bluuebunny/crossref_metadata_2025 huggingface dataset:
The Correlation Between Vitamin D at Birth and Growth at 6 Months of Age in Twins: from a Prospective Longitudinal Birth Cohort
Authors: Li Xin , Yu Jiaxiao , Wen Li , Yan Jianying , Tian Jing , Tong Chao , Tong Qi , Qi Hongbo , Saffery Richard , Kilby Mark D. , Baker Philip N.
Published: November 2020

Background: Vitamin D deficiency is a global public health issue in women and children, is associated with adverse impacts on child growth, such as rickets. However, prior studies have mainly focused on measuring vitamin D levels in singleton pregnant women and their offspring, very limited studies have revealed the prevalence of vitamin D deficiency in twin pregnant women and their offspring. The aim of this study was to investigate vitamin D levels in twin pregnant women and their neonates. We also explored the correlation of maternal vitamin D levels with neonatal outcomes and infant growth. Methods: A prospective subcohort investigation was carried out among 72 dichorionic twin pregnant mothers and their twin offspring from the Longitudinal Twin Study. Peripheral blood was collected from the mothers in the third trimester and cord blood was collected form neonates at birth to identify 25[OH]D levels. Data on the characteristics of the mothers and neonates were collected. Infant growth data and food sensitivities were also collected. Results: The average maternal 25[OH]D level was 31.78 ng/mL, with 19.4% being deficiency and 20.8% insufficiency, while the average neonatal 25[OH]D level was 15.37 ng/mL, with 99.3% being deficiency or insufficiency. A positive correlation was found between maternal and neonatal 25[OH]D levels (beta-value: 0.43, 95% CI: 0.37, 0.49). Interestingly, the higher the maternal 25[OH]D level was, the smaller the co-twins birthweight discordance (beta-value: -2.67, 95% CI: -5.11, -0.23). In addition, the infants of mothers with vitamin D deficiency were more likely to be allergic to foods at six months than those of mothers with vitamin D sufficiency. Conclusions: Twin neonates were at extremely high risk of vitamin D deficiency although their mothers’ vitamin D deficiency partially improved. Higher maternal vitamin D level was associated with smaller discordance of co-twins birthweight.Trial registration: ChiCTR-OOC-16008203
Negligible Therapeutic Impact, False-positives, Overdiagnosis and Lead-time Are the Reasons Why Radiographs Bring More Harm Than Benefits in the Caries Diagnosis of Preschool Children: Secondary Analysis of a Randomized Clinical Trial 
Authors: Pontes Laura Regina Antunes , Lara Juan Sebastian , Novaes Tatiane Fernandes , Freitas Julia Gomes , Gimenez Thais , Moro Bruna Lorena Pereira , Maia Haline Cunha Medeiros , Imparato José Carlos Pettorossi , Braga Mariana Minatel , Raggio Daniela Prócida , Mendes Fausto Medeiros
Published: November 2020

Background: To evaluate the clinical course and interventions required during two years of follow-up of dental surfaces of deciduous molars diagnosed, and consequently treated, by two different strategies: diagnosis made by clinical examination alone or associated with radiographs.Methods: This is a secondary analysis of a two-arm randomized clinical trial with two parallel groups related to the diagnostic strategy for caries detection in preschool children. 216 children (3 to 6 years old) were followed-up for two years. All dental surfaces were diagnosed by visual inspection and later, through radiographic assessment. Baseline treatment was made in accordance with the results obtained by visual inspection performed alone or combined with radiographic method, considering the allocated group. Dental surfaces with no restoration needs, or those restored at the beginning of the study were followed-up for two years. The treatment decision was made according to the allocated group. The outcome was the occurrence of failure (a new caries lesion or a restoration replacement) during the follow-up. Results: 4,383 proximal and occlusal surfaces of deciduous molars in 216 preschool children were diagnosed and treated according to the abovementioned diagnostic strategies and followed-up for 24 months. The assessment of radiographs made change the initial decision reached by visual inspection in about 30% of the surfaces when all types of interventions were considered. However, most disagreements occurred for initial lesions, where radiographs tended to underestimate them. Discordances between methods occurred in less than 5% of all surfaces when considered lesions requiring operative treatment. For discrepancy cases, the placed interventions guided by following the radiographic results did not present less failures against those made following only visual inspection. As a matter of fact, the use of radiographs in the diagnostic strategy for caries detection in children brought more harms than benefits due to the occurrence of false-positives, overdiagnosis and lead-time bias.Conclusions: Simultaneous association of visual inspection and radiographic assessment for caries detection in preschool children causes more harms than benefits, and therefore, visual inspection should be conducted alone in the regular clinical practice.Trial registration: clinicaltrials.gov platform: NCT02078453, registered on 5th March 2014
SARS-CoV-2: Characterisation and Mitigation of Risks Associated with Aerosol Generating Procedures (AGPs) in Dental Practices
Authors: Ehtezazi Touraj , Evans David G. , Jenkinson Ian D. , Evans Philip , Vadgama VJ , Vadgama Jaimini , Jarad Fadi , Grey Nicholas , Chilcott Robert P.
Published: November 2020

