bluuebunny/crossref_metadata_2025 huggingface dataset:
Why do MPFL reconstructions fail today?
Authors: Zimmermann Felix , Balcarek Peter
Published: May 2020

Aims and Objectives:

The medial patellofemoral ligament (MPFL) is the most important passive stabilizer of the patella. In recurrent lateral patellar dislocations reconstruction of the MPFL with an autologous tendon transplant is a frequently performed surgical procedure that shows a low redislocation rate between 1%-7%. However, a complication rate of up to 26% and a reoperation rate of 4% has also been observed. The question, therefore, arises which parameter determines MPFL reconstruction failure. Thus, the purpose of this study was to identify reasons for MPFL reconstruction failure with regard to patients’ complaints leading to reoperation.

Materials and Methods:

Between July 2015 and May 2019 28 patients (M/F 9/19; mean age 27 ± 8 years) with postoperative complaints after MPFL reconstructive surgery had to undergo revision surgery. Preoperative failure analysis included clinical examination (ROM, ReDPAT, J-sign, and Patella-Glide Test) and radiological imaging with regard to anatomical risk factors of patellar instability and MPFL tunnel positioning. Anatomical predisposition was assessed according to Dejour’s classification of trochlear dysplasia, tibial tuberosity-trochlear groove distance, tibial tuberosity-posterior cruciate ligament distance, patellar height, varus/valgus malalignment and torsional profile.

Results:

Three major reasons for revision surgery were identified: (1) patellar redislocation, (2) limited range of motion (ROM), and (3) anterior knee pain (AKP). Sixteen of the 28 patients (57%) suffered from recurrent patellar dislocation. Severe trochlear dysplasia (type B/D according to Dejour) (44%), valgus deformity (19%), increased patellar height (19%), and misplaced femoral drill channels (31%) could be identified as risk factors for redislocation. An increased TT-TG (>20mm) or TT-PCL (>24mm) distance could not be observed in any patient in this group. Limited ROM with an average maximum flexion ability of about 92 ± 26° was observed in 10 of the 28 patients (36%), of which 9 patients additionally complained of AKP. Misplaced femoral drill channels (80%), severe trochlear dysplasia (type B/D according to Dejour) (20%) and postoperative decreased patellar height (20%) could be identified as risk factors for postoperative limited ROM. Other reasons for postoperative AKP were increased femoral antetorsion (n=1) and retropatellar cartilage damage (n=2) without any loss of ROM.

Conclusion:

Recurrent dislocation of the patella, limited ROM and AKP were identified as most common complications after MPFL reconstruction leading to revision surgery. Failures are mainly due to neglected bony risk factors of patellar instability (trochlear dysplasia, patella alta and valgus deformity) and to misplaced femoral drill channels. Appropriate patient selection and an accurate surgical technique appear mandatory for a good clinical outcome when patellar instability is treated solely with an MPFL reconstruction.
Variability of functional knee phenotypes in osteoarthritic knees shows that a more personalized approach in TKA is needed
Authors: Moser Lukas , Hess Silvan , Behrend Henrik , Hirschmann Michael
Published: May 2020

Aims and Objectives:

Recently, the functional knee phenotype concept was introduced as a new system to classify the coronal alignment of the lower limb. Until now, this concept has only been applied to non-osteoarthritic knees. The purpose of this study was therefore to phenotype osteoarthritic knees according to this concept and investigate the distribution of these phenotypes.

Materials and Methods:

Preoperative CT scans of osteoarthritic knees scheduled for TKA collected between January 2017 and December 2019 in the KneePLAN 3D database (Symbios Orthopédie S.A.) were reviewed for patients meeting the following inclusion criteria: age>50 and <90, no signs of previous fractures, osteotomies and rheumatoid arthritis. A total of 2764 patients (1438 right and 1326 left lower limbs, Male:female ratio 1096 :1668) with a mean age ± standard deviation of 70±8.5years (range 50-90 years) were included. The following coronal alignment parameters were measured using a validated software (KneePLAN 3D, Symbios Orthopédie S.A): hip-knee-ankle angle (HKA), femoral mechanical angle (FMA), and tibial mechanical angle (TMA). Based on these measurements each leg was phenotyped according to the functional knee phenotype concept and the distribution of these phenotypes assessed. A phenotype thereby consists of a phenotype specific mean value (HKA, FMA or TMA value) and covers a range of ± 1.5° from this mean (e.g. 180°± 1.5). The phenotype specific mean values represent 3° increments of the angle starting from the rounded overall mean value of the angle.

Results:

There were 162 different functional knee phenotypes (122 male, 138 female and 97 mutual). The most common functional knee phenotype in males was VARHKA6°VARFMA3°NEUTMA0° accounting for 8% of all males. The most common functional knee phenotype in females was VARHKA3°NEUFMA0°NEUTMA0° accounting for 9% of the population. The ten most common functional phenotypes account for 50% and 42.8% of all females and males, respectively. Overall, 134 phenotypes accounted each for less than 1% of the total population (all 134 together for 26.4%).

