Computer-Aided Diagnosis Scheme for Determining Histological Classification of Breast Lesions on Ultrasonographic Images Using Convolutional Neural Network.

Abstract: It can be difficult for clinicians to accurately discriminate among histological classifications of breast lesions on ultrasonographic images. The purpose of this study was to develop a computer-aided diagnosis (CADx) scheme for determining histological classifications of breast lesions using a convolutional neural network (CNN). Our database consisted of 578 breast ultrasonographic images. It included 287 malignant (217 invasive carcinomas and 70 noninvasive carcinomas) and 291 benign lesions (111 cysts and 180 fibroadenomas). In this study, the CNN constructed from four convolutional layers, three batch-normalization layers, four pooling layers, and two fully connected layers was employed for distinguishing between the four different types of histological classifications for lesions. The classification accuracies for histological classifications with our CNN model were 83.9⁻87.6%, which were substantially higher than those with our previous method (55.7⁻79.3%) using hand-crafted features and a classifier. The area under the curve with our CNN model was 0.976, whereas that with our previous method was 0.939 (p = 0.0001). Our CNN model would be useful in differential diagnoses of breast lesions as a diagnostic aid.

computer-aided diagnosis
histological classification
breast lesion
ultrasonographic image
convolutional neural network


Contribution of Modern Echocardiographic Techniques in the Detection of Subclinical Heart Dysfunction in Young Adults with Non-Alcoholic Fatty Liver Disease.

Abstract:
Non-alcoholic fatty liver disease affects about 30% of the population and it has a growing tendecy with the increasing incidence of obesity. Currently, a large amount of clinical evidence has shown that cardiovascular disease represents the main cause of mortality in patients suffering from non-alcoholic fatty liver disease.

OBJECTIVE
In this study we investigated the structural and functional changes of the left ventricle in young adults with hepatic steatosis using modern echocardiographic techniques.

METHODS
By using tissue Doppler imaging and also Speckle tracking echocardiography the left ventricle systolic function was assessed.

RESULTS
All patients included in the study had a normal left ventricular ejection fraction but, when the longitudinal function of the left ventricle was assessed using the tissue Doppler technique (maximum systolic velocity S) statistically significant differences were found in both the group of patients with non-alcoholic fatty liver as well as in the group of patients associated with diabetes. Using speckle tracking echocardiography, we found a statistically significant decrease of the global longitudinal strain in the endocardium, in the group of patients with non-alcoholic liver disease but also in the group of those with diabetes. The overall longitudinal strain at the myocardium was significantly reduced only in the group of patients with non-alcoholic fatty liver disease and diabetes, while the overall longitudinal strain at the epicardium showed no changes in any of the groups studied. Also, no changes were observed at the circumferential strain.

CONCLUSION
Non-alcoholic fatty liver disease, diagnosed in asymptomatic young adults may be a risk factor for remodeling the left ventricle over time, being associated with subclinical myocardial dysfunction, regardless of the presence of other cardiovascular risk factors.

Moise|Cristiana Gianina|CG|
Donoiu|Ionuţ|I|
Târtea|Georgică-Costinel|GC|
Mirea|Oana|O|
Rogoveanu|Ion|I|

non-alcoholic fatty liver disease
tissue Doppler imaging
global longitudinal strain
circumferential strain
Left ventricular dysfunction


Can Adrenal Adenomas Be Differentiated From Adrenal Metastases at Single-Phase Contrast-Enhanced CT?

Abstract:
OBJECTIVE
The purpose of this study is to evaluate whether adrenal metastases can be reliably differentiated from adenomas at single-phase contrast-enhanced CT.

MATERIALS AND METHODS
Sixty-one consecutive patients from a single-institution lung cancer registry (40 metastases and 36 adenomas) who underwent single-phase contrast-enhanced CT at baseline diagnosis were retrospectively studied by two radiologists (blinded to the diagnoses) who independently evaluated four features previously described in adenomas: smooth margin, rim enhancement, central vein sign (preserved adrenal vein), and homogeneity (using a 5-point Likert scale). A third radiologist measured size and attenuation and performed quantitative texture analysis. Comparisons were performed using chi-square, logistic regression, and ROC analysis.

RESULTS
Metastases were larger than adenomas (mean [± SD] 24 ± 11 mm [range, 11-66 mm] vs 19 ± 5 mm [range, 11-34 mm]; p = 0.012), with overlap between groups. Attenuation of metastases and adenomas did not differ significantly (58.2 ± 21.0 HU [range, 21.0-108.0] vs 55.5 ± 21.5 HU [range, 14.0-105.0]; p = 0.582). Skewness and kurtosis did not differ between groups (p = 0.612 and 0.978, respectively), whereas entropy was higher in metastases (p = 0.013). The AUC for entropy to diagnose metastases was 0.65 (95% CI, 0.52-0.77). Tumor margin, rim enhancement, and the central vein sign did not differ between groups (p > 0.05). Metastases were considered more heterogeneous by both radiologists (p = 0.001 and 0.011, respectively), and agreement was satisfactory (κ = 0.51). Likert scores of 4 or 5 (mostly or completely heterogeneous) yielded sensitivity and specificity for diagnosis of metastases of 32.5% and 97.2%, respectively, for radiologist 1 and 22.5% and 97.2%, respectively, for radiologist 2.

CONCLUSION
Adrenal metastases cannot be reliably differentiated from adenomas at single-phase contrast-enhanced CT. Increased tumor size and heterogeneity were specific findings but showed unacceptably low sensitivity.

Tu|Wendy|W|
Verma|Raman|R|
Krishna|Satheesh|S|
McInnes|Matthew D F|MDF|
Flood|Trevor A|TA|
Schieda|Nicola|N|

adrenal
adenoma
metastases
CT
texture analysis


A case report of unusually long lag time between immunotactoid glomerulopathy (itg) diagnosis and diffuse large B-cell lymphoma (DLBCL) development.

Abstract:
BACKGROUND
Immunotactoid glomerulopathy (ITG) is a rare cause of proteinuria characterized by organized microtubular deposits in the glomerulus. ITG has been associated with underlying lymphoproliferative disorders and any renal impairment may be reversible with treatment of the concomitant hematologic malignancy. This case is the first reported in literature where diffuse large B cell lymphoma developed two years following the initial ITG diagnosis.

CASE PRESENTATION
A 55-year-old woman with a history of well-controlled diabetes mellitus and thalassemia trait presented with proteinuria (830 mg/day) in 2010. Initially, she was managed with renin-angiotensin-aldosterone-system blockade. In 2012, the proteinuria worsened (4.3 g/day) and a renal biopsy showed immunotactoid glomerulopathy (Fig. 1). Despite extensive work up, no lymphoproliferative disorder was initially found. In January 2014, the patient presented with a soft-palate mass found on biopsy to be diffuse large B-cell lymphoma. She received 6 cycles of R-CHOP, 4 cycles of high dose methotrexate chemotherapy for CNS prophylaxis and 30 Gy of Intensity Modulated Radiation Therapy. Follow-up revealed complete remission of diffuse large B-cell lymphoma and resolution of proteinuria from the ITG.

CONCLUSION
As we recognize that patients with ITG may develop hematopoietic neoplasms, close long-term monitoring is important. Moreover, treatment of the lymphoproliferative disorder can allow for complete remission of ITG.

Khandelwal|Aditi|A|
Trinkaus|Martina A|MA|
Ghaffar|Hassan|H|
Jothy|Serge|S|
Goldstein|Marc B|MB|

Monoclonal gammopathy of renal significance


The pleasure of revenge: retaliatory aggression arises from a neural imbalance toward reward.

Abstract: Most of daily life hums along peacefully but provocations tip the balance toward aggression. Negative feelings are often invoked to explain why people lash out after an insult. Yet people might retaliate because provocation makes aggression hedonically rewarding. To test this alternative hypothesis, 69 participants underwent functional neuroimaging while they completed a behavioral aggression task that repeatedly manipulated whether aggression was preceded by an instance of provocation or not. After provocation, greater activity in the nucleus accumbens (NAcc) (a brain region reliably associated with reward) during aggressive decisions predicted louder noise blasts administered in retaliation. Greater NAcc activation was also associated with participants' history of real-world violence. Functional connectivity between the NAcc and a regulatory region in the lateral prefrontal cortex related to lower retaliatory aggression. These findings suggest that provocation tips the neural balance towards hedonic reward, which fosters retaliatory aggression. Although such pleasure of inflicting pain may promote retaliatory aggression, self-regulatory processes can keep such aggressive urges at bay. Implications for theory and violence reduction are discussed.

aggression
reward
nucleus accumbens
lateral prefrontal cortex
self-regulation


Pseudo-hemothorax at computed tomography due to residual contrast media.

Abstract: Pleural effusion is a clinical problem that has many causes, with hemothorax being one of them. Computed tomography readily characterizes pleural fluid with determination of the attenuation value, helping to distinguish hemothorax from other types of effusion. Herein, we report the case of a 67-year-old man with end-stage renal disease in which a high-density pleural effusion due to residual contrast media was misinterpreted as hemothorax. Radiologists should consider the possibility of contrast media retention when interpreting a high-density pleural effusion in patients with end-stage renal disease. Recognition of this entity is crucial to avoid misdiagnosis, which might lead to unnecessary testing or procedures.

Computed tomography
Contrast
Media
Pleural effusion
Hemothorax
Chronic kidney failure
Differential diagnosis


Microwave-assisted of dispersive liquid-liquid microextraction and spectrophotometric determination of uranium after optimization based on Box-Behnken design and chemometrics methods.

Abstract: In this study an analytical procedure based on microwave-assisted dispersive liquid-liquid microextraction (MA-DLLME) and spectrophotometric coupled with chemometrics methods is proposed to determine uranium. In the proposed method, 4-(2-pyridylazo) resorcinol (PAR) is used as a chelating agent, and chloroform and ethanol are selected as extraction and dispersive solvent. The optimization strategy is carried out by using two level full factorial designs. Results of the two level full factorial design (2(4)) based on an analysis of variance demonstrated that the pH, concentration of PAR, amount of dispersive and extraction solvents are statistically significant. Optimal condition for three variables: pH, concentration of PAR, amount of dispersive and extraction solvents are obtained by using Box-Behnken design. Under the optimum conditions, the calibration graphs are linear in the range of 20.0-350.0 ng mL(-1) with detection limit of 6.7 ng mL(-1) (3δB/slope) and the enrichment factor of this method for uranium reached at 135. The relative standard deviation (R.S.D.) is 1.64% (n=7, c=50 ng mL(-1)). The partial least squares (PLS) modeling was used for multivariate calibration of the spectrophotometric data. The orthogonal signal correction (OSC) was used for preprocessing of data matrices and the prediction results of model, with and without using OSC, were statistically compared. MA-DLLME-OSC-PLS method was presented for the first time in this study. The root mean squares error of prediction (RMSEP) for uranium determination using PLS and OSC-PLS models were 4.63 and 0.98, respectively. This procedure allows the determination of uranium synthesis and real samples such as waste water with good reliability of the determination.


Gender trends in authorship of spine-related academic literature-a 39-year perspective.

Abstract:
BACKGROUND CONTEXT
Despite recent advances in gender equity in medicine, the representation of women in orthopedic and neurosurgery remains particularly low. Furthermore, compared with their male colleagues, female faculty members are less likely to publish research, limiting opportunities in the academic promotion process. Understanding disparities in research productivity provides insight into the "gender gap" in the spine surgeon workforce.

