bluuebunny/crossref_metadata_2025 huggingface dataset:
Nomogram-Derived Prediction of Pathologic Complete Response (pCR) in Breast Cancer Patients Treated with Neoadjuvant Chemotherapy (NCT)
Authors: pu shengyu , wang ke , liu yang , liao xiaoqin , chen heyan , he jianjun , zhang jian
Published: July 2020

Background Previous research results on the predictive factors of neoadjuvant chemotherapy (NCT) efficacy in breast cancer are inconsistent, suggesting that the ability of a single factor to predict efficacy is insufficient. Combining multiple potential efficacy-related factors to build a model may improve the accuracy of prediction. This study intends to explore the clinical and biological factors in breast cancer patients receiving NCT and to establish a nomogram that can predict the pathologic complete response (pCR) rate of NCT.Methods We selected 165 breast cancer patients receiving NCT from July 2017 to May 2019. Using pretreatment biopsy materials, immunohistochemical studies to assess estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER-2), and Ki-67 expression. The correlation between biological markers and pCR was analyzed. These predictors were used to develop a binary logistic regression model with cross-validation and to show the established predictive model with a nomogram.Results The nomogram for pCR based on lymphovascular invasion, anemia (HB≤120 g/L), ER, Ki67 expression levels and NCT regimen had good discrimination performance (area under the curve [AUC], 0.758; 95% confidence interval [CI], 0.675-0.841) and calibration coordination. According to the Hosmer-Lemeshow test, the calibration chart showed satisfactory agreement between the predicted and observed probabilities. The final prediction accuracy of cross-validation was 76%.Conclusions We developed a nomogram based on multiple clinical and biological covariations that can provide an early prediction of NCT response and can help to quickly assess the individual benefits of NCT.
Developing a Complex Intervention to Support Pregnant Women with Mild to Moderate Anxiety: Application of the Medical Research Council Framework
Authors: Evans Kerry , Spiby Helen , Morrell Jane C
Published: July 2020

Aim: To design and develop an intervention to support women with symptoms of mild to moderate anxiety in pregnancy.Methods: The development followed the MRC framework for complex interventions, utilising psychological theory, review level evidence and professional and public involvement. Two systematic reviews were completed which helped identify potentially beneficial intervention components. The theory underpinning the components was explored to consider the potential benefit for women with mild to moderate anxiety symptoms in pregnancy. Methods of delivering the intervention within maternity services were explored. The intervention comprised: group discussions, one to one support and assisted self-help resources. Midwives were identified as ideally placed to facilitate the intervention supported by midwifery support workers. A bespoke training package was provided by subject experts to prepare the facilitators. Discussion: The absence of established interventions and a paucity of evidence based approaches for pregnant women with symptoms of mild to moderate anxiety indicated the need for a rigorous and systematic approach to the intervention design. This approach led to the development of an intervention feasible for implementation in maternity care systems tailored to the needs of pregnant women. The involvement of a multi-professional advisory team and active engagement of service users helped to consider the acceptability of the intervention for women and the feasibility of delivering the intervention in the context of maternity care.Conclusion: The MRC Framework provided useful overarching guidance to develop a midwife facilitated intervention for women with symptoms of anxiety in pregnancy. The framework assisted the development of a robust rationale for each intervention component and considered the processes of evaluation and implementation into maternity care systems.
Lack of Tocilizumab effect on mortality in COVID19 patients
Authors: Holt Gregory E , Batra Mayank , Murthi Mukunthan , Kambali Shweta , Santos Kayo , Bastidas Maria Virginia Perez , Asif Huda , Haddadi Sara , Arias Sixto , Mirsaeidi Mehdi
Published: July 2020

Off-label tocilizumab use in COVID-19 patients reflects concern for cytokine release syndrome. Comparison of matched COVID-19 pneumonia patients found elevated IL-6 levels correlated with mortality that did not change with tocilizumab administration. Correlating mortality with increased IL-6 doesn’t imply causality however lack of improvement by tocilizumab requires clinical trial alterations.
Recurrence of COVID-19 with SARS-CoV-2 RNA reversion to positive and late antibody response: a case report from Brazil
Authors: Alonso Fábio de O. Martinez , Sabino Bruno Duarte , Guimarães Maria Angelica Arpon Marandino , Varella Rafael Brandão
Published: July 2020

In general, replication of the SARS-CoV-2 in the host reaches its peak in the first week of infection, decreasing rapidly afterwards, while some level of immunity is build up. Yet, the infection seems to follow a distinctive course in some individuals, reactivating after the apparent resolution of symptoms. We report here the first case of a more vigorous COVID-19 recurrence with SARS-CoV-2 RNA reversion to positive and late antibody response, and also the first to address COVID-19 recurrence in Brazil.
Association of hyperlipidemia and statin use with severity of COVID-19
Authors: Tan Wilnard YT , Young Barnaby E , Lye David Chien , Chew Daniel EK , Dalan Rinkoo
Published: July 2020

