bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of ceftriaxone plus macrolide and ampicillin/sulbactam plus macrolide in treatment for patients with community-acquired pneumonia without risk factors for aspiration: an open-label, quasi-randomized, controlled trial
Authors: Hamao Nobuyoshi , Ito Isao , Konishi Satoshi , Tanabe Naoya , Shirata Masahiro , Oi Issei , Tsukino Mitsuhiro , Matsumoto Hisako , Yasutomo Yoshiro , Kadowaki Seizo , Hirai Toyohiro
Published: June 2020

Background

Ceftriaxone (CTRX) and ampicillin/sulbactam (ABPC/SBT) are recommended by various guidelines as the first-line antibiotics for community-acquired pneumonia (CAP). However, which of these antibiotics is more effective for treating non-aspiration CAP remains unclear.

Methods

This study was a prospective, single-center, open-label, quasi-randomized controlled trial. Patients with adult CAP without risk for aspiration were allocated to either a CTRX or ABPC/SBT group based on the date of hospital admission. Macrolide was added to patients in each group. The primary outcome was the clinical response in the validated per-protocol (VPP) population at end of treatment (EOT). The secondary outcomes were clinical response during treatment and at end of study (EOS) in the VPP population, and mortality rate at day 30 in the modified intention-to-treat (MITT) population.

Results

Of 696 screened patients, 433 patients were excluded and 263 patients were allocated to receive either of the treatments. Males comprised 54% of patients and mean age and PSI were 62.1 ± 19.8 years and 69.3 ± 30.0, respectively, with 124 patients allocated to the CTRX group and 138 patients allocated to the ABPC/SBT group. The clinical effectiveness rate for the VPP population at EOT was 90% in the CTRX and 96% in the ABPC/SBT group (p = 0.072, 95% confidence interval [CI] of risk difference [RD]: − 12.6–0.8%). No significant difference in effectiveness at day 4 was observed between the CTRX and ABPC/SBT groups (p = 0.079, 95%CI of RD: − 12.1–0.4%), but at day 7, ABPC/SBT was significantly more effective than CTRX in the VPP population (p = 0.047, 95%CI of RD: − 13.3–-0.4%). No significant difference in late response at EOS was seen between CTRX and ABPC/SBT groups: cure (89 [86%] and 102 [94%]), relapse (5 [5%] and 1 [1%]) and failure (10 [10%] and 5 [5%]; p = 0.053). Deaths within 30 days in MITT population was higher in CTRX group (4 [3%]) than in ABPC/SBT group (0 [0%]) (p = 0.048, 95%CI of RD: 0.1–6.3%).

Conclusion

No significant difference in effectiveness was found between ABPC/SBT and CTRX at EOT. However, ABPC/SBT might be more effective in the early phase of treatment.

Trial registration

UMIN-CTR, UMIN000037464. Registered 25 July 2019 – Retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000042262
Governance, maternal well-being and early childhood caries in 3–5-year-old children
Authors: Folayan Morenike Oluwatoyin , El Tantawi Maha , Vukovic Ana , Schroth Robert J. , Alade Micheal , Mohebbi Simin Z. , Al-Batayneh Ola B. , Arheiam Arheiam , Amalia Rosa , Gaffar Balgis , Onyejaka Nneka Kate , Daryanavard Hamideh , Kemoli Arthur , Díaz Aída Carolina Medina , Grewal Navneet ,   on behalf of the Global Early Childhood Caries Research Group
Published: June 2020

Background

This study assessed the direct, indirect and total effect of distal – political - risk indicators (affecting populations), and proximal risk indicators (affecting women) on the global prevalence of early childhood caries (ECC) in 3–5 year old children.

Methods

Data on global ECC prevalence were obtained from a prior study. Data for distal risk indicators (voice and accountability; political stability/absence of terrorism; control of corruption) were obtained from the World Bank Governance indicators, 2016. Data for proximal risk indicators (women’s opportunity for leadership; percentage of female legislators, top officials and managers; basic employability status of women; ability of women to afford time off work to care for newborns; gross national income (GNI) per capita for females) were derived from the Human Development Index, 2016. Associations between variables were assessed with path analysis.

Results

Voice and accountability (β = − 0.60) and GNI per capita for females (β = − 0.33) were directly associated with a lower ECC prevalence. Political stability/absence of terrorism (β =0.40) and higher percentage of female legislators, senior officials and managers (β = 0.18) were directly associated with a higher ECC prevalence. Control of corruption (β = − 0.23) was indirectly associated with a lower ECC prevalence. Voice and accountability (β = 0.12) was indirectly associated with a higher ECC prevalence. Overall, voice and accountability (β = − 0.49), political stability/absence of terrorism (β = 0.34) and higher female GNI (β = − 0.33) had the greatest effects on ECC prevalence.

Conclusion

Distal risk indicators may have a stronger impact on ECC prevalence than do proximal risk indicators.. Approaches to control ECC may need to include political reforms.
Gender differences in specialty preference among medical Students at Aleppo University: a cross-sectional study
Authors: Asaad Malke , Zayegh Obada , Badawi Joud , Hmidi Zina shikh , Alhamid Ahmad , Tarzi Mario , Agha Sarab
Published: June 2020

Background

This study aims to identify gender differences in specialty preference and career choice among Syrian medical students.

Method

A cross-sectional study comprising currently enrolled second, fourth and sixth year medical students at Aleppo University was conducted. Demographics, specialty preferences and factors influencing this decision were collected and analyzed.

