bluuebunny/crossref_metadata_2025 huggingface dataset:
Comorbidity in lung cancer patients and its association with medical service cost and treatment choice in China
Authors: Ding Ruoxi , Zhu Dawei , He Ping , Ma Yong , Chen Zhishui , Shi Xuefeng
Published: March 2020

Background

It is evident that comorbidity exacerbate the complexity of the management of lung cancer, however, limited research has been conducted to investigate the impact of comorbidity on health service utilization and cost, as well as the treatment choice among lung cancer patients. We examined the association of comorbidity with medical service utilization, cost and treatment choice among lung cancer patients in China.

Methods

We used claims data from China Urban Employees’ Basic Medical Insurance (UEBMI) and Urban Residents’ Basic Medical Insurance (URBMI) between 2013 to 2016 and data from Hospital Information System (HIS) Database in Beijing Cancer Hospital (BCH). Elixhauser Comorbidity Index was used to assess comorbidity. Negative binomial regression, generalized linear model (GLM) with a gamma distribution and a log link, and logistic regression was applied to assess the associations between comorbidity and medical service utilization, cost and treatment choice, respectively.

Results

Among 8655 patients with lung cancer, 31.3% of had at least one comorbid conditions. Having comorbidity was associated with increased number of annual outpatient visits (1.6, 95%CI: 1.3, 1.9) and inpatients admissions (0.8, 95%CI, 0.70, 0.90), increased outpatient (USD635.5, 95%CI: 490.3, 780.8) and inpatient expenditure (USD2 470.3, 95CI%: 1998.6, 2941.9), as well as increased possibility of choosing radio therapy (OR: 1.208, 95%CI:1.012–1.441) and chemotherapy (1.363, 1.196–1.554), and decreased possibility of choosing surgery (0.850, 0.730–0.989). The medical utilization and expenditure, the possibility of choosing radiotherapy increases, and the possibility of choosing surgery decreases with the increasing number of chronic conditions. There are variations in the association with medical service utilization and expenditure, and treatment choice among individuals with different types of comorbid conditions.

Conclusion

Comorbidity among lung cancer patients restricts the potential treatment choices and poses an extra substantial health care burden. Our findings provide implications for both the clinical management and health service planning and financing for lung cancer patients.
Empirical examination of executive functioning, ADHD associated behaviors, and functional impairments in adults with persistent ADHD, remittent ADHD, and without ADHD
Authors: Roselló Belén , Berenguer Carmen , Baixauli Inmaculada , Mira Álvaro , Martinez-Raga Jose , Miranda Ana
Published: March 2020

Background

Previous studies suggest that childhood attention deficit hyperactivity disorder (ADHD) may continue in adulthood, producing adverse effects. Therefore, identifying factors that help to differentiate characteristics of ADHD persistence and remission has practical implications for evaluation and treatment. The first aim of this study was to analyze differences in executive functions (shift, working memory, inhibition, and plan/organize), symptoms associated with ADHD (inattention, hyperactivity, emotional lability, and self-concept), and functional impairments in adults with persistent ADHD (ADHD-P), with remittent ADHD (ADHD-R), and without ADHD (N-ADHD). The second aim was to study the contribution of functional impairments in these three groups based on executive functions and associated ADHD behaviors.

Methods

Participants were 115 adults, 61 with a childhood ADHD diagnosis (40 persisters and 21 remitters) and 54 individuals with typical development. Self-reports were collected on executive functions, symptoms associated with ADHD, and functional impairments. Multivariate Analyses of Variance were conducted to test differences between the ADHD-P, ADHD-R, and N-ADHD groups on the evaluated variables. In addition, analyses were performed using two structural equation models with observed variables (path analyses).

Results

The results indicated that significant executive and behavioral impairments and adverse functional outcomes in different life domains are related to the diagnostic persistence of ADHD. Recovery from the disorder is associated with better results, although hyperactivity/restlessness behaviors and plan/organize deficits continue to be present in remitter individuals.

Conclusions

The ADHD-P and ADHD-R groups showed some differences in their executive, behavioral, and functional impairments. Furthermore, the impairments in each group can be predicted by different executive functions and other symptoms associated with the disorder. These results should be taken into account in order to improve clinical practice.
Resection of retrohepatic inferior vena cava without reconstruction in ex vivo liver resection and autotransplantation: a retrospective study
Authors: Yang Xianwei , Wang Tao , Kong Junjie , Huang Bin , Wang Wentao
Published: March 2020

Background

Retrohepatic inferior vena cava (RIVC) resection without reconstruction in ex vivo liver resection and autotransplantation (ERAT) for advanced alveolar echinococcosis (HAE) is unclear.

Methods

This is a retrospective study of consecutive patients referred to our hospital from 2014 to 2018. Depending on the presence of a rich collateral circulation and stable blood volume in ERAT, patients did not rebuild the RIVC. Then, patients were selected some appropriate revascularization techniques for the hepatic and renal veins. Finally, all ERAT procedures were completed, and short- and long-term outcomes were observed.

Results

Five advanced HAE patients underwent ERAT without RIVC reconstruction. One patient died of circulatory failure 1 day after surgery. Another four patients, with a median follow-up duration of 18 months (range, 10–25 months), demonstrated normal liver and kidney function, no thrombosis and no HAE recurrence.

