bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of Farmers’ Facial Expression on Consumers’ Responses in Print Advertising of Local Food: The Moderating Role of Emotional Intelligence
Authors: Seo Yumi , Kang Yeong Seon
Published: September 2020

In the context of ethical consumption, we examine the effects of farmers’ facial expression in print advertising on consumers’ responses to local food. Furthermore, we try to verify the moderating role of emotional intelligence (EI) on consumers’ responses to the advertising message strategy. The advertising message strategy that connects farmers and consumers is expected to create more favorable responses among consumers toward local food and its retailers. This study examines consumers’ responses (perceived product quality, trust, and a positive attitude toward the local food retailer) to three conditions of farmers’ facial expression in the advertisement (neutral facial expression, positive facial expression, and product only, with no portrait) across two levels of EI (low and high). We find that farmers’ positive facial expressions in the advertisements have the greatest positive effects on consumers’ perceived product quality, trust, and attitude toward the local food retailer under a high level of EI. Therefore, individuals with a high level of EI were more influenced by facial expressions in print advertising, whereas those with a low level of EI were less influenced by facial expressions in print advertising, and their responses were indifferent to whether the local food farmer had a neutral or a positive facial expression in print advertising. Our findings suggest that marketing practitioners consider personal characteristics such as EI in persuading local food consumers in target markets to implement strategies to promote local food purchase and consumption.
Experimental Study on Adsorption Pore Structure and Gas Migration of Coal Reservoir Using Low‐Field Nuclear Magnetic Resonance
Authors: Li Jiazhuo , Guo Penghui , Xie Wenhao , Chu Jiaqi , Yin Zhiqiang , Yuan Anying , Zhang Ming , Jiao Zhenhua
Published: September 2020

For the quantitative recognition and characterization of the flow characteristics of polymorphism coalbed gas in tectonic coal, experiments on pore morphology, pore diameter distribution, and methane adsorption law in outburst tectonic coal were carried out by field emission scanning electron microscopy and low‐field nuclear magnetic resonance. The results revealed abundant round and dense “pyrolysis pores” in outburst tectonic coals, most of which were adsorption and seepage pores, with micropores accounting for 78.2%. Most pores were independent and formed the network pore space for gas enrichment and migration in outburst tectonic coal. The transverse relaxation time (T2) of methane adsorption in tectonic coal and crushed outburst tectonic coals presented three peaks, namely, adsorption, drifting, and free peaks. The isolation of nanopores and micropores revealed lower adsorption capacity of outburst tectonic coal than that of crushed outburst tectonic coal. The gas staged adsorption of raw coal with outburst tectonic low‐permeability was observed. Under low gas pressure, the T2 spectral peak area of methane adsorption increased remarkably, whereas that of desorbed methane increased slightly. As gas pressure was increased to a certain numerical value, the increment of methane adsorption decreased and tended to reach equilibrium. This finding reflected that methane adsorption tended to be saturated after gas pressure reached a certain value, but desorbed methane in isolated micropores increased quickly. The quantitative recognition and characterization of pore structure and gas adsorption in tectonic low‐permeability outburst coal seams based on low‐field magnetic resonance imaging provide an experimental method for gas exploitation in coal seams and the study and control of coal and gas outburst mechanism.
The Mean First Passage Time of the Stochastic Resonance Driven by Dual-Sequence-Frequency-Hopping Signal and Noise
Authors: Li Zhaorui , Wu Xiaobei , Cui Peizhang , Liu Guangkai
Published: September 2020

The mean first passage time (MFPT) represents the dynamic characteristic of stochastic resonance (SR). The study focuses on how can the Dual-Sequence-Frequency-Hopping (DSFH) signal influence the MFPT and any difficulty in solving the MFPT problem considering the DSFH signal. In this current study, the SR system driven by DSFH signal and Gaussian white noise is described with the parameters of the signal amplitude, the frequency of Intermediate Frequency (IF) of the receptive DSFH signal, the SR system parameter, scale transformation coefficient, the noise intensity, and the sampling multiple, firstly. Secondly, under the assumption that MFPT is small aqueous about the domain of 0, the nonautonomous differential equation with MFPT is transformed to a nonhomogeneous differential equation with one unknown variable coefficient of second order. Finally, the numerical solution of MFPT can be obtained by the method of Runge–Kutta. Theoretical and simulation results are shown as below: (1) the effect of the signal amplitude, the IF frequency, the noise intensity, the SR system parameter, and the scale transformation coefficient, for decrease the MFPT, are positive; however, the effect of the sampling multiple is negative; (2) the MFPT cannot follow the dynamic period of the SR controlled by the IF frequency, when SNR is low; (3) when SNR = −12 dB, the sampling multiple is 200, the IF frequency is 2100, and the duty cycle reaches 25% (available for DSFH signal detection with peek or valley decision Liu et al. (2019)), so we need to decrease the IF frequency or increase the SNR for further availability.
Ethical Aspects concerning Instrument Separation and Perforations during Endodontic Treatment: A Cross-Sectional Study
Authors: Ba-Hattab Raidan , Rahman Ishrat , Elsayed Lubna K. , Alasmari Wejdan F. , Abidia Randa , Abdelgaffar Somayah , Bahattab Awsan
Published: September 2020

