bluuebunny/crossref_metadata_2025 huggingface dataset:
Better Short-term Function After Unicompartmental Compared to Total Knee Arthroplasty
Authors: Tille Eric , Beyer Franziska , Auerbach Kai , Tinius Marco , Lützner Jörg
Published: December 2020

BackgroundUnicompartmental knee arthroplasty (UKA) is an established treatment option for patients with unicompartmental osteoarthritis (OA). However, strict patient selection is crucial for its success. The proposed advantages include nearly natural knee kinematics, faster rehabilitation and better functional outcomes. Despite these facts and it’s proven cost-effectiveness, there are hesitations for the use of UKA as an alternative to total knee arthroplasty (TKA). Key objectives of this study were therefore to assess clinical and patient-reported-outcome (PRO) as well as patient’s satisfaction after medial UKA in comparison to TKA. MethodsTo assess the outcome after UKA we conducted a prospective multi-center study. 116 patients with unicompartmental OA and indication for UKA were included. Overall 54 females and 62 males with an average age of 62.7 years (±9.8) and an average body mass index (BMI) of 29.2 (± 3.7) were recruited. Clinical results and PRO were assessed using the Knee Society Score (KSS). Follow-ups took place 3 months, 1 and 2 years after surgery including clinical examination, radiographs, assessment of PRO and adverse events. Pain and satisfaction were evaluated using a visual analog scale (VAS, 0 (worst) to 10 (best)).For comparison with TKA a propensity score matched-pair analysis was performed to eliminate confounders. Matching criteria were gender, patient´s age, BMI and comorbidities. A total of 116 matched-pairs were analysed. ResultsThere was no revision in the UKA group until 2 years after surgery. Revision rates were higher in the TKA group (0.6%).Preoperative KSS-Scores were higher within the UKA cohort (p < 0.001). After surgical treatment, PROMs displayed a significant improvement (p < 0,001) in both cohorts. Regarding the Knee-Score (Pain, Alignment, ROM) we observed no differences between cohorts after 12 months. The Function-Score demonstrated significantly better results in the UKA cohort (UKA vs. TKA 95 vs 80, p < 0.001). Patient satisfaction was higher in UKA patients (UKA vs TKA 9.0 vs 8.8, p = 0.019).ConclusionPatients of both cohorts showed high satisfaction after knee arthroplasty. UKA resulted in higher function scores compared to TKA without increased revision rate during short-term follow-up. Therefore, UKA is a good treatment option for unicompartmental OA. Trial registrationClinicaltrials.gov, NCT04598568. Registered 22 October 2020 - Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/record/NCT04598568?cond=balanSys+Uni&draw=2&rank=1
Optimal Preparation of COVID-19 Viral Transport Medium for Culture
Authors: McAuley Julie , Fraser Claire , Paraskeva Elena , Trajcevska Elizabeth , Sait Michelle , Wang Nancy , Burt Eric , Purcell Damian , Strugnell Richard
Published: December 2020

IntroductionThe sudden arrival of the COVID-19 pandemic placed significant stresses on supply chains including viral transport medium (VTM). The VTM that was urgently required needed to support viral replication, as well as other routine diagnostic approaches. We describe the preparation and validation testing of VTM for rapidly expanding diagnostic testing, where the capacity of the VTM to preserve viral integrity, for culture, isolation and full sequence analysis, was maintained.MethodsVTM was prepared using different methods of sterilization then ‘spiked’ with virus. The VTM was investigated using viral culture in Vero cells, and for nucleic acid detection by quantitative PCR (qPCR).ResultsThe best results were obtained by filter and autoclave-based sterilization. The VTM proved robust for culture-based analyses provided the inoculated VTM was stored at 4oC, and tested within 48 hours. The filtered VTM also supported PCR-based diagnosis for at least 5 days when the mock inoculated VTM was held at room temperature (RT).DiscussionThe manual handling of VTM production, including filling and sterilization, was optimized. SARS-CoV-2 was spiked into VTM to assess different sterilization methods and measure the effects of storage time and temperature upon VTM performance. While most diagnostic protocols will not require replication competent virus, the use of high quality VTM will allow for the next phase of laboratory analysis in the COVID-19 pandemic, including drug and antibody susceptibility analysis of re-isolated SARS--CoV-2, and for the testing of vaccine escape mutants.
Nearfield trapping increases lifetime of single-molecule junction by one order of magnitude
Authors: Aragonès Albert C. , Domke Katrin F.
Published: December 2020

Progress in molecular electronics (ME) is largely based on improved understanding of the properties of single molecules (SM) trapped for seconds or longer to enable their detailed characterization. We present a plasmon-supported break-junction (PBJ) platform to significantly increase the lifetime of SM junctions of 1,4-benzendithiol (BDT) without the need for chemical modification of molecule or electrode. Moderate far-field power densities of ca. 11 mW/µm2 lead to a >10-fold increase in minimum lifetime compared to laser-OFF conditions. The nearfield trapping efficiency is twice as large for bridge-site contact compared to hollow-site geometry, which can be attributed to the difference in polarizability. Current measurements and tip-enhanced Raman spectra confirm that native structure and contact geometry of BDT are preserved during the PBJ experiment. By providing a non-invasive pathway to increase short lifetimes of SM junctions, PBJ is a valuable approach for ME, paving the way for improved SM sensing and recognition platforms.
Modified Cancer TNM Classification for Localized Renal Cell Carcinoma based on the Prognostic Analysis of 3748 Cases from a Single Center
Authors: Zhang Jian , Li Xiaoli , Lin Jun , Liu Zhijia , Chen Changqing , Tao Yu , Tian Ye , Wang Qiang
Published: December 2020

