bluuebunny/crossref_metadata_2025 huggingface dataset:
Violence and Depression Among Pregnant Women in Egypt
Authors: Ghoneim Hanan M. , elprince mohamed , Ali Tamer Yehia M. , gharieb waleed , ahmed amal
Published: August 2020

Background: Depression is a serious mental health disorder that might affect women in the childbearing period. Incidences increase during pregnancy as well as after delivery. Its association with intimate partner violence has been reported in many countries. Data about this sensitive issue are lacking in Egypt. The aim of the study was to determine the relation between intimate partner violence and depression during pregnancy.Methods: This was a case control study conducted at the the outpatient clinics in Suez Canal University hospitals, from January 2019 to March 2020. The study included two groups, the study group included women exposed to violence during the current pregnancy and a control one included women with no history of violence. Women were asked to complete the Arabic validated NorVold Domestic Abuse Questionnaire. Depression was evaluated using the Arabic validated form of the Edinburgh Postnatal Depression Scale. The main outcome measure was to assess the association between intimate partner violence and depression.Results: Both groups were matched in their demographic characters. Emotional violence was the most common reported pattern among women exposed to intimate partner violence 87.9% (139/158). There was a significant difference between women exposed to violence and those who were not exposed to violence in the total depression scores (13.63 ± 5.47 and 10.65 ± 5.44, respectively with a p value <0.001). Emotional and sexual violence had significant roles as risk factors for depression during pregnancy in single regression or after control of other confounders.Conclusion: There was a strong association between intimate partner violence and depression during pregnancy with variable rates that differ according to the economic state of the countries.
Comparison of Clinical Features on Admission Between Coronavirus Disease 2019 and Influenza A among Children: A Retrospective Study in China
Authors: Liang Feng , Wang Xianfeng , Li Hui , Chen Jun , Liu Lei , Shao Jianbo , Xu Yi , He Liya , Liang Huiying , Li Kuanrong , Gong Sitang , Xia Huimin
Published: August 2020

Background: Coronavirus disease 2019 (COVID-19) share similar symptoms with influenza A (IA), but it is more worthwhile to understand the disparities of the two infections regarding their clinical characteristics on admission. Methods: A total of 71 age-matched pediatric IA and COVID-19 patient pairs were formed and their clinical data on admission were compared. Results: Fever, cough, nasal congestion and nausea/vomiting were the most common symptoms on admission for both infections but occurred less often in COVID-19. The IA patients were more likely to have lower-than-normal levels of lymphocyte count and percentage and to have higher-than-normal levels of activated partial thromboplastin time, prothrombin time, serum C-reactive protein, and serum procalcitonin, while the COVID-19 patients had higher odds of having lower-than-normal levels of neutrophil count and percentage.Conclusions: This study suggests that influenza A is more symptomatic than COVID-19 for children and might be an overall more severe infection at the time of admission.
Maternal Health Care Service Utilization Among Young Married Women in India, 1992-2016: Trends and Determinants
Authors: Singh Pooja , Singh Kaushalendra Kumar , Singh Pragya
Published: August 2020

Background: Utilizing maternal health care services can reduce a substantial proportion of maternal mortality. Maternal deaths among young women (15-24 years) shares 38% of total maternal mortality in India. However, there is a paucity of studies focusing on the maternity care needs of young women. This paper therefore aimed to examine the trends and determinants of full antenatal care (ANC) and skilled birth attendance (SBA) utilization among young married women in India.Methods: The study analysed data from the four rounds of National Family Health Surveys conducted in India during the years 1992–93, 1998–99, 2005–06 and 2015–16. Young married women aged 15-24 years with at least one live birth in the three years preceding the survey were considered for analysis in each survey round. We used descriptive statistics to assess the prevalence and trends in full ANC and SBA use. Pooled multivariate logistic regression was conducted to identify the demographic and socioeconomic determinants of the selected maternity care services.Results: The use of full ANC among young mothers increased from 27% to 46% in India, and from 9% to 28% in EAG (Empowered Action Group) states during the study period. SBA utilization was 88% and 83% during 2015-16 by showing an increment of 20% and 50% since 1992 in India and EAG states, respectively. Findings from multivariate analysis revealed significant difference in the use of selected maternal health care services by maternal age, residence, education, birth order and wealth quintile. Additionally, Muslim women, SC/ST women and women unexposed to mass media were less likely to utilize both the maternal health care services. Concerning the time effect, the odds of the utilization of full ANC and SBA among young women was found to increase over time.Conclusions: Utilization of full ANC remained unacceptably low, specifically in EAG states. Programmatic interventions, targeting women residing in EAG states, adolescents, illiterate, poor and Muslim and SC/ST women would help to increase full ANC utilization and to maintain the increasing trend of SBA use.
Cross-sectional Association Between Vitamin B12 Status and Probable Postpartum Depression in Indian Women
Authors: Dhiman Pooja , Pillai Raji R , Wilson Anand B , Premkumar Nancy , Bharadwaj Balaji , P Veena , Rajendiran Soundravally
Published: August 2020