Results

A total of 561 students (44% males, 56% females) responded to our survey (87% response rate). Surgical specialties (40%) and internal medicine (16%) comprised the two most common specialties chosen by males. In contrast, the majority of females preferred other specialties (17%), internal medicine (16%) and surgical specialties (15%). The most common factor affecting the choice of a specialty by both genders (74% females and 71% males) was ‘A specialty that I like and find interesting’. Work/life balance and anticipated income were the second most common influencing factors by females (62%), males (67%), respectively. The majority of both genders supported the idea that medical students should be able to pursue any medical specialty they want, regardless of their gender. However, females more often believed that they had decreased opportunities for professional advancement based on their gender compared to males (33% vs. 4% respectively,p < 0.001).

Conclusions

We illustrated significant gender differences in specialty preferences and factors influencing this decision. While the majority of participants agreed that medical students should be able to pursue any medical specialty they desire regardless of gender, more women believed they had decreased opportunities for professional advancement based on gender. Policy makers should advocate for a culture of gender equity and develop educational programs to insure gender balance of physicians into different specialties.
Isolation of Mycoplasma anserisalpingitidis from swan goose (Anser cygnoides) in China
Authors: Gyuranecz Miklós , Mitter Alexa , Kovács Áron B. , Grózner Dénes , Kreizinger Zsuzsa , Bali Krisztina , Bányai Krisztián , Morrow Christopher J.
Published: June 2020

Background

Mycoplasma anserisalpingitidis causes significant economic losses in the domestic goose (Anser anser) industry in Europe. As 95% of the global goose production is in China where the primary species is the swan goose (Anser cygnoides), it is crucial to know whether the agent is present in this region of the world.

Results

Purulent cloaca and purulent or necrotic phallus inflammation were observed in affected animals which represented 1–2% of a swan goose breeding flock (75,000 animals) near Guanghzou, China, in September 2019. From twelve sampled animals the cloaca swabs of five birds (three male, two female) were demonstrated to be M. anserisalpingitidis positive by PCR and the agent was successfully isolated from the samples of three female geese. Based on whole genome sequence analysis, the examined isolate showed high genetic similarity (84.67%) with the European isolates. The antibiotic susceptibility profiles of two swan goose isolates, determined by microbroth dilution method against 12 antibiotics and an antibiotic combination were also similar to the European domestic goose ones with tylvalosin and tiamulin being the most effective drugs.

Conclusions

To the best of our knowledge this is the first description of M. anserisalpingitidis infection in swan goose, thus the study highlights the importance of mycoplasmosis in the goose industry on a global scale.
LINC00689 promotes prostate cancer progression via regulating miR-496/CTNNB1 to activate Wnt pathway
Authors: Meng Liwei , Li Zhonghai , Chen Ye , Liu Deqian , Liu Zhaoxu
Published: June 2020

Background

Accumulating evidence has proved the significant influence of long non-coding RNAs (lncRNAs) in cancer formation and development, including PCa.

Methods

The role of LINC00689 in PCa was confirmed by RT-qPCR, MTT, colony formation, flow cytometry, western blot and transwell assays. Besides, the binding ability between LINC00689 and miR-496 was validated by using luciferase reporter assay. Then RT-qPCR, RIP and luciferase reporter and western blot assays were employed to verify the interactions among LINC00689, miR-496 and CTNNB1. Furthermore, the rescuing role of CTNNB1 in Wnt pathway was proved by RT-qPCR, TOP/FOP Flash and western blot assays.

Results

LINC00689 was upregulated in PCa tissues and cells as well as at the terminal stage. Further, knock down of LINC00689 repressed PCa cell proliferation, migration and invasion, and initiated PCa cell apoptosis. Additionally, miR-496 inhibitor and pcDNA3.1/CTNNB1 could neutralize the prohibitive effects of LINC00689 silencing on cell proliferation, migration and invasion, meanwhile, could offset the encouraging role of knocking down LINC00689 in cell apoptosis. Moreover, CTNNB1 upregulation exerted redemptive function in Wnt pathway inhibited by LINC00689 depletion.

Conclusions

To sum up, LINC00689 promotes PCa progression via regulating miR-496/CTNNB1 to activate Wnt pathway, which may contribute to research about new targets for PCa treatment.
Motivations and expectations driving community participation in entomological research projects: Target Malaria as a case study in Bana, Western Burkina Faso
Authors: Barry Nourou , Toé Patrice , Pare Toe Lea , Lezaun Javier , Drabo Mouhamed , Dabiré Roch K. , Diabate Abdoulaye
Published: June 2020

Background

Most field entomology research projects require active participation by local community members. Since 2012, Target Malaria, a not-for-profit research consortium, has been working with residents in the village of Bana, in Western Burkina Faso, in various studies involving mosquito collections, releases and recaptures. The long-term goal of this work is to develop innovative solutions to combat malaria in Africa with the help of mosquito modification technologies. Since the start of the project, Bana residents have played an important role in research activities, yet the motivations and expectations that drive their participation remain under-investigated. This study examines the factors that motivate some members of the local community to contribute to the implementation of Target Malaria’s activities, and, more broadly, explores the reasons that animate citizen participation in entomological research work in malaria-endemic regions.

Methods

A qualitative approach was used to survey the factors motivating members of the local community to assist in the implementation of Target Malaria’s entomological research activities in Bana. Eighty-five individual in-depth and semi-structured interviews were conducted, followed by three focus groups, one with youths who had participated in mosquito collections, and two with adult men and women from the village. All data collected were fully transcribed, processed, and subjected to thematic content analysis.

