bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Pageantries: Learning or Enjoying?
Authors: Salazar Victor William B. , Moneva Jerald C.
Published: April 2020

Pageantries, as defined connotatively, are events or outdoor performances consisting of a procession of people in elaborate costumes and attires. Beauty pageants, which often occur in schools during culminating activities, immensely help students gain a wider point of view towards education and can also be enjoyable at the same time. However, there are still plenty of students who tend to infer these events as leisure activities or sources for enjoyment. The main goal of the study is to determine which will transpire more between learning and enjoying, to do so, the researcher used the quantitative – correlational approach. To obtain the best responses possible, the chosen respondents for the study were the Grade 10 and the Senior High School students of Jagobiao National High School. The researcher first explained the purpose of the study and then assured the respondents that the data gathered will only be for research purposes. The researcher then distributed the survey questionnaires and collected them back after the given time limit. With proper analysis and interpretation of the data, it was determined that there is no significant relationship between the variables. However, pageantries offer students a unique experience and opportunity to gain more knowledge.
Description and Reliability of the AOSpine Sacral Classification System
Authors: Vaccaro Alexander R. , Schroeder Gregory D. , Divi Srikanth N. , Kepler Christopher K. , Kleweno Conor P. , Krieg James C. , Wilson Jefferson R. , Holstein Jörg H. , Kurd Mark F. , Firoozabadi Reza , Vialle Luiz R. , Oner F. Cumhur , Kandziora Frank , Chapman Jens R. , Schnake Klaus J. , Benneker Lorin M. , Dvorak Marcel F. , Rajasekaran Shanmuganathan , Vialle Emiliano N. , Joaquim Andrei F. , El-Sharkawi Mohammad Mostafa , Dhakal Gaurav R. , Popescu Eugen C. , Kanna Rishi M. , Muijs S.P.J. , Tee Jin W. , Bellabarba Carlo
Published: April 2020

Background:

Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons.

Methods:

A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (κ) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3).

Results:

Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (κ = 0.83) for fracture severity and substantial (κ = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (κ = 0.75), with the highest agreement for type-A fractures (κ = 0.95) and the lowest for type-C fractures (κ = 0.70). Overall interrater agreement was moderate (κ = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (κ = 0.81) and the lowest for A1 subtypes (κ = 0.20).

Conclusions:

To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment.
Risk factors for parastomal hernia of loop stoma and relationships with other stoma complications in laparoscopic surgery
Authors: Shiraishi Takuya , Nishizawa Yuji , Ikeda Koji , Tsukada Yuichiro , Sasaki Takeshi , Ito Masaaki
Published: April 2020

Background: Laparoscopic approach is now a widespread technique used worldwide, but there are few recent studies on risk factors for parastomal hernia. Therefore, this study was performed to analyze the incidence of parastomal hernia in laparoscopic and open operations in which a loop stoma was created and was intended to be temporary, and to determine risk factors for parastomal hernia formation. Associations between parastomal hernia and other stoma-related complications were also analyzed.Methods: A retrospective analysis of patient and surgical characteristics was performed in 153 consecutive cases with stoma creation in loop ileostomy or colostomy performed for any intra-abdominal condition at our hospital from January to December 2016.Results: Parastomal hernia developed in 77 cases (50.3%), including 39 (25.5%) diagnosed by physical examination and 38 (24.8%) detected by CT alone. In univariate analysis, a stoma that did not pass through the middle of the rectus abdominis muscle was a significant risk factor for parastomal hernia. This remained as the only independent risk factor for parastomal hernia formation in multivariate analysis. An additional analysis identified a laparoscopic approach as the only independent risk factor for formation of a stoma that did not pass through the middle of the rectus abdominis muscle. An analysis of stoma-related complications showed that peristomal skin disorders were significantly associated with parastomal hernia formation.Conclusions: This study showed that a stoma that is not formed through the middle of the rectus abdominis muscle is a risk factor for parastomal hernia, and that a laparoscopic approach is associated with this risk factor. Moreover, a parastomal hernia is significantly associated with peristomal skin disorders.
Factors associated with child health service delivery by female community health volunteers in Nepal: Findings from a national survey
Authors: Bhattarai Hari Krishna , Khanal Pratik , Khanal Vishnu , Regmi Kiran , Paudel Narendra Raj , Dhakal Liladhar , Singh Samikshya
Published: April 2020

Background: Nepal has made a significant improvement in child survival in the last few decades and the involvement of female community health volunteers (FCHVs) has been crucial in such achievement. While there have been a lot of documented studies and reports, rarely has been explored the status and factors associated with the child health service provided by these volunteers. The aim of this study was to identify the factors associated with the child health service delivery by FCHVs.Methods : A national survey was conducted in 2014 in Nepal that included 4,302 FCHVs using the structured questionnaire across the 13 geopolitical domains of the country. The data was extracted and the association of child health services with characteristics was examined using Chi-square test (χ2) followed by logistic regression. Results: Overall, 62.6% of FCHVs provided at least one child health service. Those FCHVs who utilized money from the FCHV fund, conducted health mothers’ group meeting, involved in local committees and those who supported antenatal care and outreach clinics related activities had higher odds of providing child health services. Similarly, FCHVs equipped with the stock of Cotrimoxazole tablet, Zinc tablet, Oral Rehydration Salt packets were more likely to provide child health services. The province-wise analysis showed that FCHVs from Province 5 and Sudur Paschim Province were more likely to provide child health services compared to their counterparts from province 1. Technology-wise, FCHVs who were using mobile were more likely to provide child health services.Conclusions : FCHVs are important human resource in providing child health services in Nepal. To improve child health service delivery by FCHVs, availability of key commodities, involvement of FCHVs in regular health mothers’ group meeting, use of mobile phone, involvement in other public health programs and social networks, and utilization of the FCHV fund need to be taken into consideration.
Concept Analysis of Community Health Outreach
Authors: Shin Hye Young , Kim Ka Young , Kang Purum
Published: April 2020

