bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neuroanatomical Alterations in Patients With Tinnitus Before and After Sound Therapy: A Combined VBM and SCN Study
Authors: Wei Xuan , Lv Han , Chen Qian , Wang Zhaodi , Liu Chunli , Zhao Pengfei , Gong Shusheng , Yang Zhenghan , Wang Zhenchang 
Published: September 2020

Abstract
Background: Many neuroanatomical alterations have been detected in patients with tinnitus in previous studies. However, little is known about morphological and structural covariance network (SCN) changes before and after long-term sound therapy. This study aimed to explore alterations in brain anatomical and SCN changes in patients with idiopathic tinnitus using voxel-based morphometry (VBM) analysis 24 weeks before and after sound therapy. Methods: Thirty-three tinnitus patients underwent magnetic resonance imaging scans at baseline and after 24 weeks of sound therapy. Twenty-six age- and sex-matched healthy control (HC) individuals also underwent two scans over a 24-week interval; 3.0T MRI and high-resolution 3D structural images were acquired with a 3D-BRAVO pulse sequence. Structural image data preprocessing was performed using the VBM8 toolbox. The Tinnitus Handicap Inventory (THI) score was acquired in the tinnitus group to assess the severity of tinnitus and tinnitus-related distress. Two-way mixed model analysis of variance (ANOVA) and post hoc analyses were performed to determine differences between the two groups (patients and HCs) and between the two scans (at baseline and at the 24th week). Two-sample t tests, paired-samples t tests, and Pearson’s correlation analysis were used in the post hoc analysis.Results: Interaction effects between the two groups and the two scans demonstrated significantly different gray matter (GM) volume in the right parahippocampus gyrus, right caudate, left superior temporal gyrus, left cuneus gyrus and right calcarine gyrus; we found significantly decreased GM volume in the above five brain regions among the tinnitus patients before sound therapy (baseline) compared to that in the HC group. The 24-week sound therapy group demonstrated significantly greater brain volume compared with the baseline group among these brain regions. We did not find significant differences in brain regions between the 24-week sound therapy and HC groups. The SCN results showed that the left superior temporal gyrus and left rolandic operculum were significantly different in nodal efficiency, nodal degree centrality and nodal betweenness centrality after FDR correction. Decreased THI scores and GM volume changes between the left thalamus and right thalamus were not correlated. Conclusions: This study characterized the effect of sound therapy on brain GM volume, especially in the left superior temporal lobe. Notably, sound therapy had a normalizing effect on tinnitus patients.
Intervening in the S1PR1/STAT3 Signaling Pathway Attenuates Valvular Damage Due to Rheumatic Heart Disease
Authors: Xian Shenglin , Chen Ang , Wu Yunjiao , Wen Hong , Lu Chuanghong , Wen Jianlin , Huang Feng , Zeng Zhiyu 
Published: September 2020

Abstract
Background: Rheumatic heart disease (RHD) affects many patients every year, but its pathogenesis is still unclear. Recent studies have found that the sphingosine 1-phosphate receptor 1 (S1PR1)/signal transducer and activator of transcription 3 (STAT3) signaling pathway is involved in valvular damage by promoting the differentiation of T helper 17 (Th17) cells during the development of valvular damage caused by RHD. In this work, we investigated whether altering the S1PR1/STAT3 signaling pathway attenuates valvular damage due to RHD. Methods: Inactivated Group A streptococci (GAS) was used to establish the RHD rat model. Recombinant adeno-associated virus (serotype 9) vectors carrying the S1PR1 overexpression sequence was used to overexpress the expression of S1PR1. STAT3-small interfering RNA (STAT3-siRNA) was used to inhibit the expression of STAT3. Reverse transcription-quantitative PCR (RT-qPCR) was used to detect the mRNA expression of S1PR1, STAT3, collagen type III α1 chain (Col3a1) and fibroblast-specific protein 1 (FSP1). Western blotting (WB) and immunohistochemistry were used to detect the protein expression of S1PR1, STAT3, phosphorylated (p-) STAT3, retinoic acid-related orphan receptor gamma T (RORγt). Enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry were used to detect the levels of interleukin (IL)-6 and IL-17. Haematoxylin and eosin (H&E) staining and Sirius red staining were used to evaluate the degree of inflammation and fibrosis in valve tissues.Results: The expression of S1PR1 in valve tissues of RHD model rats was decreased. The levels of IL-6 and IL-17 in valves and serum of RHD model rats were increased as well as an increase of p-STAT3. The degree of valvular inflammation and fibrosis of RHD model rats was increased. Overexpression of S1PR1 and Inhibition of STAT3 overexpressed S1PR1 expression and decreased STAT3 expression respectively and reduced the total amount of p-STAT3, resulting in decreased expression of IL-6, IL-17 and RORγt and reduced the degree of valvular inflammatory and fibrosis. Conclusions: These results suggest that the S1PR1/STAT3 signaling pathway is involved in regulating the Th17 cell-related cytokines during the vavular damage due to RHD, and altering the S1PR1/STAT3 signaling pathway could affect the expression of Th17 cell-related cytokines then attenuate the vavular damage due to RHD.
The Reasons Why Fractional Flow Reserve and Instance Wave-Free Ratio are Similar Using Wave Separation Analysis
Authors: Min Soohong , Kang Gwansuk , Paeng Dong-Guk , Choi Joon Hyouk 
Published: September 2020