PURPOSE
This study aims to determine the representation and longevity of female physician-investigators among the authors of five spine-related research journals from 1978 to 2016.

STUDY DESIGN
This is a retrospective bibliometric review.

METHODS
The authors of original research articles from five prominent spine-related journals (European Spine Journal, The Spine Journal, Spine, Journal of Spinal Disorders and Techniques, and Journal of Neurosurgery: Spine) were extracted from PubMed. For authors with a complete first name listed, gender was determined by matching first name using an online database containing 216,286 distinct names across 79 countries and 89 languages. The proportion of female first and senior authors was determined during the time periods 1978 to 1994, 1995 to 1999, 2000 to 2004, 2005 to 2009, and 2010 to 2016. The authors who had their first paper published between 2000 and 2009 were included in additional analyses for publication count and longevity (whether additional articles were published 5 years after first publication). Student t test, chi-square analysis, and Cochran-Armitage trend test were used to determine significance between groups.

RESULTS
From 1978 to 2016, 28,882 original research articles were published in the five spine-related journals. A total of 24,334 abstracts (90.9%) had first names listed, identifying 120,723 authors, in total of which 100,286 were successfully matched to a gender. A total of 33,480 unique authors were identified (female authors: 31.8%). Female representation increased for first and senior authors from 6.5% and 4.7% (1978-1994) to 18.5% and 13.6% (2010-2016, p<.001). Growth in female senior author representation declined after 2000 (12.3% vs. 12.9% vs. 13.5% between 2000-2004, 2005-2009, and 2010-2016). Compared with male authors, on average, female authors published fewer articles (mean: 2.1 vs. 3.3, p<.001). Of 15,304 authors who first published during 2000 to 2009, 3,478 authors (22.7%) continued to publish 5 years after their first publication. Female authors were less likely to continue publishing after their first article (15.3% of female authors vs. 24.8%, p<.001).

CONCLUSIONS
Female representation in academic spine research has doubled over the past 4 decades, although the growth of female representation as senior author has plateaued. Female physician-investigators are half as likely to continue participating in spine-related research longer than 5 years and on average publish half as many articles as senior author. In addition to recruiting more women into research, efforts should be made to identify and address barriers in research advancement and promotion for female physician-investigators.

Sing|David C|DC|
Jain|Deeptee|D|
Ouyang|David|D|

Gender
Authorship
Female
Diversity
Large database analysis
Leadership


Factors Affecting Contrast Sensitivity in Healthy Individuals: A Pilot Study.

Abstract:
OBJECTIVES
To determine the demographic and ocular features affecting contrast sensitivity levels in healthy individuals.

MATERIALS AND METHODS
Seventy-four eyes of 37 subjects (7-65 years old) with refractive errors less than 1.0 diopter, no history of ocular surgery, and 20/20 visual acuity were included in the study. The participants were divided by age into three groups: group 1, 7-19 years, n=11; group 2, 20-49 years, n=15; and group 3, 50-65 years, n=11. All subjects underwent anterior and posterior segment evaluation, intraocular pressure measurements, refraction measurements, and clinical evaluation for strabismus. Contrast static test was performed using Metrovision MonPack 3 vision monitor system after measuring pupil diameter. Photopic and mesopic measurements were taken sequentially from right eyes, left eyes, and both eyes together.

RESULTS
Contrast sensitivity at intermediate and high spatial frequencies was lower with increasing age. Binocular measurements were better than monocular, and mesopic measurements were better than photopic measurements at all spatial frequencies. Contrast sensitivity at higher spatial frequency was lower with hyperopic refraction values.

CONCLUSION
Increasing age, small pupil diameter, hyperopia, and photopic conditions were associated with lower contrast sensitivity in healthy individuals. Binocular contrast sensitivity measurements were better than monocular contrast sensitivity measurements in all conditions and spatial frequencies.

Karatepe|Arzu Seyhan|AS|
Köse|Süheyla|S|
Eğrilmez|Sait|S|

contrast sensitivity
age
photopic
visual function


Development of a system dynamics model for financially sustainable management of municipal watermain networks.

Abstract: This paper develops causal loop diagrams and a system dynamics model for financially sustainable management of urban water distribution networks. The developed causal loop diagrams are a novel contribution in that it illustrates the unique characteristics and feedback loops for financially self-sustaining water distribution networks. The system dynamics model is a mathematical realization of the developed interactions among system variables over time and is comprised of three sectors namely watermains network, consumer, and finance. This is the first known development of a water distribution network system dynamics model. The watermains network sector accounts for the unique characteristics of watermain pipes such as service life, deterioration progression, pipe breaks, and water leakage. The finance sector allows for cash reserving by the utility in addition to the pay-as-you-go and borrowing strategies. The consumer sector includes controls to model water fee growth as a function of service performance and a household's financial burden due to water fees. A series of policy levers are provided that allow the impact of various financing strategies to be evaluated in terms of financial sustainability and household affordability. The model also allows for examination of the impact of different management strategies on the water fee in terms of consistency and stability over time. The paper concludes with a discussion on how the developed system dynamics water model can be used by water utilities to achieve a variety of utility short and long-term objectives and to establish realistic and defensible water utility policies. It also discusses how the model can be used by regulatory bodies, government agencies, the financial industry, and researchers.

Rehan|R|R|
Knight|M A|MA|
Unger|A J A|AJ|
Haas|C T|CT|

D003247:Conservation of Natural Resources

System dynamics
Financial sustainability
Financing strategies
Infrastructure rehabilitation
Water supply


Sequential high-content profiling of the IgG-autoantibody repertoire reveals novel antigens in rheumatoid arthritis.

Abstract:
BACKGROUND
The aim was to identify novel diagnostic autoantibody candidates for rheumatoid arthritis (RA) by comprehensive screening for autoreactivity.

METHOD
We incubated 5892 recombinant proteins coupled to fluorescent beads, with patients' sera for the detection of IgG-autoantibodies in three independent patient cohorts: A (n = 72 patients with established RA); B/B- (n = 116 patients with early RA (B) and n = 51 CCP-negative patients with early RA from B (B-)); and C (n = 184 patients with early seronegative RA), in comparison to matched healthy controls. Intersects of significantly increased autoantibodies as determined by the Mann-Whitney test were sought.

RESULT
Screening of 5892 antigens in RA cohorts A and B, or the seronegative cohorts B- and C revealed intersects of 23 and 13 significantly increased autoantibodies, respectively. Reactivity to three antigens was increased in all cohorts tested: N-acetylglucosamine-1-phosphate transferase, gamma subunit (GNPTG), heterogeneous nuclear ribonucleoprotein A1-like 2 (HNRNPA1), and insulin-like growth factor binding protein 2 (IGFBP2).

CONCLUSIONS
Comprehensive sequential screening for autoantibodies reveals novel candidates for diagnostic markers in both seropositive and seronegative RA and suggests new fields of research into the pathogenesis of RA.

Vordenbäumen|Stefan|S| Lueking|Angelika|A| Budde|Petra|P| Zucht|Hans-Dieter|HD| Goehler|Heike|H| Brinks|Ralph|R| Fischer-Betz|Rebecca|R| Richter|Jutta|J| Bleck|Ellen|E| Detert|Jacqueline|J| Langer|Hans-Eckhard|HE| Sörgel|Anne|A| Burmester|Gerd-Rüdiger|GR| Schulz-Knappe|Peter|P| Schneider|Matthias|M|

Rheumatoid arthritis
Autoantibody
Biomarker


Usefulness of Tumor Tissue Biopsy for Predicting the Biological Behavior of Hepatocellular Carcinoma.

Abstract:
BACKGROUND/AIM
Assessment of the biological behavior of tumors is important for choosing an appropriate cancer therapy. In hepatocellular carcinoma (HCC), the biological behaviour can be assessed by tumor morphology and molecular biology. This study investigated the usefulness of tumor tissue biopsy for predicting the biological behavior of HCC.

PATIENTS AND METHODS
We studied 43 patients who underwent hepatectomy and preoperative liver tumor biopsy for HCC. We performed clinicopathological and immunohistochemical (IHC) analyses. The expression of the following molecules was examined: regulator of G-protein signaling 5 (RGS5), glypican-3 (GPC3), keratin 19 (K19), epithelial cell adhesion molecule (EpCAM), protein induced by vitamin K absence or antagonist-II (PIVKA-II), β-Catenin, and p53.

RESULTS
There was an overall 83.7% agreement regarding tumor differentiation between the preoperative biopsy specimens and the resected specimens. The accuracy of IHC analysis was more than 70% for all molecules between the preoperative biopsy specimens and the resected specimens. The RGS5-positive biopsy cases had higher serum α-fetoprotein levels (p=0.04), a higher rate of moderately or poorly differentiated tumors (p=0.02) and portal vein invasion (p=0.0003) than the RGS5-negative biopsy cases. The GPC3-positive biopsy cases were younger (p=0.04), had higher serum PIVKA-II levels (p=0.01), and a higher rate of portal vein invasion (p=0.03) than the GPC3-negative biopsy cases. The PIVKA-II-positive biopsy cases had significantly higher serum PIVKA-II levels than the PIVKA-II-negative biopsy cases (p=0.02). The other molecular markers showed no significantly different clinical findings between the positive and negative cases.

CONCLUSION
In HCC, there was a high agreement rate of both the histopathological and IHC findings between preoperative biopsy specimens and resected specimens. In the biopsy specimens of HCC, RGS5 and GPC3 expression were useful molecular makers for predicting portal vein invasion. Liver tumor biopsy is useful for predicting the biological behavior of HCC through histopathological and immunohistochemical findings.

Shioga|Taro|T| Kondo|Reiichiro|R| Ogasawara|Sachiko|S| Akiba|Jun|J| Mizuochi|Shinji|S| Kusano|Hironori|H| Mihara|Yutaro|Y| Tanigawa|Masahiko|M| Kinjyo|Yoshinao|Y| Naito|Yoshiki|Y| Kuromatsu|Ryoko|R| Nakashima|Osamu|O| Yano|Hirohisa|H|

Hepatocellular carcinoma
tumor morphology
immunohistochemistry


Widespread age-related differences in the human brain microstructure revealed by quantitative magnetic resonance imaging.

Abstract: A pressing need exists to disentangle age-related changes from pathologic neurodegeneration. This study aims to characterize the spatial pattern and age-related differences of biologically relevant measures in vivo over the course of normal aging. Quantitative multiparameter maps that provide neuroimaging biomarkers for myelination and iron levels, parameters sensitive to aging, were acquired from 138 healthy volunteers (age range: 19-75 years). Whole-brain voxel-wise analysis revealed a global pattern of age-related degeneration. Significant demyelination occurred principally in the white matter. The observed age-related differences in myelination were anatomically specific. In line with invasive histologic reports, higher age-related differences were seen in the genu of the corpus callosum than the splenium. Iron levels were significantly increased in the basal ganglia, red nucleus, and extensive cortical regions but decreased along the superior occipitofrontal fascicle and optic radiation. This whole-brain pattern of age-associated microstructural differences in the asymptomatic population provides insight into the neurobiology of aging. The results help build a quantitative baseline from which to examine and draw a dividing line between healthy aging and pathologic neurodegeneration.