BackgroundVitamin B12 is an essential micronutrient for neurological function, as it leads to the regeneration of methionine from homocysteine, which is precursor of biologically active molecule SAM. Pregnancy is a state of increased demand and delayed postpartum repletion of nutrients may predispose women to depression. MethodsWomen attending postpartum clinic at 6 weeks post-delivery were screened for the presence of depressive symptoms using Edinburg postpartum depression scale (EPDS). Based on a cut-off of 10, two groups were taken- women with probable depression with EPDS score>10 (n=217) and women without probable depression with EPDS score<10(n=217). Plasma total vitamin B12, holotranscobalamin, homocysteine, MMA, 5-methyl THF, SAM and serotonin levels were estimated using commercially available ELISA kits. Combined B12(cB12) score was calculated and analysis of resulting data was done using SPSS ver20.0. ResultsTotal vitamin B12 was significantly lower (p=0.001) and MMA (p=0.002) and 5-methyl THF(p<0.001) levels were higher in women with probable depression than women without probable depression. Combined B12 index was also lower in women with probable PPD (p=0.001). Women in the lowest vitamin B12 quartile had 4.53 times higher likelihood of probable postpartum depression (p < 0.001). Decreasing vitamin B12 (OR = 0.394; 95% CI: 0.189-0.822) and cB12 (OR=0.293; 95% CI:0182-0.470) and increasing MMA (OR = 2.14; 95% CI: 1.63-2.83) and 5-methyl THF levels (OR = 3.29; 95% CI: 1.59-6.83) were significantly associated with the risk of PPD.ConclusionLow vitamin B12 may contribute to depressive symptoms in vulnerable postpartum period.
Clinical Characteristics and Predictive Value of low CD4+T Count in Patients with Moderate and Severe COVID-19: A Multicenter Retrospective Study
Authors: Wen Xue-song , Gao Lei , Jiang Dan , Cheng Xiao-cheng , He Bin , Chen Yue , Lei Peng , Tan Wei-xiao , Qin Shu , Cai Guo-qiang , zhang dongying
Published: August 2020

Background In December 2019, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, Hubei, China. And, it has become a global pandemic. Describe the patient's clinical symptoms in detail, finding markers that predict the prognosis of patients with COVID-19 are of great value.MethodsIn this multicenter, retrospective study, 476 patients with COVID-19 were recruited from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death was the primary endpoint. All patients were followed up from admission till discharge or death.ResultsThe dominant symptoms observed in the study included fever on admission, cough, fatigue and shortness of breath. The most frequent comorbidities were hypertension and diabetes. Compared with patients with higher CD4+T cells level, patients with lower CD4+T cells level were older and were more frequently male. In terms of laboratory findings, lymphocyte count, CD4+T cell count, CD8+T cell count were significantly lower in low group than in higher group. The case in-hospital death rate was significant higher in patients with lower CD4+T level. After adjusting for potential confounding factors, CD4+T count below the lower limit of normal showed independent prognostic value for all-cause in-hospital death in patients with COVID-19. Conclusions: Reductions in lymphocytes and lymphocyte subsets are common in COVID-19 patients, especially in severe cases. It is the CD8+T count, not the CD4+T count, that reflected the severity of the patient’s disease. Lower CD4+T count is independently associated with an increased rate of in-hospital death. Trial registration: Prognostic Factors of Patients With COVID-19, NCT04292964. Registered 03 March 2020. https://clinicaltrials.gov/ct2/show/NCT04292964.
The shaping advantage of M-wire compared with conventional nickel-titanium rotary instruments in heavy curvature canal
Authors: Tanaka-Sato Mika , Mutoh Noriko , Shimojima Kaori , Tani-Ishii Nobuyuki
Published: August 2020

Background The purpose of this study was to evaluate the shaping advantage of M-wire NiTi ProTaper NEXT (PTN) compared with a conventional NiTi ProTaper Universal (PTU) file in heavy curvature canal. The shaping ability was measured by the amount of canal cutting and transportation between the PTN and conventional PTU. Methods Root canal shaping by the PTN and conventional PTU was classified into two experimental groups according to the final tip size, ISO #25 or ISO #40. Eighty-four J-shaped root canals (10°, 20°, 30° apical curvature) in resin block were used. Results After adjusting for the level and canal wall side, the mean transportation did not significantly decrease between the PTN and PTU with ISO #25. Significantly less deviation occurred with the PTN and PTU between 10° and 30° using ISO #40. Conclusions The M-Wire NiTi PTN improves file flexibility and enables accurate canal shaping for heavy curvature canals.
Predictive Value of Neutrophil to Lymphocyte Ratio for Disease Deterioration and Serious Adverse Outcomes in Patients with COVID-19: A Prospective Cohort Study
Authors: Zeng Zhi-Yong , Chen Gong-Ping , Wu Jiang-Nan
Published: August 2020

