Resident-Sensitive Processes of Care: Impact of Surgical Residents on Inpatient Testing

BACKGROUND

Health care value is a national priority, and there are substantial efforts to reduce overuse of low-value testing. Residency training programs and teaching hospitals have been implicated in excessive testing. We evaluated the impact of surgery residents on the frequency of inpatient testing and investigated potential inter-resident variation.

STUDY DESIGN

Inpatient laboratory and imaging orders placed on general surgery services were extracted from an academic institution from 2014 to 2016 and linked to National Surgical Quality Improvement Program data. Using negative binomial mixed effects regression with unstructured covariance, we evaluated the frequency of testing orders compared with median use, accounting for case, patient, and attending-level variables.

RESULTS

There were 111,055 laboratory orders and 7,360 imaging orders linked with 2,357 patients. Multivariable analysis demonstrated multiple significant predictors of increased testing including: postoperative complications, medical comorbidities, length of stay, relative value units, attending surgeon, and resident surgeon (95% CIs > 1, p < 0.05). Compared with the median resident physician, 47 residents (37.9%) placed significantly more laboratory orders, and 2 residents (1.6%) placed significantly more imaging orders (95% CI >1, p < 0.05). Resident identification explained 3.5% of the total variation in laboratory ordering and 4.9% in imaging orders.

CONCLUSIONS

Individual surgical residents had a significant association with the frequency of inpatient testing after adjusting for attending, case, and patient-level variables. There was greater resident variation in laboratory testing compared with imaging, yet surgical residents had small contributions to the total variation in both laboratory and imaging testing. Our models provide a means of identifying high users and could be used to educate residents on their ordering patterns.

Network Analyses of Integrated Differentially Expressed Genes in Papillary Thyroid Carcinoma to Identify Characteristic Genes

Papillary thyroid carcinoma (PTC) is the most common type of thyroid cancer. Identifying characteristic genes of PTC are of great importance to reveal its potential genetic mechanisms. In this paper, we proposed a framework, as well as a measure named Normalized Centrality Measure (NCM), to identify characteristic genes of PTC. The framework consisted of four steps. First, both up-regulated genes and down-regulated genes, collectively called differentially expressed genes (DEGs), were screened and integrated together from four datasets, that is, GSE3467, GSE3678, GSE33630, and GSE58545; second, an interaction network of DEGs was constructed, where each node represented a gene and each edge represented an interaction between linking nodes; third, both traditional measures and the NCM measure were used to analyze the topological properties of each node in the network. Compared with traditional measures, more genes related to PTC were identified by the NCM measure; fourth, by mining the high-density subgraphs of this network and performing Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis, several meaningful results were captured, most of which were demonstrated to be associated with PTC. The experimental results proved that this network framework and the NCM measure are useful for identifying more characteristic genes of PTC.

The role of the apoptosis-related protein BCL-B in the regulation of mitophagy in hepatic stellate cells during the regression of liver fibrosis

The clearance of activated hepatic stellate cells (HSCs) by apoptosis is critical for the reversibility of hepatic fibrosis. Mitochondrial homeostasis is regulated by mitophagy, which is an efficient way of clearing injured mitochondria that plays an important role in apoptosis. However, the role of mitophagy in apoptosis in HSCs and hepatic fibrosis is still unclear. Here, we show that mitophagy is enhanced in parallel with increased apoptosis in hepatic stellate cells during the reversal of hepatic fibrosis. The inhibition of mitophagy suppressed apoptosis in HSCs and aggravated hepatic fibrosis in mice. In contrast, the activation of mitophagy induced apoptosis in HSCs. Furthermore, we confirmed that BCL-B, which is a member of the BCL-2 family, is a regulator mediating mitophagy-related apoptosis. The knockdown of BCL-B resulted in increased apoptosis and mitophagy in HSCs, while the overexpression of BCL-B caused the opposite effects. BCL-B inhibited the phosphorylation of Parkin (a key regulator of mitophagy) and directly bound phospho-Parkin. Altogether, enhanced mitophagy promotes apoptosis in HSCs during the reversal of hepatic fibrosis. BCL-B suppresses mitophagy in HSCs by binding and suppressing phospho-Parkin, thereby inhibiting apoptosis. BCL-B-dependent mitophagy is a new pathway for the regulation of apoptosis in HSCs during the regression of hepatic fibrosis.

