bluuebunny/crossref_metadata_2025_split huggingface dataset:
Withholding and Withdrawal of Life Support in Mechanically Ventilated Stroke Patients
Authors: Montmollin Etienne de , Schwebel Carole , Dupuis Claire , Garrouste-Orgeas Maité , Silva Daniel da , Azoulay Elie , Laurent Virginie , Thiéry Guillaume , Grinea Alexandra , Marcotte Guillaume , Oziel Johanna , Gainnier Marc , Siami Shidasp , Reignier Jean , Sztrymf Benjamin , Adrie Christophe , Ruckly Stephane , Sonneville Romain , Timsit Jean-François 
Published: August 2020

Abstract
Background. The determinants of decisions to limit life support (withholding or withdrawal) in ventilated stroke patients have been poorly investigated.Methods. In a prospective multicenter observational cohort (2005-2016), we evaluated limitation of life support in ventilated stroke patients compared to a non-brain-injured population and identified factors associated with such decisions in stroke patients using Fine and Gray competing risk models.Results. We identified 373 stroke patients (ischemic, n=167 (45%); hemorrhagic, n=206 (55%)), and 5683 non-brain-injured patients. Decisions to limit life support were taken in 41% of ischemic stroke cases (vs. non-brain-injured patients, sHR 3.59 [95% CI 2.78-4.65]) and in 33% of hemorrhagic stroke cases (vs. non-brain-injured patients, sHR 3.9 [95% CI 2.97-5.11]). Time from ICU admission to the first limitation was longer in ischemic than in hemorrhagic stroke (5 [3 - 9] vs 2 [1 - 6] days, p<0.01). Limitation of life support preceded ICU death in 70% of ischemic strokes and 45% of hemorrhagic strokes (p<0.01). Life support limitation in ischemic stroke was associated with a vertebrobasilar location (vs. anterior circulation, sHR, 1.61 [95% CI 1.01 - 2.59]) and in hemorrhagic stroke, it was associated with an age>70 years (2.29 [1.43 - 3.69]), a Glasgow score<8 (2.15 [1.08 - 4.3]) and a lower non-neurologic admission SOFA score (per point, 0.89 [0.82 - 0.97]).Conclusions. In ventilated stroke patients, decisions to limit life support are more than 3 times more frequent than in non-brain injured patients, with different timing and associated risk factors between ischemic and hemorrhagic strokes.
Mutational Analysis of Ocriplasmin to Reduce Proteolytic and Autolytic Activity in Pichia Pastoris
Authors: Baghban Roghayyeh , Farajnia Safar , Ghasemi Younes , Hoseinpoor Reyhaneh , Safary Azam , Mortazavi Mojtaba , Zarghami Nosratollah 
Published: August 2020

Abstract
Background: Ocriplasmin (Jetrea) is using for the treatment of symptomatic vitreomacular adhesion. This enzyme undergoes rapid inactivation and limited activities duration as a result of its autolytic and proteolytic nature after injection within the eye. Moreover, the proteolytic activities can cause photoreceptor damage, which may result in visual impairment in the more serious cases.Results: The present research aimed to reduce the disadvantages of ocriplasmin using site-directed mutagenesis. To reduce the autolytic activity of ocriplasmin in the first variant, lysine 156 changed to glutamic acid and in the second variant for the proteolytic activity reduction, alanine 59 mutated to threonine. The third variant contained both the mutations. Expression of wild type and three mutant variants of ocriplasmin constructs were done in Pichia pastoris expression system. The mutant variants analyzed in silico and in vitro and compared to the wild type. The kinetic parameters of ocriplasmin variants showed both variants with K156E substitution were more resistant to autolytic degradation than wild-type. These variants also exhibited reduced Kcat and Vmax values. An increase in their Km values, leading to a decreased catalytic efficiency (the Kcat/Km ratio) of autolytic and mix variants. Moreover, in variant with A59T mutation, Kcat and Vmax values have reduced compared to wild type. The mix variants showed the most increase in Km value (almost 2-fold) as well as reduced enzymatic affinity to the substrate. Thus, the results indicated combine mutations at ocriplasmin sequence were more effective compared with single mutations. Conclusions: The results indicated such variants represent valuable tools for the investigation of therapeutic strategies aiming at non-surgical resolution of vitreomacular adhesion.
Impact of antifungal stewardship interventions on the susceptibility of Candida species in pediatric patients with malignancy
Authors: Amanati Ali , Badiee Parisa , Jafarian Hadis , Ghasemi Fatemeh , Nematolahi Samane , Haghpanah Sezaneh , Hamzavi Seyedeh Sedigheh 
Published: August 2020