Conclusions

Through the long-term results of ERAT, the pros and cons of not reconstructing the RIVC need to be re-examined. In cases with a rich collateral circulation, the RIVC cannot be reconstructed. However, in cases requiring the resection of multiple organs, RIVC without reconstruction was prudential.
Therapeutic effect of intraductal saline irrigation in chronic obstructive sialadenitis
Authors: Kim Jo-Eun , Lee Sam-Sun , Lee Chena , Huh Kyung-Hoe , Yi Won-Jin , Heo Min-Suk , Choi Soon-Chul
Published: March 2020

Background

The aim of the present study was to evaluate the effectiveness of intraductal irrigation using normal saline in chronic obstructive sialadenitis.

Methods

Patients who had one of the following symptoms were recruited: pain, swelling, stiffness, and dry mouth. A total of 58 salivary glands in 33 patients were diagnosed as having sialadenitis using sialography and ultrasonography. The patients were divided into two groups (swelling group and dry mouth group), according to the major complaint. Repeated intraductal irrigation was performed on each gland. Difference of symptom severity evaluated using numerical rating scale (NRS), and ductal width measured using ultrasonography were compared between the two groups.

Results

The average NRS score was significantly decreased from 6.0 to 3.3 after 3–5 visits of intraductal irrigation (P < 0.05). The reduction in NRS was greater in the swelling group than in the dry mouth group, although the difference between the groups was not statistically significant. There was no change of ductal width before and after the irrigation.

Conclusions

Intraductal irrigation according to this study method using normal saline is a simple treatment for the patients with chronic obstructive sialadenitis. It provides a conservative treatment option reducing the subjective symptoms.
Is social capital protective against hospital readmissions?
Authors: Zlotnick Hanna , Hoffman Geoffrey J. , Nuliyalu Ushapoorna , Engler Tedi A. , Langa Kenneth M. , Ryan Andrew M.
Published: March 2020

Background

To evaluate the association between social capital and 30-day readmission to the hospital among Medicare beneficiaries overall, beneficiaries with dementia and related memory disorders, and beneficiaries with dual eligibility for Medicaid.

Methods

Using Health and Retirement Study (HRS) data linked with 2008–2015 Medicare claims from traditional Medicare beneficiaries hospitalized during the study period (1246 unique respondents, 2212 total responses), we examined whether dementia and related memory disorders and dual eligibility were associated with social capital. We then estimated a multiple regression model to test whether social capital was associated with a reduced likelihood of readmission.

Results

Dementia was associated with an − 0.241 standard deviation (sd) change in social capital (95% CI: − 0.378, − 0.103), dual eligibility with a − 0.461 sd change (95% CI: − 0.611, − 0.310), and the occurrence of both was associated with an additional − 0.236 sd change (95% CI: − 0.525, − 0.053). 30-day readmission rates were 14.47% over the study period. In both adjusted and unadjusted models, social capital was associated with small and nonsignificant differences in 30-day readmissions. These effects did not vary across dementia status and socioeconomic status.

Conclusions

Dementia and dual eligibility were associated with lower social capital, but social capital was not associated with the risk of readmission for any population.
Progress of equalizing basic public health services in Southwest China--- health education delivery in primary healthcare sectors
Authors: Zhang Rui , Chen Yong , Liu Shili , Liang Shengxiang , Wang Geng , Li Li , Luo Xingneng , Li Ying
Published: March 2020

Background

Equalizing basic public health services (BPHS) for all has been one goal of the health system reform in China since 2009. At the end of the 12th five-year plan, we conducted a series of surveys to understand BPHS implementation in Southwest China, and firstly reported implementation of health education (HE) and explore the barriers to HE delivery.

Methods

Mixed research methods were used to investigate achievement in and barriers to HE in Southwest China. SPSS 22.0 was used for data analysis.

Results

Nine hundred and eighty-nine residents were surveyed by questionnaire. 16 health care workers (HCWs) and 16 directors from 16 PHC sectors were included in the in-depth interviews. Less than 50% of residents who knew or utilized some item of HE. Age, residence, region (Chongqing or Guizhou), marital status, education, occupation, type and quality of primary health care (PHC) sectors to deliver BPHS, self-reported health and status of chronic diseases were associated with knowledge or utilization of HE. Distance to PHC sectors was associated with the knowledge of HE, gender and health insurance were associated with utilization of HE. Age, marital status, occupation region and self-reported health were associated with satisfaction regarding HE. Barriers to HE delivery included defects in HE design, weak capacity in PHC sectors to provide HE, residents’ poor cooperation, lack of multi-sector cooperation, poor equipment and weak health system.

Conclusions

Southwest China delivered HE in all PHC sectors. However, our study underlined many barriers to equalization of HE. To address those barriers and achieve HE quality improvement, comprehensive measures to improve capacity of PHC sectors, enhance multi-sector cooperation and strengthen health information systems are all urgent needs.
A micro-elimination approach to addressing hepatitis C in Turkey
Authors: Idilman Ramazan , Razavi Homie , Robbins-Scott Sarah , Akarca Ulus Salih , Örmeci Necati , Kaymakoglu Sabahattin , Aygen Bilgehan , Tozun Nurdan , Güner Rahmet , Bodur Hurrem , Lazarus Jeffrey V.
Published: March 2020

Background

In 2016, WHO passed the Global Health Sector Strategy on Viral Hepatitis (GHSS), calling for its elimination by 2030. Two years later, Turkey approved a strategy to reach the WHO targets. This study reports new national prevalence data, breaks it down by subpopulation, and models scenarios to reach HCV elimination.

