bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of β-catenin Association with Obesity in African Americans with Premalignant and Malignant Colorectal Lesions
Authors: Shokrani Babak , Brim Hassan , Hydari Tahmineh , Afsari Ali , Lee Edward , Nouraie Mehdi , Sherif Zaki , Ashktorab Hassan
Published: August 2020

Background: African Americans (AA) are at high risk for Colorectal Cancer (CRC). Studies report a 30-60 % increase in CRC risk with physical inactivity, obesity and metabolic syndrome. Activation of the WNT/ β-catenin (CTNNB1) signaling pathway plays a critical role in colorectal carcinogenesis. Accumulating evidence also indicates a role of WNT-CTNNB1 signaling in obesity and metabolic diseases.Aim: To examine the association between obesity, β-Catenin expression and colonic lesions in African Americans.Methods: We reviewed the pathology records of 152 colorectal specimens from 2010-2012 (46 CRCs, 74 advanced adenoma and 32 normal colon tissues). Tissue Microarrays (TMA) were constructed from these samples. Immunohistochemistry (IHC) for CTNNB1 (β-catenin; clone β-Catenin-1) was performed on the constructed TMAs. The IHC results were evaluated by 2 pathologists and the nuclear intensity staining was scored from 0-4. BMI, sex, age, location of the lesion and other demographic data were obtained.Results: Positive nuclear staining in normal, advanced adenoma and CRC was 0%, 24% and 41%, respectively (P <0.001). CRC was associated with positive status for nuclear CTNNB1 intensity (adjusted OR: 3.40, 95%CI=1.42%-8.15%, P=0.006 for positive nuclear staining) compared to non-CRC samples (Normal or advanced adenoma). Nuclear staining percentage has a good diagnostic ability for CRC (AUC: 0.63, 95%CI=0.55%- 0.71%). Overweight and obese patients (BMI>25) did not show a significant (p=0.3) expression of positive status for nuclear CTNNB1 (17% positive in normal weight vs. 27% positive in overweight/obese). The association between nuclear intensity and CRC was not different between normal and overweight patients (P for interaction = 0.6). The positive nuclear CTNNB1status in CRC stage III and IV (35% of all CRC) was not different from stage I and II (50%. vs. 36%, respectively, P = 0.4).Conclusion: In our study, advanced adenoma and CRC were associated with activation of β-catenin in physically fit, overweight and obese patients. Thus, participation of the obesity and WNT pathway seem to be independent in African American patients. WNT/β-catenin signaling pathway has a potential to be used as an effector in colon carcinogenic transformation. Whether or not BMI is a modifier of this pathway needs to be investigated further.
Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and animal experiment
Authors: Lu Qun , Liu Ping , Huo Jian-Hua , Wang Yan-Ni , Ma Ai-Qun , Yuan Zu-Yi , Du Xiao-Jun , Bai Ling
Published: August 2020

Background. Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice.Methods. Two studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi'an Jiaotong University during 2015.12.~2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death. Results. CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1~14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3-6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure.Conclusion. CR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR.
A new infrared volcano monitoring using GCOM-C (SHIKISAI) satellite: Applications to the Asia-Pacific region
Authors: Kaneko Takayuki , Yasuda Atsushi , Takasaki Kenji , Nakano Shun , Fujii Toshitsugu , Honda Yoshiaki , Kajiwara Kouji , Murakami Hiroshi
Published: August 2020

The GCOM-C (SHIKISAI) satellite was developed to understand the mechanisms of global climate change. The Second-generation Global Imager (SGLI) onboard GCOM-C is an optical sensor observing wavelengths from 380 nm to 12.0 μm in 19 bands. One of the notable features is that the resolution of the 1.63-, 10.8-, and 12.0-µm bands is 250 m, with an observation frequency of 2-3 days. To investigate the effective use and potential of the 250-m resolution of these SGLI bands in the study of eruptive activities, we analyzed four practical cases. As an example of large-scale effusive activity, we studied the 2018 Kilauea eruption. By analyzing the series of 10.8-μm band images using cumulative thermal anomaly maps, we could observe that the lava effused on the lower East Rift Zone, initially flowed down the southern slope to the sea, and then moved eastward. As an example of lava dome growth and generation of associated pyroclastic flows, the activity at Sheveluch between December 2018 and December 2019 was analyzed. The 1.63- and 10.8-µm bands were shown to be suitable for observing growth of the lava dome and occurrence of pyroclastic flows, respectively. We found that the pyroclastic flows occurred during periods of rapid lava dome expansion. For the study of an active crater lake, the activity of Ijen during 2019 was analyzed. The lake temperature was found to rise rapidly in mid-May and reach 38 °C in mid-June. We also analyzed the intermittent activities of small-scale Vulcanian eruptions at Sakurajima in 2019. The 1.63-µm band was useful for detecting activities that are associated with Vulcanian eruptions. Analytical results for these case studies demonstrated that the GCOM-C SGLI images are beneficial for observing various aspects of volcanic activity, and their real-time use may contribute to reducing eruption-related disasters.
Short-course Benznidazole Treatment to Reduce Trypanosoma cruzi Parasitic Load in Women of Reproductive Age (BETTY): A Non-inferiority Randomized Controlled Trial Study Protocol
Authors: Cafferata María Luisa , Toscani María Ayelen , Althabe Fernando , Belizan Jose M. , Bergel Eduardo , Berrueta Mabel , Capparelli Edmund V. , Ciganda Álvaro , Danesi Emmaria , Dumonteil Eric , Gibbons Luz , Gulayin Pablo E. , Herrera Claudia , Momper Jeremiah D. , Rossi Steven , Shaffer Jeffrey G. , Schijman Alejandro G. , Estani Sergio Sosa , Stella Candela B. , Klein Karen , Buekens Pierre
Published: August 2020

