bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between serum growth differentiation factor 15 levels and lower extremity atherosclerotic disease is independent of body mass index in type 2 diabetes
Authors: He Xingxing , Su Jiaorong , Ma Xiaojing , Lu Wei , Zhu Wei , Wang Yufei , Bao Yuqian , Zhou Jian 
Published: March 2020

AbstractBackgroundClinical and basic investigations have indicated a significant association between circulating growth differentiation factor 15 (GDF15) and cardiovascular disease; however, the relationship between GDF15 and lower extremity atherosclerotic disease (LEAD) has been less studied. The present study aimed to explore the association between GDF15 and LEAD in Chinese patients with type 2 diabetes mellitus (T2DM). Considering that obesity is an important factor associated with circulating GDF15 levels, whether the relationship between serum GDF15 levels and LEAD is affected by body mass index (BMI) was also analysed.MethodsA total of 376 hospitalized T2DM patients were enrolled (161 with LEAD and 215 without LEAD). A sandwich enzyme-linked immunosorbent assay was used to detect the serum GDF15 levels. The femoral intima-media thickness (F-IMT) and LEAD were assessed by ultrasonography.ResultsPatients with LEAD had significantly higher serum GDF15 levels than those without LEAD, regardless of whether their BMI was < 25 kg/m2or ≥ 25 kg/m2(bothP < 0.05). Serum GDF15 levels were independently positively related to the F-IMT (standardizedβ = 0.162,P = 0.002). After adjusting for confounding factors, per 1-standard deviation (SD) increase in the serum GDF15 levels was significantly related to an approximately 1.4-fold increased risk of LEAD in the total population (P < 0.05). Regardless of whether the BMI was < 25 kg/m2or ≥ 25 kg/m2, this association remained significant, with approximately 1.6- and 1.4-fold increased risks of LEAD, respectively (bothP < 0.05).ConclusionsHigh serum GDF15 levels were significantly correlated with an increased risk of LEAD in T2DM patients, and this relationship was independent of BMI.
Association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance in older adults: National Health and nutrition examination Survey (NHANES) 2011–2014
Authors: Dong Xue , Li Shiru , Chen Jiahao , Li Yan , Wu Yanjun , Zhang Dongfeng 
Published: March 2020

Abstract
Background
Current evidence on the association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance is inconsistent. Therefore, the aim is to explore the association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance in the U.S. noninstitutionalized population of older adults.

Methods
We used data from the National Health and Nutrition Examination Survey (NHANES) 2011–2014. Intakes of ω-3 and ω-6 fatty acids were obtained through two 24-h dietary recalls and were adjusted by energy. Cognitive performance was evaluated by the Consortium to Establish a Registry for Alzheimer’s disease (CERAD) Word Learning sub-test, Animal Fluency test and Digit Symbol Substitution Test (DSST). For each cognitive test, people who scored lower than the lowest quartile in each age group were defined as having low cognitive performance. Binary logistic regression and restricted cubic spline models were applied to evaluate the association of dietary ω-3 and ω-6 fatty acids intake with cognitive performance.

Results
A total of 2496 participants aged 60 years or older were included. In the full-adjusted model, the odds ratios (ORs) with 95% confidence interval (CI) of CERAD test score, Animal Fluency test score and DSST test score were 0.58 (0.38–0.88), 0.68 (0.47–0.99) and 0.59 (0.37–0.92) for the highest versus lowest tertile of dietary ω-3 fatty acids intake, respectively; the ORs with 95% CI of CERAD test score, Animal Fluency test score and DSST test score were 0.48 (0.31–0.75), 0.60 (0.40–0.92) and 0.50 (0.34–0.75) for the highest versus lowest tertile of dietary ω-6 fatty acids intake, respectively. The association between ω-6: ω-3 ratio and cognitive performance was not statistically significant in three tests. In dose-response relationship analysis, L-shaped associations were apparent for ω-3 and ω-6 fatty acids intake with CERAD test score, Animal Fluency test score and DSST test score.