Abstract
Background and Objectives: Fractional flow reserve(FFR) and instantaneous wave-free ratio(iFR) are the two most commonly used coronary indices of physiological stenosis severity based on pressure. To minimize the effect of wedge pressure (Pwedge), FFR is measured during hyperemia conditions, and iFR is calculated as the ratio of distal and aortic pressures (Pd/Pa) in the wave-free period. The goal of this study was to predict Pwedge using the backward wave (Pback) through wave separation analysis(WSA) and to reflect the effect of Pwedge on FFR and iFR to identify the relationship between the two indices.Methods: An in vitro circulation system was constructed to calculate Pwedge. The measurements were performed in cases with stenosis percentages of 48, 71, and 88% and with hydrostatic pressures of 10 and 30 mmHg. Then, the correlation between Pback by WSA and Pwedge was calculated. In vivo coronary flow and pressure were simultaneously measured for 11 vessels in all patients. The FFR and iFR values were reconstructed as the ratios of forward wave at distal and proximal sites during hyperemia and at rest, respectively.Results: Based on the in vitro results , the correlation between Pback and Pwedge was high(r=0.990, p<0.0001). In vivo results showed high correlations between FFR and reconstructed FFR(r=0.992, p<0.001) and between iFR and reconstructed iFR(r=0.930, p<0.001).Conclusions: Reconstructed FFR and iFR were in good agreement with conventional FFR and iFR. FFR and iFR can be expressed as the variation of trans-stenotic forward pressure, indicating that the two values are inferred from the same formula under different conditions.
Analysis of Traditional Risk Factors of Atherosclerosis and Novel Risk Markers of Inflammation in Coronary Ectasia Can We Solve The Enigma ??
Authors: Mariappan Selvaganesh , S Sivakumar G , R Saravanan R , S Satheeshkumar , R Veeramani S , S Balasubramanian , A.S Arul 
Published: September 2020

Abstract
Background: Coronary artery ectasia(CAE) is speculated as a variant of atherosclerosis. The pathogenesis of CAE remains an enigma. Here in our study, we aimed to elucidate the role of traditional risk factors of atherosclerosis and inflammation in coronary ectasia.Methods and Results: This comparative study was carried in a tertiary hospital in South India.Patients with coronary artery ectasia and obstructive coronary artery disease were included as cases and controls . Traditional risk factors of atherosclerosis and risk markers of inflammation (neutrophil-lymphocyte ratio(NLR), red cell distribution width (RDW), mean platelet volume (MPV) )were evaluated and comparative analysis was done. Coronary ectasia was observed in 5.6%(n=136)of the study population. Among those with ectasia,112(82.4%) patients were having significant obstructive CAD (mixed group), isolated ectasia observed in24 (17.6%)patients. Isolated ectasia had an inverse association with diabetes mellitus and male:female ratio of (7:1). DM was seen only in 25% of isolated ectasia groups compared to 42.9%, 47.4% among mixed and obstructive CAD groups respectively (p < 0.05). Traditional risk factors were not significantly different between the mixed group and obstructive CAD group. Inflammatory markers were significantly higher among the both ectasia group compared to obstructive CAD group NLR: 3.98±0.89, 3.58±0.56, 2.82±0.60 p <0.001. RDW:12.59±0.60, 12.29±0.85,12.02±0.70, p<0.005. MPV was elevated in all three groups but not much different among groups.Conclusion: Coronary ectasia commonly seen in association with obstructive CAD, the prevalence of traditional risk factors of atherosclerosis is similar between CAE+CAD, obstructive CAD group suggest atherosclerosis as the underlying pathophysiology. Elevated markers of inflammation suggest overlying inflammation on atherosclerosis to be the contributor of ectasia.
Ectopic ACTH Syndrome and Hypothyroidism Due to Right Renal Small Round Blue Cell Tumor: A Case Report
Authors: Mao Weipu , Xu Jiajia , Lu Haowen , Wang Yali , Zhang Lihua , Ming Chen 
Published: September 2020