Aim. During endodontic treatment, dentists may face various unwanted procedural accidents, at any stage of the treatment that might compromise endodontic treatment outcome and bring obstacles to dentists as well. This study aimed to address and analyze several ethical concerns relating to the behavioural conduct of dentists towards endodontic instrument separation as well as perforation of the crown and/or root during root canal treatment in Riyadh, Saudi Arabia. Method. Hundred and eleven questionnaires were distributed among dentists working in Riyadh in university clinics and government and private sectors. Data were collected, reviewed, and statistically analyzed by Fisher’s exact and chi-square tests at a 5% significance level, using SPSS software. Results. 54.5% of the respondents have encountered instrument separation. 53.2% stated that they would inform the patient about the instrument separation. 43.6% of the respondents had experienced perforation during root canal treatment, and 54.9% reported that they would inform the patient of the accident. Conclusion. Within the limitation of this survey, we concluded that most of the dental professionals did not hesitate to adhere to the correct ethical conduct, and they would inform the patient if an incident occurred.
Underground Communications Using Capacitive Data Transfer Devices
Authors: Zang Shaoge , Hou Keran , Nguang Sing Kiong
Published: September 2020

This paper explores the feasibility of applying the capacitive power transfer (CPT) technology in underground data transmission applications. Based on the electrical properties of soils, the paper extends the existing CPT air coupler model into a more generalized model. The autonomous push-pull inverter is selected to power the CPT system and modified to further the data transmission range. With a designed load shift keying (LSK) circuitry, this self-oscillating inverter regards the data as a sequence of impedance changes, resulting in operation frequency drifts. A Frequency Shift Keying (FSK) demodulator is applied to capture the frequency variations and recover back to data. The proposed design has been simulated, verified, and implemented on a complete prototype. Various testings have been carried out, and the results are satisfactory.
Consolidation Characteristics of Artificially Structured Kaolin‐Bentonite Mixtures with Different Pore Fluids
Authors: Thanh Duong Nguyen , Van Hao Duong
Published: September 2020

The consolidation characteristics of kaolin, bentonite, their mixtures, and natural clays have been widely evaluated. However, the effect of pore fluid on the consolidation characteristics of artificially structured kaolin‐bentonite mixtures should be more investigated. In this study, the oedometer tests were carried out on mixtures of kaolin with 10%, 20%, and 30% bentonite reconstituted with distilled water and 1 M NaCl. The testing samples with an “artificial structure” were prepared using the preconsolidation procedure. The test results show that bentonite greatly affects the consolidation behavior of mixture samples, especially when the pore fluid is distilled water. In the case of distilled water, the addition of bentonite to kaolin clay significantly increased the compression index (Cc), swelling index (Cs), and coefficient of volume change (mv). In this case, the mv of mixture samples increased significantly at low effective axial stress (σ′a) levels (less than the preconsolidation pressure) and then decreased as the σ′a further increased. In the case of 1 M NaCl as the pore fluid, the Cc, Cs, and mv slightly changed with the increase of bentonite content. The research results also confirmed that the effect of saline water on the compression index was noticeable when the liquid limit of soil with distilled water was higher than 110%, and the compression index of soil with distilled water was higher than 1. Regarding the coefficient of consolidation (Cv), the Cv of kaolin sample increased as the σ′a increased, and this trend was independent of the pore fluid chemistry. By contrast, the Cv − σ′a trend of mixture samples depended not only on the pore fluids but also on the stress level.
Vibration Response Evaluation under Shock-Type Loading with Emphasis on Finite Element Model Updating
Authors: Akbari Jalal , Nazari Leila , Mirzaei Samaneh
Published: September 2020

In some cases, impulse- or shock-type excitations as the dynamic loading are inevitable, and obtaining proper response with the well-known numerical methods is not easy. This paper focuses on dynamic response estimation against short-time loading with an updated finite element model using frequency response functions (FRF) and particle swarm optimization (PSO) technique. Because there is not an analytical method for assessing the numerical responses under shock-type excitations, in this paper, experimental tests are designed on a laboratory scale to evaluate the numerical responses. The vibration responses of the system against shock loading are compared with the Newmark average acceleration scheme and also with experimental data. The results reveal that the unconditionally stable Newmark method against regular loads has an appropriate performance. Still, under short-time loading, it faces numerical damping error, and this method should not be blindly applied under shock-type loads.
Severe Metabolic Acidosis: A Case of Triple Hit with Ketogenic Diet, Vinegar, and Metformin in an Obese Patient
Authors: Rana Abdul Mughees , Mansoor Kannan , Assad Salman , Abouzid Mahmoud , Ogu Iheanyichukwu , Bandak Ghassan Salim Issa
Published: September 2020

Obesity is an epidemic with high burden of disease. It is directly proportional to increased risk of morbidity and mortality. Ketogenic diet and herbal supplements have recently gained popularity amongst patients struggling with weight loss. There are limited data available for most of these supplements contrary to the claims laid by the mainstream media. Due to lack of awareness, this patient population is at high risk of adverse effects. We present a case of severe acidosis secondary to ketogenic diet and acetic acid (vinegar) ingestion. The use of dietary acetic acid is usually well tolerated; however, in this case, the large quantities and presence of acute renal injury and metformin use may have worsened the acidosis. Severe ketosis in setting of ketogenic diets is a serious complication, which is infrequently reported in literature. Many of these diets and supplements may seem harmless, but as our case illustrates, when combined with other risk factors, patients can face serious adverse effects and even require hospitalization. It is imperative that such dietary practices are physician supervised to avoid complications. With the recent surge of over-the-counter weight loss supplements and ketogenic diets, physicians also need to engage in dietary discussion with patients when attempting to lose weight.
Research on Coordinated Development of a Railway Freight Collection and Distribution System Based on an “Entropy-TOPSIS Coupling Development Degree Model” Integrated with Machine Learning
Authors: Jing Yun , Guo Si-Ye , Wang Xuan , Chen Fang-Qiu
Published: September 2020

