bluuebunny/crossref_metadata_2025 huggingface dataset:
Faktor Ekonomi Memengaruhi Pernikahan Remaja Perempuan
Authors: Fitriyani Dian
Published: August 2021

World Health Organization (WHO) in collaboration with UNICEF which aims to improve the health of mothers and newborns in 25 countries that contributed the highest maternal mortality rate, one of them is in Indonesia. Adolescent who become pregnant will increase the health risks for her and baby. The maternal mortality reach approximately 70,000 deaths each year and maternal mortality is closely related to pregnancy and childbirth by adolescents aged 15 – 19 years in the worldwide. Objective of the research is to analyze the factors that influence adolescent girls’ marriage in Indramayu regency. This study uses qualitative method, the paradigm fenomenology. The subjects taken by purposive sampling technique. The informants is adolescent women who married about aged <20 years, her husband, and her family as much as 21 people. The results shows that family economic factors affecting marriage adolescent girls in the Indramayu regency that is caused economic status, the attitude of materialistic. Limitations of the study, there are several girls who live outside the city because they took the husband or for work outside the city, so it's likely there are many factors that have not been revealed. Economic factors affecting marriage adolescent girls in Indramayu regency, is causes by economic status and the attitude of materialistic.  It is necessary to consider the policy of the Marriage Law with the age of >20 years and the prohibition of marriages <20 years so that young girls avoid negative impacts, both physical and psychological.
Penyuluhan dengan Media Audiovisual Memengaruhi Tingkat Pengetahuan Ibu tentang Kebutuhan Dasar Ibu Hamil
Authors: Hadijah Sitti , Hidayati Hidayati , Indriani Indriani , Amin Wirawati
Published: August 2021

Efforts to accelerate the reduction of the Maternal Mortality Rate (MMR) can be carried out by ensuring that every mother is able to access quality maternal health services. Audiovisual media is one of the extension media that stimulates the senses of sight and hearing so as to increase mother's knowledge about the basic needs of pregnant women. This study aims to determine the effect of counseling with audiovisual media on the level of knowledge of mothers about the basic needs of pregnant women. The type of research used is a quasi-experimental research design non equivalent control group design. The sampling technique in this study used a consecutive sampling technique, as many as 32 respondents in the experimental group and 32 respondents in the control group. The statistical test used was the Wilcoxon test and the Mann Withney U-Test. From the results of the Wicoxon test in the two treatment groups, it was found that the p value (Asymp. Sig 2-tailed) was 0.000<0.05 so it could be concluded that there were significant differences in the extension group with audiovisual media and the extension group with leaflet media. The results of the analysis of the Mann Withney U-Test showed the largest p-value of 0.003<0.05 so it can be concluded that audiovisual counseling is more effectively used to increase mother's knowledge about the basic needs of pregnant women compared to leaflet media.
RASISME DALAM NOVEL THE KITE RUNNER
Authors: Al Ramadhan Muhammad Fakhran
Published: August 2021

Racism is rooted from colonial era that the colonizer considers their race that is different and higher than others. It produces social inequality between colonizer and their colonized. The Kite Runner depicts the story of life in Afghanistan in the middle of the tribal conflicts and war; Hazaras, the minority ethnic group genocide done by the Pashtun, the majority, children and women rapes, and civilians slaughter by Taliban. In the middle of the war, live two main characters, Amir and Hassan, ten years old boys who come from different social class yet living in the same roof.  They both have the same father without their knowing, but with different mix of race. Different race and social class results in discriminative acts not just between the two of them but also among society. This research aims to analyze and find out how The Kite Runner depicts the racism in Afghanistn during 1970s up to 2001. Pashtun Taliban represented by Assef as the villain vs Pashtun, Amir as the main character. Pashtun vs Hazara is also known by the characters; Assef with Hassan, Amir and Hassan, Assef and Sohrab, Baba and Ali, Baba and Sanaubar. This research uses descriptive analytical method. This analysis is focusing on five aspects of racism, namely (1) discrimination, (2) segregation, (3) slavery, (4) prejudice, and (5) stereotype. It can be found that the discrimination is done by Amir and his Father, Baba who treat Hassan and Ali, who are from minority ethnic, as their slaves. Next is segregation and discrimination depicted by Assef, a young Afghanistan who praises Hitler and assumes that his ethnic is more decorous than others in Afghanistan and he tries to chase Hazara from Afghanistan. The slavery can be seen when Baba and Amir treats Ali and Hassan as their maid in their house. The prejudice can be seen when there are some Pashtun thinks of the hazrasa existence living together with Baba and Amir. From Prejudice, it results the stereotyping from other people of imagining the Hazara. The authoritarian government, Taliban, also show the mistreatment of racism to the Afghans. Afghans often get sexual harassment, being raped, or even being killed if the break the law of Taliban.
EVALUATION OF HEALTHY NUTRITION INDEX-2015, DENTAL HEALTH AND ORAL FLORA RELATIONSHIP IN SCHOOL-AGE CHILDREN
Authors: KARĞIN Dicle , OMURTAG KORKMAZ Burcu , MUNGAN Nil Ceren , AKYÜZ Serap
Published: August 2021

Objective: The aim of the study is to evaluate the role of diet quality and oral flora on the dental health in the childhood period.