Abstract
Background

There is a worldwide concern with respect to the antimicrobial resistance and the inappropriate use of antifungal agents, which had led to an ever-increasing antifungal resistance. This study aimed to identify the antifungal susceptibility of Candida species isolated from the pediatric patients with cancer and also to evaluate the clinical impact of antifungal stewardship (AFS) ‎interventions on antifungal susceptibility of Candida species.
Methods

In this study, Candida species colonization were evaluated among hospitalized children with cancer in a tertiary teaching hospital, Shiraz 2017-18. The broth microdilution method was used to determine the minimum inhibitory concentrations (MICs) for polyenes (amphotericin B), echinocandins (caspofungin), and azoles (voriconazole, fluconazole, posaconazole, and itraconazole). Antifungal susceptibility of Candida species was compared with our previous study results to determine the clinical impact of AFS interventions on the antifungal susceptibility.
Results

The prevalence of Candida albicans in the present study was significantly higher than other Candida species. Candida albicans species were completely susceptible to the azoles. The sensitivity rate of C. albicans to amphotericin B and caspofungin was 93.1% and 97.1%, respectively. The results confirm the positive effect of optimized antifungal usage and bedside intervention on the susceptibility of Candida species after the implementation of the AFS program. C. albicans and C. glabrata exhibited significant increase in sensitivity after the execution of AFS program.
Conclusions

Improving the antifungal agent usage can improve antifungal ‎susceptibility and reduce resistance. The AFS is recommended to be addressed, applied, and regularly assessed in centers.
Origanum Vulgare L. Extract-mediated Synthesis of Silver Nanoparticles, Their Characterization and Antibacterial Activities
Authors: Hambardzumyan Syuzanna , Sahakyan Naira , Petrosyan Margarit , Nasim Muhammad Jawad , Jacob Claus , Trchounian Armen 
Published: August 2020

Abstract
Plant extracts serve as reducing and coating agents and are, therefore, commonly employed for the generation of silver (Ag) nanoparticles (NPs). Plant extract mediated synthesis of Ag NPs is a green, environmentally friendly and cost-effective technique which offers a new and potential alternative to chemically synthesized NPs, decreasing the utilization of hazardous and toxic chemicals and protecting the environment. Origanum vulgare L. extracts were evaluated for total flavonoid and phenol content. The free radical scavenging activity was determined employing 2,2-diphenyl-1-picrylhydrazyl assay. Ag NPs were produced exploiting ethanolic extracts of O. vulgare L. leaves. The generation of Ag NPs was carried out both in light and dark conditions. The biosynthesized Ag NPs were characterized employing microscopic and spectroscopic techniques. Antibacterial activities of Ag NPs were determined following appropriate methods. The results revealed that energy of photons was required to reduce Ag+ to Ag0. According to scanning electron microscopy reports, biologically formed Ag NPs ranged in size from 1 to 50 nmand were presented instability causing aggregation. They indicated that O. vulgare L. extracts were rich in flavonoids and phenols and exhibited strong antioxidant activity. Ag NPs exhibited good antibacterial activity immediately after production. Gram-positive strains showed higher sensitivity to Ag NPs compared to Gram-negative stains. Ag NPs can serve as an effective antibacterial agent against antibiotic-resistant strains. The kanamycin-resistant strain was more sensitive to Ag NPs than the ampicillin-resistant strain. Thus, Origanum extract-mediated synthesized Ag NPs can be recommended as alternative effective antibacterial agents, but their activity depended on bacterial species and strains.
Longitudinal Analysis of Socioecological Obesogenic Factors in a National Sample of U.S. Children
Authors: Kim Taeeung , KWON JUNHYE , Lee Chung Gun , Jang Chang-Yong 
Published: August 2020