Background: The definition of community health outreach to promote the health of vulnerable populations depends heavily on the particulars of the given health project and community. There is no consistency in the definitions attached to the concept itself. Our study aimed to clarify the general definition of community health outreach to facilitate its understanding and use. Methods: Walker and Avant’s (2010) method of concept analysis was used to understand Community Health outreach. A total of 51 articles were included in the analysis after having searched for text on database portals like PubMed, Scopus, CINAHL complete and EMBASE published between 2010 and 2018. Results: The defining attributes of the concept of community health outreach were purposive, temporary, mobile and collaborative. The antecedents were individuals facing health risks and awareness of health risks. The consequences were increased accessibility and health promotion. Conclusion: This study proposed the definition of community health outreach as a temporary, mobile project that involves the collaboration of a community to undertake its purposeful health intervention of reaching a population facing health risks. This definition provides a general understanding of the outreach undertaken by health workers and enables the strong connection between health professionals and community residents.
Immunohistochemical Expression of Vitamin D Receptor and Forkhead Box P3 in Classic Hodgkin Lymphoma: Correlation with Clinical and Pathologic Findings
Authors: Gupta Gaurav , Agrawal Tanupriya , Pilichowska Monika
Published: April 2020

Background Expression of forkhead box P3 (FOXP3), a key regulator of T-cell function, in the tumor immune microenvironment is related to survival in classic Hodgkin lymphoma (CHL). Vitamin D receptor (VDR), a transcription factor , agonists have been shown to induce FOXP3 expression in T-cells and enhance recruitment of these cells to the inflammatory sites. VDR expression is CHL has beenis described. However, there is no data on expression of VDR in context of quantity of FOXP3 positiveexpressing cells in CHL. Methods We examined and correlated immunohistochemical expression of VDR and FOXP3 along with clinical and pathology findings in 29 cases of CHL. Results VDR was expressed in Hodgkin Reed-Sternberg (HRS) cells and background lymphocytes and FOXP3 was expressed in background lymphocytes. 82% of CHL cases, regardless of the subtype, expressed VDR and in majority of the cases, VDR expression was directly proportional to the quantity of FOXP3 expressing lymphocytes in the tumor microenvironment. In cases with higher clinical stage (III/IV), only 28.5% of cases diffusely expressed VDR and FOXP3 compared to 71.4% showing focal positivity. Whereas in cases with lower clinical stages (I/II), the expression pattern of VDR and FOXP3 was almost similar (41.6% diffuse versus 33.3% focal). Interestingly, focal VDR and FOXP3 expression pattern was significantly higher among males. Mixed cellularity cases showed predilection for focal VDR and FOXP3 expression (80% cases); whereas nodular sclerosis subtype had focal and diffuse VDR and FOXP3 expression patterns in similar proportion. Cases with diffuse VDR and FOXP3 expression were less likely to have bone marrow involvement. Epstein Barr virus- encoded small RNA (EBER) positive cases were predominantly focally positive (80%) for VDR and FOXP3. Conclusions In summary, quantity of FOXP3 positive T-cells in CHL microenvironment seems to correlate with VDR expression. Clinical stage show a trend of inverse correlation with expression of VDR and quantity of FOXP3 positive T-cells. These findings suggest that VDR could be a possible prognostic and therapeutic target in CHL.
LRIG1 gene copy number analysis by ddPCR and correlations to clinical factors in breast cancer
Authors: Faraz Mahmood , Tellström Andreas , Ardnor Christina Edwinsdotter , Grankvist Kjell , Huminiecki Lukasz , Tavelin Björn , Henriksson Roger , Hedman Håkan , Ljuslinder Ingrid
Published: April 2020