Conclusion:

The broad variability of functional knee phenotypes in osteoarthritic knees shows that a more personalized TKA realignment strategy is needed. The challenge will be to identify the optimal alignment strategy for each functional knee phenotype.
Combined posteromedial or posterolateral PCL injuries: Anatomic repair and ligament bracing as a new treatment option - first results of a multicentre study
Authors: Gensior Tobias J. , Glaab Richard , Hepp Pierre , Zellner Johannes , Mester Bastian , Schoepp Christian
Published: May 2020

Aims and Objectives:

Acute, isolated PCL injuries can succesfully be managed non-operatively whereas combined PCL injuries usually require surgical management. Currently, there is a lack of evidence regarding the standard of treatment (repair vs. reconstruction, one-stage vs. two-stages procedures). Suture augmented repair leads to good and excellent results in cases of acute knee dislocations. This technique has not been investigated clinically in combined PCL injuries, yet. The aim of this multicentre study was to evaluate the clinical outcome after surgical repair with additional suture augmentation (ligament bracing) of all torn ligaments in acute combined pcl injuries (posteromedial or posterolateral).

Materials and Methods:

From 2016 to 2018, 25 patients with an acute combined PCL injury were treated with one stage anatomical repair and ligament bracing of the torn ligaments within 14 days at 6 trauma centres (5xGER, 1x SUI). Inclusion criteria: Follow-up min. 6 months, age > 18y. Exclusion criteria: ACL Injury, posteromedial AND posterolateral injury. During the follow-up evaluation, various scores were collected (International Knee Documentation Committee IKDC Score, Tegner Score , KOOS and Lysholm Score). Additional stress radiography was performed (TelosTM) postoperatively.

Results:

For now 14 combined PCL injuries (posteromedial or -lateral) with a follow-up of 20 months (range 8-33) were evaluated. 10 patients had a posteromedial (PCL + MCL/POL), 4 patients had a posterolateral (PCL + LCL) injury. 10 additional articular lesions were detected (6 meniscus tears, 4 grade IV chondral lesions) and 1 transitional peroneal nerve injury. The average IKDC score was 62.2±18.5, the average Lysholm score was 78±19.2, average KOOS 88.7±7.6. Median loss of activity in the Tegner score was 1 (range 0-5) point. Side-to-side pcl-stress-radiographs showed a difference at a mean of 4.8±3.0mm (range 1-10). 2 cases with symptomatic knee instability, both posterolateral, and 3 patients with knee stiffness needed reoperation. Interestingly, patients with posteromedial injuries showed predominantly good or excellent results according to Lysholm score and were graded as A (4/10) or B (2/10) whereas ligament bracing in posterolateral combined injuries had a high failure rate (Grade D 2/4).

Conclusion:

Primary anatomic repair and additional suture augmentation predominantly leads to good and excellent clinical results in cases of combined posteromedial PCL injuries. Patients with posterolateral injuries showed inferior clinical outcome and relatively high instability rates following ligament bracing. In conclusion, primary augmented suture repair seems to be a promising treatment option. The overall results of this study have to be evaluated for more exact recommendations.
Revision ACL Reconstruction - A retrospective failure analysis with a mean follow up of 35 months
Authors: Alm Lena , Krause Matthias , Frosch Karl-Heinz , Akoto Ralph
Published: May 2020

Aims and Objectives:

While patients following primary anterior cruciate ligament (ACL) surgery show satisfying results, the outcome after revision ACL reconstruction (ACLR) seems to be less favourable. The purpose of this study was to evaluate the outcome of patients after revision ACLR. We hypothesize that peripheral knee instabilities and further concomitant lesions are risk factors for failure of revision ACLR. Furthermore, we hypothesize that peripheral stabilisation will reduce the risk of failure.

Materials and Methods:

Between 2013 and 2016, 111 patients with revision ACLR (revision surgery after primary ACL reconstruction) were included in the retrospective study. All patients were clinically examined with a minimum of 2 years after revision surgery (mean 35 months) and identified as “failed revision ACLR” (side-to-side difference greater than 5mm and/or pivot-shift grade 2/3) and “stable revision ACLR”. Multiple logistic regression modeling was used to evaluate whether certain predisposing factors were associated with increased odds of failure of the revision ACLR.

Results:

Failure after revision ACLR occurred in 14.5% (n=16) of the cases. Preoperative medial knee instability (n=36) was associated with failure of revision ACLR, thus patients had a 17 times greater risk of failure when medial knee instability was diagnosed preoperatively. Also, the risk of failure was reduced when patients had peripheral medial (n=24) and/ or antero-lateral stabilisation (n=51). Increased posterior tibial slope (PTS, n=11 greater than 12°) and high-grade anterior knee laxity (side-to-side-difference greater than 5 mm and/or pivot-shift grade 3, n=41) were associated with failed revision ACLR. Furthermore, patients had a 9 times greater risk of failure when they were obese (BMI greater than 30 kg/m2, n=30). Also, postoperative functional scores in comparison to preoperative scores were shown to be significantly higher (Lysholm 85±27 vs. 51±31.9, p=0.024; Tegner 6.5± 1.3 vs. 4± 2.6, p=0.015).

Conclusion:

Results following revision anterior cruciate ligament reconstruction (ACLR) are less favourable than primary ACLR. Peripheral medial knee instability, high-grade anterior knee laxity, increased PTS and high BMI are risk factors for failure in revision ACLR while additional medial and/or antero-lateral stabilisation reduces the risk of failure.
The influence of High tibial osteotomies on the posterior tibial slope - Study of 190 medial open wedge and 89 lateral closed wedge cases
Authors: Schubert Ilona , Ferner Felix , Strohm Peter , Dickschas Jörg
Published: May 2020

Aims and Objectives:

High tibial osteotomies (HTO) are nowadays an established method to treat unicompartmental, medial gonarthrosis. Common surgical HTO techniques include medial open wedge (MOW) and lateral closed wedge osteotomies (LCW). In addition to the intended change in the frontal plane these surgical techniques take influence on various other biomechanical issues of the knee joint e.g. the posterior tibial slope (PTS). Aim of this study was to rate and evaluate changes of the tibial slope by HTOs dependent on the used surgical technique (MOW versus LCW).