Background Retrospective observational studies suggest that transmission of Trypanosoma cruzi does not occur in treated women when pregnant later in life. The level of parasitemia is a known risk factor for congenital transmission. Benznidazole (BZN) is the drug of choice for preconceptional treatment to reduce parasitic load. The fear of treatment-related side effects limits the implementation of the Argentine guideline recommending BZN 60d/300mg (or equivalent) treatment of T. cruzi seropositive women during the postpartum period to prevent transmission in a future pregnancy. A short and low dose BZN treatment might reduce major side effects and increase compliance, but its efficacy to reduce T. cruzi parasitic load compared to the standard 60d/300mg course is not yet established. Clinical trials testing alternative BZN courses among women of reproductive age are urgently needed.Methods and design We are proposing to perform a double-blinded, non-inferiority randomized controlled trial comparing a short low dose 30-day treatment with BZN 150mg/day (30d/150mg) vs. BZN 60d/300mg. We will recruit not previously treated T. cruzi seropositive women with a live birth during the postpartum period in Argentina, randomize them at six months postpartum, and follow them up with the following specific aims:Specific aim 1: to measure the effect of BZN 30d/150mg compared to 60d/300mg preconceptional treatment on parasitic load measured by the frequency of positive Polymerase Chain Reaction (PCR) (primary outcome) and by real-time quantitative PCR (qPCR), immediately and 10 months after treatment.Specific aim 2: to measure the frequency of serious adverse events and/or any adverse event leading to treatment interruption.Trial registration: ClinicalTrials.gov. Identifier: NCT03672487. Registered 14 September 2018, https://clinicaltrials.gov/ct2/show/NCT03672487?recrs=a&cond=Chagas+Disease&cntry=AR&draw=2&rank=3
Bladder perforation during transurethral resection of bladder tumour is not a result of deficient structure of the bladder wall
Authors: Poletajew Sławomir , Ilczuk Tomasz , Krajewski Wojciech , Niemczyk Grzegorz , Cyran Agata , Białek Łukasz , Radziszewski Piotr , Górnicka Barbara , Kryst Piotr
Published: August 2020

Background

Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are not fully understood. The aim of this study was to determine if bladder wall structure affects the risk of bladder perforation during TUR.

Methods

Fifteen patients who underwent TUR complicated by a bladder perforation (group 1) and fifteen matched controls who underwent uncomplicated TUR (group 2) were retrospectively enrolled into this morphological analysis. Surgical specimens were collected from all participating patients to describe the quality and architecture of urothelium and bladder submucosa. Immunohistochemical studies were performed with primary mouse anti-human E-cadherin, beta-catenin, type IV collagen, cytokeratin 20 and epithelial membrane antigen antibodies. The intensity of the immunohistochemical reaction was assessed using an immunoreactive score (IRS). Ultrastructural examinations were performed by transmission electron microscopy. The microscopic assessment was focused on the intensity of fibrosis in bladder submucosa and the presence of degenerative changes in the urothelium.

Results

Patients’ age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. Immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From clinical point of view, ultrastructural analysis by electron microscopy showed higher rate of severe fibrosis in group 1 (63.6% vs. 38.5%), with no differences in the rate and degree of urothelial changes. However, these differences were not statistically significant (p=0.32).

Conclusions

Bladder perforation during TUR is not a result of deficient structure of the bladder wall. Based on available evidence, surgical technique seems to play the most important role in its prevention.
­­­Characterization of integrated prophages within diverse species of clinical nontuberculous mycobacteria
Authors: Glickman Cody , Kammlade Sara M. , Hasan Nabeeh A. , Epperson L. Elaine , Davidson Rebecca M. , Strong Michael
Published: August 2020

Background
Nontuberculous mycobacterial (NTM) infections are increasing in prevalence, with current estimates suggesting that over 100,000 people in the United States are affected each year. It is unclear how certain species of mycobacteria transition from environmental bacteria to clinical pathogens, or what genetic elements influence the differences in virulence among strains of the same species. A potential mechanism of genetic evolution and diversity within mycobacteria is the presence of integrated viruses called prophages in the host genome. Prophages may act as carriers of bacterial genes, with the potential of altering bacterial fitness through horizontal gene transfer. In this study, we quantify the frequency and composition of prophages within mycobacteria isolated from clinical samples and compare them against the composition of PhagesDB, an environmental mycobacteriophage database.

