bluuebunny/crossref_metadata_2025 huggingface dataset:
Tele-ophthalmology for age-related macular degeneration during the COVID-19 pandemic and beyond
Authors: Mintz Joel , Labiste Chase , DiCaro Michael V , McElroy Evan , Alizadeh Reza , Xu Kunyong
Published: September 2020

Introduction

COVID-19 has disrupted how ophthalmic practice is conducted worldwide. One patient population that may suffer from poor outcomes during the pandemic are those with age-related macular degeneration (AMD). Many practices are performing some form of tele-ophthalmology services for their patients, and guidance is needed on how to maintain continuity of care amongst patients with AMD using tele-ophthalmology.

Methods

A literature search was conducted, ending 1 August 2020, to identify AMD outcomes and telecare management strategies that could be used during the COVID-19 pandemic

Results

237 total articles were retrieved, 56 of which were included for analysis. Four American Academy of Ophthalmology and Center for Disease Control web resources were also included.

Discussion

Risk-stratification models have been developed that let providers readily screen existing patients for their future risk of neovascular AMD (nAMD). When used with at-home monitoring devices to detect nAMD, providers may be able to determine who should be contacted via tele-ophthalmology for screening. Telemedicine triage can be used for new complaints of vision loss to determine who should be referred to a retinal specialist for management of suspected nAMD. To increase access and provider flexibility, smartphone fundus photography images sent to a centralized tele-ophthalmology service can aid in the detection of nAMD. Considerations should also be made for COVID-19 transmission, and tele-ophthalmology can be used to screen patients for the presence of COVID-19 prior to in-person office visits. Tele-ophthalmology has additional utility in connecting with nursing home, rural, and socioeconomically disadvantaged patients in the post-pandemic period.
Multi-layered sound absorption structure composed of nonwoven fabrics and polyethylene membranes
Authors: Tang Xiaoning , Liu Xueting , Zhang Xiansheng , Zhang Shangyong
Published: September 2020

This work has focused on the improvement of the sound absorption properties of multilayered structure. Nonwoven fabrics with three different thickness were used to fabricate multilayered absorber. Polyethylene membrane was then incorporated into the multilayered structure with different combinations. The acoustic measurement indicated that polyethylene membrane can improve the sound absorption properties when the thickness of nonwoven fabric is 1.01 mm and 2.38 mm respectively. However, the incorporation of polyethylene membrane will decrease the sound absorption coefficients when the thickness of nonwoven fabric is 3.41 mm. This study has indicated that the thickness of nonwoven fabric and the layer stacking sequence should be focused on consideration to prepare multilayered sound absorber.
Novel method for detection of void defects under track slabs using air-coupled ultrasonic sensors
Authors: Chen Xingjie , Zhu Wenfa , Fan Guopeng , Li Zaiwei , Shao Wei , Meng Xiangzhen , Li Liming , Zhang Haiyan
Published: September 2020

Void defects under track slabs are the main danger affecting the safe operation of high-speed railways. In the short high-speed railway maintenance periods, China’s high-speed railway line maintenance operations must quickly and dynamically determine void defects under track slabs that are in service without contact. However, the detection of void defects under track slabs still mainly relies on the manual inspection and flaw detection by railway workers during the railway maintenance period. If the defects are not quickly identified, the consequences could be disastrous. This article presents a new method for the non-contact dynamic detection of void defects under track slabs. The method involves the use of air-coupled ultrasonic sensors to generate and receive ultrasonic guided waves in the track slab to quantitatively represent the size of the void defect according to the principle of energy leakage of guided waves in the propagation process. The characteristics of the position-amplitude curve, taking the position of the beam axis as the abscissa and the amplitude of the time domain signal as the ordinate, were numerically calculated and analyzed. The quantitative relationship between the convex interval of the position-amplitude curve and the size of the void defect was obtained, and an imaging method of the void defects based on x, y two-dimensional line scanning data fusion is proposed. The excitation and reception methods of air-coupled ultrasonic guided waves were studied, and a 1:1 model of the track structure was built in the laboratory to verify the method and detect the void defect under the track slab. The experimental results show that ultrasonic guided waves can be excited and received in the track slab by air-coupled ultrasonic sensors. Based on the guided wave energy leakage principle, the quantitative characterization and imaging of the void defect under track slabs can be realized.
Patient Goals and Motivation for Thumb Carpometacarpal Osteoarthritis Surgery
Authors: Gravås Else Marit Holen , Kjeken Ingvild , Nossum Randi , Eide Ruth Else Mehl , Klokkeide Åse , Matre Karin Hoegh , Olsen Monika , Andreassen Øyvor , Haugen Ida K. , Østerås Nina , Tveter Anne Therese
Published: September 2020

Background:

Knowledge is lacking on patient goals and motivation for carpometacarpal joint osteoarthritis (CMCJ OA) surgery. The objective of this study was to explore patient goals and motivation for surgery, whether patient goals were reflected in self-reports of pain and function, and factors characterizing patients highly motivated for surgery.

Methods:

This cross-sectional study included 180 patients referred from their general practitioner for CMCJ surgical consultation. Goals for surgery were collected with an open-ended question, categorized with the International Classification of Functioning, Disability and Health coding system, and compared to self-reports of pain and function. Motivation for surgery was rated with a Numeric Rating Scale (NRS, 0-10, 0 = not motivated). Factors characterizing patients highly motivated for surgery (NRS ≥ 8) were explored with multivariate regression analyses.

