bluuebunny/crossref_metadata_2025 huggingface dataset:
Women's Expectations of Health Care Providers' Communication and Behavior in the Delivery Room: a Cross-sectional Study in the Kurdistan Region of Iraq
Authors: Ahmed Hamdia Mirkhan
Published: January 2021

Background: Having a positive childbirth experience is highlighted as being important by the World Health Organization (WHO). One way of achieving this goal is to fulfill the expectations of women. This study aimed to find out women’s expectations in the delivery room and to determine the association between their overall level of expectation and sociodemographic and obstetrical characteristics. Methods: A cross-sectional study was conducted with 1196 women who agreed to participate and who met the inclusion criteria through convenient sampling. Data were collected through direct interviews after receiving informed consent. Sociodemographic and obstetric data, along with expectations items, were summarized by frequency and percentage. A chi-square test was used to find the association between overall expectation and sociodemographic and obstetric variables, general satisfaction with birth care, and communication of health care providers. Results: A majority of the study sample expected the following from health care providers in the delivery room: presence (78.6%), positive and calming verbal (76.3%) and nonverbal expressions (72.3%), environmental control (74.6%), encouragement of different positions and mobilization (75.9%), hygiene (77.5%), promotion of urinary elimination (75.8%), and instruction on breathing and relaxation (71.9%). The overall expectation level was divided into “high expectations” (68.6), “slight expectation” (29.9), and “no expectation” (1.4). Conclusion: Knowing the women’s expectations in the delivery room and how to effectuate them helps to inform plans of care and may also increase women’s satisfaction level, providing them with a more positive birth experience.
Significance of Cytoplasmic Expression of Telomerase Reverse Transcriptase in Patients with Hepatocellular Carcinoma Undergoing Liver Resection
Authors: Nishi Yusuke , Aoki Taku , Shimizu Takayuki , Sato Shun , Matsumoto Takatsugu , Shiraki Takayuki , Sakuraoka Yuhki , Mori Shozo , Iso Yukihiro , Ishizuka Mitsuru , Kubota Keiichi
Published: January 2021

Telomerase reverse transcriptase (TERT) is reportedly expressed in various types of cancer. However, the significance of TERT expression in hepatocellular carcinoma (HCC) has not been fully evaluated. Herein, we evaluated TERT expression in resected HCC tumor tissues using immunohistochemistry. TERT expression was assessed in both the cytoplasm and the nucleus of HCC cells. The relationships between TERT expression and clinical characteristics were investigated. Among the 135 HCCs, TERT expression was positive only in the cytoplasm in 86 tumors (63.7%), was positive only in the nucleus in 3 tumors (2.2%), was positive in both the cytoplasm and the nucleus in 5 tumors (3.7%) and was negative in 41 tumors (30.4%). Cytoplasmic TERT expression was significantly associated with HBs antigen, poor tumor differentiation, and DNA-dependent protein kinase catalytic unit (DNA-PKcs) expression. However, TERT expression in the cytoplasm or in the nucleus was not significantly correlated with the overall or the recurrence-free survival periods. In conclusion, TERT was mainly expressed in the cytoplasm of HCC tissues. Cytoplasmic TERT expression is closely associated with HBV-related HCC and DNA-PKcs expression. The overexpression of TERT and DNA-PKcs arise from cccDNA and may be related to liver carcinogenesis in the presence of HBV infection.
Choroidal Thickening in Patients with Coronavirus Disease – 2019
Authors: Abrishami Mojtaba , Emamverdian Zahra , Daneshvar Ramin , Saeedian Neda , Tohidinezhad Fariba , Seddigh-Shamsi Mohsen , Mazloumi Mehdi , Eslami Saeid
Published: January 2021

Objective: To evaluate choroidal thickness in the macular region of patients with coronavirus disease 2019 (COVID-19).Methods: Patients recovered from COVID-19 were included in this cross-sectional study. Macular imaging with an SD-OCT device was performed at least 2 weeks after recovery from systemic COVID-19 and choroidal thickness was measured as the main outcome measure.Results: Thirty-four subjects were included in this study. One patient was monocular and high-quality SD-OCT images were available for the remaining 67 eyes. Dilated choroidal vessels were observed in 55 eyes (82%) and retinal pigment epitheliopathy was noticeable in 4 eyes (6%); these findings resemble those of the pachychoroid spectrum. The mean subfoveal choroidal thickness (SFCT) in our patients was 380.3±12.40 µm, which was significantly thicker than the previously reported SFCT in the normal population (310.7 ± 57.5 µm) (p<0.001).Conclusion: Patients with COVID-19 demonstrate remarkable changes in the choroid of the macular region.
IMRT Treatment for Nasopharyngeal Carcinoma (NPC) Is Superior for Relieving Xerostomia, Improving Quality of Life and Protecting the Parotid Glands
Authors: Hu Linjun , Li Xianfeng , Wu Zhenzhen , Wang Xiongwei , Meng Ruijuan , Zhang Yanlan
Published: January 2021