Background: Early identification of patients who are at high risk of poor clinical outcomes is of great important in saving lives for patients with the novel corona virus disease 2019 (COVID-19) in context of limited medical resources. Objective: To evaluate value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for prediction of the subsequent presence of disease aggravation and serious clinical outcomes (e.g., shock, death).Methods: We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020 in Yichang city, Hubei province. Patients with a NLR equal to and higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposure group. The primary outcome was disease deterioration, defined as promotion of clinical classifications of the disease during hospitalization (e.g., moderate to severe/critical; severe to critical,). The secondary outcomes were shock and death occurred during the treatment.Results: During the follow up, 51 (14.5%) patients’ condition deteriorated, 15 patients (4.3%) complicated septic shock, and 15 patients (4.3%) died. NLR was higher in patients with deterioration than those without (median: 5.33 vs. 2.14, P <0.001), as well as between patients with and without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P <0.001; death vs. survival: 7.19 vs. 2.25, P <0.001). NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of ≥ 2.6937 for the NLR in predicting subsequent disease deterioration, shock and death were 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100); and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions: The NLR measured at admission and in isolation can be used to effectively predict subsequent presence of disease deterioration and serious clinical outcomes for patients with COVID-19.
Can machine learning really solve the three-body problem?
Authors: Li Jing , Li Xiaoming , LIAO Shijun
Published: August 2020

Machine learning is becoming one of most rapidly growing technical fields, benefiting tremendous areas in science and industry. Recently, Breen et al demonstrated a new study with a multi-layered deep artificial neural network (ANN) on a chaotic three-body system and claimed that it can bring “success in accurately reproducing the results of a chaotic system” with “up to 100 million times faster than numerical integrator”. Here, we use their trained ANN model to predict periodic orbits of the same three-body system, but the detailed comparisons are disappointing. It might be due to the butterfly-effect of chaotic systems, i.e. very sensitive to tiny disturbance, but in practice nearly all ML algorithms derive their solutions statistically and probabilistically and therefore are rarely possible to train them to 100% accuracy. We illustrate here that the current accuracy of the machine learning is not precise enough for correct prediction of periodic orbits of a chaotic three-body system in a long enough duration. Thus, it is still a great challenge for machine learning to solve chaotic systems, such as the famous three-body problem. Without doubt, studies in machine learning on chaotic systems might greatly deepen and enrich our understandings not only on chaos but also on machine learning itself.
A Study to Assess the Risk Factors of Thyroid Functions among Bangladeshi Women during 1st Trimester of Pregnancy
Authors: Bushra Anika , Razzak Khandaker Sabit Bin , Hossain Mohammad Nabil , Sarwar A.S.M.
Published: August 2020

Background: In recent years many researches has centered on the influence of thyroid disease on pregnancy and the consequence of offspring.Aim: The present study was conducted to evaluate the relationship of multiple risk factors and thyroid functions among Bangladeshi young women during 1st half of the pregnancy.Material and methods: This cross-sectional study was done in in the Department of Obstetrics & Gynecology of Dhaka Medical College Hospital, Dhaka on 200 pregnant women in their 1st half of pregnancy attending antenatal clinic, DMCH from December 2018 to December 2019. Where inclusion criteria were healthy singleton pregnant women up to 20 weeks of gestation.Results:According to this study, 10.5% subclinical hypothyroidism group and 36.8% from overt hypothyroidism patients had family history of thyroid dysfunction. 6.5% had stage-1 hypertension and 11% patients had stage-2 hypertension. Also, abnormal blood pressure level is highly correlated with thyroid dysfunction status. The rate of iron disfunction strongly correlated with thyroid dysfunction. 6% patients had mid-level of iron deficiency and 13.5% had iron deficiency anemia. Also, 62.5% had mild hemoglobin level and 37.5% had moderate- severe mild hemoglobin level.Conclusion:The results indicate that, iron deficiency, hypertension can be seen in hypothyroidism during the 1st half of pregnancy. Hence, routine thyroid monitoring, checkup and appropriate management is necessary for hyperthyroidism in the 1st half of pregnancy to avoid more adverse outcome.
Comprehensively Addressing Postpartum Maternal Health: a Content and Image Review of Commercially Available Mobile Health Apps
Authors: Tucker Laura , Villagomez Alan Cuevas , Krishnamurti Tamar
Published: August 2020

Background: The United States is currently facing a maternal morbidity and mortality crisis, with the highest rates of any resource-rich nation. In efforts to address this, new guidelines for postpartum care suggest that mobile health apps can help provide complementary clinical support for new mothers during the postpartum period. However, to date no study has evaluated existing mobile health tools targeted to this time period for sufficiency of maternal health information, inclusivity of people of color, or accessibility to users.Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards were used to review the peripartum apps from the Apple and Google Play stores in either the Health/Fitness, Medical, or Education categories. Apps were then evaluated for extent and quality of maternal health information, inclusivity of people of color, and accessibility to app users.Results: Of the 301 apps from the Apple and Google Play stores, 25 met criteria for final evaluation. Of the 30 maternal health topics coded for, the median number addressed by apps was 19.5 (65%). Peripartum behaviors were more frequently addressed than peripartum outpatient care topics and peripartum acute health risks. The amount of maternal health information correlated positively with the Mobile Application Rating Scale (MARS) quality score of the app, and inclusivity of people of color in app imagery also correlated positively with the MARS quality score. Only 8 apps (32%) portrayed greater than 24% images of people of color- the percent of non-white Americans according to 2019 census estimates. There was no correlation between number of users as estimated by number of store ratings and MARS quality. In addition, apps with clinical authority had greater MARS engagement, information, aesthetics, and quality scores, but did not have greater numbers of store ratings.Conclusions: Current commercially available peripartum apps overall do not provide adequate maternal health information, are not inclusive of women of color, and are not optimally accessible to the target users. Apps authored with clinical authority and higher-quality apps, by MARS score, are more likely to meet these standards, but are not more likely to be downloaded and used.
Anterior Transpedicle Screw in Lumbosacral Spine and Radiographic Measurements: A Retrospective Analysis
Authors: Xu Wei-Xing , Ding Wei-Guo , Xu Bin , Sheng Hong-Feng , Lu Di , Hu Tian-Hong
Published: August 2020