Background The optimal cutoff point for evaluating the prognosis of localized renal cell carcinoma remains unclear. The study aimed to verify the efficacy of tumor diameter in the 2010 AJCC TNM staging system and put forward modification for TNM staging on the prognosis. Methods 3748 patients with localized renal cell carcinoma were enrolled and grouped according to the 2010 AJCC TNM staging system. COX analysis was used to stratify the prognosis and optimal cutoff point of the tumor diameter in the T1 and T2 prognosis was explored. Results 3330 (88.9%) were in stage T1 and 418 (11.1%) were in stage T2. The cancer-specific mortality rate was 2.7% (100/3748). Mean follow-up was 49.8 months. The analysis of tumor diameter at 7 cm can greatly determine the prognosis of patients at stages T1 and T2. However, the tumor diameters of 4.5 and 11 cm set as the cutoff points for T1 and T2 subclassifications of patients with LRCC seemed to have better recognition ability than 4 and 10 cm, respectively. Conclusions The 2010 AJCC TNM stage can greatly predict the prognosis of LRCC in stages T1 and T2. In addition, 4.5 and 11 cm might be optional cutoff points for the tumor diameters for subclassifying stages T1 and T2.
Establishment of a Risk Factor and Clinical Prediction Model for Distal Metastasis and Prognosis of Ewing Sarcoma: A SEER-Based Study
Authors: LI WENLE , HU Zhaohui , wang yonghui , Chen Wenyang , HE Keyun , QIN Chuan , GAO Sen
Published: December 2020

Background: the purpose of this study was to establish and validate a clinical predictive model for predicting the risk of metastasis and survival of patients with Ewing sarcoma. Methods: the data of patients diagnosed with Ewing' sarcoma (ES) from 2004 to 2015 were collected from the Surveillance, Epidemiology and final results Database (The Surveillance, Epidemiology, and End Results, SEER). By excluding vacancy data and random number method, the screened data were divided into training set (nasty 2520) and verification set (nasty 1076). Logistic regression analysis was used to analyze the risk factors related to tumor metastasis, and Kaplan-Meier curve and Cox proportional hazard model were used to explore the related risk factors affecting patient survival. A visual line chart (Nomogram) based on the above analysis was developed to predict ES tumor metastasis and patient's 3-and 5-year survival probability, and to verify it. Results: in the analysis of tumor metastasis, it was found that age over 60 years old, operation, tumor volume, radiotherapy and chemotherapy were the high risk factors of tumor metastasis. The establishment of Nomogram, to predict the risk of tumor metastasis and the use of ROC curve showed that the predictive model had better predictive ability (AUC=0.744,95%CI0.721-0.768), which could predict the existence of tumor metastasis. In the survival analysis of the training set, age (20-29, 30-60, > 60), location of tumor (axial, bone, facial bone), mode of operation (local excision, radical resection), number of primary tumor (multiple), tumor stage M (M 1,), Stage Group (II,III,IV,UNK stage), tumor volume (5 cm 10 cm, greater than 10cm), spread range (local metastasis). Distal metastasis), radiotherapy and chemotherapy are independent prognostic factors of patients. The Nomogram, established to predict 3 years and 5 years of patients is verified by the verification set, which shows a good consistency (c index = 0.747, 95% CI, 0.696-0.797).Conclusion: Nomogram with good predictive ability is developed to predict the risk of tumor metastasis and the 3-and 5-year survival rate of patients with ES. External data validation is still needed in future clinical applications, especially outside the United States.
A nomogram to Predict the Upgrading Rate of ISUP grades of Radical Prostatectomy in Patients Undergoing Transrectal Prostate Biopsy and Transperineal Prostate Cognitive Fusion Biopsy
Authors: Zhang Zhilei , Qin Fei , Ma Guofeng , Yuan Hang , Yu Yongbo , Sun Yefeng , Jiang Yanxia , Jiao Wei , Zhang Mingxin , Niu Haitao
Published: December 2020

Backgroud: This study was aimed to develop and internally validate an ISUP (International Society of Urology Pathology) upgrade risk nomogram from the biopsy tissue to the specimen of radical prostatectomy. Methods: The clinical characteristics of 166 patients with prostate cancer were retrospectively analyzed, who were divided into two groups based on the upgrade of ISUP between the biopsy tissue and radical prostatectomy specimen. Logistic regression analysis was used to predict the significant independent factors of ISUP upgrade, a nomogram was established to predict ISUP upgrade of prostatectomy specimen based on the significant factors. The C-index, calibration plot, and decision curve analysis were used to assess the discrimination, calibration, and clinical usefulness of the predicting model. Internal validation was evaluated by using the bootstrapping validation. Results: There were 47 patients in the ISUP upgrade group and 119 patients in the no ISUP upgrade group respectively. Patients in the ISUP upgrade group inclined to be younger age, smaller PV, lower GS scores and PB-ISUP than the no ISUP upgrade group (p=0.043, p=0.041, p < 0.001, p =0.04, respectively), Multivariate logistic regression analysis showed that PSA≥20 ng/ml (OR=8.558, P=0.024), Gleason score of PCa≤6 (OR=9.026, P=0.004), PB-ISUP=3,4vs5 (OR=23.232, P=0.000417; OR=26.72, P=0.000241), ways of prostate biopsy (TP-SB+COG-TB (transperineal prostate biopsy + cognitive fusion targeted biopsy) VS TR-SB (transrectal prostate system biopsy), OR=033, P=0.036) and number of positive cores < 10 (OR=0.21, P=0.002) were the independent risk factors for ISUP upgrade. A prediction nomogram model of ISUP upgrade was built based on these significant factors above, the area under the receiver operating characteristic (AUC) curve of which was 0.843. The C-index for the prediction nomogram was 0.871 (95% CI: 0.817–0.925) and the nomogram showed good calibration. Decision curve analysis also demonstrated that the threshold value of RP-ISUP upgrade risk was 1% to 89%. Conclusion: A novel nomogram incorporating PSA, Gleason score of PCa, PB-ISUP, ways of prostate biopsy and number of positive cores was built with a relatively good accuracy to assist clinicians to evaluate the risk of ISUP upgrade in the radical prostatectomy specimen, especially for the low-risk prostate cancer diagnosed by TR-SB.
Exploring Media Framing Of Abortion Content on Kenyan Television: A Qualitative Study Protocol
Authors: Kafu Catherine , Ligaga Dina , Wachira Juddy
Published: December 2020