Background: We investigated the effects of intensity-modulated radiotherapy (IMRT) on xerostomia, quality of life (QoL) and protection of the parotid glands in patients with nasopharyngeal carcinoma (NPC) compared to three-dimensional conformal radiotherapy (3D-CRT).Methods: Eighty patients with NPC were enrolled in a prospective randomized clinical study and received IMRT or 3D-CRT. A xerostomia questionnaire (XQ), QoL questionnaire and parotid gland function assessment were completed at baseline and 6 months after radiotherapy.Results: Xerostomia occurred in both groups after RT, although the XQ scores of the IMRT group were lower and, as a consequence, the QoL scores were higher than in the 3D-CRT group. A correlation analysis showed that there was some correlation between the XQ and QoL scores. After 6 months of RT, the uptake index (UI) and excretion index (EI) decreased by 34.41% and 22.66% in the IMRT group, while in the 3D-CRT group the UI and EI decreased by 54.4% and 41.9%, respectively, and the function of the parotid glands declined. Conclusions: IMRT better relieved xerostomia and improved the QoL of NPC patients by sparing the parotid glands, without compromising treatment of the target site.
Transcriptome Analysis of Ovary Tissues From Low- and High-yielding Changshun Green-shell Laying Hens
Authors: Mu Ren , Yu Yi yin , Gegen Tuya , Di Wen , Wang Fen , Chen Zhi , Xu Wen bin
Published: January 2021

Background: Changshun green-shell laying hens are unique to Guizhou Province, China, with high egg quality. At this stage, improving egg production performance has become an important breeding task. In recent years, the development of high-throughput sequencing technology provides a fast and exact method for genetic selection. Therefore, this study is based on high-throughput sequencing technology to analyze the differences in the ovarian mRNA transcriptome of low-yield and high-yield Changshun green-shell layer hens, identify critical pathways and candidate genes involved in controlling the egg production rate, and provide basic data for layer breeding.Results: The egg production rates of the low egg production group (LP) and the high egg production group (HP) were 68.00 ± 5.56% and 93.67 ± 7.09%, with extremely significant differences between the groups (p <0.01). Moreover, the egg weight, shell thickness, strength and layer weight of the LP were significantly larger than those of the HP (p <0.05). More than 41 million clean reads per sample were obtained, and more than 90% of the clean reads were mapped to the Gallus gallus genome. Further analysis identified 142 differentially expressed genes (DEGs), and among them, 55 were upregulated and 87 were downregulated in the ovaries. KEGG pathway enrichment analysis identified 9 significantly enriched pathways. Among them, the neuroactive ligand-receptor interaction pathway was the most enriched. GO enrichment analysis indicated that the molecular function GO term: transmembrane receptor protein tyrosine kinase activity, as well as the DEGs identified in this GO term, including PRLR, NRP1, IL15, BANK1, NTRK1, CCK, and HGF may play crucial roles in the regulation of egg production.Conclusions: The above-mentioned differentially expressed genes should be paid attention to in molecular breeding of Changshun green-shell laying hens. Moreover, enrichment analysis suggested that the neuroactive ligand-receptor interaction pathway and receptor protein tyrosine kinases may play crucial roles in the regulation of ovarian function and egg production.
Prevalence of Subclinical Carotid Atherosclerosis and Associated Risk Factors in Individuals Without Cardiovascular Risk Factors: Insights from General Population
Authors: Tian Yuanmeng , Zhang Suli , Li Ru , Xue Weishuang , Xing Liying , Zhang Limin , Jing Li , Yang Jun , Ma Chunyan , Liu Shuang , Li Guangxiao
Published: January 2021

Objective: Individuals without conventional cardiovascular risks (CVRFs) still have the risk of adverse outcomes, and subclinical carotid atherosclerosis is a known predictor of cardiovascular events. We aimed to assess the prevalence and associated risk factors of subclinical carotid atherosclerosis in CVRF-free population. Methods: The cross-sectional study was conducted in rural northeast China in 2017-2018. CVRFs freedom was defined as untreated blood pressure < 140/90 mmHg, fasting plasma glucose < 7.0 mmol/L, untreated total cholesterol < 6.22 mmol/L, low-density lipoprotein cholesterol < 4.14 mmol/L, high-density lipoprotein cholesterol (HDL-C) ≥ 1.04 mmol/L, and no current smoking. This subgroup population included 1449 individuals, and ultrasound was used to detect carotid atherosclerosis. Results: The mean carotid intima-media thickness is 0.74 ± 0.14 mm. The prevalence of carotid plaque is 23.4% (95%CI: 21.2%-25.6%) among CVRFs-free population, significantly higher in men than in women (37.1% vs 20.0%, p<0.001), and rises steeply with advancing age. 1.31% have moderate-to-severe carotid stenosis. Advancing age, man, glycosylated hemoglobin (OR, 1.90; 95% CI, 1.20-1.32), HDL-C level (OR, 2.31; 95% CI, 1.75-3.04), and pulse pressure (OR, 1.03; 95% CI, 1.01-1.05) are potentially related to presence of carotid atherosclerosis. Adjusted-dose-response association shows a linear relationship between HDL-C and prevalence of carotid atherosclerosis. Conclusions: The prevalence of subclinical carotid atherosclerosis in CVRF-free population was relatively high, indicating poorly defined factors might contribute to the early atherogenesis. Moreover, we observed a paradoxical response between subclinical carotid atherosclerosis and HDL-C levels, suggesting that treatment targeting to increase HDL-C levels might not reduce future cardiovascular risks.
Niclosamide Targets Inflammatory and Profibrotic Pathways in Amyotrophic Lateral Sclerosis
Authors: Milani Martina , Mammarella Eleonora , Rossi Simona , Lattante Serena , Sabatelli Mario , Cozzolino Mauro , D’Ambrosi Nadia , Apolloni Savina
Published: January 2021

