bluuebunny/crossref_metadata_2025 huggingface dataset:
Access structure
Authors: Song Yacheng , Zhang Ye , Han Dongqing
Published: February 2021

Although various hierarchical structures have been investigated with respect to the different elements of urban form, the hierarchical spatial order of access from streets to plots and buildings has not been adequately explicated and objectively assessed. In this article, a new method, access structure, is presented to bridge this knowledge gap. Based on Krop’s generic multilevel diagram of urban form, different types of access structure are developed and symbolically represented. They are then quantitatively measured and compared using three metrics and an associated ternary diagram. Subsequently, the new method is tested first in analysing the internal structure of an individual urban block and then in distinguishing urban blocks with different structural characteristics. Eight urban blocks across the city of Nanjing, China, are selected as case examples. The results show that access structure is capable of accurately describing and evaluating complex spatial relationships between streets, plots and buildings. Access structure is potentially a useful method for studying the complex emerging built form of rapidly changing cities, especially in developing countries such as China.
Proposing an integrated accessibility-based measure to evaluate spatial equity among different social classes
Authors: Azmoodeh Mohammad , Haghighi Farshidreza , Motieyan Hamid
Published: February 2021

Fair spatial distribution of services has always been a challenge for urban planners to supply sufficient accessibility for individuals and to consider the needs of vulnerable social groups. Nevertheless, equity assessment literature has mostly focused on measuring the accessibility through distance-based variables, and social stratification based on just income, as well. Accordingly, this study intends to employ an accessibility measure that considers non-distance-based variables along with distance-based ones. It uses multi-criteria decision-making to propose an accessibility index to assess vertical and horizontal equity of residents’ accessibility to a range of public facilities, in the district 6 of Tehran, Iran. Therefore, using the integration of geographical information system-based spatial analysis, wider people specification, and the Gini coefficient, this measure proposes a novel framework to examine the equity level of individuals belonging to the lower, middle, and upper social classes. Results imply a 0.228 Gini index for horizontal equity, which indicates a low level of inequity among residents. Besides, for vertical equity evaluation, Gini index of 0.097, 0.249, and 0.167, respectively, for lower, middle, and upper groups show people in the lower class experience very low levels of inequity, therefore higher accessibility is well distributed among groups with higher social needs. This approach can help planners to choose the right analysis method and prioritize urban decisions toward the equitable distribution of facilities.
Delayed-Onset Propionibacterium acnes Endophthalmitis in the Absence of Capsular Complex Following Scleral-Fixated Intraocular Lens: A Case Report
Authors: Gonzalez-Gonzalez Luis A. , Prensky Colin J. , Orlin Anton
Published: February 2021

Purpose:

This work reports a case of delayed-onset Propionibacterium acnes endophthalmitis in a patient with scleral-fixated intraocular lens (IOL), successfully treated with intravitreal antibiotics and steroids.

Methods:

Patient underwent complete ophthalmic examinations over 2 years. Vitreous cultures, optical coherence tomography, anterior segment and fundus photographs, and fluorescein angiogram were performed.

Results:

A 78-year-old man with dislocated IOL underwent IOL removal and scleral-fixated AO60. He did well for 2 months but returned 9 months later with vision loss. Examination revealed low-grade inflammation and multiple IOL opacities. Vitreous culture grew P acnes. He was treated with intravitreal clindamycin followed by dexamethasone for macular edema without IOL explantation. A year after treatment no inflammation or macular edema was noted.

Conclusion:

To our knowledge, this is the first case of P acnes endophthalmitis following scleral sutured IOL. Treatment with intravitreal injections alone, without IOL explantation, was effective, possibly because of the absence of capsular complex.
Cardiac Magnetic Resonance in Endomyocardial Fibrosis
Authors: Athni Shruthi Kalyan , Christopher Johann
Published: February 2021

Endomyocardial fibrosis is a rare cardiomyopathy. There has to be a high level of suspicion to make the diagnosis. The treatment is based on symptomatic relief and surgical management is based on the exact pathology found in the left ventricle apex. MRI is a robust investigation which can confirm diagnosis and provide management options and prognosis.
Prediction of tool wear in CFRP drilling based on neural network with multicharacteristics and multisignal sources
Authors: Zhu Guoqiang , Hu Shanshan , Tang Hongqun
Published: February 2021

Carbon fiber-reinforced polymer (CFRP) drilling is a typical process in the aircraft industry. Because the components of CFRP are different and uneven, it is difficult to extract tool wear characteristics from the machining signals, which are composed of the processing characteristics of various materials and the tool state characteristics. The aim of this work is to present a new comprehensive approach based on multicharacteristics and multisignal sources to predict the tool wear state during CFRP drilling through a combination of a backpropagation (BP) artificial neural network (ANN) model and an efficient automatic system depending on the sliding window algorithm. It was verified that the peak factor and Kurtosis coefficient of different signals and the energy value of the d5 layer of the thrust force signal and the d3 layer of the vibration signal after wavelet decomposition were related to tool wear. Among them, the energy value of the d3 layer of the vibration signal was selected as the wear indicator and was able to describe the state of the tool during the CFRP drilling process regardless of the drilling conditions and individual tool differences. A confirmatory drilling experiment using 6-mm-diameter polycrystalline diamond twist drilling under different processing parameters was conducted to verify the ANN model based on multicharacteristics and multisignal sources. A lower feed speed and a higher cutting speed were both highly correlated with the VB value of flank wear. Drill wear accelerated because of the occurrence of adhesive wear when the number of drilled holes reached around 90. The accuracy of the neural network model is 80–87% when using the value of only one characteristic but clearly increases based on multicharacteristics and multisignal sources in real time, indicating that the BP ANN model has higher accuracy in predicting the tool state in CFRP drilling through the sensor signal fusion method.
Data analytics to investigate the cohort of injection wells with earthquakes in Oklahoma
Authors: Amirlatifi Amin , KC Bijay , Adibifard Meisam , Vahedifard Farshid , Ghazanfari Ehsan
Published: February 2021