Methods
Prophages were predicted by agreement between two discovery tools, VirSorter and Phaster, and the frequencies of integrated prophages were compared by growth rate. Prophages were assigned to PhagesDB lettered clusters. Bacterial virulence gene frequency was calculated using a combination of the Virulence Factor Database (VFDB) and the Pathosystems Resource Integration Center virulence database (Patric-VF) within the gene annotation software Prokka. CRISPR elements were discovered using CRT. ARAGORN was used to quantify tRNAs.

Results
Rapidly growing mycobacteria (RGM) were more likely to contain prophage than slowly growing mycobacteria (SGM). CRISPR elements were not associated with prophage abundance in mycobacteria. The abundance of tRNAs was enriched in SGM compared to RGM.
We compared the abundance of bacterial virulence genes within prophage genomes from clinical isolates to mycobacteriophages from PhagesDB. Our data suggests that prophages from clinical mycobacteria are enriched for bacterial virulence genes relative to environmental mycobacteriophage from PhagesDB.

Conclusion
Prophages are present in clinical NTM isolates. Prophages are more likely to be present in RGM compared to SGM genomes. The mechanism and selective advantage of this enrichment by growth rate remain unclear. In addition, the frequency of bacterial virulence genes in prophages from clinical NTM is enriched relative to the PhagesDB environmental proxy. This suggests prophages may act as a reservoir of genetic elements bacteria could use to thrive within a clinical environment.
Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography
Authors: liu yu , zhang ning , he yanni , shi jiayao , zhou meijun , xu jingjiao , Liu Hongmei
Published: August 2020

Background: Four-dimensional hysterosalpingo-contrast sonography (4D-HyCoSy) is the preferred way for evaluating fallopian tubal patency and it associated with higher rate of spontaneous conception. However, Few studies have evaluated the influencing factors of spontaneous conception in 4D-HyCoSy and suggested ways to choose treatment options after 4D-HyCoSy. The study was to evaluate the correlation between spontaneous conception outcome and the patients’ clinical characteristics as well as tubal patency in infertile women to provide reference on ways to manage the patient after 4D-HyCoSy.Methods: This was a retrospective study and analysis of two hundred and eighty three (283) infertile patients who underwent a 4D-HyCoSy between December 2014 and October 2017 in our center. Eligible patients were those whose partners semen parameters were normal when based on World Health Organization(WHO) criteria, and had spontaneous conception without clinical interventions after 4D-HyCoSy.Result(s): One hundred and sixteen patients (40.9%) conceived spontaneously and the mean conception time was (8.8 ± 0.3) months. Within a year after 4D-HyCoSy, the spontaneous conception rate was highest in type VI(62.5%), followed by type IV (46.2%), type III (44.4%), type V (39.4%), type II (33.9%) and type I (14.8%). With Cox regression analysis, two factors associated with spontaneous conception outcome appeared to increase spontaneous conception rate: patients with type IV or type VI tubes and duration of infertility less than 2 years. The age, type of infertility, multiparas, history of pelvic surgery, history of uterine cavity operation, uterine fibromyomata and polycystic ovary were unrelated to spontaneous conception outcome after 4D-HyCoSy.Conclusion(s): This study showed that some infertile women could succeed in spontaneous conception after 4D-HyCoSy. Hence, We recommend the usage of 4D-HyCoSy as first line for tubal patency test and infertile patients should be advised to accept 4D-HyCoSy examination as soon as possible. Expectant treatment of about 8-9 months is reported to be feasible for infertile women whose 4D-HyCoSy findings showed one tube patency or poor patency. Alternatively, an immediate clinical intervention is recommended for those with bilateral obstructed tubes .
Specific shifts in the endocannabinoid system in hibernating brown bears
Authors: Boyer Christian , Cussonneau Laura , Brun Charlotte , Deval Christiane , de Barros Jean-Paul Pais , Chanon Stéphanie , Bernoud-Hubac Nathalie , Daira Patricia , Evans Alina L. , Arnemo Jon M. , Swenson Jon E. , Gauquelin-Koch Guillemette , Simon Chantal , Blanc Stéphane , Combaret Lydie , Bertile Fabrice , Lefai Etienne
Published: August 2020

