bluuebunny/crossref_metadata_2025 huggingface dataset:
Spatiotemporal association of low birth weight with Cs-137 deposition at the prefecture level in Japan after the Fukushima nuclear power plant accidents: an analytical-ecologic epidemiological study
Authors: Scherb Hagen , Clinic Japan Hayashi Osaka Keiji Hayashi Children's
Published: June 2020

Background: Perinatal mortality increased in contaminated prefectures after the Fukushima Daichi Nuclear Power Plant (FDNPP) accidents in Japan in 2011. Elevated counts of surgeries for cryptorchidism and congenital heart malformations were observed throughout Japan from 2012 onward. The thyroid cancer detection rate (2011 to 2016) was associated with the dose-rate at the municipality level in the Fukushima prefecture. Since the birth weight is a simple and objective indicator for gestational development and pregnancy outcome, the question arises whether the annual birth weight distribution was distorted in a dose-rate-dependent manner across Japan after Fukushima. Methods: The Japanese Ministry of Health, Labour, and Welfare provides prefecture-specific annual counts for 26.158 million live births from 1995 to 2018, of which 2.366 million births (9.04%) with weights < 2500 g. Prefecture-specific spatiotemporal trends of the low birth weight proportions were analyzed. Logistic regression allowing for level-shifts from 2012 onward was employed to test whether those level-shifts were proportional to the prefecture-specific dose-rates derived from Cs-137 deposition in the 47 Japanese prefectures. Results: The overall trend of the low birth weight prevalence (LBWp) in Japan discloses a jump in 2012 with a jump odds ratio (OR) 1.020, 95%-confidence interval (1.003,1.037), p-value 0.0246. A logistic regression of LBWp on the additional dose-rate after the FDNPP accidents adjusted for prefecture-specific spatiotemporal base-line trends yields an OR per µSv/h of 1.098 (1.058, 1.139), p-value < 0.0001. Further adjusting the logistic regression for the annual population size and physician density of the prefectures, as well as for the counts of the dead, the missing, and the evacuees due to earthquake and tsunami (as surrogate measures for medical infrastructure and stress) yields an OR per µSv/h of 1.109 (1.032, 1.191), p-value 0.0046.Conclusions: This study shows increased low birth weight prevalence related to Cs-137 deposition and the corresponding additional dose-rate in Japan from 2012 onward. Previous evidence suggesting compromised gestational development and pregnancy outcome under elevated environmental ionizing radiation exposure is corroborated.
Strategies for Diagnosis of Fetal right atrium dilation: Based on fetal cardiac anatomy and hemodynamics
Authors: Wang Yu , Zhao Leisheng , Zhang Ying
Published: June 2020

Background: Fetal right atrium (RA) dilation is frequently detected in routine screenings while it remains a challenge to clarify the reasons. This study aimed to analyze the cardiac anatomy and hemodynamics of fetal RA dilation and the changes of hemodynamic indexes. Methods: In the retrospective study, 420 fetuses with RA dilation were included, which were classified into the physiological group (n=202), volume overload group (n=142), and the pressure overload group (n=76). The ratio of right atrium to left atrium (RA/LA) were measured at four-chamber view. Peak velocity of tricuspid regurgitation (VTR) was recorded in each case, if existed. Results: The RA/LA ratio in the volume overload group is significantly higher than both the pressure overload group and the physiological group (both P=0.000) throughout the pregnancy while no difference presents between the pressure overload group and the physiological group (P=0.694 for 19-31 GW, and P=0.974 for 32-36 GW, respectively). The VTR in the pressure overload group (3.29±0.58 m/s) is significantly higher than both the volume overload group (1.85±0.45 m/s, P=0.000) and the physiological group (0.88±0.45 m/s, P=0.000). The volume overload group shows a significantly higher VTR than the physiological group (P=0.000). In the volume overload group, the ductal contraction/closure shows a significantly higher VTR than that in the pulmonary valve stenosis/atresia (3.98±0.41 m/s vs. 3.03±0.38 m/s, P=0.000).Conclusions: A strategy proposed herein is useful to clarify the reasons for RA dilatation by systematically assessing fetal hemodynamics, which may facilitate the sonographers to make an accurate diagnosis of CHD.
Epidemiology and risk factors of infective endocarditis in a tertiary hospital in China from 2007 to 2016
Authors: Wu Zhenzhu , Chen Yi , Xiao Tingting , Niu Tianshui , Shi Qingyi , xiao yonghong
Published: June 2020

Background: To explore the trends in epidemiology and risk factors related to the prognosis of infective endocarditis in a teaching hospital over the past ten years.Methods: A retrospective cohort study was performed. A total of 407 consecutive patients were included. The clinical characteristics and risk factors related to the prognosis of infective endocarditis during this period were analyzed. Results: A total of 407 patients with infective endocarditis were included, the average age was 48 ±16 years old with an increasing trend and in-hospital mortality rate was 10.6% and one-year mortality rate was 12.2%. Among patients with underlying heart disease, congenital heart disease was the most common(25.8%), followed by rheumatic heart disease which showed a decreased trend during this period (P<0.001). There were 222(54.5%) positive blood cultures and Streptococci (24.1%) was the main pathogens with an increasing trend. There were 403 patients (99%) with surgical indications, but only 234 patients (57.5%) received surgical treatment. Hemodialysis (P = 0.041, OR = 4.697, 95% CI 1.068-20.665), pulmonary hypertension (P = 0.001, OR = 5.308, 95% CI 2.034-13.852), Pitt score ≥ 4 (P <0.001, OR = 28.594, 95% CI 5.561-148.173) and vegetation length＞30mm (P = 0.011, OR = 13.754, 95% CI 1.832-103.250) were independent risk factors for in-hospital mortality.Conclusions: There was no significant change in the overall incidence of infective endocarditis, the clinical features of infective endocarditis have changed slightly during the past ten years. Streptococci infective endocarditis was still the predominant. Infective endocarditis patients with hemodialysis, pulmonary hypertension, Pitt score ≥ 4 and vegetation length＞30mm had an worse in-hospital outcome.
Antioxidant preconditioning improves therapeutic outcomes of adipose tissue-derived mesenchymal stem cells through enhancing intrahepatic engraftment efficiency in a mouse liver fibrosis model
Authors: Liao Naishun , Shi Yingjun , Wang Yingchao , Liao Fangyu , Zhao Bixing , Zheng Youshi , Zeng Yongyi , Liu Xiaolong , Liu Jingfeng
Published: June 2020

