bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound-guided quadratus lumborum block for postoperative pain control in patients undergoing unilateral inguinal hernia repair, a comparative study between two approaches
Authors: Ahmed Abeer , Fawzy Maher , Nasr Mohamed A. R. , Hussam Ayman M. , Fouad Eman , Aboeldahb Hesham , Saad Dalia , Osman Safinaz , Fahmy Rania Samir , Farid Mohamed , Waheb Mohsen M. 
Published: October 2019

Abstract

Background
Early postoperative ambulation and reduction of hospital stay necessitate efficient postoperative analgesia. Quadrates Lumborum Block (QLB) has been described to provide adequate postoperative analgesia after abdominal surgery. This randomized comparative trial was designed to compare the duration of analgesia provided by two different QLB approaches; the posterior QLB (QLB-2) and transmuscular QLB (QLB-3) in patients undergoing surgical repair of unilateral inguinal hernia.

Methods
Forty patients, aged from 18 to 50 years, ASA physical status I or II, scheduled for unilateral inguinal hernia repair were enrolled. At the end of the surgical procedure and before recovery from general anesthesia, Patients were randomly assigned into two groups to receive either posterior QLB (Group QLB-2) or transmuscular QLB (Group QLB-3) using 20 ml 0.25% bupivacaine. Duration of analgesia, postoperative VAS and postoperative opioid consumption were recorded.

Results
Duration of block was significantly longer in QLB-3 group when compared to QLB-2 group (20.1 + 6.2 h versus 12.0 + 4.8 respectively) with P value of < 0.001. A statistically significant lower VAS score was recorded in QLB-3 group immediately and 12 h postoperative. QLB-3 group showed a statistically significant delayed time of first analgesic request and less postoperative morphine consumption with P value of < 0.001 and 0.001 respectively.

Conclusions
Ultrasound guided postsurgical transmuscular approach of QLB (QLB-3) using 20 ml 0.25% bupivacaine produces more postoperative analgesic effect and less postoperative opioid consumption when compared to posterior QLB approach (QLB-2) in patients underwent unilateral inguinal hernia repair under general anesthesia.

Trial registration
ClinicalTrials.gov identifier: NCT03526731- on 16 May 2018.
TAFRO syndrome as a cause of glomerular microangiopathy: a case report and literature review
Authors: Nagayama Yoshikuni , Yamano Mizuki , Yagame Motoka , Nariyama Tomoyuki , Takahashi Mikiko , Kawamoto Masashi , Matsui Katsuyuki 
Published: October 2019

Abstract

Background
TAFRO syndrome is a systemic inflammatory disorder that manifests as thrombocytopenia (T), anasarca (A), fever (F), reticulin fibrosis (R), and organomegaly (O). Renal dysfunction is frequently complicated with TAFRO syndrome, however, it is challenging to perform kidney biopsy in patients with TAFRO syndrome in the presence of thrombocytopenia. Renal histology in TAFRO syndrome mainly shows membranoproliferative glomerulonephritis (MPGN)-like lesions or thrombotic microangiopathy (TMA)-like glomerulopathy. We review our case and previous reports of TAFRO syndrome with kidney biopsy findings and discuss the renal pathophysiology of TAFRO syndrome.

Case presentation
We describe a previously healthy 48- year-old woman with TAFRO syndrome. Kidney biopsy performed before the treatment showed diffuse global endocapillary proliferative changes with endothelial cell swelling, double contours of partial capillary walls, and mesangiolysis, consistent with TMA-like glomerulopathy. Glucocorticoid therapy including steroid pulse was ineffective and she developed anasarca, renal dysfunction and oliguria. Hemodialysis was required. However, the anti-Interleukin (IL)-6 receptor antibody (tocilizumab) therapy was very effective. An increase in urinary volume was achieved about 2 weeks after the tocilizumab therapy and hemodialysis was discontinued. To investigate the renal pathophysiology of TAFRO syndrome, we performed immunohistological staining of vascular endothelial growth factor (VEGF)-A, CD34, and D2–40, in our case and a normal control kidney. Glomerular VEGF-A was especially positive in podocytes both, in the control and in the case, with no significant difference and there was a significant increase of VEGF-A staining area in the cortical peritubular capillaries in the case. Both glomerular and renal cortical CD34 expression were significantly decreased in our case. D2–40 expression in cortex was not significantly different.