Clearing away defective mitochondria helps destroy cells in the liver that contribute to tissue scarring; the signaling pathway involved offers a new therapeutic target. Hui-Qing Jiang and colleagues from the Hebei Institute of Gastroenterology in Shijiazhuang, China, induced liver fibrosis in mice and showed that as the animals recovered and the damage to their liver tissue was reversed, injured mitochondria were cleared from fibrosis-causing cells in tandem with the cells’ controlled destruction. Experimentally inhibiting the process of mitochondrial clearance also inhibited cell death and aggravated fibrotic scarring in the mice. The researchers identified a signaling pathway that regulates mitochondrial cleanup and, in turn, also controlled cell death. Targeting this pathway offer a potential new therapeutic strategy for reversing liver fibrosis in patients.

Short Intracortical Inhibition During Voluntary Movement Reveals Persistent Impairment Post-stroke

Objective: Short intracortical inhibition (SICI) is a GABA_A-mediated phenomenon, argued to mediate selective muscle activation during coordinated motor activity. Markedly reduced SICI has been observed in the acute period following stroke and, based on findings in animal models, it has been posited this disinhibitory phenomenon may facilitate neural plasticity and contribute to early motor recovery. However, it remains unresolved whether SICI normalizes over time, as part of the natural course of stroke recovery. Whether intracortical inhibition contributes to motor recovery in chronic stroke also remains unclear. Notably, SICI is typically measured at rest, which may not fully reveal its role in motor control. Here we investigated SICI at rest and during voluntary motor activity to determine: (1) whether GABA_A-mediated inhibition recovers, and (2) how GABA_A-mediated inhibition is related to motor function, in the chronic phase post-stroke.

Methods: We studied 16 chronic stroke survivors (age: 64.6 ± 9.3 years; chronicity: 74.3 ± 52.9 months) and 12 age-matched healthy controls. We used paired-pulse transcranial magnetic stimulation (TMS) to induce SICI during three conditions: rest, submaximal grip, and performance of box-and-blocks. Upper-extremity Fugl-Meyer Assessment and Box-and-Blocks tests were used to evaluate motor impairment in stroke survivors and manual dexterity in all participants, respectively.

Results: At rest, SICI revealed no differences between ipsilesional and contralesional hemispheres of either cortical or subcortical stroke survivors, or healthy controls (P's > 0.05). During box-and-blocks, however, ipsilesional hemisphere SICI was significantly reduced (P = 0.025), especially following cortical stroke (P < 0.001). SICI in the ipsilesional hemisphere during box-and-blocks task was significantly related to paretic hand dexterity (r = 0.56, P = 0.039) and motor impairment (r = 0.56, P = 0.037).

Conclusions: SICI during motor activity, but not rest, reveals persistent impairment in chronic stroke survivors indicating that inhibitory brain circuits responsible for motor coordination do not fully normalize as part of the natural history of stroke recovery. Observation that reduced SICI (i.e., disinhibition) is associated with greater motor impairment and worse dexterity in chronic hemiparetic individuals suggests the response considered to promote neuroplasticity and recovery in the acute phase could be maladaptive in the chronic phase post-stroke.

Dependency of f states in fluorite-type XO2 (X = Ce, Th, U) on the stability and electronic state of doped transition metals

Transition metals (TMs) exhibit different quantum-mechanical oxidation state (OS_qm) population when doped into fluorite-type CeO₂, ThO₂ and UO₂.

HC-HDSD: A method of hypergraph construction and high-density subgraph detection for inferring high-order epistatic interactions

Detecting epistatic interactions, or nonlinear interactive effects of Single Nucleotide Polymorphisms (SNPs), has gained increasing attention in explaining the "missing heritability" of complex diseases. Though much work has been done in mapping SNPs underlying diseases, most of them constrain to 2-order epistatic interactions. In this paper, a method of hypergraph construction and high-density subgraph detection, named HC-HDSD, is proposed for detecting high-order epistatic interactions. The hypergraph is constructed by low-order epistatic interactions that identified using the normalized co-information measure and the exhaustive search. The hypergraph consists of two types of vertices: real ones representing main effects of SNPs and virtual ones denoting interactive effects of epistatic interactions. Then, both maximal clique centrality algorithm and near-clique mining algorithm are employed to detect high-density subgraphs from the constructed hypergraph. These high-density subgraphs are inferred as high-order epistatic interactions in the HC-HDSD. Experiments are performed on several simulation data sets, results of which show that HC-HDSD is promising in inferring high-order epistatic interactions while substantially reducing the computation cost. In addition, the application of HC-HDSD on a real Age-related Macular Degeneration (AMD) data set provides several new clues for the exploration of causative factors of AMD.