Background: Although it has been pre-clinically suggested that adipose tissue-derived mesenchymal stem cell (ADSCs)-based therapy could effectively treat chronic liver diseases, the hepatic engraftment of ADSCs is still extremely low, which severely limits their long-term efficacy for chronic liver diseases. This study was designed to investigate the impact of antioxidant preconditioning on hepatic engraftment efficiency and therapeutic outcomes of ADSC transplantation in liver fibrotic mice. Methods: Liver fibrosis model was established by using intraperitoneal injection of carbon tetrachloride (CCl 4 ) in the male C57BL/6 mice. Subsequently, the ADSCs with or without antioxidant pretreatment (including melatonin and reduced glutathione (GSH)) were administrated into fibrotic mice via tail vein injection. Afterwards, the ADSC transplantation efficiency was analyzed by ex vivo imaging, and the liver functions were assessed by biochemical analysis and histopathological examination, respectively. Additionally, a typical hydrogen peroxide (H 2 O 2 )-induced cell injury model was applied to mimic the cell oxidative injury to further investigate the protective effects of antioxidant preconditioning on cell migration, proliferation and apoptosis of ADSCs. Results: Our data showed that antioxidant preconditioning could enhance the therapeutic effects of ADSCs on liver function recovery by reducing the level of AST, ALT and TBIL, as well as the content of hepatic hydroxyproline and fibrotic area in liver tissues. Particularly, we also found that antioxidant preconditioning could enhance hepatic engraftment efficiency of ADSCs in liver fibrosis model through inhibiting oxidative injury. Conclusions: Antioxidant preconditioning could effectively improve therapeutic effects of ADSC transplantation for liver fibrosis through enhancing intrahepatic engraftment efficiency by reducing oxidative injuries. These findings might provide a practical strategy for enhancing ADSC transplantation and therapeutic efficiency.
A hypoxia-related signature for clinically predicting diagnosis, prognosis and immune microenvironment of hepatocellular carcinoma patients.
Authors: Zhang Baohui , Tang Bufu , Gao Jianyao , Li Jiatong , Kong Lingming , Qin Ling
Published: June 2020

Background Hypoxia plays an indispensable role in the development of hepatocellular carcinoma (HCC). However, there are few studies on the application of hypoxia molecules in the prognosis predicting of HCC. We aimed to identify the hypoxia-related genes in HCC and construct reliable models for diagnosis, prognosis and recurrence of HCC patients as well as exploring the potential mechanism. Methods Differentially expressed genes (DEGs) analysis was performed using The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) database and four clusters were determined by a consistent clustering analysis. Three DEGs closely related to overall survival（OS）were identified using Cox regression and LASSO analysis and the hypoxia-related signature was developed and validated in TCGA and International Cancer Genome Consortium (ICGC) database. Then the Gene Set Enrichment Analysis (GSEA) was performed to explore signaling pathways regulated by the signature and the CIBERSORT was used for estimating the fractions of immune cell types. Results A total of 397 hypoxia-related DEGs were detected and three genes (PDSS1, CDCA8 and SLC7A11) were selected to construct a prognosis, recurrence and diagnosis model. Then patients were divided into high- and low-risk groups. Our hypoxia-related signature was significantly associated with worse prognosis and higher recurrence rate. The diagnostic model also accurately distinguished HCC from normal samples and nodules. Furthermore, the hypoxia-related signature could positively regulate immune response and the high-risk group had higher fractions of macrophages, B memory cells and follicle-helper T cells, and exhibited higher expression of immunocheckpoints such as PD1and PDL1. Conclusions Altogether, our study showed that hypoxia-related signature is a potential biomarker for diagnosis, prognosis and recurrence of HCC, and it provided an immunological perspective for developing personalized therapies.
18F-FDG PET and DCE kinetic modeling and their interlinks in primary NSCLC: First-in human simultaneous [18F]FDG PET-MRI voxel-wise correlation analysis
Authors: Besson Florent L , Fernandez Brice , Faure Sylvain , Mercier Olaf , Seferian Andrei , Mignard Xavier , Mussot Sacha , Péchoux Cécile le , Caramella Caroline , Botticella Angela , Levy Antonin , Parent Florence , Bulifon Sophie , Montani David , Mitilian Delphine , Fadel Elie , Planchard David , Besse Benjamin , Ghigna-Bellinzoni Maria-Rosa , Comtat Claude , Lebon Vincent , Durand Emmanuel
Published: June 2020

