bluuebunny/crossref_metadata_2025 huggingface dataset:
Father Verspieren and Mali Aqua Viva: Lessons Learned from Fighting Drought and Poverty with Photovoltaic Solar Energy in Africa
Authors: Pagliaro Mario
Published: February 2020

Almost fifty years after the first installations, I identify the main lessons learned from fighting drought and poverty in Africa with direct solar-powered pumps thanks to Father Bernard Verspieren and Mali Aqua Viva. Six main findings and three main recommendations emerge from the present analysis which are of direct relevance to all Africa’s countries whose population has gone from 438 million in 1977 to 1308 million in 2019, with about 600 million still having no access to electricity. In place of “awareness campaigns”, I recommend to organize practice-oriented workshops on solar-powered irrigation and rainwater harvesting held by professional educators of newly established solar energy national institutes. In agreement with today’s expanded approach to education in solar energy, and with the key adult learning principle of motivation to learn, said education will include the economic and social aspects of distributed “generation” of energy and water from sunlight and rainfall.
Tingkat Kesiapan Kota Surakarta sebagai Kota Nyaman Bersepeda
Authors: Suryono Tities Amrihtasari , Rahayu Paramita , Rini Erma Fitria
Published: February 2020

Kota Surakarta merupakan kota menengah yang terus berkembang dengan total kendaraan bermotor sebanyak 85% dari total jumlah penduduk. Pemerintah Kota Surakarta saat ini mengalami kemacetan di banyak titik. Salah satu upaya untuk mengurangi kemacetan adalah dengan ditetapkannya Kota Surakarta sebagai kota nyaman bersepeda. Dalam kota nyaman bersepeda dibutuhkan integrasi antar aspek yaitu kebijakan dan kelembagaan, luas wilayah, jumlah penduduk kota, bentuk kota, infrastuktur yang dibagi menjadi jalur dan pakir sepeda, perbandingan pemilihan moda transportasi, dan sosial kebudayaan bersepeda. Tujuan penelitian ini adalah untuk mengetahui tingkat kesiapan Kota Surakarta sebagai kota nyaman bersepeda dan juga mengetahui tingkat kepentingan dari variabel kota nyaman bersepeda di Kota Surakarta. Penelitian ini menggunakan metode kuantitatif dengan menggunakan dua tahap analisis (1) analisis deskriptif untuk mengetahui kesiapan Kota Surakarta sebagai kota nyaman bersepeda yang dinilai pada setiap variabelnya (2) teknik Analytical Hierarchy Process (AHP) yang digunakan untuk memutuskan variabel mana yang mempunyai tingkat kepentingan tertinggi ke terendah terhadap kesiapan kota nyaman bersepeda. Hasil analisis menunjukkan bahwa variabel yang siap dalam konteks kota nyaman bersepeda adalah jumlah penduduk dan luas wilayah. Urutan prioritas variabel kota nyaman bersepeda di Kota Surakarta menurut para pelaku utama adalah jaringan/ jalur sepeda, kebijakan dan kelembagaan, perbandingan pemilihan moda, sosial kebudayaan bersepeda, parkir sepeda, bentuk kota, jumlah penduduk, dan urutan terakhir adalah luas wilayah.
As Potencialidades e os Limites do Direito Internacional Público Contemporâneo: uma análise do bloqueio imposto à Cuba pelos EUA
Authors: Rocha Gabriel Dourado , Silva Marcos Antonio da
Published: February 2020

Este trabalho analisa o bloqueio imposto pelos Estados Unidos da América a Cuba, considerando os princípios do Direito Internacional relativos à soberania, autodeterminação e não intervenção. Para tanto, discute como tais elementos se constituem numa marca fundamental para o desenvolvimento do Direito Internacional Público contemporâneo. Em seguida, analisa a origem e o aprimoramento, ao longo dos anos, de tal política até alcançar, nos anos 90, sua formulação mais recente e elaborada nas leis Torricelli e Helms-Burton. Finalmente, analisa os efeitos do bloqueio e a reação contrária da comunidade internacional, demonstrando que este se constitui numa violação de princípios básicos do Direito Internacional Público e num dos principais obstáculos para a normalização efetiva das relações entre Cuba e Estados Unidos da América (EUA).
Volar Plate Fixation in Adults with a Displaced Extra-Articular Distal Radial Fracture Is Cost-Effective
Authors: Mulders Marjolein A.M. , Walenkamp Monique M.J. , van Dieren Susan , Goslings J. Carel , Schep Niels W.L. ,   on behalf of the VIPER Trial Collaborators
Published: February 2020

Background:

To our knowledge, a health economic evaluation of volar plate fixation compared with plaster immobilization in patients with a displaced extra-articular distal radial fracture has not been previously conducted.

Methods:

A cost-effectiveness analysis of a multicenter randomized controlled trial was performed. Ninety patients were randomly assigned to volar plate fixation or plaster immobilization. The use of resources per patient was documented prospectively for up to 12 months after randomization and included direct medical, direct non-medical, and indirect non-medical costs due to the distal radial fracture and the received treatment.