The number of recorded earthquakes in Oklahoma has substantially increased during the last few decades, a trend that coincides with the increases in the injected volume in underground injection control (UIC) wells. Several studies have suggested the existence of spatial and temporal links between earthquakes and injection wells. However, creating a spatial connection between the earthquakes and UIC wells requires making a prior assumption about the radius of induced seismicity. In this study, we use intrinsic features of the UIC wells to find the cohort of wells with associated earthquakes, based on the level of activity and proximity of the wells to the events. For this purpose, a hybrid genetic algorithm–K-means (GA-K-means) algorithm was applied over UIC wells, and the geographical representation of the clustered wells was co-visualized with earthquake data to determine wells with induced seismic activities. The analysis was performed every year since 2002, and the most critical attributes to distinguish the behavior of wells were identified. The analysis showed a distinct change in cluster identifiers before the year 2010, which is believed to be the beginning of increased seismic activities, compared to later dates. Our approach was able to group the earthquake-associated wells from the rest of the data, and centroid analysis of these wells helped us identify the critical pressure and cumulative volume range that result in induced seismicity. These findings can be used as guidelines for designing safer injection sites for sustainable energy production in Oklahoma.
American Society of Hematology 2021 guidelines for management of venous thromboembolism: prevention and treatment in patients with cancer
Authors: Lyman Gary H. , Carrier Marc , Ay Cihan , Di Nisio Marcello , Hicks Lisa K. , Khorana Alok A. , Leavitt Andrew D. , Lee Agnes Y. Y. , Macbeth Fergus , Morgan Rebecca L. , Noble Simon , Sexton Elizabeth A. , Stenehjem David , Wiercioch Wojtek , Kahale Lara A. , Alonso-Coello Pablo
Published: February 2021

Background:

Venous thromboembolism (VTE) is a common complication among patients with cancer. Patients with cancer and VTE are at a markedly increased risk for morbidity and mortality.

Objective:

These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the prevention and treatment of VTE in patients with cancer.

Methods:

ASH formed a multidisciplinary guideline panel balanced to minimize potential bias from conflicts of interest. The guideline development process was supported by updated or new systematic evidence reviews. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess evidence and make recommendations.

Results:

Recommendations address mechanical and pharmacological prophylaxis in hospitalized medical patients with cancer, those undergoing a surgical procedure, and ambulatory patients receiving cancer chemotherapy. The recommendations also address the use of anticoagulation for the initial, short-term, and long-term treatment of VTE in patients with cancer.

Conclusions:

Strong recommendations include not using thromboprophylaxis in ambulatory patients receiving cancer chemotherapy at low risk of VTE and to use low-molecular-weight heparin (LMWH) for initial treatment of VTE in patients with cancer. Conditional recommendations include using thromboprophylaxis in hospitalized medical patients with cancer, LMWH or fondaparinux for surgical patients with cancer, LMWH or direct oral anticoagulants (DOAC) in ambulatory patients with cancer receiving systemic therapy at high risk of VTE and LMWH or DOAC for initial treatment of VTE, DOAC for the short-term treatment of VTE, and LMWH or DOAC for the long-term treatment of VTE in patients with cancer.
Blueschist mylonitic zones accommodating syn-subduction exhumation of deeply buried continental crust: the example of the Rocca Canavese Thrust Sheets Unit (Sesia–Lanzo Zone, Italian Western Alps)
Authors: Roda Manuel , Zucali Michele , Corti Luca , Visalli Roberto , Ortolano Gaetano , Spalla Maria Iole
Published: February 2021

