bluuebunny/crossref_metadata_2025 huggingface dataset:
Conjunctival Sac Microbiome in Infectious Conjunctivitis
Authors: Mohamed Yasser Helmy , Uematsu Masafumi , Morinaga Yoshitomo , Nguyen Hien-Anh , Toizumi Michiko , Sasaki Daisuke , Yanagihara Katsunori , Dang Duc-Anh , Kitaoka Takashi , Yoshida Lay Mint
Published: November 2020

Background
To determine the conjunctival bacterial community among the infectious conjunctivitis cases attending the outpatient clinic of Khanh Hoa General Hospital in Nha Trang, Vietnam from October 2016 through December 2017. Of all, 50 randomly selected samples using a computer generated random number list were included for microbiome identification. Conjunctival swabs were collected and tested using conventional culture, PCR, and 16S ribosomal RNA sequencing.
Results
The study included randomly selected 47 patients. More than 98% of all DNA reads represented five bacterial phyla. Three of these phyla constitute 92% of all sequences [Firmicutes (35%), Actinobacteria (31%), and Proteobacteria (26%)]. At the genus level, there were twelve common genera constituted about 61% of all the sequence reads. Seven of those genera were common [Streptococcus (10%), Cutibacterium (10%), Staphylococcus (7%), Nocardioides (7%), Corynebacterium 1 (5%), Anoxybacillus (5%), and Acinetobacter (5%)], which encompassed 49% of all reads. As for diversity analysis, there was no difference in PERMANOVA analysis (Unweighted UniFrac) for sex (P = 0.087), chemosis (P = 0.064) and unclassified eyedrops (P = 0.431). There was no difference in PERMANOVA analysis for pain (P = 0.315) and itching (P = 0.133). There was a statistical significant difference in cases with bilateral conjunctivitis (P = 0.017) and for using antibiotics (P = 0.020).
Conclusion
Firmicutes among the predominant phyla has the highest abundance in bacterial conjunctivitis in our study. Pseudomonas as a resident commensal microbiota has an important role for prevention of infection.
Bilateral radial head fracture with unilateral terrible triad injury in a military
Authors: BENNANI MOURAD , Cherrad Taoufik , Guendbar Mouad , Zejjari Hassan , Louaste Jamal , Amhajji Larbi
Published: November 2020

Background:

The combination of coronoid process fracture, radial head fracture, and elbow dislocation has earned the moniker “terrible triad” by virtue of its challenging treatment and historically poor outcomes. Bilateral radial head fracture with unilateral terrible triad injury is an unprecedented presentation. It raises questions regarding the mechanism of injury, the surgical indication and the rehabilitation program.
Case presentation:

We report a case of a 29-year-old man presenting a unilateral terrible triad injury of the right elbow and a left radial head fracture after he fell off his motorcycle. The patient underwent open reduction and internal fixation of the radial head with repair of the lateral collateral ligament for the right elbow while the left radial head fracture was treated by a short-term immobilization in a posterior splint. We have reached good results 2 years after the injury: The Mayo Elbow Performance Score was 100 for both elbows.
Conclusion:

The few available data suggest that bilateral elbow injury involving a terrible triad occurs mainly in male young patient as a result of a high energy trauma. Bilateral radial head fracture with unilateral terrible triad injury is unprecedented. Well adapted surgical indication followed by optimal rehabilitation program are the two keys to obtain good results.
Association of serum uric acid levels with COVID-19 severity
Authors: Hu Fang , Guo Yifan , Lin Jianghong , Zeng Yingjuan , Wang Juan , Li Man , Cong Li
Published: November 2020

Aims:
Hyperuricemia has attracted increasing attention, however, limited attention has been paid to the potential dangers of lowering serum uric acid (SUA). We observed lower levels of SUA in COVID-19 patients. Therefore, we aim to explore the SUA levels in COVID-19 patients and the relationship between SUA and the severity of COVID-19.
Methods:
A case-control study based on 91 cases with COVID-19 and 1:3 age- and sex-matched healthy control subjects (N = 273) were included. We firstly compared the SUA levels and the uric acid/creatinine (UA/Cr) ratio between COVID-19 patients and the healthy controls. Then, we examined the association of the SUA levels and UA/Cr ratios with COVID-19 severity defined according to the fifth edition of China’s Diagnosis and Treatment Guidelines of COVID-19.
Results:
SUA levels at admission were 2.59% lower, UA/Cr ratios 6.06% lower in COVID-19 patients compared to controls. In sex stratified analysis, SUA and UA/Cr were lower in male COVID-19 patients while only SUA was lower in female COVID-19 patient. Moreover, SUA and UA/Cr values were 4.27% and 8.23% lower in the severe group than in the moderate group among male COVID patients. A multiple linear regression analysis showed that SARS-CoV-2 infection and male sex were independent factors associated with lower SUA levels. COVID-19 male patients with low SUA levels at had higher risk of developing severe symptoms than those with high SUA levels (incidence rate ratio: 4.05; 95% CI:1.11,14.72) at admission. After completion of the first follow-up of the COVID-19 patients within 1–3 weeks after discharge, we found that male patients experienced severe symptoms had significantly lower SUA and UA/Cr ratio levels comparing to moderate patients but no significant difference between different time points. In females, female patients have both SUA and UA/Cr ratio levels lower at discharge than that at admission, however these differences disappear at follow-up exam.
Conclusion:
COVID-19 patients had SUA and UA/Cr values lower than normal at admission. Male COVID-19 patients with low SUA levels had a significantly higher risk of developing severe symptoms than those with high SUA levels. During the aggravation course of the disease, the level of SUA gradually decreased until discharge. At follow-up exam, the level of SUA is similar to the levels at admission.
Metformin Reduces Therapeutic Effects in the New in Vitro Tumor Therapy Model 
Authors: Meyer Felix Benjamin , Goebel Sophie , Spangel Sonja Barbara , Leovsky Christiane , Hoelzer Doerte , Thierbach René
Published: November 2020