Results

Data showed that the willingness of local community members to participate in entomological research activities was informed by a wide range of motivational factors. Although interviewees expressed their motivations under different semantic registers, the data showed a degree of consistency around five categories of motivation: (a) enhance domestic protection from mosquitoes and malaria, (b) contribute to a future world free of the disease, (c) acquire knowledge and skills, (d) earn financial compensation, and (e) gain social prestige for the village.

Conclusion

These varying motivations reflect a set of differing personal and collective perceptions about the participation process, combining short and long-term, individual and collective motivations. Beyond the specific circumstances of this case, the study highlights the complex reasons that drive collective participation in entomological research and vector control activities. Detailed knowledge of community expectations should underpin any effort to mobilize local participation in field research activities.
Constructing social identity through multiple “us and them”: a grounded theory study of how contextual factors are manifested in the lives of residents of a vulnerable district in Brazil
Authors: Vincens Natalia , Stafström Martin , Ferreira Efigênia , Emmelin Maria
Published: June 2020

The association between contextual factors and health inequalities is well documented, also in Brazil. However, questions about how contextual factors actually affect health and well-being persist. The aim of this qualitative study was to explore how contextual factors—i.e., social stratification and neighborhood opportunity structures—are manifested in the lives of the residents of a vulnerable district in Brazil. We used a Constructivist Grounded Theory approach based on 12 in-depth interviews. The core category constructing social identity through multiple “us and them” is supported by eight main categories that characterize different pairs of “us and them”, based on internal and external aspects of the social processes involved. Our findings strengthen and support the links between contextual factors and health inequalities, highlighting the relevance of downward social comparison, territorial segregation and stigmatization and erosion of social capital in the construction of social identities and the manifestation of social hierarchies and neighborhood structures in the Brazilian context. Ultimately, these create shame and stress but also pride and empowerment, which are recognized determinants of health inequities.
Dietary patterns and their association with breast milk macronutrient composition among lactating women
Authors: Huang Zhi , Hu Yu-ming
Published: June 2020

Backgroud

Breast milk is the optimal food for infant growth and development. The purpose of this study was to evaluate the association between breast milk macronutrient composition with dietary pattern among lactating women.

Methods

A total of 220 lactating women from 2011 to 2012 in Changsha, a city of south-central China, was recruited using a multi-stage sampling method. Breast milk was collected, and the protein, fat, lactose, total dry matter, and energy contents of breast milk were measured. A 24 h recall method on three consecutive days was used to collect the dietary information of lactating women and an exploratory factor analysis was performed was to identify dietary patterns. The association between the concentration of a breast milk component and dietary pattern was assessed using a multivariable linear regression model.

Results

Three major dietary patterns were classified. Lactating women with dietary pattern 1 mainly ate fresh vegetables and fresh legumes. Those with dietary pattern 2 mainly ate red meat, cereals and eggs, and those with dietary pattern 3 mainly ate fungi and algae, dries legumes and soy milk. Pattern 2 was positively associated with the concentration of protein (B = 0.07, 95% CI 0.00, 0.15), total dry matter (B = 0.20, 95% CI 0.02, 0.38) and energy (B = 1.66, 95% CI 0.03, 3.30) in breast milk. Morever, lactation period was negatively associated with the protein and total dry matter concentrations and positively associated with lactose.

Conclusions

The results show the lactation period was an important factor affecting milk composition and a dietary pattern with high intake of red meat, cereals, and eggs was associated with higher protein, total dry matter, and energy contents in breast milk. These findings show that the dietary patterns of lactating women can affect breast milk macronutrient composition and provide a foundation for improving child health.
Comparison of three Agrobacterium-mediated co-transformation methods for generating marker-free transgenic Brassica napus plants
Authors: Liu Fang , Wang Pandi , Xiong Xiaojuan , Fu Ping , Gao Hongfei , Ding Xinhua , Wu Gang
Published: June 2020

Background

Generation of marker-free transgenic plants is very important to the regulatory permission and commercial release of transgenic crops. Co-transformation methods that enable the removal of selectable marker genes have been extensively used because they are simple and clean. Few comparisons are currently available between different strain/plasmid co-transformation systems, and also data are related to variation in co-transformation frequencies caused by other details of the vector design.

Results

In this study, we constructed three vector systems for the co-transformation of allotetraploid Brassica napus (B. napus) mediated by Agrobacterium tumefaciens and compared these co-transformation methods. We tested a mixed-strain system, in which a single T-DNA is harbored in two plasmids, as well as two “double T-DNA” vector systems, in which two independent T-DNAs are harbored in one plasmid in a tandem orientation or in an inverted orientation. As confirmed by the use of PCR analysis, test strips, and Southern blot, the average co-transformation frequencies from these systems ranged from 24 to 81% in T0 plants, with the highest frequency of 81% for 1:1 treatment of the mixed-strain system. These vector systems are valuable for generating marker-free transgenic B. napus plants, and marker-free plants were successfully obtained in the T1 generation from 50 to 77% of T0 transgenic lines using these systems, with the highest frequency of 77% for “double T-DNA” vector systems of pBID RT Enhanced. We further found that marker-free B. napus plants were more frequently encountered in the progeny of transgenic lines which has only one or two marker gene copies in the T0 generation. Two types of herbicide resistant transgenic B. napus plants, Bar+ with phosphinothricin resistance and Bar+EPSPS+GOX+ with phosphinothricin and glyphosate resistance, were obtained.