Results:

The mean quality-adjusted life-years (QALYs) at 12 months were higher in patients treated with volar plate fixation (mean QALY difference, 0.16 [bias-corrected and accelerated 95% confidence interval (CI), 0.07 to 0.27]). (The 95% CIs throughout are bias-corrected and accelerated.) In addition, the mean total costs per patient were lower in patients treated with volar plate fixation (mean difference, −$299 [95% CI, −$1,880 to $1,024]). The difference in costs per QALY was −$1,838 (95% CI, −$12,604 to $9,787), in favor of volar plate fixation. In a subgroup analysis of patients who had paid employment, the difference in costs per QALY favored volar plate fixation by −$7,459 (95% CI, −$23,919 to $3,233).

Conclusions:

In adults with a displaced extra-articular distal radial fracture, volar plate fixation is a cost-effective intervention, especially in patients who had paid employment. Besides its better functional results, volar plate fixation is less expensive and provides a better quality of life than plaster immobilization.

Level of Evidence:

Economic Level I. See Instructions for Authors for a complete description of levels of evidence.
Association Between High-Sensitivity C-Reactive Protein and Idiopathic Adhesive Capsulitis
Authors: Park Hyung Bin , Gwark Ji-Yong , Jung Jaehoon , Jeong Soon-Taek
Published: February 2020

Background:

Chronic inflammation is implicated in the development of idiopathic adhesive capsulitis (IAC), whose association with high-sensitivity C-reactive protein (CRP), an inflammation marker, is undetermined. This study’s purposes were to investigate the association between high-sensitivity CRP levels and IAC and to determine the metabolic factors associated with high-sensitivity CRP.

Methods:

This case-control study examined a group of 202 patients with IAC and without intrinsic shoulder lesions or extrinsic causes and a control group of 606 age and sex-matched persons seeking general check-ups at our health promotion center during the same period as the case group. Control subjects had normal shoulder function and no previously diagnosed adhesive capsulitis; no medication for diabetes, dyslipidemia, and thyroid abnormalities; and no history of trauma or of shoulder surgery. The studied variables were body mass index; diabetes; thyroid abnormalities; dyslipidemias; triglyceride/high-density lipoprotein (TG/HDL) >3.5; serum levels of thyroid hormone, fasting glucose, and glycosylated hemoglobin A1c (HbA1c); and high-sensitivity CRP >1.0 mg/L. Multivariable conditional logistic regression analysis evaluated the matched sets of subjects. Odds ratios (ORs) and 95% confidence intervals (CIs) were determined for the studied variables possibly affecting IAC.

Results:

Serum high-sensitivity CRP >1.0 mg/L was significantly associated with IAC (OR, 2.47 [95% CI, 1.65 to 3.70]) after adjusting for diabetes, fasting glucose level, HbA1c, dyslipidemia, TG/HDL >3.5, and thyroid-stimulating hormone (p ≤ 0.031). Diabetes (OR, 1.71 [95% CI, 1.09 to 3.33]), fasting glucose level (OR, 1.54 [95% CI, 1.12 to 2.12]), HbA1c (OR, 2.00 [95% CI, 1.25 to 3.22]), hypertriglyceridemia (OR, 1.70 [95% CI, 1.03 to 3.41]), hypo-high-density lipoproteinemia (OR, 1.98 [95% CI, 1.04 to 3.79]), and TG/HDL >3.5 (OR, 1.37 [95% CI, 1.06 to 1.88]) were significantly associated with high-sensitivity CRP >1.0 mg/L in patients with IAC (p ≤ 0.039).

Conclusions:

Serum high-sensitivity CRP >1.0 mg/L is an independent associated marker for IAC. Dyslipidemia, insulin resistance, and hyperglycemia, which are recognized factors associated with IAC, are also associated with high-sensitivity CRP >1.0 mg/L in these patients, supporting the interaction of chronic systemic inflammation in IAC.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The Use and Adverse Effects of Oral and Intravenous Antibiotic Administration for Suspected Infection After Revision Shoulder Arthroplasty
Authors: Yao Jie J. , Jurgensmeier Kevin , Woodhead Benjamin M. , Whitson Anastasia J. , Pottinger Paul S. , Matsen Frederick A. , Hsu Jason E.
Published: February 2020

Background:

When performing revision shoulder arthroplasty, surgeons do not have access to the results of intraoperative culture specimens and will administer empiric antibiotics to cover for the possibility of deep infection until the culture results are finalized. The purpose of this study was to report the factors associated with the initiation, modification, and adverse events of 2 different postoperative antibiotic protocols in a series of revision shoulder arthroplasties.

Methods:

In this study, 175 patients undergoing revision shoulder arthroplasty were treated with either a protocol of intravenous (IV) antibiotics if there was a high index of suspicion for infection or a protocol of oral antibiotics if the index of suspicion was low. Antibiotics were withdrawn if cultures were negative and were modified as indicated if the cultures were positive. Antibiotic course, modification, and adverse effects to antibiotic administration were documented.

Results:

On univariate analysis, factors significantly associated with the initiation of IV antibiotics were male sex (p < 0.001), history of infection (p < 0.001), intraoperative humeral loosening (p = 0.003), and membrane formation (p < 0.001). On multivariate analysis, male sex (p = 0.003), history of infection (p = 0.003), and membrane formation (p < 0.001) were found to be independent predictors of the initiation of IV antibiotics. On the basis of preoperative and intraoperative characteristics, surgeons anticipated the culture results in 75% of cases, and modification of antibiotic therapy was required in 25%. The modification from oral to IV antibiotics due to positive culture results was made significantly more often in male patients (p < 0.001). Adverse effects of antibiotic administration occurred in 19% of patients. The rates of complications were significantly lower in the patients treated with oral antibiotics and a shorter course of antibiotics (p < 0.001).