Results:

The mean age of the participants was 63 years (SD = 7.6), and 142 (79%) were women. The most common goals for surgery were to reduce pain and improve arm and hand use, but these were not reflected in self-reports of pain and function. Fifty-six (31%) of the patients were characterized as highly motivated for surgery. High motivation for surgery was strongly associated with reporting more activity limitations (odds ratio [OR] = 4.00, P = .008), living alone (OR = 3.18, P = .007), and a young age (OR = 0.94, P = .002).

Conclusions:

Decisions on CMCJ OA surgery should be based on assessment and discussion of patients’ life situation, hand pain, activity limitations for, and goals and motivation for surgery. According to the european league against rheumatism (EULAR) recommendations, previously received conservative and pharmacological treatment should also be evaluated.
Parafoveal degradation during reading reduces preview costs only when it is not perceptually distinct
Authors: Vasilev Martin R , Yates Mark , Prueitt Ethan , Slattery Timothy J
Published: September 2020

There is a growing understanding that the parafoveal preview effect during reading may represent a combination of preview benefits and preview costs due to interference from parafoveal masks. It has been suggested that visually degrading the parafoveal masks may reduce their costs, but adult readers were later shown to be highly sensitive to degraded display changes. Four experiments examined how preview benefits and preview costs are influenced by the perception of distinct parafoveal degradation at the target word location. Participants read sentences with four preview types (identity, orthographic, phonological, and letter-mask preview) and two levels of visual degradation (0% vs. 20%). The distinctiveness of the target word degradation was either eliminated by degrading all words in the sentence (Experiments 1a–2a) or remained present, as in previous research (Experiments 1b–2b). Degrading the letter masks resulted in a reduction in preview costs, but only when all words in the sentence were degraded. When degradation at the target word location was perceptually distinct, it induced costs of its own, even for orthographically and phonologically related previews. These results confirm previous reports that traditional parafoveal masks introduce preview costs that overestimate the size of the true benefit. However, they also show that parafoveal degradation has the unintended consequence of introducing additional costs when participants are aware of distinct degradation on the target word. Parafoveal degradation appears to be easily perceived and may temporarily orient attention away from the reading task, thus delaying word processing.
Beneficial effect of probiotics on Pseudomonas aeruginosa–infected intestinal epithelial cells through inflammatory IL-8 and antimicrobial peptide human beta-defensin-2 modulation
Authors: Huang Fu-Chen , Lu Yi-Ting , Liao Yu-Hsuan
Published: September 2020

The human pathogen Pseudomonas aeruginosa can rapidly induce fatal sepsis, even in previously healthy infants or children treated with appropriate antibiotics. To reduce antibiotic overuse, exploring novel complementary therapies, such as probiotics that reportedly protect patients against P. aeruginosa infection, would be particularly beneficial. However, the major mechanism underlying the clinical effects is not completely understood. We thus aimed to investigate how probiotics affect IL-8 and human beta-defensin 2 (hBD-2) in P. aeruginosa–infected intestinal epithelial cells (IECs). We infected SW480 IECs with wild type PAO1 P. aeruginosa following probiotic treatment with Lactobacillus rhamnosus GG or Bifidobacterium longum spp. infantis S12, and analysed the mRNA expression and secreted protein of IL-8 and hBD-2, Akt signalling and NOD1 receptor protein expression. We observed that probiotics enhanced hBD-2 expression but suppressed IL-8 responses when administered before infection. They also enhanced P. aeruginosa–induced membranous NOD1 protein expression and Akt activation. The siRNA-mediated Akt or NOD1 knockdown counteracted P. aeruginosa–induced IL-8 or hBD-2 expression, indicating regulatory effects of these probiotics. In conclusion, these data suggest that probiotics exert reciprocal regulation of inflammation and antimicrobial peptides in P. aeruginosa–infected IECs and provide supporting evidence for applying probiotics to reduce antibiotic overuse.
The painful ear
Authors: Lai Kenneth , Oshinyemi Pamela , Grounds Robert
Published: September 2020

Otalgia, or ear pain, is a common presentation in general practice. It can be broadly divided into primary and secondary otalgia. Primary otalgia is pain that arises from pathology of the external, middle and inner ear. Secondary otalgia, or referred otalgia, is pain that arises from pathology outside the ear. There are many causes of secondary otalgia, due to the complex sensory innervation of the ear. History and physical examination are vital in determining the aetiology. This clinical review discusses the possible causes of ear pain, and provides a systematic approach to assessment and management, including when to refer to specialists.
Reproducibility of an Automated Quantitative MRI Assessment of Low-Grade Knee Articular Cartilage Lesions
Authors: Juras Vladimir , Szomolanyi Pavol , Schreiner Markus M. , Unterberger Karin , Kurekova Andrea , Hager Benedikt , Laurent Didier , Raithel Esther , Meyer Heiko , Trattnig Siegfried
Published: September 2020

Objective

The goal of this study was to assess the reproducibility of an automated knee cartilage segmentation of 21 cartilage regions with a model-based algorithm and to compare the results with manual segmentation.