Background

The anterior transpedicle screw technique for L5 and S1 is crucial for proper anterior lumbar interbody fusion. This study aimed to determine the projection, screw trajectory angle, and bone screw passageway length (BSPL) of the anterior transpedicle screw in L5 and S1, as well as the screw’s insertion regularity and the operating area that is safe for its insertion.
Methods

Forty patients with low back pain, all of whom had lumbar computed tomography scans available, were included in a retrospective analysis. Radiographic parameters were measured, including the distances from the projection to the upper endplate, lower endplate, and midline; the transverse and sagittal screws’ angles; and the BSPL. Ten fresh adult cadaveric lumbosacral spine segments were chosen to determine the safe anatomical area at which to operate. Finally, anterior transpedicle screws were inserted in L5 and S1 to determine the regularity of anterior pedicle screw insertion.
Results

We measured the anterior projection parameters, including the distances to the upper endplate (L5:12.5 ± 1.3 mm; S1: 4.54 ± 0.87 mm), lower endplate (L5: 17.3 ± 1.6 mm), and midline (L5: 6.6 ± 0.7 mm; S1: 6.6 ± 0.6 mm); the screw trajectory angle, including the transverse screw angle (L5: 25.3° ± 2.8°; S1: 25.7° ± 2.6°), sagittal screw angle (L5: 17.1° ± 1.7°; S1: 22.4° ± 1.1°); and the BSPL (L5: 48.6 ± 3.5 mm; S1: 48.0 ± 3.5 mm). We then identified the safe operating area and the regularity of L5 and S1 anterior pedicle screw insertions.
Conclusions

We determined the projection, screw trajectory angle, and BSPL of anterior transpedicle screws in L5 and S1, their insertion regularity, and the area in which the operation could be safely performed.
Access to and Quality of Primary Healthcare: a Multi-Country Qualitative Case Study in West and East Africa
Authors: Ameh Soter , Akeem Bolarinwa Oladimeji , Ochimana Caleb , Oluwasanu Abayomi Olabayo , Mohamed Shukri F , Okello Samson , Muhihi Alfa , Danaei Goodarz
Published: August 2020

Background: Universal health coverage is one of the Sustainable Development Goal targets known to improve population health and reduce financial burden. There is little qualitative data on access to and quality of primary healthcare in West and East Africa. We elicited in-depth viewpoints of healthcare users and providers, and other stakeholders regarding access to and quality of healthcare.Methods: A qualitative case study was conducted in four communities in Nigeria, and one community each in Kenya, Uganda and Tanzania in 2018. Purposive sampling was used to recruit 155 participants for 24 focus group discussions, 24 in-depth interviews, and 12 key informant interviews. The conceptual framework in this study combined elements of the Health Belief Model, Health Care Utilisation Model, four ‘As’ of access to care, and pathway model to better understand health-seeking behaviours of the study participants. The data were analysed with MAXQDA 2018 qualitative software to identify three themes identified a priori and one emerging theme.Results: Access to primary healthcare in the seven communities was limited. Quality of care was perceived to be unacceptable in public facilities whereas cost of care was unaffordable in private facilities. Patients and health providers and stakeholders highlighted shortage of equipment, frequent drug stock-outs and long waiting times as major issues, but had varying opinions on satisfaction with care. Use of herbal medicines and other traditional treatments delayed or deterred seeking modern healthcare in Nigerian sites. Conclusions: There was a substantial gap in primary healthcare coverage and quality in the selected communities in rural and urban East and West Africa. Alternative models of healthcare delivery should be used to fill this gap and facilitate achieving universal health coverage.
Fidelity Evaluation of the Compared Procedures for Conducting the PREDIAPS Implementation Strategy to Optimize Diabetes Prevention in Primary Care
Authors: Sánchez Alvaro , Rogers Heather Lynn , Pablo Susana , García Esther , Rodríguez Inmaculada , Flores Mª Antonia , Galarza Olga , Gaztañaga Ana B. , Martínez Pedro A. , Alberdi Eider , Resines Elena , Llarena Ana I. , Grandes Gonzalo , Group PREDIAPS
Published: August 2020