Background Leucine-rich repeats and immunoglobulin-like domains 1 ( LRIG1 ) copy number alterations and unbalanced gene recombination events have been reported to occur in breast cancer. Importantly, LRIG1 loss was recently shown to predict early and late relapse in stage I-II breast cancer. Methods We developed droplet digital PCR (ddPCR) assays for the determination of relative LRIG1 copy numbers and used these assays to analyze LRIG1 in twelve healthy individuals, 34 breast tumor samples previously analyzed by fluorescence in situ hybridization (FISH), and 423 breast tumor cytosols. Results Four of the LRIG1 /reference gene assays were found to be precise and robust, showing copy number ratios close to 1 (mean, 0.984; standard deviation, +/-0.031) among the healthy control population. The correlation between the ddPCR assays and previous FISH results was low, possibly because of the different normalization strategies used. One in 34 breast tumors (2.9%) showed an unbalanced LRIG1 recombination event. LRIG1 copy number ratios were associated with the breast cancer subtype, steroid receptor status, ERBB2 status, tumor grade, and nodal status. Both LRIG1 loss and gain were associated with unfavorable metastasis-free survival; however, they did not remain significant prognostic factors after adjustment for common risk factors in the Cox regression analysis. Furthermore, LRIG1 loss was not significantly associated with survival in stage I and II cases. Conclusions Although LRIG1 gene aberrations may be important determinants of breast cancer biology, and prognostic markers, the results of this study do not verify an important role for LRIG1 copy number analyses in predicting the risk of relapse in early-stage breast cancer.
Development of a clinical prediction rule for sepsis in primary care: protocol for the TeSD-IT study
Authors: Loots Feike J. , Hopstaken Rogier , Jenniskens Kevin , Frederix Geert W.J. , de Pol Alma C. van , Bruel Ann Van den , Oosterheert Jan Jelrik , Zanten Arthur R.H. van , Smits Marleen , Verheij Theo J.M.
Published: April 2020

Background Early recognition and treatment of sepsis is crucial to prevent detrimental outcomes. General practitioners (GPs) are often the first healthcare providers to encounter seriously-ill patients. The aim of this study is to assess the value of clinical information and additional tests to develop a clinical prediction rule to support early diagnosis and management of sepsis by GPs. Methods We will perform a diagnostic study in the setting of out-of-hours home visits in four GP cooperatives in the Netherlands. Acutely ill adult patients suspected of a serious infection will be screened for eligibility by the GP. The following candidate predictors will be prospectively recorded: 1) age; 2) body temperature; 3) systolic blood pressure; 4) heart rate; 5) respiratory rate; 6) peripheral oxygen saturation; 7) mental status; 8) history of rigors and 9) rate of progression. After clinical assessment by the GP, blood samples will be collected in all patients to measure C-reactive protein, lactate and procalcitonin. All patients will receive care as usual. The primary outcome is presence or absence of sepsis within 72 hours after inclusion, according to an expert panel. The need for hospital treatment for any indication will be assessed by the expert panel as a secondary outcome. Multivariable logistic regression will be used to design an optimal prediction model first, and subsequently derive a simplified clinical prediction rule that enhances feasibility of using the model in daily clinical practice. Bootstrapping will be performed for internal validation of both the optimal model and simplified prediction rule. Performance of both models will be compared to existing clinical prediction rules for sepsis. Discussion This study will enable us to develop a clinical prediction rule for the recognition of sepsis in a high-risk primary care setting to aid in the decision which patients have to be immediately referred to a hospital and who can be safely treated at home. As clinical signs and blood samples will be obtained prospectively, near complete data will be available for analyses. External validation will be needed before implementation in routine care and to determine in which pre-hospital settings care can be improved using the prediction rule. Trial registration The study is registered in the Netherlands Trial Registry (registration number NTR7026).
Reduced serum VGF levels are linked with suicide risk in Chinese Han patients with major depressive disorder
Authors: Li Xingxing , Ge Huifei , Zhou Dongsheng , Wu Xiangping , Qi Gangqiao , Chen Zan , Yu Chang , Zhang Yuanyuan , Yu Haihang , wang chuang
Published: April 2020

Background: VGF (nonacronymic) is a neuropeptide that plays an important role in the pathogenesis of major depressive disorder (MDD). However, no studies have yet investigated VGF levels in patients with MDD who are at risk of suicide. The purpose of the present study was to determine whether serum VGF levels are related to suicide risk in patients with MMD.Methods: A total of 107 patients with MDD and 40 normal control participated in the present study. The risk of suicide was assessed using the Nurses Global Assessment of Suicide Risk (NGASR). On this basis, 60 patients were assigned to a high-risk group (NGASR≥9) and 47 were assigned to a low-risk group (NGASR<9). The severity of depression was measured using the 17-item Hamilton Depression Rating Scale (HDRS). Levels of serum VGF were determined using a double antibody sandwich enzyme-linked immunosorbent assay.Results: Serum VGF levels in the high-risk group (883.34±139.67 pg/mL) were significantly lower than in the low-risk group (1020.56±131.76 pg/mL) and in the control group (1107.00±155.38 pg/mL) (F=31.90, p<0.001). In patients with MDD, suicide risk was significantly negatively correlated with VGF levels (r = -0.55, p=0.001). Conclusions: Reduced serum VGF levels are related to risk of suicide in patients with MDD, so VGF may be a biomarker of suicide risk in MDD.
Intralesional curettage versus Prosthetic replacement,which approach is suitable for bone tumors ?------ A finite element analysis of limb salvage simulation in biomechanics
Authors: PENG Matthew Jian-Qiao , SHEN ChuLong , CHEN Hai-Yan , HU Yong , HE Er-Xing , LAU YongQiang
Published: April 2020

The authors have withdrawn this preprint due to author disagreement.
Orange Peel As Low-cost Adsorbent In The Elimination Of Cd(II) Ions: Kinetics, Isotherm, Thermodynamic And Optimization Evaluations
Authors: Akinhanmi Fola Temilade , Ofudje Edwin Andrew , Adeogun Idowu Abideen , Peter Aina , Ilo Joseph Mayowa
Published: April 2020

