bluuebunny/crossref_metadata_2025 huggingface dataset:
Dynamic Profiles and Transcriptional Preferences of Histone Modifications During Spermiogenesis
Authors: Li Yinchuan , Mi Panpan , Chen Xue , Wu Jiabao , Qin Weibing , Shen Yiqi , Zhang Pingbao , Tang Yunge , Cheng C Yan , Sun Fei
Published: November 2020

During spermiogenesis, extensive histone modifications take place in developing haploid spermatids besides morphological alterations of the genetic material to form compact nuclei. Better understanding on the overall transcriptional dynamics and preferences of histones and enzymes involved in histone modifications may provide valuable information to dissect the epigenetic characteristics and unique chromatin status during spermiogenesis. Using single-cell RNA-Sequencing, the expression dynamics of histone variants, writers, erasers, and readers of histone acetylation and methylation, as well as histone phosphorylation, ubiquitination, and chaperones were assessed through transcriptome profiling during spermiogenesis. This approach provided an unprecedented panoramic perspective of the involving genes in epigenetic modifier/histone variant expression during spermiogenesis. Results reported here revealed the transcriptional ranks of histones, histone modifications, and their readers during spermiogenesis, emphasizing the unique preferences of epigenetic regulation in spermatids. These findings also highlighted the impact of spermatid metabolic preferences on epigenetic modifications. Despite the observed rising trend on transcription levels of all encoding genes and histone variants, the transcriptome profile of genes in histone modifications and their readers displayed a downward expression trend, suggesting that spermatid nuclei condensation is a progressive process that occurred in tandem with a gradual decrease in overall epigenetic activity during spermiogenesis.
Adult Emergence Agitation: A Veteran-Focused Narrative Review
Authors: Tolly Brian , Waly Amr , Peterson Garrett , Erbes Christopher R. , Prielipp Richard C. , Apostolidou Ioanna
Published: November 2020

Emergence agitation (EA) is a self-limited state of psychomotor excitement during awakening from general anesthesia. EA is confined to the emergence period as consciousness is restored, which sharply distinguishes it from other postoperative delirium states. Sporadic episodes of EA may become violent with the potential for harm to both patients and caregivers, but the long-term consequences of such events are not fully understood. Current literature on EA in adults is limited to small-scale studies with inconsistent nomenclature, variable time periods that define emergence, a host of different surgical populations, and conflicting diagnostic criteria. Therefore, true incidence rates and risk factors are unknown. In adult noncardiac surgery, the incidence of EA is approximately 19%. Limited data suggest that young adults undergoing otolaryngology operations with volatile anesthetic maintenance may be at the highest risk for EA. Currently suggested EA mechanisms are theoretical but might reflect underblunted sympathetic activation in response to various internal (eg, flashbacks or anxiety) or external (eg, surgical pain) stimuli as consciousness returns. Supplemental dexmedetomidine and ketamine may be utilized for EA prevention. Compared to the civilian population, military veterans may be more vulnerable to EA due to high rates of posttraumatic stress disorder (PTSD) manifesting as violent flashbacks; however, confirmatory data are limited. Nonetheless, expert military medical providers suggest that use of patient-centered rapport tactics, PTSD trigger identification and avoidance, and grounding measures may alleviate hyperactive emergence phenomena. Future research is needed to better characterize EA in veterans and validate prophylactic measures to optimize care for these patients. This narrative review provides readers with an important framework to distinguish EA from delirium. Furthermore, we summarize current knowledge of EA risk factors, mechanisms, and adult management strategies and specifically revisit them in the context of veteran perioperative health. The anesthesiology care team is ideally positioned to further explore EA and develop effective prevention and treatment protocols.
Comparison of Monotherapy Versus Combination of Intravenous Ibuprofen and Propacetamol (Acetaminophen) for Reduction of Postoperative Opioid Administration in Children Undergoing Laparoscopic Hernia Repair: A Double-Blind Randomized Controlled Trial
Authors: Lee Hye-Mi , Park Ji-Hoon , Park Su-Jung , Choi Haegi , Lee Jeong-Rim
Published: November 2020

BACKGROUND:

Extensive efforts have been made toward reducing postoperative opioid use in children. In this study, we assessed whether propacetamol, or a nonsteroidal anti-inflammatory drug (NSAID), or their combination could effectively reduce opioid use in children after laparoscopic inguinal hernia repair.

METHODS:

This randomized, double-blind clinical trial included 159 children aged 6 months to 6 years. Children were allocated into 1 of the following 3 groups: group I was treated with 10 mg·kg−1 ibuprofen, group P was treated with 30 mg·kg−1 propacetamol, and group I + P was treated with both drugs in their respective concentrations. If the face–legs–activity–crying–consolability (FLACC) score was ≥4 during the postanesthesia care unit stay, 1.0 µg·kg−1 fentanyl was administered as a rescue analgesic. The number of patients who received rescue fentanyl in the postanesthesia care unit was defined as the primary outcome; this was analyzed using the χ2 test. The secondary outcomes included the FLACC and the parents’ postoperative pain measure (PPPM) scores until the 24-hour postoperative period.