Conclusions:

Complications associated with antibiotic administration after revision shoulder arthroplasty are not infrequent and are more common in patients whose initial protocol is IV antibiotics. Further study is needed to balance the effectiveness and risks of post-revision antibiotic treatment given the frequency of antibiotic-related complications.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Symptomatic Benign Prostatic Hyperplasia
Authors: Yazdi Hamidreza , Restrepo Camilo , Foltz Carol , Hammad Mohammed , Chung Paul H. , Gomella Leonard G. , Parvizi Javad
Published: February 2020

Background:

Male patients undergoing total joint arthroplasty have a higher risk of periprosthetic joint infection (PJI) compared with female patients. The exact reason for this finding is not well known. This study aimed to determine if patients with symptomatic benign prostatic hyperplasia (BPH) are at increased risk of PJI.

Methods:

A total of 12,902 male patients who underwent primary or revision total joint arthroplasty from January 2006 to April 2017 were retrospectively identified. The mean patient age was 62.47 years and the mean patient body mass index was 30.1 kg/m2. The majority of patients were Caucasian or African American. Most surgical procedures involved the hip joints (57.8%) and were primary arthroplasties (86%). Of these patients, 386 (3%) had symptomatic BPH. Among this group, 250 patients with symptomatic BPH were identified and were matched in an approximate 1:3 ratio with 708 control patients. Using the International Consensus Meeting criteria, patients who developed PJI were identified.

Results:

The PJI rate was 7.9% in the symptomatic BPH group and 2.8% in the control group. Multivariate regression analysis in unmatched groups showed that symptomatic BPH was a strong independent risk factor for PJI. After matching for variables related to outcomes, symptomatic BPH remained a significant risk factor for PJI (p = 0.01).

Conclusions:

Patients with symptomatic BPH had a higher risk of PJI compared with the control patients. This may partly explain the higher rate of PJI that is seen in male patients.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Functional Outcomes of Tillaux and Triplane Fractures with 2 to 5 Millimeters of Intra-Articular Gap
Authors: Lurie Benjamin , Van Rysselberghe Noelle , Pennock Andrew T. , Upasani Vidyadhar V.
Published: February 2020

Background:

The treatment of transitional ankle fractures (Tillaux and triplane) is often dictated by the amount of displacement at the articular surface. Although >2 mm is a common indication for operative management, this practice has not been strongly supported by either the pediatric or adult literature. The purpose of this study was to determine whether operative treatment of transitional fractures with 2 to 5 mm of intra-articular gap leads to superior functional outcomes compared with cast management.

Methods:

A retrospective review of all patients treated for distal tibial fractures at a single institution between 2009 and 2017 was conducted. Computed tomographic images obtained after closed reduction were reviewed to identify patients with 2 to 5 mm of displacement (either gap or step-off) at the articular surface of the tibial plafond. Complications were classified according to the modified Clavien-Dindo system. Only patients with functional outcome data (Foot and Ankle Ability Measure [FAAM]) at a minimum of 2 years after treatment were included. Two multivariable linear regression models were developed using backward stepwise regression with either the FAAM Sports score or the Single Assessment Numerical Evaluation (SANE) Sports score as the dependent variables.

Results:

Fifty-seven patients (34 with triplane fractures and 23 with Tillaux fractures) with a mean follow-up of 4.5 years (range, 2.0 to 9.2 years) met inclusion criteria. Thirty-four patients were treated operatively, and 23 patients were treated with closed reduction and cast application. Nonoperative treatment, greater intra-articular gap, and presence of a grade-III complication were associated with worse functional outcomes in both multivariable regression models. A gap after closed reduction remained a negative predictor of functional outcome even in patients who were treated operatively. Patients who were treated nonoperatively and had ≤2.5 mm of gap had a significantly higher mean SANE Sports score at 90% than those patients with >2.5 mm of gap at 75% (p = 0.03).

Conclusions:

In Tillaux and triplane fractures with 2 to 5 mm of gap at the tibial plafond, a greater gap after closed reduction, nonoperative treatment, and complications were negative predictors of functional outcome at a mean follow-up of 4.5 years. Surgical management likely conveys the greatest functional benefit when the intra-articular gap exceeds 2.5 mm.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Novel Use of Subcostal Polyethylene Bands to Manage Tumor-Related Scoliosis Requiring Serial Imaging
Authors: Toll Brandon J. , Pahys Joshua M. , Yezdani Samir G. , Samdani Amer F. , Hwang Steven W.
Published: February 2020

Case:

A 16-year-old male patient with severe kyphoscoliosis, paraplegia, and neurogenic bowel/bladder caused by a juvenile pilocytic astrocytoma was treated surgically using a hybrid fusion construct with polyethylene bands after neoplasm resection. Owing to the necessity of serial postoperative magnetic resonance imaging studies to evaluate the recurrence of pathology and known effect of metal artifact from spinal instrumentation, preservation of radiographic resolution was critical.