Methods: A cross-sectional study was carried out with the participation of 98 children aged 9-14 and their parents who applied to the Pedodontics Clinic Dental Faculty of Marmara University. The decayed, missing, filled tooth and surfaces and DMFT, DMFS indexes were determined through visual dental examination. Anthropometric measurements and saliva samples, as well as 24 h food consumption records, were taken from each child. Saliva samples were analyzed microbiologically. To evaluate dietary quality from intakes Healthy Eating Index-2015 (HEI-2015) scores were calculated.

Results: The mean age of children was 10.8±1.5 and study sample compromised 44.9% males and 55.1% females. 75% of the children had normal height and 58.2% of them had normal BMI according to World Health Organisation (WHO) references. The mean number of decayed tooth and surface was 3.07±2.35; 4.34±3.78 respectively and the mean number of DMFT and DMFS indexes were 5.88±2.31; 8.05±4.58 respectively. The mean number of decayed, missing, filled teeth and DMFT, DMFS scores were found to be higher in children with poor diets (according to HEI-2015) but the difference was not statistically significant (p>0.05). The presence of lactobacilli in saliva samples of 5.5% of the children was observed and children have lactobacilli in their saliva samples had more decayed teeth (p
Opposite Roles of Tumor Cell Proliferation and Immune Cell Infiltration in Postoperative Liver Metastasis of PDAC
Authors: Wang Guangfu , Dai Shangnan , Gao Hao , Gao Yong , Yin Lingdi , Zhang Kai , Huang Xumin , Lu Zipeng , Miao Yi
Published: August 2021

Background

Recurrence of liver metastasis after pancreatectomy is often a predictor of poor prognosis. Comprehensive genomic analysis may contribute to a better understanding of the molecular mechanisms of postoperative liver metastasis and provide new therapeutic targets.

Methods

A total of 67 patients from The Cancer Genome Atlas (TCGA) were included in this study. We analyzed differentially expressed genes (DEGs) by R package “DESeq2.” Weighted gene co-expression network analysis (WGCNA) was applied to investigate the key modules and hub genes. Immunohistochemistry was used to analyze tumor cell proliferation index and CD4+ T cells infiltration.

Results

Functional analysis of DEGs between the liver metastatic and recurrence-free groups was mainly concentrated in the immune response. The liver metastasis group had lower immune and stroma scores and a higher TP53 mutation rate. WGCNA showed that the genes in key modules related to disease-free survival (DFS) and overall survival (OS) were mainly enriched in the cell proliferation process and tumor immune response. Immunohistochemical analysis showed that the pancreatic cancer cells of patients with early postoperative liver metastasis had higher proliferative activity, while the infiltration of CD4+ T cells in tumor specimens was less.

Conclusion

Our study suggested that increased immune cell infiltration (especially CD4+ T cells) and tumor cell proliferation may play an opposite role in liver metastasis recurrence after pancreatic cancer.
Decrease in the Number of Patients Presenting With ST-Segment Elevation Myocardial Infarction Across Catheterization Centers in Indonesia During the Coronavirus Disease 2019 Pandemic
Authors: Firman Doni , Mangkuanom Arwin Saleh , Iryuza Nanda , Fahri Ismir , Artha I Made Junior Rina , Mulia Erwin , Syukri Muhammad , Yonas Emir , Pranata Raymond , Alkatiri Amir Aziz
Published: August 2021

Background: The coronavirus disease 2019 (COVID-19) pandemic has become a global problem, put a heavy burden on the health care system, and resulted in many fatalities across the globe. A reduction in the number of cardiac emergencies, especially ST-segment elevation myocardial infarction (STEMI), is observed worldwide. In this study, we aimed to analyze the trends of cases and presentation of STEMI across several cardiac catheterization centers in Indonesia.

Method: This retrospective study was performed by combining medical record data from five different hospitals in Indonesia. We compared data from the time period between February to June 2019 with those between February and June 2020. Patients who were diagnosed with STEMI and underwent primary percutaneous coronary intervention (PPCI) procedures were included in the study.

Results: There were 41,396 emergency department visits in 2019 compared with 29,542 in 2020. The number of patients with STEMI declined significantly from 338 in 2019 to 190 in 2020. Moreover, the total number of PPCI procedures reduced from 217 in 2019 to 110 in 2020. The proportion of PPCI was not significantly reduced (64.2 vs. 57.9%). The majority of the patients were men, with a mean age of 54 years in 2019 and 55 years in 2020. We observed a significantly longer door-to-balloon time in 2020 than in 2019 (p < 0.001). We also observed a difference in the door-to-balloon time and ischemic time between the two periods.