RESULTS:

Among the 144 enrolled patients, 28.6% in group I, 66.7% in group P, and 12.8% in group I + P received rescue fentanyl in the postanesthesia care unit (P < .001). The highest FLACC score was lower in group I + P than in either group I or P (P = .007 and P < .001, respectively). Group I + P presented significantly lower PPPM scores than group P at 4 and 12 hours postoperative (P = .03 and .01, respectively).

CONCLUSIONS:

The use of ibuprofen plus propacetamol immediately following laparoscopic hernia repair surgery in children resulted in the reduced use of an opioid drug compared with the use of propacetamol alone.
Irreducible anteromedial radial head fracture-dislocation: value of pre-operative magnetic resonance imaging
Authors: Lim Lee Kai , Beh Joey
Published: November 2020

We describe a case of an anteromedial fracture-dislocation of the radial head in an adult patient, which was initially irreducible using closed means, and remained challenging to reduce despite open surgery. Further advanced CT/MRI revealed entrapment of the radial head due to the interposition of the brachialis tendon posteriorly, thereby preventing sustained reduction. While three other cases of irreducible anteromedial radial head dislocation due to the brachialis tendon have been reported in the English surgical literature, none of the imaging findings have been described in the radiological literature. Only one other case published in a surgical journal briefly demonstrated pre-operative MRI imaging. We would like to share the value of pre-operative MRI in this rare presentation, which would be helpful in diagnosing not only cases with interposition of the brachialis tendon, but potentially other types of soft tissue interposition which also limit closed reduction. To the best of the authors’ knowledge, this would be the first report on the imaging findings in a radiological journal. Awareness of this phenomenon would assist radiologists in the diagnosis and management of this rare condition.
Rare Disease Research Partnership (RAinDRoP): a collaborative approach to identify research priorities for rare diseases in Ireland
Authors: Somanadhan Suja , Nicholson Emma , Dorris Emma , Brinkley Aoife , Kennan Avril , Treacy Eileen , Atif Awan , Ennis Sean , McGrath Vicky , Mitchell Derick , O’Sullivan Grace , Power Julie , Lawlor Anne , Harkin Paul , Lynch Sally Ann , Watt Philip , Daly Avril , Donnelly Susie , Kroll Thilo
Published: November 2020

Background:

Rare diseases are individually rare, but collectively these conditions are common. Research on rare diseases are currently focused on disease-specific needs rather than a life-course perspective. The Rare Disease Research Partnership (RAinDRoP) was established in 2018 to bring together a wide variety of diverse voices in the rare disease community in Ireland and form a research partnership.

Methods:

A participatory multiple phase approach was used to identify research priorities for rare diseases. The research process involved three main phases: Phase I, Public Consultation Survey(PCS); Phase II, Research Prioritisation Workshop (RPW); Phase III, Public Prioritisation Ranking Survey (PRS). The time frame for the entire study was from November 2018 to June 2019.

Results:

In total, 240 individuals completed the phase I, of which only 96 survey participants provided information on their background,  32% (n=31) self-identified as a person living with a rare disease(s). One thousand and fifteen statements were collected, which reflected issues and shared challenges in rare diseases. MSExcel was used to gain frequencies and percentages. Phase II was focused on three main themes (1) Route to Diagnosis (2) Living with Rare Disease (3) Integrated and Palliative Care. 42 participants engaged at each workshop. Seventy-five individuals completed the phase III prioritisation ranking survey and ranked the top 15 research priorities.  The top five priorities were (1)Support at the time of diagnosis, (2) Diagnostic test for rare diseases (3)Education and training (4) Patient voice (5) Data sharing and integration of services for rare diseases.

Conclusions:

The research priorities identified here for rare diseases were developed jointly in collaboration with patients, families, healthcare professionals and policymakers. So, we encourage researchers, funding bodies and other stakeholders to use this priority list as a guiding document for future research work to improve the health and lives of people living with rare diseases.
Remote Love or Graphical Courses in Pandemic Conditions
Authors: Tikhonov-Bugrov D. , Abrosimov S.
Published: November 2020

In this paper it is noted that a characteristic and most important feature of domestic education is close interaction of teacher and student, mentoring, the dominant formula: first love, and then teach. It is feared that the teacher-student personal interaction is lost with the introduction of a graduated training system, dominance of all kinds of testing, and development of distance education technologies.

At the same time it is noted, that distance education technologies are good for distance learning and self-training, however, they do not contribute to the training of basic, elite specialists. The noted factors give no way to pay due attention to the training of talented students-intellectuals. They are nervous about the popular belief that vast arrays of high intelligence are merely useless for today's society and economy.

The results of work in the distance learning conditions at the BSTU "VOENMEKH" chair for graphic training of future specialists in the defense industry’s area are analyzed in this paper. It contains also information on adjustments for the educational process, communication features, and evaluation criteria. The conclusion has been drawn that significant difficulties and contingent losses are associated with the loss of possibility for close teacher-student personal interaction that has not allowed the teacher to show proper love for the student.

The assumption that the most of students are unbred to effective independent work was confirmed. The best adapted to this situation were those former scholars who were taught in an environment that allows them to receive electives of engineering profile or special courses.

