bluuebunny/crossref_metadata_2025_split huggingface dataset:
Different hypothermic and cerebral perfusion strategies in extended arch replacement for acute type A aortic dissection: a retrospective comparative study
Authors: Dong Song-Bo , Xiong Jian-Xian , Zhang Kai , Zheng Jun , Xu Shang-Dong , Liu Yong-Min , Sun Li-Zhong , Pan Xu-Dong 
Published: September 2020

Abstract
Background: The optimal hypothermic level in total arch replacement with stented elephant trunk implantation for acute type A aortic dissection (aTAAD) has not been established, and the superiority of unilateral or bilateral cerebral perfusion remains a controversial issue. Therefore, we evaluated the application of moderate hypothermic circulatory arrest (MHCA) with a core temperature of 29℃ and bilateral selective antegrade cerebral perfusion in aTAAD treated by total arch replacement with stented elephant trunk implantation. Methods: From July 2019 to January 2020, 25 aTAAD patients underwent total arch replacement with stented elephant trunk implantation via MHCA (29℃) and bilateral selective antegrade cerebral perfusion (modified group). Thirty-six patients treated by the same procedure with MHCA (25℃) and unilateral selective antegrade cerebral perfusion during this period were selected as controls. Results: There were no differences between the two groups of patients in terms of age, sex, incidence of hypertension, malperfusion, and pericardial effusion, although the incidence of cardiac tamponade was higher in the modified group (control 2.8%, modified 20%; P = 0.038). The lowest mean circulatory arrest temperature was 24.6±0.9℃ in the control group, and 29±0.8℃ in the modified group (P < 0.001). In-hospital mortality was 4.9% (3/61) for the entire cohort (control 8.3%, modified 0; P = 0.262). The incidence of permanent neurologic deficit was 4.9% (control 8.3%, modified 0; P = 0.262). There were no significant differences in the occurrence of temporary neurological deficit, renal failure, and paraplegia between groups. The rate of major adverse events in the modified group was lower (30.6% vs. 4%, P = 0.019). A shorter duration of ventilation and ICU stay was identified in the modified group, as well as a reduced volume of drainage within the first 48 h and red blood cell transfusion.Conclusions: The early results of MHCA (29℃) and bilateral selective antegrade cerebral perfusion applied in total arch replacement with stented elephant trunk implantation for aTAAD were acceptable, providing similar inferior cerebral and visceral protection compared with that of the conventional strategy. A higher core temperature may account for the shorter duration of ventilation and ICU stay, as well as a reduced volume of drainage and red blood cell transfusion.
Chronic Obstructive Pulmonary Disease (COPD) management in the community: how could primary care team contribute?
Authors: CHEN Catherine Xiao Rui , Leung Siu Hong , Li Yim Chu 
Published: September 2020

Abstract
Background: Chronic obstructive pulmonary disease (COPD) is a progressive lung disease commonly encountered in primary care. This study aimed to audit COPD care at primary care clinics of Hong Kong and to work out improvement strategies. Method: All COPD patients aged 40 or above who had been followed up at 13 public primary care clinics of Kowloon Central Cluster (KCC) under the Hospital Authority of Hong Kong (HAHK) were included in this clinic audit. Evidence-based audit criteria and performance standards were established after thorough literature review. Phase 1 was from 1st April 2016 to 31st March 2017, with deficiencies of care identified. It was followed by a one-year implementation phase through which a series of improvement strategies were executed. Outcome of the enhancement was reviewed during Phase 2 from 1st April 2018 to 31st March 2019. Chi-square test and student’s t test were used to detect statistically significant changes between Phase 1 and Phase 2. Results: A total of 2,358 COPD cases were identified in Phase 1 where 658 of them were smokers. Of those smokers, 332 (50.5%) had been referred to Smoking Counselling and Cessation Service (SCCS) and 289 (43.9%) actually attended it. 991 cases (42%) received Seasonal Influenza Vaccine (SIV) and 938 cases (39.8%) received Pneumococcal Vaccine (PCV). 698 patients (29.6%) had spirometry done before and 423 patients (17.9%) had been admitted to hospital due to acute exacerbation of COPD (AECOPD). With the concerted effort taken during the implementation phase, Phase 2 data showed significant improvement in nearly all criteria. There was a marked increase in the SIV and PCV uptake rate, spirometry performance rate and most importantly, a significant reduction in AECOPD rate leading to hospital admission (13.5%, P=0.000043). However, the referral rate and attendance rate of SCCS among smokers remained stagnant (P>0.05). Conclusion: Via a systematic team approach, COPD care at primary care clinics of KCC under HAHK had been significantly improved for most of the audit criteria, which in turn reduced the burden of the healthcare system.
Identification, characterization and functional analysis of AGAMOUS subfamily genes associated with floral organs and seed development in Marigold (Tagetes erecta)
Authors: Zhang Chunling , Wei Ludan , Wang Wenjing , Qi Wenquan , Cao Zhe , Li Hang , Bao Manzhu , he yanhong 
Published: September 2020

