bluuebunny/crossref_metadata_2025 huggingface dataset:
Complications and Long-Term Outcomes of Open Reduction and Plate Fixation of Proximal Humeral Fractures
Authors: Robinson C. Michael , Stirling Paul H.C. , Goudie Ewan B. , MacDonald Deborah J. , Strelzow Jason A.
Published: October 2019

Background:

The optimal treatment of complex proximal humeral fractures in adults remains controversial. We evaluated the risk of complications and the long-term outcomes in patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus treated with open reduction and plate fixation (ORIF).

Methods:

Between 1995 and 2012, 5,897 consecutive patients with a proximal humeral fracture were referred to a specialist shoulder clinic for surgical assessment. Indications for surgery included anterior or posterior fracture-dislocation, substantial tuberosity involvement with >1 cm of displacement in a Neer 3 or 4-part fracture configuration, disengagement of the head from the shaft, or severe varus or valgus deformity of the head. All patients who met the surgical criteria and had been followed for 2 years were included, and standardized clinical and radiographic assessments of outcomes were performed. At a median of 10.8 years (range, 5 to 22 years) after ORIF, all surviving cognitively intact patients completed a patient-reported questionnaire assessing functional outcomes and satisfaction.

Results:

Three hundred and sixty-eight patients (6.2%) met the inclusion criteria and had the appropriate follow-up. The study population had a high rate of complex fracture configurations; 77.2% had tuberosity involvement, 54.1% had complete head-shaft disengagement, and 44.0% had a dislocated head. Eighty-seven patients (23.6%) had postoperative stiffness, 25 (6.8%) had fixation failure/nonunion, and 16 (4.3%) had late osteonecrosis/posttraumatic osteoarthritis; these complications were the reason for the majority of the reoperations in the cohort. The survivorship until any reoperation was 74% at 10 years, but when reoperations for stiffness were excluded, the survivorship was 90% during the same time period. The patients’ mean levels of pain, function, and satisfaction with treatment were good to excellent.

Conclusions:

Our results support the use of primary ORIF in medically fit patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus in centers where the expertise to carry out such treatment exists.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Topics, Skills, and Cases for an Undergraduate Musculoskeletal Curriculum in Southern Africa
Authors: Held Michael F.G. , Laubscher Maritz , Graham Simon M. , Kruger Nicholas , Njisane Phinda , Njisane Vela , Dunn Robert N. ,   on behalf of the Learning Innovation via Orthopaedic Networks (LION) Group
Published: October 2019

Background:

Most patients with orthopaedic pathology in low to middle-income countries are treated by nonspecialists. A curriculum to prepare undergraduate medical students for this duty should reflect the local pathology and skills that are required to manage patients in a resource-restricted environment. The aim of this study was to establish and prioritize a list of core orthopaedic-related knowledge topics, clinical cases, and skills that are relevant to medical students in southern Africa and areas with a similar clinical context.

Methods:

A modified Delphi consensus study was conducted with 3 interactive iterative rounds of communication and prioritization of items by experts from Africa, Europe, and North America. Preferred priorities were selected but were limited to 50% of all of the possible items. Percent agreement of ≥75% was defined as consensus on each of these items.

Results:

Most of the 43 experts who participated were orthopaedic surgeons from 7 different countries in southern Africa, but 28% were general practitioners or doctors working in primary or secondary-level facilities. Experts prioritized cases such as patients with multiple injuries, a limping child, and orthopaedic emergencies. Prioritized skills were manipulation and immobilization of dislocations and fractures. The most important knowledge topics included orthopaedic infections, the treatment of common fractures and dislocations, any red flags alerting to specialist referral, and back pain. Surgical skills for the treatment of urgent care conditions were included by some experts who saw a specific need in their clinical practice, but these were ranked lower.

Conclusions:

A wide geographic, academic, and expertise-specific footprint of experts informed this international consensus through their various clinical and academic circumstances. Knowledge topics, skills, and cases concerning orthopaedic trauma and infection were prioritized by the highest percent agreement. Acute primary care for fractures and dislocations ranked high. Furthermore, the diagnosis and the treatment of conditions not requiring specialist referral were prioritized. This study can inform national curricula in southern Africa and assist in the allocation of student clinical rotations.
Design Aspects of Complex Toe-to-Heel Flooding
Authors: Algarhy Ahmed , Soliman Mohamed , Turta Alex
Published: October 2019

Complex Toe-to-Heel Flooding (CTTHF) is a short distance flooding technique developed by the authors for sandstone formations. CTTHF applied on horizontal wells and requires at least one barrier and injector hydraulic fracture, also it requires at least one method to control early water production. This paper discusses the design aspects of the CTTHF including the design of barrier fracture, injector fracture, and the produced water control methods. Technical and economical evaluation to rank different design setups is performed and presented.

Advanced commercial reservoir simulator with hydraulic fracturing module was used to simulate different CTTHF setups and reservoir conditions to set the reservoir selection criteria and proper design methodology. In this study, Toe-to-Heel Waterflooding was considered the base case. Sensitivity studies for barrier fracture and injector design has been achieved and presented. Moreover, a sensitivity studies for hydraulic fractures spacing, number of barrier fractures, batch injection scheduling and changing packer location have been performed.