The percentage of students who has not started the distance education or has not coped with it is about 35%, which significantly exceeds the losses of previous years for the same period. At the same time it is noted that past losses were actually determined from the very beginning of training. The current losses have an onset coinciding with the pandemic onset. These data confirm doubts about students' commitment to distance learning.
Review of Educational Courses Based on Augmented Reality Technologies
Authors: Ignat'ev S. , Tret'yakova Z. , Voronina Marianna
Published: November 2020

The research relevance is due to the growing interest of teachers in introducing Augmented Reality (AR) technologies into the course of Engineering and Computer Graphics (ECG). The research aims to study the current state of knowledge and practice of existing courses using AR-technologies, including those for geometric-graphic training of high educational institutions students. The research object was the subject readiness of engineering students to master graphic disciplines based on the AR-concept. More than 200 scientific papers published between 2005 and 2020 were selected to review the qualitative and quantitative AR-research in the education area. For this purpose, the following factors were taken into account: category of educational institution and student, publication year, academic discipline, AR-technologies. Have been presented examples for AR-technologies implementation at different levels of education, such as preschool, school, higher and special ones. Special focus has been on consideration of teachers’ experience related to AR-technologies introducing in geometric training courses. It has been revealed that at present the AR-concept has gained popularity not only among designers, but also among schoolteachers, as well as among engineering high educational institutions’ lecturers. The lack of sufficient amount of scientifically based and tested programs and training materials for student teaching on ECG using AR has been proved. The necessity for further scientific research in the area of AR application to teach students on ECG has been justified. The research base was St. Petersburg Mining University. The paper materials may be useful for high educational institutions’ lecturers, schoolteachers, and parents.
Extracellular matrix graft for the surgical management of Hurley stage III hidradenitis suppurativa: a pilot case series
Authors: Chaffin Abigail E , Buckley Marie-Claire
Published: November 2020

Objective:

Surgical management of Hurley stage III hidradenitis suppurativa (HS) typically involves the excision of diseased tissue and subsequent reconstruction, potentially leading to complications or recurrence of the disease. This pilot case series sought to evaluate a decellularised ovine forestomach matrix (OFM) extracellular matrix (ECM) graft for soft tissue regeneration as part of surgical reconstruction of stage III HS of the axilla.

Method:

The prospective pilot case series involved six participants and a total of eight defects. The ECM graft was used either as a dermal substitute for a staged reconstruction (n=3 defects) or as an implant under a fasciocutaneous flap (n=5 defects) following wide excision of the diseased tissue.

Results:

In all cases complete healing was achieved, with no major surgical complications. When used as a dermal substitute the OFM graft was completely granulated within 2–4 weeks, with defects closing by secondary intention or following placement of a split-thickness skin graft. When used as an implant beneath a fasciocutaneous flap, healing of the surgical sites was observed after 1–3 months. At the long-term follow-up (3–12 months), all participants had excellent range of motion and none had reported disease recurrences.

Conclusion:

This pilot case series explored the implementation of an ECM graft as part of the surgical management of axilla Hurley stage III HS. Although the study had a limited number of participants, long-term outcomes were promising and suggest further studies are warranted.
A European randomised controlled trial for venous leg ulcers: a mathematical model analysis
Authors: Renner Regina
Published: November 2020

Objective:

Mathematical models have the potential to provide valuable insights into complex, biochemical and biomechanical processes. Previously, we developed a mathematical model with a non-linear growth function but could only confirm the feasibility of this model in clinical trials with a small number of patients. This limited the validity of our model. To increase validity, we applied the model to a larger number of patients.

Method:

The mathematical model was applied to patient data from a randomised controlled trial as part of the post-evaluation of the model. In this trial, patients with venous leg ulcers were randomised for treatment with either a two-layer bandage or a four-layer bandage.

Results:

Data for 186 patients were analysed (two-layer bandage group, n=93; four-layer bandage group, n=93). Using the non-linear growth function, it was confirmed that the two-layer bandage was not inferior to the four-layer bandage. In addition, the mathematical model calculated individual wound healing trajectories and mean wound healing trajectories for both bandage systems. By extrapolating to t→∞, the two-layer bandage had a marginal benefit and resulted in a persistent wound area that was 7% of the initial wound area compared with 17% for the four-layer bandage.

Conclusion:

This analysis supported the previously performed statistical analysis, and allowed us to obtain details of the treated study population that may help in non-inferiority trials via extrapolation. It also provided new insights into the wound healing process by generating wound healing trajectories.
Assessment of pelvic morphology using 3D imaging and analysis in unilateral Crowe-IV developmental dysplasia of the hip
Authors: Huang Yi-Fan , Gao Yu-Hang , Li Ye-Ran , Ding Lu , Liu Jian-Guo , Qi Xin
Published: November 2020

Aims

Morphological abnormalities are present in patients with developmental dysplasia of the hip (DDH). We studied and compared the pelvic anatomy and morphology between the affected hemipelvis with the unaffected side in patients with unilateral Crowe type IV DDH using 3D imaging and analysis.

Methods

A total of 20 patients with unilateral Crowe-IV DDH were included in the study. The contralateral side was considered normal in all patients. A coordinate system based on the sacral base (SB) in a reconstructed pelvic model was established. The pelvic orientations (tilt, rotation, and obliquity) of the affected side were assessed by establishing a virtual anterior pelvic plane (APP). The bilateral coordinates of the anterior superior iliac spine (ASIS) and the centres of hip rotation were established, and parameters concerning size and volume were compared for both sides of the pelvis.