Conclusions
Dietary ω-3 and ω-6 fatty acids intake might be inversely associated with low cognitive performance.
Hundred year projected carbon loads and species compositions for four National Forests in the northwestern USA
Authors: Fekety Patrick A. , Crookston Nicholas L. , Hudak Andrew T. , Filippelli Steven K. , Vogeler Jody C. , Falkowski Michael J. 
Published: March 2020

Abstract
Background
Forests are an important component of the global carbon balance, and climate sensitive growth and yield models are an essential tool when predicting future forest conditions. In this study, we used the dynamic climate capability of the Forest Vegetation Simulator (FVS) to simulate future (100 year) forest conditions on four National Forests in the northwestern USA: Payette National Forest (NF), Ochoco NF, Gifford Pinchot NF, and Siuslaw NF. Using Forest Inventory and Analysis field plots, aboveground carbon estimates and species compositions were simulated with Climate-FVS for the period between 2016 and 2116 under a no climate change scenario and a future climate scenario. We included a sensitivity analysis that varied calculated disturbance probabilities and the dClim rule, which is one method used by Climate-FVS to introduce climate-related mortality. The dClim rule initiates mortality when the predicted climate change at a site is greater than the change in climate associated with a predetermined shift in elevation.

Results
Results of the simulations indicated the dClim rule influenced future carbon projections more than estimates of disturbance probability. Future aboveground carbon estimates increased and species composition remained stable under the no climate change scenario. The future climate scenario we tested resulted in less carbon at the end of the projections compared to the no climate change scenarios for all cases except when the dClim rule was disengaged on the Payette NF. Under the climate change scenario, species compositions shifted to climatically adapted species or early successional species.

Conclusion
This research highlights the need to consider climate projections in long-term planning or future forest conditions may be unexpected. Forest managers and planners could perform similar simulations and use the results as a planning tool when analyzing climate change effects at the National Forest level.
The role of cancer-derived microRNAs in cancer immune escape
Authors: Yi Ming , Xu Linping , Jiao Ying , Luo Suxia , Li Anping , Wu Kongming 
Published: March 2020

AbstractDuring malignant transformation, accumulated somatic mutations endow cancer cells with increased invasiveness and immunogenicity. Under selective pressure, these highly immunogenic cancer cells develop multiple strategies to evade immune attack. It has been well established that cancer cells could downregulate the expression of major histocompatibility complex, acquire alterations in interferon pathway, and upregulate the activities of immune checkpoint pathways. Besides, cancer cells secret numerous cytokines, exosomes, and microvesicles to regulate the functions and abundances of components in the tumor microenvironment including immune effector cells and professional antigen presentation cells. As the vital determinant of post-transcriptional regulation, microRNAs (miRNAs) not only participate in cancer initiation and progression but also regulate anti-cancer immune response. For instance, some miRNAs affect cancer immune surveillance and immune escape by interfering the expression of immune attack-associated molecules. A growing body of evidence indicated that cancer-derived immune modulatory miRNAs might be promising targets to counteract cancer immune escape. In this review, we summarized the role of some miRNAs in cancer immune escape and discussed their potential clinical application as treatment targets.
The dawn of physiological closed-loop ventilation—a review
Authors: Platen Philip von , Pomprapa Anake , Lachmann Burkhard , Leonhardt Steffen 
Published: March 2020

AbstractThe level of automation in mechanical ventilation has been steadily increasing over the last few decades. There has recently been renewed interest in physiological closed-loop control of ventilation. The development of these systems has followed a similar path to that of manual clinical ventilation, starting with ensuring optimal gas exchange and shifting to the prevention of ventilator-induced lung injury. Systems currently aim to encompass both aspects, and early commercial systems are appearing. These developments remain unknown to many clinicians and, hence, limit their adoption into the clinical environment. This review shows the evolution of the physiological closed-loop control of mechanical ventilation.
Reduction of circulating innate lymphoid cell progenitors results in impaired cytokine production by innate lymphoid cells in patients with lupus nephritis
Authors: Ryu Seungwon , Lee Eun Young , Kim Dong Ki , Kim Yon Su , Chung Doo Hyun , Kim Ji Hyung , Lee Hajeong , Kim Hye Young 
Published: March 2020

Abstract
Background
Innate lymphoid cells (ILCs) play an essential role in maintaining homeostasis; however, they can also cause chronic inflammation and autoimmune disease. This study aimed to identify the role of ILCs in the pathogenesis of lupus nephritis (LN).