Methods

Literature was reviewed for estimates of HCV disease burden in Turkey. They were discussed with stakeholders and used as inputs to develop a disease burden model. The infected population was estimated by sequelae for the years 2015–2030. Three scenarios were developed to evaluate the disease burden in Turkey: a Base 2017 scenario, representing the current standard of care in Turkey; an increased treatment scenario, representing the impact of improved access to DAAs; and a WHO targets scenario, which meet the WHO GHSS viral hepatitis targets of a 65% reduction in mortality and 90% diagnosis rate of the infected population by 2030.

Results

At the beginning of 2017, 271,000 viremic infections were estimated. Of these, 58,400 were diagnosed and 10,200 treated. Modelling results showed that, with the current treatment paradigm in Turkey, by 2030 the total number of viremic HCV infections would decline by 35%, while liver-related deaths, hepatocellular carcinoma (HCC), and decompensated cirrhosis would decrease by 10–25%. In theincreased treatment scenario, by 2030 viremic HCV infections would decrease by 50%; liver-related deaths, HCC and decompensated cirrhosis would decrease by 45–70%. In theWHO targets scenario, HCV infections would decrease by 80%; sequelae would decrease by 80–85%. Data on disease burden in micro-elimination target subpopulations are largely unavailable.

Conclusions

To meet the WHO Global Health Sector Strategy targets for the elimination of HCV, Turkey needs to increase treatment. Better data are needed as well as countrywide access to DAAs.
DDX39B interacts with the pattern recognition receptor pathway to inhibit NF-κB and sensitize to alkylating chemotherapy
Authors: Szymura Szymon J. , Bernal Giovanna M. , Wu Longtao , Zhang Zhongqin , Crawley Clayton D. , Voce David J. , Campbell Paige-Ashley , Ranoa Diana E. , Weichselbaum Ralph R. , Yamini Bakhtiar
Published: March 2020

Background

Nuclear factor-κB (NF-κB) plays a prominent role in promoting inflammation and resistance to DNA damaging therapy. We searched for proteins that modulate the NF-κB response as a prerequisite to identifying novel factors that affect sensitivity to DNA damaging chemotherapy.

Results

Using streptavidin-agarose pull-down, we identified the DExD/H-box RNA helicase, DDX39B, as a factor that differentially interacts with κB DNA probes. Subsequently, using both RNA interference and CRISPR/Cas9 technology, we demonstrated that DDX39B inhibits NF-κB activity by a general mechanism involving inhibition of p65 phosphorylation. Mechanistically, DDX39B mediates this effect by interacting with the pattern recognition receptor (PRR), LGP2, a pathway that required the cellular response to cytoplasmic double-stranded RNA (dsRNA). From a functional standpoint, loss of DDX39B promoted resistance to alkylating chemotherapy in glioblastoma cells. Further examination of DDX39B demonstrated that its protein abundance was regulated by site-specific sumoylation that promoted its poly-ubiquitination and degradation. These post-translational modifications required the presence of the SUMO E3 ligase, PIASx-β. Finally, genome-wide analysis demonstrated that despite the link to the PRR system, DDX39B did not generally inhibit interferon-stimulated gene expression, but rather acted to attenuate expression of factors associated with the extracellular matrix, cellular migration, and angiogenesis.

Conclusions

These results identify DDX39B, a factor with known functions in mRNA splicing and nuclear export, as an RNA-binding protein that blocks a subset of the inflammatory response. While these findings identify a pathway by which DDX39B promotes sensitization to DNA damaging therapy, the data also reveal a mechanism by which this helicase may act to mitigate autoimmune disease.
Phase-I trial of survivin inhibition with EZN-3042 in dogs with spontaneous lymphoma
Authors: Thamm Douglas H. , Joseph Jenette K. , Rose Barbara J. , Meuten Travis K. , Weishaar Kristen M.
Published: March 2020

Background

Lymphoma is a common cancer in dogs. While most dogs receiving chemotherapy experience remission, very few are cured, and median survival times are generally in the 12-month range. Novel approaches to treatment are unquestionably needed. The Inhibitor of Apoptosis Protein (IAP) family member survivin, which is one of the most commonly overexpressed proteins in human cancer, plays a key role in apoptosis resistance, a major cause of drug-resistant treatment failure. Survivin targeting therapies have shown promise preclinically; however, none have been evaluated in dogs to date. The goal of the current study was to determine the safety and pharmacodynamic effects of systemic administration of the anti-survivin locked nucleic acid antisense oligonucleotide EZN-3042 in dogs with lymphoma.

Results

We performed a prospective phase-I clinical trial in dogs with biopsy-accessible peripheral nodal lymphoma. Eighteen dogs were treated with EZN-3042 as a 2-h IV infusion at 5 dose levels, from 3.25 to 8.25 mg/kg twice weekly for 3 treatments. No dose-limiting toxicities were encountered. Reduction in tumor survivin mRNA and protein were observed in 3 of 5 evaluable dogs at the 8.25 mg/kg dose cohort.