Background and Aims: We aim to study the association of hyperlipidemia and statin use with COVID-19 severity.Methods: We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤94% requiring supplemental oxygen, intensive-care unit (ICU) admission , invasive mechanical-ventilation and death. Logistic regression models were used to study the association between hyperlipidemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined , in a nested case-control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05.Results: One hundred fifty-six (21.8%) patients had hyperlipidemia and 97% were on statins. There were no significant associations between hyperlipidemia and clinical outcomes. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: b-0.12(-0.23,-0.01); p=0.028). There were no other significant differences in other outcomes.Conclusion: Treated hyperlipidemia was not an independent risk factor for severe COVID-19. Statin use independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.
Impact of COVID-19 on outpatient therapy with iloprost for Systemic Sclerosis digital ulcers
Authors: Crisafulli Francesca , Lazzaroni Maria-Grazia , Zingarelli Stefania , Rossi Mara , Tincani Angela , Franceschini Franco , Airò Paolo
Published: July 2020

Introduction and objectivesThe outbreak of COVID-19 epidemic imposed temporary changes in the management of patients with chronic diseases. We analyzed the impact of COVID-19 epidemic in patients with Systemic Sclerosis (SSc) receiving intravenous iloprost infusions for digital ulcers (DU) treatment.MethodsDuring the epidemic, iloprost infusion therapy in our Hospital was guaranteed; patients were regularly contacted by telephone before the scheduled infusions. DU were evaluated with DUCAS (DU Clinical Assessment Score).ResultsBetween 20th February and 31st May 2020, 47/64 SSc patients did not receive at least one of the scheduled infusions, for patients fear and/or logistical difficulties (43 cases), COVID-19 (2), or other intercurrent diseases (2). At the last evaluation before 20th February DUCAS was not different between patients who stopped the therapy and those who continued it. The 2 groups had similar rate of new DU during the emergency period, but DUCAS slightly increased during therapy discontinuation, decreasing after resuming it. After COVID-19, one patient underwent a fingertip sub-amputation, and an 85-year-old male with multiple comorbidities died for complications related to the infection.ConclusionsMost SSc patients briefly discontinued iloprost therapy, without increase of new DU number, but with a slight increase of their severity. The regular telephonic contact helped the management that, although not optimal, was adapted to the needs of the individual patient during this emergency period. DUCAS proved to be a useful tool for rheumatologists. COVID-19 had serious consequences in the two patients who contracted it.
Exogenous coronavirus interacts with endogenous retrotransposon in human cells
Authors: Yin Ying , Liu Xiao-zhao , He Ximiao , Zhou Li-quan
Published: July 2020

Background: There is an increased global outbreak of diseases caused by coronaviruses affecting respiratory tracts of birds and mammals. Recent particularly dangerous coronaviruses are MERS-CoV, SARS-CoV and SARS-CoV-2, causing respiratory illness and even failure of several organs. However, profound impact of coronavirus on host cells remains elusive. Results: Here, we go deep into transcriptome of MERS-CoV, SARS-CoV and SARS-CoV-2 infected human lung-derived cells, and observed that infection of these coronaviruses all induced increase of retrotransposon expression through upregulation of TET genes. Similar upregulation of retrotransposon was also observed in SARS-CoV-2 infected human intestinal organoids. Retrotransposon upregulation will lead to increased genome instability and more frequent readthrough from retrotransposon to dysregulate gene expression. People with higher basal level of retrotransposon like cancer patients and aged people will have increased risk of symptomatic infection. Additionally, we show evidence supporting long-term epigenetic inheritance of retrotransposon upregulation. We also observed significant amount of chimeric transcripts of retrotransposon and SARS-CoV-2 RNA for potential human genome invasion of viral fragments, with the front and the rear part of SARS-CoV-2 genome being easier to form chimeric RNA, and this may apply for other coronaviruses. Here we suggest that primers and probes for nucleic acid detection should be designed in the middle of virus genome to identify live virus with higher probability. Conclusions: In summary, we propose that infection of coronaviruses especially SARS-CoV-2 induce retrotransposon activation, formation of chimeric coronavirus-retrotransposon RNA, and elicits more severe symptoms in patients with underlying diseases. More attention may need to be paid to potential harm contributed by retrotransposon dysregulation in treatment of coronavirus-infected patients.
A Study of the Spatial Network Structure of the Health Economy in China: Benefits and Spillover Effects on Patient Mobility
Authors: Fu Liping , Kaibo Xu , Feng Liu , Lu Liang , Zhengmin Wang
Published: July 2020