The objectives of this study were to characterise the particle size distribution of aerosols generated by standard dental aerosol generating procedures (AGPs) and to assess the impact of aerosol management interventions on ‘fallow time’. Aerosol management interventions included combinations of high-volume intra-oral suction (HVS(IO)), high volume extra-oral suction (HVS(EO)) and an air cleaning system (ACS). A sequence of six AGPs were performed in succession on a phantom head. Real-time aerosol measurements (size range 0.0062 – 9.6 µm) were taken using a high-resolution particle sizer acquiring air samples from six locations within a typical dental treatment room (35 m3). The majority (>99%) of AGP particles were < 0.3 µm diameter and remained at significant levels around the dental team during the AGPs. This emphasises the importance of personal protection equipment, particularly, the use of properly fitted respiratory protection to the appropriate (FFP3) standard. In the absence of active aerosol management interventions, AGP particles were estimated to remain above the baseline range for around 25-31 minutes from the end of the sequence of procedures. It was found that HVS(IO), either alone or in combination with the ACS, reduced particle concentrations to baseline levels on completion of AGPs. These data indicated that there is scope to reduce fallow time to 0 minutes.
Epidemiological and Clinical Risk Factors Related to Severe COVID-19 in Iran: A multi-center study
Authors: Hashemi-Shahri Seyed Mohammad , Tabatabaei Seyed Mohammad Nasiraldin , Ansari-moghaddam Alireza , Mohammadi Mahdi , Okati-Aliabad Hassan , Tabatabaei Seyed Mehdi , Ansari Hossein , Abbasi Mohammadhadi , Sheikhzadeh Khodadad , Baygi Mehdi Zanganeh , Sartipi Majid , Sanei-Sistani Sharareh , Khorashad Ali Reza Salimi , Ansari-Moghadam Fatemeh , Torab Neda , Khalili Tahereh , Miri-Aliabad Ghasem
Published: November 2020

Background Iran was one of the first countries to be affected by COVID-19. Identifying factors associated with severity of COVID-19 is effective in disease management. This study investigated the epidemiological and clinical features and factors associated with severity of COVID-19 in one of the less privileged areas in Iran.Methods In a multi-center study, all patients admitted to hospitals of Zahedan University of Medical Sciences located in southeastern Iran were investigated from February 29 to April 31, 2020. Demographic, epidemiological and clinical data of patients were extracted from medical records. To explore the risk factors associated with severity of COVID-19, bivariate and multivariate logistic regression models were used.Results Among the 413 patients, 55.5% were male and 145 (35.10%) were in a severe condition at admission time. Multivariate analysis showed that the adjusted odds of the disease severity increased in patients with older age (OR 3.51; 95% CI, 2.28-5.40), substance abuse (OR 2.22; 95% CI, 2.05-5.78) and at least one underlying disease (OR 3.45; 95% CI, 1.01-1.32).Conclusions COVID-19 was more severe in older patients, patients with a history of substance abuse, and patients with at least one underlying disease. Understanding the factors affecting the disease severity can help for clinical management of COVID-19, especially in less privileged areas where fewer resources are available.
Mining Revenue Optimization Algorithm of Miners in PoW-based Blockchain Networks
Authors: Chen Yourong , Chen Hao , Han Meng , Liu Banteng , Chen Qiuxia , Ma Zhenghua , Wang Zhangquan
Published: November 2020

In order to improve the revenues of attack mining pools and miners under block withholding attack, we propose the mining revenue optimization algorithm (MROA) of miners in PoW-based blockchain network. MROA establishes the revenue optimization model of each attack mining pool and revenue optimization model of entire mining attack pools under block withholding attack with the mathematical formulas such as attack mining pool selection, effective computing power, mining cost and revenue. Then MROA solves the model by using the modified artificial bee colony algorithm based on Pareto. Namely, employed bee operations include evaluation value calculation, selection probability calculation, crossover operation, mutation operation and Pareto domination calculation, and can update each food source. The onlooker bee operations include confirmation probability calculation, crowding degree calculation, neighborhood crossover operation, neighborhood mutation operation and Pareto domination calculation, and can find the optimal food source in multidimensional space with smaller distribution density. Scout bee operations delete the local optimal food source which cannot produce new food sources to ensure the diversity of solutions. The simulation results show that no matter how the number of attack mining pools and the number of miners change, MROA can find a reasonable miner work plan for each attack mining pool, which improves minimum revenue, average revenue and the evaluation value of optimal solution, and reduces the spacing value and variance of revenue solution set. MROA outperforms the state-of-arts such as ABC, NSGA2 and MOPSO.
Commonly Diagnosed Mental Disorders in a General Hospital System
Authors: Scott George , Beauchamp-Lebrón Alessandra , Rosa-Jiménez Ashley , Hernández-Justiniano Javier , Ramos-Lucca Axel , Asencio-Toro Gloria , Jiménez-Chávez Julio
Published: November 2020