Conclusion

We were successful in removing selectable marker genes in transgenic B. napus plants using all three co-transformation systems developed in this study. It was proved that if a appropriate mole ratio was designed for the specific length ratio of the twin T-DNAs for the mixed-strain method, high unlinked co-insertion frequency and overall success frequency could be achieved. Our study provides useful information for the construction of efficient co-transformation system for marker-free transgenic crop production and developed transgenic B. napus with various types of herbicide resistance.
Radiotherapy in the treatment of aggressive fibromatosis: experience from a single institution
Authors: Seidensaal K. , Harrabi S. B. , Weykamp F. , Herfarth K. , Welzel T. , Mechtersheimer G. , Lehner B. , Schneider M. , Fröhling S. , Egerer G. , Debus J. , Uhl M.
Published: June 2020

Background

Desmoid-type fibromatosis is a rare, potentially locally aggressive disease. Herein we present our experience in the treatment with radiotherapy.

Methods and materials

In total 40 patients who received 44 treatments from 2009 to 2018 at the Heidelberg University Hospital with photons (N = 28) as well as protons (N = 15) and carbon ions (N = 1) were investigated. The median age at radiotherapy was 41 years [range 8–78]. Familial adenomatous polyposis (FAP) was confirmed for nine patients and 30 had a unifocal desmoid tumor. The localizations were abdominal wall, abdominopelvic cavity, thoracic wall, extremity, head and neck and trunk. The median prescribed dose was 54 Gy/ Gy (RBE) [range 39.6–66, IQR 50–60]. Eleven treatments were performed at the time of first diagnosis; 33 at the time of progression or recurrence. Post-operative radiotherapy was performed in 17 cases. The median planning target volume was 967 ml [84–4364 ml, IQR 447–1988]. Survival analysis was performed by the Kaplan-Meier Method.

Results

The median follow-up time was 32 months [1–153]. At the end of the follow-up interval all patients but one were alive. The estimated local progression free survival of the treated lesion in 3 and 5 years was 76.4% and 63,8%, respectively. The progression-free survival in 3 and 5 years was 72.3 and 58.4% and the overall survival was 97.4 and 97.4%, respectively. In case of macroscopic tumor (N = 31) before radiotherapy a partial remission was observed in 12 cases (38.7%) and a complete remission in 4 cases (12.9%). Progression was observed in 13 (29.5%) cases, predominantly at the margin of the planning target volume (PTV,N = 5, 38,4%) followed by progression within the PTV (N = 4, 30.8%). In univariate analysis multifocal localization was associated with impaired progression-free survival (p = 0.013). One patient developed a grade V gastrointestinal bleeding, otherwise no acute toxicity >°III was observed. Late toxicity was depending on the localization of the desmoid tumor and was especially severe in patients with FAP and abdominopelvine desmoids including gastrointesinal fistula, perforation and abscess.

Conclusion

Radiotherapy in the treatment of desmoids can lead to long term control. Treatment of patients with abdominopelvine desmoids should be avoided, as the risk of higher-grade complications is substantial.
Does gender influence the outcomes of total ankle arthroplasty in patients with ankle osteoarthritis?
Authors: Lee Gun-Woo , Lee Keun-Bae
Published: June 2020

Background

Total ankle arthroplasty has progressed as a treatment option for patients with ankle osteoarthritis. However, no studies have been conducted to evaluate the effect of gender on the outcome. The purpose of the present study was to evaluate outcomes, survivorship, and complications rates of total ankle arthroplasty, according to gender differences.

Methods

This study included 187 patients (195 ankles) that underwent mobile-bearing HINTEGRA prosthesis at a mean follow-up of 7.5 years (range, 4 to 14). The two groups consisted of a men’s group (106 patients, 109 ankles) and a women’s group (81 patients, 86 ankles). Average age was 64.4 years (range, 45 to 83).

Results

Clinical scores on the Ankle Osteoarthritis Scale for pain and disability, and American Orthopaedic Foot and Ankle Society ankle-hindfoot score improved and the difference was not statistically significant between the two groups at the final follow-up. There were no significant differences in complication rates and implant survivorship between the two groups. The overall survival rate was 96.4% in men and 93.4% in women at a mean follow-up of 7.5 years (p = 0.621).

Conclusions

Clinical outcomes, complication rates, and survivorship of total ankle arthroplasty were comparable between men and women. These results suggest that gender did not seem to affect outcomes of total ankle arthroplasty in patients with ankle osteoarthritis.

Level of evidence

Therapeutic level III
Bioinformatic analysis and experimental identification of blood biomarkers for chronic nonunion
Authors: Wu Jingwei , Liu Limin , Hu Huaijian , Gao Zhihua , Lu Shibao
Published: June 2020

Background

Incomplete fracture healing may lead to chronic nonunion; thus, determining fracture healing is the primary issue in the clinical treatment. However, there are no validated early diagnostic biomarkers for assessing chronic nonunion. In this study, bioinformatics analysis combined with an experimental verification strategy was used to identify blood biomarkers for chronic nonunion.

Methods

First, differentially expressed genes in chronic nonunion were identified by microarray data analysis. Second, Dipsaci Radix (DR), a traditional Chinese medicine for fracture treatment, was used to screen the drug target genes. Third, the drug-disease network was determined, and biomarker genes were obtained. Finally, the potential blood biomarkers were verified by ELISA and qPCR methods.