Materials and Methods:

414 HTOs, that had been performed in our institution between 2004 and November 2018, were reviewed retrospectively. 135 cases were excluded. The included 279 cases from 247 patients were divided into two groups dependent on the used surgical technique (MOW/LCW). In both groups the values of PTS were defined by measuring the proximal posterior tibia angle (PPTA) on lateral x-rays of the knee from before and 4 to 6 weeks after surgery. The change of PTS was evaluated as delta-PPTA. Microsoft Excel was used for statistical analysis.

Results:

279 cases were included: 190 were assigned to the group of MOW and 89 to the group of LCW osteotomies. Considering demographic data the MOW-group showed a gender distribution of 124 men/ 46 women in 93 left and 97 right knees, and the LCW-group of 46 men/43 women in 40 left and 49 right knees. The mean value of age in the MOW group was 47,6 +/- 10 years (15-70 years) and in the LCW-group 40,6+/-13,7 years (15-67 years). Before surgery there was no statistical significant difference in the PPTA-values between both groups (p=0,720): The mean PPTA in the MOW-group measured 79,9°+/-3,2° (68-88°), in the LCW-group 80,6°+/-2,6° (74-88°). The change caused by surgery showed no statistical significance in the MOW-group (delta-PPTA 0,07°+/- 2,9° [-12° bis 11°]). However, in the LCW-Gruppe we observed a significant (p<0,001) decrease of the PTS (delta-PPTA -3,09°+/- 4,5° [-12°bis 5°]). Nevertheless, the analysis of delta-PPTA in the LCW-group over the timeline of the study period showed tendencies of a decline of slope-reduction.

Conclusion:

As the PTS plays a relevant role in biomechanics of the knee joint a consideration of the impact of changes in PTS by HTOs is indispensable. Our results support the common thesis of a slope-reduction by LCW osteotomies but nevertheless the analysis throughout the study period showed a reduction of the slope-decrease over timeline. The common thesis of a slope-increase by MOW osteotomies was not supported by our results which showed no significant change.
Teaching natural selection in early elementary classrooms: can a storybook intervention reduce teleological misunderstandings?
Authors: Brown Sarah A. , Ronfard Samuel , Kelemen Deborah
Published: May 2020

Background

Despite the importance of understanding the mechanism of natural selection for both academic success and everyday decision-making, this concept is one of the most challenging to learn in contemporary science. In addition to cumulative socio-cultural influences, intuitive cognitive biases such as the teleological bias—the early developing tendency to explain phenomena in terms of function or purpose—contribute to the difficulty of accurate learning when the process is taught in high school or later. In this work, we therefore investigate—for the first time—the viability of a teacher-led classroom-based storybook intervention for teaching natural selection in early elementary school. The intervention was designed to counteract teleological explanations of adaptation. In consequence, we specifically examined the nature and extent of elementary school children’s teleological reasoning about biological trait change before and after this intervention.

Results

Second and third grade students demonstrated a variety of misunderstandings at pretest, including teleological preconceptions. Most of these teleological ideas were explicitly accompanied by incorrect mechanistic ideas, confirming that the teleological reasoning observed in this young sample reflected fundamental misunderstandings of adaptation as a goal-directed event. Overall, learning from the classroom intervention was substantial, with students performing significantly better on all measures of natural selection understanding at posttest. Interestingly, explicit teleological reasoning displayed at the pretest did not have a differentially greater impact on learning than other kinds of marked pretest misunderstandings. One explanation for this might be that children displaying teleological misunderstandings at pretest also tended to demonstrate more biological factual knowledge than other students. Another explanation might be that pretest misunderstandings that were not overtly teleological were, nevertheless, implicitly teleological due to the nature of the mechanisms that they referenced. The differential impact of teleological preconceptions on learning might therefore have been underestimated.

Conclusions

In summary, early elementary school children show substantial abilities to accurately learn natural selection from a limited but scalable classroom-based storybook intervention. While children often display explicit teleological preconceptions, it is unclear whether these ideas represent greater impediments to learning about adaptation than other substantial misunderstandings. Reasons for this, and limitations of the present research, are discussed.
Comparison of clinical features of acute lower respiratory tract infections in infants with RSV/HRV infection, and incidences of subsequent wheezing or asthma in childhood
Authors: Ding Qin , Xu Lili , Zhu Yun , Xu Baoping , Chen Xiangpeng , Duan Yali , Xie Zhengde , Shen Kunling
Published: May 2020

Background

To compare the clinical characteristics of acute lower respiratory tract infections (ALRTIs) caused by respiratory syncytial virus (RSV) and human rhinovirus (HRV) and to explore the relationship between the development of recurrent wheezing/asthma and RSV/ HRV infections in infancy.

Methods

Retrospective study was conducted to compare the clinical characteristics of acute lower respiratory tract infections (ALRTIs). Hospitalized patients with ALRTIs from March 2007 to December 2016 were screened. Single RSV cases (s-RSV), single HRV cases (s-HRV), and cases who had co-infection with the two viruses were enrolled. Follow-up was performed to determine whether either specific respiratory virus infection was related to subsequent development of recurrent wheezing/asthma.