Callaghan|Martina F|MF|
Freund|Patrick|P|
Draganski|Bogdan|B|
Anderson|Elaine|E|
Cappelletti|Marinella|M|
Chowdhury|Rumana|R|
Diedrichsen|Joern|J|
Fitzgerald|Thomas H B|TH|
Smittenaar|Peter|P|
Helms|Gunther|G|
Lutti|Antoine|A|
Weiskopf|Nikolaus|N|


Comparison of the Haemodynamic Effects of Three Different Methods at the Induction of Anaesthesia.

Abstract:
OBJECTIVE
Haemodynamic variations are inevitable during induction of anaesthetic drugs. The present study investigates the haemodynamic variations of three different drugs (thiopental, propofol, and etomidate) used for induction of general anaesthesia together with fentanyl.

METHODS
In a randomized, double-blind study, 45 patients were assigned to one of three groups (n=15 each). Fentanyl 1 μg kg(-1) was injected over 60 sec followed by propofol 2 mg kg(-1) (Group P), thiopentone 6 mg kg(-1) (Group T), or etomidate 0.3 mg kg(-1) (Group E). Noninvasive measurements of systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), and heart rate (HR) was performed on admittance, immediately before the induction of anaesthesia, and 1, 3, and 5 min thereafter. Cardiac output (CO) values were recorded before induction, immediately after the injection of the drug, and at 1 min after the intubation.

RESULTS
In all groups, during the study period, SAP, DAP, MAP, and CO values decreased with respect to time before induction. Following the administration of the induction dose of propofol (Group P), a significantly greater decrease of systolic and diastolic blood pressure was observed with etomidate (Group E) or thiopentone (Group T). Decrease in CO was also more marked with propofol (Group P) than with etomidate (Group E) or thiopentone (Group T).

CONCLUSION
It's concluded that, in this study, the combination of fentanyl-etomidate is safer than both the groups of fentanyl-propofol and fentanyl-thiopental in terms of providing haemodynamic stability.

Uygur|Mehmet Levent|ML|
Ersoy|Ayşın|A|
Altan|Aysel|A|
Ervatan|Zekeriya|Z|
Kamalı|Sedat|S|

induction
thiopental
Propofol
etomidate
haemodynamic changes


In-hospital mortality in patients with systemic lupus erythematosus: a study from Jordan 2002-2017.

Abstract: We aimed to study the mortality among hospitalized patients with systemic lupus erythematosus (SLE). We performed a retrospective cross-sectional study and identified patients with SLE who were hospitalized at Jordan University Hospital (JUH) between 2002 and 2017.There were 990 admissions among which 283 were SLE patients. The mean age at disease onset was 34 ± 12.5 years and the female to male ratio was 8.4:1. Forty patients died during the 15-year period. In-hospital case fatality was 14% over 15 years. For the deceased patients, the female to male ratio was 3.4:1, mean age at disease onset was 27.8 ± 11.5 years, mean age at death was 35.1 ± 12 years, and mean disease duration was 7.5 ± 6.9 years. Twenty patients had disease duration ≤ 5 years. Infection and SLE-related complication contributed equally to mortality in hospitalized SLE patients (42.5% [CI 27.5%-59%] and 40% [95% CI 25%-56.5%], respectively). Infection related mortality compared to SLE-related mortality was associated with younger age and shorter disease duration (29.5 years versus 38.3 years and 6.4 versus 8.7 years, respectively). CRP was higher in infection related mortality compared to SLE-related mortality (131.4 mg/dl versus 87.6 mg/dl, respectively). Most SLE-related deaths were secondary to pulmonary disease. Renal disease did not contribute directly to mortality. No fatalities were attributed to cardiovascular disease (CVD) or cancer. Infection and active SLE accounted for the majority of deaths at a young age. Significant pulmonary related deaths may indicate a change in trends in SLE mortality, as renal related mortality is expected to decline due to proper management.

Mortality
Systemic lupus erythematosus
Jordan


Investigating the Universality of Preoperative Health-Related Quality of Life (HRQoL) for Surgically Treated Spinal Deformity in Young Adults: A Propensity Score-Matched Comparison Between African and US Populations.

Abstract:
STUDY DESIGN
Retrospective analysis of propensity score-matched (PSM) observational cohorts.

OBJECTIVES
To evaluate and compare preoperative health-related quality of life (HRQoL) scores and radiographic measurements of young African and US adults with spinal deformity (ASD).

SUMMARY OF BACKGROUND DATA
Young ASD patients in the United States are motivated more to correct coronal and sagittal plane deformities than to alleviate pain. Motivations for surgical correction in young ASD patients in Africa have not been previously investigated.

METHODS
Retrospective review of two large databases of African and US patients with ASD. African patients who underwent ASD surgery were PSM by age, gender, and pelvic tilt with US patients. Preoperative radiographic parameters and HRQoL scores (ODI, SRS-22r, back/leg pain) were compared between cohorts. Pearson correlations used to evaluate relationships between radiographic parameters and HRQoL scores.

RESULTS
Fifty-four US patients (average age 22.9 ± 4.9 years; 0% African American) and 54 African patients (24.6 ± 7.2 years) met inclusion criteria. Compared to the United States, African patients had significantly lower body mass index (21.1 ± 3.3 vs. 24.6 ± 7.2) and more severe scoliosis, coronal malalignment, and sagittal malalignment (p < .05). Africans also had significantly better Oswestry Disability Index (12.8 vs. 17.7), worse Scoliosis Research Society questionnaire (SRS-22r)-Appearance (2.5 vs. 3.2), SRS-Function (3.3 vs. 3.9), and SRS-Total (3.2 vs. 3.5) scores than US patients (p < .05). SRS-Appearance scores correlated with Cobb angles of the upper thoracic (r = -0.321), thoracic (r = -0.277), and thoracolumbar (r = -0.300) curves for US patients. For African patients, global sagittal alignment and C7 inclination correlated with SRS-Appearance (r = -0.347, -0.346, respectively).

CONCLUSIONS
Young African ASD patients have significantly more severe deformity, less disability, and worse SRS-22r scores preoperatively than a matched cohort of US patients. Spinal deformity and associated poor self-image appear to be the major drivers of surgical intervention in this cohort. Global malalignment in African patients is most closely correlated with appearance scores and should be surgically addressed accordingly.

LEVEL OF EVIDENCE
Level III.

Harris|Bradley Y|BY|
Roth|Matthew F|MF|
Diebo|Bassel G|BG|
Bess|Shay|S|
Theologis|Alexander A|AA|
Scheer|Justin K|JK|
Schwab|Frank J|FJ|
Lafage|Virginie|V|
Ames|Christopher P|CP|
Hodes|Richard|R|
Ayamga|Jennifer|J|
Boachie-Adjei|Oheneba|O|
|||

HRQoL
Adult spinal deformity
African spinal deformity


Effects of sodium hypochlorite as dentin deproteinizing agent and aging media on bond strength of two conventional adhesives.

Abstract: This study evaluated the effect of 10% sodium hypochlorite (NaOCl) as deproteinizing agent and storage media on bond strength (BS) of two etch-and-rinse adhesive systems to dentin. Twenty-eight sound extracted human third molars were divided in four groups (n = 7), according to dentin treatment (conventional etching or etching followed by 10% NaOCl application) and adhesive systems (GB-Gluma 2Bond and OS-One-Step). After dentin treatments and adhesive application, a composite block was built-up on dentin surface and teeth were serially sectioned to obtain bonded sticks specimens. The sticks were submitted to three aging conditions: (24H) 24 hr in water (immediate), (SH) 3 hr of NaOCl accelerated-aging or (1Y) 1 year of water storage. Afterward, submitted to microtensile bond strength test (μTBS), failure modes and adhesive interfaces analyzes. Data were analyzed by two-way analysis of variance (ANOVA) and Tukey's test (α = .05). Dentin deproteinization before bonding significantly reduced μTBS for GB-treated group (p < .05), regardless the aging conditions. Water storage for 1 year (1Y) and NaOCl accelerated-aging (SH) decreased μTBS for both adhesives. Yet, the groups stored in NaOCl (SH) exhibited the lowest BS results (p < .05). Bond strength of deproteinized dentin was dependent on the adhesive system composition and NaOCl accelerated-aging promoted decreased bond strength and further degradation than water storage for 1 year.

sodium hypochlorite
deproteinized dentin
bonding systems
hybrid layer


Effect of Adjuvant Radiotherapy on Survival in Patients with Locoregional Urothelial Malignancies of the Upper Urinary Tract.

Abstract:
BACKGROUND
While radical nephroureterectomy is the treatment of choice for localized or regional urothelial carcinoma of the upper urinary tract (UTUC), the role of adjuvant radiotherapy is unclear, with conflicting data from various small studies.

PATIENTS AND METHODS
We sought to study the impact of adjuvant radiotherapy on UTUC by utilizing the Survelliance, Epidemiolgy, and End Results (SEER) 9 database from 1998-2011.

RESULTS
Of 2,572 identified cases, 113 patients (4.4%) received adjuvant radiotherapy, with a median age of 74 years (range=22-100 years). In univariate analysis, patients treated with adjuvant radiation therapy seemed to have a lower survival time than those without radiation therapy (19 months versus 31 months, p<0.05). However, after adjusting for covariates, including age at diagnosis, gender, race, year of diagnosis, stage, histological grade and surgery, radiation therapy did not seem to influence survival (hazard ratio=0.68; 95% confidence interval=0.68-1.06, p=0.85).

CONCLUSION
This hypothesis-generating, population-based analysis shows that adjuvant radiotherapy may not influence survival among patients with locoregional UTUC.

Hahn|Andrew W|AW|
Giri|Smith|S|
Pathak|Ranjan|R|
Bhatt|Vijaya Raj|VR|
Martin|Mike G|MG|

Radiotherapy
upper urinary tract
urothelial carcinoma


Automated approach for detection of ischemic stroke using Delaunay Triangulation in brain MRI images.

Abstract: It is difficult to develop an accurate algorithm to detect the stroke lesions using magnetic resonance imaging (MRI) images due to variation in different lesion sizes, variation in morphological structure, and similarity in intensity of lesion with normal brain in three types of stroke, namely partial anterior circulation syndrome (PACS), lacunar syndrome (LACS) and total anterior circulation stroke (TACS). In this paper, we have integrated the advantages of Delaunay triangulation (DT) and fractional order Darwinian particle swarm optimization (FODPSO), called DT-FODPSO technique for automatic segmentation of the structure of the stroke lesion. The approach was validated on 192 MRI images obtained from different stroke subjects. Statistical and morphological features were extracted and classified according to the Oxfordshire community stroke project (OCSP) using support vector machine (SVM) and random forest (RF) classifiers. The method effectively detected the stroke lesions and achieved promising results with an average sensitivity of 0.93, accuracy of 0.95, JI of 0.89 and Dice similarity index of 0.93 using RF classifier. These promising results indicates the DT based optimized approach is efficient in detecting ischemic stroke and it can aid the neuro-radiologists to validate their routine screening.

Subudhi|Asit|A|
Acharya|U Rajendra|UR|
Dash|Manasa|M|
Jena|Subhransu|S|
Sabut|Sukanta|S|

Ischemic stroke
Delaunay triangulation
FODPSO
Segmentation
Random forest


The Analysis of Field Strains Isolated From Food, Animal and Clinical Sources Uncovers Natural Mutations in Listeria monocytogenes Nisin Resistance Genes.