Abstract
Background: Childhood obesity is a serious public health threat. Although many researchers conducted research on socioecological determinants of childhood obesity, their longitudinal effects remain inconclusive especially among young children. This study examined socioecological factors and associated transitions of children’s body mass index (BMI) status throughout children’s kindergarten to elementary school years, using data from a national longitudinal sample.Methods: The baseline sample of this study included 1,264 children (weighted N=379,297) extracted from the Early Childhood Longitudinal Study (baseline mean age: 5.24 years). The socioecological framework guided selection of socioecological obesogenic variables (e.g., family activity and parental involvement). Longitudinal ordered logistic regressions were performed to determine the associations between socioecological obesogenic variables and unhealthy/healthy changes in BMI status that captured transitions between healthy and unhealthy weight status (i.e., overweight, obesity, and severe obesity).Results: Children with Hispanic ethnicity and nonwhite race, less socioeconomic and environmental support, and living in households with fewer family members were more likely than their counterparts to have unhealthy BMI status changes over time (all ps<0.05). Over the study period, girls were more likely than boys to experience transitions to unhealthy BMI status (all ps<0.05).Conclusion: As hypothesized a priori, the findings of the current affirmed multiple dimensions of how sociological obesogenic factors may influence children’s BMI status changes in a longitudinal setting. In order to maintain children’s long-term healthy weight, more attention should be paid to socioeconomic obesogenic factors surrounding children as well as individual determinants of obesity (e.g., being physically active and having well-balanced nutrition).
Long Term Outcome for OnabotulinumtoxinA (Botox) Therapy in Chronic Migraine: A 2-Year Follow up of Patients Attending the Hull (UK) Migraine Clinic
Authors: Ahmed Fayyaz , Buture Alina , Tanvir Taukir , Khalil Modar 
Published: August 2020

Abstract
ObjectiveThe objective of this prospective analysis was to determine the long-term outcome of patients diagnosed with chronic migraine who were treated with OnabotulinumtoxinA for the prevention of chronic migraine.BackgroundThe long-term outcomes of patients treated with OnabotulinumtoxinA remains uncertain, including information on the number of cycles and duration of OnabotulinumtoxinA needed to successfully convert chronic migraine to episodic migraine, development of resistance to treatment and sustainability of response after stopping treatment.MethodsA total of 655 adult patients diagnosed with chronic migraine who received OnabotulinumtoxinA at the Hull Migraine Clinic were followed up prospectively for a minimum of 2 years. OnabotulinumtoxinA was delivered as per the PREEMPT study protocol and patients were asked to keep a headache diary for at least 30 days prior to and continuously after receiving OnabotulinumtoxinA. The primary outcome was either the number of patients who achieved a ≥50% reduction in headache days or migraine days or an increment in crystal clear days twice that of baseline in a 30-day period. Patients were also assessed for analgesic medication overuse.ResultsTreatment data were available for 655 patients who commenced treatment between July 2010 and October 2016 and followed for at least 2 years (24–70 months). Of the 655 patients, 380 patients responded to treatment after two cycles and went on to receive the third cycle. Of these, 152 patients were still on active treatment at 2 years. Of the 228 patients who stopped treatment, 112 were successfully converted to episodic migraine and showed a sustained response, 28 reverted to chronic migraine after the initial response inspite of continuing treatment (developed resistance), 14 were lost to follow up and 61 patients after achieving remission relapsed after a mean of 9 months (range 4–24 months) and recommenced treatment with OnabotulinumtoxinA. ConclusionAfter a minimum of 2 years, 29.4% of patients with chronic migraine who initially responded to treatment were successfully converted to episodic migraine and maintained a sustained response. Forty percent of the initial cohort of responders continued therapy with OnabotulinumtoxinA to manage their chronic migraine.
Safety of Measles, Mumps, and Rubella Vaccine in Egg Allergy:in Vivo and in Vitro Management
Authors: Magistà Stefania , Albanesi Marcello , Chaoul Nada , Bona Danilo Di , Leo Elisabetta Di , Nettis Eustachio , Caiaffa Maria Filomena , Macchia Luigi 
Published: August 2020