The Rocca Canavese Thrust Sheets Unit (RCTU) is a subduction-related mélange that represents the eastern-most complex of the Sesia–Lanzo Zone (SLZ), bounded by the Periadriatic (Canavese) Lineament that separates the Alpine subduction complex from the Southalpine domain. The RCTU is limited to the south by the Lanzo Massif (LM) and to the east by the Eclogitic Micaschists Complex (EMC). Particularly the tectonic contact area of the RCTU, adjacent to the neighbouring SLZ and the LM is characterised by a 100–200-m-thick mylonitic to ultra-mylonitic zone (MZ) that was active under blueschist-to greenschist-facies conditions. Despite the dominant mylonitic structure, some rocks (garnet-bearing gneiss, garnet-free gneiss and orthogneiss) still preserve pre-mylonitic parageneses in meter-sized domains. The scarcity of superposed structures and the small size of relicts impose a detailed microstructural analysis supported by chemical investigation to reconstruct the tectono-metamorphic history of the MZ. Therefore, we integrated the classical meso- and microstructural analysis approach with a novel quantitative technique based on the Quantitative X-Ray Map Analyzer (Q-XRMA), used to classify rock-forming minerals starting from an array of X-ray elemental maps, both at whole thin section and micro-domain scale, as well as to calibrate the maps for pixel-based chemical analysis and end-member component maps, relevant for a more robust conventional geothermobarometer application as well for calculating reliable PT pseudosections. Pre-Alpine relicts are garnet and white mica porphyroclasts in the garnet-bearing gneiss and biotite and K-feldspar porphyroclasts in garnet-free gneiss and orthogneiss, respectively, providing no PT constraints. The Alpine evolution of the MZ rocks, has been subdivided in three deformation and metamorphic stages. The first Alpine structural and metamorphic equilibration stage (D1 event) occurred at a pressure of ca. 1.25–1.4 GPa and at a temperature of ca. 420–510 °C, i.e. under blueschist-facies conditions. The D2 event, characterised by a mylonitic foliation that is pervasive in the MZ, occurred at ca. 0.95–1.1 GPa and ca. 380–500 °C, i.e. under epidote-blueschist-facies conditions. The D2 PT conditions in the MZ rocks are similar to those predicted for the blocks that constitute the RCTU mélange, and they overlap with the exhumation paths of the EMC and LM units. Therefore, the RCTU, EMC and LM rocks became coupled together during the D2 event. This coupling occurred during the exhumation of the different tectono-metamorphic units belonging to both continental and oceanic lithosphere and under a relatively cold thermal regime, typical for an active oceanic subduction zone, pre-dating Alpine continental collision.
Discovery of vanoxerine dihydrochloride as a CDK2/4/6 triple-inhibitor for the treatment of human hepatocellular carcinoma
Authors: Zhu Ying , Ke Kun-Bin , Xia Zhong-Kun , Li Hong-Jian , Su Rong , Dong Chao , Zhou Feng-Mei , Wang Lin , Chen Rong , Wu Shi-Guo , Zhao Hui , Gu Peng , Leung Kwong-Sak , Wong Man-Hon , Lu Gang , Zhang Jian-Ying , Jiang Bing-Hua , Qiu Jian-Ge , Shi Xi-Nan , Lin Marie Chia-mi
Published: February 2021

Background

Cyclin-dependent kinases 2/4/6 (CDK2/4/6) play critical roles in cell cycle progression, and their deregulations are hallmarks of hepatocellular carcinoma (HCC).

Methods

We used the combination of computational and experimental approaches to discover a CDK2/4/6 triple-inhibitor from FDA approved small-molecule drugs for the treatment of HCC.

Results

We identified vanoxerine dihydrochloride as a new CDK2/4/6 inhibitor, and a strong cytotoxicdrugin human HCC QGY7703 and Huh7 cells (IC50: 3.79 μM for QGY7703and 4.04 μM for Huh7 cells). In QGY7703 and Huh7 cells, vanoxerine dihydrochloride treatment caused G1-arrest, induced apoptosis, and reduced the expressions of CDK2/4/6, cyclin D/E, retinoblastoma protein (Rb), as well as the phosphorylation of CDK2/4/6 and Rb. Drug combination study indicated that vanoxerine dihydrochloride and 5-Fu produced synergistic cytotoxicity in vitro in Huh7 cells. Finally, in vivo study in BALB/C nude mice subcutaneously xenografted with Huh7 cells, vanoxerine dihydrochloride (40 mg/kg, i.p.) injection for 21 days produced significant anti-tumor activity (p < 0.05), which was comparable to that achieved by 5-Fu (10 mg/kg, i.p.), with the combination treatment resulted in synergistic effect. Immunohistochemistry staining of the tumor tissues also revealed significantly reduced expressions of Rb and CDK2/4/6in vanoxerinedihydrochloride treatment group.

Conclusions

The present study isthe first report identifying a new CDK2/4/6 triple inhibitor vanoxerine dihydrochloride, and demonstrated that this drug represents a novel therapeutic strategy for HCC treatment.
Dental caries and associated factors in Ethiopia: systematic review and meta-analysis
Authors: Zewdu Tesfu , Abu Duresa , Agajie Mulatu , Sahilu Tamiru
Published: February 2021

Background

Globally, dental caries may be a major public health issue which may be preventable. Many studies have been conducted on dental caries in Ethiopia which present inconsistent results.

Objective

This meta-analysis was expected to consolidate the findings conducted in various regions of the country and generate country representative information on the burden and its associated factors of dental caries in Ethiopia.

Methods

Our systematic review and meta-analysis was carried out to estimate the pooled prevalence of dental caries and its associated factors in the Federal Democratic Republic of Ethiopia. Medical specialty databases like ScienceDirect, HINARI, Embase, PubMed, Google Scholar, and Cochrane Library were consistently and exhaustively searched. To determine the aggregate prevalence, studies delineating the prevalence of dental caries and associated factors were included. Important data were extracted employing a standardized data extraction tool ready in Microsoft Excel and imported to the STATA version-13 statistical software package for analyses. To assess non-uniformity, the Cochrane Q test statistics andI2test were performed respectively. A random effects model meta-analysis was accustomed to estimate the pooled burden of dental caries.

Results

The result of thirteen studies disclosed that the overall prevalence of dental caries in the Federal Democratic Republic of Ethiopia was found to be 40.98 (31.62, 50.34). Within the subgroup analysis, the uppermost prevalence was determined in Tigray region (46.59% (24.64, 68.54)) whereas the bottom prevalence was determined in Addis Ababa (34.20% (8.42, 59.97)). Dental caries prevalence was considerably high among study subjects who consumed sweet food (OR= 2.4 (95% CI (1.91, 3.01))). But the presence of dental plaque (OR = 5.14 (95% CI (0.67, 39.39))) and habit of tooth- cleaning (OR = 0.71 (95% CI (0.17, 2.96))) were not statistically significant with the outcome of interest.