Background: Media framing of abortion messages is an emerging field of research. However, little is known about how the news media frames abortion messages aimed at influencing adolescents’ reproductive health choices. This study therefore seeks to investigate the framing of abortion in TV news items on three leading Kenyan TV outlets over a period of 3 years, understand Kenyan journalists’ perceptions and experiences with abortion coverage, and to examine adolescents’ perceptions and experiences with abortion coverage on Kenyan televised news media. Methods: This qualitative study which will be conducted in two sites-Nairobi and Uasin Gishu counties-in Kenya will purposively sample abortion news items from three leading media outlets aired between January 2016 to December 2019, for content analysis. Additionally, 12 journalists (9 reporters, 3 news editors) will be purposively sampled for Key Informant Interviews (KIIs) on journalist framing of abortion messages. Finally, convenience sampling will be used to select approximately 48 university-going adolescents for four Focus Group Discussions (FGDs)-2 female, 2 male- aimed at examining adolescents’ perceptions and experiences with abortion coverage in the broadcast news media. The KIIs and FGDs will be audio-recorded, transcribed and translated. These data will be analyzed thematically.Discussion: This study moves beyond interrogating only media items to further exploring framing from the perspectives of media consumers and investigations in the process behind production of abortion messages. The study interrogates abortion messages aimed at younger demographics such as adolescents as well as the gendered differences of the effects of these abortion messages, an area barely explored. The study findings will be informative to those who wish to develop media that could be used to promote safe abortion as well as advocate for sexual reproductive health rights, especially among adolescents.
Transit Time Flow Measurement Predicts Graft Patency in Off-pump Coronary Artery Bypass Grafting Upon 5-Year Angiographic Follow-up
Authors: zeng caiwu , Li Xiaomi , Dai Yan , Zhou Ye , Li Chenglong , Liu Nan , Wang Jiangang
Published: December 2020

Objective: This retrospective study sought to evaluate the efficacy of transit time flow measurement (TTFM) as a means of predicting bypass graft patency as assessed by coronary artery angiography (CAG) upon 5-year follow-up. Method: Of 311 patients undergone isolated off-pump coronary artery bypass graft (CABG) surgery from January 2014 through December 2014, 202 (65%) underwent both intraoperative TTFM and angiography at follow-up. 610 grafts, 202 left internal mammary artery grafts and 408 saphenous vein grafts were checked. Any grafts that exhibited Fitzgibbon type B or O lesions upon angiographic evaluation were considered to be failing. Receiver operating characteristic (ROC) curves were used to identify the optimal TTFM values for predicting graft patency. Results: A total of 610 grafts were included in this analysis, including 202 LIMA grafts and 408 SV grafts, of which 107, 129, 129, and 43 anastomosed to DIAG, OM, PDA, and PLA, respectively. LIMA, DIAG, OM, PDA, and PLA bypass grafts had overall patency rates of 95.0%, 74.8%, 73.6%, 71.5%, and 74.4%, respectively, upon 5-year follow up. No significant differences in TTFM values (MGF, PI, and DF) were observed when comparing outcomes associated with individual or sequential SV grafting. MGF was found to be predictive of graft failure regardless of the target vessel (P<0.05). While PI was found to predict LIMA, OM, and PDA graft failure (P<0.05), it was not associated with the failure of grafts associated with DIAG and PLA vessels. Similarly, DF was found to predict OM and PDA graft failure (P<0.05), but was not significantly associated with the failure of grafts associated with LIMA, DIAG, or PLA vessels.Conclusion: LIMA bypass grafts were associated with better 5-year graft patency relative to SV bypass grafts. Similar graft patency rates were observed for both individual and sequential bypass grafts. TTFM was able to predict bypass graft failure in patients that underwent off-pump CABG surgery, with MGF cut-off values for LIMA, DIAG, OM, PDA, and PLA grafts being 14.5 mL/min, 14.5 mL/min, 14.5 mL/min, 13.5 mL/min, and 16.5 mL/min, respectively.
Aberrant Feeding Artery Mutilation Treatment of Pulmonary Sequestration: A Case Report
Authors: Liu Yukang , Han Wei , Wang Ruoyao , Xiao Peng , Hu Yan , Yu Fenglei , Liu Wenliang
Published: December 2020