Results

Fifty-five patients with open long bone fractures (39 healed and 16 nonunion) were enrolled in this study, and urgent surgical debridement and the severity of soft tissue injury had a significant effect on the prognosis of fracture. After the systems pharmacology analysis, six genes, including QPCT, CA1, LDHB, MMP9, UGCG, and HCAR2, were chosen for experimental validation. We found that all six genes in peripheral blood mononuclear cells (PBMCs) and serum were differentially expressed after injury, and five genes (QPCT, CA1, MMP9, UGCG, and HCAR2) were significantly lower in nonunion patients. Further, CA1, MMP9, and QPCT were markedly increased after DR treatment.

Conclusion

CA1, MMP9, and QPCT are biomarkers of nonunion patients and DR treatment targets. However, HCAR2 and UGCG are biomarkers of nonunion patients but not DR treatment targets. Therefore, our findings may provide valuable information for nonunion diagnosis and DR treatment.

Trial registration

ISRCTN, ISRCTN13271153. Registered 05 April 2020—Retrospectively registered.
Clinical application and observation of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma
Authors: Yin Qifan , Liu Huining , Song Yongbin , Zhou Shaohui , Yang Guang , Wang Wenhao , Qie Peng , Xun Xuejiao , Liu Lijun
Published: June 2020

Background

Transthoracic esophagectomy is a crucial independent risk factor for the incidence of postoperative cardiopulmonary complications in elderly or comorbid patients. To reduce postoperative cardiopulmonary complications and promote postoperative recovery. We made an attempt to adopt the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer to observe the clinical application and effect.

Method

Data of patients with esophageal carcinoma were collected in the Hebei General Hospital from May 2018 to November 2019. The operation time, surgical blood loss, the number of dissected lymph nodes, duration of drainage tube, duration of time on the ventilator, the length of stay in ICU, postoperative complications, the length of postoperative hospital stay were collected to assess the safety and feasibility of the single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal cancer.

Results

A total of 22 patients with esophageal cancer were analyzed in our research. There were no cases of conversion to thoracotomy、perioperative death or postoperative cardiopulmonary complications. The average operation time of all enrolled patients was 4.26 ± 0.52 h、The surgical blood loss was 142 ± 36.50 ml、The amount of dissected lymph nodes were 21.6 ± 4.2、The duration of drainage tube was 5.8 ± 2.5 days、The duration of time on the ventilator was 6.5 ± 3.4 h、The length of stay in ICU was 1.2 ± 0.4 days、The postoperative hospital stay was 12.6 ± 2.5 days. Among all the enrolled patients, one patient (4.5%) developed anastomotic fistula on the third day after surgery. Anastomotic stricture was found in 5 patients (22.7%). Pleural effusion was found in 4 cases (18.2%). Recurrent laryngeal nerve injury caused hoarseness or cough after drinking water in 3 cases (13.6%).There was one patient (4.5%) of conversion to laparotomy as the patient had serious peritoneal adhesion. All of the patients were discharged successfully.

Conclusion:Our results showed that this surgery of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma is safe and feasible. The feasibility and safety could be further and better investigated with a RCT to achieve more conclusive results.
Use of the right internal mammary artery and the great saphenous vein for left anterior descending artery revascularization in patients whose left internal mammal artery cannot be used: a study based on transit-time flow measurement
Authors: Zhang Guodong , Zhao Zhou , Chen Yu , Chen Shenglong , Liu Gang
Published: June 2020

Background

Owing to the high patency, the use of the left internal mammary artery (LIMA) for left anterior descending artery (LAD) grafting has been a cornerstone of coronary artery bypass grafting surgery (CABG). However, for some patients whose LIMA cannot be used, surgeons have to choose other conduit materials to revascularize the LAD. The purpose of this study was to explore the differences in different conduit materials used for LAD in terms of parameters measured by transit-time flow measurement (TTFM) and the early graft patency detected by computed tomography angiography.

Methods

We retrospectively collected the data of 410 patients who underwent isolated primary OPCAB with intraoperative TTFM data. According to the strategy of the LAD revascularization, 410 patients were assigned to three groups: a left internal mammal artery (LIMA) group (n = 333), a right IMA (RIMA) group (n = 34) and a great saphenous vein (SVG) group (n = 43). The baseline and perioperative blood parameters were compared for the three groups, as well as the early graft patency rates.

Results

Compared with the LIMA-LAD group, the SVG-LAD group had a significantly higher mean graft flow volume (MGF) (37.15 ± 23.29 vs 29.71 ± 20.94 ml/min, P = 0.036), however, had a lower value of pulse index (PI) (2.07 ± 0.62 vs 2.65 ± 1.01, P<0.001). There was no significant difference between the two groups in terms of DF (P>0.05). Compared with the RIMA-LAD group, the SVG-LAD group just had a lower value of PI (2.07 ± 0.62 vs 2.56 ± 0.96, P = 0.029). However, there was no significant difference between the two groups in terms of MGF and DF (P>0.05). Compared with the LIMA-LAD group, the RIMA-LAD group had a slightly lower value of DF (70.76 ± 11.87 vs 74.06 ± 7.09, P = 0.018), while there was no difference in terms of MGF and PI between the two groups (P>0.05). The patency rate of the LIMA-LAD group was 98.72% (309/313), that of RIMA-LAD group was 97.06% (33/34), and that of SVG-LAD group was 100%. There was no difference among the three groups in patency rate (P = 0.405).

