bluuebunny/crossref_metadata_2025 huggingface dataset:
A Simulation Study of the Effect of Delayed Retirement on Welfare of the Elderly: Evidence from China
Authors: Shen Zheng , Yang James
Published: June 2021

In order to cope with population aging and emerging labor shortages, the Chinese government may soon introduce a policy to address this problem by raising the normal retirement age. However, the effects of planning for delayed retirement on the welfare of the elderly remain unknown. From an intergenerational support perspective, we develop a dynamic optimization model that can simulate changes in the welfare of the elderly over the years under different delayed retirement scenarios. Simulation results show that delaying retirement will produce a detrimental effect on old-age welfare. We further analyze strategies to mitigate this adverse effect and improve people’s welfare. First, the delayed retirement policy should raise the pension replacement rate, which could transfer part of the social welfare improvements from delayed retirement to the elderly through the transfer payment mechanism. Second, when adopting a defined-contribution pension system, the delayed retirement could increase the welfare of the elderly and the social well-being. Implications for future research and public policies concerning welfare effects of delayed retirement are discussed.
Measure of CLV Toward Market Segmentation Approach in the Telecommunication Sector (Vietnam)
Authors: Binh Tu Van , Thy Ngo Giang , Phuong Ho Thi Nam
Published: June 2021

This study is based on data used by a telecommunications industry over a period of 6 months, beginning July 1, 2018, until December 31, 2018. The approached model of customer lifetime value (CLV) was concerned on the sample size of 245,355 records made by cell phones of active prepaid subscribers. The aim of this article is to estimate CLV through survival function with adjusted variables enclosed, for example, marketing cost. To do this, a statistical model was used to predict the individual CLV and confirmed a different finding to some previous study, in which this new finding brings an important message that the telecom providers should take care of customer earlier before too late because after the 10th of tenure, the subscribers can churn the telecom operator’s service. The result of CLV is well supported to segment market. It will also benefit the telecom providers to maintain their market competitiveness.
Maternal Depression, Child Temperament, and Early-Life Stress Predict Never-Depressed Preadolescents’ Functional Connectivity During a Negative-Mood Induction
Authors: Liu Pan , Vandermeer Matthew R. J. , Mohamed Ali Ola , Daoust Andrew R. , Joanisse Marc F. , Barch Deanna M. , Hayden Elizabeth P.
Published: June 2021

Understanding the development of depression can inform etiology and prevention/intervention. Maternal depression and maladaptive patterns of temperament (e.g., low positive emotionality [PE] or high negative emotionality, especially sadness) are known to predict depression. Although it is unclear how these risks cause depression, altered functional connectivity (FC) during negative-emotion processing may play an important role. We investigated whether maternal depression and age-3 emotionality predicted FC during negative mood reactivity in never-depressed preadolescents and whether these relationships were augmented by early-life stress. Maternal depression predicted decreased medial prefrontal cortex (mPFC)–amygdala and mPFC–insula FC but increased mPFC–posterior cingulate cortex (PCC) FC. PE predicted increased dorsolateral prefrontal cortex–amygdala FC, whereas sadness predicted increased PCC-based FC in insula, orbitofrontal cortex, and anterior cingulate cortex (ACC). Sadness was more strongly associated with PCC–insula and PCC–ACC FC as early stress increased. Findings indicate that early depression risks may be mediated by FC underlying negative-emotion processing.
Abetalipoproteinemia Due to a Novel Splicing Variant in MTTP in 3 Siblings
Authors: Vlasschaert Caitlyn , McIntyre Adam D. , Thomson Lauren A. , Kennedy Brooke A. , Ratko Suzanne , Prasad Chitra , Hegele Robert A.
Published: June 2021

Abetalipoproteinemia (ABL) is a rare recessive condition caused by biallelic loss-of-function mutations in the MTTP gene encoding the microsomal triglyceride transfer protein large subunit. ABL is characterized by absence of apolipoprotein B–containing lipoproteins and deficiencies in fat-soluble vitamins leading to multisystem involvement of which neurological complications are the most serious. We present 3 siblings with ABL who were born to non-consanguineous parents of Filipino and Chinese background. Identical twin boys with long-standing failure to thrive and malabsorption were diagnosed at age 2 years. ABL therapy with vitamins and a specialized diet was initiated, replacing total parenteral nutrition at age 3 years. Their younger sister was diagnosed from a blood sample taken at birth; treatment was instituted shortly thereafter. We observed in the twins reversal and in their sister prevention of ABL systemic features following early implementation of fat restriction and high doses of oral fat-soluble vitamins. A targeted sequencing panel found that each affected sibling is homozygous for a novel MTTP intron 13 -2A>G splice acceptor site mutation, predicted to abolish splicing of intron 13. This variant brings to more than 60 the number of reported pathogenic mutations, which are summarized in this article. The twin boys and their sister are now doing well at 11 and 4 years of age, respectively. This experience underscores the importance of early initiation of targeted specialized dietary and fat-soluble vitamin replacements in ABL.
Retrospective Review of Virologic and Immunologic Response in Treatment-Experienced Patients on Third-Line HIV Therapy in Lusaka, Zambia
Authors: Zulu Paul Msanzya , Toeque Mona-Gekanju , Hachaambwa Lottie , Chirwa Lameck , Fwoloshi Sombo , Siwingwa Mpanji , Mbewe Melody , Rosser Joelle I , Stafford Kristen A , Lindsay Brianna , Mulenga Lloyd , Claassen Cassidy W
Published: June 2021