Background: Pulmonary sequestration (PS) is a rare congenital pulmonary pulmonary malformation. In this study, we reported a case of PS treated with aberrant feeding artery mutilation in our center.Case Presentation: A 29 –year-old female patient presented to our center in March 2020 due to repeated hemoptysis for more than 15 years, she received CTA examination which showed an aberrant feeding artery from the thoracic aorta into the left lower lobe of the lung and was therefore diagnosed with left lower lung pulmonary sequestration. Given that she complained with no infectious symptoms, she was treated with thoracoscopic feeding artery mutilation in June 2020 . She and experienced an uneventful postoperative course and was discharged 2 days postoperatively. On the postoperative follow-up of 4 months, thise patient’s physical condition was excellent and free of any symptoms such as hemoptysis or cough.Conclusion: Surgery is still the first choose for the treatment of PS. When pulmonary lesion is small-sized,for PS patients with non-infectious symptoms, aberrant feeding artery mutilation can be attempted as an alternative to intravascular technology for the treatment of PS. Future large studies are required to further verify its long-term efficacy and scope of application.
Analysis of the Comparative Occurrence of Salmonella Typhimurium and Its Monophasic Variant (4,[5],12:i:-) in Healthy and Clinically Ill Pigs in Northern Italy
Authors: D'Incau Mario , Salogni Cristian , Giovannini Stefano , Ruggeri Jessica , Scali Federico , Tonni Matteo , Formenti Nicoletta , Guarneri Flavia , Pasquali Paolo , Alborali Giovanni Loris
Published: December 2020

Background
The serovar Typhimurium (4,[5],12:i:1,2), is the most frequently isolated serovar in case of illness in pigs in Europe and its monophasic variant (4,[5],12:i:-) has been increasingly responsible for Salmonella outbreaks in humans. A total of 29,549 samples were collected, during the years 2002–2017, from 1,359 pig farms located in Northern Italy. Samples were collected from different material sources including fecal samples, gut content and different organs.
Results
Salmonella was isolated in 16.94% of samples and, among the isolates, 733 were typed as Salmonella Typhimurium (ST) or its monophasic variant (MST). Over time, there was a progressive increase of isolation of MST which outnumbered ST. Most of the strains were isolated in animals during the weaning stage and the growing – fattening period whereas the clinical cases were mainly present in young pigs after weaning.
Conclusion
This study confirms the role of pig as a source of ST and its monophasic variant MST. In the last few years, ST has been progressively replaced by MST suggesting that MST has a competitive advantage over ST, probably due to its reduced virulence which renders the infection stealthier to recognize and control.
Space-making particle therapy for unresectable hilar cholangiocarcinoma
Authors: Hashimoto Yu , Komatsu Shohei , Terashima Kazuki , Tsugawa Daisuke , Yanagimoto Hiroaki , Suga Masaki , Demizu Yusuke , Tokumaru Sunao , Okimoto Tomoaki , Sasaki Ryohei , Ajiki Tetsuo , Fukumoto Takumi
Published: December 2020

Background
Although the primary treatment option for hilar cholangiocarcinoma (HC) has been surgical resection, most patients present with unresectable advanced tumors at the time of diagnosis. Particle therapy (PT) holds a great potential for HC, even though the anatomical proximity to the gastrointestinal tract prevents delivering a radical dose to the tumor. Space-making PT (SMPT), consisting of spacer placement surgery and subsequent PT, has been developed to minimize complications and maximize the therapeutic benefit of dose escalation for HC. This study aimed to conduct a dosimetric evaluation and examine the effectiveness of SMPT for the treatment of HC.
Methods
Between 2007 and 2018, 12 patients with unresectable HC treated with SMPT were enrolled. The treatment outcomes and effectiveness of spacer placement surgery were evaluated through analyses of pre- and post- surgical parameters of dose volume histograms.
Results
All patients completed the planned SMPT protocol. The median survival time was 29.6 months, and the 1- and 3-year overall survival rates were 82.5% and 45.8%, respectively. The mean V95% value (volume irradiated with 95% of the planned treatment dose) of the gross tumor volume and clinical target volume after spacer placement surgery improved to 98.5% and 96.6% from preoperative values of 85.6% and 78.1%, respectively (p = 0.0196 and p = 0.0053 respectively). Grade 3 or higher adverse events after SMPT were seen in 6 patients.
Conclusions
SMPT led to improvements in dosimetric parameters and showed good feasibility and excellent outcomes. SMPT can be a promising novel alternative for unresectable HC.
Radiation-induced heart energy metabolism dysfunction leads to heart fibrosis
Authors: Xu Peng , Yi Yali , Luo Yijing , Liu Zhicheng , Xu Yilin , Cai Jing , Huang Long , Zeng Zhimin , Liu Anwen
Published: December 2020

Thoracic radiotherapy increases the risk of radiation-induced heart disease (RIHD), but its molecular mechanisms are not fully understood. We aimed to explore the effects of radiation on the mouse heart using high-throughput proteomics. An RIHD mouse model was established by exposing the whole heart to 16 Gy high-energy X-rays, and cardiac injuries were verified by cardiac echocardiogram, serum BNP, HE and Masson staining 5 months after irradiation. Proteomics experiments were performed using the whole heart tissue of the irradiated mice and the control mice not exposed to irradiation. The proteomics data were subjected to bioinformatics analysis, and they indicated that irradiated mouse hearts showed alterations in cardiac fibrosis and energy metabolism proteins. Then, we confirmed the cardiac fibrosis and energy metabolism changes by IHC staining and WB analysis. Extracellular matrix proteins such as Col1a1, Col3a1, Vimentin and CTGF, along with metabolism-related proteins such as Fans and Slc25a1, were overexpressed after exposure to ionizing radiation. Additionally, myocardial mitochondria inner membranes presented with injury, ATP declined and lactic acid accumulated in the irradiated heart tissues. This study suggests that high doses of ionizing radiation lead to structural remodeling, functional injury and fibrosis alterations in the mouse heart. Radiation-induced mitochondrial damage and metabolic alterations of the cardiac tissue may be one of the pathogenic mechanisms of RIHD.
Delphi consensus on strategies in the management of opioid-induced constipation in cancer patients
Authors: Sarrió Regina Gironés , Calsina-Berna Agnès , García Adoración Gozalvo , Esparza-Miñana José Miguel , Ferrer Esther Falcó , Porta-Sales Josep
Published: December 2020

