bluuebunny/crossref_metadata_2025 huggingface dataset:
Reducing maternal and newborn mortality in Nigeria—a qualitative study of stakeholders’ perceptions about the performance of community health workers and the introduction of community midwifery at primary healthcare level
Authors: Okereke Ekechi , Ishaku Salisu Mohammed , Unumeri Godwin , Mohammed Bello , Ahonsi Babatunde
Published: December 2019

Background

Rural communities in Nigeria account for high maternal and newborn mortality rates in the country. Thus, there is a need for innovative models of service delivery, possibly with greater community engagement. Introducing and strengthening community midwifery practice within the Nigerian primary healthcare system is a clear policy option. The potential of community midwifery to increase the availability of skilled care during pregnancy, at birth and within postpartum periods in the health systems of developing countries has not been fully explored. This study was designed to assess stakeholders’ perceptions about the performance of community health workers and the feasibility of introducing and using community midwifery to address the high maternal and newborn mortality within the Nigerian healthcare system.

Methods

This study was undertaken in two human resources for health (HRH) project focal states (Bauchi and Cross River States) in Nigeria, utilizing a qualitative research design. Interviews were conducted with 44 purposively selected key informants. Key informants were selected based on their knowledge and experience working with different cadres of frontline health workers at primary healthcare level. The qualitative data were audio-recorded, transcribed and then thematically analysed.

Results

Some study participants felt that introducing community midwifery will increase access to maternal and newborn healthcare services, especially in rural communities. Others felt that applying community midwifery at the primary healthcare level may lead to duplication of duties among the health worker cadres, possibly creating disharmony. Some key informants suggested that there should be concerted efforts to train and retrain the existing cadres of community health workers via the effective implementation of the task shifting policy in Nigeria, in addition to possibly revising the existing training curricula, instead of introducing community midwifery.

Conclusion

Applying community midwifery within the Nigerian healthcare system has the potential to increase the availability of skilled care during pregnancy, at birth and within postpartum periods, especially in rural communities. However, there needs to be broader stakeholder engagement, more awareness creation and the careful consideration of modalities for introducing and strengthening community midwifery training and practice within the Nigerian health system as well as within the health systems of other developing countries.
UGM: a more stable procedure for large-scale multiple testing problems, new solutions to identify oncogene
Authors: Liu Chengyou , Zhou Leilei , Wang Yuhe , Tian Shuchang , Zhu Junlin , Qin Hang , Ding Yong , Jiang Hongbing
Published: December 2019

Variations of gene expression levels play an important role in tumors. There are numerous methods to identify differentially expressed genes in high-throughput sequencing. Several algorithms endeavor to identify distinctive genetic patterns susceptable to particular diseases. Although these processes have been proved successful, the probability that the number of non-differentially expressed genes measured by false discovery rate (FDR) has a large standard deviation, and the misidentification rate (type I error) grows rapidly when the number of genes to be detected become larger. In this study we developed a new method, Unit Gamma Measurement (UGM), accounting for multiple hypotheses test statistics distribution, which could reduce the dependency problem. Simulated expression profile data and breast cancer RNA-Seq data were utilized to testify the accuracy of UGM. The results show that the number of non-differentially expressed genes identified by the UGM is very close to the real-evidence data, and the UGM also has a smaller standard error, range, quartile range and RMS error. In addition, the UGM can be used to screen many breast cancer-associated genes, such as BRCA1, BRCA2, PTEN, BRIP1, etc., provides better accuracy, robustness and efficiency, the method of identification differentially expressed genes in high-throughput sequencing.
Eumelanin and pheomelanin pigmentation in mollusc shells may be less common than expected: insights from mass spectrometry
Authors: Affenzeller Susanne , Wolkenstein Klaus , Frauendorf Holm , Jackson Daniel J.
Published: December 2019

Background

The geometric patterns that adorn the shells of many phylogenetically disparate molluscan species are comprised of pigments that span the visible spectrum. Although early chemical studies implicated melanin as a commonly employed pigment, surprisingly little evidence generated with more recent and sensitive techniques exists to support these observations.

Results

Here we present the first mass spectrometric investigations for the presence of eumelanin and pheomelanin in 13 different molluscan species from three conchiferan classes: Bivalvia, Cephalopoda and Gastropoda. In the bivalve Mytilus edulis we demonstrate that eumelanin mainly occurs in the outermost, non-mineralised and highly pigmented layer of the shell (often referred to as the periostracum). We also identified eumelanin in the shells of the cephalopod Nautilus pompilius and the marine gastropods Clanculus pharaonius and Steromphala adriatica. In the terrestrial gastropod Cepaea nemoralis we verify the presence of pheomelanin in a mollusc shell for the first time. Surprisingly, in a large number of brown/black coloured shells we did not find any evidence for either type of melanin.