In recent years, with the gradual networking of high-speed railways in China, the existing railway transportation capacity has been released. In order to improve transportation capacity, railway freight transportation enterprises companies have gradually shifted the transportation of goods from dedicated freight lines to passenger-cargo lines. In terms of the organization form of collection and distribution, China has a complete research system for heavy-haul railway collection and distribution, but the research on the integration of collection and distribution of the ordinary-speed railway freight has not been completed. This paper combines the theories of the integration of collection and distribution theory, coordination theory, and coupling theory and incorporates the machine learning fuzzy mathematics to construct an “Entropy-TOPSIS Coupling Development Degree Model” for dynamic intelligent quantitative analysis of the synergy of railway freight collection and distribution systems. Finally, we take the Tongchuan Depot of “China Railway Xi’an Group Co., Ltd.” as a research object to construct a target system and use the intelligent information acquisition system to collect basic data. The analysis results show that through the coordinated control of the freight collection and distribution system, the coordination between the subsystems of the integrated freight collection and distribution system is increased by 5.94%, which verifies the feasibility of the model in the quantitative improvement of the integration of collection and distribution system. It provides a new method for the research of integrated development of railway freight collection and distribution.
Quality of Life in Patients with Psoriasis Seen in the Department of Dermatology, Antananarivo, Madagascar
Authors: Sendrasoa Fandresena Arilala , Razanakoto Naina Harinjara , Ratovonjanahary Volatantely , Raharolahy Onivola , Ranaivo Irina Mamisoa , Andrianarison Malalaniaina , Rakotoarisaona Mendrika Fifaliana , Rakotonaivo Niriantsoa Avotriniaina , Sata Moril , Ramarozatovo Lala Soavina , Rapelanoro Rabenja Fahafahantsoa
Published: September 2020

Background. Psoriasis is a chronic, inflammatory, and multifactorial dermatosis that impairs quality of life (QoL). Health‐related QoL has become an important element in medical decision‐making along with the effectiveness and the harmlessness of the treatments. Objective. To assess the impact of psoriasis in the QoL of patients with psoriasis by using the DLQI scales. Methods. A cross‐sectional study from January to June 2018 was conducted in the Department of Dermatology of the University Hospital Joseph Raseta Befelatanana, Antananarivo, Madagascar, including patients more than 18 years old with mild to severe psoriasis. The severity of psoriasis was assessed using the “Psoriasis Area and Severity Index (PASI)”. QoL of patients with psoriasis was evaluated by using the DLQI scales. Results. 80 patients were included, their mean age was 36.5 years, and the male to female was 1.5 : 1. The mean DLQI score was 13.8. Symptoms, feelings, and psychic were the most altered dimensions. QoL was impaired in young patients, single, having medium level education. Even though patients with disease duration more than 5 years had higher DLQI score than other patients, the difference was not statistically significant (p = 0.36). Furthermore, the clinical presentation of psoriasis did not influence the patient’s QoL (p = 0.73). Patients with nail involvement had QoL impaired but the difference with another localization was not statistically significant (p = 0.2). The quality of life was influenced by body area involved. The higher the body surface area involved, the more QoL is impaired (p = 0.002). Furthermore, the higher the PASI, the more QoL is altered (p = 0.002). Conclusion. Psoriasis has a negative impact in the quality of life in Malagasy patients with psoriasis, especially in younger and single patients. Worse quality of life is correlated to severity of psoriasis.
Long-Term Visual Quality after Microincision Cataract Surgery
Authors: Huang Qing , Li Ruili , Feng Liwen , Miao Na , Fan Wei
Published: September 2020

Purpose. Few studies have focused on long-term postoperative visual quality. This study aimed to evaluate the long-term visual quality after microincision cataract surgery (MICS). Methods. 96 patients (144 eyes) diagnosed with age-related cataracts were enrolled in this one-year study. The patients underwent MICS and received aspheric monofocal intraocular lens implants. Uncorrected distance visual acuity (UDVA) was evaluated together with best-corrected distance visual acuity (BCDVA), best-corrected near visual acuity (BCNVA), contrast sensitivity, and surgically induced astigmatism (SIA). Results. Compared to preoperative measurements, UDVA, BCDVA, and BCNVA were significantly better after surgery (P<0.001), and they remained stable throughout follow-up. Contrast sensitivity was also significantly better after surgery (P<0.001). Mean SIA during follow-up was 0.57 ± 0.33 D at 1 week, 0.36 ± 0.25 D at 3 months, and 0.18 ± 0.16 D at 1 year. SIA decreased significantly during the postoperative period (P<0.001). The 1-year postoperative absolute residual diopter value was 0.32 ± 0.28 D. Conclusion. MICS can provide excellent visual quality as soon as on postoperative day 1, which persists during the follow-up period of 1 year. In contrast to previous studies, SIA decreases over time and may not completely stabilize for as long as 1 year postoperatively.
Clinical Characteristics of Hospitalized Patients with Drug‐Induced Acute Kidney Injury and Associated Risk Factors: A Case‐Control Study
Authors: Yu Chengxuan , Guo Daihong , Yao Chong , Yang Hongyi , Liu Siyuan , Zhu Yu , Kong Xianghao
Published: September 2020