Design

Thirteen patients with low-grade femoral cartilage defects were included in the study and were scanned twice on a 7-T magnetic resonance imaging (MRI) scanner 8 days apart. A 3-dimensional double-echo steady-state (3D-DESS) sequence was used to acquire MR images for automated cartilage segmentation, and T2-mapping was performed using a 3D triple-echo steady-state (3D-TESS) sequence. Cartilage volume, thickness, and T2 and texture features were automatically extracted from each knee for each of the 21 subregions. DESS was used for manual cartilage segmentation and compared with automated segmentation using the Dice coefficient. The reproducibility of each variable was expressed using standard error of measurement (SEM) and smallest detectable change (SDC).

Results

The Dice coefficient for the similarity between manual and automated segmentation ranged from 0.83 to 0.88 in different cartilage regions. Test-retest analysis of automated cartilage segmentation and automated quantitative parameter extraction revealed excellent reproducibility for volume measurement (mean SDC for all subregions of 85.6 mm3), for thickness detection (SDC = 0.16 mm) and also for T2 values (SDC = 2.38 ms) and most gray-level co-occurrence matrix features (SDC = 0.1 a.u.).

Conclusions

The proposed technique of automated knee cartilage evaluation based on the segmentation of 3D MR images and correlation with T2 mapping provides highly reproducible results and significantly reduces the segmentation effort required for the analysis of knee articular cartilage in longitudinal studies.
Mimicking Alpine thrusts by passive deformation of synsedimentary normal faults: a record of the Jurassic extension of the European margin (Mont Fort nappe, Pennine Alps)
Authors: Pantet Adrien , Epard Jean-Luc , Masson Henri
Published: September 2020

The Mont Fort nappe, former uppermost subunit of the Grand St-Bernard nappe system, is an independent tectonic unit with specific structural and stratigraphic characteristics (Middle Penninic, NW Italy and SW Switzerland). It consists in a Paleozoic basement, overlain by a thin, discontinuous cover of Triassic-Jurassic metasediments, mainly breccias, called the Evolène Series. The contact of this Series over the Mont Fort basement is debated: stratigraphic or tectonic? We present new observations that support the stratigraphic interpretation and consequently imply that the Evolène Series belongs to the Mont Fort nappe. We moreover show that the Mont Fort nappe was strongly affected by normal faulting during Jurassic. These faults went long unnoticed because Alpine orogenic deformation blurred the record. Alpine strain erased their original obliquity, causing confusion with an Alpine low-angle thrust. These Jurassic faults have been passively deformed during Alpine tectonics, without inversion or any other kind of reactivation. They behaved like passive markers of the Alpine strain. Detailed field observations reveal the link between observed faults and specific breccia accumulations. Areas where the Evolène Series is missing correspond to sectors where the fault scarps were exposed on the bottom of the sea but were too steep to keep the syn- to post-faulting sediments. The Mont Fort nappe thus represents an example of a distal rifted margin. The succession of synsedimentary extensional movements followed by orogenic shortening generated a situation where passively deformed normal faults mimic an orogenic thrust.
Effectiveness and sustainability of a motor-cognitive stepping exergame training on stepping performance in older adults: a randomized controlled trial
Authors: Hauer Klaus , Litz Elena , Günther-Lange Michaela , Ball Caroline , de Bruin Eling D. , Werner Christian
Published: September 2020

Background

Training effects reported for stepping exergames on stepping performances in older adults often based on not comprehensively validated outcomes measures, and follow-up data on their sustainability are lacking. The aim of this study is to evaluate the effectiveness and sustainability of a motor-cognitive stepping exergame training on the stepping performance in older adults.

Methods

Fifty-eight older adults (78.3 ± 6.5 years) participated in the randomized controlled trial with a 10-week intervention and 10-week follow-up period. The intervention group (IG: n = 29) took part in a once-weekly exercise program including strength and balance exercises supplemented with an additional stepping exergame training. The control group (CG: n = 29) only performed the strength and balance exercises. Outcome measures included stepping reaction times (SRTs) and games scores for individual stepping exergame levels and for the overall exergame performance, as measured by an assessment strategy previously validated in older adults.

Results

SRTs and/or games scores for 7 out of 10 levels and the overall exergame performance significantly improved in the IG compared to the CG during the intervention (p ≤ 0.001–0.039, ηp2 = 0.090–0.445). Training gains were sustained for 2 levels and for the overall exergame performance (p = 0.017–0.033, ηp2 = 0.127–0.193).

Conclusion

The study demonstrates that the additional stepping exergame training effectively and sustainably improves the performance in complex motor-cognitive stepping exergame tasks in older adults, which can be relevant for preventing falls. Future research is needed to evaluate the effectiveness of such training on reducing the number of falls.

Trial registration

ISRCTN registry, ISRCTN14855620, 06/06/2019 (retrospectively registered).
Moderately high folate level may offset the effects of aberrant DNA methylation of P16 and P53 genes in esophageal squamous cell carcinoma and precancerous lesions
Authors: Wang Shaokang , Pan Da , Su Ming , Huang Guiling , Sun Guiju
Published: September 2020

Background

This study evaluated gene-nutrition interactions between folate and the aberrant DNA methylation of tumor suppressor genes in different stages of carcinogenesis of esophageal squamous cell carcinoma (ESCC).

Methods

Two hundred ESCC cases, 200 esophageal precancerous lesion (EPL) cases, and 200 controls matched by age (± 2 years) and gender were used for this study. Baseline data and dietary intake information was collected via questionnaire. The serum folate levels and methylation status of promoter regions of p16 and p53 were detected.