Conclusions

We recommend methods such as high-performance liquid chromatography with mass spectrometric detection for the analysis of complex biological samples to avoid potential false-positive identification of melanin. Our results imply that many molluscan species employ as yet unidentified pigments to pattern their shells. This has implications for our understanding of how molluscs evolved the ability to pigment and pattern their shells, and for the identification of the molecular mechanisms that regulate these processes.
Individualized feedback to change multiple gait deficits in chronic stroke
Authors: Day Kevin A. , Cherry-Allen Kendra M. , Bastian Amy J.
Published: December 2019

Background

Walking deficits in people post-stroke are often multiple and idiosyncratic in nature. Limited patient and therapist resources necessitate prioritization of deficits such that some may be left unaddressed. More efficient delivery of therapy may alleviate this challenge. Here, we look to determine the utility of a novel principal component-based visual feedback system that targets multiple, patient-specific features of gait in people post-stroke.

Methods

Ten individuals with stroke received two sessions of visual feedback to attain a walking goal. This goal consisted of bilateral knee and hip joint angles of a typical ‘healthy’ walking pattern. The feedback system uses principal component analysis (PCA) to algorithmically weight each of the input features so that participants received one stream of performance feedback. In the first session, participants had to explore different patterns to achieve the goal, and in the second session they were informed of the goal walking pattern. Ten healthy, age-matched individuals received the same paradigm, but with a hemiparetic goal (i.e. to produce the pattern of an exemplar stroke participant). This was to distinguish the extent to which performance limitations in stroke were due neurological injury or the PCA based visual feedback itself.

Results

Principal component-based visual feedback can differentially bias multiple features of walking toward a prescribed goal. On average, individuals with stroke typically improved performance via increased paretic knee and hip flexion, and did not perform better with explicit instruction. In contrast, healthy people performed better (i.e. could produce the desired exemplar stroke pattern) in both sessions, and were best with explicit instruction. Importantly, the feedback for stroke participants accommodated a heterogeneous set of walking deficits by individually weighting each feature based on baseline walking.

Conclusions

People with and without stroke are able to use this novel visual feedback to train multiple, specific features of gait. Important for stroke, the PCA feedback allowed for targeting of patient-specific deficits. This feedback is flexible to any feature of walking in any plane of movement, thus providing a potential tool for therapists to simultaneously target multiple aberrant features of gait.
Inhibition effects of patchouli alcohol against influenza a virus through targeting cellular PI3K/Akt and ERK/MAPK signaling pathways
Authors: Yu Yunjia , Zhang Yang , Wang Shuyao , Liu Wei , Hao Cui , Wang Wei
Published: December 2019

Background

Patchouli alcohol (PA) is a tricyclic sesquiterpene extracted fromPogostemonis Herba, which is a traditional Chinese medicine used for therapy of inflammatory diseases. Recent studies have shown that PA has various pharmacological activities, including anti-bacterial and anti-viral effects.

Methods

In this study, the anti-influenza virus (IAV) activities and mechanisms were investigated both in vitro and in vivo. The inhibitory effects of PA against IAV in vitro were evaluated by plaque assay and immunofluorescence assay. The neuraminidase inhibition assay, hemagglutination inhibition (HI) assay, and western blot assay were used to explore the anti-viral mechanisms. The anti-IAV activities in vivo were determined by mice pneumonia model and HE staining.

Results

The results showed that PA significantly inhibited different IAV strains multiplication in vitro, and may block IAV infection through inactivating virus particles directly and interfering with some early stages after virus adsorption. Cellular PI3K/Akt and ERK/MAPK signaling pathways may be involved in the anti-IAV actions of PA. Intranasal administration of PA markedly improved mice survival and attenuated pneumonia symptoms in IAV infected mice, comparable to the effects of Oseltamivir.

Conclusions

Therefore, Patchouli alcohol has the potential to be developed into a novel anti-IAV agent in the future.
Can pulsatile CSF flow across the cerebral aqueduct cause ventriculomegaly? A prospective study of patients with communicating hydrocephalus
Authors: Holmlund P. , Qvarlander S. , Malm J. , Eklund A.
Published: December 2019

Background

Communicating hydrocephalus is a disease where the cerebral ventricles are enlarged. It is characterized by the absence of detectable cerebrospinal fluid (CSF) outflow obstructions and often with increased CSF pulsatility measured in the cerebral aqueduct (CA). We hypothesize that the cardiac-related pulsatile flow over the CA, with fast systolic outflow and slow diastolic inflow, can generate net pressure effects that could source the ventriculomegaly in these patients. This would require a non-zero cardiac cycle averaged net pressure difference (ΔPnet) over the CA, with higher average pressure in the lateral and third ventricles.

Methods

We tested the hypothesis by calculating ΔPnet across the CA using computational fluid dynamics based on prospectively collected high-resolution structural (FIESTA-C, resolution 0.39 × 0.39 × 0.3 mm3) and velocimetric (2D-PCMRI, in-plane resolution 0.35 × 0.35 mm2) MRI-data from 30 patients investigated for communicating hydrocephalus.

Results

The ΔPnet due to CSF pulsations was non-zero for the study group (p = 0.03) with a magnitude of 0.2 ± 0.4 Pa (0.001 ± 0.003 mmHg), with higher pressure in the third ventricle. The maximum pressure difference over the cardiac cycle ΔPmax was 20.3 ± 11.8 Pa and occurred during systole. A generalized linear model verified an association between ΔPnet and CA cross-sectional area (p = 0.01) and flow asymmetry, described by the ratio of maximum inflow/outflow (p = 0.04), but not for aqueductal stroke volume (p = 0.35).