Three mutations of adult type 1 Gaucher disease found in a Chinese patient: A case report

RATIONALE

Gaucher disease (GD), characterized by glucosylceramide accumulation in the macrophage-monocyte system, is caused by glucosidase b acid (GBA) gene mutations which lead to the deficiency of lysosomal enzyme glucocerebrosidase. The mutation spectrum of GBA in Chinese patients is quite different from those seen in Jewish and non-Jewish Caucasian patients. Thus, it is relatively hard to diagnose GD in Chinese.

PATIENT CONCERNS

A 24-year-old Chinese female with intermittent abdominal distension and progressive decrease in strength but without neurologic symptoms was initially referred for femoral head necrosis on the right feet. Laboratory examinations results indicated panhematopenia. Bone marrow aspiration smear and biopsy specimen found typical "wrinkled" Gaucher cells. Molecular-genetic testing of GBA gene revealed 3 mutations including R159W (c. 475 C > T), V1230G (c. 689T > G), and G241A (c. 721G > A).

DIAGNOSES

On the basis of these findings and clinical manifestations, the final diagnosis of type 1 GD was made.

INTERVENTIONS

Enzyme replacement therapy (ERT) with velaglucerase α was carried out after the diagnosis of type 1 GD.

OUTCOMES

The platelet and hemoglobin levels were restored by ERT.

LESSONS

To our knowledge, this is the first report of GD patient carrying 3 mutations in Chinese. These mutations in GBA in the present case imply a potential pool of patients with GD with this mutation in Chinese.

Mechanical Metamaterials Foams with Tunable Negative Poisson's Ratio for Enhanced Energy Absorption and Damage Resistance

Systematic and deep understanding of mechanical properties of the negative Poisson’s ratio convex-concave foams plays a very important role for their practical engineering applications. However, in the open literature, only a negative Poisson’s ratio effect of the metamaterials convex-concave foams is simply mentioned. In this paper, through the experimental and finite element methods, effects of geometrical morphology on elastic moduli, energy absorption, and damage properties of the convex-concave foams are systematically studied. Results show that negative Poisson’s ratio, energy absorption, and damage properties of the convex-concave foams could be tuned simultaneously through adjusting the chord height to span ratio of the sine-shaped cell edges. By the rational design of the negative Poisson’s ratio, when compared to the conventional open-cell foams of equal mass, convex-concave foams could have the combined advantages of relative high stiffness and strength, enhanced energy absorption and damage resistance. The research of this paper provides theoretical foundations for optimization design of the mechanical properties of the convex-concave foams and thus could facilitate their practical applications in the engineering fields.

[Relationship between expression of RBM38 and distant metastasis and prognosis of breast cancer]

Objective: To investigate the relationship between the expression of RNA-binding protein 38 (RBM38) and distant metastasis and prognosis of breast cancer. Methods: A total of 161 cases of breast cancer tissues were selected, and the expression of RBM38 was detected by immunohistochemical SP method. The relationship between the expression of RBM38 and the distant metastasis and prognosis of breast cancer patients were analyzed. Cox regression model was applied to analyze the influence factors of distant metastasis of breast cancer. Results: Among the 161 breast cancer patients, high expression of RBM38 was observed in 85 cases and low expression was observed in 76 cases. Log rank test showed that the distant metastasis rate of RBM38 highly expressed group was significantly lower than that of RBM38 lowly expressed group (P=0.010), while the survival rate was significantly higher (P=0.009). Univariate Cox regression analysis showed that the pathological stage (P=0.001), axillary lymph node positive (P=0.001), and the expression of RBM38 (P=0.015) were dramatically related to the distant metastasis of breast cancer patients. Multivariate Cox regression analysis showed that positive axillary lymph node was an independent risk factor (RR=4.222, 95% CI: 1.235-14.432), and high expression of RBM38 was an independent protective factor (RR=0.328, 95% CI: 0.128-0.839) of distant metastasis of breast cancer patients. Conclusion: High expression of RBM38 is positively related with low distant metastasis rate and good prognosis of breast cancer patients. Hence, high expression of RBM38 is an independent protective factor of distant metastasis.