BackgroundAn increasing number of studies evidence that amyotrophic lateral sclerosis (ALS) is characterized by extensive alterations in different cell types and in different regions besides the CNS. We previously reported the up-regulation in ALS models of a gene called fibroblast-specific protein (FSP)-1 or S100A4, generally recognized as a pro-inflammatory and profibrotic factor. Since inflammation and fibrosis are often mutual-sustaining events that contribute to establish a hostile environment for organ functioning, the comprehension of the elements responsible for these interconnected pathways is crucial to disclose novel aspects involved in ALS pathology.MethodsHere we employed fibroblasts derived from ALS patients harboring the C9orf72 hexanucleotide repeat expansion and sporadic ALS patients with no mutations in known ALS-associated genes and we downregulated S100A4 using siRNA or the S100A4 transcriptional inhibitor niclosamide. Mice overexpressing human FUS were adopted to assess the effects of niclosamide in vivo on ALS pathology.ResultsWe demonstrated that S100A4 underlies impaired autophagy and a profibrotic phenotype, which characterize ALS fibroblasts. Indeed, its inhibition reduces inflammatory, autophagic and profibrotic pathways in ALS fibroblasts, and to interfere with different markers known as pathogenic in the disease, such as mTOR, SQSTM1/p62, STAT3, α-SMA and NF-κB. Importantly, niclosamide in vivo treatment of ALS-FUS mice reduces the expression of S100A4, α-SMA and PDGFRβ in the spinal cord, as well as gliosis in central and peripheral nervous tissues, together with axonal impairment and displays beneficial effects on muscle atrophy, by promoting muscle regeneration and reducing fibrosis.ConclusionOur findings show that S100A4 has a role in ALS-related mechanisms, and that drugs such as niclosamide that are able to target inflammatory and fibrotic pathways could represent promising pharmacological tools for ALS.
Clinical and Demographic Pattern of Chronic Granulomatous Disease (CGD) from a Multicenter Perspective: Malaysia’s Experience Over 26 Years
Authors: Noh Lokman Mohd , Latiff Amir Hamzah Abdul , Ismail Intan Hakimah , N Rahim Md , Wahab Asrul Abdul , Hamid Intan Juliana Abd. , Ripen Adiratna Mat , Abdulla Nasuruddin B , Razali Kamarul Azhar , Zainudin Norzila Mohamed , Bakon Florence , Long Kok Juan , Ali Adli , Aziz Bilkis Banu S Abd , Latif Hasniah Abdul , Mohamad Siti Mardhiana , Zainudeen Zarina T , Hashim Ilie Fadzilah , Sendut Iean Hamzah , Nadarajaw Thiyagar , Jamil Faizah Mohamed , Ng David CE , Abidin Mohd Azri Zainal
Published: January 2021

Background:A retrospective review of clinical manifestations and demographic pattern of patients diagnosed as chronic granulomatous disease (CGD) from 7 hospitals in Malaysia.Methods: Data from the Malaysia Primary Immunodeficiency Network (MyPIN) with cases of CGD diagnosed from 1991 until 2016 were collated and analysed.Results: Twenty patients were diagnosed as CGD. Males (N=13, 65%) outnumber females (N=7, 35%). The mean age of diagnosis was 3.7 years. There was a positive family history in 40 %. Abscess was the main presenting feature in 16 patients (80%) with one involving the brain (brain abscess). Pneumonia occurred in 10 (50%) with one (1) with complicated bronchiectasis. Catalase-positive bacteria were the most commonly isolated pathogen with Chromobacterium violaceum (C violaceum) predominating, N=5 (25%) with consequent high mortality, N=4 (80%). CGD is commonest amongst the Malays (65%) followed by the Chinese (15.0%), Indians (10.0%) and natives of Borneo (10.0%) reflective of the ethnic composition of the country.Conclusion: This study has shown CGD occurs in the major ethnic groups of Malaysia. To the best of our knowledge, this is the earliest and the largest series of chronic granulomatous disease in South East Asia (SE Asia) which may be reflective of similar clinical pattern in the region. Chromobacterium violaceum infection is associated with a higher mortality in CGD patients in Malaysia. All the CGDs with (C violaceum) infection in this patient series displayed CD4+ (T helper) lymphopenia. We recorded rare clinical manifestation of CGD viz. brain abscess and bronchiectasis.
Developing and Optimization of Fragmented Electroactive Biofilm Reactor (FAB) to Increase Microbial Fuel Cell Bioelectricity Generation and Treatment Performance
Authors: Atnafu Tesfalem , Leta Seyoum
Published: January 2021