Conclusions

In conclusion, reduced survivin expression was demonstrated in lymphoma tissues in the majority of dogs treated with EZN-3042 at 8.25 mg/kg twice weekly, which was associated with minimal adverse effects. This dose may be used in future studies of EZN-3042/chemotherapy combinations in dogs with spontaneous lymphoma and other cancers.
Characterization of a novel family VIII esterase EstM2 from soil metagenome capable of hydrolyzing estrogenic phthalates
Authors: Sarkar Jayita , Dutta Arindam , Pal Chowdhury Piyali , Chakraborty Joydeep , Dutta Tapan K.
Published: March 2020

Background

Microbes are rich sources of enzymes and esterases are one of the most important classes of enzymes because of their potential for application in the field of food, agriculture, pharmaceuticals and bioremediation. Due to limitations in their cultivation, only a small fraction of the complex microbial communities can be cultured from natural habitats. Thus to explore the catalytic potential of uncultured organisms, the metagenomic approach has turned out to be an effective alternative method for direct mining of enzymes of interest. Based on activity-based screening method, an esterase-positive clone was obtained from metagenomic libraries.

Results

Functional screening of a soil metagenomic fosmid library, followed by transposon mutagenesis led to the identification of a 1179 bp esterase gene, estM2, that encodes a 392 amino acids long protein (EstM2) with a translated molecular weight of 43.12 kDa. Overproduction, purification and biochemical characterization of the recombinant protein demonstrated carboxylesterase activity towards short-chain fatty acyl esters with optimal activity for p-nitrophenyl butyrate at pH 8.0 and 37 °C. Amino acid sequence analysis and subsequent phylogenetic analysis suggested that EstM2 belongs to the family VIII esterases that bear modest similarities to class C β-lactamases. EstM2 possessed the conserved S-x-x-K motif of class C β-lactamases but did not exhibit β-lactamase activity. Guided by molecular docking analysis, EstM2 was shown to hydrolyze a wide range of di- and monoesters of alkyl-, aryl- and benzyl-substituted phthalates. Thus, EstM2 displays an atypical hydrolytic potential of biotechnological significance within family VIII esterases.

Conclusions

This study has led to the discovery of a new member of family VIII esterases. To the best of our knowledge, this is the first phthalate hydrolase (EstM2), isolated from a soil metagenomic library that belongs to a family possessing β-lactamase like catalytic triad. Based on its catalytic potential towards hydrolysis of both phthalate diesters and phthalate monoesters, this enzyme may find use to counter the growing pollution caused by phthalate-based plasticizers in diverse geological environment and in other aspects of biotechnological applications.
Porous gold nanoparticles for attenuating infectivity of influenza A virus
Authors: Kim Jinyoung , Yeom Minjoo , Lee Taeksu , Kim Hyun-Ouk , Na Woonsung , Kang Aram , Lim Jong-Woo , Park Geunseon , Park Chaewon , Song Daesub , Haam Seungjoo
Published: March 2020

Background

Influenza viruses (IVs) have become increasingly resistant to antiviral drugs that target neuraminidase and matrix protein 2 due to gene mutations that alter their drug-binding target protein regions. Consequently, almost all recent IV pandemics have exhibited resistance to commercial antiviral vaccines. To overcome this challenge, an antiviral target is needed that is effective regardless of genetic mutations.

Main body

In particular, hemagglutinin (HA), a highly conserved surface protein across many IV strains, could be an effective antiviral target as it mediates binding of IVs with host cell receptors, which is crucial for membrane fusion. HA has 6 disulfide bonds that can easily bind with the surfaces of gold nanoparticles. Herein, we fabricated porous gold nanoparticles (PoGNPs) via a surfactant-free emulsion method that exhibited strong affinity for disulfide bonds due to gold–thiol interactions, and provided extensive surface area for these interactions. A remarkable decrease in viral infectivity was demonstrated by increased cell viability results after exposing MDCK cells to various IV strains (H1N1, H3N2, and H9N2) treated with PoGNP. Most of all, the viability of MDCK cells infected with all IV strains increased to 96.8% after PoGNP treatment of the viruses compared to 33.9% cell viability with non-treated viruses. Intracellular viral RNA quantification by real-time RT-PCR also confirmed that PoGNP successfully inhibited viral membrane fusion by blocking the viral entry process through conformational deformation of HA.

Conclusion

We believe that the technique described herein can be further developed for PoGNP-utilized antiviral protection as well as metal nanoparticle-based therapy to treat viral infection. Additionally, facile detection of IAV can be achieved by developing PoGNP as a multiplatform for detection of the virus.
Volume replacement with diced acellular dermal matrix in oncoplastic breast-conserving surgery: a prospective single-center experience
Authors: Gwak Hongki , Jeon Ye-Won , Lim Seung-Taek , Park Seon-Young , Suh Young-Jin
Published: March 2020

Background

Several studies have reported the use of acellular dermal matrix in breast reconstruction. However, the primary role of acellular dermal matrix in these studies was to support the implant; there are no reports on the use of acellular dermal matrix exclusively as volume replacement. Thus, we aimed to evaluate the safety and effectiveness of filling of the defect with acellular dermal matrix in oncoplastic breast-conserving surgery.

Methods

We prospectively recruited 120 adult breast cancer patients who were scheduled to undergo oncoplastic breast-conserving surgery with acellular dermal matrix filling from 2017 to 2018. Intraoperatively, diced human acellular dermal matrix measuring 3–5 mm was used on each side to fill in the excisional defect immediately. After 6 months, satisfaction of the patients and surgeons with overall and cosmetic outcomes was evaluated with a survey using a 10-point scale. Postoperative complications were assessed at 2 weeks and 6 months postoperatively.