Conclusion

Our meta-analysis found that the prevalence of dental caries was comparatively high, and sweet food consumption was the most risk issue for dental caries in Ethiopia. The Ethiopian Federal Ministry of Health ought to offer a lot of attention to strengthen the oral health care system and also the implementation of community-level interference programs.
A low-cost wireless endoscope camera: a preliminary report
Authors: Lazarus J. M. , Ncube M.
Published: February 2021

Background

Technology currently used for surgical endoscopy was developed and is manufactured in high-income economies. The cost of this equipment makes technology transfer to resource constrained environments difficult. We aimed to design an affordable wireless endoscope to aid visualisation during rigid endoscopy and minimally invasive surgery (MIS). The initial prototype aimed to replicate a 4-mm lens used in rigid cystoscopy.

Methods

Focus was placed on using open-source resources to develop the wireless endoscope to significantly lower the cost and make the device accessible for resource-constrained settings. An off the shelf miniature single-board computer module was used because of its low cost (US$10) and its ability to handle high-definition (720p) video. Open-source Linux software made monitor mode (“hotspot”) wireless video transmission possible. A 1280 × 720 pixel high-definition tube camera was used to generate the video signal. Video is transmitted to a standard laptop computer for display. Bench testing included latency of wireless digital video transmission. Comparison to industry standard wired cameras was made including weight and cost. The battery life was also assessed.

Results

In comparison with industry standard cystoscope lens, wired camera, video processing unit and light source, the prototype costs substantially less. (US$ 230 vs 28 000). The prototype is light weight (184 g), has no cables tethering and has acceptable battery life (of over 2 h, using a 1200 mAh battery). The camera transmits video wirelessly in near real time with only imperceptible latency of < 200 ms. Image quality is high definition at 30 frames per second. Colour rendering is good, and white balancing is possible. Limitations include the lack of a zoom.

Conclusion

The novel wireless endoscope camera described here offers equivalent high-definition video at a markedly reduced cost to contemporary industry wired units and could contribute to making minimally invasive surgery possible in resource-constrained environments.
Distribution, source apportionment, and health risk assessment of phthalate esters in indoor dust samples across China
Authors: Li Xu , Zhang Wenping , Lv Jiapei , Liu Wenxiu , Sun Shanwei , Guo Changsheng , Xu Jian
Published: February 2021

Background

Phthalates were detected in various environments due to their widespread application. In this study, indoor dust samples from 94 buildings, including 72 residences and 22 dormitories, were collected in seven geographical regions in China and analyzed for eight phthalate esters (PAEs). Investigation of contamination profiles, geographical distribution, sources, and risks of PAEs in indoor dusts was explored.

Results

The highest Σ8PAEs concentration in residential buildings was found in Northeast China (median: 164.71 μg·g−1), which was 2.3 and 2.8 times higher than that in South China (median: 71.71 μg·g−1) and Southwest China (median: 58.53 μg·g−1), respectively. Di (2-ethylhexyl) phthalate (DEHP), di-iso-butyl phthalate (DIBP), and di-n-butyl phthalate (DBP) were the dominant compounds of Σ8PAEs in indoor dusts from residences and dormitories. The administrative levels revealed that the highly serious contamination occurred in the provincial capital, followed by nonprovincial cities and countries. Such an occurrence was related to the usage of PAE products and the level of urbanization. Principal component analysis (PCA) and positive matrix factorization (PMF) showed that the emission from cosmetics and personal care products, plasticizers, and household building materials were the possible PAE sources in indoor dusts. Among three routes of ingestion, dermal adsorption, and inhalation, dust ingestion was the main route of human exposure to PAEs. The health risk of PAE exposure for different populations in descending order of children > women > men. The hazard indexes of noncancer were higher than the threshold value of 10−6 during human exposure to DBP and DEHP. Children also faced potential noncancer risk due to benzyl butyl phthalate (BBzP) and di-n-octyl phthalate (DnOP) exposure. The carcinogenic risks via exposure to BBzP and DEHP were negligible.

Conclusion

Overall, PAEs were widely presented in indoor dusts. Obvious difference was observed in the distribution of PAEs concentration in indoor dusts due to the differences in economic development and usage of PAEs product. Plasticizers, household building materials, and cosmetics and personal care products were likely PAE sources in indoor dusts. The risk assessment suggested that carcinogenic risks of BBzP and DEHP were negligible, but DBP, DEHP, DnOP, and BBzP may pose noncancer risks to humans.
Transcriptomic and genome-wide association study reveal long noncoding RNAs responding to nitrogen deficiency in maize
Authors: Ma Peng , Zhang Xiao , Luo Bowen , Chen Zhen , He Xuan , Zhang Haiying , Li Binyang , Liu Dan , Wu Ling , Gao Shiqiang , Gao Duojiang , Zhang Suzhi , Gao Shibin
Published: February 2021

Background

Long noncoding RNAs (lncRNAs) play important roles in essential biological processes. However, our understanding of lncRNAs as competing endogenous RNAs (ceRNAs) and their responses to nitrogen stress is still limited.