Background: Assessing the fidelity of an implementation strategy is important to understand why and how the strategy influences the uptake of evidence-based interventions. The present study aims to assess the fidelity of the two procedures for engaging primary care (PC) professionals and for the deployment of an implementation strategy for optimizing type 2 diabetes prevention in routine PC within the PREDIAPS randomized cluster implementation trial. Method: We conducted an observational descriptive fidelity evaluation study of the PREDIAPS implementation strategy. Nine PC centers from the Basque Health Service (Osakidetza) were allocated to two different procedures to engage physicians and nurses and deploy a implementation strategy to model and adapt the clinical intervention and its implementation to their specific contexts: a Global procedure, promoting the cooperation of all healthcare professionals from the beginning; or a Sequential procedure, centered first on nurses who then pursued the pragmatic cooperation of physicians. Process indicators of the delivery and receipt of implementation strategy actions among centers and groups compared and the comparison of documented modifications to the planned implementation strategy were used to assess the following components of fidelity: adherence, dose, quality of delivery, professionals’ responsiveness and program differentiation. Results: Generally, the procedures compared for professionals engagement and deployment of the implementation strategy were carried out with the planned differentiation. Nonetheless, some unexpected between-group differences were observed, the initial rate of collaboration of nurses being higher in the Sequential (93%) than in the Global (67%) groups. Exposure rate to the programed implementation actions (% of hours received out of those delivered) were similar in both groups by professional category, with nurses (86%) having a higher rate of exposure than physicians (75%). Professionals identified half of the planned discrete strategies and their rating of strategies’ perceived usefulness was overwhelmingly positive, with few differences between Sequential and Global centers. Conslusions: The PREDIAPS implementation strategy has been implemented with high fidelity and minor unplanned reactive modifications. Professionals’ exposure to the implementation strategy was high in both groups. The centers’ organizational context (i.e., work overload) led to small mismatches between groups in participation and exposure of professionals to implementation actions.Trial Registration: Clinicaltrials.gov identifier: NCT03254979. Registered 16 August 2017, https://www.clinicaltrials.gov/ct2/show/NCT03254979
Chromatin Loop Anchors Are Core Structural Components of the Gene Expression Machinery in Maize
Authors: Deschamps Stephane , Crow John A , Chaidir Nadia , Peterson-Burch Brooke , Kumar Sunil , Lin Haining , Zastrow-Hayes Gina , May Gregory D.
Published: August 2020

Background Three-dimensional chromatin loop structures connect regulatory elements to their target genes in regions known as anchors. In complex plant genomes, such as maize, it has been proposed that loops span heterochromatic regions marked by higher repeat content, but little is known on their spatial organization and genome-wide occurrence in relation to transcriptional activity. Results Here, ultra-deep Hi-C sequencing of maize B73 leaf tissue was combined with gene expression and open chromatin sequencing for chromatin loop discovery and correlation with transcriptional activity. Chromatin loops, made of two “anchors” flanking a loop “interior”, overlap with up to 90% of high-resolution interaction domains from a previous public maize interactome dataset. A majority of all anchors are shared between multiple loops, suggesting a highly dynamic environment, with a conserved set of anchors involved in multiple interaction networks. Chromatin loop interiors are marked by higher repeat contents than the anchors flanking them. A small fraction of high-resolution interaction anchors, fully embedded in larger chromatin loops, co-locate with active genes and putative protein-binding sites. Combinatorial analysis indicate that all anchors studied here co-locate with at least 81.5% of expressed genes and 74% of open chromatin regions. Up to 63% of all unique variants derived from a prior public maize eQTL datasets overlap with Hi-C loop anchors. Anchor annotation suggests that <7% of all loops detected from one Hi-C library are potentially devoid of any genes or regulatory elements. The overall conservation and organization of chromatin loop anchors in the maize genome suggest a loop modeling system hypothesized to resemble phase separation of repeat-rich regions. Conclusions A majority of expressed genes and open chromatin regions co-locate with a conserved set of chromatin loop anchors. The results presented here will be a useful reference to further investigate the function of chromatin loop anchors and of the formation of interaction regions in the regulation of gene expression in maize.
Endoscopic Submucosal Dissection for Gastric Tube Carcinoma After Esophagectomy Contributes to Long-Term Outcomes: A Retrospective Case Series
Authors: Hashimoto Satoru , Sato Hiroki , Mizuno Ken-ichi , Takahashi Kazuya , Takatsuna Masafumi , Yokoyama Junji , Ichikawa Hiroshi , Takeuchi Manabu , Kobayashi Masaaki , Terai Shuji
Published: August 2020

Background: Gastric tube carcinoma (GTC) after esophagectomy has been observed increasingly in recent years after advanced treatment of esophageal carcinoma. Surgical removal of the reconstructed gastric tube is not usually preferred; however, endoscopic submucosal dissection (ESD) is greatly anticipated to be a promising option. This study investigated the efficacy and safety of ESD for GTC. Methods: This study was designed based on a retrospective survey performed at our single center between 2003 and 2018. Patients with GTC were treated with ESD and followed-up according to the policy of our institution. The curability of ESD was evaluated histologically according to the Japanese gastric cancer treatment guidelines. Patient characteristics, outcomes of ESD procedures, and long-term outcomes were analyzed. Results: A total of 31 patients (2 females; median age, 73 years) with 45 GTC cases were treated with ESD. The mean period from esophagectomy to the diagnosis of GTC was 10.6 years. The only adverse event due to ESD was bleeding (2 patients: 4.4%). No fatal events, such as perforation, occurred. The rates of complete resections and curative resections were 86.7% and 60.0%, respectively. The 3-year and 5-year overall survival rates were 67.6% and 47.7%, respectively. The 3-year and 5-year disease-specific survival rates were 100% and 92.9%, respectively. One patient died of GTC and 14 patients died of other diseases, including five primary carcinomas. Conclusions: ESD for GTC can be a safe treatment and contribute to positive long-term outcomes. Long-term regular gastroscopy is required for early detection. Screening should be performed before ESD and follow-up should be performed after ESD to prolong overall survival.
High-density lipoprotein cholesterol is a predictor of survival in cirrhotic patients with acute gastrointestinal bleeding: a retrospective study
Authors: Cheng Ran , Tan Ning , Kang Qian , Luo Hao , Chen Hongyu , Pan Jiali , Han Yifan , Yang Yuqing , Xu Xiaoyuan
Published: August 2020