Established antiretroviral therapy (ART) programs in sub-Saharan Africa have well-defined first-and second-line therapies but no standard third-line ART regimen. The impact of third-line ART on patients with multiclass-resistant HIV in resource-limited settings has not been well characterized. We conducted a retrospective review of patients on third-line ART at the University Teaching Hospital in Lusaka, Zambia. We assessed virologic and immunologic outcomes following 6 months of third-line therapy and found among those with a documented viral load, viral suppression (≤1000 copies/ml) at 24 weeks was 95% (63/66) with a mean increase in CD4 count of 116 cells/mm3 and viral suppression of 63% (63/100) by imputation of missing data. This study suggests that third-line therapy is clinically and virologically effective among patients with multiclass-resistance in a resource-limited setting in sub-Saharan Africa.
The Coming of the Drawloom: A Chapter in the Technological Transmission between Iran and India
Authors: Alam Ishrat
Published: June 2021

In the history of technology, the loom has come to occupy an important place. While the horizontal handloom has a comparatively simple mechanism, this is not true of the vertical drawloom, which through centuries has developed complex forms. The question of the latter’s presence in India in early times has aroused some controversy. The case is made in this article that it arrived in the thirteenth century from Iran but failed to supplant the handloom in most areas of textile production, except for carpet weaving, mainly in Kashmir.
Factors associated with early reperfusion improvement after intra-arterial fibrinolytics as rescue for mechanical thrombectomy
Authors: Kaesmacher Johannes , Peschi Giovanni , Abdullayev Nuran , Maamari Basel , Dobrocky Tomas , Vynckier Jan , Piechowiak Eike , Pop Raoul , Behme Daniel , Sporns Peter B , Styczen Hanna , Virtanen Pekka , Meyer Lukas , Meinel Thomas R , Cantré Daniel , Kabbasch Christoph , Maus Volker , Pekkola Johanna , Fischer Sebastian , Hasiu Anca , Schwarz Alexander , Wildgruber Moritz , Seiffge David J , Langner Sönke , Martinez-Majander Nicolas , Radbruch Alexander , Schlamann Marc , Mihoc Dan , Beaujeux Rémy , Strbian Daniel , Fiehler Jens , Mordasini Pasquale , Gralla Jan , Fischer Urs
Published: June 2021

Objective:

To identify factors associated with early angiographic reperfusion improvement (EARI) following intra-arterial fibrinolytics (IAF) after failed or incomplete mechanical thrombectomy (MT).

Methods:

A subset of patients treated with MT and IAF rescue after incomplete reperfusion included in the INFINITY (INtra-arterial FIbriNolytics In ThrombectomY) multicenter observational registry was analyzed. Multivariable logistic regression was used to identify factors associated with EARI. Heterogeneity of the clinical effect of EARI on functional independence (defined as modified Rankin Score ≤2) was tested with interaction terms.

Results:

A total of 228 patients (median age: 72 years, 44.1% female) received IAF as rescue for failed or incomplete MT and had a post-fibrinolytic angiographic control run available (50.9% EARI). A cardioembolic stroke origin (adjusted odds ratio (aOR) 3.72, 95% confidence interval (CI) 1.39–10.0) and shorter groin puncture to IAF intervals (aOR 0.82, 95% CI 0.71–0.95 per 15-min delay) were associated with EARI, while pre-interventional thrombolysis showed no association (aOR 1.15, 95% CI 0.59–2.26). The clinical benefit of EARI after IAF seemed more pronounced in patients without or only minor early ischemic changes (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) ≥9, aOR 4.00, 95% CI 1.37–11.61) and was absent in patients with moderate to severe ischemic changes (ASPECTS ≤8, aOR 0.94, 95% CI 0.27–3.27, p for interaction: 0.095).

Conclusion:

Early rescue and a cardioembolic stroke origin were associated with more frequent EARI after IAF. The clinical effect of EARI seemed reduced in patients with already established infarcts. If confirmed, these findings can help to inform patient selection and inclusion criteria for randomized-controlled trials evaluating IAF as rescue after MT.
Myocardial injury in acute ischemic stroke
Authors: Nolte Christian H , Endres Matthias , Scheitz Jan F
Published: June 2021

Since antiquity, the interaction of brain and heart has inspired physicians and philosophers. Today, our knowledge has vastly improved, but the exact way of their interaction still holds many secrets to reveal. The interaction between brain and heart merits particular attention in the aftermath of a sudden injury to the brain-like acute ischemic stroke (AIS). This narrative review gives an overview of current knowledge on frequency, prognosis, and potential pathophysiological mechanisms of myocardial injury following AIS.
Image processing algorithm for detection, quantification and classification of microdefects in wire electric discharge machined precision finish cut surfaces
Authors: Abhilash P. M. , Chakradhar D.
Published: June 2021