Conclusions

The results supported the hypothesis with respect to the direction of ΔPnet, although the magnitude was low. Thus, although the pulsations may generate a pressure difference across the CA it is likely too small to explain the ventriculomegaly in communicating hydrocephalus.
Fluctuating light experiments and semi-automated plant phenotyping enabled by self-built growth racks and simple upgrades to the IMAGING-PAM
Authors: Schneider Dominik , Lopez Laura S. , Li Meng , Crawford Joseph D. , Kirchhoff Helmut , Kunz Hans-Henning
Published: December 2019

Background

Over the last years, several plant science labs have started to employ fluctuating growth light conditions to simulate natural light regimes more closely. Many plant mutants reveal quantifiable effects under fluctuating light despite being indistinguishable from wild-type plants under standard constant light. Moreover, many subtle plant phenotypes become intensified and thus can be studied in more detail. This observation has caused a paradigm shift within the photosynthesis research community and an increasing number of scientists are interested in using fluctuating light growth conditions. However, high installation costs for commercial controllable LED setups as well as costly phenotyping equipment can make it hard for small academic groups to compete in this emerging field.

Results

We show a simple do-it-yourself approach to enable fluctuating light growth experiments. Our results using previously published fluctuating light sensitive mutants, stn7 and pgr5, confirm that our low-cost setup yields similar results as top-prized commercial growth regimes. Moreover, we show how we increased the throughput of our Walz IMAGING-PAM, also found in many other departments around the world. We have designed a Python and R-based open source toolkit that allows for semi-automated sample segmentation and data analysis thereby reducing the processing bottleneck of large experimental datasets. We provide detailed instructions on how to build and functionally test each setup.

Conclusions

With material costs well below USD$1000, it is possible to setup a fluctuating light rack including a constant light control shelf for comparison. This allows more scientists to perform experiments closer to natural light conditions and contribute to an emerging research field. A small addition to the IMAGING-PAM hardware not only increases sample throughput but also enables larger-scale plant phenotyping with automated data analysis.
Mechanisms for the temporal regulation of substrate ubiquitination by the anaphase-promoting complex/cyclosome
Authors: Bansal Shivangee , Tiwari Swati
Published: December 2019

The anaphase-promoting complex/cyclosome (APC/C) is a multi-subunit, multifunctional ubiquitin ligase that controls the temporal degradation of numerous cell cycle regulatory proteins to direct the unidirectional cell cycle phases. Several different mechanisms contribute to ensure the correct order of substrate modification by the APC/C complex. Recent advances in biochemical, biophysical and structural studies of APC/C have provided a deep mechanistic insight into the working of this complex ubiquitin ligase. This complex displays remarkable conformational flexibility in response to various binding partners and post-translational modifications, which together regulate substrate selection and catalysis of APC/C. Apart from this, various features and modifications of the substrates also influence their recognition and affinity to APC/C complex. Ultimately, temporal degradation of substrates depends on the kind of ubiquitin modification received, the processivity of APC/C, and other extrinsic mechanisms. This review discusses our current understanding of various intrinsic and extrinsic mechanisms responsible for ‘substrate ordering’ by the APC/C complex.
The essentiality landscape of cell cycle related genes in human pluripotent and cancer cells
Authors: Viner-Breuer Ruth , Yilmaz Atilgan , Benvenisty Nissim , Goldberg Michal
Published: December 2019

Background

Cell cycle regulation is a complex system consisting of growth-promoting and growth-restricting mechanisms, whose coordinated activity is vital for proper division and propagation. Alterations in this regulation may lead to uncontrolled proliferation and genomic instability, triggering carcinogenesis. Here, we conducted a comprehensive bioinformatic analysis of cell cycle-related genes using data from CRISPR/Cas9 loss-of-function screens performed in four cancer cell lines and in human embryonic stem cells (hESCs).

Results

Cell cycle genes, and in particular S phase and checkpoint genes, are highly essential for the growth of cancer and pluripotent cells. However, checkpoint genes are also found to underlie the differences between the cell cycle features of these cell types. Interestingly, while growth-promoting cell cycle genes overlap considerably between cancer and stem cells, growth-restricting cell cycle genes are completely distinct. Moreover, growth-restricting genes are consistently less frequent in cancer cells than in hESCs. Here we show that most of these genes are regulated by the tumor suppressor gene TP53, which is mutated in most cancer cells. Therefore, the growth-restriction system in cancer cells lacks important factors and does not function properly. Intriguingly, M phase genes are specifically essential for the growth of hESCs and are highly abundant among hESC-enriched genes.

Conclusions

Our results highlight the differences in cell cycle regulation between cell types and emphasize the importance of conducting cell cycle studies in cells with intact genomes, in order to obtain an authentic representation of the genetic features of the cell cycle.
“The role as a champion is to not only monitor but to speak out and to educate”: the contradictory roles of hand hygiene champions
Authors: Goedken Cassie Cunningham , Livorsi Daniel J. , Sauder Michael , Vander Weg Mark W. , Chasco Emily E. , Chang Nai-Chung , Perencevich Eli , Reisinger Heather Schacht
Published: December 2019

Background

Implementation science experts define champions as “supporting, marketing, and driving through an implementation, overcoming indifference or resistance that the intervention may provoke in an organization.” Many hospitals use designated clinical champions—often called “hand hygiene (HH) champions”—typically to improve hand hygiene compliance. We conducted an ethnographic examination of how infection control teams in the Veterans Health Administration (VHA) use the term “HH champion” and how they define the role.

