Pakistan and evaluated for drought tolerance at germination and early seedling stages, furthermore, at late vegetative growth stages physiochemical traits and multi-environment yield performance were also tested.

Results

Chickpea genotypes under different environments, were significantly varied for different seedling traits, physio-chemical attributes and seed yield. Genotypes showing drought tolerance by performing better at an early seedling stages were not correspondingly high yielding. Screening for drought tolerance on seed yield basis is the most appropriate trait to develop the drought tolerant as well as high yielding chickpea genotypes. Results confirmed that traits of early growth stages were not reflecting the drought tolerance at terminal growth stages and also did not confer high yielding. NIAB-rain fed environment proved ideal in nature to screen the chickpea genotypes whereas, NIAB-lysimeter and Kalur Kot was least effective for selecting genotypes with high seed yield. Genotypes D0091–10, K010–10, D0085–10, K005–10, D0078–10, 08AG016, 08AG004, D0080–10, 09AG002, K002–10 and D0099–10 were high yielding and drought tolerant based on their performance across multiple hotspot environments.

Conclusions

The selected genotypes are intended for further evaluation for varietal approval to recommend for general cultivation on farmer fields in drought hit areas of Pakistan. Among physio-biochemical traits, higher proline, glycine betain, RWC and CMS were reflecting the higher capability to tolerate the drought stress in chickpea. Drought sensitive genotypes (K0037–10, 2204, K0052–10, 09AG015, K0042–10, CM709/06, K0068–10, K004–10, K0026–10 and K0063–10) were also identified in present study which were resourceful asset for using as contrasting parents in hybridization programs. To our knowledge, this is first report using an integrated approach involving, physio-biochemical indices, and multi-environmental yield trials, for comparison, screening and selection of chickpea genotypes for drought tolerance.
Comparison of two Norepinephrine rescue bolus for Management of Post-spinal Hypotension during Cesarean Delivery: a randomized controlled trial
Authors: Hassabelnaby Yasmin S. , Hasanin Ahmed M. , Adly Nada , Mostafa Maha M. A. , Refaat Sherin , Fouad Eman , Elsonbaty Mohamed , Hussein Hazem A. , Mahmoud Mohamed , Abdelwahab Yaser M. , Elsakka Ahmed , Amin Sarah M.
Published: April 2020

Background

Data on the best norepinephrine bolus dose for management of hypotension are limited. The aim of this study was to compare the efficacy and safety of two norepinephrine bolus doses in the rescue management of maternal hypotension during cesarean delivery.

Methods

This randomized, controlled trial included mothers scheduled for cesarean delivery with spinal anesthesia with a prophylactic norepinephrine infusion. Following spinal anaesthesia administration, a participant was considered hypotensive if systolic blood pressure was ≤80% compared to the baseline reading. Participants were allocated to receive either 6 mcg or 10 mcg norepinephrine bolus for the management of hypotensive episodes. The hemodynamic response after administration of norepinephrine bolus was recorded. The episode was considered successfully managed if systolic blood pressure returned to within 80% from the baseline reading within 2 min after norepinephrine bolus administration, and did not drop again within 6 min after the norepinephrine bolus. The primary outcome was the incidence of successful management of the first hypotensive episode. Other outcomes included systolic blood pressure, heart rate, incidence of maternal bradycardia, and reactive hypertension.

Results

One hundred and ten mothers developed hypotensive episodes and received norepinephrine boluses for management. The number of successfully managed first hypotensive episodes was 50/57 (88%) in the 6 mcg-treated episodes and 45/53 (85%) in the 10 mcg-treated episodes (p = 0.78). Systolic blood pressure was comparable after administration of either bolus dose. Heart rate was lower after administration of 10 mcg bolus compared to 6 mcg bolus, without significant bradycardia requiring atropine administration. The incidence of reactive hypertension was comparable between both groups.

Conclusion

In mothers undergoing elective cesarean delivery under prophylactic norepinephrine infusion at 0.05 mcg/kg/min, there was no advantage to the use of 10 mcg norepinephrine bolus over 6 mcg norepinephrine bolus for the rescue management of first hypotensive episode. Neither of the 2 bolus doses reached a 100% success rate. The incidences of bradycardia and reactive hypertension were comparable between both norepinephrine doses.

Trial registration

At clinicaltrial.gov registry system on January 4, 2019 Clinical trial identifier:NCT03792906.
Correction to: Efficiency as a determinant of loyalty among users of a Community of Clinical Practice: a comparative study between the implementation and consolidation phases
Authors: Tintorer David Lacasta , Domínguez Josep Maria Manresa , Jiménez-Zarco Ana , Rodríguez-Blanco Teresa , Beneyto Souhel Flayeh , Torán-Monserrat Pere , Tuduri Xavier Mundet , Saigí-Rubió Francesc
Published: April 2020