Background: Lipid profiles are declined in patients with viral liver cirrhosis and correlated with severity of liver disease. Hepatitis B virus (HBV) is the leading cause of liver cirrhosis in China. Our primary aim was to investigate whether serum lipids and lipoproteins associate with survival in patients with HBV-related cirrhosis and acute gastrointestinal bleeding, and develop a 6-week mortality risk score that incorporates it.Methods: From January 2008 to December 2015, consecutive cirrhotic patients with acute gastrointestinal bleeding admitted to our hospital were evaluated and divided into the derivation (n=593) and validation (n=350) cohorts. A logistic regression model was established to confirm the association between lipoprotein cholesterol and mortality. Accuracy to predict mortality were assessed by area under the receiver operating characteristic curves (AUROCs) and compared using the Hanley and McNeil test.Results: Among study subjects, the 6-week mortality rate was 10.6%. High-density lipoprotein cholesterol (HDL-C) level was found to correlate most strongly with prognostic scores. On ROC analysis, HDL-C showed excellent diagnostic accuracy for 6-week mortality. Logistic regression analysis provided a simple algorithm based on the combined use of 4 variables (serum sodium (Na), HDL-C, presence of hepatocellular carcinoma (HCC) and QT interval prolongation), allowing accurate early discrimination of 3 distinct prognostic subgroups with 1.7% (low risk), 10.6% (intermediate risk), and 55.6% (high risk) mortality. Its accuracy was similar to the D’Amico score and significantly better than that of Child–Pugh, the model of end-stage liver disease (MELD), albumin-bilirubin (ALBI), and Augustin score. Baseline HDL-C values ≤ 0.57mmol/L were associated with markedly lower 6-week survival. Comparable results were found in the validation set. Conclusion: HDL-C is a potential indicator for the prognosis of patients with cirrhosis and acute gastrointestinal bleeding. The new algorithm based on HDL-C allowed an accurate predictive assessment of 6-week mortality after bleeding attack.
Differential Ketogenic Diet-Induced Shift in CSF Lipid/Carbohydrate Metabolome of Pediatric Epilepsy Patients With Optimal Vs. No Anticonvulsant Response
Authors: Masino Susan A. , Ruskin David N. , Freedgood Nathalie R. , Lindefeldt Marie , Dahlin Maria
Published: August 2020

Background: The low carbohydrate, high fat ketogenic diet can be an effective anticonvulsant treatment in some pediatric patients with pharmacoresistant epilepsy. Its mechanism(s) of action, however, remain uncertain. Direct sampling of cerebrospinal fluid before and after metabolic therapy may reveal key changes associated with differential clinical outcomes. Methods: We performed metabolomic analysis of cerebrospinal fluid samples taken before and during ketogenic diet treatment in patients with optimal response (100% seizure remission) and patients with no response (no seizure improvement) to search for differential diet effects in hallmark metabolic compounds in these two groups. Optimal responders and non-responders were similar in age range and included males and females. Seizure types and the etiologies or syndromes of epilepsy varied but did not appear to differ systematically between responders and non-responders. Results: Principal component analysis showed a strong effect of ketogenic diet treatment on the cerebrospinal fluid metabolome. Longitudinal and between-subjects analyses revealed that many lipids and carbohydrates were changed significantly by ketogenic diet, with changes typically being of larger magnitude in responders. Notably, responders had more robust changes in glucose and the ketone bodies b-hydroxybutyrate and acetoacetate than non-responders; conversely, non-responders had significant increases in fructose and sorbose, which did not occur in responders. Conclusions: The data suggest that a differential and stronger metabolic response to the ketogenic diet may predict a better anticonvulsant response, and such variability is likely due to inherent biological factors of individual patients. Strategies to boost the metabolic response may be beneficial.
COPD patients prescribed inhaled corticosteroid in primary care – Time for re-assessment based on exacerbation rate and blood eosinophils?
Authors: Savran Osman , Godtfredsen Nina Skavlan , Sørensen Torben , Jensen Christian , Ulrik Charlotte
Published: August 2020

