bluuebunny/crossref_metadata_2025 huggingface dataset:
Protein Phosphatase 4 (PPP4) Prevents Female Reprogramming in the Mouse Testis After Sex Determination and Protects Male Fertility
Authors: Han Feng , Dong Ming-Zhe , Lei Wen-Long , Xu Zhi-Liang , Gao Fei , Schatten Heide , Wang Zhen-Bo , Sun Xiao-Fang , Sun Qing-Yuan
Published: May 2021

Background: Impairment of lineage specification and function of gonadal somatic cells can lead to disorders of sexual development (DSDs) and fertility defects in humans. However, little is known about the function of protein phosphatases in testis development. Results: We showed that protein phosphatase 4 (PPP4) could maintain SOX9 expression in Sertoli cells and play an essential role in Sertoli cell lineage maintenance and male fertility. Conditional deletion of Ppp4c, a PPP4 catalytic subunit gene, caused the reprogramming of Sertoli cells to granulosa-like cells postnatally by inducing ectopic expression of FOXL2, which in turn led to testicular BTB structure damage, germ cell loss and ultimate testis to ovary-like gland transformation. Conclusion: Reprogramming of Sertoli cells due to absence of PPP4 may help explain the etiology of disorders of sexual differentiation and male infertility.
Multi-Omics Integrative Analysis Identifying EPC1 as a Prognostic Biomarker in Head and Neck Squamous Cell Carcinoma
Authors: Dai Yongmei , chen Wenhan , Huang Junpeng , Cui Tongjian , huang chen
Published: May 2021

Background: To investigate the prognostic significance and related mechanisms of the expression of enhancer of polycomb homolog 1 ( EPC1 ) in head and neck squamous cell carcinoma (HNSCC) from a multi-omics perspective. Methods: The Kaplan-Meier plotter was used to evaluate the prognostic significance of EPC1 . Based on the LinkedOmics, UALCAN, and Timer platforms, the multi-omics expression of EPC1 in HNSCC was explored to investigate mechanisms affecting prognoses. Results: At the genetic level, 8208 genes were negatively correlated with EPC1 expression, and 11,956 genes were positively correlated with EPC1 expression. For the noncoding region, a competing endogenous RNA (ceRNA) network was constructed, and 6 microRNAs (miRNAs) and 3 long noncoding RNAs (lncRNAs) were identified. At the protein level, a protein-protein interaction (PPI) network related to EPC1 expression was constructed and was involved in human papillomavirus (HPV) infection, endocrine resistance, and multiple cancer pathways. At the immune level, EPC1 expression was correlated with a variety of immune cells, immune molecules, and chemokine receptors, which together constitute the immune microenvironment of tumors. According to the clinical data, high EPC1 expression in HNSCC was a predictor of patient prognosis (hazard ratio (HR)=0.64; 95% confidence interval (CI) 0.49-0.83; P<0.01). EPC1 expression differentiated clinical subtypes and was related to key factors such as TP53 and HPV (P<0.05). Conclusion: High EPC1 expression is a protective factor in HNSCC and benefits patient survival. EPC1 may participate in the genomics, transcriptomics, proteomics, and immunomics of HNSCC, and the results can provide a reference for the development of targeted drugs and the evaluation of patient prognosis.
Effects of Self-Esteem on the Associations of Infertility-Related Stress With Psychological Distress Among Chinese Women With Infertility: A Cross-Sectional Study
Authors: Cui Chunying , Wang Yu , Wang Lie , Wang Xiaoxi
Published: May 2021

Background: Anxiety and depression are the most common occurring psychological distress in infertile patients. Our study aimed to evaluate the prevalence of depression and anxiety, and investigate the association of infertility-related stress with them among Chinese infertility patients. Meanwhile, the role of self-esteem in this association was explored as a positive psychological resource.Methods: The investigation was conducted between December 2017 to May 2018. Questionnaires that measured infertility-related stress, self-esteem, depression, and anxiety were distributed to 536 female infertility patients in Shenyang, China. Hierarchical linear regression analyses were used to examine the mediating and moderating role of self-esteem. Baron and Kenny’s technique, asymptotic, and resampling strategies were used to confirm the mediating role of self-esteem on the associations of infertility-related stress with depression and anxiety.Results: The prevalence of depression and anxiety was 27.9% and 42.2% among Chinese female infertility patients. Infertility-related stress was positively associated with depression and anxiety, whereas self-esteem was negatively associated with depression and anxiety. Besides, the effect of infertility-related stress on depression and anxiety gradually decreases with the increase of self-esteem. Meanwhile, self-esteem partially mediated the association of infertility-related stress with depression and anxiety.Conclusions: There was a high prevalence of psychological distress. Infertility-related stress and self-esteem were associated with psychological distress, which helped to explain why infertile women suffered higher prevalence of depression and anxiety. Besides, self-esteem mediated and moderated the effects of infertility-related stress on depression and anxiety. Interventions that focus on self-esteem may be effective and available resource to combat mental problems.
Bioinformatic Analysis of Key Genes Related to Tumor Microenvironment in Hepatocellular Carcinoma
Authors: Zhang Jingxu , Liu Hao , Zhao Keyi , Bao Zhiye , Zhang Zhishuo , Li Ye
Published: May 2021