Conclusion: We observed a decline in the number of patients presenting with STEMI to our centers. However, we observed no significant decline in the percentage of PPCI performed across our centers during this pandemic.
Solar Irradiance Nowcasting for Virtual Power Plants Using Multimodal Long Short-Term Memory Networks
Authors: Haputhanthri Dilantha , De Silva Daswin , Sierla Seppo , Alahakoon Damminda , Nawaratne Rashmika , Jennings Andrew , Vyatkin Valeriy
Published: August 2021

The rapid penetration of photovoltaic generation reduces power grid inertia and increases the need for intelligent energy resources that can cope in real time with the imbalance between power generation and consumption. Virtual power plants are a technology for coordinating such resources and monetizing them, for example on electricity markets with real-time pricing or on frequency reserves markets. Accurate short-term photovoltaic generation forecasts are essential for such virtual power plants. Although significant research has been done on medium- and long-term photovoltaic generation forecasting, the short-term forecasting problem requires special attention to sudden fluctuations due to the high variability of cloud cover and related weather events. Solar irradiance nowcasting aims to resolve this variability by providing reliable short-term forecasts of the expected power generation capacity. Sky images captured in proximity to the photovoltaic panels are used to determine cloud behavior and solar intensity. This is a computationally challenging task for conventional computer vision techniques and only a handful of Artificial Intelligence (AI) methods have been proposed. In this paper, a novel multimodal approach is proposed based on two Long Short-Term Memory Networks (LSTM) that receives a temporal image modality of a stream of sky images, a temporal numerical modality of a time-series of past solar irradiance readings and cloud cover readings as inputs for irradiance nowcasting. The proposed nowcasting pipeline consists of a preprocessing module and an irradiance augmentation module that implements methods for cloud detection, Sun localization and mask generation. The complete approach was empirically evaluated on a real-world solar irradiance case study across the four seasons of the northern hemisphere, resulting in a mean improvement of 39% for multimodality.
Integrative Analysis of Gene Expression Through One-Class Logistic Regression Machine Learning Identifies Stemness Features in Multiple Myeloma
Authors: Ban Chunmei , Yang Feiyan , Wei Min , Liu Qin , Wang Jiankun , Chen Lei , Lu Liuting , Xie Dongmei , Liu Lie , Huang Jinxiong
Published: August 2021

Tumor progression includes the obtainment of progenitor and stem cell-like features and the gradual loss of a differentiated phenotype. Stemness was defined as the potential for differentiation and self-renewal from the cell of origin. Previous studies have confirmed the effective application of stemness in a number of malignancies. However, the mechanisms underlying the growth and maintenance of multiple myeloma (MM) stem cells remain unclear. We calculated the stemness index for samples of MM by utilizing a novel one-class logistic regression (OCLR) machine learning algorithm and found that mRNA expression-based stemness index (mRNAsi) was an independent prognostic factor of MM. Based on the same cutoff value, mRNAsi could stratify MM patients into low and high groups with different outcomes. We identified 127 stemness-related signatures using weighted gene co-expression network analysis (WGCNA) and differential expression analysis. Functional annotation and pathway enrichment analysis indicated that these genes were mainly involved in the cell cycle, cell differentiation, and DNA replication and repair. Using the molecular complex detection (MCODE) algorithm, we identified 34 pivotal signatures. Meanwhile, we conducted unsupervised clustering and classified the MM cohorts into three MM stemness (MMS) clusters with distinct prognoses. Samples in MMS-cluster3 possessed the highest stemness fractions and the worst prognosis. Additionally, we applied the ESTIMATE algorithm to infer differential immune infiltration among the three MMS clusters. The immune core and stromal score were significantly lower in MMS-cluster3 than in the other clusters, supporting the negative relation between stemness and anticancer immunity. Finally, we proposed a prognostic nomogram that allows for individualized assessment of the 3- and 5-year overall survival (OS) probabilities among patients with MM. Our study comprehensively assessed the MM stemness index based on large cohorts and built a 34-gene based classifier for predicting prognosis and potential strategies for stemness treatment.
Health-Related Quality of Life: Longitudinal Analysis From the Time of Breast Biopsy Into the Post-treatment Period
Authors: Boivin Michael J. , Sikorskii Alla , Haan Pamela , Smith Stephanie S. , Symonds Laura L. , Khattree Ravindra , Giordani Bruno , Blow Adrian J. , Osuch Janet R.
Published: August 2021

Background: The physical, psychological, social, and spiritual quality of life (QoL) may be affected by breast cancer diagnosis and treatment, with mixed findings for psychological quality of life and cognitive ability performance. The present study aimed to evaluate QoL in women over 1 year from biopsy for a breast abnormality.

Methods: Self-reported measures of physical, psychological, social, and spiritual QoL were obtained after biopsy results but prior to treatment initiation (baseline), 4 and 12 months later. CogState computerized neuropsychological screening battery also provided an evaluation of psychological QoL. Three groups of women including those with benign biopsy results, those with malignancy treated with chemotherapy, and those with malignancy not treated with chemotherapy were compared at 4 and 12 months after adjusting for baseline to isolate the effects of treatment. Additional covariates included are age, level of education, and income.

Results: Benign biopsy results group included 72 women, whereas malignancy was found in 87 women of whom 33 were treated with chemotherapy and 54 without chemotherapy. At the time of diagnosis, women with cancer had worse psychological and social QoL but better spiritual QoL than those with benign biopsy results. Only CogState monitoring accuracy was worse for women with cancer compared with the controls at the time of biopsy results. After adjusting for QoL at baseline, women treated for cancer had worse physical and social QoL at 4 and 12 months later. Psychological well-being was worse for women with cancer at 4th month but improved at 1 year. No differences in cognition were found at 4 and 12 months when adjusted for baseline cognition and covariates.

Discussion: Breast cancer is a traumatic life event for women, affecting psychological and social QoL domains, yet increasing spiritual QoL. Later, cancer treatment worsens physical, psychological, and social QoL compared with those without cancer.