Background and objective Inhaled corticosteroid (ICS) therapy for COPD should be guided by exacerbations and blood eosinophils according to the GOLD 2020 strategy document. In the present study, we applied these recent recommendations in a large cohort of COPD patients recruited from general practice. Methods The participating general practitioners (n = 144) recruited patients with a diagnosis of COPD currently prescribed ICS and reported data on exacerbation history and blood-eosinophils. Clinical variables were compared using multinomial logistic regression. Results The study cohort comprised 1,567 COPD patients (44% males and mean age 73 years). In the past 12 months, 849 (54%) of the COPD patients currently prescribed ICS had had no exacerbation, whereas 383 (24%) and 328 (21%) patients, respectively, had a history of one exacerbation and two or more exacerbations. Compared to patients with one or no exacerbation, patients with ≥2 exacerbations (21%) per year reported more respiratory symptoms (p<0.001). Among patients with no and at least one exacerbation within the preceding 12 months, 30% and 27%, respectively, had a blood-eosinophil count ≥ 0.3 x 10 9 /L. In patients with two or more exacerbations within the last 12 months, 77% had a blood-eosinophil count of ≥ 0.1 x 10 9 /L. Furthermore, 166 patients (11%) had at least one hospital admission due to COPD exacerbation, and a blood-eosinophil count of ≥ 0.1 x 10 9 /L. Conclusion This study of a large cohort of COPD patients currently prescribed inhaled corticosteroids suggest the need for re-evaluating the management strategy to increase benefit and reduce adverse effects of ICS treatment in COPD patients managed in primary care.
Prognostic Factors on Low-Birth-Weight Infants of Atresia and/or Tracheoesophageal Fistula: a Cohort Study
Authors: Xu Xiaonan , Zhang Ni , Li Binde , Huang Li
Published: August 2020

Background: Low-birth-weight is the main factor affecting the survival rate of esophageal atresia (EA)/ tracheoesophageal fistula (TEF). The study aims to summarize the factors influencing the prognosis of EA/TEF, which is expected to be helpful for clinical diagnosis and treatment. Methods: A retrospective data analysis was performed in our hospital underwent TEF/EA repair between January 2012 and January 2015. The incidence of preoperative, intraoperative critical events and postoperative complications and overall survival (OS) were compared between two groups of infants: 81 patients with EA/TEF, 24 low-birth-weight patients (<2500 g) with EA/TEF and 57 patients (>2500 g). The morbidity was compared between patients with stress hyperglycemia and euglycemia postoperatively. Results: The overall incidence of preoperative, intraoperative critical events and postoperative complications in low-birth-weight patients was significantly higher (P=0.002, P=0.001, P=0.001), but OS was lower (75.9% vs 92.3%, p=0.027). OS of patients with stress hyperglycemia postoperatively was lower than that of euglycemia (81.0% vs 93.6%, p=0.03).Conclusions: Low-birth-weight still was the main factor that impacted on the prognosis of EA/TEF. The lower the birth weight was, the higher the mortality was. Postoperative stress hyperglycemia was one of the important factors that influenced survival rate.
Modeling Plasmodium falciparum Diagnostic Test Sensitivity using Machine Learning with Histidine-Rich Protein 2 Variants
Authors: Ford Colby T , Alemayehu Gezahegn , Blackburn Kayla , Lopez Karen , Dieng Cheikh Cambel , Golassa Lemu , Lo Eugenia , Janies Daniel
Published: August 2020

Malaria, predominantly caused by Plasmodium falciparum , poses one of largest and most durable health threats in the world. Previously, simplistic regression-based models have been created to characterize malaria rapid diagnostic test performance, though these models often only include a couple genetic factors. Specifically, the Baker et al., 2005 model uses two types of particular repeats in histidine-rich protein 2 (PfHRP2) to describe a P. falciparum infection, though the efficacy of this model has waned over recent years due to genetic mutations in the parasite.
In this work, we use a dataset of 102 P. falciparum PfHRP2 genetic sequences collected in Ethiopia and derived a larger set of motif repeat matches for use in generating a series of diagnostic machine learning models. Here we show that the usage of additional and different motif repeats proves effective in predicting infection. Furthermore, we use machine learning model explanability methods to highlight which of the repeat types are most important, thereby showcasing a novel methodology for identifying potential targets for future versions of rapid diagnostic tests.
Real-world Experience of Nintedanib Therapy in Idiopathic-inflammatory-myopathy-related Interstitial Lung Disease: Efficacy and Tolerability
Authors: Liang Junyu , Cao Heng , Yang Yang , Ke Yini , Sun Chuanyin , Yue Lihuan , Lin Jin
Published: August 2020

Background

Interstitial lung disease (ILD) is a common and frequently fatal extra-muscular complication in patients with idiopathic inflammatory myopathy (IIM), and is refractory to the conventional immunosuppressive medications. Nintedanib has previously been proven to be effective and tolerable in idiopathic pulmonary fibrosis, systemic-sclerosis-related ILD, etc. However, the efficacy and safety of nintedanib in idiopathic-inflammatory-myopathy-related ILD (IIM-ILD) remain unknown. The purpose of this study was to initially explore the efficacy and tolerability of nintedanib in IIM-ILD patients.
Methods

A real-world analysis was conducted to explore the efficacy and tolerability of nintedanib in IIM-ILD patients who regularly received outpatient visit or hospitalization from January 2018 to October 2019 in one medical center. The primary end point was occurrence of rapid progression of interstitial lung disease (RP-ILD) in the follow-up. And time to death from any cause, complication of pulmonary infection and difference in immunosuppressive regimen were taken as secondary end points in this study. Adverse events were descriptively recorded.
Results

