bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pregnancy and Lactation Impair Subchondral Bone Leading to Reduced Rat Supraspinatus Tendon-to-Bone Insertion Site Failure Properties
Authors: Fung Ashley K. , Shetye Snehal S. , Li Yihan , Zhou Yilu , Sherry Liu X. , Soslowsky Louis J. 
Published: June 2020

Abstract
Pregnant women experience weight gain, gait changes, and biochemical fluctuations that impair joint function and alter the maternal skeleton. Hormonal changes increase pelvic ligament laxity in preparation for childbirth and affect peripheral joint laxity. Calcium demands also rise during pregnancy and lactation, resulting in reduced bone mineral density (BMD) and maternal bone loss. Altered tendon properties and bone loss during pregnancy and lactation may impact tendon insertion sites, such as rotator cuff tendons where insertion site ruptures are common. However, the effects of pregnancy and lactation at the tendon-to-bone interface have not been investigated. Therefore, the objective of this study was to evaluate supraspinatus tendon mechanical properties and insertion site microstructure during pregnancy, lactation, and postweaning recovery in female rats. We hypothesized that pregnancy and lactation would compromise supraspinatus tendon mechanical properties and subchondral bone microstructure. Female rats were divided into virgin, pregnancy, lactation, and recovery groups, and supraspinatus tendons were mechanically evaluated. Surprisingly, tendon mechanics was unaffected by pregnancy and lactation. However, tendon modulus decreased two-weeks postweaning. Additionally, tendons failed by bony avulsion at the insertion site, and the lactation group exhibited reduced failure properties corresponding to decreased subchondral bone mineralization. Lactation also resulted in dramatic bone loss at the epiphysis, but trabecular bone microarchitecture recovered postweaning. In conclusion, lactation following pregnancy impaired trabecular bone microstructure and subchondral bone mineralization, leading to reduced supraspinatus tendon-to-bone insertion site failure properties. These findings will contribute toward understanding the pathogenesis of tendon-to-bone disorders.
Semikinetic Model for Acid Dew Point Prediction in an Engine Cylinder
Authors: Li Deli , Wang Enlu , Cui Yi , Li Kai , Dong Jingjin 
Published: June 2020

Abstract
In this work, a simplified kinetic model of the SO3 generation reaction is proposed with a test diesel engine, and the semikinetic model was further developed and applied to predict the acid dew point (ADP) temperature. In the model, the one-dimensional combustion model and the reaction kinetic model of O-radicals and SO3 generation were considered. The recommended kinetic constant equation was also provided. In addition, the evolution of O-radicals and SO3 and the effects of both on the semikinetic ADP model were also discussed. To the best of my knowledge, the introduction of dynamics into the ADP model is a new and noteworthy contribution. The research results indicated that the ADP model based on the semikinetic method improved the prediction accuracy of the thermodynamic ADP model. The key factors in the O2 dissociation reaction were the high-temperature environment and the presence of flame and ignition. The O-radical concentration played a leading role in the SO3 formation reaction, and the SO3/SO2 conversion ratio was less than 10% in the cylinder.
12-year analysis of incidence, microbiological profiles and in vitro antimicrobial susceptibility of infectious keratitis: the Nottingham Infectious Keratitis Study
Authors: Ting Darren Shu Jeng , Ho Charlotte Shan , Cairns Jessica , Elsahn Ahmad , Al-Aqaba Mouhamed , Boswell Tim , Said Dalia G , Dua Harminder Singh 
Published: June 2020