Methods
The percentage of ILCs within the peripheral blood mononuclear cell (PBMC) population and urine of patients with LN (n = 16), healthy controls (HC; n = 8), and disease controls (ANCA-associated vasculitis (AAV; n = 6), IgA nephropathy (IgAN; n = 9), and other glomerular diseases (n = 5)) was determined by flow cytometry analysis. In addition, ILCs were sorted and cultured with plasma from LN patients or HC to elucidate whether the reduced population of CD117+ ILCs observed in LN was due to changes in the ILC progenitor population.

Results
The percentage of total ILCs and CD117+ ILCs in LN was significantly lower than that in HC. The percentage of cytokine-secreting ILCs was also lower in LN; however, when the disease stabilized, cytokine production was restored to levels similar to those in HC. The increase in the number of exhausted ILCs (cells unable to secrete cytokines) correlated positively with disease activity. When CD117+ ILCs were cultured with LN plasma, the number of CD117+ ILCs fell, but that of other ILC subsets increased.

Conclusions
The percentage of CD117+ ILCs and the capacity of ILCs to secrete cytokines fell as LN severity increased, suggesting that an inflammatory environment of LN induces persistent differentiation and exhaustion of ILCs.
The immune microenvironment of uterine adenosarcomas
Authors: Ali Ali Mohammed Refaat , Tsai Jen-Wei , Leung Cheuk Hong , Lin Heather , Ravi Vinod , Conley Anthony P. , Lazar Alexander J. , Wang Wei-Lien , Nathenson Michael J. 
Published: March 2020

Abstract
Background
Uterine adenosarcoma (UA) is an extremely rare sarcoma subtype. There has been limited evaluation of the immune microenvironment in these tumors. The objective of this study is to examine and describe the immune infiltrate and PD-1/PD-L1 expression in UA and to correlate these changes in the tumor micro-environment with the overall survival status or the disease-free survival status (DFSS), respectively.

Methods
Patients (pts) treated at our center from 1982 to 2014 with UA were identified. Fifteen cases had tumor paraffin-embedded blocks available. Immunohistochemistry studies for CD3, CD8, FOXP3, CD163, PD-1 and PD-L1 (clone 22C3) were performed. Image analysis was used to assess the density (cells/mm2), except in PD-L1, where the percentage of membranous staining on tumor cells was noted.

Results
Immune infiltrate analysis median (range) density in cells/mm2 varied broadly: CD3 178 (15–802); CD8 117 (11–661); FoxP3 4.8 (0.2–82); CD163 791 (264–1861); and PD1 5 (1–65). 3 cases had rare (1%) PD-L1 tumor membranous labeling. The reports yielded that ten pts were alive, and 5 were dead. Pts who were alive had significant higher CD3 and CD8 median densities in tumors than those who were dead (p = 0.040). There was no correlation between DFSS and CD3 or CD8 median densities. Patients who had no local recurrence had significantly higher CD3 and CD8 median densities in tumors than those who had local recurrence (p = 0.040).

Conclusions
In conclusion, this is the first report characterizing the presence of immune infiltrate and PD-1/PD-L1 expression in UA. CD3+ CD8+ T-cells density may be prognostic. The immune-responsiveness of UA needs to be further investigated in a larger study.
Flow diversion in challenging vascular anatomies: the use of low profile stent retrievers for safe and accurate positioning of the microcatheter
Authors: Quäschling Ulf , Kläver Monika , Richter Cindy , Hamerla Gordian , Mucha Simone , Scherlach Cordula , Maybaum Jens , Hoffmann Karl-Titus , Schob Stefan 
Published: March 2020

Abstract
Background
Hemodynamic therapy with Flow-Diverters has become a fundamental option for treatment of cerebral aneurysms. A major obstacle of Flow-Diverters is the comparatively stiff microcatheter required for implantation. Consequentially, maneuverability is limited and primary catheterization of peripheral targets may be difficult or even futile in challenging vascular anatomies. To overcome this, a highly navigable microcatheter must be used to attain the desired vascular segment, followed by a hardly controllable exchange-maneuver via a long microwire, involving a high risk for wire-perforation. Our study aimed to investigate the value of low-profile stent-retrievers as a railway for introduction of the required microcatheter, which allows to maintain a stable endovascular position and reduce the risk for procedural vessel injury.