Background. Drug‐induced acute kidney injury (D‐AKI) is increasingly common and can extend the hospital length of stay and increase mortality. This study is aimed at analyzing the clinical characteristics of hospitalized patients with D‐AKI and the associated risk factors in a multidrug environment. Methods. A retrospective study among hospitalized patients was conducted in July 2019 based on the Adverse Drug Events Active Surveillance and Assessment System‐2 developed by the authors. Four controls were matched with each case according to the matching criteria. The risk factors for D‐AKI were identified by binary multivariate logistic regression. Results. A total of 23,073 patients were hospitalized in July 2019, 21,131 of whom satisfied the inclusion criteria. The independent risk factors for D‐AKI consisted of alcohol abuse (odds ratio (OR), 2.05; 95% confidence interval (CI), 1.04‐4.07), nonsteroidal anti‐inflammatory drug (NSAID) use (OR, 2.39; 95% CI, 1.25‐4.58), diuretic use (OR, 2.64; 95% CI, 1.42‐4.92), prior anemia (OR, 4.10; 95% CI, 1.94‐8.67), and prior chronic kidney disease (OR, 2.33; 95% CI, 1.07‐5.08). Conclusions. The occurrence of D‐AKI in hospitalized patients had significant associations with alcohol abuse, combination therapy with NSAIDs or diuretics, and prior anemia or chronic kidney disease. Clinicians should meticulously follow patients with the above characteristics.
Breast Cancer Cell Detection and Characterization from Breast Milk–Derived Cells
Authors: Bhat-Nakshatri Poornima , Kumar Brijesh , Simpson Ed , Ludwig Kandice K. , Cox Mary L. , Gao Hongyu , Liu Yunlong , Nakshatri Harikrishna
Published: September 2020

Radiologic techniques remain the main method for early detection for breast cancer and are critical to achieve a favorable outcome from cancer. However, more sensitive detection methods to complement radiologic techniques are needed to enhance early detection and treatment strategies. Using our recently established culturing method that allows propagation of normal and cancerous breast epithelial cells of luminal origin, flow cytometry characterization, and genomic sequencing, we show that cancer cells can be detected in breast milk. Cells derived from milk from the breast with cancer were enriched for CD49f+/EpCAM−, CD44+/CD24−, and CD271+ cancer stem–like cells (CSC). These CSCs carried mutations within the cytoplasmic retention domain of HDAC6, stop/gain insertion in MORF4L1, and deletion mutations within SWI/SNF complex component SMARCC2. CSCs were sensitive to HDAC6 inhibitors, BET bromodomain inhibitors, and EZH2 inhibitors, as mutations in SWI/SNF complex components are known to increase sensitivity to these drugs. Among cells derived from breast milk of additional ten women not known to have breast cancer, two of them contained cells that were enriched for the CSC phenotype and carried mutations in NF1 or KMT2D, which are frequently mutated in breast cancer. Breast milk–derived cells with NF1 mutations also carried copy-number variations in CDKN2C, PTEN, and REL genes. The approach described here may enable rapid cancer cell characterization including driver mutation detection and therapeutic screening for pregnancy/postpartum breast cancers. Furthermore, this method can be developed as a surveillance or early detection tool for women at high risk for developing breast cancer.

Significance:

These findings describe how a simple method for characterization of cancer cells in pregnancy and postpartum breast cancer can be exploited as a surveillance tool for women at risk of developing breast cancer.
ERG-Mediated Coregulator Complex Formation Maintains Androgen Receptor Signaling in Prostate Cancer
Authors: Shah Neel , Kesten Nikolas , Font-Tello Alba , Chang Matthew E.K. , Vadhi Raga , Lim Klothilda , Flory Mark R. , Cejas Paloma , Mohammed Hisham , Long Henry W. , Brown Myles
Published: September 2020

The TMPRSS2-ERG fusion is the most common genomic rearrangement in human prostate cancer. However, in established adenocarcinoma, it is unknown how the ERG oncogene promotes a cancerous phenotype and maintains downstream androgen receptor (AR) signaling pathways. In this study, we utilized a murine prostate organoid system to explore the effects of ERG on tumorigenesis and determined the mechanism underlying prostate cancer dependence on ERG. Prostate organoids lacking PTEN and overexpressing ERG (Pten−/− R26-ERG) faithfully recapitulated distinct stages of prostate cancer disease progression. In this model, deletion of ERG significantly dampened AR-dependent gene expression. While ERG was able to reprogram the AR cistrome in the process of prostate carcinogenesis, ERG knockout in established prostate cancer organoids did not drastically alter AR binding, H3K27ac enhancer, or open chromatin profiles at these reprogrammed sites. Proteomic analysis of DNA-bound AR complexes demonstrated that ERG deletion causes a loss of recruitment of critical AR coregulators and basal transcriptional machinery, including NCOA3 and RNA polymerase II, but does not alter AR binding itself. Together, these data reveal a novel mechanism of ERG oncogene addiction in prostate cancer, whereby ERG facilitates AR signaling by maintaining coregulator complexes at AR bound sites across the genome.

Significance:

These findings exploit murine organoid models to uncover the mechanism of ERG-mediated tumorigenesis and subsequent oncogenic dependencies in prostate cancer.
Chloroquine SensitizesGNAQ/11-mutated Melanoma to MEK1/2 Inhibition
Authors: Truong Amanda , Yoo Jae Hyuk , Scherzer Michael T. , Sanchez John Michael S. , Dale Kali J. , Kinsey Conan G. , Richards Jackson R. , Shin Donghan , Ghazi Phaedra C. , Onken Michael D. , Blumer Kendall J. , Odelberg Shannon J. , McMahon Martin
Published: September 2020

Purpose:

Mutational activation of GNAQ or GNA11 (GNAQ/11), detected in >90% of uveal melanomas, leads to constitutive activation of oncogenic pathways, including MAPK and YAP. To date, chemo- or pathway-targeted therapies, either alone or in combination, have proven ineffective in the treatment of patients with metastatic uveal melanoma.