Conclusion:

We describe the novel utility of polyethylene bands placed around the ribs as a safe and effective form of hybrid construct for reducing radiographic metal artifact in spinal deformity cases requiring serial imaging.
In Search of Shifting and Emergent Librarian Identities
Authors: Klein Sara , Lenart Bartlomiej
Published: February 2020

This paper argues that while the classical, essentialist conception of identity is appealing due to its simplicity, it does not adequately capture the complexity of professional or individual identity. The appeal to essentialism in librarianship contributes to some serious problems for the profession, such as exclusion and homogeneity in the workplace, high attrition rates of minority librarians, exploitation and alienation of an underrepresented workforce, as well as stereotyping. This paper examines the theoretical landscape with regard to the identity question and proposes a more fitting alternative to essentialism, namely the relational conception of identity, and engages in a philosophical argument for the adoption of the relational account as a theoretical grounding for an understanding of the complex, fluid, and emergent nature of librarian identity within our dynamic profession.
Screening and Identification of LncRNAs Related to Villus Growth of Liaoning Cashmere Goats and Their Effects on Growth after FGF5 Treatment
Authors: Jin Mei , Zhao Qin Feng , Ni Ping , Piao Jun , Piao Ai Jing
Published: February 2020

(Background)Liaoning cashmere goat cashmere has high economic value FGF5 is an important factor regulating its growth. The role of long non-coding RNA (LncRNA) in the mammalian villus growth cycle has still not been studied in detail.(Results)This study investigated how LncRNA mediates the effects of FGF5 on the growth of Liaoning cashmere goats. By using RNA-seq sequencing technology, over-expression and interference lentiviral technology and qPCR, we demonstrated that treatment of skin cells with FGF5 inhibited the expression of LncRNA in cells, down-regulated the expression of the target genes CBS and CTH, and promoted the expression of related keratin genes k26, kap11.1. Then, overexpressing LncRNA in skin cells reversed the inhibiting effect of FGF5 on the target genes CBS and CTH which further inhibited the expression of k26, kap11.1. Finally, we demonstrated the inhibition of CBS and CTH and elevation k26 and kap11.1 genes when the expression level of LncRNA gene is downregulated using RNA interference. (Conclusions)Therefore, we believe that FGF5 can regulate the growth and development of cashmere goat hair by promoting the expression of related keratin and keratin-associated protein genes. This mechanism is achieved by inhibiting the expression of the LncRNA gene and then down-regulating the expression of the target genes CBS and CTH.
Supporting children who have a parent with a mental illness in Tyrol: A situational analysis for informing co-development and implementation of practice changes
Authors: Zechmeister-Koss Ingrid , Goodyear Melinda , Tüchler Heinz , Paul Jean Lillian
Published: February 2020

Background: A research project aimed to improve the situation of children of parents with a mental illness (COPMI) is underway in the Austrian region of Tyrol. The project aims to strengthen formal and informal support structures around the child, through enhancing their village of collaborative support. Understanding the current situation in the region is vital for implementing practice change. This paper aims to gain knowledge on the Tyrolean societal and service provision context. Methods: We collected qualitative (e.g. interviews) and quantitative data (e.g. administrative data from the health insurance) on overall societal characteristics, epidemiology of mental illness in Tyrol, current services within adult mental healthcare and for supporting children, parents and families, uptake of services, and current practices and challenges of identifying and supporting COPMIs. We analysed data along several external context dimensions: 1) professional influences, 2) political support, 3) social climate, 4) local infrastructure, 5) policy and legal climate, 6) relational climate, 7) target population, and 8) funding and economic climate. Results: We identified that there is awareness of challenges related to COPMIs at professional and planning level, however there is a lack of installed support processes and standards to meet these children’s needs across Tyrol. A variety of services are available both for unwell parents, and families and individual family members. Yet, only one small service addresses COPMIs directly. Services fall into different sectors (education, health, social affairs) and are funded from different sources, making coordination difficult. Access varies from universal to rather restricted (i.e. through referral). The potential number of parents which could be reached in order to identify their children via adult mental health differs considerably by setting. Societal structures indicate that the informal and voluntary sector may be a realistic source for supporting COPMIs in Tyrol. Conclusions: Societal structures and current services provide a rich resource for improving identification and supporting of COPMIs, however considerable coordination and behaviour change effort will be required due to the fragmentation of the system and professional cultures. Insights into the context of supporting COPMIs have been of high value for developing and implementing practice changes in local organizations.
The R2R3-type LoMYB20s gene regulates programmed cell death and secondary wall biosynthesis, and affects anther development and dehiscence in Lily
Authors: Tong Zheng , Li Qiuhua , Khaskheli AllahJurio , Gao Junping , He Junna , Hong Bo
Published: February 2020

Background Lilies are the widely cultivated cut flowers worldwide, while lily anthers carry a large amount of colored pollen dispersed easily to stain petals that makes serious problems for commerical sales. Improving pollen pollution in lily is one of the major goals of lily breeding. Results In this study, we identified a putative R2R3 MYB transcription factor LoMYB20s from oriental lily ( Lilium spp. ‘Siberia’). LoMYB20s mainly expressed in anther wall during the late stages of lily anther development. Suppression of LoMYB20s by virus-induced gene silencing (VIGS) in lily led to a failure of the anthers to dehisce. Induction of LoMYB20s in DEX::LoMYB20s transgenic Arabidopsis caused the rosette leaves turning yellow and the inflorescences becoming procumbent and infertile. And the downstream genes of LoMYB20s were involved in multiple metabolic processes including jasmonate (JA) biosynthetic, gibberellin (GA)-deactivating, programmed cell death (PCD), and secondary wall biosynthesis (SWB). These results suggested that LoMYB20s participated in anther development and dehiscence possibly through regulating the PCD and SWB processes in a JA/GA-associated manner. Conclusions Our results demonstrated the indispensable role of LoMYB20s in lily anther development and dehiscence, and provide a possibility of using LoMYB20s silencing to produce anther-indehicent lilies.
Novel heavy metal resistance gene clusters are present in the genome of Cupriavidus neocaledonicus STM 6070, a new species of Mimosa pudica microsymbiont isolated from heavy-metal-rich mining site soil
Authors: Klonowska Agnieszka , Moulin Lionel , Ardley Julie , Braun Florence , Gollagher Margaret , Zandberg Jaco Daniel , Marinova Dora , Huntemann Marcel , Reddy T.B.K. , Varghese Neha , Woyke Tanja , Ivanova Natalia , Seshadri Rekha , Kyrpides Nikos , Reeve Wayne
Published: February 2020