Results

The s-RSV children were the youngest (P = 0.021), they experienced the most serious condition (P < 0.001) and respiratory failure (P < 0.001), they also required highest demand of oxygen therapy (P < 0.001). And in s-RSV group, the incidence of development of recurrent wheezing was significantly higher in subgroup with the family history of wheezing than that without (P < 0.001).

Conclusion

The s-RSV cases suffered from the worst severity of illness, respiratory failure and required highest demand of oxygen therapy. Recurrent wheezing was more common in s-RSV group with family history of wheezing than those without.
Thrombocytopenia and platelet course on hospital mortality in neurological intensive care unit: a retrospective observational study from large database
Authors: Zhou Dawei , Li Zhimin , Wu Lei , Shi Guangzhi , Zhou Jianxin
Published: May 2020

Background

Thrombocytopenia (TP) has been shown to be an independent predictor of mortality in the intensive care unit (ICU) patients. Studies are lacking in the neurological ICU (NICU) population. The aim was to evaluate the incidence of TP in NICU and the relationship between TP and outcomes.

Methods

We conducted a retrospective multicenter study of prospectively collected data of all patients admitted to the NICU between 2014 and 2015 from a large database (eICU Collaborative Research Database). The main exposure was TP at admission and TP developed during NICU stay. Multivariable logistic regression and Cox proportional hazard models were used to evaluate the relationship of TP at admission and platelet course with hospital mortality. The primary outcome was hospital mortality.

Results

7450 patients in NICU from 17 hospitals were included. Hospital mortality was 9%. TP at admission was present in 20% of patients, TP developed during NICU stay was present in 13.2% of patients. TP at admission was not associated with hospital mortality after adjusting for confounders (OR 1.14 [95% CI 0.92–1.41, p = 0.237]). Hospital mortality of continuous TP during NICU stay was 15% while hospital mortality of recovery from TP at admission was 6% (p < 0.001). Patients with TP developed during NICU stay had higher odds ratio for hospital mortality (OR 1.65 [95% CI 1.3–2.09, p < 0.001]).

Conclusions

Thrombocytopenia is common in NICU and patients who have thrombocytopenia not resolving have increased mortality. Patients’ recovery from thrombocytopenia may predict a good prognosis.
The prediction of intraoperative cervical cord function changes by different motor evoked potentials phenotypes in cervical myelopathy patients
Authors: Wang Shujie , Ren Zhifu , Liu Jia , Zhang Jianguo , Tian Ye
Published: May 2020

Background

Surgery is usually the treatment of choice for patients with cervical compressive myelopathy (CCM). Motor evoked potential (MEP) has proved to be helpful tool in evaluating intraoperative cervical spinal cord function change of those patients. This study aims to describe and evaluate different MEP baseline phenotypes for predicting MEP changes during CCM surgery.

Methods

A total of 105 consecutive CCM patients underwent posterior cervical spine decompression were prospectively collected between December 2012 and November 2016. All intraoperative MEP baselines recorded before spinal cord decompression were classified into 5 types (I to V) that were carefully designed according to the different MEP parameters. The postoperative neurologic status of each patient was assessed immediately after surgery.

Results

The mean intraoperative MEP changes range were 10.2% ± 5.8, 14.7% ± 9.2, 54.8% ± 31.9, 74.1% ± 24.3, and 110% ± 40 in Type I, II, III, IV, and V, respectively. There was a significant correlation of the intraoperative MEP change rate with different MEP baseline phenotypes (r = 0.84, P < 0.01). Postoperative transient new spinal deficits were found 0/31 case in Type I, 0/21 in Type II, 1/14 in Type III, 2/24 in Type IV, and 4/15 in Type V. No permanent neurological injury was found in our cases series.

Conclusions

The MEP baselines categories for predicting intraoperative cervical cord function change is proposed through this work. The more serious the MEP baseline abnormality, the higher the probability of intraoperative MEP changes, which is beneficial to early warning for the cervical cord injury.
Beyond coverage: a qualitative study exploring the perceived impact of Gabon’s health insurance plan on access to and quality of prenatal care
Authors: Sanogo N’doh Ashken , Fantaye Arone Wondwossen , Yaya Sanni
Published: May 2020

Background

Access to affordable and adequate healthcare in a health system determines the universal health coverage achievement for all residents in a country. Achieving access to healthcare requires the availability of a financing system that ensures access to and provision of adequate care, regardless of the ability to pay. In sub-Saharan Africa, accessibility, use and coverage of prenatal visits are very low and poor, which reduces the quality of care. This paper explored the impact of a social health insurance scheme on the quality of antenatal care in Gabon.

Methods

This qualitative study involved the analysis of data collected from semi-structured interviews and non-participant observations to assess the quality of antenatal care. The study elicited perceptions on the demand side (pregnant women) and the supply side (health professionals) in health facilities. Fifteen semi-structured interviews were conducted with pregnant women (aged between 15 and 49) and 5 with health professionals, who each had a seniority of at least 10 years, at different levels of care. Nine non-participant observations were also conducted. Coded transcripts were reviewed and analyzed using the Canadian Institute for Public Administration of Citizen-Centered Services model as an analytical guide.

Results

On the demand side, women were generally satisfied with the prenatal services they receive in health facilities. However, complaints were made about the rudeness of some nurses, the high price of the delivery kit (50,000 XAF), and the fact that some essential medicines for maternity are not covered. On the supply side, participants agreed that compulsory health insurance is important in providing antenatal care access to those who need it the most. However, some problems remain. The participants outlined some logistical problems and a lack of medical equipment, including the stock of drugs, disinfectants, and the absence of clean water.