Background/aimsTo examine the incidence, causative microorganisms and in vitro antimicrobial susceptibility and resistance profiles of infectious keratitis (IK) in Nottingham, UK.MethodsA retrospective study of all patients who were diagnosed with IK and underwent corneal scraping between July 2007 and October 2019 (a 12-year period) at a UK tertiary referral centre. Relevant data, including demographic factors, microbiological profiles and in vitro antibiotic susceptibility of IK, were analysed.ResultsThe estimated incidence of IK was 34.7 per 100 000 people/year. Of the 1333 corneal scrapes, 502 (37.7%) were culture-positive and 572 causative microorganisms were identified. Sixty (4.5%) cases were of polymicrobial origin (caused by ≥2 different microorganisms). Gram-positive bacteria (308, 53.8%) were most commonly isolated, followed by Gram-negative bacteria (223, 39.0%), acanthamoeba (24, 4.2%) and fungi (17, 3.0%). Pseudomonas aeruginosa (135, 23.6%) was the single most common organism isolated. There was a significant increase in Moraxella spp (p<0.001) and significant decrease in Klebsiella spp (p=0.004) over time. The in vitro susceptibilities of Gram-positive and Gram-negative bacteria to cephalosporin, fluoroquinolone and aminoglycoside were 100.0% and 81.3%, 91.9% and 98.1%, and 95.2% and 98.3%, respectively. An increase in resistance against penicillin was observed in Gram-positive (from 3.5% to 12.7%; p=0.005) and Gram-negative bacteria (from 52.6% to 65.4%; p=0.22).ConclusionIK represents a relatively common and persistent burden in the UK and the reported incidence is likely underestimated. Current broad-spectrum antimicrobial treatment provides a good coverage for IK, although challenged by some level of antimicrobial resistance and polymicrobial infection.
Reduced vessel density in deep capillary plexus correlates with retinal layer
thickness in choroideremia
Authors: Arrigo Alessandro , Romano Francesco , Parodi Maurizio Battaglia , Charbel Issa Peter , Birtel Johannes , Bandello Francesco , Maclaren Robert E 
Published: June 2020

Background
To assess retinal layer thickness in choroideremia (CHM) and to reveal its
correlation with optical coherence tomography (OCT) angiography (OCTA)
findings.

Methods
The study was designed as an observational, cross-sectional clinical
series of patients with CHM, which included 14 CHM eyes and 14 age-matched
controls. Multimodal imaging included OCT and OCTA. The vessel density (VD) of
superficial capillary (SCP), deep capillary (DCP) and choriocapillaris (CC)
plexuses was analysed by OCTA. The apparently preserved retinal islet and
atrophic regions were investigated separately. Main outcome measures were as
follows: best-corrected visual acuity (BCVA), total retinal layers, ganglion
cell layer (GCL), inner plexiform layer (IPL), inner nuclear layer (INL), outer
plexiform layer (OPL), outer nuclear layer (ONL), ellipsoid zone–retinal
pigment epithelium (EZ-RPE) layer, choroidal thickness and VDs of SCP, DCP and
of CC.

Results
Mean BCVA was 0.0±0.0 LogMAR in both groups. GCL, ONL, EZ-RPE and choroid
were significantly thinned in CHM, particularly in the atrophic region. OPL was
unaffected in the apparently preserved islet, whereas INL and IPL were
similarly thinned in the atrophic and apparently preserved retina. DCP appeared
severely affected in both regions, while CC was only altered in the atrophic
retina. Significant correlations were found between OCT and OCTA
parameters.

Conclusions
Our study showed severe alterations in both outer and inner retinal layers
of patients with CHM. The extended retinal involvement might be the consequence
of neuronal and vascular trophic factor reduction produced by the primarily
altered RPE and/or secondary Müller glial cell reaction.
Hepatic venous pressure gradient-guided laparoscopic splenectomy and pericardial devascularisation versus endoscopic therapy for secondary prophylaxis for variceal rebleeding in portal hypertension (CHESS1803): study protocol of a multicenter randomised controlled trial in China
Authors: Shao Ruoyang , Li Zhiwei , Wang Jitao , Qi Ruizhao , Liu Qingbo , Zhang Weijie , Mao Xiaorong , Song Xiaojing , Li Lei , Liu Yanna , Zhao Xin , Liu Chuan , Li Xun , Zuo Changzeng , Wang Weidong , Qi Xiaolong 
Published: June 2020