In small hibernators, global downregulation of the endocannabinoid system (ECS), which is involved in modulating neuronal signaling, feeding behavior, energy metabolism, and circannual rhythms, has been reported to possibly drive physiological adaptation to the hibernating state. In hibernating brown bears (Ursus arctos), we hypothesized that beyond an overall suppression of the ECS, seasonal shift in endocannabinoids compounds could be linked to bear’s peculiar features that include hibernation without arousal episodes and capacity to react to external disturbance. We explored circulating lipids in serum and the ECS in plasma and metabolically active tissues in free-ranging subadult Scandinavian brown bears when both active and hibernating. In winter bear serum, in addition to a 2-fold increase in total fatty acid concentration, we found significant changes in relative proportions of circulating fatty acids, such as a 2-fold increase in docosahexaenoic acid C22:6 n-3 and a decrease in arachidonic acid C20:4 n-6. In adipose and muscle tissues of hibernating bears, we found significant lower concentrations of 2-arachidonoylglycerol (2-AG), a major ligand of cannabinoid receptors 1 (CB1) and 2 (CB2). Lower mRNA level for genes encoding CB1 and CB2 were also found in winter muscle and adipose tissue, respectively. The observed reduction in ECS tone may promote fatty acid mobilization from body fat stores, and favor carbohydrate metabolism in skeletal muscle of hibernating bears. Additionally, high circulating level of the endocannabinoid-like compound N-oleoylethanolamide (OEA) in winter could favor lipolysis and fatty acid oxidation in peripheral tissues. We also speculated on a role of OEA in the conservation of an anorexigenic signal and in the maintenance of torpor during hibernation, while sustaining the capacity of bears to sense stimuli from the environment.
Measurement of Sustainment of Prevention Programs and Initiatives: The Sustainment Measurement System Scale
Authors: Palinkas Lawrence A. , Chou Chih-Ping , Spear Suzanne E. , Mendon Sapna J. , Villamar Juan A. , Brown C. Hendricks
Published: August 2020

Background: Enhancing the sustainability of evidence-based prevention programs for mental and behavioral health requires tools for measuring both sustainability determinants and sustainment outcomes. The aim of this study was to develop the Sustainment Measurement System Scale (SMSS) and to assess its reliability and construct validity for measuring both determinants and outcomes of efforts to sustain prevention programs and initiatives. Methods: A 42-item scale comprised of items identified from qualitative data collected from 45 representatives of 10 programs and 8 SAMHSA program officers was administered to 186 representatives of 145 programs funded by 7 SAMHSA prevention grant initiatives. Cronbach’s alphas were used to determine inter-item reliability. Convergent validity was assessed by comparisons of a global measure of sustainment with current SAMHSA-funding status and continued operation in the same form. Discriminant validity was assessed by comparisons of sustainability determinants with whether or not the program had undergone adaptations. Results: Confirmatory Factor Analysis provided support for a 35-item model fit to the data. Cronbach’s alpha was .84 for the sustainment outcome construct and ranged from .70 to .93 for the sustainability determinants constructs. All of the determinant constructs were significantly associated with sustainment outcome individual and global measures for the entire sample (p < 0.01 to 0.001) and for community-based programs and programs with a substance abuse focus (p < 0.05 to 0.001). Convergent validity was supported by significant associations between the global sustainment measure and current SAMHSA funding status and continued operation in the same form (p < 0.001). Four of the sustainability determinant constructs (responsive to community needs; coalitions, partnerships and networks; organizational staff capability; and evaluation, feedback and program outcomes) were also significantly associated with current SAMHSA funding status (p < 0.5 to 0.01). With the exception of organizational staff capability, all sustainability determinants were unrelated to program adaptation as predicted. Conclusions: The SMSS demonstrated good reliability and convergent and discriminant validity in assessing likelihood of sustainment of SAMHSA funded prevention programs and initiatives. The measure demonstrates potential in identifying predictors of program sustainment and as a tool for enhancing the likelihood of successful sustainment through ongoing evaluation and feedback.
Coeruptive and posteruptive crustal deformation associated with the 2018 Kusatsu-Shirane phreatic eruption based on PALSAR-2 time-series analysis
Authors: Himematsu Yuji , Ozawa Taku , Aoki Yosuke
Published: August 2020

Coeruptive deformation helps to interpret physical processes associated with volcanic eruptions. Because phreatic eruptions cause small, localized coeruptive deformation, we sometimes fail to identify plausible deformation signals. Satellite synthetic aperture radar (SAR) data allow us to identify extensive deformation fields with high spatial resolutions. Herein, we report coeruptive crustal deformation associated with the 2018 Kusatsu-Shirane phreatic eruption detected by time series analyses of L-band satellite SAR (ALOS-2/PALSAR-2) data. Cumulative deformation maps derived from SAR time series analyses show that subsidence and eastward displacement dominate the southwestern side of an eruptive crater with a spatial extent of approximately 2 km in diameter. Although we were unable to identify any significant deformation signals before the 2018 eruption, posteruptive deformation on the southwestern side of the crater has been ongoing until the end of 2019. This prolonged deformation implies the progression of posteruptive physical processes within a confined hydrothermal system, such as volcanic fluid discharge, similar to the processes observed during the 2014 Ontake eruption. Although accumulated snow and dense vegetation hinder the detection of deformation signals on Kusatsu-Shirane volcano using conventional InSAR data, L-band SAR with various temporal baselines allowed us to successfully extract both coeruptive and posteruptive deformation signals. The extracted cumulative deformation is well explained by a combination of normal faulting with a left-lateral slip component along a southwest-dipping fault plane and an isotropic deflation. Based on the geological background in which the shallow hydrothermal system develops across Kusatsu-Shirane volcano, the inferred dislocation plane can be considered as a degassing pathway from the shallow hydrothermal system to the surface due to the phreatic eruption. We reconfirmed that SAR data is a robust tool for detecting coeruptive and posteruptive deformations, which are helpful for understanding shallow physical processes associated with phreatic eruptions at active volcanoes.
Acute Bone Damage Through Liver-bone Axis Induced by Thioacetamide in Rats
Authors: Li Yang , Li Jianghua , Cheng Linyan , Yao Yetao , Shen Hao , Wang Bili , Ren Jun , Ying Hang , Xu Jian
Published: August 2020