Results

The interactions of increased serum folate level with unmethylated p16 and p53 promoter regions were significantly associated with a reduced risk of both EPL and ESCC (p for interaction < 0.05). The interactions of the lowest quartile of serum folate level with p16 or p53 methylation was significantly associated with an increased risk of ESCC (OR = 2.96, 95% CI, 1.45–6.05; OR = 2.34, 95% CI, 1.15–4.75). An increased serum folate level was also related to a decreasing trend of EPL and ESCC risks when p16 or p53 methylation occurred. The interaction of spinach, Chinese cabbage, liver and bean intake with unmethylated p16 and p53 was significantly associated with a reduced risk of EPL or ESCC (p for interaction < 0.05).

Conclusions

The interactions between a high folate level and unmethylated p16 and p53 promoter regions may have a strong preventive effect on esophageal carcinogenesis. Additionally, a high folate level may offset the tumor-promoting effects of aberrant DNA methylation of the genes, but it is also noteworthy that a very high level of folate may not have a protective effect on EPL in some cases.
NormiRazor: tool applying GPU-accelerated computing for determination of internal references in microRNA transcription studies
Authors: Grabia Szymon , Smyczynska Urszula , Pagacz Konrad , Fendler Wojciech
Published: September 2020

Background

Multi-gene expression assays are an attractive tool in revealing complex regulatory mechanisms in living organisms. Normalization is an indispensable step of data analysis in all those studies, since it removes unwanted, non-biological variability from data. In targeted qPCR assays it is typically performed with respect to prespecified reference genes, but the lack of robust strategy of their selection is reported in literature, especially in studies concerning circulating microRNAs (miRNA). Unfortunately, this problem impedes translation of scientific discoveries on miRNA biomarkers into widely available laboratory assays. Previous studies concluded that averaged expressions of multi-miRNA combinations are more stable references than single genes. However, due to the number of such combinations the computational load is considerable and may be hindering for objective reference selection in large datasets. Existing implementations of normalization algorithms (geNorm, NormFinder and BestKeeper) have poor performance and may require days to compute stability values for all potential reference as the evaluation is performed sequentially.

Results

We designed NormiRazor - an integrative tool which implements those methods in a parallel manner on a graphics processing unit (GPU) using CUDA platform. We tested our approach on publicly available miRNA expression datasets. As a result, the times of executions on 8 datasets containing from 50 to 400 miRNAs (subsets of GSE68314) decreased 18.7 ±0.6 (mean ±SD), 104.7 ±4.2 and 76.5 ±2.2 times for geNorm, BestKeeper and NormFinder with respect to previous Python implementation. To allow for easy access to normalization pipeline for biomedical researchers we implemented NormiRazor as an online platform where a user could normalize their datasets based on the automatically selected references. It is available at norm.btm.umed.pl, together with instruction manual and exemplary datasets.

Conclusions

NormiRazor allows for an easy, informed choice of reference genes for qPCR transcriptomic studies. As such it can improve comparability and repeatability of experiments and in longer perspective help translate newly discovered biomarkers into readily available assays.
Integrated metabolic profiling and transcriptome analysis of pigment accumulation in diverse petal tissues in the lily cultivar ‘Vivian’
Authors: Yin Xiaojuan , Lin Xinyue , Liu Yuxuan , Irfan Muhammad , Chen Lijing , Zhang Li
Published: September 2020

Background

Petals are the colorful region of many ornamental plants. Quality traits of petal color directly affect the value of ornamental plants. Although the regulatory mechanism of flower color has been widely studied in many plants, that of lily flower color is still worth further exploration.

Results

In this study, the pigmentation regulatory network in different regions of the petal of lily cultivar ‘Vivian’ was analyzed through tissue structure, metabolites biosynthesis, and gene expression. We found that cell morphology of the petal in un-pigmented region differed from that in pigmented region. The cell morphology tends to flatten in un-pigmented region where the color is lighter. Moreover, high level anthocyanin was found in the pigmented regions by metabonomic analysis, especially cyanidin derivatives. However, flavanones were accumulated, contrast with anthocyanin in the un-pigmented regions of lily petal. To understand the relationship of these different metabolites and lily flower color, RNA-Seq was used to analyze the differentially expressed genes-related metabolite biosynthesis. Among these genes, the expression levels of several genes-related cyanidin derivatives biosynthesis were significantly different between the pigmented and un-pigmented regions, such asLvMYB5, LvMYB7, LvF3’H, LvDFR, LvANSandLv3GT.

Conclusions

This data will help us to further understand the regulation network of lily petal pigmentation and create different unique color species.
Analgesic efficacy of ultrasound guided paravertebral block in percutaneous nephrolithotomy patients: a randomized controlled clinical study
Authors: Yaman Ferda , Tuglu Devrim
Published: September 2020

Background

Paravertabral blocks (PVB) are in use to adequately manage pain arising from a variety of operations on the thorax, abdomen or pelvis. PVB is straightforward, efficacious in operations performed. This study was undertaken to evaluate how efficacious ultrasound-guided thoracic paravertebral block is when used in patients undergoing percutaneous nephrolithotomy (PCN).