Experimental Design:

We tested the efficacy of chloroquine or hydroxychloroquine, in combination with MAPK pathway inhibition in GNAQ/11-mutated cells in vitro and in vivo and identified mechanisms of MEK1/2 inhibitor plus chloroquine-induced cytotoxicity.

Results:

Inhibition of GNAQ/11-mediated activation of MAPK signaling resulted in the induction of autophagy. Combined inhibition of Gα and autophagy or lysosome function resulted in enhanced cell death. Moreover, the combination of MEK1/2 inhibition, using trametinib, with the lysosome inhibitor, chloroquine, also increased cytotoxicity. Treatment of mice bearing GNAQ/11-driven melanomas with trametinib plus hydroxychloroquine resulted in inhibition of tumor growth and significantly prolonged survival. Interestingly, lysosomal- and autophagy-specific inhibition with bafilomycin A1 was not sufficient to promote cytotoxicity in combination with trametinib. However, the addition of YAP inhibition with trametinib plus bafilomycin A1 resulted in cell death at comparable levels to trametinib plus chloroquine (T/CQ) treatment. Furthermore, T/CQ-treated cells displayed decreased YAP nuclear localization and decreased YAP transcriptional activity. Expression of a constitutively active YAP5SA mutant conferred resistance to T/CQ-induced cell death.

Conclusions:

These results suggest that YAP, MEK1/2, and lysosome function are necessary and critical targets for the therapy of GNAQ/11-driven melanoma, and identify trametinib plus hydroxychloroquine as a potential treatment strategy for metastatic uveal melanoma.
Gut Microbiota Dysbiosis Drives the Development of Colorectal Cancer
Authors: Fan Xiaoyan , Jin Yuelei , Chen Guang , Ma Xueqiang , Zhang Lixia
Published: September 2020

Background: The gut microbiota is a diverse community of microbes that maintain the stability of the intestinal environment. Dysbiosis of the gut microbiota has been linked to gastrointestinal diseases, such as colorectal cancer (CRC) – a leading cause of death for cancer patients. Summary: Candidate pathogens have been identified using bacterial culture and high-throughput sequencing techniques. Currently, there is evidence to show that specific intestinal microbes drive CRC development and progression, yet their pathogenic mechanisms are still unclear. Key Messages: In this review, we describe the known healthy gut microbiota and its changes in CRC. We especially focus on exploring the pathogenic mechanisms of gut microbiota dysbiosis in CRC. This is crucial for explaining how gut microbiota dysbiosis drives the process of colorectal carcinogenesis and tumor progression. Evaluation of changes in the gut microbiota during CRC development and progression offers a new strategy for the diagnosis and treatment of this disease.
Assessment of Muscle Strength and Volume Changes in Patients with Breast Cancer-Related Lymphedema
Authors: Baklaci Musa , Eyigör Sibel , Tanıgör Göksel , Özgür İnbat Menekşe , Çalışkan Kabayel Sedef
Published: September 2020

Introduction: To determine whether complete decongestive therapy (CDT) used in breast cancer-related lymphedema affects muscle strength in the affected arm while assessing the efficacy of the therapy itself. Material and Methods: Seventy-four patients with breast cancer-related lymphedema were included in this study. The demographic and clinical history characteristics of the patients were taken. The patients were then evaluated with measurements of extremity volumes and handgrip strengths using a hand dynamometer before and after the CDT. Data were then assessed using relevant statistical methods. Results: The mean CDT duration was 17.5 ± 8.93 days for the patients. Therapy resulted in significant improvement in the affected arm (p < 0.01). The difference between the arm with lymphedema and the other side was statistically significant, and this difference remained after the therapy (p < 0.01). The change in handgrip strength in the side with lymphedema was not found to be statistically significant after therapy (p > 0.05). Handgrip strength differences and volume differences before and after the treatment in the affected arm were not correlated (p > 0.05). Conclusion: Limbs affected with lymphedema were found to be weaker in handgrip strength and this weakness continued throughout the therapy. Strengthening exercises should be considered to be added into the treatment of patients undergoing CDT to gain better functional potential.
Cryostorage to What End? – Autologous Stem Cell Products in Burkitt Lymphoma, Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, and Myeloproliferative Neoplasm Patients
Authors: Kriegsmann Katharina , Pavel Petra , Bochtler Tilmann , Schmitt Anita , Sauer Sandra , Kriegsmann Mark , Bruckner Thomas , Klein Stefan , Klüter Harald , Müller-Tidow Carsten , Wuchter Patrick
Published: September 2020