When CTTHF is applied in high permeable sandstone formation, early water production is expected, except produced water control method is used. This study states the feasibility conditions for each proposed produced water control technique. Also, a methodology for candidate reservoir selection, design of barrier and injector fractures is developed and presented. There are multiple fluid systems can be used to create the barrier to seal a pre-determined zone. CTTHF is better reservoir management approach.

The novelty of the CTTHF is giving multiple options for produced water control that maximizes the produced oil and minimizes the water production. CTTHF's produced water control can make some reservoirs economic to produce.
Robust Estimation of Arps Decline Parameters Using Regularizing Priors
Authors: Ravikumar Arjun , Lee John
Published: October 2019

Decline curve analysis is widely used in industry to perform production forecasting and to estimate reserves volumes. A useful technique in verifying the validity of a decline model is to estimate the Arps decline parameters, the loss ratio and the b-factor, with respect to time. This is used to check the model fit and to determine the flow regimes under which the reservoir produces. Existing methods to estimate the b-factor are heavily impacted by noise in production data. In this work, we introduce a new method to estimate the Arps decline parameters.

We treat the loss ratio and the b-factor over time as parameters to be estimated in a Bayesian framework. We include prior information on the parameters in the model. This serves to regularize the solution and prevent noise in the data from being amplified. We then fit the parameters to the model using Markov chain Monte Carlo methods to obtain probability distributions of the parameters. These distributions characterize the uncertainty in the parameters being estimated. We then compare our method with existing methods using simulated and field data.

We show that our method produces smooth loss ratio and b-factor estimates over time. Estimates using the three-point derivative method are not matched with data, and results in biased estimates of the Arps parameters. This can lead to misleading fits in decline curve analysis and unreliable estimates of reserves. We show that our technique helps in identification of end of linear flow and start of boundary dominated flow. We use our method on simulated data, with and without noise. Finally, we demonstrate the validity of our method on field cases.

Fitting a decline curve using the loss ratio and b-factor plots is a powerful technique that can highlight important features in the data and the possible points of failure of a model. Calculating these plots using the Bourdet three-point derivative induces bias and magnifies noise. Our analysis ensures that this estimation is robust and repeatable by adding prior information on the parameters to the model and by calibrating the estimates to the data.
Effect of Pore Size Heterogeneity on Hydrocarbon Fluid Distribution and Transport in Nanometer-Sized Porous Media
Authors: Zhang Kaiyi , Du Fengshuang , Nojabaei Bahareh
Published: October 2019

In this paper, we investigate the effect of pore size heterogeneity on multicomponent multiphase hydrocarbon fluid composition distribution and its subsequent influence on mass transfer through shale nano-pores. We use a compositional simulation model with modified flash calculation, which considers the effect of large gas-oil capillary pressure on phase behavior. We consider different average pore sizes for different segments of the computational domain and investigate the effect of the resulting heterogeneity on phase and composition distributions, and production. A two dimensional formulation is considered here for the application of matrix-fracture cross mass transfer. Note that the rock matrix can also consist of different regions with different average pore sizes. Both convection and molecular diffusion terms are included in the mass balance equations, while different reservoir fluids such as Bakken and Marcellus are considered. The simulation results show that since oil and gas phase compositions depend on the pore size, there is a concentration gradient between the two adjacent pores with different sizes. Considering that shale permeability is small, we expect the mass transfer between two sections of the reservoir/core with two distinct average pore sizes to be diffusion-dominated. This observation implies that there can be a selective matrix-fracture component mass transfer during both primary production and gas injection EOR as a result of confinement-dependent phase behavior. Therefore, molecular diffusion term should be always included in the mass transfer equations, for both primary and gas injection EOR simulation of heterogeneous shale reservoirs.
Refrac Implementation in Legacy Shale Play Re-Development: A Multivariable Approach
Authors: Sharma Akash , Mathukutty Shibu , Siegel Samantha
Published: October 2019

Improved completion design and field development strategies have provided commodity price resilience by sustained efficiency gains across most major US Shale plays. This rapid evolution in completion practices, however, has created behind pipe opportunities. Refracturing offers a viable solution to maximize on these opportunities, however, its effectiveness is dependent on a variety of factors. The present paper explores the implementation of refracturing as a re-development strategy in legacy shale plays and evaluates it as a truly multivariable problem.

The paper takes into consideration petrophysical parameters, initial completion design, chemical composition, formation quality, time from original completion, refrac completion design and production performance to quantify impact on refrac KPIs such as IP ratio, EUR ratio, decline trend impact, amongst others. The paper does this by using an ACE (alternating conditional expectation) non-linear regression model that incorporates the KPI’s as response variables and utilizes the transforms of a wide range of input variables to identify cause and effect relationships. By running this analysis across multiple legacy shale plays, including the Haynesville, and Barnett, the paper provides best-practices to maximize refracturing success.

While refrac can offer a viable solution in obtaining incremental production, depending on the basin, a refrac can be a tenth of the expense of a new well and can beneficially impact the production from the existing well. In most cases, the analysis found EUR predictions improved by 30% - 200%. While correlations varied across basins and completion design, an inverse correlation was found between refrac KPIs and initial frac intensity.