Methods

An ethnographic study was conducted with infection control teams and frontline staff directly involved with hand hygiene across 10 geographically dispersed VHA facilities in the USA. Individual and group semi-structured interviews were conducted with hospital epidemiologists, infection preventionists, multi-drug-resistant organism (MDRO) program coordinators, and quality improvement specialists and frontline staff from June 2014 to September 2017. The team coded the transcripts using thematic content analysis content based on a codebook composed of inductive and deductive themes.

Results

A total of 173 healthcare workers participated in interviews from the 10 VHA facilities. All hand hygiene programs at each facility used the term HH champion to define a core element of their hand hygiene programs. While most described the role of HH champions as providing peer-to-peer coaching, delivering formal and informal education, and promoting hand hygiene, a majority also included hand hygiene surveillance. This conflation of implementation strategies led to contradictory responsibilities for HH champions. Participants described additional barriers to the role of HH champions, including competing priorities, staffing hierarchies, and turnover in the role.

Conclusions

Healthcare systems should consider narrowly defining the role of the HH champion as a dedicated individual whose mission is to overcome resistance and improve hand hygiene compliance—and differentiate it from the role of a “compliance auditor.” Returning to the traditional application of the implementation strategy may lead to overall improvements in hand hygiene and reduction of the transmission of healthcare-acquired infections.
Prediction of VMAT delivery accuracy with textural features calculated from fluence maps
Authors: Park Jong Min , Kim Jung-in , Park So-Yeon
Published: December 2019

Background

Comprehensively textural feature performance test from volumetric modulated arc therapy (VMAT) fluences to predict plan delivery accuracy.

Methods

A total of 240 VMAT plans for various treatment sites were analyzed, with Trilogy and TrueBeam STx systems. Fluence maps superposed fluences at each control point per plan. The textural features were the angular second moment (ASM), inverse difference moment (IDM), contrast, variance, correlation, and entropy, calculated from fluence maps using three displacement distances. Correlation analysis of textural feature performance as predictors of VMAT delivery accuracy used global gamma passing rates with MapCHECK2 and ArcCHECK dosimeters, and mechanical delivery errors calculated from machine log files.

Results

Spearman’s rank correlation coefficients (r) of the ASM (d = 10) to the gamma passing rates with 1%/2 mm using the MapCHECK2 were 0.358 and 0.519, respectively (p <  0.001). For the ArcCHECK, they were 0.273 (p = 0.001) and 0.259 (p = 0.009), respectively. The r-values of the ASM (d = 10) to the Trilogy and TrueBeam STx MLC errors were − 0.843 and − 0.859, respectively (p <  0.001), and those to the MU delivery errors were − 0.482 and − 0.589, respectively (p <  0.001). The ASM (d = 10) showed better performance in predicting VMAT delivery accuracy.

Conclusions

The ASM (d = 10) calculated from VMAT plan fluence maps were strongly correlated with global gamma passing rates and MLC delivery errors, and can predict VMAT delivery accuracy.
Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord for single-segment cervical spondylotic myelopathy: The technical interpretation and 2 years of clinical follow-up
Authors: Kong Weijun , Xin Zhijun , Du Qian , Cao Guangru , Liao Wenbo
Published: December 2019

Background

ACDF is the standard procedure for treatment of cervical spondylotic myelopathy (CSM), but a long-term follow-up has been revealed some associated complications of swallowing discomfort, displacement of the fusion device, and accelerated degeneration of the adjacent segment.

Objective

To evaluate the clinical outcomes of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) for single-segment CSM and to analyze the clinical efficacy, surgical characteristics, and complication prevention.

Methods

A total of 32 patients who underwent APFETDSC for single-segment CSM from Aug. 2015 to Apr. 2017 were reviewed. Operating time, time of walking out of bed postoperation, length of hospitalization, complications, neck pain visual analog scale (VAS), and Japanese Orthopaedic Association Score (JOA) were evaluated. Measurement of intervertebral height (HI) of surgical segments on cervical neutral X-ray, Harrison’s method was used to measure cervical spine angle (CSA).

Results

The operation time was 103.3 ± 12.95 min, time of walking out of bed after surgery was 19.81 ± 4.603 h, the length of postoperative hospital stay was 57.48 ± 19.48 h. The postoperative neck pain VAS and JOA were significantly improved compared with preoperation(p < 0.001). The postoperative HI was statistical significance decreased compared with preoperation(p < 0.001), but the HI reduction was less than 0.5 mm, without adverse clinical symptoms. The postoperative CSA was significantly improved compared with preoperative(p < 0.001). The excellent and good rate was 87.5%, and the JOA improvement rate was 75.52 ± 11.11%. There was no cervical instability, vertebral fracture, wound infection, and other complications.

Conclusions

APFETDSC is a safe and effective minimally invasive technique with small auxiliary injuries for single-segment CSM while avoiding the sequelae of ACDF. Its short-term clinical efficacy was good and no significant effect on cervical stability.
Development, validation and assessment of the test on knowledge about basic life support and use of automated external defibrillator among schoolchildren
Authors: Borovnik Lesjak Vesna , Šorgo Andrej , Strnad Matej
Published: December 2019

Background

Educating lay public can significantly strengthen the Chain of Survival after out of hospital cardiac arrest. Schoolchildren are an accessible population for learning basic life support (BLS) and use of an automated external defibrillator (AED) and can be regarded as multipliers of knowledge that can reach the whole population. This study aimed to develop and validate a test for examining levels of knowledge about BLS and AED among schoolchildren that can be used to uniformly present reliable data.

Methods

A knowledge test about BLS and AED consisting of 10 multiple-choice questions was developed and implemented before and after a 2-h BLS and AED course consisting of an interactive lecture and a practical workshop for 783 students in seventh and ninth grades of elementary schools in Maribor, Slovenia. Each question was analyzed and presented with descriptive statistics and educometric parameters (difficulty and discriminating indices). All variables were checked for normality with the Kolmogorov-Smirnov test and analyzed using non-parametric tests. Statistical significance of the differences in knowledge before and after intervention were calculated with chi-square statistics and effect sizes r are reported. Differences between genders, grades and previous attendance to BLS courses were compared using Mann – Whitney U test. The effect size was calculated from the Z score and reported as r value.

Results

After educometric analysis, questions were adjusted to meet the requirements of satisfactory functioning difficulty and discriminating indices (values between 0,40 and 0,60, and above 0,20, respectively). Only one question had to be eliminated due to inadequate difficulty and discriminating index (0,99 and 0,02, respectively). Measurement invariance across gender (p < 0,001), school grade (p < 0,001), and attendance to previous courses (p = 0,303) was assured.

Conclusions

A test for accurate and reliable measurement of knowledge of BLS and AED among schoolchildren was developed and validated. According to the findings it can now reliably be used to assess baseline knowledge and potential improvement in knowledge after a course on BLS and AED. Standardized data gathered with a validated tool can now be presented at legislative levels to promote BLS and AED courses implementation in school curricula.
A comparison framework and guideline of clustering methods for mass cytometry data
Authors: Liu Xiao , Song Weichen , Wong Brandon Y. , Zhang Ting , Yu Shunying , Lin Guan Ning , Ding Xianting
Published: December 2019

Background

With the expanding applications of mass cytometry in medical research, a wide variety of clustering methods, both semi-supervised and unsupervised, have been developed for data analysis. Selecting the optimal clustering method can accelerate the identification of meaningful cell populations.

Result

To address this issue, we compared three classes of performance measures, “precision” as external evaluation, “coherence” as internal evaluation, and stability, of nine methods based on six independent benchmark datasets. Seven unsupervised methods (Accense, Xshift, PhenoGraph, FlowSOM, flowMeans, DEPECHE, and kmeans) and two semi-supervised methods (Automated Cell-type Discovery and Classification and linear discriminant analysis (LDA)) are tested on six mass cytometry datasets. We compute and compare all defined performance measures against random subsampling, varying sample sizes, and the number of clusters for each method. LDA reproduces the manual labels most precisely but does not rank top in internal evaluation. PhenoGraph and FlowSOM perform better than other unsupervised tools in precision, coherence, and stability. PhenoGraph and Xshift are more robust when detecting refined sub-clusters, whereas DEPECHE and FlowSOM tend to group similar clusters into meta-clusters. The performances of PhenoGraph, Xshift, and flowMeans are impacted by increased sample size, but FlowSOM is relatively stable as sample size increases.

Conclusion

All the evaluations including precision, coherence, stability, and clustering resolution should be taken into synthetic consideration when choosing an appropriate tool for cytometry data analysis. Thus, we provide decision guidelines based on these characteristics for the general reader to more easily choose the most suitable clustering tools.
Non-placement versus placement of a drainage tube around the cervical anastomosis in McKeown esophagectomy: study protocol for a randomized controlled trial
Authors: Oshikiri Taro , Takiguchi Gosuke , Miura Susumu , Takase Nobuhisa , Hasegawa Hiroshi , Yamamoto Masashi , Kanaji Shingo , Yamashita Kimihiro , Matsuda Yoshiko , Matsuda Takeru , Nakamura Tetsu , Suzuki Satoshi , Kakeji Yoshihiro
Published: December 2019

Background

Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal cancer. Currently, transthoracic and abdominal esophagectomy with cervical anastomosis (McKeown esophagectomy) is a frequently used technique in Japan. However, cervical anastomosis is still an invasive procedure with a high incidence of anastomotic leakage. The use of a drainage tube to treat anastomotic leakage is effective, but the routine placement of a closed suction drain around the anastomosis at the end of the operation remains controversial. The objective of this study is to evaluate the postoperative anastomotic leakage rate, duration to oral intake, hospital stay, and analgesic use with nonplacement of a cervical drainage tube as an alternative to placement of a cervical drainage tube.