IntroductionGastro-oesophageal variceal bleeding is one of the most common and severe complications with high mortality in cirrhotic patients who developed portal hypertension. Hepatic venous pressure gradient (HVPG) is a globally recommended golden standard for the portal pressure assessment and an HVPG ≥16 mm Hg indicates a higher risk of death and rebleeding. This study aims to compare the effectiveness and safety of splenectomy and pericardial devascularisation (laparoscopic therapy) plus propranolol and endoscopic therapy plus propranolol for variceal rebleeding in cirrhotic patients with HVPG between 16 and 20 mm Hg.Methods and analysisThis is a multicenter, randomised, controlled clinical trial. Participants will be 1:1 assigned randomly into either laparoscopic or endoscopic groups. Forty participants whose transjugular HVPG lies between 16 and 20 mm Hg with a history of gastro-oesophageal variceal bleeding will be recruited from three sites in China. Participants will receive either endoscopic therapy plus propranolol or laparoscopic therapy plus propranolol. The primary outcome measure will be the occurrence of gastro-oesophageal variceal rebleeding. Secondary outcome measures will include overall survival, occurrence of hepatocellular carcinoma, the occurrence of venous thrombosis, the occurrence of adverse events, quality of life and tolerability of treatment. Outcome measures will be evaluated at baseline, 12 weeks, 24 weeks, 36 weeks, 48 weeks and 60 weeks. Multivariate COX regression model will be introduced for analyses of occurrence data and Kaplan-Meier analysis with the log-rank test for intergroup comparison.Ethics and disseminationEthical approval was obtained from all three participating sites. Primary and secondary outcome data will be submitted for publication in peer-reviewed journals and widely disseminated.Trial registration numberNCT03783065; Pre-results.Trial statusRecruitment for this study started in December 2018 while the first participant was randomised in January 2019. Recruitment is estimated to stop in October 2019.
Impact of massive blood transfusion during adult extracorporeal membrane oxygenation support on long-term outcomes: a nationwide cohort study in Taiwan
Authors: Chen Fang-Ting , Chen Shao-Wei , Wu Victor Chien-Chia , Hung Kuo-Chun , Chang Shang-Hung , Ting Pei-Chi , Chou An-Hsun 
Published: June 2020

ObjectivesBleeding is a common problem during adult extracorporeal membranes oxygenation (ECMO) support, requiring blood transfusion for correction of volume depletion and coagulopathy. The goal of this study is to investigate the long-term outcomes for adults under support of ECMO with massive blood transfusion (MBT).DesignRetrospective nationwide cohort study.SettingData were provided from Taiwan National Health Insurance Research Database (NHIRD).Participants and interventionsTotally 2757 adult patients were identified to receive MBT (red blood cell ≥10 units) during ECMO support from 2000 to 2013 via Taiwan NHIRD.Main outcome measuresThe outcomes included in-hospital major complications/mortality, all-cause mortality, cardiovascular death, newly onset end-stage renal disease and respiratory failure during the follow-up period.ResultsPatients with MBT had higher in-hospital mortality (65.6% vs 52.1%; OR 1.74; 95% CI 1.53 to 1.98) and all-cause mortality during the follow-up (47.0% vs 35.8%; HR 1.46; 95% CI 1.25 to 1.71) than those without MBT. Not only higher incidences of post ECMO sepsis, respiratory failure and acute kidney injury, but also longer duration of ECMO support, ventilator use and intensive care unit stay were demonstrated in the MBT group. Moreover, a subdistribution hazard model presented higher cumulative of respiratory failure (19.8% vs 16.2%; subdistribution HR 1.36; 95% CI 1.07 to 1.73) for the MBT cohort. Positive dose–dependent relationship was found between the amount of transfused red blood cell product and in-hospital mortality. In the MBT subgroup analysis for the impact of transfused ratio (fresh frozen plasma/packed red blood cell) on in-hospital mortality, ratio ≥1.0 had higher mortality.ConclusionsPatients with MBT during ECMO support had worse long-term outcomes than non-MBT population. The transfused amount of red blood cell had positive dose–dependent effect on in-hospital mortality.
Effect of knee arthroplasty on sports participation and activity levels: a systematic review and meta-analysis
Authors: Konings Marco J , De Vroey Henri , Weygers Ive , Claeys Kurt 
Published: June 2020

ObjectiveDesires and expectations of patients in regard to resume participation in sport activities after knee arthroplasty strongly increased in recent years. Therefore, this review systematically reviewed the available scientific literature on the effect of knee arthroplasty on sports participation and activity levels.DesignSystematic review and meta-analysis.Data sourcesPubMed, Embase, SPORTDiscus and reference lists were searched in February 2019.Studies eligibility criteriaInclusion of knee osteoarthritis patients who underwent total knee arthroplasty (TKA) and/or unicondylar knee arthroplasty. Studies had to include at least one preoperative and one postoperative measure (≥1 year post surgery) of an outcome variable of interest (ie, activity level: University of California, Los Angeles and/or Lower Extremity Activity Scale; sport participation: type of sport activity survey).ResultsNineteen studies were included, consisting data from 4074 patients. Knee arthroplasty has in general a positive effect on activity level and sport participation. Most patients who have stopped participating in sport activities in the year prior to surgery, however, do not seem to reinitiate their sport activities after surgery, in particular after a TKA. In contrast, patients who continue to participate in sport activities until surgery appear to become even more active in low-impact and medium-impact sports than before the onset of restricting symptoms.ConclusionsKnee arthroplasty is an effective treatment in resuming sports participation and physical activity levels. However, to achieve the full benefits from knee arthroplasty, strategies and guidelines aimed to keep patients capable and motivated to participate in (low-impact or medium-impact) sport activities until close before surgery are warranted.
Cross-sectional survey of the wish to die among palliative patients in Spain: one phenomenon, different experiences
Authors: Belar Alazne , Arantzamendi Maria , Santesteban Yolanda , López-Fidalgo Jesús , Martinez Marina , Lama Marcos , Rullán Maria , Olza Inés , Breeze Ruth , Centeno Carlos 
Published: June 2020

ObjectiveCultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context.MethodsA cross-sectional study with consecutive advanced inpatients was conducted. Data about WTD (Assessing Frequency & Extent of Desire to Die(AFFED) interview) and anxiety and depression (Edmonton Symptom Assessment System-revised(ESAS-r)) were collected through two face-to-face clinical encounters. Data were analysed with descriptive statistics, χ2and analysis of variance.Results201 patients participated and 165 (82%) completed both interviews. Prevalence of WTD was 18% (36/201) in the first interview and 16% (26/165) in the second interview (p=0.25). After the first interview, no changes in depression (p=0.60) or anxiety (p=0.90) were detected. The AFFED shows different experiences within WTD: 11% of patients reported a sporadic experience, while 7% described a persistent experience. Thinking about hastening death (HD) appeared in 8 (22%) out of 36 patients with WTD: 5 (14%) out of 36 patients considered this hypothetically but would never take action, while 3 (8%) out of 36 patients had a more structured idea about HD. In this study, no relation was detected between HD and frequency of the appearance of WTD (p=0.12).ConclusionsOne in five patients had WTD. Our findings suggest the existence of different experiences within the same phenomenon, defined according to frequency of appearance and intention to hasten death. A linguistically grounded model is proposed, differentiating the experiences of the ‘wish’ or ‘desire’ to die, with or without HD ideation.
CD200 promotes immunosuppression in the pancreatic tumor microenvironment
Authors: Choueiry Fouad , Torok Molly , Shakya Reena , Agrawal Kriti , Deems Anna , Benner Brooke , Hinton Alice , Shaffer Jami , Blaser Bradley W , Noonan Anne M , Williams Terence M , Dillhoff Mary , Conwell Darwin L , Hart Phil A , Cruz-Monserrate Zobeida , Bai Xue-Feng , Carson III William E , Mace Thomas A 
Published: June 2020

BackgroundA significant challenge to overcome in pancreatic ductal adenocarcinoma (PDAC) is the profound systemic immunosuppression that renders this disease non-responsive to immunotherapy. Our supporting data provide evidence that CD200, a regulator of myeloid cell activity, is expressed in the PDAC microenvironment. Additionally, myeloid-derived suppressor cells (MDSC) isolated from patients with PDAC express elevated levels of the CD200 receptor (CD200R). Thus, we hypothesize that CD200 expression in the PDAC microenvironment limits responses to immunotherapy by promoting expansion and activity of MDSC.MethodsImmunofluorescent staining was used to determine expression of CD200 in murine and human PDAC tissue. Flow cytometry was utilized to test for CD200R expression by immune populations in patient blood samples. In vivo antibody blocking of CD200 was conducted in subcutaneous MT-5 tumor-bearing mice and in a genetically engineered PDAC model (KPC-Brca2 mice). Peripheral blood mononuclear cells (PBMC) from patients with PDAC were analyzed by single-cell RNA sequencing. MDSC expansion assays were completed using healthy donor PBMC stimulated with IL-6/GM-CSF in the presence of recombinant CD200 protein.ResultsWe found expression of CD200 by human pancreatic cell lines (BxPC3, MiaPaca2, and PANC-1) as well as on primary epithelial pancreatic tumor cells and smooth muscle actin+ stromal cells. CD200R expression was found to be elevated on CD11b+CD33+HLA-DRlo/−MDSC immune populations from patients with PDAC (p=0.0106). Higher expression levels of CD200R were observed in CD15+ MDSC compared with CD14+ MDSC (p<0.001). In vivo studies demonstrated that CD200 antibody blockade limited tumor progression in MT-5 subcutaneous tumor-bearing and in KPC-Brca2 mice (p<0.05). The percentage of intratumoral MDSC was significantly reduced in anti-CD200 treated mice compared with controls. Additionally, in vivo blockade of CD200 can also significantly enhance the efficacy of PD-1 checkpoint antibodies compared with single antibody therapies (p<0.05). Single-cell RNA sequencing of PBMC from patients revealed that CD200R+ MDSC expressed genes involved in cytokine signaling and MDSC expansion. Further, in vitro cytokine-driven expansion and the suppressive activity of human MDSC was enhanced when cocultured with recombinant CD200 protein.ConclusionsThese results indicate that CD200 expression in the PDAC microenvironment may regulate MDSC expansion and that targeting CD200 may enhance activity of checkpoint immunotherapy.
Hyperprogression to camrelizumab in a patient with esophageal squamous cell carcinoma harboring EGFR kinase domain duplication
Authors: Wang Wei , Wu Meihong , Liu Minglu , Yan Zhengqing , Wang Guoqiang , Mao Dongliang , Wang Mei 
Published: June 2020