Abstract
Background: AGAMOUS ( AG ) subfamily genes regulate the floral organs initiation and development, fruit and seed development. At present, there has been insufficient study of the function of AG subfamily genes in Asteraceae. Marigold ( Tagetes erecta ) belongs to Asteraceae family whose unique inflorescence structure makes it an important research target for understanding floral organ development in plants. Results: Four AG subfamily genes of marigold were isolated and phylogenetically grouped into class C ( TeAG1 and TeAG2 ) and class D ( TeAGL11-1 and TeAGL11-2 ) genes. Expression profile analysis demonstrated that these four genes were highly expressed in reproductive organs of marigold. Subcellular localization analysis suggested that all these four proteins were located in the nucleus. Protein-protein interactions analysis indicated that class C proteins had a wider interaction manner than class D proteins. Function analysis of ectopic expression in Arabidopsis thaliana revealed that TeAG1 displayed a C function specifying the stamen identity and carpel identity, and that TeAGL11-1 exhibited a D function regulating seed development and petal development. In addition, overexpression of both TeAG1 and TeAGL11-1 leaded to curling rosette leaf and early flowering in Arabidopsis thaliana . Conclusions: This study provides an insight into molecular mechanism of AG subfamily genes in Asteraceae species and technical support for improvement of several floral traits.
Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre
Authors: Lin Zhi-qin , Luo Zeng-rong , Li Qian-zhen , Chen Liang-wan , lin feng 
Published: September 2020

Abstract
Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.
Total versus conventional laparoscopic cyst excision and Roux-en-Y hepaticojejunostomy in children with choledochal cysts: a case-control study
Authors: LIU FEI , Xu Xiaogang , Lan Menglong , Tao Boyuan , Li Le , Wu Qiang , Chai Chengwei , Zeng Jixiao 
Published: September 2020

Abstract
Background : To compare the efficacy of total and conventional laparoscopic hepaticojejunostomy (TLH and CLH) in children with choledochal cysts (CDCs). Methods: Patients undergoing TLH and CLH between August 2017 and December 2018 were retrospectively analyzed. Intraoperative blood loss, time for jejunum-co-jejunum anastomosis, time to oral intake, postoperative hospital stay, hospitalization expenses, postoperative complications were compared. Results: All 55 patients (TLH=30, CLH=25) were successfully treated without conversion to open surgery. In the TLH and CLH groups, the time to oral intake was 3.57±0.19 d and 4.56±0.27 d, respectively ( t =3.07, P <0.01), the postoperative hospital stay was 5.50±0.28 d and 7.00±0.74 d ( t =2.03, P <0.05), the hospitalization expenses were CNY 40085±2447 and CNY 26084±2776 ( t =3.79, P <0.001). There were no significant differences in intraoperative blood loss (9.57±3.28ml vs 8.2±1.13 ml, t =0.37, P = 0.72) and time for jejunum-co-jejunum anastomosis (80.5±2.46 min vs 75.00±2.04 min, t =1.68, P =0.10). The median follow-up periods of TLH and CLH group were 17 and 16 months respectively. Overall comlication rates were comparable between two groups (10% vs 8%, c ² =0.07, P =0.79). Conclusions: TLH in children with CDCs has the advantages of rapid gastrointestinal functional recovery and short hospitalization. However, hospitalization is relatively expensive.
Anatomical analysis of the left upper lobe of lung on three-dimensional images with focusing the branching pattern of the subsegmental veins
Authors: Isaka Tamami , Mitsuboshi Shota , Maeda Hideyuki , Kikkawa Takuma , Oyama Kunihiro , Murasugi Masahide , Kanzaki Masato , Onuki Takamasa 
Published: September 2020