Abstract
Background: Small round blue cell malignancies are rare and highly aggressive tumors that are commonly located in the soft tissues or axial bones of the bone or trunk and are particularly rare in the kidney. The common cause of ectopic ACTH syndrome is pulmonary neuroendocrine tumors, such as small cell carcinomas and carcinoid tumors. Here, we present an unusual case of ectopic ACTH syndrome and hypothyroidism caused by small round blue cell tumor of the right kidney.Case presentation: A 19-year-old girl presented with a history of right lumbar pain and discomfort for 2 months, aggravated for 2 days. Abdominal contrast-enhanced computed tomography and computed tomography angiography showed right suprarenal pole occupancy with subepithelial hemorrhage. Preoperative hormone levels including plasma total cortisol (PTC), adrenocorticotrophic hormone (ACTH) and thyroid hormone measurements were abnormal, indicating that the patient had Cushing syndrome and hypothyroidism. The patient underwent right radical nephrectomy. Histopathological analysis revealed a renal small round blue cell tumor (consistent with a primitive neuroectodermal tumor), with positive immunohistochemistry for CD99 and Ki67 (about 10%) and molecular pathology for EWSR1 gene fusions. PTC, ACTH and thyroid hormone returned to normal after surgery.Conclusions: We report a rare ectopic ACTH syndrome and hypothyroidism due to renal small round blue cell tumor. The clinical manifestation of renal small round blue cell tumor is non-specific and the diagnosis relies on pathological morphology, immunohistochemistry and fusion gene detection. At present, surgery combined with radiotherapy and chemotherapy is used in the treatment, but the prognosis is still not optimistic.
Abnormal Expression of MST1 and YAP1 in Fetal Heart Tissue in a Hyperglycemic Environment and Their Roles in Mediating Apoptosis
Authors: Su Dongmei , Li Yanhua , Guan Lina , Li Qian , Shi Cuige , Ma Xu , Song Yonghui 
Published: September 2020

Abstract
Background：Gestational diabetes mellitus is a risk factor for congenital heart defects. The article aimed to investigate the expression and roles of Mst1, Yap1, Last1/2 and Survivin in modulating HG-induced cardiomyocyte apoptosis and maternal diabetes-induced heart abnormality. Methods：The gene and protein expression were assessed by quantitative PCR, western blot, and immunohistochemical staining. The protein phosphorylation level were analyzed by western blot .Knockdown of gene expression were assessed by RNA interference. Hoechst 33342 staining assay were performed to explore H9C2 apoptosis. Diabetes mellitus was induced in rats using streptozotocin.Results：Our results revealed that increased MST1 protein levels in the heart tissues of the offspring of diabetic rats in vivo occurred concomitantly with HG-induced apoptosis in H9C2 cardiomyocytes in vitro. Knockdown and overexpression experiments showed that MST1 played a key role in mediating HG-induced apoptosis in cardiomyocytes. Downregulation of YAP1 was associated with HG-induced, MST1-mediated cardiomyocyte apoptosis. Further study showed that MST1 downregulated the protein level of YAP1 through mediation of YAP1 phosphorylation on Ser127 and Ser397; this process also required LATS1/2 participation. MST1 overexpression increased the phosphorylation levels of LATS1/2, which were also shown to be increased in the heart tissues of diabetic offspring. We also found that YAP1 mediated the expression of Survivin during HG-induced apoptosis, and the Survivin-inhibitor YM155 partially inhibited the role of YAP1 in suppressing apoptosis induced by HG in cardiomyocytes. Conclusion：These findings reveal a regulatory mechanism of MST1/YAP1/Survivin signaling in modulating cardiomyocyte apoptosis in vitro and maternal diabetes-induced congenital heart defects in vivo.
Designing an Evidence-Based Behavior Change Strategy to Promote Antibiotic Use in Primary Healthcare in Gezira State, Sudan
Authors: Lohiniva Anna-Leena , Elwali Einas S. , Abuobaida Duha , Abdulrahim Ashwag , Bukuluki Paul , Talaat Maha 
Published: September 2020