Although, refracturing in horizontal shale wells is a well-established practice, a significant amount of analysis on their performance is focused on one or two key variables. The present paper adds to the existing body of literature by using data analytics and machine learning to evaluate this strategy from a truly multivariable standpoint. The paper also provides best practices to evaluate and predict refrac performance to de-risk refrac as a field re-development strategy.
Improved Drilling Efficiencies Using Offline Cementing Saves Days on Well and Reduces Costs
Authors: Van Meter Samuel , Kutchak Kristin , Guerrero Habib
Published: October 2019

Drilling in the Appalachian basin in Pennsylvania has evolved since its inception. Operators have shifted their focus from mere wellbore delivery to delivering wells in the shortest amount of time to reduce risks and costs, as well as drive efficiency. This paper presents a case study in which offline cementing helped improve operation efficiency by reducing drilling times and provided significant cost savings.

Offline cementing is not a new concept. In Q4 2015, an operator drilling in the Eagle Ford shale began the movement of their program toward offline cementing of both the surface and production casings. The operator determined that reducing flat time was crucial to create a cost savings (Hsieh 2018). When another operator began their 2018 drilling program in northeastern Pennsylvania, improving efficiencies was discussed with the service company. After quantifying the experience obtained during a previous project, the service company proposed offline cementing because of the economic benefits it could provide.

The service company was able to cement both the surface and intermediate casing strings offline while the operator skidded to the next well to begin rigging up. All surface casings were drilled and cemented offline and the rig skidded back to drill for the intermediate casings, which were also cemented offline. Approximately 15 hours was saved by skidding between surface strings, and another 16 hours was saved between intermediate casings.

This paper discusses the successful use of offline cementing during drilling operations in northeastern Pennsylvania. The flat time reduction achieved during this drilling program can be quantified into a cost savings of approximately USD 80,000 per well.
Pneumocystis jirovecii Colonization and Its Association with Pulmonary Diseases Based on a Multicenter Study by an Improved Loop-Mediated Isothermal Amplification Assay
Authors: Xue Ting , Ma Zhuang , Liu Fan , Du Wei-Qin , He Li , Wang Jin-Yan , An Chun-Li
Published: October 2019

Background
Pneumocystis jirovecii ( P. jirovecii ) is an opportunistic fungal pathogen and the role of its colonization in pulmonary diseases has become a popular focus in recent years. The aim of this study is to develop an improved loop-mediated isothermal amplification (LAMP) assay for detection of Pneumocystis jirovecii ( P. jirovecii ) DNA and use it to examine the prevalence and association of P. jirovecii colonization among non-HIV patients with various pulmonary diseases.
Methods
We modified the previously reported LAMP assay for P. jirovecii by adding real-time detection. This method was used to detect P. jirovecii colonization in pulmonary samples collected from 403 non-HIV patients with various pulmonary diseases enrolled from 5 hospitals in China. We determined the prevalence of P. jirovecii colonization in 7 types of pulmonary diseases and assessed the association of P. jirovecii colonization with clinical characteristics of these diseases.
Results
The new LAMP assay showed no cross-reactivity with other common pulmonary microbes and was 1,000 times more sensitive than that of conventional PCR. Using the new LAMP assay, we detected P. jirovecii colonization in 281 (69.7%) of the 403 patients enrolled. P. jirovecii colonization was more common in interstitial lung diseases than in chronic obstructive pulmonary disease (COPD) (84.6% vs 64.5%, P < 0.05). Patients with acute exacerbation of COPD had a higher prevalence of P. jirovecii colonization compared to patients with stabilized COPD (67.4% vs 43.3%, P < 0.05). P. jirovecii colonization was associated with decreased pulmonary function, increased levels of 1,3-β-D-glucan and C-reactive protein, and decreased levels of CD4+ T-cell counts (P < 0.05 for each). Approximately 70% of P. jirovecii colonized patients had confections with other fungi or bacteria.
Conclusions
We developed an improved LAMP assay for detecting P. jirovecii . Our multi-center study of 403 patients supports that P. jirovecii colonization is a risk factor for the development of pulmonary diseases and highlights the need to further study the pathogenesis and transmission of P. jirovecii colonization in pulmonary diseases.
Regorafenib plus FOLFIRI with irinotecan dose escalated according to uridine diphosphate glucuronosyltransferase 1A1 genotyping in previous treated metastatic colorectal cancer patients: study protocol for a randomized controlled trial
Authors: Ma Cheng-Jen , Chang Tsung-Kun , Tsai Hsiang-Lin , Su Wei-Chih , Huang Ching-Wen , Yeh Yung-Sung , Chang Yu-Tang , Wang Jaw Yuan
Published: October 2019