Methods

A total of 44 patients, falling in categories I to III of the American Society of Anesthesiologists, and aged between 18 and 65 years, who were scheduled for PCN, were randomly distributed into two groups. The anaesthetic intervention group (PVB) contained 22 individuals, who were injected at level T8-T9 with 20 mL 0.25% bupivacaine as a single administration. In the control group C, also containing 22 individuals, the intervention was not carried out. The groups were compared after PCN in terms of opioid use, pain score, opioid adverse effects profile and the need for supplemental analgesia.

Results

Visual analogue scale pain scores whilst at rest or moving were lower at the level of statistical significance in the PVB group compared to controls at 2 and 4 h post-surgery. At 6 and 8 h post-surgery, the control group had a lower VAS score when moving, and this result reached statistical significance (p < 0.05). The controls used more opioid relief than the PVB group and had lower scores for satisfaction (p < 0.05).

Conclusion

Ultrasound-guided PVB using bupivacaine and an in-plane technique provides effective analgesia in PNL. It is associated with high scores on patient satisfaction and minimal complications.

Trial registration

ClinicalTrials.gov, NCT04406012. Registered retrospectively, on 27 May 2020.
Pulse oximetry-based capillary refilling evaluation predicts postoperative outcomes in liver transplantation: a prospective observational cohort study
Authors: Yamamoto Miyuki , Doi Kent , Hayase Naoki , Asada Toshifumi , Akamatsu Nobuhisa , Kaneko Junichi , Hasegawa Kiyoshi , Morimura Naoto
Published: September 2020

Background

Capillary refill time (CRT) is a non-invasive technique to evaluate tissue perfusion, and quantitative CRT (Q-CRT) adapted to pulse oximetry was developed with patients with sepsis and compared to blood lactate and sepsis scores. In post liver transplantation, large amounts of fluid administration are necessary for maintaining tissue perfusion to grafted liver against intravascular hypovolemia. This study aimed to evaluate whether Q-CRT can predict poor outcomes by detecting peripheral tissue perfusion abnormality in patients with liver transplantations who were treated with massive fluid administration.

Methods

In this single-center prospective cohort study, we enrolled adult patients with liver transplantations between June 2018 and July 2019. Measurement of Q-CRT was conducted at intensive care units (ICU) admission and postoperative day 1 (POD1).

Results

A total of 33 patients with liver transplantations were enrolled. Significant correlations of Q-CRT and ΔAb, a tissue oxygen delivery parameter calculated by pulse oximetry data, at ICU admission with the postoperative outcomes such as length of ICU and hospital stay and total amount of ascitic fluid discharge were observed. Quantitative CRT and ΔAb at ICU admission were significantly associated with these postoperative outcomes, even after adjusting preoperative and operative factors (MELD score and bleeding volume, respectively). However, quantitative CRT and ΔAb at POD1 and changes from ICU admission to POD1 failed to show significant associations.

Conclusions

Q-CRT values were significantly associated with postoperative outcomes in liver transplantation. Although the mechanisms of this association need to be clarified further, Q-CRT may enable identification of high-risk patients that need intensive postoperative managements.
A study on depression of the elderly with different sleep quality in pension institutions in Northeastern China
Authors: Zhang Jun , Zhang Yingying , Luan Zhenggang , Zhang Xiujie , Jiang Haoran , Wang Aiping
Published: September 2020

Background

China owns he largest aged population in the world, and the elderly adults who live in pension institutions are more likely to suffer from mental disorders than other elderly adults. The purpose of this study is to discover the risky factors of depression among nursing home residents with various sleeping quality.

Methods

We conducted a cross-sectional study in Northeastern China from May to September in 2017 using multistage sampling method and 507 elderly people without cognitive impairment in six pension institutions were interviewed. The Pittsburgh Sleep Quality Index (PSQI) and Geriatric Depression Scale (GDS) were adopted to collect the information of sleep quality and depression. We used logistic regression to analyze the factors influencing depression among the elderly adults with poor or good sleep quality.

Results

The overall depression rate among elderly adults was 21.7%. The logistic regression analysis revealed that marital status, chronic disease, regular exercise, physical ache, filial piety and chewing ability had significant effects on the depression of the elderly with good sleep quality. Loneliness, self-caring ability, chewing ability and chronic diseases had significant effects on depression of the elderly with poor sleep quality.

Conclusion

The prevalence of depressive symptoms in the elderly is not high. However, sleeping quality distinguishes root causes on elderly adults depression. Therefore, the risk factors of depression among elderly adults should be analyzed separately.
Disseminated Bacillus Calmette–Guérin (BCG) infection and acute exacerbation of interstitial pneumonitis: an autopsy case report and literature review
Authors: Shimizu Gen , Amano Ryota , Nakamura Itaru , Wada Akane , Kitagawa Masanobu , Toru Shuta
Published: September 2020

Background

Intravesical administration of Bacillus Calmette–Guérin (BCG) has proven useful for treatment and prevention of recurrence of superficial bladder cancer and in situ carcinoma. However, fatal side effects such as disseminated infections may occur. Early diagnosis and accurate therapy for interstitial pneumonitis (IP) are important because exacerbation of IP triggered by infections is the major cause of death. Although some fatality reports have suggested newly appeared IP after intravesical BCG treatment, to our knowledge, there are no reports which have demonstrated acute exacerbation of existing IP. Moreover, autopsy is lacking in previous reports. We report the case of a patient with fatal IP exacerbation after BCG instillation and the pathological findings of the autopsy.