Following publication of the original article [1], in order to comply with the current regulations for the submission of Doctoral Thesis by compendium of articles, the Universitat Autónoma de Barcelona Doctoral School asks us to update the affiliation number 3, adding “Departament de Medicina” at the beginning, as follows:
Retrospective analysis of salvage surgery for local progression of brain metastasis previously treated with stereotactic irradiation: diagnostic contribution, functional outcome, and prognostic factors
Authors: Mitsuya Koichi , Nakasu Yoko , Hayashi Nakamasa , Deguchi Shoichi , Oishi Takuma , Sugino Takashi , Yasui Kazuaki , Ogawa Hirofumi , Onoe Tsuyoshi , Asakura Hirofumi , Harada Hideyuki
Published: April 2020

Background

Stereotactic irradiation (STI) is a primary treatment for patients with newly diagnosed brain metastases. Some of these patients experience local progression, which is difficult to differentiate from radiation necrosis, and difficult to treat. So far, just a few studies have clarified the prognosis and effectiveness of salvage surgery after STI. We evaluated the diagnostic value and improvement of functional outcomes after salvage surgery. Based on these results, we reconsidered surgical indication for patients with local progression after STI.

Methods

We evaluated patients with brain metastases treated with salvage surgery for local progression from October 2002 to July 2019. These patients had undergone salvage surgery based on magnetic resonance imaging findings and/or clinical evidence of post-STI local progression and stable systemic disease. We employed two prospective strategies according to the eloquency of the lesions. Lesions in non-eloquent areas had been resected completely with a safety margin, utilizing a fence-post method; while lesions in eloquent areas had been treated with minimal resection and postoperative STI. Kaplan-Meier curves were used for the assessment of overall survival. Prognostic factors for survival were analyzed.

Results

Fifty-four salvage surgeries had been performed on 48 patients. The median age of patients was 63.5 years (range 36–79). The median interval from STI to surgery was 12 months. The median overall survival was 20.2 months from salvage surgery and 37.5 months from initial STI. Primary cancers were lung 31, breast 9, and others 8. Local recurrence developed in 13 of 54 lesions (24%). Leptomeningeal dissemination occurred after surgery in 3 patients (5.6%). Primary breast cancer (breast vs. lung: HR: 0.17), (breast vs. others: HR: 0.08) and RPA class 1–2 (RPA 1 vs. 3, HR:0.13), (RPA 2 vs 3, HR:0.4) were identified as good prognostic factors for overall survival (OS) in multivariate analyses. The peripheral neutrophil-to-lymphocyte ratio (NLR) of ≤3.65 predicted significantly longer OS (median 25.5 months) than an NLR > 3.65 (median 8 months).

Conclusion

We insist that salvage surgery leads to rapid improvement of neurological function and clarity of histological diagnosis. Salvage surgery is recommended for large lesions especially with surrounding edema either in eloquent or non-eloquent areas.
Correlates of type 2 diabetes and glycaemic control in adults in Saudi Arabia a secondary data analysis of the Saudi health interview survey
Authors: Al Slamah Thamer , Nicholl Barbara I. , Alslail Fatima Y. , Harris Leanne , Kinnear Deborah , Melville Craig A.
Published: April 2020

Background

There is evidence that type 2 diabetes self-management programmes may have a positive impact on health outcomes of adults living in Gulf countries. However, none of the programmes evaluated were developed using evidence about the specific needs of adults with Type 2 diabetes living in the Gulf countries. This study is part of a wider programme of research, which uses a cultural adaptation framework to generate information on how to tailor type 2 diabetes self-management to the Saudi context.

Methods

Secondary data analysis of the Saudi Health Interview Survey (SHIS) (N = 10,821) was conducted. Bivariate and multivariate logistic regression modelling assessed factors associated with type 2 diabetes and its control / self-management including sociodemographic factors (e.g. age, gender), lifestyle (e.g. diet, physical activity), and health seeking behaviours (e.g. chronic illnesses, health services).

Results

7% (N = 808) of all participants had type 2 diabetes (59% male), however it represents 35% at or above 55 years. In multivariate analysis at older age, being overweight or obese, male, having hypertension, and reporting a reduction in health status in the 12 months prior to questionnaire completion, were significantly associated with having type 2 diabetes. Participants who reported walking for more than 10 min per day were less likely to report type 2 diabetes. Unexpectedly there was a significant association between type 2 diabetes and lower frequency of fast food intake, while increased fruit and vegetable intake was associated with poor glycaemic control.

Conclusions

Being overweight and/or hypertensive are concomitant with type 2 diabetes in Saudi Arabia. Any self-management programmes for type 2 diabetes patients with either of these conditions should be tailored accordingly. Walking behaviours should be prioritised in Saudi self-management programmes. Prediabetes management programmes may be of special importance to the Saudi community.
Correction to: Development and content validity of the Abilitator: a self-report questionnaire on work ability and functioning aimed at the population in a weak labour market position
Authors: Wikström Miia , Anttila Heidi , Savinainen Minna , Kouvonen Anne , Joensuu Matti
Published: April 2020

It was highlighted that the original article [1] contained an ambiguity in the citation of Reference 2 in the Results section.
Use of endoscopic tissue morcellator in removing retroperitoneal fat in retroperitoneoscopic radical nephrectomy
Authors: Yang Guang , Xu Yong , Wan Shaw P. , Qu Genyi , Nie Haibo , Duan Guangjun
Published: April 2020

Background

Evaluate the safety and effectiveness of using an endoscopic tissue morcellator (ETM) to remove the retroperitoneal fat during retroperitoneoscopic radical nephrectomy (RRN).