Results

Of the 117 patients who were evaluated for their satisfaction, 94.0% were strongly satisfied with the cosmetic outcomes and 90.4% were strongly satisfied overall. Patient overall satisfaction scores were higher than surgeon satisfaction scores (p < 0.001). Of the 117 patients who underwent evaluation of complications 6 months postoperatively, six (5.1%) had hematoma and seven (6.0%) had seroma. The overall reoperation rate due to complications was 8.5%. Only two patients needed acellular dermal matrix removal due to hematoma and inflammation.

Conclusion

Oncoplastic breast-conserving surgery with acellular dermal matrix filling of defects can be performed safely with high cosmetic satisfaction.

Trial registration

ICTRP, KCT0003886; retrospectively registered May 3, 2019, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=KCT0003886
Historical ethnobotanical review of medicinal plants used to treat children diseases in Romania (1860s–1970s)
Authors: Petran Madalina , Dragos Dorin , Gilca Marilena
Published: March 2020

Background

Romanian ethnopediatrics has a long history of medicinal plant use. The main objective of the present review was to identify, collect, systematize, and prioritize the available bibliographical data related to medicinal plants traditionally used to treat various pediatric diseases in Romania during the 1860s–1970s.

Methods

Information was mainly obtained by manual systematic search in various relevant historical works focused on the traditional use of medicinal plants in Romania (1860s–1970s), found in the Archives of Romanian Academy Library and National Romanian Library.

Results

A total of 153 medicinal plants belonging to 52 families were identified as having ethnopediatric significance. The plant traditional indications, targeted body systems, parts used, and way of administration were provided. We have also proposed one index (expressed as percentage) in order to assess the ethnopediatric applicability area of species: ethnopediatric relative therapeutic versatility (ERTV), which was calculated on the basis of the number of distinct uses mentioned for a species. The species identified to have the highest ERTV scores wereDryopteris filix-mas(100%),Gratiola officinalis(85.71%),Allium sativum(71.42%),Eryngium planum(71.42%),Juglans regia(71.42%),Matricaria chamomilla(71.42%),Plantago major(71.42%).

Conclusions

The present study exposed for the first time to the international scientific community important ethnopediatric information contained in several local Romanian bibliographical resources that could guide the local and international researchers towards new directions of plant valorization.
Does surgical treatment produce better outcomes than conservative treatment for acute primary patellar dislocations? A meta-analysis of 10 randomized controlled trials
Authors: Xing Xuewu , Shi Hongyu , Feng Shiqing
Published: March 2020

Purpose

The objective of this study was to conduct the latest meta-analysis of randomized controlled trials (RCTs) that compare clinical results between surgery and conservative therapy of acute primary patellar dislocation (APPD), focusing on medial patellofemoral ligament (MPFL) reconstruction.

Methods

We performed a literature search in Embase, The Cochrane Library, PubMed, and Medline to identify RCTs comparing APPD surgical treatment with conservative treatment from the establishment of each database to January 2019. The methodological quality of each RCT was assessed independently by the two authors through the Cochrane Collaboration’s “Risk of Bias” tool. Mean differences of continuous variables and risk ratios of dichotomous variables were computed for the pooled data analyses. The I2 statistic and the χ2 test were used to evaluate heterogeneity, with the significance level set at I2 > 50% or P < 0.10.

Results

Ten RCTs with a sum of 569 patients (297 receiving surgical treatment and 263 receiving conservative treatment) met the inclusion criteria for meta-analysis. Pooled data analysis showed no statistical difference in the field of subluxation rate, Kujala score, patient satisfaction, and frequency of reoperation between the two groups. Tegner activity score and recurrent dislocation rate in the conservative group were significantly higher than those in the surgically treated group.

Conclusions

Conservative treatment may produce better outcomes than surgery for APPD in consideration of Tegner activity score. However, in view of limited research available, the interpretation of the discoveries should be cautious. More convincing evidence is required to confirm the effect of MPFL reconstruction.
Five year mortality and direct costs of care for people with diabetic foot complications are comparable to cancer
Authors: Armstrong David G. , Swerdlow Mark A. , Armstrong Alexandria A. , Conte Michael S. , Padula William V. , Bus Sicco A.
Published: March 2020

Background

In 2007, we reported a summary of data comparing diabetic foot complications to cancer. The purpose of this brief report was to refresh this with the best available data as they currently exist. Since that time, more reports have emerged both on cancer mortality and mortality associated with diabetic foot ulcer (DFU), Charcot arthropathy, and diabetes‐associated lower extremity amputation.

Methods

We collected data reporting 5‐year mortality from studies published following 2007 and calculated a pooled mean. We evaluated data from DFU, Charcot arthropathy and lower extremity amputation. We dichotomized high and low amputation as proximal and distal to the ankle, respectively. This was compared with cancer mortality as reported by the American Cancer Society and the National Cancer Institute.

Results

Five year mortality for Charcot, DFU, minor and major amputations were 29.0, 30.5, 46.2 and 56.6%, respectively. This is compared to 9.0% for breast cancer and 80.0% for lung cancer. 5 year pooled mortality for all reported cancer was 31.0%.

Direct costs of care for diabetes in general was $237 billion in 2017. This is compared to $80 billion for cancer in 2015. As up to one‐third of the direct costs of care for diabetes may be attributed to the lower extremity, these are also readily comparable.