Background: Considering many patients seek care from general hospitals, these healthcare institutions are uniquely situated to address comorbid mental and physical health needs. Little is documented, however, on the most common mental disorders in patients seeking care in general hospital settings, especially in Puerto Rico. The objective of this study was to characterize the five most common DSM-5 mental disorder diagnoses made in a hospital system in southern Puerto Rico between January 2015 and December 2019. Methods: A retrospective study of cross-sectional data obtained from 5,494 inpatients was implemented and a multinomial logistic regression was used to assess the odds of being diagnosed with a current mental disorder.Results: Overall, 53% of the entire sample was diagnosed with a mental disorder during hospitalization. Major depressive, neurocognitive, anxiety, substance-related and schizophrenia-spectrum disorders were the most frequently diagnosed. Interestingly, females were 23% less likely to have been diagnosed with major depressive disorder than males (aOR: .769, CI [.650, .909], p = .002). Thus, males evidenced 1.30 higher odds of being diagnosed with depression. Conclusion: The integration of clinical health psychology services within a general hospital facilitated our team’s work of identifying and treating co-occurring mental disorders among hospitalized patients. Future studies examining the opportunities and barriers of integrating clinical health psychology services within a general hospital’s administrative and clinical infrastructure for rapid identification and treatment of co-occurring mental disorders among medical patients are warranted.
Gm9795 Promotes Inflammation in Non-Alcoholic Steatohepatitis via NF-κB/JNK Pathway by Endoplasmic Reticulum Stress
Authors: Ye Liangying , Zhao Dan , Xu Yangzhi , Lin Jiaen , Xu Jiahui , Wang Kunyuan , Ye Zhanhui , Luo Yufeng , Liu Shiming , Yang Hui
Published: November 2020

Background: Non-alcoholic steatohepatitis (NASH) is a key stage in leading development of non-alcoholic simple fatty liver (NAFL) into cirrhosis and even liver cancer. This study aimed at exploring the lncRNA expression profifile in NASH and the biological function of a novel LncRNA-gm9795. Methods: Microarray analysis was performed to compare the expression profifiles of lncRNAs in the liver of NASH, NAFLD and normal mice. Methionine-choline-deficient Medium(MCD) with Lipopolysaccharide(LPS) or palmitic acid（PA）were used to built NASH cell models.The role and mechanism of LncRNA-gm9795 in NASH were explored by knocking down or over-expressing its expression. Results: A total of 381 lncRNAs were found to be not only highly expressed in NAFLD, but also is going to go even higher in NASH. A novel LncRNA-Gm9795 was significantly highly expressed in liver tissues of NASH animal models and NASH cell models. By staining with Nile red, we found that Gm9795 did not affect the fat accumulation of NASH. However, Gm9795 in NASH cell models significantly promoted the expression of TNFα, IL-6, IL-1β, the important inflammatory mediators in NASH. At the same time, we found that Gm9795 upregulated the key molecules in endoplasmic reticulum stress (ERS), while NF-κB/JNK pathways were also activated. When ERS activator Thapsigargin(TG) was introduced in cells with Gm9757 si-RNA, NF-κB and JNK pathways were activated. Conversely, ERS inhibitor Tauroursodeoxycholic(TUDCA) acid inhibited NF-kB and JNK pathways in cells with Gm9795 overexpression plasmid. Conclusion: LncRNA-gm9795 promotes inflammatory response in NASH through NF-kB and JNK pathways by ERS, which might provide theoretical basis for revealing the pathogenesis of NASH and discovering new therapeutic targets
Stereopsis Deficits in Parkinson’s Disease and Their Clinical Implications
Authors: Ba Fang , Sang Tina T. , Fatehi Jaleh , He Wenjing , Mostofi Emanuel , Zheng Bin
Published: November 2020

Background: Parkinson's disease (PD) is not exclusively a motor disorder. Among non-motor features, PD patients possess sensory visual dysfunctions. Stereopsis deficit can significantly impact patients' motor performance. However, it is not routinely tested, and its significance is under-investigated. Studying stereopsis using reliable 3D stimuli may help determine its implications in disease status in PD.The objective of the study is to investigate stereopsis abnormalities in PD with reliable and more physiological tools, and their correlation with indicators of PD severity. Methods: Twenty-four healthy control and 20 PD participants were first evaluated for visual acuity, visual field, contrast acuity, and stereoperception with 2D and Titmus stereotests, followed by the assessment with the 3D active shutter system. The correlation between stereopsis and disease severity, Unified Parkinson’s disease rating scale motor scores (UPDRS-III), levodopa equivalent daily dose (LEDD), course of disease and cognitive status were evaluated using univariate regression models. Results: Screening visual tests did not reveal any differences between PD and control group. With the 3D active shutter system, PD patients demonstrated significantly worse stereopsis (i.e p=0.002, 26 seconds of arc). There was a trend that UPDRS-III and LEDD negatively correlate with the stereo acuity, suggesting poorer stereoperception is related to disease severity. Preserved cognitive function correlated with more intact stereo acuity. Conclusion: With more reliable and physiological tools, PD patients exhibit poorer stereopsis. These deficits reflected PD motor and cognitive status. How stereopsis relates to gait, fall risks and navigation warrants more investigations in the future.
Analysis of IgM, IgA, and IgG Isotype Antibodies Directed Against SARS‑CoV‑2 Spike Glycoprotein and ORF8 in the Course of COVID‑19.
Authors: Meinberger Denise , Koch Manuel , Roth Annika , Hermes Gabriele , Stemler Jannik , Cornely Oliver A. , Streichert Thomas , Klatt Andreas R.
Published: November 2020