Introduction: Recently, we identified a huge discrepancy between the collection practice and the actual utilization of cryopreserved peripheral blood stem cells (PBSCs) for high-dose chemotherapy (HDCT) and autologous blood stem cell transplantation (ABSCT). Specifically, patients with Burkitt lymphoma, acute leukemia, and myeloproliferative neoplasms (MPN) were frequently not referred for ABSCT after successful PBSC collection. Objective: The aim of this study was to identify variables that are associated with the non-utilization of PBSC grafts. Methods: We retrospectively analyzed the collection, storage, and disposal of PBSC grafts in Burkitt lymphoma (n = 18), acute lymphoblastic leukemia (ALL, n = 22), MPN (n = 18), and acute myeloid leukemia (AML, n = 71) patients. Patients who underwent autologous PBSC collection at 2 collection and transplantation centers between 2001 and 2012 were included and followed up until 2016. Results: None of the Burkitt lymphoma patients were referred for ABSCT. Only in 1 (6%) patient, the graft was discarded after the patient’s death. In all other patients (n = 17, 94%), the grafts were stored independently of the patient’s status (death, n = 4, 22%; no follow-up, n = 6, 33%; no indication for ABSCT given, n = 7, 39%). In ALL patients, 4 (18%) patients underwent ABSCT after a median follow-up of 74 (1–182) months. In the remaining patients, PBSC grafts were either discarded (8 patients, 36%) or stored until the reference date (10 patients, 45%). Seven of 18 MPN patients (39%) underwent ABSCT. ABSCT was performed in 24 (34%) AML patients. In 20 (28%) patients who were not referred to ABSCT, an allogeneic transplantation (TPL) was performed. Fifteen (21%) patients received palliative care or deceased, and their grafts were discarded in all but 1 patient. Additional grafts were discarded in 21 (31%) patients and stored in 9 (13%) patients who underwent ABSCT or allogeneic TPL (n = 44). Conclusions: As the role and efficacy of autologous HDCT/ABSCT are not established in the analyzed entities, the indication for PBSC collection should be reanalyzed in regular intervals. Moreover, PBSC grafts from patients who have deceased, have insufficient grafts, or have already undergone an allogeneic TPL should be considered for disposal or (if applicable) for research use, to economize storage costs on a rational basis.
The Connection between Urinary Equol Levels and the Prevalence of Atopic Dermatitis
Authors: Chiba Takahito , Nagai Takuya , Kohda Futoshi , Nakahara Takeshi , Kono Michihiro
Published: September 2020

Background: Soy isoflavones and their metabolites such as equol have been associated with a reduced risk of hormone-sensitive tumors and metabolic syndromes. However, individual soy isoflavones and equol levels in atopic dermatitis remain uninvestigated. Objective: The aim of this study is to compare the levels of urinary daidzein, genistein, and equol between atopic dermatitis patients and normal subjects and to examine the correlation between equol concentration and the severity of clinical symptoms. Methods: A cross-sectional study was conducted at Akita University Hospital and Aso Iizuka Hospital in Japan. Fifty patients with confirmed atopic dermatitis diagnosis and 67 healthy controls were recruited. Daidzein, genistein, and equol in urine were measured by using a high-performance liquid chromatography-mass spectrometry system. Results: Urinary equol levels were significantly lower in the atopic dermatitis patients than in the healthy controls (p = 0.002). The difference was particularly noticeable in young people (6–19 years, p < 0.001). No correlations were found between urinary equol levels and the severity of clinical symptoms and laboratory data in the atopic dermatitis patients. Conclusion: Equol levels in childhood might be involved in the development of atopic dermatitis.
Therapeutic and Immunoregulatory Effects of Tacrolimus in Patients with Refractory Generalized Myasthenia Gravis
Authors: Wu Hui , Wang Zhangyang , Xi Jianying , Liu Jue , Yan Chong , Song Jie , Wang Liang , Jing Sisi , Wang Yan , Zhao Chongbo
Published: September 2020

Objectives: The aim of this study wasto investigate the efficacy of tacrolimus treatment in patients with refractory generalized myasthenia gravis (MG) and explore its impact on lymphocytic phenotypes and related cytokines mRNA expression. Methods: A total of 24 refractory generalized MG patients were enrolled. Before treatment and at 2, 6, and 12 months after tacrolimus treatment, the therapeutic effect was evaluated by the quantitative MG score of the Myasthenia Gravis Foundation of America (QMG), Manual Muscle Test (MMT), MG-specific Activities of Daily Living (MG-ADL), 15-item Myasthenia Gravis Quality-of-Life Scale (MG-QOL15), and changes of prednisone dosage. Also, we used the flow cytometer for the lymphocytic immunophenotyping and real-time PCR for the qualification of cytokine mRNA in peripheral blood mononuclear cells (PBMCs) at different time points during the treatment. Results: Significantly decreased QMG, MMT, MG-ADL, and MG-QOL15 were observed at all time points during the tacrolimus treatment. The dosage of prednisone also reduced at the end of the observation period with only 6 adverse events reported. The immunological impact of tacrolimus was revealed by reduced percentages of Tfh, Breg, CD19+BAFF-R+ B cells, and increased percentages of Treg cells as well as down-regulated expression of IL-2, IL-4, IL-10, and IL-13 mRNA levels in PBMCs during the treatment. Conclusion: Our study indicated the clinical efficacy of tacrolimus in patients with refractory generalized MG. The underlying immunoregulatory mechanism of tacrolimus may involve alterations in the phenotypes of peripheral blood lymphocytes and Th1/Th2-related cytokine expression of PBMCs.
Incidence of Postoperative Adhesions after Laparoscopic Myomectomy with Barbed Suture
Authors: Kumakiri Jun , Kikuchi Iwaho , Kitade Mari , Ozaki Rie , Kawasaki Yu
Published: September 2020