Abstract
Background: Abuse of antibiotics is a major contributing factor to the emergence of antibiotic resistance (ABR) globally. Misuse and overuse of antibiotics is common also in Sudan. Addressing antibiotic use is a key component of AMR response.Objectives: The project aimed to develop a theory driven behavior change strategy based on local understanding of drivers of antibiotic use at primary healthcare settings in Gezira State in Sudan. The strategy is needed to enhance the prescribers’ appropriate prescription of antibiotics and to reduce the patient’s demand towards unnecessary antibiotics.Methods: The strategy was designed based on the Theoretical Domains Framework (TDF) to identify behavioral barriers and the Behavior Change Wheel to select appropriate behavior change techniques (BCTs). The process included two major elements (1) a formative qualitative research study using focus group discussions and in-depth interviews targeting prescribers and patients. (2) a knowledge co-production workshop that utilized the results of the qualitative study and aimed to design a salient, legitimate and credible behavior change strategy identifying relevant behavior change techniques (BCTs) to overcome key barriers.Results: The main TDF domains that emerged from the discussions with prescribers were knowledge of antibiotics and AMR, skills to answer patient demand on antibiotics, prescription habits and work exhaustion, social influences, intention to change prescription practices and environmental factors. The main TDF domains that emerged through discussions with patients were antibiotic use habits, social influences, professional role belief in capabilities and intention to change. The workshop discussions resulted in the selection of five BTCs that included education, training, modeling, enablement and persuasion.Conclusion: This study, using the TDF and BCW taxonomy, explored the fact that antibiotic prescribing is influenced by many social and contextual factors. Knowledge co- production offered real benefits in addressing these complexities to come up with a set of context appropriate behavior change interventions.
Inspiratory Muscle Training in Children: Moderate Loads (60%) Are Safe and Promote an Increase in PIMAX
Authors: Nascimento Milena Siciliano , Prado Cristiane do , Ejzenberg Fernanda , Kushida Simone Sayuri , Fontes Amanda , Almeida João Fernando , Medeiros Daniela Nasu 
Published: September 2020

Abstract
Background: Weaning failure are complex outcomes as it involves some aspects including weakness of the respiratory muscles. Ventilator-induced diaphragmatic dysfunction has been described as one of the main complications of IMV. Inspiratory muscle training with moderate loads was described in adults as having excellent results in terms of disconnection from the IMV literature. On pediatric population there is still a scarcity of and most of it consists of descriptions of isolated case reports. Methods: This study aims at evaluating whether muscle training using moderate loads will cause an increase in maximal inspiratory pressure (PIMAX) in patients dependent on mechanical ventilation. This is a retrospective study conducted in 2 Pediatric Intensive Care Units from January 2016 to December 2017. All patients who underwent muscle training during the period of the study were included. PIMAX was measured using a manovacuometer. Three measurements were made with an occlusion time of 15 seconds and a recovery interval of 2 minutes between them. Muscle training was performed following the institutional protocol (4 sets of 6 repetitions with a load equivalent to 60% of PIMAX) 1x/day, 6 days a week, excluding the day of the measurement of PIMAX. Results: Six patients undergoing prolonged mechanical ventilation (average time of mechanical ventilation of 9647 hours) who underwent muscle training to disconnect mechanical ventilation were included. The measurements of PIMAX pre-training were compared to weeks 1 to 4. A significant difference on PIMAX was observed after the second week of training (p <0.001). Five patients progressed to IMV disconnection. Conclusion: Our study supports the performance of IMT using moderate loads (60%), with no risk of muscle fatigue as it resulted in a significant increase in PIMAX after 2 weeks of training, with positive outcomes regarding weaning from mechanical ventilation.
A Randomized Trial of Albumin Infusion to Prevent Intradialytic Hypotension in Hypoalbuminemic Patients
Authors: Macedo Etienne , Karl Bethany , Lee Euyhyun , Mehta Ravindra L. 
Published: September 2020