22 patients receiving nintedanib therapy and 82 patients under conventional medications were included. After propensity score matching, the primary comparison revealed that better survival (P = 0.036) and prominently less RP-ILD (P = 0.031) in patients with nintedanib therapy. Logistic regression analysis identified that disease activity (P = 0.032), anti-PM-Scl75 antibody (P = 0.027) and nintedanib therapy (P = 0.023, OR value = 0.063) were significantly correlated with RP-ILD. Cox proportional hazards regression analysis demonstrated that disease activity (P = 0.007), anti-MDA5 antibody (P = 0.004) and nintedanib therapy (P = 0.027, HR value = 0.190) were significantly associated with survival of IIM-ILD patients. Similar results can also be seen in analyses before propensity score matching. In the 22 patients with nintedanib therapy, diarrhea was the most common adverse event (54.5%) and hepatic insufficiency contributed to most dosage reduction (50%) or therapy discontinuation (50%).
Conclusion

Nintedanib therapy might reduce incidence of RP-ILD and improve survival in IIM-ILD patients. Anti-PM-Scl75 and anti-MDA5 antibodies could predict RP-ILD and survival respectively. In addition to the most frequent diarrhea, hepatic insufficiency was closely related to dosage reduction or therapy discontinuation.
Trial registration:

ISRCTN.com, ISRCTN 10507540. Retrospectively registered.
The extended stability of cervical swabs in careHPV™ Collection Medium
Authors: Tan Cheng-Siang
Published: August 2020

Background:

The careHPV™ Test is a US FDA approved, CE mark, and WHO prequalified in vitro diagnostic test that is designed to screen for 14 HRHPV genotypes. The careHPV™ Test is the only commercial HPV tests validated to be used in the low resource settings, boasting the economy of processing a maximum of 90 samples per batch and a near point-of-care turnaround time of 3 hours. Cervical swabs stored in the careHPV™ Collection Medium are stable for 30 days when stored between 2–8 °C according to the manufacturer. However, we often had difficulty to consolidate enough samples for a full batch-test within 30 days, especially when screening women living in the low-density villages in the rural Sarawak, Malaysian Borneo.
Objectives:

The aim of this study is to determine the stability and repeatability of cervical swabs preserved in careHPV™ Collection Medium stored at 4 °C over the recommended 30 days using the careHPV™ Test.
Methods:

Two groups of confirmed HRHPV positive and HRHPV negative cervical swab samples in careHPV™ Collection Medium consisting of 4 samples each were maintained at 4 °C and tested using careHPV™ Test at day-38, -123, -131, -223 and − 395.
Results:

All cervical swabs in careHPV™ Collection Medium stored at 4 °C remained stable for testing and demonstrated 100% repeatability for at least 395 days from the day of collection.
Conclusion:

The careHPV™ Test can be successfully performed on cervical swabs preserved in the careHPV Collection Medium, which are stored at 4 °C for at least 395 days.
Does simulated microgravity induce significant changes in human gut microbiota? New answers with dry immersion, an innovative ground-based model.
Authors: Jollet Maxence , Goustard Bénédicte , Mariadassou Mahendra , Rué Olivier , Ollendorff Vincent , Vernus Barbara , Bonnieu Anne , Nay Kévin , Bareilles Marie-Pierre , Beck Arnaud , Gauquelin-Koch Guillemette , Derbré Frédéric , Koechlin-Ramonatxo Christelle
Published: August 2020

Background A new problematic on the gut microbiota of the astronauts and the effects of microgravity emerged recently as that bacteria community is sensitive to physical (in)activity which could be hampered during spaceflights. Therefore, the objective of our study was thus to determine the effects of dry immersion, an innovative ground-based human model of simulated microgravity, on human gut microbiota composition. We collected stools from 14 healthy men before and after 5 days of Dry Immersion to determine taxonomic profiles by 16S metagenomic.Results Our analyses show preservation of α–diversity through Observed, Chao1, Shannon and InvSimpson indices. β–diversity is also not impacted by Dry Immersion as represented by PCoA plots with Jaccard, Bray-Curtis and UniFrac indices. Phyla abundances for OTUs associated to BacteroidetesP, FirmicutesP, ProteobacteriaP and ActinobacteriaP are also preserved. Interestingly, metagenomics analysis of the 32 families and 44 associated genera underscored that OTUs associated to ClostridialesO order and LachnospiraceaeF family are increased (p < 0.01) belonging to FirmicutesP phylum.Conclusion The diversity and global composition of the gut microbiome remained unaltered in response to Dry Immersion confirming the robustness of gut microbiota. However, it’s sufficient to led to several significant changes at the lower taxonomy levels. This suggests that the human gut microbiota, with its known strong impact on human health and performance, is a potential biological target of microgravity and underscores the need to investigate further this new field of research on gut microbiota – microgravity.Trial registration: ClinicalTrials.gov Identifier NCT03915457- Registered 16 April 2019 - Retrospectively registered - https://clinicaltrials.gov/ct2/show/NCT03915457.