Case presentation

A 77-year-old man with a medical history of IP was referred to our hospital because of fever and malaise. He had received an intravesical injection of BCG 1 day before the admission. His fever reduced after the use of antituberculosis drugs, so he was discharged home. He was referred to our hospital again because of a high fever 7 days after discharge. On hospitalisation, he showed high fever and systemic exanthema. Hepatosplenomegaly and myelosuppression were also observed. Biopsies revealed multiple epithelioid cell granulomas with Langhans giant cells of the liver and bone marrow. Biopsy DNA analyses of Mycobacterium bovis in the bone marrow, sputum, and blood were negative. His oxygen demand worsened drastically, and the ground-glass shadow expanded on the computed tomography scan. He was diagnosed with acute exacerbation of existing IP. We recommenced the antituberculosis drugs with steroid pulse therapy, but he died on day 35 because of respiratory failure. The autopsy revealed a diffuse appearance of multiple epithelioid cell granulomas with Langhans giant cells in multiple organs, although BCG was not evident.

Conclusions

We report the first case of acute exacerbation of chronic IP by BCG infection. This is also the first case of autopsy of a patient with acute exacerbation of existing IP induced by intravesical BCG treatment. Whether the trigger of acute IP exacerbation is infection or hypersensitivity to BCG is still controversial, because pathological evidence confirming BCG infection is lacking. Physicians who administer BCG against bladder cancer should be vigilant for acute exacerbation of IP.
Hemophagocytic syndrome associated with Mycobacterium bovis in a patient with X-SCID: a case report
Authors: Shi Buyun , Chen Ming , Xia Zhi , Xiao Shuna , Tang Wen , Qin Chenguang , Cheng Ying , Huang Tao , Huang Chengjiao , Li Yong , Xu Hui
Published: September 2020

Background

Mycobacterium bovis could infect patients with immunodeficiency or immunosuppressive conditions via Bacillus Calmette-Guérin (BCG) vaccination. Tuberculosis-related hemophagocytic syndrome (HPS) is reported, but not HPS caused by Mycobacterium bovis in children.

Case presentation

A 4-month Chinese boy presented fever and cough. The initial laboratory investigation showed the lymphocyte count of 0.97 × 109/L, which decreased gradually. HPS was diagnosed based on the test results that fulfilled the HLH-2004 criteria. In addition, Mycobacterium tuberculosis complex was detected from his peripheral blood via metagenomic next-generation sequencing (mNGS) and M. bovis was identified by polymerase chain reaction-reverse dot blot (PCR-RDB). Thus, the patient was treated with Isoniazid, Rifampin, and Pyrazinamide, but not improved. However, parents refused to accept further therapy, and was discharged on the day 12 of admission. To confirm the pathogenesis, genetic analysis was performed. Mutation in the interleukin-2 receptor subunit gamma gene: Exon 6: c.854G > A; p. Arg285Gln was detected in the patient and the mother, which could underlie X-linked severe combined immunodeficiency.

Conclusions

A boy with X-SCID was diagnosed with M. bovis-associated HPS, emphasizing that X-SCID should be considered when M. bovis is detected in a male infant with low lymphocyte counts.
Novel FHL1 mutation variant identified in a patient with nonobstructive hypertrophic cardiomyopathy and myopathy – a case report
Authors: Giucă Adrian , Mitu Cristina , Popescu Bogdan Ovidiu , Bastian Alexandra Eugenia , Capşa Răzvan , Mursă Adriana , Rădoi Viorica , Popescu Bogdan Alexandru , Jurcuţ Ruxandra
Published: September 2020

Background

Hypertrophic cardiomyopathy (HCM) is a genetic disorder mostly caused by sarcomeric gene mutations, but almost 10% of cases are attributed to inherited metabolic and neuromuscular disorders. First described in 2008 in an American-Italian family with scapuloperoneal myopathy, FHL1 gene encodes four-and-a-half LIM domains 1 proteins which are involved in sarcomere formation, assembly and biomechanical stress sensing both in cardiac and skeletal muscle, and its mutations are responsible for a large spectrum of neuromuscular disorders (mostly myopathies) and cardiac disease, represented by HCM, either isolated, or in conjunction with neurologic and skeletal muscle impairment. We thereby report a novel mutation variant in FHL1 structure, associated with HCM and type 6 Emery-Dreifuss muscular dystrophy (EDMD).

Case presentation

We describe the case of a 40 year old male patient, who was referred to our department for evaluation in the setting of NYHA II heart failure symptoms and was found to have HCM. The elevated muscular enzymes raised the suspicion of a neuromuscular disease. Rigid low spine and wasting of deltoidus, supraspinatus, infraspinatus and calf muscles were described by the neurological examination. Electromyography and muscle biopsy found evidence of chronic myopathy. Diagnosis work-up was completed by next-generation sequencing genetic testing which found a likely pathogenic mutation in the FHL1 gene (c.157-1G > A, hemizygous) involved in the development of X-linked EDMD type 6.