Results

Here, we surveyed the lncRNAs and miRNAs in maize inbred line P178 leaves and roots at the seedling stage under high-nitrogen (HN) and low-nitrogen (LN) conditions using lncRNA-Seq and small RNA-Seq. A total of 894 differentially expressed lncRNAs and 38 different miRNAs were identified. Co-expression analysis found that two lncRNAs and four lncRNA-targets could competitively combine with ZmmiR159 and ZmmiR164, respectively. To dissect the genetic regulatory by which lncRNAs might enable adaptation to limited nitrogen availability, an association mapping panel containing a high-density single–nucleotide polymorphism (SNP) array (56,110 SNPs) combined with variable LN tolerant-related phenotypes obtained from hydroponics was used for a genome-wide association study (GWAS). By combining GWAS and RNA-Seq, 170 differently expressed lncRNAs within the range of significant markers were screened. Moreover, 40 consistently LN-responsive genes including those involved in glutamine biosynthesis and nitrogen acquisition in root were identified. Transient expression assays in Nicotiana benthamiana demonstrated that LNC_002923 could inhabit ZmmiR159-guided cleavage of Zm00001d015521.

Conclusions

These lncRNAs containing trait-associated significant SNPs could consider to be related to root development and nutrient utilization. Taken together, the results of our study can provide new insights into the potential regulatory roles of lncRNAs in response to LN stress, and give valuable information for further screening of candidates as well as the improvement of maize resistance to LN stress.
Immunotherapy reversed myopathy but not cardiomyopathy in a necrotizing autoimmune myopathy patient with positive anti-SRP and MDA-5 autoantibodies
Authors: Ma Xue , Xu Li , Li Yue , Bu Bitao
Published: February 2021

Background

Necrotizing autoimmune myopathy (NAM) is pathologically characterized by myofiber necrosis and regeneration with paucity or absence of inflammatory cells in muscle biopsy. Two autoantibodies, namely anti-signal recognition particle (SRP)-antibodies and anti-3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR)-antibodies, are typically specific with NAM. Anti-SRP-positive NAM can be associated with cardiomyopathy which responds well to immunotherapy. Here we reported an anti-SRP-antibody and anti-MDA5-antibody NAM patient who developed severe cardiomyopathy after gaining significant improvement of myopathy and subsequently accepted heart transplantation.

Case presentation

A NAM case with both positive anti-SRP and MDA-5 antibodies who gained significant improvement of the skeletal muscle weakness with immunotherapy, but 3 years later he developed severe dilated cardiomyopathy and at last received heart transplantation. Myocardial biopsy showed disarranged and atrophic myofibers, remarkable interstitial fibrosis without inflammatory infiltrates. Immunohistochemistry analysis revealed increased polyubiquitin-binding protein p62/SQSTM1 protein expression and the positive staining of cleaved-caspase 3 in a few cardiomyocytes. After the transplantation, the patient was symptom-free on oral prednisone (10 mg/day) and tacrolimus (2 mg/day).

Conclusions

We described the first case of anti-SRP and anti-MAD5 positive NAM who had received heart transplantation because of cardiopathy. Though the myopathy had been clinically improved after immunotherapy, the cardiomyopathy remained progressive and lethal. The processes of dysfunctional autophagy and augmented apoptosis were putatively pathophysiological mechanisms underlying cardiac damage in anti-SRP and anti-MAD5 positive NAM.
Antibiotics for fever in patients without perforation after gastric endoscopic submucosal dissection and endoscopic submucosal excavation may be unnecessary: a propensity score-matching analysis
Authors: Lai Yongkang , Zhang Qian , Pan Xiaolin , Zhu Zhenhua , Long Shunhua , Zhou Xiaojiang , Li Guohua , Zhu Yin , Chen Youxiang , Shu Xu
Published: February 2021

Background

Endoscopic submucosal dissection (ESD) and endoscopic submucosal excavation (ESE) have been widely used and have gradually become the main endoscopic treatment for gastrointestinal mucosal and submucosal lesions. Whether antibiotics are necessary for fever after gastric ESD and ESE remain unclear. The aim of this study was to analyse the value of using antibiotics in patients without perforation after ESD or ESE with fever.

Methods

In this retrospective study, patients with fever without perforation after ESD or ESE from January 2014 to January 2019 were included and divided into 2 groups: the antibiotic group and the non-antibiotic group. Fever and hospitalization time were compared between the 2 groups after propensity score matching.

Results

Overall, 253 patients meeting the inclusion criteria were enrolled in the present study, with 186 patients in the non-antibiotic group and 67 patients in the antibiotic group before matching, 55 patients in the non-antibiotic group and 55 patients in the antibiotic group after matching with all baseline characteristics balanced (p > 0.05). The duration of fever was not significantly different between the 2 groups (p = 0.12). However, the median hospitalization stay in the antibiotic group was longer than that in the non-antibiotic group (8 vs 7, p = 0.007).

Conclusions

Antibiotics may be unnecessary for fever in patients without perforation and without serious co-morbidities after gastric ESD or ESE.
Polygenic risk score is a predictor of adenomatous polyps at screening colonoscopy
Authors: Northcutt Michael J. , Shi Zhuqing , Zijlstra Michael , Shah Ayush , Zheng Siqun , Yen Eugene F. , Khan Omar , Beig Mohammad Imran , Imas Polina , Vanderloo Adam , Ansari Obaid , Xu Jianfeng , Goldstein Jay L.
Published: February 2021

Background

Single nucleotide polymorphism (SNP)-based polygenic risk scoring is predictive of colorectal cancer (CRC) risk. However, few studies have investigated the association of genetic risk score (GRS) with detection of adenomatous polyps at screening colonoscopy.

Methods

We randomly selected 1769 Caucasian subjects who underwent screening colonoscopy from the Genomic Health Initiative (GHI), a biobank of NorthShore University HealthSystem. Outcomes from initial screening colonoscopy were recorded. Twenty-two CRC risk-associated SNPs were obtained from the Affymetrix™ SNP array and used to calculate an odds ratio (OR)-weighted and population-standardized GRS. Subjects with GRS of < 0.5, 0.5–1.5, and > 1.5 were categorized as low, average and elevated risk.