Methods

The use of ETM in the removal of retroperitoneal fat was retrospectively analyzed in patients who underwent RRN for localized renal cancer in our hospital from January 2010 to January 2018. We accrued the appropriate patients and divided them into two groups. The first group included patients of RRN where ETM was used to remove the retroperitoneal fat, while the second group was comprised of patients of RRN where ETM was not performed, which served as the control group. Each group was further divided into two subgroups, including obese patients (BMI ≥ 28) and patients suffering from high-volume renal cancer (Stage T2a). The differences between the two groups as well as their subgroups were analyzed and statistically compared.

Results

All 222 nephrectomies were completed under retroperitoneoscopy, ETM was used in 105 of these 222 patients. Among them, 31 cases were of obese patients, and 26 cases were of high-volume renal cancer patients. The other 117 patients had undergone RRN without the use of ETM. Among them, 36 cases were of obese patients, and 28 cases were of high-volume renal cancer patients. The differences in age, BMI, tumor position, and tumor size between the two groups were not statistically significant, P > 0.05. Both the surgical time and the blood loss for the ETM group were significantly lower than the control group, p < 0.05. In the subgroup analysis, the obese patients and patients with high tumor volume also showed a significantly lower surgical time and less blood loss, p < 0.05. The postoperative hospitalization time, the total survival rate, and the disease-free survival rate were not statistically significant, p > 0.05.

Conclusions

The use of ETM in removing the retroperitoneal fat during the RRN can potentially reduce the surgical time and lessen the blood loss. This technique is especially advantageous for obese and large-volume tumor patients.
A treatment with a boiled aqueous extract of Hancornia speciosa Gomes leaves improves the metabolic status of streptozotocin-induced diabetic rats
Authors: Neto Leila S. , Moraes-Souza Rafaianne Q. , Soares Thaigra S. , Pinheiro Marcelo S. , Leal-Silva Thaís , Hoffmann Juliana C. , Américo Madileine F. , Campos Kleber E. , Damasceno Débora C. , Volpato Gustavo T.
Published: April 2020

Background

Hancornia speciosa is usually used in Brazilian folk medicine to treat diabetes. The hypothesis of the present study is that this medicinal plant exerts beneficial effects on hyperglycemia, preventing diabetic complications. Therefore, the aim of this study was to evaluate the treatment effect of the aqueous extract of H. speciosa leaves on metabolic parameters of diabetic rats.

Methods

The H. speciosa extract (400 mg/Kg) was administered to both nondiabetic and severely diabetic female Wistar rats by gavage. The Oral Glucose Tolerance Test was performed and the area under the curve (AUC) was estimated on day 17 of pregnancy. After 21 days of treatment, the animals were anesthetized and killed to obtain organ weights. Blood samples were collected for an analysis of serum biochemical parameters.

Results

After treatment with the H. speciosa extract, the parameters of nondiabetic rats remained unchanged. In treated diabetic rats, glycemia, AUC, dyslipidemia parameters, and relative organ weights were decreased compared with nontreated diabetic rats. Severely diabetic rats showed decompensated hyperglycemia, polydipsia, hyperphagia and dyslipidemia. However, the aqueous extract of H. speciosa leaves decreased diabetes complications (indicating a lack of toxicity), reduced blood glucose levels, and exerced lipid-lowering effects.

Conclusion

Based on or findings, the H. speciosa leaf extract may be a safe and promising candidate treatment for diabetes and other diseases.
Development and pilot testing of a health education program to improve immigrants’ access to Canadian health services
Authors: Ghahari Setareh , Burnett Shawna , Alexander Libby
Published: April 2020

Background

In Canada’s increasing immigrant population, a phenomenon called the “healthy immigrant effect” has arisen in which health declines after four years of settling. Access to healthcare is an important consideration. There is strong evidence that immigrants lack confidence and knowledge for navigating health services. The aim of this study was to develop and pilot test the Accessing Canadian Healthcare for Immigrants: Empowerment, Voice & Enablement (ACHIEVE) program.

Method

The study employed an exploratory sequential mixed methods design. A qualitative study was completed. Program content was developed based on a scoping review and refined in a formative evaluation. Then, a pilot test of the program measured participants’ perceived efficacy in improving confidence in healthcare navigation, program satisfaction, and learning in individual sessions.

Results

Researchers found significantly higher rates of health navigation and an increase in knowledge about the Canadian health system post-program.