Abstract
Background Egg allergy is the second most prevalent form of food allergy in childhood. In spite of the evidence accumulated, inoculating egg allergy children with attenuated vaccines grown on chick embryo cell cultures, such as the measles, mumps, and rubella (MMR) vaccine, is regarded (erroneously) as potentially dangerous or even anaphylactogenic, by many. An issue perceived as particularly conflicting also by Health Professionals.Case presentation A 15-year-old boy, with a history of severe egg allergy in early infancy, who was still sensitized to egg allergens, including baked egg, had never received MMR vaccination, in fear of possible anaphylaxis, in spite of the fact that this vaccination is mandatory in the first year of life, in Italy. Because of that, he was not allowed to attend school, longer, and was referred to us in order to assess the potential risk of MMR vaccination. Upon thorough allergological workup, sensitization to MMR vaccine components was excluded by an in vivo approach, consisting in skin prick tests, intradermal tests, and subcutaneous injection test, corroborated by vaccine-specific B-lymphocyte proliferation assay, ex vivo. T-cell proliferation in response to MMR vaccine was also excluded. Eventually, the boy was inoculated with MMR vaccine and was readmitted to school.Conclusions The diagnostic strategy adopted appears feasible and easy-to-perform and may be adopted in controversial cases (as the one reported), characterized by previous severe allergic reactions to egg. The B-lymphocyte proliferation assay we developed may represent a useful and reliable tool not only in research but also in clinical practice.
Survey on patients’ organisations’ knowledge and position paper on screening for&nbsp;&nbsp;inherited neuromuscular diseases in Europe
Authors: Lamy François , Ferlini Alessandra , Board EURO-NMD Patient Advisory , Evangelista Teresinha 
Published: August 2020

Abstract
BackgroundThe development of new genetic testing methods and the approval of the first treatments raises questions regarding when and how to perform screening for inherited neuromuscular conditions. Screening directives and access to the different techniques is not uniform across Europe. The patient advisory board of the European reference network for rare neuromuscular diseases (NMD) conducted a qualitative study to understand the state of play of screening for inherited NMD in Europe and the patients’ needs. ResultsWe collected answers from 30 patient organisations (POs) from 18 European countries. Fifteen acknowledge the existence of pre-implantation genetic diagnosis in their country. Regarding prenatal screening, we had 25 positive answers and 5 negative ones. Twenty-four POs mentioned that newborn screening was available in their country. We had some contradicting answers from POs from the same country and in some cases; diseases said to be part of the screening programmes were not hereditary disorders. Twenty-eight organisations were in favour of testing. The reasons for the two negative answers were lack of reimbursement and treatment, religious beliefs and eventual insurance constrains. Most POs (21) were in favour of systematic screening with the option to opt-out. Regarding the timing for screening, “at birth” reunites most of the responses.The main priority to perform screening for NMDs was early access to treatment, followed by shorter time to diagnostic, preventive care and genetic counselling. ConclusionsThis is the first study to assess knowledge and needs of POs concerning screening for NMDs. The knowledge of POs regarding screening techniques is quite uneven. This implies that, even in communities highly motivated and knowledgeable of the conditions they advocate for, there is a need for better information. Differences in the responses to the questions “how and when to screen” shows that the screening path depends on the disease specificity and the presence of a disease modifying treatment.The unmet need for screening inherited NMDs should follow an adaptive pathway related to the fast moving medical landscape of NMDs. International coordination leading to a common policy would certainly be a precious asset tending to harmonize the situation amongst European countries.
Bacterial Community Assemblages in Classroom Floor Dust of 50 Public Schools in a Large City: Characterization Using 16s rRNA Sequences and Associations with Environmental Factors
Authors: Park Ju-Hyeong , Lemons Angela R. , Roseman Jerry , Green Brett J. , Cox-Ganser Jean M. 
Published: August 2020