Results

Among 1,769 subjects, 520 (29%) had 1 or more adenomatous polyps. GRS was significantly higher in subjects with adenomatous polyps than those without; mean (95% confidence interval) was 1.02 (1.00–1.05) and 0.97 (0.95–0.99), respectively, p < 0.001. The association remained significant after adjusting for age, gender, body mass index, and family history, p < 0.001. The detection rate of adenomatous polyps was 10.8%, 29.0% and 39.7% in subjects with low, average and elevated GRS, respectively, p-trend < 0.001. Higher GRS was also associated with early age diagnosis of adenomatous polyps, p < 0.001. In contrast, positive family history was not associated with risk and age of adenomatous polyps.

Conclusions

GRS was significantly associated with adenomatous polyps in subjects undergoing screening colonoscopy. This result may help in stratifying average risk patients and facilitating personalized colonoscopy screening strategies.
How aware are swingers about their swing sex partners’ risk behaviours, and sexually transmitted infection status?
Authors: Niekamp Anne-Marie , Spauwen Laura W. L. , Dukers-Muijrers Nicole H. T. M. , Hoebe Christian J. P. A.
Published: February 2021

Background

Swingers are members of a heterosexual couple who, as a couple, have sex with others. They constitute a hidden subpopulation that is at risk for sexually transmitted infections (STIs). This study aimed to determine swingers’ level of awareness about the STI risk (indicators: bisexual behaviour, number of sex partners, and STI status) of their swing sex partners (i.e. alters).

Methods

In this cross-sectional study, data were collected from a convenience sample of swingers who visited our STI clinic. The sample consisted of 70 participants (i.e. egos) and their 299 swing sex partners (i.e. alters) who had undergone an STI test at our clinic. We compared network data (i.e. information that egos provided about alters) and data stored in the electronic patient record (EPR) in our clinic (i.e. information provided by alters themselves). We assessed the agreement (correct estimation, overestimation and underestimation) between the network data and EPR data using chi-squared tests.

Results

Egos underestimated the bisexual behaviours of 37% of their male alters and overestimated the number of sex partners of 54 and 68% of their male and female alters, respectively. Egos correctly estimated the STI statuses of only 22% of the alters who had an STI during the past six months.

Conclusions

The participating swingers underestimated the bisexual behaviours of their male swing sex partners, overestimated their number of sex partners, and underestimated their positive STI status. Underestimating their alters’ STI statuses can cause swingers to underestimate their own STI risk and fail to implement preventive measures. The latter finding has implications for STI prevention. Therefore, more attention should be paid to swingers in general and the promotion of actual partner notification and STI testing among swingers in specific.
Fast calculation software for modified Look-Locker inversion recovery (MOLLI) T1 mapping
Authors: Kim Yoon-Chul , Kim Khu Rai , Lee Hyelee , Choe Yeon Hyeon
Published: February 2021

Background

The purpose of this study was to develop a software tool and evaluate different T1 map calculation methods in terms of computation time in cardiac magnetic resonance imaging.

Methods

The modified Look-Locker inversion recovery (MOLLI) sequence was used to acquire multiple inversion time (TI) images for pre- and post-contrast T1 mapping. The T1 map calculation involved pixel-wise curve fitting based on the T1 relaxation model. A variety of methods were evaluated using data from 30 subjects for computational efficiency: MRmap, python Levenberg–Marquardt (LM), python reduced-dimension (RD) non-linear least square, C++ single- and multi-core LM, and C++ single- and multi-core RD.

Results

Median (interquartile range) computation time was 126 s (98–141) for the publicly available software MRmap, 261 s (249–282) for python LM, 77 s (74–80) for python RD, 3.4 s (3.1–3.6) for C++ multi-core LM, and 1.9 s (1.9–2.0) for C++ multi-core RD. The fastest C++ multi-core RD and the publicly available MRmap showed good agreement of myocardial T1 values, resulting in 95% Bland–Altman limits of agreement of (− 0.83 to 0.58 ms) and (− 6.57 to 7.36 ms) with mean differences of − 0.13 ms and 0.39 ms, for the pre- and post-contrast, respectively.

Conclusion

The C++ multi-core RD was the fastest method on a regular eight-core personal computer for pre- or post-contrast T1 map calculation. The presented software tool (fT1fit) facilitated rapid T1 map and extracellular volume fraction map calculations.
Outcome registry of early intensive neurorehabilitation in patients with disorders of consciousness: study protocol of a prospective cohort study
Authors: Driessen Danielle M. F. , Utens Cecile M. A. , Ribbers Gerard M. , van Erp Willemijn S. , Heijenbrok-Kal Majanka H.
Published: February 2021

Background

Prolonged disorders of consciousness (PDOC) may occur after severe brain injury. Two diagnostic entities are distinguished within PDOC: unresponsive wakefulness syndrome (UWS, previously known as vegetative state) and minimally conscious state (MCS). Patients with PDOC may benefit from early intensive neurorehabilitation (EIN). In the Netherlands, the EIN programme is provided by one designated expert rehabilitation centre and forms the starting point of a dedicated chain of specialised rehabilitation and care for this group. This study project, called DOCTOR: Disorders of Consciousness; Treatment and Outcomes Registry, sets up a registry and systematically investigates multiple short- and long-term outcomes of patients with PDOC who receive EIN.