Background: The distribution of medical resources in China is seriously imbalanced due to imbalanced economic development in the country, and unbalanced distribution of medical resources makes patients try to seek better health services. Against this backdrop, this study aims to analyse the spatial network characteristics and spatial effects of China's health economy ,and then find evidence that affects patient mobility. Methods: Data for this study were drawn from the China Health Statistical Yearbooks and China Statistical Books. The gravitational value of China’s health spatial network was calculated to establish a network of gravitational relationships. The social network analysis method is used for centrality analysis and spillover effect analysis. Based on the gravitational value, we used indicators for visits, health expenditure, GDP and geographical distance, as well as an illustrative index for the population, bed utilization, and burden of consultations per day. Results: A gravity correlation matrix was constructed among provinces by calculating the gravitational value, indicating the spatial relationships of different provinces in the health economic network. Economically developed provinces, such as Shanghai and Jiangsu, are at the centre of the health economic network (centrality degree=93.333). These provinces also play a strong intermediary role in the network and have connections with other provinces. In the CONCOR analysis, 31 provinces are divided into four blocks. In the traditional meaning analysis, the gap between eastern and western China is still obvious. In comparing the northern and southern regions, this study finds that the concentration of medical resources in northern provinces seems to be higher. The spillover effect of the blocks indicates provinces with medical resource centres have beneficial effects, while provinces with insufficient resources have obvious spillover effects. Conclusion: There is a significant gap in the geographical distribution of medical resources, and the health economic spatial network structure needs to be improved. Most medical resources are concentrated in economically developed provinces, and these provinces’ positions in the health economic spatial network are becoming more centralized. By contrast, economically underdeveloped regions are at the edge of the network, causing patients to move to provinces with medical resource centres. There are health risks of the increasing
Cerium oxide nanoparticles conjugated to anti-inflammatory microRNA-146a prevent bleomycin-induced acute lung injury
Authors: Niemiec Stephen , Hilton Sarah , Wallbank Alison , Azeltine-Bannerman Mark , Louiselle Amanda , Elajaili Hanan , Allawzi Ayed , Xu Junwang , Mattson Courtney , Dewberry Lindel , Hu Junyi , Singh Sushant , Sakthivel Tamil , Nozik-Grayck Eva , Smith Bradford , Seal Sudipta , Zgheib Carlos , Liechty Kenneth
Published: July 2020

Acute respiratory distress syndrome (ARDS) is a devastating pulmonary disease with significant inhospital mortality and is the leading cause of death in COVID-19 patients. Potential therapies remain limited despite advancements in understanding ARDS pathophysiology. Excessive leukocyte recruitment, unregulated inflammation, and resultant fibrosis contribute to poor ARDS outcomes. In this study, we evaluated the potential of the radical scavenging cerium oxide nanoparticle (CNP) conjugated to the anti-inflammatory microRNA-146a (CNP-miR146a) to prevent acute lung injury (ALI) following exposure to bleomycin. We have found that CNP-miR146a can prevent ALI by altering leukocyte recruitment, reducing inflammation, and decreasing collagen deposition, ultimately improving pulmonary biomechanics.
Short-Term Outcomes of Low Versus High Inspiratory Oxygen Fraction During Induction of General Anesthesia in Noncardiac Surgery: A Pragmatic Open-Label Randomized Non-Inferiority Trial
Authors: Su Tzu-Huan , Li Kuang-Yao , Chen Tzu-Shan , Chang Shu-Ching , Su Yi-Kai , Li Chung-Yi , Lam Chen-Fuh
Published: July 2020

Background. High inspiratory oxygen fraction (FIO2) is associated with increased perioperative pulmonary morbidity and postoperative mortality. However, the use of pure oxygen is still currently recommended during the anesthesia induction.Methods, This open-label randomized non-inferiority trial was conducted in two metropolitan hospitals at Southern Taiwan. A total of 302 surgical patients (ASA PC≤III) who received endotracheal general anesthesia (ETGA) were randomized to receive 100% (FIO2 1.0) or 60% (FIO2 0.6) oxygen during induction. The primary endpoint was presence of hypoxemia (SpO2≤92%) during the induction of anesthesia. The secondary endpoint was the development of major complications immediately and within 3 days after surgery.Results. A total of 5 patients in the FIO2 0.6 group developed hypoxemia during induction (3.9% vs 0% for FIO2 0.6 vs FIO2 1.0, respectively; P=0.167 for non-inferiority), suggesting that FIO2 0.6 was inferior than FIO2 1.0 for anesthesia induction. The mean lowest SpO2 during induction was also significantly lower in FIO2 0.6 group. Four patients reached the primary endpoint had increased body mass indexes (BMI>30 kg/m2). However, the overall incidence of desaturation developed after removal of endotracheal tube was higher in FIO2 1.0 group (1.4% vs 5.8%, FIO2 0.6 vs FIO2 1.0; odd ratio 0.22, 95% confidence interval 0.05-1.05; P=0.064).Conclusions. High fractions of oxygen should be used for oxygenation during induction of ETGA in general population, especially in the obese patients. However, the supplement of high FIO2 during induction was associated with increased hypoxemic events after removal of endotracheal tube that might have a more significant impact on perioperative care.
Assessment of Community Psycho-behavioral Responses during the outbreak of novel coronavirus (2019-nCoV): A cross-sectional study
Authors: Magdy Doaa , Metwally Ahmed , Magdy Omar
Published: July 2020