Background: Thioacetamide（TAA）is used in various fields, such as synthetic drugs, organic chemical synthesis, and materials chemistry. In the medical field, TAA is mainly used to establish animal liver injury models and other organ damage models to explore their mechanisms for helping patients with liver disease, however, TAA caused bone damage is barely understood. Therefore, the aim of our study consisted in building a rat model reflecting the TAA-treated caused acute bone damage. Results: Serum samples collected from 5-times TAA-treated rats and were used in biochemical test, we found the level of aspartate aminotransferase (AST), alanine aminotransferase (ALT), uric acid (UA), total bile acid (TBA), alkaline phosphatase (ALP), carbamide (UREA) and creatinine (CREA) exhibited sharply rise, while the level of serum content of total protein (TP), lactate dehydrogenase (LDH), calcium (Ca) and phosphorus (P) were severely reduced. At the same time, we obtained some data about cortical bone and trabecular bone by Micro-CT analysis, it revealed significantly decreased bone surface, tissue surface, bone volume, tissue volume in TAA-treated rats, moreover, we used a static biomechanical test system to test the femoral force range of the hind limbs of SD rats, we found bone can resist less pressure and it is easy to take fracture. Conclusions: Summarizing, our rat model presents possible mediators of liver damage, liver damage and changes in bone structure and mineralization are already visible by Micro-CT analysis after five-times of TAA treatment. The fast response and easy building possibly make it an ideal model to investigate bone metabolism in liver damage after they were affected by TAA.
The strategies of perioperative management in orthopedic department during the pandemic of COVID-19
Authors: Zeng Hui , Li Guoqing , Weng Jian , Xiong Ao , Xu Chang , Yang Yifei , Wang Deli
Published: August 2020

Background: Coronavirus disease 2019 (COVID-19) broken out and spread rapidly nationwide at the beginning of 2020, which has brought huge impacts to people and work. The current situation of prevention and control is severe and urgent guidance for clinicians, especially for the medical systems. In the hope of providing a reference and recommendation for the prevention and control of the COVID-19, we carried out research to improve the quality of patients care and prevention during this epidemic.Methods: All of the involved health care personnel were rapidly trained to use personal protection equipment in our department. The managements of the surgery patients and association of two periods were described and analyzed. We reviewed and compared the patients’ discharged records in our database who underwent surgery in the Department of Bone & Joint Surgery at Peking University Shenzhen Hospital, who were discharged between January 1st to March 1st in 2019 and January 1st to March 1st in 2020. Both chi-squared test and Student’s t-test were performed to determine the relationship between the two periods.Results: Analysis revealed that gender, class and duration of surgery, and anaesthetization had no significantly differences between two periods (p＞0.05). However, age and blood loss had significant relationship of the two periods (p＜0.05).Conclusions: The results of the study imply that we have been benefited from the strict flow charts in management of perioperative for orthopedic patients, which could be a valid tool in routine clinical practice and a consultation for clinicians during pandemic of the COVID-19.
Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study
Authors: Feng Wan-Li , Yang Jun-Song , Wei Dongmei , Gong Han-Lin , Xi Yong , Lv Hui-Qiang , Wang Xin-Gang , Xia Bin , Wei Jian-Min
Published: August 2020

Background

During the process of shearing the ligamentum ﬂavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, GA is recommended and well accepted by most surgeons when performing PELD via the interlaminar approach. The aim of our study was to explore the efficacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient LA in patients with L5/S1 disc herniation.

Methods

This retrospective study was conducted between December 2017 and June 2018. The study included 50 consecutive patients who met the study criteria, had single-level L5/S1 disc herniation, and underwent PELD via the interlaminar approach under gradient LA. Different concentrations of LAC were injected into different tissues inside and outside the ligamentum flavum to complete gradient LA. The evaluation criteria included the intraoperative satisfaction score, VAS score, ODI, complications and adverse reactions.

Results

The intraoperative satisfaction score was consistently over 7, with an average score of 9.3±0.7, indicating that LAC can achieve satisfactory pain control throughout the PELD operation without additional anesthesia. The postoperative VAS score and ODI were dramatically improved at each follow-up interval (P < 0.001, respectively). There was no serious complication such as dural rupture caused by puncture, dural laceration caused by manipulation under endoscopy, total spinal anesthesia, iatrogenic nerve root injury, epidural hematoma, infections or local anesthetic-related adverse reactions. Three patients experienced transient postoperative dysesthesia of the lower limbs that gradually recovered within 24 hours.