BackgroundMicrobial fuel cells (MFCs) drawbacks are anode (cathode) limitation and electrochemical loss. Engineering the biofilm for enhanced attachment to the electrode is the prospect of MFC. Recent studies, recommend the formation of thick anode biofilm that could result in a synergetic effect between microbial communities. To address these issues, a microbial electrode jacket dish (MEJ-dish) was invented that supports microbial growth over the anode electrode surface. The MFC reactor with MEJ-dish was hypothesized to develop a fragment of biofilm (thick and thin) across the electrode. This reactor is called a fragmented electroactive biofilm-microbial fuel cell reactor (FAB-MFC).ResultsThe maximum voltage generated (0.87 V) was recorded in FAB-MFC. In addition, during the first 3-10 days, the FAB system enables to significantly (p<0.05) maximize the voltage generation at pH variation from 6.5 to 7.5. However, at alkaline pH 8.5, the FAB system generates a lower voltage relative to non-FAB. On the contrary, in FAB reactors the COD removal was improved regardless of pH variation (6.5-8.5). This shows, unlike voltage generation, the biofilms (either electroactive or not) formation were vital for COD removal even without voltage generation. At acidic and neutral pH (7.5), the fragmented (hybrid) biofilm formation across the bioelectrode (anode) could not only important for voltage generation but also contributes to the effective functioning of electroactive biofilm (EABs) growth and development by reducing the effect of pH variation. To address this contradictory effect of increasing COD removal associated with the lower voltage at higher pH, might be to use both FAB and non-FAB in a single MFC reactor. There might be a mutualistic effect across the bioelectrode biofilms.ConclusionsThis study showed that the voltage generated was significantly higher in FAB-MFC as compared with non-FAB-MFC setup within limited pH (6.5-7.5); relatively, COD removal was enhanced within wider pH 6.5-8.5. This supports the conclusion that biofilm formed across the FAB was vital for COD removal, even though not participated in voltage generation. However, this might be affected by the degradable organic content and the nature of the microbial community in the inoculum and domestic wastewater, which requires further studies.
Risk Factors for Venous Thromboembolism Induced by Prolonged Bed Rest during Interstitial Brachytherapy for Gynecological Cancer: A Retrospective Study
Authors: Murofushi Keiko , Tomita Tetsuya , Ohnishi Kayoko , Nakai Kei , Akiyama Azusa , Sasaki Tsukasa Saida , Okumura Toshiyuki , Karasawa Katsuyuki , Satoh Toyomi , Sakurai Hideyuki
Published: January 2021

Background: Screening and management of venous thromboembolism (VTE) after surgery is important in preventing sublethal VTE. However, the risk factors for VTE during interstitial brachytherapy (ISBT) remain unknown, and appropriate screening and management strategies are yet to be established. This study therefore aimed to evaluate the risk factors for VTE resulting from requisite bed rest during ISBT for gynecologic cancers.Methods: We retrospectively analyzed 47 patients. For patients without definitive preceding radiotherapy, whole pelvic irradiation (30-50 Gy) followed by ISBT of 12-30 Gy/2-5 fx/1-3 days was administered to CTV D90. For patients with preceding radiotherapy, 36-42 Gy/6-7 fx/3-4 days was delivered by ISBT alone. D-dimer (DD) was measured at initial presentation, 1 week before ISBT, pre-ISBT, on the day of, and the day following needle removal. Patients were divided into three groups according to the risk of VTE and were managed accordingly. Group 1: DD was not detected (negative) before ISBT. Group 2: VTE was not detected on venous ultrasound imaging, although DD was positive before ISBT. Group 3: VTE was detected (positive) before ISBT. An intermittent pneumatic compression device was used during ISBT; for this, patients without VTE before ISBT required to remain in the supine position. Heparin or oral anticoagulants were administered to patients with VTE before ISBT.Results: Overall, the median values of DD pre-ISBT, on the day of, and on the day following needle removal were 1.0 (0.4-5.8), 1.1 (0.5-88.9), and 1.5 (0.7-40.6) μg/mL, respectively. After ISBT, no patients had deep vein thrombosis (DVT) in groups 1 and 2. In group 3, 7 of 14 patients experienced worsening of VTE but remained asymptomatic. In univariate analysis, DVT diagnosed before ISBT, Caprini score ≥5, and difference in DD values between pre-ISBT and the day of or the day following needle removal ≥1 were associated with the incidence or worsening of VTE.Conclusion: DD should be measured before and after ISBT to detect the incidence or worsening of VTE in patients with DVT. The Caprini score may help in the prediction of VTE during or after ISBT.
miR-218 Affects the ECM Composition and Cell Biomechanical Properties of Glioblastoma Cells
Authors: Grabowska Małgorzata , Kuczyński Konrad , Piwecka Monika , Rabiasz Alicja , Zemła Joanna , Głodowicz Paweł , Wawrzyniak Dariusz , Lekka Małgorzata , Rolle Katarzyna
Published: January 2021

BackgroundGlioblastoma (GBM) is the most common malignant brain tumour. GBM cells have ability to infiltrate into the surrounding brain tissue, which results in a significant decrease in the patient’s survival rate. Infiltration is a consequence of the low adhesion and high migration of the tumour cells, two features being associated with the highly remodelled extracellular matrix (ECM). MethodsThe expression profile of miRNAs and mRNAs was analysed by qPCR on 19 GBM tissue samples. Than luciferase assay was performed to confirm interaction between miR-218 and target sequences. Next we checked how supplementation of glioma cell line (U118-MG) with microRNA 218 will change expression pattern of TN-C and SDC both on transcript level and on protein level. Analysis of protein level were made with western-blot technique. Last step in expression profiling of genes connected to cellular motility and adhesion was done with use of qPCR analysis after supplementation with miR-218. To assess the abilities of cells to migrate and proliferate real-time cell culture analysis with use of Incelligence system were utilized. Also this results were backed by classic wound-healing assay. To conclude we used atomic force microscopy (AFM) to measure physical properties such as adhesion and stiffness of cells. This study was supported by microscopy analysis of cytoskeleton changes after supplementation of miR-218.ResultsIn this study, we report that ECM composition is partially regulated at the posttranscriptional level by miRNA. Particularly, we show that miR-218, a well-known miRNA suppressor, is involved in direct regulation of ECM components, tenascin-C (TN-C) and syndecan-2 (SDC-2). We demonstrated that the overexpression of miR-218 reduces the mRNA and protein expression levels of TN-C and SDC-2, and subsequently influences biomechanical properties of GBM cells. Atomic force microscopy (AFM) and real-time migration analysis revealed that miR-218 overexpression impairs the migration potential and enhances the adhesive properties of cells. AFM analysis followed by F-actin staining demonstrated that expression level of miR-218 has an impact on cell stiffness and cytoskeletal reorganization. Global gene expression analysis showed deregulation of a number of genes involved in tumour cell motility and adhesion or ECM remodelling upon miR-218 treatment, suggesting further indirect interactions between the cells and ECM. Conclusion The results demonstrated a direct impact of miR-218 reduction in GBM tumours on the qualitative ECM content, leading to changes in the rigidity of the ECM and GBM cells being conducive to increased invasiveness of GBM.
Comparison of Bone Scintigraphy and PET/CT for the Evaluation of Disease Activity in Patients with Rheumatoid Arthritis: Application of Bone Scintigraphy
Authors: Lee Sang Jin , Hong Chae Moon , Cho Il , Ahn Byeong-Cheol , Eun Jung Su , Kim Na Ri , Kang Jong Whan , Kang Young Mo
Published: January 2021