Background Regorafenib is an oral multi-kinase inhibitor for metastatic colorectal cancer (mCRC) previously treated with fluoropyrimidines, irinotecan, oxaliplatin, monoclonal antibodies targeting vascular endothelial growth factor (VEGF), and monoclonal antibodies targeting epidermal growth factor receptor (EGFR). A dose reduction from 160 mg to 120 mg regorafenib reduces regorafenib-associated adverse events (AEs). Dose adjustment of irinotecan in FOLFIRI regimen on basis of individual uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1) genotype provides optimal oncological outcomes with acceptable AEs. This study is trying to address the efficacy and safety of dose adjusted combination of regorafenib and FOLFIRI for patients with mCRC. Methods A prospective, multicenter, randomized in a 2:1 ratio, controlled, clinical trial with two parallel arms will be conducted to compare irinotecan dose escalated FOLFIRI according to UGT1A1 genotyping plus 120 mg regorafenib with 120 mg regorafenib alone in previously treated patients with mCRC. The primary endpoint is progression-free survival (PFS) and the secondary endpoints are overall survival (OS), disease control rate (DCR), time to progression (TTP), and duration of treatment (DoT). Safety assessments are recorded as well. Discussion Dose adjustment for regorafenib and irinotecan makes treatment-related AEs tolerable and makes the concomitant treatment practicable. This study will provide initial evidences regarding the efficacy and safety of a new combination of chemotherapy and a targeted agent for mCRC.
Dual effect of the Valsalva maneuver on autonomic nervous system activity, intraocular pressure, Schlemm’s canal, and iridocorneal angle morphology
Authors: Sun Li , Chen Wei , Chen Zhiqi , Xiang Yan , Guo Jingmin , Hu Tian , Xu Qiongfang , Zhang Hong , Wang Junming
Published: October 2019

Background: The Valsalva maneuver (VM) is widely used in daily life, and has been reported to cause high intraocular pressure (IOP). This study aimed to assess changes in IOP, the Schlemm’s canal (SC), autonomic nervous system activity, and iridocorneal angle morphology in healthy individuals during different phases of the VM.

Methods: The high frequency (HF) of heart rate (HR) variability, the ratio of low frequency power (LF) and HF (LF/HF), heart rate (HR), IOP, systolic (SBP) and diastolic blood pressure (DBP), the area of SC (SCAR), pupil diameter (PD), and some iridocorneal angle parameters (AOD500, ARA750, TIA500 and TISA500) were measured in 29 young healthy individuals at baseline, phase 2, and phase 4 of the VM. SBP and DBP were measured to calculate mean arterial pressure (MAP) and mean ocular perfusion pressure (MOPP). HF and the LF/HF ratio were recorded using Kubios HR variability premium software to evaluate autonomic nervous system activity. The profiles of the anterior chamber were captured by a Spectralis optical coherence tomography device (anterior segment module).

Results: Compared with baseline values, in phase 2 of the VM, HR, LF/HF, IOP (15.1±2.7 vs. 18.8±3.5 mmHg, P < 0.001), SCAR(mean) (7712.112±2992.14 vs. 8921.12±4482.79 μm2, P = 0.039), and PD increased significantly, whereas MOPP, AOD500, TIA500, and TISA500 decreased significantly. In phase 4, DBP, MAP, AOD500, ARA750, TIA500and TISA500 were significantly lower than baseline value, while PD and HF were remarkably larger than baseline. The comparison between phase 2 and phase 4 showed that HR, IOP (18.8±3.5 vs. 14.7±2.9 mmHg, P < 0.001) and PD decreased significantly from phase 2 to phase 4, but there were no significant differences in other parameters.

Conclusions: The expansion and collapse of the SC in different phases of the VM may arise from changes in autonomic nervous system activity. Further, the effects of the VM on IOP may be attributed to changes in blood flow and ocular anatomy.
Genome-wide identification and transcript analysis of TCP transcription factors in grapevine
Authors: leng xiangpeng , Wei Hongru , Xu Xiaozhao , Ghuge Sandip A. , Jia Dongjie , Liu Gengsen , Wang Yongzhang , Yuan Yongbing
Published: October 2019

Background The plant-specific TCP transcription factors play different functions in multiple processes of plant growth and development. TCP family genes have been identified in several plant species, but no comprehensive analysis of the TCP family in grapevine has been undertaken to date, especially their roles in fruit development. Results A total of 18 non-redundant grapevine TCP (VvTCP) genes distributing on 11 chromosomes were identified. Phylogenetic and structural analysis showed that VvTCP genes were divided into two main classes - class I and class II. The Class II genes were further classified into two subclasses, the CIN subclass and the CYC/TB1 subclass. Segmental duplication was a predominant duplication event which caused the expansion of VvTCP genes. The cis-acting elements analysis and tissue-specific expression patterns of VvTCP genes demonstrated that these VvTCP genes might play important roles in plant growth and development. Expression patterns of VvTCP genes during fruit development and ripening were analyzed by RNA-Seq and qRT-PCR. Among them, eleven VvTCP genes were down-regulated during different fruit developmental stages, while only one VvTCP genes were up-regulated, suggesting that most VvTCP genes were probably related to early development in grapevine fruit. Futhermore, the expression of most VvTCP genes can be inhibited by drought and waterlogging stresses. Conclusions Our study establishes the first genome-wide analysis of the grapevine TCP gene family and provides valuable information for understanding the classification and functions of the TCP genes in grapevine.
Effect of HELLP syndrome on acute kidney injury in pregnancy and pregnancy outcomes: a systematic review and meta-analysis
Authors: Liu Qiang , LING Guan-jun , ZHANG Shao-quan , ZHAI Wen-qing , CHEN Yi-juan
Published: October 2019