Conclusions: These findings suggest that interventions to improve psychological QoL may be especially important at the time of cancer diagnosis, while interventions to improve physical well-being are the most needed during and following cancer treatment. Support to improve social QoL is needed from the time of diagnosis into post-treatment survivorship.
Phylogenomics Based on Transcriptome Data Provides Evidence for the Internal Phylogenetic Relationships and Potential Terrestrial Evolutionary Genes of Lungfish
Authors: Zhao Linlin , Wang Shouqiang , Lou Fangrui , Gao Tianxiang , Han Zhiqiang
Published: August 2021

The evolutionary relationships of lungfish can provide crucial information on the transition from Sarcopterygii to tetrapods. Phylogenomics is necessary to explore accurate internal phylogenetic relationships among all lungfish species. In the context of the lack of genome-wide genetic information forProtopterus amphibious, we are the first to systematically report the transcriptome ofP. amphibiusand these sequences can be used to enrich the genome-wide genetic information of lungfish. Meanwhile, we also found significant differences in the expression levels of 3,189 genes between the lung and heart ofP. amphibious. Based on phylogenomics, 1,094 shared orthologous genes were identified and then applied to reconstruct the internal phylogenetic structure of lungfish species. The reconstructed phylogenetic relationships provide evidence that lungfish is the sister group of terrestrial vertebrates and thatNeoceratodus forsteriis the most primitive lungfish. Moreover, the divergence time between the most primitive lungfish and other lungfish species is between 186.11 and 195.36 MYA. Finally, 43 protein metabolism-related, stress response-related, and skeletogenesis-related genes were found to have undergone positive selection and fast evolution inN. forsteri. We suspected that these genes possibly helped ancient fish adapt to the new terrestrial environment and ultimately contributed to its spreading to land.
A Universal Approach for Maximizing Terahertz Wave Absorption in Graphene Cut-Wires
Authors: Zhu Hongjia , Wang Ximiao , Cao Zhaolong , Chen Huanjun , Deng Shaozhi
Published: August 2021

Graphene micro-/nanostructures and their arrays have attracted considerable attention in infrared (IR) and terahertz (THz) applications due to their strong plasmon responses. However, as too many parameters, including geometry, carrier concentration, frequency, and adjacent substrate, can affect the plasmonic behaviors of the micro-/nanostructures, the optimization of the THz-IR responses, such as absorption and reflection, of these structures and their arrays require tremendous computations on parameter scanning. Here, we propose a theoretical approach to design graphene cut-wires with maximized THz wave absorption. Analytical expression describing the THz absorption/reflection of graphene cut-wires is derived. Accordingly, a maximum THz wave absorption of the array, regardless of its operating frequencies and geometrical parameters, can be achieved by simply tuning the cut-wires duty ratio. The analytical results are further validated by numerical simulations. This intuitive design manner is of significance for the design of graphene arrays with high-efficiency THz responses as well as promoting their practical applications in THz functional devices.
Non-structural Proteins of Severe Fever With Thrombocytopenia Syndrome Virus Suppress RNA Synthesis in a Transcriptionally Active cDNA-Derived Viral RNA Synthesis System
Authors: Ren Fuli , Shen Shu , Ning Yun-Jia , Wang Qiongya , Dai Shiyu , Shi Junming , Zhou Min , Wang Hualin , Huang Chaolin , Zhang Ding-Yu , Deng Fei
Published: August 2021

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by the tick-borne SFTS bunyavirus (SFTSV) resulting in a high fatality rate up to 30%. SFTSV is a negative-strand RNA virus containing three single-stranded RNA genome segments designated as L, M, and S, which respectively, encode the RNA-dependent RNA polymerase (RdRp), glycoproteins Gn and Gc, and nucleoprotein (N) and non-structural proteins (NSs). NSs can form inclusion bodies (IBs) in infected and transfected cells. A previous study has provided a clue that SFTSV NSs may be involved in virus-like or viral RNA synthesis; however, the details remain unclear. Our work described here reveals that SFTSV NSs can downregulate virus-like RNA synthesis in a dose-dependent manner within a cDNA-derived viral RNA synthesis system, i.e., minigenome (−) and minigenome (+) systems based on transfection, superinfection, and luciferase reporter activity determination; meanwhile, NSs also show a weak inhibitory effect on virus replication. By using co-immunoprecipitation (Co-IP) and RT-PCR combined with site-directed mutagenesis, we found that NSs suppress virus-like RNA or virus replication through interacting with N but not with RdRp, and the negative regulatory effect correlates closely with the IB structure it formed but is not associated with its role of antagonizing host innate immune responses. When the cytoplasmic structure of IB formed by SFTSV NSs was deprived, the inhibitory effect of NSs on virus-like RNA synthesis would weaken and even disappear. Similarly, we also evaluated other bandavirus NSs that cannot form IB in neither infected nor transfected cells, and the results showed that the NSs of Heartland bandavirus (HRTV) did not show a significant inhibitory effect on virus-like RNA synthesis within a minigenome system. Our findings provide experimental evidence that SFTSV NSs participate in regulating virus-like or viral RNA synthesis and the negative effect may be due to the NSs–N interaction.
Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit
Authors: Turner Ashley D. , Sullivan Travis , Drury Kurt , Hall Trevor A. , Williams Cydni N. , Guilliams Kristin P. , Murphy Sarah , Iqbal O’Meara A. M.
Published: August 2021