Conclusions

SVG-LAD has a higher intraoperative MGF and a lower value of the PI than both LIMA-LAD and RIMA-LAD. RIMA has a higher preoperative blood flow and a lower value of the PI than LIMA; however, there were no significant difference between RIMA grafted to LAD and LIMA grafted to LAD in terms of MGF, PI and DF. In situ skeletonized RIMA did not increase blood flow compared to pedicled LIMA.
Body fluids may contribute to human-to-human transmission of severe acute respiratory syndrome coronavirus 2: evidence and practical experience
Authors: Mohseni Amir Hossein , Taghinezhad-S Sedigheh , Xu Zhigang , Fu Xiangsheng
Published: June 2020

Background

In December 2019, an unbelievable outbreak of pneumonia associated with coronavirus was reported in the city of Wuhan, Hubei Province. This virus was called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although much effort has been spent on clarifying the transmission route of SARS-CoV-2, but, very little evidence is available regarding the relationship between human body fluids and transmission of SARS-CoV-2 virus. Considerable evidence from hospital in Wuhan indicates that strict rules to avoid occupational exposure to patients’ body fluids in healthcare settings, particularly among every medical staff, limited person-to-person transmission of nosocomial infections by direct or indirect contact.

Conclusion

We tried to provide important information for understanding the possible transmission routes of SARS-CoV-2 via body fluids including bronchoalveolar-lavage, saliva, blood, urine, feces, sputum, tears, and semen in order to control coronavirus disease 2019 (COVID-19) occurrences.
Protective mechanism of rhubarb anthraquinone glycosides in rats with cerebral ischaemia–reperfusion injury: interactions between medicine and intestinal flora
Authors: Li Qiuying , Guo Ying , Yu Xiahui , Liu Wenhong , Zhou Liping
Published: June 2020

Background

Anthraquinone glycosides extracted from rhubarb have been proven to have significant therapeutic effects on ischaemic stroke. It is well known that anthraquinone glycosides are not easily absorb. Thus, how can rhubarb anthraquinone glycosides (RAGs) exert protective effects on the brain? Is this protective effect related to interactions between RAGs and intestinal flora?

Methods

The model used in this study was established by middle cerebral artery occlusion (MCAO) and reperfusion. Twenty-seven adult male Sprague–Dawley (SD) rats were randomly divided into 3 groups: the normal group (A) (non-MCAO + 0.5% sodium carboxymethyl cellulose (CMC-Na)), model group (B) (MCAO + 0.5% CMC-Na) and medicine group (C) (MCAO + RAGs (15 mg/(kg day)). The rats were fed by gavage once a day for 7 days. Fresh faeces were collected from the normal group to prepare the intestinal flora incubation liquid. Add RAGs, detect the RAGs and the corresponding anthraquinone aglycones by HPLC–UV at different time points. On the 8th day, the rats were euthanized, and the colonic contents were collected and analysed by high-throughput sequencing. In addition, 12 adult male SD rats were randomly divided into 2 groups: the normal group (D) (non-MCAO + RAGs (15 mg/(kg day)) and model group (E) (MCAO + RAGs (15 mg/(kg day)). The rats were fed by gavage immediately after reperfusion. Blood was collected from the orbital venous plexus, and the RAGs and anthraquinone aglycones were detected by HPLC–UV.

Results

The abundance and diversity of the intestinal flora in rats decreased after cerebral ischaemia–reperfusion injury (CIRI). RAGs could effectively improve the abundance of the intestinal flora. In addition, in vitro metabolism studies showed that RAGs were converted into anthraquinone aglycones by intestinal flora. In the in vivo metabolism studies, RAGs could not be detected in the plasma; in contrast, the corresponding anthraquinone aglycones could be detected. Absorption of RAGs may be inhibited in rats with CIRI.

Conclusions

CIRI may lead to intestinal flora disorder in rats, and after the administration of RAGs, the abundance of intestinal flora can be improved. RAGs can be metabolized into their corresponding anthraquinone aglycones by intestinal flora so that they can be absorbed into the blood.
Medical expenditure for patients with hemophilia in urban China: data from medical insurance information system from 2013 to 2015
Authors: Gong Guang-wen , Chen Ying-chun , Fang Peng-qian , Min Rui
Published: June 2020

Background

Hemophilia, a high-cost disease, is the only rare disease covered by basic medical insurance in all province of China. However, very few studies have estimated the medical expenditure of patients with this rare disease Therefore, this study is aimed at evaluating the medical expenditure of patients with hemophilia and identifying its determinants.

Methods

The study population included 450 patients with hemophilia who were extracted from the national insurance database between 2014 and 2016. An independent-sample Kolmogorov–Smirnov test was performed to compare the medical expenditure of patients with hemophilia covered under urban employee basic medical insurance (UEBMI) and urban residence basic medical insurance (URBMI). Quantile regression analysis was conducted to explore the factors that affect the medical expenditure of patients with hemophilia.

Results

The total annual medical expenditure of patients with hemophilia in 2013, 2014, and 2015 had median of ¥7167 (US$ 1156), ¥3522 (US$ 577), and ¥4197 (US$ 677), respectively. The median medical expenditures of patients with hemophilia covered by UEBMI were ¥10,991 (US$ 1773), ¥2301 (US$ 377) and ¥8074 (US$ 1302), those of patients covered by URBMI were ¥4000 (US$ 645), ¥5717 (US$ 937) and ¥3141 (US$ 507) from 2013 to 2015. The differences in the medical expenditure of patients with hemophilia between UEBMI and URBMI from 2013 to 2015 were statistically significant. The number of admissions and the number of hospital days were statistically significant and positive for all quantiles. The types of medical service were statistically significant and negative for 50th quantile, and the reimbursement ratio was statistically significant and positive for 50th and 75th quantiles. (p < 0.05).