Background Despite considerable medical proceedings, cancer is still a leading cause of death. Major problems for tumor therapy are chemoresistance as well as toxic side effects. In recent years, the additional treatment with the antidiabetic drug metformin during chemotherapy showed promising results in some cases. The aim of this study was to develop an in vitro tumor therapy model in order to further investigate the potential of a combined chemotherapy with metformin. Methods Cytotoxic effects of a combined treatment on BALB/c fibroblasts were proven by the resazurin assay. Based on the BALB/c cell transformation assay, the BALB/c tumor therapy model was established successfully with four different chemotherapeutics (Doxorubicin, Docetaxel, Mitomycin C and 5-Fluorouracil). Moreover, glucose consumption in the medium supernatant was measured and protein expressions were determined by Western Blotting. Results Initial tests for the combined treatment with metformin indicated unexpected results as metformin could partly mitigate the cytotoxic effects of the chemotherapeutic agents. These results were further confirmed as metformin induced resistance to some of the drugs when applied simultaneously in the tumor therapy model. Mechanistically, an increased glucose consumption was observed in non-transformed cells as well as in the mixed population of malignant transformed cell foci and non-transformed monolayer cells, suggesting that metformin could also increase glucose consumption in transformed cells. Conclusion In conclusion, this study suggests a cautious use of metformin during chemotherapy. Moreover, the BALB/c tumor therapy model offers a potent tool for further mechanistic studies of drug-drug interactions during cancer therapy.
VATS right upper posterior segmentectomy with anomalous bronchiand pulmonary vessels: a case report and literature review
Authors: Zhang Jianbin , Zhu Yilv , Li Hongwei , Yu Caihua , Min Weiwei
Published: November 2020

BackgroundAnatomic variation may increase the difficulty and risk for anatomic segmentectomy. The preoperative three-dimensional computed tomography bronchography and angiography(3D-CTBA) can provide a detailed model of the segmental structure, and contribute to precise and safe segmentectomy.Case presentationWe report a case with anomalous bronchi and pulmonary vessels in the right upper posterior segment (RS2), under the guidance of 3D-CTBA, anatomic RS2segmentoctomywas performed accurately and safely, the postoperative condition was uneventful.ConclusionsThis rare case highlights the importance of 3D-CTBA to guild accurate segmentectomy with anatomic variation.
The authors have requested that this preprint be removed from Research Square.
Authors: Removed Author
Published: November 2020

The authors have requested that this preprint be removed from Research Square.
Lack of Correlation of Brucella Antibody Titers With Clinical Outcomes and Culture Positivity of Brucellosis
Authors: Alsubaie Shahad A. , Turkistani Shouq A. , Zeaiter Alanoud A. , Thabit Abrar K.
Published: November 2020

BackgroundBrucellosis is a zoonotic disease caused by Brucella spp., namely B. melitensis and B. abortus in humans. Culturing is the gold standard method for diagnosis; however, because Brucella is a slow-growing bacterium, which may delay diagnosis, other faster methods, such as serology, are used. Studies on the correlation between Brucella antibody titers and clinical outcomes are limited. Therefore, this study assessed such correlation and evaluated the correlation between baseline serological results with culture positivity and clinical picture.MethodsPatients tested positive for Brucella antibodies at baseline and diagnosed with brucellosis between January 2008 and December 2018 were included. Collected data included clinical outcomes, baseline culture positivity (growth in culture), arthralgia, baseline and end of therapy (EOT) temperature, white blood cell count, C-reactive protein level, and erythrocyte sedimentation rate.ResultsOf 695 patients tested for Brucella antibodies, only 94 had positive baseline serology and diagnosed with acute brucellosis, among whom 63 had EOT serology. No significant correlations were found between EOT antibody titers of both Brucella spp. and clinical cure, mortality, length of stay, and duration of therapy. Additionally, no correlations were found between baseline serology and culture positivity, arthralgia, temperature, and other lab values.ConclusionBrucella serology does not correlate with clinical outcomes at EOT nor with culture positivity at baseline. Therefore, healthcare providers are advised to consider the whole clinical picture of a brucellosis patient without relying solely on serological results during follow up and not replace culturing with serology testing alone at the time of diagnosis.
Child Witchcraft Confessions as an Idiom of Distress in Sierra Leone; Results of a Rapid Qualitative Inquiry and Recommendations for Mental Health Interventions.
Authors: Yoder Heleen , de Jong Joop T.V.M. , Tol Wietse Anton , Duncan Joshua Abioseh , Bayoh Amjata , Reis Ria
Published: November 2020