In the midst of concerns for potential neurodevelopmental effects after surgical anesthesia, there is a growing awareness that children who require sedation during critical illness are susceptible to neurologic dysfunctions collectively termed pediatric post-intensive care syndrome, or PICS-p. In contrast to healthy children undergoing elective surgery, critically ill children are subject to inordinate neurologic stress or injury and need to be considered separately. Despite recognition of PICS-p, inconsistency in techniques and timing of post-discharge assessments continues to be a significant barrier to understanding the specific role of sedation in later cognitive dysfunction. Nonetheless, available pediatric studies that account for analgesia and sedation consistently identify sedative and opioid analgesic exposures as risk factors for both in-hospital delirium and post-discharge neurologic sequelae. Clinical observations are supported by animal models showing neuroinflammation, increased neuronal death, dysmyelination, and altered synaptic plasticity and neurotransmission. Additionally, intensive care sedation also contributes to sleep disruption, an important and overlooked variable during acute illness and post-discharge recovery. Because analgesia and sedation are potentially modifiable, understanding the underlying mechanisms could transform sedation strategies to improve outcomes. To move the needle on this, prospective clinical studies would benefit from cohesion with regard to datasets and core outcome assessments, including sleep quality. Analyses should also account for the wide range of diagnoses, heterogeneity of this population, and the dynamic nature of neurodevelopment in age cohorts. Much of the related preclinical evidence has been studied in comparatively brief anesthetic exposures in healthy animals during infancy and is not generalizable to critically ill children. Thus, complementary animal models that more accurately “reverse translate” critical illness paradigms and the effect of analgesia and sedation on neuropathology and functional outcomes are needed. This review explores the interactive role of sedatives and the neurologic vulnerability of critically ill children as it pertains to survivorship and functional outcomes, which is the next frontier in pediatric intensive care.
Organization and Implementation of a Stroke Center in Panamá, a Model for Implementation of Stroke Centers in Low and Middle Income Countries
Authors: Novarro-Escudero Nelson , Moon Yoon Ji , Olmedo Argelis , Ferguson Teresa , Caballero Ileana , Onodera Eduardo , Effio Euclides , Klein Lisa M. , Zink Elizabeth K. , Johnson Brenda , Urrutia Victor C.
Published: August 2021

Background: Stroke is the second leading cause of death and disability worldwide. Stroke centers have become a central component of modern stroke services in many high-income countries, but their feasibility and efficacy in low, middle, and emerging high-income countries are less clear. Also, despite the availability of international guidelines, many hospitals worldwide do not have organized clinical stroke care. We present a methodology to help hospitals develop stroke centers and review quality data after implementation.

Objectives: To describe and compare demographics, performance, and clinical outcomes of the Pacífica Salud, Hospital Punta Pacífica (PSHPP) stroke center during its first 3 years 2017–2019.

Methods: Pacífica Salud, Hospital Punta Pacífica was organized to implement protocols of care based on the best practices by international guidelines and a quality improvement process. The methodology for implementation adapts a model for translating evidence into practice for implementation of evidence-based practices in medicine. This is a retrospective study of prospectively collected quality data between March of 2017 to December of 2019 for patients admitted to PSHPP with primary diagnosis stroke. Data collected include demographics, clinical data organized per the Joint Commission's STK Performance Measures, door to needle, door to groin puncture, 90 day modified Rankin Score, and hemorrhagic complications from IV thrombolysis and mechanical thrombectomy (MT). Primary outcome: year over year proficiency in documenting performance measures. Secondary outcome: year over year improvement.

Results: A total of 143 patients were admitted for acute ischemic stroke, TIA, or hemorrhagic stroke. Of these, 36 were admitted in 2017, 50 in 2018, and 57 in 2019. Performance measure proficiency increased in the year-over-year analysis as did the total number of patients and the number of patients treated with IV thrombolysis and MT.

Conclusions: We present the methodology and results of a stroke program implementation in Panamá. This program is the first in the country and in Central America to achieve Joint Commission International (JCI) certification as a Primary Stroke Center (PSC). We postulate that the dissemination of management guidelines is not sufficient to encourage the development of stroke centers. The application of a methodology for translation of evidence into practice with mentorship facilitated the success of this program.
Association Between Processed Electroencephalogram-Based Objectively Measured Depth of Sedation and Cerebrovascular Response: A Systematic Scoping Overview of the Human and Animal Literature
Authors: Froese Logan , Dian Joshua , Gomez Alwyn , Batson Carleen , Sainbhi Amanjyot Singh , Zeiler Frederick A.
Published: August 2021

Background: Current understanding of the impact that sedative agents have on neurovascular coupling, cerebral blood flow (CBF) and cerebrovascular response remains uncertain. One confounding factor regarding the impact of sedative agents is the depth of sedation, which is often determined at the bedside using clinical examination scoring systems. Such systems do not objectively account for sedation depth at the neurovascular level. As the depth of sedation can impact CBF and cerebral metabolism, the need for objective assessments of sedation depth is key. This is particularly the case in traumatic brain injury (TBI), where emerging literature suggests that cerebrovascular dysfunction dominates the burden of physiological dysfunction. Processed electroencephalogram (EEG) entropy measures are one possible solution to objectively quantify depth of sedation. Such measures are widely employed within anesthesia and are easy to employ at the bedside. However, the association between such EEG measures and cerebrovascular response remains unclear. Thus, to improve our understanding of the relationship between objectively measured depth of sedation and cerebrovascular response, we performed a scoping review of the literature.