Conclusions
We reviewed our case and other 10 previous reports about renal biopsy findings in TAFRO syndrome and found that glomerular microangiopathy was a common finding. IL-6-VEGF-axis-induced glomerular microangiopathy may play a crucial role in developing acute kidney injury in TAFRO syndrome and the anti-IL-6 receptor antibody therapy may be useful for TAFRO syndrome refractory to glucocorticoids. About the pathophysiology of VEGF in TAFRO syndrome, VEGF balance in the glomerulus and perhaps in the peritubular capillary system as well may be critical. Further investigation is needed.
Mortality and severe morbidity of very preterm infants: comparison of two French cohort studies
Authors: Godeluck Anais , Gérardin Patrick , Lenclume Victorine , Mussard Corinne , Robillard Pierre-Yves , Sampériz Sylvain , Benhammou Valérie , Truffert Patrick , Ancel Pierre-Yves , Ramful Duksha 
Published: October 2019

Abstract

Background
In Reunion Island, a French overseas department, the burden of preterm birth and perinatal mortality exceed those observed in mainland France, despite similar access to standard perinatal care. The purpose of the study was to compare the outcome of two cohorts of NICU-admitted very preterm infants born between 24 and 31 weeks of gestation (WG): the registry-based OGP (Observatoire de la Grande Prématurité, Reunion Island, 2008–2013) cohort, and the nationwide EPIPAGE-2 (mainland France, 2011) observational cohort.

Methods
The primary outcome was adverse neonatal outcomes defined as a composite indicator of in-hospital mortality or any of three following severe morbidities: bronchopulmonary dysplasia (BPD), necrotising enterocolitis, or severe neurological injury (periventricular leukomalacia or grade III-IV intraventricular haemorrhages). Logistic regression modelling adjusting for confounders was performed.

Results
A total of 1272 very preterm infants from the Reunionese OGP cohort and 3669 peers from the mainland EPIPAGE-2 cohort were compared. Adverse neonatal outcomes were more likely observed in the OGP cohort (32.6% versus 26.6%, p <  0.001), as result of both increased in-hospital mortality across all gestational age strata and increased BPD among the survivors of the 29–31 WG stratum. After adjusting for gestational age, gender and multiple perinatal factors, the risk of adverse neonatal outcomes was higher in the OGP cohort than in the EPIPAGE-2 cohort across all gestational age strata.

Conclusions
Despite similar guidelines for standard perinatal care, very preterm infants born in Reunion Island have a higher risk for death or severe morbidity compared with those born in mainland France.
Modifying ankle foot orthosis stiffness in patients with calf muscle weakness: gait responses on group and individual level
Authors: Waterval Niels F. J. , Nollet Frans , Harlaar Jaap , Brehm Merel-Anne 
Published: October 2019

Abstract

Background
To improve gait, persons with calf muscle weakness can be provided with a dorsal leaf spring ankle foot orthosis (DLS-AFO). These AFOs can store energy during stance and return this energy during push-off, which, in turn, reduces walking energy cost. Simulations indicate that the effect of the DLS-AFO on walking energy cost and gait biomechanics depends on its stiffness and on patient characteristics. We therefore studied the effect of varying DLS-AFO stiffness on reducing walking energy cost, and improving gait biomechanics and AFO generated power in persons with non-spastic calf muscle weakness, and whether the optimal AFO stiffness for maximally reducing walking energy cost varies between persons.

Methods
Thirty-seven individuals with neuromuscular disorders and non-spastic calf muscle weakness were included. Participants were provided with a DLS-AFO of which the stiffness could be varied. For 5 stiffness configurations (ranging from 2.8 to 6.6 Nm/degree), walking energy cost (J/kg/m) was assessed using a 6-min comfortable walk test. Selected gait parameters, e.g. maximal dorsiflexion angle, ankle power, knee angle, knee moment and AFO generated power, were derived from 3D gait analysis.

Results
On group level, no significant effect of DLS-AFO stiffness on reducing walking energy cost was found (p = 0.059, largest difference: 0.14 J/kg/m). The AFO stiffness that reduced energy cost the most varied between persons. The difference in energy cost between the least and most efficient AFO stiffness was on average 10.7%. Regarding gait biomechanics, increasing AFO stiffness significantly decreased maximal ankle dorsiflexion angle (− 1.1 ± 0.1 degrees per 1 Nm/degree, p < 0.001) and peak ankle power (− 0.09 ± 0.01 W/kg, p < 0.001). The reduction in minimal knee angle (− 0.3 ± 0.1 degrees, p = 0.034), and increment in external knee extension moment in stance (− 0.01 ± 0.01 Nm/kg, p = 0.016) were small, although all stiffness’ substantially affected knee angle and knee moment compared to shoes only. No effect of stiffness on AFO generated power was found (p = 0.900).