Aim: The aim of the study was to assess the incidence of postoperative adhesion by baseball running suture using barbed suture (BS) in laparoscopic myomectomy in comparison with sutures using an absorbable thread. Methods: Two hundred fifteen patients who underwent second-look laparoscopy (SLL) 6 months after laparoscopic myomectomy at our hospital between 2010 and 2014 were retrospectively reviewed. The incidence, numbers, types, and extent of adhesions were evaluated according to the more comprehensive adhesion scoring method. Propensity score matching (PS) (1:1) between the groups was performed by using the diameter of the largest myoma, the number of enucleated myomas, and the type of adhesion barrier. Results: Running baseball sutures and running sutures were applied to 28 and 187 patients with unidirectional BS and absorbable thread, respectively, to close the incised serosal wounds enucleating largest myomas during laparoscopic myomectomy. After PS matching for the patients, surgical findings and the incidence of postoperative wound adhesions were compared between the groups, including 22 patients each. The surgical findings were similar between the groups, except for the total surgical duration and blood loss (medians), which were significantly shorter and lower in the BS group than in the absorbable thread group (70 vs. 100 min; p = 0.01, 50 vs. 100 mL; p = 0.02). Regarding findings of SLL, no significant differences in the incidence of postoperative wound adhesions were found between the groups (BS, 4/22 [18.2%] versus absorbable thread, 8/22 [36.4%]; p = 0.31). Conclusion: Our data indicated that the incidence of postoperative adhesion following the use of BS for wound closure in laparoscopic myomectomy was similar to that following the use of conventional suture.
Incorporation of Urinary Neutrophil Gelatinase-Associated Lipocalin and Computed Tomography Quantification to Predict Acute Kidney Injury and In-Hospital Death in COVID-19 Patients
Authors: He Li , Zhang Qunzi , Li Ze , Shen Li , Zhang Jiayin , Wang Peng , Wu Shan , Zhou Ting , Xu Qiuting , Chen Xiaohua , Fan Xiaohong , Fan Ying , Wang Niansong
Published: September 2020

Background: The prevalence of acute kidney injury (AKI) in COVID-19 patients is high, with poor prognosis. Early identification of COVID-19 patients who are at risk for AKI and may develop critical illness and death is of great importance. Objective: The aim of this study was to develop and validate a prognostic model of AKI and in-hospital death in patients with COVID-19, incorporating the new tubular injury biomarker urinary neutrophil gelatinase-associated lipocalin (u-NGAL) and artificial intelligence (AI)-based chest computed tomography (CT) analysis. Methods: A single-center cohort of patients with COVID-19from Wuhan Leishenshan Hospital were included in this study. Demographic characteristics, laboratory findings, and AI-assisted chest CT imaging variables identified on hospital admission were screened using least absolute shrinkage and selection operator (LASSO) and logistic regression to develop a model for predicting the AKI risk. The accuracy of the AKI prediction model was measured using the concordance index (C-index), and the internal validity of the model was assessed by bootstrap resampling. A multivariate Cox regression model and Kaplan-Meier curves were analyzed for survival analysis in COVID-19 patients. Results: One hundred seventy-four patients were included. The median (±SD) age of the patients was 63.59 ± 13.79 years, and 83 (47.7%) were men.u-NGAL, serum creatinine, serum uric acid, and CT ground-glass opacity (GGO) volume were independent predictors of AKI, and all were selected in the nomogram. The prediction model was validated by internal bootstrapping resampling, showing results similar to those obtained from the original samples (i.e., 0.958; 95% CI 0.9097–0.9864). The C-index for predicting AKI was 0.955 (95% CI 0.916–0.995). Multivariate Cox proportional hazards regression confirmed that a high u-NGAL level, an increased GGO volume, and lymphopenia are strong predictors of a poor prognosis and a high risk of in-hospital death. Conclusions: This model provides a useful individualized risk estimate of AKI in patients with COVID-19. Measurement of u-NGAL and AI-based chest CT quantification are worthy of application and may help clinicians to identify patients with a poor prognosis in COVID-19 at an early stage.
Increasing Age and Nonliver Comorbidities in Patients with Chronic Hepatitis B in Taiwan: A Nationwide Population-Based Analysis
Authors: Tseng Cheng-Hao , Hsu Yao-Chun , Ho Hsiu J. , Nguyen Mindie H. , Wu Chun-Ying
Published: September 2020

Background: Data from the USA suggest that chronic hepatitis B (CHB) patients have aged in the past decade. However, the burden of nonliver comorbidities has not been well characterized in Taiwan, where CHB is very prevalent. Aim: Our study examined this issue as it presented between 2001 and 2011 in Taiwan. Methods: This study identified adult patients (≥18 years) who were diagnosed with CHB in 2001, 2006, and 2011, from the Taiwan National Health Insurance Research Database (NHIRD). Changes in demographic characteristics, prevalence of nonliver comorbidities, and medication usage over the decade were examined. Non-CHB controls were adults without CHB diagnosis from the Longitudinal Health Insurance Database 2000 (LHID2000). Results: A total of 102,158, 252,809, and 338,200 eligible patients were identified in 2001, 2006, and 2011, respectively. The mean age significantly advanced from 45.4 to 52.3 years over the decade (p < 0.001). The prevalence of comorbidities, including diabetes mellitus, hypertension, stroke, chronic kidney disease, and bone fracture, significantly increased between 2001 and 2011 (all p < 0.001), as so were medication usage (all p < 0.001). Moreover, within each study period, compared to non-CHB controls, CHB patients were also older and more likely to have metabolic and cardiovascular comorbidities (all p < 0.001). In addition, the annual nonliver mortality in the CHB population significantly increased from 2001 to 2011. Conclusions: Over a decade, the CHB population in Taiwan has aged with a higher nonliver comorbidity burden and increasing nonliver mortality. These findings may provide information to care providers in the monitoring and management of CHB patients.
Drug-Induced Arrhythmias: A Scientific Statement From the American Heart Association
Authors: Tisdale James E. , Chung Mina K. , Campbell Kristen B. , Hammadah Muhammad , Joglar Jose A. , Leclerc Jacinthe , Rajagopalan Bharath ,   On behalf of the American Heart Association Clinical Pharmacology Committee of the Council on Clinical Cardiology and Council on Cardiovascular and Stroke Nursing
Published: September 2020