Methods

Single-centre prospective cohort study with a 2-year follow-up period. Patients with PDOC due to acute brain injury who receive EIN, aged 16 years and older are included. Measurements will take place at start EIN, in week 5, 10, and at discharge from the EIN programme (duration = max 14 weeks) and at week 28, 40, 52, and 104 after admission to the EIN programme, following patients through the health-care chain. Outcome measures are the changes over time in level of consciousness, using the Coma Recovery Scale-Revised; the frequency and type of medical complications; the mortality rate; level of disability, including the level of motor, cognitive, behavioural and emotional functioning; participation; and quality of life. Secondary outcomes include self-efficacy of caregivers, caregivers’ strain and cost-effectiveness of the programme.

Discussion

The DOCTOR study will provide insight in the recovery patterns and predictors of recovery for multiple outcomes in PDOC patients after following EIN. The results of the study will enable us to benchmark and improve EIN and the organisation of the health-care chain, both for patients with PDOC and for their families.

Trial registration

Netherlands Trial Register,NL 8138. Retrospectively registered 6 November 2019.
Wireless versus routine physiologic monitoring after cesarean delivery to reduce maternal morbidity and mortality in a resource-limited setting: protocol of type 2 hybrid effectiveness-implementation study
Authors: Boatin Adeline A. , Ngonzi Joseph , Wylie Blair J. , Lugobe Henry M. , Bebell Lisa M. , Mugyenyi Godfrey , Mohamed Sudi , Martinez Kenia , Musinguzi Nicholas , Psaros Christina , Metlay Joshua P. , Haberer Jessica E.
Published: February 2021

Background

Women in sub-Saharan Africa have the highest rates of morbidity and mortality during childbirth globally. Despite increases in facility-based childbirth, gaps in quality of care at facilities have limited reductions in maternal deaths. Infrequent physiologic monitoring of women around childbirth is a major gap in care that leads to delays in life-saving interventions for women experiencing complications.

Methods

We will conduct a type-2 hybrid effectiveness-implementation study over 12 months to evaluate using a wireless physiologic monitoring system to detect and alert clinicians of abnormal vital signs in women for 24 h after undergoing emergency cesarean delivery at a tertiary care facility in Uganda. We will provide physiologic data (heart rate, respiratory rate, temperature and blood pressure) to clinicians via a smartphone-based application with alert notifications if monitored women develop predefined abnormalities in monitored physiologic signs. We will alternate two-week intervention and control time periods where women and clinicians use the wireless monitoring system during intervention periods and current standard of care (i.e., manual vital sign measurement when clinically indicated) during control periods. Our primary outcome for effectiveness is a composite of severe maternal outcomes per World Health Organization criteria (e.g. death, cardiac arrest, jaundice, shock, prolonged unconsciousness, paralysis, hysterectomy). Secondary outcomes include maternal mortality rate, and case fatality rates for postpartum hemorrhage, hypertensive disorders, and sepsis. We will use the RE-AIM implementation framework to measure implementation metrics of the wireless physiologic system including Reach (proportion of eligible women monitored, length of time women monitored), Efficacy (proportion of women with monitoring according to Uganda Ministry of Health guidelines, number of appropriate alerts sent), Adoption (proportion of clinicians utilizing physiologic data per shift, clinical actions in response to alerts), Implementation (fidelity to monitoring protocol), Maintenance (sustainability of implementation over time). We will also perform in-depth qualitative interviews with up to 30 women and 30 clinicians participating in the study.

Discussion

This is the first hybrid-effectiveness study of wireless physiologic monitoring in an obstetric population. This study offers insights into use of wireless monitoring systems in low resource-settings, as well as normal and abnormal physiologic parameters among women delivering by cesarean.

Trial registration

ClinicalTrials.gov, NCT04060667. Registered on 08/01/2019.
Impact of nicotine and maternal BMI on fetal birth weight
Authors: Günther Veronika , Alkatout Ibrahim , Vollmer Christoph , Maass Nicolai , Strauss Alexander , Voigt Manfred
Published: February 2021

Background

According to the World Health Organization, smoking is the most important risk factor for adverse pregnancy outcomes in industrialized nations. As the individual factors (body mass index – BMI (kg/m2) – and cigarette consumption) have been extensively investigated in pregnancy, we aimed to establish how maternal BMI and nicotine interact with regard to perinatal outcomes and birth weight.

Methods

Data from 110.047 singleton pregnancies, achieved from the German Perinatal Survey in Schleswig-Holstein and registered between 2010 and 2017 were analyzed in August 2018 concerning maternal BMI and smoking. The BMI was taken from the maternity log. Information concerning the smoking status were self-reported and further subdivided into the following four categories: a) non-smokers; b) 1–7 cigarettes/day; c) 8–14 cigarettes/ day; and d) ≥ 15 cigarettes/ day.

Furthermore, we classified women by their BMI into underweight, normal weight, overweight and obese. Comparisons between non-smokers and the respective smoking group, and their relationship with maternal BMI were performed by the t-test (birth weight). A P-value ≤0.05 was considered to indicate statistical significance.

Results

A number of 97.092 women (88.2%) were non-smokers and 12.955 (11.8%) were smokers. Furthermore 10.3% of women of normal weight smoked during pregnancy, but both high and low BMI were associated with a high prevalence of smoking. The proportion of smokers was highest (18.1%) among underweight women (BMI ≤ 18.5 kg/m2). A large number of smokers (15.5%) were registered in the obesity group (BMI ≥ 30 kg/m2).