This study aims to create an image processing algorithm that categorises the wire electric discharge machine (WEDM) processed finish cut surfaces, based on surface microdefects. The algorithm also detects the defect locations and suggests alternate parameter settings for improving the surface integrity. The proposed automated analysis is more precise, efficient and repeatable compared to manual inspection. Also, the method can be used for automatic data generation to suggest parameter changes in closed loop systems. During the training phase, mean, standard deviation and defect area fraction of enhanced binary images are extracted and stored. The training dataset consists of 27 WEDM finish cut surface images with labels, ‘coarse’, ‘average’ and ‘smooth’. The trained model is capable of categorising any machined surface by detecting the microdefects. If the machined surface image is not classified as a smooth image, then alternate input parameter settings will be suggested by the model to minimise the microdefects. This is done based on the Euclidean distance between the current image datapoint and the nearest ‘smooth’ class datapoint.
Gender Dysphoria in Psychiatric Practice: Understanding the Clinical Ambiguity and Management
Authors: Venkataramu Vyjayanthi N. , Banerjee Debanjan
Published: June 2021

There have been several myths and misconceptions about the dichotomous understanding of sex and gender. While sex is biologically determined, gender and gender identity depend on childhood experiences, upbringing, social expectations, beliefs, family environment, and peer interactions and is socially constructed. Gender dysphoria (GD) is the extreme distress experienced by an individual because of a mismatch between their gender identity and the sex assigned at birth. GD has been an ambiguous category in psychiatry, initially termed as “gender identity disorder” till Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition ( DSM-5) considered removal of the term “disorder” to reduce the stigma associated. The critical element in GD is “clinically significant distress” that differentiates it from gender nonconformity. Individuals with GD identify themselves as transgender and frequently are victims of coercive social norms, discrimination, and stigma. This leads to delay in expression of distress, psychiatric mismanagement, and high comorbidity of depression, anxiety, post-traumatic stress, self-harm, and suicidality. Though management involves a holistic multidisciplinary approach including psychotherapy, social support, and gender-reassignment treatments (medical/surgical), there has been considerable debate and ambiguity related to the same. With this background, the article critics the understanding of GD, focuses on the WPATH SOC-7 treatment guidelines, and highlights the role of mental health professionals for better care.
Azithromycin and hydroxychloroquine in hospitalised patients with confirmed COVID-19: a randomised double-blinded placebo-controlled trial
Authors: Sivapalan Pradeesh , Ulrik Charlotte Suppli , Lapperre Therese Sophie , Bojesen Rasmus Dahlin , Eklöf Josefin , Browatzki Andrea , Wilcke Jon Torgny , Gottlieb Vibeke , Håkansson Kjell Erik Julius , Tidemandsen Casper , Tupper Oliver , Meteran Howraman , Bergsøe Christina , Brøndum Eva , Bødtger Uffe , Bech Rasmussen Daniel , Graff Jensen Sidse , Pedersen Lars , Jordan Alexander , Priemé Helene , Søborg Christian , Steffensen Ida E. , Høgsberg Dorthe , Klausen Tobias Wirenfeldt , Frydland Martin Steen , Lange Peter , Sverrild Asger , Ghanizada Muhzda , Knop Filip K. , Biering-Sørensen Tor , Lundgren Jens D. , Jensen Jens-Ulrik Stæhr
Published: June 2021

Background

Combining the antibiotic azithromycin and hydroxychloroquine induces airway immunomodulatory effects, with the latter also havingin vitroantiviral properties. This may improve outcomes in patients hospitalised for coronavirus disease 2019 (COVID-19).

Methods

Placebo-controlled double-blind randomised multicentre trial. Patients aged ≥18 years, admitted to hospital for ≤48 h (not intensive care) with a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription PCR test were recruited. The intervention was 500 mg daily azithromycin for 3 days followed by 250 mg daily azithromycin for 12 days combined with 200 mg twice-daily hydroxychloroquine for all 15 days. The control group received placebo/placebo. The primary outcome was days alive and discharged from hospital within 14 days (DAOH14).

Results

After randomisation of 117 patients, at the first planned interim analysis, the data and safety monitoring board recommended stopping enrolment due to futility, based on pre-specified criteria. Consequently, the trial was terminated on 1 February 2021. 61 patients received the combined intervention and 56 patients received placebo. In the intervention group, patients had a median (interquartile range) 9.0 (3–11) DAOH14versus9.0 (7–10) DAOH14 in the placebo group (p=0.90). The primary safety outcome, death from all causes on day 30, occurred for one patient in the intervention groupversustwo patients receiving placebo (p=0.52), and readmittance or death within 30 days occurred for nine patients in the intervention groupversussix patients receiving placebo (p=0.57).