Abstract: Nisin is a commonly used bacteriocin for controlling spoilage and pathogenic bacteria in food products. Strains possessing high natural nisin resistance that reduce or increase the potency of this bacteriocin against Listeria monocytogenes have been described. Our study sought to gather more insights into nisin resistance mechanisms in natural L. monocytogenes populations by examining a collection of 356 field strains that were isolated from different foods, food production environments, animals and human infections. A growth curve analysis-based approach was used to access nisin inhibition levels and assign the L. monocytogenes strains into three nisin response phenotypic categories; resistant (66%), intermediate (26%), and sensitive (8%). Using this categorization isolation source, serotype, genetic lineage, clonal complex (CC) and strain-dependent natural variation in nisin phenotypic resistance among L. monocytogenes field strains was revealed. Whole genome sequence analysis and comparison of high nisin resistant and sensitive strains led to the identification of new naturally occurring mutations in nisin response genes associated with increased nisin resistance and sensitivity in this bacterium. Increased nisin resistance was detected in strains harboring RsbUG77S and PBPB3V240F amino acid substitution mutations, which also showed increased detergent stress resistance as well as increased virulence in a zebra fish infection model. On the other hand, increased natural nisin sensitivity was detected among strains with mutations in sigB, vir, and dlt operons that also showed increased lysozyme sensitivity and lower virulence. Overall, our study identified naturally selected mutations involving pbpB3 (lm0441) as well as sigB, vir, and dlt operon genes that are associated with intrinsic nisin resistance in L. monocytogenes field strains recovered from various food and human associated sources. Finally, we show that combining growth parameter-based phenotypic analysis and genome sequencing is an effective approach that can be useful for the identification of novel nisin response associated genetic variants among L. monocytogenes field strains.

Wambui|Joseph|J|
Eshwar|Athmanya K|AK|
Aalto-Araneda|Mariella|M|
Pöntinen|Anna|A|
Stevens|Marc J A|MJA|
Njage|Patrick M K|PMK|
Tasara|Taurai|T|

mutation
Listeria monocytogenes
nisin
resistance
genes
bacteriocin


Yinchenhao decoction suppresses rat liver fibrosis involved in an apoptosis regulation mechanism based on network pharmacology and transcriptomic analysis.

Abstract: Yinchenhao decoction (YCHD) is a classical Traditional Chinese Medicine (TCM) formula that has been widely used in the treatment of liver fibrosis caused by chronic hepatitis B and jaundice for more than 1800 years. The purpose of this study was to investigate the apoptosis regulation mechanisms of YCHD and its active components suppresses liver fibrosis. The active components and putative targets of YCHD were predicted by network pharmacology approach. Functional and pathway enrichment analysis were presented in the present study by using clusterProfiler. Further, experimental validation was done by using terminal deoxynucleotidyl transferase (TDT) dUTP nick end labelling (TUNEL) assay and western blotting in dimethylnitrosamine (DMN)-induced liver fibrosis rats, and cell proliferation assay, apoptosis assay, and western blotting in human hepatic L02 cells and LX2 cells. 45 active compounds in YCHD formula, 592 potential target proteins and 1191 liver fibrosis-related human genes were identified. Functional and pathway enrichment analysis indicated that YCHD obviously influenced TNF, PI3K-Akt signaling pathways. Further, In vivo experiment indicated that YCHD treatment not only attenuated the symptoms of liver fibrosis, but also decrease the apoptosis of hepatic parenchyma cells. Moreover, in vitro experiments showed that rhein, kaempferol and quercetin treatments remarkably decreased the protein levels of cleaved caspase-3 and increased p-ERK1/2, PI3K and Bcl-XL protein expression in TNF-α-stimulated L02 cells. On the contrary, rhein, kaempferol, aloe-emodin and quercetin inhibited the proliferation of LX2 cells and up-regulated the protein levels of Bax and cleaved caspase-8. In conclusion, 45 active components and 296 potential targets of YCHD against liver fibrosis were identiﬁed by the analysis of network pharmacology and transcriptomics combination. The mechanisms of YCHD against liver fibrosis were involved in the regulation of multiple targets, especially affecting the apoptosis-related signaling pathways.

Cai|Fei-Fei|FF| Bian|Yan-Qin|YQ| Wu|Rong|R| Sun|Yang|Y| Chen|Xiao-Le|XL| Yang|Meng-Die|MD| Zhang|Qian-Ru|QR| Hu|Yuanjia|Y| Sun|Ming-Yu|MY| Su|Shi-Bing|SB|

Yinchenhao decoction
Liver fibrosis
Apoptosis
Network pharmacology
Transcriptomics


When friend turns foe: central and peripheral neuroinflammation in central nervous system injury.

Abstract: Injury to the central nervous system (CNS) is common, and though it has been well studied, many aspects of traumatic brain injury (TBI) and stroke are poorly understood. TBI and stroke are two pathologic events that can cause severe, immediate impact to the neurostructure and function of the CNS, which has been recognized recently to be exacerbated by the body's own immune response. Although the brain damage induced by the initial trauma is most likely unsalvageable, the secondary immunologic deterioration of neural tissue gives ample opportunity for therapeutic strategists seeking to mitigate TBI's secondary detrimental effects. The purpose of this paper is to highlight the cell death mechanisms associated with CNS injury with special emphasis on inflammation. The authors discuss sources of inflammation, and introduce the role of the spleen in the systemic response to inflammation after CNS injury.

Marcet|Paul|P|
Santos|Nicole|N|
Borlongan|Cesar V|CV|

central nervous system
systemic
spleen
Head trauma
inflammatory response
secondary cell death


A reactive phase against disruptions for designing a proactive platelet supply network.

Abstract: Previous studies in blood supply chain network design often follow a commonly used approach in protecting the chain against disruptions, considering the effects of disruptions on the designing phase. However, in many real-world situations, disruptions cannot be adequately measured in advance. Moreover, using disruptions in the designing phase through the common two-stage stochastic programming models impose high costs on the network, since they cannot be updated based on unpredicted disruptions. This paper proposes an updatable two-phase approach which deals with disruptions in the operational phase, not in the strategic design phase. In the first step, called the proactive phase, a nominal platelet supply chain network is designed under operational uncertainty, using the whole-blood collection method. In the event of disruptions, the second step, called the reactive phase, is applied, and the tailored network is updated based on the realized data, using apheresis as the collection mechanism. The operational risks are captured using a fuzzy programming approach in the model. Based on the real data from Fars province of Iran, we compare the performance of the two-phase approach with the commonly used approaches in the literature, resulting in more flexible decisions, and consequently, less conservatism degree rather than the existing approaches.

Samani|Mohammad Reza Ghatreh|MRG|
Hosseini-Motlagh|Seyyed-Mahdi|SM|
Homaei|Shamim|S|

Reactive phase
Disruption
Blood supply chain
Proactive phase
Uncertainty
Platelet network


A cross-sectional study of experienced coercion in adolescent mental health inpatients.

Abstract:
BACKGROUND
Involuntary care and coercive measures are frequently present in mental healthcare for adolescents. The purpose of this study was to examine to what extent adolescents perceive or experience coercion during inpatient mental health care, and to examine predictors of experienced coercion.

METHODS
A cross-sectional sample of 96 adolescent inpatients from 10 Norwegian acute and combined (acute and sub-acute) psychiatric wards reported their experienced coercion on Coercion Ladder and the Experienced Coercion Scale in questionnaires. Staff reported use of formal coercion, diagnoses, and psychosocial functioning. We used two tailed t-tests and mixed effects models to analyze the impact from demographics, alliance with parents, use of formal coercion, diagnostic condition, and global psychosocial functioning.

RESULTS
High experienced coercion was reported by a third of all patients. In a mixed effects model, being under formal coercion (involuntary admission and / or coercive measures); a worse relationship between patient and parent; and lower psychosocial functioning, significantly predicted higher experienced coercion. Twenty-eight percent of the total sample of patients reported a lack of confidence and trust both in parents and staff.

CONCLUSIONS
Roughly one third of patients in the sample reported high experienced coercion. Being under formal coercion was the strongest predictor. The average scores of experienced coercion in subgroups are comparable with adult scores in similar care situations. There was one exception: Adolescents with psychosis reported low experienced coercion and almost all of them were under voluntary care.

Nyttingnes|Olav|O|0000-0003-0991-7176 Ruud|Torleif|T| Norvoll|Reidun|R| Rugkåsa|Jorun|J| Hanssen-Bauer|Ketil|K|

Cross-sectional studies
Involuntary admission
Adolescent psychiatry
Perceived coercion


Leachable-Free Fabrication of Hydrogel Foams Enabling Homogeneous Viability of Encapsulated Cells in Large-Volume Constructs.

Abstract: The popularity of cell-laden injectable hydrogels has steeply increased due to their compatibility with minimally invasive surgical procedures. However, the diffusion of indispensable molecules for cell survival through bulk hydrogel structures, particularly oxygen, is often limited to micrometric distances, often hampering cell viability or uniform tissue formation in constructs with clinically relevant sizes. The introduction of micropores in hydrogels or the use of oxygen-generating materials has enabled combining advantages of porous 3D scaffolds with the injectability properties of in situ-solidifying hydrogels. Here, cell-laden injectable gelatin methacryloyl (GelMA) foams are fabricated using a single polymer formulation. Air bubbles are introduced into GelMA solutions using a simple-to-implement method based on pulling/pushing the solution through a syringe. Human mesenchymal stem cells derived from the adipose tissue (hASCs) cultured in bulk hydrogels (diameter c.a. 5 mm) show low permanence in the core of the materials and stain for factors associated to hypoxia (hypoxia-inducible factor-1 alpha (HIF-1α)) after 7 days of culture. In opposition, cells cultured in optimized foams do not stain for HIF-1α, show high permanence, homogeneous viability, and consistent phenotype in the whole depth of the biomaterials, while secreting increased amounts of regenerative growth factors to the surrounding medium.

hydrogel foams
air bubbles
3D hydrogels
cell encapsulation


Association of Vitamin D Metabolites with Parathyroid Hormone, Fibroblast Growth Factor-23, Calcium, and Phosphorus in Dogs with Various Stages of Chronic Kidney Disease.

Abstract:
BACKGROUND
Hypovitaminosis D is associated with progression of renal disease, development of renal secondary hyperparathyroidism (RHPT), chronic kidney disease-mineral bone disorder (CKD-MBD), and increased mortality in people with CKD. Despite what is known regarding vitamin D dysregulation in humans with CKD, little is known about vitamin D metabolism in dogs with CKD.

OBJECTIVES
The purpose of our study was to further elucidate vitamin D status in dogs with different stages of CKD and to relate it to factors that affect the development of CKD-MBD, including parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), calcium, and phosphorus concentrations.

METHODS
Thirty-seven dogs with naturally occurring CKD were compared to 10 healthy dogs. Serum 25-hydroxyvitamin D [25(OH)D], 1,25-dihydroxyvitamin D [1,25(OH)2 D], and 24,25-dihydroxyvitamin D [24,25(OH)2 D], and PTH and FGF-23 concentrations were measured. Their association with serum calcium and phosphorus concentrations and IRIS stage was determined.