BackgroundReports about child witchcraft are not uncommon in sub-Saharan Africa. In this study we approach child witchcraft as an idiom of distress. In an environment that may prohibit children from openly expressing distress, belief in witchcraft can provide a shared language to communicate about psychosocial suffering. We used an ecological approach to study how some children in distressing circumstances come to a witchcraft confession, with the aim to set out pathways for mental health interventions. MethodsWe employed rapid qualitative inquiry methodology, with an inductive and iterative approach, combining emic and etic perspectives. We conducted 37 interviews and 12 focus group discussions with a total of 127 respondents in Freetown, Sierra Leone. Inductive analysis was used to identify risk and protective factors related to witchcraft accusations and confessions. ResultsWe identified risk and protective factors related to the individual child, the family, peer relations, teachers and other professionals in a child’s life, traditional healers, pastors and the wider society. We found that in the context of a macrosystem that supports witchcraft, suspicions of witchcraft are formed at the mesosystem level, where actors from the microsystem interact with each other and the child. The involvement of a traditional healer or pastor often forms a tipping point that leads to a confession of witchcraft. ConclusionsChild witchcraft is an idiom of distress, not so much owned by the individual child as well as by the systems around the child. Mental health interventions should be systemic and multi-sectoral, to prevent accusations and confessions, and address the suffering of both the child and the systems surrounding the child. Interventions should be contextually relevant and service providers should be helped to address conscious and subconscious fears related to witchcraft. Beyond mental health interventions, advocacy, peacebuilding and legislation is needed to address the deeper systemic issues of poverty, conflict and abuse.
Identifying The Functions of Two Biomarkers in Human Oligodendrocyte Progenitor Cell Development
Authors: zhou Haipeng , He Ying , Yang Yinxiang , Wang Zhaoyan , Wang Qian , Hu Caiyan , Wang Xiaohua , Lu Siliang , Li Ke , Luan Zuo
Published: November 2020

Background: Myelin oligodendrocytes develop from migratory and proliferative human oligodendrocyte progenitor cells (hOPCs), which express typical marker proteins and lipids. It is well known that NG2 and A2B5 are important biological markers of hOPCs. Yet, the differences in myelination ability between the two cell lineages have not been studied in depth. The sequence of expression of NG2 and A2B5 during the development of hOPCs is also controversial. Methods: Using cell sorting technology, we obtained a large number of sterile, high-purity NG2+/-, A2B5+/- cells with high viability. Further research was then conducted via in vitro cell proliferation and migration assays, single-cell sequencing, mRNA sequencing, and cell transplantation into shiverer mice. Results: The results showed that the ability of cell migration and proliferation of the four groups of cells from high to low was: A2B5->NG2->NG2+>A2B5+. The ability for oligodendrocyte differentiation from high to low was: NG2->A2B5->A2B5+>NG2+. Conclusion: The results of this study suggest that the migration ability of the cells was inversely proportional to their myelination ability. NG2 may be a marker of early oligodendrocyte progenitor cells, and is conducive to cell migration and proliferation, while A2B5 may be a marker of slightly mature oligodendrocyte progenitor cells and is conducive to cell differentiation. The migration, proliferation, and myelination capacities of the negative cell population were stronger than those of the positive cell population. In summary, these results suggest that oligodendrocyte progenitor cells in the mid-stage may be most suitable for clinical cell transplantation to treat demyelinating diseases.
WITHDRAWN: Incidence of Chronic Kidney Disease and Its Association with Fasting Blood Sugar Change Among Diabetic Patients in Resource Limited Setting in Case of Ethiopia: Bayesian Joint Modeling
Authors: Debele Gebiso Roba , Wolde Haileab Fekadu , Yenit Melaku Kindie
Published: November 2020