Results

The ASIS on the dislocated side was located inferiorly and anteriorly compared to the healthy side (coordinates on the y-axis and z-axis; p = 0.001; p = 0.031). The centre of hip rotation on the dislocated side was located inferiorly and medially compared to the healthy side (coordinates on the x-axis and the y-axis; p < 0.001; p = 0.003). The affected hemipelvis tilted anteriorly in the sagittal plane (mean 8.05° (SD 3.57°)), anteriorly rotated in the transverse plane (mean 3.31° (SD 1.41°)), and tilted obliquely and caudally in the coronal plane (mean 2.04° (SD 0.81°)) relative to the healthy hemipelvis. The affected hemipelvis was significantly smaller in the length, width, height, and volume than the healthy counterpart. (p = 0.014; p = 0.009; p = 0.035; p = 0.002).

Conclusion

Asymmetric abnormalities were identified on the affected hemipelvis in patients with the unilateral Crowe-IV DDH using 3D imaging techniques. Improved understanding of the morphological changes may influence the positioning of the acetabular component at THA. Acetabular component malpositioning errors caused by anterior tilt of the affected hemi pelvis and the abnormal position of the affected side centre of rotation should be considered by orthopaedic surgeons when undertaking THA in patients with Crowe-IV DDH. Cite this article: Bone Joint J 2020;102-B(10):1311–1318.
Retrospective evaluation of outcomes of bone peg fixation for osteochondral lesion of the talus
Authors: Park Chul H. , Song Kwang-Soon , Kim Jung R. , Lee Si-Wook
Published: November 2020

Aims

The hypothesis of this study was that bone peg fixation in the treatment of osteochondral lesions of the talus would show satisfactory clinical and radiological results, without complications.

Methods

Between September 2014 and July 2017, 25 patients with symptomatic osteochondritis of the talus and an osteochondral fragment, who were treated using bone peg fixation, were analyzed retrospectively. All were available for complete follow-up at a mean 22 of months (12 to 35). There were 15 males and ten females with a mean age of 19.6 years (11 to 34). The clinical results were evaluated using a visual analogue scale (VAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score preoperatively and at the final follow-up. The radiological results were evaluated using classification described by Hepple et al based on the MRI findings, the location of the lesion, the size of the osteochondral fragment, and the postoperative healing of the lesion.

Results

The mean VAS and AOFAS score improved significantly from 6.3 (4 to 8) and 70.6 (44 to 78) preoperatively to 1.6 (0 to 5) and 91.1 (77 to 100) at the final follow-up, respectively (p < 0.001). The classification on MRI was stage 2a in nine patients, stage 3 in 14, and stage 4 in two. The lesion was located on the posteromedial aspect of the dome of the talus in 19 patients, the anterolateral aspect in five, and the centrolateral aspect in one. The mean size of the fragment was 11.2 mm (5 to 20) horizontally, 10.4 mm (7 to 18) vertically, and 5.2 mm (3 to 10) deep, respectively. The postoperative healing state was good in 19 patients and fair in six.

Conclusion

Bone peg fixation for osteochondral lesions of the talus showed satisfactory clinical and radiographic results, without complications. This technique could be a good form of treatment for patients with this condition who have an osteochondral fragment. Cite this article: Bone Joint J 2020;102-B(10):1349–1353.
Clinical application of artificial intelligence-assisted diagnosis using anteroposterior pelvic radiographs in children with developmental dysplasia of the hip
Authors: Zhang Si-Cheng , Sun Jun , Liu Chuan-Bin , Fang Ji-Hong , Xie Hong-Tao , Ning Bo
Published: November 2020

Aims

The diagnosis of developmental dysplasia of the hip (DDH) is challenging owing to extensive variation in paediatric pelvic anatomy. Artificial intelligence (AI) may represent an effective diagnostic tool for DDH. Here, we aimed to develop an anteroposterior pelvic radiograph deep learning system for diagnosing DDH in children and analyze the feasibility of its application.

Methods

In total, 10,219 anteroposterior pelvic radiographs were retrospectively collected from April 2014 to December 2018. Clinicians labelled each radiograph using a uniform standard method. Radiographs were grouped according to age and into ‘dislocation’ (dislocation and subluxation) and ‘non-dislocation’ (normal cases and those with dysplasia of the acetabulum) groups based on clinical diagnosis. The deep learning system was trained and optimized using 9,081 radiographs; 1,138 test radiographs were then used to compare the diagnoses made by deep learning system and clinicians. The accuracy of the deep learning system was determined using a receiver operating characteristic curve, and the consistency of acetabular index measurements was evaluated using Bland-Altman plots.

Results

In all, 1,138 patients (242 males; 896 females; mean age 1.5 years (SD 1.79; 0 to 10) were included in this study. The area under the receiver operating characteristic curve, sensitivity, and specificity of the deep learning system for diagnosing hip dislocation were 0.975, 276/289 (95.5%), and 1,978/1,987 (99.5%), respectively. Compared with clinical diagnoses, the Bland-Altman 95% limits of agreement for acetabular index, as determined by the deep learning system from the radiographs of non-dislocated and dislocated hips, were -3.27° - 2.94° and -7.36° - 5.36°, respectively (p < 0.001).

Conclusion

The deep learning system was highly consistent, more convenient, and more effective for diagnosing DDH compared with clinician-led diagnoses. Deep learning systems should be considered for analysis of anteroposterior pelvic radiographs when diagnosing DDH. The deep learning system will improve the current artificially complicated screening referral process. Cite this article: Bone Joint J 2020;102-B(11):1574–1581.
The Importance of Authentic Workplace-Based Assessment: A Study From VET Teacher Education
Authors: Dahlback Jorunn , Berg Olstad Hanne , Sylte Ann Lisa , Wolden Anne-Catrine
Published: November 2020

Context: This article is based on a pragmatic theoretical perspective on education, in which theoretical and practical competences are developed through experiences and participation in real-world teaching contexts. Previous research points to a lack of culture for authentic workplace-based assessment in vocational and professional education in many countries. Prior to this study, professors/authors and student-teachers in a vocational teacher education program in Norway experienced that student-teachers were unable to demonstrate comprehensive teaching competence, as examinations and assessments assess theoretical knowledge separately from practice. Research questions: 1) How can an authentic workplace-based exam during placement give student-teachers an opportunity to showcase their comprehensive teacher competence? 2) What factors are important to emphasize in such an exam? 3) How do the student-teachers demonstrate and develop comprehensive teacher competence through an authentic exam?Methods: Using action research, professors/authors carried out sequential actions to develop a practical-theoretical exam in an authentic professional setting. This included demonstrating elements of practical and theoretical competence conducted during teaching practice. The exam involved planning in line with a guidance document and practical teaching in the classroom in VET-schools, followed by a piece of reflective writing based on teaching experiences. Supervisors and professors/authors observed the student-teachers teaching as part of multiple qualitative methods.Findings: The empirical results show how student-teachers demonstrate and develop comprehensive teaching competence. Both the student-teacher and the supervisors in VET-schools experienced the authentic exam as realistic and professionally based. The biggest challenge involved logistics: Compensating the professors’/authors’ time and financial frameworks related to the observation of the student-teachers. However, this kind of authentic assessment leads to stronger coherence between both theory and practice, and between the vocational teacher education at the university and the VET in upper secondary school. It also supports the job-relevant learning process towards comprehensive teacher competence.Conclusions: This kind of authentic assessment i.e. an authentic exam requires an understanding of the complex role of teachers within their professional context in VET. Therefore, the professors/authors see the need of a broader, more comprehensive teacher competence in VET to meet the work life needs for competence.
Exploiting a holographic polarization microscope for rapid autofocusing and 3D tracking
Authors: Che Leiping , Xiao Wen , Pan Feng , Ferraro Pietro
Published: November 2020

We report a fast autofocusing and accurate 3D tracking scheme for a digital hologram (DH) that intrinsically exploits a polarization microscope setup with two off-axis illumination beams having different polarization. This configuration forms twin-object images that are recorded in a digital hologram by angular and polarization multiplexing technique. We show that the separation of the two images on the recording plane follows a linear relationship with the defocus distance and indicates the defocus direction. Thus, in the entire field of view (FOV), the best focus distance of each object can be directly retrieved by identifying the respective separation distance with a cross-correlation algorithm, at the same time, 3D tracking can be performed by calculating the transverse coordinates of the two images. Moreover, we estimate this linear relationship by utilizing the numerical propagation calculation based on a single hologram, in which the focus distance of one of the objects in the FOV is known. We proved the proposed approach in accurate 3D tracking through multiple completely different experimental cases, i.e., recovering the swimming path of a marine alga (tetraselmis) in water and fast refocusing of ovarian cancer cells under micro-vibration stimulation. The reported experimental results validate the proposed strategy’s effectiveness in dynamic measurement and 3D tracking without multiple diffraction calculations and any precise knowledge about the setup. We claim that it is the first time that a holographic polarization multiplexing setup is exploited intrinsically for 3D tracking and/or fast and accurate refocusing. This means that almost any polarization DH setup, thanks to our results, can guarantee accurate focusing along the optical axis in addition to polarization analysis of the sample, thus overcoming the limitation of the poor axial resolution.
Der Einfluss von IoT-, Big-Data- und Mobile-Health-Lösungen auf die Wertschöpfung in Krankenhäusern: Gap-Analyse und Handlungsempfehlungen
Authors: Neft Florian , Kappler Karolin Eva , Smolnik Stefan
Published: November 2020

Deutsche Krankenhäuser sehen sich heutzutage mit Herausforderungen wie der Globalisierung, dem demographischen Wandel, nachhaltiger Entwicklung und den Folgen des Corona-Virus konfrontiert. Um in diesen Zeiten die Versorgungsqualität zu verbessern, profitabel zu wirtschaften und die Resilienz gegenüber diesen allgemeinen und spezifischen Risiken zu erhöhen, ist in Krankenhäusern ein Optimierungsbedarf erkennbar. Daher werden in dieser Arbeit Mängel im Leistungsspektrum deutscher Krankenhäuser untersucht, um darauf aufbauend aktuelle Lösungsansätze zu diskutieren. Die hierfür interviewten Krankenhausleiter erkennen in der Kommunikation, der Reaktionsfähigkeit bei Patientenanstiegen, der Verwaltung sowie der IT-Ausstattung Verbesserungspotenziale. Die Antworten zu den verwendeten IT-Systemen weisen darauf hin, dass die Krankenhäuser bereits diverse Technologien einsetzen, diese allerdings häufig veraltet sind, zu wenige Schnittstellen besitzen und somit die Anforderungen des Personals und der Patienten nicht erfüllen. In der Evaluierung zeigen sich durch die Verwendung von Informations- und Kommunikationstechnologien wie Mobile Health, Big Data und dem Internet of Things langfristig Potenziale, die Leistungs- und Nachhaltigkeitsdefizite zu lösen. Weiterhin tragen sie zur Verbesserung vieler Wertschöpfungsprozesse bei. Auch für andere Technologien wie Robotik, Virtual und Augmented Reality sowie RFID bestehen zahlreiche Nutzungspotenziale. Dennoch bindet die Digitalisierung personelle und finanzielle Mittel, dient aber durch verbesserte Planungsmöglichkeiten der Ressourceneinsparung und somit der Nachhaltigkeit.
Machine learning assisted intraoperative assessment of brain tumor margins using HRMAS NMR spectroscopy
Authors: Cakmakci Doruk , Karakaslar Emin Onur , Ruhland Elisa , Chenard Marie-Pierre , Proust Francois , Piotto Martial , Namer Izzie Jacques , Cicek A. Ercument
Published: November 2020

Complete resection of the tumor is important for survival in glioma patients. Even if the gross total resection was achieved, left-over micro-scale tissue in the excision cavity risks recurrence. High Resolution Magic Angle Spinning Nuclear Magnetic Resonance (HRMAS NMR) technique can distinguish healthy and malign tissue efficiently using peak intensities of biomarker metabolites. The method is fast, sensitive and can work with small and unprocessed samples, which makes it a good fit for real-time analysis during surgery. However, only a targeted analysis for the existence of known tumor biomarkers can be made and this requires a technician with chemistry background, and a pathologist with knowledge on tumor metabolism to be present during surgery. Here, we show that we can accurately perform this analysis in real-time and can analyze the full spectrum in an untargeted fashion using machine learning. We work on a new and large HRMAS NMR dataset of glioma and control samples (n = 565), which are also labeled with a quantitative pathology analysis. Our results show that a random forest based approach can distinguish samples with tumor cells and controls accurately and effectively with a median AUC of 85.6% and AUPR of 93.4%. We also show that we can further distinguish benign and malignant samples with a median AUC of 87.1% and AUPR of 96.1%. We analyze the feature (peak) importance for classification to interpret the results of the classifier. We validate that known malignancy biomarkers such as creatine and 2-hydroxyglutarate play an important role in distinguishing tumor and normal cells and suggest new biomarker regions. The code is released athttp://github.com/ciceklab/HRMAS_NC.
Few-shot learning for classification of novel macromolecular structures in cryo-electron tomograms
Authors: Li Ran , Yu Liangyong , Zhou Bo , Zeng Xiangrui , Wang Zhenyu , Yang Xiaoyan , Zhang Jing , Gao Xin , Jiang Rui , Xu Min
Published: November 2020

Cryo-electron tomography (cryo-ET) provides 3D visualization of subcellular components in the near-native state and at sub-molecular resolutions in single cells, demonstrating an increasingly important role in structural biology in situ. However, systematic recognition and recovery of macromolecular structures in cryo-ET data remain challenging as a result of low signal-to-noise ratio (SNR), small sizes of macromolecules, and high complexity of the cellular environment. Subtomogram structural classification is an essential step for such task. Although acquisition of large amounts of subtomograms is no longer an obstacle due to advances in automation of data collection, obtaining the same number of structural labels is both computation and labor intensive. On the other hand, existing deep learning based supervised classification approaches are highly demanding on labeled data and have limited ability to learn about new structures rapidly from data containing very few labels of such new structures. In this work, we propose a novel approach for subtomogram classification based on few-shot learning. With our approach, classification of unseen structures in the training data can be conducted given few labeled samples in test data through instance embedding. Experiments were performed on both simulated and real datasets. Our experimental results show that we can make inference on new structures given only five labeled samples for each class with a competitive accuracy (> 0.86 on the simulated dataset with SNR = 0.1), or even one sample with an accuracy of 0.7644. The results on real datasets are also promising with accuracy > 0.9 on both conditions and even up to 1 on one of the real datasets. Our approach achieves significant improvement compared with the baseline method and has strong capabilities of generalizing to other cellular components.
Microutrophin expression in dystrophic mice displays myofiber type differences in therapeutic effects
Authors: Banks Glen B. , Chamberlain Jeffrey S. , Odom Guy L.
Published: November 2020