Abstract
Characterizing indoor microbial communities using molecular methods provides insight into bacterial assemblages present in environments that can influence occupants’ health. We conducted an environmental assessment as part of an epidemiologic study of 50 elementary schools in a large city in the northeastern United States. We vacuumed dust from the edges of the floor in 500 classrooms accounting for 499 processed dust aliquots for 16S Illumina MiSeq sequencing to characterize bacterial assemblages. DNA sequences were organized into operational taxonomic units (OTUs) and identified using a database derived from the National Center for Biotechnology Information. Bacterial diversity and ecological analyses were performed at the genus level. We identified 29 phyla, 57 classes, 148 orders, 320 families, 1,193 genera, and 2,045 species in 3,073 OTUs. The number of genera per school ranged from 470 to 705. The phylum Proteobacteria was richest, followed by Firmicutes, Actinobacteria, Bacteroidetes, and Cyanobacteria while Firmicutes was most abundant. The most abundant order included Lactobacillales, Spirulinales, Clostridiales, Bacteroidales, Pseudomonadales, and Micrococcales. Halospirulina was the most abundant genus (the only genus within the order Spirulinales), followed by Lactobacillus, Streptococcus, Sphingomonas, Clostridium, and Pseudomonas. Gram-negative bacteria were more abundant and richer (relative abundance=0.53;1,632 OTUs) than gram-positive bacteria (0.47; 1,441). The Bray-Curtis dissimilarity index ranged from 0.22 to 0.63, with a median of 0.40. Effects of school location, degree of water damage, building condition, number of students, air temperature and humidity, floor material, and classroom’s floor level on the bacterial richness or community composition were statistically significant but subtle. Our study indicates that classroom floor dust had a characteristic bacterial community represented by more gram-negative bacteria, in comparison to typical house dust that is represented by more gram-positive bacteria. Health implications of exposure to the microbiomes in classroom floor dust may be different from those in homes for school staff and students.
Atractylenolide-I suppresses tumorigenesis of breast cancer by inhibiting toll-like receptor 4 (TLR4)-mediated NF-κB signaling pathway
Authors: Long Fangyi , Lin Hong , Zhang Xiqian , Zhang Jianhui , Xiao Hongtao , Wang Ting 
Published: August 2020

Abstract
Background: Toll-like receptor 4 (TLR4) is an essential sensor related to tumorigenesis, and overexpression of TLR4 in human tumors often correlates with poor prognosis. Atractylenolide I (AT-I) is a major bioactive component from Rhizoma Atractylodes Macrocephalae. Emerging evidence suggests that AT-I exerts anti-tumor effects on various cancers such as colorectal cancer, bladder cancer and melanoma. Nevertheless, the effects of AT-I on mammary tumorigenesis remain unclear.Methods: In order to ascertain the correlation of TLR4/NF-κB pathway with breast cancer, the expression of TLR4 and NF-κB in normal breast tissues and cancer tissues with different TNM-stages was detected by human tissue microarray (TMA) and immunohistochemistry technology. The effects of AT-I on tumorigenesis were investigated by cell viability, colony formation, apoptosis, migration and invasion assays in two breast cancer cells (MCF-7 and MDA-MB-231), and N-Nitroso-N-methylurea (NMU) induced rat breast cancer models were developed to evaluate the anti-tumor effects of AT-I in vivo. The possible underlying mechanisms were further explored by western blot and ELISA assays after a series of LPS treatment and TLR4 knockdown experiments.Results：We found that TLR4 and NF-κB were significantly up-regulated in breast cancer tissues, and was correlated with advanced TNM-stages. AT-I could inhibit TLR4 mediated NF-κB signaling pathway and decrease NF-κB-regulated cytokines in breast cancer cells, thus inhibiting cell proliferation, migration and invasion, and inducing apoptosis of breast cancer cells. Furthermore, AT-I could inhibit NMU-induced rat mammary tumor progression through TLR4/NF-κB pathway.Conclusions: Our findings demonstrated that TLR4 and NF-κB were over expressed in breast cancer, and AT-I could suppress tumorigenesis of breast cancer via inhibiting TLR4-mediated NF-κB signaling pathway.
Nano-zeolite-graphene oxide composite for calcium hardness removal: isotherm and kinetic study
Authors: Konale Ram Ashok , Mahale Nilesh Keshavrao , Ingle Sopan Tukaram 
Published: August 2020

AbstractThe present study is an attempt to synthesize and explore the applications of the synthetic nano-zeolites (nZ) and its composites with graphene oxide (GO) for water purification. The modified Hummer's method and hydrothermal methods were applied for the synthesis of the graphene oxide and nano zeolites respectively, followed by the preparation of the composite with the ultrasonic method. Scanning electron microscopy, energy dispersive analysis of X-rays, Fourier transform infrared spectroscopy and X-ray fluorescence were used for physico-chemical characterization of the composite. The various parameters of adsorbent dose, contact time, initial and final pH of solution were optimized for the removal of calcium hardness. The results indicate optimum removal (98%) can be reached at pH 7 while the removal is highly adsorbent dose-dependent. The nZGO removal data were investigated by pseudo-first-order, pseudo-second-order, Elovich, and intraparticle diffusion. In that, pseudo-second-order and intraparticle diffusion models are best fitted to the experimental data. The experimental data were also analysed by Langmuir, Freundlich and Temkin isotherms, the experimental data follows the Langmuir isotherm and the determination coefficient is 0.99.