Background: Chronic kidney disease (CKD) is one of most common microvascular complication of diabetes and become a major health burden worldwide. Despite the effect of fasting blood sugar on the rate of prevent diabetic kidney disease has a pivotal role on the prevention of the diseases, their association is not well investigated. Therefore, the aim of this study was to assess Incidence and predictors of chronic kidney disease and its association with longitudinal fasting blood sugar change among diabetic patients in Southwest Ethiopia.Methods: A retrospective follow-up study was conducted among type 1 and type 2 diabetes patients (DM) at Jimma university medical center, Southwest Ethiopia. A total of 405 diabetes patients who newly enrolled in the DM chronic care from 2012 to 2015 were selected using the simple random sampling technique. Selected patients with complete information were followed until February 2020. Data was extracted from patients’ medical records. Cox proportional hazard with linear mixed effect model was jointly modeled using Bayesian approach, and 95% credible interval was used to select significant variables. Model adequacy was checked by residuals plot.Results: A total of 405 DM patients with complete information were followed for 27494.44 person-month (PM) observation. Overall, 63 patients developed chronic kidney disease with an incidence rate of 2.29 per1000 PM observation (95% CI: [1.79, 2.93]. Time dependent fasting blood sugar was significantly associated with risk of CKD (AHR=4.23, 95% CrI [2.53, 8.23]). Female sex (AHR= 0.51, 95%CrI: [0.27, 0.94]), positive proteinuria (AHR= 2.85, 95%CrI: [1.48, 5.55]), having hypertension (AHR= 2.31, 95%CrI: [1.03, 5.56]) and HDL <40 mg/dl (AHR=3.19, 95% CrI [1.73, 5.98]) were significant predictors of CKD. Conclusion: Chronic kidney disease among diabetes patients continue to be a significant public health problem in Ethiopia. Longitudinal fasting blood sugar change had significant associations with risk of CKD and high FBS can be used as a signal to screen DM patients for CKD. Female sex, positive proteinuria, hypertension and HDL-C <40mg/dl were significant predictors of chronic kidney disease.
A Rare Case Report: an Inextricable Shoulder Pain as the Exclusive Presentation of Lung Adenocarcinoma With Metastasis Over Contralateral Clavicle
Authors: Wu Karl , Wu Karl , Huang Yu-Hao , Huang Yu-Hao
Published: November 2020

BackgroundLung cancer is the fourth most common form of tumor spreading to the bone. Among all patientsof the lung carcinoma, the most common sites of bone metastasis are spine and ribs. Bycomparison, the clavicle is an extremely rare site of metastases in not only the population of lungcancer but among all type of tumors. Enlightened by this existing fact, we would like to share ourexperience of management of an uncommon clavicular metastasis and illuminate the obscuremechanism of its scarcity.Case presentationA 56-year-old female without any systemic disease had suffered from a sole intermittent rightshoulder pain without any other discomfort for 3 months. Physical examination at our OPD,tenderness over right distal third of clavicle with limited range-of-motion of right shoulder. EGFRmutatedlung adenocarcinoma with metastasis over right clavicle resulting in a pathologicalfracture was confirmed with a serial of radiology and pathology diagnoses. Concurrentchemoradiation therapy accompanied with target therapy was manipulated. Eighteen monthspostoperatively, the clavicle pain was found to be subsided with stationary bony lesion underappropriate medication and palliative radiotherapy during the subsequent follow-up.ConclusionsClavicle is an exceedingly unusual site with 2% of metastatic involvement of all type of tumors andonly 1% among the population of carcinoma of lung due to its scanty red marrow and sparsevascular supply. Despite unpleasant prognosis of clavicular metastasis from primary lungadenocarcinoma, promising quality of life is achievable under multidisciplinary management.
Comparative Analysis of the Transcriptomes of Three Varieties Provides Insights Into the Diversity of the Heat Response Mechanisms in Clematis Species
Authors: Zhang Hao , Jiang Changhua , Zhang Long , Gai RuoNan , Peng Siyuan , Zhang Yi , Mao Chanjuan , Lou Yuxia , Feng Shucheng , Ming Feng
Published: November 2020

Background: Clematis species are commonly grown in western and Japanese gardens. Heat stress can inhibit many physiological processes mediating plant growth and development. The mechanism regulating responses to heat has been well characterized in Arabidopsis thaliana and some crops, but not in horticultural plants, including Clematis species. Results: In this study, we identified a heat-sensitive Clematis variety (Clematis alpina ‘Stolwijk Gold’) and two heat-tolerant Clematis varieties (Clematis vitalba and Clematis viticella ‘Polish Spirit’) based on heat-related physiological indices. The leaf transcriptomes under normal and heat stress conditions were analyzed by RNA sequencing. Additionally, heat tolerance-related genes (HTGs) were identified and their expression levels were analyzed. Following heat treatments, 41.67% of the differentially expressed HTGs in Stolwijk Gold had down-regulated expression levels, whereas only 9.80% and 21.36% of the differentially expressed HTGs in C. vitalba and Polish Spirit, respectively, had the same trend. The HTGs’ co-expression and protein–protein interaction networks revealed that the hub genes regulating Clematis resistance to heat stress encode heat shock transcription factors (HSFs) and heat shock proteins (HSPs). Moreover, the sensitivity of Stolwijk Gold to heat is mainly due to the heat-induced down-regulated expression of these genes. On the basis of phylogenetic and expression analyses, the differentially expressed HSF and HSP genes in the three examined varieties were divided into three and four clades, respectively, with similar expression profiles common among orthologous family members. Furthermore, we identified two HSF classes in C. vitalba that may have diverse functions influencing heat resistance. Conclusions: Our study provides insights into the diversity of the heat response mechanisms among Clematis species and may be useful for breeding new heat-resistant ornamental Clematis varieties.
Fitness Characteristics of the Malaria Vector, Anopheles Funestus, During an Attempted Laboratory Colonization
Authors: Ngowo Halfan S , Hape Emmanuel E , Matthiopoulos Jason , Ferguson Heather M , Okumu Fredros O
Published: November 2020