Methods: A systematically conduced scoping review of the existing literature on objectively measured sedation depth and CBF/cerebrovascular response was performed, search multiple databases from inception to November 2020. All available literature was reviewed to assess the association between objective sedation depth [as measured through processed electroencephalogram (EEG)] and CBF/cerebral autoregulation.

Results: A total of 13 articles, 12 on adult humans and 1 on animal models, were identified. Initiation of sedation was found to decrease processed EEG entropy and CBF/cerebrovascular response measures. However, after this initial drop in values there is a wide range of responses in CBF seen. There were limited statistically reproduceable associations between processed EEG and CBF/cerebrovascular response. The literature body remains heterogeneous in both pathological states studied and sedative agent utilized, limiting the strength of conclusions that can be made.

Conclusions: Conclusions about sedation depth, neurovascular coupling, CBF, and cerebrovascular response are limited. Much further work is required to outline the impact of sedation on neurovascular coupling.
Infant Attachment and Social Modification of Stress Neurobiology
Authors: Packard Katherine , Opendak Maya , Soper Caroline Davis , Sardar Haniyyah , Sullivan Regina M.
Published: August 2021

Decades of research have informed our understanding of how stress impacts the brain to perturb behavior. However, stress during development has received specific attention as this occurs during a sensitive period for scaffolding lifelong socio-emotional behavior. In this review, we focus the developmental neurobiology of stress-related pathology during infancy and focus on one of the many important variables that can switch outcomes from adaptive to maladaptive outcome: caregiver presence during infants’ exposure to chronic stress. While this review relies heavily on rodent neuroscience research, we frequently connect this work with the human behavioral and brain literature to facilitate translation. Bowlby’s Attachment Theory is used as a guiding framework in order to understand how early care quality impacts caregiver regulation of the infant to produce lasting outcomes on mental health.
Estimation of Muscle Mass in the Integrated Assessment of Patients on Hemodialysis
Authors: Sabatino Alice , Broers Natascha J. H. , van der Sande Frank M. , Hemmelder Marc H. , Fiaccadori Enrico , Kooman Jeroen P.
Published: August 2021

Assessment of muscle mass (MM) or its proxies, lean tissue mass (LTM) or fat-free mass (FFM), is an integral part of the diagnosis of protein-energy wasting (PEW) and sarcopenia in patients on hemodialysis (HD). Both sarcopenia and PEW are related to a loss of functionality and also increased morbidity and mortality in this patient population. However, loss of MM is a part of a wider spectrum, including inflammation and fluid overload. As both sarcopenia and PEW are amendable to treatment, estimation of MM regularly is therefore of major clinical relevance. Whereas, computer-assisted tomography (CT) or dual-energy X-ray absorptiometry (DXA) is considered a reference method, it is unsuitable as a method for routine clinical monitoring. In this review, different bedside methods to estimate MM or its proxies in patients on HD will be discussed, with emphasis on biochemical methods, simplified creatinine index (SCI), bioimpedance spectroscopy (BIS), and muscle ultrasound (US). Body composition parameters of all methods are related to the outcome and appear relevant in clinical practice. The US is the only parameter by which muscle dimensions are measured. BIS and SCI are also dependent on either theoretical assumptions or the use of population-specific regression equations. Potential caveats of the methods are that SCI can be influenced by residual renal function, BIS can be influenced by fluid overload, although the latter may be circumvented by the use of a three-compartment model, and that muscle US reflects regional and not whole body MM. In conclusion, both SCI and BIS as well as muscle US are all valuable methods that can be applied for bedside nutritional assessment in patients on HD and appear suitable for routine follow-up. The choice for either method depends on local preferences. However, estimation of MM or its proxies should always be part of a multidimensional assessment of the patient followed by a personalized treatment strategy.
SNAP25 Inhibits Glioma Progression by Regulating Synapse Plasticity via GLS-Mediated Glutaminolysis
Authors: Huang Qiongzhen , Lian Changlin , Dong Yaoyuan , Zeng Huijun , Liu Boyang , Xu Ningbo , He Zhenyan , Guo Hongbo
Published: August 2021

Background

Neuronal activity regulated by synaptic communication exerts an important role in tumorigenesis and progression in brain tumors. Genes for soluble N-ethylmaleimide-sensitive factor attachment protein receptors (SNAREs) annotated with the function ‘vesicle’ about synaptic connectivity were identified, and synaptosomal-associated protein 25 (SNAP25), one of those proteins, was found to have discrepant expression levels in neuropathies. However, the specific mechanism and prognostic value of SNAP25 during glioma progression remain unclear.