Objectives: To decipher the interlinks between PET and DCE kinetic parameters in non-small-cell lung cancer (NSCLC), by using voxel-wise analysis of full dynamic simultaneous [18F]FDG PET-MRI. Material and methods: Fourteen treatment-naïve patients with biopsy proven NSCLC prospectively underwent a one-hour dynamic [18F]FDG thoracic PET-MRI scan including DCE. The PET and DCE data were normalized to their corresponding T1-weighted MR morphological space, and tumors were masked semi-automatically. Voxel-wise parametric maps of PET and DCE kinetic parameters were computed by fitting the dynamic PET and DCE tumor data to the Sokoloff and Extended Tofts models respectively, by using in-house developed procedures. Curve fitting errors were assessed by computing the relative root mean square error (rRMSE) of the estimated PET and DCE signals at the voxel level. For each tumor, Spearman correlation coefficients (r s ) between all the pairs of PET and DCE kinetic parameters were estimated on a voxel-wise basis, along with their respective bootstrapped 95% confidence intervals (n = 1000 iterations). Results: Curve fitting metrics provided fit errors under 20% for almost 90% of the PET voxels (median rRMSE,= 10.3, interquartile ranges IQR = 8.1; 14.3), whereas 73.3% of the DCE voxels showed fit errors under 45% (median rRMSE = 31.8%, IQR = 22.4; 46.6). The PET-PET, DCE-DCE and PET-DCE voxel-wise interlinks were heterogeneous, with variations related to individual tumor behaviors. Beyond this wide variability, the PET-PET and DCE-DCE interlinks were mainly high (absolute r s values > 0.7), whereas the PET-DCE interlinks were mainly low to moderate (absolute r s values < 0.7). Half the tumors showed an hypometabolic with low perfused/vascularized profile, a hallmark of hypoxia and tumor aggressiveness. Conclusion: The interlinks between dynamic PET and DCE kinetic parameters assessed simultaneously with [18F]FDG PET-MRI are heterogeneous among NSCLC tumors. In the era of precision medicine, PET-MRI has unique capability to go further insight the individual tumor behavior in NSCLC.
A Comparison Between the Effectiveness of a Gamified Approach with the Conventional Approach in Point-of-care Ultrasonographic Training
Authors: Lai Aaron Kuo Huo , Azhar Abdul Muhaimin Noor , Bustam Aidawati , Tiong Xun Ting , Chan Hiang Chuan , Ahmad Rashidi , Chew Keng Sheng
Published: June 2020

Background: Although gamification increases user engagement, its effectiveness in point-of-care ultrasonographic training has yet to be fully established. This study was conducted with the primary outcome of evaluating its effectiveness in point-of-care ultrasonographic training as compared to conventional approach. Methods: Participants consisting of junior doctors were randomized into either the (1) gamified or the (2) conventional educational approach for ultrasonographic training. Results: A total of 31 junior doctors participated in this study (16 participants in gamified arm, 15 in the conventional arm after one participant from the conventional arm dropped out due to work commitment). Two-way mixed ANOVA test showed that there was no statistically significant interaction between the types of educational approach and time of testing (pre-test, post-test, 2 months post-training) for both theoretical knowledge score and practical skills score, with F(2, 58) = 39.6, p < 0.001, partial η2 = 0.4 and F(2, 58) = 3.06, p = 0.06, partial η2 = 0.095, respectively. For theoretical knowledge score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/- 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/- 0.65, 95% CI 18.94-21.60) were better than the pre-test scores (12.99 +/-0.50, 95% CI 11.97-14.00) with p-values <0.001 for both comparisons respectively. Similarly, for practical skill score, pairwise comparisons showed that the mean 2 months post-training scores (20.28 +/- 0.70, 95% CI 18.87-21.69) and mean post-test scores (20.27 +/- 0.65, 95% CI 18.94-21.60) were also better than the pre-test scores (12.99 +/-0.50, 95% CI 11.97-14.00) with p-values <0.001 for both comparisons respectively. Participants in the gamification arm generally perceived the various game elements and game mechanics as useful in contributing and motivating them to learn ultrasonography.Conclusions: Gamification approach could be an effective alternative or more effective than face-to-face learning in point-of-care ultrasonographic training.
Total alpha-synuclein assay in cerebrospinal fluid is of interest in the differential diagnosis between Alzheimer's disease and dementia with Lewy bodies from the prodromal stage
Authors: BOUSIGES Olivier , Philippi Nathalie , Lavaux Thomas , Perret-Liaudet Armand , Lachmann Ingolf , Schaeffer-Agalède Caroline , Anthony Pierre , Botzung Anne , Rauch Lucie , Jung Barbara , de Sousa Paulo Loureiro , Demuynck Catherine , Martin-Hunyadi Catherine , Cretin Benjamin , Blanc Frédéric
Published: June 2020

Background: Several studies have investigated the value of alpha-synuclein assay in the cerebrospinal fluid (CSF) of Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) patients in the differential diagnosis of these two pathologies. However, very few studies have focused on this assay in AD and DLB patients at the MCI stage.Methods: All patients were enrolled under a hospital clinical research protocol from the tertiary Memory Clinic (CM2R) of Alsace, France, by an experienced team of clinicians. A total of 166 patients were included in this study: 21 control subjects (CS), 51 patients with DLB at the prodromal stage (pro-DLB), 16 patients with DLB at the demented stage (DLB-d), 33 AD patients at the prodromal stage (pro-AD), 32 AD patients at the demented stage (AD-d) and 13 patients with mixed pathology (AD+DLB). CSF levels of total alpha-synuclein were assessed using a commercial enzyme-linked immunosorbent assay (ELISA) for alpha-synuclein (AJ Roboscreen). Alzheimer’s biomarkers (t-Tau, P-Tau, Aβ42 and Aβ40) were also measured.Results: The alpha-synuclein assays showed a significant difference between the AD and DLB groups. Total alpha-synuclein levels were significantly higher in AD patients than in DLB patients. Interestingly, the levels appeared to be altered from the prodromal stage in both AD and DLB. Furthermore, alpha-synuclein levels were elevated not only in AD patients with a typical “Alzheimer” profile (i.e. 2 or 3 pathological biomarkers) but also in AD patients with an atypical “Alzheimer” profile (i.e. one or no pathological biomarkers).Conclusions: The modification of total alpha-synuclein levels in the CSF of patients occurs early, from the prodromal stage. Moreover, alpha-synuclein assay appears to be of particular interest in the differential diagnosis of AD in cases where the Alzheimer biomarkers do not have a typical profile of the disease, i.e. when there is only one or no pathological biomarkers.Trial registration: ClinicalTrials.gov, (AlphaLewyMa, Identifier: NCT01876459)
Optimal Length of R-R Interval Segment Window for Lorenz Plot Detection of Paroxysmal Atrial Fibrillation by Machine Learning
Authors: Kisohara Masaya , Masuda Yuto , Yuda Emi , Ueda Norihiro , Hayano Junichiro
Published: June 2020