Conclusion

Understanding the perceptions of pregnant women and health professionals regarding the quality of antenatal care can help to inform refinements to methods through which the services can be better provided. In addition, the study findings are vital to increasing the use of care, as well as combating high maternal mortality rates. Compulsory health insurance has improved the accessibility and utilization of healthcare services and has contributed to improved quality of care.
LINC00173.v1 promotes angiogenesis and progression of lung squamous cell carcinoma by sponging miR-511-5p to regulate VEGFA expression
Authors: Chen Jiarong , Liu Aibin , Wang Zhihui , Wang Bin , Chai Xingxing , Lu Wenjie , Cao Ting , Li Ronggang , Wu Minyan , Lu Zhuming , Pang Wenguang , Xiao Lin , Chen Xiangmeng , Zheng Yan , Chen Qiong , Zeng Jincheng , Li Jun , Zhang Xin , Ren Dong , Huang Yanming
Published: May 2020

Background

Anti-angiogenic therapy represents a promising strategy for non-small-cell lung cancer (NSCLC) but its application in lung squamous cell carcinoma (SQC) is limited due to the high-risk adverse effects. Accumulating evidence indicates that long noncoding RNAs (lncRNAs) mediate in tumor progression by participating in the regulation of VEGF in NSCLC, which might guide the development of new antiangiogenic strategies.

Methods

Differential lncRNA expression in SQC was analyzed in AE-meta and TCGA datasets, and further confirmed in lung cancer tissues and adjacent normal tissues with RT-qPCR and in-situ hybridization. Statistical analysis was performed to evaluate the clinical correlation between LINC00173.v1 expression and survival characteristics. A tube formation assay, chick embryo chorioallantoic membrane assay and animal experiments were conducted to detect the effect of LINC00173.v1 on the proliferation and migration of vascular endothelial cells and tumorigenesis of SQC in vivo. Bioinformatics analysis, RNA immunoprecipitation and luciferase reporter assays were performed to elucidate the downstream target of LINC00173.v1. The therapeutic efficacy of antisense oligonucleotide (ASO) against LINC00173.v1 was further investigated in vivo. Chromatin immunoprecipitation and high throughput data processing and visualization were performed to identify the cause of LINC00173.v1 overexpression in SQC.

Results

LINC00173.v1 was specifically upregulated in SQC tissues, which predicted poorer overall and progression-free survival in SQC patients. Overexpression of LINC00173.v1 promoted, while silencing LINC00173.v1 inhibited the proliferation and migration of vascular endothelial cells and the tumorigenesis of SQC cells in vitro and in vivo. Our results further revealed that LINC00173.v1 promoted the proliferation and migration of vascular endothelial cells and the tumorigenesis of SQC cells by upregulating VEGFA expression by sponging miR-511-5p. Importantly, inhibition of LINC00173.v1 via the ASO strategy reduced the tumor growth of SQC cells, and enhanced the therapeutic sensitivity of SQC cells to cisplatin in vivo. Moreover, our results showed that squamous cell carcinoma-specific factor ΔNp63α contributed to LINC00173.v1 overexpression in SQC.

Conclusion

Our findings clarify the underlying mechanism by which LINC00173.v1 promotes the proliferation and migration of vascular endothelial cells and the tumorigenesis of SQC, demonstrating that LINC00173.v1-targeted drug in combination with cisplatin may serve as a rational regimen against SQC.
Omega-3 fatty acid exposure with a low-fat diet in patients with past hypertriglyceridemia-induced acute pancreatitis; an exploratory, randomized, open-label crossover study
Authors: Dunbar Richard L. , Gaudet Daniel , Davidson Michael , Rensfeldt Martin , Yang Hong , Nilsson Catarina , Kvarnström Mats , Oscarsson Jan
Published: May 2020

Background

Omega-3 fatty acids (OM3-FAs) are recommended with a low-fat diet for severe hypertriglyceridemia (SHTG), to reduce triglycerides and acute pancreatitis (AP) risk. A low-fat diet may reduce pancreatic lipase secretion, which is required to absorb OM3-ethyl esters (OM3-EEs), but not OM3-carboxylic acids (OM3-CAs).

Methods

In this exploratory, randomized, open-label, crossover study, 15 patients with SHTG and previous AP were instructed to take OM3-CA (2 g or 4 g) and OM3-EE 4 g once daily for 4 weeks, while adhering to a low-fat diet. On day 28 of each treatment phase, a single dose was administered in the clinic with a liquid low-fat meal, to assess 24-h plasma exposure. Geometric least-squares mean ratios were used for between-treatment comparisons of baseline (day 0)-adjusted area under the plasma concentration versus time curves (AUC0–24) and maximum plasma concentrations (Cmax) for eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).

Results

Before initiating OM3-FA treatment, mean baseline fasting plasma EPA + DHA concentrations (nmol/mL) were 723 for OM3-CA 2 g, 465 for OM3-CA 4 g and 522 for OM3-EE 4 g. At week 4, mean pre-dose fasting plasma EPA + DHA concentrations increased by similar amounts (+ 735 − + 768 nmol/mL) for each treatment. During the 24-h exposure assessment (day 28), mean plasma EPA + DHA increased from pre-dose to the maximum achieved concentration by + 32.7%, + 45.8% and + 3.1% with single doses of OM3-CA 2 g, OM3-CA 4 g and OM3-EE 4 g, respectively. Baseline-adjusted AUC0–24 was 60% higher for OM3-CA 4 g than for OM3-EE 4 g and baseline-adjusted Cmax was 94% higher (both non-significant).