Background: Tumor microenvironment (TME) plays important roles in the development of different types of cancer. However, the critical regulatory members of TME related to hepatocellular carcinoma (HCC) remain unclear. In this study, a bioinformatic analysis based on Cancer Genome Atlas (TCGA) and Estimation of STromal and Immune cells in Malignant Tumor tissues using Expression data (ESTIMATE) datasets was conducted to predict the key genes affecting TME in HCC.Material and Methods: First, 340 patients and 20531 genes’ expression data with ESTIMATE scores were filtered and combined to identify differentially expressed genes. Next, protein-protein interaction (PPI) network and functional enrichment analysis were conducted to find hub genes. Then, log-rank test and functional enrichment analysis were conducted on the consensus genes and hub genes. Finally, Kaplan-Meier curves of the hub genes were drawn. As verification, those genes were searched on Oncomine database.Results: Among all differentially expressed genes, 916 genes were expressed in both the immune and stromal groups. The Gene Ontology (GO) terms they enriched were T cell activation, leukocyte migration, collagen-containing matrix, external side of plasma membrane, receptor ligand and activator activity. Cytokine-cytokine receptor interaction was the most significant Kyoto Encyclopedia of Genes and Genomes (KEGG) term. Furthermore, cd3e, cd3g, hla-dpa1, hla-dpb1, lck, and map4k1 hub genes were low expressed in 304 patients, participating in a variety of responses including immune response−activating cell surface receptor signaling, immune response−activating signal transduction, clathrin−coated vesicle membrane, immune receptor activity， peptide binding and amide binding pathways. Their low expression was also verified on Oncomine database.Conclusion: cd3e, cd3g, hla-dpa1, hla-dpb1, lck, and map4k1 participated in many aspects related to TME, and their low expression constructs a signature, may predict a poor 5 years’ survival in hepatocellular carcinoma.
Identification of Coronary Risk Factors Among Urban and Rural Malaysian Youths and Their Possible Underlying Causes
Authors: Nor Noor Shafina Mohd , Chua Yung-An , Razak Suraya Abdul , Ismail Zaliha , Nawawi Hapizah Mohd
Published: May 2021

Background: Coronary artery disease (CAD) is one of the major causes of morbidity and mortality worldwide. Early identification of the coronary risk factors (CRF) among youths assists in determining the high-risk group to develop CAD in later life. In view of the modernised lifestyle, both urban and rural residing youths are thought to be equally exposed to various CRF. This study aimed to describe the common CRF including obesity, dyslipidaemia, hypertension, smoking and family history of premature CAD in Malaysian youths residing in urban and rural areas. Methods: We recruited 942 Malaysian subjects aged 15–24 years old [(males=257, and urban=555 vs rural=387, (mean age + SD = 20.5 + 2.1 years)] from the community health screening programmes organised in both rural and urban regions throughout Malaysia. Medical history and standardised anthropometric measurements were recorded. Laboratory investigations were obtained for fasting serum lipid profiles and plasma glucose levels. Results: Youths in the rural were more overweight and obese (49.4% vs 42.7%, p<0.044) and have higher family history of hyperlipidaemia (16.3% vs 11.3%, p<0.036) than youths in the urban areas. Low-density lipoprotein (LDL-c) (2.8 vs 2.7 mmol/L) and total cholesterol (TC) (4.7 vs 4.5 mmol/L) were significantly higher in urban compared to rural youths (p<0.019 and p<0.012). Overall, more youth in this study has CRF rather than not (Has CRF = 67.0% vs No CRF = 33.0%). Significantly more rural youths have at least one CRF compared to urban youths (rural = 71.6% vs urban = 63.8%, p=0.012). Conclusion: In conclusion, rural youths have significantly higher BMI with higher family history of hyperlipidaemia compared to urban youths. However, urban youths have higher LDL-c and TC levels. Other coronary risk factors are not significantly different between urban and rural youths. CRF were significantly more prevalent among rural compared to urban youths.
The Thresholds of Greening Unit Serving Set as an Arousal Task Based on EEG and Eye Movement
Authors: ZHANG Yu-Le , Zhu Shoulin
Published: May 2021

Monotony is the most prominent characteristic feature of the prairie highway. Monotony can cause a decrease in the level of arousal, leading to lower vigilant. This study sets the greening unit as an arousal task to withstand the monotony and examines the different landscapes’ effects on EEG(electroencephalo-graph) and eye movement for drivers. 26 participants took part in a simulated driving experiment. Three scenes correspond to other greening units, respectively, one set as the control group without greening. The results show that the greening unit will improve driver vigilance and external eye movement control preponderance. The type of eye movement and [(alpha + theta) / beta] performance optimal arousal is immediate but discontinuous; The type of eye movement and alpha sample entropy show different spatial patterns of landscapes have different effective lengths. In conclusion,(1) Landscape（Fully open with triangular shape） provides superior arousal effect；(2)The greening unit length threshold corresponding to the optimal arousal level of drivers is 666 m; (3)The alpha sample entropy of less than 0.234 can be identified as the threshold of effect greening length
Recursive Bit Assignment With Neural Reference Adaptive Step (RNA) MPPT Algorithm for Photoviolatic System
Authors: Hegazy Eman , Shokair Mona , saad waleed
Published: May 2021

BackgroundNowadays, most of the recent research is directed towards photovoltaic harvesting systems due to their great characteristics. To increase the efficiency of a photoviolatic harvesting system, Maximum Power Point Tracking algorithms are utilized to achieve the maximum output power of the PV. This is done by optimizing the duty ratio of the DC-DC boost converter. ResultsIn this paper, a proposed RNA algorithm is introduced as an efficient MPPT algorithm for the PV system. This proposed RNA algorithm depends on two main parts. The First part is an artificial neural network to produce a reference power. The Second one is a proposed Recursive Bit Assignment network to present the variable step size of the duty ratio of the DC-DC boost converter. The RBA network consists of N-bit memory. The instantaneous PV power value sets the contents of the memory to generate the variable step size of the duty ratio. Moreover, the design of the neural network to give its best performance is explained. ConclusionsThe performance of the chosen PV module is simulated for a variable solar radiation and a constant temperature. Simulation studies are performed using MATLAB to evaluate the system performance. From simulation results, the proposed RNA can achieve a fast tracking time, a high power efficiency, an actual maximum power point and an acceptable ripple. Additionally, comparisons between the RNA algorithm and other related algorithms such as Perturbe and Observe, Neural Network, and Adaptive Neural Interference System algorithms are executed. The proposed RNA achieves the best performance in all terms.
Robust Intelligent Fault-Tolerant Based Finite-Time Attitude Control for Quadrotor UAV Without Angular Velocity Measurements
Authors: Liu Kang , Wang Rujing
Published: May 2021