Methods

Using RNA sequencing data from The Cancer Genome Atlas (TCGA) database, the differential synaptosis-related genes between low grade glioma (LGG) and glioblastoma (GBM) were identified as highly correlated. Cox proportional hazards regression analysis and survival analysis were used to differentiate the outcome of low- and high-risk patients, and the Chinese Glioma Genome Atlas (CGGA) cohort was used for validation of the data set. RT-qPCR, western blot, and immunohistochemistry assays were performed to examine the expression level of SNAP25 in glioma cells and samples. Functional assays were performed to identify the effects of SNAP25 knockdown and overexpression on cell viability, migration, and invasion. Liquid chromatography-high resolution mass spectrometry (LC-MS)-based metabolomics approach was presented for identifying crucial metabolic disturbances in glioma cells. In situ mouse xenograft model was used to investigate the role of SNAP25 in vivo. Then, an immunofluorescence assay of the xenograft tissue was applied to evaluate the expression of the neuronal dendron formation marker-Microtubule Associated Protein 2 (MAP2).

Results

SNAP25 was decreased in level of expression in glioma tissues and cell lines, and low-level SNAP25 indicated an unfavorable prognosis of glioma patients. SNAP25 inhibited cell proliferation, migration, invasion and fostered glutamine metabolism of glioma cells, exerting a tumor suppressor role. Overexpressed SNAP25 exerted a lower expression level of MAP2, indicating poor neuronal plasticity and connectivity. SNAP25 could regulate glutaminase (GLS)-mediated glutaminolysis, and GLS knockdown could rescue the anti-tumor effect of SNAP25 in glioma cells. Moreover, upregulated SNAP25 also decreased tumor volume and prolonged the overall survival (OS) of the xenograft mouse.

Conclusion

SNAP25, a tumor suppressor inhibited carcinogenesis of glioma via limiting glutamate metabolism by regulating GLS expression, as well as inhibiting dendritic formation, which could be considered as a novel molecular therapeutic target for glioma.
Maintenance Treatment With Low-Dose Decitabine After Allogeneic Hematopoietic Cell Transplantation in Patients With Adult Acute Lymphoblastic Leukemia
Authors: Liu Jia , Jiang Zhong-Xing , Xie Xin-Sheng , Wan Ding-Ming , Cao Wei-Jie , Wang Meng , Liu Zhen-Zhen , Dong Zhen-Kun , Wang Hai-Qiong , Lu Run-Qing , Zhang Yin-Yin , Cheng Qian-Qian , Fan Ji-Xin , Li Wei , He Fei , Guo Rong
Published: August 2021

Background

Post-transplant relapse remains a principal leading cause of failure after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in patients with adult acute lymphoblastic leukemia (ALL). The aim of this study was to investigate the efficacy and safety of low-dose decitabine on the prevention of adult ALL relapse after allo-HSCT.

Methods

In this prospective study, we enrolled 34 patients with ALL who underwent allo-HSCT from August 2016 to April 2020 and received low-dose decitabine maintenance treatment after transplantation. The primary objectives were cumulative incidence of relapse rate (CIR), overall survival (OS), and disease-free survival (DFS). The secondary objectives were graft-versus-host disease (GVHD) and safety.

Results

Among the enrolled 34 patients, 6 patients relapsed and 6 patients died. The 2-year CIR, OS, and DFS were 20.2, 77.5, and 73.6%, respectively. Subgroup analysis revealed the 2-year CIR, OS, and DFS rates of 12 patients with T-ALL/lymphoblastic lymphoma (LBL) were 8.3, 90, and 81.5%, respectively. None of the seven patients with T-ALL relapsed. During maintenance treatment, only one patient (2.9%) developed grade IV acute GVHD and four (11.8%) patients had severe chronic GVHD. Thirty-two patients (94.1%) developed only grade I to II myelosuppression, and two patients (5.8%) developed grade III to IV granulocytopenia.

Conclusions

Maintenance treatment with low-dose decitabine after allo-HSCT may be used as a therapeutic option to reduce relapse in patients with adult ALL, especially in patients with T-ALL. Our findings require confirmation in larger-scale controlled trials.

Clinical Trial Registration

Chinese Clinical Trials Registry, identifier ChiCTR1800014888.
Prognostic Value of the Systemic Inflammatory Response Index in Patients Undergoing Radical Cystectomy for Bladder Cancer: A Population-Based Study
Authors: Ni Jinliang , Wang Keyi , Zhang Houliang , Xie Jinbo , Xie Jun , Tian Changxiu , Zhang Yifan , Li Weiyi , Su Bin , Liang Chaozhao , Song Xinran , Peng Bo
Published: August 2021

Purpose

The aim of this study was to evaluate the prognostic significance of the systemic inflammatory response index (SIRI) in patients with bladder cancer (BCa) treated with radical cystectomy (RC) and develop a survival predictive model through establishing a nomogram.

Materials and Methods

A total of 203 BCa patients who underwent RC were included in this study. The relationship between the SIRI and overall survival (OS), disease-free survival (DFS), and clinicopathological features were evaluated. Cox regression analysis was performed to investigate the effect of the factors on the OS and DFS. The results were applied in the establishment of a nomogram. Receiver operating characteristic (ROC) curves, decision curve analysis (DCA) curves, and calibration curves were performed to assess the predictive performance and accuracy of the nomogram, respectively.