Methods

This is an investigator-initiated, investigator-driven, open-label, randomized controlled parallel-group, noninferiority trial. All adult patients (aged ≥20 and ≤85 years) with histologically proven, surgically resectable (cT1–3 N0–3 M0) squamous cell carcinoma, adenosquamous cell carcinoma, or basaloid squamous cell carcinoma of the intrathoracic esophagus, and European Clinical Oncology Group performance status 0, 1, or 2 are assessed for eligibility. Patients (n = 110) with resectable esophageal cancer who provide informed consent in the outpatient clinic are randomized to either nonplacement of a cervical drainage tube (n = 55) or placement of a cervical drainage tube (n = 55).

The primary outcome is the percentage of Clavien–Dindo grade 2 or higher anastomotic leakage.

Discussion

This is the first randomized controlled trial comparing nonplacement versus placement of a cervical drainage tube during McKeown esophagectomy with regards to the usefulness of a drain for anastomotic leakage. If our hypothesis is correct, nonplacement of a cervical drainage tube will be recommended because it is associated with a similar anastomotic leakage rate but less pain than placement of a cervical drainage tube.

Trial registration

UMIN-CTR, 000031244. Registered on 1 May 2018.
Effects of electroacupuncture frequencies on chronic low back pain in older adults: triple-blind, 12-months protocol for a randomized controlled trial
Authors: Francescato Torres Sarina , Brandt de Macedo Ana Carolina , Dias Antunes Mateus , Merllin Batista de Souza Ingred , Dimitre Rodrigo Pereira Santos Francisco , de Sousa do Espírito Santo Adriana , Ribeiro Jacob Flávia , Torres Cruz Ariela , de Oliveira Januário Priscila , Pasqual Marques Amélia
Published: December 2019

Background

Low back pain (LBP) is the most frequent complaint in clinical practice. Electroacupuncture treatment may be effective; however, the supporting evidence is still limited, especially in older adults.

Objective

The current study is a randomized controlled trial that aims to evaluate the clinical efficacy of electroacupuncture in older adults with LBP.

Methods

A five-arm randomized controlled trial with patients and evaluators blinded to the group allocation. A total of 125 participants with non-specific LBP will be randomly assigned into one of five groups: three electroacupuncture groups (low, high, and alternating frequency); one control group; and one placebo group. The electroacupuncture will be applied twice a week (30 min per session) for five weeks. The primary clinical outcome measure will be pain intensity. The secondary outcomes include: quality of pain; physical functioning; perceived overall effect; emotional functionality; patient satisfaction; and psychosocial factors. Patients will be evaluated before the first session, immediately after the last, and followed up after six and 12 months to check the medium- and long-term effects.

Discussion

Although electroacupuncture is increasingly used to treat LBP, there is no guidance regarding the parameters used, which leads to inconsistent results. Thus, the effect of electroacupuncture (EA) on LBP remains controversial and requires more studies, especially in the older adult population.

Conclusion

This is the first randomized controlled trial to evaluate the efficacy of different frequencies of electroacupuncture for treating chronic LBP in older adults. This study will provide evidence on the effectiveness of electroacupuncture as an alternative treatment method for LBP and will entail wider debate about an appropriate acupuncture intervention in this population.

Trial registration

Clinicaltrials.gov,NCT03802045. Registered on 14 January 2019.
Rapid Access to Contrast-Enhanced spectral mammogRaphy in women recalled from breast cancer screening: the RACER trial study design
Authors: Neeter L. M. F. H. , Houben I. P. L. , Nelemans P. J. , Van Nijnatten T. J. A. , Pijnappel R. M. , Frotscher C. , Osinga-de Jong M. , Sanders F. , Van Dalen T. , Raat H. P. J. , Essers B. A. B. , Wildberger J. E. , Smidt M. L. , Lobbes M. B. I.
Published: December 2019

Background

In the Dutch breast cancer screening program, women recalled with a BI-RADS 0 score are referred for additional imaging, while those with BI-RADS 4/5 scores are also directed to an outpatient breast clinic. Approximately six out of ten women are recalled without being diagnosed with a malignancy. However, these recalls require additional imaging and doctor visits, which result in patient anxiety and increased health care costs. Conventional types of imaging used for additional imaging are full-field digital mammography and tomosynthesis. Contrast-enhanced spectral mammography has proved to have higher sensitivity and specificity than conventional imaging in women recalled from screening. Therefore, the aim is to study if CESM instead of conventional imaging is a more accurate, patient-friendly, and cost-effective strategy in the work-up of women recalled from breast cancer screening.

Methods

This prospective, multicenter, randomized controlled trial will be conducted at four centers and will include 528 patients recalled for suspicious breast lesions from the Dutch breast cancer screening program. Participants are randomized in two groups: (1) standard care using conventional breast imaging techniques as initial imaging after recall versus (2) work-up primarily based on CESM. Written informed consent will be collected prior to study inclusion. The primary outcome is the diagnostic accuracy for detection of breast cancer. Secondary outcomes are numbers of additional diagnostic exams, days until final diagnosis, health care costs, and experienced patient anxiety.

Discussion

Based on previously published retrospective studies, we expect to demonstrate in this prospective multicenter randomized controlled trial, that using CESM as a primary work-up tool in women recalled from breast cancer screening is a more accurate, cost-effective, and patient-friendly strategy.