This study considers the problem of finitetime attitude control for quadrotor unmanned aerial vehicles (UAVs) subject to parametric uncertainties, external disturbances, input saturation, and actuator faults. Under the strong approximation of radial basis function neural networks (RBFNN), an adaptive finitetime NN observer is first presented to obtain the accurate information of unavailable angular velocity. More importantly, an adaptive mechanism to adjust the output gain of the fuzzy logic system (FLS) is developed to avoid the selection of larger control gains, and can even work well without the prior information on the bound of the lumped disturbance. Based on the nonsingular fast terminal sliding mode manifold, a novel switching control law is designed by incorporating the adaptive FLS and fast continuous controller in order to remove the undesired chattering phenomenon and solve the negative effects induced from the parametric uncertainty, external disturbance, and actuator fault. To deal with the input saturation, an auxiliary system is constructed. The rigorous theoretical analysis is given to prove that all the signals in the closed-loop system are uniformly bounded, and tracking errors converge into bounded neighborhoods near the origin in finite time. Moreover, the issue of selecting control parameters is analyzed in detail. Last but not least, the comparative simulation results show the validity and feasibility of the proposed control framework.
Sensitivity Enhancement of Ag-Ni Functional Bimetallic SPR Sensor Using Black Phosphorus in the Visible Region
Authors: kumar prem , Kumar Rajeev , Harsh O. K. , Singh Vikram
Published: May 2021

In this seminal, a highly sensitive bimetallic layer for surface plasmon resonance (SPR) sensor applications is proposed with the BK7 prism, silver–nickel (Ag–Ni) bimetallic films, and hybrid structure of black phosphorus layer under angular interrogation technique. Sensitivity, minimum reflectivity (Rmin), DA, and FoM are the criterion for the sensing applications. By tuning these parameters, the maximum sensitivity of 347°/RIU is obtained with two-dimensional (2D) black phosphorus and the optimized thickness of the Silver layer at 633nm wavelength. 2D black phosphorus (BP) has attracted immense interest from the research community because of its unique properties like high charge density, direct bandgap, and better binding to the various molecules. The noble bimetallic layer-based SPR sensors have improved the sensor performance due to their exciting properties of large optical field enhancements follow on to the strong scattering and absorption of light. Herein, the Black Phosphorus-based SPR sensor is optimized with the thickness variation of the Silver layer due to ease of synthesis, a high degree of surface functionalization, and tunable Physico-chemical properties to the various sensing-medium refractive indices ranging from 1.330 to 1.335. Although there are many analogous sensors reported, limited attention has been paid to propose one, which exhibits the higher sensitivity, better DA, and superior FoM. The increased sensitivity of bimetallic layer and 2D, Black Phosphorus-based sensor providing promising applications in biosensing.
Catalyst-Free Crosslinking Modification of Nata-De-Coco-Based Bacterial Cellulose Nanofibers Using Citric Acid
Authors: Salihu Rabiu , Razak Saiful Izwan Abd , Zawawi Nurliyana Ahmad , Shahir Shafinaz , Sani Mohd Helmi , Wsoo Mohammed Ahmad , Nayan Nadirul Hasraf Mat
Published: May 2021

Bacterial cellulose (BC) has gained research attention in materials science and biomedicine due to its fascinating properties. BCs' fiber collapse phenomenon (inability to reabsorb water after dehydration) is one of the drawbacks that limit its potentials. To overcome this, a catalyst-free thermal crosslinking reaction was employed to modify the BC using citric acid (CA) without compromising the biocompatibility. Properties evaluation of the modified BC (MBC) by FTIR, XRD, SEM/EDX, TGA, and Tensile analysis confirmed the fiber crosslinking and improvement of some properties that could be advantageous for various applications. The modified nanofiber seems to maintain its inherent crystallinity and thermal stability with an increased water absorption/swelling and tensile modulus. The resulting MBC reported here can be relevant for wound dressings and tissue scaffolding.
Analytical Performances of the Point-of-Care BIOSYNEX COVID-19 Ag BSS for the Detection of SARS‐CoV‐2 Nucleocapsid Protein in Nasopharyngeal Swabs: A Prospective Field Evaluation During the COVID-19 Third Wave in France
Authors: Fitoussi Fréderic , Tonen-Wolyec Serge , Awaida Natalio , Dupont Raphael , Belec Laurent
Published: May 2021