Results

According to the classification of the SIRI, 81 patients (39.9%) were assigned to SIRI grade 1, 94 patients (46.3%) to SIRI grade 2, and the remaining 28 patients (13.8%) to SIRI grade 3. Multivariate Cox regression revealed that a higher SIRI grade was significantly associated with a poor prognosis and served as an independent prognostic factor for the OS [Grade 2 vs Grade 1, odds ratio = 2.54, 95% confidence interval (CI),1.39–4.64, P = 0.002; Grade 3 vs Grade 1, odds ratio = 4.79, 95%CI: 2.41–9.50, P < 0.001] and DFS [Grade 2 vs Grade 1, odds ratio = 2.19, 95% CI, 1.12–4.31, P = 0.023; Grade 3 vs Grade 2, odds ratio = 3.36, 95%CI, 1.53–7.35, P = 0.002]. The ROC and DCA analysis indicated that the nomogram based on the SIRI contained a better predictive performance compared with the TNM stage (AUC = 0.750 and 0.791; all P < 0.05). The ROC analysis showed that nomograms can better predict the 3- and 5-year OS and DFS. The calibration curves exhibited a significant agreement between the nomogram and the actual observation.

Conclusion

SIRI as a novel independent prognostic index and potential prognostic biomarker can effectively improve the traditional clinicopathological analysis and optimize individualized clinical treatments for BCa patients after RC.
Under-utilization of Narrow-Spectrum Antibiotics in the Ambulatory Management of Pediatric UTI: A Single-Center Experience
Authors: Lee Philip , Kim Mimi , Herold Betsy C. , Soma Vijaya L.
Published: August 2021

Objective: There are urinary tract infection (UTI) guidelines for treatment of patients <2 years old, but there is a paucity of data for other pediatric age groups including the potential role for stewardship to reduce prescription of broad-spectrum antibiotics. We assessed practice patterns for the diagnosis and empiric treatment of UTI for outpatient and school health sites affiliated with a large urban pediatric medical center. We hypothesized that outpatient providers under-utilize narrow-spectrum antibiotics, such as first-generation cephalosporins, for uncomplicated UTI.

Study Design: Retrospective study from December 1st, 2015 to May 31st, 2016.

Results: The study population included 903 children (70.1% female) with a median age of 11 years, evaluated in an outpatient clinic (n = 780, 86.4%) or school health site (n = 123, 13.6%). E. coli was the most common urinary pathogen (50.9%) and 92.6% of E. coli isolates were susceptible to cephalexin. However, cephalexin was prescribed empirically for only 12.8% of patients. In contrast, sulfamethoxazole-trimethoprim was commonly prescribed, but only 79% of E. coli isolates were susceptible. Antibiotics were discontinued in only three of 48 children who had negative urine cultures.

Conclusions: Cephalexin may be the most appropriate first-line choice for management of outpatient UTI for our patient population. Antibiotics were rarely discontinued for those with negative urine cultures. Antibiotic stewardship in the outpatient setting could reduce unnecessary antibiotic exposure in the management of pediatric UTI.
Comparison of Two Different Cut-Off Values of Scoring System for Diagnosis of Hirschsprung-Associated Enterocolitis After Transanal Endorectal Pull-Through
Authors: Gunadi  , Luzman Raedi Ardlo , Kencana Sagita Mega Sekar , Arthana Bhagas Dwi , Ahmad Fauzan , Sulaksmono Ganjar , Rastaputra Agitha Swandaru , Arini Golda Puspa , Pitaka Ririd Tri , Dwihantoro Andi , Makhmudi Akhmad
Published: August 2021

Background: Hirschsprung-associated enterocolitis (HAEC) is a major contributor in the mortality of Hirschsprung disease (HSCR) patients that can occur both preoperatively and post-operatively. Several cut-off values of HAEC score have been used, i.e., ≥10 and ≥4. Here, we compared the HAEC frequency after transanal endorectal pull-through (TEPT) using two cut-offs of scoring system and associated them with the risk factors.

Methods: Cross-sectional analysis was conducted using medical records of HSCR patients who were aged ≤18 years old and underwent TEPT at our institution, Indonesia between 2009 and 2016. HAEC was determined using the scoring system with cut-off values of ≥10 and ≥4.

Results: Seventy subjects were used in the final analysis, consisting of 44 males and 26 females. There was a significant difference in one HAEC finding between the ≥10 and ≥4 cut-off groups; diarrhea with explosive stools (p = 0.002). The HAEC frequency was 5/70 (7.1%) and 49/70 (70%) patients using cut-off values of ≥10 and ≥4 (p < 0.0001), respectively. We found that patients with anemia (i.e., iron deficiency anemia) had a higher risk of HAEC after TEPT than patients with normal hemoglobin level with OR of 3.77 (95% CI = 1.28–11.1; p = 0.027), while no associations were found between other variables, including sex, age at diagnosis, age at definitive therapy, albumin level, and nutritional status and HAEC following TEPT (p = 0.87, 0.15, 0.33, 0.26, and 0.60, respectively). Also, no associations were observed between maternal education level, mother's age at pregnancy and gestational age and HAEC after definitive surgery (p = 0.10, 0.46, and 0.86, respectively).

Conclusions: This report is the first study comparing two different cut-off values of scoring system to evaluate the HAEC frequency after TEPT and results suggest further using cut-off of ≥4 to expand the diagnosis of HAEC. Moreover, we also show for the first time that hemoglobin level is a strong risk factor for the HAEC development after TEPT.