Mean birth weight (≥ 37 + 0 gestational age) increased with increasing maternal BMI, and was reduced by smoking for every BMI category. The differences between smokers and non-smokers were always highly significant (p < 0.001). Mean birth weight varied between 2995 g in underweight frequent smokers and 3607 g in obese non-smokers.

Conclusion

Both maternal BMI and smoking during pregnancy influences the birth weight and therefore pregnancy outcome. Smoking during pregnancy was significantly associated with low birth weight. Pregnant women should be advised to cease or at least reduce smoking in order to improve the birth weight of the newborn and to minimize child morbidities.
Maternal age at first cesarean delivery related to adverse pregnancy outcomes in a second cesarean delivery: a multicenter, historical, cross-sectional cohort study
Authors: Bi Shilei , Zhang Lizi , Chen Jingsi , Huang Minshan , Huang Lijun , Zeng Shanshan , Li Yulian , Liang Yingyu , Jia Jinping , Wen Suiwen , Cao Yinli , Wang Shaoshuai , Xu Xiaoyan , Feng Ling , Zhao Xianlan , Zhao Yangyu , Zhu Qiying , Qi Hongbo , Zhang Lanzhen , Li Hongtian , Wang Zhijian , Du Lili , Chen Dunjin
Published: February 2021

Background

To determine the effects of maternal age at first cesarean on maternal complications and adverse outcomes of pregnancy with the second cesarean.

Methods

This was a multicenter, historical, cross-sectional cohort study involving singleton pregnancies ≥28 gestational weeks, with a history of 1 cesarean delivery, and who underwent a second cesarean between January and December 2017 at 11 public tertiary hospitals in 7 provinces of China. We analyzed the effects of maternal age at first cesarean on adverse outcomes of pregnancy in the second cesarean using multivariate logistic regression analysis.

Results

The study consisted of 10,206 singleton pregnancies. Women were at first cesarean between 18 and 24, 25–29, 30–34, and ≥ 35 years of age; and numbered 2711, 5524, 1751, and 220 cases, respectively. Maternal age between 18 and 24 years at first cesarean increased the risk of placenta accreta spectrum (aOR, 1.499; 95% CI, 1.12–2.01), placenta previa (aOR, 1.349; 95% CI, 1.07–1.70), intrahepatic cholestasis of pregnancy (aOR, 1.947; 95% CI, 1.24–3.07), postpartum hemorrhage (aOR, 1.505; 95% CI, 1.05–2.16), and blood transfusion (aOR, 1.517; 95% CI, 1.21–1.91) in the second cesarean compared with the reference group (aged 25–29 years). In addition, maternal age ≥ 35 years at first cesarean was a risk factor for premature rupture of membranes (aOR, 1.556; 95% CI, 1.08–2.24), placental abruption (aOR, 6.464, 95% CI, 1.33–31.51), uterine rupture (aOR, 7.952; 95% CI, 1.43–44.10), puerperal infection (aOR, 6.864; 95% CI, 1.95–24.22), neonatal mild asphyxia (aOR, 4.339; 95% CI, 1.53–12.32), severe asphyxia (aOR, 18.439; 95% CI, 1.54–220.95), and admission to a neonatal intensive care unit (aOR, 2.825; 95% CI, 1.54–5.17) compared with the reference group (aged 25–29 years).

Conclusions

Maternal age between 18 and 24 years or advanced maternal age at first cesarean was an independent risk factor for adverse maternal outcomes with the second cesarean. Advanced maternal age at the first cesarean specifically increased adverse neonatal outcomes with the second. Therefore, decisions as to whether to perform a first cesarean at a young or advanced maternal age must be critically evaluated.
High fascin-1 expression in colorectal cancer identifies patients at high risk for early disease recurrence and associated mortality
Authors: Tampakis Athanasios , Tampaki Ekaterini-Christina , Nonni Afrodite , Kostakis Ioannis D. , Posabella Alberto , Kontzoglou Konstantinos , von Flüe Markus , Felekouras Evangelos , Kouraklis Gregory , Nikiteas Nikolaos
Published: February 2021

Background

Fascin is the main actin cross-linker protein that regulates adhesion dynamics and stabilizes cell protrusion, such as filopodia. In human cancer, fascin expression correlates with aggressive clinical features. This study aimed to determine the expression patterns of fascin-1 and assessed its prognostic significance in colorectal cancer.

Methods

One hundred eleven specimens of patients with primary resectable colorectal cancer were examined via immunohistochemistry for the expression of fascin-1, and the results were correlated with clinicopathological characteristics and survival data.

Results

Fascin-1 staining displayed strong intensity in the cytoplasm of the colorectal cancer cells and endothelial cells of tumor blood vessels. Moderate to high fascin-1 expression was associated with progressive anatomic disease extent (p < 0.001), higher T classification (p = 0.007), the presence of lymph node (p < 0.001) and distant metastasis (p = 0.002), high grade tumors (p = 0.002) and vascular invasion (p < 0.001). Patients displaying moderate and high fascin-1 expression demonstrated a significantly worse 5-year overall survival [HR; 3.906, (95%CI) = 1.250–12.195] and significantly worse 3-year progression-free survival [HR; 3.448, (95%CI) = 1.401–8.475] independent of other clinicopathological characteristics. Besides, high fascin-1 expression in early-stage cancer only was associated with a dismal prognosis.

Conclusions

High fascin-1 expression in colorectal cancer is an independent negative prognostic factor for survival, increasing the risk for disease recurrence or death almost by sevenfold. Fascin-1 expression could be potentially utilized to identify high-risk patients prone to metastasis already in early-stage disease.