The presence of heavy metals in polluted water is known not only to cause stern harm to marine organisms but also to terrestial plants and animals including human beings. This research applied low-cost and environmental benign adsorbent primed from waste orange peel (OP) in the removal of Cd(II) ions from aqueous solution via the batch process. The surface properties of the orange peel powder was studied using scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (XRD) and Fourier transform infrared spectroscopy FT-IR). Operational conditions like temperature, contact time, sorbent dosage, solution pH and initial adsorbate concentration were investigated. The utmost uptake of Cd(II) ion was obtained at the contact time of 120 min, initial metal concentration of 240 mg/L, adsorbent dosage of 0.04 g/L, temperature of 45 °C and solution pH of 5.5 on the adsorption of Cd(II) ion. Equilibrium results showed that the orange peel adsorbent has an adsorption capacity of 27.916 mg/g as obtained from the Langmuir isotherm. The adsorption kinetics data followed a Pseudo-first-order kinetic model with correlation coefficient (R2) > 0.9 and low standard % error values. The adsorption process was found to be spontaneous, feasible and with enthalpy of 0.0046 kJ mol− 1 and entropy of -636.865 Jmol− 1K− 1 respectively. Results from the optimization study indicated that higher adsorbent dosage and lower Cd(II) ion concentration increased the percentage of Cd (II) ion removal. Thus, orange peel could be used in the removal of Cd(II) ion from aqueous solutions.
Minimal evisceration combined with orbital implantation
Authors: Zhang Haitao , Shen Shuhao , Yang Jiajun , Xu Zhe
Published: April 2020

Background: To evaluate the minimal evisceration technique, which aims to reduce surgical damage and complications and achieve better cosmetic outcomes.Methods: Eighty patients were enrolled from January 2013 to January 2019. All of the patients underwent a minimal evisceration and hydroxyapatite (HA) implant procedure, including making a lateral incision on the sclera only, transecting the optic nerve, and placing an HA implant behind the posterior sclera in the muscular cone. The implant was covered by two layers of the sclera. The main outcome measures were surgery time, blood loss, days of hospitalization, time interval for placement of prosthesis after surgery, complications, such as implant extrusion or exposure, enophthalmos, conjunctival sac stenosis, and cosmetic outcome.Results: All of the patients received minimal evisceration combined with an orbital implant. The average surgery time was 30 min, blood loss was 3 ml, days of hospitalization were 3, and the time interval for placement of the prosthesis after surgery was 4 week. No complications were recorded. The cosmetic appearance and implant mobility were satisfactory.Conclusions: This technique has advantages such as less damage, fast recovery, good effects and fewer complications. It appears to be a perfect modification for anophthalmic socket reconstruction.
Metrics of Perineal Support (MOPS) Study
Authors: Kalis Vladimir , Rušavŷ Rusavy , HAVELKOVA Linda , ZITKA Tomas , TOLAR David , Ismail Khaled M.K.
Published: April 2020

Background: Manual perineal protection (MPP) is an intrapartum intervention suggested to protect perineal integrity during childbirth. Proper execution of MPP is complex and evaluation of its true contribution is difficult in the clinical setting because of the large number of obstetric variables, some of which are hardly quantifiable. In this study we aimed to gather initial data on the forces executed by the accoucheur's thumb, index and middle fingers during MPP at the time of fetal head expulsion, quantify the duration of the intervention and investigate the timely interaction of the different components of MPP.Methods: Two bespoke right-handed measurement gloves (MG), with built in sensors, were designed and produced. The MG allowed the electronic real-time measurement of applied forces during MPP and transferred this data wirelessly to an integrated computer system. Sterile gloves were worn over the MG when used at the time of birth. The study was undertaken between January and December 2019. Singleton, term pregnant women having their first vaginal birth who provided a valid written consent were enrolled into this prospective pilot study. All deliveries were undertaken by one of two obstetricians experienced in MPPResults: Twenty women were enrolled. The mean duration of execution of MPP during the last contraction was 13.6 s. In 20% it lasted < 5 s. The overall means of the mean and maximum forces of the thumb, index and middle fingers were 26.7 N; 25.5 N; 20.2 N and 34.3 N; 32.6 N; and 27.6 N respectively. The onset of fingers and thumb activity was simultaneous in 13 cases (65%), while in seven (35%) deliveries the middle finger's force activity was initiated later.Conclusions: MPP during fetal head expulsion happens over a short period of time. In the majority of cases the thumb and fingers actions started simultaneously. There were differences in the duration of application and the forces executed by the fingers and thumb between the two practitioners, however this was only significant for thumb measurements. The results obtained will aid in improving further MPP modeling studies to optimize the technique.
Transmitted drug resistance mutations and subtype diversity among HIV-1 sero-positive voluntary blood donors in Accra, Ghana
Authors: Obeng Billal Musah , Bonney Evelyn Yayra , Asamoah-Akuoko Lucy , Nii-Trebi Nicholas Israel , Mawuli Gifty , Abana Christopher Zaab-Yen , Sagoe Kwamena William Coleman
Published: April 2020