Objectives: To examine the public’s knowledge and psychological impact during the outbreak of (2019-nCoV) and the extent to which precautionary measures have been adopted. We conducted an online survey on precautionary measures against (2019-nCoV), self-health evaluation, knowledge about (2019-nCoV), and appraisal of crisis management. The psychological impact was assessed by the General Anxiety Disorder 7-item scale. Results: This study included 1200 respondents. In total, 80% of respondents rated the psychological impact; 18% reported minimal anxiety; 34% reported mild anxiety, and (48%) with moderate anxiety symptoms. (74%) believed that they were very or somewhat likely to contract (2019-nCoV) while only 35% believed they were unlikely to survive if they contracted the disease. (58%) of the respondents, practiced the precautionary measures directed against droplet spread. Respondents with a moderate level of anxiety were most likely to take comprehensive precautionary measures. Also, older, female, more educated people as well as those who are more likely to contract the infection. Conclusions: The psychological needs during the outbreak should be addressed appropriately. Our results highlight the need to promote protective personal health practices in the community. Therefore, educational public programs about preventive measures should be targeted to groups with low current uptake of precautions.
Minocycline Might Be an Adjunctive Therapy Option for the Treatment of COVID-19: In Silico Screening, Structure-affinity Relationship, and Literature Review
Authors: Xiao Bin
Published: July 2020

Up to now, there is no specific therapy for the globally ongoing COVID-19. To explore potential inhibitors of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) for the treatment of novel coronavirus disease (COVID-19), in silico screening of 135 clinical drugs was performed targeting on 3-chymotrypsin-like protease (3CLpro, or M pro ). Six drugs including anti-HIV drug (raltegravir), antibacterial drugs (cefonicid, cefoperazone, minocycline), and antidiabetic drugs (canaglifozin, glyburide) showed high binding affinities (≤ -8.5 kcal/mol) and interesting binding conformations compared with the designed co-crystal ligand N3 (-7.7 kcal/mol). In which the antibiotic minocycline, an inhibitor of bacterial ribosomal rRNA, showed the highest binding affinity (-9.6 kcal/mol). Valuable hydrogen bonding and hydrophobic interactions were found between minocycline and Mpro active site. Beside the hydrogen bond with Cys145, minocycline formed a Pi-Cation with His41, which strongly supported minocycline as a Michael Addition acceptor to bind with the catalytic site of Mpro . The structure-affinity relationship was studied based on molecular docking of minocycline analogues. Literature review found that minocycline had both in vitro and in vivo broad-spectrum antiviral as well as anti-inflammatory activities, and the levels of a broad-spectrum of biological markers during minocycline administration were opposed to those of COVID-19 condition (both severe and non-severe). Minocycline deserves in vitro and in vivo evaluations as SARS-CoV-2 inhibitor as well as a randomized controlled trial to investigate the efficacy for COVID-19. These studies will shed new light on an adjuvant treatment strategy for this potentially lethal viral disease.
Clinical competence of serum miR-372 expression in diagnosing prostate cancer
Authors: Li Sheng , Ruan Xiaolan , Liu Tongzu
Published: July 2020

Background: Prostate cancer (PCa) is considered as a serious healthy burden among males around the world. The limited diagnosis leads to poor outcomes of this malignancy. Aberrant expression of microRNAs (miRNAs) have been found in human cancers and play crucial roles in these malignant diseases. MicroRNA-372 (miR-372), as a type of miRNAs, has ever been investigated in various cancers. The purpose of the present study was to assess the expression patterns and diagnostic value of miR-372 in patients with PCa.Methods: 134 PCa patients and 68 healthy individuals were included in this study. The serum expression of miR-372 was examined by quantitative real-time PCR (qRT-PCR). To verify the diagnostic significance of miR-372, receiver operating characteristics (ROC) analysis was conducted for PCa patients.Results: Downregulated miR-372 expression was detected in serum samples collected from PCa patients compared with the healthy controls (P<0.001). The decreased expression of miR-372 was influenced by the positive lymph node metastasis (P=0.016), high prostate-specific antigen (PSA) concentration (P=0.002) and advanced TNM stage (P=0.013). The ROC curve was obtained with an AUC value of 0.896. At the cutoff value of 2.855, the sensitivity and specificity were 82.8% and 87.3%, respectively, suggesting the high diagnostic accuracy of miR-372.Conclusion: In summary, serum downregulated expression of miR-372 could serve as an efficient diagnostic biomarker for patients with PCa.
Study on the Risk Factors of Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture
Authors: Chang Wenjie , Wang Bin , Li Qiwei , Zhang Yongkui , Xie Wenpeng
Published: July 2020

Background:The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by deep vein thrombosis (DVT), and to help surgeons aptly prevent it.Methods:A retrospective analysis was conducted on the orthopedic inpatient records of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from July 2014 to November 2018, and 11,891 patients with closed fractures of lower extremities were selected.By analyzing each patient's gender, age, presence or absence of diabetes and hypertension,preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by DVT were analyzed.Results: A total of 11,891 patients were selected, including 4462 with cases of peri-hip fractures, 754with cases of femoral shaft fractures, 1776 with cases of peri-knee fractures, 1961 with cases of tibiofibular fractures, and 2938 with cases of ankle fractures.Of these patients, 643 with DVT were detected, displaying a total incidence of 5.4%.All patients were categorized into either the DVT group or non-DVT group.The results demonstrate that there were statistically significant differences between the two groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level (p<0.05), but there was no statistically significant difference in sex (p>0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT.Conclusion: Age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level were found to be correlated with the incidence of DVT. Moreover,age, the presence of diabetes, the preoperative fracture site, and the plasma D-dimer level were found to be independent risk factors.
Examination of the Exchange Rate and Import Price Pass-through to Inflation: A View from Nigeria
Authors: Onipede Samuel F , Bashir Nafiu A , Nduka Kodili N , Usman Nuruddeen
Published: July 2020