Introduction: The malaria vector Anopheles funestus is increasingly recognized as a dominant vector of residual transmission in many African settings. Efforts to better understand its biology and control are significantly impeded by the difficulties of colonizing it under laboratory conditions. To identify key bottlenecks in colonization, this study compared the development and fitness characteristics of wild An. funestus from Tanzania (FUTAZ) and their F1 offspring during colonization attempts. The demography and reproductive success of wild FUTAZ offspring were compared to that of individuals from one of the only An. funestus strains that has been successfully colonized (FUMOZ, from Mozambique) under similar laboratory conditions.Methods: Wild An. funestus (FUTAZ) were collected from three Tanzanian villages and maintained inside an insectary at 70-85% RH, 25-27oC and 12hr:12hr photoperiod. Eggs from these females were used to establish three replicate F1 laboratory generations. Larval development, survival, fecundity, mating success, percentage pupation and wing length were measured in the F1 FUTAZ offspring and compared with wild FUTAZ and FUMOZ mosquitoes.Results: Wild FUTAZ laid fewer eggs (64.1; 95%CI [63.2, 65.0]) than FUMOZ females (76.1; 95%CI [73.3, 79.1]). Survival of F1-FUTAZ larvae under laboratory conditions was low, with an egg-to-pupae conversion rate of only 5.9% compared to 27.4% in FUMOZ. The median lifespan of F1-FUTAZ females (32 days) and males (33 days) was lower than FUMOZ (52 and 49 for females and males respectively). The proportion of female F1-FUTAZ inseminated under laboratory conditions (9%) was considerably lower than either FUMOZ (72%) or wild-caught FUTAZ females (92%). This resulted in nearly zero viable F2-FUTAZ eggs produced. Wild FUTAZ wings appear to be larger compared to the lab reared F1-FUTAZ and FUMOZ. Conclusions: This study indicates that poor larval survival, mating success, low adult fecundity and shorter survival under laboratory conditions all contribute to difficulties in colonizing of An. funestus. Future studies should focus on enhancing these aspects of An. funestus fitness in the laboratory, with the biggest barrier likely to be poor mating.
SARS-CoV-2 infects brain astrocytes of COVID-19 patients and impairs neuronal viability
Authors: Crunfli Fernanda , Carregari Victor Corasolla , Veras Flavio Protásio , Vendramini Pedro Henrique , Valença Aline Gazzola Fragnani , Antunes André Saraiva Leão Marcelo , Brandão-Teles Caroline , Zuccoli Giuliana da Silva , Reis-de-Oliveira Guilherme , C.Silva-Costa Lícia , Saia-Cereda Verônica Monteiro , Codo Ana Campos , Parise Pierina Lorencini , Toledo-Teixeira Daniel A. , Souza Gabriela Fabiano de , Muraro Stéfanie Primon , Melo Bruno Marcel Silva , Almeida Glaucia M. , Firmino Egidi Mayara Silva , Paiva Isadora Marques , Silva Bruna Manuella Souza , Ludwig Raíssa Guimarães , Ruiz Gabriel Palermo , Knittel Thiago Leite , Davanzo Gustavo Gastão , Gerhardt Jaqueline Aline , Rodrigues Patrícia Brito , Forato Julia , Amorim Mariene Ribeiro , Silva Natália Brunetti , Martini Matheus Cavalheiro , Benatti Maíra Nilson , Batah Sabrina , Siyuan Li , João Rafael Batista , Silva Lucas Scardua , Nogueira Mateus Henrique , Aventurato Ítalo Karmann , Brito Mariana Rabelo de , Alvim Marina , Júnior José Roberto da Silva , Damião Lívia Liviane , Stefano Maria Ercilia de Paula Castilho , Sousa Iêda Maria Pereira de , Rocha Elessandra Dias da , Gonçalves Solange Maria , Silva Luiz Henrique Lopes da , Bettini Vanessa , Campos Brunno de , Ludwing Guilherme , Viana Rosa Maria Mendes , Martins Ronaldo , Vieira Andre Schwambach , Alves-Filho José Carlos , Arruda Eurico , Sebollela Adriano , Cendes Fernando , Cunha Fernando , Damásio André Ricardo de Lima , Vinolo Marco Aurélio Ramirez , Munhoz Carolina , Rehen Stevens K. , Mauad Thais , Duarte-Neto Amaro , Silva Luiz Fernando Ferraz da , Dolhnikoff Marisa , Saldiva Paulo , Fabro Alexandre , Farias Alessandro S. , Moraes-Vieira Pedro Manoel M. , Módena José Luiz Proença , Yasuda Clarissa , Mori Marcelo A. , Cunha Thiago Mattar , Souza Daniel Martins de
Published: November 2020