Background: Detection of HIV-1 transmitted drug resistance (TDR) and subtype diversity (SD) are public health strategies to assess current HIV-1 regimen and ensure effective therapeutic outcomes of ART among HIV-1 patients. Globally, limited data exist on TDR and SD among blood donors. In this study, drug resistance mutations and subtype diversity among HIV-1 sero-positive blood donors in Accra, Ghana was characterized.Methods: Purposive sampling method was used to collect 81 HIV sero-positive blood samples from the Southern Area Blood Center and confirmed by serology as HIV-1 and/or HIV-2. Viral RNA was only extracted from plasma samples confirmed as HIV-1 positive. Complementary DNA (cDNA) was synthesized using the RNA as a template and subsequently amplified by nested PCR with specific primers. The expected products were verified, purified and sequenced. Neighbor-joining tree with the Kimura’s 2-parameter distances was generated with the RT sequences using Molecular Evolutionary Genetic Analysis version 6.0 (MEGA 6.0).Results: Out of the 81 plasma samples, 60 (74%) were confirmed as HIV-1 sero-positive by INNO-LIA HIVI/II Score kit with no HIV-2 and dual HIV-1/2 infections. The remaining samples, 21 (26%) were confirmed as HIV sero-negative. Of the 60 confirmed positive samples, (32) 53% and (28) 50% were successfully amplified in the RT and PR genes respectively. Nucleotide sequencing of amplified samples revealed the presence of major drug resistance mutations in two (2) samples; E138A in one sample and another with K65R. HIV-1 Subtypes including subtypes A, B, CRF02_AG and CRF09_cpx were found. Conclusion: This study found major drug resistance mutations, E138A and K65R in the RT gene that confer high level resistance to most NNRTIs and NRTI respectively. CRF02_AG was most predominant, the recorded percentage of subtype B and the evolutionary relationship inferred by phylogenetic analysis suggest possible subtype importation. The data obtained would inform the selection of drugs for ART initiation to maximize therapeutic options in drug-naïve HIV-1 patients in Ghana.
Effect of ambient air pollutants and meteorological factors on COVID-19 transmission
Authors: Jiang Ying , Xu Xiao-Long , Dai Da-Wei , Wu Xiao-Jun , Wang Jun-Yu , Wang Yun-Kun , Huang Zhen-Yu , Wang Guang-Ming , Guan Yan-Jun
Published: April 2020

The authors have withdrawn this preprint due to author disagreement.
Clinical observation and prognostic analysis of patients with Klebsiella pneumoniae bloodstream infection
Authors: sun tongwen , zhang shuguang , yang ziyue , sun limin , wang zhenhua , sun liutao , xu jinli , zeng li
Published: April 2020

Background and Purpose: The clinical prognosis of Klebsiella pneumoniae bloodstream infection is poor, and the prevalence of drug-resistant bacteria makes clinical anti-infective treatment more challenging. This retrospective study evaluated the epidemiological characteristics of patients with Klebsiella pneumoniae, the risk factors for drug-resistant bacterial infection and death, and analyzed treatment options. Methods: Clinical data of 297 patients diagnosed with Klebsiella pneumoniae bacteremia between June 2014 and June 2019 were collected.Results: Intensive care unit hospitalization history, operation history, recent antibiotic use history, mechanical ventilation, and number of days hospitalized before bloodstream infection were found to be independent risk factors for drug-resistant bacterial infection. The risk of death for carbapenem-resistant Klebsiella pneumoniae infection was 2.942 times higher than that for carbapenem-sensitive Klebsiella pneumoniae infection. For extensively drug-resistant Klebsiella pneumoniae bacteremia patients, the mortality rate of combined anti-infective therapy was lower.Conclusions: Clinicians should pay attention to patients with high-risk drug-resistant bacteria infection and administer timely anti-infection treatment. The findings of this study may provide some suggestions for early identification and standardized treatment of patients with Klebsiella pneumoniae bacteremia.
Real-world efficacy of the impulse oscillometry system for the management of bronchial asthma
Authors: Sugawara Hiroyuki , Saito Atsushi , Yokoyama Saori , Tsunematsu Kazunori , Chiba Hirofumi , Takahashi Hiroki
Published: April 2020

Background: Bronchial asthma (BA) has different phenotypes, and it requires a clinically effective subtype classification system. The impulse oscillometry system (IOS) is a novel device used in respiratory functional tests. However, its efficacy has not been validated. Therefore, this study aimed to assess the relationship between BA and the IOS parameters, and the difference in the therapeutic effects of inhaled corticosteroids (ICSs) among the subtype classifications was evaluated using the IOS.Methods: Of the 245 patients with bronchial asthma who were screened, 108 patients were enrolled in this study. These patients were divided based on three subtypes according to the IOS result: Central predominant type (n=34), Peripheral predominant type (n=58), and resistless type (n=16). Then, the following ICSs were randomly prescribed in daily medical care: coarse-particle ICS (fluticasone propionate [FP]), fine-particle ICS (mometasone furoate [MF]), and moderate-particle ICS (budesonide [BUD]). The treatment effects were assessed using the Asthma Health Questionnaire (AHQ) and the Asthma Control Test (ACT), and were compared among the three subtypes.Results: In the central predominant type, the AHQ score of the MF group was significantly higher than that of the FP group (15.4 vs. 3.6, p<0.01) and BUD group (15.4 vs. 8.8, p<0.05), and the ACT score of the FP group was significantly higher than that of the MF and BUD groups (24.3 vs 21.7, 22.3, respectively, p<0.05) at 4 weeks after treatment. In the peripheral predominant type, the AHQ score of the FP group was significantly higher than that of the MF group (14.1 vs. 3.4, p<0.05) and the ACT score of the FP group was lower than that of the MF and BUD groups (22.8 vs 24.6, 24.4, respectively, p<0.01) at 4 weeks after treatment. In the resistless type, no significant difference was observed in the both scores among the three groups. Conclusions: A strong association was observed between IOS subtype classification and ICS particle size in terms of therapeutic efficiency in BA. This result indicates that the ICS particle size must be identified using the IOS subtype classification before treatment.
Azithromycin added to Hydroxychloroquine in Patients Admitted to Intensive Care due to Coronavirus Disease 2019 (COVID-19) – Protocol of Randomized Controlled Trial AZIQUINE-ICU
Authors: Duška František , Waldauf Petr , Halačová Milada , Zvoníček Václav , Bala Jakub , Balík Martin , Beneš Jan , Klementová Olga , Kozáková Irena , Kubricht Viktor , Roy Anne Le , Vymazal Tomáš , Řehořová Veronika , Černý Vladimír
Published: April 2020