RESULTS
Compared to healthy dogs, all vitamin D metabolite concentrations were significantly lower in dogs with International Renal Interest Society (IRIS) stages 3 and 4 CKD (r [creatinine]: -0.49 to -0.60; P < .05) but not different in dogs with stages 1 and 2 CKD. All vitamin D metabolites were negatively correlated with PTH, FGF-23, and phosphorus concentrations (r: -0.39 to -0.64; P < .01).

CONCLUSIONS AND CLINICAL IMPORTANCE
CKD in dogs is associated with decreases in all vitamin D metabolites evaluated suggesting that multiple mechanisms, in addition to decreased renal mass, affect their metabolism. This information could have prognostic and therapeutic implications.

Parker|V J|VJ|
Harjes|L M|LM|
Dembek|K|K|
Young|G S|GS|
Chew|D J|DJ|
Toribio|R E|RE|

renal secondary hyperparathyroidism
international renal interest society
calcitriol
diet


Fibrochondrocyte Growth and Functionality on TiO₂ Nanothin Films.

Abstract: Disorders affecting the temporomandibular joint (TMJ) are a long-standing health concern. TMJ disorders (TMJD) are often associated with an internal disc derangement accompanied by a suite of symptoms including joint noises, jaw dysfunction, and severe pain. The severity of patient symptoms and their reoccurrence can be alleviated to some extent with conservative therapy; however, refractory cases often require surgery that has shown only limited success. Bioengineered scaffolds with cell supportive surfaces an d nanoarchitectures that mimic TMJ tissue structure may offer an alternative treatment modality. In this study, titanium dioxide (TiO₂) nanothin films, fabricated by layer-by-layer assembly, were examined as means for creating such a scaffold. The viability and growth of TMJ discal fibrochondrocytes (FCs) were assessed through MTT and DNA assays and total protein content over a 14-day experimental period. ELISA was also used to measure expression of types I and II collagen, decorin and aggrecan. Quantitative analyses demonstrated that FCs synthesized characteristic discal matrix proteins, with an increased production of type I collagen and decorin as opposed to collagen type II and aggrecan. A stimulatory effect on discal FC proliferation and extracellular matrix (ECM) expression with thicker nanofilms was also observed. The cumulative results suggest that TiO₂ nanofilms may have potential as a TMJ scaffolding material.

fibrochondrocytes
functionality
titanium dioxide
nanoassembly
substrate


The Antioxidant Effects of Hydroxytyrosol and Vitamin E on Pediatric Nonalcoholic Fatty Liver Disease, in a Clinical Trial: A New Treatment?

Abstract: Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in children. Several studies suggest that the improvement of oxidative stress is suggested as a possible therapeutic strategy for pediatric nonalcoholic steatohepatitis. We performed a randomized, double-blind placebo-controlled trial to test the potential efficacy, assessed by improvement of oxidative stress parameters and liver ultrasound, and tolerability of a mixture of vitamin E and hydroxytyrosol (HXT) in adolescents with biopsy-proven NAFLD. Four hundred forty consecutive patients were screened, 80 of these with biopsy-proven NAFLD were enrolled. Forty patients received an oral dose of HXT and vitamin E and 40 children received the capsules of placebo for 4 months. Seventy patients completed the study. Patients in the treatment arm showed a decrease of insulin resistance (IR), triglyceride levels, oxidative stress parameters, and steatosis grade. Noteworthy, the steatosis improvement correlates with the levels of advanced glycation end products and carbonylated proteins. The HXT and vitamin E treatment improved the main oxidative stress parameters, IR, and steatosis in children with NAFLD. The use of two natural molecules that may have antioxidant effects seems a promising strategy that could be easily diet integrated to improve NAFLD-related liver damage in children.

Nobili|Valerio|V| Alisi|Anna|A| Mosca|Antonella|A| Crudele|Annalisa|A| Zaffina|Salvatore|S| Denaro|Marcella|M| Smeriglio|Antonella|A| Trombetta|Domenico|D|

D017127:Glycation End Products, Advanced

D065626:Non-alcoholic Fatty Liver Disease

hydroxytyrosol
vitamin E
nonalcoholic fatty liver disease
children
oxidative stress


Modelling the fear effect in predator-prey interactions.

Abstract: A recent field manipulation on a terrestrial vertebrate showed that the fear of predators alone altered anti-predator defences to such an extent that it greatly reduced the reproduction of prey. Because fear can evidently affect the populations of terrestrial vertebrates, we proposed a predator-prey model incorporating the cost of fear into prey reproduction. Our mathematical analyses show that high levels of fear (or equivalently strong anti-predator responses) can stabilize the predator-prey system by excluding the existence of periodic solutions. However, relatively low levels of fear can induce multiple limit cycles via subcritical Hopf bifurcations, leading to a bi-stability phenomenon. Compared to classic predator-prey models which ignore the cost of fear where Hopf bifurcations are typically supercritical, Hopf bifurcations in our model can be both supercritical and subcritical by choosing different sets of parameters. We conducted numerical simulations to explore the relationships between fear effects and other biologically related parameters (e.g. birth/death rate of adult prey), which further demonstrate the impact that fear can have in predator-prey interactions. For example, we found that under the conditions of a Hopf bifurcation, an increase in the level of fear may alter the direction of Hopf bifurcation from supercritical to subcritical when the birth rate of prey increases accordingly. Our simulations also show that the prey is less sensitive in perceiving predation risk with increasing birth rate of prey or increasing death rate of predators, but demonstrate that animals will mount stronger anti-predator defences as the attack rate of predators increases.

D000818:Animals
D001522:Behavior, Animal
D004924:Escape Reaction
D005239:Fear
D008954:Models, Biological
D011235:Predatory Behavior

Anti-predator defence functional response


Structural and theoretical characterization of a new twisted 4'-substituted terpyridine compound: 4'-(isoquinolin-4-yl)-2,2':6',2''-terpyridine.

Abstract: 4'-Substituted derivatives of 2,2':6',2''-terpyridine with N-containing heteroaromatic substituents, such as pyridyl groups, might be able to coordinate metal centres through the extra N-donor atom, in addition to the chelating terpyridine N atoms. The incorporation of these peripheral N-donor sites would also allow for the diversification of the types of noncovalent interactions present, such as hydrogen bonding and π-π stacking. The title compound, C24H16N4, consists of a 2,2':6',2''-terpyridine nucleus (tpy), with a pendant isoquinoline group (isq) bound at the central pyridine (py) ring. The tpy nucleus deviates slightly from planarity, with interplanar angles between the lateral and central py rings in the range 2.24 (7)-7.90 (7)°, while the isq group is rotated significantly [by 46.57 (6)°] out of this planar scheme, associated with a short Htpy...Hisq contact of 2.32 Å. There are no strong noncovalent interactions in the structure, the main ones being of the π-π and C-H...π types, giving rise to columnar arrays along [001], further linked by C-H...N hydrogen bonds into a three-dimensional supramolecular structure. An Atoms In Molecules (AIM) analysis of the noncovalent interactions provided illuminating results, and while confirming the bonding character for all those interactions unquestionable from a geometrical point of view, it also provided answers for some cases where geometric parameters are not informative, in particular, the short Htpy...Hisq contact of 2.32 Å to which AIM ascribed an attractive character.

Granifo|Juan|J| Arévalo|Beatriz|B| Gaviño|Rubén|R| Suárez|Sebastián|S| Baggio|Ricardo|R|

theoretical characterization
AIM
4′-substituted 2,2′:6′,2′′-terpyridine
Bader's theory
atoms-in-molecules
attractive H...H interaction
crystal structure


The present and future of intrapartum computerized cardiotocography: role of pattern recognition incorporating single vs. multiple parameters.

Abstract: Computer assisted cardiotocography holds a great promise in minimizing human errors thereby improving perinatal outcome. Despite exponential growth (Moore's law) in computing power for decades, this promise remains unrealized. The systematic analyses of studies on computerized cardiotocography offer little guide to future. This analytical review presents a more qualitative discussion of available evidence as well as concepts regarding the development and acceptance of computerized cardiotocography. To begin with, a workable approach would be for computer algorithms to follow the most scientific visual cardiotocography interpretation frameworks incorporating multiple fetal heart rate parameters and uterine contractions. This ability could be studied and form the basis for regulation of computer algorithms. Addition of background risk factors would be another step. This may take form of familiar multi-tier systems or new alternative strategies like the fetal reserve index. "Machine learning" will remain challenging because of complex variability in fetal-maternal conditions, labor characteristics and clinical intervention changing the outcomes. Randomized controlled trials of adequate size may remain very rare. However, prospective and retrospective testing of computer algorithms with careful qualitative and comparative approach would help clinicians and hospital managers in their decisions. Singular parameters like the popular "deceleration area" and "deceleration capacity" have poor predictive value for fetal acidemia or hypoxic injury. Scientific pattern-recognition of important fetal heart rate parameters like decelerations seems crucial for visual as well as computerized cardiotocography. Success of computerizedcardiotocography depends on team effort by the obstetricians with in-depth practical knowledge/experience and skilled artificial intelligence (AI) specialists.

computerized cardiotocography
cardiotocography
computer assisted cardiotocography
deceleration area
deceleration capacity
Intrapartum fetal monitoring
fetal heart rate decelerations


Controlled release of folic acid through liquid-crystalline folate nanoparticles.

Abstract: The present study explores folate nanoparticles as nano-carriers for controlled drug delivery. Cross-linked nanoparticles of liquid crystalline folates are composed of ordered stacks. This paper shows that the folate nanoparticles can be made with less than 5% loss in folate ions. In addition, this study shows that folate nanoparticles can disintegrate in a controlled fashion resulting in controlled release of the folate ions. Release can be controlled by the size of nanoparticles, the extent of cross-linking and the choice of cross-linking cation. The effect of different factors like agitation, pH, and temperature on folate release was also studied. Studies were also carried out to show the effect of release medium and role of ions in the release medium on disruption of folate assembly.

Control release
Folates
Nanoparticles
Cross-linking
Chromonics


Assessment of farmers practices to date palm soil fertilization and its impact on productivity at Al-Hassa oasis of KSA.

Abstract: Al-Hassa oasis is considered as the biggest irrigated one in the World, being well known for its extensive date palm cultivation with an estimate of at least three million trees. The aim of this study is to evaluate the impact of soil fertilization practices on the productivity potential of date palm trees grown under the climatic conditions of Al-Hassa oasis, KSA. The opinions of 258 active farmers were randomly surveyed using specifically designed questioners that were also fortified with personal communications. The size of the samples was designated in accordance to Cocoran equation. The total samples were allocated into two major parts (193 for the old oasis and 65 for the new oasis). Results showed that the farm features (utilized agricultural area (UAA), ownership and labors) are different in both parts of the oasis. Fertilization practices (quantity applied per area or per tree) were diverse causing dissimilar productivity potentials (total or per area or tree). The average production of a tree in the old oasis is 81.4 kg, whilst it is 54.6 kg in the new oasis. Date palm production is significantly affected by total number of trees, applied fertilizer quantity, cultivated area and labor power. The impact of these factors is unlike between the two parts of the oasis. It is then concluded from the study that there are sincere needs for improving the soil fertilization practiced for the date palm trees grown in the Al-Hassa oasis, KSA in order to increase their productivity potential and hence improve the farmers' income.

Almadini|Abdulrahman M|AM|
Ismail|Ahmed I H|AIH|
Ameen|Faleh A|FA|

Fertilization
Productivity
Al-Hassa
Oasis
Palm date


Consequence of replacing nitrogen with carbon dioxide as atmosphere on suppressing the formation of polycyclic aromatic hydrocarbons in catalytic pyrolysis of sawdust.