Abstract
Background: Intradialytic hypotension (IDH) is a frequent complication of intermittent hemodialysis (IHD), occurring from 15 to 50% of ambulatory sessions, and is more frequent among hospitalized patients with hypoalbuminemia 1. IDH limits adequate fluid removal and increases the risk for vascular access thrombosis, early hemodialysis (HD) termination, and mortality. Albumin infusion before and during therapy has been used for treating IDH with varying results. We evaluated the efficacy of albumin infusion in preventing IDH during IHD in hypoalbuminemic inpatients. Methods: A randomized, crossover trial was performed in 65 AKI or ESRD patients with hypoalbuminemia (albumin<3g/dl) who required HD during hospitalization. Patients were randomized to receive 100ml of either 0.9%sodium chloride or 25% albumin intravenously at the initiation of each dialysis. These two solutions were alternated for up to 6 sessions. Patients’ vital signs and ultrafiltration removal rate were recorded every 15 to 30 minutes during dialysis. IDH was assessed by different definitions reported in the literature. All symptoms associated with a noted hypotensive event as well as interventions during the dialysis were recorded. Results: 65 patients were submitted to 249 sessions; mean age was 58 (+/-12), 46 (70%) were male with a mean weight of 76 (+/-18) kg. Presence of IDH was lower during albumin sessions based on all definitions. The risk of hypotension was significantly decreased based on the Kidney Disease Outcomes Quality Initiative (KDOQI) definition; (15% with NS vs. 7% with albumin, p=0.002). Lowest intradialytic SBP was significantly worse in patients that received 0.9% sodium chloride in comparison to albumin (NS 83 vs. Albumin 90 mmHg,p = 0.035). Overall ultrafiltration rate was significantly higher in the albumin therapies (NS -8.25 ml/kg/h (-11.18 -5.80) vs. 8.27ml/kg/h (-12.22 - 5.53) with albumin, p =0.011). Conclusion: In hypoalbuminemic patients who need HD, administration of albumin before dialysis results in fewer episodes of hypotension and improves fluid removal. Albumin infusion may be of benefit to improve safety of HD and achievement of fluid balance in these high-risk patients.ClinicalTrials.gov Identifier: NCT04522635Retrospectively registered in August 21, 2020
Early Corticosteroids Decrease Mortality in Critically Ill Patients with COVID-19: A Cohort Study
Authors: Monedero Pablo , Gea Alfredo , Castro Pedro , Candela-Toha Angel M. , Hernández-Sanz María L. , Arruti Egoitz , Villar Jesús , Ferrando Carlos 
Published: September 2020

Abstract
Background: Critically ill patients with coronavirus disease 19 (COVID-19) have a high fatality rate likely due to a dysregulated immune response. Corticosteroids could attenuate this inappropriate response, although there are still some concerns regarding its use, timing, and dose. Methods: This is a nationwide, prospective, multicenter, observational, cohort study in critically ill adult patients with COVID-19 admitted into Intensive Care Units (ICU) in Spain from March 12th to June 29th, 2020. Using a multivariable Cox model with inverse probability weighting, we compared relevant outcomes between patients treated with early corticosteroids (before or within the first 48h of ICU admission) with those who did not receive early corticosteroids or any corticosteroids at all. Primary endpoint was ICU mortality. Secondary endpoints included 7-day mortality, ventilator-free days, and complications. Results: A total of 691 patients out of 882 (78.3%) received corticosteroid during their hospital stay. Patients treated with early-corticosteroids (n=485) had a lower ICU mortality (30.3% vs 40.6%, HR 0.71, 95% CI 0.57-0.89) and higher number of ventilator-free days (mean difference 2.5 days, 95% CI 1.3-3.8) compared to non-early treated patients. There were no differences in 7-day mortality (HR 0.76, 95% CI 0.48-1.2), medical complications (OR 2.18, 95% CI 0.91-5.25) or secondary infections (OR 0.88, 95% CI 0.67-1.15) between both groups. Of note, early use of moderate-to-high doses was associated with better outcomes than low dose regimens. Conclusion: Early use of corticosteroids in critically ill patients with COVID-19 is associated with lower mortality (10.3% absolute risk reduction) and shorter duration of mechanical ventilation.