We examine the effect of exchange rate and import price pass-through to inflation in Nigeria using headline inflation and import price data, with the aid of a non-recursive Structural Vector Autoregression model. Our results indicate mostly incomplete ERPT and IPPT to inflation. Specifically, we found that (i) the ERPT to the INF is incomplete at all horizons. (ii) IPPT to the INF is incomplete at all horizons. (iii) IPPT to inflation is relatively more rapid than the ERPT to inflation. The findings further suggest that the monetary authority should be wary of using devaluation of the domestic currency as a way of propping up the economy as that would not only aggravate domestic inflation but likely to also increase the ERPT. Similarly, harmonizing the disparate exchange rate windows in the economy might reduce import price pass-through to domestic inflation. Also, the size and speed of both ERPT and IPPT from the study suggest that relevant authorities need to strengthen domestic industries and instill confidence in consumers, to reduce reliance on imports.JEL Classification: C32; E31; F31; 055
Cost-effectiveness of a Population-based AAA Screening Program for Men Over 65 Years Old in Iran
Authors: Daroudi Rajabali , Shafe Omid , Moosavi Jamal , Salimi Javad , Bayazidi Yahya , Zafarghandi Mohammad Reza , Maleki Majid , Moini Majid , Farshidmehr Pezhman , Sadeghipour Parham
Published: July 2020

Background: Screening program tend to recognized patients in their early stage and consequently improve health outcomes. Cost-effectiveness of the abdominal aortic aneurysm (AAA) screening program has been scarcely studied in developing countries. We sought to evaluate the cost-effectiveness of a screening program for the abdominal aortic aneurysm (AAA) in men aged over 65 years in Iran.Methods: A Markov cohort model with 11 mutually exclusive health statuses was used to evaluate the cost-effectiveness of a population-based AAA screening program compared with a no-screening strategy. Transitions between the health statuses were simulated by using 3-month cycles. Data for disease transition probabilities and quality of life outcomes were obtained from published literature, and costs were calculated based on the price of medical services in Iran and the examination of the patients’ medical records. The outcomes were life-years gained, the quality-adjusted life-year (QALY), costs, and the incremental cost-effectiveness ratio (ICER). The analysis was conducted for a lifetime horizon from the payer’s perspective. Costs and effects were discounted at an annual rate of 3%. Uncertainty surrounding the model inputs was tested with deterministic and probabilistic sensitivity analyses. Results: The mean incremental cost of the AAA screening strategy compared with the no-screening strategy was $140 and the mean incremental QALY gain was 0.025 QALY, resulting in an ICER of $5566 per QALY gained. At a willingness-to-pay of 1 gross domestic product (GDP) per capita ($5628) per QALY gained, the probability of the cost-effectiveness of AAA screening was about 50%. However, at a willingness-to-pay of twice the GDP per capita per QALY gained, there was about a 95% probability for the AAA screening program to be cost-effective in Iran.Conclusions: The results of this study showed that at a willingness-to-pay of 1 GDP per capita per QALY gained, a 1-time AAA screening program for men aged over 65 years could not be cost-effective. Nevertheless, at a willingness-to-pay of twice the GDP per capita per QALY gained, the AAA screening program could be cost-effective in Iran. Further, AAA screening in high-risk groups could be cost-effective at a willingness-to-pay of 1 GDP per capita per QALY gained.
Household Costs Associated With Seeking Malaria Treatment During Pregnancy: Evidence From Burkina Faso and The Gambia
Authors: Duval Laetitia , Sicuri Elisa , Scott Susana , Traoré Maminata , Daabo Bunja , Tinto Halidou , Grietens Koen Peeters , d’Alessando Umberto , Schallig Henk , Mens Petra , Conteh Lesong
Published: July 2020

Background: Malaria in pregnancy remains a major health threat in sub-Saharan Africa to both expectant mothers and their unborn children. To date, there have been very few studies focused on the costs associated with seeking treatment for malaria during pregnancy.

Methods . A cross-sectional survey was undertaken in Burkina Faso and The Gambia to estimate the direct (medical and non-medical) and indirect costs associated with outpatient consultations (OP) and inpatient admissions (IP). In total, 220 pregnant women in Burkina Faso and 263 pregnant women in The Gambia were interviewed about their treatment seeking decisions, expenditure, time use and financial support associated with each malaria episode .