Abstract: This study evaluates the effect of replacement of N2 with CO2 as atmosphere in catalytic pyrolysis of waste lignocellulosics with acidic and metal-modified zeolites, respectively, on the 16 EPA priority pollutant polycyclic aromatic hydrocarbons (PAHs) in bio-oils. By coupling solid phase extraction pretreatment with single ion monitoring detection, it is found that the replacement alleviates PAHs in bio-oil concerning synchronously abating the 16 PAHs with low, medium and high molecular weights, and the benzo[a]pyrene equivalent toxicity of bio-oil decreases. Meanwhile, CO2 decreases the content of small oxygenates, e.g. furans, ketones, acids, and increases phenolics and aromatics affording more stable and valuable bio-oils. Moreover, CO2 enhances carbon conversion efficiency, especially in combination with Fe-modified zeolite, which presents a synergistic effect. This study indicates the practical application of CO2 as an atmosphere in catalytic pyrolysis to improve the bio-oil quality by suppressing PAHs formation and adjusting compound constituent.

He|Yao|Y| Chen|Si|S| Chen|Junjie|J| Liu|Dongxia|D| Ning|Xunan|X| Liu|Jingyong|J| Wang|Tiejun|T|

Carbon dioxide
Polycyclic aromatic hydrocarbons
Catalytic pyrolysis
Zeolite
Lignocellulosic biomass


Mesenchymal stem cells act as stimulators of neurogenesis and synaptic function in a rat model of Alzheimer's disease.

Abstract:
Background
Alzheimer's disease (AD) is one of the most common NDs leading to cognitive dysfunctions and dementia which are progressively worsen with age. Cell therapy is currently of particular interest in treatment of neurodegenerative disease (ND) such as AD. However, the effective treatment for AD is yet to be found.

Objective
In this study, the possible roles of human umbilical mesnchymal stromal cord (hUMSCs) and adipose mesenchymal stem cells (hAD-MSCs) in neurogenesis and synaptic function were investigated using a β-amyloid 1-42 (β A42)-induced AD rat model.

Methods
hUMSCs and hAD-MSCs were isolated from umbilical cord stroma and adipose tissue, respectively. The expression of Mesenchymal (CD73, CD90 and CD105) and hematopoietic (CD45 and CD133) markers of hUMSCs and hAD-MSCs were confirmed by flow cytometry. Alzheimer's rat model was created by β-amyloid 1-42 injection into the hippocampus and confirmed by Morris Water Maze and immunohistochemical staining. hUMSCs and hAD-MSCs were injected in Alzheimer's rat model, intravenously. Deposition of β-amyloid in the CA1 of hippocampus was assayed 3 months after cell administration. The expression of synaptophysin and GAP43 proteins was assessed by Western blot. Neural death was assessed by Nissl staining.

Results
The data obtained from flow cytometry showed that surface mesenchymal and hematopoteic markers of the fibroblastic like cells isolated from adipose tissue and umbilical cord were expressed highly in hUMSCs and mostly in hAD-SCs. Transplantation of MSCs reduced β-amyloid deposition in the hippocampus of the AD rats compared to the β-amyloid group. The rate of neuronal cell death in the hippocampus of the β-amyloid-treated rats was significantly increased compared to that of the control group. The percentage of apoptotic cells in this group was 72.98 ± 1.25, which was significantly increased compared to the control group. Transplantation of either hUMSCs or hAD-SCs, respectively, resulted in a significant reduction in the apoptotic rate of the neuronal cells in the hippocampus by 39.47 ± 0.01 (p = 0.0001) and 43.23 ± 0.577 (p = 0.001) compared to the β-amyloid group. MSC transplantation resulted in a significant up-regulation in the expression levels of both synaptogenic (synaptophysin) and neurogenic markers (GAP43) by 1.289 ± 0.112 (P = 0.02) and 1.112 ± 0.106 (P = 0.005) fold in the hUMSCs-treated group and 1.174 ± 0.105 (P = 0.04) and 0.978 ± 0.167 (P = 0.008) fold in the hAD-SCs-treated group, respectively.

Conclusion
Intravenous injection of hUMSCs and hAD-MSCs is a safe approach that improves synaptic function and neurogenesis via up-regulation of synaptophysin and GAP43 protein expression levels, respectively, in Alzheimer's model. Intravenous injection of both applied SCs could improve learning and cognitive impairment induced by β A42 injection.

Doshmanziari|Maryam|M|
Shirian|Sadegh|S|
Kouchakian|Mohammad-Reza|MR|
Moniri|Seyedeh Farzaneh|SF|
Jangnoo|Saranaz|S|
Mohammadi|Niloofar|N|
Zafari|Fariba|F|

Alzheimer's disease
hUMSCs
Flow cytometry
Synaptophysin
GAP43
Western blot
hAD-SCs


Breastfeeding at 1, 3 and 6 Months after Birth According to the Mode of Birth: A Correlation Study.

Abstract:
BACKGROUND
Breastfeeding is a determinant of child and maternal health. However, evidence is limited on how mode of birth influences breastfeeding. Research aim: To examine the mode of birth and breastfeeding duration and the type of lactation at one, three and six months after birth in XXX, during 2017.

METHODS
Correlation study on breastfeeding duration and type of lactation during the six months after birth, and mode of birth, in a randomised sample. Women ≥18 years of age with term singleton infants, were included. Collected data through interviews and hospital records. Pearson's and Spearman's correlation analyses were conducted. SPSSv21 and α = 0.05 were used.

RESULTS
Breastfeeding duration was shorter in women with greater parity (-0.055 **) (p < 0.01) and epidural analgesia (0.057 **) (p < 0.01), and longer in mothers with episiotomy (-0.267 **) (p < 0.01). Episiotomy was associated with breastfeeding at one month (0.112 **) (p < 0.01), and at six months (0.347 *) (p < 0.01). The prevalence of breastfeeding was lower in women who received epidural analgesia at three months (-0.140 **) (p < 0.01) and higher at six months (0.013 **) (p < 0.01). The percentages of breastfeeding at three months were significantly greater in women with no perineal tears (2.1) (p < 0.05). At six months, small rates of breastfeeding were found in women with greater parity (0.051 **) (p < 0.01). No significant association was detected, neither between the type of lactation and the mode of birth, nor between breastfeeding duration and the mode of birth.

CONCLUSIONS
Epidural analgesia, episiotomy, perineal tears and parity influence the type of lactation and duration of breastfeeding during the six months after birth. The results suggest no association between the type of lactation and the mode of birth or between breastfeeding duration and the mode of birth.

Agea-Cano|Irene|I|
Linares-Abad|Manuel|M|
Ceballos-Fuentes|Antonio Gregorio|AG|
Calero-García|María José|MJ|

breastfeeding
breastfeeding duration
lactation
mothers
newborn
parturition


Sleep coaching: non-pharmacological treatment of non-restorative sleep in Austrian railway shift workers.

Abstract: Sleep coaching by Holzinger & Klösch™ is a new, Gestalt therapy-based holistic approach to non-pharmacological treatment of non-restorative sleep. It includes psychotherapeutic aspects which enable participants to improve their sleep quality by developing their own coping strategies as a daily routine. Dream work and relaxation techniques are also part of the programme. The aim of this study was to measure the effectiveness of a two-day sleep coaching seminar on sleep quality, daytime sleepiness, and work and life quality in shift workers employed in an Austrian railway company (Österreichische Bundesbahnen, ÖBB). Thirty shift workers (28 male; mean age=24±45.90, age range 24-56 years) answered the same survey before and six months after the seminar (baseline and follow-up) containing items of the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS), their chronotype, personality factors, and burnout risk factors. The baseline findings in this group were compared with those of non-completers (who did not take the follow-up survey) (N=154) to see if the two groups differed significantly enough to create a bias among completers (who took the follow-up survey as well). Groups differed significantly in burnout levels as well as sleep duration, but not in the distribution of critical PSQI and ESS values. The two-day sleep coaching seminar resulted in a significant improvement in total PSQI score and subjective sleep quality and in a significant reduction in diurnal fatigue, sleep latency, and daytime sleepiness. Nevertheless, more research with a larger sample and a longitudinal design is needed to establish the long-term effects of sleep coaching.

Holzinger|Brigitte|B| Mayer|Lucille|L| Levec|Katharina|K| Munzinger|Melissa-Marie|MM| Klösch|Gerhard|G|

D020178:Sleep Disorders, Circadian Rhythm

sleep coaching by Holzinger & Klösch™
sleep quality
daytime sleepiness
sleep disorders


Multicenter study evaluating the impact of COVID-19 outbreak on dermatology outpatients in Turkey.

Abstract: COVID-19 pandemic has a significant impact on public health, whether directly or indirectly. The first case was seen in Turkey on March 11, and the World Health Organization (WHO) declared a pandemic on March 12, 2020. The study aimed to document the effect of pandemic on dermatology outpatient clinics in Turkey. Fifteen tertiary hospitals from 13 provinces were included in the study, which was conducted between January 12 and May 12, 2020. The International Codes of Diseases (ICD-10) categories and patients' characteristics were evaluated before and after the pandemic. A total of 164 878 patients, 133 131 before and 31 747 after the pandemic, were evaluated. The daily hospital applications were found reduced by 77%. The three of the most frequent diagnoses; dermatitis, acne, and psoriasis remained unchanged after the pandemic. While the frequency of herpes zoster, scabies, urticaria, pityriasis rosea and sexually transmitted diseases increased significantly; allergic and irritant contact dermatitis decreased after the pandemic. The applications regarding cutaneous neoplasms were considerably reduced during the pandemic, and this effect was more pronounced in cities with higher COVID incidence. The pandemic caused a noteworthy reduction in the number of patients accessing dermatological care. The pandemic caused significant changes in the frequency of a wide range of dermatological diseases. The application of cutaneous neoplasms is considerably reduced after the pandemic, and this effect was more pronounced in cities where pandemics are frequent. Therefore, the pandemic has resulted on numerous impacts on many critical issues in dermatology and dermatological care.

Kartal|Selda Pelin|SP|
Çelik|Gökçen|G|0000-0002-0032-5572
Sendur|Neslihan|N|
Aytekin|Sema|S|
Serdaroğlu|Server|S|
Doğan|Bilal|B|
Yazıcı|Ayca Cordan|AC|
Çiçek|Demet|D|
Borlu|Murat|M|
Kaçar|Nida Gelincik|NG|
Özden|Müge Güler|MG|0000-0001-7383-9868
Bayramgürler|Dilek|D|
Doğramacı|Asena Cigdem|AC|
Balcı|Didem Didar|DD|
Sarıcaoglu|Hayriye|H|
Serdar|Zehra Asiran|ZA|
Dönmez|Levent|L|
Alpsoy|Erkan|E|

COVID-19
dermatology outpatients
pandemic


Multiple epidural steroid injections and body mass index linked with occurrence of epidural lipomatosis: a case series.

Abstract:
BACKGROUND
Epidural lipomatosis (EL) is an increase of adipose tissue, normally occurring in the epidural space, sufficient to distort the thecal sac and compress neural elements. There is a lack of knowledge of risk factors, impact on patient's symptoms, and its possible association with epidural steroid injections.