External biomechanical constraints impair maximal voluntary grip force stability post-stroke

BACKGROUND

Grip strength is frequently measured as a global indicator of motor function. In clinical populations, such as hemiparesis post-stroke, grip strength is associated with upper-extremity motor impairment, function, and ability to execute activities of daily living. However, biomechanical configuration of the distal arm and hand may influence the magnitude and stability of maximal voluntary grip force and varies across studies. The influence of distal arm/hand biomechanical configuration on grip force remains unclear. Here we investigated how biomechanical configuration of the distal arm/hand influence the magnitude and trial-to-trial variability of maximal grip force performed in similar positions with variations in external constraint.

METHODS

We studied three groups of 20 individuals: healthy young, healthy older, and individuals post-stroke. We tested maximal voluntary grip force in 4 conditions: 1: self-determined/"free"; 2: standard; 3: fixed arm-rest; 4: gripper fixed to arm-rest, using an instrumented grip dynamometer in both dominant/non-dominant and non-paretic/paretic hands.

FINDINGS

Regardless of hand or group, maximal voluntary grip force was highest when the distal limb was most constrained (i.e., Condition 4), followed by the least constrained (i.e., Condition 1) (Cohen's f = 0.52, P's < 0.001). Coefficient of variation among three trials was greater in the paretic hand compared with healthy individuals, particularly in more (Conditions 3 and 4) compared to less (Conditions 1 and 2) constrained conditions (Cohen's f = 0.29, P's < 0.05).

INTERPRETATION

These findings have important implications for design of rehabilitation interventions and devices. Particularly in individuals post-stroke, external biomechanical constraints increase maximal voluntary grip force variability while fewer biomechanical constraints yield more stable performance.

Microwave ablation combined with doxorubicin enhances cell death via promoting reactive oxygen species generation in breast cancer cells

PURPOSE

To evaluate the mechanism for enhancing cell death induced by microwave ablation (MWA) combined with doxorubicin treatment in breast cancer cells.

MATERIALS AND METHODS

Different temperatures of heat treatment were used to mimic the tumor affected by sublethal heat during MWA in vitro. Breast cancer cells were treated at 43°C and 45°C, with or without doxorubicin. Cell viability, apoptosis, and intracellular reactive oxygen species (ROS) were evaluated in MDA-MB-231 and SUM-1315 cells. Nude mice breast cancer models were randomly divided into control, MWA, doxorubicin, and combined treatment groups. Tumor apoptosis and DNA damage were evaluated in these groups.

RESULTS

The combined group had lower cell viability than the heat or doxorubicin group (all P<0.05), and enhanced apoptosis rate was observed in the combined group compared to others (all P<0.01) in MDA-MB-231 and SUM-1315. Increased capase3 (all P<0.01) and decreased Bcl-Xl (all P<0.01) were detected after combined therapy compared to single treated group in vitro. The raisedCaspase3 and DNA damage marker histone H2A.X induced by combined treatment were also approved in the nude mice models. Combined treatment promoted ROS generation compared to doxorubicin or MWA treatment (all P < 0.01). NF-κB expression in the combined group was higher than that of the single treatment group (all P<0.05). N-acetylcysteine (NAC), a ROS scavenger, partly restrained the combined treatment induced cell proliferation inhibition, Caspase3 and NF-κB compared to doxorubicin treatment (all P<0.05).

CONCLUSION

MWA combined with doxorubicin promote cell death via ROS induced cell apoptosis and DNA damage. Increasing ROS has potential for improving the efficiency of combined treatment.

Ectopic expression of a Brassica rapa AINTEGUMENTA gene (BrANT-1) increases organ size and stomatal density in Arabidopsis

The AINTEGUMENTA-like (AIL) family plays a central role in regulating the growth and development of organs in many plants. However, little is known about the characteristics and functions of the AIL family in Chinese cabbage (Brassica rapa L. ssp. pekinensis). In this study, a genome-wide analysis was performed to identify the members of the AIL family in Chinese cabbage. We identified three ANT genes and six ANT-like genes of Chinese cabbage, most of which were differentially expressed in different organs or tissues. Furthermore, compared with the wild-type line, the size of different organs in the 35S-BrANT-1 line was significantly increased by promoting cell proliferation. Meanwhile, over-expression of BrANT-1 also increases the stomatal number and delays the leaf senescence. Transcriptome analyses revealed that a set of cell proliferation and stoma development genes were up-regulated, while the senescence-associated genes were down-regulated, suggesting these genes may be involved in BrANT-1 regulated processes for controlling organ size, stomatal density and leaf senescence. In summary, this study offers important insights into the characteristics and functions of the ANT genes in Chinese cabbage, and provides a promising strategy to improve yield or head size in Chinese cabbage breeding programs.