BackgroundPrevious studies have reported that the amplification of some genes, such as Murine Double Minute 2 or 4 and Epidermal Growth Factor Receptor (EGFR), may be related to hyperprogressive disease (HPD). Exploring somatic gene alterations might be an effective method to predict HPD. Herein we characterize the somatic alterations in a patient with esophageal squamous cell carcinoma (ESCC) who developed HPD to investigate the potential origins of HPD.Case presentationA man in his mid-40s was diagnosed with ESCC. After the failure of first-line treatment with cisplatin and docetaxel, the patient participated in a phase III randomized, open, multicenter clinical trial (CTR20170307) and subsequently received camrelizumab. After 4 weeks of immunotherapy, the tumor size increased by 79% compared with baseline imaging; the progressive pace was 2.5-fold higher than preimmunotherapy, and a new liver metastasis appeared. A rare EGFR exon 2–28 duplication was discovered in both preimmunotherapy and postimmunotherapy tumor tissues.ConclusionThis is the first report on a patient with ESCC harboring rare EGFR kinase domain duplication in exons 2–28 and developing HPD in the process of camrelizumab treatment. This case suggested that EGFR kinase domain duplication might be associated with HPD. Administration of immune checkpoint inhibitor monotherapy in this subgroup of patients harboring EGFR kinase domain duplication should be performed with caution. These results need to be further confirmed in a larger cohort of patients.
COVID-19 in South Korea
Authors: Choi Jun Yong 
Published: June 2020

AbstractA novel coronavirus (severe acute respiratory syndrome-CoV-2) that initially originated from Wuhan, China, in December 2019 has already caused a pandemic. While this novel coronavirus disease (COVID-19) frequently induces mild diseases, it has also generated severe diseases among certain populations, including older-aged individuals with underlying diseases, such as cardiovascular disease and diabetes. As of 31 March 2020, a total of 9786 confirmed cases with COVID-19 have been reported in South Korea. South Korea has the highest diagnostic rate for COVID-19, which has been the major contributor in overcoming this outbreak. We are trying to reduce the reproduction number of COVID-19 to less than one and eventually succeed in controlling this outbreak using methods such as contact tracing, quarantine, testing, isolation, social distancing and school closure. This report aimed to describe the current situation of COVID-19 in South Korea and our response to this outbreak.
COVID-19: lessons for junior doctors redeployed to critical care
Authors: Coughlan Charles , Nafde Chaitanya , Khodatars Shaida , Jeanes Aimi Lara , Habib Sadia , Donaldson Elouise , Besi Christina , Kooner Gurleen Kaur 
Published: June 2020

ABSTRACTApproximately 4% of patients with coronavirus disease 2019 (COVID-19) will require admission to an intensive care unit (ICU). Governments have cancelled elective procedures, ordered new ventilators and built new hospitals to meet this unprecedented challenge. However, intensive care ultimately relies on human resources. To enhance surge capacity, many junior doctors have been redeployed to ICU despite a relative lack of training and experience. The COVID-19 pandemic poses additional challenges to new ICU recruits, from the practicalities of using personal protective equipment to higher risks of burnout and moral injury. In this article, we describe lessons for junior doctors responsible for managing patients who are critically ill with COVID-19 based on our experiences at an urban teaching hospital.