Background: Evaluating the accuracy and reliability of rapid diagnostic testing kits is crucial for surveillance and diagnosis of SARS-CoV-2 infections in general population. The aim of the study was to assess the analytical performances of the antigen-rapid diagnosis test (Ag-RDT) BIOSYNEX COVID-19 Ag BSS (Biosynex Swiss SA, Freiburg, Switzerland), targeting the SARS-CoV-2 N nucleocapsid protein, for the diagnosis of COVID-19, by reference to real-time RT-PCR (rtRT-PCR).Methods: A total 967 adults living in Paris region were prospectively included during the third wave of the COVID-19 epidemic in France. Paired nasopharyngeal flocked swabs were collected at the same timepoint from persons aged ≥18 years receiving testing for SARS-CoV-2, at two private laboratories.Results: Overall, the Ag-RDT showed high sensitivity, specificity, PPV and NPV of 81.8%, 99.6%, 96.6% and 97.5%, respectively, as well as high or almost perfect agreement (97.0%), reliability assessed by Cohen’s κ coefficient (0.87), and accuracy assessed by Youden’s J index (81.6%) to detect SARS-CoV-2. The analytical performances of the Ag-RDT remained high in the event of significant viral excretion (i.e., N gene Ct values ≤ 33 by reference rtRT-PCR), while the sensitivity of the Ag-RDT dropped to 55.2% with low or very low viral shedding (Ct> 33).Conclusions: The Ag-RDT BIOSYNEX COVID-19 Ag BSS showed high specificity and sufficient sensitivity for the detection of SARS-CoV-2. This test is a promising potential easy diagnostic tool, especially in situations of symptomatic COVID-19 and/or proven contagiousness.
Nutritional Status and Dietary Pattern of the Elderly in Tshiulungoma and Maniini Village of Thulamela Municipality, Vhembe District.
Authors: motadi selekane , Khorommbi Tshifhiwa , Maluleke Lungile
Published: May 2021

Introduction: Dietary patterns provide a comprehensive information about the food consumption habits within a population. Dietary patterns of every individual changes as we grow older. Dietary pattern of elderly is essential to the evaluation of their nutritional status. This study aimed to describe the nutritional status and dietary pattern of the elderly. Methods: This was a cross sectional study involving elderly people aged 60 years and above. Socio demographic information was obtained from elderly people through a questionnaire. Dietary information was assessed using a questionnaire and dietary diversity score. Data on dietary intake were collected using Food Frequency Questionnaire (FFQ). Height and weight were measured. BMI were determined and classified using BMI category. Results: A total of 300 elderly people had participated in the study, 150 from Maniini village and 150 from Tshiulungoma village. The prevalence of underweight, overweight and obesity was 2%, 34% and 17% respectively. Most (66%) of the participants ate three meals per day. It was found that 13.7% of the elderly skipped breakfast every day. About 19.6% of elderly ate supper sometimes while 13.7% did not eat supper.Conclusion: The findings of study reveals that most of the participants ate three main meals a day, with minority skipping either breakfast or dinner or eat in- between meals. Obesity was more prevalent in female as compared to the male counterparts. Improving nutritional status of elderly should follow an integrated approach tackling both malnutrition at the same time considering behavioural approach.
Delirium in Covid-19 patients: Incidence, Risk Factors and Early Outcomes.
Authors: Mejia-Mantilla Jorge Humberto , Gempeler Andrés , Gaviria Leidy K , Amaya Pablo , Aldana Jose Luis , Muñoz Beatriz Elena , Pinilla Gabriel , Rivillas Julian , Scarpetta Diego , Perdomo Cristhian Camilo Rojas , Echeverri Nicolás Orozco , Sotomayor Alex , Yara Julián , Jimenez Javier A , Arango Akemi , Orozco Jorge Luis
Published: May 2021

Background: Delirium is a frequent event in severely ill patients; its incidence and prevalence varies depending on several factors; Covid has been associated to high incidence of delirium leading to speculation of specific mechanisms of neurotoxicity by the SARS-CoV-2. We present the analysis of risk factors for delirium incidence and the impact of delirium in the functional outcomes.Methods: We included patients admitted to a referral center in Cali, Colombia between April and August 2020. Patients were evaluated for demographics, severity of disease, comorbidities, clinical outcomes, delirium and survival at discharge. We evaluated the association of patient characteristics and disease factors with delirium incidence by multivariate analysis (Hosmer and Lemeshow) and the associations of delirium with functional outcome at dischargeResults: Among 333 patients, 58 (17.42%. 95% CI: 13.62%–21.77%) presented delirium 16 (IQR: 11 –20) days after symptom onset. Patients with delirium were older, reported muscular weakness more often, had a higher NEWS2 score at admission, and had more comorbidities (mainly Diabetes Mellitus II). Multivariate analysis of hospitalization events and treatments found mechanical ventilation as the only significant covariate. The association between need for mechanical ventilation and delirium development was estimated at OR=11.72, (95%CI=4.16–34.23). Patients who developed delirium had a higher frequency of functional impairment: mRs>2 (70.7% vs 24.7%, p<0.001) and had a prolonged ICU stay (median 13 days, IQR 8–21 vs median 5, IQR 3–10 days, p<0.0001) compared to patients without delirium.Conclusion: Our data show that premorbid functional status, the severity of respiratory disfunction and the presence of inflammatory markers are determinant in the risk of delirium; we believe that delirium is not specially related to SARS-CoV-2 infections, but rather its high frequency during this pandemic is the result of concurring factors shared between critically-ill patients and severe COVID-19 patients.
Combined Application of Chromosome Karyotype and Microarray Analysis in Fetus With Increased Nuchal Translucency
Authors: Chaohong Wang , Junxiang Tang , Yuxiu Sun , Yu Pang , Keting Tong , Jiansheng Zhu
Published: May 2021