Conclusions

Results provide promising evidence that ACHIEVE may improve confidence in healthcare access among immigrants, demonstrating potential for dispersion on a larger scale.
Cost–related unmet need for healthcare services in Kenya
Authors: Njagi Purity , Arsenijevic Jelena , Groot Wim
Published: April 2020

Background

The assessment of unmet need is one way to gauge inequities in access to healthcare services. While there are multiple reasons for unmet need, financial barriers are a major reason particularly in low- and middle-income countries where healthcare systems do not offer financial protection. Moreover, accessibility and affordability are paramount in achieving universal health coverage. This study examines the extent of unmet need in Kenya due to financial barriers, the associated determinants, and the influence of regional variations.

Methods

We use data from the 2013 Kenya household health expenditure and utilization (KHHEUS) cross sectional survey. Self-reported unmet need due to lack of money and high costs of care is used to compute the outcome of interest. A multilevel regression model is employed to assess the determinants of cost-related unmet need, confounding for the effect of variations at the regional level.

Results

Cost-related barriers are the main cause of unmet need for outpatient and inpatient services, with wide variations across the counties. A positive association between county poverty rates and cost-related unmet is noted. Results reveal a higher intraclass correlation coefficient (ICC) of 0.359(35.9%) for inpatient services relative to 0.091(9.1%) for outpatient services. Overall, differences between counties accounted for 9.4% (ICC ~ 0.094) of the total variance in cost-related unmet need. Factors that positively influence cost-related unmet need include older household heads, inpatient services, and urban residence. Education of household head, good self-rated health, larger household size, insured households, and higher wealth quintiles are negatively associated with cost-related unmet need.

Conclusion

The findings underscore the important role of cost in enabling access to healthcare services. The county level is seen to have a significant influence on cost-related unmet need. The variations noted in cost-related unmet need across the counties signify the existence of wide disparities within and between counties. Scaling up of health financing mechanisms would fundamentally require a multi-layered approach with a focus on the relatively poor counties to address the variations in access. Further segmentation of the population for better targeting of health financing policies is paramount, to address equity in access for the most vulnerable and marginalized populations.
Evaluation of an online training tool for scoring programmed cell death ligand-1 (PD-L1) diagnostic tests for lung cancer
Authors: Jasani Bharat , Bänfer Gudrun , Fish Rebecca , Waelput Wim , Sucaet Yves , Barker Craig , Whiteley Jessica L. , Walker Jill , Hovelinck Rudy , Diezko Rolf
Published: April 2020

Background

Numerous studies indicate that higher tumour programmed cell death ligand-1 (PD-L1) expression is associated with greater response to anti-programmed cell death-1 (PD-1)/PD-L1 immunotherapy in non-small cell lung cancer (NSCLC). In the era of precision medicine, there is a need to provide reliable, standardised training for pathologists to improve their accuracy of interpretation and scoring, as the results are used directly to inform clinical decisions. Here we present findings regarding reader reproducibility of PD-L1 tumour cell (TC) staining scoring for NSCLC using a PD-L1 e-trainer tool as part of a PD-L1 immunohistochemistry reader training course.

Methods

The PD-L1 training course was developed based on the use of VENTANA PD-L1 (SP263) and Dako PD-L1 IHC PharmDx 22C3 stained NSCLC samples in combination with a PD-L1 e-trainer tool. Five-hundred formalin-fixed, paraffin-embedded archival samples were obtained from commercial sources and stained for PD-L1. Slides were scored by two expert pathologists, then scanned to produce digital images and re-scored. Thirty-three cases were selected and sorted into three sets: a training set and two self-assessment tests (pre-test and ‘competence’ test). Participants (all selected board-certified pathologists) received face-to-face training including use of an e-trainer tool. Statistical analyses were performed using the competence test set. Overall percentage agreement (OPA) was assessed between the participant pathologists’ registered scores and the reference scores assigned by expert pathologists at clinically relevant PD-L1 cut-offs (≥1%, ≥25% and ≥ 50%).

Results

Seven sessions were held and 69 participant pathologists completed the training. Inter-reader concordance indicated high OPA (85–95%) for PD-L1 TC scoring at clinically relevant cut-offs, with Fleiss’ Kappa > 0.5.

Conclusions

Use of this web-based training tool incorporated into classroom-style training was associated with an overall moderately good level of inter-reader reproducibility at key cut-offs for TC PD-L1 expression testing in NSCLC. Overall, the online training tool offers a means of standardised training for practising pathologists in a clinical setting.
Impaired brain glucose metabolism and presynaptic dopaminergic functioning in a mouse model of schizophrenia
Authors: Tomasella Eugenia , Falasco German , Urrutia Leandro , Bechelli Lucila , Padilla Lucia , Gelman Diego M.
Published: April 2020

Background

Schizophrenia is a disease diagnosed by visible signs and symptoms from late adolescence to early adulthood. The etiology of this disease remains unknown. An objective diagnostic approach is required. Here, we used a mouse model that shows schizophrenia-like phenotypes to study brain glucose metabolism and presynaptic dopaminergic functioning by positron emission tomography (PET) and immunohistochemistry. PET scannings were performed on mice after the administration of [18F]-FDG or [18F]-F-DOPA. Glucose metabolism was evaluated in basal conditions and after the induction of a hyperdopaminergic state.