Immunoassays are a standard diagnostic tool assessing immunity in severe acute respiratory syndrome coronavirus type 2 (SARS‑CoV‑2) infection. However, immunoassays do not provide information about contaminating antigens or cross‑reactions and might exhibit inaccurately high sensitivity and low specificity. We aimed to gain insight into the serological immune response of SARS‑CoV‑2 patients by immunoblot analysis.We analyzed serum immunoglobulins IgM, ‑A, and ‑G directed against SARS‑CoV‑2 proteins by immunoblot analysis from 12 infected patients. We determined IgG isotype antibodies by commercially available ELISA and assessed the clinical parameters of inflammation status and kidney and liver injury.We found evidence for antibody cross‑reactivity, which calls into question a reliable assessment of serum samples tested negative for anti‑SARS‑CoV‑2 antibodies by immunoassays. Nevertheless, for the detection of IgG anti‑SARS‑CoV‑2 antibodies, our data suggest that the use of the spike glycoprotein in immunoassays should be sufficient to identify positive patients. Using a combination of the spike glycoprotein and the open reading frame 8 protein could prove to be the best for the detection of patients positive for anti‑SARS‑CoV‑2 IgM antibodies. We found that the antibody response alone is not decisive for the course of the disease, but inflammation parameters are promising indicators.
Evaluation of Myocardial Injury Patterns and ST Changes among Critical and Non-critical Patients with Coronavirus-19 Disease
Authors: Liaqat Anam , Ali-Khan Rao Saad , Asad Muhammad , Rafique Zakia , Hasan Syed Shahzad , Page Amy T , Qin Xiwen Simon
Published: November 2020

Background: Novel coronavirus disease (COVID-19) has led to a major public health crisis globally. Currently, myocardial damage is speculated to be associated with COVID-19, which can be seen as one of the main causes of death of patients with COVID-19. Therefore, in this study, we aim to investigate the effects of COVID-19 diagnosed patients on myocardial injury. Methods: A prospective study was conducted among 201 patients with COVID-19 in the Pakistan Military Hospital from April 1 to August 31, 2020, including non-critical cases and critical cases. COVID-19 patients were stratified as critical and non-critical according to signs and symptoms with those requiring intensive care and ventilator support as critical and those don’t require ventilator support as non-critical Results: A total of 201 COVID-19 patients with critical and non-critical categories presented with myocardial injury. All patients with myocardial injury had an elevation in CKMB and Trop 1 levels. Of these patients, 43.7% presented with new electrocardiography (ECG) changes, ST depression is observed in 36.3% patients, and 16.9% presented with abnormal electrocardiogram findings, with right ventricular dilatation and dysfunction. Results analyzed by a logistic regression model showing COVID-19 direct contribution to myocardial injury in these patients. Conclusion: COVID-19 disease directly leads to cardiovascular damage among critical and non-critical patients. Myocardial injury is associated not only with abnormal ECG changes but also with myocardial dysfunction on echocardiography and more commonly observed among critical patients.
A creatinine-based model to predict recurrent bleeding after modified percutaneous transhepatic variceal embolization in cirrhotic patients
Authors: Li Zhen , Ji Kun , Zhu Han-Long , Zhao Si , Li Xin , Zhan Peng-Chao , Shi Yang , Ye Shu-Wen , Xie Bing-Can , Zhang Yu-Yuan , Yu Peng , Ren Zhi-Gang , Ding Juan , Han Xin-Wei
Published: November 2020

Background: Patients who survived the initial esophagogastric variceal bleeding (EVB) experienced an increased risk of recurrent bleeding and death, but a reliable predictive model is lacking. We aim to develop and validate a model for rebleeding prediction in cirrhotic patients with EVB after modified percutaneous transhepatic variceal embolization (PTVE) with cyanoacrylate.Methods: A total of 122 patients with EVB who underwent PTVE from January 2015 to March 2020 were enrolled in this study. The multivariate logistic analyses were conducted to determine independent risk factors for nomogram construction. The discrimination, calibration and clinical utility of the nomogram were compared with the Model for End-stage Liver Disease (MELD) and Child–Pugh model. Additionally, a risk stratification was developed according to nomogram.Results: Rebleeding within 3 months after PTVE occurred in 32 patients (26.2%). The independent rebleeding indicators included the history of endoscopic therapy, Child–Pugh score, partial splenic embolization and creatinine level. The nomogram incorporating these four predictors achieved excellent calibration and discriminatory abilities with a concordance index of 0.85 which was confirmed to be 0.83 through bootstrapping validation. The nomogram harbored better discrimination and clinical applicability than the MELD and Child–Pugh model. As shown in the Kaplan-Meier curves, the patients at high risk were significantly associated with the high probability of rebleeding (P < 0.001). Conclusions: We created a creatinine-based nomogram to predict rebleeding in cirrhotic patients received PTVE, which could help clinicians to discern the high-risk patients to perform more aggressive treatments earlier and formulate intensive follow-up plan for them.
The study of laser deep penetration processing on prefabricated cracks of high carbon steel
Authors: Liu Dongwei , Shi Yan , Liu Jia
Published: November 2020