Conclusion

This case report highlights the importance of multimodality diagnostic approach in a patient with a neuromuscular disorder and associated hypertrophic cardiomyopathy by identifying a novel mutation variant in FHL1 gene. Raising awareness of non-sarcomeric gene mutations which can lead to HCM is fundamental, because of diagnostic and clinical risk stratification challenges.
Reconstruction of lncRNA-miRNA-mRNA network based on competitive endogenous RNA reveals functional lncRNAs in skin cutaneous melanoma
Authors: Zhu Junyou , Deng Jin , Zhang Lijun , Zhao Jingling , Zhou Fei , Liu Ning , Cai Ruizhao , Wu Jun , Shu Bin , Qi Shaohai
Published: September 2020

Background

Human skin cutaneous melanoma is the most common and dangerous skin tumour, but its pathogenesis is still unclear. Although some progress has been made in genetic research, no molecular indicators related to the treatment and prognosis of melanoma have been found. In various diseases, dysregulation of lncRNA is common, but its role has not been fully elucidated. In recent years, the birth of the “competitive endogenous RNA” theory has promoted our understanding of lncRNAs.

Methods

To identify the key lncRNAs in melanoma, we reconstructed a global triple network based on the “competitive endogenous RNA” theory. Gene Ontology and KEGG pathway analysis were performed using DAVID (Database for Annotation, Visualization, and Integration Discovery). Our findings were validated through qRT-PCR assays. Moreover, to determine whether the identified hub gene signature is capable of predicting the survival of cutaneous melanoma patients, a multivariate Cox regression model was performed.

Results

According to the “competitive endogenous RNA” theory, 898 differentially expressed mRNAs, 53 differentially expressed lncRNAs and 16 differentially expressed miRNAs were selected to reconstruct the competitive endogenous RNA network. MALAT1, LINC00943, and LINC00261 were selected as hub genes and are responsible for the tumorigenesis and prognosis of cutaneous melanoma.

Conclusions

MALAT1, LINC00943, and LINC00261 may be closely related to tumorigenesis in cutaneous melanoma. In addition, MALAT1 and LINC00943 may be independent risk factors for the prognosis of patients with this condition and might become predictive molecules for the long-term treatment of melanoma and potential therapeutic targets.
Immunological and clinicopathological characteristics of C1RL in 2120 glioma patients
Authors: Wang Junyou , Tong Luqing , Lin Gaojun , Wang Hui , Zhang Liang , Yang Xuejun
Published: September 2020

Background

Glioma is a deadly and immunosuppressive brain tumour. Complement C1r subcomponent like (C1RL), a prognostic biomarker in several kinds of tumours, has attracted increasing attention from oncologists. However, the role of C1RL in glioma remains unclear.

Methods

Through analysis of 2120 glioma patients from 5 public datasets, the relationships between C1RL expression and clinicopathological characteristics were evaluated. Furthermore, the C1RL-associated genes were screened, and Gene Ontology (GO) analysis was conducted to investigate biological process enrichment. In addition, tumour purity, leukocyte infiltration and overall survival were evaluated based on C1RL expression.

Results

We found that C1RL expression was upregulated in glioblastoma (GBM), especially mesenchymal GBM and primary GBM. Increased C1RL expression accompanied the IDH1-wt phenotype in both lower grade glioma (LGG) and GBM. C1RL- associated genes were mainly enriched in biological processes related to the immune response. C1RL expression was also correlated with reduced tumour purity and increased M2 macrophage infiltration. Higher C1RL expression predicted unfavourable survival in patients with glioma and therapeutic resistance in GBM.

Conclusions

Our results imply that C1RL is involved in immunological activities and is an independent unfavourable prognostic biomarker in patients with glioma. C1RL is a potential clinical immunotherapeutic target for glioma treatment in the future.
Quantifying the direct secondary health care cost of seasonal influenza in England
Authors: Moss Joe W. E. , Davidson Craig , Mattock Richard , Gibbons Ilana , Mealing Stuart , Carroll Stuart
Published: September 2020

Background

The winter pressure often experienced by NHS hospitals in England is considerably contributed to by severe cases of seasonal influenza resulting in hospitalisation. The prevention planning and commissioning of the influenza vaccination programme in the UK does not always involve those who control the hospital budget. The objective of this study was to describe the direct medical costs of secondary care influenza-related hospital admissions across different age groups in England during two consecutive influenza seasons.

Methods

The number of hospital admissions, length of stay, and associated costs were quantified as well as determining the primary costs of influenza-related hospitalisations. Data were extracted from the Hospital Episode Statistics (HES) database between September 2017 to March 2018 and September 2018 to March 2019 in order to incorporate the annual influenza seasons. The use of international classification of disease (ICD)-10 codes were used to identify relevant influenza hospitalisations. Healthcare Resource Group (HRG) codes were used to determine the costs of influenza-related hospitalisations.

Results

During the 2017/18 and 2018/19 seasons there were 46,215 and 39,670 influenza-related hospital admissions respectively. This resulted in a hospital cost of £128,153,810 and £99,565,310 across both seasons. Results showed that those in the 65+ year group were associated with the highest hospitalisation costs and proportion of in-hospital deaths. In both influenza seasons, the HRG code WJ06 (Sepsis without Interventions) was found to be associated with the longest average length of stay and cost per admission, whereas PD14 (Paediatric Lower Respiratory Tract Disorders without Acute Bronchiolitis) had the shortest length of stay.

Conclusion

This study has shown that influenza-related hospital admissions had a considerable impact on the secondary healthcare system during the 2017/18 and 2018/19 influenza seasons, before taking into account its impact on primary health care.
Determinants of malaria among under-five children in Ethiopia: Bayesian multilevel analysis
Authors: Aychiluhm Setognal Birara , Gelaye Kassahun Alemu , Angaw Dessie Abebaw , Dagne Getachew Asfaw , Tadesse Abay Woday , Abera Adugna , Dillu Dereje
Published: September 2020

Background

In Ethiopia, malaria is one of the public health problems, and it is still among the ten top leading causes of morbidity and mortality among under-five children.