Results

Mutant animals show reduced glucose metabolism in prefrontal cortex, amygdala, and nucleus reuniens under the hyperdopaminergic state. They also show reduced [18F]-F-DOPA uptake in prefrontal cortex, substantia nigra reticulata, raphe nucleus, and ventral striatum but increased [18F]-F-DOPA uptake in dorsal striatum. Mutant animals also show reduced tyrosine hydroxylase expression on midbrain neurons.

Conclusions

Dopamine D2 mutant animals show reduced glucose metabolism and impaired presynaptic dopaminergic functioning, in line with reports from human studies. This mouse line may be a valuable model of schizophrenia, useful to test novel tracers for PET scanning diagnostic.
Correction to: The cost-effectiveness of albumin in the treatment of decompensated cirrhosis in Germany, Italy, and Spain
Authors: Runken M. Chris , Caraceni Paolo , Fernandez Javier , Zipprich Alexander , Carlton Rashad , Bunke Martin
Published: April 2020

Following publication of the original article [1], the authors reported that one of the numbers within Fig. 6 contains a mistake.
The regulatory effect of Lactobacillus rhamnosus GG on T lymphocyte and the development of intestinal villi in piglets of different periods
Authors: Shonyela Seria Masole , Feng Bo , Yang Wentao , Yang Guilian , Wang Chunfeng
Published: April 2020

The maturation and development of T cells were not completed until T cells were selected in thymus. It was not until the early 1960s that j.f.a.p. discovered the importance of thymus in T cell development. Twelve healthy piglets were randomly divided into two groups, the experimental group (LGG group) and the control group (saline group). The LGG group piglets were given 1 ml LGG (6 × 109 CFU/ml) per day. The saline group was given 1 ml of normal saline per day. The piglets were slaughtered at 30 days and 45 days, respectively, and the MLN, jejunum and ileum PPs, LP of the piglets were taken. The expression of CD3+CD4+ T lymphocytes was detected by flow cytometry, and intestinal villi development was observed by intestinal paraffin section. The results showed that the flow cytometry results at 30 days and 45 days showed that the CD3+CD4+ T lymphocytes in the MLN group were significantly different from those in the saline group (P < 0.05, P < 0.01).The CD3+CD4+ T lymphocytes in the jejunum PP of piglets in LGG group were significantly different from those in saline group (P < 0.05). The CD3+CD4+ T lymphocytes in the ileum PP of the LGG group were significantly different from those in the saline group (P < 0.05, P < 0.01). CD3+CD4+ T lymphocytes and normal saline in the piglets of the LGG group There was a significant difference between the two groups (P < 0.001, P < 0.05). P < 0.001). HE staining results showed the length of the LGG group ileal villi in piglets at 30 days, 45 days was significantly different from that in normal saline group (P < 0.01, P < 0.01). LGG can also regulate the proliferation of T lymphocytes in the intestine of early weaned piglets at 30 days and 45 days increase the number of CD3+CD4+ T lymphocytes.
Comparison of the intensity of biofilm formation by Listeria monocytogenes using classical culture-based method and digital droplet PCR
Authors: Grudlewska-Buda Katarzyna , Skowron Krzysztof , Gospodarek-Komkowska Eugenia
Published: April 2020

Listeria monocytogenes is a Gram-positive bacterium, commonly found in food, water or sewage. This microorganism is capable of forming biofilm on different surfaces such as steel, glass, polypropylene etc. Recently an increase in cases of listeriosis has been noted, making L. monocytogenes the important health threat. Therefore, there is a need for rapid and sensitive detection of this pathogen. This study aimed to compare the number of L. monocytogenes cells recovered from the biofilm (prepared on steel and polypropylene) using the detection and amplification of the hlyA gene (droplet digital PCR, ddPCR) and the classical culture method. The research material consisted of 96 L. monocytogenes strains. A total of 58 isolates were obtained from clinical samples and 38 isolates derived from the municipal sewage treatment plant. Additionally, the reference strain ATCC®19111™ (WDCM00020) was used. The Pearson correlation coefficient for the results obtained by the classical culture-based method and ddPCR was 0.864 and 0.725, for biofilms produced on AISI 304 stainless steel surface and the polypropylene surface, respectively. Correlations were statistically significant (p ≤ 0.001), indicating that the ddPCR technique is an effective tool for the assessment of bacteria number in the biofilm.
Temporal transcriptome change of Oncomelania hupensis revealed by Schistosoma japonicum invasion
Authors: Feng Xinyu , Zhu Lingqian , Qin Zhiqiang , Mo Xiaojin , Hao Yuwan , Jiang Ying , Hu Wei , Li Shizhu
Published: April 2020

Background

The freshwater snail Oncomelania hupensis is the obligate intermediate host for Schistosoma japonicum in China. Transcriptomic examination of snail–schistosome interactions can provide valuable information of host response at physiological and immune levels.