METHODS
History, physical examination, patient chart, and MRI were analyzed from 856 outpatients referred for epidural steroid injections. Seventy patients with signs of EL on MRI comprised the study group. Thirty-four randomly selected patients comprised the control group. The severity of EL was determined by the MRI assessment. The impact of EL was determined by the patient's history and physical examination. Logistic regression was used to correlate the probability of developing EL with BMI and epidural steroid injections.

RESULTS
EL was centered at L5 and S1 segments. The average BMI for patients with EL was significantly greater than that of control group (36.0 ± 0.9 vs. 29.2 ± 0.9, p <0.01). The probability of developing EL with increasing BMI was linear up to the BMI of 35 after which it plateaued. Triglycerides were significantly higher for the EL group as compared to controls (250 ± 30 vs. 186 ± 21 mg/dL p < 0.01). The odds of having EL were 60% after two epidural steroid injections, 90% after three epidural steroid injections and approached 100% with further injections, independent of BMI. Other risk factors considered included alcohol abuse, use of protease inhibitors, levels of stress, hypothyroidism and genetic predisposition. However there were insufficient quantities to determine statistical significance with a degree of confidence. The impact of EL on patient's symptoms correlated with EL severity with Spearman correlation coefficient of 0.73 at p < 0.01 significance level.

CONCLUSIONS
The BMI and triglycerides levels were found to be significantly elevated for the EL group, pointing to an increased risk of EL occurrence in progressively more obese US population. The data also revealed a strong correlation between the number of subsequent epidural steroid injections and EL occurrence calling for caution with the use of corticosteroids.

Epidural steroid injection
Epidural lipomatosis
Obesity
Cortisol
Sciatica


Properties of water as a novel stationary phase in capillary gas chromatography.

Abstract: A novel method of separation that uses water as a stationary phase in capillary gas chromatography (GC) is presented. Through applying a water phase to the interior walls of a stainless steel capillary, good separations were obtained for a large variety of analytes in this format. It was found that carrier gas humidification and backpressure were key factors in promoting stable operation over time at various temperatures. For example, with these measures in place, the retention time of an acetone test analyte was found to reduce by only 44s after 100min of operation at a column temperature of 100°C. In terms of efficiency, under optimum conditions the method produced about 20,000 plates for an acetone test analyte on a 250μm i.d.×30m column. Overall, retention on the stationary phase generally increased with analyte water solubility and polarity, but was relatively little correlated with analyte volatility. Conversely, non-polar analytes were essentially unretained in the system. These features were applied to the direct analysis of different polar analytes in both aqueous and organic samples. Results suggest that this approach could provide an interesting alternative tool in capillary GC separations.

Gallant|Jonathan A|JA|
Thurbide|Kevin B|KB|

Water
Stationary phase
Capillary
Gas chromatography


An Interdisciplinary Approach to the Management of a Young Patient with Generalized Periodontitis - A Case Report with a 3-Year Follow-up.

Abstract: Periodontitis has a multifactorial etiology as a result of interactions between periodontal pathogens and the host response. Due to the complex etiology and esthetic complications, the management of such patients is a challenging task. Vast arrays of treatment modalities are employed in the treatment of generalized periodontitis with varying success rates. Placental-derived tissues as allografts have recently been introduced for guided tissue regeneration in dentistry with favorable results. In this case report, successful periodontal treatment of a 25-year-old male patient with generalized periodontitis; Stage IV, Grade C, is presented with a 3-year follow-up. An interdisciplinary approach using regenerative periodontal surgery and a modified Andrew's bridge was used to successfully rehabilitate the patient. In a compliant patient with a well-structured interdisciplinary approach, questionable and hopeless teeth too can be retained over an extended period of time with no detrimental effect on the adjacent teeth.

Sethna|Gulnar Dara|GD|
Moghe|Ameya Gajanan|AG|
Sonkurla|Sapna Poshanna|SP|
Kamble|Avinash Mahadev|AM|
Kapri|Anita|A|
Rajanna|Shobha|S|

generalized periodontitis
case report
guided tissue regeneration
Bone grafts
India


Restructuring the surgical process after regional reform in Emilia-Romagna: an action-research project at Rizzoli Orthopedic Institute.

Abstract:
BACKGROUND
Hospitals performing surgery in Italy underwent important transformations in recent years, with decreasing economic resources and higher expected standards of care. Regional authorities acted differently across the country to adapt to the new scenario, generating heterogeneous outcomes. The Rizzoli Orthopedic Institute (ROI) in the Emilia-Romagna region started its reorganization in 2017, after the issue of new regional regulations about surgical activity. Aim of this paper is to describe the actions taken at ROI and discuss their outcomes.

STUDY DESIGN
Action-research.

METHODS
From 2017 to 2019 an action-research project was developed to introduce organizational changes within ROI and close the existing gaps between regional requirements and actual features of the Institute. Four areas of intervention were identified: surgical scheduling, appropriateness of surgical setting, monitoring and management of the surgical path and accountability. Progress was monitored through the collection of performance indicators and qualitative investigation of the organizational culture.

RESULTS
Changes were implemented in all areas of intervention. Key features were the introduction of Operating Room Management (ORM) skills and the establishment of multiprofessional teams to drive the changes. Performance indicators showed a positive trend in the comparison between 2017 and 2018. Improvements were observed in terms of productivity, scheduling, and respect of standard waiting time, while case-mix did not significantly change.

CONCLUSIONS
Effective ORM and collaborative practices can successfully drive the change towards a more efficient surgical process without increasing resources consumption.

Ubiali|A|A| Rochira|A|A| Buccioli|M|M| Perger|P|P| Bonarelli|S|S| Campagna|A|A| Rolli|M|M| Cavalli|M|M|

Action-research
Surgery
Operating Room Management


The Evolving Role of Pre-pectoral ADM-assisted Approach in Implant-based Immediate Breast Reconstruction Following Conservative Mastectomy: An Overview of the Literature and Description of Technique.

Abstract:
BACKGROUND/AIM
The recent development of acellular dermal matrix (ADM) devices has enhanced implant-based breast reconstruction surgery following conservative mastectomy for therapeutic and risk-reducing purposes leading to improved aesthetics. In the traditional sub-pectoral approach, coverage of the implant is provided by the pectoral muscles superiorly and the ADM inferiorly. The need to eliminate breast animation, reduce post-operative dysfunctional pain and the risk of capsular contracture, have stimulated surgeons to investigate the feasibility of placing the implant over the pectoralis major muscle with complete coverage with ADM thus inventing a novel pre-pectoral approach.

MATERIALS AND METHODS
We reviewed the literature regarding this evolving technique of muscle sparing ADM-assisted implant-based immediate breast reconstruction. Also, we describe our technique, and present pictures of the post-operative result.

RESULTS AND CONCLUSION
The early reported results of the pre-pectoral breast reconstruction approach are encouraging and confirmed the potential benefits of eliminating breast animation and reducing postoperative pain. However, most of these studies had a small sample size (<100 patients) and were retrospective in nature with a limited follow-up duration and lack of data regarding the objective aesthetic assessment and oncological outcome. Nevertheless, suitable patients undergoing conservative mastectomy and implant-based reconstruction should be offered this option while further evaluation is being performed.

Breast reconstruction
dermal matrix
pectoral muscle
breast cancer


Improvements in Cycling Time Trial Performance Are Not Sustained Following the Acute Provision of Challenging and Deceptive Feedback.

Abstract: The provision of performance-related feedback during exercise is acknowledged as an influential external cue used to inform pacing decisions. The provision of this feedback in a challenging or deceptive context allows research to explore how feedback can be used to improve performance and influence perceptual responses. However, the effects of deception on both acute and residual responses have yet to be explored, despite potential application for performance enhancement. Therefore, this study investigated the effects of challenging and deceptive feedback on perceptual responses and performance in self-paced cycling time trials (TT) and explored whether changes in performance are sustained in a subsequent TT following the disclosure of the deception. Seventeen trained male cyclists were assigned to either an accurate or deceptive feedback group and performed four 16.1 km cycling TTs; (1 and 2) ride-alone baseline TTs where a fastest baseline (FBL) performance was identified, (3) a TT against a virtual avatar representing 102% of their FBL performance (PACER), and (4) a subsequent ride-alone TT (SUB). The deception group, however, were initially informed that the avatar accurately represented their FBL, but prior to SUB were correctly informed of the nature of the avatar. Affect, self-efficacy and RPE were measured every quartile. Both groups performed PACER faster than FBL and SUB (p < 0.05) and experienced lower affect (p = 0.016), lower self-efficacy (p = 0.011), and higher RPE (p < 0.001) in PACER than FBL. No significant differences were found between FBL and SUB for any variable. The presence of the pacer rather than the manipulation of performance beliefs acutely facilitates TT performance and perceptual responses. Revealing that athletes' performance beliefs were falsely negative due to deceptive feedback provision has no effect on subsequent perceptions or performance. A single experiential exposure may not be sufficient to produce meaningful changes in the performance beliefs of trained individuals beyond the acute setting.

Jones|Hollie S|HS|
Williams|Emily L|EL|
Marchant|David|D|
Sparks|S Andy|SA|
Bridge|Craig A|CA|
Midgley|Adrian W|AW|
Mc Naughton|Lars R|LR|

cycling
deception
feedback
pacing
self-efficacy
endurance performance
previous performance


Evaluation of the role of TAX, HBZ, and HTLV-1 proviral load on the survival of ATLL patients.

Abstract:
BACKGROUND
Adult T-cell leukemia/lymphoma (ATLL) is an aggressive malignancy with very poor prognosis and short survival, caused by the human T-lymphotropic virus type-1 (HTLV-1). The HTLV-1 biomarkers trans-activator x (TAX) and HTLV-1 basic leucine zipper factor (HBZ) are main oncogenes and life-threatening elements. This study aimed to assess the role of the TAX and HBZ genes and HTLV-1 proviral load (PVL) in the survival of patients with ATLL.

METHODS
Forty-three HTLV-1-infected individuals, including 18 asymptomatic carriers (AC) and 25 ATLL patients (ATLL), were evaluated between 2011 and 2015. The mRNA expression of TAX and HBZ and the HTLV-1 PVL were measured by quantitative PCR.

RESULTS
Significant differences in the mean expression levels of TAX and HBZ were observed between the two study groups (ATLL and AC, P=0.014 and P=0.000, respectively). In addition, the ATLL group showed a significantly higher PVL than AC (P=0.000). There was a significant negative relationship between PVL and survival among all study groups (P=0.047).

CONCLUSION
The HTLV-1 PVL and expression of TAX and HBZ were higher in the ATLL group than in the AC group. Moreover, a higher PVL was associated with shorter survival time among all ATLL subjects. Therefore, measurement of PVL, TAX, and HBZ may be beneficial for monitoring and predicting HTLV-1-infection outcomes, and PVL may be useful for prognosis assessment of ATLL patients. This research demonstrates the possible correlation between these virological markers and survival in ATLL patients.

Akbarin|Mohammad Mehdi|MM|
Shirdel|Abbas|A|
Bari|Alireza|A|
Mohaddes|Seyedeh Tahereh|ST|
Rafatpanah|Houshang|H|
Karimani|Ehsan Ghayour|EG|
Etminani|Kobra|K|
Golabpour|Amin|A|
Torshizi|Reza|R|


Associations Between Glucose Tolerance, Insulin Secretion, Muscle and Fat Mass in Cystic Fibrosis.