Objective：To examine the risk of chromosomal abnormalities when the thickness of the nuchal translucency( NT ) is 2.5-2.9mm, to evaluate the cutoff value of NT for prenatal diagnosis, to explore the value of combined application of chromosome karyotype and microarray analysis, and to explore the relationship between NT ≥ 5.0mm and fetal prognosis. Methods：A total of 366 pregnant women who underwent prenatal diagnosis in Anhui Province Maternity and Child Health Hospital from January 2018 to August 2020 were collected, of which 241 cases had NT ≥ 2.5mm, 125 cases were elderly (35-38 years old) with NT < 2.5mm. We made grouping statistics on chromosome abnormalities,and compared the detection of chromosome abnormalities by karyotype and microarray analysis. At the same time, we followed up the fetuses with NT ≥ 5.0mm and analyzed their prognosis. Results: (1)Among the 366 cases with NT thickening,the detection rates of chromosome abnormalities by karyotype analysis and microarray analysis(CMA) were 13.39% (49/366) and 13.93% (51/366), respectively, and there was no significant difference (P>0.05), including 25 cases of trisomy 21, 5 cases of trisomy 18, 5 cases of Turner synthesis and 16 cases of other chromosome abnormalities. (2)We compared the effect of different NT value on the detection rate of pathogenic chromosomes, and found that the difference between NT ≥2.5mm and NT < 2.5mm was statistically significant(P<0.05). The detection rates of pathogenic chromosomal abnormalities in NT < 2.5mm group,2.5-2.9mm group, 3.0-3.4mm group,3.5-4.4mm group,4.5-5.4mm group and NT ≥ 5.5mm group were 0.8%(1/ 125), 11.63%(10/ 86), 17.81%(13/ 73), 20%(10/ 49), 47.62%(10/ 21) and 63.64%(7/ 11) respectively. (3)Our study found that different prenatal diagnostic indicators for abnormal chromosome detection rate difference was statistically significant(P<0.05). The detection rates of NT thickening alone and NT thickening combined with other abnormalities were 13.17%(22/ 167) and 35.14%(26/ 74) respectively(P<0.05). (4)Among 18 pregnant women with NT ≥ 5.0 mm, 9 fetuses were chromosomal abnormalities, and 9 fetuses survived healthily. Conclusions：When the NT value is 2.5-2.9mm, the incidence of fetal chromosome abnormality is significantly higher than that in the normal group. It is suggested that invasive prenatal diagnosis should be performed for pregnant women with NT ≥ 2.5mm. Chromosome karyotype analysis and CMA can complement each other, which is conducive to prenatal genetic counseling. The fetuses with NT thickening usually have good pregnancy outcomes when excluding fetal chromosome and prenatal ultrasound does not indicate any abnormalities.
Impact of COVID-19 Pandemic on Open Fractures: a Retrospective Multi-centre Cohort Study in the Different Risk Periods of China
Authors: Chen Jialei , Luo Rong , Zhong Gang , Liu Ming
Published: May 2021

BackgroundThe COVID-19 pandemic has had a significant impact on orthopaedic trauma worldwide, but the extent of this impact regarding the low-risk period is still unclear. This study aims to evaluate the epidemiology of open limbs fractures during the different risk periods and the effect of routine prevention and control measures.MethodsA retrospective multi-centre cohort study was conducted in three different level trauma centres. Three 60-day periods were analyzed: the high-risk period - 2020/1/24-2020/3/24, the low-risk period - 2021/1/24-2021/3/25, and the no-risk period as a control group for comparison - 2019/1/24-2019/3/25. Demographic data, medical history, and surgery and antibiotic therapy data at presentation were collected and evaluated.ResultsA total of 123 patients met the inclusion criteria. We observed a significant "J" shaped change in the total number of patients, with fewer patients in 2020 (n=34, -17%) and more in 2021 (n=48, +17%) compared to 2019 (n=41). However, fewer patients visited the level I centre in the low-risk period (82.9% 2019 vs. 70.6% 2020 vs. 56.3% 2021, P=0.024). Meanwhile, longer antibiotics therapy period (＞48 hours) were more prevalent in low-risk period (39% 2019 vs. 58.8% 2020 vs. 68.8% 2021, P=0.018). Regarding definitive closure type, increase in direct closure was observed in high-risk period (51% 2019 vs. 78.9% 2020 vs. 63.5% 2021, P=0.024). ConclusionDuring the high-risk period, the total number of patients was expected to decline, whereas in the low-risk period, the number may increase. They preferred the lower level II and III centre for patients during the pandemic rather than the higher level I centre. For surgeons, they were prone to direct closure and a more extended antibiotic therapy period. Routine prevention and control measures seem not adversely affect the treatment outcomes and process of open fractures.Trial registrationChiCTR, ChiCTR 2100046151. Registered 5 May 2021, http://www.chictr.org.cn/edit.aspx?pid=123490&htm=4.
Secondary bacterial infections trigger New Onset Atrial Fibrillation in ICU Covid-19 ARDS patients
Authors: Zakynthinos George E , Tsolaki Vasiliki , Karavidas Nikitas , Vazgiourakis Vassileios , Dimeas George , Mantzarlis Konstantinos , Vavougios George , Makris Demosthenes
Published: May 2021

Background

Cardiac arrhythmias, mainly atrial fibrillation (AF), is frequently reported in COVID-19 patients, yet causality has not been explored. Intensive Care Unit patients frequently present AF during critical illness. Sepsis is one of the main contributors of AF occurrence in ICU patients. The aim of the study was to explore if Covid-19 myocardial involvement is the only contributor for New Onset Atrial Fibrillation (NOAF) in intubated ICU patients.
Methods

Consecutive intubated, Covid-19ARDS patients, were prospectively studied for factors triggering NOAF. Demographics, data on Covid-19 infection duration, severity of illness and ARDS are reported. Echocardiographic findings, troponin levels and secondary infection (sepsis/septic shock) data were collected on the day of AF and compared to the preceding days’ and/or ICU admission data. Comparison was also performed between NOAF and control group (no AF) on admission.
Results