Results : In Burkina Faso 6.7% sought treatment elsewhere before their OP visits, and 32.9% before their IP visits. This compares to 1.3% for OP and 24.1% for IP in The Gambia. Once at the facility, the average direct costs (out of pocket) were 3.91US$ for an OP visit and 15.38US$ of an IP visit in Burkina Faso, and 2.75US$ for an OP visit and 9.19US$ for an IP visit in The Gambia. Inpatient direct costs were driven by drug costs (9.27US$) and transportation costs (2.72US$) in Burkina Faso and drug costs (3.44 US$) and food costs (3.44 US$) in The Gambia. Indirect costs of IP visits, valued as the opportunity cost of time lost due to the illness, were estimated at 11.85US$ in Burkina Faso and 4.07US$ in The Gambia. The difference across the two countries was mainly due to the longer time of hospitalization in Burkina Faso compared to The Gambia. In The Gambia, the vast majority of pregnant women reported receiving financial support from family members living abroad, most commonly siblings (65%).

Conclusions: To reach successful global malaria control, there is an urgent need to understand the barriers pregnant women face when seeking prevention and treatment for malaria at health facilities. Our findings suggest that direct and indirect costs, both medical and non-medical, are likely to affect access to health care.
Deciphering The Complex Circulating Immune Cell Microenvironment in Chronic Lymphocytic Leukemia Using Patient Similarity Networks
Authors: Mikulkova Zuzana , Manukyan Gayane , Turcsanyi Peter , Urbanova Renata , Savara Jakub , Ochodkova Eliska , Kudelka Milos , Brychtová Yvona , Molinsky Jan , Simkovic Martin , Starostka David , Novak Jan , Janca Ondrej , Dihel Martin , Ryznerova Pavlina , Mohammad Lekaa , Papajik Tomas , Kriegova Eva
Published: July 2020

Background: The tissue microenvironment in chronic lymphocytic leukemia (CLL) plays a key role in promoting neoplastic cell survival, proliferation, and drug resistance. There is a lack of complex characterization of CLL blood microenvironment and its clinical impact. Methods: Immunophenotypic profiles of circulating immune cells in 244 CLL patients (untreated, n=123; novel agents, n=67; previous immunochemotherapy, n=54) and age/sex-matched healthy controls (n=52) were assessed using flow cytometry and analyzed by multivariate patient similarity networks (PSNs). Results: Our study revealed high inter-individual heterogeneity in distribution and activation status of bystander immune cells in CLL, depending on the bulk of CLL cells. High CLL counts were associated with low activation status on circulating monocytes, T and NK cells and vice versa low CLL counts with high activation of immune cells, reaching levels in controls. Regarding treatment, the highest activation of immune cells, particularly of intermediate and non-classical monocytes, was evident in patients treated with novel agents. Clustering and visualization using PSNs confirmed low activation of immune cells in progressive disease, irrespectively of IgHV status and Binet stage. Calculating time-to-event endpoint, patients with high intermediate monocytes (>5.4%), predominantly low activated, were associated with 2.5-fold higher likelihood (95% CI 1.421-4.403, P =0.002) of event than those with low percentage of intermediate monocytes. Conclusions: Activation of circulating immune cells are dependent on the CLL cell counts and used therapy, with the lowest activation in patients with progressive disease. Percentage and activation of intermediate monocytes could be of prognostic value in CLL.
High Anti-Müllerian Hormone Level is Associated with A Lower Chromosomal Aberration Rate in Miscarried Conceptus From Women with Early Spontaneous Abortion
Authors: Mu Mingkun , Sun Simin , Zheng Wei , Yang Chen , Yang Shuheng , Zu Ruowen , Zhang Linlin , Gao Jinshuang , Li Jing , Wang Xingling , Guan Yichun
Published: July 2020

Background: Approximately 10-15% of clinically recognized pregnancies end in abortion. Most miscarriages occur as early spontaneous abortions. There are many factors leading to early spontaneous abortion, and 50–60% of such cases are associated with chromosomal abnormalities. The reason for this occurrence is not clear, but advanced age is a risk factor for chromosomal aberration in miscarried conceptus from women with early spontaneous abortion. As a marker of ovarian reserve, anti-Müllerian hormone (AMH) is negatively correlated with age. As women become older, AMH levels decrease. The objective of this study was to investigate whether different anti-Müllerian hormone (AMH) levels are associated with chromosomal aberration rate in miscarried conceptus from women who experience early spontaneous abortion.Methods: We collected the clinical history and miscarried conceptus of 434 women with early spontaneous abortion from January 2016 to June 2019. The women were divided into three groups according to AMH level (Group 1: low AMH <1.1 ng/ml [N =13], Group 2: normal AMH 1.1–4.5 ng/ml [N = 138], and Group 3: high AMH≥4.5 ng/ml [N =283]). Clinical history included age, anti-Müllerian hormone (AMH) level, number of previous abortions, estradiol (E2) level, luteinizing hormone (LH) level, follicle-stimulating hormone (FSH) level, infertile years, body mass index (BMI) and infertility factors. The miscarried conceptus was submitted for chromosomal copy number variation (CNV) analysis in the gene testing laboratory of the Third Affiliated Hospital of Zhengzhou University. Results: There were significant differences in age (39.5±4.3 vs. 33.0±5.3v s. 29.7±3.9, P＜0.001), E2 (187.9±513.4 vs. 92.9±160.6 vs. 66.5±139.3, P=0.019), LH (5.1±3.9 vs. 4.5±2.5 vs. 5.4±3.5, P=0.039), and FSH (10.7±5.6 vs. 7.3±2.6 vs. 6.4±2.1, P＜0.001) in different AMH groups. There were no significant differences in infertility years, BMI and infertility factors among the three groups.There was a significant difference in chromosomal aberration rate between different AMH groups (76.9% vs. 67.4% vs. 53.7%, Groups 2 vs. 3, respectively, P=0.008, OR 0.797, 95% CI 0.680-0.934). With the increase in AMH level, the chromosomal aberration rate in miscarried conceptus decreased gradually. After age stratification, the chromosomal aberration rate in miscarried conceptus was still significantly different among AMH groups, with a similar trend in women ≥35 years old (88.9% versus 76.0% versus 51.5%, P2 vs. 3 = 0.021, OR 0.678, 95% CI 0.470-0.977). There was the same trend in the younger group (＜35 years), but there was no significant difference (88.9% vs. 76.0% vs. 51.5).Conclusions: These findings indicate that high AMH level was associated with reduced risk of chromosomal aberration rate, especially in women of advanced age (≥35 years).
Clinical Features and Risk Factors Associated with Mortality in Critically ill Children Requiring Continuous Renal Replacement Therapy
Authors: Duyu Muhterem , Turkozkan Ceren
Published: July 2020