Background HELLP syndrome is a common complication during pregnancy,especially among those who with gestational hypertension. At present, the impact of HELLP syndrome on AKI（acute kidney injury） and maternal and infant outcomes is controversial. Thus, we conducted a meta-analysis to find out more about the relationship between HELLP syndrome and acute kidney injury during pregnancy and pregnancy outcomes. Methods We systematically searched PubMed , Embase and Cochrane Databases for cohort studies to assess the effect of HELLP syndrome on P-AKI(acute kidney injury in pregnancy) and maternal and infant outcomes. Using odds ratio (OR) with 95% confidence interval (CI) were pooled with a random- or fixed-effect models when appropriate. Results This meta-analysis included 11 cohort studies with a total of 6333 Participants, including 355 cases of pregnant women with HELLP syndrome and 5979 cases that without. HELLP syndrome has been associated with relatively higher risk of AKI during pregnancy（OR4.87 95% CI 3.31～7.17，P＜0.001）, fetal mortality（OR1.56 95% CI 1.45～2.11，P＜0.001） and Maternal death（OR3.70 95% CI 1.72～7.99，P＜0.001）. Conclusions HELLP syndrome has been associated with relatively higher risk of P-AKI, fetal mortality and Maternal death .
Antiseptics As Adjuncts To Scaling And Root Planing In The Treatment Of Periodontitis: A Systematic Literature Review
Authors: Ramanauskaite Egle , Machiulskiene Vita
Published: October 2019

Background: Periodontitis is microbially-associated, host-mediated inflammatory condition that results in loss of periodontal attachment. The goals of periodontal therapy include arresting the disease progression, establishing healthy, stable, maintainable periodontal conditions. A fundamental strategy of treating periodontitis is scaling and root planing (SRP), however its efficacy may be restricted in areas inaccessible for mechanical instrumentation. As periodontitis is infectious in nature, it might be helpful to use additional antimicrobial adjuncts, in order to eliminate or inactivate pathogenic microflora. The aim of this study is to evaluate the current evidence regarding the potential clinical benefits of using additional antiseptics for SRP in nonsurgical periodontal therapy. Methods: An electronic literature search was conducted in the MEDLINE (Ovid) and Cohrane Central Register of Controlled Trials (CENTRAL) databases for articles published between January 1, 2000 and September 22, 2019. Randomized controlled clinical trials in English that compare the effectiveness of one or more antiseptic agents as adjuncts to SRP with a follow-up of ≥ 6 months were included. A meta-analysis using the random-effects model was performed on the selected qualifying articles. Results: The search resulted in 12 articles that met the inclusion criteria. Based on the vehicle employed to deliver the antiseptic agent, studies were divided into adjunctive sustained-release antiseptics (gels, chips and varnish) and adjunctive irrigation with antiseptics. The meta-analysis demonstrated significant improvements in probing depth (PD) reduction (p = 0.001), clinical attachment level (CAL) gain (p = 0.001), and bleeding on probing (BOP) values (p = 0.001) following the adjunctive subgingival application of sustained-release antiseptics. Additional subgingival irrigation with antiseptics failed to show significant improvements in PD (p = 0.321), CAL (p = 0.7568), or BOP values (p = 0.3549) over SRP alone. Conclusions: Adjunctive subgingivally delivered antiseptics with a sustained-release delivery have significant clinical benefits compared to SRP alone.
Understanding the ward environment: a mixed-methods exploratory study of factors determining medical students’ ‘ward smarts’.
Authors: Poynton-Smith Emma , Colwill Erica , Sahota Opinder
Published: October 2019

BackgroundMedical students are expected to know how to function on hospital wards and to be at ease within the ward environment. Such ward-based knowledge indicates that a student is ‘ward smart’: levels of ward smarts vary between students (e.g. based on prior work experience and opportunities offered by placements). However, formal teaching in this area seems to be somewhat neglected, with students being left to ‘pick up’ this knowledge as they go along, which can have an impact on their clinical education. MethodsData were collected via an online questionnaire comprising both closed and open questions designed to assess students’ ward smarts, focusing on knowledge of the ward environment (routines, equipment, and terminology used), relevant clinical knowledge, and communication/roles of other members of the multi-disciplinary team. Multiple regression was used to identify factors influencing students’ scores (i.e. demographics, work experience). Thematic analysis was used to explore medical students’ opinions on how their ward understanding could be improved.ResultsIn our sample of 53 medical students, 96% did not know how to turn on a hearing aid and only 31% knew what a Waterlow score was. Furthermore, 88% did not know how to read an oxygen flowmeter, and only 57% knew where the CPR lever on the bed was situated.Multiple regression showed that ward smarts can be predicted by previous hospital-based work and year group, both of which may represent time spent on wards. Thematic analysis suggested that students felt their understanding of wards would benefit from more ward time and shadowing allied healthcare professionals on the wards.ConclusionsThis suggests that students may not be prepared to work in a ward environment. We propose, based on training implemented in other medical schools, that a specific ward-based interprofessional learning placement or experience should be added to the medical curriculum. As an initial step, specific teaching and/or practical sessions for students centred around patient communication and understanding the ward environment would be beneficial.
Prevalence Of Human Papillomavirus And Co-existent Sexually Transmitted Infections Among Female
Authors: Belfort Ilka Kassandra Pereira , Leite Carla Figueredo Belfort , Belfort Francisco Pedro , Gaspar Renata Lemos , Monteiro Pablo Matos , Costa Lucas Henrique de Lima , Cunha Ana Paula Almeida , Vidal Flávia Castello Branco , Barros Allan Kardec Duailibe , Monteiro Sally Cristina Moutinho
Published: October 2019