Conclusions

The combination of azithromycin and hydroxychloroquine did not improve survival or length of hospitalisation in patients with COVID-19.
The role of bronchoscopy in patients with SARS-CoV-2 pneumonia
Authors: Arenas-De Larriva Marisol , Mart�n-DeLeon Roberto , Urrutia Royo Blanca , Fern�ndez-Navamuel Iker , Gimenez Velando Andr�s , Nu�ez Garc�a Laura , Centeno Clemente Carmen , Andreo Garc�a Felipe , Rafecas Codern Albert , Fern�ndez-Arias Carmen , Pajares Ruiz Virginia , Torrego Fern�ndez Alfons , Rajas Olga , Iturricastillo Gorane , Garcia Lujan Ricardo , Comeche Casanova Lorena , S�nchez-Font Albert , Aguilar-Colindres Ricardo , Larrosa-Barrero Roberto , Garc�a Garc�a Ruth , Cordovilla Rosa , N��ez-Ares Ana , Briones-G�mez Andr�s , Cases Viedma Enrique , Franco Jos� , Cosano Povedano Javier , Rodr�guez-Per�lvarez Manuel Luis , Cebrian Gallardo Jose Joaquin , Nu�ez Delgado Manuel , Pav�n-Masa Mar�a , Valdivia Salas Maria del Mar , Flandes Javier
Published: June 2021

Background

The role of bronchoscopy in coronavirus disease 2019 (COVID-19) is a matter of debate.

Patients and methods

This observational multicentre study aimed to analyse the prognostic impact of bronchoscopic findings in a consecutive cohort of patients with suspected or confirmed COVID-19. Patients were enrolled at 17 hospitals from February to June 2020. Predictors of in-hospital mortality were assessed by multivariate logistic regression.

Results

A total of 1027 bronchoscopies were performed in 515 patients (age 61.5�11.2 years; 73% men), stratified into a clinical suspicion cohort (n=30) and a COVID-19 confirmed cohort (n=485). In the clinical suspicion cohort, the diagnostic yield was 36.7%. In the COVID-19 confirmed cohort, bronchoscopies were predominantly performed in the intensive care unit (n=961; 96.4%) and major indications were: difficult mechanical ventilation (43.7%), mucus plugs (39%) and persistence of radiological infiltrates (23.4%). 147 bronchoscopies were performed to rule out superinfection, and diagnostic yield was 42.9%. There were abnormalities in 91.6% of bronchoscopies, the most frequent being mucus secretions (82.4%), haematic secretions (17.7%), mucus plugs (17.6%), and diffuse mucosal hyperaemia (11.4%). The independent predictors of in-hospital mortality were: older age (OR 1.06; p<0.001), mucus plugs as indication for bronchoscopy (OR 1.60; p=0.041), absence of mucosal hyperaemia (OR 0.49; p=0.041) and the presence of haematic secretions (OR 1.79; p=0.032).

Conclusion

Bronchoscopy may be indicated in carefully selected patients with COVID-19 to rule out superinfection and solve complications related to mechanical ventilation. The presence of haematic secretions in the distal bronchial tract may be considered a poor prognostic feature in COVID-19.
Cruxome: a powerful tool for annotating, interpreting and reporting genetic variants
Authors: Han Qingmei , Yang Ying , Wu Shengyang , Liao Yingchun , Zhang Shuang , Liang Hongbin , Cram David S. , Zhang Yu
Published: June 2021

Background

Next-generation sequencing (NGS) is an efficient tool used for identifying pathogenic variants that cause Mendelian disorders. However, the lack of bioinformatics training of researchers makes the interpretation of identified variants a challenge in terms of precision and efficiency. In addition, the non-standardized phenotypic description of human diseases also makes it difficult to establish an integrated analysis pathway for variant annotation and interpretation. Solutions to these bottlenecks are urgently needed.

Results

We develop a tool named “Cruxome” to automatically annotate and interpret single nucleotide variants (SNVs) and small insertions and deletions (InDels). Our approach greatly simplifies the current burdensome task of clinical geneticists and scientists to identify the causative pathogenic variants and build personal knowledge reference bases. The integrated architecture of Cruxome offers key advantages such as an interactive and user-friendly interface and the assimilation of electronic health records of the patient. By combining a natural language processing algorithm, Cruxome can efficiently process the clinical description of diseases to HPO standardized vocabularies. By using machine learning, in silico predictive algorithms, integrated multiple databases and supplementary tools, Cruxome can automatically process SNVs and InDels variants (trio-family or proband-only cases) and clinical diagnosis records, then annotate, score, identify and interpret pathogenic variants to finally generate a standardized clinical report following American College of Medical Genetics and Genomics/ Association for Molecular Pathology (ACMG/AMP) guidelines. Cruxome also provides supplementary tools to examine and visualize the genes or variations in historical cases, which can help to better understand the genetic basis of the disease.

Conclusions

Cruxome is an efficient tool for annotation and interpretation of variations and dramatically reduces the workload for clinical geneticists and researchers to interpret NGS results, simplifying their decision-making processes. We present an online version of Cruxome, which is freely available to academics and clinical researchers. The site is accessible at http://114.251.61.49:10024/cruxome/.
Effects of S24–7 on the weight of progeny rats after exposure to ceftriaxone sodium during pregnancy
Authors: Yang Xin , Tang Ting , Wen Jing , Li Mengchun , Chen Jie , Li Tingyu , Dai Ying , Cheng Qian
Published: June 2021