Methods

To investigate S. japonicum-induced changes in O. hupensis gene expression, we utilized high-throughput sequencing to identify transcripts that were differentially expressed between infected snails and their uninfected controls at two key time-point, Day 7 and Day 30 after challenge. Time-series transcriptomic profiles were analyzed using R package DESeq 2, followed by GO, KEGG and (weighted gene correlation network analysis) WGCNA analysis to elucidate and identify important molecular mechanism, and subsequently understand host–parasite relationship. The identified unigenes was verified by bioinformatics and real-time PCR. Possible adaptation molecular mechanisms of O. hupensis to S. japonicum challenge were proposed.

Results

Transcriptomic analyses of O. hupensis by S. japonicum invasion yielded billion reads including 92,144 annotated transcripts. Over 5000 differentially expressed genes (DEGs) were identified by pairwise comparisons of infected libraries from two time points to uninfected libraries in O. hupensis. In total, 6032 gene ontology terms and 149 KEGG pathways were enriched. After the snails were infected with S. japonicum on Day 7 and Day 30, DEGs were shown to be involved in many key processes associated with biological regulation and innate immunity pathways. Gene expression patterns differed after exposure to S. japonicum. Using WGCNA, 16 modules were identified. Module-trait analysis identified that a module involved in RNA binding, ribosome, translation, mRNA processing, and structural constituent of ribosome were strongly associated with S. japonicum invasion. Many of the genes from enriched KEGG pathways were involved in lysosome, spliceosome and ribosome, indicating that S. japonicum invasion may activate the regulation of ribosomes and immune response to infection in O. hupensis.

Conclusions

Our analysis provided a temporally dynamic gene expression pattern of O. hupensis by S. japonicum invasion. The identification of gene candidates serves as a foundation for future investigations of S. japonicum infection. Additionally, major DEGs expression patterns and putative key regulatory pathways would provide useful information to construct gene regulatory networks between host-parasite crosstalk.
Estimations of fractional integral operators for convex functions and related results
Authors: Chen Zhihua , Farid Ghulam , Ur Rehman Atiq , Latif Naveed
Published: April 2020

This research investigates the bounds of fractional integral operators containing an extended generalized Mittag-Leffler function as a kernel via several kinds of convexity. In particular, the established bounds are studied for convex functions and further connected with known results. Furthermore, these results applied to the parabolic function and consequently recurrence relations for Mittag-Leffler functions are obtained. Moreover, some fractional differential equations containing Mittag-Leffler functions are constructed and their solutions are provided by Laplace transform technique.
Reduction of in situ force through the meniscus with phased inner resection of medial meniscus: an experimental study in a porcine model
Authors: Hirose Takehito , Mae Tatsuo , Tachibana Yuta , Ohori Tomoki , Fujie Hiromichi , Yoshikawa Hideki , Nakata Ken
Published: April 2020

Purpose

Partial meniscectomy can cause osteoarthritic changes in knees, as inner portion as well as peripheral portion of meniscus is important. The hypothesis of this study was that the amount of the inner resection of medial meniscus affected the in situ forces through the meniscus and the tibial varus and external rotation under axial load.

Methods

Fourteen intact porcine knees were investigated with a six-degree of freedom robotic system and force/moment, and the three-dimensional path of intact knees were recorded by universal force sensor when an axial load of 300-N was applied at four different flexion angles (30°, 60°, 90°, and 120°). The same examination was performed on three phased inner resections (30%, 60%, and 90% width) of the medial meniscus. Finally, all paths were reproduced after total medial meniscectomy, and in situ forces of the medial meniscus were calculated based on the superposition principle. Changes in tibiofemoral varus/valgus and internal/external rotation alignment during an axial load were also calculated.

Results

In situ forces of the medial meniscus decreased according to the amount of meniscal resection at all flexion angles. The reduction was significant in knees with inner resections of > 60% width at all flexion angles and even of 30% width at a flexion angle of 120° (p < .05). Incremental changes in the tibiofemoral varus alignment increased depending on the inner resection width at all flexion angles (p < .05).

Conclusion

The amount of inner resection of the medial meniscus was related to reduction of its in situ forces and increment of the tibial varus rotation under axial load.
Gastric volvulus with perforation 1 year after total pancreatectomy: a case report
Authors: Takahashi Yusuke , Seki Hitoshi
Published: April 2020

Background

Because of its rare indication and relatively simple reconstruction procedure (only choledochojejunostomy and gastrojejunostomy) compared to those for pancreatoduodenectomy, the technical tips and pitfalls of total pancreatectomy are rarely discussed. Herein, we discuss a rare case of gastric volvulus 1 year after total pancreatectomy and provide advice to prevent such cases.