Background: Heartbeat interval Lorenz plot (LP) imaging is a promising method for detecting atrial fibrillation (AF) in long-term monitoring, but the optimal segment window length for the LP images is unknown. We examined the performance of AF detection by LP images with different segment window lengths by machine learning with convolutional neural network (CNN). LP images with a 32 x 32-pixel resolution of non-overlapping segments with lengths between 10 and 500 beats were created from R-R intervals of 24-h ECG in 52 patients with chronic AF and 58 non-AF controls as training data and in 53 patients with paroxysmal AF and 52 non-AF controls as test data. For each segment window length, discriminant models were made by 5-fold cross-validation subsets of the training data and its classification performance was examined with the test data.Results: In machine learning with the training data, the averages of cross-validation scores were 0.995 and 0.999 for 10 and 20-beat LP images, respectively, and >0.999 for 50 to 500-beat images. The classification of test data showed good performance for all segment window lengths with an accuracy from 0.970 to 0.988. Positive likelihood ratio for detecting AF segments, however, showed a convex parabolic curve linear relationship to log segment window length and peaked at 85 beats, while negative likelihood ratio showed monotonous increase with increasing segment window length.Conclusions: This study suggests that the optimal segment window length that maximizes the positive likelihood ratio for detecting paroxysmal AF with 32 x 32-pixel LP image is 85 beats.
Diffusion Tensor Imaging Quantifying the Severity of Chronic Hepatitis in Rats
Authors: Huang Mengping , Lu Xin , Wang Xiaofeng , Shu Jian
Published: June 2020

Background: Diffusion tensor imaging (DTI) is mainly used for detecting white matter fiber in the brain. DTI was applied to assess fiber in liver disorders in previous studies. However, the data obtained have been insufficient in determining if DTI can be used to exactly stage chronic hepatitis. This study assessed the value of DTI for staging of liver fibrosis (F), necroinflammatory activity (A) and steatosis (S) with chronic hepatitis in rats. Methods: Seventy male Sprague-Dawley rats were divided into a control group(n=10) and an experimental group(n=60). The rat models of chronic hepatitis were established by abdominal subcutaneous injections of 40% CCl4. All of the rats underwent 3.0T MRI. Regions of interest (ROIs) were subjected to DTI to estimate the MR parameters (rADC value and FA value). Histopathology was used as the reference standard. Multiple linear regression was used to analyze the associations between the MR parameters and pathology. The differences in the MR parameters among the pathological stages were evaluated by MANOVA or ANOVA. The LSD test was used to test for differences between each pair of groups. ROC analysis was also performed. Results: The count of each pathology was as follows: F0(n=15), F1(n=11), F2(n=6), F3(n=9), F4(n=6); A0(n=8), A1(n=16), A2(n=16), A3(n=7); S0(n=10), S1(n=7), S2(n=3), S3(n=11), S4(n=16). The rADC value had a negative correlation with liver fibrosis (r=-0.392, P=0.008) and inflammation (r=-0.359, P=0.015). The FA value had a positive correlation with fibrosis (r=0.409, P=0.005). Significant differences were found in the FA values between F4 and F0~F3 (P=0.03), while no significant differences among F0~F3 were found (P> 0.05). The AUC of the FA value differentiating F4 from F0~F3 was 0.909 (p<0.001) with an 83.3% sensitivity and an 85.4% specificity when the FA value was at the cut-off of 588.089 (×10-6mm2/s).Conclusion: The FA value for DTI can distinguish early cirrhosis from normal, mild and moderate liver fibrosis, but the rADC value lacked the ability to differentiate among the fibrotic grades. Both the FA and rADC values were unable to discriminate the stages of necroinflammatory activity and steatosis.
Knockdown of hspg2 is associated with mandibular jaw joint fusion and neural crest cell dysfunction in zebrafish
Authors: Castellanos Barbara S. , Quintana Anita
Published: June 2020