Gene therapy approaches for DMD using recombinant adeno-associated viral (rAAV) vectors to deliver miniaturized (or micro) dystrophin genes to striated muscles have shown significant progress. However, concerns remain about the potential for immune responses against dystrophin in some patients. Utrophin, a developmental paralogue of dystrophin, may provide a viable treatment option. Here we examine the functional capacity of an rAAV-mediated microutrophin (μUtrn) therapy in themdx4cvmouse model of DMD. We found that rAAV-μUtrn led to improvement in dystrophic histopathology & mostly restored the architecture of the neuromuscular and myotendinous junctions. Physiological studies of tibialis anterior muscles indicated peak force maintenance, with partial improvement of specific force. A fundamental question for μUtrn therapeutics is not only can it replace critical functions of dystrophin, but whether full-length utrophin impacts the therapeutic efficacy of the smaller, highly expressed μUtrn. As such, we found that μUtrn significantly reduced the spacing of the costameric lattice relative to full-length utrophin. Further, immunostaining suggested the improvement in dystrophic pathophysiology was largely influenced by favored correction of fast 2b fibers. However, unlike μUtrn, μdystrophin (μDys) expression did not show this fiber type preference. Interestingly, μUtrn was better able to protect 2a and 2d fibers inmdx:utrn-/-mice than inmdx4cvmice where the endogenous full-length utrophin was most prevalent. Altogether, these data are consistent with the role of steric hindrance between full-length utrophin & μUtrn within the sarcolemma. Understanding the stoichiometry of this effect may be important for predicting clinical efficacy.
Urine metabolomics of rats with chronic atrophic gastritis
Authors: Zu Guo-Xiu , Sun Qian-Qian , Chen Jian , Liu Xi-Jian , Sun Ke-Yun , Zhang Liang-Kun , Li Ling , Han Tao , Huang Hai-Liang
Published: November 2020

Background/aim

To use liquid chromatography-mass spectrometry (LC-MS) to identify endogenous differential metabolites in the urine of rats with chronic atrophic gastritis (CAG).

Materials and methods

Methylnitronitrosoguanidine (MNNG) was used to produce a CAG model in Wistar rats, and HE staining was used to determine the pathological model. LC-MS was used to detect the differential metabolic profiles in rat urine. Diversified analysis was performed by the statistical method.

Results

Compared with the control group, the model group had 68 differential metabolites, 25 that were upregulated and 43 that were downregulated. The main metabolic pathways were D-glutamine and D-glutamic acid metabolism, histidine metabolism and purine metabolism.

Conclusion

By searching for differential metabolites and metabolic pathways in the urine of CAG rats, this study provides effective experimental data for the pathogenesis and clinical diagnosis of CAG.
Organizing pneumonia of COVID-19: Time-dependent evolution and outcome in CT findings
Authors: Wang Yan , Jin Chao , Wu Carol C. , Zhao Huifang , Liang Ting , Liu Zhe , Jian Zhijie , Li Runqing , Wang Zekun , Li Fen , Zhou Jie , Cai Shubo , Liu Yang , Li Hao , Liang Yukun , Tian Cong , Yang Jian
Published: November 2020

Background

As a pandemic, a most-common pattern resembled organizing pneumonia (OP) has been identified by CT findings in novel coronavirus disease (COVID-19). We aimed to delineate the evolution of CT findings and outcome in OP of COVID-19.

Materials and methods

106 COVID-19 patients with OP based on CT findings were retrospectively included and categorized into non-severe (mild/common) and severe (severe/critical) groups. CT features including lobar distribution, presence of ground glass opacities (GGO), consolidation, linear opacities and total severity CT score were evaluated at three time intervals from symptom-onset to CT scan (day 0–7, day 8–14, day > 14). Discharge or adverse outcome (admission to ICU or death), and pulmonary sequelae (complete absorption or lesion residuals) on CT after discharge were analyzed based on the CT features at different time interval.

Results

79 (74.5%) patients were non-severe and 103 (97.2%) were discharged at median day 25 (range, day 8–50) after symptom-onset. Of 67 patients with revisit CT at 2–4 weeks after discharge, 20 (29.9%) had complete absorption of lesions at median day 38 (range, day 30–53) after symptom-onset. Significant differences between complete absorption and residuals groups were found in percentages of consolidation (1.5% vs. 13.8%, P = 0.010), number of involved lobe > 3 (40.0% vs. 72.5%, P = 0.030), CT score > 4 (20.0% vs. 65.0%, P = 0.010) at day 8–14.

Conclusion

Most OP cases had good prognosis. Approximately one-third of cases had complete absorption of lesions during 1–2 months after symptom-onset while those with increased frequency of consolidation, number of involved lobe > 3, and CT score > 4 at week 2 after symptom-onset may indicate lesion residuals on CT.
Comparison of VEGF-A secretion from tumor cells under cellular stresses in conventional monolayer culture and microfluidic three-dimensional spheroid models
Authors: Sarkar Sreerupa , Peng Chien-Chung , Tung Yi-Chung
Published: November 2020