Background Cupriavidus strain STM 6070 was isolated from nickel-rich soil collected near Koniambo massif, New Caledonia, using the invasive legume trap host Mimosa pudica. STM 6070 is a heavy metal-tolerant strain that is highly effective at fixing nitrogen with M. pudica. Here we have provided an updated taxonomy for STM 6070 and described salient features of the annotated genome, focusing on heavy metal resistance (HMR) loci and heavy metal efflux (HME) systems.Results The 6,771,773 bp high-quality-draft genome consists of 107 scaffolds containing 6,118 protein-coding genes. ANI values show that STM 6070 is a new species of Cupriavidus. The STM 6070 symbiotic region was syntenic with that of the M. pudica-nodulating Cupriavidus taiwanensis LMG 19424T. In contrast to the nickel and zinc sensitivity of C. taiwanensis strains, STM 6070 grew at high Ni2+ and Zn2+ concentrations. The STM 6070 genome contains 55 genes, located in 12 clusters, that encode HMR structural proteins belonging to the RND, MFS, CHR, ARC3, CDF and P-ATPase protein superfamilies. These HMR molecular determinants are putatively involved in arsenic (ars), chromium (chr), cobalt-zinc-cadmium (czc), copper (cop, cup), nickel (nie and nre), and silver and/or copper (sil) resistance. Seven of these HMR clusters were common to symbiotic and non-symbiotic Cupriavidus species, while four clusters were specific to STM 6070, with three of these being associated with insertion sequences. Within the specific STM 6070 HMR clusters, three novel HME-RND systems (nieIC cep nieBA, czcC2B2A2, and hmxB zneAC zneR hmxS) were identified, which constitute new candidate genes for nickel and zinc resistance.Conclusions STM 6070 belongs to a new Cupriavidus species, for which we have proposed the name Cupriavidus neocaledonicus sp. nov.. STM6070 harbours a pSym with a high degree of gene conservation to the pSyms of M. pudica-nodulating C. taiwanensis strains, probably as a result of recent horizontal transfer. The presence of specific HMR clusters, associated with transposase genes, suggests that the selection pressure of the New Caledonian ultramafic soils has driven the specific adaptation of STM 6070 to heavy-metal-rich soils via horizontal gene transfer.
Tumor Characteristics and Treatment Outcomes of Older Women with Breast Cancer in Jordan
Authors: Abdel-Razeq Hikmat , Rahman Fadwa Abdel , Al-Masri Hanan , Abdulelah Hazem , Nasser Mahmoud Abu , Salam Mourad , Taqash Ayat
Published: February 2020

Background : Less than 10% of newly diagnosed breast cancer in our region are diagnosed in women 70 years or older. Treatment plans of such patients is less clear and have poor outcomes. In this paper, we describe clinical presentation, tumor characteristics and treatment outcomes in such patients.
Methods : Consecutive patients aged 65 years or older with pathologically-confirmed diagnosis of breast cancer were included. Medical records and hospital databases were searched for patients’ characteristics and treatment outcomes.
Results : A total of 553 patients, median age 70 (range: 65-91) years, were included. On presentation, 114 (20.6%) patients had metastatic disease and was mostly visceral (81; 71.1%). Patients with non-metastatic disease had poor pathological features including node-positive in 244 (55.6%), GIII in 170 (38.7%) and lymphovascular invasion in 173 (39.4%). Patients were treated less aggressively; 144 (32.8%) patients with early-stage disease and 98 (86.0%) with metastatic disease never had chemotherapy.
After a median follow up of 45 months, 5-year overall survival for the whole group was 67.6%. Survival was better for patients with non-metastatic disease (78.8% vs. 25.4%, P<0.001) and for those with node-negative compared to node-positive disease (85.4% vs. 74.1%, P=0.002). On Cox regression, only positive lymph nodes were associated with poor outcome in patients with non-metastatic disease (Hazard Ratio [HR], 1.75; 95% CI: 1.006-3.034, P=0.048).
Conclusions : Older Jordanian women with breast cancer present with more aggressive features and advanced-stage disease that reflect poorly on treatment outcomes. Because of comorbidities and poor performance status, some patients were not aggressively treated.
Unstable intertrochanteric fractures are associated with a greater hemoglobin drop during the perioperative period: a retrospective case control study
Authors: Lin Po-Hsun , Chien Jui-Teng , Hung Jung-Pin , Hong Chih-Kai , Tsai Tzung-Yi , Yang Chang-Chen
Published: February 2020