Background: Novel coronavirus SARS-CoV-2 is known to be susceptible in vitro to exposure to hydroxychloroquine and its effect have been found to be potentiated by azithromycin. We hypothesize, that early administration of hydroxychloroquine alone or in combination with azithromycin can prevent respiratory deterioration in patients admitted to intensive care due to rapidly progressive COVID-19 infection. Methods: Design: Prospective, multi-centre, double blind, randomised, controlled trial (RCT). Participants: Adult (>18 years) within 24 hours of admission to intensive care unit with proven or suspected COVID-19 infection, whether or not mechanically ventilated. Exclusion criteria include duration symptoms of febrile disease for ≥1 week, treatment limitations in place or moribund patients, allergy or intolerance of any study treatment, pregnancy. Interventions: Patients will be randomized in 1:1:1 ratio to receive Hydroxychloroquine 800mg orally in two doses followed by 400mg daily in two doses and Azithromycin 500 mg orally in one dose followed by 250 mg in one dose for a total of 5 days (HC-A group) or Hydroxychloroquine+ placebo (HC group) or placebo + placebo (C-group) in addition to best standard of care, which may evolve during the trial period but will not differ between groups. Primary outcome is the composite percentage of patients alive and not on end-of-life pathway who are free of mechanical ventilation at day 14. Secondary outcomes: The percentage of patients who were prevented from needing intubation until day 14; ICU length of stay; mortality (in hospital) at day 28 and 90.Discussion: Although both investigational drugs are often administered off label to patients with severe COVID-19, at present, there is no data from RCTs on their safety and efficacy. In vitro and observational trial suggest their potential to limit viral replication and the damage to lungs as the most common reason for ICU admission. Therefore, patients most likely to benefit from the treatment are those with severe, but early disease. This trial is designed and powered to investigate whether the treatment in this cohort of patients leads to improved clinical patients-centered outcomes, such as mechanical ventilation-free survival.Trial registration: Clinical trials.gov: NCT04339816 (Registered on 9th April 2020); Eudra CT number: 2020-001456-18 (Registered on 29th March 2020)
Scanning Electron Microscopic Observation of the In Vitro Cultured Protozoan, Perkinsus olseni, Isolated from the Manila Clam, Ruditapes philippinarum
Authors: Gajamange Dinesh , Kim Seung-Hyeon , Choi Kwang-Sik , Azevedo Carlos , Park Kyungil
Published: April 2020

Background
Perkinsosis is a major disease affecting the commercially important marine mollusk Ruditapes philippinarum (Manila clam) in Asian waters. In this study, we investigated the morphological characteristics of Perkinsus olseni, the causative agent of perkinsosis, cultured under laboratory conditions at different stages of its life cycle by using a scanning electron microscope (SEM).
Results
Prezoosporangia that formed following induction with Ray’s fluid thioglycollate medium developed into zoosporangia. During this process, a discharge tube formed a porous sponge-like structure that detached before the zoospores were released; thus, this organelle operated as a bung. Liberated zoospores gradually transformed into immature trophozoites, during which detachment of the anterior flagella occurred but loss of the posterior flagella was not clearly observed in the present study. Mature trophozoites underwent schizogony by cleaving the cell forming a number of merozoites in schizonts, which were released by the rupturing of the cellular membrane of the schizont within a few days.
Conclusions
Our morphological and ultrastructural studies contribute new information on the life cycle and propagation of P. olseni.
Three-dimensional random walk models of individual animal movement and their application to trap counts modelling
Authors: Ahmed Danish Ali , Benhamou Simon , Bonsall Michael , Petrovskii Sergei
Published: April 2020