This paper describes the testing of laser deep penetration processing on controlled fragmentation of high carbon steel (50SiMnVB). The objective of this research is to make use of defects in deep penetration zones and optimize the quality of prefabricated cracks. The research shows that a deeper central crack appear in the deep penetration zone when the heat input is 60 J/mm, and the appeared crack is affected by martensite in microstructure, high microhardness and a high magnitude of tensile stress. Furthermore, the fracture mode of the deep penetration zones is mixed-mode (ductile and brittle fracture).
I see how you feel: facial expressions’ recognition and distancing in the time of COVID-19
Authors: Marta Calbi , Nunzio Langiulli , Francesca Ferroni , Martina Montalti , Anna Kolesnikov , Vittorio Gallese , Alessandra Umiltà Maria
Published: November 2020

The COVID-19 pandemic has dramatically changed the nature of our social interactions. In order to understand how protective equipment and distancing measures influence the ability to comprehend others’ emotions and, thus, to effectively interact with others, we carried out an online survey across the Italian population during the first pandemic peak. Participants were shown static facial expressions (Angry, Happy and Neutral) covered by a sanitary mask or by a scarf. They were asked to evaluate the expressed emotions as well as to assess the degree to which one would adopt physical and social distancing measures for each stimulus. Results demonstrate that, despite the covering of the lower-face, participants correctly recognized the facial expressions of emotions with a polarizing effect on emotional valence ratings found in females. Noticeably, while females’ ratings for physical and social distancing were driven by the emotional content of the stimuli, males were influenced by the “covered” condition. The results also show the impact of the pandemic on anxiety and fear experienced by participants. Taken together, our results offer novel insights on the impact of the COVID-19 pandemic on social interactions, providing a deeper understanding of the way people react to different kinds of protective face covering.
Perforator Preservation Technologies (PPT) Based on a New Neuro-interventional Classification in Endovascular Treatment of Perforator Involving Aneurysms (piAN)
Authors: Li Chen , Liu Ao-Fei , Qiu Han-Cheng , Lv Xianli , Zhou Ji , Zhang Yi-Qun , Lv Jin , Zhang Ying-Ying , Hu Sushan , Liu Fang , Liu Yun-e , Jin Min , Jiang Wei-jian
Published: November 2020

Background and Purpose Treatment of perforator involving aneurysm (piAN) remains a challenge to open and endovascular neurosurgeons. Our aim is to demonstrate a primary outcome of endovascular therapy for piANs with the use of perforator preservation technologies (PPT) based on a new neuro-interventional classification.Methods The piANs were classified into Type I: aneurysm really arises from perforating artery; Type II: saccular aneurysm involves perforating arteries arising from its neck (IIa) or dome (IIb); Type III: fusiform aneurysm involves perforating artery. Stent protection technology of PPT was applied in Type I and III aneurysms, and coil-basket protection technology in Type II aneurysms. Immediate outcome of aneurysmal obliteration after treatment was evaluated (Satisfactory Obliteration: The saccular aneurysm body is densely embolized (I), leaving a gap in the neck (IIa) or dome (IIb) where the perforating artery arising; fusiform aneurysm is repaired and has a smooth inner wall), and successful perforating artery preservation was defined as keeping good antegrade flow of those perforators on postoperative angiography. Periprocedural complication was closely monitored, and clinical and angiographic follow-up were performed.Results Six consecutive piANs (2 ruptured and 4 unruptured; 1 Type I, 2 Type IIa, 2 Type IIb and 1 Type III) in 6 patients (aged from 43 to 66 years; 3 males) underwent endovascular therapy between November 2017 and July 2019. The immediately angiography after treatment showed 6 aneurysms obtained satisfactory obliteration; and all of their perforating arteries were successfully preserved. During clinical follow-up of 13–50 months), no ischemic or hemorrhagic event of brain occurred in the 6 patients, but one who developed ischemic event in the territory of involving perforators 4 h after operation, and completely resolved within 24 h. Follow-up angiography at 3M to 10M showed patency of the parent artery and perforating arteries of treated aneurysms, with no aneurysmal recurrence.Conclusions Our perforator preservation technologies on basis of the new neuro-interventional classification seems feasible, safe and effective in protecting involved perforators while occluding aneurysm.
Transverse myelitis in COVID-19 patients: Report of two cases
Authors: Advani Soroor , Zali Alireza , Ommi Davood , Fatemi Alireza , Khoshnoud Reza Jalili , Ashrafi Farzad
Published: November 2020