Case presentation

A 66-year-old woman underwent total pancreatectomy with splenectomy for mixed-type intraductal papillary mucinous neoplasm of the pancreas. Choledochojejunostomy (retro-colic route) and gastrojejunostomy (ante-colic route, Billroth II method) were performed for reconstruction. The final diagnosis was mixed-type intraductal papillary mucinous adenoma of the pancreas without malignant neoplasm. She had no clinical symptoms, such as abdominal pain and fever, during postoperative follow-up. However, at 1 year postoperatively, she complained of abdominal pain. Contrast-enhanced abdominal computed tomography showed volvulus and perforation of the stomach. Emergent surgery was performed. The stomach fornix was located on the right side and was partly perforated. We resected the perforation site with a linear cutter® (New Type Linear Cutter, Ethicon, USA) and released the gastric volvulus. Moreover, we fixed the stomach to the left abdominal wall using non-absorbable thread. The cause of the perforation was clinically and pathologically unclear. Her serum albumin and cholinesterase levels temporarily decreased postoperatively, but gradually increased. A recurrence of volvulus-related symptoms has not been observed.

Conclusions

After total pancreatectomy with splenectomy, although the stomach is connected with the jejunum, it is typically fixed only by the pedicle of the left gastric artery and vein. In the present case, this anatomical change may have been a cause of the gastric volvulus. Thus, it might be better to fix the remnant stomach in total pancreatectomy with splenectomy.
Baseline serum lactate dehydrogenase levels are highly predictive of superior outcomes in patients with advanced melanoma: Results from extended follow-up from the dacarbazine/oblimersen (Bcl-2 Antisense) multinational trial
Authors: Pavlick A. C. , Eggermont A. , Haluska F. , Millward M. , Gore M. , Pehamberger H. , Hersey P. , Bedikian A. Y.
Published: April 2020

18001

Background: Bcl-2 inhibits apoptosis, confers resistance to chemotherapy in many cancers, is often over-expressed in advanced melanoma, and is a prime candidate for pro-apoptotic targeted therapy. Recent studies by the EORTC and others show that lactate dehydrogenase (LDH) is a powerful prognostic determinant in advanced melanoma patients (pts). The chief treatment effect of oblimersen (Obl) + dacarbazine (DTIC) was obtained from the largest cohort of normal LDH pts studied to date; detailed efficacy and safety data are reported. Methods: Previously untreated pts (N = 771) were randomized to receive DTIC 1000 mg/m2 IV Q 3W alone or preceded by Obl (7 mg/kg/d × 5D). Pts were stratified pre-randomization by performance status, liver metastases, and visceral metastases and/or elevated LDH. Serum LDH was ≤ the cutoff of 1.1 × upper limit of normal in 508 pts. Treatment group characteristics were well matched. Results: Combining Obl and DTIC significantly increased all efficacy outcomes in pts with baseline (BL) nonelevated (NE) LDH, including overall survival (median 11.4 vs 9.7 mo; P = .018), progression-free survival (3.1 vs. 1.6 mo; P = .0007), objective response (17.2% vs 9.3%; P = .009), complete response (3.4% vs 0.8%; P = .041), and durable response ≥6 mo (9.6% vs 4.0%; P = .014). In contrast, there were no significant differences in outcomes for pts with elevated BL LDH (n = 252). BL LDH was the only stratification variable significantly associated with a treatment interaction effect. Compared with the entire study population, pts with NE LDH in both groups had a lower incidence of treatment-emergent adverse events (TEAEs) with an outcome of death, serious TEAEs, and discontinuations due to TEAEs. Conclusions: With extended follow-up, this large trial confirms that serum LDH (prospectively stratified pre-randomization) is probably the most important prognostic factor in advanced melanoma. Given the demonstrable lack of benefit and high potential to yield misleading evidence regarding therapeutic activity, pts with elevated LDH should probably be excluded from trials of new therapies until establishing efficacy in pts with nonelevated LDH.

No significant financial relationships to disclose.
Phase II study of ‘hybrid‘ biochemotherapy for advanced melanoma
Authors: Papadopoulos N. E. , Eton O. , Kim K. B. , Camacho L. H. , Hwu P. , Bedikian A. Y.
Published: April 2020

18007

Background: The clinical activity of a hybrid biochemotherapy regimen was determined. This regimen incorporated important elements of previously studied sequential and concurrent biochemotherapy regimens in order to potentially increase dose intensity of the antitumor agents while decreasing morbidity, complexity of in-patient management, and length of hospital days. Methods: The antitumor agents and starting doses in the hybrid regimen were: cisplatin (25 mg/m2) IV on days 2–5, vinblastine (1.4–1.6 mg/m2) IV on days 1–5, dacarbazine (800 mg/m2) IV day 1 only, rIL-2 (12 MIU/m2) SC on days 6–10, and interferon-a2b (10 MU/m2) SC on days 2–6. Thirty-seven patients (pts) with a median age of 49 (range 19–63) yrs and Zubrod’s PS of 0–2 were treated. Patients with prior chemotherapy, rIL-2, active brain metastases were excluded. All cycles were 21 days or longer and the median number of courses delivered per patient was 4 (range 1–6). Results: Thirty-five pts were evaluated for response. There were 3/35 (9%) complete responses (CRs) and 17/35 (49%) partial responses (PRs). One CR and one PR were confirmed pathologically. The median overall survival was 12.6 months (95% CI: 9.9, 20.3). The median time to progression for all patients was 5.7 months (95% CI: 4.3, 9.8), while the TTP of responders was 7.2 months (95% CI: 5.1, 18.9). Brain metastases developed in 13 pts, -either while receiving treatment and responding systemically (5 pts) -or post-treatment with progressive systemic disease (8 pts). There were 2/12 (17%) early deaths in pts receiving vinblastine (1.6 mg/m2), one with typhlitis and the other with sepsis. Therefore, the vinblastine dose was reduced to 1.4 mg/m2 for patients #13–35. Neutropenia, with a median lowest neutrophil count of 0.08 (range 0–3) on day 13 (range day 6–16), and fever during rIL-2 treatment, increased the median days of hospitalization of all patients to 15 (range 12–23) for the first cycle. Conclusions: Hybrid biochemotherapy produced a high response rate and an overall survival similar to previously reported schedules. Length of hospital stay was significantly increased compared to the concurrent schedule. Development of brain metastases in responding pts resulted in early withdrawal from the program. Hybrid biochemotherapy with reduced doses of vinblastine was better tolerated.