Abstract
Background : Although a clear understanding of the anatomical characteristics of the pulmonary veins (PVs) is essential for the successful performance of segmentectomy and is important to avoid intraoperative pulmonary vessels injury, there is no report showing the relations between the branching patterns of PVs and pulmonary arteries (PAs). Moreover, internationally accepted symbols for describing the PVs remain unavailable. For anatomically assessing the branches and courses of the subsegmental veins in the left upper lobe (LUL), the diverse branching patterns of blood vessels and bronchi should be investigated. Methods : The branching patterns and intersegmental courses of PVs were assessed by performing three-dimensional image analysis of the bronchi, and PAs and PVs in the LUL in 103 patients who were scheduled to receive segmentectomy in LUL from January 2008 through August 2012. Results : Branching types of the bronchus and pulmonary vessels failed to be independent each other. Combinations of anterior extension type of bronchi with the inter-lobar type (IL-type) of arterial branching pattern were often observed, but those with the mediastinal type (M-type) were rarely observed. The combinations of apical vein dominant type with the IL-type of arteries, and intermediate and central vein type with the M-type were often observed. LUL was adjoined by various subsegments, and the intersegmental pulmonary veins showed diverse patterns. Conclusions : This study found the relationship among PA, PV, and bronchus patterns, and in the subsegment where the branching patters were fixed in 103 cases. This study discovered PVs that was difficult to be named by the conventional naming systems because of the diversity of the locations in the subsegment.
Deciphering the transcriptional changes in Escherichia coli strains C41(DE3) and C43(DE3) that makes them a superior choice for membrane protein production.
Authors: Webb Chaille Teresa , Lithgow Trevor 
Published: September 2020

Abstract
Background: The production of membrane proteins for functional and structural protein analysis remains a bottleneck in the continuing quest for understanding biological systems. For recombinant membrane proteins, the Walker strains C41(DE3) and C43(DE3) are a valuable tool because they are capable of producing levels of functional protein that would otherwise be toxic to the cell. At the genome level, amongst only a handful of genetic changes, mutations in the lac UV5 promoter region upstream from the bacteriophage T7 RNA polymerase gene distinguish these strains from BL21(DE3) but do not inform on how the strains have adapted for superior production of recombinant membrane proteins. Results: Comparative transcriptomic analyses revealed a moderate change in gene expression in C41(DE3) and C43(DE3) compared to their parent strain BL21(DE3) under standard growth conditions. However, under the conditions used for membrane protein production (with plasmid carriage and addition of IPTG), the differential response of C41(DE3) and C43(DE3) compared to their parent strain BL21(DE3) was striking. Over 2000 genes were differentially expressed in C41(DE3) with a two-fold change and false discover rate < 0.01 and 1700 genes differentially expressed in C43(DE3) compared to their parent strain BL21(DE3). Conclusion : These results illuminate the cellular adaptations occurring in the Walker strains in response to minimal genetic changes. These changes in the transcriptome may help alleviate the toxic effects that can occur and improve membrane protein production. The BL21(DE3) derivatives strains C41(DE3) and C43(DE3), are adept to the process of membrane biogenesis in E. coli , making them superior to their parent strain for the production of membrane proteins and potentially other toxic proteins.
Long Term Outcomes of Colon Polyps with High Grade Dysplasia Following Endoscopic Resection
Authors: Chang Jia-Jang , Chien Cheng-Hung , Chen Shuo-Wei , Chen Li-Wei , Liu Ching-Jung , Yen Cho-Li 
Published: September 2020