Abstract:
Background
A frequent comorbidity in cystic fibrosis (CF) is CF related diabetes (CFRD) caused by a gradual decline in insulin secretion. The reduction in the anabolic hormone, insulin, might explain the weight loss that precedes onset of CFRD. We investigated the association between muscle and fat mass in relation to glucose tolerance and insulin function.

Methods
In a cross-sectional study with CF patients (⩾18 years), we conducted an oral glucose tolerance test and dual energy X-ray absorptiometry scan (DXA). Based on plasma glucose, glucose tolerance was defined as normal (NGT): 1-hour <11.1 mmol/L and 2-hour <7.8 mmol/L, impaired (IGT): 2-hour ⩾7.8 and <11.1 mmol/L or CFRD: 2-hour ⩾11.1 mmol/L. Insulin resistance (HOMA-IR) was derived from fasting levels of plasma glucose and plasma insulin, and fat-free and fat mass index (kg/m2) from DXA. Associations were evaluated using linear regression models adjusted for age, sex, and pancreas insufficiency.

Results
Among 79 CF patients with exocrine pancreas insufficiency, impairment of glucose tolerance corresponded to reduced insulin secretion. In the IGT group the fat-free mass index (FFMI) was 1.2 kg/m2 (95% CI: [-2.3, -0.03] kg/m2, P = .044) lower compared to the NGT group. FFMI increased insignificantly by 0.4 kg/m2 (95% CI: [-0.6, 1.5] kg/m2, P = .422) among the insulin-treated CFRD group compared to IGT. Fat mass index (FMI) was not different between groups but tended to decrease with glucose tolerance impairment. For each 100 pmol/L increase in fasting insulin FFMI increased by 1.77 kg/m2 (95% CI: [0.21, 3.33] kg/m2/pmol/L/100) and FMI increased by 6.15 kg/m2 (95% CI: [3.87, 8.44] kg/m2/pmol/L/100). In multivariate analyses, HOMA-IR was positively associated with FFMI (β = 0.5 kg/m2/HOMA-IR, 95% CI: [0.08, 0.92] kg/m2/HOMA-IR, P = .021) and FMI (β = 1.5 kg/m2/HOMA-IR, 95% CI: [0.87, 2.15] kg/m2/HOMA-IR, P < .001).

Conclusions
Muscle mass was significantly lower among participants with impaired glucose tolerance (IGT), while muscle mass was normalized among those treated with insulin.

Fat mass
Cystic Fibrosis
Diabetes
Fat-free mass
Insulin secretion deficiency


Smoking and blood DNA methylation: an epigenome-wide association study and assessment of reversibility.

Abstract: We conducted a genome-wide association study of blood DNA methylation and smoking, attempted replication of previously discovered associations, and assessed the reversibility of smoking-associated methylation changes. DNA methylation was measured in baseline peripheral blood samples for 5,044 participants in the Melbourne Collaborative Cohort Study. For 1,032 participants, these measures were repeated using blood samples collected at follow-up, a median of 11 years later. A cross-sectional analysis of the association between smoking and DNA methylation and a longitudinal analysis of changes in smoking status and changes in DNA methylation were conducted. We used our cross-sectional analysis to replicate previously reported associations for current (N = 3,327) and former (N = 172) smoking. A comprehensive smoking index accounting for the biological half-life of smoking compounds and several aspects of smoking history was constructed to assess the reversibility of smoking-induced methylation changes. This measure of lifetime exposure to smoking allowed us to detect more associations than comparing current with never smokers. We identified 4,496 cross-sectional associations at P < 10-7, including 3,296 annotated to 1,326 genes that were not previously implicated in smoking-associated DNA methylation changes at this significance threshold. We replicated the majority of previously reported associations (P < 10-7) for current and former smokers. In our data, we observed for former smokers a substantial degree of return to the methylation levels of never smokers, compared with current smokers (median: 74%, IQR = 63-86%), corresponding to small values (median: 2.75, IQR = 1.5-5.25) for the half-life parameter of the comprehensive smoking index. Longitudinal analyses identified 368 sites at which methylation changed upon smoking cessation. Our study demonstrates the usefulness of the comprehensive smoking index to detect associations between smoking and DNA methylation at CpGs across the genome, replicates the vast majority of previously reported associations, and quantifies the reversibility of smoking-induced methylation changes.

Smoking
blood
DNA Methylation
Epigenome-wide association study
reversibility
replication


Prevalence of eosinophilic oesophagitis in adults presenting with oesophageal food bolus obstruction.

Abstract:
AIM
To look at the relationship between eosinophilic oesophagitis (EO) and food bolus impaction in adults.

METHODS
We retrospectively analysed medical records of 100 consecutive patients who presented to our hospital with oesophageal food bolus obstruction (FBO) between 2012 and 2014. In this cohort, 96 were adults (64% male), and 4 paediatric patients were excluded from the analysis as our centre did not have paediatric gastroenterologists. Eighty-five adult patients underwent emergency gastroscopy. The food bolus was either advanced into the stomach using the push technique or retrieved using a standard retrieval net. Biopsies were obtained in 51 patients from the proximal and distal parts of the oesophagus at initial gastroscopy. All biopsy specimens were assessed and reviewed by dedicated gastrointestinal pathologists at the Department of Pathology, University Hospital Geelong. The diagnosis of EO was defined and established by the presence of the following histological features: (1) peak eosinophil counts > 20/hpf; (2) eosinophil microabscess; (3) superficial layering of eosinophils; (4) extracellular eosinophil granules; (5) basal cell hyperplasia; (6) dilated intercellular spaces; and (7) subepithelial or lamina propria fibrosis. The histology results of the biopsy specimens were accessed from the pathology database of the hospital and recorded for analysis.

RESULTS
Our cohort had a median age of 60. Seventeen/51 (33%) patients had evidence of EO on biopsy findings. The majority of patients with EO were male (71%). Classical endoscopic features of oesophageal rings, furrows or white plaques and exudates were found in 59% of patients with EO. Previous episodes of FBO were present in 12/17 patients and 41% had a history of eczema, hay fever or asthma. Reflux oesophagitis and benign strictures were found in 20/34 patients who did not have biopsies.

CONCLUSION
EO is present in approximately one third of patients who are admitted with FBO. Biopsies should be performed routinely at index endoscopy in order to pursue this treatable cause of long term morbidity.

Heerasing|Neel|N|
Lee|Shok Yin|SY|
Alexander|Sina|S|
Dowling|Damian|D|

Oesophagitis
Food bolus obstruction
Endoscopy
Dysphagia
Eosinophilia


A synopsis of the Euphaeidae (Odonata: Zygoptera) of Vietnam, with descriptions of two new species of Euphaea.

Abstract: 23 species of Euphaeidae (Odonata: Zygoptera) are reported from Vietnam including two new species of Euphaea, E. saola Phan Hayashi, sp. nov. and E. sanguinea Kompier Hayashi, sp. nov., and four species not recorded previously, Bayadera continentalis Asahina, 1973, B. hyalina Selys, 1879, B. nephelopennis Davies Yang, 1996 and Euphaea pahyapi Hämäläinen, 1985. The females of Anisopleura bipugio Hämäläinen Karube, 2013, Bayadera serrata Davies Yang, 1996 and Euphaea hirta Hämäläinen Karube, 2001 are described for the first time. The mutual taxonomic status of Bayadera hyalina and B. strigata Davies Yang, 1996 is discussed. Distribution maps of all known Vietnamese species, with detailed distribution records, are provided.

Phan|Quoc Toan|QT|
Kompier|Tom|T|
Karube|Haruki|H|
Hayashi|Fumio|F|

Odonata, Euphaeidae, new species, distribution map, Vietnam


Behr's Syndrome is Typically Associated with Disturbed Mitochondrial Translation and Mutations in the C12orf65 Gene.

Abstract:
BACKGROUND
Behr's syndrome is a classical phenotypic description of childhood-onset optic atrophy combined with various neurological symptoms, including ophthalmoparesis, nystagmus, spastic paraparesis, ataxia, peripheral neuropathy and learning difficulties.

OBJECTIVE
Here we describe 4 patients with the classical Behr's syndrome phenotype from 3 unrelated families who carry homozygous nonsense mutations in the C12orf65 gene encoding a protein involved in mitochondrial translation.

METHODS
Whole exome sequencing was performed in genomic DNA and oxygen consumption was measured in patient cell lines.

RESULTS
We detected 2 different homozygous C12orf65 nonsense mutations in 4 patients with a homogeneous clinical presentation matching the historical description of Behr's syndrome. The first symptom in all patients was childhood-onset optic atrophy, followed by spastic paraparesis, distal weakness, motor neuropathy and ophthalmoparesis.

CONCLUSIONS
We think that C12orf65 mutations are more frequent than previously suggested and screening of this gene should be considered not only in patients with mitochondrial respiratory chain deficiencies, but also in inherited peripheral neuropathies, spastic paraplegias and ataxias, especially with pre-existing optic atrophy.

Pyle|Angela|A|
Ramesh|Venkateswaran|V|
Bartsakoulia|Marina|M|
Boczonadi|Veronika|V|
Gomez-Duran|Aurora|A|
Herczegfalvi|Agnes|A|
Blakely|Emma L|EL|
Smertenko|Tania|T|
Duff|Jennifer|J|
Eglon|Gail|G|
Moore|David|D|
Yu-Wai-Man|Patrick|P|
Douroudis|Konstantinos|K|
Santibanez-Koref|Mauro|M|
Griffin|Helen|H|
Lochmüller|Hanns|H|
Karcagi|Veronika|V|
Taylor|Robert W|RW|
Chinnery|Patrick F|PF|
Horvath|Rita|R|

mitochondrial translation
optic atrophy
ataxia
peripheral neuropathy
spastic paraplegia
Behr’s syndrome


Long noncoding RNA ERICD interacts with ARID3A via E2F1 and regulates migration and proliferation of osteosarcoma cells.

Abstract: Long noncoding RNA (lncRNA) dysregulation is known to be taking part in majority of cancers, including osteosarcoma. In one of our previous studies, we showed that lncRNA MEG3 is being regulated by microRNA-664a (miR-664a) suppresses the migratory potential of osteosarcoma cells (U-2OS). We now report a novel lncRNA, namely, ERICD, which is linked to the transcription factor AT-rich interaction domain 3A (ARID3A) in U-2OS cells. We show that ARID3A binds to ERICD and indirectly interacts with each other via the E2F transcription factor 1 (E2F1). Furthermore, small interfering RNA (siRNA)-mediated knockdown of ERICD inhibited cell migration, formation of colonies, and proliferation in U-2OS cells. Overexpression of ARID3A inhibited cell migration, colony formation, and proliferation, whereas siRNA-mediated knockdown of ARID3A promoted cell migration, colony formation, and proliferation. Our findings indicate that ARID3A and lncRNA ERICD have plausible tumor suppressive and oncogenic functions, respectively, in osteosarcoma. Our data demonstrate the converse interaction between ARID3A and lncRNA ERICD that target DNA-binding proteins and dysregulation of their expression through E2F1 augments osteosarcoma progression. The cell rescue experiment also indicated E2F1 to be involved in the regulation of ARID3A and ERICD.

D015972:Gene Expression Regulation, Neoplastic

ARID3A
migration
osteosarcoma
colony formation
lncRNA ERICD
DNA-binding lncRNA