Background: Heparan sulfate proteoglycan 2 (HSPG2) encodes for perlecan, a large proteoglycan that plays an important role in cartilage formation, cell adhesion, and basement membrane stability. Mutations in HSPG2 have been associated with Schwartz-Jampel syndrome and Dyssegmental Dysplasia Silverman-Handmaker Type, two disorders characterized by skeletal abnormalities. These data indicate a function for HSPG2 in cartilage development/maintenance. However, the mechanisms in which HSPG2 regulates cartilage development are not completely understood. Here, we explored the relationship between this gene and craniofacial development through morpholino-mediated knockdown of hspg2 in zebrafish. Results: Knockdown of hspg2 resulted in a fusion of the mandibular jaw joint at 5 days post fertilization (dpf). We surmised that defects in mandible development were a consequence of neural crest cell (NCC) dysfunction, as these multipotent progenitors produce the cartilage of the head. Early NCC development was normal in morphant animals as measured by distal-less homeobox 2a (dlx2a) and SRY-box transcription factor 10 (sox10) expression at 1 dpf. However, subsequent analysis at later stages of development (4 dpf) revealed a decrease in the number of Sox10 + and Collagen, type II, alpha 1a (Col2a1a)+ cells within the mandibular jaw joint region of morphants relative to random control injected embryos. Concurrently, morphants showed a decreased expression of NK3 homeobox 2 (nkx3.2), a jaw joint molecular marker at 4 dpf. Conclusions: Collectively, these data suggest a complex role for hspg2 in jaw joint formation and late stage NCC differentiation.
Experiences of oral health: before, during and after becoming a regular user of GC Tooth Mousse Plus ®
Authors: Sbaraini Alexandra , Adams Geoffrey G , Reynolds Eric C
Published: June 2020

Background
Clinical trials and laboratory studies from around the world have shown that GC Tooth Mousse Plus® (TMP) is effective in protecting teeth from tooth decay and erosion, buffering dental plaque pH, remineralising white spot lesions and reducing dentine hypersensitivity. However, no other study has assessed the experiences of oral health, before, during and after individuals became regular users of TMP.
Aim
To identify how participants’ oral health status changed after introducing TMP into their oral hygiene routine.
Methods
A qualitative study using Charmaz’s grounded theory methodology was conducted. Fifteen purposively sampled regular users of TMP were interviewed. Transcripts were analysed after each interview. Data analysis consisted of transcript coding, detailed memo writing, and data interpretation.
Results
Participants described their experiences of oral health and disease, before, during and after introducing TMP into their daily oral hygiene routine, together with the historical, biological, financial, psychosocial and habitual dimensions of their experiences. Before becoming a regular user of TMP, participants described themselves as having a “damaged mouth” with “vulnerable teeth, dry mouth and sensitivity”. Various aspects of participants’ histories were relevant, such as, family history and history of oral disease. Having a “damaged mouth” with “vulnerable teeth, dry mouth and sensitivity” was explained by these historical elements. Despite some initial barriers, once being prescribed TMP by a dental professional, a three-fold process of change was initiated: starting a new oral hygiene routine, persevering daily and experiencing reinforcing outcomes. This process led to a fundamental lifestyle change. Participants transitioned from having a “damaged mouth with vulnerable teeth” to having “a comfortable mouth with strong teeth”; at the same time participants felt empowered by this newly found status of being able to “keep their teeth for life”. Barriers and facilitators for incorporating TMP on daily oral hygiene routine were also identified.
Conclusions
Participants valued having “a comfortable mouth” and being able to “keep their teeth for life”. Seeing concrete results in their mouths and experiencing a more “comfortable mouth” boosted adherence to daily applications of TMP, which was maintained overtime.
A Research of self-help ventilator Sharing based on Internet of Things in Hospital
Authors: Xue-Bin Chen , An Zheng , Li Tian-Qing , Duan Jun , Song De-Jing , Lin Yang , Wu Qiao-Ling , Gao Min , Yan Dan
Published: June 2020

Background: To solve the problem of medical equipment sharing in clinical emergency rescue between different units in hospital, especially for ventilator. Methods : In the research a self-help ventilator sharing mode based on Internet of Things is introduced, and six special programs for basic security, quality control, clinical operation, disinfection, cost estimation, and health technology assessment are formulated to support the project. Results : An Internet of Things mobile APP is developed, and the running status and real-time location of ventilators can be got and spare ventilators can be shared by Medical stuff themselves on the APP. The 6 special programs are applied to support the self-service ventilator sharing mode. For trial operations of six months, 15 spare ventilators are taken in the pool of shared equipment, which are shared for 16799 hours by 7 clinical units.Conclusions : The self-service of ventilator sharing mode meets the clinical need for equipment for emergency rescue and improves efficiency, which makes a useful exploration for the innovation management for medical equipment by Internet of Things in hospital.
Preprocedural Ultrasound Guidance for Combined Spinal-Epidural Anesthesia Results in Better Success Rates in Elderly Patients with Hip Fracture: A Randomized Controlled Trial
Authors: Qu Bo , Chen Luying , Zhang Yuling , Jiang Mengting , Wu Caineng , Ma Wuhua , Li Yuhui
Published: June 2020

Background: Combined spinal-epidural (CSE) anesthesia is considerably challenging for elderly patients with hip fractures. This study aimed to investigate the ability of a modified preprocedural ultrasound-guided technique to improve the success rate and efficacy of CSE anesthesia for elderly patients with hip fractures. Methods: This prospective, single-blind, parallel-group randomized controlled trial included 80 patients (aged ≥ 65 years) who were scheduled for elective hip fracture surgery with CSE anesthesia. Patients were randomly allocated into either the landmark group (n = 40) or the ultrasound group (n = 40). The primary outcome was first-pass success rate. Secondary outcomes included first-attempt success rate; number of needle insertion attempts; number of needle passes; locating, puncture, and total time; level of block; procedural adverse reactions and postoperative complications; and patient satisfaction score. Patients were blinded to group allocation.Results: All patients,40 in each group, completed the study and were included in the final analysis. The first-pass success rates for the landmark and ultrasound groups were 20% and 70%, respectively (P < 0.001). The first-attempt success rates in the landmark and ultrasound groups were 42.5% and 85%, respectively (P < 0.001). The number of needle insertion attempts and passes in the landmark group were 2 (1, 2) and 3 (2, 4), respectively; values of 1 (1, 1) and 1 (1, 2) were documented for the ultrasound group (median [interquartile range], all P < 0.001). The locating time (P < 0.001) and total time (P = 0.001) were longer in the ultrasound group, while puncture time was shorter (P = 0.003). No significant difference was found regarding the incidence of adverse reactions and complications. More patients in the ultrasound group had a satisfaction score of 4–5 (P = 0.007). Subgroup analysis demonstrated benefits for ultrasound in patients with scoliosis.Conclusions: Modified ultrasound-assisted CSE anesthesia increases first-pass and first-attempt success rates, and reduces needle insertion attempts, passes, and puncture time for elderly patients with hip fracture, especially those with scoliosis. This technique improves patient satisfaction and warrants consideration for application in clinical practice.Trial registration: Chinese Clinical Trial Register, ChiCTR1900020819. Registered January 20, 2019, http://www.chictr.org.cn/showprojen.aspx?proj=34634
Necessity of contrast agents to identify the injection site in selective nerve root block
Authors: Ko Sangbong , Song Sukkyoon , Lee Jaejun
Published: June 2020