Conclusions

Greater 24-h exposure of OM3-CA versus OM3-EE was observed for some parameters when administered with a low-fat meal at the clinic on day 28. However, increases in pre-dose fasting plasma EPA + DHA over the preceding 4-week dosing period were similar between treatments, leading overall to non-significant differences in baseline (day 0)-adjusted AUC0–24 and Cmax EPA + DHA values. It is not clear why the greater 24-h exposure of OM3-CA versus OM3-EE observed with a low-fat meal did not translate into significantly higher pre-dose fasting levels of DHA + EPA with longer-term use.

Trial registration

ClinicalTrials.gov, NCT02189252, Registered 23 June 2014.
Experiences, opinions and current policies on users’ choice and change of the allocated primary mental health professional: a survey among directors of community mental health centers in the Emilia-Romagna region, Italy
Authors: Rioli G. , Ferrari S. , Henderson C. , Galeazzi G. M.
Published: May 2020

Background

The subject of how the initial allocation of the primary mental health professional (PMHP) in community mental health services is made and the frequency and management of users’ requests to choose and/or change their allocated PMHPs has been scarcely investigated. The present paper is aimed at exploring the experiences and opinions of directors of community mental health centers (CMHC) on this topic.

Methods

A cross-sectional survey was conducted. Electronic ad hoc questionnaires with both multiple choice and open-ended questions were e-mailed to the institutional addresses of CMHC directors in the Emilia-Romagna Region (Northern Italy) with the consent of their heads of department and the Ethical Committee. Quantitative data were analysed by means of Microsoft Excel software and STATA 14.2 (College Station, TX), while the qualitative analysis was performed using the Nvivo12 software.

Results

Twenty-eight questionnaires were collected (response rate: 71.8%) that were equally distributed between males and females. For the initial PMHP allocation, casual allocation by “fixed-rota” was commonly performed (39.3%). Moreover, hope for a change of prescription by a different psychiatrist was the most frequent reason for users’ requests to change their PMHP. In two mental health departments only (Parma and Bologna), written guidelines to manage users’ requests of change of PMHP were available. In this context, most participants classified the explored topics as relevant and believed that written policies, especially if shared with users, could be useful.

Conclusions

In Emilia-Romagna CMHCs, neither users nor professionals were generally involved in the initial choice of the PMHP. Further national-level studies should be conducted in order to confirm this finding. Additionally, written and shared guidelines for managing users’ request to choose/change their PHMP may be useful.
Safety and efficacy of direct Cardiac Shockwave Therapy in patients with ischemic cardiomyopathy undergoing coronary artery bypass grafting (the CAST-HF trial): study protocol for a randomized controlled trial
Authors: Pölzl Leo , Nägele Felix , Graber Michael , Hirsch Jakob , Lobenwein Daniela , Mitrovic Martina , Mayr Agnes , Theurl Markus , Schreinlechner Michael , Pamminger Matthias , Dorfmüller Christian , Grimm Michael , Gollmann-Tepeköylü Can , Holfeld Johannes
Published: May 2020

Background

Coronary artery diseases (CAD) remains a severe socio-economic burden in the Western world. Coronary obstruction and subsequent myocardial ischemia result in progressive replacement of contractile myocardium with dysfunctional, fibrotic scar tissue. Post-infarctional remodeling is causal for the concomitant decline of left-ventricular function and the fatal syndrome of heart failure. Available neurohumoral treatment strategies aim at the improvement of symptoms. Despite extensive research, therapeutic options for myocardial regeneration, including (stem)-cell therapy, gene therapy, cellular reprogramming or tissue engineering, remain purely experimental. Thus, there is an urgent clinical need for novel treatment options for inducing myocardial regeneration and improving left-ventricular function in ischemic cardiomyopathy.

Shockwave Therapy (SWT) is a well-established regenerative tool that is effective for the treatment of chronic tendonitis, long-bone non-union and wound-healing disorders. In preclinical trials, SWT regenerated ischemic myocardium via the induction of angiogenesis and the reduction of fibrotic scar tissue, resulting in improved left-ventricular function.

Methods/design

In this prospective, randomized controlled, single-blind, monocentric study, 80 patients with reduced left-ventricular ejection fraction (LVEF≤ 40%) are subjected to coronary-artery bypass-graft surgery (CABG) surgery and randomized in a 1:1 ratio to receive additional cardiac SWT (intervention group; 40 patients) or CABG surgery with sham treatment (control group; 40 patients). This study aims to evaluate (1) the safety and (2) the efficacy of cardiac SWT as adjunctive treatment during CABG surgery for the regeneration of ischemic myocardium. The primary endpoints of the study represent (1) major cardiac events and (2) changes in left-ventricular function 12 months after treatment. Secondary endpoints include 6-min Walk Test distance, improvement of symptoms and assessment of quality of life.

Discussion

This study aims to investigate the safety and efficacy of cardiac SWT during CABG surgery for myocardial regeneration. The induction of angiogenesis, decrease of fibrotic scar tissue formation and, thus, improvement of left-ventricular function could lead to improved quality of life and prognosis for patients with ischemic heart failure. Thus, it could become the first clinically available treatment strategy for the regeneration of ischemic myocardium alleviating the socio-economic burden of heart failure.