Conclusions

Gradient local anesthesia can satisfactorily and safely control intraoperative pain during the PELD via the interlaminar approach. It can not only improve intraoperative satisfaction, but also reduce local anesthesia-related adverse reactions and surgery-related complications.
A Network Pharmacology-Based Study on Active Ingredients of Corydalis Rhizoma on Coronary Heart Disease
Authors: Li Ying , Wei Guhang , Zhuang Zhenkun , Chen Mingtai , Lin Haidan , Li Meihuan , Wu Yanhui , Yuan Changjian , Chen Hongyu , Zhang Zhong , Cheng Hong
Published: August 2020

Background. Corydalis Rhizoma(CR) showed a high efficacy for coronary heart disease (CHD). However, the interaction between the active ingredients of CR and the targets of CHD has not been unequivocally explained in previous researches. To study the active components and potential targets of Corydalis Rhizoma and to determine the mechanism underlying the exact effect of Corydalis Rhizoma on coronary heart disease, a method of network pharmacology was used. Materials and Methods. The active components of CR and targets corresponding to each component were scanned out from Traditional Chinese medicine systems pharmacology database and analysis platform (TCMSP), and target genes of CHD were searched on GeneCards database and Online Mendelian Inheritance in Man(OMIM) database. The active components and common targets of CR and CHD were used to build the “CR-CHD” network through Cytoscape (version 3.2.1) software as well as protein-protein interaction(PPI) network on String database. Gene Ontology (GO) enrichment and Kyoto Encyclopedia of Genes and Genomes(KEGG) pathway enrichment analysis was executed by clusterProfiler(version 3.8) and DOSE(version 3.6) package on R platform. Results. 49 active ingredients and 394 relevant targets of CR and the 7173 CHD-related genes were retrieved. 40 common genes were selected for subsequent analysis. Crucial biological processes and pathways were obtained and analyzed, including DNA-binding transcription activator activity, RNA polymerase II-specific, RNA polymerase II transcription factor binding, kinase regulator activity, ubiquitin-like protein ligase binding, fluid shear stress and atherosclerosis, TNF signaling pathway, apoptosis, MAPK signaling pathway and PI3K-Akt signaling pathway. Conclusions. Overall, CR could alleviate CHD through the mechanisms predicted by network pharmacology, laying the foundation for future development of new drugs from traditional Chinese medicine on CHD.
Burnout and Depression Among Psychiatry Residents During COVID-19 Pandemic
Authors: Alkhamees Abdulmajeed A. , Assiri Hatem , Alharbi Hatim Yousef , Nasser Abdullah , Alkhamees Mohammad A.
Published: August 2020

Very few studies have assessed the impact of an infectious outbreak on burnout among health care workers, especially non-frontline health care workers, such as psychiatrists. The role of psychiatrists and other mental health providers in such instances as a source of psychological support to the public and frontline workers is indispensable and valuable. This study aims to assess the prevalence of burnout and depression, and their correlation, during the COVID-19 pandemic among psychiatry residents in Saudi Arabia. A total of 121 out of 150 psychiatry residents in Saudi Arabia completed the Maslach Burnout Inventory and Patient’s Health Questionnaire for the assessment of burnout and depression. Around 27.3% reported having burnout and depression, with a significant relationship between them. Participants in the first two years of training and having a history of receiving mental health treatment in the past two years were at higher risk. The need is urgent to increase investment in mental health services or risk a massive increase in mental health conditions in the coming months. Hence, the need to construct a plan to reduce this risk of burnout and depression among psychiatrists by developing preventative strategies to prevent burnout and promote wellness is more important than ever.
Efficacy and Safety of Propofol combined with different doses of Remifentanil for gastroscopy: A-randomized controlled trial
Authors: Zhong Chaochao , Qin Yi-bin , Miao Hai-hang , Huang Xin-chong
Published: August 2020

Background Propofol is used to induce sadation or general anesthesia for procedures. Adjuvants, such as remifentanil characterized by a rapid onset of analgesia and a very short duration of action, which was proved to be an effective opioid receptor agonist considering its effective inhibition of autonomic nervous reflex during endoscopy. Meanwhile, it brings respiratory depression and hypoxia in particular, but there is few reports to explore the optimal dose of remifentanil during gastroscopy so far. So we design this randomized controlled trial (RCT) to identify an optimal remifentanil dosage in patients receiving gastroscopy. Methods A total of 200 patients were recruited and randomly assigned to receive one of four doses of remifentanil: 0 (control group), 1.25μg/ml (PR1 group), 2.5μg/ml (PR2 group), 5μg/ml (PR3 group) combined with propofol anesthesia. The primary outcome is the incidence of hypoxia. The secondary outcomes are the dosage of propofol, patients’ awakening time, and perioperative adverse reactions such as hypotension, hypertension, bradycardia, tachycardia, body movements, nausea and vomiting.Results The onset time of PR2 (19 ± 2 s) and PR3(18 ± 4 s) group were shorter than control group (21 ± 3 s). Awaking time in PR2 (1.6 ± 0.4 min) and PR3 (1.7 ± 0.6 min) groups were significantly less than control group (4.1± 1.1min). The dose of propofol in PR2(90 ± 11 mg) and PR3(87±12 mg) groups were also significantly less than control group( 180 ± 20 mg)。The incidence of hypoxia and increase the flow of oxygen and jaw lift in PR2 group were significantly decreased from 38% to 14% and 32% to 10% compared with the control group, respectively (p<0.01).While the incidence of hypoxia in PR3 group was increased to 46%, higher than other groups (p<0.01). Total number of Sedation-related adverse events in PR2 was significantly decreased from 32% to 8% (p=0.03).Conclusions Both 2.5μg/ml (PR2) and 5μg/ml (PR3) remifentanil combined with propofol used in gastroscopy can reduce the onset time、awaking time and the amount of propofol. But the incidence of hypoxia and total number of sedation-related adverse events in PR2 group were significantly decreased compared with other groups. In our study, 2.5μg/ml remifentanil combined with propofol in gastroscopy is an optimal remifentanil dosage.Trial registration: ClinicalTrials.gov, ChiCTR2000029216.
Morphological Neurite Changes Induced by Porcupine Inhibition Are Rescued by Wnt Ligands
Authors: Godoy Juan A. , Espinoza-Caicedo Jasson , Inestrosa Nibaldo C
Published: August 2020