miR-126 promotes the growth and proliferation of leukemia stem cells by targeting DNA methyltransferase 1

Previous studies have showed that the interaction between microRNAs (miRNAs) and leukemia stem cells (LSCs) may be a cause of drug resistance of acute myeloid leukemia (AML). However, whether miR-126 participates in the pathogenesis of AML remains unclear. In our study, we first examined the expression of miR-126 in CD34+ or CD34- cells isolated from blood samples and LSC cell line: KG-1a-LSCs and MOLM13-LSCs by qRT-PCR analysis. Then miR-126 inhibitor and mimics were applied to evaluate the roles of miR-126 in cell proliferation of LSC cell lines using CCK-8 assay and Ki-67 staining. Moreover, flow cytometry analysis was used to assess the apoptosis of LSC cell lines treated with miR-126 inhibitor of mimics. In addition, we analyzed the relationship between miR-126 and DNA methyltransferase 1 (DNMT1) by bioinformatics analysis and dual-luciferase reporter assay. Western blot analysis was applied to examine the protein expression level of DNMT1 in miR-126 mimics treated LSC cells. Results showed that miR-126 expression was significantly higher in CD34+ cells and KG-1a-LSCs and MOLM13-LSCs. Knockdown of miR-126 in KG-1a-LSCs and MOLM13-LSCs inhibited cell proliferation, and promoted apoptosis. miR-126 could regulate DNA methyltransferase 1 (DNMT1) expression by directly binding to it. In conclusion, these findings suggested that miR-126 may promote cell proliferation of LSCs by targeting DNMT1.

[Cohort Study of EGFR-TKIs Combined with Traditional Chinese Medicine and Single EGFR-TKIs for Advanced NSCLC (Non₋small Cell Lung Cancer)]

OBJECTIVE

To explore the curative effect of epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKIs) combined with Traditional Chinese Medicine (TCM) versus single EGFR-TKIs for Advanced non-small-cell lung cancer (NSCLC).

METHODS

A total of 59 NSCLC patients with EGFR mutation were divided (2:1) into treatment group and control group. Patients in treatment group (39 cases) take EGFR-TKIs plus TCM and control group (20 cases) take EGFR-TKIs. Analysis the progression-free survival (PFS), disease control rate (DCR) and treatment-related adverse events of two groups.

RESULTS

The DCR of the treatment group and control group was 94.1% and 84.2% respectively (P=0.24). In the total population, PFS was 12.1 months in treatment group and 9.1 months in control group [hazard ratio (HR) 0.46; 95%CI 0.23-0.9; P=0.025]. Among patients with exon 19 deletion (19-del), PFS between treatment group and control group was 10.5 months and 9.5 months respectively (P=0.17). For patients with exon Leu858Arg point mutation (L858R), PFS was significantly longer with treatment group than withcontrol group (median 13.2 months vs. 7.8 months; HR 0.32, 95%CI 0.10-0.97; P=0.046). Grade 3-4 treatment-related adverse events were less common withtreatment-group (8.33 %) than control group (15.00%) (P=0.65).

CONCLUSION

For NSCLC patients with EGFR mutation, EGFR-TKIs combined with TCM has a certain effect to prolong PFS, especially for the patients with L858R.

CD300A inhibits tumor cell growth by downregulating AKT phosphorylation in human glioblastoma multiforme

Glioblastoma multiforme (GBM) is a primary malignant tumor of the central nervous system with the highest incidence and dismal prognosis. As a member of the CD300 glycoprotein family, CD300A plays a role in cell proliferation, apoptosis, differentiation, and immune response, but its role in solid tumors remains unknown. In this study, CD300A was observed to be overexpressed in human GBM samples using real-time PCR and western blotting. To investigate the role of CD300A in GBM, CCK8, transwell and flow cytometry analysis were performed to examine the proliferation, migration and apoptosis in GBM cell lines, respectively. From our results, knockdown of CD300A blocks cell proliferation and migration, and induces cell apoptosis in human GBM cells U251MG and U87MG. Further, we assessed AKT expression level in CD300A knockdown and negative control cells. The phosphorylation level of AKT was significantly suppressed in CD300A knockdown cells in comparison to negative control cells, suggesting that CD300A promoted tumor cell growth through the AKT pathway. In conclusion, our findings expand the knowledge of CD300A as an oncogene in solid tumor, and provide experimental and theoretical basis for further clinical application.