Background: The aims of this study were to describe the epidemiology and demographic characteristics of critically ill children requiring continuous renal replacement therapy (CRRT) at our pediatric intensive care unit (PICU) and to explore risk factors associated with mortality. Methods: A retrospective cohort of 121 critically ill children who received CRRT from May 2015 to May 2020 in the PICU of a tertiary healthcare institution was evalauted. The demographic information, admission diagnosis, indication for CRRT, clinical variables at the initiation of CRRT, time related variables and the laboratory results at initiation of CRRT were compared between survivors and non-survivors.Results: The most common diagnoses were renal disease (30.6%), hemato-oncological disease (12.4%), and sepsis (11.6%). The overall mortality was 29.8%. When compared according to diagnosis at admission, we found that patients with hemato-oncologic disease (73.3%) and those with pneumonia/respiratory failure (72.7%) had the highest mortality, while patients with renal disease had the lowest mortality (5.4%). The most common CRRT indications were: electrolyte or acid base imbalance (38.8%), acute kidney injury (29.8%) and fluid overload (14.9%). There was no relationship between mortality and indication for CRRT. The time interval between PICU admission and CRRT initiation was also unassociated with mortality (p=0.146). In patients diagnosed with sepsis, time until the initiation of CRRT was significantly shorter in survivors compared to non-survivors (p=0.004). Based on multivariate logistic regression, presence of comorbidity (odds ratio: 5.71; %95 CI: 1.16-27.97), being diagnosed with pneumonia/respiratory failure at admission (odds ratio: 16.16; %95 CI: 1.56-167.01), and high lactate level at the initiation of CRRT (odds ratio: 1.43; %95 CI: 1.17-1.79) were independently associated with mortality.Conclusions: In the context of the population studied mortality rate was lower than previously reported. In critically ill children requiring CRRT, mortality seems to be related to underlying disease, presence of comorbidity, and high lactate levels at CRRT initiation. We also found that early initiation of CRRT in sepsis can reduce mortality.
Microbiota community assembly in wild rice (Oryza longistaminata) in response to drought stress shows phylogenetic conservation, stochasticity, and aboveground-belowground patterns
Authors: ding xia , Peng Xiaojue , Chen Zhichao , Li Yingjie , Mao Lihui , Xie Hongwei , Cai Yaohui
Published: July 2020

Background

Drought is a global environmental stress that limits crop yields. Microbial communities control many biogeochemical processes, and a predictive understanding of how crop microbial communities assemble in response to drought stress is central to addressing the challenges caused by drought. Little is known about the microbiome assembly processes in rice-ecosystems, particularly with regard to their environmental adaptation. Wild rice may serve as a source of superior drought tolerance candidate for rice breeding. There is an urgent need to explore wild rice resistance mechanisms to drought stress. Here, we evaluated the effect of drought stress on the microbial community recruitment and assembly in the endosphere (leaf, stem, and root) and rhizosphere of Oryza longistaminata.
Results

Species replacement was the dominant process shaping microbial community composition under drought stress. O. longistaminata recruited the phyla Actinobacteria and Fusobacteria, the genus Streptomyces, and phototrophic prokaryotes to improve its fitness. The host exerted strong effects on microbiome assembly, and the responses of the microbial community structure to the drought environment showed above- and belowground patterns. Drought reduced taxonomic α-diversity and destabilized co-occurrence network properties in the leaves and stems, but not in the roots and rhizosphere. Drought promoted the restructuring and strengthening of belowground network links to more strongly interconnect network properties. The drought response of the microbiome was phylogenetically conserved. Stochastic (neutral) processes acted on microbial community reassembly in response to drought stress across all four compartments.
Conclusions

Our results provide new insight into the mechanisms through which drought alters microbial community assembly in drought-tolerant wild rice and reveal a potential strategy for manipulating plant microbiomes to improve crop fitness.
Assessment of Chronic Disease Self-management in Patients With Chronic Heart Failure Based on the MCID of Patient-reported Outcomes by the Multilevel Model
Authors: Tian Jing , Zhao Jinghua , Zhang Qing , Ren Jia , Han Linai , Li Jing , Zhang Yanbo , Han Qinghua
Published: July 2020