Background: human papillomavirus is one of the most common sexually transmitted infections in the world, with a higher prevalence among young adults at the onset of sexual activity, Methods: prospective cross-sectional study were performed among 162 women aged between 18 and 73 years. For the DNA/HPV isolation, samples were collected and placed in the HC2 DNA Collection buffer (QIAGEN, CA, USA), and frozen at -20°C until processed. DNA/HPV extraction were performed by using QIAamp DNA Mini and Blood kit (QIAGEN, CA, USA) according to manufacturer instructions. Total DNA was isolated, eluted in 100 mL AE buffer and stored at 80˚C. Extracted DNA was quantified using a NanoVue unit (GE Healthcare Life Sciences, Little Chalfont, UK). Statistical analysis was performed using IBM SPSS® software version 23. Data were initially subjected to descriptive analysis, plus mean and standard deviation. Results: among the participants, 61.7% had DNA / HPV and 66.7% were users of illicit drugs and 59.3% were non-users, making them statistically significant. Among DNA/HPV positive users there was a higher proportion of sexually transmitted infections (STIs) (27.9%) compared to non-users (9.27%) (p> 0.05). Conclusion: the vulnerability of women to STIs and the high influence caused by the socioeconomic context in the course of these infections, the importance of public policies that establish appropriate strategies for their prevention, early diagnosis and treatment is emphasized, so that there is. The Research Ethics Committee of the University Hospital of the Federal University of Maranhão approved the project under the number CAAE 76328917.5.0000.5086, and informed consent was obtained from all subjects.
Thrombospondin-4 (TSP4) gene-modified bone marrow stromal cells (BMSCs) promote the effect of therapeutic angiogenesis in critical limb ischemia (CLI) of diabetic rats
Authors: Zhang Qian , Wang Tao , Wu Xiangfeng , Wang Ying , Wu Xuanqin , Zhou Meiling , Li Zhu , Liu Bing , Zheng Feng , Sun Xizhuo , Liu Tao
Published: October 2019

Background: Critical limb ischemia (CLI) is the leading cause of lower limb amputation. Traditional treatments for CLI have limitations. Studies have shown that thrombospondin-4 (TSP4) can promote the growth of neovascularization. Results: In this study, we observed the angiogenesis efficiency of TSP4-overexpressing BMSC transplantation in CLI treatment. The recombinant FT106-tsp4-gfp lentiviral vector plasmid was constructed and transfected into 293FT cells. Primary BMSCs were successfully infected with the tsp4 virus, and TSP4 overexpression was confirmed before TSP4-BMSCs infusion. In vitro, TSP4-BMSCs were co-cultured with human umbilical vein endothelial cells (HUVECs). Vascular endothelial growth factor (VEGF) and transforming growth factor-β (TGF-β) secretion were measured in the co-culture supernatants by ELISA. The effect of TSP4-BMSCs on endothelial cell proliferation and migration was detected. Meanwhile, the effects of TSP4-BMSC on the angiogenesis of endothelial cells were tested by tube formation experiment and arterial ring test. In vivo, a rat CLI model was established, and 60 CLI rats were randomly divided into the CLI, BMSC + CLI and TSP4-BMSC + CLI groups. The effect of TSP4-BMSC on angiogenesis was detected by the motor function, immunohistochemistry and immunofluorescence staining assays. Neovascular density was detected by digital substraction angiography (DSA). Our results demonstrated that TSP4-BMSCs obviously increased TSP4, VEGF, Ang-1, MMP9, MMP2 and p-Cdc42/Rac1 expression in endothelial cells. TSP4-BMSCs treatment notably upregulated the TGF-β/smad2/3 signal pathway in HUVECs. In vivo, TSP4-BMSCs improved the motor function score of the CLI rats and increased MMP2, MMP9, Ang-1, VEGF and vWF protein expression in tissue of the ischaemic area. Meanwhile, new blood vessels can be observed around the ischemic area after TSP4-BMSCs treatment. Conclusion: Our data illustrate that TSP4-BMSCs can promote endothelial cell proliferation, migration, tube formation and the recovery of motor function in diabetic hind limb ischaemic rats. TSP4-BMSCs have better therapeutic effects than BMSCs.
Effects of medical and surgical treatment on the risk of major adverse cardiovascular and cerebrovascular events in Asian women with endometriosis
Authors: Chiang Hsin-Ju , Lan Kuo-Chung , Yang Yao-Hsu , Chiang John Y. , Kung Fu-Tsai , Huang Fu-Jen , Lin Yu-Ju , Su Yu-Ting , Sung Pei-Hsun
Published: October 2019