Methods
14cases (8females, mean-age 59y) of Flow-Diverter-Implantation requiring the use of a low-profile stent-retriever were reviewed. All cases featured a challenging vascular anatomy. After micro-catheterization of the desired segment, the stent-retriever was carefully deployed as an anchor in a secure, distal location. In all cases a pREset/LITE-stent-retriever was used for introduction of the equipment required for implantation.

Results
In all cases the anchoring-maneuver was performed without technical complications. The stent-retrievers maintained a stable position after deployment in all situations. No potential traumatic sudden movements of the microcatheter occurred. No procedure-related perforations, dissections or vasospasms were observable during the interventions or their aftermath.

Conclusions
In our experience the stent-retriever-anchoring-maneuver represents a potentially essential and safe amendment for flow diverter treatment in technically challenging situations.
A combined medical/surgical appendicitis pathway decreases pediatric CT utilization, perforation, and negative appendectomy rates
Authors: Johnson Sidney M. , Puapong Devin P. , Peebles Charles , Ishihara Kelli , Bogenberger Kenneth , Woo Russell K. 
Published: March 2020

Abstract
Background
We sought to improve the care of pediatric patients with possible appendicitis by decreasing unnecessary CT scanning. In an early QI initiative, we systematically emphasized the superiority of Ultrasonography (US) over CT, but did not find a decrease in CT utilization in practice. We therefore redoubled our initiative using a multimodal approach. We hypothesized a combined diagnostic and treatment pathway that allowed residual diagnostic uncertainty and used both surgery and antibiotic therapy for appendicitis that would decrease the need for diagnostic CT scanning.

Results
Prior to implementation of the protocol, 33% of ER patients with appendicitis typical abdominal pain were treated for appendicitis (with surgery); after implementation, the total number treated remained unchanged 32.5% (p = NS), but the appendectomy rate dropped from 33 (204/619) to 23% after implementation of the pathway (96/419, p < 0.0005) with 50 patients treated with antibiotics. There was a reduction in CT scanning (pre 39% vs. 11%, p < 0.0001) while the use of US increased (pre 30% vs. 53%, p < 0.0001). The perforation rate decreased from 12 to 5% (p < 0.002) and negative appendectomy decreased from 13 to 4% (p < 0.0001). Of the 50 patients treated with antibiotics, 10 eventually crossed over to surgery.

Conclusion
The use of a diagnostic and therapeutic pathway that offers antibiotic therapy for early probable appendicitis decreases the need for diagnostic CT scanning without increasing morbidity in pediatric appendicitis. Adherence to a medical/surgical treatment protocol that reserves surgery for clinically advanced appendicitis results in a reduction in CT scanning, perforation rates, negative appendectomy rates, and overall surgery for appendicitis.
Zebrafish cyp11c1 Knockout Reveals the Roles of 11-ketotestosterone and Cortisol in Sexual Development and Reproduction
Authors: Zhang Qifeng , Ye Ding , Wang Houpeng , Wang Yaqing , Hu Wei , Sun Yonghua 
Published: March 2020