Antibiotic exposure during pregnancy will adversely affect the growth of offspring; however, this remains controversial and the mechanism is poorly understood. To study this phenomenon, we added ceftriaxone sodium to the drinking water of pregnant rats and continuously monitored the body weight of their offspring. The results showed that compared with the control group, the offspring exposed to antibiotics during pregnancy had a higher body weight up to 3 weeks old but had a lower body weight at 6 weeks old. To determine the role of the gut microbiota and its metabolites in the growth of offspring, we collected feces for sequencing and further established that the experimental group has a different composition ratio of dominant bacteria at 6 week old, among which S24–7 correlated negatively with body weight and the metabolites that correlated with body weight-related unique flora were L-Valine, L-Leucine, Glutaric acid, N-Acetyl-L-glutamate, and 5-Methylcytosine. To further explore how they affect the growth of offspring, we submitted these data to Kyoto Encyclopedia of Genes and Genomes website for relevant pathway analysis. The results showed that compared with the control, the following metabolic pathways changed significantly: Valine, leucine, and isoleucine biosynthesis; Protein digestion and absorption; and Mineral absorption. Therefore, we believe that our findings support the conclusion that ceftriaxone sodium exposure in pregnancy has a long-lasting adverse effect on the growth of offspring because of an imbalance of gut microbiota, especially S24–7, via different metabolic pathways.
Up-regulation of matrix metalloproteinases-9 in the kidneys of diabetic rats and the association with neutrophil gelatinase-associated lipocalin
Authors: Yang Huayu , Chen Haiping , Liu Fenghua , Ma Qing
Published: June 2021

Background

Matrix metalloproteinases-9 (MMP-9) can regulate extracellular matrix deposition in diabetic glomerular injury. However, it remains unknown whether MMP-9 is involved in the renal tubular injury. Meanwhile, neutrophil gelatinase-associated lipocalin (NGAL), defined as a biomarker of proximal tubular injury, may influence MMP-9 by forming the MMP-9/NGAL complex. The aim of this study was to investigate MMP-9 expression in proximal renal tubules and the relationship of MMP-9 and NGAL in diabetic rat model treated with Valsartan.

Methods

Sprague Dawley rats were randomly divided into three groups: Diabetic group, Control group, and Treated group. The diabetic rat model was established by injection of streptozotocin. Related indexes were measured at the end of the 2nd, 4th, 8th and 12th week post-modeling.

Results

In diabetic groups, the concentrations of MMP-9 markedly increased in the serum and urine of rats in the early stage, even before the appearance of pathological albuminuria. Markedly elevated MMP-9/NGAL complex concentrations were also tested in diabetic groups. Western blot and qPCR tests confirmed that MMP-9 expression levels in the proximal renal tubular epithelial cells of diabetic rats were significantly higher than in control groups (P < 0.05). Correlation analysis showed that MMP-9 was positively correlated with NGAL at both protein and gene expression levels. In addition, Valsartan observably reduced tubular injury as well as MMP-9 expression in diabetic rats.

Conclusions

In diabetic kidney injury, the expression of MMP-9 in the proximal renal tubular epithelial cells was significantly increased. Besides, a positive correlation was found between MMP-9 and NGAL expression, along with high levels of MMP-9/NGAL complex, which indicated that NGAL might participate in the regulation of MMP-9 expression. The administration of Valsartan may reduce this effect.
Tracking the dropout patients of neoadjuvant chemotherapy with locally advanced oral cavity cancer
Authors: Fu Jin-Ye , Zhang Chen-Ping , Zhang Zhi-Yuan
Published: June 2021

Background

Patients with locally advanced oral cavity cancer sometimes stopped treatment after neoadjuvant chemotherapy. There are no guidelines of the management for these patients. Before designing clinical trials, we conducted this study to investigate their characteristics, reasons of dropout, and the follow-up information.

Methods

Medical records were consecutively reviewed of patients with locally advanced oral cavity cancer who underwent neoadjuvant chemotherapy from Jan 2017 to Dec 2019.Variables were compared between patients stopped treating after chemotherapy and completed treatments by student t-test and Chi-square test. Logistic regression model was used to calculate the odd rations of potential predictors of dropout. The dropout patients were followed up for reasons and results of their decision.

Results

A total of 171 patients were included with 23 not undergoing surgery after chemotherapy. The odd ratios of age over 65 and single marital status were 3.11 (95%CI: 1.1, 8.7) and 4.935 (95%CI: 1.5, 16.1), respectively, for the dropout. The median survival of patients without surgery was 7.4 months. Believing that chemotherapy would be effective and being afraid of the consequence of surgery were the main reasons of refusing surgery.

Conclusions

The prognosis was poor of these dropout patients. Symptom relief and fear of surgery were the reasons of dropout. Age and marital status affected their decision. Clinical trials are needed to be designed for these patients.
Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications
Authors: Fukui Taro , Noda Hiroshi , Watanabe Fumiaki , Kato Takaharu , Endo Yuhei , Aizawa Hidetoshi , Kakizawa Nao , Iseki Masahiro , Rikiyama Toshiki
Published: June 2021

Introduction

The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD.

Methods

A total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated.

Results

One hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587–0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651–0.856), with a calculated optimal cut-off value of 332 ml.