Conclusion

The medical expenditure of patients with hemophilia was lower than that of patients with other common rare diseases that were not included in the scope of basic medical insurance reimbursement. It was also observed that the medical expenditure was mainly influenced by the severity of disease, and partly affected by the reimbursement rate.
Prospective cardiovascular magnetic resonance imaging in adults with Alström syndrome: silent progression of diffuse interstitial fibrosis
Authors: Baig Shanat , Dowd Rory , Edwards Nicola C. , Hodson James , Fabritz Larissa , Vijapurapu Ravi , Liu Boyang , Geberhiwot Tarekegn , Steeds Richard P.
Published: June 2020

Background

Alström syndrome (ALMS) is a rare ciliopathy characterised by early onset insulin resistance, obesity, and dyslipidaemia and is a model for diseases that have huge social, health and economic impact. Cardiomyopathy develops in the majority, with high rates of morbidity and mortality, the definitive features of which are coarse replacement fibrosis and diffuse myocardial fibrosis (DIF). The pathogenesis of heart failure is thought to involve fibroblast accumulation and expansion of the extracellular matrix with excess protein deposition, leading to distorted organ architecture and impaired contractile function. Consecutive adults with genetically proven ALMS attending the National Centre for Rare Disease in Birmingham, England were studied. All patients underwent serial CMR, echocardiography and venous blood sampling, with computed tomography coronary angiography (CTCA) performed to assess severity of CAD. The aims of this study were: 1) to evaluate changes over time in DIF by cardiovascular magnetic resonance tissue characterization in ALMS; 2) to examine whether changes in DIF are associated with alteration in systolic or diastolic function; and 3) to evaluate the frequency and severity of coronary artery disease as a confounder for progression of ischaemic versus non-ischaemic fibrosis.

Results

In total, 30/32 adults (63% male; 67% White British) participated. The median age at first scan was 21.3 years (interquartile range: 19.0–32.6) and participants were followed for a maximum of 67 months. Only 4 patients had significant coronary artery stenosis on post-mortem, invasive coronary angiography or CTCA. Mid short axis myocardial T1 times, myocardial extracellular volume, and left ventricular mass increased significantly over time, by an average of 21.8 ms (95% CI 17.4–26.1; p < 0.001), 1.1 percentage points (0.6–1.6, p < 0.001), and 2.8 g/m2 (1.9–3.7; p < 0.001) per year, respectively. These changes were not associated with significant deterioration in myocardial structure or function.

Conclusions

This is the first comprehensive prospective study demonstrating progression of DIF in ALMS over time, although no structural or functional consequences were noted within a median three and a half years’ follow up. Further study is warranted to define whether DIF is a by-stander or the driver to impaired contractile function, heart failure and death.
Non-coding RNAs shuttled via exosomes reshape the hypoxic tumor microenvironment
Authors: Wang Wenyu , Han Youngjin , Jo Hyun A , Lee Juwon , Song Yong Sang
Published: June 2020

Exosomes are small extracellular vesicles secreted by almost all the cells. Molecular cargos of exosomes can partially reflect the characteristics of originating cells. Exosome-mediated cell-to-cell interactions in the microenvironment are critical in cancer progression. Hypoxia, a key pro-cancerous feature of the tumor microenvironment, alters the releasing and contents of exosomes. A growing body of evidence shows that hypoxia induces more aggressive phenotypes in cancer. Of note, non-coding RNAs shuttled in hypoxic tumor-derived exosomes have been demonstrated as fundamental molecules in regulating cancer biology and remodeling tumor microenvironment. Furthermore, these hypoxic tumor-derived exosomal non-coding RNAs can be detected in the body fluids, serving as promising diagnostic and prognostic biomarkers. The current review discusses changes in cancer behaviors regulated by exosomes-secreted non-coding RNAs under hypoxic conditions.
Th17 cells inhibit CD8+ T cell migration by systematically downregulating CXCR3 expression via IL-17A/STAT3 in advanced-stage colorectal cancer patients
Authors: Wang Dan , Yu Weina , Lian Jingyao , Wu Qian , Liu Shasha , Yang Li , Li Feng , Huang Lan , Chen Xinfeng , Zhang Zhen , Li Aitian , Liu Jinbo , Sun Zhenqiang , Wang Junxia , Yuan Weitang , Zhang Yi
Published: June 2020

Background

CD8+T cell trafficking to the tumor site is essential for effective colorectal cancer (CRC) immunotherapy. However, the mechanism underlying CD8+T cell infiltration in colorectal tumor tissues is not fully understood. In the present study, we investigated CD8+T cell infiltration in CRC tissues and the role of chemokine–chemokine receptor signaling in regulation of T cell recruitment.

Methods

We screened chemokines and cytokines in healthy donor and CRC tissues from early- and advanced-stage patients using multiplex assays and PCR screening. We also utilized transcription factor activation profiling arrays and established a xenograft mouse model.