Abstract
Background The risk of recurrent colonic adenoma associated with high-grade dysplasia (HGD) colon polyps at baseline colonoscopy remains unclear. We conducted a clinical cohort study with patients who underwent polypectomy during screen colonoscopy to assess recurrent colonic adenoma risk factors. Methods 11,565 patients at our facility underwent screen colonoscopy between September 1998 and August 2007. Data from patients with HGD colon polyps who had undergone follow-up colonoscopy were included for analysis. Results Data from 211 patients was included. Rates of metachronous adenoma and advanced adenoma at follow-up were 58% and 20%, respectively. Mean follow-up period was 5.5 ± 1.8 (3-12) years. Univariate logistic regression analysis revealed that an adenoma count of ≥ 3 at baseline colonoscopy was strongly associated with overall recurrence, multiple recurrence, advanced recurrence, proximal recurrence, and distal adenoma recurrence with odds ratios of 4.32 (2.06-9.04 95%CI), 3.47 (1.67-7.22 95%CI), 2.55 (1.11-5.89 95%CI), 2.46 (1.16-5.22 95%CI), 2.89 (1.44-5.78 95%CI), respectively. Multivariate analysis revealed gender (male) [P=0.010; OR 3.09(1.32-7.25 95% CI)] and adenoma count ≥ 3 [P=0.002; OR 3.08(1.52-6.24 95%CI)] at index colonoscopy to be significantly associated with recurrence of advanced adenoma. Conclusion Recurrence of colonic adenoma at time of follow-up colonoscopy is common in patients who undergo polypectomy for HGD colon adenomas during baseline colonoscopy. Risk of further developing advanced adenomas is associated with gender and the number of colon adenomas present.
A clinical analysis of causes of hand injuries and their countermeasures during the COVID-19 outbreak and work resumption period
Authors: Jin Qianjun , Zhou Haiying , lu hui 
Published: September 2020

Abstract
Background: In the new circumstances created by the COVID-19 pandemic, fuller knowledge of hand injury patterns may help with the injury prevention in factories and the management of related medical institutions. Methods: 95 patients were admitted to an orthopedics department with an emergent hand injury within half a year of the COVID-19 outbreak. Data was collected from January 23, 2020 to July 23, 2020. Information about demographics, types of injury, location of the injuries, side of the lesions, mechanism of the injuries, place where the injuries occurred, surgical management and outcomes was collected. Results: The number of total emergency visits due to hand injury during the COVID-19 outbreak decreased 37% from the same period of the previous year. During the resumption of work it saw an increase of 40%. In comparison with the corresponding period of the previous year, most of the injured patients during the COVID-19 outbreak stage were women (60%) with a mean age of 56.7, while during the work resumption stage they were men (82.4%) with a mean age of 44.8. Most of the injuries in the work resumption period occurred at work (64.7%), significantly more than in the same period in 2019 (37.3%), and machine injury was the most frequent injury mechanism (58.8%). Cutting injuries of different degrees comprised the majority of the total cases (82.4%), far more than simple fractures and dislocations. Fingers were the most commonly injured body part. The majority of the injuries were classified as minor or moderate (90%) during the outbreak, and major (40%) during the work resumption. The proportion of major injuries during the work resumption stage in this year (40%) was almost double that of the previous year (pre-pandemic) (21.8%). Conclusion: The resumption of work following the COVID-19 outbreak is a time of high risk for hand injuries. The overall number of patients with hand injuries admitted into our department has decreased compared to the corresponding period of last year. However, workplace injuries, especially machine injury increased greatly during the six months after the outbreak of COVID-19. The proportion of major injuries increased by a large margin. Emergency and surgical service provides should be aware of the pattern of hand injuries during this atypical time in order to prepare and plan services accordingly.
Metabolomics analysis reveals Embden Meyerhof Parnas pathway activation and flavonoids accumulation during dormancy transition in tree peony
Authors: Zhang Tao , Yuan Yanchao , Zhan Yu , Cao Xinzhe , Liu Chunying , Zhang Yuxi , Gai Shupeng 
Published: September 2020