Among 105 patients screened, 79 were eligible; nineteen presented NOAF (24%). Baseline characteristics did not differ between the NOAF and control groups. Troponin levels were mildly elevated upon ICU admission in both groups. NOAF occurred on the 18 ± 4.8 days from Covid-19 symptoms’ onset, and the 8.5 ± 2.1 ICU day. Seventeen patients in the NOAF group (89.5%) presented a septic secondary infection vs 25 (41.6%) in the control group (p < 0.001). In sixteen NOAF patients (84.2%), AF occurred concurrently with a secondary septic episode. Noradrenaline, lactate levels and inflammation biomarkers presented a gradual increase in the days preceding the AF day (all p < 0.05). Troponin increased compared to admission (p = 0.017). AF did not resolve or re-occurred if sepsis persisted. Upon ICU admission left ventricular ejection fraction was rather normal, yet, global longitudinal strain was equally impaired (< 16.5%) in 63% vs 78% in the NOAF and control groups, respectively. The right ventricle was mildly dilated, and 36 (45.6%) patients had pericardial effusion. Echocardiographic findings did not change on NOAF occurrence.
Conclusion

Secondary infections seem to be major contributors for NOAF in Covid-19 patients, probably playing the role of the “second hit” in an affected myocardium from Covid-19.
Risk Stratification and Individualized Chemotherapy for Elderly Patients with Locoregionally Advanced Nasopharyngeal Carcinoma
Authors: Kou Jia , Zhang Lu-Lu , Wen Dan-Wan , Zhou Guan-Qun , Wu Chen-Fei , Xu Si-Si , Yang Xing-Li , Zheng Wei-Hong , Qi Zhen-Yu , Sun Ying , Lin Li
Published: May 2021

Backgroud: The optimal treatment strategy for elderly patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) remains unclear. We aimed to develop individualized treatment strategies for such patients according to their pretreatment risk stratification and the degree of comorbidities.Methods: A total of 583 elderly LA-NPC patients diagnosed between January 2011 and January 2018 were retrospectively studied. Based on prognostic factors confirmed by multivariate analysis, we constructed a nomogram for disease-free survival (DFS). The entire cohort was then divided into two groups according to the nomogram cutoff value determined by X-tile analysis. The degree of comorbidities was assessed by Charlson Comorbidity Index (CCI). We performed subgroup analysis based on the degree of complications in the low- and high-risk groups to compare the survival outcomes of different treatment regimens using the Kaplan-Meier method and the log-rank test.Results: A nomogram for DFS was constructed with T/N classification, Epstein-Barr virus DNA and albumin. The high-risk group had significantly poorer survival compared with the low-risk group. The 3-year DFS and overall survival (OS) of the low-risk group and the high-risk group were 76.7% vs. 44.6%, 81.5% vs. 51.0% (both P <0.001) respectively. Only high-risk patients with fewer comorbidities (CCI =2) would benefit from induction chemotherapy combined with concurrent chemoradiotherapy, while patients in the low-risk group or the high-risk group with more comorbidities (CCI >2) would not have.Conclusion: We constructed a prognostic nomogram for DFS and generated two risk groups. Combining risk stratification and degree of comorbidities can better guide individualized treatment for elderly LA-NPC patients.
Intraspinal Space-Occupying Lesions in Children: Clinical Features, Neuroimaging and Surgical Outcomes of 27 Cases
Authors: Chang Haigang , Yan Jingkuo , Wang Yaxiao , Hui Lei , Li Yan , Ma Pengju , Jin Zhe , Wang Feng
Published: May 2021

Background: Pediatric intraspinal space-occupying lesions are relatively uncommon. However, these lesions can result in neurological disabilities due to misdiagnosis and delayed treatment. The main goal of the present study is to evaluate the clinical and radiological features and treatment options of pediatric intraspinal space-occupying lesions in order to improve the clinical recognition and management. Methods: Clinical data of 27 children with intraspinal space-occupying lesions who underwent surgery treatment in a tertiary-care hospital between 2010 and 2018 were retrospectively reviewed and analyzed. Results: Of these 27 patients, 14 (51.85%) were girls and 13 (48.15%) were boys. The most common age group affected was 10~14 years (62.96%, 9 girls and 8 boys in this age group). The mean age was 10.11 years old. Pain and weakness were the most common clinical symptoms. Preoperative magnetic resonance imaging (MRI) identified intramedullary (10 cases, 37.04%), intradural extramedullary (10 cases, 37.04%) and extradural (7 cases, 25.92%) lesions, respectively. The majority of the lesions were intraspinal tumors (23 cases, 85.19%). The histological diagnosis of tumors included embryonic residual tumors (6 cases, 22.22%), ependymoma (5 cases, 18.52%), primitive neuroectodermal tumors (PNET) (3 cases, 11.11%), schwannomas (2 cases, 7.4%), ganglioneuroma (1 case, 3.7%), Ewing’s sarc (1 case, 3.7%), B-cell non Hodgkin lymphoma (1 case, 3.7%), Hodgkin lymphoma (1 case, 3.7%), chondrosarcoma (1 case, 3.7%), ganglioglioma (1 case, 3.7%), and glioma (1 case, 3.7%). Conclusions: The incidence of pediatric intraspinal space-occupying lesions is low, and the clinical manifestation is lack of specificity. The prognosis for children with malignant tumors is poor and surgical resection is still the primary treatment option.
Galectin-3 as Prognostic Predictor in Patients with COVID-19 Acute Respiratory Failure
Authors: Portacci Andrea , Diaferia Fabrizio , Santomasi Carla , Dragonieri Silvano , Boniello Esterina , Serio Francesca Di , Carpagnano Giovanna Elisiana
Published: May 2021