Background: Random walks (RWs) have proved to be a powerful modelling tool in ecology, particularly in the study of animal movement. An application of RW concerns trapping which is the predominant sampling method to date in insect ecology, invasive species, and agricultural pest management. A lot of research effort has been directed towards modelling ground-dwelling insects by simulating their movement in 2D, and computing pitfall trap counts, but comparatively very little for flying insects with 3D elevated traps. Methods: We introduce the mathematics behind 3D RWs and present key metrics such as the mean squared displacement (MSD) and path sinuosity, which are already well known in 2D. We develop the mathematical theory behind the 3D correlated random walk (CRW) which involves short-term directional persistence and the 3D Biased random walk (BRW) which introduces a long-term directional bias in the movement so that there is an overall preferred movement direction. In this study, we consider three types of shape of 3D traps, which are commonly used in ecological field studies; a spheroidal trap, a cylindrical trap and a rectangular cuboidal trap. By simulating movement in 3D space, we investigated the effect of 3D trap shapes and sizes and of movement diffusion on trapping efficiency. Results: We found that there is a non-linear dependence of trap counts on the trap surface area or volume, but the effect of volume appeared to be a simple consequence of changes in area. Nevertheless, there is a slight but clear hierarchy of trap shapes in terms of capture efficiency, with the spheroidal trap retaining more counts than a cylinder, followed by the cuboidal type for a given area. We also showed that there is no effect of short-term persistence when diffusion is kept constant, but trap counts significantly decrease with increasing diffusion. Conclusion: Our results provide a better understanding of the interplay between the movement pattern, trap geometry and impacts on trapping efficiency, which leads to improved trap count interpretations, and more broadly, has implications for spatial ecology and population dynamics.
A retrospective cohort study of clinical characteristics, treatment patterns, and disease outcomes of chronic kidney disease in patients with diabetes using a Japanese claims database
Authors: Yamazaki Toru , Yoshihara Nariaki , Yi Jingbo , Tanimura Yoko , Bruce Crawford
Published: April 2020

Objectives: The primary objective of this study was to characterize the clinical characteristics, treatment patterns, and clinical outcomes of chronic kidney disease (CKD) patients with diabetes, using a Japanese claims database and focusing on the use of mineralocorticoid receptor antagonists (MRAs) in this population in the real-world setting.Methods: This retrospective cohort study used the Medical Data Vision database, a large, electronic health records-based claims database in Japan. The observation period was a maximum of 8 years (from 1st April 2008 to 31st August 2016). The inclusion criteria were a claim with a diagnosis of diabetes (ICD-10: E10-E14), eGFR less than 60 mL/min/1.73 m2 at the index date, and use of any antiglycemic medications within 6 months prior to the index date or during the index month. Patients who had a claim for an MRA drug after the index date were identified as the MRA subcohort. This exploratory study investigated the burden of disease in patients with CKD and diabetes, including demographics, treatments, safety, and time-to-event analysis for renal and cardiovascular-related endpoints.Results: A total of 19,582 patients were included in the analysis, and 2,295 MRA patients were included in the subcohort. Renin-angiotensin-aldosterone system inhibitors were used at baseline by 52.3% in the overall cohort and 58.8% in the MRA subcohort. Cumulative incidences of hyperkalemia were 5.19% in the overall cohort and 7.63% in the MRA subcohort. Cox models showed that the 30–44 mL/min/1.73 m2 eGFR group had a significantly higher hazard of composite cardiovascular outcomes compared to the 45–59 mL/min/1.73 m2 group (HR, 1.22; 95% CI, 1.09–1.36).Conclusion: There are residual risks for hyperkalemia and renal and cardiovascular-related events in diabetic patients with CKD in the real-world setting in Japan, even after starting treatment with steroidal MRA drugs. The unmet needs and burden of disease should be considered in future treatments for CKD patients with diabetes.
Single cell transcriptomics of human nephritis reveal the cellular origin of kidney disease associated genes
Authors: chen zhejun , zhang ting , wang qin , li zhenyuan , xie yuanyuan , yuan xiaodong , ying liang , zhang ming , mou shan
Published: April 2020

Background Single cell RNA sequencing (scRNA-seq) have become a powerful tool in discovering a novel cell type and pinpointing cellular specific gene within tissues. However, in diseased kidneys, especially caused by glomerulonephritis, there have few study focusing on revealing gene expression changes at the cellular level. Methods To reveal cellular gene expression profiles of glomerulonephritis, we performed scRNA-seq of 2 human kidney transplantation donor samples, 4 human glomerulonephritis samples, 1 human malignant hypertension sample and 1 human chronic interstitial nephritis sample, all tissues were taken from biopsy. Results Upon disease occur, immune cells infiltrate which can be proved by our dataset. In the cluster of podocyte, two glomerulonephritis related genes named FXYD5 and CD74 were found, and interferon alpha/beta signalling pathway and antigen processing and presentation was enriched in podocyte of LN and IgAN comparing with other samples, thus inhibiting these signalling pathway may alleviate the symptom of these disease. Conclusions Cellular origin of kidney disease associated genes and the activated signaling pathways the genes involved in can be found by scRNA-seq.
Mitochondrial Accumulation of Apurinic/Apyrimidinic Endonuclease 1 Protein in Early Stages of Hepatocellular Carcinoma Enhances mtDNA Repairing Rate Contributing to Cell Proliferation and Mitochondrial Functionality.
Authors: Bazzani Veronica , Barchiesi Arianna , Radecka Dorota , Pravisani Riccardo , Guadagno Antonio , Loreto Carla Di , Baccarani Umberto , Vascotto Carlo
Published: April 2020