Background: COVID-19 has been associated with several neurological complications. One of these complications is transverse myelitis. Several cases of acute transverse myelitis are reported in association with this disease among the world. As there is lack of knowledge about the association of COVID-19 and myelitis and the clinical features of this complication are still ambiguous, we report two patients with transverse myelitis following COVID-19 infection. Patients: This study was performed in a referral center of COVID-19 in Iran(Shohada Tajrish hospital) and two patients with paraparesis and diagnosis of transverse myelitis were enrolled. Both patients had longitudinally extensive transverse myelitis that resulted in paraparesis. One of the patients had favorable outcome after treatment with plasma exchange but the other had no improvement following treatment.Conclusion: Transverse myelitis could be a complication of COVID-19 and infarction and inflammation could be suggested as probable mechanisms for this condition.
COVID-19 progression in kidney transplant recipients: A single-center case series
Authors: Rahimzadeh Hormat , Keykhaei Mohammad , Razeghi Effat , Zivari Ensieh , Mansouri Ensieh Sadat
Published: November 2020

The novel coronavirus disease 2019 (COVID-19) is a respiratory infection that has received much attention due to its rapid expansion. Currently, it has been revealed that patients with underlying disease, especially those with kidney disease are more prone to develop complications. Some studies associate kidney transplantation as a risk factor for COVID-19 progression; however, epidemiologic data that demonstrate this are amazingly rare. Considering the importance of the topic, we report on six kidney transplant recipients (median age 47 [41-55]) with confirmed or clinically suspected COVID-19. The most common admission presentations were fever (83.3%), dyspnea, and myalgia. At baseline, immunosuppressive therapy was ceased, prednisolone dose was increased, and all patients received antiviral treatment including hydroxychloroquine and umifenovir. After a median follow-up of 11.5 days from admission, six patients (100%) developed acute kidney injury (AKI), 50% required intensive care unit (ICU) admission, and two patients (33.3%) deceased as a result of deterioration in respiratory status. Overall, these findings demonstrate that AKI development and respiratory involvement may be risk indicators of in-hospital mortality in kidney recipients with COVID-19. Therefore, more intensive attention should be paid to kidney transplant recipients with COVID-19.
Bacteria-derived ferrichrome inhibits tumor progression in sporadic colorectal neoplasms and colitis-associated cancer
Authors: IWAMA TAKUYA , Fujiya Mikihiro , Konishi Hiroaki , Tanaka Hiroki , Murakami Yuki , Kunogi Takehito , Sasaki Takahiro , Takahashi Keitaro , Ando Katsuyoshi , Ueno Nobuhiro , Kashima Shin , Moriichi Kentaro , Tanabe Hiroki , Okumura Toshikatsu
Published: November 2020

BACKGROUND: Colorectal cancers develop through several pathways, including the adenoma–carcinoma sequence and colitis-associated carcinogenesis. An altered intestinal microflora has been reported to be associated with the development and progression of colorectal cancer via these pathways. We identified Lactobacillus casei-derived ferrichrome as a mediator of the bacterial anti-tumor effect of colorectal cancer cells through the upregulation of DDIT3. In this study, we investigated the anti-tumor effects of ferrichrome on precancerous conditions and cancer cells associated with sporadic as well as colitis-associated colorectal cancer.METHODS: SRB and MTT assays were performed to assess growth inhibition in vitro. Eighteen organoids were prepared from biopsy specimens obtained by colonoscopy. An AOM-DSS carcinogenesis model and xenograft model of colorectal cancer cells were generated for the assessment of the tumor suppressive effect of ferrichrome in vivo. RESULTS: Ferrichrome inhibited the cell growth of colorectal cancer cells in vitro and in in vivo xenograft models. Ferrichrome exerted a strong tumor-suppressive effect that was superior to that of currently available anti-tumor agents, including 5-FU and cisplatin, both in vitro and in vivo. The tumor-suppressive effect of the combination of ferrichrome and 5-FU was superior to that of single treatment with either drug. The tumor suppressive effects of ferrichrome were confirmed through the upregulation of DDIT3 in patient-derived organoids of adenoma and carcinoma. Ferrichrome inhibited the tumor progression in the AOM-DSS model while exhibiting no anti-inflammatory effect in the DSS-colitis model, suggesting that ferrichrome inhibited cancer cells, but not a precancerous condition, via the colitis-associated pathway.CONCLUSIONS: Ferrichrome exerts a tumor suppressive effect on precancerous conditions and cancer cells associated with sporadic as well as colitis-associated colorectal cancer. The anti-tumor effect of ferrichrome was mediated by the upregulation of DDIT3, and was superior to that of 5-FU or cisplatin. These results suggest that Lactobacillus brevis-derived ferrichrome may be a candidate anti-tumor drug for the treatment of colorectal neoplasms.
Google analytics of a pilot study to characterize the visitor website statistics and implicate for enrollment strategies in Medical University
Authors: Chen Szu-Chieh , Tsao Thomas Chang-Yao , Lue Ko-Huang , Tsai Yafang
Published: November 2020