Background. Galectin-3 is β-galactoside-binding lectin with several roles in immune-inflammatory response. To date, there is no evidence of Galectin-3 role as a prognostic predictor in COVID-19 disease. The aim of this study is to clarify the prognostic role of Galectin-3 in patients with COVID 19 acute respiratory failure.Methods. We enrolled 156 consecutive patients with COVID-19 disease. Routine laboratory test, arterial blood gas, chest X-ray or Computed Tomography and Galectin-3 dosage were performed. The primary outcome was to assess Galectin-3 predictive power for 30-day mortality. Secondary outcomes were 30-day Intensive Care Unit admission and Acute Respiratory Distress Syndrome stratification according to Galectin-3 dosage. We performed Mann-Whitney U and Kruskal-Wallis tests for continuous variables comparison. Fisher’s exact test or Chi-square test were used for categorical variables analysis. Relationships between Galectin-3, clinical and laboratory data were identified using Spearman analysis. Receiver Operating Characteristic curves estimated Galectin-3 predictive power for the endpoints. With a fixed cut-off of 35.3 ng/ml, Kaplan-Meier with Log-Rank test and Cox Regression were performed to assess mortality and Intensive Care Unit admission risk. Results. Galectin-3 correlated with many other prognostic predictors tested in our analysis. Moreover, patients with serum levels of Galectin-3 above 35.3 ng/ml had increased risk for mortality, Intensive Care Unit admission and severe Acute Respiratory Distress Syndrome. Conclusions. Our study demonstrates the role of Galectin-3 as a predictor of mortality, Intensive Care Unit access and ARDS stratification in patients with COVID 19 acute respiratory failure.
Renal Replacement Therapy and Concurrent Fluconazole Therapy Increase Linezolid-Related Thrombocytopenia Among Adult Patients
Authors: Hsu Yueh-chun , Chen Szu-ying , Hung Yung-jun , Huang Yu-wei
Published: May 2021

Background: Linezolid, an antibiotic used against gram-positive pathogens, has been reported to be associated with thrombocytopenia. However, limited information is available on susceptibility to thrombocytopenia after linezolid usage. We aimed to investigate the risk factors for linezolid-associated thrombocytopenia. Methods: We conducted a retrospective cohort study of patients aged ≥ 18 years who received linezolid for ≥ 5 d during hospitalization in 2019. Demographic information, hospitalized information and laboratory data were extracted from electronic medical records. Thrombocytopenia was defined as a platelet count of <100,000 cells/mm3 or a reduction from baseline ≥ 25%. Binary logistic regression and survival analyses were used to evaluate the risk factors for linezolid-associated thrombocytopenia.Results: A total of 98 patients were enrolled. Thrombocytopenia occurred in 52 patients (53.1%), with a median first presentation 9 d after initiation of linezolid. There was no significant difference in the mortality or proportion of platelet transfusions between patients with and without thrombocytopenia. A higher risk of linezolid-associated thrombocytopenia was found in patients who received renal replacement therapy (RRT) (OR 4.8 [1.4-16.4]), concurrent fluconazole (OR 3.5 [1.2-9.8]), or a longer duration of linezolid treatment (OR 1.1 [1.0-1.1]). Patients who received RRT or concurrent fluconazole therapy had a shorter median time to develop thrombocytopenia (with vs. without RRT: 8 vs. 15 d; with vs. without fluconazole: 11 vs. 15 d). Those who simultaneously received RRT and fluconazole had the shortest median of time (6.5 d) and the highest risk of developing thrombocytopenia (87.5%).Conclusions: Patients who received RRT, concurrent fluconazole treatment, or a longer-duration linezolid had a higher risk of developing linezolid-associated thrombocytopenia.
Transcriptome Analysis Reveals Drought Stress response Mediated by Biological Processes and Key Pathways in Gossypium darwinii
Authors: Xu Cuilian , Magwanga Richard , Khan M Kashif Riaz , Zhou Zhongli , Cai Xiaoyan , Li Yujun , Agong Stephene Gaya , Wang Kunbo , Liu Fang , Chen Haodong
Published: May 2021

Background: The allotetraploid wild cotton species, Gossypium darwinii, possess important traits of stress tolerance and good genetic stability that can be used for cotton improvement. In this study, we analyzed the RNA-seq transcriptomes from leaves of G. darwinii seedlings with and without drought stress. Results: A total of 86.7 million valid reads with an average length of 95.79 bp were generated from the two samples and 58,960 transcripts with a length of more than 500 bp were assembled. We searched the known proteins on the strength of sequence similarity; these transcripts were annotated with COG, KEGG, and GO functional categories. According to gene expression abundance RPKM value, we carried out RT-qPCR analysis to determine the expression pattern of the obtained transcription factors. A total of 58,961 genes was differentially expressed (DEG), with 32,693 and 25,919 genes found to be upregulated and downregulated, respectively. Through gene ontology and KEGG pathways, the upregulated genes were found to associate with all the GO terms, molecular functions (MF), biological process (BP) and cellular components (CC), which are highly linked to enhancing drought stress tolerance. The results obtained provide valuable information and a large number of transcripts, which can be exploited by cotton breeders in developing a more drought stress tolerant cotton germplasm.
Solitary Bone Metastasis and Oligometastatic Bone Disease in Breast Cancer: Are They Two Different Entities?
Authors: Zengel Baha , Kilic Mustafa , Tasli Funda , Simsek Cenk , Karatas Murat , Ozdemir Ozlem , Cavdar Demet , Durusoy Raika , Bas Kadir Koray , Uslu Adam
Published: May 2021