Background: Endometriosis (EM) is linked to cardiovascular disease (CVD). However, whether this finding can be applied to the Asian population remained unanswered. Results are still conflicting in terms of therapeutic effect on the risk of CVD in patients with EM. Therefore, we investigated the association between EM and major adverse cardiovascular and cerebrovascular events (MACCE) and the therapeutic effect on the risk of MACCE in Asian women with EM. Methods: The Taiwan National Health Insurance Research Database was used for this retrospective population-based cohort study from 1997 to 2013. A total of 17 543 patients with EM aged between 18 and 50 years were identified from a general population of 1 million after excluding diagnoses of major CVD and cerebrovascular accident (CVA) prior to EM. The comparison group (n = 70 172) without EM was selected by matching the study cohort with age, sex, and income and urbanization levels in a 4:1 ratio. Demographic data and the frequency of comorbidities between groups were compared using the independent t test and chi-square test. The incidence and risk of MACCE were analyzed using the log-rank test and a multivariate Cox proportional hazards model. Results: During a median follow-up period of 9.2 years, Asian women with EM had a significantly higher frequency of comorbidities, medical and surgical treatment, and MACCE than did their non-EM counterparts (2.76% vs 2.18%, P < .0001). After adjustment for comorbidities, patients with EM had an approximately 1.2-fold increased risk of MACCE (95% CI 1.05-1.29; P = .0053) and a higher cumulative incidence of MACCE compared with the normal population. Among women with EM, neither medical nor surgical treatment increased the risk of MACCE, including major CVD and CVA. Furthermore, medical treatment for EM appeared to be protective against MACCE. Conclusion: Asian women with EM not only had a substantially higher frequency of comorbidities but also an increased risk of MACCE compared with the general population. In terms of medical or surgical treatment of EM, the safety concern regarding MACCE was not evident.
Sufficient Tissue Acquisition Rate of Peroral Cholangioscopy-guided Forceps Biopsy
Authors: Onoyama Takumi , Takeda Yohei , Kawata Soichiro , Kurumi Hiroki , Koda Hiroki , Yamashita Taro , Hamamoto Wataru , Sakamoto Yuri , Matsumoto Kazuya , Isomoto Hajime
Published: October 2019

Background: Peroral cholangioscopy (POCS)-guided forceps biopsy is a method for diagnosing indeterminate biliary strictures and for the preoperative identification of the exact perihilar and distal margins of biliary tract cancer (BTC). However, POCS-guided forceps biopsy may result in an insufficient amount of specimen at times. Aims: We evaluated the sufficient tissue acquisition rate and the factors affecting the sufficient tissue acquisition of POCS-guided forceps biopsy for the biliary tract. Methods: Patients who underwent POCS-guided forceps biopsy for biliary disease between September 2016 and October 2018 at our hospital were enrolled retrospectively. We evaluated the sufficient tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion and that for non-stenotic bile duct. In addition, the factors affecting the sufficient tissue acquisition rate of POCS-guided forceps biopsy were evaluated. Results and Conclusions : We enrolled 47 patients with the biliary disease and performed POCS-guided forceps biopsy for biliary lesion and POCS-guided forceps mapping biopsy for non-stenotic bile duct in 40 and 36 patients, respectively. The sufficient tissue acquisition rates of POCS-guided forceps biopsy for biliary lesions and that for non-stenotic bile duct were 86.4%, and 68.9%, respectively. In the multivariate logistic regression analyses, age and previous biliary stenting before POCS were factors affecting the sufficient tissue acquisition rate of POCS-guided forceps biopsy for the biliary lesion. For non-stenotic bile duct, the location of the biliary lesion, endoscopic sphincterotomy, and procedure time of POCS were factors affecting the sufficient tissue acquisition rate of POCS-guided forceps mapping biopsy.
The risk factors for post-polypectomy bleeding and establishment of a risk-scoring model for small colorectal polyps (<1.5cm) in an ambulatory surgery center: a retrospective analysis
Authors: Lei Tiantian , Yan Hailin , Lu Qing , Wang Yilan , Ma Hongsheng , Yang Jinlin
Published: October 2019

Background: As one of the most common complications of colonoscopy, the risk factors of post-polypectomy bleeding (PPB) has been rarely explored in an ambulatory surgery unit. We aim to develop a risk-scoring model to predict the risk of PPB forsmall colorectal polyps (<1.5cm) in an ambulatory surgery unit. Methods: The patients with single small colorectal polyps (<1.5cm) who underwent endoscopic polypectomy in the Ambulatory Surgery Center of our hospital between January 2014 and June 2017 were included and retrospectively reviewed. We analyzed patient’s clinical characteristics, morphological and pathological characteristics of polyps, polypectomy techniques, and the occurrence of PPB. Risk factors of PPB were identified with a multivariable logistic regression model. In addition, a risk-scoring system was developed and validated eventually. Results: Among the 771 patients enrolled, 26 (3.4%) patients suffered PPB. The male gender, elderly age (≥ 60 years), using hot biopsy forceps as polypectomy technique adenoma in histopathology, complicated withhypertension, use of anticoagulant or antiplatelet agents, and early excessive activities significantly increased the risk of PPB (P＜0.05) as indicated by the results of multivariable logistic regression analysis. The area under the ROC curve (AUC) in the model group (0.890) and validation group (0.924) indicated that the risk-scoring model could predict the occurrence of PPB effectively. Conclusions: This risk-scoring method may help to predict the risk of PPB forsmall colorectal polyps, fit well in the Ambulatory Surgery Center, and provide a new approach to help reduce the incidence of hemorrhage after colorectal polypectomy.Trial registration: This study was retrospectively registered and approved by the Ethics Committee of West China Hospital of Sichuan University (IRB number: ChiCTR1800020201).
Do the human gut metagenomic species possess the minimal set of core functionalities necessary for life?
Authors: Soverini Matteo , Rampelli Simone , Turroni Silvia , Brigidi Patrizia , Biagi Elena , Candela Marco
Published: October 2019