COVID-19 patients may exhibit neuropsychiatric and neurological symptoms. We found that anxiety and cognitive impairment are manifested by 28-56% of SARS-CoV-2-infected individuals with mild respiratory symptoms and are associated with altered cerebral cortical thickness. Using an independent cohort, we found histopathological signs of brain damage in 25% of individuals who died of COVID-19. All of the affected brain tissues exhibited foci of SARS-CoV-2 infection and replication, particularly in astrocytes. Infection of neural stem cell-derived astrocytes changed energy metabolism, altered key proteins and metabolites used to fuel neurons and for biogenesis of neurotransmitters, and elicited a secretory phenotype that reduces neuronal viability. Our data support the model where SARS-CoV-2 reaches the brain, infects astrocytes and triggers neuropathological changes that contribute to the structural and functional alterations in the brain of COVID-19 patients.
Birth Companionship in a Government Health System: A Pilot Study in Kigoma, Tanzania
Authors: Chaote Paul , Mwakatundu Nguke Richard , Dominico Sunday Alfred , Mputa Alex , Mbanza Agnes , Metta Magdalena , Lobis Samantha , Dynes Michelle , Mbuyita Seleman , McNab Shanon , Schmidt Karen , Serbanescu Florina
Published: November 2020

Background: Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using9intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania.Methods: The pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018.Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics. Results: Over 80% of women delivering at intervention sites had a birth companion who provided support during childbirth; including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96%–99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82%–97%).Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman’s status, and provided emotional support. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p=0.003), interact in a friendly way (p<0.001), greet women respectfully (p<0.001), and try to make them more comfortable (p=0.003). Higher proportions of women who gave birth at intervention sites reported being “very satisfied” with the care they received (p<0.001), and that the staff were “very kind” (p<0.001) and “very encouraging” (p<0.001). Conclusion: Birth companionship was feasible and well accepted by health providers, government officials and most importantly, women who delivered at intervention facilities. The introduction of birth companionship improved women’s experience of birth and the maternity ward environment overall.
How Do Specialist Surgeons Treat the Atrophic Tooth Gap? - A Vignette-based Study Among Maxillofacial and Oral Surgeons
Authors: Korsch Michael , Walther Winfried , Robra Bernt-Peter , Sahin Aynur , Hannig Matthias , Bartols Andreas
Published: November 2020

BackgroundThere is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons.MethodsA total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants “patient age” and “endocarditis prophylaxis” and vignette 2 with determinants “anxiety” and “bisphosphonate therapy”. Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle.ResultsA total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. “Patient age” and “patient anxiety” were not significantly associated with any therapy decision. However, required “endocarditis prophylaxis” led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. “Bisphosphonate therapy” was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision.Conclusion“Patient age” as well as “patient anxiety” appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy.
Factors Associated with Opioid Overdose During Medication-Assisted Treatment: How Can We Identify Individuals at Risk?
Authors: Au Vivian Yin On , Rosic Tea , Sanger Nitika , Hillmer Alannah , Chawar Caroul , Worster Andrew , Thabane Lehana , Samaan Zainab
Published: November 2020

Background: Due to the loss of tolerance to opioids during medication-assisted treatment (MAT), this period may represent a time of heightened risk for overdose. Identifying factors associated with increased risk of overdose during treatment is therefore paramount to improving outcomes. We aimed to determine the prevalence of opioid overdoses in patients receiving MAT. Additionally, we explored factors associated with opioid overdose during MAT and the association between length of time enrolled in MAT and overdose. Methods: Data were collected prospectively from 2,360 participants receiving outpatient MAT in Ontario, Canada. Participants were divided into three groups by overdose status: no history of overdose, any lifetime history of overdose, and emergency department visit for opioid overdose in the last year. We used a multivariate multinomial regression model to assess demographic and clinical factors associated with overdose status. Results: Twenty four percent of participants reported a lifetime history of overdose (n=562) and 8% reported an emergency department (ED) visit for opioid overdose in the last year (n=179). Individuals with a recent ED visit for opioid overdose were in treatment for shorter duration (odds ratio [OR] = 0.92, 95% confidence interval [CI] = 0.87, 0.97, p = 0.001). Individuals with a lifetime or recent history of overdose were more likely to be younger in age (OR = 0.93, 95% CI = 0.89, 0.98, p = 0.007 and OR = 0.84, 95% CI = 0.77, 0.92, p <0.001, respectively), report more physical symptoms (OR = 1.02, 95% CI = 1.01, 1.03, p =0.005 and OR = 1.03, 95% CI = 1.01, 1.05, p = 0.005, respectively), and had higher rates of non-prescription benzodiazepine use (OR = 1.87, 95% CI = 1.32, 2.66, p <0.001 and OR = 2.34, 95% CI = 1.43, 3.81, p = 0.001, respectively) compared to individuals with no history of overdose. Conclusions: A considerable number of patients enrolled in MAT have experienced overdose. Our study highlights that there are identifiable factors associated with a patient’s overdose status that may represent areas for intervention. In particular, longer duration in MAT is associated with a decreased risk of overdose.
A Wider Range of Conditions Contributing to Death in a Cohort of People Who Have Injected Drugs. Findings from an Edinburgh Cohort.
Authors: Robertson Roy , Copeland Lorraine , McKenzie James
Published: November 2020