Conclusion

A low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.
Understanding female and male empowerment in Burkina Faso using the project-level Women’s Empowerment in Agriculture Index (pro-WEAI): a longitudinal study
Authors: Crookston Benjamin T. , West Josh H. , Davis Siena F. , Hall P. Cougar , Seymour Greg , Gray Bobbi L.
Published: June 2021

Background

Achieving gender equality and women’s empowerment is a major global priority. The purpose of this study was to determine whether the Building the Resilience of Vulnerable Communities in Burkina Faso (BRB) project, an agricultural development program, improved women’s empowerment, as measured by the project-level Women’s Empowerment in Agriculture Index (pro-WEAI).

Methods

This study used a longitudinal, quasi-experimental study design. Participants included both treatment and comparison groups (total N = 751) comprising female members of savings groups and their husbands or main male household member in Burkina Faso. All participants completed the pro-WEAI questionnaire at both baseline and endline. The treatment group received a comprehensive intervention package consisting of agriculture loans and services, microenterprise loans, and education, nutrition education, and women’s empowerment programs including gender-based discussions designed to facilitate personalized changes in gender relations.

Results

The proportion of the treatment group achieving empowerment did not change from baseline for women, but improved substantially for men. Women from the comparison group saw an increase in empowerment at endline while men saw a substantial decrease. Gender parity was high for women in both groups at baseline and increased slightly at endline. Women were more likely to have adequate empowerment in input in productive decisions, group membership, and membership in influential groups than men while men were more likely to have adequate empowerment in attitudes about domestic violence, control over use of income, and work balance than women. Participants from the treatment group reported an increase in the average number of empowerment indicators that they were adequate in while the comparison group saw a decrease in average adequacy over time (p = 0.002) after controlling for age, sex, and level of education.

Conclusion

Despite starting at an empowerment disadvantage, the treatment group experienced gains in individual indicators of empowerment while the comparison group men and women experienced mixed results, with the women gaining, and the men losing empowerment. This research suggests that the BRB intervention may have provided some protection for the treatment group when they faced an economic down-turn prior to the endline, indicative of household resilience. Future research should consider and strengthen relationships between resilience and empowerment.
Resident perspectives on the value of interdisciplinary conference calls for geriatric patients
Authors: Naderi Roxana , Oberndorfer Tyson A. , Jordan Sarah R. , Dollar Blythe , Cumbler Ethan U. , Jones Christine D.
Published: June 2021

Background

There are limited competency-based educational curricula for transitions of care education (TOC) for internal medicine (IM) residency programs. The University of Colorado implemented a virtual interdisciplinary conference call, TEAM (Transitions Expectation and Management), between providers on the inpatient Acute Care of the Elder (ACE) unit and the outpatient Seniors Clinic at the University of Colorado Hospital. Residents rotating on the ACE unit participated in weekly conferences discussing Seniors Clinic patients recently discharged, or currently hospitalized, to address clinical concerns pertaining to TOC. Our goals were to understand resident perceptions of the educational value of these conferences, and to determine if these experiences changed attitudes or practice related to care transitions.

Methods

We performed an Institutional Review Board-approved qualitative study of IM housestaff who rotated on the ACE unit during 2018–2019. Semi-structured interviews were conducted to understand perceptions of the value of TEAM calls for residents’ own practice and the impact on patient care. Data was analyzed inductively, guided by thematic analysis.

Results

Of the 32 IM residents and interns who rotated on ACE and were invited to participate, 11 agreed to an interview. Three key themes emerged from interviews that highlighted residents’ experiences identifying and navigating some of their educational ‘blind spots:’ 1) Awareness of patient social complexities, 2) Bridging gaps in communication across healthcare settings, 3) Recognizing the value of other disciplines during transitions.

Conclusions

This study highlights learner perspectives of the benefit of interdisciplinary conference calls between inpatient and outpatient providers to enhance transitions of care, which provide meaningful feedback and serve as a vehicle for residents to recognize the impact of their care decisions in the broader spectrum of patients’ experience during hospital discharge. Educators can maximize the value of these experiences by promoting reflective debriefs with residents and bringing to light previously unrecognized knowledge gaps around hospital discharge.
Healthcare workforce transformation: implementing patient-centered medical home standards in an academic medical center
Authors: Gendelman Rebecca , Preis Heidi , Chandran Latha , Blair Robyn J. , Chitkara Maribeth , Pati Susmita
Published: June 2021

Background

Large scale implementation of new strategies and healthcare delivery standards in academic medical centers (AMCs) requires training of healthcare workforce at different stages of their medical career. The patient-centered medical home (PCMH) model for healthcare delivery involves adoption by all members of the healthcare workforce, including seasoned professionals and trainees. Though widely known, the PCMH model has been implemented sporadically at large AMCs and methods to implement the model across healthcare workforce have not been well-documented.

Methods

To meet all PCMH standards and achieve sustainable level 3 recognition, the authors implemented in 2014–2015 a multi-pronged approach that capitalized on existing educational infrastructure among faculty, residents, and medical students. Within 18 months, the authors applied new interdisciplinary practices and policies, redesigned residency training in continuity practices and extensively modified medical school curricula.