Conclusion

Diabetic lower extremity complications remain enormously burdensome. Most notably, DFU and LEA appear to be more than just a marker of poor health. They are independent risk factors associated with premature death. While advances continue to improve outcomes of care for people with DFU and amputation, efforts should be directed at primary prevention as well as those for patients in diabetic foot ulcer remission to maximize ulcer‐free, hospital‐free and activity‐rich days.
Development, characterization, and cross-amplification of polymorphic microsatellite markers for North American Trachymyrmex and Mycetomoellerius ants
Authors: Matthews Alix E. , Rowan Chase , Stone Colby , Kellner Katrin , Seal Jon N.
Published: March 2020

Objective

The objective of this study is to develop and identify polymorphic microsatellite markers for fungus-gardening (attine) ants in the genusTrachymyrmexsensu lato. These ants are important ecosystem engineers and have been a model group for understanding complex symbiotic systems, but very little is understood about the intraspecific genetic patterns across most North American attine species. These microsatellite markers will help to better study intraspecific population genetic structure, gene flow, mating habits, and phylogeographic patterns in these species and potentially other congeners.

Results

Using next-generation sequencing techniques, we identified 17 and 12 polymorphic microsatellite markers fromT. septentrionalisandMycetomoellerius(formerlyTrachymyrmex)turrifex, respectively, and assessed the genetic diversity of each marker. We also analyzed the cross-amplification success of theT. septentrionalismarkers in two other closely relatedTrachymyrmexspecies, and identified 10 and 12 polymorphic markers forT. arizonensisandT. pomonae, respectively.
Challenges and practical recommendations for successfully recruiting inactive, statin-free older adults to clinical trials
Authors: Deane Colleen S. , Phillips Bethan E. , Smith Kenneth , Steele Anna M. , Libretto Tina , Statton Sarah A. , Atherton Philip J. , Etheridge Timothy
Published: March 2020

Objectives

To outline the challenges and provide practical recommendations for recruiting inactive, statin-free older adults to facilitate feasible study designs. Data was obtained from a double-blind randomised-controlled clinical trial investigating the effects of acipimox versus placebo on muscle function and metabolism in older (65–75 years), inactive, statin-free males. The initial recruitment target was 20 volunteers within 12 months (November 2016–November 2017).

Results

Recruitment occurred via the Exeter 10,000 database containing 236 ‘eligible’ males, a Facebook campaign reaching > 8000 ≥ 65 years old males, 400 directly-addressed letters to ≥ 66 year old males, > 1500 flyers distributed within the community, > 40 emails to local community groups, 4 recruitment talks, 2 magazine adverts and 1 radio advert. Widespread recruitment efforts reaching > 120,000 people led to the recruitment of 20 volunteers (18 completed the clinical trial) within a 25-month timeframe, highlighting the challenge of the timely recruitment of inactive, statin-free older adults for clinical trials. We recommend recruitment for future clinical trials should take a multi-pronged approach from the outset, prioritising the use of volunteer databases, Facebook campaigns and delivering recruitment talks.
Circulating tumour cell liquid biopsy in selecting therapy for recurrent cutaneous melanoma with locoregional pelvic metastases: a pilot study
Authors: Guadagni Stefano , Fiorentini Giammaria , Papasotiriou Ioannis , Apostolou Panagiotis , Masedu Francesco , Sarti Donatella , Farina Antonietta Rossella , Mackay Andrew Reay , Clementi Marco
Published: March 2020

Objectives

Circulating tumour cells (CTCs) from liquid biopsies provide an exceptional opportunity to obtain real-time tumour information and are under current investigation in several cancers, including cutaneous melanoma, but face significant drawbacks in terms of non-standardised methodology, low viable cell numbers and accuracy of CTC identification. In this pilot study, we report that chemosensitivity assays using liquid biopsy-derived metastatic melanoma (MM) CTCs, from 7 patients with stage IIIC, BRAF wild-type metastatic melanomas, localized exclusively to the pelvic region, un-eligible for immunotherapy and treated with melphalan hypoxic pelvic perfusion (HPP), is both feasible and useful in predicting response to therapy. Viable MM CTCs (> 5 cells/ml for all 7 blood samples), enriched by transient culture, were characterised in flow cytometry-based Annexin V-PE assays for chemosensitivity to several drugs.

Results

Using melphalan as a standard, chemosensitivity cut-off values of > 60% cell death, were predictive of patient RECIST 1.1 response to melphalan HPP therapy, associated with calculated 100% sensitivity, 66.67% specificity, 33.33% positive predictive, 100% negative predictive, and 71.43% accuracy values. We propose that the methodology in this study is both feasible and has potential value in predicting response to therapy, setting the stage for a larger study.

Trial registration Clinical Trials.gov Identifier NCT01920516; date of trial registration: August 6, 2013
Laparoscopic surgery for diverticular colovesical fistula: single-center experience of 11 cases
Authors: Kitaguchi Daichi , Enomoto Tsuyoshi , Ohara Yusuke , Owada Yohei , Hisakura Katsuji , Akashi Yoshimasa , Takahashi Kazuhiro , Ogawa Koichi , Shimomura Osamu , Oda Tatsuya
Published: March 2020

Objective

Laparoscopic surgery for diverticular colovesical fistula (CVF) is technically challenging, and the incidence of conversion to open surgery (COS) is high. This study aimed to review our experience with laparoscopic surgery for diverticular CVF and identify preoperative risk factors for COS.