However, the studies conducted in the country have been inconclusive and inconsistent. Thus, this study aimed to assess factors associated with malaria among under-five children in Ethiopia.

Methods

We retrieved secondary data from the malaria indicator survey data collected from September 30 to December 10, 2015, in Ethiopia. A total of 8301 under-five-year-old children who had microscopy test results were included in the study. Bayesian multilevel logistic regression models were fitted and Markov chain Monte Carlo simulation was used to estimate the model parameters using Gibbs sampling. Adjusted Odd Ratio with 95% credible interval in the multivariable model was used to select variables that have a significant association with malaria.

Results

In this study, sleeping under the insecticide-treated bed nets during bed time (ITN) [AOR 0.58,95% CI, 0.31–0.97)], having 2 and more ITN for the household [AOR 0.43, (95% CI, 0.17–0.88)], have radio [AOR 0.41, (95% CI, 0.19–0.78)], have television [AOR 0.19, (95% CI, 0.01–0.89)] and altitude [AOR 0.05, (95% CI, 0.01–0.13)] were the predictors of malaria among under-five children.

Conclusions

The study revealed that sleeping under ITN, having two and more ITN for the household, altitude, availability of radio, and television were the predictors of malaria among under-five children in Ethiopia. Thus, the government should strengthen the availability and utilization of ITN to halt under-five mortality due to malaria.
Individual-level factors attributable to urban-rural disparity in mortality among older adults in China
Authors: Zhao Yuan , Xu Xin , Dupre Matthew E. , Xie Qianqian , Qiu Li , Gu Danan
Published: September 2020

Background

Urban-rural disparity in mortality at older ages is well documented in China. However, surprisingly few studies have systemically investigated factors that contribute to such disparity. This study examined the extent to which individual-level socioeconomic conditions, family/social support, health behaviors, and baseline health status contributed to the urban-rural difference in mortality among older adults in China.

Methods

This research used the five waves of the Chinese Longitudinal Healthy Longevity Survey from 2002 to 2014, a nationally representative sample of older adults aged 65 years or older in China (n = 28,235). A series of hazard regression models by gender and age group examined the association between urban-rural residence and mortality and how this association was modified by a wide range of individual-level factors.

Results

Older adults in urban areas had 11% (relative hazard ratio (HR) = 0.89,p < 0.01) lower risks of mortality than their rural counterparts when only demographic factors were taken into account. Further adjustments for family/social support, health behaviors, and health-related factors individually or jointly had a limited influence on the mortality differential between urban and rural older adults (HRs = 0.89–0.92,p < 0.05 top < 0.01). However, we found no urban-rural difference in mortality (HR = 0.97,p > 0.10) after adjusting for individual socioeconomic factors. Similar results were found in women and men, and among the young-old and the oldest-old populations.

Conclusions

The urban-rural disparity in mortality among older adults in China was largely attributable to differences in individual socioeconomic resources (i.e., education, income, and access to healthcare) regardless of gender and age group.
Forecasting disability-adjusted life years for chronic diseases: reference and alternative scenarios of salt intake for 2017–2040 in Japan
Authors: Nomura Shuhei , Yoneoka Daisuke , Tanaka Shiori , Ishizuka Aya , Ueda Peter , Nakamura Keiji , Uneyama Hisayuki , Hayashi Naoki , Shibuya Kenji
Published: September 2020

Background

In Japan, a high-sodium diet is the most important dietary risk factor and is known to cause a range of health problems. This study aimed to forecast Japan’s disability-adjusted life year (DALYs) for chronic diseases that would be associated with high-sodium diet in different future scenarios of salt intake. We modelled DALY forecast and alternative future scenarios of salt intake for cardiovascular diseases (CVDs), chronic kidney diseases (CKDs), and stomach cancer (SC) from 2017 to 2040.

Methods

We developed a three-component model of disease-specific DALYs: a component on the changes in major behavioural and metabolic risk predictors including salt intake; a component on the income per person, educational attainment, and total fertility rate under 25 years; and an autoregressive integrated moving average model to capture the unexplained component correlated over time. Data on risk predictors were obtained from Japan’s National Health and Nutrition Surveys and from the Global Burden of Disease Study 2017. To generate a reference forecast of disease-specific DALY rates for 2017–2040, we modelled the three diseases using the data for 1990–2016. Additionally, we generated better, moderate, and worse scenarios to evaluate the impact of change in salt intake on the DALY rate for the diseases.

Results

In our reference forecast, the DALY rates across all ages were predicted to be stable for CVDs, continuously increasing for CKDs, and continuously decreasing for SC. Meanwhile, the age group-specific DALY rates for these three diseases were forecasted to decrease, with some exceptions. Except for the ≥70 age group, there were remarkable differences in DALY rates between scenarios, with the best scenario having the lowest DALY rates in 2040 for SC. This represents a wide scope of future trajectories by 2040 with a potential for tremendous decrease in SC burden.

Conclusions

The gap between scenarios provides some quantification of the range of policy impacts on future trajectories of salt intake. Even though we do not yet know the policy mix used to achieve these scenarios, the result that there can be differences between scenarios means that policies today can have a significant impact on the future DALYs.