Purpose:The minimal clinically important difference (MCID) of a patient-reported outcome (PRO) represents the threshold value of the change in the score for that PRO. It is deemed to have an important implication in clinical management. This study was performed to evaluate the clinical significance of chronic disease self-management (CDSM) for patients with chronic heart failure based on the MCID of the chronic heart failure - PRO measure (CHF-PROM).Methods: A multicenter, prospective cohort study of 555 patients with heart failure were enrolled from May 2017 to May 2019. Advice of CDSM was provided in written form at discharge to all patients. Information regarding CHF-PROM and CDSM were collected during follow-up. Multilevel models were applied to dynamically evaluate the effects of CDSM for CHF-PROM scores, as well as its physical and psychological domains. MCID changes of the PRO were introduced and compared with β values of CDSM obtained from the multi-level models to further evaluate the clinical significance.Results: Scores for CHF-PROM improved significantly after discharge. The multilevel models showed that a regular schedule, avoidance of over-eating, a low-sodium diet and exercise increased scores on CHF-PROM. Compared with the MCID, avoidance of over-eating almost every day (13.60 vs. 10.71) and maintenance of a regular schedule often (12.03 vs. 10.71) reached clinical significance for the overall summary. Avoidance of over-eating (4.56 vs. 4.14) and a regular schedule almost every day (4.76 vs. 4.14) reached clinical significance for the physical scores. Avoidance of over-eating often (5.73 vs. 5.35) and a regular schedule almost every day (6.36 vs. 5.35) demonstrated clinical significance for the psychological scores.Conclusions: This study observed an association of avoidance of over-eating and maintenance of a regular schedule with the improvement of CHF-PROM. It provides further evidence for management of heart failure.Trial registration: 2018LL128, RegisteredJanuary 2, 2018-Prospective registered, http://www.sxmu.edu.cn/.
SARS-COV-2 infection during pregnancy, a risk factor for eclampsia or neurological manifestations of COVID-19? Case report.
Authors: Rodriguez Alejandro Garcia , Contreras Sergio Marcos , Manovel Santiago Manuel Fernandez , Vidal Jose Miguel Marcos , Buron Fernando Diez , Fernandez Camino Fernandez , Gonzalez Maria del Carmen Riveira
Published: July 2020

Background: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and SARS-COV-2 infection. We do not just face new and unknown manifestations, but also how different patients groups are affected by SARS-Cov-2 infection, like pregnant women. COVID-19, preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. Case presentation: We present a case of a 35 years old pregnant woman, who comes to our hospital because of tonic-clonic seizures at home and SARS-COV-2 infection. After Caesarean section, we initiate antihypertensive treatment with labetalol, amlodipine and captopril. Few hour after C-section, she develops blindness with total recuperation after 72 hours, normal brain CT scan and normal CT angiography. She had normal pregnancy control and no other symptoms before tonic-clonic seizures development. Conclusion: SARS-COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.
Relationship Between Maternal Meat Consumption During Pregnancy and Umbilical Cord Ferritin Concentration
Authors: Castro Mario Moraes , Camacho Fabiola Ruth Castedo , Ceriani Florencia , Fares Nelson , Herrera Tamara Isabel , Ferreira Catalina Vaz , Arocena Elsa , Girona Alejandra , Cavalleri Fiorella , Colistro Valentina , Borbonet Daniel
Published: July 2020

Background: Nutrition during pregnancy impacts the health of the fetus and the newborn, with effects at the epigenetic level determining long-term neurological consequences. Iron requirements in pregnancy are estimated at 27 mg/day. The best absorbed heme iron is found in meat: beef, pork, poultry, and fish.The determination of ferritin in umbilical cord blood can be used to assess iron deposits reached during the fetal stage. Ferritin levels were associated with long-term effects on child development.Methods: A descriptive, observational study with prospectively collected data was carried out during one-year period at the Department of Neonatology of the Pereira Rossell Hospital Center (CHPR) in Montevideo, Uruguay. A total of 188 patients met the inclusion criteria. Umbilical cord blood was drawn following a strict cord clamping after one minute of life. Ferritin was measured using the chemoimmunofluorescence method. A maternal nutritional survey was applied, using a qualitative-quantitative form measuring the frequency of consumption of iron source foods and approximated quantities consumed during the last trimester of pregnancy. This survey was focused on maternal consumption of beef as the major heminic iron source in Uruguay. The relationship between these variables was analysed.Results: Latent iron deficiency (ferritin in the umbilical cord <100 ng / ml) was associated with less consumption of beef during pregnancy. Fisher p-value: 0.0133, OR: 3.71, 95% CI [1.25 - 11.05].Conclusions: This study considers adequate evidence that low levels of total iron and meat consumption during pregnancy will determine an increased risk of latent iron deficiency and lower levels of ferritin in newborns, and therefore, greater risk of long-term adverse effects on myelination and neurocognitive development.