Background: With an increase in the elderly population, the occurrence of hip fractures, femoral neck fractures, and intertrochanteric fractures (ITFs) is also increasing. It is important to establish effective perioperative methods that would help reduce the morbidity and mortality rates associated with ITFs. The purpose of this study was to determine the effects of ITFs according to the AO classification for perioperative hemoglobin drop. Methods: Seventy-six patients with ITFs classified as AO 31-A1 or A2 and fixated with intramedullary nails participated in this retrospective cohort study. Medical records of these patients were retrospectively reviewed from September 2016 to August 2018. The perioperative hemoglobin drop was chosen as the main outcome measure and calculated as the difference between pre- and postoperative hemoglobin levels. Multivariate linear regression analysis was performed and included the following variables: AO classification (A1.1-A2.1 [stable] vs. A2.2-A2.3 [unstable]), time interval between injury and surgery, age, body mass index, and use of anticoagulation medicine.Results: Among the 76 patients who met the inclusion criteria, a significantly higher hemoglobin drop was observed in the AO 31 A2.2-A2.3 (unstable) group than in the AO 31 A1.1-A2.1 (stable) group (p = 0.04). The multivariate analysis also showed a greater hemoglobin drop in the unstable group (p < 0.05).Conclusions: Patients with unstable ITFs showed a greater hemoglobin drop and suspected hidden blood loss around the fracture site. We believe that this should be taken into consideration when presurgical blood transfusion is being planned for patients with unstable ITFs, to reduce the associated postoperative complications, especially in patients with severe anemia or high mortality risk.
A combination of Spearmint and flaxseed extract improved endocrine and histomorphology of ovary in experimental PCOS
Authors: Mina Mehraban , Jelodar Gholamali - , Farhad Rahmanifar
Published: February 2020

Background Polycystic ovary syndrome (PCOS) is a complex reproduction and endocrine disorder of women in the reproductive age. Spearmint (Mentha Spicata L.) has anti-androgenic activity and flaxseed (Linum Usitatissimum L.) contains phytoestrogen and was reported to improve PCOS conditions. This study aimed to evaluate PCOS conditions following administration of a mixture of these two plants. Methods Twenty-four rats with regular cycles were randomly divided into four groups as control (C) and treatment-control (TC) received a combination of spearmint extract (SE) + flaxseed extract (FE). PCOS was induced in PCOS and treatment (T) groups by a single intramuscular injection of estradiol valerate. The treatment group received a combination of SE and FE for 30 days, 7 weeks after injection of estradiol valerate. Estrous cycles were monitored for 10 days and in the last day animals were sacrificed, ovaries were collected for the histomorphometric study and the serum levels of progesterone, testosterone, estradiol, and dehydroepiandrosterone (DHEA) were measured. Result Significant rise in progesterone and a decrease in testosterone and estradiol with no significant change of DHEA in the T group, was observed in comparison with the PCOS group ( P<0.05 ). No significant difference noticed between T and control groups (C &CT) regarding evaluated hormones. A significant increase in primary, pre-antral and antral follicles noticed in the T group compared to the PCOS group. The number of cystic follicles decreased in the T group compared with the PCOS group. Granulosa layer thickness increased while the thickness of theca decreased significantly in the T group compared to the PCOS group ( P<0.05 ). No significant endocrine or histological differences noticed between C and TC groups. Conclusion A combination of flaxseed and spearmint extract improved the endocrine profile and the histomorphometric features of the ovary in the T group compared to the PCOS group.
A rapid and simple method for routine determination of antibiotic sensitivity to biofilm populations of Pseudomonas aeruginosa
Authors: Wannigama Dhammika Leshan , Hurst Cameron , Hongsing Parichart , Pearson Lachlan , Saethang Thammakorn , Chantaravisoot Naphat , Singkham-in Uthaibhorn , Luk-in Sirirat , Storer Robin James , Chatsuwan Tanittha
Published: February 2020

Treatment of infections of Pseudomonas aeruginosa forming biofilms after antimicrobial testing on planktonic bacteria can result in substantial failure. Therefore, we offer a robust and simple experimental platform to test the impact of antimicrobials on biofilms. Antibiotic response patterns varied uniquely within biofilm formation capacity and minimal biofilm eradication concentrations (MBECs) has a significantly better discriminatory power than minimum inhibitory concentrations (MICs) to differentiate the overall efficiency of antibiotics to eradicate biofilm. Our resazurin-based 96-well-plate platform is able to emulate bacterial responses to antibiotics under biofilm conditions in a fast, simple, and cost-effective screening method adaptable to automation, and warrants trials in the clinic.
Protein changes as robust signatures of fish chronic stress: a proteomics approach in fish welfare research
Authors: de Magalhães Cláudia Raposo , Schrama Denise , Farinha Ana Paula , Revets Dominique , Kuehn Annette , Planchon Sébastien , Rodrigues Pedro Miguel , Cerqueira Marco Alexandre
Published: February 2020