Abstract
Background: Bud dormancy is a sophisticated strategy which plants evolve to survive in tough environments. Endodormancy is a key obstacle for anti-season culture of tree peony, and sufficient chilling exposure is an effective method to promote dormancy release in perennial plants including tree peony. However, the mechanism of dormancy release is still poorly understood, and there are few systematic studies on the metabolomics during chilling induced dormancy transition. Results: The tree peony buds were treated with artificial chilling, and the metabolmics analysis was employed at five time points after 0-4ºC treatment for 0, 7, 14, 21 and 28 d, respectively. A total of 535 metabolites were obtained and devided into 11 groups including flavonoids, amino acid and its derivatives, lipids, organic acids and its derivates, nucleotide and its derivates, alkaloids, hydroxycinnamoyl derivatives, carbohydrates and alcohols, phytohormones, coumarins and vitamins. Totally, 118 differential metabolites (VIP≥1, P <0.05) during chilling treatment process were detected, and their KEGG pathways involved in several metabolic pathways related to dormancy. Sucrose was the most abundant carbohydrate in peony bud. Starch was degradation and Embden Meyerhof Parnas (EMP) activity were increased during the dormancy release process, according to the variations of sugar contents, related enzyme activities and key genes expression. Flavonoids synthesis and accumulation were also promoted by prolonged chilling. Moreover, the variations of phytohormones (salicylic acid, jasmonic acid, abscisic acid, and indole-3-acetic acid) indicated they played different roles in dormancy transition. Conclusion: Our study suggested that starch degradation, EMP activation, and flavonoids accumulation were crucial and associated with bud dormancy transition in tree peony.
Extravascular risk factors in the prognostic evaluation for spinal cord injury during thoraco-abdominal aortic aneurysm exclusion: a case report.
Authors: Villani Flavio , Fargion Aaron Thomas , Melani Alberto , Esposito Davide , Domenico Rossella Di , Dorigo Walter , Pratesi Carlo 
Published: September 2020

Abstract
Background: The etiology of delayed-onset spinal cord injury (SCI) following endovascular repair of thoraco-abdominal aortic aneurysms (TAAA) is still unclear and may be related to multiple factors. Extravascular factors, such as lumbar spinal stenosis (LSS), may play a significant role in the selection of patient at risk of SCI. In this report we describe a case of paraplegia following thoracic endovascular aortic repair (TEVAR) in a patient suffering from severe and symptomatic LSS and undergoing staged endovascular repair of a TAAA. Case presentation : A 70-year-old man was admitted to our department with an asymptomatic type III TAAA in previous open repair for abdominal aortic aneurysm. The patient complained of buttock and thigh claudication in the absence of defects in the pelvic perfusion; a spinal magnetic resonance angiography (MRA) showed a severe narrowing of the lumbar canal. After 24 hours from first-step procedure (TEVAR) paraplegia was detected. A cerebrospinal fluid (CSF) drainage was then placed with incomplete recovery. Conclusions : Stenotic damage to the spinal cord is thought to be the result of direct compression of the neural elements and ischemic disruption of arterial and venous structures surrounding the spinal cord. This comorbidity may constitute an additional anatomic risk factor in those patients currently recognized as prognostically associated to the development of SCI.