Background: Opioid-induced constipation (OIC) is a frequent and bothersome adverse event related with opioid therapy in cancer patients. Despite the high prevalence, medical management of OIC is often uncertain. The current project aimed to investigate expert opinion on OIC management and provide practical recommendations to improve the clinical approach of OIC in cancer patient.Methods: A modified Delphi method was conducted involving 46 different physicians experts in OIC. Using a structured questionnaire of 67 items this project intended to seek consensus on aspects related to diagnosis, treatment, and quality of life of cancer patients suffering with OIC.Results: After two rounds, a consensus was reached in 91% of the items proposed, all in agreement. Agreement was obtained on OIC definition (95.7%). Objective and patient-reported outcomes included in that definition should be assessed routinely in clinical practice. Responsive to symptom changes and easy-to-use assessment tools were recommended (87.2%). Successful diagnosis of OIC requires increase clinicians awareness of OIC and proactivity to discuss symptoms with their patients (100%). Successful management of OIC requires individualization of the treatment (100%), regular revaluation once is established, and keeping it for the duration of opioid treatment (91.5%). Oral Peripherally Acting µ-Opioid Receptor Agonists (PAMORAs), were considered good alternatives for the treatment of OIC in cancer patients (97.9%). This drugs and laxatives can be co-prescribed if OIC coexist with functional constipation.Conclusions: The panelists, based on their expert clinical practice, presented a set of recommendations for the management of OIC in cancer patients.
Modified Talk Test: A randomised cross-over trial investigating the comparative utility of two “Talk Test” for determining aerobic training zones in overweight and obese patients
Authors: Orizola-Cáceres Ignacio , Cerda-Kohler Hugo , Burgos-Jara Carlos , Meneses-Valdes Roberto , Gutierrez-Pino Rafael , Sepulveda Carlos
Published: December 2020

Background: to validate the traditional talk test (TTT) and an alternative talk test (ATT; using a visual analog scale) in overweight/obese (OW-OB) patients and to establish its accuracy in determining the aerobic training zones.Methods: We recruited 19 subjects aged 34.9 ± 6.7 years, diagnosed with overweight/obesity (BMI 31.8 ± 5.7). Every subject underwent incremental cycloergometric tests for maximal oxygen consumption, and TTT in a randomized order. At the end of each stage during the TTT each subject read out loud a 40 words text and then had to identify the comfort to talk in two modalities: TTT which consisted in answering “Yes”, “I don’t know” or “No” to the question Was talking comfortable?, or ATT through a 1 to 10 numeric perception scale (visual scale analog: VAS). The magnitude of differences was interpreted in comparison to the smallest worthwhile change and was used to determine agreement.Results: Agreement between the power output at the VAS 2-3 of ATT and the power output at the ventilatory threshold 1 (VT1) (very likely equivalent; mean difference -1.3 Watts (W), 90 % confidence limit (CL) (-8.2; 5.6), % chances for higher/similar/lower values of 0.7/99.1/0.2 %). Also, there was an agreement between the power output at the VAS 6-7 of ATT and the power output at the ventilatory threshold 2 (VT2) (very likely equivalent; mean difference 11.1 W, 90 % CL (2.8; 19.2), % chances for higher/similar/lower values of 0.0/97.6/2.4 %). Conclusions: ATT is a tool to determine exercise intensity and to establish aerobic training zones for exercise prescription in OW-OB patients.
Family achievements in struggling with schizophrenia: life experiences in a qualitative content analysis study in Iran
Authors: darban fatemeh , Mehdipour_Rabori Roghayeh , Farokhzadian Jamileh , Nouhi Esmat , Sabzevari Sakineh
Published: December 2020

Background: The challenges of living with and taking care of a patient with schizophrenia can lead to positive changes depending on the experiences and reactions of family caregivers. Such changes may directly affect the family performance and the patient's recovery stage. Present study aimed to explain the positive experiences reported by family caregivers of patients with schizophrenia.Methods: The present study is a qualitative study of content analysis. Data were collected using semi-structured and in-depth interviews with 15 family caregivers of patients with schizophrenia referring to one of the psychiatric hospitals in Zahedan, Southeast part of Iran. Purposive sampling method was applied and data analysis was conducted using conventional content analysis proposed by Graneheim and Lundman. Results: Data analysis created a theme entitled “family achievements in struggling with schizophrenia”. This theme included four categories including Developing positive personality traits in family members, Strengthening family ties, developing insight into the life, and social mobility.Conclusions: The results provided insights that the experience of taking care of patients with schizophrenia led to positive consequences for family caregivers. Thus, it is recommended that psychiatrists or consultants help families rely on positive experiences and share these experiences with families with a newly-suffered patient.
The effect of atorvastatin on inflammatory markers in sulfur mustard gas induced bronchitis; a randomized double-blinded, placebo-control clinical trial
Authors: Momeni Behrooz , Nazer Saeed , Masoompour Seyed Masoom , Geramizadeh Bita , Sajadi Seyed Vahid
Published: December 2020