Trial registration

ClinicalTrials.gov, ID: NCT03859466. Registered on 1 March 2019.
Landform type mediates compositional change in a hurricane-disturbed sub-tropical forest
Authors: Spicer Robert L. , Lugo Ariel E. , Ruhl Nathan
Published: May 2020

Background

Categorization of topographical features into landform type is a long-standing method for understanding physiographic patterns in the environment. Differences in forest composition between landform types are driven primarily by concurrent differences in soil composition and moisture, but also disturbance regime. Many studies have focused on the interaction between fire disturbance, succession, and landforms, but the effects of hurricane disturbance on compositional differences between landforms are poorly understood. In the study presented here, we assess compositional and structural differences between landform types in the tree community of a young sub-tropical forest that is frequently subjected to hurricanes. Specifically, we ask whether the tree community (1) changed structurally over the study period, (2) experienced compositional change over the study period, (3) is compositionally different between landform types, and (4) exhibits compositional change mediated by landform type.

Results

The tree community experienced significant structural change over the course of our study, but compositional change was only significant for some landforms.

Conclusion

Despite large-scale, intense, and frequent hurricane disturbance to our study system, compositional change in the tree community was localized and only significant for some landform types.
Structural dimensions depending on light intensity in a 3D printing method that utilizes in situ light as a guide
Authors: Lim Jongkyeong , Lee Sangmin , Kim Joonwon
Published: May 2020

Conventional 3D printing methods require the addition of a supporting layer in order to accurately and reliably fabricate the desired final product. However, the use of supporting material is not economically viable, and during the process of removing the supporting material, the shape or the properties of the final product may be distorted. In our previous work, we proposed and demonstrated the concept of a new 3D printing method that utilizes the in situ light as a guide for the fabrication of freestanding overhanging structures without the need for supporting material. In this study, the influence of the light intensity on the diameter of the structure and the thickness of the layer produced per droplet is analyzed in order to identify the geometric range of structures that can be fabricated by the new 3D printing method. As the intensity of the light increased, the diameter of the structure also increased and the thickness of the layer per droplet decreased. This result is determined by a combination of factors; (1) the rebound motion of the photocurable droplet and (2) the surface area of the structure that needs to be covered.
RIPK2 Dictates Insulin Responses to Tyrosine Kinase Inhibitors in Obese Male Mice
Authors: Duggan Brittany M , Cavallari Joseph F , Foley Kevin P , Barra Nicole G , Schertzer Jonathan D
Published: May 2020

Tyrosine kinase inhibitors (TKIs) used in cancer are also being investigated in diabetes. TKIs can improve blood glucose control in diabetic cancer patients, but the specific kinases that alter blood glucose or insulin are not clear. We sought to define the role of Receptor Interacting Serine/Threonine Kinase 2 (RIPK2) in mouse models of insulin resistance. We tested the TKI gefitinib, which inhibits RIPK2 activity, in wild-type (WT), Nod1–/–, Nod2–/–, and Ripk2–/– mice fed an obesogenic high-fat diet. Gefitinib lowered blood glucose during a glucose tolerance test (GTT) in a nucleotide-binding oligomerization domain (NOD)–RIPK2-independent manner in all obese mice. However, gefitinib lowered glucose-stimulated insulin secretion only in obese Ripk2–/– mice. Gefitinib had no effect on insulin secretion in obese WT, Nod1–/–, or Nod2–/– mice. Hence, genetic deletion of Ripk2 promoted the insulin-sensitizing potential of gefitinib, since this TKI lowered both blood glucose and insulin only in Ripk2–/– mice. Gefitinib did not alter the inflammatory profile of pancreas, adipose, liver, or muscle tissues in obese Ripk2–/– mice compared with obese WT mice. We also tested imatinib, a TKI that does not inhibit RIPK2 activity, in obese WT mice. Imatinib lowered blood glucose during a GTT, consistent with TKIs lowering blood glucose independently of RIPK2. However, imatinib increased glucose-stimulated insulin secretion during the glucose challenge. These data show that multiple TKIs lower blood glucose, where actions of TKIs on RIPK2 dictate divergent insulin responses, independent of tissue inflammation. Our data show that RIPK2 limits the insulin sensitizing effect of gefitinib, whereas imatinib increased insulin secretion.
Energies of Hypergraphs
Authors: Cardoso Kauê , Trevisan Vilmar
Published: May 2020

In this paper, energies associated with hypergraphs are studied. More precisely, results are obtained for the incidence and the singless Laplacian energies of uniform hypergraphs. In particular, bounds for the incidence energy are obtained as functions of well known parameters, such as maximum degree, Zagreb index and spectral radius. It is also related the incidence and signless Laplacian energies of a hypergraph with the adjacency energies of its subdivision graph and line multigraph, respectively. In addition, the signless Laplacian energy for the class of the power hypergraphs is computed.
Short Communication: The most active fraction of red turi flowers (Sesbania grandiflora) on the cytotoxic activity of HepG2 cells
Authors: Sulasmi Sulasmi , OKID P. ASTIRIN  , TETRI WIDIYANI
Published: May 2020