Background: In order to have a greater understanding of fish welfare, sensitive technological tools, such as proteomics, may assist the aquaculture industry as it allows an unbiased approach for the discovery of potential biomarkers for stress monitoring. Stress is characterized by a cascade of physiological responses that end-up inducing further changes at the whole-animal level that might either increase fitness or impair welfare. Monitorization of this dynamic process, up till now relies on indicators that are only a snapshot of the stress level experienced. Within this scope, using G ilthead seabream ( Sparus aurata ) as model, three chronic stress conditions, namely overcrowding, handling and hypoxia, were employed to evaluate the potential of the fish protein-based adaptations as reliable signatures of chronic stress, in contrast with the commonly used hormonal and metabolic indicators. Results: A large spectrum of biological variation regarding cortisol and glucose levels was observed, which values rose higher in net handled fish. In this sense, a potential pattern of stressor-specificity was evidenced since the magnitude of response and tolerance varied markedly from a permanent (crowding) to a repetitive stressor (handling). Gel-based proteomics analysis of the plasma proteome also revealed that net handled fish had the highest number of differential proteins, compared to the other trials . M ass spectrometric analysis, followed by gene ontology enrichment and protein-protein interaction analyses, characterized those as humoral components of the innate immune system and key elements on the response to stimulus. Conclusions: Overall, this study represents the first screening of more reliable signatures of physiological adaptation to chronic stress in fish, allowing the future development of novel biomarker models to monitor fish welfare.
Identification and analysis of CYP450 supergene family members from the transcriptome of Aralia elata (Miq.) Seem reveal candidate genes for triterpenoid saponin biosynthesis
Authors: Cheng Yao , Liu Hanbing , Tong Xuejiao , Liu Zaimin , Zhang Xin , Li Dalong , Jiang Xinmei , Yu Xihong
Published: February 2020

Background: Members of the cytochrome P450 (CYP450) gene superfamily have been shown to play essential roles in regulating secondary metabolites biosynthesis. However, the systematic identification and bioinformatics analysis of CYP450s have not been reported in Aralia elata (Miq.) Seem , a highly valued medicinal plant. Results: In the present study we conducted the RNA-sequencing (RNA-seq) analysis of the leaves, stems, and roots of A. elata, yielding 66,713 total unigenes. Following the annotation and classification of these unigenes, we were able to identify two pathways and 19 putative genes associated with the synthesis of triterpenoid saponins in these plants, with qRT-PCR subsequently being used to validate these gene expression patterns. Scanning with the CYP450 model from Pfam resulted in the identification of 111 full-length and 143 partial-length CYP450s, with the full-length CYP450s being further clustered into 7 clans and 36 families. Through phylogenetic and conserved motif analyses, we were further able to group these CYP450 proteins into two primary branches: A-type (53%) and non-A type (47%). We further conducted representative protein sequence alignment for these CYP450 family members, with secondary elements being assigned in light of the recently published Arabidopsis CYP90B1 structure. Using the available sequence information, we further identified predicted substrate recognition sites (SRSs) and substrate binding sites within these putative proteins.We further assessed the expression patterns of these 111 CYP450 genes across A. elata tissues, with 12 members of this gene family being selected at random for qRT-PCR validation. From these data, we identified CYP716A295 and CYP716A296 as the candidate genes most likely to be associated with oleanolic acid synthesis, while CYP72A763 was identified as being the most likely to play a role in hederagenin biosynthesis. Finally, we assessed the subcellular localization of these CYP450 proteins within Arabidopsis protoplasts, highlighting the fact that they localize to the endoplasmic reticulum. Conclusions: This study presents a systematic analysis of the CYP450 gene family in A. elata and provided a foundation for further functional characterization of CYP450 genes.
Security considerations for telemedicine systems
Authors: Kim Dong-won , Choi Jin-young , Han Keun-hee
Published: February 2020

Background: In this study, the effects of cybersecurity threats on telemedicine were investigated, and methods to evaluate security risks were considered. Many research institutes and investigation agencies have provided information about cybersecurity incidents in the medical field, between 2009 and 2019. Methods: The scenario information about cybersecurity threats was directly collected through a field survey. Potential threats that can occur in telemedicine services were accurately identified, and objective security requirements were derived by threat modeling using attack trees. The attack occurrence probability and attack success probability according to the importance of telemedicine service assets were included as variables. Results: The introduction of telemedicine guarantees accessibility to medical services for vulnerable areas. However, potential security threats and response measures in the telemedicine environment, which includes users and patients, remote medical devices, home networks, gateway devices, the Internet, and the telemedicine system, have not been considered thus far. Conclusion: This study contributes to the improvement of security by introducing methods to identify and evaluate security threats and preparing security measures for the telemedicine environment.
Clinical implication of plasma exchange on life-threatening antineutrophil cytoplasmic antibody-associated vasculitis
Authors: Park Pil Gyu , Yoo Byung-Woo , Song Jason Jungsik , Park Yong-Beom , Lee Sang-Won
Published: February 2020

Background: We assessed the rate of and the predictor for all-cause mortality in antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) patients receiving plasma exchange (PLEX) and evaluated the survival-benefit of PLEX for diffuse alveolar haemorrhage (DAH) between AAV patients receiving PLEX and those not receiving. Methods: We retrospectively reviewed the medical records of 212 AAV patients. Demographic, clinical and laboratory data at the time of PLEX was collected from both 9 patients receiving PLEX and 10 AAV patients with DAH. The follow-up duration was defined as the period from the time of PLEX or DAH occurrence to death for the deceased patients and as that to the last visit for the survived patients. Results: The median age of 9 AAV patients receiving PLEX was 71.0 years and 5 patients were men. Four of 9 patients receiving PLEX died at a median follow-up duration of 92.0 days. Three died of sepsis and one died of no response to PLEX. When patients with DAH receiving PLEX and those not receiving were compared, there were no significant differences in variables between the two groups. The cumulative patients’ survival rate between patients with DAH receiving PLEX and those not receiving were also compared using the Kaplan-Meier survival analysis but no survival-benefit of PLEX for DAH was observed. Conclusion: The rate of all-cause mortality in 9 AAV patients receiving PLEX was assessed as 44.4% and it was controversial that PLEX is beneficial for the improvement of prognosis of AAV-related DAH.
Prevalence and risk factors for HBV and HCV among incarcerated people who inject drugs in Iran: a cross sectional study
Authors: Moradi Ghobad , Mohamadi Parvin , Zarei Bushra , Rasouli Mohammad Aziz , Gouya Mohammad Mehdi , Jafari Saeede
Published: February 2020

Background

This study aimed at determining the prevalence and risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) among incarcerated people who inject drugs (PWID) in Iran during 2015-16.