Results

This was a single institution, retrospective, observational study of 11 patients (10 males and 1 female) who underwent laparoscopic sigmoid colon resection with fistula resection for diverticular CVF from 2014 to 2019. Preoperative magnetic resonance imaging (MRI) was performed to evaluate the fistula location in the bladder, patency of the rectovesical pouch (i.e., the destination of dissection procedure between sigmoid colon and bladder) and estimate the contact area between the sigmoid colon and bladder. The relationship between preoperative variables and COS incidence was analyzed between completed laparoscopy and COS groups. The overall incidence of postoperative morbidity (Clavien–Dindo classification Grade II or higher) was 36% (4/11). Severe morbidity, reoperation, and mortality were not observed. The incidence of COS was 27% (3/11). Posterior bladder fistulas were significantly associated with COS. CVFs located on the posterior bladder appears to be a risk factor for COS. Identifying risk factors for COS preoperatively could help guide the intraoperative course.
The age-related effect on cognitive performance in cognitively healthy elderly is mainly caused by underlying AD pathology or cerebrovascular lesions: implications for cutoffs regarding cognitive impairment
Authors: Borland Emma , Stomrud Erik , van Westen Danielle , Hansson Oskar , Palmqvist Sebastian
Published: March 2020

Background

As research in treatments for neurocognitive diseases progresses, there is an increasing need to identify cognitive decline in the earliest stages of disease for initiation of treatment in addition to determining the efficacy of treatment. For early identification, accurate cognitive tests cutoff values for cognitive impairment are essential.

Methods

We conducted a study on 297 cognitively healthy elderly people from the BioFINDER study and created subgroups excluding people with signs of underlying neuropathology, i.e., abnormal cerebrospinal fluid [CSF] β-amyloid or phosphorylated tau, CSF neurofilament light (neurodegeneration), or cerebrovascular pathology. We compared cognitive test results between groups and examined the age effect on cognitive test results.

Results

In our subcohort without any measurable pathology (n = 120), participants achieved better test scores and significantly stricter cutoffs for cognitive impairment for almost all the examined tests. The age effect in this subcohort disappeared for all cognitive tests, apart from some attention/executive tests, predominantly explained by the exclusion of cerebrovascular pathology.

Conclusion

Our study illustrates a new approach to establish normative data that could be useful to identify earlier cognitive changes in preclinical dementias. Future studies need to investigate if there is a genuine effect of healthy aging on cognitive tests or if this age effect is a proxy for higher prevalence of preclinical neurodegenerative diseases.
Can routine perioperative haemodynamic parameters predict postoperative morbidity after major surgery?
Authors: Bonnet Jean-Francois , Buggy Eleanor , Cusack Barbara , Sherwin Aislinn , Wall Tom , Fitzgibbon Maria , Buggy Donal J.
Published: March 2020

Background

Postoperative morbidity occurs in 10–15% of patients undergoing major noncardiac surgery. Predicting patients at higher risk of morbidity may help to optimize perioperative prevention. Preoperative haemodynamic parameters, systolic arterial pressure (SAP) < 100 mmHg, pulse pressure (PP) > 62 mmHg or < 53 mmHg, and heart rate (HR) > 87 min-1 are associated with increased postoperative morbidity. We evaluated the correlation between these and other routine haemodynamic parameters, measured intraoperatively, with postoperative morbidity. Postoperative morbidity was measured using the Comprehensive Complication Index (CCI) and length of stay (LOS). Additionally we correlated CCI with the cardiac risk biomarker, preoperative NT-ProBNP.

Methods

This is a retrospective analysis of patients in MET-REPAIR, a European observational study correlating self-reported physical activity with postoperative morbidity. Patients’ electronic anaesthetic records (EARs) including perioperative haemodynamic data were correlated with 30-day postoperative morbidity, CCI and LOS parameters. Statistical analysis to assess for correlation was by Kendall’s Correlation Coefficient for tied ranks (Tau-B) or Spearman’s Correlation Coefficient. Blood for N-terminal prohormone of brain natriuretic peptide (NT-proBNP) measurement was collected < 31 days before surgery.

Results

Data from n = 50 patients were analysed. When stratified according to age > 70 years and ASA > 3, the duration of MAP < 100 mmHg, < 75 mmHg or < 55 mmHg were associated with a higher CCI (tau = 0.57, p = 0.001) and duration < 75 mmHg was associated with prolonged LOS (tau = 0.39, p = 0.02). The intraoperative duration of PP > 62 mmHg was associated with LOS (tau = 0.317, p = 0.007). There was no correlation between preoperative NT-proBNP and either CCI or LOS.

Conclusions

In older and higher risk patients, duration of intraoperative hypotension by a variety of definitions, or PP > 62 mmHg, are associated with increased postoperative CCI and LOS. These findings warrant confirmation in larger databases with evaluation of whether real-time intraoperative intervention could reduce postoperative morbidity.
Early age at menarche and its associated factors in school girls (age, 10 to 12 years) in Bangladesh: a cross-section survey in Rajshahi District, Bangladesh
Authors: Malitha Jannatul Maowa , Islam Md. Ariful , Islam Saima , Al Mamun Abu Sayed Md. , Chakrabarty Suman , Hossain Md. Golam
Published: March 2020

Background

Early onset of menarche is one of the most important factors for breast cancer and other associated health hazards. The aim of this study was to investigate the early age at menarche and its associated factors in school girls (age, 10–12 years) in Rajshahi District, Bangladesh.

Methods

Data was collected from Rajshahi District, Bangladesh, using multistage random sampling. Independent sample t test and binary logistic regression model were used in this study. A total number of 386 school girls aged 10–12 years were considered as a sample for this study.