Conclusions
The optimal efficient DLS-AFO stiffness varied largely between persons with non-spastic calf muscle weakness. Results indicate this is caused by an individual trade-off between ankle angle and ankle power affected differently by AFO stiffness. We therefore recommend that the AFO stiffness should be individually optimized to best improve gait.

Trial registration number
Nederlands Trial Register 5170. Registration date: May 7th 2015. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5170
Characterization of Cronartium ribicola dsRNAs reveals novel members of the family Totiviridae and viral association with fungal virulence
Authors: Liu Jun-Jun , Xiang Yu , Sniezko Richard A. , Schoettle Anna W. , Williams Holly , Zamany Arezoo 
Published: October 2019

AbstractBackgroundMycoviruses were recently discovered in the white pine blister rust (WPBR) fungusCronartium ribicola(J.C. Fisch.). Detection and characterization of their double stranded RNA (dsRNA) would facilitate understanding of pathogen virulence and disease pathogenesis in WPBR systems.MethodsFull-length cDNAs were cloned from the dsRNAs purified from viral-infectedC. ribicola, and their cDNA sequences were determined by DNA sequencing. Evolutionary relationships of the dsRNAs with related mycoviruses were determined by phylogenetic analysis. Dynamic distributions of the viral RNAs within samples of their fungal hostC. ribicolawere investigated by measurement of viral genome prevalence and viral gene expression.ResultsIn this study we identified and characterized five novel dsRNAs fromC. ribicola, designated asCronartium ribicolatotivirus 1–5 (CrTV1 to CrTV5). These dsRNA sequences encode capsid protein and RNA-dependent RNA polymerase with significant homologies to dsRNA viruses of the familyTotiviridae. Phylogenetic analysis showed that the CrTVs were grouped into two distinct clades. CrTV2 through CrTV5 clustered within the genusTotivirus. CrTV1 along with a few un-assigned dsRNAs constituted a distinct phyletic clade that is genetically distant from presently known genera in theTotiviridaefamily, indicating that CrTV1 represents a novel genus in theTotiviridaefamily. The CrTVs were prevalent in fungal samples obtained from infected western white pine, whitebark pine, and limber pines. Viral RNAs were generally expressed at higher levels duringin plantamycelium growth than in aeciospores and urediniospores. CrTV4 was significantly associated withC. ribicolavirulent pathotype and specificC. ribicolahost tree species, suggesting dsRNAs as potential tools for dissection of pathogenic mechanisms ofC. ribicolaand diagnosis ofC. ribicolapathotypes.ConclusionPhylogenetic and expression analyses of viruses in the WPBR pathogen,C. ribicola,have enchanced our understanding of virus diversity in the familyTotiviridae, and provided a potential strategy to utilize pathotype-associated mycoviruses to control fungal forest diseases.
Effect of modern high-dose versus standard-dose radiation in definitive concurrent chemo-radiotherapy on outcome of esophageal squamous cell cancer: a meta-analysis
Authors: Luo He-San , Huang He-Cheng , Lin Lian-Xing 
Published: October 2019

Abstract

Background and objectives
Radiation Therapy Oncology Group (RTOG) 94–05 has demonstrated that higher dose radiation didn’t improve outcome of patients with esophageal cancer (EC). However, several retrospective studies showed that a higher dose radiation based on modern radiotherapy techniques could improve overall survival (OS) and local control rate (LCR) of patients with EC, especially esophageal squamous cell cancer (ESCC). As trials have provided updated and controversial data, we performed this updated meta-analysis to investigate whether high-dose (> = 60 Gy) radiotherapy in definitive concurrent chemo-radiotherapy (CCRT) could yield benefit compared to standard dose radiotherapy.

Methods
A systematic literature search was carried out in the database of MEDLINE, PubMed and Embase. All studies published between 1 January 1990 and 31 December 2018 on the association between radiation dose and curative efficiency in EC were included in this meta-analysis. The hazard ratio (HR) was used to evaluate the time-to-event data employing RevMan version 5.3.

Results
Eight articles with a total of 3736 patients were finally included. Results indicated that there was a significant benefit in favor of high dose radiotherapy (HD-RT) regarding OS (HR = 0.78, 95%CI: 0.72–0.84, p < 0.001; 2-year OS risk ratio (RR) = 1.25, 95%CI: 1.14–1.37, p < 0.001), progression-free survival (PFS) (P = 0.001, HR = 0.7, 95%CI: 0.57–0.87) and LRFS (P < 0.001, HR = 0.52, 95%CI: 0.36–0.74) .