Background: This study was performed to evaluate the anti-inflammatory effect of atorvastatin in patients with chronic bronchitis, exposed to sulfur mustard gas. Methods: In this randomized double-blinded clinical trial we recruited patients with chronic bronchitis after exposure to sulfur mustard gas. Ninety men 45-75 years old diagnosed with chronic bronchitis after exposure to mustard gas during the Iran-Iraq war, were randomly assigned to receive either atorvastatin (40 mg) or placebo once a day for 3 months. The interleukin 6 (IL-6), tumor necrosis factor α (TNF-α), procalcitonin, highly sensitive CRP and COPD assessment test (CAT) score was compared at baseline and after 12 weeks. Results: After consuming atorvastatin for 12 weeks, IL-6 level (mean difference [95%CI]; 0.2[-0.05, 0.5]), TNF-α(mean difference [95%CI]; -0.07[-0.2, 0.07]), high sensitive CRP(mean difference [95%CI] -0.1[-1.2, 0.9]), and procalcitonin (mean difference [95%CI]; 0.003[-0.02, 0.03]) did not change significantly. However, in the placebo group, only IL-6 (mean difference [95%CI]; 0.6[0.2, 1.05]) decreased significantly after 12 weeks, but levels of high sensitive CRP (mean difference [95%CI]; -0.3[-1.4, 0.8]) TNF-α (mean difference [95%CI]; -0.2[-0.34, -0.06]) and procalcitonin (mean difference [95%CI]; 0.02[-0.001, 0.04]) did not change significantly. After 12 weeks, the mean differences in TNF- α, IL-6 level, high sensitive CRP, procalcitonin, and CAT score did not significantly differ between the two groups. Conclusions: The administration of 40 mg atorvastatin for 3 months did not significantly change the inflammatory markers or the quality of life of patients exposed to mustard gas with chronic bronchitis.Trial registration: IRCT, IRCT138904144312N1. Registered 16 August 2014, https://en.irct.ir/trial/4577
A comparison of the bilateral decompression via unilateral approach versus conventional approach transforaminal lumbar interbody fusion for the treatment of lumbar degenerative disc disease in the elderly
Authors: Huang Yifan , Chen Jian , Gao Peng , Gu Changjiang , Fan Jin , Hu Zhiyi , Cao Xiaojian , Yin Guoyong , Zhou Wei
Published: December 2020

Background: Bilateral decompression via unilateral approach(BDUA) is an effective surgical approach for treating lumbar degenerative diseases.However, no studies of prognosis, especially the recovery of the soft tissue, have reported using BDUA in an elderly population.The aims of these research were to investigate the early efficacy of the bilateral decompression via unilateral approach versus conventional approach transforaminal lumbar interbody fusion(TLIF)for the treatment of lumbar degenerative disc disease in the patients over 65 years of age, especially in the perioperative factors and the recovery of the soft tissue. Methods: The clinical data from 61 aging patients with lumbar degenerative disease who received surgical treatment were retrospectively analyzed. 31 cases who received the lumbar interbody fusion surgery with bilateral decompression via unilateral approach (BDUA) were compared with 30 cases who received conventional approach transforaminal lumbar interbody fusion. The radiographic parameters were measured using X-ray including lumbar lordosis angle and fusion rate. Japanese Orthopedic Association (JOA), Visual Analogue Scale (VAS) and Oswestry Disability Index（ODI）scores were used to evaluate the clinical outcomes at different time points. Fatty degeneration ratio and area of muscle/vertebral body were used to detect recovery of soft tissue. Results: The BDUA approach group was found to have significantly less intraoperative blood loss(p<0.05) and postoperative drainage(p<0.05) compared to conventional approach transforaminal lumbar interbody fusion group. Symptoms of spinal canal stenosis and nerve compression were significantly relieved postoperatively, as compared with the preoperative state. However, the opposite side had a lower rate of fatty degeneration (9.42±3.17%) comparing to decompression side (11.68±3.08%) (P<0.05) six months after surgery in the BDUA group. While there were no significant differences (P>0.05) in two sides of conventional transforaminal lumbar interbody fusion approach group six months after surgery. Conclusions: Bilateral decompression via unilateral approach (BDUA) is able to reduce the intraoperative and postoperative body fluid loss in the elderly. The opposite side of decompression in BDUA shows less fatty degeneration in 6 months, which indicates better recovery of the soft tissue of the aging patients.
Study on the derived based catalysts from Theobroma cacao pod husks for the conversion of beef tallow blend with waste used vegetable oil for fatty acid ethyl ester synthesis: burnt, submerged fermented, calcination, hybrid design, catalyst refining and reusability
Authors: F Adepoju T , A Ibeh M , O Babatunde E , Jackson Asuquo A , C Eloboka
Published: December 2020