[Construction of an eukaryotic expression plasmid for AY358935 gene]

OBJECTIVE

To construct an eukaryotic expression plasmid for AY358935 gene and explore its function.

METHODS

cDNA of the AY358935 gene was amplified by reverse transcription-PCR and cloned into pGEM-Teasy. The pGEM-T-AY was validated by sequencing and served as a template for the construction of eukaryotic expression plasmid. The pcDNA3.1-AY recombinant was validated by double enzyme digestion and used for transient transfection of M14 cells. Expression of the AY358935 protein and proliferation of the M14 cells were determined respectively by Western blotting and 3-(4,5)-dimethylthiahiazo(-z-y1)-3,5-di-phenytetrazoliumromide (MTT) colorimetry.

RESULTS

The amplicons of RT-PCR were confirmed to have similar size with the cDNA fragment of the AY358935 gene as well as cloned region of pcDNA3.1-AY. The cloned region of pGEM-T-AY was sequenced to be identical with cDNA sequence of the AY358935 gene. M14 cells were transfected by the AY358935 gene, pcDNA3.1 and liposomes, respectively. After 48 h, expression of the AY358935 protein in M14 cells transfected with the AY358935 gene was significantly higher than other two groups. They also had a significantly higher absorbance value (A=0.74) than other two groups (A=0.39 and 0.46, respectively; P<0.05).

CONCLUSION

An eukaryotic expression plasmid of the AY358935 gene was successfully constructed. Product of the AY358935 gene may promote the proliferation of M14 cells.

Assessment of CAD-CAM zirconia crowns designed with 2 different methods: A self-controlled clinical trial

STATEMENT OF PROBLEM

In computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry, the correlation method is an efficient way to design complete crowns. However, the occlusal relationship and patient satisfaction with prostheses fabricated using this method remain unclear.

PURPOSE

The purpose of this clinical trial was to compare the occlusion of monolithic zirconia crowns designed using the correlation and library methods.

MATERIAL AND METHODS

Twenty-three teeth of 21 participants received 2 monolithic zirconia crowns designed by using the correlation or the library method. Defective teeth were scanned using an intraoral scanner to obtain references and working casts from before and after the preparation. Before cementation, the occlusal relationship of both crowns and patient satisfaction were evaluated, and the occlusal adjustment time was recorded.

RESULTS

The correlation method resulted in less lateral occlusal interference of the crowns than the library method (P<.01). The occlusal adjustment times of the correlation and library conditions were 455.8 ±357.1 seconds and 575.3 ±488.0 seconds, respectively (P>.05). Relative occlusal force was significantly higher in the correlation than in the library condition and was related to before preparation relative occlusal force (r=0.706, P<.01). The visual analog score before occlusal adjustment was higher in the correlation than in the library condition (P<.05). The occlusal contacts, occlusal contact distributions, and number of occlusal contacts did not differ between conditions (P>.05).

CONCLUSIONS

Better eccentric occlusion and reduced lateral occlusal interference were obtained when the correlation method was used to design crowns. The correlation method yielded higher relative occlusal force, which helped to restore the original occlusal force.

Effectiveness and Safety Comparison for Systemic Corticosteroid Therapy With and Without Inhaled Corticosteroids for COPD Exacerbation Management

Background: Only 1 small, single-center study has evaluated the combination of systemic plus inhaled corticosteroid (ICS) routes for chronic obstructive pulmonary disease (COPD) exacerbation management. This study aims to further improve the existing quantity and quality of evidence regarding the utility for combination therapy in the management of COPD exacerbation. Objectives: To evaluate length of hospital stay, readmission rate, incidence of infection, and mortality in hospitalized patients who experience a COPD exacerbation and receive systemic corticosteroid therapy with or without concurrent ICS. Methods: Design: retrospective cohort study. Participants and setting: patients at least 18 years old admitted between May 31, 2015, and May 31, 2016, for an acute COPD exacerbation at any of 7 Indiana University Health system hospitals. Interventions: patients who received an oral or intravenous systemic corticosteroid either with or without concurrent ICS therapy. Results: This study included 241 patients. No significant difference was found between rates of 30-day readmission or inpatient mortality. Patients receiving concurrent therapy had longer lengths of stay versus those who only received systemic corticosteroid therapy (6.35 ± 3.98 vs 4.99 ± 2.89 days, P = 0.0039). Differences in the rates of antifungal use and mechanical ventilation did not statistically differ. Conclusion and Relevance: There was no significant benefit demonstrated when adding ICS to systemic corticosteroid therapy for COPD exacerbation management. These preliminary findings build on the limited evidence on how best to manage corticosteroid therapy in the inpatient setting, but a large, prospective trial remains warranted to confirm these findings given the design, size, and concern for selection bias limitations in the present study.