Background: Wnt signaling plays key roles in cellular and physiological processes, including cell proliferation, differentiation and migration during development and tissue homeostasis in adults. This pathway can be defined as Wnt/β-catenin-dependent or β-catenin-independent or "non-canonical", both signaling are involved in neurite and synapse development/maintenance. Porcupine (PORCN), an acylase that o-acylates Wnt ligands, a major modification in secretion and interaction with its receptors. We use Wnt-C59, a specific PORCN inhibitor, to block the secretion of endogenous Wnts in young hippocampal neurons (DIV 4). Under these conditions, the morphology and length of the neurites and the complexity of the dendritic tree and axonal polarity were evaluated. Methods: Cultured primary young hippocampal neurons obtained from Sprague-Dawley rat fetuses (E18), were cultured until day in vitro (DIV) 4 (according to Banker´s protocol) and treated with Wnt-C59 for 24h, Wnt ligands were added to the cultures on DIV 3 for 24h. Dendritic arbors and neurites were analysis by fluorescence microscopy. Transfection with Lipofectamine 2000 on DIV 2 of plasmid expressing eGFP and KIF5-Cherry and neurons were fixed on DIV 4. Immunostaining was performed with MAP1B and Tau protein. Immunoblot analysis was carried out with Wnt3a, b-catenin and GSK-3b (p-Ser9). Quantitative analysis of dendrite morphology was carried out with ImageJ (NIH) software with Neuron J Plugin.Results: We report, here, that Wnt-C59 treatment changed the morphology of the dendritic arbors and neurites of young hippocampal neurons, with decreases -catenin and Wnt3a and an increase in GSK-3 (p-Ser9) levels No effect was observed on axonal polarity. In sister cultures, addition of exogenous Wnt3a, 5a and 7a ligands rescued the changes in neuronal morphology. Wnt3a restored the length of neurites to near that of the control, but Wnt7a increased the neurite length beyond that of the control. Wnt5a also restored the length of neurites relative Wnt concentrations. Conclusions: Our results indicated that all 3 Wnt ligands restored dendritic arbor complexity with recovery of secondary and tertiary projections in young hippocampal neurons. We proposed that PORCN is an emerging molecular target of interest in the search for preclinical options to study and treat neurological diseases.
Pulmonary Benign Metastasizing Leiomyomas: a Case Series of 23 Patients at a Single Facility
Authors: Fan Rong , Feng Fengzhi , Yang Hua , Xu Kaifeng , Li Shanqing , You Yan , Wan Xirun , Zhu Lan
Published: August 2020

Background: Pulmonary benign metastasizing leiomyoma (PBML) is a rare disease characterized by leiomyoma of benign histopathology existing in the lungs. Because of its rarity, limited literature with a single case or small number of cases has been regarding to the clinical course, pathology or management of PBML. Methods: A retrospective study was performed of all PBML cases diagnosed and managed at Peking Union Medical College Hospital (PUMCH) from 2001 to 2019. The clinical characteristics, pathology, treatment and outcomes of each case were studied. Results: There were 25 PBML patients identified in the 19-year period in PUMCH, and 23 patients’ data was analyzed. The median age at diagnosis was 46 years. There were 7 patients (30.4%) diagnosed with postmenopausal status. 2 patients (8.7%) had no uterine leiomyoma, and 3 patients (13.0%) had no gynecologic surgery history. Immunohistochemistry of most lesions demonstrated positive for desmin, SMA and Estrogen/Progesterone Receptors; and negative for S-100 were shown in 7 cases. After curative or diagnostic surgeries for the PBML, several treatments from observation to medical or surgical castration were performed. 9 premenopausal patients preserved their ovaries at first. At a median follow-up of 8 years, 3 patients finally had oophorectomy.Conclusions: PBML is a disease that not only be found in premenopausal women. Treatment should be individualized. Curative surgery for patients with limited lesions can achieve the complete response. For patients that are young and asymptomatic, close observation is recommended as the first choice. All patients should undergo long-term surveillance.
Association between polypharmacy and the persistence of delirium: a retrospective cohort study
Authors: Kurisu Ken , Miyabe Daisuke , Furukawa Yoshiko , Shibayama Osamu , Yoshiuchi Kazuhiro
Published: August 2020