Conclusions
HD-RT (> = 60 Gy) based on modern radiotherapy techniques in definitive CCRT appears to improve OS, PFS amd LRFS compared to the SD-RT in patients with ESCC.
The development of a provincial multidisciplinary framework of consensus-based standards for Point of Care Ultrasound at the University of Saskatchewan
Authors: Olszynski Paul , Kim Daniel J. , Ma Irene W. Y. , Clunie Michelle , Lambos Peggy , Guzowski Tom , Butz Matthew , Thoma Brent 
Published: October 2019

Abstract

Objectives
The development and adoption of Point-of-Care Ultrasound (POCUS) across disciplines have created challenges and opportunities in implementing training and utilization standards. Within the context of a large, geographically disparate province, we sought to develop a multidisciplinary POCUS framework outlining consensus-based standards.

Methods
A core working group of local POCUS leaders from Anesthesia, Emergency Medicine, Family Medicine, Intensive Care, Internal Medicine, Pediatrics, and Trauma, in collaboration with western Canadian colleagues, developed a list of key domains for the framework along with a range of potential standards for each area. The members of the working group and the registrants for a multidisciplinary Roundtable discussion at the University of Saskatchewan’s annual POCUS conference (SASKSONO19, Saskatoon, Saskatchewan, March 2nd, 2019) were invited to complete a survey on POCUS standards for each domain. The survey results were presented to and discussed by participants at the Roundtable discussion at SASKSONO19 who reached consensus on modified standards for each domain. The modified standards were considered for endorsement by all conference attendees using an audience-response system.

Results
The working group proposed standards in eight domains: scope of use, credentialing and privileges, documentation, quality assurance, leadership and governance, teaching, research, and equipment maintenance. Consensus on modified standards was achieved in the 18 participant Roundtable. Each standard was then endorsed by > 90% of conference respondents.

Conclusion
The resulting framework will inform the utilization of POCUS within Saskatchewan. Both this process and its outcomes could inform the development of multidisciplinary POCUS standards within other jurisdictions.
Hopf bifurcation of a delayed worm model with two latent periods
Authors: Liu Juan , Zhang Zizhen 
Published: October 2019

Abstract
We investigate a delayed epidemic model for the propagation of worm in wireless sensor network with two latent periods. We derive sufficient conditions for local stability of the worm-induced equilibrium of the system and the existence of Hopf bifurcation by regarding different combination of two latent time delays as the bifurcation parameter and analyzing the distribution of roots of the associated characteristic equation. In particular, we investigate the direction and stability of the Hopf bifurcation by means of the normal form theory and center manifold theorem. To verify analytical results, we present numerical simulations. Also, the effect of some influential parameters of sensor network is properly executed so that the oscillations can be reduced and removed from the network.
Molecular mutations as a possible factor for determining extent of thyroid surgery
Authors: Krasner Joshua R. , Alyouha Nourah , Pusztaszeri Marc , Forest Veronique-Isabelle , Hier Michael P. , Avior Galit , Payne Richard J. 
Published: October 2019

Background Molecular testing of thyroid nodules is a diagnostic tool used to better understand the nature of thyroid nodules. The aim of this study is to better comprehend the relationship between specific mutations and aggressive behavior of the tumour as demonstrated on postoperative pathological analysis. Methods A retrospective chart review of 103 cases was performed. Included were patients who had undergone molecular testing using a panel that tests for 9 mutations (ThyGenX®) and were found to have malignant tumours. The following gene alterations were found pre-operatively in the nodules: BRAF V600E ( n = 32), BRAF K601E ( n = 4), NRAS ( n = 11), HRAS ( n = 4), KRAS ( n = 3), RET/PTC1 rearrangement ( n = 1), TERT promoter ( n = 2), PAX8-PPARγ rearrangement ( n = 1), and 45 cases where no mutation was detected. Aggressive behavior was defined by extra-thyroidal extension (ETE), lymph node metastasis (LN+), and the following variants of papillary thyroid carcinoma: tall cell, solid, diffuse sclerosing, columnar cell and hobnail. Chi-squared testing was performed to compare groups. Results The group with BRAF V600E, RET/PTC1 rearrangement, and TERT promoter mutations was associated with ETE 37.1%, and LN+ 45.7% of the time compared to 4.3 and 13.0% in the group with other mutations, and 4.4 and 4.4% in the group with no mutations ( p-value 0.02, p-value < 0.001, p-value 0.006). In addition, the BRAF V600E, RET/PTC1 rearrangement, and TERT mutations group demonstrated tall cell variants (17.1%), columnar cell variants (5.7%), and hobnail variants (3%). The other mutations group demonstrated columnar cell variants (4.3%), and the no mutations group demonstrated solid variants (2.2%). Conclusions In this study, BRAF V600E, RET/PTC1 rearrangement, and TERT mutations were associated with aggressive behaving thyroid malignancies as defined above. Molecular testing may be a useful method to anticipate aggressive tumour types and therefore assist in planning the extent and timing of surgery.
A machine learning model for the prediction of survival and tumor subtype in pancreatic ductal adenocarcinoma from preoperative diffusion-weighted imaging
Authors: Kaissis Georgios , Ziegelmayer Sebastian , Lohöfer Fabian , Algül Hana , Eiber Matthias , Weichert Wilko , Schmid Roland , Friess Helmut , Rummeny Ernst , Ankerst Donna , Siveke Jens , Braren Rickmer 
Published: October 2019