Billions of dollars paid by industries on catalysts used as feedstocks to obtain their end products are increasing at a geometrical rate, the report revealed that the global marketplace price of catalysts stood at USD 26.1 billion in 2019, and is anticipated to increase by 4% in 2020, and 4.5% progress rate in 2025. To salvage the world from extravagance spending, there is an urgent need for biomass wastes consideration and utilization. In this paper, three novel CaO-based catalysts derived from Theobroma cacao pod husks were tested based on efficacy for the production of biodiesel (fatty acid ethyl ester: FAEE) from the blend of beef tallow oil (BTO)-waste used oil (WUO) in the ratio of 5:95 (BTO5),10:90 (BTO10),15:85 (BTO15), 20:80 (BTO20),….., 95:5 (BTO95), respectively. Process optimization of the transesterification reaction was carried out using a hybrid design to determine the effects of catalyst on the fatty acid ethyl ester (FAEE) yield. The efficiencies of the catalyst were tested via the refining and reusability test. Results revealed the oil blend ratio of BTO60: WUO40 sufficiently produced low viscous oil that was easily converted to biodiesel. Catalysts' characterization revealed the three catalysts produced high CaO-based of 68.20, 81.46, and 87.65 (wt.%), which accounted for the high yield of FAEEs. Mathematical optimization showed that the catalyst amount (F-value between 14159.69-3063.24 with P-value between 0.0053-0.0115), played the most significant role in oil conversion to biodiesel among the constraint factors considered (reaction time, catalyst amount, reaction temperature, and ethanol/oil molar ratio: EtOH/OMR). Based on Box-Cox transformation, the values of the lambda obtained indicated a normal data results with an inverse function of Y2 and Y3 and normal function of Y3 for polynomial model accuracy. Optimum validated FAEEs yields of 92.81, 93.02, and 99.64 (%wt.), respectively, with high R2. The qualities of the FAEEs were within the standard specification and the produced catalysts can serve as feedstocks for industrial application.
Cytoreductive radiotherapy combined with abiraterone in metastatic castration-resistance prostate cancer: a single center experience
Authors: Liu Yang , Long Wen , Zhang Zitong , Mai Lixin , Huang Sijuan , Liu Boji , Cao Wufei , Wu Jianhua , Zhou Fangjian , Li Yonghong , He Liru
Published: December 2020

Background: To investigate the potential benefit of cytoreductive radiotherapy (cRT) in metastatic castration-resistant prostate cancer (mCRPC) patients receiving abiraterone.Methods: From February 2014 to February 2019, 149 mCRPC patients treated with abiraterone were identified. Patients receiving cRT before abiraterone failure (AbiRT group) were matched by one-to-two propensity score to patients without cRT before abiraterone failure (non-AbiRT group).Results: The median follow-up was 23.5 months. Thirty patients (20.1%) were in the AbiRT group, whereas 119 patients (79.9%) were in the non-AbiRT group. The 2-year OS of patients managed by AbiRT and non-AbiRT were 89.5% and 73.5%, respectively (P = 0.0003). On multivariate analysis, only AbiRT (HR, 0.17; 95%CI, 0.05–0.58; P = 0.004) and prognostic index (HR, 2.71; 95% CI, 1.37–5.35; P = 0.004) were significant factors. After matching, AbiRT continued to be associated with improved OS (median OS not reached vs. 44.0 months, P = 0.009). Subgroup analysis revealed that patients aged ≤65 years (HR, 0.09; 95%CI, 0.01–0.65; P = 0.018), PSA ≤20 ng/mL (HR, 0.29; 95% CI, 0.09–0.99; P = 0.048), chemotherapy-naïve upon abiraterone treatment (HR, 0.20; 95% CI, 0.06–0.66; P = 0.008) and in intermediate prognosis groups by COU-AA-301 prognostic index (HR, 0.13; 95% CI, 0.03-0.57; P = 0.007) had improved OS with AbiRT. Conclusions: cRT before resistance to abiraterone may improve survival in selected mCRPC patients: age ≤65 years old, chemotherapy-naïve, with a relatively low PSA level at the diagnosis of mCRPC and intermediate prognosis.
Role of Liver Enzymes in Patients with Blunt Abdominal Trauma to Diagnose Liver Injury
Authors: Shrestha Anup , Neupane Harish Chandra , Tamrakar Kishor Kumar , Bhattarai Abhishek , Katwal Gaurav
Published: December 2020

Background:The liver is the second most injured organ following blunt abdominal trauma (BAT) after spleen. Although the computed tomography (CT) scan is considered as the gold standard for diagnosing liver injury in BAT, it is not readily available in the hospital. This study was performed to evaluate the role of aspartate transaminase (AST) and alanine transaminase (ALT) in patients with BAT and its significance in predicting the diagnosis and severity of the liver injury.Method:The study was conducted in Chitwan Medical College Teaching Hospital (CMCTH) study from February 2019 to May 2020. It was a prospective observational study. All the patients with BAT were received by on duty surgical residents in the Emergency Department. Based on the imaging and operative finding patients with liver injury and without liver injury were noted with the associated injury. For comparisons of clinical and grading characteristics between the two groups (liver injury and no liver injury). The Chi-squared test was used for categorical variables as appropriate, and Mann-Whitney U test used for quantitative variables (AST and ALT). The comparisons between more than two groups (grade of injury) were performed using Kruskal-Wallis test. The Receiver operating characteristic (ROC) was used to calculate the optimal cut-off value of AST and ALT.Results:Among the 96 patients admitted with BAT, 38 patients had liver injury and 58 patients had no liver injury. The median length of the intensive care unit (ICU) stay of patients with liver injury was higher than without liver injury. There was a significant difference in the median level of AST and ALT (<0.001) between patients with liver injury and no liver injury. The area under the ROC curve of AST was 0.89(95% Confidence Interval 0.86-0.98) and of ALT was 0.92(95% Confidence Interval 0.83-0.97). The area under the curve demonstrated that the test was a good predictor for the identification of liver injury and also the severity of liver enzymes. The cut-off values for the liver injury were 106 U/l and 80 U/l for AST and ALT respectively. Based on these values, AST ≥ 106 U/l had a sensitivity of 71.7 %, a specificity of 90 %, a positive predictive value of 86.8 %, and a negative predictive value of 77.6 %. The corresponding values for ALT ≥ 80 U/l were 77.8 %, 94.1%, 92.1% and 82.8 %, respectively.ConclusionIn conclusion, we report the optimal cut-off value of AST and ALT for liver injury in BAT as ≥ 106 U/l and 80 U/l respectively. The elevated level of AST and ALT might assist the emergency physicians and surgeons to timely refer the suspected patients with the liver to a tertiary center.
Influence of the knot position on the union of the greater trochanter after bipolar hip arthroplasty via the modified Dall approach: A prospective non-randomized study
Authors: Kataoka Masanao , Fujita Hiroshi , Hara Hiroaki , Harada Hideto , Okutani Yuki , Murotani Yoshiki
Published: December 2020