Methods

The required data was obtained from the Iranian national bio-behavioral surveillance surveys (BBSSs), which examined 11988 prisoners who were selected using multi-stage sampling from 55 prisons in 19 provinces during 2015-16. The demographic and behavioral status of these subjects were measured through interviews and HBV and HCV exposure were examined using ELISA test of blood samples. A total of 1387 individuals with a history of drug injection in their lifetime were enrolled into this study. Survey analysis was used to analyze the data. The univariate and multivariate logistic regression were used to investigate the relationships between risk factors and outcome.

Results

The mean age of the incarcerated PWID was 36.83 ± 8.13; of all, 98.46% were male, 50.97% were married, and 96.57% had non-academic education. The prevalence of HCV and HBV was 40.52% and 2.46%, respectively. HCV prevalence was associated with an age≥30 years, being single, non-academic education, prison term>5 years, history of piercing, and extramarital sex in lifetime (P<0.05).

Conclusions

The prevalence of HCV is alarmingly high. However, prison by facilitating the easy access to infected group can be considered as an opportunity to achieve the goal of eliminating HCV in the country. It is recommended to design interventions while considering the risk factors of prison term, piercing, and extramarital sex.
The pattern and magnitude of Dietary Free Sugar (DFS) consumption and dental caries in school children: A systematic review
Authors: Pakdaman A , Zeinab Mahboobi , Reza Yazdani , Leila Azadbakht
Published: February 2020

Background Dietary Free Sugar (DFS) is considered as one of the main risk factor for dental caries development. This systematic review was designed to assess the relationship between pattern and magnitude of Dietary Free Sugar (DFS) consumption and dental caries in school children aged among 6 to 12 years old. Methods An electronic search of the databases consists of Medline/PubMed, Embase, ISI Web of Science and Scopus was conducted using relevant keywords. Longitudinal studies reporting the relationship between DFS and dental caries focused on school children that were published between 2004 and 2019 in English were selected. The title and abstract of the papers were reviewed by 2 independent researchers and irrelevant papers were excluded. After duplicate removal, the full text of the papers was reviewed. The reference search of the selected papers was performed and finally the quality of included papers assessed using the STROBE check list and the main findings were extracted. Results From 2120 articles searched, 12 longitudinal studies included in this review. Three articles report insignificant relationship between DFS consumption of and dental caries. However, Dietary Free Sugar and dental caries were significantly associated in the primary and permanent dentition of children. Frequent intake of sweet foods and drinks especially before bed, consumption of processed starches and soft drink were considered as important risk factors while frequent consumption of water and dairy product had protective effect. Conclusion This study confirms the limitation of dietary free sugar in school children especially in the form of processed starch and sweet snacks especially before bedtime. Still, there is a need for well-designed studies in this field.
Statin Use Is Associated With Reduced Mortality On Mechanically Ventilated Patients: A Retrospective Propensity-Matched Analysis Of MIMIC-III Database
Authors: Lin Qiuhai , Chen Daonan , Xu Jiyao , Miao Congliang , Huang Yuan , Wang Liu , Ge Fangxia , Kang Mei , Tian Rui , Zhu Yong , Zhang Huifang , xie Yun , Wang Ruilan , Du Jiang
Published: February 2020

Objective: Mechanical ventilation can cause injury and inflammatory disorders in the lungs of critically ill patients. We sought to determine whether statin treatment has a protective effect on the outcome of these patients. Methods: A retrospective observational study of ICU patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Information on ventilated patients was analyzed using data from the MIMIC-III database. The non-statin cohort was selected using 1:1 propensity matching with the statin cohort by age, sex, severity scores and 29 other variables. Compared with nonusers, the use of statins was associated with improved 28-day survival in the unmatched cohort (HR 0.85 95% CI 0.80~0.90) and matched cohort (HR 0.72 95% CI 0.67~0.77). Statin use was also associated with improved in-hospital survival in both the unmatched cohort (HR 0.90, 95% CI 0.85~0.95) and the matched cohort (HR 0.75 95% CI 0.70~0.80). In the multivariate Cox model, the use of statins was also associated with an improvement in 28-day survival in the unmatched cohort (HR 0.73 95% CI 0.68～0.77) and in the matched cohort (HR 0.73 95% CI 0.68~0.78). The use of statins was associated with longer ICU length of stay (LOS), shorter ventilator-free days (VFDs) and fewer model for end-stage liver disease score (MELD) in the matched cohort. The subgroup analysis results showed improved 28-day survival, but this improvement was not observed in patients with pneumonia, obesity, septicemia or acute respiratory failure. Conclusions: In a population of mechanically ventilated patients, the use of statins may be associated with reduced mortality.