In this study, we planned to investigate the clinical course of breast cancer patients with oligometastatic bone disease (OMBD).The patients were grouped according to the characteristics and the sites of metastases. Group I included 928 patients without metastasis. Group II, OMBD group, icluded 68 patients. Group III, widespread metastasis group, consisted of 185 patients with multiple bone metastases and/or solid organ metastases.The mean overall survival of the groups were 16.7 ± 0.3 years in Group 1, and 7.8 ± 0.8 and 5.9 ± 0.4 years in Group 2 and 3, respectively (p<0,001 for the comparison of all three groups together; p <0.001 for Group 1 vs 2 & 3) and (p=0.037 for Group 2 vs. Group 3). In the subgroup survival analysis of patients in Group 2 (OMBD), the mean and median survival were 5.5 ± 0.8 and 4.0±0.8 years versus 9.2 ± 0.98 and 9.0 ±1.05 years in more than one bone metastasis and SBM patients, respectively (p = 0.019).As a result; OMBD seems to be a different disease than breast cancer with isolated bone metastases. The high risk of developing OMBD especially following locoregional recurrences increases the importance of locoregional therapy in large T and N stage tumors.
Arterial thrombosis, the unfairly forgotten actor in COVID-19: a case series
Authors: CILLÁN SERGIO RAMOS , BLANCO LAURA SOLÁN , MALLEBRERA MARTA TOMÁS , DÍAZ ANA B. ARRIBAS , NAVASCUES JAVIER CORNAGO , LORENZO JOSE LUIS LÓPEZ , SILLERO MARIA PILAR LLAMAS
Published: May 2021

Background. - It is known that patients with COVID-19 are at increased risk of thrombosis. Although COVID-19 infection primarily affects the lower respiratory tract system, emerging reports suggest direct and indirect cardiovascular complications. However, the key mechanisms under thrombosis development at great arterial vessels are still unclear.Case presentation. – We report the cases of 4 patients who were admitted to our hospital and suffered from arterial thrombotic complications. All of them were older than 60 years and only 1 did not have cardiovascular risk factors. It should be noted that days prior to the diagnosis of arterial thrombosis, 3 of the 4 patients were under anticoagulant treatment. It is also interesting that in contrast to already known typical microvascular locations, our patients suffered from large arterial vessels thrombosis. Furthermore, none of them would present with severe respiratory symptoms. Conclusions. – The underlying mechanism of COVID-19-associated arterial thrombosis remains unclear and might be independent of the cytokine storm that occurs in patients with COVID-19-associated venous thrombosis. Also, the role of anti-platelets agents as prophylactic treatment in high-risk patients remains unclear. Multicenter clinical trials are necessary to clarify these issues.
Ceftolozane/Tazobactam Versus Colistin in the Treatment of Ventilator-Associated Pneumonia Due to Extensively Drug-Resistant Pseudomonas Aeruginosa: A Comparative Cohort Study.
Authors: Mogyoródi Bence , Csékó András B , Hermann Csaba , Gál János , Iványi Zsolt D
Published: May 2021

Background: Pseudomonas aeruginosa is a common pathogen in the intensive care unit (ICU). Resistant strains are frequently isolated, leaving colistimethate sodium (CMS), the drug with known toxicity and questionable pharmacokinetics, as the last-line conventional therapeutic option.The new cephalosporin and β-lactamase inhibitor combinations like ceftolozane/tazobactam (C/T) expanded the available antibiotics for Gram-negative infections. We aimed to compare C/T with CMS in the treatment of ventilator-associated pneumonia (VAP) due to extensively drug-resistant (XDR) Pseudomonas aeruginosa. Methods: A retrospective, observational study was performed at a tertiary care ICU. Patients with VAP due to XDR Pseudomonas aeruginosa were enrolled. Clinical and microbiological success rate, 28-day all-cause mortality, and adverse events were compared in patients who received C/T with those treated with systemic CMS. Multivariate logistic regression was performed to identify predictors of clinical success. Results: A total of 51 patients were included in the study (18 in the C/T and 33 in the CMS group). The represented population was acutely and chronically severely ill with a median Acute Physiology and Chronic Health Evaluation II score of 26 (interquartile range [IQR] 20-31) and a median Charlson Comorbidity Index of 4 (IQR 3-6) without statistical significant intergroup difference. Clinical success rates in the C/T and CMS groups were 13 (72.2 %) and 10 (30.3 %), respectively. On multivariate regression analysis, treatment with ceftolozane/tazobactam was independently associated with clinical success (odds ratio 4.47, 95% CI = 1.17-17.08). There was no difference in 28-day all-cause mortality (27.8 % and 33.3 % in the C/T and CMS group, p = 0.76). Acute kidney injury was more common in patients who received CMS (48.5 % vs 11.1 %, p = 0.01). There was a tendency for lower incidence of Clostridioides difficile colitis in the C/T compared to the CMS group (0 vs 9.1%). Conclusions: Ceftolozane/tazobactam proved to be efficient in the treatment of XDR Pseudomonas aeruginosa VAP and showed a better safety profile compared to CMS. Trial registration: Retrospectively registered with ClinicalTrials.gov (identifier NCT04352855).
Primary Thyroid Lymphoma: A Clinicopathologic Study of 9 Cases and Review of the Literature
Authors: Wang Wei-wei , Pan Li-jing , Liao Shan-wei , Zhou Xiao-cong
Published: May 2021

Background: Primary thyroid lymphoma（PTL）is extremely rare, thus the dilemma of diagnosis and treatment persists and prognosis remain incompletely understood. Materials and methods: The clinicopathological characteristics, treatment outcomes and prognoses of 9 consecutive primary thyroid lymphoma patients were analyzed retrospectively. Data such as age, gender, presence of Hashimoto’s thyroiditis (HT), treatment protocol, pathologic results and survival status were evaluated. Stage was determined according to the Ann Arbor staging system.Results: They were mostly females with female to male ratio of 1.25：1. The 9 patients ranged in age from 15 to 77 years, with a median age of 63 year. Most of them（7/9）were older than 40 year. A previous history of Hashimoto’s thyroiditis (HT) was observed in 4 patients. All of the nine patients were non-Hodgkin lymphoma（NHL）, eight patients were B cell NHL and one patient was T cell NHL. All patients were treated with surgical excision and most patients received 5-7 circle of CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) based chemotherapy post-operation only. Conclusions: The majority of them had good prognosis. Except two lost cases, 85%（6/7）of patients had a survival period of more than 5 years.