BackgroundThe morbidity and mortality attributed to injecting drug use is a substantial contributor to any study on causes of premature death. Understanding the extent of this may be limited by difficulties in observing and recording outcomes over several decades. Historic studies have recorded information in a period when blood borne virus and drug deaths were a smaller proportion or, in the cases of Hepatitis C and HIV/AIDS, absent from National mortality figures.Design and settingA cohort of people who had, ever, injected drugs was established over a prolonged period of observation in one, community based, medical practice in Edinburgh (UK). Outcomes were measured in the clinical situation and by accessing death certificates from national, UK, registers.FindingsCauses of death in a cohort of 794 people who inject drugs (PWIDs) varied over time, some conditions relating to single pathological diagnoses and others were more complicated, multimorbid, and cumulative over time. HIV/AIDS was a striking cause of death until 1995 when antiviral chemotherapy was introduced. Drug related deaths (mainly overdose) remained a significant cause of death and death due to alcohol, respiratory, cardiovascular and cancer (mainly lung) increased over time. A wide range of other causes including suicide and violence and trauma were recorded.ConclusionsMortality resulting from present or historic drug use may be underestimated in current recoding systems, which largely record deaths from overdose or a single pathological event in an acute situation. The range of conditions causing or contributing to premature death is enormous reflecting multiple risks associated with drug use.
Nasal Probe Tests Decreased the Procedure Time During Flexible Bronchoscopy: A Randomized Controlled Trial
Authors: Zhu Wenjun , Zhang Yuchen , Shi Jingyu , Wang Xiaoqin , Li Renjiao , Liu Jia , Liu Dan , Luo Fengming
Published: November 2020

Background: Nasal insertion is the preferred method in flexible bronchoscopy; however, the relatively narrow nasal cavity increases the difficulty of bronchoscope insertion. The aim of the study was to investigate the advantages of a prior nasal cavity probe during flexible bronchoscopy and to investigate whether this novel method could reduce the complications associated with flexible bronchoscopy.Methods: This prospective randomized controlled trial was conducted in a tertiary hospital between May 2020 and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: a control group, a simple cotton bud detection group (CD group), and an adrenaline detection group (AD group). The outcomes were the time to pass the glottis, the first-pass intubation success rate, and postoperative complications, especially nasal bleeding.Results: In total, 189 men and 111 women were enrolled in the study, with a mean age of 55.69 ± 12.86 years. The operation time was longer in the control group (24 [14.25-45.75] s) than in the CD group (19.5 [12.25-32.75] s). Compared with that in the CD group, the first-pass intubation success rate was significantly lower in the control group (p<0.05). There was no difference in nasal bleeding between the control group and the CD group (p=0.506). Nasal bleeding after flexible bronchoscopy was more common in the CD group than in the AD group (p=0.005); however, there was no significant between-group difference in hemostatic use (p=0.245). Conclusions: Use of a prior nasal cavity probe during flexible bronchoscopy can significantly reduce the time to pass the nasal cavity, improve the first-pass intubation success rate, and reduce postoperative nasal bleeding. Nasal detection is recommended as a time-saving procedure for patients undergoing flexible bronchoscopy. Trial registration: ChiCTR2000032668, 6th May.2020.
WITHDRAWN: Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices
Authors: Evison Hugo , Sweeny Amy , Ranse Jamie , Carrington Mercedes , Marsh Nicole , Byrnes Joshua , Rickard Claire , Carr Peter , Keijzers Gerben
Published: November 2020

Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February - 18 March 2017 and 5 January - 4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression.Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%-31.9%) remained idle at 24h. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs 7.4%). Nursing staff inserted idle PIVC at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC insertion in the ED was the only factor significantly (p=<.001) predicting an idle outcome (Odds Ratio: 2.4; 95%CI 1.7-3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of ante-cubital insertion. Reasons for these differences are not well understood and requires more targeted research.
Socioeconomic Inequalities in Care-Seeking for Children Under Five Before and After the Free Healthcare Initiative in Sierra Leone: An Analysis of Population-Based Survey Data
Authors: Bognini Joel Dofinisery , Samadoulougou Sekou , Ouedraogo Mady , Kangoye Tiga David , Malderen Carine Van , Tinto Halidou , Kirakoya-Samadoulougou Fati
Published: November 2020