Study Design:
Control arm of randomized trial
Background

While injecting contrast agents may give patients additional lower extremity radiating pain, additional radiation exposure, or delay in procedure time, care should be taken when they are used in patients with renal disease. Therefore, it is hypothesized that if it is confirmed that the pain caused by the injection needle coincides with the radiating pain that the patient mainly complains of, then the contrast agents may be used less. The purpose of this study is to understand if the identification of lancinating identical pain in the procedure could replace the use of contrast agents.
Methods

This retrospective study included 165 patients who met exclusion criteria from among patients who underwent selective nerve root block (SNRB) for the treatment of radiating lower extremity pain from January 2015 to November 2019. With the identical and lancinating pain confirmed in the same site of the patient, consistent with that of the original symptom, the subjects were divided into two groups: one without contrast injection (Non-Dye (ND) group; 57 patients) and the other with contrast injection (Dye (D) group; 108 patients). The degree of lower extremity radiating pain in the two groups was evaluated using visual analog scale (VAS) before injection, 1, 2, 6, and 12 weeks after injection. Functional outcomes were measured using Oswestry Disability Index (ODI) and Rolland Morris Disability Questionnaire (RMDQ), whereas quality of life was measured using Physical Component Score (PCS) and Mental Component Score (MCS) of Short Form – 36 (SF-36) before injection and 3 months after injection.
Results

There was no statistically significant difference in the lower extremity radiating pain severity in both groups at all times and no statistical difference in the degree of VAS improvement relative to the before-injection VAS value between the two groups at 2 and 6 weeks after injection. At 12 weeks after injection, there was a statistically significant difference, with group ND 4.37 ± 2.81 and group D 3.48 ± 2.43 (p = 0.037), but they were below Minimal Clinically Important Difference (MCID), bearing little clinical implications.
Conclusions

Instead of contrast agent injections that have been used for accurate nerve root identification during SNRB, the method of merely checking if the needle-induced pain under fluoroscopic imaging is consistent with the lower extremity radiating pain that the patient predominantly experiences shows the same effect in the patient’s pain control and functional outcome.
Medial Abrasion Syndrome: A Neglected Cause of Persistent Pain After Knee Arthroplasty
Authors: Lyu Shaw-Ruey , Hsu Chia-Chen , Hung Jung-Pin
Published: June 2020

Background: Persistent postoperative pain (PPOP) has detracted from some otherwise successful knee arthroplasties. This study investigated medial abrasion syndrome (MAS) as a cause of PPOP after knee arthroplasty and presented the technique and outcome of arthroscopic medial release (AMR) procedure to treat such patients. Methods: In a one-year period, the author performed unicompartmental or total knee arthroplasty (the UKA or TKA group) that also eliminated MAS on 196 knees of 150 patients at advanced stages of knee osteoarthritis (OA). During the same year, 16 knees of 16 patients with unknown causes of PPOP after knee arthroplasty were referred to the author for the AMR procedure (the AMR group). Subjective satisfaction, Knee Society Score (KSS), and Knee injury and Osteoarthritis Outcome Score (KOOS) evaluations were used for outcome study.Results: All 166 patients were followed up for more than 3 years (mean: 3.7 years, 3.1-4.2) for outcome study. All knees receiving arthroplasty showed pathologic medial plicae of various severities at the time of arthroplasty. Only 2 patients suffered PPOP: one was a neglected tibial plateau fracture with residual varus deformity after UKA and the other was a late infection after TKA and received revision. The satisfactory rate was 98.8% in the UKA group, 99.1% in the TKA group, and 100% in the AMR group. The Knee Society scores and all subscales of KOOS were statistically improved in all groups.Conclusion: MAS is a cause of pain in patients who have received knee arthroplasty, and MAS should be managed before wound closure to ensure a successful knee arthroplasty. PPOP after knee arthroplasty can be caused by MAS, which can be managed by AMR.
Relative Hyperlactatemia in the Emergency Department: A Retrospective Cohort Study
Authors: Chebl Ralphe Bou , Jamali Sarah , Mikati Nancy , Assaad Reem Al , Daem Karim Abdel , Kattouf Nadim , Safa Rawan , Makki Maha , Tamim Hani , Dagher Gilbert Abou
Published: June 2020

Objective

The clinical interpretation of lactate ≤ 2.00 mmol/L in emergency department (ED) patients is not well characterized. This study aims to determine the optimal cutoff value for lactate within the reference range that predicts in-hospital mortality among ED patients with initial serum lactate levels within the reference range.
Methods