Background: Taiwan’s colleges and universities are struggling to maintain their student enrollment rates owing to the declining fertility rate. Focusing on students in higher education programs, this study aims to analyze online behavioral patterns for university departmental websites and accordingly, suggests response strategies to increase the rate of enrollment.Methods: We use Google Analytics to examine the websites of two departments in a medical university between February 1 and July 30, 2018. We study website patterns during the study periods for three college admission routes: STARS program, personal applications, and admission through examination and placement.Results: Most website visitors during the three visiting date ranges for the two departments are 18–24 years. The visitor groups are mainly freshmen at the university and their parents. The homepage and Subject Credits, Course Planning, Teacher Lineup, and Certificate of Subjects were the most visited webpages. The overall number of daily page views varied by academic event.Conclusions: University departments should enhance the presentation of featured courses on their webpage or distinguish course characteristics from those of competing departments in the curriculum to ensure clear market segmentation. In addition, departments should consider examining online data to identify suitable high schools that can be visited to attract potential students and to improve students’ willingness to choose their university.
Knowledge, attitude, and practice of pharmacy and medical students regarding self-medication, a study in Zabol University of Medical Sciences; Sistan and Baluchestan province in south-east of Iran
Authors: Hashemzaei Mahmoud , Afshari Mahdi , Koohkan Zahra , Bazi Ali , Rezaee Ramin , Tabrizian Kaveh
Published: November 2020

Background: Self-medication is defined as using medicinal products to treat the disorders or symptoms diagnosed by oneself. Although informed self-medication is one of the ways to reduce health care costs, inappropriate self-treatment can pose various risks including drug side effects, recurrence of symptoms, drug resistance, etc. The purpose of this study was to investigate the knowledge, attitude, and practice of pharmacy and medical students toward self-medication.Methods: This study was conducted in Zabol University of Medical Sciences in 2018. Overall, 170 pharmacy and medical students were included. A three-part researcher-made questionnaire was designed to address the students’ knowledge, attitude, and practice. Statistical analysis was performed in SPSS 25 software.Results: According to the results, 97 (57.1%) students had carried out self-medication within the past 6 months. Overall, the students self-medicated on average 4.2 ±2.9 times per year. Self-medication was more common in male students (65.4%, P=0.043). Cold was the most common ailment treated with self-medication (93.2%), and antibiotics (74.4%) were the most commonly used drugs. The primary information sources used by the students were their previous prescriptions (47.4%). Pharmacy students had a higher level of drug information (P<0.001). There was a statistically significant association between the level of drug information and the tendency for self-medication (P=0.005). Disease recurrence was the most common negative complication of self-medication.Conclusion: There is a need to educate pharmacy and medical students regarding self-medication and its side effects. The high prevalence of self-medication and the overuse of antibiotics can pose a significant risk of drug resistance.
Research Training Program in a Turkish Medical School: Challenges, Barriers and Opportunities from the Perspectives of the Students and Faculty Members
Authors: Öcek Zeliha Asli , Bati Hilal , Sezer Ebru Demirel , Koroglu Ozge Altun , Yilmaz Özlem , Yiımaz Nilufer Demiral , Mandiracioglu Aliye
Published: November 2020

Background: Providing medical students with opportunities for research experience is challenging for medical schools in developing countries. The Research Training Program (RTP), which is carried out in Ege University Faculty of Medicine (EUFM) parallel to the core curriculum, aims to improve the scientific competencies of the highly motivated students and to provide them with the opportunity to conduct a research. The purpose of this project is to evaluate RTP through the perspectives of students and faculty members.Methods: This phenomenological study included two groups; students of RTP and faculty members who contributed to the program. Interviews were conducted with the research group whose selection was determined by maximum variation technique. Interviews with new individuals continued until data saturation was reached. Interpretative data analysis started with close reading of the transcripts and generating a list of codes. Coding by two independently, developing categories and themes were the following steps.Results: Twenty-one RTP students and 14 faculty members were interviewed. The main motivation for students to participate was the desire to learn how to do research. The introduction course providing the students with the basic competencies needs to be improved in terms of practical activities. It was reported that during the project process students needed intensive guidance especially in finding a research topic and a mentor. The students' lack of time, deficit of enough mentoring and the fact that conducting a research does not provide a competitive advantage for residency are important obstacles to the completion of the program. The most frequently mentioned achievement of the students is to learn all the stages of the research as well as getting acquainted with critical thinking.Conclusions: This research showed that it was realistic to implement research programs for highly motivated students in medical schools with conditions like those in EUFM. The solution of mentor shortage emerged in this study is dependent on the adoption of student research as a national policy. Getting acquainted with the interrogative thinking style, conducting research, and making lifelong learning a core value are more important outcomes of research programs than the number of completed projects.
Ninjurin 2 rs118050317 gene polymorphism and endometrial cancer risk
Authors: Cheng Yimin , Yang Liting , Shi Guangyao , Chen Peng , Li Liang , Fang Hangrong , Chen Chao
Published: November 2020