Background: We aimed to compare the reliability of bone scintigraphy (BS) and fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)–derived parameters in the detection of active arthritis in 28-joint areas and evaluate the reliability of joint counts between BS and clinical assessment in patients with rheumatoid arthritis (RA). Methods: We enrolled 106 patients (67 in the development group and 39 in the validation groups) with active RA who underwent BS, 18F-FDG PET/computed tomography (CT), and clinical evaluation of disease activity. We compared the results of BS-derived joint assessment with those of PET-derived and clinical joint assessments. Subsequently we developed a disease activity score (DAS) using BS-positive joints and validated it in an independent group.Results: The number of BS-positive joints in 28-joint areas significantly correlated with the swollen /tender joint counts (SJC/TJC) and PET-derived joint counts. A BS uptake score of 2 (strong positive) was significantly more sensitive compared with a BS uptake score of 1 (weak positive) in detecting a PET-positive joint among the 28-joints. After conducting multivariate analyses including erythrocyte sediment rate (ESR) and patient global assessment (PGA) in addition to BS-derived parameters, BS/DAS was obtained as follows: 0.056 × number of BS-positive joints in 28 joints + 0.012 × ESR + 0.030 × PGA. A significant correlation between BS/DAS and DAS28-ESR was confirmed in the validation group. Conclusion: Strong positive uptake of BS is sensitive and reproducible for the detection of active joints, and can complement the clinical assessment of disease activity in RA.
Cardiac Dysfunction in Critically Ill patients with COVID-19 – A Multicentre Observational Study
Authors: Holmqvist Jacob , Beck-Friis Josefine , Jensen Carl , Dalla Keti , Mårdstam Simon , Christensen Jens , Nordén Nina , Rosén-Wetterholm Elin , Cavefors Oscar , Yilmaz Aylin , Cronhjort Maria , Redfors Björn , Oras Jonatan
Published: January 2021

Introduction: The importance of cardiac dysfunction in critically ill patients with COVID-19 is not well studied. The aim of the study was to assess the incidence, clinical risk factors, and prognosis of cardiac dysfunction in critical illness caused by COVID-19, and to evaluate if cardiac biomarkers can detect this condition.Methods: This was a multicentre observational study performed in five intensive care units (ICUs) in Sweden. Patients admitted to participating ICU with COVID-19 were examined with echocardiography within 72 hours from admission to the ICU and again after four to seven days. Cardiac biomarkers and clinical data were collected at the time of echocardiography. Cardiac dysfunction was defined as either left ventricular (LV) dysfunction (having an ejection fraction < 50% and/or regional hypokinesia) or right ventricular (RV) dysfunction (having a tricuspid annular plane systolic excursion (TAPSE) < 17mm or a moderate/severe RV dysfunction assessed visually).Results: We included 132 patients of whom 94 (71%) were included prospectively. The vast majority were intubated (n=127). At the time of admission to ICU, 35 (27%) patients had cardiac dysfunction and 7 patients (5%) had cardiac dysfunction detected later in the ICU-period. LV dysfunction was found in 18 patients and RV dysfunction in 17 patients, 7 patients had both RV and LV dysfunction. Noradrenaline > 0.20µg/kg/min was the only clinical variable associated with a higher risk of cardiac dysfunction. RV dysfunction was associated with an increased risk of death in a risk-adjusted model (OR 3.98, p = 0.013). Troponin and N-terminal pro b-type natriuretic peptide (NTproBNP) had moderate values in detecting cardiac dysfunction (AUC 0.729 and AUC 0.744, respectively). A combination of troponin < 1.44 times the upper reference limit and NTproBNP < 857ng/L had 85% probability of excluding cardiac dysfunction.Conclusions: Cardiac dysfunction is common in critically ill patients with COVID-19. Although not easily detected with clinical variables, cardiac biomarkers might be helpful. RV dysfunction is associated with an increased risk of death, these patients might benefit from further investigation or treatments. Trial registration: Registered on 24 Aug 2020 at Clinicaltrials.gov; registration number NCT04524234.
Dose Optimization Study of Therapeutic Hypercapnia for Prevention of Secondary Ischemia After Severe Subarachnoid Hemorrhage
Authors: Stetter Christian , Weidner Franziska , Lilla Nadine , Weiland Judith , Kunze Ekkehard , Ernestus Ralf-Ingo , Muellenbach Ralf Michael , Westermaier Thomas
Published: January 2021