This was a retrospective study of adult patients presenting to a tertiary ED between the dates of January 1, 2014 and June 30, 2019 with an initial serum lactate level less than 2.00 mmol/L. The primary outcome was in-hospital mortality. Youden’s index was utilized to determine the optimal threshold that predicts mortality. Patients above the threshold were labeled as having relative hyperlactatemia. A multivariate logistic regression was performed to determine the association between relative hyperlactatemia and in-hospital mortality. Subgroup analyses were done to further examine the interaction between relative hyperlactatemia and hospital mortality.
Results

During the study period, 1638 patients were included. The mean age was 66.9 ± 18.6 years, 47.1% of the population were female, and the most prevalent comorbidity was hypertension (56.7%). The mean lactate level at presentation was 1.5 ± 0.3 mmol/L. In-hospital mortality was 3.8% in the overall population and 16.2% were admitted to the ICU. A lactate of 1.33 mmol/L was found to be the optimal cutoff that best discriminates between survivors and non-survivors. Relative hyperlactatemia was an independent predictor of in-hospital mortality (OR 1.78 CI1.18-4.03; p 0.02). Finally, Relative hyperlactatemia was associated with increased mortality in patients without hypertension (4.7% versus 1.1%; p 0.008), as well as patients without diabetes or COPD.
Conclusion

The optimal cutoff of initial serum lactate that discriminates between survivors and non-survivors is in the ED 1.33 mmol/L. Relative hyperlactatemia is associated with increased mortality in emergency department patients, and this interaction seems to be more important in healthy patients.
EphA4 regulates Aβ production via BACE1 expression in neurons
Authors: Tamura Kensuke , Chiu Yung-Wen , Shiohara Azusa , Hori Yukiko , Tomita Taisuke
Published: June 2020

BackgroundSeveral lines of evidence suggest that the aggregation and deposition of amyloid-β peptide (Aβ) initiate the pathology of Alzheimer disease (AD). Recently, a genome- wide association study demonstrated that a single-nucleotide polymorphism proximal to the EPHA4 gene, which encodes a receptor tyrosine kinase, is associated with AD risk. However, the molecular mechanism of EphA4 in the pathogenesis of AD, particularly in Aβ production, remains unknown.MethodsTo clarify the molecular regulatory mechanism of EphA4 in detail, we performed several pharmacological and biological experiments both in vitro and in vivo. In addition, we referred to two public RNAseq datasets to confirm the changes in EPHA4 mRNA expression levels in the brains of AD patients.ResultsWe demonstrated that EphA4 is responsible for the regulation of Aβ production. Pharmacological inhibition of EphA4 signaling and knockdown of Epha4 led to increased Aβ levels accompanied by increased expression of β-site APP cleaving enzyme 1 (BACE1), which is an enzyme responsible for Aβ production. On the other hand, EPHA4 overexpression and activation of EphA4 signaling via ephrin ligands decreased Aβ levels. In particular, the sterile-alpha motif domain of EphA4 was necessary for the regulation of Aβ production. Finally, EPHA4 mRNA levels were significantly reduced in the brains of AD patients, and negatively correlated with BACE1 mRNA levels.ConclusionsOur results indicate a novel mechanism of Aβ regulation by EphA4, which is involved in AD pathogenesis.
ATF4 promotes renal tubulointerstitial fibrosis by suppressing autophagy in diabetic nephropathy
Authors: Liang Qiuer , Liu Tianhao , Guo Tingting , Tao Wencong , Chen Xudong , Chen Weihao , Chen Liguo , Xiao Ya
Published: June 2020

Background
Diabetic nephropathy (DN) is the dominant cause of end-stage renal disease which is characterized by extracellular matrix accumulation. The purpose of this study was to investigate the role of activating transcription factor 4 (ATF4) in regulating renal fibrosis and autophagy in DN.
Methods
Streptozotocin (STZ) was administered to heterozygous ATF4 knockout (KO) and wild-type (WT) mice via an intraperitoneal injection to induce DN. NRK-52E cells were cultured in high glucose to mimic diabetic pathological. qRT-PCR, western blot, immunofluorescence, histology and electron microscopic analysis were performed. The autophagy flow was observed by tandem mRFP-GFP-LC3 fluorescence microscopy.
Results
DN mice experienced severe renal injury and fibrosis and showed increased expression of ATF4 and inhibition of autophagy in kidney tissues. STZ-induced ATF4 KO mice showed significant improvement in urinary albumin, serum creatinine and blood urea nitrogen and the pathological changes of renal tubulointerstitial fibrosis compared with STZ-induced WT mice. Furthermore, western blot assays and immunofluorescence staining revealed that inhibition of ATF4 could restore autophagy in DN mice. Overexpression of ATF4 in NRK-52E cells cultured in high glucose condition suppressed autophagy and upregulated Col-IV expression, while inhibition of ATF4 could increase the number of the autophagosomes, improve autophagic flux and decrease Col-IV level.
Conclusion
Our study provided the first evidence of a crucial role for ATF4 in inhibiting autophagy against diabetic kidney damage. Suppression of ATF4 may be an effective therapy in restraining renal tubulointerstitial fibrosis in DN.
Maternal Sevoflurane Exposure Affects Differentiation of Hippocampal Neural Stem Cells by Regulating microRNA-410-3p and ATN1
Authors: ZHANG YI , WU ZIYI , LI XINGYUE , WAN YUXIAO , ZHANG YINONG , ZHAO PING
Published: June 2020