Background.
Advances in bioinformatics recently allowed for the recovery of ‘metagenomes assembled genomes’ from human microbiome studies carried on with shot-gut sequencing techniques. Such approach has been proposed as a mean to discover new so-called ‘uncultured metagenomic species’.
Results.
In the present analysis we compare 400 genomes from isolates available on NCBI database and 400 human gut metagenomic species, screening all of them for the presence of a minimal set of core functionalities necessary, but not sufficient, for life. Even if a genome completeness up to 96% is reported in the original study, the metagenomic species resulted substantially depleted in genes encoding for essential functions to support autonomous bacterial life, with the 16S rRNA gene missing in 237 out of the 400 metagenomic species we analyzed.
Conclusions.
The relevant degree of lacking core functionalities that we observed in metagenomic species raises some concerns about the effective completeness of metagenome-assembled genomes, suggesting caution in extrapolating information about their metabolic propensity and ecological role in the human gastrointestinal tract.
Exploring the Changing Landscape of Cell-to-Cell Variation After CTCF Knockdown via Single Cell RNA-seq
Authors: Wang Wei , Ren Gang , Hong Ni , Jin Wenfei
Published: October 2019

Background: CCCTC-Binding Factor (CTCF), also known as 11-zinc finger protein, participates in many cellular processes, including insulator activity, transcriptional regulation and organization of chromatin architecture. Based on single cell flow cytometry and single cell RNA-FISH analyses, our previous study showed that deletion of CTCF binding site led to a significantly increase of cellular variation of its target gene. However, the effect of CTCF on genome-wide landscape of cell-to-cell variation is unclear.
Results: We knocked down CTCF in EL4 cells using shRNA, and conducted single cell RNA-seq on both wild type (WT) cells and CTCF-Knockdown (CTCF-KD) cells using Fluidigm C1 system. Principal component analysis of single cell RNA-seq data showed that WT and CTCF-KD cells concentrated in two different clusters on PC1, indicating gene expression profiles of WT and CTCF-KD cells were systematically different. Interestingly, GO terms including regulation of transcription, DNA binding, Zinc finger and transcription factor binding were significantly enriched in CTCF-KD-specific highly variable genes, indicating tissue-specific genes such as transcription factors were highly sensitive to CTCF level. The dysregulation of transcription factors potentially explain why knockdown of CTCF lead to systematic change of gene expression. In contrast, housekeeping genes such as rRNA processing, DNA repair and tRNA processing were significantly enriched in WT-specific highly variable genes, potentially due to a higher cellular variation of cell activity in WT cells compared to CTCF-KD cells. We further found cellular variation-increased genes were significantly enriched in down-regulated genes, indicating CTCF knockdown simultaneously reduced the expression levels and increased the expression noise of its regulated genes.
Conclusions: To our knowledge, this is the first attempt to explore genome-wide landscape of cellular variation after CTCF knockdown. Our study not only advances our understanding of CTCF function in maintaining gene expression and reducing expression noise, but also provides a framework for examining gene function.
Joint Modelling of Colorectal Cancer Recurrence and Death after resection using Multi-State Model with Cured Fraction
Authors: Alafchi Behnaz , Roshanaei Ghodratollah , Tapak Leili , Abasi Mohammad , Mahjub Hossein
Published: October 2019

Background Curing of colorectal cancer (CRC) occurs at the time of resection, but it is not immediately observable. If the cancer is not completely eliminated, the patient will not be cured of cancer and will experience a recurrence as the tumor has regrown to a detectable size. The main proposes of the present study was to assess the effects of different covariates on the probability of being cured as well as the time to recurrence, time to death, and time to death after recurrence in CRC patients by using multi-state cure model.Methods In the present study, the information of 283 patients with adenocarcinoma CRC, who underwent resection, from 1992 to 2015 in Imam Khomeini Hospital of Hamadan, Iran, were analyzed. A multi-state cure model is used to joint modeling the recurrence and death in patients with CRC when a fraction of patients was apparently cured after resection.Results The results revealed that females, patients diagnosed at stage IV and whom underwent radiotherapy were less likely to be apparently cured. Also, more than 50% of not cured patients recurred later. Moreover, the survival time of patients was affected by the stage of disease, age at diagnosis and receiving radiation therapy. In addition, sex had a significant effect on the time-to-recurrence.Conclusions The multi-state cure model provided a flexible framework to study and compare the effects of prognostic factors simultaneously on the transition between different health states and the probability of being apparently cured of CRC.