BackgroundAim of this study was to investigate the time point at which the cerebral blood flow (CBF) enhancing effect of controlled hypercapnia in patients with severe aneurysmal subarachnoid hemorrhage (SAH) starts to extenuate. This point is assumed to be the time at which buffer systems become active and annihilate a possible therapeutic effect. MethodsIn this prospective interventional study in a neurosurgical ICU the arterial partial pressure of carbon dioxide (PaCO2) was increased to a target range of 50 - 55 mmHg for 120 minutes by modification of the respiratory minute volume (RMV) one time a day between day 4 and 14 in 12 mechanically ventilated poor-grade SAH-patients. Arterial blood gases were measured every 15 minutes. CBF and brain tissue oxygen saturation (StiO2) were the primary and secondary end points. Intracranial pressure (ICP) was controlled by an external ventricular drainage. ResultsUnder continuous hypercapnia (PaCO2 of 53.17 ± 5.07), CBF was significantly elevated between 15 and 120 minutes after the start of hypercapnia. During the course of the trial intervention, cardiac output also increased significantly. To assess the direct effect of hypercapnia on brain perfusion, the increase of CBF was corrected by the parallel increase of cardiac output. The maximum direct CBF enhancing effect of hypercapnia of 31% was noted at 45 minutes after the start of hypercapnia. Thereafter, the CBF enhancing slowly declined. No relevant adverse effects were observed. Conclusion CBF and StiO2 reproducibly increased by controlled hypercapnia in all patients. After 45 minutes, the curve of CBF enhancement showed an inflection point when corrected by cardiac output. Temporary hypercapnia of 45 minutes is, thus, likely to be the optimum duration for a therapeutic use and for a controlled comparative trial. Longer intervals bear the risk of a negative rebound effect after return to normal ventilation parameters and may be counterproductive inducing ischemia in a state of critical perfusion after SAH. Trial registrationThe study was approved by the institutional ethics committee (AZ 230/14) and registered at ClinicalTrials.gov (Trial-ID: NCT01799525). Registered 01 January 2015. Retrospectively registered.
Forest Structure, Diversity and Regeneration Pattern Along Altitudinal Gradient in Temperate Zone of Nanda Devi Biosphere Reserve (a World Heritage Site), Western Himalaya, India
Authors: Maletha Ajay , Maikhuri Rakesh Kumar , Bargali Surendra Singh
Published: January 2021

BackgroundThe present study exhibited forest structure, plant species composition and regeneration pattern in temperate zone of Nanda Devi Biosphere Reserve (NDBR), western Himalaya along the different altitudinal gradient (2600 to 3600 m asl). The diverse ecosystems of the NDBR contain a tremendous array of floral and faunal diversity, many of which are rare and endangered species. ResultsA total of 223 species of vascular plants (Angiosperm, Gymnosperm and Pteridophytes) were identified within the study area. Rosacaeae (17.69 %) family was exhibited dominant followed by Asteraceae (14.97 %) and Ranunculaceae (12.93 %). Among all the plant species, Betula utilis had highest tree density (724 & 324 individuals ha-1 in each site) and contributed maximum dominance of species cover (44 % and 36 % ) at Tolma and Ghangaria sites followed by Pinus wallichiana (24 %) and Cedrus deodara (15 %), respectively. In Ghangaria site, 56 % tree species showed fair regeneration, 22 % good, 11% exhibited poor and remaining (11 %) indicated no regeneration while at Tolma site, 40 % species showed fair regeneration, 40 % good and remaining 20 % no regeneration. ConclusionOur results suggest to monitor the change in vegetation structure, species composition and regeneration pattern, we should establish permanent study plots in different forest types located along the elevational gradients for an effective and comprehensive monitoring programme to tracks the response of changing climate at both community and species level. Therefore, it is necessary to development of appropriate weather and meteorological station in this sensitive and ecologically important area for regional projection of micro climatic condition and generation of scientific data on changing vegetation composition and advancement of the native species.
Extended Doxycycline Treatment Versus Aspiration of Hydrosalpingeal Fluid in the Management of Patients With Ultrasound Visible Hydrosalpinx Who Refused or Not Eligible to Undergo Salpingectomy Prior to IVF-ET
Authors: Fouda Usama , Elshaer Hesham S. , Sobh Sherin M. , Salah Emad M. , Darweesh Fatma F. , Wali Ahmed A. , Husseiny Tarek El , Taymour Mohammad A.
Published: January 2021

Background: The purpose of this study was to detect whether antibiotic therapy during IVF-ET cycle is as effective as aspiration of hydrosalpinx fluid under ultrasound guidance in preventing the adverse effect of hydrosalpinx on IVF-ET results.Methods: During the period between November 2012 and January 2020, patients with ultrasound visible hydrosalpinges undergoing IVF-ET who refused to undergo laparoscopic salpingectomy or not eligible for laparoscopy were advised to receive antibiotic therapy during IVF-ET cycle or to undergo aspiration of hydrosalpinx fluid under ultrasound guidance at the time of ovum pick up. A retrospective analysis was done for the results of IVF-ET cycles of patients who received antibiotic therapy ( n = 52 ) or underwent aspiration of hydrosalpinx fluid under ultrasound guidance ( n = 76). In the aspiration group, the tip of the suction needle was introduced into the hydrosalpinx to aspirate the hydrosalpinx fluid after completing the ovum pick up. In the antibiotic group, doxycycline (100 mg/12 h) was commenced one week before ovum pick up and was continued for another week after ovum pick up.Results: The implantation, clinical pregnancy, ongoing pregnancy and live birth rates were significantly higher in the aspiration group ( 16.67%% Vs. 8.33%, P value =0.029, 32.89% Vs. 15.38% P value = 0.026, 30.26% Vs. 13.46%,P value =0.028 and 28,95% Vs. 13.46% P value = 0.04 respectively). Conclusion: The aspiration of hydrosalpinx fluid under ultrasound guidance is more effective than antibiotic therapy in preventing the negative impact of hydrosalpinx on the results of IVF-ET. The results of the current study should be proved by subsequent randomized controlled studies.
The Role of Nickel-titanium Shape Memory Alloy Embracing Fixator in Determination of the Implantation Angle of Hip Tumor Prosthesis Stem Following Tumor Resection and the Analysis of Its Efficacy: a Retrospective Study
Authors: Wang Yang , Zhou Panyu , Xia Demeng , Wang Yunyun , Wang Sheng , Zhang Hongyue , Xu Shuogui
Published: January 2021