BackgroundCurrently, numerous animal studies have shown that exposure to commonly used general anesthetics during pregnancy may cause neurocognitive impairment in the offspring. Reportedly, exposure to sevoflurane during mid-trimester of pregnancy can inhibit proliferation of neural stem cells (NSCs) and lead to early apoptosis. Whether exposure to sevoflurane during pregnancy affects the differentiation of NSCs remains unclear. MethodsIn the present study, pregnant rats were exposed to 3% sevoflurane once for 2 h on gestational day 14 (G14) or 3 times for 2 h on G13, G14, and G15. Next, the differentiation of NSCs was measured using neuron marker β-tubulin III and astrocyte marker glial fibrillary acidic protein (GFAP) in fetal brain tissues 24 h and 72 h after anesthesia and in hippocampus on postnatal day 28. The same procedures were performed on primary cultured rat NSCs to explore the mechanism. ResultsThe results showed that during mid-trimester, multiple exposure to sevoflurane can cause premature differentiation of NSCs in developing brains of offspring and lead to long-term neuron reduction and astrocyte proliferation in hippocampus. The data from the present study indicated that repeated exposure to sevoflurane downregulated ATN1 expression and caused early differentiation of NSCs. Overexpression of ATN1 via lentivirus transfection attenuated the influence of sevoflurane. Using dual luciferase assay, ATN1 was found to be a target gene of microRNA‐410-3p (miR‐410-3p). MiR-410-3p suppression via lentivirus transfection recovered the ATN1 expression and differentiation of NSCs.ConclusionsThe results from the present study demonstrated that repeated exposure to sevoflurane leads to early differentiation of NSCs and long-term effects via the miR-410-3p/ATN1 pathway.
Sociodemographic profile, clinical characteristics, anxiety, and depression of 74 patients infected with COVID-19: first report from Bangladesh
Authors: Hasan Mohammad Jahid , Khan Md. Abdullah Saeed , Rahman Monjur , Islam Md. Shahnoor , Debnath Sourav , Fardous  , Amin Professor Dr. Mohammad Robed
Published: June 2020

Background: The pandemic of Corona Virus Disease 2019 (COVID-19) has cost a large number of lives and is causing substantial mental stress among people. We conducted a study to identify the sociodemographic and clinical characteristics and prevalence of anxiety and depression among confirmed COVID-19 cases in Bangladesh.Methods: An online cross-sectional survey using a preformed questionnaire adapted in Google form was conducted for data collection. The form was shared along with a brief introduction and rationale via Facebook, Twitter, Facebook Messenger, Viber, and What’s App. Formal ethical clearance was taken from the Biomedical Research Foundation, Bangladesh. Informed consent was ensured before participation.Results: Seventy-four patients with COVID-19 who had an average age of 42.59±14.43 years with male predominance (77%) were included. A total of 29.7% were doing health-care related jobs, and 14.9% lost their jobs due to COVID-19. Patients had a median income of BDT 30000. Of all, 87.8% of patients were symptomatic and presented with fever (77%), cough (58.8%), breathlessness (24.3%), myalgia (24.3%), sore throat (21.6%), fatigue (17.6%), nausea and/or vomiting (12.2%), headache (12.2%), runny nose (9.5%), chest pain (9.5%), diarrhea (8.1%), ARDS (2.7%), stuffy nose (2.7%), conjunctivitis (1.4%) and oral ulcer (1.4%). Overall, the prevalence of anxiety and depression was 60% and 52.9%, respectively. Among the participants, 11.4% had only anxiety, 4.3% had only depression and 48.6% had both.Conclusion: Patients were mostly middle aged, male and healthy workers. Typical presentations were fever and cough. Nearly two-thirds of the patients had either or both anxiety and depression.
The relationship between credit policy and firms’ profitability: empirical evidence from Indian pharmaceutical sector
Authors: H.S. Farhan Najib , I. Tabash Mosab , Yameen Mohammad
Published: June 2020

Credit policy plays a vital role in the operational efficiency of credit departments as it reduces the ambiguity of credit departments’ functions by giving clear guidelines and instructions. It also reduces the loan default and speeds up accounts receivable turnover. This paper seeks to evaluate the effect of credit policy on the profitability of pharmaceutical firms listed on the Bombay Stock Exchange (BSE), using a balanced panel data of 82 pharmaceutical firms from 2008 to 2017. The number of days’ collection period and the number of days’ payable deferral period are chosen for measuring firms’ credit policy, while return on assets (ROA) is used for measuring firms’ profitability. It is found that the number of days’ collection period and the number of days’ payable deferral period have a negative and significant effect on the profitability of the pharmaceutical firms, while the control variables leverage, firm size, and age negatively impact the profitability of pharmaceutical firms. Financial managers in pharmaceutical companies should reduce the number of days’ collection period and increase the number of days’ deferral period to reduce the risk of bad debts. Furthermore, they should conduct a credit analysis to evaluate potential clients as it prevents bad debts.
Влияние структуры PtCuAu-наночастиц на активность в реакции окисления метанола
Authors: Беленов С. В. , Меньщиков В. С. , Невельская А. К. , Резван Д. В.
Published: June 2020

PtCuAu/C-катализаторы с различной структурой получены методом совместного восстановления прекурсоров металлов и методом гальванического замещения. По результатам сравнительного исследования каталитической активности в реакции окисления метанола показано позитивное влияние атомов золота в составе триметаллических наночастиц независимо от способа синтеза. Изучено влияние термической обработки в инертной атмосфере при 300°С на структуру и активность в реакции окисления метанола полученных PtCuAu/C-материалов. Показано снижение площади активной поверхности и активности в реакции окисления метанола после термической обработки, наибольшую устойчивость продемонстрировал материал, полученный методом гальванического замещения. Показана перспективность триметаллических PtCuAu/C-материалов как эффективных катализаторов для использования в метанольных топливных элементах.