Background Hepatocellular carcinoma (HCC) is the leading cause of primary liver cancers. Surveillance of individuals at specific risk of developing HCC, early diagnostic markers, and new therapeutic approaches are essential to obtain a reduction in disease-related mortality. Apurinic/apyrimidinic endonuclease 1 (APE1) expression levels and its cytoplasmic localization have been reported to correlate with a lower degree of differentiation and shorter survival rate. The aim of this study is to fully investigate, for the first time, the role of the mitochondrial form of APE1 in HCC.Methods As a study model, we analyzed samples from a cohort of patients diagnosed with HCC who underwent surgical resection. Mitochondrial APE1 content, expression levels of the mitochondrial import protein Mia40, and mtDNA damage of tumor tissue and distal non-tumor liver of each patient were analyzed. In parallel, we generated a stable HeLa clone for inducible silencing of endogenous APE1 and re-expression of the recombinant shRNA resistant mitochondrially targeted APE1 form (MTS-APE1). We evaluated mtDNA damage, cell growth, and mitochondrial respiration.Results APE1’s cytoplasmic positivity in Grades 1 and 2 HCC patients showed a significantly higher expression of mitochondrial APE1, which accounted for lower levels of mtDNA damage observed in the tumor tissue with respect to the distal area. In the contrast, the cytoplasmic positivity in Grade 3 was not associated with APE1’s mitochondrial accumulation even when accounting for the higher number of mtDNA lesions measured. Loss of APE1 expression negatively affected mitochondrial respiration, cell viability, and proliferation as well as levels of mtDNA damage. Remarkably, the phenotype was efficiently rescued in MTS-APE1 clone, where APE1 is present only within the mitochondrial matrix.Conclusions Our study confirms the prominent role of the mitochondrial form of APE1 in the early stages of HCC development and the relevance of the non-nuclear fraction of APE1 in the disease progression. We have also confirmed overexpression of Mia40 and the role of the MIA pathway in the APE1 import process. Based on our data, inhibition of the APE1 transport by blocking the MIA pathway could represent a new therapeutic approach for reducing mitochondrial metabolism by preventing the efficient repair of mtDNA.
Elevated serum iron level is a predictor of prognosis in severe patients with acute kidney injury
Authors: Shu Jie , HU Yufeng , Yu Xueshu , Chen Jiaxiu , Xu Wenwei , Pan Jingye
Published: April 2020

Background: Accumulation of iron is associated with oxidative stress (OS), inflammation and regulated cell death. The above three reactions contribute to the development of acute kidney injury (AKI). Here we aimed to investigate the association between the serum iron level and prognosis in severe patients with AKI.Methods: A total of 483 patients with AKI defined by Kidney Disease: Improving Global Guidelines (KIDGO) were included in this retrospective study. The data was extracted from the single-center Medical Information Mart for Intensive Care Ⅲ (MIMIC-Ⅲ) database. The max serum iron concentration measured after Intensive Care Unit (ICU) admission was defined as the serum iron in the study and divided into three groups (Low group, Middle group, High group). We plotted boxplots and Kaplan–Meier curves and used cox regression analysis to analyze data.Results: In univariable Cox regression analysis, serum iron levels were significantly correlated to the prognosis of AKI patients. After adjusting for confounding variables, higher serum iron level was remained to associate with the increase in 90-day mortality in the multivariable Cox regression analysis. Moreover, the risk of 90-day mortality stepwise increased as the groups of serum iron levels increased in AKI patients.Conclusions: From our study, we investigated that high serum iron level was associated with the increased mortality in severe patients with AKI. Serum iron levels on admission can be a predictor for predicting the prognosis of AKI patients.
The impact of scrubber washwater on inland waters
Authors: Teuchies Johannes , Cox Tom J.S. , Itterbeeck Katrien Van , Me Filip J.R. , Blust Ronny
Published: April 2020

Background : The International Maritime Organization (IMO) has set limits on sulphur content in fuels for marine transport. However, vessels continue to use these residual high sulphur fuels in combination with exhaust gas cleaning systems (EGCS or scrubbers). Next to high sulphur, combustion of these fuels also results in higher emissions of contaminants including metals and PAHs. In scrubbers, exhaust gases are sprayed with water in order to remove SOx, resulting in acidic washwater with elevated contaminant concentrations discharged in the aquatic ecosystem. The number of vessels with scrubbers is increasing rapidly, but knowledge on washwater quality and impact are limited. Results : The scrubber washwater is found to be acidic with elevated concentrations of e.g. zinc, vanadium, copper, nickel, phenanthrene, naphthalene, fluorene and fluoranthene. Model calculations on the effects of scrubber (20% of vessels) discharge on aquatic systems showed a decrease in pH of 0.015 units and an increase in surface water concentrations for e.g. naphthalene (110% increase) and vanadium (17% increase). Conclusions : The IMO established sulphur regulations to mitigate the impact of high sulphur emissions of the maritime sector. However, the use of open loop scrubbers as an abatement technology will not reduce their contribution to the acidification. In addition, different types of scrubbers discharge washwater that is acute toxic for aquatic organisms. However, washwater is diluted and the compounds for which a large increase in surface water concentrations was calculated (Naphthalene > Phenanthrene > Fluorene > Acenaphthene > Vanadium) were not the compounds that already exceed their respective Water Quality Standards (WQS). Nevertheless, existing WQS exceedances of ‘priority hazardous substances’ (Water Framework Directive) that are also identified in the washwater indicate that coastal waters and estuaries, often with large ecological value, are already under pressure. In these areas the discharge of scrubber washwater should be discouraged.