Background: To explore the role of nickel-titanium(NiTi) shape memory alloy embracing fixator in determination of implantation angle of hip tumor prosthesis stem and analyze its efficacy. Methods: 36 patients with proximal femur tumor were treated with extended tumor resection and prosthetic replacement. 14 patients received prosthetic replacements with the embracing fixators fixing between the junction of the prosthesis stem and the femur temporarily, while the other 22 patients received the same replacements but without the fixators. Following aspects were compared: occurrence of complications, limb function and active hip ROM.Results: There are fewer cases of hip dislocation in the group received prosthetic replacements with the use of embracing fixators. Occurrence of deep infection presented no difference between the two groups. Better limb function and higher active range of motion (ROM) on abduction or flexion were also found in the group using embracing fixators. Conclusion: Ni-Ti shape memory alloy embracing fixator plays a key part in assisting the accurate implantation angle of the prosthesis stem in the prosthetic replacement. The prosthesis stem can be adjusted to the optimal angle with the help of the embracing fixator. Patients have lower chance of dislocation, better limb function, and higher active hip ROM. Trial registration: retrospectively registered.
Comparison of Efficacy and Safety of Duloxetine and Nonsteroidal Anti-inflammatory Drugs in Subacromial Impingement Syndrome
Authors: Zhao Li , Teng Li , Xu Feng , Zhang Huayun , Xie Zhigang , Huang Bin
Published: January 2021

Background: Subacromialimpingement syndrome (SIS) is characterized by shoulder pain and restriction in range of motion (ROM), which lead to debility and decrease quality of life (QoL). Duloxetine could provide persistent long-term pain relief in chronic musculoskeletal pain. Therefore, we aimed to investigate the efficacy of duloxetine in stage I or II SIS patients through comparing the nonsteroidal anti-inflammatory drugs (NSAIDs) treatment.Methods: The patients diagnosed with stage I or II SISwere randomly assigned into the duloxetine group (N= 37) and NSAIDs group (N= 37). Duloxetine group patients started on oral duloxetine 40 mg per day for one week and then titrated up to 60 mg per day for one week. NSAIDs group patients received oral loxoprofen sodium tablets 60mg3 times a day for two weeks. The standard measures for investigating the efficacy include pain intensity (VAS), ROM, shoulder functional status, and the QoL at baseline, end of treatment, and at 1 and 3 months follow-up.Results: 74 eligible patients completed the treatment and evaluation. Both treatment groups improved significantly from baseline over time. And all parameters of pain intensity, shoulder functionalstatus and QoL in the duloxetine group were significantly better than those in the NSAIDs group.And no one manifested SIS recurrence and side effects during the entire follow-up period.Conclusions: Both duloxetine and NSAIDs can be beneficial in the rehabilitation of stage I or II SIS patients. Moreover, duloxetine resulted in improvements in outcomes greater than NSAIDs for the treatment of SIS. The current results indicated that duloxetine treatment might be used as a new safe and effective alternative for SIS. Given the encouraging results of this study, it would be worthwhile to confirm our findings in randomized placebo-controlled multicentre clinical trials.
Fractures of the Lateral Process of the Talus: A New Classification Based on CT
Authors: Wang Yuchuan , Zhu Yanbin , Deng Xiangtian , Wang Zhongzheng , Tian Siyu , Tan Zhanchao , Fu Lei , Ma Jiangtao , Zhang Yingze
Published: January 2021

Background: The common classifications of the fractures of the lateral process of the talus（LTPFs）are based on radiographs and may underestimate the complexity of LTPF, therefore, requiring a comprehensive classification based on CT(Computed tomography) scan. The aim of this study is to propose a such classification system, and to evaluate its reliability and reproducibility.Methods: On the basis of the most widely recognized classifications of Hawkins as well as McCrory-Bladin, we proposed a new and comprehensive classification based on CT scan for the LTPF. We retrospectively reviewed 42 patients involving LTPF. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by three surgeons. The analysis of interobserver and intraobserver agreements was done using kappa statistics.Results: This new classification included two types based on presence of concomitant injuries or not, with type I consisting of three subtypes and type II of five subtypes. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ=0.846 and 0.823, respectively)，showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ=0.737 and 0.689, respectively) as well as McCrory-Bladin classification (κ=0.748 and 0.714, respectively). Conclusion: This new classification system for the LTPF based on CT is a comprehensive classification considering concomitant injuries. It is more reliable and reproducible and can potentially become a useful instrument for decision making of treatment options for LTPFs. Further studies on the evaluation of their clinical relevance (especially the long-term outcome) are warranted.
Insecticide Resistance Status of Anopheles Arabiensis in Irrigated and Non-irrigated Areas in Western Kenya
Authors: Orondo Pauline , Nyanjom Steven , Atieli Harrysone , Githure John , Ondeto Benyl , Ochwedo Kevin , Omondi Collince , Kazura James , Lee Ming-Chieh , Zhou Guofa , Zhong Daibin , Githeko Andrew , Yan Guiyun
Published: January 2021