No significant financial relationships to disclose.
Phase II study of docetaxel and vinorelbine plus GM-CSF in malignant melanoma
Authors: Fruehauf J. P. , Kong K. M. , Jakowatz J. G.
Published: April 2020

18017

Background: Patients having locoregional or metastatic melanoma have a poor prognosis, with 50% to 10% of patients dying from the disease within 5 years. Current chemotherapy regimens offer limited benefits to these patients and more effective and less toxic treatments are needed. Methods: We developed a phase II clinical trial to evaluate the activity of an every two week schedule of docetaxel (40mg/m2, d1), vinorelbine (30 mg/m2, d1) IV and sargramostim (GMCSF, 250 ug/m2 sq d2–11). This regimen was developed based on preclinical synergistic activity of paclitaxel plus vinorelbine (Neale et al. Melanoma Res 11:601, 2001), and evidence that the docetaxel plus vinorelbine combination can be given safely to lung cancer patients (Sanchez et al. Lung Ca 38:309, 2002). Sargramostim was included based on preliminary clinical data that it delays time to progression in stage IV melanoma patients resected for cure (Spitler, JCO 18:1614, 2000). We report here an interim analysis for the initial 21 patients with stage IV melanoma treated in first or second line. Results: The primary endpoint was time to progression. Grade III/IV toxicities included anemia (12.5%) and neutropenia (5%), with one patient requiring 25% dose reduction. To date, median time to progression (TTP) is 7 months, with 30% of cases showing greater than 8 months TTP. Conclusions: This result compares favorably with biochemotherapy, which has a median TTP of 5 months and overall survival of 8.4 months (Atkins Proc ASCO 22:708. 2003), while being significantly less toxic. Based on these favorable findings, we are continuing to accrue patients to this trial.

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Perspectives on psychological distress in cancer patients: Comparison between expected, perceived and actual disturbances in a clinic from Argentina
Authors: Torrente F. , Gercovich D. , Hirsch H. , Margiolakis P. , Gil Deza E. , Morgenfeld E. , Pollola J. , Rolnik B. , Gercovich F. G.
Published: April 2020

18515

Background: Psychological distress is a widespread phenomenon in cancer patients (pts.) Notwithstanding, its recognition and the threshold criteria for referral to a specialized unit are still problematic in clinical practice. Correspondingly, the aim of this study was to explore how much psychological distress (PD) is expected by the oncologists, how much distress is actually present in these pts., and finally how many of them are detected as having significant problems and referred to the mental health unit (MHU). Methods: Three sources of data were compared for the purpose of this study. Firstly, a survey to the practicing oncologists (n =18) was carried out in order to establish the rate of PD expected by them. Secondly, a consecutive sample of 259 pts. was evaluated in the waiting room with the Hospital Anxiety and Depression Scale (HADS) for establishing an estimation of the actual rate of PD in this population. Finally, 115 pts. from the MHU were studied for determining the rate and the accuracy of the referral made by the oncologists. Results: Sixty one percent of the surveyed oncologists considered that 75% or more of their pts would need psychological assistance. The waiting room sample evaluated with the HADS showed that 74.9% of patients surpassed the cutoff score (11 points) for either anxiety or depression, or both. Despite this, less than 5% of the total population of the clinic was referred to the MHU. From this sample, 38.3% of the pts. scored below the cutoff line. The proportion of pts. who exceeded the cutoff score for depression was significantly higher in the MHU sample. Conclusions: Most of the oncologists expect a high rate of PD in their patients, and even overestimate it. Actual rates of anxiety and depression were also high. On the contrary, the rate of referral to specialized mental health treatment was extremely low and the pts. referred were not necessarily highly disturbed. Depression is probably better recognized than anxiety by oncologists. In conclusion, both quantitative and qualitative problems were detected in the referral to the MHU, regardless the awareness of the oncologists about PD.

No significant financial relationships to disclose.