Results

These innovative transformational education efforts addressed the six PCMH standards for faculty, residents, and undergraduate medical students. Faculty played a major role as system change agents and facilitators of learning. Residents learned to better understand patients’ cultural needs, identify ‘at-risk’ patients, ensure continuity of care, and assess and improve quality of care. Medical students were exposed to PCMH core standards throughout their training via simulations, training in the community and with patients, and evaluation tasks. By implementing these changes across the healthcare workforce, the AMC achieved PCMH status in a short time, changed practice culture and improved care for patients and the community. Since then, the AMC has been able to maintain PCMH recognition annually with minimal effort.

Conclusions

Successful strategies that capitalize on existing strengths in infrastructure complemented by innovative educational offerings and inter-professional partnerships can be adapted by other organizations pursuing similar transformation efforts. This widespread transformation across the healthcare workforce facilitate a deep-rooted change that enabled our academic medical center to sustain PCMH recognition.
Cotton D genome assemblies built with long-read data unveil mechanisms of centromere evolution and stress tolerance divergence
Authors: Yang Zhaoen , Ge Xiaoyang , Li Weinan , Jin Yuying , Liu Lisen , Hu Wei , Liu Fuyan , Chen Yanli , Peng Shaoliang , Li Fuguang
Published: June 2021

Background

Many of genome features which could help unravel the often complex post-speciation evolution of closely related species are obscured because of their location in chromosomal regions difficult to accurately characterize using standard genome analysis methods, including centromeres and repeat regions.

Results

Here, we analyze the genome evolution and diversification of two recently diverged sister cotton species based on nanopore long-read sequence assemblies and Hi-C 3D genome data. Although D genomes are conserved in gene content, they have diversified in gene order, gene structure, gene family diversification, 3D chromatin structure, long-range regulation, and stress-related traits. Inversions predominate among D genome rearrangements. Our results support roles for 5mC and 6mA in gene activation, and 3D chromatin analysis showed that diversification in proximal-vs-distal regulatory-region interactions shape the regulation of defense-related-gene expression. Using a newly developed method, we accurately positioned cotton centromeres and found that these regions have undergone obviously more rapid evolution relative to chromosome arms. We also discovered a cotton-specific LTR class that clarifies evolutionary trajectories among diverse cotton species and identified genetic networks underlying the Verticillium tolerance of Gossypium thurberi (e.g., SA signaling) and salt-stress tolerance of Gossypium davidsonii (e.g., ethylene biosynthesis). Finally, overexpression of G. thurberi genes in upland cotton demonstrated how wild cottons can be exploited for crop improvement.

Conclusions

Our study substantially deepens understanding about how centromeres have developed and evolutionarily impacted the divergence among closely related cotton species and reveals genes and 3D genome structures which can guide basic investigations and applied efforts to improve crops.
Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial
Authors: Khunti Kamlesh , Griffin Simon , Brennan Alan , Dallosso Helen , Davies Melanie J. , Eborall Helen C. , Edwardson Charlotte L. , Gray Laura J. , Hardeman Wendy , Heathcote Laura , Henson Joe , Pollard Daniel , Sharp Stephen J. , Sutton Stephen , Troughton Jacqui , Yates Tom
Published: June 2021

Background

Physical activity is associated with a reduced risk of type 2 diabetes and cardiovascular disease but limited evidence exists for the sustained promotion of increased physical activity within diabetes prevention trials. The aim of the study was to investigate the long-term effectiveness of the Walking Away programme, an established group-based behavioural physical activity intervention with pedometer use, when delivered alone or with a supporting mHealth intervention.

Methods

Those at risk of diabetes (nondiabetic hyperglycaemia) were recruited from primary care, 2013–2015, and randomised to (1) Control (information leaflet); (2) Walking Away (WA), a structured group education session followed by annual group-based support; or (3) Walking Away Plus (WAP), comprising WA annual group-based support and an mHealth intervention delivering tailored text messages supported by telephone calls. Follow-up was conducted at 12 and 48 months. The primary outcome was accelerometer measured ambulatory activity (steps/day). Change in primary outcome was analysed using analysis of covariance with adjustment for baseline, randomisation and stratification variables.

Results

One thousand three hundred sixty-six individuals were randomised (median age = 61 years, ambulatory activity = 6638 steps/day, women = 49%, ethnic minorities = 28%). Accelerometer data were available for 1017 (74%) individuals at 12 months and 993 (73%) at 48 months. At 12 months, WAP increased their ambulatory activity by 547 (97.5% CI 211, 882) steps/day compared to control and were 1.61 (97.5% CI 1.05, 2.45) times more likely to achieve 150 min/week of moderate-to-vigorous physical activity. Differences were not maintained at 48 months. WA was no different to control at 12 or 48 months. Secondary anthropometric and health outcomes were largely unaltered in both intervention groups apart from small reductions in body weight in WA (~ 1 kg) at 12- and 48-month follow-up.

Conclusions

Combining a pragmatic group-based intervention with text messaging and telephone support resulted in modest changes to physical activity at 12 months, but changes were not maintained at 48 months.