Effects of different surface treatments on the cyclic fatigue strength of one-piece CAD/CAM zirconia implants

OBJECTIVES

The effects of different surface treatments on cyclic fatigue strengths of computer-aided design and computer-aided manufacturing (CAD/CAM) zirconia implants and its mechanisms were evaluated.

MATERIAL AND METHODS

One-piece cylindrical screw-type zirconia (Y-TZP) implants with diameters of 4.1-mm were fabricated using CAD/CAM technique; they were divided into four groups according to the type of surface treatment: (i) sintering (control group, CTRL), (ii) sandblasting (SB), (iii) sandblasting and etching with an experimental hot etching solution (SB-ST), and (iv) sandblasting and etching with hydrofluoric acid (SB-HF). The surface morphology and roughness of the implants were evaluated. Tetragonal to monoclinic transformation was measured on the surface by micro Raman spectroscopy. Static and fatigue tests were carried out at room temperature following the ISO 14801:2014 Standard. The cyclic fatigue strength of each group was determined using the staircase method. Specimens that survived the fatigue test were statically loaded to measure the residual fracture strength.

RESULTS

Among the four groups, SB-HF exhibited the highest surface roughness. Compared with the CTRL group, the surface monoclinic content was higher after all three types of surface treatments, amongst which, SB-HF had the highest content (39.14%), significantly more than the other three groups (P < 0.01). The cyclic fatigue strengths of CTRL, SB, SB-ST, and SB-HF implants were 530 N, 662.5 N, 705 N, and 555 N, respectively. The fracture strength after fatigue loading was higher than that before fatigue loading with no significant difference (P＞0.05).

CONCLUSIONS

SB and SB-ST remarkably enhanced the fatigue resistance of zirconia implants, while SB-HF did not. One-piece 4.1-mm diameter CAD/CAM zirconia implants have sufficient durability for application in dental implants.

Comparison of the common spatial interpolation methods used to analyze potentially toxic elements surrounding mining regions

The appropriate spatial interpolation methods must be selected to analyze the spatial distributions of Potentially Toxic Elements (PTEs), which is a precondition for evaluating PTE pollution. The accuracy and effect of different spatial interpolation methods, which include inverse distance weighting interpolation (IDW) (power = 1, 2, 3), radial basis function interpolation (RBF) (basis function: thin-plate spline (TPS), spline with tension (ST), completely regularized spline (CRS), multiquadric (MQ) and inverse multiquadric (IMQ)) and ordinary kriging interpolation (OK) (semivariogram model: spherical, exponential, gaussian and linear), were compared using 166 unevenly distributed soil PTE samples (As, Pb, Cu and Zn) in the Suxian District, Chenzhou City, Hunan Province as the study subject. The reasons for the accuracy differences of the interpolation methods and the uncertainties of the interpolation results are discussed, then several suggestions for improving the interpolation accuracy are proposed, and the direction of pollution control is determined. The results of this study are as follows: (i) RBF-ST and OK (exponential) are the optimal interpolation methods for As and Cu, and the optimal interpolation method for Pb and Zn is RBF-IMQ. (ii) The interpolation uncertainty is positively correlated with the PTE concentration, and higher uncertainties are primarily distributed around mines, which is related to the strong spatial variability of PTE concentrations caused by human interference. (iii) The interpolation accuracy can be improved by increasing the sample size around the mines, introducing auxiliary variables in the case of incomplete sampling and adopting the partition prediction method. (iv) It is necessary to strengthen the prevention and control of As and Pb pollution, particularly in the central and northern areas. The results of this study can provide an effective reference for the optimization of interpolation methods and parameters for unevenly distributed soil PTE data in mining areas.