Results

This study revealed that more than 48% girls already attained menarche within the age of 12 years, among them 25.6%, 41.0%, and 58.3% girls experienced menarche at the age of 10, 11, and 12 years, respectively. It was observed that the menarcheal girls were significantly taller (p < 0.01) and heavier (p < 0.01) than non-menarcheal girls. The menarcheal girls’ mothers were heavier (p < 0.01), shorter (p < 0.01), had more BMI (p < 0.01), reached menarche (p < 0.05) earlier than non-menarcheal girls’ mothers. Menarcheal girls had less number of siblings (p < 0.01) and lower order of birth (p < 0.05) than non-menarcheal girls. After controlling the effect of other factors, multiple logistic regression model demonstrated that obese girls were more likely to attain menarche than under- [AOR = 0.279, CI 95% 0.075–0.986; p < 0.05] and normal [AOR = 0.248, CI 95% 0.082–0.755; p < 0.05] weight girls. Urban school girls had more chance to get menarche than rural school girls at same age (AOR = 0.012, 95% CI 0.003–0.047; p < 0.01).

Conclusions

Therefore, modern lifestyle changes may have the important factors for early age at menarche of the studied girls in Bangladesh.
The 3D stress state from geomechanical–numerical modelling and its uncertainties: a case study in the Bavarian Molasse Basin
Authors: Ziegler Moritz O. , Heidbach Oliver
Published: March 2020

Knowledge of the undisturbed stress state is a key parameter for borehole stability, productivity and induced seismicity hazard assessment. Due to the sparse and incomplete availability of data records, 3D geomechanical–numerical modelling is applied to estimate the stress state in a volume. To assess the quality of the model results, the model uncertainties have to be quantified. We present an approach that provides the uncertainties of the six independent stress tensor components at each location in the model volume by an average value and its standard deviation. We explore the uncertainties introduced to the model results with respect to the stress magnitude data used for model calibration. We test our approach on a model of the Bavarian Molasse Basin which includes the area around Munich with many geothermal projects. In the test area, we find large uncertainties in the modelled magnitude of the maximum horizontal stress ($$\text{S}_\text {Hmax}$$SHmax) in the order of 15–30%. The uncertainties in the magnitude of the minimum horizontal stress ($$\text{S}_\text {hmin}$$Shmin) are smaller between 5 and 20%. In connection with an adequate failure criterion, we compare our model results to the seismological observations at two neighbouring geothermal projects. Whilst Aschheim/Feldkirchen/Kirchheim remained seismically quiet, induced seismicity was recorded in Poing. Our modelled undisturbed stress state was confirmed by these observations by showing in average a stable stress state in Aschheim/Feldkirchen/Kirchheim and a critical stress state in Poing. If the uncertainties in terms of two standard deviations are considered, this does not change. This demonstrates the increase in model significance when uncertainties are available.
Reconstruction of geothermal boreholes in Poland
Authors: Bujakowski Wiesław , Bielec Bogusław , Miecznik Maciej , Pająk Leszek
Published: March 2020

The beginnings of geothermal implementation research in Poland date back to 1989–1993 when the Mineral and Energy Economy Research Institute of the Polish Academy of Sciences (MEERI PAS) launched the first geothermal installation in the Podhale region, using the reconstructed Bańska IG-1 well. The knowledge acquired during these 30 years has highlighted the importance of geothermal energy—among other things, borehole reconstruction operations and the need for their further refinement. The technologies developed have been used in virtually all geothermal heating systems operating in Poland. Examples of successful reconstruction work include the Bańska IG-1 and Biały Dunajec PAN-1 wells operated by the PEC Geotermia Podhalańska S.A. geothermal company. The Mszczonów IG-1 well, which is operated by the Geotermia Mazowiecka S.A. heating company, has also undergone considerable work almost 24 years after its complete closure. Reconstruction processes can also be important in adapting existing wells for geothermal purposes. After World War II, more than 8000 boreholes deeper than 1000 m were drilled in Poland. They were primarily made for the purpose of geological surveys and hydrocarbon exploration. Some of these boreholes can be adapted for operation in geothermal systems. The paper presents selected methods of reconstructing abandoned, disused (not abandoned and not decommissioned) or damaged boreholes in order to use them in the geothermal water extraction process. Four examples of borehole reconstruction, designed and carried out with the participation of MEERI PAS in Kraków, are discussed in more detail.
Class structure and income inequality in transitional China
Authors: Liu Xin
Published: March 2020

Integrating Kornai’s concept of coordination mechanism and Weber’s types of domination, the author argues that, based on the different property rights embedded within the state power structure, bureaucratic and market coordination define class positions in bureaucratic domination by virtue of authority and in market domination by virtue of market capacity. Class relations are defined as relations of domination and economic interest distribution. A class framework composed of 16 class positions is constructed in terms of authority or market capacity in dual domination. The seven-class scheme generated by aggregation of the 16 class positions fits well with a four-cluster model estimated with latent class analysis of the 2010 CGSS, suggesting that the proposed framework is empirically relevant. The statistical findings also show that, compared to advanced industrialized societies, China has a larger proportion of command classes, a relatively equal share of new and old middle classes, and a smaller working class. China has significantly more farmers, especially in the central and western regions. The class structure is olive-shaped in the eastern region but “圭” (gui)-shaped in the central and western regions. The proposed class scheme can significantly predict income inequality, supporting the argument that class relations have the character of a “domination-interest duality.”