Abstract. Sulasmi, Astirin OP, Widiyanti T. 2020. Short Communication: The most active fraction of red turi flowers (Sesbania grandiflora) on the cytotoxic activity of HepG2 cells. Nusantara Bioscience 12: 68-72. Red turi flowers (Sesbania grandiflora L.Pers) contain many chemical compounds with high bioactivity. One of the chemical compounds is flavonoid compound. Quercetin is a class of flavonoid compound. This compound is obtained by extraction with methanol as a solvent then it is partitioned by water and ethyl acetate as a solvent. The fraction obtained is given phytochemical tests, which is further test using Thin Layer Chromatography (TLC) to detect the quercetin compounds. The level of flavonoid is determined using UV Vis spectrophotometer. Water and ethyl acetate fractions are tested cytotoxically using the MTT method (3-(4,5-dimethyltiazol-2-il)-2,5-diphenyltetrazolium bromide) with ELISA Microplate Reader. This study aims to determine the most active fraction of red turi flowers on the cytotoxic activity of HepG2 cells, which are model cells for liver cancer. The results of water fraction do not contain quercetin compounds, with IC50 value of 961.11µg/mL. The ethyl acetate fraction contains quercetin compounds with total flavonoid equivalent quercetin of 1.76% b/b and IC50 value of 149.15µg/mL. Ethyl acetate fraction is more active than the water fraction with moderate cytotoxicity.
Axial strain applied in-fiber Mach-Zehnder interferometer for acceleration measurement
Authors: Zhang Gang , Wu Xuqiang , Ge Qiang , Li Shili , Zhang Wujun , Shi Jinhui , Gui Lei , Yu Benli
Published: May 2020

We present an axial strain applied in-fiber Mach-Zehnder interferometer (MZI) for acceleration measurement. A thin core fiber is sandwiched between two single-mode fibers with core offset to form the MZI. A controlled high fringe visibility in the transmission spectrum is obtained by applying an axial strain, leading to a large slope at the quadrature point. The MZI is then clamped to work as an accelerometer. Experimental results show that the resolution achieves 86 ng/√Hz (g is gravity of 9.8 m/s2), the dynamic range reaches as large as 104.1 dB and the linearity of acceleration response is as high as 99.994%. Moreover, the resonance frequency can be tailored by the clamped fiber length and applied axial strain. The proposed sensor is attractive for practical applications due to low temperature crosstalk, compact size and high sensitivity.
Subwavelength focusing of a spatio-temporal wave packet with transverse orbital angular momentum
Authors: Chen Jian , Wan Chenhao , Chong Andy , Zhan Qiwen
Published: May 2020

We report the method of producing a spatio-temporal (ST) wave packet carrying pure transverse orbital angular momentum (OAM) with subwavelength spatial sizes. Due to the lack of temporal focusing, an ST wave packet focused by a high numerical aperture (NA) objective lens experiences a “spatio-temporal astigmatism” effect similar to the focusing action of a cylindrical lens on the transverse profile of optical field. Thus an ST vortex with a spiral phase in the ST domain focused through a high NA objective will be distorted and lose the ST characteristic spiral phase pattern. With the understanding of such an ST astigmatism, the ST wave packet can be pre-conditioned such that an ST vortex carrying OAM with subwavelength transverse sizes can be obtained after strong focusing. This is the first revelation that a tightly focused ST vortex beam with transverse OAM can be realized, paving the way for potential applications including microscopy, optical trapping, laser machining, nonlinear light-matter interactions, and so on. The ST astigmatism effect also offers insights for the focusing and propagation studies of other types of ST wave packets.
Photon blockade by enhancing coupling via a nonlinear medium
Authors: Liu Jin-Song , Yang Jun-Ya , Liu Hong-Yu , Zhu Ai-Dong
Published: May 2020

A significantly low value of the single-photon coupling constant is a major challenge in the creation of a single-photon source via photon blockade. Here, we propose a photon blockade scheme composed of a weakly second-order nonlinear medium with an optical parametric amplification in a low-frequency cavity. Unlike the traditional weakly coupled system, the effective coupling strength in the proposed scheme can be significantly higher than the decay rate of the cavity mode. This can be achieved by adjusting the squeezing parameter even if the original coupling strength is weak. The thermal noise of the squeezed cavity mode can be suppressed by a squeezed vacuum field. Using a probability amplitude method, we obtain the optimal condition of photon blockade in the steady-state. By solving the master equation numerically in the steady-state, a strong photon antibunching effect that is consistent with the optimal conditions can be obtained in the cavity with low frequency. Besides, the photon blockade phenomenon and cross-correlation of two cavities can be significantly enhanced under a specific squeezing parameter. Our results may be useful for future studies on the characteristics of photon statistics.
Stable generation of cylindrical vector beams with an all-fiber laser using polarization-maintaining and ring-core fibers
Authors: Yimin Zhang , Tao Runxia , Li Hongxun , Fang Wentan , Dong Zhipeng , Dai Chuansheng , Xu Lixin , Gu Chun , Chen Wei , Zhu Yonggang , Zhan Qiwen , Yao Peijun
Published: May 2020

An all-fiber laser using polarization-maintaining and ring-core fibers that are capable of automatically generating stable TE01 and TM01 modes is proposed and demonstrated experimentally. Two vector-mode coupling long-period fiber gratings (LPFGs) fabricated by a high-frequency CO2 laser are used in the fiber laser to realize efficient coupling between HE11 mode and TE01/TM01 mode. The polarization dependence of the LPFGs is simulated using the coupled-mode theory and verified by experiments. A ring-core fiber is employed to support the stable propagation of TE01 and TM01 modes. By carefully aligning the polarization direction of the input light, the mode coupling ratios of both LPFGs exceed 15 dB. The mode purities of TE01 and TM01 modes are 92.4% and 97.3%, respectively. Owing to the all-polarization-maintaining structure, the laser output is highly stable under environmental disturbance. This laser can be used as a stable cylindrical vector beam source for a wide range of applications, including surface plasmon excitation, optical tweezers, high-resolution metrology and so on.