Background: Malaria control in Kenya is based on case management and vector control using long lasting insecticidal nets (LLINs) and indoor residual spraying (IRS). Irrigation practices maintain vector population and thus transmission during dry season. Development of insecticide resistance further compromises the effectiveness of insecticide-based vector control programs. The aim of this study was to assess the status and mechanism of insecticide resistance in malaria vectors in irrigated and non-irrigated areas in western Kenya and the contribution of public health interventions and agriculture to insecticide resistance. Methodology: The study was carried out in 2018–2019 in Homa Bay County, western Kenya. Anopheline larvae were collected in irrigated and non-irrigated fields, reared to F1 adults and 2-5 day-old female vector mosquitoes were subjected to standard WHO insecticide susceptibility tests. The test specimens were then screened for knock-down resistance, kdr alleles, and analyzed for presence of acetyl-cholinesterase inhibiting enzyme; angiotensin-converting enzyme (Ace-1) genes. All field-collected samples were preserved for species identification by polymerase chain reaction. To ascertain the probable cause of vector resistance to insecticides, a questionnaire was administered to farmers, households and veterinary officers in the study area to assess the use of public health and agricultural insecticides/pesticides.Results: Anopheles arabiensis was the only species tested in irrigated (100%, n=154) area and predominant species in the non-irrigated areas (97.5%, n= 162) and the rest were An. gambiae sensu stricto. In 2018, susceptibility was observed in the vector species in the irrigated area and phenotypic resistance in the non-irrigated area while in 2019, phenotypic resistance was observed from all areas However, susceptibility to malathion (mortality 100%), DDT (98.98%-100%) and PBO- deltamethrin (100%) was observed. Molecular analysis of the vectors from the irrigated and non-irrigated areas revealed low levels of leucine- serine/ phenylalanine substitution at position 1014 (L1014S/ L1014F) with a mutation frequencies of 1%-16%, and almost zero mutation in Ace-1R gene (0.7%). In addition to very high coverage of LLINs impregnated with pyrethroids and IRS with organophosphate insecticides, pyrethroids were the predominant chemical class in pesticides used for crop and animal protection.Conclusion: Extensive use of pyrethroids in agriculture and public health could have resulted in the initial development of insecticide resistance. The susceptibility of these malaria vectors to organophosphates and PBO synergist in pyrethroids offers a promising future for IRS and ITN based vector control interventions.
Genetically-informed behavioral and cognitive interventions may improve management of tinnitus
Authors: Gkouskou Kalliopi , Vlastos Ioannis , Gazouli Maria , Eliopoulos Aristides G. , Prokopakis Emmanuel
Published: January 2021

Introduction: Psychological and behavioral interventions, such as Cognitive Behavioral Treatment (CBT) and Tinnitus Retraining Therapy (TRT), are commonly applied either alone or in combination for the management of tinnitus but selection of the intervention model remains arbitrary. Herein we evaluated the hypothesis that genetic markers may guide the choice of tinnitus treatment towards improved therapeutic outcomes.Results: Patients with subjective idiopathic tinnitus were assigned to either a genetically-informed CBT or TRT intervention protocol based on the status of four single nucleotide polymorphisms (SNPs) of the dopamine and serotonin pathways, namely COMT rs4680, HTR2A rs7997012, HTR2A rs6311, and TPH2 rs4570625, that have been associated with behavioral or cognitive responses (Group A), or to a conventional approach (Group B) in which the choice of treatment was not directed by genotypic data. Tinnitus Handicap Index (THI) scores of perceived tinnitus severity were recorded at the initial and at the fourth session of treatment using appropriate questionnaires. A statistically significant reduction in the THI scores was evident only in the genotype-guided group A (t = 3.03, p = 0.01).Conclusion: Individualized incorporation of genetic information may improve the outcome of behavioral and cognitive interventions in tinnitus.
Identification of An Immune Signature Predicting Prognosis Risk of Patients in Gastric Cancer
Authors: dang wei , Chen Cai , Ruiqiao Zhang , Qingquan Fan , Xiaoling Song , Weimin Wang , Jun Gu
Published: January 2021

Background

Gastric cancer is a common but lethal cancer owing to deficient in effective treatment. Substantial evidences have proved that immune infiltration plays a key role in progression of gastric cancer. This study aimed to establish a signature based on immune related genes that can predict clinical outcomes and therapeutic efficacy.
Methods

The expression data from The Cancer Genome Atlas database and 4617 immune related genes from previously published 160 immune gene sets were collected for development and validation of the signature. Cox proportional hazard regression model was used to construct the signature. The reliability and forecasting ability were evaluated by two independent datasets from GEO.
Results

A gene model consisting of 47 immune related genes was used as our signature. Risk scores were calculated based on the coefficient and the expression level of each gene in this model. The low risk score group had an obviously favorable prognosis than the other group in all cohorts. Both of univariate and multivariate analysis suggested that our immune gene signature was an independent prognostic factor. Single sample gene Set Enrichment Analysis (ssGSEA) revealed that high risk score was associated with high Th17 cell infiltration, low mast cell and pro- angiogenesis immune cell infiltration. More importantly, patients with high risk score presented high tumor mutation burden (TMB), which is an essential element for predicting therapeutic efficacy of immune check point inhibitor.
Conclusion

This signature is a promising tool to predict prognosis and screen out population who can get benefit from immune check point inhibitor.