Trial registration

Netherlands Trial Register, NL6413/NTR6589. Registered on 6 July, 2017.
Engineered Pseudomonas putida KT2440 co-utilizes galactose and glucose
Authors: Peabody George L. , Elmore Joshua R. , Martinez-Baird Jessica , Guss Adam M.
Published: December 2019

Background

Efficient conversion of plant biomass to commodity chemicals is an important challenge that needs to be solved to enable a sustainable bioeconomy. Deconstruction of biomass to sugars and lignin yields a wide variety of low molecular weight carbon substrates that need to be funneled to product.Pseudomonas putidaKT2440 has emerged as a potential platform for bioconversion of lignin and the other components of plant biomass. However,P. putidais unable to natively utilize several of the common sugars in hydrolysate streams, including galactose.

Results

In this work, we integrated a De Ley–Doudoroff catabolic pathway for galactose catabolism into the chromosome ofP. putidaKT2440, using genes from several different organisms. We found that the galactonate catabolic pathway alone (DgoKAD) supported slow growth ofP. putidaon galactose. Further integration of genes to convert galactose to galactonate and to optimize the transporter expression level resulted in a growth rate of 0.371 h−1. Additionally, the best-performing strain was demonstrated to co-utilize galactose with glucose.

Conclusions

We have engineeredP. putidato catabolize galactose, which will allow future engineered strains to convert more plant biomass carbon to products of interest. Further, by demonstrating co-utilization of glucose and galactose, continuous bioconversion processes for mixed sugar streams are now possible.
Nitrogen-dependent coordination of cell cycle, quiescence and TAG accumulation in Chlamydomonas
Authors: Takeuchi Tomomi , Benning Christoph
Published: December 2019

Microalgae hold great promises as sustainable cellular factories for the production of alternative fuels, feeds, and biopharmaceuticals for human health. While the biorefinery approach for fuels along with the coproduction of high-value compounds with industrial, therapeutic, or nutraceutical applications have the potential to make algal biofuels more economically viable, a number of challenges continue to hamper algal production systems at all levels. One such hurdle includes the metabolic trade-off often observed between the increased yields of desired products, such as triacylglycerols (TAG), and the growth of an organism. Initial genetic engineering strategies to improve lipid productivity in microalgae, which focused on overproducing the enzymes involved in fatty acid and TAG biosynthesis or inactivating competing carbon (C) metabolism, have seen some successes albeit at the cost of often greatly reduced biomass. Emergent approaches that aim at modifying the dynamics of entire metabolic pathways by engineering of pertinent transcription factors or signaling networks appear to have successfully achieved a balance between growth and neutral lipid accumulation. However, the biological knowledge of key signaling networks and molecular components linking these two processes is still incomplete in photosynthetic eukaryotes, making it difficult to optimize metabolic engineering strategies for microalgae. Here, we focus on nitrogen (N) starvation of the model green microalga,Chlamydomonas reinhardtii, to present the current understanding of the nutrient-dependent switch between proliferation and quiescence, and the drastic reprogramming of metabolism that results in the storage of C compounds following N starvation. We discuss the potential components mediating the transcriptional repression of cell cycle genes and the establishment of quiescence in Chlamydomonas, and highlight the importance of signaling pathways such as those governed by the target of rapamycin (TOR) and sucrose nonfermenting-related (SnRK) kinases in the coordination of metabolic status with cellular growth. A better understanding of how the cell division cycle is regulated in response to nutrient scarcity and of the signaling pathways linking cellular growth to energy and lipid homeostasis, is essential to improve the prospects of biofuels and biomass production in microalgae.
In vitro activity of 1H-phenalen-1-one derivatives against Leishmania spp. and evidence of programmed cell death
Authors: López-Arencibia Atteneri , Reyes-Batlle María , Freijo Mónica B. , Sifaoui Ines , Bethencourt-Estrella Carlos J. , Rizo-Liendo Aitor , Chiboub Olfa , McNaughton-Smith Grant , Lorenzo-Morales Jacob , Abad-Grillo Teresa , Piñero José E.
Published: December 2019

Background

The in vitro activity against Leishmania spp. of a novel group of compounds, phenalenone derivatives, is described in this study. Previous studies have shown that some phenalenones present leishmanicidal activity, and induce a decrease in the mitochondrial membrane potential in L. amazonensis parasites, so in order to elucidate the evidence of programmed cell death occurring inside the promastigote stage, different assays were performed in two different species of Leishmania.

Methods

We focused on the determination of the programmed cell death evidence by detecting the characteristic features of the apoptosis-like process, such as phosphatidylserine exposure, mitochondrial membrane potential, and chromatin condensation among others.

Results

The results showed that four molecules activated the apoptosis-like process in the parasite. All the signals observed were indicative of the death process that the parasites were undergoing.