Abstract

Background
To develop a supervised machine learning (ML) algorithm predicting above- versus below-median overall survival (OS) from diffusion-weighted imaging-derived radiomic features in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods
One hundred two patients with histopathologically proven PDAC were retrospectively assessed as training cohort, and 30 prospectively accrued and retrospectively enrolled patients served as independent validation cohort (IVC). Tumors were segmented on preoperative apparent diffusion coefficient (ADC) maps, and radiomic features were extracted. A random forest ML algorithm was fit to the training cohort and tested in the IVC. Histopathological subtype of tumor samples was assessed by immunohistochemistry in 21 IVC patients. Individual radiomic feature importance was evaluated by assessment of tree node Gini impurity decrease and recursive feature elimination. Fisher’s exact test, 95% confidence intervals (CI), and receiver operating characteristic area under the curve (ROC-AUC) were used.

Results
The ML algorithm achieved 87% sensitivity (95% IC 67.3–92.7), 80% specificity (95% CI 74.0–86.7), and ROC-AUC 90% for the prediction of above- versus below-median OS in the IVC. Heterogeneity-related features were highly ranked by the model. Of the 21 patients with determined histopathological subtype, 8/9 patients predicted to experience below-median OS exhibited the quasi-mesenchymal subtype, whilst 11/12 patients predicted to experience above-median OS exhibited a non-quasi-mesenchymal subtype (p < 0.001).

Conclusion
ML application to ADC radiomics allowed OS prediction with a high diagnostic accuracy in an IVC. The high overlap of clinically relevant histopathological subtypes with model predictions underlines the potential of quantitative imaging in PDAC pre-operative subtyping and prognosis.
Nutritional potentials and in vitro estimation of composite cocoa pod husk-based diets for ruminants
Authors: Omotoso Oluwatosin Bode 
Published: October 2019

Abstract

Background
The use of cocoa pod husk in livestock nutrition is being limited because of its fibrous nature and anti-nutrients, which have detrimental effect(s) on the animals. This study was conducted to evaluate the nutritive value and effects of replacing urea-treated ensiled cocoa pod husk meal (urea-treated CPHM) with cassava peel in a complete concentrate diet (CCD) on in vitro digestibility and methane (CH4) production.

Methods
Urea-treated CPHM was prepared by soaking the raw milled pod in 5% urea solution under anaerobic condition for 7 days, and decanted and the filtrates were further ensiled for 28 days, dried, and were replaced with cassava peel meal in CCD at 0, 5, 7.5, 10, 12.5, and 15% on part basis. Feed samples (n = 3) were analyzed for chemical composition, and data generated from in vitro study were subjected to statistical analysis in a completely randomized design experiment.

Results
Results revealed that the treatment significantly reduced the crude fiber, fiber fraction contents, and anti-nutrients and improved the crude protein content of the pod by 71.84%. Dry matter and crude protein of the diets ranged from 89.34–89.71% and 10.52–12.84%, respectively. The in vitro dry matter digestibility (IVDMD) increased with increasing levels of urea-treated CPHM in the diets. With increasing levels of urea-treated CPHM, CH4 production relatively reduced as compared to diet E. Metabolizable energy (5.66 Kcal/g) of diet F was the highest. Therefore, the inclusion of urea-treated CPHM at 15% in CCDs has the potential for improving digestibility and reducing CH4 production in ruminants.