Background: Although the association between polypharmacy and the occurrence of delirium has been well studied, the influence of polypharmacy on the persistence of delirium remains unclear. We aimed to explore the effect of polypharmacy on the persistence of delirium.Methods: This retrospective cohort study was conducted at a tertiary hospital. The medical records of patients diagnosed with delirium who were referred to the Department of Psychosomatic Medicine were reviewed. Presentation with delirium on day 3 was set as the outcome in this study. We counted the number of drugs prescribed on the date of referral, excluding general infusion fluids, nutritional or electrolytic products, and psychotropics. To define polypharmacy, we developed a classification and regression tree (CART) model and drew a receiver operating characteristic (ROC) curve. The odds ratio (OR) of polypharmacy for the persistence of delirium on day 3 was calculated using a logistic regression model with the propensity score as a covariate.Results: We reviewed the data of 113 patients. The CART model and ROC curve indicated an optimal polypharmacy cutoff of six drugs. Polypharmacy was significantly associated with the persistence of delirium both before [OR, 3.02; 95% confidence interval (CI), 1.39–6.81; P = 0.0062] and after (OR, 3.19; 95% CI, 1.32–8.03; P = 0.011) propensity score adjustment.Conclusion: We discovered an association between polypharmacy and worsening courses of delirium and suggest that polypharmacy is a prognostic factor for delirium.
Medical Students' Perception Towards E-learning During COVID 19 Pandemic in a high Burden Developing Country
Authors: AWADALLA MOHAMED DAFFALLA , MOHAMED MOHAMED Soud , Ibrahim Omaima , Elhassan Moawia , MOHAMMED MOHAMMED
Published: August 2020

Background: In High-income countries, many academic institutions are using e-learning during COVID 19 Pandemic. However, in limited resource countries, like Sudan, shifting towards E-learning require many adjustments to be made in order to make sure the e-learning is held in a proper manner, as best as possible. This study was undertaken to assess medical students’ perception towards implementing E-learning during COVID 19 Pandemic and to highlight difficulties of E-learning implementation in a limited-resource setting. Methods: A cross-sectional descriptive study was conducted between 10 to 25 May 2020 among the undergraduate medical students at the Faculty of medicine, University of Gezira, Sudan. A predesigned online-based questionnaire was used for data collection. Results: The total numbers of 358 medical undergraduate students responded to the survey and completely fill the electronic questionnaire. The majority (87.7%) of student agreed that, the closure of university is an essential decision to control spread of the COVID-19 infection. Approximately two-third (64%) of student perceived that E-learning is the best solution during COVID 19 lockdown. Level of student in the university and residence has strong relation to students’ opinion regards start the online education. Internet bandwidth and connectivity limitation, Unfamiliarity with E-learning system, Technical support limitation and time flexibility in case of technical problems during online exams and Lack of face-to-face interaction were the factors considered by medical students to be against the E-learning implementation.Conclusion: Majority of medical students had a positive perception towards E-learning. However, there are many challenges considered as inhibitory factor for utilizing electronic technologies for medical education. We recommend that challenges of E-learning in our setting should be systematically evaluated and that effective strategies should be developed to overcome their inhibitory effects.
Clinical Efficacy of Short-Term Pre-Operative Halo-Pelvic Traction in the Treatment of Severe Spinal Deformities Complicated With Respiratory Dysfunction
Authors: Qi Longtao , Xu Beiyu , Li Chunde , Wang Yu
Published: August 2020

Background Halo traction has been used as an adjunctive method in the treatment of severe spinal deformities. But there are few reports on the clinical efficacy of halo-pelvic traction (HPT) in the treatment of severe spinal deformities complicated with respiratory dysfunction. This study was to evaluate the clinical efficacy and complications associated with pre-operative HPT in the treatment of severe spinal deformities with respiratory dysfunction.Methods Thirty patients with severe spinal deformities complicated with respiratory dysfunction treated with short-term pre-operative HPT were retrospectively reviewed. Inclusion criteria were: (1) patients with severe kyphoscoliosis (coronal Cobb angle or kyphosis angle ≥100°) and respiratory failure, (2) patients undergoing HPT until posterior fusion surgery. All patients underwent general anesthesia for HPT application, which the pelvic ring used in this study was a half-ring, and the rods were all placed on the anterolateral side of the truck. Results The major coronal curve scoliosis averaged 116.00 ± 16.70° and was reduced to 63.23 ± 14.00° after HPT, 46.33 ± 10.70° after surgery. The major kyphosis was 102.40 ± 27.67° and was reduced to 52.23 ± 14.16° after HPT, 42.0 ± 11.92° after surgery. A signiﬁcantly increased FVC was observed after HPT (p<0.001), with a signiﬁcantly improved FVC% (p<0.001). Similarly, a signiﬁcantly increased FEV1 was also observed (p <0.001), with a signiﬁcantly improved FEV1% (p<0.001).Conclusion This study indicated that the modified HPT could be used to help patients with severe spinal deformities complicated with respiratory dysfunction achieve significant correction in both the coronal and sagittal deformities during the pre-operative treatment period along with improved respiratory function and in the absence of severe complications.