Many widely used medications may cause or exacerbate a variety of arrhythmias. Numerous antiarrhythmic agents, antimicrobial drugs, psychotropic medications, and methadone, as well as a growing list of drugs from other therapeutic classes (neurological drugs, anticancer agents, and many others), can prolong the QT interval and provoke torsades de pointes. Perhaps less familiar to clinicians is the fact that drugs can also trigger other arrhythmias, including bradyarrhythmias, atrial fibrillation/atrial flutter, atrial tachycardia, atrioventricular nodal reentrant tachycardia, monomorphic ventricular tachycardia, and Brugada syndrome. Some drug-induced arrhythmias (bradyarrhythmias, atrial tachycardia, atrioventricular node reentrant tachycardia) are significant predominantly because of their symptoms; others (monomorphic ventricular tachycardia, Brugada syndrome, torsades de pointes) may result in serious consequences, including sudden cardiac death. Mechanisms of arrhythmias are well known for some medications but, in other instances, remain poorly understood. For some drug-induced arrhythmias, particularly torsades de pointes, risk factors are well defined. Modification of risk factors, when possible, is important for prevention and risk reduction. In patients with nonmodifiable risk factors who require a potentially arrhythmia-inducing drug, enhanced electrocardiographic and other monitoring strategies may be beneficial for early detection and treatment. Management of drug-induced arrhythmias includes discontinuation of the offending medication and following treatment guidelines for the specific arrhythmia. In overdose situations, targeted detoxification strategies may be needed. Awareness of drugs that may cause arrhythmias and knowledge of distinct arrhythmias that may be drug-induced are essential for clinicians. Consideration of the possibility that a patient’s arrythmia could be drug-induced is important.
Life’s Simple 7 and Incident Hypertension: The REGARDS Study
Authors: Plante Timothy B. , Koh Insu , Judd Suzanne E. , Howard George , Howard Virginia J. , Zakai Neil A. , Booth John N. , Safford Monika M. , Muntner Paul , Cushman Mary
Published: September 2020

Background

The Life’s Simple 7 (LS7) metric incorporates health behaviors (body mass index, diet, smoking, physical activity) and health factors (blood pressure, cholesterol, glucose) to estimate an individual’s level of cardiovascular health. The association between cardiovascular health and incident hypertension is unresolved. Hypertension’s threshold was recently lowered and it is unclear if better cardiovascular health is associated with lower risk of incident hypertension with the updated threshold or in a multirace cohort. We sought to assess the association between better LS7 score and risk of incident hypertension among Black and White adults using a 130/80 mm Hg hypertension threshold.

Methods and Results

We determined the association between LS7 metric and incident hypertension in the REGARDS (Reasons for Geographic and Racial Disparities in Stroke) study, including participants free of baseline hypertension (2003–2007) who completed a second visit between 2013 and 2016. Hypertension was defined as systolic/diastolic blood pressure ≥130/80 mm Hg or antihypertensive medication use. Each LS7 component was assigned 0 (poor), 1 (intermediate), or 2 (ideal) points. We generated a 14‐point score by summing points. Among 2930 normotensive participants (20% Black, 80% White), the median (25th–75th percentiles) LS7 total score was 9 (8–10) points. Over a median follow‐up of 9 years, 42% developed hypertension. In the fully adjusted model, each 1‐point higher LS7 score had a 6% lower risk of incident hypertension (risk ratio, 0.94 per 1 point; 95% CI, 0.92–0.96).

Conclusions

Better cardiovascular health was associated with lower risk of incident hypertension using a 130/80 mm Hg hypertension threshold among Black and White adults.
The Impact of Outer-Core Surface Heat Fluxes on the Convective Activities and Rapid Intensification of Tropical Cyclones
Authors: Peng Chin-Hsuan , Wu Chun-Chieh
Published: September 2020

The rapid intensification (RI) of Typhoon Soudelor (2015) is simulated using a full-physics model. To investigate how the outer-core surface heat fluxes affect tropical cyclone (TC) structure and RI processes, a series of numerical experiments are performed by suppressing surface heat fluxes between various radii. It is found that a TC would become quite weaker when the surface heat fluxes are suppressed outside the radius of 60 or 90 km [the radius of maximum surface wind in the control experiment (CTRL) at the onset of RI is roughly 60 km]. However, interestingly, the TC would experience stronger RI when the surface heat fluxes are suppressed outside the radius of 150 km. For those sensitivity experiments with capped surface heat fluxes, the members with greater intensification rate show stronger inner-core mid- to upper-level updrafts and higher heating efficiency prior to the RI periods. Although the outer-core surface heat fluxes in these members are suppressed, the inner-core winds become stronger, extracting more ocean energy from the inner core. Greater outer-core low-level stability in these members results in aggregation of deep convection and subsequent generation and concentration of potential vorticity inside the inner core, thus confining the strongest winds therein. The abovementioned findings are also supported by partial-correlation analyses, which reveal the positive correlation between the inner-core convection and subsequent 6-h intensity change, and the competition between the inner-core and outer-core convections (i.e., eyewall and outer rainbands).