Conclusions

The present results highlight the potential use of phenalenone derivatives against Leishmania species and further studies should be undertaken to establish them as novel leishmanicidal therapeutic agents.
Does antennal sensilla pattern of different populations of Triatoma maculata (Hemiptera: Reduviidae) reveal phenotypic variability?
Authors: Müller Josiane Nogueira , Gonçalves Teresa Cristina Monte , Ricardo-Silva Alice Helena , Souza Amanda Coutinho , Santos Francisco Maciel , Santos Rosangela , Vargas Nathalia Coelho , Lopes Catarina Macedo , Carbajal-de-la-Fuente Ana Laura
Published: December 2019

Background

In Brazil, Triatoma maculata is only found in the State of Roraima and is a vector of Trypanosoma cruzi, the etiological agent of Chagas disease. It occurs in wild, peridomestic and domestic habitats, with an urban infestation in Boa Vista, the capital of this Brazilian state. The aim of this study was to assess the morphological variability of the T. maculata antennal phenotype in three populations of Roraima State, using the antennal sensilla pattern analyzed under optical microscopy.

Methods

The number and distribution of four antennal sensilla types (bristles, thin and thick walled trichoidea, and basiconic) of three Brazilian populations of T. maculata from Roraima State were compared. Univariate and multivariate analyses were performed.

Results

The antenna of T. maculata presented the four types of sensilla. According to the density and distribution of the antennal sensilla characteristics, the multivariate analyses showed that the laboratory population is morphologically structured. Urban specimens showed a pronounced phenotypic variability. The main differences were observed in the pedicel segment, and between males and females.

Conclusions

We determined the antennal phenotype in three Roraima populations of T. maculata. These results support the idea that the patterns of antennal sensilla are sensitive markers for distinct populations in the Triatominae. The infestations of T. maculata in different habitats reinforces the ability of this vector to become adapted to a variety of environments, which, could have eco-epidemiological implications for the T. cruzi transmission that are still not well understood.
Epigenetic therapy of myelodysplastic syndromes connects to cellular differentiation independently of endogenous retroelement derepression
Authors: Kazachenka Anastasiya , Young George R. , Attig Jan , Kordella Chrysoula , Lamprianidou Eleftheria , Zoulia Emmanuela , Vrachiolias George , Papoutselis Menelaos , Bernard Elsa , Papaemmanuil Elli , Kotsianidis Ioannis , Kassiotis George
Published: December 2019

Background

Myelodysplastic syndromes (MDS) and acute myeloid leukaemia (AML) are characterised by abnormal epigenetic repression and differentiation of bone marrow haematopoietic stem cells (HSCs). Drugs that reverse epigenetic repression, such as 5-azacytidine (5-AZA), induce haematological improvement in half of treated patients. Although the mechanisms underlying therapy success are not yet clear, induction of endogenous retroelements (EREs) has been hypothesised.

Methods

Using RNA sequencing (RNA-seq), we compared the transcription of EREs in bone marrow HSCs from a new cohort of MDS and chronic myelomonocytic leukaemia (CMML) patients before and after 5-AZA treatment with HSCs from healthy donors and AML patients. We further examined ERE transcription using the most comprehensive annotation of ERE-overlapping transcripts expressed in HSCs, generated here by de novo transcript assembly and supported by full-length RNA-seq.

Results

Consistent with prior reports, we found that treatment with 5-AZA increased the representation of ERE-derived RNA-seq reads in the transcriptome. However, such increases were comparable between treatment responses and failures. The extended view of HSC transcriptional diversity offered by de novo transcript assembly argued against 5-AZA-responsive EREs as determinants of the outcome of therapy. Instead, it uncovered pre-treatment expression and alternative splicing of developmentally regulated gene transcripts as predictors of the response of MDS and CMML patients to 5-AZA treatment.

Conclusions

Our study identifies the developmentally regulated transcriptional signatures of protein-coding and non-coding genes, rather than EREs, as correlates of a favourable response of MDS and CMML patients to 5-AZA treatment and offers novel candidates for further evaluation.
Unexpected normal left ventricular systolic function after total chronic occlusion of left main coronary artery and stenosis of right coronary artery: a case report and review of the literature
Authors: Moutakiallah Younes , Mounir Reda , Ali Amir Aden , Nya Fouad , Seghrouchni Aniss , Atmani Noureddine , Bouzerda Abdelmajid , Lakhal Zouhair , Drissi Mohamed , Aithoussa Mahdi
Published: December 2019

Introduction

Total occlusion of the left main coronary artery is a very rare finding in coronary angiography because of its highly lethal nature. Right coronary artery dominance and extensive collateral circulation are the principal determinant factors of survival after total occlusion of the left main coronary artery. The impact on the left ventricle is often significant with a profound alteration of its systolic function.

Case presentation

We describe a 52-year-old North African man, a tobacco smoker, who presented symptoms of unstable angina related to a total chronic occlusion of his left main coronary artery with a right coronary artery stenosis. Unexpectedly, the impact on his left ventricle was absent with normal dimensions and systolic function. He underwent a successful on-pump coronary artery bypass grafting with uneventful postoperative course and good recovery.

Conclusions

Total occlusion of the left main coronary artery is a rare condition, the fact that the left ventricle retains a normal size and systolic function makes it exceptional, which must be kept in mind to avoid dangerous examinations and delayed treatment. Coronary artery bypass surgery should be considered the main treatment of total chronic occlusion of the left main coronary artery.