Background: There are real socioeconomic inequalities between and within countries, leading to disparities in the use of health services. In children under five years of age, this could be responsible for child mortality by depriving children of healthcare. By removing healthcare fees, the Free Healthcare Initiative (FHCI) adopted in Sierra Leone can contribute to reducing these inequities in healthcare-seeking for children. This study aimed to assess the socioeconomic inequalities in healthcare-seeking for children under five years of age before and after the implementation of the FHCI.Methods: We included 1207, 2815, and 1633 children under five years of age with fever from the 2008, 2013, and 2016 nationwide surveys database, respectively. Concentration curves were drawn for the period before (2008) and after (2013 and 2016) the implementation of the FHCI to assess socioeconomic inequalities in healthcare-seeking. Finally, concentration indices were calculated to understand the magnitude of these socioeconomic inequalities.Results: We found that before the implementation of the FHCI, there were inequalities in care-seeking for children under five (concentration index (CIn) = 0.168, standard error (SE) = 0.049) in favor of the wealthy households. These inequalities decreased after the implementation of the FHCI but remained in favor of the rich households (CIn = 0.039, SE = 0.040). There were more disparities in the healthcare-seeking between districts before the implementation of the FHCI. After the initiation of the FHCI, these disparities were reduced, and 12 of the 14 districts had a CIn around the value of equality. Conclusion: Our study observed pro-rich inequalities in care-seeking for children under five years of age before the implementation of the FHCI and a decrease in these inequalities after its implementation, even if it remained pro-rich. To continue to reduce wealth-related inequalities, policy actions can focus on the increase of availability of health services in the districts where the care-seeking was pro-rich.
miR-145 Inhibits Mitochondrial Function of Ovarian Cancer by Targeting ARL5B
Authors: Zhao Shuo , Zhang Yun , Pei Meili , Wu Lei , Li Jie
Published: November 2020

Metabolic reprogramming refers to the transformation of the whole metabolic network including glycolysis and mitochondrial metabolism, mainly manifested in Warburg effect and mitochondrial metabolic reprogramming. The roles of miR-145 in glycolysis have been established in ovarian cancer cells. Howerer, its roles in mitochondrial metabolic reprogramming are still unclear. This study aims to identify whether miR-145 regulates mitochondrial metabolic reprogramming in ovarian cancer cells. First, functional experiment showed that overexpression of miR-145 inhibited mitochondrial function in ovarian cancer cells, evident by the decreased mtDNA copy numbers, ATP level, mitochondrial membrane potential, and the expression levels of mitochondrial markers. Mechanistically, miR-145 inhibited mitochondrial function by targeting ARL5B directly. Futhermore, miR-145 overexpression decreased ARL5B expression in ovarian cancer tissue subcutaneous tumors of nude mice. In conclusion, we have highlighted that miR-145 inhibits mitochondrial function and achieves this by targeting ARL5B directly for the first time. The results provides a more adequate theoretical basis for understanding the molecular pathology of ovarian cancer, and provides the necessary basic data for miR-145 as a potential diagnosis and treatment target for ovarian cancer.
Antibiotic treatment duration for patients with bloodstream infection: a systematic review and meta-analysis
Authors: Li Yuting , Yang Juan , Yang Hongmei , Guo Jianxing , Zhang Dong
Published: November 2020

Objectives: The optimal duration of therapy for primary bloodstream infection (BSI) and BSI secondary to major organ system infections has been poorly defined. A systematic review and meta-analysis was performed to evaluate the impact of short (≤10 days)and long course(>10 days) of antibiotic treatment on clinical outcomes in patients with BSI.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials(RCTs) and cohort studies from inception to the 1st of October 2020. We included studies involving patients with BSI. All authors reported our primary outcome of all-cause mortality and clearly comparing short versus long course of antibiotic treatment with clinically relevant secondary outcomes(source control and relapse). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI).Results: Six studies including 3593 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR=1.10; 95% CI, 0.82 to 1.48; P=0.52; Chi2=7.57; I2=34%) . Secondary outcomes demonstrated that there was no statistically significant difference in the source control(OR=0.82; 95% CI, 0.61 to 1.10; P=0.18; Chi2=2.68; I2=25%)and relapse(OR=1.20; 95%CI,0.71 to 2.01; P=0.49; Chi2=0.26; I2=0%) between two groups. Conclusions: Short course of antibiotic treatment is not associated with either an increased risk of mortality or an increased odds of relapse compared with longer antibiotic treatment course for BSI. Furthermore, short course of antibiotic therapy is non-inferior to long course in terms of source control. Further large-scale RCTs are still required to confirm these results.