Trial registration

ISRCTN 83465245 (registered on 14 June 2012).
The cssR gene of Corynebacterium glutamicum plays a negative regulatory role in stress responses
Authors: Liu Yang , Yang Wenzhi , Su Tao , Che Chengchuan , Li Guizhi , Chen Can , Si Meiru
Published: June 2021

Background

CssR, the product of the Corynebacterium glutamicum ncgl1578 gene cotranscribed with ncgl1579, is a TetR (tetracycline regulator) family repressor. Although many TetR-type regulators in C. glutamicum have been extensively described, members of the TetR family involved in the stress response remain unidentified.

Results

In this study, we found that CssR regulated the transcription of its own gene and the ncgl1576-ncgl1577 operon. The ncgl1576-ncgl1577 operon, which is located upstream of cssR in the orientation opposite that of the cssR operon, encodes an ATP-binding cassette (ABC), some of which are involved in the export of a wide range of antimicrobial compounds. The cssR-deletion (ΔcssR) mutant displayed increased resistance to various stresses. An imperfect palindromic motif (5′-TAA(G)TGN13CA(G)TTA-3′; 25 bp) located at the intergenic region between cssR and ncgl1577 was identified as the sole binding site for CssR. Expression of cssR and ncgl1577 was induced by antibiotics and heavy metals but not H2O2 or diamide, and the DNA-binding activity of CssR was impaired by antibiotics and heavy metals but not H2O2. Antibiotics and heavy metals caused CssR dissociation from target gene promoters, thus derepressing their transcription. Oxidant treatment neither altered the conformation of CssR nor modified its cysteine residues, indicating that the cysteine residues in CssR have no redox activity. In the ΔcssR mutant strain, genes involved in redox homeostasis also showed increased transcription levels, and the NADPH/NADP+ ratio was higher than that of the parental strain.

Conclusion

The stress response mechanism of CssR in C. glutamicum is realized via ligand-induced conformational changes of the protein, not via cysteine oxidation-based thiol modification. Moreover, the crucial role of CssR in the stress response was demonstrated by negatively controlling the expression of the ncgl1576-ncgl1577 operon, its structural gene, and/or redox homeostasis-related genes.
IFI35 is involved in the regulation of the radiosensitivity of colorectal cancer cells
Authors: Hu Yan , Wang Bing , Yi Ke , Lei Qingjun , Wang Guanghui , Xu Xiaohui
Published: June 2021

Background

Interferon regulatory factor-1 (IRF1) affects the proliferation of colorectal cancer (CRC). Recombinant interferon inducible protein 35 (IFI35) participates in immune regulation and cell proliferation. The aim of the study was to examine whether IRF1 affects the radiation sensitivity of CRC by regulating IFI35.

Methods

CCL244 and SW480 cells were divided into five groups: blank control, IFI35 upregulation, IFI35 upregulation control, IFI35 downregulation, and IFI35 downregulation control. All groups were treated with X-rays (6 Gy). IFI35 activation by IRF1 was detected by luciferase reporter assay. The GEPIA database was used to examine IRF1 and IFI35 in CRC. The cells were characterized using CCK-8, EdU, cell cycle, clone formation, flow cytometry, reactive oxygen species (ROS), and mitochondrial membrane potential. Nude mouse animal models were used to detect the effect of IFI35 on CRC.

Results

IRF1 can bind to the IFI35 promoter and promote the expression of IFI35. The expression consistency of IRF1 and IFI35 in CRC, according to GEPIA (R = 0.68, p < 0.0001). After irradiation, the upregulation of IFI35 inhibited cell proliferation and colony formation and promoted apoptosis and ROS, while IFI35 downregulation promoted proliferation and colony formation and reduced apoptosis, ROS, and mitochondrial membrane potential were also reduced. The in vivo experiments supported the in vitro ones, with smaller tumors and fewer liver metastases with IFI35 upregulation.

Conclusions

IRF1 can promote IFI35 expression in CRC cells. IFI35 is involved in the regulation of radiosensitivity of CRC cells and might be a target for CRC radiosensitization.
Dielectric properties and lamellarity of single liposomes measured by in-liquid scanning dielectric microscopy
Authors: Di Muzio Martina , Millan-Solsona Ruben , Dols-Perez Aurora , Borrell Jordi H. , Fumagalli Laura , Gomila Gabriel
Published: June 2021

Liposomes are widely used as drug delivery carriers and as cell model systems. Here, we measure the dielectric properties of individual liposomes adsorbed on a metal electrode by in-liquid scanning dielectric microscopy in force detection mode. From the measurements the lamellarity of the liposomes, the separation between the lamellae and the specific capacitance of the lipid bilayer can be obtained. As application we considered the case of non-extruded DOPC liposomes with radii in the range ~ 100–800 nm. Uni-, bi- and tri-lamellar liposomes have been identified, with the largest population corresponding to bi-lamellar liposomes. The interlamellar separation in the bi-lamellar liposomes is found to be below ~ 10 nm in most instances. The specific capacitance of the DOPC lipid bilayer is found to be ~ 0.75 µF/cm2 in excellent agreement with the value determined on solid supported planar lipid bilayers. The lamellarity of the DOPC liposomes shows the usual correlation with the liposome's size. No correlation is found, instead, with the shape of the adsorbed liposomes. The proposed approach offers a powerful label-free and non-invasive method to determine the lamellarity and dielectric properties of single liposomes.