Results

Compared with tumor tissues of early-stage CRC patients, CD8+T cell density was lower in advanced-stage tumor tissues. PCR screening showed that CXCL10 levels were significantly increased in advanced-stage tumor tissues. CXCR3 (the receptor of CXCL10) expression on CD8+T cells was lower in the peripheral blood of advanced-stage patients. The migratory ability of CD8+T cells to CXCL10 depended on CXCR3 expression. Multiplex arrays showed that IL-17A was increased in advanced-stage patient sera, which markedly downregulated CXCR3 expression via activating STAT3 signaling and reduced CD8+T cell migration. Similar results were found after CD8+T cells were treated with Th17 cell supernatant. Adding anti-IL-17A or the STAT3 inhibitor, Stattic, rescued these effects in vitro and in vivo. Moreover, survival analysis showed that patients with low CD8 and CXCR3 expression and high IL-17A levels had significantly worse prognosis.

Conclusions

CD8+T cell infiltration in advanced-stage tumor was systematically inhibited by Th17 cells via IL-17A/STAT3/CXCR3 axis. Our findings indicate that the T cell infiltration in the tumor microenvironment may be improved by inhibiting STAT3 signaling.
IMpower, CASPIAN, and more: exploring the optimal first-line immunotherapy for extensive-stage small cell lung cancer
Authors: Huang Chengliang , Gan Gregory N. , Zhang Jun
Published: June 2020

The life expectancy of extensive-stage small cell lung (ES-SCLC) cancer patients has not improved in the last 2–3 decades until two recent trials (CASPIAN and IMpower133) showing the addition of anti-programmed death ligand (PD-L1) therapy to chemotherapy has survival benefit over chemotherapy alone. However, such benefit is relatively small and was not even observed in some other trials using immunotherapy, raising the question of optimal chemoimmunotherapy combination in the 1st-line setting for ES-SCLC. Here, we discussed several thought-provoking questions with the focus on IMpower133 and CASPIAN trials.
Evolving therapy of adult acute lymphoblastic leukemia: state-of-the-art treatment and future directions
Authors: Samra Bachar , Jabbour Elias , Ravandi Farhad , Kantarjian Hagop , Short Nicholas J.
Published: June 2020

Recent years have witnessed major advances that have improved outcome of adults with acute lymphoblastic leukemia (ALL). The emergence of the concept of measurable residual disease has fine-tuned our prognostic models and guided our treatment decisions. The treatment paradigms of ALL have been revolutionized with the advent of tyrosine kinase inhibitors targeting BCR-ABL1, monoclonal antibodies targeting CD20 (rituximab), antibody-drug conjugates targeting CD22 (inotuzumab ozogamicin), bispecific antibodies (blinatumomab), and CD19 chimeric antigen receptor T cell therapy (tisagenlecleucel). These highly effective new agents are allowing for novel approaches that reduce reliance on intensive cytotoxic chemotherapy and hematopoietic stem cell transplantation in first remission. This comprehensive review will focus on the recent advances and future directions in novel therapeutic strategies in adult ALL.
Circular RNA hsa_circ_0078607 suppresses ovarian cancer progression by regulating miR-518a-5p/Fas signaling pathway
Authors: Zhang Nan , Jin Yue , Hu Qiubo , Cheng Shanshan , Wang Chao , Yang Zhiyou , Wang Yu
Published: June 2020

Background

Increasing researches have demonstrated the critical functions of circular RNAs (circRNAs) in the progression of malignant tumors, including ovarian cancer. In this study, we aim to investigate abnormally expression of hsa_circ_0078607 and the role of hsa_circ_0078607 during ovarian cancer pathogenesis.

Methods

RT-PCR were used to detect the expression of circ_0078607 in ovarian cancer tissues. To determine the functional roles of circ_0078607 in ovarian cancer, cell proliferation and cell invasion assays were performed. Bioinformatics and luciferase reporter analysis were used to predict the target of circ_0078607.

Results

In the present study, we first found that circ_0078607 was downregulated in ovarian cancer. Forced circ_0078607 expression significantly suppressed proliferation and promoted apoptosis of ovarian cancer cells. Mechanically, bioinformatics and luciferase reporter analysis identified miR-518a-5p as a direct target of circ_0078607, while Fas as a direct target of miR-518a-5p. MiR-518a-5p negatively regulated Fas in ovarian cancer cells, while overexpression of circ_0078607 could increase the expression of Fas inhibited by miR-518a-5p. Furthermore, overexpression of circ_0078607 could inhibit the proliferation and invasion of ovarian cancer cells caused by miR-518a-5p mimic.

Conclusion

The results of the present study revealed that circ_0078607 suppressed ovarian cancer progression by sponging oncogenic miR-518a-5p to induce Fas expression, which may provide new therapeutic approach for ovarian cancer.
Admission decisions to intensive care units in the context of the major COVID-19 outbreak: local guidance from the COVID-19 Paris-region area
Authors: Azoulay Élie , Beloucif Sadek , Guidet Bertrand , Pateron Dominique , Vivien Benoît , Le Dorze Matthieu
Published: June 2020

SARS-CoV-2 has caused a global pandemic unprecedented in size, spread, severity, and mortality. The influx of patients with severe or life-threatening disease means that in some cases, the available medical resources are not sufficient to meet the needs of all patients. Hence, healthcare providers may be forced to make difficult choices about which patients should be referred to the ICU. This document is intended to provide conceptual support to all healthcare teams currently engaged in the frontline management of the COVID-19 pandemic. It aims to assist physicians in the decision-making process for ICU admission and to help them provide uninterrupted and high-quality care.