Abstract
Androgen is essential for male development and cortisol is involved in reproduction in fishes. However, the in vivo roles of cortisol and specific androgens such as 11-ketotestosterone (11-KT) in reproductive development need to be described with genetic models. Zebrafish cyp11c1 encodes 11β-hydroxylase, which is essential for the biosynthesis of 11-KT and cortisol. In this study, we generated a zebrafish mutant of cyp11c1 (cyp11c1-/-) and utilized it to clarify the roles of 11-KT and cortisol in sexual development and reproduction. The cyp11c1-/- fish had smaller genital papilla and exhibited defective natural mating but possessed mature gametes and were found at a sex ratio comparable to the wildtype control. The cyp11c1-/- males showed delayed and prolonged juvenile ovary-to-testis transition and displayed defective spermatogenesis at adult stage, which could be rescued by treatment with 11-ketoandrostenedione (11-KA) at certain stages. Specifically, during testis development of cyp11c1-/- males, the expression of insl3, cyp17a1, and amh was significantly decreased, suggesting that 11-KT is essential for the development and function of Leydig cells and Sertoli cells. Further, spermatogenesis-related dmrt1 was subsequently downregulated, leading to insufficient spermatogenesis. The cyp11c1-/- females showed a reduction in egg spawning and a failure of in vitro germinal vesicle breakdown, which could be partially rescued by cortisol treatment. Taken together, our study reveals that zebrafish Cyp11c1 is not required for definite sex differentiation but is essential for juvenile ovary-to-testis transition, Leydig cell development, and spermatogenesis in males through 11-KT, and it is also involved in oocyte maturation and ovulation in females through cortisol.
Electroencephalography-Guided Anesthetic Delivery for Preventing Postoperative Delirium in Adults: An Updated Meta-analysis
Authors: Sun Yi , Ye Fan , Wang Jing , Ai Pan , Wei Changwei , Wu Anshi , Xie Wuxiang 
Published: March 2020

BACKGROUND:
Postoperative delirium is a major debilitating complication for patients and is associated with poor outcomes. Previous studies have suggested that excessive general anesthesia may lead to postoperative delirium. Electroencephalography (EEG)-based monitors have been administered in clinical practice in an attempt to deliver appropriate anesthesia. The aim of this updated meta-analysis was to evaluate the current body of research concerning the effects of EEG-based monitor on postoperative delirium.

METHODS:
We conducted a meta-analysis of randomized controlled trials of the effect of processed EEG monitor on postoperative delirium as the primary outcome. The search was performed in CENTRAL, MEDLINE, and EMBASE, with no language restrictions from inception until June 23, 2019. Two independent reviewers screened records and full-text articles for inclusion. Data extraction and risk-of-bias assessment were conducted by 3 independent reviewers. Random-effects models were used to calculate combined-effect estimates. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence.

RESULTS:
Of 5904 records screened, 5 studies met our inclusion criteria, including 3612 patients. Meta-analysis revealed no significant effect of EEG-based monitors on postoperative delirium (risk ratio [RR], 0.79; 95% confidence interval [CI], 0.60–1.05; I
2 = 73%). The results showed a statistically significant reduction in intensive care unit (ICU) length of stay (3 studies, weight mean difference [WMD] −0.29 days; 95% CI, −0.53 to −0.05) in patients with EEG monitored. EEG-guided anesthesia did not have a statistically significant difference in all-cause mortality (3 studies, RR, 0.63; 95% CI, 0.31–1.29) and hospital length of stay (4 studies, WMD −0.61 days; 95% CI, −1.34 to 0.11). Few studies investigated the effects of EEG-guided anesthesia on perioperative major nonneurological complications and did not come up with promising results.

CONCLUSIONS:
The current evidence is not sufficient to support the prevention effects of EEG monitor on postoperative delirium. More robustly designed and well-conducted studies with emphasis on this matter are warranted.
Lung Ultrasound Findings in the Postanesthesia Care Unit Are Associated With Outcome After Major Surgery: A Prospective Observational Study in a High-Risk Cohort
Authors: Zieleskiewicz Laurent , Papinko Mickael , Lopez Alexandre , Baldovini Alice , Fiocchi David , Meresse Zoe , Boussuges Alain , Thomas Pascal Alexandre , Berdah Stephane , Creagh-Brown Ben , Bouhemad Belaid , Futier Emmanuel , Resseguier Noémie , Antonini François , Duclos Gary , Leone Marc 
Published: March 2020

Background:
Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment.

METHODS:
Patients with an American Society of Anesthesiologists (ASA) score >1 and who were scheduled for major surgery of >2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models.

RESULTS:
Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 [7–18] vs 8 [4–12]; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2–11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57–0.71).

CONCLUSIONS:
When lung ultrasound is performed precociously <2 hours after extubation, detection of immediate postoperative alveolar consolidation and pleural effusion by lung ultrasound is associated with postoperative pulmonary complications and morbi-mortality. Further study is needed to determine the effect of ultrasound-guided intervention for patients at high risk of postoperative pulmonary complications.