Background: In our institute, all elderly patients with displaced femoral neck fracture were treated with cemented bipolar hemiarthroplasty (BHA) using the modified Dall approach. To our knowledge, there are no reports on the knot position of the greater trochanter reattachment. The aim of this study was to determine influence of two knot positions (anterior or posterior) on the complications of the greater trochanter.Methods: This is a prospective non-randomized study conducted on 95 elderly patients (95 hips) from September 2013 to December 2017. The knot position was changed from anterior to posterior alternately. The X-ray images obtained immediately after the operation were compared with those obtained at 3 months postoperatively; thereafter, the status of the greater trochanter was classified into three types: type A, no apparent shifting and fracture; type C, over 1-mm shifting of the fragment; and type F, fracture of the greater trochanter.Results: Regarding age at operation, sex, BMI, size of the greater trochanteric fragment, stem type, and surgeon, there was no significant difference between two groups. In the anterior group, 34 hips (72.3%), 5 hips (10.6%), and 8 hips (17.0%) were classified under type A, C, and F, respectively. In the posterior group, 44 hips (91.7%), 1 hip (2.1%), and 3 hips (6.3%) were classified under type A, C, and F, respectively. There were significantly fewer greater trochanteric complications in the posterior group. Conclusions: The posterior knot position improved the union of the greater trochanter after BHA compared with the anterior knot position.Trial registration: We had approved IRB at our hospital clinical research review committee. Retrospectively registered.
Rapid water parcel transport across the Kuroshio Extension in the lower thermocline from dissolved oxygen measurements by Seaglider
Authors: Hosoda Shigeki , Inoue Ryuichiro , Nonaka Masami , Sasaki Hideharu , Sasai Yoshikazu , Hirano Mizue
Published: December 2020

Small water parcels, which are characterized by a low salinity and high dissolved oxygen (DO) are observed by Seaglider in the main thermocline (26.0–27.0 sq) south of the Kuroshio Extension (KE), have horizontal and vertical scales of a few ten kilometers and a few ten meters, respectively. Water mass analyses revealed larger negative salinity anomalies (<−0.05 PSS-78) and positive DO anomalies (>15 μmol kg−1) than those of the surrounding water. The characteristics are similar to those of water mass with low salinity and high DO in the subpolar Northwestern Pacific Ocean. Additionally, higher DO anomaly water parcels appear in the upper layer (<26.7 σθ) while low salinity parcels appear in the lower layer (>26.7 sq). Oxygen consumption rates from the apparent oxygen utility suggest that the small water parcels consume less oxygen than the surrounding water, implying that they migrate in a shorter time across the KE after subduction and their characteristics may reflect the sea surface temperature, salinity, and DO in the subduction region. Similar small water parcels represented by high-resolution numerical simulations indicate that they pass through the KE in one month. The simulations support the oxygen consumption rate from the Seaglider observations. The existence of a fast process for water mass migration via meso- and submesoscale subduction processes across the KE affects the amount, subduction, and exchange process of water mass. Our study indicates a small water mass contributes to the exchange process across the KE rapidly, which had not been identified in previous studies. Consequently, detailed observations using multiple Seagliders should capture detailed spatial and temporal variability of the water mass exchange process.
Feasibility of a quality improvement project to increase adherence to evidence-based pulmonary embolism diagnosis in the emergency department.
Authors: Germini Federico , Hu Yang , Afzal Sarah , Al-haimus Fayad , Puttagunta Srikanth A. , Niaz Saghar , Chan Teresa , Clayton Natasha , Mondoux Shawn , Thabane Lehana , de Wit Kerstin
Published: December 2020

Background: Many evidence-based clinical decision tools are available for the diagnosis of pulmonary embolism (PE). However, these clinical decision tools have had suboptimal uptake in the everyday clinical practice in emergency departments (EDs), despite numerous implementation efforts. We aimed to test the feasibility of a multi-faceted intervention to implement an evidence-based PE diagnosis protocol.Methods: We conducted an interrupted time series study in three EDs in Ontario, Canada. We enrolled consecutive adult patients accessing the ED with suspected PE from January 1, 2018 to February 28, 2020. Components of the intervention were: clinical leadership endorsement; a new pathway for PE testing; physician education; personalized confidential physician feedback, and collection of patient outcome information. The intervention was implemented in November 2019. We identified six criteria for defining the feasibility outcome: successful implementation of the intervention in at least two of the three sites; capturing data on ≥ 80% of all CTPAs ordered in the EDs; timely access to electronic data; rapid manual data extraction with feedback preparation before the end of the month ≥ 80% of the time; time required for manual data extraction and feedback preparation ≤ 2 day per week in total.Results: The intervention was successfully implemented in two out of three sites. 5,094 and 899 patients were tested for PE in the period before and after the intervention, respectively. We captured data from 90% of CTPAs ordered in the EDs, and we accessed the required electronic data. The manual data extraction and individual emergency physician audit and feedback were consistently finalized before the end of each month. The time required for manual data extraction and feedback preparation was ≤ 2 days per week (14 hours).Conclusions: We proved the feasibility of implementing an evidence-based PE diagnosis protocol in two EDs. We were not successful implementing the protocol in the third ED.Registration: The study was not registered.Funding: CanVECTOR Network, McMaster Division of Hematology & Thromboembolism.