Background: Endometrial cancer is one of the most common female reproductive system tumors. Ninjurin2 (NINJ2) is a new adhesion factor. As a vascular susceptibility gene, it is highly expressed in other cancers and promotes the growth of cancer cells. We conducted an association analysis between NINJ2 gene polymorphism and endometrial cancer risk.Methods: Five SNPs rs118050317, rs75750647, rs7307242, rs10849390 and rs11610368 of NINJ2 gene were genotyped in 351 endometrial cancer patients and 344 healthy controls. The clinical index difference between cases and controls were tested by one-way analysis of variance. The allele and genotype frequency of cases and controls were been compared by Chi-square test. The odds ratios (OR) with 95% confidence interval (95% CI) were examined by logistic regression analysis. Results: The SNP rs118050317 mutant allele C and homozygote CC genotype were significant increased the endometrial cancer risk (OR = 1.46, 95% CI = 1.04 – 2.06, p = 0.028; OR = 8.43, 95% CI = 1.05 – 67.89, p = 0.045). In the clinical index analysis, there were significant higher quantities of CEA, CA125 and AFP in cases serum than controls.Conclusion: The NINJ2 gene polymorphism loci rs118050317 mutant allele C was associated with an increased risk of endometrial cancer. CEA, CA125 and AFP quantities were significant higher in endometrial cancer patients.
Integrating sexual and reproductive health into health system strengthening in humanitarian settings: a planning workshop toolkit to transition from minimum to comprehensive services in the Democratic Republic of Congo, Bangladesh, and Yemen
Authors: Tran Nguyen Toan , Greer Alison , Kini Brigitte , Abdi Hassan , Rajeh Kariman , Cortier Hilde , Boboeva Mohira
Published: November 2020

BackgroundPlanning to transition from the Minimum Initial Service Package for Sexual and Reproductive Health (SRH) toward comprehensive SRH services has been a challenge in humanitarian settings. To bridge this gap, a workshop toolkit for SRH coordinators was designed to support effective planning. This article aims to describe the toolkit design, piloting, and final product.MethodsAnchored in the Health System Building Blocks Framework of the World Health Organization, the design entailed two complementary and participatory strategies. First, a collaborative design phase with iterative feedback loops involved global partners with extensive operational experience in the initial toolkit conception. The second phase engaged stakeholders from three major humanitarian crises to participate in pilot workshops to contextualize, evaluate, validate, and improve the toolkit using qualitative interviews and end-of-workshop evaluations. The aim of this two-phase design process was to finalize a planning toolkit that can be utilized in and adapted to diverse humanitarian contexts, and efficiently and effectively meet its objectives. Pilots occurred in the Democratic Republic of Congo for the Kasai region crisis, Bangladesh for the Rohingya humanitarian response in Cox’s Bazar, and Yemen for selected Governorates.ResultsResults suggest that the toolkit enabled facilitators to foster a systematic, participatory, interactive, and inclusive planning process among participants over a two-day workshop. The approach was reportedly effective and time-efficient in producing a joint work plan. The main planning priorities cutting across settings included improving comprehensive SRH services in general, healthcare workforce strengthening, such as midwifery capacity development, increasing community mobilization and engagement, focusing on adolescent SRH, and enhancing maternal and newborn health services in terms of quality, coverage, and referral pathways. Recommendations for improvement included a dedicated and adequately anticipated pre-workshop preparation to gather relevant data, encouraging participants to undertake preliminary study to equalize knowledge to partake fully in the workshop, and enlisting participants from marginalized and underserved populations.ConclusionCollaborative design and piloting efforts resulted in a workshop toolkit that could support a systematic and efficient identification of priority activities and services related to comprehensive SRH. Such priorities could help meet the SRH needs of communities emerging from acute humanitarian situations while strengthening the overall health system.
Vancomycin-lock therapy for prevention of catheter-related bloodstream infection in very low body weight infants
Authors: Liang Hong , Zhang Lian , Guo Xiaoping , Sun Li
Published: November 2020

Background: This study was to evaluate the effectiveness and safety of vancomycin- lock therapy for the prevention of catheter-related bloodstream infection (CRBSI) in very low body weight (VLBW) preterm infant patients. Methods: One hundred and thirty-seven cases of VLBW preterm infants who retained peripherally inserted central catheters (PICCs) were retrospectively reviewed, including 68 treating with heparin plus vancomycin (vancomycin-lock group) and 69 with heparin only (control group). The incidence of CRBSI, related pathogenic bacteria, adverse events during the treatment, complications, antibiotic exposure, PICC usage time, hospital stay, etc. were compared between the above two groups. Results: The incidence rate of CRBSI in the vancomycin-lock group (4.4%, 3/68) was significantly less than in the control group (21.7%, 15/69, p =0.004). Total antibiotic exposure time during the whole observation period was significantly shorter in the group than in the control group (11.2±10.0 vs 23.6±16.1 d; p <0.001). No hypoglycemia occurred during the locking, and the blood concentrations of vancomycin were not detectable. Conclusions: Vancomycin-lock may effectively prevent CRBSI in Chinese VLBW preterm infants and reduce the exposure time of antibiotics, without causing obvious side complications.
Regional inequality in the Janani Suraksha Yojana coverage in India: A Geo-spatial Analysis
Authors: Mishra Prem Shankar , Kumar Pradeep , SRIVAST SHOBHIT
Published: November 2020

IntroductionAlthough India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels.MethodsThe study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015-16, India. The sample size of this study was 148,145 women aged 15-49 years who gave last birth in the institution during five years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran’s I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization.ResultsThe value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only.ConclusionIt is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels.