bluuebunny/crossref_metadata_2025 huggingface dataset:
Multi‐label learning on principles of reverse k‐nearest neighbourhood
Authors: Sadhukhan Payel , Palit Sarbani
Published: August 2020

In this article, we present a novel neighbourhood based multi‐label classifier, Multi‐label Learning on principles of Reverse k‐Nearest Neighbourhood (ML‐RkNN) where we estimate the neighbourhood of the points on the basis of their reverse k‐nearest neighbourhood (RkNN). Through RkNN, for the same value of k, we get different number of neighbours for different instances and this happens adaptively according to the neighbourhood configuration of the points. The automatically adaptive neighbourhood helps us in better learning of the local configurations around the points. Our scheme also facilitates implicit handling of the local imbalances prevailing in the datasets by comparing the class distributions of the test points and their reverse nearest neighbours. This implicit and adaptive handling is particularly useful for multi‐label label datasets, whose labels are differentially imbalanced. Empirical study is performed on 10 real‐world multi‐label datasets considering five neighbourhood based multi‐label learners. Macro F1 is used as the evaluating metric. The proposed method has given statistically superior and statistically comparable performances with respect to three and two comparing methods respectively. Additionally, we have explored the use of two different distance metrics, Euclidean and Jaccard in our scheme for nominal datasets.
Left‐BehindChildren's Grandparent–Child and Parent–Child Relationships and Loneliness: A Multivariable Mediation Model
Authors: Song Jingjing , Ma Chensen , Ruan Yifan
Published: August 2020

Objective

The current study tested the association between family relationships and left‐behind children's loneliness, as well as mediators of those associations.

Background

There is considerable concern in China about the psychological well‐being of rural children whose parents move to urban areas for work, so‐called left‐behind children. However, there have been inconsistent results in the research concerning loneliness for these children.

Method

Participants were Chinese left‐behind children from rural families in which one or both parents had left to work in an urban area (N = 399; 139 females; 11–16 years of age). The children completed questionnaires on grandparent–child relationships, parent–child relationships, emotional intelligence, peer relationships, and loneliness.

Results

Positive parent–child relationships were negatively associated with left‐behind children's loneliness. Path analysis showed that more positive grandparent–child and parent–child relationships were associated with a higher level of emotional intelligence and better peer relationships, which in turn were negatively associated with lower child loneliness. Moreover, the unique effect of parent–child relationships was higher than that of grandparent–child relationships in predicting left‐behind children's loneliness.

Conclusion

It appears possible that a positive relationship with grandparents can lessen the loneliness experienced by left‐behind children, but the parent–child relationship is still more important for this aspect of psychological adjustment. Emotional intelligence and peer relationships appear to be mechanisms that account for the association between positive family relationships and lower loneliness in this group of children.

Implications

The results are discussed in terms of the role that parents and grandparents can play in interventions to help this population.
Pityriasis in dermatology: an updated review
Authors: Chin Laura D. , Parvinnejad Nikoo , Haber Richard M.
Published: August 2020

Dermatology has a very distinctive lexicon. The term pityriasis refers to several dermatologic conditions which all feature scaling of the skin. According to the Merriam‐Webster dictionary, the term pityriasis was first used in print in 1684. Although the diseases beginning with the name pityriasis are of diverse causation, they do represent important dermatologic diseases, with some common and others quite rare. It is important for dermatologists to be aware and updated on all pityriasis conditions in dermatology.
Tinzaparin for venous thromboembolism in patients with renal impairment: a single‐centre, prospective pilot study
Authors: Yeung James , Dix Caroline H. K. , Ritchie Angus G. , Kow Marian , Chen Vivien M. Y.
Published: August 2020

Background: Low molecular weight heparins (LMWH) are used extensively for prophylaxis and treatment of venous thromboembolism (VTE), bridging therapy for warfarin and standard of care in cancer‐associated VTE (CA‐VTE). Tinzaparin has the highest molecular weight of all LMWH and relies least on renal clearance to Cockcroft‐Gault creatinine clearance (CrCl) of 20 mL/min. Previous pharmacological studies have demonstrated safety and effectiveness in elderly patients. Prospective clinical trials have confirmed these findings to CrCl 20 mL/min and in CA‐VTE. We describe the pilot program developed at Concord Repatriation General Hospital for tinzaparin.

Aims: We aim to confirm the deliverability of tinzaparin in patients with renal insufficiency.

Methods: Twenty patients were established on tinzaparin as therapeutic anticoagulation with CrCl or CKD‐EPI estimated glomerular filtration rate (eGFR) 20–50 mL/min with an indication for anticoagulation. Tinzaparin was given as a subcutaneous injection at 175 units/kg as a single daily dose, rounded to the nearest vial size. Tinzaparin anti‐Xa levels were tested at Days 2, 7 and 14 (±1 day) and transition to oral anticoagulants were allowed at clinician discretion.

Results: No accumulation of tinzaparin was seen into Day 14. Two patients required dose‐adjustment, five patients had bleeding complications (two major, three minor) and four patients died during follow‐up, all attributable to patients' comorbidities. CrCl and body surface area‐standardised CrCl were significantly correlated with tinzaparin anti‐Xa level only on Day 2, and this effect was lost when patients with CrCl >50 mL/min were excluded. Data from our cohort confirm the deliverability of therapeutic tinzaparin in patients with CrCl or CKD‐EPI eGFR 20–50 mL/min. Bleeding and death outcomes were also comparable to other trials using tinzaparin in CA‐VTE.

Conclusion: For patients with renal insufficiency, tinzaparin represents an attractive alternative anticoagulant with once‐daily administration in a range of potential indications.
Scintillating glass‐ceramic substrates for indirect flat panel detectors in digital radiography
Authors: Leonard Russell L. , Berkowitz Danielle T. , Thomas Austin , Howansky Adrian , Lubinsky Anthony R. , Johnson Jacqueline A.
Published: August 2020

Indirect flat panel detectors (I‐FPDs) enable digital radiography at high X‐ray energies. However, the performance of these devices is limited due to the large number of X rays that pass through them undetected. The authors hypothesize that a glass‐based scintillator may serve as a substrate for the thin film transistors and photodiodes in an I‐FPD, leading to improvements in X‐ray detection for improved performance. The authors synthesized a series of five glass‐ceramic scintillators based on an oxyhalide glass matrix. Each glass ceramic contains barium chloride crystals which serve as scattering centers to prevent “light trapping” in the material; barium chloride is also a well‐known scintillation crystal. Four of the samples contain trivalent terbium, which serves as a second luminescent center. The light output of each sample was compared against a well‐known X‐ray scintillator, gadolinium oxysulfide (GOS) under RQA9 exposure conditions, in the back‐irradiation configuration. The addition of terbium oxide to the glass composition increases the detected light output, which varies by concentration. The thickness of the glass‐ceramic scintillator has a profound effect on performance, with the results influenced by such factors as self‐attenuation of emission in the thicker samples and decreased X‐ray capture in the thinner samples. The brightest sample tested achieved a light output 13% that of the GOS intensifier screen. The results indicate that the use of scintillating glass‐ceramic substrates should lead to increased performance in indirect digital radiography.
MicroRNA‐203–mediated inhibition of doublecortin underpins cardioprotection conferred by sevoflurane in rats after myocardial ischaemia‐reperfusion injury
Authors: Tan Jian , Wu Zhiguo , Liu Jun , Zhang Wenting , Yuan Wanqiu , Peng Hong
Published: August 2020

Myocardial ischaemia‐reperfusion (I/R) injury is a serious illness with high morbidity and mortality. Mounting evidence indicates the utility of sevoflurane (SEV) in the treatment of myocardial I/R injury. This study aimed to explore the molecular mechanisms underlying the protective action of SEV against myocardial I/R injury. A rat model of myocardial I/R injury was established, and I/R rats were treated with different concentrations of SEV. MicroRNA‐203 (miR‐203) and doublecortin (DCX) expression levels were determined using reverse transcription‐quantitative polymerase chain reaction. Putative target relationship between miR‐203 and DCX was explored using dual‐luciferase reporter gene assay and RNA‐binding protein immunoprecipitation assay. Ischaemia‐reperfusion rats were treated with SEV, miR‐203 antagomir or sh‐DCX, followed by determination of oxidative stress‐ and inflammation‐related factor levels using nitrite and enzyme‐linked immunosorbent assays, and that of apoptosis‐related factors using Western blot analysis. The apoptotic rate of myocardial tissues was determined using TdT‐mediated dUTP‐biotin nick end labeling (TUNEL) staining, and the infract area was evaluated using triphenyltetrazolium chloride staining. The results showed miR‐203 was poorly expressed and DCX was highly expressed in myocardial tissues of I/R rats. Sevoflurane was found to elevate miR‐203, and miR‐203, in turn, could target and reduce DCX expression. Sevoflurane, miR‐203 overexpression or DCX silencing resulted in declined oxidative stress, inflammation, apoptosis and infarct area, ultimately alleviating myocardial I/R injury. Collectively, these findings showed that SEV‐activated miR‐203 exhibited suppressive effects on myocardial I/R injury in rats and highlighted the SEV/miR‐203/DCX axis as a promising therapeutic target for myocardial I/R injury management.
Musashi2 promotes the progression of pancreatic cancer through a novel ISYNA1‐p21/ZEB‐1 pathway
Authors: Zhou Lei , Sheng WeiWei , Jia Chao , Shi Xiaoyang , Cao Rongxian , Wang Guosen , Lin Yiheng , Zhu Fang , Dong Qi , Dong Ming
Published: August 2020

Our previous studies found overexpression of Musashi2 (MSI2) conduced to the progression and chemoresistance of pancreatic cancer (PC) by negative regulation of Numb and wild type p53 (wtp53). Now, we further investigated the novel signalling involved with MSI2 in PC. We identified inositol‐3‐phosphate synthase 1 (ISYNA1) as a novel tumour suppressor regulated by MSI2. High MSI2 and low ISYNA1 expression were prevalently observed in 91 PC tissues. ISYNA1 expression was negatively correlated with MSI2 expression, T stage, vascular permeation and poor prognosis in PC patients. What's more, patients expressed high MSI2 and low ISYNA1 level had a significant worse prognosis. And in wtp53 Capan‐2 and SW1990 cells, ISYNA1 was downregulated by p53 silencing. ISYNA1 silencing promoted cell proliferation and cell cycle by inhibiting p21 and enhanced cell migration and invasion by upregulating ZEB‐1. However, MSI2 silencing upregulated ISYNA1 and p21 but downregulated ZEB‐1, which can be rescued by ISYNA1 silencing. Moreover, reduction of cell migration and invasion resulting from MSI2 silencing was significantly reversed by ISYNA1 silencing. In summary, MSI2 facilitates the development of PC through a novel ISYNA1‐p21/ZEB‐1 pathway, which provides new gene target therapy for PC.
Invivocharacterization of healthy human skin with a novel, non‐invasive imaging technique: line‐field confocal optical coherence tomography
Authors: Monnier J. , Tognetti L. , Miyamoto M. , Suppa M. , Cinotti E. , Fontaine M. , Perez J. , Orte Cano C. , Yélamos O. , Puig S. , Dubois A. , Rubegni P. , del Marmol V. , Malvehy J. , Perrot J.L.
Published: August 2020

Background

Line‐field confocal optical coherence tomography (LC‐OCT) is a non‐invasive optical technique recently developed for skin examinationin vivo. It provides real‐time, high‐resolution vertical images with an isotropic resolution of ~1 µm and a penetration depth of ~500 µm.

Objectives

Study goals were to qualitatively/quantitatively characterize healthy skin at different body sites using LC‐OCT.

Methods

The skin of young healthy volunteers was imaged with a handheld LC‐OCT imaging device. Seven body sites (back of the hand, forehead, cheek, nose, chest, forearm and back) were investigated. An independent qualitative [cutaneous structures' description; visibility of keratinocytes' nuclei and dermal–epidermal junction (DEJ)] and quantitative [stratum corneum(SC)/epidermal thicknesses; height of dermal papillae] assessment of the LC‐OCT images was performed.

Results

A total of 88 LC‐OCT images were collected from 29 participants (20 females; nine males; mean age 25.9 years). Keratinocytes' nuclei and DEJ were visible in the totality of images. The different layers of the epidermis and the remaining cutaneous structures/findings were visualized. Body sites‐related variability was detected for SC/epidermal thicknesses and height of dermal papillae. Inter‐observer agreement was excellent (SC thickness), good‐to‐excellent (epidermal thickness) and moderate‐to‐good (papillae).

Conclusions

Line‐field confocal‐OCT provides non‐invasive, real‐time imaging of the skinin vivowith deep penetration and high resolution, enabling the visualization of single cells. The histology‐like vertical view provides an easy way to recognize/measure different cutaneous structures/findings. LC‐OCT appears as a promising technique for the examination of physiological/pathological skin.
Iterative taxonomy reveals a new species ofTrichomycterusValenciennes 1832 (Siluriformes, Trichomycteridae) widespread in Rio Doce basin: a pseudocryptic ofT. immaculatus
Authors: Reis Vinícius J. C. , dos Santos Sergio A. , Britto Marcelo R. , de Assis Volpi Thaís , de Pinna Mário C. C.
Published: August 2020

This paper reports on a new species ofTrichomycterusfrom the Rio Doce basin. Unusually for new taxa in the genus during the past few decades, the new species is not narrowly endemic but instead widely distributed in its major drainage, the Rio Doce. The species has been collected and deposited in scientific collections for some years, but has been systematically misidentified as the more abundantTrichomycterus immaculatusor, to a lesser degree, as other morphologically similar species from south‐eastern Brazil such asT. nigricansandT. pradensis. A combination of several morphological characteristics, such as vertebral number, pectoral‐fin ray counts, pigmentation pattern and barcoding distance, were iteratively used and unambiguously distinguish the new species from all congeners. The present case reveals a pattern of diversity‐discovery in which rare and narrowly endemic morphologically conspicuous species are discovered and described before visually inconspicuous taxa, even when the latter are more abundant and widespread. The morphological similarities among south‐eastern Brazilian species with a uniform dark‐grey color serve as basis for a brief discussion about the concepts of cryptic and pseudo‐cryptic species inTrichomycterusand their consequences for potentially hidden diversity in the genus.
Outcome Measures for Interventions to Reduce Inappropriate Chronic Drugs: A Narrative Review
Authors: Aubert Carole E. , Kerr Eve A. , Maratt Jennifer K. , Klamerus Mandi L. , Hofer Timothy P.
Published: August 2020

BACKGROUND

Inappropriate prescribing is a highly important problem, given the growing aging multimorbid population with associated polypharmacy. An increasing number of studies have recently developed and tested interventions to withdraw inappropriate drugs, a process called deprescribing. However, we still lack complete information on the types and prevalence of measures used to assess the success of such interventions.

OBJECTIVE

To categorize and synthesize the full spectrum of measures used in intervention studies focused on reducing inappropriate prescribing of chronic drugs in adults, to standardize measurements in future studies and help researchers design studies inclusive of the important measure types.

DESIGN

We searched Ovid/MEDLINE to identify intervention studies focused on deprescribing chronic drugs in adults, published between 2010 and 2019.

MEASUREMENTS

We extracted data on study characteristics, intervention components, and outcome measures. We categorized and synthesized the measures using a comprehensive and systematic framework, separating measures of intended and unintended consequences.

RESULTS

Most (90/93) studies used measures of appropriate prescribing, such as drug cessation or dose reduction. The following measures were used infrequently across studies: patient‐reported experience, preferences, and outcome (12 (13%), 2 (2%), and 25 (27%) studies, respectively); provider‐reported experience (11 (12%) studies); patient‐provider interaction (4 (4%) studies); and measures of unintended consequences (24 (26%) studies). Studies varied in the type and number of measures assessed, ranging from 1 to 20 different measures by study.

CONCLUSION

To ensure initiation, success, and long‐term sustainability of deprescribing, it is important to assess the success of intervention studies using clinically relevant patient‐ and provider‐centered measures. This categorized synthesis of outcome measures used in deprescribing studies may facilitate implementation of important measure types (e.g., patient‐reported measures and measures of unintended consequences) in future studies. J Am Geriatr Soc 68:2390–2398, 2020.
SINAT E3 ligases regulate the stability of the ESCRT component FREE1 in response to iron deficiency in plants
Authors: Xiao Zhidan , Yang Chao , Liu Chuanliang , Yang Lianming , Yang Shuhong , Zhou Jun , Li Faqiang , Jiang Liwen , Xiao Shi , Gao Caiji , Shen Wenjin
Published: August 2020

The endosomal sorting complex required for transport (ESCRT) machinery is an ancient, evolutionarily conserved membrane remodeling complex that is essential for multivesicular body (MVB) biogenesis in eukaryotes. FYVE DOMAIN PROTEIN REQUIRED FOR ENDOSOMAL SORTING 1 (FREE1), which was previously identified as a plant‐specific ESCRT component, modulates MVB‐mediated endosomal sorting and autophagic degradation. Although the basic cellular functions of FREE1 as an ESCRT component have been described, the regulators that control FREE1 turnover remain unknown. Here, we analyzed how FREE1 homeostasis is mediated by the RING‐finger E3 ubiquitin ligases, SINA of Arabidopsis thaliana (SINATs), in response to iron deficiency. Under iron‐deficient growth conditions, SINAT1‐4 were induced and ubiquitinated FREE1, thereby promoting its degradation and relieving the repressive effect of FREE1 on iron absorption. By contrast, SINAT5, another SINAT member that lacks ubiquitin ligase activity due to the absence of the RING domain, functions as a protector protein which stabilizes FREE1. Collectively, our findings uncover a hitherto unknown mechanism of homeostatic regulation of FREE1, and demonstrate a unique regulatory SINAT–FREE1 module that subtly regulates plant response to iron deficiency stress.
Self‐transcendence and life stories of humanistic growth among late‐midlife adults
Authors: Reischer Hollen N. , Roth Laura J. , Villarreal Jorge A. , McAdams Dan P.
Published: August 2020

Objective

Self‐transcendence is the experience of feeling connected to something greater than oneself. Previous studies have shown high scores on self‐transcendence are associated with well‐being and other psychological benefits, but have rarely examined the lived experiences of highly self‐transcendent people.

Method

Black and White men and women in late‐midlife completed Life Story Interviews and self‐report measures of self‐transcendence. In Study 1 (N = 144, Mage = 56.4), we used grounded theory methodology to differentiate the stories told by participants scoring either extremely high or extremely low on self‐transcendence. In Study 2 (N = 125; Mage = 60.4), we created a quantitative coding scheme and scored 1,375 new life story scenes.

Results

In Study 1, six narrative themes were identified (closure, interconnectedness, lifelong learning, secure attachment, self‐actualization, and spiritual pluralism) as part of a “humanistic growth story.” In Study 2, four of the narrative themes were found to predict self‐transcendence scores with significant effect sizes of β = .26 to .47.

Conclusions

In our sample, highly self‐transcendent individuals tended to narrate their lived experiences as spiritual journeys of humanistic growth. This study adds to our understanding of one path of personality growth in late‐midlife, that toward self‐transcendence.
Reimagining Just War as Anchored in, Tethered to, and Tempered by Mercy
Authors: Winright Tobias
Published: August 2020

This essay considers whether the just war tradition is compatible with Christian theologically grounded conceptions of mercy. After considering and rejecting positions that pit mercy and war against each other, the essay mines the work of Walter Kasper and James Keenan on Christian mercy to develop a position that reimagines mercy as compatible with traditional just war criteria. In particular, this analysis leads to the conclusion that Christians may endorse just war in the form of humanitarian intervention. By doing so, they allow mercy to temper the aspects of warfare that diminish the humanity of others.
Mercy as a Public Virtue
Authors: Flores Nichole
Published: August 2020

James F. Keenan defines mercy as “the willingness to enter the chaos of another.” Mercy thus defined, he argues, is the distinctive characteristic of Christian morality. This essay asserts that mercy is, in fact, a public virtue, one that can be affirmed across a broad range of religious and moral traditions. As a public virtue, mercy ought to shape both affective and effective responses to the Syrian refugee crisis in the United States.
Thinking fast and slow in the evaluation of injury plausibility in child protection
Authors: Skellern Catherine
Published: August 2020

In evaluating injury in children, child protection paediatricians are tasked with determining whether the history given by parents or caregivers is valid with respect to explaining injury causation. This paper summarises metacognition and in particular the dual processing theory of ‘fast and slow thinking’ to explain how complex information in contexts of uncertainty is processed to produce decisions and responses, applied to a child protection context. An example is used that resembles abusive head trauma which focuses on understanding the difference between likelihood and plausibility in forensic interpretations of injury causation.
Recent trends in targeting miRNAs for cancer therapy
Authors: Shah Vandit , Shah Jigna
Published: August 2020

Objectives

MicroRNAs (miRNAs) are a type of small noncoding RNA employed by the cells for gene regulation. A single miRNA, typically 22 nucleotides in length, can regulate the expression of numerous genes. Over the past decade, the study of miRNA biology in the context of cancer has led to the development of new diagnostic and therapeutic opportunities.

Key findings

MicroRNA dysregulation is commonly associated with cancer, in part because miRNAs are actively involved in the mechanisms like genomic instabilities, aberrant transcriptional control, altered epigenetic regulation and biogenesis machinery defects. MicroRNAs can regulate oncogenes or tumour suppressor genes and thus when altered can lead to tumorigenesis. Expression profiling of miRNAs has boosted the possibilities of application of miRNAs as potential cancer biomarkers and therapeutic targets, although the feasibility of these approaches will require further validation.

In this review, we will focus on how miRNAs regulate tumour development and the potential applications of targeting miRNAs for cancer therapy.
Atlanto‐axial ventral stabilisation using 3D‐printed patient‐specific drill guides for placement of bicortical screws in dogs
Authors: Toni C. , Oxley B. , Behr S.
Published: August 2020

Objective

To report outcome and complications following atlanto‐axial stabilisation by polymethylmethacrylate applied to screws placed using 3D‐printed patient‐specific drill guides.

Materials and Methods

Case series of dogs treated with this technique between May 2016 and August 2018 including pre‐ and post‐operative modified Frankel score, imaging and complications. Screw placement was graded using a modified Zdichavsky classification based on post‐operative CT. Telephone follow‐up was obtained for surviving dogs.

Results

Twelve cases were included. At presentation, modified Frankel score was 3 in five dogs and 4 in seven dogs on presentation. Of 61 bicortical screws placed, 57 (93%) were fully contained within the pedicle and vertebral body and four (7%) partially breached the medial pedicle wall. Post‐operative CT revealed good alignment of C1 and C2 in all planes. Reversible perioperative adverse events were described in five of 12 dogs and two dogs were euthanased shortly after discharge. At 18 to 50 days after surgery eight dogs had improved neurological status. Neurological status remained unchanged in the remaining two dogs. All dogs were reported ambulatory and pain‐free at telephone follow‐up (median 405 days post‐surgery, range 180 to 780 days).

Clinical Significance

This technique resulted in safe bicortical screw placement in dogs with atlanto‐axial subluxation.
A new approach for open‐end sequential change point monitoring
Authors: Gösmann Josua , Kley Tobias , Dette Holger
Published: August 2020

We propose a new sequential monitoring scheme for changes in the parameters of a multivariate time series. In contrast to procedures proposed in the literature which compare an estimator from the training sample with an estimator calculated from the remaining data, we suggest to divide the sample at each time point after the training sample. Estimators from the sample before and after all separation points are then continuously compared calculating a maximum of norms of their differences. For open‐end scenarios our approach yields an asymptotic level procedure, which is consistent under the alternative of a change in the parameter. By means of a simulation study it is demonstrated that the new method outperforms the commonly used procedures with respect to power and the feasibility of our approach is illustrated by analyzing two data examples.
Towards a critical realist epistemology?
Authors: Albert Katelin , Brundage Jonah Stuart , Sweet Paige , Vandenberghe Frédéric
Published: August 2020

When critical realists consider epistemology they typically start from “epistemological relativism.” We find this position necessary, but we also find it insufficient because it lacks a critique of the highly unequal social relations among observers themselves—relations that shape the very production of knowledge. While it is indeed the case that all knowledge is fallible, it is also the case that all knowledge is positioned, with a particular standpoint. What is more, the social power relations between standpoints organize the production of truth in ways that produce systematic distortions. In this paper, we propose a critical realist social epistemology. We introduce feminist standpoint theory and postcolonial theory as our suggested interventions into critical realism and we use two case studies of existing work to highlight i) the social production of truth and the real, and ii) what is at stake for radicalizing epistemology in critical realism. In so doing, our paper emphasizes the epistemic complexities that continuously shape ontology, a commitment to subaltern voices or experiences, and a thorough interrogation of the relations between positions of knowledge production.
The prognostic role of soluble transforming growth factor‐β and its correlation with soluble programmed death‐ligand 1 in biliary tract cancer
Authors: Kim Jin Won , Lee Kyung‐Hun , Kim Ji‐Won , Suh Koung Jin , Nam Ah‐Rong , Bang Ju‐Hee , Jin Mei Hua , Oh Kyoung‐Seok , Kim Jae‐Min , Kim Tae‐Yong , Oh Do‐Youn
Published: August 2020

Background

This study aimed to evaluate the association between soluble TGF‐β (sTGF‐β) and soluble PD‐L1 (sPDL1), the dynamics of sTGF‐β during treatment and its prognostic role in biliary tract cancer (BTC).

Methods

The study population consisted of 90 BTC patients with first‐line chemotherapy (cohort 1) and 35 BTC patients with second‐ or third‐line chemotherapy (cohort 2). Plasma sTGF‐β and sPDL1 levels were measured using an enzyme‐linked immunosorbent assay.

Results

In both groups, sTGF‐β was positive correlated with sPDL1 for baseline and change values after treatment. sTGF‐β was elevated at disease progression compared to baseline in cohort 1 (P < .001). Increased sTGF‐β after treatment revealed worse DFS and OS (P = .024, P = .028, respectively) in cohort 1 and significantly shorter OS (P = .020) in cohort 2. In multivariable analysis, this prognostic value of increased sTGF‐β for OS retained its significance in both cohorts (Hazard ratio (HR) = 1.8, 95% CI, 1.1‐3.0, P = .028, in cohort 1; HR = 4.7, 95% CI, 1.5‐14.6, P = .007, in cohort 2).

Conclusions

In BTC, sTGF‐β was positively correlated with sPDL1 for baseline and changes after chemotherapy, and increased as tumour burden. sTGF‐β could be associated with survival; particularly, an elevated value after treatment suggests worse prognosis.
The association of the steatosis severity in fatty liver disease with coronary plaque pattern in general population
Authors: Hsu Pai‐Feng , Wang Ying‐Wen , Lin Chung‐Chi , Wang Yuan‐Jen , Ding Yaw‐Zon , Liou Teh‐Ling , Huang Shao‐Sung , Lu Tse‐Min , Chan Wan‐Leong , Lin Shing‐Jong , Leu Hsin‐Bang
Published: August 2020

Background and Aims

Nonalcoholic fatty liver disease (NAFLD) is commonly observed in patients with cardiovascular disease (CVD). However, whether the steatosis severity of NAFLD is independently associated with coronary artery atherosclerosis is still controversial.

Methods

Consecutive Taiwanese individuals (1502) who received coronary computed tomography angiography (CCTA) and abdominal sonography as part of a general routine health evaluation were enrolled. The association between steatosis severity, coronary atherosclerosis involvement and various plaque patterns were analysed.

Results

Compared with non‐steatosis, NAFLD subjects had more cardiovascular risk factors that correlated with the severity of steatosis (P for the trend <.05). The presence of atherosclerotic plaques correlated with the severity of steatosis (none: 53%, mild: 64.1%, and moderate to severe: 66.9%; P for the trend <.001). Parameters of coronary atherosclerosis, including atheroma burden obstructive score (ABOS), segment involvement score (SIS) and segment stenosis score (SSS), were higher in the moderate to severe steatosis group. After adjusting for major confounding factors, the severity of steatosis still correlated with the mixed plaque pattern (P = .043). Subgroup analysis of the risk of the presence of overall coronary and mixed plaques showed a significant association with increasing severity of steatosis, especially among these who were <65 years old, male, without metabolic syndrome, and with lower low‐density lipoprotein choleseterol values.

Conclusion

In this general population, steatosis severity of NAFLD is associated with coronary artery atherosclerosis burden. Furthermore, steatosis severity correlated with the risk of the presence of coronary plaques, especially high‐risk plaques, and was independent of traditional risk factors.
Bladder neck and urethral erosions after Macroplastique injections
Authors: Rodríguez Dayron , Jaffer Ata , Hilmy Mustafa , Zimmern Philippe
Published: August 2020

Aims

To evaluate the presentation, risk factors, diagnostic workup, management, and outcomes of Macroplastique (MPQ) erosions.

Methods

We performed a retrospective chart review of women experiencing MPQ erosion at two tertiary care centers (United States and United Kingdom). Data collected included age, presenting symptoms, parity, comorbidities, hormone replacement therapy, sexual activity, and smoking status. Previous surgical history, time from MPQ injection, urine culture results, and cystoscopic and imaging findings were also reviewed. Development of stress urinary incontinence (SUI) after MPQ removal and subsequent SUI treatments were recorded.

Results

From 2012 to 2018, 18 patients were identified with a median follow‐up time of 24 months (interquartile range [IQR] 8‐33). All patients presented with recurrent urinary tract infections (rUTI) and had cystoscopic evidence of MPQ erosion. The most common location of erosion was the bladder neck area (72%). Median time to presentation since MPQ injection was 14 months (IQR 11‐35). The majority of patients (72%) had a previous history of anti‐incontinence surgery. The overall success rate of endoscopic management defined as resolution of presenting symptoms including rUTI was 80%. The majority of patients (80%) developed recurrent SUI following MPQ resection with 33% requiring a subsequent autologous fascial sling placement.

Conclusion

MPQ erosions present predominantly with UTI, sometimes years after the original injection, and may necessitate endoscopic management with satisfactory results in most patients. Following excision of MPQ, these patients are highly likely to experience SUI recurrence and need to be appropriately counseled. Some may require additional subsequent autologous fascial sling placement for treatment of their SUI symptoms.
Lost and found: Frogs in a biodiversity hotspot rediscovered with environmental DNA
Authors: Lopes Carla Martins , Baêta Délio , Valentini Alice , Lyra Mariana Lúcio , Sabbag Ariadne Fares , Gasparini João Luiz , Dejean Tony , Haddad Célio Fernando Baptista , Zamudio Kelly Raquel
Published: August 2020

Declines and extinctions are increasing globally and challenge conservationists to keep pace with biodiversity monitoring. Organisms leave DNA traces in the environment, e.g., in soil, water, and air. These DNA traces are referred to as environmental DNA (eDNA). The analysis of eDNA is a highly sensitive method with the potential to rapidly assess local diversity and the status of threatened species. We searched for DNA traces of 30 target amphibian species of conservation concern, at different levels of threat, using an environmental DNA metabarcoding approach, together with an extensive sequence reference database to analyse water samples from six montane sites in the Atlantic Coastal Forest and adjacent Cerrado grasslands of Brazil. We successfully detected DNA traces of four declined species (Hylodes ornatus, Hylodes regius, Crossodactylus timbuhy, and Vitreorana eurygnatha); two locally disappeared (Phasmahyla exilis and Phasmahyla guttata); and one species that has not been seen since 1968 (putatively assigned to Megaelosia bocainensis). We confirm the presence of species undetected by traditional methods, underscoring the efficacy of eDNA metabarcoding for biodiversity monitoring at low population densities, especially in megadiverse tropical sites. Our results support the potential application of eDNA in conservation biology, to evaluate persistence and distribution of threatened species in surveyed habitats or sites, and improve accuracy of red lists, especially for species undetected over long periods.
Therapeutic response time of topical voriconazole 1% and intrastromal voriconazole 0.05% versus topical natamycin 5% monotherapy in Fusarium keratitis in rabbit
Authors: Edwar Lukman , Janna Yulia M. , Rozaliyani Anna , Louisa Melva
Published: August 2020

Background

Fungal keratitis can be more difficult to treat than bacterial keratitis with worse outcomes.

Objective

To evaluate the therapeutic response time of topical voriconazole combined with intrastromal voriconazole, and topical natamycin on Fusarium keratitis.

Methods

The stroma of corneas of twelve New Zealand White rabbits was inoculated with Fusarium sp spores. Seven days after inoculation, they were divided into 2 groups randomly. Group A was treated with topical natamycin 5% for 21 days. Group B was treated with intrastromal voriconazole 0.05% single injection at the beginning of treatment, continued with topical voriconazole 1% for 21 days. Clinical evaluations for epithelial defect size and clinical scores in each group were performed on 1st, 3rd, 7th, 10th, 14th and 21st days after treatment. Mycological examinations were performed before and after the treatment.

Results

After treatment, there was no statistically significant difference between natamycin and voriconazole in reducing epithelial defect size at first, second or third week after treatment (P = .15; P = .39; and P = .90). The clinical scores on both groups also showed no statistically significant differences at first, second and third weeks after treatment (P = .24; P = .09; and P = .32). Qualitative mycological evaluation before and after the treatment showed no statistically significant difference in KOH examination (P = 1; P = 1) and culture in Sabouraud dextrose agar (P = 1; P = 1).

Conclusion

Intrastromal voriconazole injection combined with topical voriconazole seems to give similar response time but not earlier in improving clinical presentation of Fusarium keratitis as topical natamycin.
Alteration of the pattern of regenerative corneal subbasal nerves after laser in‐situ keratomileusis surgery
Authors: Chao Cecilia , Lum Edward , Golebiowski Blanka , Stapleton Fiona
Published: August 2020

Purpose

Corneal nerves exhibit high plasticity, which allows successful reinnervation after nerve damage caused by laser in‐situ keratomileusis (LASIK) surgery. This study aimed to examine corneal subbasal nerve orientation during regeneration after LASIK.

Methods

This study involved 20 healthy, myopic subjects who had undergone bilateral Femto‐LASIK 12–16 months prior with a superior hinge position. The corneal subbasal nerve plexus at the central, mid‐temporal and mid‐superior cornea on the right eye were imaged using in vivo confocal microscopy. Global nerve fibre orientation (indicating the overall pattern) and variation of nerve fibre orientation (indicating the consistency of the orientation) was determined using customised MATLAB™ software (www.mathworks.com/products/matlab.html). Differences in nerve orientation variables between groups were examined using the Mann‐Whitney U test. Linear mixed models with Bonferroni adjustment were conducted to examine differences between corneal regions, and over time, after LASIK.

Results

There were no differences between post‐LASIK and control groups in global nerve orientation at any of the examined corneal regions. The post‐LASIK subjects had a greater variation of nerve orientation at the central (p = 0.007) and temporal (p = 0.049) cornea than the controls. There was a difference in global nerve fibre orientation between corneal regions (p < 0.001) in the controls but not in the post‐LASIK group. The variation of nerve fibre orientation was higher at the central, compared to the temporal and superior cornea after LASIK (p < 0.001), although there were no differences between corneal regions in controls.

Conclusions

Our results demonstrate that there was an increased variability in the corneal subbasal innervation patterns following LASIK when compared to controls.
Influence of early extubation on post‐operative outcomes after pediatric lung transplantation
Authors: Labarinas Sonia , Coss‐Bu Jorge A. , Onyearugbulem Chinyere , Heinle Jeffery S , Mallory George B , Gazzaneo Maria C.
Published: August 2020

Lung transplantation has become an accepted therapeutic option for a select group of children with end‐stage lung disease. We evaluated the impact of early extubation in a pediatric lung transplant population and its post‐operative outcomes. Single‐center retrospective study. PICU within a tertiary academic pediatric hospital. Patients <22 years after pulmonary transplant between January 2011 and December 2016. A total of 74 patients underwent lung transplantation. The primary pretransplantation diagnoses included cystic fibrosis (58%), pulmonary fibrosis (9%), and surfactant dysfunction disorders (10%). Of 60 patients, 36 (60%) were extubated within 24 hours and 24 patients after 24 hours (40%). A total of seven patients (11.6%) required reintubation within 24 hours. Median length of stay for the early extubation group was shorter at 3 days ([(IQR) 2.2‐4.7]) compared to 5 days (IQR, 3‐7) (P = .02) in the late extubation group. Median costs were lower for the early extubation group with 13,833 US dollars (IQR, 9980‐22,822) vs 23 671 US dollars (IQR, 16 673‐39 267) (P = .043). Fourteen patients were in the PICU prior to their transplantation; this did not affect their early extubation success. Neither did the fact of requiring invasive or non‐invasive mechanical ventilation before transplantation. Early extubation appears to be safe in a pediatric population after lung transplantation and is associated with a shorter LOS and decreased hospital costs. It may prevent known complications associated with mechanical ventilation.
Characterization of the novel HLA‐DQB1*05:237 allele by next‐generation sequencing
Authors: Genebrier Steve , Elsermans Vincent , Nivet Carl , Chérel Mathilde , Renac Virginie
Published: August 2020

DQB1*05:237 differs from DQB1*05:01:01:01 by one nucleotide substitution at position 67 in exon 1.
Characterization of the novel HLA‐DQB1*04:78 allele by sequencing‐based typing
Authors: Cargou Marine , Elsermans Vincent , Top Isabelle , Blouin Laura , Visentin Jonathan
Published: August 2020

HLA‐DQB1*04:78 differs from HLA‐DQB1*04:02:01:04 by one nucleotide substitution in codon 95 in exon 3.
Bloodstream infections by gram‐negative bacteria in kidney transplant patients: Incidence, risk factors, and outcome
Authors: Tsikala‐Vafea Maria , Basoulis Dimitrios , Pavlopoulou Ioanna , Darema Maria , Deliolanis John , Daikos George L. , Boletis John , Psichogiou Mina
Published: August 2020

Background

Kidney transplant recipients (KTRs) are at increased risk of infections.

Methods

The aims of this study were to describe the incidence of bloodstream infections (BSIs) by gram‐negative bacteria in a cohort of KTRs, the risk factors for BSI due to multi‐drug–resistant (MDR) gram‐negative bacteria, and the predictors for unfavorable outcome, defined as death or nephrectomy or return to dialysis, within 30 days from BSI. We conducted a retrospective cohort study at the renal transplant unit of a tertiary care hospital in Athens, Greece.

Results

In a total of 1962 KTRs, we recorded 195 BSI episodes in 182 single patients (male/female = 97/85), with a median (interquartile range) age of 57.2 (44‐64.9) years. The incidence was 1.393/100 patient‐years. The most common source of infection was urinary tract (70.9%), and Escherichia coli (63.7%) was the most common pathogen. 19.2% of the infecting organisms were MDR; previous antibiotic use (OR 8.2; CI 2.1‐32.9) and previous stay in the intensive care unit (OR 34.2; CI 1.6‐730.2) were associated with MDR BSIs. 6% of patients died, and 2.2% underwent nephrectomy, while no patients had to return to dialysis. Diabetes mellitus (OR 8.1; 95% CI 1.3‐50.3), Pseudomonas aeruginosa BSI (OR 46.1; 95% CI 3.9‐552.3), and septic shock (OR 46.7; 95% CI 1.7‐1304.9) were independent predictors of unfavorable outcome.

Conclusion

Bloodstream infections in KTRs have a significant impact on allograft and patients outcome.
Analysis of Bitcoin prices using market and sentiment variables
Authors: Kapar Burcu , Olmo Jose
Published: August 2020

This paper proposes an empirical model for analysing the dynamics of Bitcoin prices. To do this, we consider a vector error correction model over two overlapping periods: 2010–17 and 2010–19. Price discovery is achieved through the Gonzalo–Granger permanent‐transitory decomposition. The pricing factors are endogenous linear combinations of the S&P 500 index, gold price, a Google search variable associated to Bitcoin and a fear index proxied by the FED Financial Stress Index. Our empirical analysis shows that during the first period, a linear combination of four pricing factors describes the efficient Bitcoin price. The S&P 500 index and Google searches have a positive effect whereas gold prices and the fear index have a negative effect. In contrast, during the second period, the efficient price behaves idiosyncratically and can be only rationalised by individuals' search for information on the cryptocurrency. These findings provide empirical evidence on the presence of a correction in Bitcoin prices during the period 2018–19 uncorrelated to market fundamentals. We also show that standard empirical asset pricing models perform poorly for explaining Bitcoin prices.
Impact of a Formal Educational Skill‐Building Program Based on the ARCC Model to Enhance Evidence‐Based Practice Competency in Nurse Teams
Authors: Gorsuch Col (ret) Penelope F. , Gallagher Ford Lynn , Koshy Thomas Bindu , Melnyk Bernadette Mazurek , Connor Linda
Published: August 2020

Background

Implementation of evidence‐based practice (EBP) is necessary for healthcare systems to improve quality, safety, patient outcomes, and costs. Yet, EBP competency is lacking in many nurses and clinicians across the country.

Aim

The purpose of this initiative was to determine whether nursing teams (Executive Leader, Clinical/Mid‐level Leader, and Direct Care Nurse) attending a 5‐day EBP continuing education skill‐building program (immersion) was an effective strategy to build EBP competence, practice, and culture sustainability over time. The Advancing Research and Clinical Practice Through Close Collaboration Model was used to guide this initiative.

Methods

A project team was assembled, including leaders with EBP expertise from the Air Force Medical Service and The Helene Fuld Health Trust National Institute for EBP in Nursing and Healthcare at The Ohio State University. Five survey instruments were used to evaluate outcomes, including Organizational Culture and Readiness for System‐Wide Implementation of Evidence‐Based Practice, Evidence‐Based Practice Beliefs, Evidence‐Based Practice Implementation, and Evidence‐Based Practice Competencies, as well as the Knowledge Assessment Questionnaire test. Nursing teams were invited to participate and complete the program with the implementation of EBP projects over the following year.

Results

Participants’ EBP knowledge, skills, competencies, and beliefs were significantly improved and sustained over 12 months.

Linking Evidence to Action

A team‐based EBP skill‐building program was an effective strategy for building EBP competence, practice, and culture. This initiative demonstrated that the direct involvement of leadership and infrastructure to support EBP were crucial factors for building and sustaining an EBP culture.