Vascular endothelial growth factor (VEGF) is a major cytokine in tumor biology affecting tumor survival, aggressiveness and pro-angiogenetic activities. In addition, cellular stresses often result in aggressive pro-angiogenetic behavior in tumors. For in vitro study, conventional monolayer cell culture has been broadly exploited; however, it often provides limited information due to its different microenvironment from that in vivo. Recently, three-dimensional (3D) cell spheroid culture provides in vivo-like microenvironments to study tumor biology and their survival mechanisms with better predictive power. In this work, vascular endothelial growth factor of type A (VEGF-A) secretion from osteosarcoma (MG-63) cells cultured using monolayer and 3D spheroid models under two stress conditions: nutrient deficiency (reduced serum culture) and hypoxia-inducible factor (HIF) inhibition (HIF inhibitor, YC-1) are characterized and systematically compared. In order to obtain ample sample size for consistent characterization of cellular responses from cancer spheroids under the stresses and compare the responses to those from the conventional monolayer model, a microfluidic spheroid formation and culture device is utilized in the experiments. In the analysis, cell viability is estimated from captured images, and quantification of VEGF-A secreted from the cells is achieved using enzyme-linked immunosorbent assay (ELISA). The experimental results show that the viabilities decrease when the cells face higher stress levels in both monolayer and 3D spheroid culture models; however, the VEGF-A secretion profiles between the cell culture models are different. The VEGF-A secretion decreases when the cells face higher stress conditions in the monolayer cell culture. In contrast, for the 3D spheroid culture, the VEGF-A concentration decreases for low stress levels but increases while the stress level is high. The VEGF-A regulation in the 3D models mimics in vivo cases of tumor survival and can provide insightful information to investigate tumor angiogenesis in vitro. The approach developed in this paper provides an efficient method to quantitatively and statistically study tumor growth kinetics and stress responses from highly uniform samples and it can also be applied to compare the underlying biomolecular mechanisms in monolayer and 3D spheroid culture models to elucidate the effects of microenvironments on cellular response in cancer research.
Increased malaria parasitaemia among adults living with HIV who have discontinued cotrimoxazole prophylaxis in Kitgum district, Uganda
Authors: Orishaba Philip , Kalyango Joan N. , Byakika-Kibwika Pauline , Arinaitwe Emmanuel , Wandera Bonnie , Katairo Thomas , Muzeyi Wani , Nansikombi Hildah Tendo , Nakato Alice , Mutabazi Tobius , Kamya Moses R. , Dorsey Grant , Nankabirwa Joaniter I.
Published: November 2020

Background

Although WHO recommends cotrimoxazole (CTX) discontinuation among HIV patients who have undergone immune recovery and are living in areas of low prevalence of malaria, some countries including Uganda recommend CTX discontinuation despite having a high malaria burden. We estimated the prevalence and factors associated with malaria parasitaemia among adults living with HIV attending hospital outpatient clinic before and after discontinuation of CTX prophylaxis.

Methods

Between March and April 2019, 599 participants aged 18 years and above, and attending Kitgum hospital HIV clinic in Uganda were enrolled in a cross study. A standardized questionnaire was administered and physical examination conducted. A finger-prick blood sample was collected for identification of malaria parasites by microscopy. The prevalence of parasitaemia was estimated and compared among participants on and those who had discontinued CTX prophylaxis, and factors associated with malaria parasitaemia assessed.

Results

Of the enrolled participants, 27 (4.5%) had malaria parasites and 452 (75.5%) had stopped CTX prophylaxis. Prevalence of malaria parasitaemia was significantly higher in participants who had stopped CTX prophylaxis (5.5% versus 1.4% p = 0.03) and increased with increasing duration since the discontinuation of prophylaxis. Compared to participants taking CTX, those who discontinued prophylaxis for 3–5 months and >5 months were more likely to have malaria parasites (adjusted prevalence ratio (aPR) = 1.64, 95% CI 0.37–7.29, p = 0.51, and aPR = 6.06, 95% CI 1.34–27.3, P = 0.02). Low CD4 count (< 250cells/mm3) was also associated with increased risk of having parasites (aPR = 4.31, 95% CI 2.13–8.73, p <0.001).

Conclusion

People from malaria endemic settings living with HIV have a higher prevalence of malaria parasitaemia following discontinuation of CTX compared to those still on prophylaxis. The risk increased with increasing duration since discontinuation of the prophylaxis. HIV patients should not discontinue CTX prophylaxis in areas of Uganda where the burden of malaria remains high. Other proven malaria control interventions may also be encouraged in HIV patients following discontinuation of CTX prophylaxis.
Multiple observations of Bigfin Squid (Magnapinna sp.) in the Great Australian Bight reveal distribution patterns, morphological characteristics, and rarely seen behaviour
Authors: Osterhage Deborah , MacIntosh Hugh , Althaus Franziska , Ross Andrew
Published: November 2020

One of the most remarkable groups of deep-sea squids is the Magnapinnidae, known for their large fins and strikingly long arm and tentacle filaments. Little is known of their biology and ecology as most specimens are damaged and juvenile, and in-situ sightings are sparse, numbering around a dozen globally. As part of a recent large-scale research programme in the Great Australian Bight, Remotely Operated Vehicles and a towed camera system were deployed in depths of 946–3258 m resulting in five Magnapinna sp. sightings. These represent the first records of Bigfin Squid in Australian waters, and more than double the known records from the southern hemisphere, bolstering a hypothesis of cosmopolitan distribution. As most previous observations have been of single Magnapinna squid these multiple sightings have been quite revealing, being found in close spatial and temporal proximity of each other. Morphological differences indicate each sighting is of an individual rather than multiple sightings of the same squid. In terms of morphology, previous in-situ measurements have been roughly based on nearby objects of known size, but this study used paired lasers visible on the body of a Magnapinna squid, providing a more accurate scaling of size. Squid of a juvenile size were also recorded and are confirmed to possess the long distal filaments which have thus far been mostly missing from specimens due to damage. We have described fine-scale habitat, in-situ colouration, and behavioural components including a horizontal example of the ‘elbow’ pose, and coiling of distal filaments: a behaviour not previously seen in squid. These sightings add to our knowledge of this elusive and intriguing genus, and reinforce the value of imagery as a tool in deep-sea squid research.